Full Disclosure

I am now nearing that time where it is inevitable that residency programs will google me and likely find this blog, so I think it is in everyone's best interest that I preface what you will find here with some brief context.

"Skipping Through the Old City Fountain" chronicles my experiences during medical school, from year 1 to now, year 4, after my graduation from Harvard in 2008. It is a labour of love... not really a labour, maybe just love. It has provided opportunity for me to develop my writing, which I will happily say has progressed nicely over the years. It has also been a forum for the expression of my deepest reflections on the various steps involved in the transformation from lay-student to medical professional. My passions, my frustrations, insights and even more personal, non-medical revelations and evolving philosophies are contained herein.

I didn't always know I wanted to be an Obstetrician-Gynecologist -this realization came with time and experience. I originally thought I wanted to be a family physician, while focusing on women's health, deliveries, sexual health, as well as primary care psychiatry and palliative care. But as I discovered how I loved the OR, how I loved the bread and butter of Obstetrics & Gynecology, and could not tolerate some other aspects of family practice, I changed my mind. Medical school allows us to do this, especially as it changes even who we are, right through to our souls. The training of future physicians is a fully transformative experience, full of beauty, trauma, ideals shattering in complex realities, allowing us to form a new vision and concept of who we are and what our role will be in truly making this world a better place.

I have detailed my experiences in the classroom setting, as a clerk rotating through various specialities, and most importantly, the touching stories of patients who mirror our own existential dilemmas. Our love for them and our love for the profession facilitates our own metamorphosis.

I have done my utmost to protect the confidentiality of patients -I do not say in which hospitals I was working, nor the names or particulars of patients. Sometimes, I have even modified context or details to ensure their protection. Any frustrations or generalities that I have expressed regarding the less palatable personalities or approaches that we see in medicine, I realize full-well are not actually particular to this field (saints and demons abound in any profession, and all kinds in between!). I have allowed myself a position of vulnerability and imperfection, because that is in fact the true nature of the human condition.

I feel that I have learned so much through medical school and I can say with full sincerity that I am very grateful to McGill for giving me the opportunity to become a doctor. To practice medicine is an honour and a privilege -our training cannot be perfect because human institutions are bound to be fallible. I can appreciate all the good that was there, and the good that it did me. The challenges probably did me an even greater service, so I am grateful for those as well. My greatest hope, perhaps too lofty, was that in sharing these experiences with solely family and friends initially and now the vast, diverse population that may have surfed their way onto these shores, others could learn from my experiences as well. Or at least feel that they are not alone in these fundamentally human struggles.

Toeing the Line: the Personal Patient

They say doctors make the worst patients. I thought that was mostly right from what I observed in my own colleagues, or physicians who come in as patients or as the patient's next of kin. But not for me. Of course not. Obviously, I was the exception to the rule. In fact, I thought I did a darn good job of being the "good" patient when they discovered the retinal tear a few months ago and had to laser ablate. I was stoic in the face of a scary and painful procedure, I didn't complain, I accepted the recommended treatment, with a few questions, but not too many. I may have even succeeded.

But God forbid that any of my nearest and dearest should get sick. A mama bear I didn't even know existed just comes growling out, annoyingly second-guessing, researching all the options, insisting on thoroughly investigating -partly protective, partly because "there's no way I'm having their blood on my hands". I felt so responsible -perhaps, more responsible than I should have. I called everyone I knew for help and advice, I read various articles and paid heed to stats that I would dismiss if it was myself. When it's me, I just let it all go and trust the system, trust my doc. It's too much energy not to and I'm already stressed about everything that's happening. But if it's my grandmother, or my friend or anyone I'm close to, I worry, I research, I advocate and make sure anyone I know who might be able to help is also on board, and if I can't be there to speak up for my loved-one, then I will provide the necessary information for them to advocate for themself, even if it means I may be alarming them more than necessary. Medics are hypochondriacs, notoriously. But we've all heard those stories of the sister who insisted on one more test, or the son who pushed for a second opinion, and ended up saving the life of a brother and a father. No such heroism in my case, but better safe than sorry, right.

It's an instinct that develops in the process of becoming a doctor, I suppose. I never really thought about what's at stake. When we get involved, we are putting our personal relationships on the line. We are risking everything that matters most in life -love, family, friends. This is the stuff they tell you is the only thing that matters when you die. That's what we're prepared to give up -we are ready to sell our own souls. Their lives are more important than friendship, bonds, intimate promises. None of that matters -we love them enough to lose them, but at least we did our best by them. Sometimes we choose not to, deferring to superiors, colleagues, especially when we are out of our depth. That's when you hear the line about doctors not treating friends and family -it's even a law. But we cannot help advocating for them -isn't that our duty? And we know the worst possible scenario, and we'll be damned if it's not ruled out. It's easy to forget that part of our training which teaches us about the limits of testing and imaging and screening, that it's all a balance of probabilities. Like who cares if there's only a 1% chance that this particular situation is that deadly condition -my loved one is not going to be that 1% and you better darn well see to it that they are as far away as possible from that 1% chance.

We are no longer reasonable. But sometimes that's how lives are saved. And other times, maybe we cross a line and boundaries blur, as you wonder suddenly whether this person has become your patient or whether they are still your friend and which hat should you be wearing? Of course they mostly just need your love and support, a hand to hold. But who will advocate for them if not you? Certainly nobody else. A tricky balance indeed.

Perhaps the answer lies in release and untethering. None of us has ultimate control. We say our medical bit, we give our kisses and warmth and then we should powerfully choose to go sit in the backseat. It was never in our hands anyway.

Uncertain Times & Banal Wanderings of a Festinating Soul

There comes a point in a medical student's life where it all gets to be a little much. Even after being a part of the most exquisite wedding in the UAE, desert safaris, ascending towers, watching fountains dance, alight in the night to passionate opera-like music or with local belly-dance flair. You come back to reality. And that reality is more pressure than you've ever felt in your life, threatening to boil over, burst through your pores, your mouth, your eyes, like a fiery volcano. But it's not just the pressure of everything you have to do, it's also the uncertainty about where it's all going... none of which is in your control.

And then, the real icing on the cake, you're stuck in geriatrics. Enough said. Old people need doctors and special care tailored to their needs. But they also need doctors who really love doing just that. For better or for worse, I am not one of them. If it was palliative care, no problem -I like their philosophy and their approach. But regular old-people medicine? So not my thing. I really just want to run to labour and delivery, or the NICU or the nursery for a breath of fresh air. Or talk about contraception and safe sex with some teenager. It's all just a week away, until I'm back where I belong. But until then, I'm stuck in a veritable hell. They are dying okay, or at least most of my patients are. Yet we delay consulting palliative care. We force them into the futility of physio, nutrition, long-term care placement, etc. And for what? I say, consult palliative care now before they're gasping for that last oxygen-full. Let them embark on that existential journey we all deserve at least a chance at, before we die. Let them live their last days or weeks or maybe even months (not likely), in comfort, without someone constantly nagging at them to eat and walk, drawing bloods, stethoscopes. I mean, seriously. Everyone is suffering, suffering, suffering. And we're doing diddley-doo about the most important suffering here, which is the family and the patient's psychological suffering and ensuing demoralization.

I realize I am not the authority. I'm a medical student so maybe it's not my place. But I have learned this. When you truly dislike your work, those are the most exhausting days. We are doctors trained to work long hours, not sleep, not eat and passionately be little medical energizer bunnies. That is changing only very slowly. In the meanwhile, you will be happy to know that when you find what you love, the madness of this philosophy is only half as crazy as you originally thought, and you will happily go through all this in the name of what you enjoy. But put me on a geriatrics ward for a morning and I am beat -physically, psychologically, emotionally.

I miss my women and their babies. I miss the OR terribly. I just want to practice knots and ultrasound. Or share in the tragedy of the occasional miscarriage. That's not an easy job either. But I enjoy it and would gladly give up so much more than geriatrics may have technically ever asked of me. It doesn't matter. I am learning, I am busy, but there is no fire and the undercurrent is boredom. In Parkinson's, individuals develop a festinating gait, defined as "a manner of walking in which a person's speed increases in an unconscious effort to "catch up" with a displaced center of gravity". Geriatrics festinates my spirit -the only way to find my center will be to get out. It has been the longest rotation of my life and in all honesty, I can't wait for it to be over and never go back.

