Standing here, face to the wind -a storm this way comes!

Something funny happened since last time. I just stopped wanting to write about my job. I have still had great days and awful ones, moments of inspiration and others filled with doubt and the lurking jaded, feeling insecure and out of place and occasionally, like I totally fit in. But I didn't feel like telling you about it and I didn't feel like it was worth telling.

Today I realized that I'm just over the anecdotal form. I want more from my life, I want more from my reflections and when I see that 'more', then I'll really have something to write to you about. Part of me still drifts off into the fantasies of those unwritten stories -real good fiction that tells itself in my head, at random points in the day.

Pacing, driving, not sleeping, restlessly eating, walking about the hospital and the city and through the maze of my overwhelmed thoughts, it was gently and beautifully pointed out to me this evening that this is all part of the process. I'm not the first one to feel all this, and to feel alone in it. For moments at a time, I still feel alone. Despite making lots of friends at work and somehow, spectacularly, outside of the health professionals circuit too; despite enjoying my work and the people with whom I spend the greater part of my life these days; despite indulging in the breathtaking scenic and culinary delights of this coastal city; despite the rejuvenation and pleasure of rigorous, near-competitive Masters swim classes... despite all this, I find that I am sometimes overcome by a sharp sense of alone-ness.

Initially, I mistook this for loneliness. But they are not one and the same. I stole myself in the secret shame of longing for old loves, that familiar intimacy and companionship, as I stressed about belonging in a new place, all the work there is to do, the magnitude of the demands on me spiritually, intellectually, emotionally and physically. Nuits blanches, fretting and frittering. It's not an honest agony though. The real source of all that is in the anticipation and the stress of personal transformation. Living alone, having a real, serious, grown-up job, getting settled, and preparing for the quest within that this residency will be. I am alone in this. Even if I found my 'great love', even if I lived with my family, even if I was surrounded by old friends who really knew me. That "me" is changing. It has to. And it will do it alone. With hard work, prayer, and of course plenty of support and love from all those wonderful people with whom I share my past, as well as with all the new and interesting people with whom I share this present and future, I will be an evolved me at the end of these five years. Not really an island at all, but fundamentally experiencing exactly what I only can experience and know, completely alone.

How does one accept aloneness so well that it's nearly impossible to be lonely? I'm a natural introvert -even though I can be gregarious and social and enjoy good company -I draw my energy from within and cherish the sanctity of my solitude! Yet I feel restless and uncomfortable with the realization that at a certain point in life, you're alone in exactly how you think, what you want to do, and how you feel you need to do it... like you've "specialized" in the general ideas you used to have, that perhaps more people could understand or relate to or share. Some things can no longer be fully shared. Maybe not even with that great love of your life with whom you might share plenty else. I've never really been confronted so fully with that reality as now. And I'm still working on it.

This evening, I walked down the slanted streets of this town in the blues and silvers of dusk on the shimmering harbour waters. I smelled that smoky-pine in the air that kissed summer heat and the golden early fall farewell, with a brisk chill breeze through my hair. Winter winds, gales, blizzards, snow and ice are on their way -I feel them coming, within. I only hope the dazzling sun will reflect those sparkling bright fuscias, greens, yellows, violets... the whole spectrum of joy in the diamonds they leave in their wake. 

Folk Fiddle-Dee-Dees At Last!

If a picture is worth a thousand words, then how much is a video clip worth? 

Suffice to say that on a day when the young woman felt simultaneously rested, refreshed, alone and sad, with that little hint of an insatiable emptiness deep in the hollow of her gut, she sought out some live music with a friend. And after already a few disappointments as far as music went until this point, she was pleasantly surprised, at long last, to have found the folk fiddle music she had been craving. Her favourite was definitely the local Newfoundlander 'kids' (or at least she thought they looked so young... and so multitalented for so young!) who called themselves The Freels, though the Donahues from Northern Ireland were pretty good too. 'Couldn't really put the whole experience well into words, so she attempted her first video clip montage. It didn't quite capture the energy in the pub, the stories of the Irish and Newfoundlander musicians who sang the songs of their grandfathers, the back-stories of songs about ships that sank on their way from Ireland to Newfoundland, or the farmer who murdered his landlord in Ireland and then ran away to America. But still, at least she could share the music of the 3 of the 4 groups of musicians she had the pleasure to hear in those blessed two hours at the Ship Pub (formerly the Ship Inn).

