Light on the Wards

She's the reason I went into medicine. This young, wise palliative care physician, with enlightenment shining from her eyes, who is compassionate and humble and excellent at her job. She is the reason -so that I could be her. Or at least this side of her that I met today in the Montreal General Hospital Palliative Care Unit.

This was probably my best clinical encounter. Because it is calm and peaceful, and there is a seemingness of 'all the time in the world' for the patients, for the doctors to be with their patients, for them to share in a common human experience, to grieve and be existentially reborn, to walk together into very dark places, and if they're lucky, to enjoy just a moment of blinding clarity. But only a moment, most of the time. She said it well, that doctor: "Because how long can you stare at the sun".

And the patient. What a special woman. She also had that light in her eyes -the light of someone who has suffered, who is still struggling, someone with an abundance of joy and fear and love and frustration and hope and despair, all at the same time. She described the cancer that has made itself comfortable in her physical body like a monster lurking inside that she hoped would stay sleeping, so that she can live just a bit longer, so that she can be there for her teenage daughter, who is everything to her and the only thing to her, even amongst supportive friends. And she had been afraid to enter Palliative Care (who wouldn't right?) -but when she did go, she found she was looked after "like a Princess", her pain was addressed as the primary medical concern, and proper pain management is really complex medicine -doctors do not abandon their patients in end-of-life care. In fact, this patient said this doctor was the best doctor she had ever had -a doctor who she felt she could trust, who understood her, who had time for her, who what would she have done without her. They had a bond, that doctor and that patient -a real deep, existential connection that I have never seen before.

The doctor told us that there is a surprising similarity in experiencing the world of Obstetrics and Gynecology and Palliative Care -they were the only times that physicians were granted the privilege of being a part of the very personal, intimate human existential moments that were birth and death, for the sake of birth and death. I get that. I don't know it at all of course, I'm just a first-year medical student. But there's a beautiful synchrony there that I can understand, esoterically, anyway.

And it is beautiful indeed. Not easy though. Not at all. I didn't cry there -I went with the patient on her emotional 'roller-coaster' (excuse the cliche) as she told the story from her diagnosis, to her prognosis, to her multiple events of suffering, surgery, pain, infection -all of which had been debilitating in some way, whether physically, emotionally, psychologically, etc... I heard her talk about how she turned to God to get through those times in her life, one moment I watched her comment hopefully about getting on with life and going home soon, and the next, I felt the lump in my throat and forced back the wet, quivering scene in front of me, as tears flowed from her light grey-green eyes, down her cheeks and neck. No, it does not look at all easy. And yet.

It seems that in a big hospital frenzy of waits and lines, and crazies (the health care workers, not the patients), the impatience, the egos, rushing, rushing, rushing (time pressure indeed!), the place where patients, before they enter, perceive fearfully as death row, is actually where there is calm, there is time, there is cooperation between professionals which is inter- and intra-disciplinary, where the well-being of patients and medical staff are both taken into consideration (which means better doctoring!), where there is space to embark at last on your spiritual, existential journey -where you can, if you choose to, 'conference with the birds' -through valleys and mountains, hells and heavens until you transcend yourself and return home (as in your physical home, to be with your family and friends in your last days), or return directly Home. It doesn't happen that way for everyone, all the time -this is clear. What is also clear though is that people are not just going to Palliative Care to die. The doctors and patients in Palliative Care seem to me really to be living in the truest sense of being alive -intensely with heart, mind, and body. The end-of-life world seems to be a microcosm of life itself, really -it roughs you up pretty bad and you only get the spiritual reward of healing some of the time. But what an honour for a physician to be a part of all of that. Don't you think?

May's Perfumes that Flood the Air

"You can't say to the spring: 'Come now and last as long as possible.' You can only say: 'Come and bless me with your hope, and stay as long as you can.'"

Words lost on the wind. But I needed to hear them, and he needed to say them. I fell asleep, although I don't know when. I dreamed, not of a situation or of a person, but of a perfume that flooded the air.

~Paulo Coelho, Eleven Minutes

Aren't these words delicious? Love 'em (I do). Just finished the novel by the way and it is quite good -one of those self-discovery, spiritual journey type of stories... easy to read, but also quite profound and revealing. Also there's lots of sex so prepare yourself accordingly if you decide to read it (I mean, it's the spiritual adventure of a prostitute after all). Anyway, I read it this week almost only during my commute between school and home -what a wonderful discovery to be able to escape into a different kind of personal growth and pleasure whilst using one's time so efficiently! Usually reading in moving things gives me headaches and nausea, but not this one. I'm part way through Ayn Rand's Fountainhead though and I probably ought not to take that one up in the BMW (Bus, Metro, Walk). Just like I can't really study my Med World material there neither.