Back in the womb of inspiration

So here I am, back at Harvard, albeit just for a visit. I watch as sparkle-eyed, innocent, eager freshmen lunch with their parents in the Square, and as seasoned students and professors meander their way along these cobblestone streets, contemplating some academic dilemma, or perhaps a personal one. I arrived late last night to find the area bustling with youthful energy, in bowties, black suits, shimmery dresses, high heels. Oh how I miss this energy! This place I once called my home. Oh it's absolutely nostalgic as I sit here in the little coffee shop, with an unsweetened pumpkin spice chai and my laptop, the air alight with big ideas and plans, limitless dreams, potential, everything -hope and such a love of learning. It is truly most inspiring and wonderful. Even that awkwardness, that ridiculousness, that naivete even, is utterly endearing. I loved belonging here.

And I'm here to do some work... work on those residency applications, and revisit with old friends. All the worries of the world are across the border -here, it's just me. Who goes to Boston or Cambridge just to sit at their laptop and work? My mind has space here. Indeed, this is one of those places that prioritizes room for thinking, reflecting, and then turning that into something. Promising, for such an important task at hand, wouldn't you agree?

Being back here is like being in love, or perhaps, remembering an old love... in the most important way that is... to feel joy, lightness and inspired.

Rejuvenating 24-hour Call: Baby Love, Human Love!

There's something very special about that post-call day. The call itself can sometimes be rejuvenating, believe it or not. Regular days may be interesting enough, following clinic patients and getting into a bit of a groove. But life's pebbles can stick in your shoe every now and then -the little worries, the trivial fretting, wondering why this thing turned out that way, or why someone would say that, or why they didn't say that.

Then suddenly, you're in scrubs for 24 hours. Seeing a slew of patients on an unpredictable labour and delivery ward, running from here to there, room to OR, to triage and back to the OR, down for a quick coffee and back to the floor. And there's the adrenaline rush of those life and death-moment emergencies. The pleasure of surgery, the joy in a new mother's face, the cry of a newborn babe. And perhaps you catch a couples hours wink of sleep. But you finish that call, refreshed, centred, content. This is the stuff that matters. This is where I belong, where I make a difference, where I feel so fulfilled and blessed and happy. And all those silly nothing thoughts kind of don't matter so much. The act of loving in this total-human way, with the movements of your body, running here, retracting there, snipping, the activity of your mind thinking through possibilities, options for management, and your heart cradling space and bringing comfort to your patients... this act of loving is enough.

It's kind of a metaphysical graceland... maybe Paul Simon was right, maybe we all will be received in that place, even after we've lost love, found love, lost love... opened up those windows into our hearts, where "everyone sees you're blown apart". But we've all been blown apart before. The miracle and beauty of the whole thing is how sweetly it all comes back together. And our capacity to continue loving in every aspect of our life... that people feel more understood and more loved as they look through their own windows into ours, and heal.

And those lovely fresh newborn angels. As Dickens said (or wrote, most likely), "I love these little people; and it is not a slight thing when they, who are so fresh from God, love us." It is also no slight thing when, hearts blown apart or not, we continue to love each other.

Autumn days: Comfort & Company

The leaves have already turned their golden to coral hue -it's fall again, reminding me of another year past, and the beginning of the next. Days shorten like the cervix of a complicated pregnancy, preparing for the release of snow and ice, sooner than we'd like (okay, bad joke, but I can't help myself -it's all high risk obstetrics in Toronto now and then Ottawa, in a week)! Anyway, this city has been good to me, this time around, or perhaps despite the chill, I've been warming up to it a bit. Continuing to discover good eats (Sukothai, Gilead, Oliver & B's) and revisit the places I've enjoyed in the past (Red Lobster, Sushi Bar, Spring Rolls). This is a picture of the best dessert I've had in Toronto (post-lunch indulgence today): Sticky toffee pudding with Chantilly cream at Gilead, in Corktown... yummy! Meeting old and new friends, in various contexts (work & play). I saw a beautiful foreign film at the Film Festival, "Habibi", a modern Laila & Majnun set in Gaza -the poetry on the city walls was the best part really. I've met some lovely physicians and am generally enjoying this downtown hospital. Learning a lot about medicine, life, love, pacing and myself. It's a good place these days, this temple that is my body.

Before arriving here, I had the simultaneous fortune and misfortune of having a retinal tear discovered in my right eye. Right -that side with which we give, share and work. Misfortune in that I was scared out of my wits thinking about the possibility of retinal detachment, going blind in one eye, losing stereopsis, and perhaps not being able to become a surgeon one day. Fortune in that the tear was discovered before I had any symptoms, was incredibly rapidly diagnosed and treated with laser within 24 hours. The other blessing was that I got to re-experience what being a real patient is all about. Fitting for the end of my short palliative care elective -nothing like wearing the shoes yourself, you know.

First of all, can I just say that it is very difficult to be a medical student and a patient at the same time. See, we know what being the "good patient" is, and we understand that medicine makes no guarantees or promises and that there are enough risks in any given situation. Most physicians will tell you that doctors are the worst patients -always questioning, analyzing, etc in their awareness of all the risks. But then there are people like me, who like to be liked. Which means I have to be the "good patient" -smiling, being stoic / tough / courageous, asking a few questions but not too many, and above all, no whining, no complaining, no losing our cool, especially because we are medical students. And yet, despite the fact that the residents and fellows in opthalmology spoke to me and treated me as one of their own and I knew I was in good hands, I found I felt immensely alone in my state of just being a patient: worried, scared, wondering what the best decision for treatment would be, exhausted by having numerous dilating eye drops and many a bright light shone into my eyes for a total of just over 2 hours, feeling stressed and overwhelmed and entirely disrupted and unrooted from my life, even if only for 24 hours. The only moment where I felt myself relax and breathe momentarily again was after my eye had been repeatedly lasered, tears silently running down the sides of my face and temples (it hurt, but I was doing my best to just tough it and ignore the emotional and physical trauma of the whole ordeal) -the fellow put a hand on my shoulder, asking if I wanted a little break and then acknowledged that it couldn't be any fun, that he'd never had it done himself and would probably be a big baby if he was in my place. I was so relieved. I had been wondering whether those strong, brave patients we all love so much, actually never felt the pain that much or whether they just did a good job of hiding it, unlike my own body which betrayed humble suffering.

And so I had been patient, and as kind and empathetic as I could with my palliative care patients prior to that fated day, when in a sense, I became one of them. Not in their state of imminent death of course, but in sharing that heartache of being 'sick', having pain, seeking comfort, company and love. That is just the human condition. That's what I loved about palliative care -it was all about our humanity. Our physical, emotional, psychological and spiritual health, as patients, as their families, and as the interdisciplinary care team. Imagine a doctor walking into a patient's room and asking them how they are doing, how they are feeling, asking about their fears, their pain, their hopes. And then, turning to their anxious spouse, or niece, or young daughter and asking how they were doing, how they were coping and letting them know that all the support resources available to the patient were also available to them -psychologists, music therapists, massage therapists, the works. This is the model for all health care. And in an ideal world, all patients need and deserve it, as do their families.

Until then, I remain yours truly, doing the best that I can. My goal as a physician will be to make sure my patients feel supported and loved as we treat their physical ailments, and also to love and support my colleagues so that as a team, we can do better.

Enchanting Cerebrum & Solidifying the Path

The moon hangs delicately in the dark sky tonight, a solitary pearl on an invisible thread. The humidity seems to have dissipated, somewhat. The light of day that used to linger late, now sets a bit sooner than we expect. The trees still fill the air with their fragrant perfume on a magical night stroll down avenues and park lanes in my sweet neighborhood. August at last.

