Light on the Wards

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

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

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

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

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

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

May's Perfumes that Flood the Air

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

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

~Paulo Coelho, Eleven Minutes

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

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

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

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

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

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

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

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

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

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

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

Montreal gets blossoms!

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

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

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

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

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

Much Love.

Her Inner World

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

Revisiting Those Cobblestone Streets of My Beloved, Self-Created Former Life: What it was Like and What it all Means.

I begin this entry lovingly with this: if you have not read Elizabeth Gilbert's Eat, Pray, Love, please immediately get yourself to a library, bookstore, second-hand bookstore, Amazon, or a friend-who-has-it and do. It will speak to you if you are the gourmande (ahem, I live to eat, so yes, I fall in this category, as further evidenced by how much of my long-weekend was spent doing just that). Or if you've ever suffered any sort of heartache (I was once a pre-teen, teen and sophomore -literally, a "wise fool" -and continue to be human, so of course, count me in this category too). Or if you've ever even so much as attempted a philosophical, spiritual or existential self-search (if I'm writing this blog... well, enough said). And finally, if you have just been craving a darn good read, you will fall in love with the author / protagonist, her writing and her story, with every part of your being. Now, I do have to admit that I had to stiffle my giggles in the bookstore when I came across a memoirs that clearly sought to mock Gilbert's fabulous work, this mockery entitled, "Drink, Play, F@#!", but nonetheless, as the infamous athletic-wear brand would say, "Just Do It".

"Getting There"

As the anatomy mnemonic for the 12 cranial nerves goes "Oh, once one takes the anatomy final, very good vacations are had!" And so they were. I began my precious week off with a drive down to Plattsburgh, NY with my Mum (which was a lovely mother-daughter time) last Thursday, from where I boarded a nine-passenger aircraft to Boston. If you want some idea of how tiny the airport was, know that the free parking lot is infinitely larger than the actual airport, that one need only arrive at check-in 15 minutes prior to departure, and should you arrive any earlier than that, you may find yourself seemingly the only person in the whole airport until you ring the little bell and the one check-in-lady/luggage-porter/seating hostess emerges from behind some back-room. If you want some idea of how tiny this plane was, think of it this way: they asked me how much I weighed when I checked in, everyone one the plane had a window and an aisle seat, the lightest people had to sit in the back, it was like piling into a van where once you're sitting, that's it, there's no "moving around". However, the ride was absolutely stunning. At first, I was just stunned with the bumpiness of the ride (almost like the flight to Flagstaff, AZ). But then, suddenly, only sheer beauty all around.

We were weaving our way through the sky on an invisible current, just beneath a canopy of grey and pearl cotton. The steel Adirondacks held their own below, still dusted with snow, and the plateaus of New York and Vermont stretched out brown and hungry for life after a harsh winter. Water canyons snaked their way, cutting through the land, leaving behind silver mirror shards for lakes. A warm spring sun scattered it's light between the cracks of canopy, over my arm and face, and blessed the Earth below. 'Made you wonder 2 things: firstly, whether Heaven truly lies above in the skies or in the Earthly beauty on which you looked down, and secondly, why anyone would ever pay hundreds of dollars for those silly helicopter tours that last all of 5 seconds, when they could get the same spectacular view for a mere $108 US (return!), for a whole 75 minutes, while actually traveling to a real destination.

"Awkward to Be Back" and "Moving on More Than You Thought You Had"