Breathtaking Newfoundland!

The young woman thought that today perhaps she ought to share some of the hidden beauties of her new abode. First, the majesty of the brilliant ocean on a warm, sunny, windy day, with the coastline along the base of Signal Hill.

Last weekend she had ventured to Ferryland, on the Rock's Southshore. It was nearly forlorn when she had hiked up the little trail to the lighthouse with one of her new friends from work. They had stopped to gaze at the rocky islets in the midst of the ocean on one side, giant windmills turning on the other, above coniferous forest that stretched on, untouched, unscathed all around and below.

Home on the Quidi Vidi Lake Trail

The young woman -that same one, so melancholy and lonely just a few days ago -early one evening, pulled up into the grocery store parking lot. Hopping out and locking up the car with a beep, she made her way to the pebbly gravel trail that snaked around the lake. The summer sun shone bright yet, blessing the Earth's garden here with it's golden rays. Ducks swam and scratched, ruffling their feathers, quacking and honking, ducklings swimming along behind them close to shore. A dark ponytail swooshed by and then a blond one. A couple walked by hand-in-hand. A youthful man jogged slowly by, another at least thirty years his senior sprinted past. Everyone went at their own pace here.

A cool breeze blowed through the young woman's dark locks, strands of her curls flew into her face and flirtatiously played at her shawl, sliding it off her shoulders. She chose to wear it as an open scarf instead, smiling to herself and pulling down her shades. Today her earphones whispered the light gentle airs of her college years, music she had ripped off the dorm network -Paul Simon, The Dispatch, 80s Madonna, Ben Folds, Guster, Journey. It was that kind of balmy eve.

A gazebo approached on her left, snuggled in the grassy hill. The water rippled and shimmered to her right. And then the exercise park was before her. A couple of women lifted bars with plump arms and laughing faces, a lone boy lay hanging off a low bench by one hand. Just behind, the swings beckoned, old, but solid, big kid swings along side the baby basket ones. The wind tickled her neck again, the scarf blew up like a blue flame about her arms. She sat in the black curve and pushed off into the freedom of that bright, nearly cloudless sky above, letting the air caress her face, her arms, her legs and collar bones. One father pushed his little daughter in the neighbouring basket, another his toddler son, adjacent. The former squealed with delight as the other cried out, fearing the fall. There is no fall though, only flight, she thought to herself, now dragging one foot in the rocks and then walking slowly back towards the trail.

Long, lush green and purple grasses blew like rivers to kiss the lake, The underside of little leaves shooting up on the tops of the trees, like silver-white flowers of a different place and time. The trail hid shyly now amidst weeds, rocks, trees and more of the grasses. Buttercups scattered themselves between bushes of big pink flowers and little red ones, a cluster of violet lupins off to one side, park benches, docks, picnic tables and artist's nooks in the perfect places. Wish I had that body, the young woman thought as a slim figure ran towards her in a bright turquoise sports top. The wrinkled smile under the blonde bob surprised her as the timeless woman ran past. Something out of a picture book for sure. The air had grown sweetly fragrant, melting away those insecurities and she inhaled deeply -it was intoxicating. Then the sharper whiff of a lone pine amongst the leafy shrubs and trees. She passed circularly about a brooke that really did bubble into the lake. Bliss was poetic too, she thought, but the cliches are way more obvious. She wished she knew what azaleas were in that moment, just so she could say that she then spotted a cluster of those, but she didn't know the name of those flowers. Neither did she know what birds chirped by as they sailed up into the tree overhead, maybe swallows? Did they even have swallows out here? A tree bough leaned gracefully over the lake with a sort of honouring tenderness. The young woman felt so blessed and alive. What a beautiful place this was, what peace it brought... home indeed.