And, at last, these lovely, wondrous, romantic thoughts fill my mind and spirit all over again. My wounded heart -this cut, not quite so deep as in the past -has healed again. The heart is probably the only organ that scars may beautify, powerfully transforming who we were into who we are. Perhaps, my language here is a bit excessively deliberate, enthralled by this physical world of nature, and the mysterious physical world of the human body. Only a surgical rotation could enchant me to poetry, I suppose, and here I am.

Neurosurgery. The pulsating brain and spine, the intricate vessels above, below and within, that clear fluid unlike any other bodily fluid, the aponeurosis they call the Galea (even their names for certain kinds of anatomy are more magical!), stemming from temporalis that ensheaths the cranium, and a thin sheet of scalp above. Sigh. Really it's a beauty and an honour. And what pleasure to learn about its inner workings, to unveil a sliver of the secrets of this truly supreme human organ. The root of invention, innovation, creativity... even love! Ah yes, this is love.

It's a once-in-a-lifetime experience for a determined would-be obstetrician / gynecologist. Yes, that is still exactly what I want to be. 100% sure. It's just that this is therefore my only chance to learn about and watch the brain and those amazing men (they are 90% men, those particular breed of doctors) perform intricate, delicate surgeries on that most prized cerebrum. It's amazing. It's like watching Picasso or Monet or Renoir in action (or what I would imagine that to be, not knowing from first-hand experience). I'm no Picasso or Monet or Renoir. I'm just me and I know that I would not be happy painting for the rest of my life. I'm a writer and soon-to-be doctor. But I can still admire their artistic works. Appreciate them, perhaps love them even.

Afterall, neurosurgery combined with obstetrics is what inspired me to want to become a doctor -intrauterine neurosurgery on a fetus who would have been born with spina bifida and who, following this intervention, was born with full functioning of their nervous system! Breathtaking, really.

So this is what neurosurgery has been for me so far -I'm loving it, the doctors I work with (striking residents aside) are great, I'm learning a lot from self-teaching, and from their experiences.

My elective prior to this, was in obstetrics and gynecology and was truly fantastic. The independence, the technical skills I got to practice, the one-on-one teaching with many different staff. Learning how to do obstetrical ultrasound at some very, very basic level, all by myself (I can tell you by sonography whether the baby is cephalic or breech, whether they have a heartbeat and their abdominal circumference... I have even had success at determining the fetus' sex -not as easy as you would think!). I got to scrub in for nearly every single C-section. I got to close peritoneum thrice! I got to see how to manage shoulder dystocia twice. I got to assist in laparoscopic gynecologic surgeries and exploratory laparotomies. I got to bond with those lovely, glowing, strong, inspiring women as they became new mothers or continued their already-commenced journey of motherhood. It was fabulous. This is what I want to do, this is for sure.

It's so comforting to know my path in this regard, in the larger trail of whatever my life's work will be. Thank you God, thank you Universe, thank you love. And thank you creative muse, wherever you are.

From the Mind's Gables

I look out to those beginnings with hope, and love and fervour and anticipation. Because I have had my share of endings in a recent short period of time. Always more endings -the end of my short vacation, the end of my third year of medicine, the end of a sweet, brief romance. And with every end, a piece of me dies, making space for something new to grow in its place. I'm no botanist, no herbologist, but this is real. Summer's kiss, the caress of the sun, now a faint memory, life pleading, experience pushing, pressing, pulsing against me, within and through me, that I may shatter infinitely. And who will I be at the end of all that? What will I be like, once I've toughened up real good? Once I weld up and layer this formerly delicate armour? What kind of a person will breathe softly beneath it all? What kind of doctor will remain cloaked in the wine-toned gowns of the Earth, whose gravity pulls her face to the soil, filling her eyes, mouth and nostrils and then demanding that she see, speak, smell and live?

And yet the ending of all these, signal new beginnings too. It's a cliche. But death is necessary for rebirth. Pleasure, joy and fulfilment are known only through our experience and concept of their opposites and their lack. I'm finally going to be doing what I love in this next elective -I can only hope and pray that my path be revealed and confirmed in the coming three weeks, that I fall in love so deeply and so madly with my profession that I overflow, flooding, annhilating all other emotions, wounds, memories. The real romance should only ever be with oneself, one's work, one's God. The rest is for the meek hearted. Be your own rock in the storm. Let the thunder and the waves crash down and around -the water breaks, not the stone. It is hard and cold, perhaps even cracked in some places, but it does not weep nor does it fall to pieces.

As Anne Shirley would say, "Tomorrow is a new day, with no mistakes!" When we get the blessed opportunity for a fresh start, we'd best go into it a little wiser.

Fragmented Moments

The one patient, my favourite patient said to me, "Thank you, really, thank you -you doctors, you really saved my life!" and smiled with a twinkle in his eye. And then I was back in the ER, excited to do my second blood gas and boom, within 20 minutes, that other patient went from clutching my hand to dead -without warning, without family, without anyone to hold his hand. Just like that. And then there was jazz playing inside the window and cold drinks melting on the patio table, and the deep sigh. Prayers today. I nearly cried, I felt so sad and I didn't know why. It's warm, the air still fragrant with spring before the theoretical lazy bliss of summer. All of this impacted and compacted into a splinter of time, a moment's hair, the poo of the invisible speck that we are in this Universe. It's kind of unreal.

Days like today make you want to retire from it all. Friends moving away from their own cities, not even your own, and yet, you feel sad as though they were leaving you. Patients dying and you feel so shocked, when you know that this is part of your job -people die, just deal with it. But they were in pain, and they were sick and oh, they suffered like hell before the end. And you feel like the fact that it happened that way is like a violation of your own soul. And tonight the deep sigh doesn't reassure you, nor the deliciousness of your dinner. Because all you want is the embrace, the caress, the hand holding yours, someone telling you that it's going to be okay. So that you can still tell your patients the same, without feeling like it's all a lie. But that's the thing. Doctors hold patients' hands... who holds the doctor's hand?

Stories from the 'House of God' and Spring's Aphrodite

The confession is that I have never actually read that book. But it's been talked up quite a bit this first month of Internal Medicine. And my sense it that it's probably an apt title for this entry.

It's been a while. That's the nature of Internal Medicine and sweet, fragrant spring days -either slaving, studying or trying to live a little. It can actually be enough to throw you totally off balance sometimes.

My first month was on hematology-oncology wards and I got lucky: best senior residents I've ever had, amazing attending staff who loved to teach, told interesting, funny stories of their own experiences as medical students and residents, sharing their wealth of knowledge and experience, and yes, in the spirit of excellence and love. My patients provided me with challenges, new perspectives, nearly drowned me in the mud of the unfortunate circumstances that were their lives, and once in a while, inspired me with the blessings from their souls. All of them taught me something invaluable. That someone else's mistake would be mine too if I didn't catch it -that although it may take at least 3 levels of error to actually reach a patient, the ultimate responsibility rested with us, the physicians. But that when we find those errors, acknowledge them and apologize, and then try to find solutions, we're helping future physicians, pharmacists, nurses... evolving a system that can better benefit our patients.

I learned that your favourite patient (ah, yes, I will certainly admit to having favourites -they are the ones that keep you going through a possibly otherwise miserable, chaotic day), the one who was doing so well, the one who was meant to go home tomorrow, in the flash of a few moments, can go from stable and smiling to vomiting blood, crashing blood pressure and O2 sat and being rushed to the ICU. All the while, you watch in awe as your beloved seniors, calmly order units of packed red cells, bolus fluids and load him up with pressors before the transfer. But you, you are just frozen. And then you look back at the extremely slowly trending down hemoglobin, the slightly increased BUN that afternoon and think to yourself, "I should have known". But your senior kindly points it out "Okay, let's say you saw it coming. What would you have done?" To which my response was, "Call GI" and which he quickly finished, "and maybe they would have scoped him tomorrow [because until that sudden episode of hematemesis, he was stable -it was not an apparent emergency]" So it wouldn't have made a difference. But still. It scared the crap out of me. Massive GI bleed, requiring over 12 units of blood in 24 hours. One of my happiest moments was when that patient came back to the ward from the ICU. And he was smiling and joking and squirming antsy-ly in his hospital bed, in a grey sweatsuit, anticipating a nice lunch of spanakopita at home.