I arrived to a warm, sunny, familiar Boston, and surely had a ridiculous, stupid smile plastered on my face the whole Silver-Red Line journey "home" to Harvard Square. It was so good to be back! First things first. Paid my visit to the dear old Kirkland House security guard that we all know and love -cynical and endearing as ever. Saw various K-House people walking about between the JCR and D-hall, lounging around the courtyard... it was exactly as I remembered leaving it. Except now, I was a ghost... everything was the same, but the graduate no longer belongs there. Not because anyone is unfriendly -in fact, people are quite friendly and welcoming (well some are, others are their usual arrogant, awkward selves -and let me tell you, if you managed to desensitize yourself to it during your four years of undergrad, even to the point where you were denying the "awkward turtle" as myth, it is painfully in your face upon revisitation... so I must say that in true Harvard spirit, it was awkward to be back. Which was fitting and quaint in many ways) -it's just that you realize that you have changed, you have grown (yes, even in that one measly year since graduation), you've moved on more than you thought you had (a perfect example of this to follow shortly), and thus, you no longer belong there. Because you belong exactly right where you are in life now -that is fully your rightful place, and what you really, truly miss is not something you can "go back and visit". This closure was very important for me and the timing was quite perfect. I think I'd even venture to say that the visit as a whole, was perfectly self-revealing, perfectly exhilirating, and perfectly FUN (oh sooooo much fun!)!!!

Most of all I enjoyed the company of my ol' peoples, my ol' haunts, and even some new discoveries. Right here, I would like to again thank the three generous friends who lent me their spare beds, their roommates' beds and their couches for the five nights I spent in Cambridge -nothing like sleep-over style chatties, bonding and... sleeping. Remember, mi casa es tu casa tambien. Anyhow, back to food and friends.

On that first evening, I spent five hours catching up with my Quincy-blockmate, exchanging stories, advice, gossip, mozzarella sticks and french fries (at The Pub), and tastes of different mochi ice cream flavours at Boston Tea Stop. Of course, I had been craving the best bubble tea in the world for eons by now, and thusly purchased a rose-flower-black-milk-tea-with-boba, despite the fact that it was after 4:00 pm and I thus risked a sleepless night due to that crazy Asian black tea (which did in unfortunate fact prove to be a poor choice as I found myself tossing and turning restlessly until about 5:00 a.m.). Now after taking that first, what should have been "divine" sip, you know what I found myself thinking? Brace yourself for this blasphemy: "Naila, it's great, but really, what's the big deal?" What's the big deal? Seriously? Clearly I had moved on more than I thought, right!

"YUUUUUUUUUUMMMMMM!!!!" said the Glutton

Oh, but I ate delicious food and had a wonderful time back in my former home -really, a full-out Harvard / Cambridge / Boston / me experience. From the tasty smoked turkey, Swiss, tomato and lettuce "Fayerweather" sandwich on garlic and rosemary bread at Darwin's to the light grilled chicken, buffalo mozzarella and red pepper thin-crust pizza at Cambridge One -oh, I did indulge! Rich, dark hot chocolate at Burdick's. Sweet, creamy chocolate chip cannoli at Mike's. Succulant lamb and cinnamon-brown rice Qablee pillaw, and Afghan Kadoo (sugary pumpkin, with yogurt, meat sauce and various chutnees) at Helmand. My favourite Greenhouse Cafe chicken wings (little known gem of this Science Center "restaurant"). Burnt sugar ice cream at Christina's. Steak quesadilla with rice, guacamole, "fresh" salsa and jalapeno hot sauce at Anna's Taqueria (near MIT), where I also tried their almond-milky Mexican drink, which tastes like Turkish rice pudding in a cup. Sesame fried shrimp rice rolls, and yummy butter chicken at Super 88 across from khane.

And that's not including the new places I tried! I went to Henrietta's Table (in the Charles Hotel) for the first time, for brunch with one of my almost-little-sister who suggested that fabulous book that I just finished pushing on you (above). Yummy, surprisingly reasonably-priced breakfast food indeed! Also fabulous freshly-squeezed orange-carrot juice. Really, this little sis has impeccable taste and I am so very proud of the beautiful, confident, strong woman she has become!

