I prefer winter and fall, when you feel the bone structure of the landscape… Something waits beneath it, the whole story doesn’t show. (Andrew Wyeth)

I'm still figuring out this residency thing and I am by no means an all-star at surgery... but a med student asked me the other day how to be a successful resident after they are accepted through CaRMS to surgery and this is the best answer I could come up with...

How to be a Successful Resident in 4 Simple Steps

1. All for one, one for all. You will never make it across the finish line if you don't do it as a team. The team is everything, it has to come first. Be altruistic, help out whenever you can. Show kindness. Use your strengths and know your weaknesses. Learn to ask for and accept help when it's your turn. Geese don't fly south by always being in the same position within the V. They take turns being the lead and then enjoying the draft. You're all on the same journey, get there together.

2. Cultivate an attitude of gratitude.

Remember all those friends of yours who applied to med school but didn't get in? Look around you during your interviews, the person on either side of you may not get a spot in surgery. Be humble. You carry the burden of responsibility to make up for their missed opportunities. Don't take that lightly.

Also, be grateful for hardship. Laundry doesn't become clean by lying around on the bed. It has to be put in hot water, tumbled around, spun down, and hung out to dry. The attendings who are the hardest on you are the ones who will make you better. Compliments, while nice, rarely improve you. Criticism, while uncomfortable, can transform you- provided that you are open to it. So be grateful for hardship. Lean into the discomfort, not away. In the face of reprimand and disappointed expectations, let the first words through you lips be "thank you"-- thank you for correcting me, thank you for taking the time to teach me, thank you for seeing my potential and wanting me to succeed.

3. Residency is, simply put, an endurance test. Starting PGY 1 on July 1st is like getting out of bed and deciding that today you're going to start walking across Canada. You have 5 years to get to the other side. Some days will be stormy and it will take every particle of your efforts just to cover a minimum of ground. Some days, you'll have a tailwind and the distance will fly by. Every day is another chance to recommit yourself to the journey. Repeat your affirmations. Reflect on the distance you've come. Look ahead and resist the urge to be overwhelmed by the mountains in the distance. Take every day on its own, one step at a time.

4. Acknowledge the privilege you have in hearing patient's most intimate details of their lives, in knowing their bodies in a way their mothers and fathers / husbands and wives will never know, and be humbled by the trust they put in you to guide them on their journey. There is no room for ego here. Treat every patient like they are your mother. Cut away their disease meticulously. Sew them back together tenderly. Attend them on the ward postoperatively in order to rejoice in their healing and grieve in their set backs. They are the heart of what you do. Never forget that.

An optimist stays up until midnight to see the New Year in. A pessimist stays up to make sure the old year leaves.

Wow - I can't believe that it's been nearly a year since I've posted here. I feel pretty disappointed about that since I really do enjoy writing these posts - and Penguin says that he has enjoyed reading them. Alas, since starting 2nd year and working 100 hour weeks on a regular basis, most of my "free" time has evaporated. Perhaps with a little effort and some revisions of the weekly posting headers, I can work having a weekly post back into my normal routine.

In the meantime, I'd like to present to you The Best of 2012. My list of the best of everything we did over the past year. Hope your year was just as amazing and wonderful as ours. Wishing you a very Merry Christmas and a Happy New Year. xo Saroja + Penguin

The Best of 2012 

Best Album: July Talk (self-titled)

Best Book: When God Was a Rabbit by Sarah Winman

Best Comic: found this on facebook... laughed for a week straight.

Best Date Night Idea: Going to see the Stars in concert!! (They were incredible!)

Best Decision: (aside from saying YES! when Penguin proposed) Joining a CSA for the summer.

Best Dinner: our first homemade Thanksgiving dinner together in our new apartment.

Best Gift: Stained Glass Window from Penguin for our 5^th Anniversary

Best Idea: Dear Sophie Video from Google Chrome = genius. Makes me choke up a little every time.

