Clerkship Update: Palliative Care

I had an incredible experience on my palliative care rotation. Going into it, I wasn’t sure what to expect. Whenever I informed people what rotation I was in, many wrinkled up their faces and said, “Ooh, it’s got to be depressing being around so many dying people”.

I have to say that my experience was quite the opposite. It is a different way of practicing medicine. Rather than focusing on curing a patient, one is focused on making them as comfortable as possible as they navigate the last months, weeks, days, hours and seconds of their lives. I found it a true privilege to accompany people on this journey.

I very much enjoyed how much time I got to spend with each patient and their families on a daily basis. It was certainly never easy discussing a short prognosis but in some ways, families found relief in having an idea of their loved one’s trajectory and in knowing they would be kept as comfortable as possible. The main things that impact heavily on dying patients, particularly in the context of terminal cancer, are pain, nausea, lack of appetite and a progressive sense of loss as they decline in function. Although it can be  difficult to do much about the loss of function, it is staggering to see how much better a patient feels when their pain and nausea can be controlled.

On this rotation, I worked with an excellent interdisciplinary team of doctors, nurses, social workers, PABs and art therapists.  I was truly inspired by their dedication and compassion for our patients.  I certainly struggled with my emotions when I lost a patient (which was almost on a daily basis) especially seeing the profound impact on the family members left behind. I truly treasure the meaningful connections I had with patients and their families on this rotation.

I also had the opportunity to participate in home visits. There was something especially touching about being able to go into a patient’s home and deliver care to them in an environment where they feel most at home.

Overall, my palliative care rotation was one of my best experiences in medical school. I encourage medical students out there wondering what electives to take to strongly consider taking it. It will change your perspective on life.

As my fourth year of medical school continues, I feel my confidence as a doctor-in-training progressively growing. There is still so much to learn of course. One of the great things about medicine, is the challenge of constantly growing and learning new things. As I ponder the current stage in my training, I am so grateful to be on this path to becoming a doctor, as difficult and challenging as it can be.

Featured image courtesy of https://www.medstarfranklinsquare.org

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Clerkship Update: In-Patient Psychiatry

Happy 2019 dear readers! I hope you had a fantastic December holiday!

Clerkship Updates! I have just completed a month in In-Patient Psychiatry and I have to say that it was an extremely humbling and eye-opening experience! My rotation consisted of following patients in the psychiatric unit, doing consults and reassessments in the ER, reassessing medical patients with psychiatric symptoms on a number of different wards, as well as interviewing and assessing families in Child Psychiatry.

What I learned from this rotation

I went into this rotation with trepidation because I felt I did not have much experience managing mental illness but I learned so much from my patients about their life-stories, hardship and resilience. I was humbled by what they have been through and how far they have come. I was surprised by how attached I got to some of my patients and how much emotion I felt towards them. These were people from all walks of life. It could be me, it could be you. A very humbling experience. I also feel that this rotation really helped me improve my interviewing skills which will be very applicable to my interests in Family Medicine.

What I enjoyed most

Seeing my patients get better and discharged from the hospital, particularly after a long admission! I also really enjoyed the human side of medicine on this rotation. Many of my patient interviews were simply about getting to know the person in great detail, which was really a wonderful and sometimes emotional experience. The teaching and support during this rotation was also excellent, with plenty of opportunities to share our reactions and feelings about the rotation.

What I struggled with the most

The greatest challenge for me on this rotation was wondering if I was really helping my patients significantly. But I was amazed how many patients appreciated simply being listened to during their moments of crisis and how the hospital was actually a refuge and place of stability for them.

My take home message

My In-patient psychiatry rotation was really great. I learned so much from the staff and patients. I am realizing now more than ever that it is really important to reflect on each day and process the feelings you have about what you see. It is human nature to feel the pain others have and so I feel it’s important to process these feelings in a way that works for you. Some suggestions include reflection, art, music, talking about it or writing about it.

Next rotation….Urban Family Medicine! Thoroughly excited! Stay tuned for more updates. Wishing you all the best for 2019!

Featured image courtesy of medium.com

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Christmas morning!
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Christmas morning!
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Birthday girl!
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Family time in the Laurentians!

 

Clerkship Update: Rural Family Medicine

Clerkship updates! I just completed my 4-week rural family medicine rotation and I absolutely loved it! My rotation was a mix of clinic, ER and wards. I had the opportunity to see patients of all ages. While on the wards, I was responsible for admitting patients, rounding on them myself each morning, writing prescriptions, ordering tests and coming up with management plans. It was a very rewarding experience!

