After that fantastic, maddening passionate last ramble about my affair with myself and my senses, I feel that it is only fair that I share with you my wanderings through the caves and shadows as well -those dark places deserve to be acknowledged with full acceptance as much as the ecstasy of Eden.
But first, a little sweetness (to draw you in, obviously). Really, I'm just starting backwards. What happened is that I went through the agony of self-reflection (below) and then enjoyed the blossom of love, captured in a moment. It's not love-love, like the kind that scares people away or binds souls together till death-do-them-part, or even till break-up-do-them-part. It's the eternal moment. A moment of love that does not demand more than what it is, but is just as worthy of the word. So, a love-moment, as I will honestly and unconventionally call it. Love is to be seen and accepted and embraced exactly as you are, right now, in this moment. That happens only once you've seen all that in yourself first. Which sometimes means you must walk through the cold valleys, guarded by your own demons before you can find yourself once again.
It is not always easy to love oneself and this was felt most acutely about 5 pm this afternoon, on the brink of evaluation as this inner city health rotation draws to a close. Sometimes it is excrutiatingly painful and exceedingly difficult. Especially when the candlelight, pretty sights, delicious scents and delectable food lose a bit of their shimmer and novelty. What about afterwards. After gaining some weight, after being way overdue for some aesthetic TLC, after nights of restless sleep, fatigue and too much passion. What happens when we hit the metaphorical hang-over? When your spirit feels stretched and busted up because you weigh it down with all those unreasonable expectations of yourself.
Case in point: this writer is a genuinely happy person, who gives of herself, loves with all her heart and works very hard, but as any human being, will lose her temper, have moments of insecurity and immaturity, frustration and despair. Now, this is part of life and the human experience. She rationally acknowledges and even accepts this. Yet the emotional being is torn to pieces, swept up in an emotional tornado of anger and guilt and general hostility that predictably rains down time and again because she failed to meet her self-expectations of perfection, and that is absolutely, unrefutably unforgivable. And that little voice of super-ego (or is it just ego) whispers in a slithery voice, not unlike Gollum's, "This is what you deserve, precious. You are unworthy, you are unlovable, you barely deserve to live".
This is the protypical inner voice of the perfectionist. Just ask her; just ask any of them. Anything good is due to chance and happy coincidence -the stuff of miracles, you know. And anything bad is so totally, utterly, completely and solely our fault. Some of us realize that we make a cognitive error here (or we have Eckhart Tolle beating down Gollum with a philosopher's quill), so we don't slip into these midnight labyrinths of self-loathing as often -that insight is a blessing. But every now and then, Gollum (who, if you remember well, took over 1000 pages and a freakin' war in order to die in the fires of Mount Doom) pipes up: hello, precious. And, of course, he'll only kick you when you're already down. Not when you're feeling strong and sexy and empowered. That is the nature of the beast.
So what to do about it? Harm reduction, baby. Or risk management. Whatever you want to call it. Prepare yourself to still love yourself when you're beat up and crashed up and no amount of sensual pleasure can ellicit that solid soulful contentment you once perceived as an unflickering light, even to the point where you know that all you need to do is take a breath, meditate and pray, but Gollum's slippery words keep even these out of your reach. You're falling down the rabbit hole. So what to do?
Free fall. There are no miracles and there are no faults. It just is. E=mc2. Everything is matter and energy, which know no judgment, so maybe just withold your own for a moment. We do not learn from mistakes -the word 'mistake' is the most negative judgment we can place on ourselves, us perfectionists. Learn from experience. Try not to beat yourself up for the fact that you don't already know everything (what an absurd concept! but try to not judge even that ;). Now here is the scariest part, right: how the heck can we achieve any of our goals and be happy if we don't continue to engage in this vicious cycle of essentially vicious behaviour towards ourselves, which we have always done, our whole lives? Oh, Gollum, just shut it.
This is when we just have to call it quits, lock ourselves up in a big glass cube with a beach view and a mountain view and a rolling countryside and a starry sky, with nothing but blank sheets of parchment and a quill. Or a laptop in a cozy Starbucks (same difference). And just write and write until your soul oozes out of your pores, purified clean, unscathed by the darkness and drama, filth and passion. And then sunlight all around and within. At last you are once again in a place of unshirkable, solid wholeness. It feels good. Why would I do anything but write until my last breath on this Earth.
And that's when a deep voice, full of comfort, friendship and sincerity, in that eternal, caressing love-moment said, "You are always in a good mood -happy. You say what you think; you are candid. You are original. You are not afraid to be yourself. You are very romantic and passionate. You love deeply [and of course, you are smart and beautiful too]" Essentially, what's not to love? And I recognized myself fully, in those words.
That's right, Gollum. Suck it.
Thursday, February 10, 2011
Monday, January 31, 2011
Indulgence and Romance on the eve of 26
Really, the sexiest, most fabulous relationship you could ever have in this world is the love affair you have with yourself. It takes a lot of work -a lifetime's worth, sometimes more. And it blows hot and cold. And you sometimes never want to see your face again. But those rare at times, frequent at other times, moments where you're in rapture with yourself, with your life, with your body, your scent, your mind and your heart, those are the beautiful, blessed moments of human existence.