Best Moment of 2012: Penguin proposing in March. Swoon.

Best New Tradition: having everyone who is far from home coming over to our house for dinner on the first Sunday of every month

Best Picture: taking a picture in our bathing suits at -23 degrees celsius while winter camping.

Best Project: Writing the "Happiness Manifesto" and putting it up on our fridge.

Best Purchase: (obviously my wedding dress but I feel I should save this for next year, so...) the furniture for the balcony, on which I spent many an hour sipping sangria and studying while listening to the boats on the river.

Best Recipe: Pork Roast and Thyme-Scented Plums by The Noble Pig (one of our favourite food blogs). We found this entre is best accompanied with cheesy zucchini rice (partially because we had an average of 7 zucchinis in our fridge on any given day from the CSA basket!)

Best Rendezvous: meeting Lemonriffic and Kate on a random weekend in Ottawa!

Best Surprise: Scarlett and Constellation's super-awesome-and-still-kinda-secret-news!!!

Best Surprise Visitor: my aunt from BC who came for Folk Fest

Best Vacation: Going to Mexico for Jorge and Dafnne’s Wedding / Christmas

Best Weekend Warrior Adventure: Winter Camping in a Yurt for my birthday

I'm a kind of paranoiac in reverse. I suspect people of plotting to make me happy.

• Getting the Squeeze out of Life
• Holy Crap. What hasn't happened over the past few months since I last posted something on this blog? The problem with posting infrequently is that the enormity of the body of stories you need to catch up on writing grows, making the task more overwhelming with time. So, if you'll beg my pardon, I'm going to try and just list the important points...

• Penguin Proposed. I should have seen it coming but I really, truly didn't. He proposed at home, one on one, and gave me a beautiful button ring that he designed himself. I didn't even hesitate to say yes... in fact, I said yes so quickly that Penguin didn't get to make the speech he planned before I sat down on the couch quietly hyperventilating with joy. The ring is a button because buttons hold things together. But buttons can't work alone: they need a hole that's just the right size, just like Penguin is just the right fit for me! The 4 holes at the center represent the 2 of us and our 2 families, with the thread that ties us all together. The thread makes an X and the button makes an O, for XO, or LOVE!






• As an added bonus, Penguin has also acquired a job out here in Winnipeg - so, for the first time in the 5 years that we've been dating, we finally live in the same city (not to mention the same apartment). Cohabitation has been pure Eden. Everyone warned us that there would be bumps along the way as we transitioned from living independently to living with each other but frankly, we haven't really noticed them because we're both just so grateful to have each other around all the time. It really is incredible.
• Lastly, I'm almost done my first year of residency!!! And (a) I'm not dead, and (b) I haven't killed anyone (yet). I didn't realize how much I'd learned or how far I'd come until we had a patient come in at 4 am one night while I was on the acute care service. I was alone in the hospital - my senior and attending had both gone home to sleep - and this patient arrived somnolent, septic, and unstable. I didn't hesitate: 2 large bore IVs, 2L of normal saline under pressure, stat blood work, upright chest xray, EKG, antibiotics... and without having to ask for help (although I called my senior to give them a head's up on the situation), I flooded that patient with 6L of fluid and had them stabilized and ready for the OR in a matter of 2 hours. It turned out that they had a gastric ulcer that had perforated, creating a hole in the stomach the size of my fist. Had the same patient come in during the first few months of my residency, I would have been filled with uncertainty and certainly needed my senior there to guide me through their care. It was a big turning point for me when I realized that I knew how to deal with an unstable patient all on my own.

• Recipe I've Been Drooling Over
• Penguin recently made these "Boyfriend Approved Vegan Burgers" and I've got to say that they're pretty delightful. We ate them with hummus instead of catsup and it was awesome.

• Favourite Thing on Etsy this Week
• Best. Cat. Toy. Ever. (It's even organic, too!)