And then another morning, I went to Zoe's for breakfast (also a first). Omelet with smoked salmon, asperagus and cream cheese equals almost to die for, really. I thought I would get too full to finish. This turned out to be false. I laughed the hardest with the friends I was visiting over this meal, as we discussed how crazy it is, not just that so many people we know are getting married (I actually found out 3 more of my friends got engaged while I was in Boston -in fact, I was having dinner with 2 of these friends when word and photos were received via crackberry regarding the third "fresh" engagement -madness indeed, but congrats all around of course!), but how ridiculous some of the websites that some engaged couples make for themselves are. We thought it would be particularly hilarious if the three of us girls made a "spoof" website with a play-by-play of the divorce (a la "this was the first straw" -with a photo of a faux-slap -and "this was the last straw" captions) of a polygamous lesbian marriage. Moreover, we thought it would be additionally funny to have a "hoodlink" to the site (a la Rick Astley's "Never Gonna Give You Up"), so that people actually think they're clicking on a link called "somethingconservative.com". Oh what a partay that was... =)

But back to food and drink. Believe it or not, but I had never been to Tealuxe before, so also tried that -what a quaint place with lovely blueberry white tea indeed (and with yet another sweet friend)! And catching up with friends -we talked about it all. Sex, boyfriends (or lack thereof), jobs (or lack thereof), med school (or lack thereof... i.e. waits and apps), philosophies on healthcare, medicine, history of medicine (again, or lack thereof... at least in our professional school programs, which is a tragedy in our humble opinions), food, reminiscings, life outside Harvard, life inside Harvard, life after Harvard, life at the end of Harvard (i.e. Commencement speakers past and future), good books, interesting ideas, dumb economies, amazing and crap and convoluted politics (is that just redundant?), good TV (i.e. the Food channel), good movies, great travel... I also visited briefly with a few of my professors which was wonderful.

So basically, I was a glutton over Easter -a glutton for conversation, food and general pleasure (including some shopping in bookstores, Downtown Crossing, Little Italy, and various "Squares" -Harvard, Central, Inman, etc -roaming around Boston and Cambridge, watching the magical and excellent-in-every-way foreign film "Faubourg 36" or "Paris 36" in Kendall Theatre on the one very rainy day, enjoying the company of a very attractive male, Harvard grad total stranger at 'Noch's over a mutual penchant for the spinach Sicilian pizza, hearing stories about the Aga Khan's visits to Afghanistan "When the King is Good, the Rain will Come" and how even in that arid, mountainous place, everytime he goes to visit, there is rain, even in the unlikliest of seasons...)

Luckily, I am not a Catholic, though, so I will not perish in purgatory (or is it perish in Hell and something else in purgatory?) for my indulgence. However, I did go to St. Paul's Catholic Church in Harvard Square on Good Friday (first time going to mass in Mass.) -I sure as heck chose quite a day to go! To call it "heavy" would be putting it lightly, although it was still an interesting and enjoyable experience... I've never heard "The Passion" read (or should I say "sung") like that before, so that was cool. Anyway. I can appreciate the beauties of other religions and forget the intolerances and ugly politics. Every religion's got 'em. But I firmly maintain there must be at least an infinity of paths to spiritual peace, enlightenment, God, the Universe... whatever it is you believe in. And if Science is your only God, then so be it. Just "live and let live" as the old cliche goes.

"The Revelation" (no prophets involved)

I leave you now with the following revelation that I had during my break:

If God came down and said that I could only be one thing in life, I would choose being a writer over being a doctor. But. I am blessed because in real life, I don't have to choose -I can have many passions and many things that bring me (and thus those around me) happiness. And working as a physician is still 1000% my calling. Just if my physical body were burned to ash, the essence left behind is a writer first. So in my life, I will write, and fall in love, and travel, and go to the ballet, and enjoy delicious food, and have a wonderful family, and pray, and read for pleasure, take hikes in Nature, maybe one day swim across a very large body of water, and also be a doctor and serve others the best that I can. If I could not do all of these things, I would not be whole and my life would not have meaning for me. It is my hope, prayer and intention that all these may manifest for myself and for anyone else who may desire these as well. And I thank all the forces that be in advance for doing their best by my dreams.

p.s. okay nerds, for anyone who was dying to know what those 12 cranial nerves from the mnemonic are: Optic, Olfactory, Occulomotor, Trochlear, Trigeminal, Abducens, Facial, Vestibulococchlear, Glossopharyngeal, Vagus, Accessory, Hypoglossal. see? you didn't really want to know did you.