Last week's long weekend in Niagara was really perfect. We did all the touristy things -Maid of the Mist, right beneath the Falls, ate at the revolving restaurant (with a spectacular view and pretty good food), watched the IMAX film about the crazy daredevils who curled up in barrels which were then sealed, pumped up with oxygen and then thrown into the Niagara River to go tumbling down to near-death with the millions-of-bathtubs-full-at-any-given-moment of waterfall. And then pretty little Niagara-on-the-Lake all a-blossom, lush green parks, quaint little shops, vast vineyards (with Icewine that was really something else, I must confess -the Vidal, and the Riesling, especially, although the Cab Franc was not too bad... don't worry, on the official tasting, they probably only serve you half a champagne-flute total ;), and of course, an enchantingly entertaining couple of hours at the Theatre to experience some of this world famous Shaw Festival (it was a play called 'Brief Encounters' from Noel Coward's collection of 10 one-act plays called Tonight at 8:30).

Here's the thing about long weekends though: the following so-called 'short week' always feels long! How is this possible? I don't know really, but somehow the gods seem to like 'making it up' to us. It was hectic, but good. Immunology has been interesting,

Trekking out to St. Mary's Hospital was also interesting (my new Small Group this semester is terrific though! hey, i served my time with the rude crew if you recall ;),

Osler Society stuff -interesting too: Wednesday, we hosted a lecture in the Osler Library on "Art, Anatomy and the Representation of Knowledge", including a viewing of original 16th-19th century manuscripts; Thursday, we hosted a Philosopher's Cafe moderated by the famous conservative McGill Law Professor and bioethicist Margaret Somerville on "Crisis of conscience: should health-care professionals park their values at the door?". The latter became a heated debate on abortion and euthanasia for the first part before being steered back towards the larger concept of freedom of conscience. Parties on both sides get quite emotional about these things. Which is fine, who doesn't (they're called 'hot issues' for a reason), but it is a useful exercise to try to keep that emotional aspect under control so that open, healthy discussion can yield fruit, especially if you really want to discover why you believe what you believe, and even more reasons why you will continue to believe what you believe -no one's asking you to renounce your values... well, that's a lie.

It's a lie because Pro-Life people are in fact asking Pro-Choice people to renounce their values. Now. I am Pro-Choice. But I can recognize that the argument, "I believe what I believe, you believe what you believe, let's not impose our values on each other" is intrinsically a Pro-Choice stance. If Pro-Lifers truly believe that abortion is murder, then what I believe and what you believe is besides the point, right, because they're talking murder. Even if you disagree with that position (and I absolutely DO disagree!), you have to admit that it makes no sense for them to accept the Pro-Choice position.

Now a while back, I was asked by some friends when I considered 'life' to begin, and why I'm Pro-Choice (and essentially, how on Earth do you live with yourself, you crazy, heartless psycho). I would like to start by saying this: I consider myself Pro-Choice-on-a-spectrum, which means that there are surely certain rare kinds of situations in which I think most Pro-Choice doctors feel less comfortable performing abortions. And most of the time, we should ask the deeper question of why it is that these particular cases (later in gestation, the rare woman who presents her situation flippantly) get to this point, and what we might do to address these deeper problems (also, just because someone may appear to act 'flippantly' doesn't mean that they don't realize the seriousness of the decision they are making, and are in fact using 'flippancy' merely as a mask for much more complex, deeper concerns, which I do not feel is my place to judge). But I remain Pro-Choice even then because I do believe the woman's life comes first, especially because she is a part of society, and society as a whole suffers when she suffers, and loses an important participant when she loses her ability to function optimally and live within it.

