New Brunswick elective

• Today was my first real clinical day of 2010. I've been in the classroom, doing oral exams (i passed - yay!), flying around for residency interviews and now in NB doing a palliative care elective. The first day was a palliative care course (which was fine but I'm sick of classroom stuff) and yesterday my preceptor was sick so I spent the morning with the team and then went home for the afternoon to "read". So today was my first day fully back at it.
• The way things work here, my preceptor does hospital rounds/visits in the morning and then drives out into the community to see patients in the afternoon. She's currently the only full time palliative care physician in the hospital here and for the last 3 years has been busy setting up some structure around it and educating other physicians on how to use palliative care. It's been interesting to watch her at work and observe her style - something I love to do since everyone's personal style is so different. She's very caring and I've seen her give out lots of hugs and even kiss a patient on the forehead (with offers of Thanksgiving dinners from grateful relatives). That's another thing that's great about palliative care, you get to develop short but intense relationships with people and their families and get to know them perhaps as well (or better) than you would as a family doc over a span of 20 years.
• Anyway, this afternoon we did a home visit to a young patient in her 40's dying of stomach cancer. She has a teenage son and they only 2 weeks ago moved to the area, leaving behind everyone she knew. They moved here for her son's job, but she's obviously in denial about how sick she is because from the looks of things, she only has weeks to live and her son had no idea until yesterday about that. It's pretty heartbreaking because he's taken a leave from his new parttime job, which is their only source of income, to take care of her and they have no one around them to help support them emotionally. Yikes!! They both spoke only French so for the first time, I had to do an extended interview using the home care nurse as a translator. It was interesting. It's so easy to try to talk to the interpreter rather than the patient but I quickly caught myself doing just that and then began asking her the questions directly - looking at her and asking "Do YOU have any pain?" vs "Does she have any pain?". Tricky to get the subtleties of how someone's feeling by what they do/don't say, and her facial expressions didn't give too much away. A good experience for me.
• It's also neat to be in a different province and learn about how palliative care works provincially and in a smaller community about 1/2 the size of Victoria. It's a bit lonely though and although I brought my books to study for my big final exam in May, it's hard to get motivated to study for something so far away! Maybe tomorrow. Last weekend I was in Fredericton visiting my dear friends Lori & Chris, and this weekend I'm hoping that Lori comes up to visit. Hope the snow doesn't keep her away or maybe I will have to resort to studying. bleh.
• As for residency, I'm still in the process of ranking them, with the odd tweak here and there. The one constant is that my #1 choice is Queen's Kingston much to my surprise! I'll keep you posted as this process unfolds.