And for some patients it goes from pretty darn awful, to worse... and no one deserves that kind of hell. Imagine living with poorly controlled schizoaffective disorder, along with at least 7 other serious medical conditions. You come into the hospital with medication toxicity and new pulmonary embolus. And you leave with f-ing cancer. And now imagine being the spouse of that patient. Yes no wonder they're a bit of a grouch. Yet, it's so hard for a medical student to deal with that chronically grumpy, angry, accusing spouse in addition to our clinical responsibilities and trying to learn around our cases and get it all done efficiently. You kind of feel like you're helping nobody and maybe they even hate you, but you learn not to take it personally. Then one day your attending staff comes to you and says, "You wanna call back patient X's husband? I talked to him earlier and he said he only wanted to talk with you" What? Has the world gone mad. And you call back and he's still Grumpy McGrumpster. But he asked for you.

And there's the vibrant, smiling, rosy-cheeked woman with multiple myeloma (a kind of bone marrow / blood cancer) who lights up every morning when you round, and tells you every day that you'll be a wonderful doctor someday, and thanks you for doing your best for her everyday. Her platelets are dropping everyday and then it's time to transfuse her. And she is in tears, and her eyes are filled with fear. This is how her beloved started their downward spiral into the grave... all she can remember was the many transfusions. You explain to her that we expected this though. That this one transfusion does not mean she's going to die too. And you sit there and hold her hand and then, she's smiling again. You have her blessing too, but only because you were blessed enough to know to listen, to know to explain.

At the end of that first month, I admitted an older woman in her 90s. She was basically palliative, with multiple comorbidities, not the least of which was an Aortic Stenosis with an ASA of 3 mm (basically a 3mm diameter through which the heart was meant to pump blood to the whole rest of the body)... 4 years ago (which means, even smaller now). She couldn't talk, she could hardly breathe, she was in pain. She had no family, no friends. She was a Level 3 -no Code. We gave her oxygen, we managed her pain. I would check in on her every morning. And then on my last Friday on the wards, as usual, I couldn't understand a muffled word she uttered. Then distinctly made out her plea: "stay". So I pulled up a chair, took her frail hand in mine, "I'm here now, you rest". The struggle abated, her breathing slowed, her facial muscles relaxed and she held my hand firmly. It reminded me of when I held my grandmother's hand right before the end. That evening at sign-out, the new attending on the wards said, "Oh for goodness sakes, there's nothing really we can do for this patient. What she really needs is someone to sit by her and hold her hand." To which I responded gently, "Yes, I did that for a bit earlier today". "Well, good for you for taking the time to be a human being". She passed away the following morning.

I'm now one week into my second month of Internal medicine and well, let's say the blinders are off. The idealism... has metamorphosed into a compassionate realism. This world is both the filthy garbage dump and the rose garden. And medicine is no different. It's about what we choose to focus on once the sun has set, the moon has risen and we're collapsing into bed. Those fleeting pre-dream thoughts.

Believe it or not though, through the frenzy and chaos, we still make time for a little romance. Walks through pot-holed sidewalks and cobblestone streets, kisses in the park, those fabulous kinds of conversations with the eternal tangent, new flavours in sizzling bowls, or sweet mapley desserts melting in your mouth amidst brightly coloured flowers and live jazz. Or learning a new board game, discovering a funny TV show. Or the beauty of the still, in calm, soothing, comfortable company. Life blesses us with those joyous, carefree moments too.

Whether it's the dark black waters of a bottomless ocean, or the golden shimmer or sunlight hitting petals and leaves in the garden, for such adventure and all these opportunites to learn, grow and share my joy, yes, I am so grateful.

Finding Magic

I miss Nova Scotia so much. Yes, I'm actually pining. Did I tell you I even cried on the airplane on the way back home? I still listen to my pretty fiddle music and get all nostalgic. But it's comforting too and I feel like everything will be okay. I was watching a short bit of movie with my mother this evening and one of the lines really jumped out at me: "Stop looking for obstacles instead of looking for magic".

Isn't that what we do when we feel vulnerable or scared or like we don't have control? Look for obstacles right? Why: because it's easier to identify a problem and then try to fix it as opposed to just riding the Atlantic wave, lest you get crashed up against some jagged rocks hidden (and sometimes not so hidden!) amidst the soft, white sand. But the magic was never about where the current brought you, it was always about the cool, refreshing majesty of blue blue sea (I know, I just changed my metaphor... my best memories of riding waves for hours at a time are in the Mediterranean), around, behind, in front and under you, lifting you up to the pale sky, alight with golden rays, for moments at a time. It's the high. And magically, every high is not followed by blood, scrapes and bruises (however, as a future surgeon, I will gladly sew those up for you!). You don't have to land in sand or split your skin on the rocks. If you flow with the waves, when the one ebbs, the next will cradle you back up -it's the perpetual high, the ever-lasting wet kiss of that crystalline liquid that gives us life at all. And when it's time to rest, we can wash up on shore with the surf -calm, relaxed, composed, radiant with exhilaration and joy. Magic, right.

It's like that with medicine. It's like that with love. It's like that with so many, many things. And the Truth of it gives me goosebumps from head to toe. Letting go is a choice, it's wilful surrender -a gain, a blessing... not a loss, not anything to be feared. Sometimes pretending that not feeling anything is easier or better than feeling so profoundly that your soul may shatter through your broken heart. But by shattering your soul, so many more will know you, and so many more will you touch with your love. I suppose that's where God resides.

I'm just over a week into my Internal Medicine rotation, and thanks to my refreshing Nova Scotian happy-place-in-my-soul, I've actually been able to appreciate, learn and even enjoy parts of it. I have a great team, and a few lovely patients, and there is a wealth of knowledge to be imbibed! Challenging, tiring (and okay, not as cool as surgical things) but so much better than I could have ever imagined! And I finally did my first ABG (arterial blood gas) and I got it on the very first try -it was the best part of my week!

Well, back to my work. Let the magic continue!

Nova Scotian Fiddle!

I'm obsessed. But I found some youtube links of the music i've been playing over and over ever since I acquired it here, and thought you might enjoy a little taste!

Anna Ludlow:
http://www.youtube.com/watch?v=I87h4Hqgj8A&feature=related
http://www.youtube.com/watch?v=xhY4hAxZjFs&feature=related
http://www.youtube.com/watch?v=dotzGF_9-Sc

reel-love,
me=)

Little-Girl Fairytales to Loving Reels

I've already begun to tell you about my sweet, slow, inspired romance with the Maritimes. Like falling in love though, completely drunk and high with passion -grand flames bursting and snapping about with enlightened joy, yet a slow glowing smolder beneath, comfortingly reassuring that this love won't die.

Perhaps today, we're all entitled to a little princess-love fantasy, in celebration of the marriage of the lovely Kate Middleton to Prince William, now Duke and Duchess of Cambridge. That stunning wedding gown of creamy lace and satin, those stolen glances, shy smiles, balcony kisses and general merriment... it's our collective little-girl fairytale! And it was beautiful, the sentiment simple and good -to have happiness aired all day long in the news, on the net, in papers, on the radio -just for a moment to share in that dream, and suspend some of the more complicated challenges of our various realities. So in this spirit, I share with you, my love for this East Coast province.

Today was a glowing, glorious day for me in medicine -small joys make it all wonderful: all by myself, I locally anesthetized, excised a skin nevus (or "mole") and sutured lovingly, delicately and with undivided attention a woman's inner thigh. Time flew as I practiced the artful technique of my supervisor, under his supervision, earning his praise, the patient's praise and my own satisfaction. I will be a surgeon. Hopefully an obstetrician, but certainly a surgeon of sorts. Today made it so obvious to me, I had to laugh that I ever thought I could ever be anything else!