Walking leisurely behind the regatta boathouse and then back onto the last bit of trail, all she asked was that she could remember as much of this enchanting beauty as possible. Perhaps this place would make her a real writer yet.

From the Old City Fountain to the Harbour on the Ocean...

A young woman picked up her long powder blue skirts, pale pink flowers swishing in the cool breeze of dusk. Down her new hilly street and right in the heart of town. A town once utterly foreign, now slightly familiar within the few blocks radius of her new home. A gentle loneliness snuggled close to her heart as she slipped on the ear buds. She had made it a point not to wear earphones until today -stay open to the novelty, the opportunity for happy coincidence, surprise meetings and the forging of friendships. No more formality now, no more niceties. Enough trying to make this place home. Home was lost somewhere inside of her... it was not outside.

She took a long breath, walking past a group of protestors down to the waterfront. Even here, there were protestors, she thought, sighing to herself, choosing to walk the outer perimeter of the park to avoid the ruckus. Motorcyclists revved up at the zebra crossing, after slowing to watch the mini-parade.

But she walked onward onto an abandoned road that ran parallel to a wired fence, broken glass and garbage strewn amidst dirt and gravel. At least no one was here. The green ocean ran thick and milky, silver shimmers and mirrors appearing between waves as the sun set behind. Dark forested cliffs ran towards each other on the other shore, never meeting as the water opened out into the forever of the horizon.

The clamour died down and the woman made her way back up and around into the park, wrapping her shawl closer around her bare shoulders. It was the first time she walked this city avoiding people's gaze, looking up, down and beyond, but choosing not to acknowledge those souls that ventured neighbourly friendliness. She passed the stone dogs that stood guard -this province's namesake, the Newfoundlander  and the Lab. Quickly scanning the park bench for signs of spilled booze or human expectorations from the long-weekend's festivities (and finding neither), she took a seat, near the edge of the dock.

Small boats rocked up and down, swaying slightly from side to side, well-anchored. Second Chance and some lame name from Toronto. She liked Second Chance, blue and simple with that picture-bookish scrawl of the painted white name on its side. She stared into the wind, into the green water, the colourful houses in the distance on one of those reaching cliffs -mere lego structures from here -the large boats, the small boats, the smell of a salty sea. And the tears had already arrived. What was she doing here? Did she even belong in this far-away place? The a cappella in her ears soothed like a lullaby, as she watched a couple birds fly off together, grazing the coastline and then up into the fluffed eggshells on the last bit of blue sky.

An old man with his dog, stopped by before leaving -"Wouldn't want to go out on them boats, no. I'm gettin' sea-sick just lookin' at 'em." She laughed good-naturedly in agreement, but only to be agreeable. Truthfully, she wanted nothing more in that moment to go out in one of those boats right now, out into that infinite ocean and far away from all the unknowns of this new life, all the expectations, mainly of her own self. And far away from the loneliness in her heart and soul. At least sadness is more poetic she thought, as she stood to leave. Turning around, a peach stingray shone against the sky before morphing into a little dragon and then dappled cotton. The cars stopped to let her cross. A hundred wreaths of flowers and conifers were strewn about the grand statue and she didn't know why or what they commemorated. The restaurant she had been recommended a week ago that had been closed because of a "small fire" had reopened and teemed with hungry locals, couples and tourists amidst candlelight and dark tables and chairs. She walked past the Long Dick's Sausages truck, past the family-run chocolaterie and the Heritage Shop, then up past the brown, turquoise and yellow clapboard townhouses until she reached the navy blue of her own. My ship, my home.

As she unlocked the door and put on some tea, she found that the sadness had lifted, washed away in that sea. 

A Critical Day in Critical Care and Med School.

It is my final clinical rotation as a medical student, and my last few days of it. I have spent this past month doing an elective in Critical Care medicine. But today was truly a critical day -the most intense of all my days on this intensive care unit, revealing a lovely synergy of lessons from my entire experience as a medical student. How appropriate for the metaphorical 'eve' of my becoming a real doctor.