Let's Play Doctor!

Really, it was good and it was so much fun!

Today I had my first mock-patient-interview at the McGill Simulation Center. Basically, McGill Medical School has hired a bunch of actors who pretend to be different patients, with various personal profiles, medical conditions, social / psychological issues, etc, so that doctors and nurses-in-training can practice doing the standard medical interview in a simulation before doing it on real people. Good chance to hone bedside manner, as well as learning how to get the critical information efficiently and effectively to better serve our future patients.

How it worked for us today:

• Stand behind closed door for 1 minute and read the paper with the patient's name, age and very basic profile (mine was "Phil Wilson is a 21-yr old law student")
• Then there's a voice that comes over the loudspeaker telling you to go in -you have 8 minutes to conduct the interview.
• The voice comes back on the speaker letting you know when there's 2 mintues left
• Once time is up or if you finish before, 2 of your peers who have been watching you through a double-sided mirror and listening to you with headsets, join you and the actor who was your patient in the room.
• You say how you think it went, your peers say how they think it went, and then the actor gives you probably the most important constructive feedback since they really know about all this from doing it all the time.
• Then each of your peers has a turn with a different patient, and you get to watch them on the other side of the double mirror (creepy, but effective).

It was amazing. Felt so real. And we all know I'm a bit Type A so I had prepared a little. Lots of it (and especially today because as first year med students, let's face it, we know very little medically-speaking) was really about whether or not we could draw out a narrative from the patient from a physical, social and personal perspective -"whole person care" -and make them feel comfortable and like they could trust us -"bedside manner". So I had written down a few lines on how I would go about my questioning in a logical and flowing manner: start with introducing myself, then ask the patient how they prefer to be called, then ask them what brought them into the clinic or hospital that day. Let them talk uninterrupted. Then back-track: when did it start? how much pain? where? the quality of the pain? how often and how frequent? anything that made it feel better or worse? what did the patient think may have caused it? Then go into the patient's medical history, medications, allergies, family history. Then ask them about their personal life, stressors, social life, occupation and (wait for it...) their sex life (gah! this last question remains the most uncomfortable / difficult one for me to ask).

K. So I had rehearsed all this in my head about 3 times before going to the SIM Ctr. And I was all professional in my shirt and tie. And I was sweating over whether I would get the most difficult patient-type ever, which for me would be the 'seductive patient'. You know that male patient that hits on you, makes you feel uncomfortable, asks inappropriate questions... I was like, "Please give me the crazy cranky old lady" or the pathological liar, or the hyper-active child... just not the sexy one who hits on you (it's worse if they are hot because if they are not, it's easier to more directly say things like "this is not appropriate" etc... otherwise I am bound to just passively ignore the flirtation a la "if i pretend it doesn't exist, then it doesn't exist").

And I mean today proved the following: I didn't get the 'seductive patient', but I definitely still got the young, very attractive patient, and I could not for the life of me ask him about his sex life (the closest I got was "so how are things in your personal life?"). Now actually, the fact that he was good-looking was not so bad because luckily he wasn't sooooooooooo hot that it was a distraction preventing me from focusing on my job. In fact, I got lots of positive feedback from the actor and my peers regarding professionalism, friendliness, putting the patient at ease / making him feel comfortable and that he could trust me, not being judgmental, sympathizing with him, reassuring him without making any false promises, etc... The actor even said that making him feel comfortable and not judged was really key since he was a young guy and I was a young woman doctor and he was embarrassed about his condition, but felt comfortable telling me more details about his symptoms, etc. But still, I failed on the 'difficult questions' front (i.e. sex and illicit drug use). You see, the fear of the seductive / attractive patient is actually a rather separate issue from the "tell me about your sexual activity"-question phobia. I don't know why I have such a hard time asking about this, even after telling myself "you're the almost-doctor, you're allowed to ask these questions, you need to ask these questions to help your patients" and even after hearing the actor say, "you're the doctor, you have the power, so don't be afraid to ask those difficult questions about sex and drugs, etc... because you need to know about it and patients will be okay telling you about it".

