Back to the rural

It's kind of odd being back in Hinton where I finished my rural rotation about a year and a half ago. The reason I say so is because it's like this place was frozen in time when I left, and it's almost exactly the same since I came back. Granted, it wasn't that long ago but it's still kind of a bizarre feeling. The most dramatic change I noticed was one of the doctor's hair is a bit more salt than pepper and one of the hospital's walls are a slightly darker grey colour.
It also makes me hope that it seems that I've improved in my clinical training, judgment and management skillz. I may not know prenatals like the back of my hand as I did before but I'm hoping everything else has gained at least +1 EXP.
The one new thing I have enjoyed is the teaching role I've taken with the medical students. It's something I've already noticed I enjoy doing, and it adds something unique to my day. I'm finding myself looking to incorporate that into my future career.

Each day I'm also trying to look for what I would like to do in at least my more immediate career... both major and minor factors. It's difficult to evaluate because I still give the usual "Iiiiii... dunno" shrug whenever someone asks me, but small pieces are coming in here and there. It doesn't seem that full-time rural life is in the cards... at least for now. In many ways I still like the academic life, exploring cities, and while the schizoid side of me enjoys the remoteness, being in a hub city makes travel much more accessible. These may seem like minor factors in the end, but they're something for now.

Charlie

Our family dog, Charlie, died on September 8th, 2012. I knew I had to write something about it, but didn't want to say anything until I had it just right. Most of what I wanted to say, I passed along through my family but what I wanted to tell the general public or interweb I have had a difficult time trying to phrase.

He lived over 13 years old, and over 95% of it he was incredibly healthy. He developed some arthritis that slowed him down a bit in the last year, but before that he was full speed all the time. We got him many years ago on a family vacation on the way back from Waterton National park. We had stopped at Hutterite farm to get some lamb (random, I know) and while walking around this tiny pup jumped out of the grass in front of us. My sister squealed and immediately wanted to keep him. Me being the fun sponge of the kids said that we couldn't be responsible enough to take care of him since we had gotten a bird a few years ago and I was doing the lion's share of the work to take care of her. With some persuasion, and only $175 less later, this puppy was in a cardboard box in our van on the way home.

Only did I read later on that border collies have too much energy for their own good, but Charlie sure stayed true to that fact. He bolted anywhere at full speed if wanted to play, and wouldn't stop playing until he was either exhausted or we forced him to stop because he had cut his lip on a stick or something. This energy also manifested itself in his mischievous nature. He would wander off or sneak out of the house if we left a door unlocked on occasion, but he would either wander back rather casually or be stopped by a good samaritan. We would be panicked, frustrated, even angry if he ran away, but would always be relieved and overall in better spirits once he was back home.

Outside of his energy, his primary characteristic was his reliability and loyalty. As my siblings and I grew up, and as our family went through some tumultuous times, Charlie was always there for anyone... especially if we were brave enough to walk him in the dead of winter, or goof around with him inside the house. He bonded the most with my dad, but he would be excited to see any of us, and would nudge his nose against us if we ever seemed down, and that never changed even as he aged.

In his final days (and thankfully this phase only lasted a matter of days), it was incredibly hard because we knew his time was coming and we knew soon we would have to say goodbye, but we equally didn't want him to suffer through his liver disease. I unfortunately couldn't be there to say goodbye to him, but one of the most heartbreaking things my sister said happened was when the whole family was there at the vet for the last visit, and when everyone was obviously very upset, he looked around and seemed distressed seeing the whole family crying. In his fatally ill state, he was still trying to look after them. He left us very peacefully, already asleep.

Despite the ending, I am thankful and in fact incredibly pleased that he lived a very happy and healthy life. It still hurts a bit here and there when I think of him, but the good memories far outweigh the bad ones, and I'll remember him fondly, especially that distinct running style :-)

unveiling coming soon...

La pièce da resistance has finally arrived! My table is here and assembled. But more about that when I do my massive post about my place. For now, a sneak peek as I break it in.

Lance Armstrong stops fighting: is it really a concession?

Breaking just this evening, Lance Armstrong, undoubtedly the most famous athlete in cycling history and a major icon in fundraising cancer research, has decided to end his fight against charges made by the United States Anti-Doping Agency.

Stories found at The New York Times, but a more thorough one for now (suprisingly) at ESPN.

What does this mean exactly? Well now, the USADA can pursue charging Armstrong for doping and are looking to strip him of his seven Tour de France titles and ban him for life from cycling. I'm not exactly sure how this procedure works given that the International Cycling Union is the governing body, but I'll leave that to the lawyers to explain.

More damaging however, is that the USADA can proceed now without opposition, and publicly without Armstrong denying the claims many people can assume that it is an admission of guilt. Of course, Armstrong vehemently denies this notion.

So which is it? A judge had previously questioned the USADA's motivations in pursuing Armstrong after his retirement, while the USADA counters that they have evidence he has been doping for over a decade and has former teammates willing to testify. Armstrong has never failed a drug test, but in this day and age that can't be taken at face value either.

Unless all the facts come out, we'll never know for sure. Regardless, the damage has been done. The legacy Armstrong prided himself on is forever tarnished, at the very least, with an asterisk. Countless people looked to him as a role model, including patients with cancer and their families. He won't be seen the same way again.