• What I'm Reading Right Now
• I've read 2 books in the past few months... When God was a Rabbit by Sarah Winman, which in my opinion is on par with Come Thou Tortoise by Jessica Grant (aka the best book ever!). The other is Let's Pretend This Never Happened by Jenny Lawson, which is hilarious and frivolous (the best kind of study break, in my opinion).

• TED Talk I Watched This Week
• As suggested by a good friend, here's a TED Talk on vulnerability. Enjoy!

• Song of the Week
• This week, Penguin is away at a conference. While living together is pretty damn blissful, there is still something to be said for those times when one finds themselves alone in the house. It's an opportunity to shower with the bathroom door open, to wear only your underwear while making dinner, to eat only crackers for dinner without someone heckling your lousy nutrition... I used to think that by doing these things every day when I lived alone, I'd never be remediated into normal company again but it turns out that it's not hard to be civilized when the man you love is around. So, now that my alone time is scarce (which is exactly how I like it), I do my best to enjoy it. This video strongly attests to some of the antics I get up to when Penguin is away.

• Thing I'm Most Grateful for This Week
• Having Penguin here in Winnipeg with me. He sacrificed a lot to come out here, start a new job, and still barely gets to see me as I race back and forth between long hours at work and too few hours spent sleeping. I sometimes wonder how I'm ever going to really show him just how much it means to me.

• Thing I'm Most Looking Forward to This Week
• Hitting the gym more often. I've been slacking for the last little while and I'm looking forward to re-establishing some balance.

• Bunny Photo of the Week
• No available bunny photo this week. Although I can report that Hoyle has settled in well with his new buddy, Penguin's kitten Zoe. Hoyle immediately established the leadership role and Zoe has been running scared ever since. Hoyle also outweighs Zoe by a few pounds, so I don't blame her for being nervous around him. Haha.

Weekly Update: Less than a Week Until Christmas!!

• Getting the Squeeze out of Life
• In follow up to my previous post, and in response to the emails of some concerned family and friends, there is no doubt in my mind that I've picked the right profession. There is also no greater reward than taking into hospital someone fiercely injured and sending them home a week or two later largely in-tact again. So despite all the anguish and horror, trauma has been my favourite rotation so far. The only thing that really gets to me is when people survive catastrophic injuries with significant morbidity. At this point, it's hard to see beyond their loss of function and emotional scars. It's hard not to think - as unpolitically correct as it may seem - they would have been better off dead. I think, though, that this is largely because we don't often get to see the long-term recovery of these patients. When we sign off as a surgical service, the patients are still in the first phases of their recovery and therefore still appear as mangled, dysfunctional bodies that entrap the bright and aware minds and souls of their hosts. However, I did manage to find the perfect TED talk that addresses this particular conundrum. I'll include it with some details down below.
• For me, dealing with some of the rather unsavory personality types that come in via the trauma service was not as difficult as I thought it might be. I met a whole slew of people who did awful, horrible things to others: from serial rapists, to murderers, to gang bangers, to cop killers. You name it, I laid hands on them, sutured them, talked to them every day about their physical pain, and stayed up late at night trying to solve their problems and get them well again. And for me, it wasn't a crisis of conscience. In dealing with these people, I was reminded of a quote from Joan Halifax, "Compassion has enemies: pity, moral outrage, and fear". Anytime it became difficult to treat one of these patients, my reaction was easily identified as one of those 3 responses, and then, once identified, set aside so that the work could be done.
• It's one thing to limit your practice to "the easy patients" - I mean, if you were given the choice, who would you rather round on every day: a sweet-mannered soccer mom who was in a car accident and broke her leg, does everything you recommend for healing, and sends you and the staff a gift basket when discharged - or-  the impoverished, homeless woman with lice and paranoid schizophrenia who happens to have appendicitis and throws her food tray at your head when you try to assess her belly? The fact is, both of them need help. I, for one, would never want to limit my practice to exclude the latter case simply because it makes my day easier. Medicine, for me, is about treating the breadth of humanity - and trauma has a way of being rather non-selective in its demographics. You are just as likely to get the homeless lady who was hit by a car as you the soccer mom who was driving it.

