White Coats: Becoming a Real Almost-Doctor...

This is my carrot (and I must say, that unlike other things in life, like good food and kisses, one does not reap as much satisfaction with all that holding off and anticipation... for me, it was rather anti-climatic... there is something to be said for that 'spontaneous freshness' of creative imaginings... still, hopefully you will still find it interesting!). I was actually going to treat myself to blogging yesterday if I got all the work done that I had planned, but as it always goes, I only finished it up today (all caught up now though -let the real studying begin! I guess in a way it's good that it's going to pour rain for the next couple days and we can't go hiking up north anymore... I mean not really, I was so looking forward to that, but well, what to do!). At least I have Madonna's "Celebration" to keep making me happy here ;)

Before telling you about the big White Coat day, I just want to briefly mention that last weekend I was in Quebec City for a family medicine symposium where, not only did I get to take part in a suturing workshop and learn some basic kinds of stitching techniques (and incidentally, get filmed by the RDI crew... I didn't even realize that I was on TV last Saturday night apparently ;), but I also had the most amazing opportunity to hear the real Dr. Patch Adams speak. Yes, I will now say the most cliche thing ever: he was really so inspiring, that idealized family doctor who will do anything for his patients, who never charged any of his patients a dime (he held side jobs, essentially 'paying' to practice medicine for 39 years), goes around to underprivileged areas (of the U.S. and the world, I think) to health care facilities that don't have enough resources to adequately manage patients' pain, and provides psychosocial relief through his Clown Tours... he travels 300 days a year (doing this, giving these motivational talks too, I'm sure, visiting good friends / patients -one and the same for Patch, based on his stories) and writes over 600 letters by hand, per year to essentially fans from around the world... he's pretty much awesome. And wonderful to hear in person, standing casually before us, dressed in a clown outfit with a long greying ponytail, telling us to love ourselves and each other and not to forsake love for rigid, old-school "professionalism" and dehumanizing, patient-alienating rules in medicine (don't worry, I can take the message from this without going the extreme, but he did make some excellent points!).

And now, for the White Coat Ceremony.

Yesterday was a momentous day -I had my more formally entitled, "2009 Dr. Joseph Wener Donning the Healer's Habit Ceremony", beginning (half an hour late) with a "musical prelude" from the Medici di McGill String Quartet -a really lovely piece by Dvorak and another by Carlos Gardel -followed by intros and addresses from the Associate Dean, Dean and a family med / medical humanities doctor from Michigan / Texas (it was actually a pretty good talk -a First Nations story about the healer's journey, and the importance of virtue and love in medical practice to complement all that solid technical knowledge). The most moving though was hearing the reflections of a Med-4 at McGill talking about his personal experience being diagnosed with MS when he was a Med-1 and how the right kind of doctor with the right kind of communication skills can make the difference between a doctor who leaves their patients feeling helpless and afraid, or reassured and full of hope. It was quite touching to hear his story -so compelling (and apparently, when I react to people's stories I'm expressive enough to warrant the photographer zooming in on my face, which was kind of weird, really...).

Then we were "donned" with our White Coats -basically, 200 of us have our White Coats ceremoniously put on (2 at a time) by a big-shot McGill Medicine Faculty person and posing for a photographer... long, but, well... I guess that's partly the point. It does feel different when they put the coat on though, I'm not gonna lie. Especially because we also have our official engraved McGill nametags pinned on as well for when we go into the hospitals... it's kind of like "now, you're legit", but also "now, you better know stuff so you can help people", and frankly, people will expect quite a lot from us. That sense of responsibility was lost on no one, despite the sometimes snarky comments and making fun of all the pomp and circumstance of the ceremony beforehand... it's nice to have a tangible thing, a kind of rite of passage as we transition into real almost-doctors.