But is it really an admission of guilt? It is very reasonable to suggest that after years and years of being hounded and pursued by the USADA, this accusation has worn him to his core. I bet, regardless of his guilt, it was truly exhausting. Perhaps he is simply throwing his arms up in despair, conceding this defeat in the name of temporary peace.

Or perhaps it's a re-evaluation of his priorities. Maybe all that matters to him is that he truly knows he won those races fairly, and that his family knows he won the races fairly. Maybe that's enough for him. Maybe he's decided it's not worth the headache, and he knows that although he will lose many fans, many more will still rally around him for what he has done for cancer research so far. This wouldn't be the first time that what was someone's livelihood no longer matters; it was a first life. He could be ready to turn the page and throw that old book away, where he wants to refocus on his endeavours and philanthropy.

Or maybe he's guilty. We'll likely never know.

Something that makes you stop in your tracks

I felt compelled to write this down while the feeling is still fresh and my thoughts sincere and in the moment.

Today I got news that someone close to me has a young relative with Type IIIB lung cancer. She's a non-smoker, a loving wife and mother of two small children. In short, the prognosis is poor and % survival rate after 5 years of the diagnosis is in the single digits. It's a terrible diagnosis for anyone, let alone someone in that situation.

I don't want to make this story seem like it's about me, because of course it's not; I only want to write how this tragic scenario this family is going through is making me feel. It's a strange zone in which I feel I'm residing. It's two degrees of separation, but barely so - enough that I'm feeling much more sombre and pensive than if it was something I had read or heard about, or seen at work. There's a face to the name, and faces to her family.

As a result, two big thought processes come to mind:

1. Priorities - there are long laundry lists of priorities we compile in our lifetime as we get older, more ingrained in the workforce, have access to more money and more material spoils. It's easy, nay, extremely difficult, nay, impossible to not get caught up with at least some of these aspects occasionally when it's around us all the time. We can lose track of the true value of life, and the fragility of it... and that at any moment, a more defined time limit can be added on to it, or it can be simply taken away all in an instant. When these sobering moments happen, it's incredibly interesting how some priorities drop off and seem distant, while others come rising to the surface, sometimes in a profound or violent manner.

Of course it's impossible to stay in this type of mindset forever. It's exhausting, time-consuming and frankly, depressing. Thinking about life and death all the time would make it difficult to be optimistic to any degree. It's important to keep as a perspective though... like that photo that catches your eye every now and then, and reminds you it's there. It's something that can catch you when you're getting a bit off-track; whether it's going on autopilot for days to weeks, or re-appreciating the things and people you love.

2. Medicine - it's sort of related to thought #1, but it's specific to the reminder of the privilege and the magnitude of the "job". In the grind of residency, the hours, the struggle to keep up with reading and knowledge, and climbing that ladder, the grand scope of what medicine can meet to patients and families can get lost. It makes me feel guilty when thoughts go through my head of wondering how much longer I'll be staying at work in a day, thinking of cutting corners, or when I get annoyed by a patient. No matter what position we eventually attain, our role in patient's lives is a privilege... and it should be treated that way as much as we can.

I think I'm losing steam here, so I'll end the post with things song - "The Wilhelm Scream" by James Blake. It's dark and brooding, but still great to hear. The way he sings "falling..." could be interpreted in a number of ways, but in the process of doing so he sings about how we question what we feel, what we love, and what we dream. Fewer things in life call us to question these emotions than news like this.


James Blake - The Wilhelm Scream

The maps (continued) and the next vacation...

It took a long time for me to decide what to put up on my bare walls. I figured there would be a number of days when I'd just be staring into space and it should be something I enjoy looking at, but complex enough that I don't get bored seeing it every day, AND something that can get my mind going. You could say... something to promote momentum. Figurative, literal or otherwise. I chose maps.

Exhibit A: Star map
If you know me, you know I love space - its immensity, mystery and the way it will unconditionally humble anyone. It's tangible but is incomprehensible. I think this strange balance (or imbalance?) of the known and the unknown of the cosmos have always intrigued me... hence the reason for this star map.

Exhibit B: "interactive" world map

This one plays a number of roles. It's in my bedroom, and is the first thing I see each time I wake up in the morning. The pins on it indicate places outside of Canada I've visited. I'll probably add the ones in Canada eventually when I get those small pins designed for use on maps, but for now the thumb tacks will do. I also intend to add photos of my friends in different places of Canada, and eventually the world. It'd be interesting to track changes to it over the next few months and years and see how it evolves. I hope to get it a lot more busy, and be forced to buy many more pins...

... which leads me to my next point, the next vacation has been decided. Plane ticket purchased via the recent seat sale on Porter. There's a bit of adventure, food, city and outdoors all mixed together -- New England. Hopefully I'm there just before the mad rush for the autumn but in time still to see some evidence of the season change. Should be awesome. I'm pumped.

Salmon

I was wandering around the market today and noticed an apparently good deal on salmon at one of the fish stores. It was for "wild chum salmon". I asked the seafood man behind the counter what the difference was between this and other species, he just mumbled something about it "just being another species". Thinking it was no big deal, I shrugged and bought a sizeable amount and feeling smug about scoring what I thought was a bargain.

Not familiar with the "chum" salmon, I google image searched it on my way home and discovered that...

I had just bought the salmon clan's ugly cousin! Who could love such a creature! My further research found that it has a milder flavour, is more lean and is often used in drying. Fair enough, but seriously how hideous are these guys?

I felt so duped.