Earlier this week, on the afternoon I had off, I was treated to the experience of the stunning, understated beauty of Nova Scotia's South Shore, visiting Bridgewater, Lunenberg and Mahone Bay. Listening to Celtic reels (Nova Scotian though) and other Canadian musical artists to get us into the free, local spirit, driving along a mesmerizing coastline, the sun gradually peeping through the clouds, finally breaking and bathing the Atlantic waters in that infinity sky-blue, brightly coloured little cottages and fishermen's homes (and sometimes mansions -who said fishermen were poor ;), docks, churches, friendly, smiling faces, little shops, golf courses, lighthouses and harbours (including the home of the Bluenose -the large sailboat on the back of the Canadian dime... though it wasn't there yet, so we settled for the Caledonia).

We passed little brooks and streams, pebbled streets called "Kissing Bridge Rd", smiling faces, and inhaled big wafts of salty sea air filled with the promise of summery days, tourists and ice cream. We had a scrumptuous lunch of homemade fishburgers, chips and Nanaimo bars at Lahave Bakery, amidst old newspaper clippings, wood-cottage-like warmth, British and communist flags, hanging guitars and corners filled with old books. The day ended with a visit to Greenfield -and the most serene cottage on one of the two lakes, cozily nestled in a forest of fragrant pine, birch and soon-to-bud leafy trees. I was recounted stories of community wide feasts of planked salmon over large fires, and starry nights over the lake, family time and love -a little Maritime Eden.

Then after my final 24-hour call, instead of taking the usual post-call day of rest after a night of 3.5 hours of sleep, I spent the day gallavanting about Halifax. Starting bright and early with the Maritime Museum of the Atlantic -nothing like a healthy dose of history, monuments, anecdotes, tales of sinking ships, treasure hunters, privateers, Canadian naval stories, hundreds of ship and sailboat models, real artifacts from the Titanic, lighthouse magnifying glass, old paintings, film clips and diary entries of the 1917 Halifax Explosion to provide a little context, to this captivating, unique and beautiful province and region. This was followed by a delightful lunch at McKelvie's: seafood chowder, fresh lobster roll, rasberry zinger mocktail and mini-carrot cake dessert, topped with lemon cream, burnt coconut shavings and a chocolate drizzle -at long last, a "very Maritime", seafood experience!

I really got walking after that, unfazed by the rain, determined to make the most of my one day in the Maritime capital -truly felt like a cross between Ottawa and Quebec city -small city town, lots of character, right on the coast (a harbour town indeed... or as my father used to call it, "a sailor town", though less so now than 20 years ago, probably!), plenty of university students wandering or rushing about, buses and cars milled about in traffic, but only on the few 'main roads', with a downtown core only a few blocks long by a few blocks wide. Still, distinctly a city, albeit not a typical one. Dinner theatre, musical theatre, banks, high rises, restaurants, bars and pubs, a few Starbucks, local cafe franchises, eccentric little shops, parks, statues and monuments, residential streets with those typical, brightly coloured, gabled Maritime homes -prettier areas and less pretty areas. Overall, entirely endearing. Walking along Barrington St and up Spring Garden, I began with a visit to the IWK children's and women's hospital, one of the Dalhousie teaching sites, skirting past the main Dalhousie campus... the same university that graduated many a bright Canadian scientist, lawyer, doctor... including the late CD Howe, the politician responsible for the funding of the Avro Arrow project.

Then a lovely stroll through the Public Gardens -one of Canada's oldest and probably prettiest Victorian-style gardens, with little man-made ponds, picture-book walking bridges, ducks, Renaissance-style, goddess-like statues, gazebos, gardens-yet-to-be-flower-filled, magnolias already abloom with young blossoms, people young and old, taking rest on the park benches, or jogging along the trails, and a beautiful empty stage, with rows of empty benches below (perhaps for summer performances of opera or theatre or fiddle-playing? I'll bet this is wedding-central in the summer!). I made my way up to the Citadel, full of history and great views of the coast and the city from above, walking along the top of high stone walls, old canons with some kind of army training happening down below. Meandered my way back to where I started, popping into Starbucks to juice up my phone, over a long-craved green tea soy latte, and into strange little shops full of imported Indian jewlery and knick-knacks, or tarot cards, scented candles, rocks and Celtic folk books, or the most fantastic used book store I've seen in a while, where I purchased a second hand copy of Robertson Davies "Tempest Lost" and some other book on the peaceful coexistence of diverse religious groups in medieval Spain. Quickly flitted into the gift shop of the art museum to pick up some stationary (I'm such a sucker for stationary and the most beautiful and interesting ones always come from museum gift shops! would have liked to see the actual museum, but it was closing in 10 minutes!)... and then a lazy drive back.

We came home after eating a decadent serving of "garlic fingers" -like pizza, but garlic butter instead of tomato sauce, topped with mozzarella, cheddar, banana peppers, which you then dip generously dip into the side order of "donair sauce" (really like a sweet garlic cream... mmmm), at the local pizzeria in town. Early night to bed (much needed)! Definitely "burned the wick at both ends", but well-worth it!

P.S. all the photos of the food, except for the garlic fingers + donair, are all dishes that I have cooked / baked since being here... various seafood concoctions of salmon, scallops and shrimp, pasta with a hearty sauce, asperagus omelet with canned salmon mixed with dill, lemon and mayo, and of course my "specialty" (after being taught by my college roommate, followed by my own modifications) chocolate chip cookies... yes, be impressed ;)

Hidden Gem: Nova Scotia, Seafood delight and Shaving to Save!

So this is also about my thoughts on family medicine, but in short, although I was sincerely hoping to have my mind changed about family medicine in this new setting, I am learning quickly that even in the best possible situation, the bread and butter of family medicine is not for me!

I do however find myself madly in love with this Nova Scotian countryside coast-town, where I am currently doing the second half of my rural family medicine core rotation. The first half was in a small Quebec town, close to the Ontario border -it was... adequate. The best part was assisting in a delivery that became complicated, with failed vantouse and having to go to C-section done by a general surgeon and beautifully finished with a clean subcuticular stitch as opposed to the tackyness of clips. It was a cute little town, a nice little hospital, simple, friendly farmland folk -I probably would have loved it if I was doing obstetrics or surgery... I just don't get excited by the typical family medicine run-of-the-mill type issues.

I thought I was into "women's health" -their "whole bodies, not just their vaginas and pregnancies", but actually, I only get excited when I get to do procedures... PAPs, deliveries, etc. The rest is rather unfulfilling (though I do enjoy the mental health stuff, in all fairness). I did learn a lot though. And am continuing to learn away through 24-hour calls and busy days here in this little Maritime town. My supervisor here is truly amazing -so passionate, really loves to teach, very hospitable and fun, so I am enjoying the experience of medicine more generally here, as well as the experience of Nova Scotia.

So when I was post-call yesterday, I got to do a little exploring of this place, and really I am in love. This little town is right on the coast, beautiful Atlantic ocean all around, cute non-cookie-cutter homes (pretty architecture, very different from the French Canadian of home, or the tackiness of some of big city Ontario buildings) with lots of forest and garden space, and there are actually little brooks that bubble and run between properties in some places!

There are 4 churches within 4 blocks right in the heart of town, whose bells chime every hour on the hour, and beautiful old mansions have been converted into doctors' offices on the main street. Lovely parks with old fashioned street lamps lining the paths, and benches right on the banks of the blue Atlantic are just a few steps away from where I'm staying.

And just a few minutes drive away, there are beautiful white, sandy beaches -hidden gems -pristine, uncommercialized, with forest along the banks, sea shells and sand dollars on the shores, and giant rocks to pick your way through and stand on so you get the best view of the waves crashing up against them... the lady I'm staying with took me there around sunset yesterday evening. It was gorgeous, and we were literally the only people on the whole beach!

Also, the people are also so friendly here, non-pretentious, genuine... all the cars stop if you want to cross the road, if you make eye contact with someone, they will absolutely say 'hello' (I often smile at strangers when i'm walking about and usually, the best I get in return is a reciprocal smile, let alone a "hi")...