Anyway, we ended by reciting an Oath / Pledge on which a few of us from our class had worked really hard, right before the summer... okay, yes, I will just admit that I had a pretty big hand in its compilation, synthesizing the others' ideas into one cohesive message that represented all our values, to the best we could. It was a good Oath and I was very happy with it, but the real pride will be in, God-willing, being able to uphold it:

Pledge – Class of 2012

Remember the excitement of our first days as medical students? That early passion, which we surely feel again today, will be our motivation throughout our careers as we strive for excellence in delivery of care, scientific exploration and ethical conduct for the benefit of our patients, colleagues and society.

In full awareness that this journey is ongoing, recognizing our diverse talents and the value of supporting each other’s health and well-being, that we may fulfill our social and professional mandate, and

Appreciating that, through the generosity of our time, knowledge and understanding, our collective achievement will exceed our individual contributions,

We pledge, together, to our patients and to Society:

To be fully present with you, recognizing the unique fabric of your existence;

To learn from our mistakes and from you, that we may gain wisdom to adapt our methods to serve you better;

When we do meet with clinical and innovative success, to remain grounded, without pride or complacency, that we may continue re-phrasing our questions and searching for answers within the context of mutual respect, openness and trust;

To be your advocates, not just in words, but through our actions; your social struggles are ours too. We seek to transcend our differences and work together across disciplines, that we may make you well, keep you well and prevent your illnesses, no matter your background or status.

We recognize that microscopic pathologies often reflect larger social challenges. We will do our best to address those social determinants that prevent you from maintaining health and well-being.

To Medicine, we commit, both as career and vocation:

To be not the servants of science, nature, nations, personal beliefs or even our desire to preserve life. Understanding the reality of our own mortality, we endeavour, instead, to heal our fellow human beings and free them from constraint, so that they may flourish.

We embark upon this calling with humility, fervour and love for humanity.

Autopsies, Congestive Heart Failure and... Fried Bananas!

Yes, I do actually tell you how to make the most delicious fried bananas in the world, based on my mum's exquisite culinary instincts, at the end of this post...

I watched my first autopsy yesterday -coolest thing ever (so far)! It was kind of a nice surprise -our pathology small group leader at St. Mary's Hospital decided to give us a break between discussions of theoretical 'clinical cases' on athersclerosis and congestive heart failure, so that we could see not only what a real, recently infarcted heart looks like, but examine the surrounding tissue, clues from the state of the once-patient's body and better understand the pathophysiological mechanisms that lead to their death. It was fascinating. Also, you should know, it was done quite respectfully. I agree with our small group doctor -autopsies should be more regularly requested. Because even if the docs are 90% sure of the cause of death, you never really know until you go in. Sometimes it can be genetic, in which case, the whole, still-alive family can benefit from the diagnosis. Other times the first diagnosis might have been right, but reasoning how and why that particular lethal final event came about may have been inaccurate. Autopsies are important because they allow us to do justice to our patients and to their families after the end, and they also allow us to learn from our mistakes so that we can be better doctors.

These days we are learning a lot about congestive heart failure, coronary artery disease and hypertension. Something you should know point-blank about heart failure is this (a surprise to me, incidentally): all those meds (Beta-blockers, ACE inhibitors, diuretics, statins, etc...), they help alleviate suffering from the symptoms, perhaps prolong life a little bit... but ultimately, people in heart failure are going to die -the meds don't "fix" them. 50% of patients with heart failure do not live past 5 years from their diagnosis. The only way to give these people a new life is to give them a new heart. Harsh reality, and yes there are nuances... and there's reason to be hopeful in the sense that there's still 50% who do live longer than 5 years, but, well... better to know the stats and then make the best of the time one has left. It does not mean that you go around breaking bad news to people like its common, but it's important that patients are not being deluded into thinking that heart failure is just another medical condition, like the flu or even cancer, that can be overcome and then you move on with your life. You should move on with your life anyway, of course. But I'm just sayin'. Prevention, of course, is totally worth it. High LDL:HDL cholesterol ratios -bring 'em down; hypertension -bring it down; diabetes -keep it under control; getting old... well, can't do much about that... Really though, take your health seriously, so that you don't have to worry about taking life so seriously... at least you'll be there for it!