Still, I guess this is a hang-up I just need to work on. "What has your sexual activity been like lately? Do you sleep with men, women or both? Do you use protection? How many sexual partners have you had?" These questions are all inappropriate in a non-medical context when talking to a complete stranger. Put the white coat on and it's okay. Well, for me, right now, it doesn't quite matter yet whether I think "white coat" or "purple hat" or "pink slippers", I'm still just me, getting all up in their business and asking them about sex, sex, sex. Don't get me wrong, it is a fascinating topic for conversation, for reading, for writing, for movies and TV (don't we all hold our breath for that hot scene in "Cold Mountain", or "Sex and the City" or "Grey's Anatomy", or even Dagny's dramas with her lovers in one of the best novels of all-time, Atlas Shrugged, whose main theme, you should know, is not sex, but the sex is very lovely-ly depicted) and for euphemizing. But I'm sure I must have turned six shades of blush, just asking my faux-patient "how his personal life was going". What's wrong with me? We're not 12 anymore, you know.

You know, maybe it's because medicine is so existential though -like if you do anything wrong, even something that's a relative 'nothing' can become a matter of life and death. And sex must be the most ultimate expression of being alive in a sense, right (okay, fine, as a caveat, I guess we can also admit than any passion for that person is also the ultimate expression of their life energy)? And if illness can sometimes be almost-death (okay, fine, caveat #2, suffering may be the only way we know we're still alive and passionate and not dead...), then when your patient comes to you worried sick about their ability to express other forms of their aliveness -being able to go on with their life, in their occupation, in their studies, in sports, in moving from place to place, in their many other kinds of relationships -and then you ask them about how it is for them when it comes to expressing the ultimate act of aliveness, do you really want to hear that the problem or the sickness or debilitating-ness lies in the sex? Isn't this why STDs and STIs are so particularly scary? Because the act that should be the ultimate expression of life can be a death sentence, the ultimate tragic irony?

But maybe I'm philosophically way off too. Maybe I am just euphemizing again (and I do this quite well, so don't be fooled people). Maybe sometimes we're just 12 and we're in denial about it.

Moral Dilemmas and The Mind (the part that's in the brain)

Moral Dilemmas. The fun stuff of life right.

Like if you're working really hard on a project intended to serve the greater community and you wanted to keep it on the LD, and have it be wonderfully "grassroots"-y and possess a certain lovely anonymity -the stuff of that ideal of civil society. And it's all going well, and you find yourself often just you and God (or the Universe, or whatever you believe in that's bigger than yourself) because your conviction drives you to get the job done and help people, even if you sometimes feel that you're 'going it alone' when it comes to organizing and planning and setting the wheels in motion. And you spend hours upon hours and it's a wonderful labour of love and you're getting satisfaction just by doing it really -it doesn't matter if people know it's you or it's not you or it's the wind. You feel happy about it.

But then you hear through the grapevine that someone has decided to play politics with your brainchild. They poach it and claim it as their own and announce it suchly to the world. It's as though these people sit around waiting for people who actually care to do something, just so that they can snap it up like vultures. It's a filthy business. Setting the record straight though, also a yucky business. But we feel compelled to because suddenly you feel violated to your core, insulted, undermined -the spirit and integrity of what the project was meant to be, a beacon of youthful goodwill in a still, stale fog of inaction and apathy, has been dimmed. And it feels deeply moral because if you don't stand up for yourself and what things were meant to be, and what they really represent and that the whole darn thing was born out of love and not out of guilt or a feeling of mere obligation, then they will walk all over you and abuse you for life. And it's not just me, it's not about me at all. But the reality that the youth are capable of getting shit done by themselves without the interference of old bureaucrats -and the youth as a whole should get credit for that. Because then other youth can be inspired to do the same -that youth and youth alone can make a difference, that they are a force with which to reckon, that they are unstoppable, and that they can change the world and make it right.