It's like the beauty of British Columbia without the pretention and granola... very real and grounding with the gentle, soothing waves kissing the sands of this little Canadian province. I'm such an East Coast girl (though I've only been to the Maritimes once before for a road trip when I was 10... a pilgrimage to the home of Anne of Green Gables in PEI ;) But really, this place is full of that ethereal spiritual kind of romance that I love, as well as a very peaceful and enjoyable solitude. I love it. Also one can get great seafood here.

Case in point, I bought salmon at the grocery store and baked it up very nicely at home, for the first time ever, and honestly, it was the best salmon I've ever had in my life -really! Here it is below:

Purple Pebble's Salmon Concoction

Heat oven to 425F. Line pan with aluminum. Wash salmon filet and lay on aluminum. Mix crushed garlic, lemon juice, capers, dill, chives and onion salt in a bowl. Sprinkle some lemon juice onto salmon filet, followed by some lemon pepper. Pour mixture onto salmon liberally. Dot with butter. Close up aluminum foil around salmon, leaving a little opening on top (keeping the moisture in, but not letting it get too mushy when it cooks in the oven). Pop in the oven for 15-17 minutes. Let each forkful melt in your mouth (as it surely will). Repeat :)

And finally, I am so proud of my little sister who "shaved to save" last weekend, along with 2 of her friends to raise awareness about the socio-cultural reality that people undergoing cancer chemotherapy have to live, donating her hair to make wigs for people with cancer, and raising nearly $7000 in just 1 week for the Children's Wish Foundation. She was right when she said "but if I shave it all off, more people will donate, and they will donate more!" So courageous, such a great cause! Check out the awesome short link below to witness this beautiful act of love:

http://www.youtube.com/watch?v=7TNrzxtpc_k

General Surgery: the Fire and the Patient's Blessing

--
The Fire

In medicine, and in clerkship particularly, it is so easy to get caught up in the hospital madness. I felt it most ostensibly during my general surgery rotation this past month: patients waiting, nurses hollering, the requests for consults beeping, beeping; running up the stairs, down the stairs, finish rounding on 30 patients by 7:30 am and rushing off to the OR; running up the stairs, down the stairs, checking labs, nagging interventional radiology and nutrition and physio and thrombosis (advocating for your patients, essentially), and at the end of the day, pre-ops for the next day (so that you can repeat it all over again). It is exhausting.

The fulfilling part is the patients. Seeing patients, talking to them, operating on them for sure! Goodness, I love the OR. It's a beautiful place where you see the beauty of God's work in the fascial layers, muscles, nerves and vessels of the human body. And then you cut and resect and stitch with love and fervour. Yes, with fervour. Does anyone realize how passionate surgeons are about their work? I have not seen that anywhere else so far. They know true love, really. They will not eat or sleep or pee (or care to complain) if they are operating.

But it's not just about the surgery -I found that they are just the 'passionate type', period. For better or for worse, they will aggressively advocate for themselves, their patients and their cause. They will walk into the ER for a consult, glance around at the beds of patients in the halls and angrily vociferate, "This is disgusting -it's inhumane! You'd think we're in the third-world here!" Some will flex the muscle of their reputation or hierarchy to turf colleagues out of the OR so they can operate on their own patients first. Certainly egos are huge like nobody's business, but they would also give their lives for the love of their work... and they do. They will review their mistakes and take themselves and each other to task so it doesn't happen again. They seek the tangible Truth, not mere theory. On our last day as clerks, we had breakfast with the residents, while engaging in passionate and witty banter about politics in the Middle East -it was fireworks, cynical, reality-checked humour. And yes, there are lots of innuendos, double-entendres and sexual jokes between colleagues. But they've got that Fire. They embrace it, they fight for it and they become it, for all its potential to provide warmth, destroy and salvage. Surgeons are like the warriors of medicine, with their fair share of villains and heroes, and the Iliad is in the OR.

I am so a 'surgical' type, I don't care what people say... whether or not I decide to become a surgeon, that's a different story, but am I the type? Absolutely, yes. I am all about the Fire.

The thing is, when you play with fire, you risk getting burned. And when the fire's all up inside you, you risk spontaneous combustion. Firstly, people forget that the warriors are still human. Odyssius sure was and so are surgeons. We had been in the OR for nearly 7 hours (of a 12-hour surgery) and the general surgeon, although he had given the resident and I breaks, had not taken any himself. So I asked him, "Doctor, are you planning on taking even 5 minutes of a break?"

"If I wanted to take a break, I would have taken one already, but you never know what can happen when you step out of the OR and if something goes wrong later, how would I know that it's not because of what happened when I left for a few minutes? So I prefer to just stay."

But I pressed, "Okay, Doctor, 'makes sense. But if you feel you want to step out for even just 2 minutes, I have a granola bar in my pocket, so you can eat something."

The surgeon literally stopped what he was doing for a moment in his surprise. The medical student was making sure that he was okay? Of course, I was. Isn't that the human thing to do? Someone is hungry, offer food; someone is tired, offer rest. And if the scrub nurses weren't rotating off every few hours, I would have offered them the same. He was so touched that someone should care for his well-being as a person. Not as a big-shot doc, but as a human who has basic needs, and who may function optimally if those needs are met.

And then it struck me that perhaps people get so caught up in their roles in the hospital that they forget each other's humanity. Nurses get frustrated with docs (sometimes rightfully so, sometimes completely uncalled for), so their tone can be rude and demanding (and they probably don't realize it). Doctors are perceived as gods by some and devils / assholes by others (the worst is when they buy into these delusions themselves). Orderlies are there to bring you stuff. Unit coordinators are there to be efficient for the floor. And all these egos clash and flail, slave and dominate. And unfortunately, if often becomes a survival jungle: everyone for themselves. People forget that if you show love and compassion towards your colleagues, and if in the heart of a fire, with flames licking your feet, you can show patience and humility, the blessing of that service to humanity comes back to you. In essence, you won't burn.

The Patient's Blessing

So anyway, I was burning in one of these fires at the end of a long, trying day, with everyone snapping and nagging all around me, for what I could recognize as nothing that I did wrong. But I have learned that when one reaches that moment of loathing and despair, despite this awareness (because really, how much can you take before, very humanly, losing your patience), the best thing to do is go see patients. Go see patients and remember that it's about them, it's not about you and count your blessings.

I had no choice anyway, the pre-op history and physical had to be done. So I did. The patient's wife was in the room and his two daughters as well. And you could literally feel the worry and anxious energy in that room. I sat down next to the patient's bed and went through my questions: you know why you're here, you know what surgery you're having, what are your meds, allergies, medical conditions, what symptoms are you having and not having right now; stop eating at midnight, drink this bowel prep, etc. And then came his questions. And oh, so many! So I would explain, smile, reassure, which obviously only led to more questions and sometimes, repeating the same question over.

It had been a very long day, and I was honestly at my wit's end. But then I reminded myself of what it would be like to be that patient, right now, not fully understanding why I need surgery again, not fully understanding exactly what will be done and scared shitless that something could go wrong or that I might need surgery yet again in the future. I briefly thought, "Really, I can't believe the surgeon didn't explain this to him! It's the least that could have been done!" But then I remembered all that medical anthropology, all that history of medicine, all those books I've read by surgeons and other doctors, all those anecdotes and testimonials from patients and from Physicianship in the early days of medical school. When people are sick and scared, they remember F-all. Most likely the surgeon did explain everything, but my patient had some fear-induced amnesia. It happens all the time. So my job was to judge no one and make no assumptions, but just calmly and patiently explain one more time, and perhaps, one more time after that.

I took a deep breath, smiled, put my hand on the patient's arm and explained again, this time, drawing diagrams on the back of my report. I reassured them about what I knew, looked up what I didn't know and came back to the room 5 minutes later to explain further and reassure further. I explained the reasoning of risk management that we do in medicine -what happened to you happens to a small percentage of surgical patients; the reason we are doing so much radiological imaging is because the benefit of finding stuff and then being able to fix it outweighs the risk of having too much exposure to radiation. And only once my patient was as satisfied as he would be, had no further questions and seemed a wee-bit calmer did I leave that room. 40 minutes later.

