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.