Almost a Doctor

I haven't written in a long time. Deliberately. CaRMS rank order lists being in now, I am free once again. But I cannot really blame residency programs and the match system for my cautionary tip-toeing... really, it was my own stress and anxiety that stifled me.

I knew what I wanted or at least I thought I did. Then the "Tour": flying in and out of sleepy towns and bustling cities, run-down hospitals and new facilities, friendly faces, impersonal glares, plastic smiles, dancing eyes. Crisp and clean, sharp and smart, strutting down corridors, streets and wards. I sell myself and then it's your turn. We eat sandwiches and cookies and more of the same. Hotel for a day, steak almost every evening, it's crowded, yet lonely, hectic and exhausting, yet I read three novels and a philosophical treatise. Prepping, handshakes, tours and every night a new bed, dropping cash and credit cards the whole long way... the damage done is more than my pocketbook. But only once damaged do we really learn, grow and change, ready to start anew soon enough. Perhaps it is fitting afterall.

Repeatedly building up and shattering my ego and my life for people I hardly knew and could only hope would be kindred spirits. And then they ranked, and now we rank. What do I want? Where do I want to be? But these questions merely gloss the beast beneath: I am almost a doctor and am I really ready? Will I thrive or barely survive the next step of my training? People's lives will truly be in my hands... am I ready? Will I deserve the title of "Dr."?

I am scared. I secretly think we all are. Yes, there is so much to look forward to, following our specific passions at last, making more of a difference (for better or for worse), maturing in this profession and having a voice -these are all good. But are we ready to pay an increasing price for each mistake and will the lessons we continue to learn be truly worth the resulting damage? We will have to be more efficient... does that mean we have to love less? We're meant to advocate, yet not rock the boat too much. We're meant to diagnose and treat rapidly and discharge. We will need to know so much and practice that art the most -the art of knowing, the art of doing. How much space will there really be for the art of learning?

I have more questions you know, they are endless. More uncertainty and mystery. But it will be my confidence that my patients and colleagues will most need... How do I draw water from that well amidst all this? Diagnose and plan, but we're told to treat patients, not diseases, while medicine teaches us mainly the latter and less so, the former.

And speaking of former, I am trying to find my constant. These four years have changed me so -it's nearly impossible not to transform. And with that transformation, there's experience, a vascillating hardening and softening of the mind and spirit and heart. We have new eyes even though we didn't realize that we were asking for them all along. Is my essence the same or has that changed too? And is it for the better? Will I be happy on this path, always? Will I be good enough? Should my happiness depend on how good I am or how well I do or how much I am liked?

Ah, well, you see, I am still that same philosopher girl. Still asking and wondering. Yes, now after watching vibrant, accomplished women deteriorate before my eyes, and once-strong men succumb to the deadliest illnesses, after seeing babies die and the elderly cry, families scream and groan while their loved ones sleep and moan, I must say this: Our world is filled with tragedies and joys, catastrophes and miracles, every single bloody, but light-filled day. It is a strange and beautiful place. But as the 6 year-old me once said, "The sun is shining and I love the world".

My last book for pleasure was The Untethered Soul by Michael Singer. It has shown me this Universe through yet another lens, and perhaps the question I should be asking, the one that penetrates through all these many layers of fear, worry and insecurity, is not "Why?" or "How", but "Who?" In mindful practice, it is the Observer within, in the seat of consciousness, who is aware and watching all this internal chaos. I am not the chaos though, nor am I in crisis. I am neither afraid nor alone. In all that dark unknown, one might ask, "Who is aware of the darkness?"

Doctor, don't worry, everything will be alright.

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.