I realized that the reason they teach us about these scenarios and empathy in Physicianship is not because they think we're a bunch of cold, heartless dweebs and that they're going to "teach us empathy". It's because even the nicest, most compassionate people could easily become jerks under stress, or just become slightly less thoughtful, slightly more self-involved... basically, what came naturally before, may not come so easily under the high levels of stress we experience as clerks at the bottom of the medical food chain. By drilling all the official empathy diagrams and physicianship mumbo-jumbo into our conscious awareness, this program has essentially created a sort of safety valve so that when the unconscious, naturally-flowing compassion and kindness very humanly wavers under stress, there is a conscious secondary mechanism for empathy to kick in. And that is exactly what I used that day with that patient.

Two days later, post-op day #1 for my patient, during rounds after the residents had asked all the questions and I had scribbled them down as efficiently as possible in the patient's chart, I had smiled warmly at the patient and said "Good to see you're doing well, sir". I was about to leave the room and then he said "Wait, please come here". I approached his bedside. He took my hand in both of his own and looked into my eyes with his soul. "Thank you. Thank you so much for taking that time to explain everything to me that night." From the other side of the bed, his wife added "Oh, it made such a difference, you have no idea! You will make such a good doctor one day."

I looked back at the patient, "I'm glad I could make you feel better about the surgery -that's my job!"

"Well, it really helped a lot -thank you."

"You're happy, then I'm happy. Have a lovely day, sir -be strong, you're doing great."

It is our job. It is, and it feels wonderful to hear that you are doing your job well from the people who matter the most -the patients. In my ethnic and religious culture, we call this kind of feedback, in this particular way that it happened, the patient's du'a, or prayer. Appreciation or positive vibes that come from the heart. It's really only with the blessings of our patients that we can truly become good doctors, the only evaluation that counts for anything, in the end.

As I continue making my way through the fires of medical school, at times singed senseless, at times cremated and reborn, I am so grateful for each one of those blessings.

See Yourself and Be Seen

After that fantastic, maddening passionate last ramble about my affair with myself and my senses, I feel that it is only fair that I share with you my wanderings through the caves and shadows as well -those dark places deserve to be acknowledged with full acceptance as much as the ecstasy of Eden.

But first, a little sweetness (to draw you in, obviously). Really, I'm just starting backwards. What happened is that I went through the agony of self-reflection (below) and then enjoyed the blossom of love, captured in a moment. It's not love-love, like the kind that scares people away or binds souls together till death-do-them-part, or even till break-up-do-them-part. It's the eternal moment. A moment of love that does not demand more than what it is, but is just as worthy of the word. So, a love-moment, as I will honestly and unconventionally call it. Love is to be seen and accepted and embraced exactly as you are, right now, in this moment. That happens only once you've seen all that in yourself first. Which sometimes means you must walk through the cold valleys, guarded by your own demons before you can find yourself once again.

It is not always easy to love oneself and this was felt most acutely about 5 pm this afternoon, on the brink of evaluation as this inner city health rotation draws to a close. Sometimes it is excrutiatingly painful and exceedingly difficult. Especially when the candlelight, pretty sights, delicious scents and delectable food lose a bit of their shimmer and novelty. What about afterwards. After gaining some weight, after being way overdue for some aesthetic TLC, after nights of restless sleep, fatigue and too much passion. What happens when we hit the metaphorical hang-over? When your spirit feels stretched and busted up because you weigh it down with all those unreasonable expectations of yourself.

Case in point: this writer is a genuinely happy person, who gives of herself, loves with all her heart and works very hard, but as any human being, will lose her temper, have moments of insecurity and immaturity, frustration and despair. Now, this is part of life and the human experience. She rationally acknowledges and even accepts this. Yet the emotional being is torn to pieces, swept up in an emotional tornado of anger and guilt and general hostility that predictably rains down time and again because she failed to meet her self-expectations of perfection, and that is absolutely, unrefutably unforgivable. And that little voice of super-ego (or is it just ego) whispers in a slithery voice, not unlike Gollum's, "This is what you deserve, precious. You are unworthy, you are unlovable, you barely deserve to live".

This is the protypical inner voice of the perfectionist. Just ask her; just ask any of them. Anything good is due to chance and happy coincidence -the stuff of miracles, you know. And anything bad is so totally, utterly, completely and solely our fault. Some of us realize that we make a cognitive error here (or we have Eckhart Tolle beating down Gollum with a philosopher's quill), so we don't slip into these midnight labyrinths of self-loathing as often -that insight is a blessing. But every now and then, Gollum (who, if you remember well, took over 1000 pages and a freakin' war in order to die in the fires of Mount Doom) pipes up: hello, precious. And, of course, he'll only kick you when you're already down. Not when you're feeling strong and sexy and empowered. That is the nature of the beast.

So what to do about it? Harm reduction, baby. Or risk management. Whatever you want to call it. Prepare yourself to still love yourself when you're beat up and crashed up and no amount of sensual pleasure can ellicit that solid soulful contentment you once perceived as an unflickering light, even to the point where you know that all you need to do is take a breath, meditate and pray, but Gollum's slippery words keep even these out of your reach. You're falling down the rabbit hole. So what to do?

Free fall. There are no miracles and there are no faults. It just is. E=mc2. Everything is matter and energy, which know no judgment, so maybe just withold your own for a moment. We do not learn from mistakes -the word 'mistake' is the most negative judgment we can place on ourselves, us perfectionists. Learn from experience. Try not to beat yourself up for the fact that you don't already know everything (what an absurd concept! but try to not judge even that ;). Now here is the scariest part, right: how the heck can we achieve any of our goals and be happy if we don't continue to engage in this vicious cycle of essentially vicious behaviour towards ourselves, which we have always done, our whole lives? Oh, Gollum, just shut it.

This is when we just have to call it quits, lock ourselves up in a big glass cube with a beach view and a mountain view and a rolling countryside and a starry sky, with nothing but blank sheets of parchment and a quill. Or a laptop in a cozy Starbucks (same difference). And just write and write until your soul oozes out of your pores, purified clean, unscathed by the darkness and drama, filth and passion. And then sunlight all around and within. At last you are once again in a place of unshirkable, solid wholeness. It feels good. Why would I do anything but write until my last breath on this Earth.

And that's when a deep voice, full of comfort, friendship and sincerity, in that eternal, caressing love-moment said, "You are always in a good mood -happy. You say what you think; you are candid. You are original. You are not afraid to be yourself. You are very romantic and passionate. You love deeply [and of course, you are smart and beautiful too]" Essentially, what's not to love? And I recognized myself fully, in those words.

That's right, Gollum. Suck it.

Indulgence and Romance on the eve of 26

Really, the sexiest, most fabulous relationship you could ever have in this world is the love affair you have with yourself. It takes a lot of work -a lifetime's worth, sometimes more. And it blows hot and cold. And you sometimes never want to see your face again. But those rare at times, frequent at other times, moments where you're in rapture with yourself, with your life, with your body, your scent, your mind and your heart, those are the beautiful, blessed moments of human existence.

And so on the eve of 26 years in the life of me, I took myself out for a very romantic, very indulgent dinner at Table 17 (yes, I am presently in Toronto). I started with a rosé wine of plums, rose petals, violets and orange rind. Some fresh bread with olive oil. Then came the beet salad with hazlenuts and arugula. I had steak-frites, with chimichuri sauce for my medium-rare sirloin (okay, in all honesty, they over-cooked it a little, and I prefer filet mignon to top sirloin... we probably get better in Montreal, easily, but it was still pretty good), and homemade-tasting mayonnaise for my divinely perfect french fries. For dessert, I had a sticky toffee pudding with Barchard Orchard apple butter -soft, warm, spongy comfort. It was fantastic -I relished every moment of that romantic 75 minutes of culinary pleasure. Yes, I would prefer to be blind, mute and deaf than lose my sense of taste (okay, maybe not blind because then I couldn't write... and I do love the Simon & Garfunkel playing nostalgically now in the background of these scrumptious thoughts...).