But the whole point was not to be political remember? So what does one do? Fight for which cause -the object of the action in the first place, or the philosophical, existential cause of the actors and the group of people they represent, and what that means for future change, expanding the base of individuals who feel that it is within their power to act? And is it possible to do both?

It's not just this -it has been a week of moral dilemmas. I've been interviewing various people for the article I'm working on for my community project on health care rights, specifically dealing with the 3-month Delai de Carence that mainly affects new immigrants in Quebec. See, I have mainly often thought that to really change the world, you gotta do it from the 'inside'. But it's hard to really know. Because when you're on the inside trying to make change, you inevitably have to compromise your ideals, and is it really okay to do this just in the name of expediency? I don't know. And a lot of people get sucked in and sell out even though they originally thought they were going in as a 'mole'. It's tricky -really a moral pretzel. I don't know. And when you interview politicians who obviously have little moral conscience, you wonder how they raised their children. Because how can you tell your son or daughter to lead an ethical, moral life, to maintain consistency between thought and action in the name of what's right and just and good and principled when you're off lying, cheating, manipulating and misconstruing in your everyday professional life, for power and profit and that's it. It is not okay. And it's even less okay if you took an oath to do no harm and to serve your fellow human being. It is not okay.

And what about all those people who say the reason that Canada's health care system is failing is because it is a public system and that privatization would solve all the problems? Don't they have any conscience at all about the lot of the poor and disenfranchised? Do they not feel like they are cheating their own minds by this reductionist argument? It is not about throwing money at a weak system. Yes, money is necessary, but not as much as people think. This is what I learned more about today from Michael Rachlis, one of Canada's leading health policy analysts, who came to give a couple of talks here. And it's not about needing to quadruple the number of doctors working in the system even though we should at least try to hold on to the doctors that we train in this country. How about giving them a reason to stay? Innovations in that area called 'Advanced Access' are what's going to save this system. It costs less money in the long run and not trillions even in the short run. It will make the system more efficient, it will make patients happier and healthier, it will decrease mortality and morbidity within the hospitals, it will strengthen the sense of community and common goals of various professionals involved in health care (doctors, nurses, pharmacists, social workers, psychologists, nutritionists, etc...) and it will rejuvinate and remotivate tired, disenchanted doctors. The research has already been done. It has been implemented with positive results in a few little towns. It's here now. And yet all those lobbyists for private health care turn a blind eye, all those false 'grassroots' pharmaceutical-sponsored "researchers", they're convincing people that privatization is the only way. It is not the only way. And it is not okay.

Neuro is Amazing.
In other news, we have finished the blood, muscles and bones unit and we're now doing neuro. Coolest so far, especially in anatomy (I held a real human brain! and it sooooo cool!). Also we had the most famous neuropsychologist in the world lecture us over the last couple of days. Dr. Brenda Milner (http://www.mcgill.ca/about/history/pioneers/milner/) -probably the most impressive professor I have ever had, more so because she is so unassuming and down to earth and is so old but still on the cutting edge of research. She comes from that whole generation of passionate scientists who did much of their groundbreaking work in the 1950s-1970s -and really had the 'big picture', that fiery approach where anything is possible in such a real way... like I've never met a scientist of a later generation with that same openness, who brings that higher philosophical, existential passion to scientific endeavour. Like Woody Hastings. Milner is to cognitive neuroscience like what Hastings is to chronobiology. And her lecture was so very engaging -she is still so passionate -and the tales of her experiments and their conclusions were peppered with anecdotes of what it was like to work with Dr. Wilder Penfield (often called the 'father' of neurobiology) at McGill. Anyway, she was very inspiring and has received all the honour that she deserves in Canada, in the U.S. and in the world. Pretty awesome.