It started off ordinary, unremarkable -dare I say, a "slow" day, in the ICU. I joked with the other med student, "It's the calm before the storm". I was lucky to even have a patient by the end of the morning. Something was amuck with her -we knew that since yesterday. Now, more obviously in Acute Respiratory Distress Syndrome (ARDS) -not ASA toxicity, not as likely an inflammatory / autoimmune process, most likely infectious and not faring too great. We decided it would be best to intubate her. With that small chin and big, thick tongue, we predicted a difficult intubation and had anesthesia present for back-up. The room was loaded: nurses, resp therapists, students, residents, fellows and staff physicians, and the bunch of us watching through the glass, from the outside. One, two, three tries; oxygen saturations plummeting down within moments from 90% to 80, to 70, to 40, to 7. I was strongly reminded of my little NICU baby who had also been difficult to intubate and had so desaturated a year and a half ago. Mask ventilate. Then the fourth try, and the tube is in. The tube is in, but the balloon is busted, so the other staff comes, threads a guidewire and then another tube. Stable on the vent. That got our own adrenaline going, but the patient was okay -we felt she was safer. Yes, this was better. "That was a close call" said the others. Someone started to go on about what they would have done differently -easy for them to say, but I know it's not the same when you're there. I had been there, with that baby -I could at least appreciate that it could happen to any of us, so cut them some slack.

And then a good, long lull. We went for lunch. I had some Mediterranean vegetable and cheese streudel and a Cott Black Cherry. Laughed, vented, talked shop and life. Walked back to the unit. Still nothing. The residents had sorted who would be presenting at Morbidity & Mortality (M&M) Rounds the next day. We still had a lot of empty beds. It was just hitting on 1 pm. The fellow and I sat at the desk, wondering what to do next.

"Code Blue. Code Blue."

The ICU nurses had already run upstairs. The code team was huge -ER docs, Medicine docs, nurses... we didn't think we'd be needed so much, but we walked up briskly anyway. One year ago, it would have all been a blurr. But I wasn't shocked or frightened this time. I listened, I stood back and out of the way. Surgeons spoke with the nurses, who spoke with the medicine residents and fellows. Our team hung back for a moment. I caught bits and pieces of the patient's history. She had been on the ward a while, a complicated post-op cancer patient, with multiple other illnesses -the standard poor old lady. Stable this morning and then suddenly, vomited massive amounts of blood and just wouldn't stop. And then somebody said "Anesthesia?" and our team member disappeared into the room to help intubate the patient. The morning's episode turned out to be a 'dry run' for this afternoon crisis. They pumped fluids, pressors, unit after unit of packed red blood cells, platelets and clotting factors and still the patient bled and was unstable.

And then on one side, stood the third year medical student, shocked in a daze, running frantically to get things that the doctors inside asked for, but always returning after someone else had already acquired what was needed. That was me last year, with my jolly, Greek patient, who was always "fine", teased me regularly, but always said "Thank you Doctor". And then one day, the day before he was meant to be discharged home, he had vomited blood. So much blood. He had lost consciousness. My seniors had pumped him up with the goods, just like the more experienced residents, fellows and staff were doing for this poor old lady now. My patient had spent a week in the ICU where they finally managed to control the bleed. But he almost died.

Here now, this girl, only one year my junior, her patient was almost dying the exact same way. Nobody was with her, nobody was explaining anything, understandably, given the circumstances. I went over and asked her to tell me more about the patient's history -afterall, she was the one who followed this poor old lady every single day. I nodded, sometimes asked a question, mainly just listened to the story. A pause. And then she added, "You know, I really liked this patient a lot -she was one of my favourites."

"Yes, I know. I had a patient like her once."

"She would joke with me a lot about how she was going to eat pizza once she left the hospital. Oh, and juice. She really likes juice and was looking forward to being able to have some again."

"Okay. Once she is stable in the ICU, I will give her your regards and let her know you would have really liked to bring her some pizza."

"Okay."

