Eau De Prince George

The sweet yet sour smell of skim milk powder, part chemical, part organic. It wafts across the valley and settles thinly over everything, permeating the environment. Apparently its from the pulp mill, the billowing towers you can see from most parts of town. As I open my front door in the darkness of early morning I get smacked in the gizzard both by the sharp, biting cold accompanied by the tangy odour singeing my nostrils. I've nearly been up here three months now, granted with a short interlude in Uganda, but it will rank among the best rotations of residency.

Its a strange medical community Prince George, like none other I've seen, they may have missed a memo. There's no open shaming and ridiculing of residents. No pointless scut work to help you build character. The attendings genuinely seem to care about your learning. Strange, very strange. Invites to obstetricians' houses to 'drop by whenever just to hang out', you tend to see your attendings in a different light after competing against them and their kids in Wii dancing.

I didn't know why everyone seemed to care about the HUGE solar flare that happened last week. Northern lights dumb city kid. Shimmering fluidly across the sky, only fading next to the full moon. PG is positively charming, I listetned to a home grown white boy reggae band on Friday night, not something I would have done in Vancouver. Although, unfortunately I started mocking them with the lead guitarist standing right behind me...shoot. Next to my front door are a pair of Sorel boots, snowshoes, hockey skates and cross-country skis...it just depends how much time I have and how cold it is.

The cold was a shock to my now pansy-fied Vancouver-accustomed system and the irony of spending an hour digging my car out of a snowdrift so I could go for a swim in the local pool was not lost on me. Also, FYI, snowshoeing at -32 C is not recommended without significant toe frostbite protection, my eyelashes were fluttering with ice at the end of it. But the benefit of the all too accessibly snow is that 15 minutes after you get off work you can be out at Otway skiing for a few hours, either as the sun sets, turning the clouds yellow to peach to brilliant orange or under the brightness of the stars above.

Whereas at other community rotation sites where residents have the highest chance of being called a ‘tard’ (as in retard) or ‘cretin’ for their OR skills, in PG you have the highest chance of being called ‘sweetie’, ‘buddy’ or ‘love’ and fed by the frequent OR ‘food fests’ to within inches of your life with delicious homemade dishes. I felt affirmed, respected and embraced as part of a team. Although I didn’t expect it, I would absolutely work here in the future if given a chance, my soul fund has been topped up.

And now back to the big smoke and the baby mill…well, with an Ecuadorian interlude that is.

My Screaming Ovaries

There is a divine and messy moment after birth. I peeked my head around the door to see if the baby had been born yet. It was one of those consults that causes obstetricians to go into early retirement. A recommendation for assisted delivery had been made, and it had been declined. One can only step away and wait. Regardless, the parents were lovely, both well along in successful careers.

So it was with a wave of relief that I witnessed this tender moment. An exhausted but exhilarated mother holding her naked child against her chest, the father leaned in close, tears streaming down his face, tenderly kissing the top of his daughter's head, telling his partner how much he loved them both.

But the pediatrician walked back and forth restlessly, the babe had to go to NICU. She was much sicker than expected and needed multiple interventions. Later that night I found out baby had been urgently flown down south for further care. Mom and dad were going with.

Dread. Nausea. Sadness. Guilt. I can't find words to describe the feeling. Should I have made a fuss? Demanded delivery? Pulled the "your baby will be gorked if we don't deliver it now" line? Would that have made any difference? No one can say.

The next day I called the NICU down south to see how baby was doing. Not good. On ECMO (a heart-lung machine for babies) with uncontrolled pulmonary hypertension. The baby had a common trisomy and the parents were giving her up for adoption.

My ovaries screamed in unison and my heart exploded. I jumped in my car, drove the 10 hours down to Vancouver in the snow, only wanting to wrap that baby in my arms and love her for however long her life might be. My soul aching, thinking of that tiny baby all alone in a NICU far away.

Okay, I didn't actually get in the car. More just a compulsion to do so.

Damn ovaries.

Unsettlingly Serious

There was a gnawing unrest somewhere deep in my belly as I walked out of the hospital tonight, and I'm not talking overdosing on Timmy's coffee unrest. I could chalk it up to the communal grief of the seven family members crowded into the small assessment room after they found out the baby had died at 33 weeks gestation. A familiar wave of nausea and dread swept over me as I sat on the edge of the bed, searching desperately with the ultrasound for the flapping heart in the grainy picture. The cardiac anatomy was outlined clearly, sitting eerily still and unfamiliar under the railroad tracts of the spine as the taut belly shook with sobbing.

But if I'm truthful, it wasn't just fetal demise that has unsettled me, its that things are getting serious. The weight has gradually but solidly settled on my shoulders. Surgery isn't just cutting and fun anymore...well, its still fun, but serious fun. I did surgery on a woman for uterine cancer last week, who made zero urine the next day. Zero. Oh, and developed a sky high creatinine (that means renal failure). I felt sick. My night was spent tossing and turning, in my mind replacing every single suture I had placed, each vessel I had cauterized, trying to figure out how I had tied off her ureter or cut an unrecognized hole in her bladder. I woke up soaked in sweat and nauseous (no, I don't have cancer and I'm not pregnant if you're symptom fishing).

Last night I had to deliver a distressed baby by forceps before the attending could make it, egged on by an anxious GP. As the fetal heart rate tapped out ominously, I did the pudendal block, then slid on the forceps smoothly, double checking their placement. Perfect application as the silver salad tong suctioned into place creating the baby's ergonomically designed helmet. Beautiful delivery over two pushes. Perineum INTACT. Impressive, no? No, not at all, you're not SUPPOSED to pull babies out with forceps sunny-side up Einstein, its not AS ergonomical to wear your helmet backwards. Not a delivery I was proud of. The baby went to NICU, not because of the forceps, because of a fever. Obstetrics can be humbling.

The responsibility of the vocation I'm training for is becoming clearer. An obvious result of the increased autonomy I'm given here. I hope I find the balance between the fun and the fear. You see, I've just never been described as serious before, but I haven't been joking as much lately either. My renal failure lady had an intact bladder and ureters and turned the corner just fine, the nurses went out of their way to care for the grieving family and my sunny-side up baby is breastfeeding with mama now.

P.S. I know unsettlingly isn't a word.

Breech Baby Breech!

Beeeeeeeep beeeeeeeeeep beeeeeeeeeeep.

My phone call to an old friend is rudely interrupted and I go into the kitchen and grab the phone to answer the page.

Code pink, vaginal breech, primip with meconium.

At first I think the maternity nurses are playing a joke on me, knowing what the wet dreams of OB residents are made of. But no joke, its for real.

Everyone is there, the OR staff, several dozen folks from NICU (it seemed) and no obstetrician (yet). The baby's heart rate looks lovely, so I consent the mom for a STAT C-section just in case and tell her all about breech deliveries...truth is, we can see a scrotum coming out each time she pushes which would make a C-section quite challenging at this point.

The Grandfather of obstetrics rolls in calmly, shirt and tie with scrubs top over top as his signature outfit, and peaks over my shoulder. His only words, in his usual unflappable manner and quiet voice:

Looks like the little guy's pecker is pointing up there, I suppose you'll be getting ready for an episiotomy.

Right, of course...as I scramble to get some local anesthetic. The delivery is beautiful, the kid starts screaming and the crowd disperses fairly quickly.

I notice a huge blood clot has dolloped onto my jeans during the process, which I hadn't had time to change on the way in. Well, in the grand scheme of things, that delivery was worth a good pair of jeans!

As I head to the nurses' station to do the paper work feeling rather exhilarated, the Grandfather says: Great job, now you can do them in your practice, right?

Right.