I must admit, that this last barely 2.5 weeks, I have been surprisingly impressed by my Toronto experience. Yes, we Montrealers who pride ourselves, snobbishly, on hating Toronto... but let's face it, over the last 15 years, at least in some ways (read: food and esthetic-quaintness of some parts of town), TO has stepped it up. I have delighted in the following restaurants since I have been here and recommend them all (especially if you're going for broke, but when you're a medical student in debt already, what's a little more debt...):

Spring Rolls (yes it is a chain, but truly fabulous and well-presented dim-sum)
The Wine Bar (tapas-style yumminess... highly recommend the apparently 'famous' fries, scallops and beef ribs)
Kalendar (more impressed by the soup and salad, than the main, but a lot of potential if I avoid chicken next time...)
Bonjour Brioche (buttery decadent breakfast / brunch)
Milestones (yeah, I know, it's a chain that you can find anywhere, but I happened to have such a life-changing cajun shrimp thing that I can't not include this experience on my list!)
Sushi Bar (Queen and Broadview... great food, great price... kamikaze kicks dynamite's bum if you have to choose, and you get a miso soup, beansprout salad and tofu tempura piece included with your sushi, as well as a peach-orange sorbet to finish... so you can actually fill-up pretty well with a "mere" 8 pieces of sushi... or you can pig-out on double... like me ;)
Brassaii (fancy-shmancy supper club... but those scallops and that rabbit risotto were something else, followed by delicious red-velvet birthday cake brought from elsewhere, delicious birthday Veuve Clicquot champagne, dancing and good company)
Saving Grace (cute and tasty breakfast / brunch... banana-walnut buttery pancakes and poached eggs on black rice and shredded turkey sausage with this green chutney, buttery baguette slices, salad and roasted potato; their fresh ginger tea is also pretty yum)
The Canadian Pie Company (this pie will make you want to live on pie -i've tried the swiss chocolate-banana pie, the asperagus quiche and the apple-cranberry-brown sugar pies...), and now
Table 17 (described in great detail above)

I know. Did I come to Toronto for medicine or for food right? Well, I actually came to Toronto to figure out whether or not I could live here one day, since I'm seriously considering moving to this city for residency in a year and a half. The medicine has been great -today I got to see methadone therapy patients, do a couple well-woman exams (yay PAPs!) and I saw a few kids too, administered my first vaccine. And I found a subtle breast lump (a proud discovery, but I hope it ends up being nothing for the patient's sake).

So what's my assessment so far of this place? The food is great. It sucks that there are no coffee shops open 24 hours in this city (let's just face it, Toronto will never be Montreal). People here (or at least, too many people here, though not all people here) are way too obsessed with their image, with designers and money and being flashy, often without any sense of true, genuine big-picture purpose. Don't get me wrong, we all want and like things -that's just part of being human. But it's this obsession that I'm talking about, the lack of perspective and vision and the sense of something bigger and more important than oneself in young professionals. Or at least, my feeling is that there is a dearth of young people with substance here -maybe I just haven't met enough of them.

As a dear old friend said, so aptly, "Toronto tries too hard, whereas Montreal just is". She also quoted a former school-mate of mine who also very aptly described Toronto as "very good on paper -the diversity, arts, culture, sports, food, things to do, places to go. But when you actually meet it, eh, there's no spark."

Personally, I think this is related to that image-obsessed culture, the one-upmanship, the materialism, all those people lost in their short-term wants and needs without a sense of what's most important and true in the long-run (besides everyone being dead)... everyone's trying, trying, rat-racing. But who's just being, and thriving at just being? Maybe they exist and I just haven't met them yet, apart from the doctors I work for, who are truly amazing, wonderful doctors, teachers and people, with a lot of passion for the work they do and that I could not praise enough. I absolutely adore the clinic in which I've been working. Also the hospitals here kick falling-apart Montreal hospitals' bum (but the medicine practiced even in those falling-apart hospitals is pretty awesome, so in terms of quality of training, I have no complaints of my home-city).

So anyway, there are pluses and minuses to every place in this world... just have to weigh what's most important. I remain undecided for now. Perhaps I pass harsh judgment on this city too early. Just to be clear, I am not talking about any one person that I have met while I've been here. I'm talking about the overall "feel" of this city... the shallowness is disenchanting. The medicine is wonderful. The food is pretty awesome. The people (apart from the ones I already know and love, obviously!)... I haven't met enough yet, I think. But you know, it takes time to fall in love sometimes, or even in like. Even with a city, and especially when there's no spark from the outset. It does not mean that attraction is never possible. And I'm still getting to know this one a bit better before I commit.

Taking Stock... with love and gratitude :)

This is one of those life moments that gives one pause for gentle, thoughtful reflection. Falling maddeningly in love with obstetrics & gynecology, craving change, and discovering a beautiful, serene joy and natural "knack" as I begin this Inner City Health family medicine elective in a different city, where life is nicely balanced. What do I want? What is important to me? I have once again had the time to write and to submit my writing for publishing... we'll see where that goes. One day, love will also come knocking on my door and all the blessings that accompany it. Where will I be then in my life? Will I still be the me that I know now?

Sometimes this kind of unknown and uncertainty throws one off-keel. Especially for us control-freaks right. But there is also so much excitement and beauty in all that unknown -it's a realm of infinite possibilities, pure universal potential. Just have to remember your worth, as an eternal, spiritual being, as a physically capable individual, as a philosopher, healer and lover. And trust that everything will work out, I suppose, especially in those areas where we have the most insecurities (and we all have them).

I love where I am now.

Old, reassuring brick inside my bedroom with comforting coffee-coloured tones on the other walls and my bedspread, the sofa chair and this leather window seat, embossed white ceiling tiles from another century, antique-style gilded mirrors, modern Japanese "zen" lamps. I want to live in a place with bedrooms like this. I go to the clinic on the streetcar.

At the clinic, I see patient-types I've never seen before: HIV, transgender issues, highly educated refugees who were victims of torture in their country of origin, young healthy people with their normal, existential concerns whose lives you can still change. I love the variety. But I get so totally, over-the-top excited when I get to do a speculum exam / PAP, or see a newly-pregnant young woman. I would have been ecstatic if the adolescent who just had sex for the first time a couple weeks ago would have let me see her, with all her worries about the consequences, grappling with the emotions, questions about her sexuality and hidden secrets about what that first experience is all about in real life, without all the fake-Hollywood lustre. I was made for that conversation and would have loved the opportunity to take that time to talk with her about it (but not everyone is okay with talking to the medical student so it happens... actually very hard for me to deal with that situation this week; gotta remember that it's not personal).

Oh these girls, these women, these sweet, slowly-dementing old ladies... my heart has a soft spot for all of them... almost universally not well-understood by the people in their lives, under-appreciated, under-loved, frankly. We are complex beings, full of passion, heart, sorrow, grief and joy -and so many are punished for that, and so many more struggle to harness all that. So much for us to learn, us women, yet so many do not have the support for this evolution, so that their strengths may flourish and that they may show to the world the goddesses that they really are. We are all Athena, Lakshmi, Aphrodite, Kali, Aceso, Saraswati... I love my women patients and their babies. But I also loved seeing that gay man with his traumas of not being accepted for what he is in his old country with new-onset psychosis. I am less fond of the alcoholic who does not perceive his drinking as a problem, but even he needs a place to go and be safe and cared for. These are all people that need our support, our compassion, and our applied medical-knowledge.

I love medicine these days. I love going to work and the work that I get to do. Life is pretty good too -good food, good company, catching up with new and old friends. Having the time to want to pray and to pray a bit more mindfully. Enjoying the exhilaration of independence and self-determination. This is what it's all about. I just have to remember that more often... I guess we all do, in our more 'human' moments.

p.s. a good friend sent me this link, and in light of reflections on women and their place in society and this world, i think the following TED talk is apt, with truth and good advice: http://www.ted.com/talks/sheryl_sandberg_why_we_have_too_few_women_leaders.html