Firstly, I am not God to know or decide when life begins and frankly, neither are you. But before 22 weeks of pregnancy, it is riskier (in terms of life and death here, let me be extremely clear) for a pregnant woman to continue being pregnant than to abort, so I think she is perfectly within her rights to do so, especially in this case. The question of the viability of the fetus later on is often a hot button, yeah. Personally, I have no qualms about the issue at all prior to viability (so while I cannot decide when life begins, I do not think it has begun prior to the fetus being truly viable). Once it is viable though, I think that if a woman is forced to go through with an unwanted pregnancy (whether the reason for that is rape by a stranger, rape by her husband, being forbidden to use birth control for socio-cultural and religious reasons, and a variety of other reasons), the trauma of that pregnancy and subsequent birth is a threat to her mental and physical health (including compromised immunity associated with that kind of trauma paired with the physiological and psychological stress of a pregnancy), and a threat to health is a threat to life -her life, the pregnant woman's life. And so even though, most doctors probably don't feel fabulous about aborting a fetus at 30 weeks, compassion for this particular kind of distress and health and life risks for the pregnant woman is about deciding whether the means justify the ends. The fact that rape has been deemed an act of genocide shows to what extent a traumatic, unwanted pregnancy is a form of extermination of the woman's right to self-determination, within the context of a larger society in which they function, and a society that benefits from their optimal ability to function (so don't give me that 'abortion is selfish' argument).

Finally, yes, we can all recognize that it is problematic when a few women use abortion as a form of birth control -but there are deeper problems at the heart of this, including education, access to birth control, understanding various traditional, cultural practices, amongst other concerns (please listen to Barack Obama's response when asked about abortion -he expresses a similar point quite eloquently). Doctors do not blindly perform abortions -they do in fact talk to their patients about all their options, investigate the reasons the patient thinks they want an abortion, etc...

And remember. If someone wants an abortion, they're going to have one, regardless of whether the doctor provides the service. People used to drink all kinds of toxic substances to induce miscarriage, hangers and various other barbaric tools were used resulting in the death of both the mother and the fetus, and pregnant women have also been known to commit suicide because of an unwanted pregnancy. There are dangerous practical implications to trying to impose one's values (especially in law -and Somerville by the way, opposes making abortion illegal within the law even though she is Pro-Life) through law. Anyway, see the Morgentaler case for beautifully articulated arguments (this is the Canadian edition of Roe v. Wade).

There are my thoughts. You don't have to agree with them. We can agree to disagree. But like I said before, for Pro-Lifers that's just not possible. I know. I know why. I do get where you're coming from. On this particular topic, I am okay with having a different view from yours and I'm okay with the fact that you're not going to be okay with my different view. Esoterically. Legally, I'd raise hell to uphold my values in practice.

Montreal gets blossoms!

I had forgotten. Or maybe I was just never around when the trees were blossoming these last few years (because I was busy enjoying the magnolias, etc in Cambridge). But on this perfect 20-degree-Celsius, sunny day, walking downtown, it feels like summer. Street vendors are out, street painters too, the cheezy feel-good Andes musicians are playing and McGill College (which is a street for all you non-Montrealers -Canadians never refer to any part of their universities as 'college') is literally lined with fuschia and cotton-candy tulips and lovely pink blossoming trees...

I am officially not a proper writer because I cannot name every kind of flora in existence, followed by weaving into an elegant, seamless beautiful-word-orgy, but I did some Googling... and to little avail. In any case, they kind of look like cherry or almond trees blossoming, but smell kind of lilac-y... I give up. But it's really pretty. And makes one feel quite happy.

We are done with neuro now. Starting Immunology/Microbiology/Pathology unit -fitting for allergy season (did they plan it that way on purpose?). Life goes on but in sunshine and with joy now -long days and good weather make all the difference. I'm off to a most authentic, delicious restaurant that is like being in Turkiye in Montreal (Cafe Avesta) before going to the Med-Dent Talent Show (For A Cause). Niagara Falls trip planned with the famille (nuclear) for the Victoria-Day long weekend.

Oh also. One of my Harvard blockmates sent the following link out today -it's hilarious and wonderful and true. I think you're special, but more importantly, YOU should think you're special. If you're ever forgetting, please visit accordingly: http://www.reasonsyouarespecial.com/

Another interesting site (especially if you're a writer I think!): http://www.mylifeisaverage.com/ Now a word of caution: it is EXTREMELY average. That's why it's wonderful -you can see all the little mundane things about our day-to-day lives that illuminate how utterly absurd they often are. And yet they're all the words we use instead of the much deeper thoughts and feelings we mean. Anyway, you gotta dig a little (deeper in your imagination) to dig this site.

Much Love.

Her Inner World

One of beauty and passion, joy and shadows. I love these paintings (some famous, some less famous, some not even paintings...), especially together, because they express a kind of wonderfully existential, romantic truth about life and this Earth. Don't you think so?