What I enjoyed the most

I loved working with patients of all ages and the variety of cases I saw each day. You never knew what would come through the door and it forced me to think on my feet! I also was pleasantly surprised at the variety of contexts you could work in as a family doctor. I had always pictured it as being more of a clinic setting  but while on this rotation, I was amazed at what family doctors do in the ER and how much they were responsible for running the wards.

Interestingly, I always thought that working in a clinic would be my preferred setting and while this is still the case, I also found that I enjoyed working in a community hospital (as opposed to a large academic hospital). The staff were great to work with and I really enjoyed the team work and inter-professional collaboration.

The town I worked in was beautiful and I really enjoyed my drive into work each day (which ironically was a shorter commute than driving into my previous urban rotations!)

One of the best things about this rotation was the great work-life balance. I was able to apply myself fully at work during the day and still get to spend a good amount of time with my family and friends.

What I struggled with the most

My greatest challenge on this rotation was communicating and charting in French. But despite my linguistic errors, I found patients and staff to be very understanding and I feel I have improved significantly in my French during the course of this past month.

My take home message

I absolutely LOVED my rural family medicine rotation! There was plenty of variety of cases which were intellectually stimulating. I loved the flexibility of working in different contexts. I also very much like the idea of building long-lasting relationships with my patients and the holistic approach of being involved in all aspects of their care.

Next up is Inpatient Psychiatry. I am looking forward to this rotation because I feel this is the area of medicine that I have the least experience and knowledge in, so it will be a great opportunity for me to build my skills and abilities in taking care of patients with mental health issues.

In other exciting news, I have decided what specialty I will be going into! Stay tuned for my next post, the big reveal!

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The town where I did my rural family medicine rotation (picture taken in the summer courtesy of http://www.tourisme-monteregie.qc.ca)

Featured image: Our little munchkins excited for Christmas!

Clerkship Update: Pediatrics Inpatient

Clerkship updates! I just completed a 4-week rotation on the pediatric wards and it has been one of my favorite rotations so far! My schedule consisted of 2 weeks of day shifts and 2 weeks of evening/night shifts plus 2 weekends. During the day shifts, my day consisted of teaching sessions/lectures, rounding on patients, writing progress notes and discharge summaries. My night shifts mostly consisted of admitting patients to the ward and writing admission notes. I also spent one amazing afternoon in the newborn nursery where I had the opportunity to refine my skills in conducting a newborn physical exam.

What I enjoyed the most

I very much enjoyed working with children of all ages and worked with a fantastic team of staff physicians and residents from different specialties (pediatrics, family medicine and pediatric neurology). There was also excellent teaching during this rotation with plenty of support. I felt I grew in my history taking, physical exam skills as well as coming up with a differential diagnosis and management plan. I felt that having had my own children really helped me communicate with young children and relate to the anxieties that parents have about their sick children. Also, although I used to dread the night shifts, I decided to change my attitude about it and focus on the positive aspects of working at night such as avoiding rush-hour traffic and getting to spend the mornings with my children, go on walks with them, or surprise my son at school at lunch time.

What I struggled with the most

My greatest challenge during this rotation was having to communicate in French. Many of the patients and families I encountered were Francophone and did not speak much English so I was forced to put my French language skills to the test! It was not easy getting a history or communicating plans to families in French but it certainly gave me plenty of practice! I definitely feel that I am improving!

My take home message

Pediatrics is a fantastic field if you love children and interacting with families as a whole. I also find the environment to be very positive and supportive! When it comes to night shifts, working strange schedules in medicine can be a challenge both mentally and physically. However, trying to find ways to adapt, adopting a positive mindset and getting creative with our time can ease the strain and pleasantly surprise us!

This ends my very first block of third year!  I am very excited to be starting my rural Family Medicine rotation next! Stay tuned!

Featured image photo credit: lakeviewpediatrics.net

Clerkship Update: OBGYN Part 2

My very first clerkship rotation was in OBGYN outpatient clinics which I posted about here including some tips for surviving clerkship in general. This past month was a continuation of my OBGYN experience. The first 3 weeks were based in the birthing center where I had the opportunity to take part in a variety of interesting tasks:

  • Interview and examine pregnant patients in triage
  • Assist with vaginal deliveries and C-sections
  • Round on post-partum patients
  • Conduct consults in the ER

My last week was Gynecology-based where I got to assist with some gynecology surgical procedures in the OR, round on post-op patients, see patients in Gynecology/Early Pregnancy clinics and conduct consults in the ER.