• Recipe I've Been Drooling Over
• So, on average I manage to score about 4-5 hrs of sleep a night... which means eating breakfast before leaving the house is a tough feat. Fortunately, a leftover can of pumpkin puree in my fridge inspired me to look up this recipe: cheddar, black pepper, and pumpkin muffins are the perfect solution to a fast morning routine plus they have a 5/5 'stick to your ribs' quality that is only beat by steel-cut oats. I highly recommend you try them!

• Favourite Thing on Etsy this Week
• Christmas is coming! Christmas is coming! And, while I'll be working, it doesn't mean that I've been above cruising the internerd for some great gift ideas. Here are my favourites from Etsy this year:

• If any man were to wear  a bowtie of this caliber, he would be guaranteed to make me swoon. What a delight!

• It's a snowflake and snuggling rabbits! Best Christmas Ornament Ever!

• If you can blink your way past the price tag, this piece of art is both profound and inspiring. Not only does it make use of my favourite medium, linocut, but also perfectly captures the best of my favourite season. With that in mind, I think the artist has priced their piece well: good work deserves good value.

• Last but not least, I can't help but smile when I look at this picture. It comes with a sequel that describes "animals of low moral standing"... but I feel that it is important to point out at the trifecta of animal awesomeness are all included in the high moral standing group: penguin, frog, and rabbit. :)

• What I'm Reading Right Now
• Textbooks upon textbooks upon textbooks....  'nuff said. :(

• TED Talk I Watched This Week
• What better than a first hand account of what it's like to survive one of the traumas that so disturb me. This woman was hit by a car, remained in a coma for 18 months, and was discharged to a senior's home because there was no long term care or rehab facility appropriate for her needs. When she says, "they had given up on me, called me a gomer... and the hospital really didn't know what to do with someone in my state", she couldn't be more correct. We deal very poorly with people who do not quickly return to their baseline, require very long term rehab, and have morbidities that make us uncomfortable about our job performance.

• Song of the Week
• special thanks to scarlett for another terrific referral! I promise to post something more festive next week. :)

The Shrine / An Argument from Sean Pecknold on Vimeo.

• Thing I'm Most Grateful for This Week
• Family and friends. And sleep.... dear lord, do I love sleep. It makes everything so much better.

• Thing I'm Most Looking Forward to This Week
• Christmas!!!! Since I can't be there in person, Penguin is going to skype me in for his family's Chrismas morning so I can still share in the family fun. xo

• Bunny Photo of the Week
• It is with a heavy heart that Hoyle, Penguin, and I wish Jazz bunny a fond farewell. A few weeks ago she became acutely ill and passed away quite suddenly at the vet's. It was a very difficult time for all of us and we miss her very much.
• Hoyle felt things most acutely for she was his 24/7 friend and, well they are rabbits, lover. Every day, he'd search the house looking for her and when he couldn't find her, he'd start the search all over again. It was heartbreaking to watch. He lost his appetite, lost interest in doing anything but looking for his friend, and was clearly depressed.
• It took about a week and a half before I realized that my human love couldn't heal his broken bunny heart, so off we set to find him a new bunny. No rabbits were available at the local shelter, so we drove for an hour out of town to meet a breeder of rex rabbits. Hoyle met several bunnies that day and chose, to my surprise, a wee boy bunny whom we have now named Murphy (surprised? I thought not. haha).
• Murphy is settling in nicely and while they aren't cohabitating yet, they are doing very well together.
• Hoyle and I still miss Jazz very much but Hoyle is doing much better since Murphy has come home. And Murphy seems to understand that Hoyle is in need of some tender bunny loving and goes out of his way to groom and snuggle Hoyle as much as he can.

With great love for her indomitable spirit and
sweet peaceful soul- we miss you terribly,  Jazz: 2008-2011.

Welcome to the Family, Murphy!