But you know -exercise, proper diet, all of this is well and good and you should do it. Some culinary delights that may be on the unhealthy side are still okay in moderation... like fried bananas, which I just learned how to make. Get butter to bubble in pan on high heat. Place cut bananas (if normal size, cut in half across and in half long-ways... if larger, cut in thirds across) in sizzling butter. Wait until they get goldeny-red (some can even get black... the more carmelized, the more yummy), then turn them over and let the same thing happen to the other side. Make sure you add a bit more butter accordingly (the bottom of the pan should not be dry). Once done, pour some lemon juice over all of it and stir them around and let simmer for a couple of minutes on low heat. If the bananas were not very ripe or over-ripe upon frying, you will need to add some brown sugar as well (when you add the lemon juice).

Taking them along with mango-peach-pineapple sorbet and fresh raspberries for dessert to a dumpling-making party later this evening. Should be delish. Well... guess I should do just a bit of work before leaving! Love you mucho...

"We're not a mistake" and "You can't earn love"

A very wise friend dispensed these grains of wisdom recently. So for all my fellow perfectionists, these are things that you probably already know, in terms of your "reasoning self", but emotionally... yeah, it can be a hard one to swallow.

We're all imperfect and we live in an imperfect world -cut yourself some slack. Making yourself perfect does not equal making yourself more worthy of love and being less perfect does not make you less deserving or less likely to receive it. Us Type-A's enjoy the idea that everything in life can be 'earned' -work hard, stay focused and you will succeed... right? Right. Except love does not work that way -whether it's love from our families, our friends, our teachers or romantic interests. Which, so, at first makes you feel disempowered right (because what the hell can you do about it right... all those 'games' are for naught)? The thing is that real love is not about power. Empowerment, disempowerment -both are moot. Yes, we may feel empowered as a consequence of love (or disempowered as a consequence of hate... just ask all those helpless women and kids in Karachi's slums)... but love itself is not about power. It's about love -that is, presence, warmth, closeness. And thank God for that because otherwise who'd help you up and hold your hand every time you fell? We can't control it all -often times this sucks, but well, what fun would life be if we controlled everything, and all of our mignons did whatever we said (even if, let's face it, we know what's best for them, for society, for the world... it's hard to care about things that are easy, or feel committed to things that are 100%-guaranteed in our control)?

So well, I do my best now (and before... these things are dynamic though so sometimes even if you think you know, you can forget) to just let it go. As they say in Pakistan, what to do.

After losing 4 lbs in 1 week, I got scared enough to up some of those calories... I mean, I'm just trying to be healthy here, really... it's just when you're not used to watching what you eat, you're more likely to err on the side of less... but you know, I'm working on it. I talk to the people I love about it. I'm talking to you about it. I still eat cookies or half-cookies if tempted by them and I try to eat when I feel hungry. Going easy on carbs and upping the veggies actually makes you feel more alive anyway. And as a good friend said to me today, in my defence, slight dietary restriction is not necessarily unhealthy, and there's just a fine balancing here that I'm working out. If you dropped 12-16 lbs and felt like a million bucks, you wouldn't want me to chastise you for it right?

Things to be grateful for today: fun lunch with good friend, soon-to-be fun dinner with other good friend, feeling confident in small group about learning some medical history-taking tips beforehand and therefore not being intimidated by small-group leader, sleeping in and feeling happy about it, sunny day, parents come back from vacation that felt like an eternity (despite having enjoyed me-time and independence again, I'm ready to not live in a big, empty house devoid of hugs... see at least, you get this latter when you have roommates!), feeling gorgeous... and MOST of all, making the time to write!

wishing you love...