What I enjoyed most:

I very much enjoyed interacting with pregnant patients and helping them through the beautiful, life-changing experience of welcoming their child into the world. I was also grateful to come out of this rotation with tangible, practical skills like delivering babies and suturing.

What I struggled with most:

The environment was fast-paced and quite stressful. It was difficult seeing patients experience pregnancy loss, particulary having gone through the experience myself. The schedule was exhausting with evening/night shifts and 2 weekends back-to-back. I definitely struggled with balancing work and family life and missed the kids a lot.

My take home message:

OBGYN is a great speciality in many ways. There is plenty of variety in terms of the work, it is rewarding bringing babies into the world and being a part of patients lives during such critical moments. For me personally, the demanding lifestyle was not a good fit for my family life, but I am grateful for all that I learned during this rotation and that it helped to clarify my interests more definitively.

Feature image photo credit: advocarepremierobgyn.com

Clerkship Update: Medical Genetics

I just completed my 2-week rotation in Medical Genetics and it was an incredible experience. My first week consisted of clinics where I got to meet pediatrics patients with a variety of genetic conditions. During my second week, I was assigned to the in-patient service where we were consulted  by the neonatal and pediatric Intensive Care Units to evaluate newborns and toddlers.

What I enjoyed most: 

This is a very intellectual specialty that requires extensive reading around cases. I very much enjoyed coming up with a differential diagnosis of possible conditions. The best part of this rotation was getting to spend an hour or more with each patient as we require much of this time to work through family histories in great detail as well as conduct a very thorough physical exam looking for dymorphologies, skeletel dysplasias, and any other abnormalities that could signal a possible genetic condition. I also appreciated refreshing my knowledge about the different types of Genetic testing such as FISH (Fluorescent In Situ Hybridization), aCGH (array Comparative Genomic Hybridization) and karyotyping.

What I struggled with most:

There is a vast amount of information to know in Genetics such as various syndromes, which definitely poses a challenge! Genetics deals mostly with diagnoses and counselling of patients. Although being able to provide a diagnosis for a child’s condition was very satisfying and would assist parents in learning how to manage the condition going forward, it was also emotionally challenging to not have a cure or solution for their condition. I wished there was more I could do for these families!

My take home message: 

This rotation increased my knowledge and understanding of congenital conditions which I feel will be important to consider when  assessing patients in the future. Medical Genetics is a fascinating field and this rotation increased my appreciation for the molecular intricacies of the human body. It was also humbling to witness how just one single DNA mutation could result in severe disease. It reminded me that having good health is something we cannot take for granted.

Featured image: Plethrons-Basics of DNA

Clerkship Update: Neonatal Intenstive Care Unit

I recently completed my 2-week rotation in the Neonatal Intensive Care Unit and it was a fantastic experience. The format of this rotation was such that medical students were integrated as part of the NICU team, attending sign-outs, rounding on patients, managing patients (physical exams etc), writing admission notes, progress notes and discharge summaries. We also took part in consults from the Obstetrics department and observed the resuscitation team who were prepped and ready for babies delivered by C-section.

What I enjoyed most: On this rotation, I had the wonderful opportunity to work with a a great team of staff physicians, residents, international medical students, nurses, nurse practitioners, nutrionists as well as various consultants. I very much enjoyed the teamwork! And of course,  I loved the patients (the babies) who were the real heros of the unit. I also really appreciated that we were assigned our own babies to manage and this afforded us plenty of autonomy and self-directed learning. On most days, we also had about 1 hour of teaching which was very beneficial.

What I struggled with most: Having to present my patients on rounds was quite intimidating some times but by the end of the 2-weeks, I felt much more confident, even if my management plans were sometimes off-track!

My take home message: The NICU was a fantastic experience and my favorite rotation so far. I am yet to do my core pediatrics rotation but I certainly enjoy working with the pediatric population. Since I also enjoy working with adult patients, I would currently rank pediatrics as a “medium” on a scale of low-medium-high, as a future potential specialty for me.

My current rotation is an elective in Pathology which has been very interesting and a different pace from clinical rotations. I will share my experiences on this in the coming weeks!

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Hubby and I on a date. We went on a nice long walk up Mont Royal, had lunch at a new vegetarian restaurant and went to see Mission Impossible: Fallout. We had a blast!
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We saw this piece of artwork on a park bench and thought it was quite unique (plus I had to take a picture of it for my daughter who loves giraffes!)