"Also, feel free to come visit her when she's in the ICU -she'll appreciate the familiar face and you'll have the continuity of care, if you would like. Now do you want me to explain what's going on in that room?"

"Yes!" replied the other medical student, with that yearning for understanding, for knowledge, and a way to cope. And though I am not that knowledgable, I have learned a thing or two through my experiences as a medical student and now, during this ICU rotation.

So I explained that when a patient has massive bleeding, the main concern is that they are losing volume. So we give lots of fluids and fast, and then we give lots of blood, and then once we give lots of blood, we have to also replace platelets and factors, and when we give lots of those we also need to give calcium since the preservative in blood products will bind the calcium in a patient's blood, so in very large quantities, this matters more and we have to replace it at some point. I explained that it is important to keep the patient's blood pressure high enough to perfuse / oxygenate their organs well, so we also give pressor medications to help with that, and I specified which ones we usually give.

And then, still standing back, we watched the dynamic scene before us. I was struck by how much I was moved by the whole endeavour, in the middle of seemingly organized-chaos. Yes, the Canadian medical system is so imperfect on so many levels, but acute care management is not one of them. There in front of us, it was plain as day that the hospital and the whole system was designed for this very moment. Here it was that cherished cliché: doctors saving lives. We watched them, the whole fleet of 10, 15, 20 residents, fellows, staff physicians and nurses, so many nurses, called from almost every corner of the hospital -general surgery, ENT, anesthesia, internal medicine, ICU -pumping, poking, loading, watching, organizing, moving, down to the ICU from the ward, down to angiography from the ICU and finally, to the operating room. Her red face, blood-stained cheeks, sheets and lines, her empty blue eyes. But not dead yet. An army of medical personnel for a whole half day and evening to save one life.

It is the greatest blessing we have in this country, and an honour to witness it. That we can value one life so very much -that one life is so precious that a team of 20 or 30 health care professionals will drop everything they are doing for their other patients, to go save that one life. It is moving to witness that. It reminds us why we went into medicine. And while it is true that in the hospital, we mobilize so many resources -blood, people, drugs, technology, time, money -to save that one life, and yet, people in the community die everyday from poverty, homelessness, and other, less costly social ills, the point is, that this single act within the hospital, represents the most beautiful aspects of our humanity. The love of life, no matter whose life it is, if they are a Level 1 (i.e. they want their life saved at all costs), that person will not be allowed to die without a fight.

I have no illusions about the reality of medicine. We try to do the best we can by our patients. We can help, but we're usually not drastically changing outcomes on a regular basis. Patients are resilient, tremendously so -it's actually amazing. So often, they live despite us, not because of us.

But the spirit of the true physician, who wants so much to help and serve and save their patients, spare them from suffering... it is an honour to witness their passion and love for life and their patients in action. This institution and this profession may be flawed, but it is still inspiring.

And for me, on just another day where I couldn't do much more than watch -just another medical student -I felt I had played my own part in the process, taking on the role of little teacher. I will never know everything, but a big part of being a doctor is in fact, teaching others -colleagues, juniors, even patients and their families. We impart whatever little knowledge we have, but also, we can impart the spirit of this profession. We can validate feelings, we can provide emotional support, we can teach each other to be the kind of doctor we want to see more of in this world, and we can lead by example. I learned something by watching my seniors go through the code and I taught by guiding my junior through her first one. That was a profound lesson for me today. Perhaps it was an early initiation into the role of teacher that I will play for the rest of my medical career, and especially, as I start my obstetrics & gynecology residency in just a few months time, on that far away rock they call 'Newfoundland'.

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.

Enchanting Cerebrum & Solidifying the Path

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

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

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

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

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

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

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

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

From the Mind's Gables

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

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

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

Fragmented Moments

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

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

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

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

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

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

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

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

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

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

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

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

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

Finding Magic

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

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

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

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

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

Nova Scotian Fiddle!

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

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

reel-love,
me=)

Little-Girl Fairytales to Loving Reels

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

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

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

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

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

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

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

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

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

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