Epiphanies Upon Return and Inner Demons

What a whirlwind of Life since I came back home. If Pakistan was physically, emotionally and spiritually rough... well, it didn't stop upon my return to Montreal.

First couple of weeks back, I was a royal mess. Really. I thought the extent of my "reverse culture shock" would be walking on the left side of the road instead of the right. Wrong.

They don't tell you about what really happens when you come back from the developing world, that it varies from person to person. We only ever hear about the "enlightened return" -you know, where the traveler or do-gooder or whoever, comes back with a secret kind of wisdom and understanding, strong, solid, confident, unshakable, and a bottomless well of compassion. I mean, it's who I wanted to be, that's for sure.

Let me tell you what happened to me in real life -it was humbling, to say the least. First week of school: I was more Type-A than ever, I was not able to 'rise above' with all that 'developing world perspective' -I needed to control everything. I swore at computers, ran around doing my errands like a paranoid, crazy. I felt like I regressed into old insecurities, but amplified now, with a vengeance, including a new obsession with weight, calorie-counting and prettiness. I have dropped about 1.5 BMI points, including the weight-loss of being sick twice in Karachi. I felt alone in a crowd. I felt like no one understood me, and that I didn't understand myself. I was right, at least about the latter.

See, I managed to convince myself that the emergent control-freak was because rather than feeling "enlightened", I felt an overwhelming sense of responsibility. Having seen what I saw in Pakistan, it was my responsibility to be perfect, remember every single little medical detail in my training because if you forget a detail someone will die out there because you never know if anyone else will remember that tid-bit that you should have known. So I had to be perfect on the inside... and I reasoned that somewhere in my head, I had decided that inner perfection required outer perfection... and whose body couldn't be a bit more perfect than what it is right?

Wrong again. I talked about it with my best friend, my best mentor, my sister and the Truth revealed itself to me. Since when does "a sense of responsibility" make one hate oneself, make one want to punish oneself, make one feel unworthy of love and cut off from the world? Yes, I do feel a sense of responsibility, but that was not the driving emotion behind my crazy behaviour. That was Guilt. Shame. Unacceptance. Guilt for what? That although I learned so very much working in Pakistan, that despite having met some wonderful people, having had some very special, life-changing experiences, having been blessed to be able to contribute to the work there in a meaningful way, I really, really, really did not love it. I felt no joy. I did not feel alive. It felt like a sacrifice, and I know that I am not the type to truly be able to sacrifice my whole life in this way. And now I was back, and all those feelings were so in my face, and it scared me to death because this is what I was supposed to want, this is what I thought I wanted my whole life. But I don't and I felt like a demon of a human being for that.

I do want to serve humanity still -that will never change. But I will do it in my own way. I want to help the poor, the disenfranchised, the uneducated, the sick... but I know my limits now and of course, I am still working through all of this. God-willing, at some later point in my life, maybe for a short period of time, I will be able to go back to some other part of the developing world and do more work 'on the ground'. I have my own gifts and passions. I can be a good doctor here, I can write for the world, I can effect policy level change at home and maybe in a broader context (I have, afterall, seen what it's like out there, for myself... and really, once you've seen it, you've seen it), but I don't actually want to martyr my life away in an abrasive environment that makes me sick all the time, brings down my energy, makes me feel legally vulnerable and fragile... look, see. If there is no happiness in it for you, how can you expect to bring happiness to others? Your own vessel will be empty. And that would be a fraud indeed.

So I am not fully resolved now, by any means. But I am starting to slowly chew over these early personal revelations. It helps to leave town for a weekend with friends, go out and be careless and carefree and have fun for the sake of fun -real fun, with real freedom. We are so blessed here... I can't give up those blessings. But this week, this second week, I have been embracing those blessings as much as I can.

Life surprises. It's dynamic, ever-changing -what 'is' today, may not be, tomorrow. And I find I am in awe of the mysteries that lie tucked away within myself.