And so on the eve of 26 years in the life of me, I took myself out for a very romantic, very indulgent dinner at Table 17 (yes, I am presently in Toronto). I started with a rosé wine of plums, rose petals, violets and orange rind. Some fresh bread with olive oil. Then came the beet salad with hazlenuts and arugula. I had steak-frites, with chimichuri sauce for my medium-rare sirloin (okay, in all honesty, they over-cooked it a little, and I prefer filet mignon to top sirloin... we probably get better in Montreal, easily, but it was still pretty good), and homemade-tasting mayonnaise for my divinely perfect french fries. For dessert, I had a sticky toffee pudding with Barchard Orchard apple butter -soft, warm, spongy comfort. It was fantastic -I relished every moment of that romantic 75 minutes of culinary pleasure. Yes, I would prefer to be blind, mute and deaf than lose my sense of taste (okay, maybe not blind because then I couldn't write... and I do love the Simon & Garfunkel playing nostalgically now in the background of these scrumptious thoughts...).
I must admit, that this last barely 2.5 weeks, I have been surprisingly impressed by my Toronto experience. Yes, we Montrealers who pride ourselves, snobbishly, on hating Toronto... but let's face it, over the last 15 years, at least in some ways (read: food and esthetic-quaintness of some parts of town), TO has stepped it up. I have delighted in the following restaurants since I have been here and recommend them all (especially if you're going for broke, but when you're a medical student in debt already, what's a little more debt...):
Spring Rolls (yes it is a chain, but truly fabulous and well-presented dim-sum)
The Wine Bar (tapas-style yumminess... highly recommend the apparently 'famous' fries, scallops and beef ribs)
Kalendar (more impressed by the soup and salad, than the main, but a lot of potential if I avoid chicken next time...)
Bonjour Brioche (buttery decadent breakfast / brunch)
Milestones (yeah, I know, it's a chain that you can find anywhere, but I happened to have such a life-changing cajun shrimp thing that I can't not include this experience on my list!)
Sushi Bar (Queen and Broadview... great food, great price... kamikaze kicks dynamite's bum if you have to choose, and you get a miso soup, beansprout salad and tofu tempura piece included with your sushi, as well as a peach-orange sorbet to finish... so you can actually fill-up pretty well with a "mere" 8 pieces of sushi... or you can pig-out on double... like me ;)
Brassaii (fancy-shmancy supper club... but those scallops and that rabbit risotto were something else, followed by delicious red-velvet birthday cake brought from elsewhere, delicious birthday Veuve Clicquot champagne, dancing and good company)
Saving Grace (cute and tasty breakfast / brunch... banana-walnut buttery pancakes and poached eggs on black rice and shredded turkey sausage with this green chutney, buttery baguette slices, salad and roasted potato; their fresh ginger tea is also pretty yum)
The Canadian Pie Company (this pie will make you want to live on pie -i've tried the swiss chocolate-banana pie, the asperagus quiche and the apple-cranberry-brown sugar pies...), and now
Table 17 (described in great detail above)
I know. Did I come to Toronto for medicine or for food right? Well, I actually came to Toronto to figure out whether or not I could live here one day, since I'm seriously considering moving to this city for residency in a year and a half. The medicine has been great -today I got to see methadone therapy patients, do a couple well-woman exams (yay PAPs!) and I saw a few kids too, administered my first vaccine. And I found a subtle breast lump (a proud discovery, but I hope it ends up being nothing for the patient's sake).
So what's my assessment so far of this place? The food is great. It sucks that there are no coffee shops open 24 hours in this city (let's just face it, Toronto will never be Montreal). People here (or at least, too many people here, though not all people here) are way too obsessed with their image, with designers and money and being flashy, often without any sense of true, genuine big-picture purpose. Don't get me wrong, we all want and like things -that's just part of being human. But it's this obsession that I'm talking about, the lack of perspective and vision and the sense of something bigger and more important than oneself in young professionals. Or at least, my feeling is that there is a dearth of young people with substance here -maybe I just haven't met enough of them.
As a dear old friend said, so aptly, "Toronto tries too hard, whereas Montreal just is". She also quoted a former school-mate of mine who also very aptly described Toronto as "very good on paper -the diversity, arts, culture, sports, food, things to do, places to go. But when you actually meet it, eh, there's no spark."
Personally, I think this is related to that image-obsessed culture, the one-upmanship, the materialism, all those people lost in their short-term wants and needs without a sense of what's most important and true in the long-run (besides everyone being dead)... everyone's trying, trying, rat-racing. But who's just being, and thriving at just being? Maybe they exist and I just haven't met them yet, apart from the doctors I work for, who are truly amazing, wonderful doctors, teachers and people, with a lot of passion for the work they do and that I could not praise enough. I absolutely adore the clinic in which I've been working. Also the hospitals here kick falling-apart Montreal hospitals' bum (but the medicine practiced even in those falling-apart hospitals is pretty awesome, so in terms of quality of training, I have no complaints of my home-city).
So anyway, there are pluses and minuses to every place in this world... just have to weigh what's most important. I remain undecided for now. Perhaps I pass harsh judgment on this city too early. Just to be clear, I am not talking about any one person that I have met while I've been here. I'm talking about the overall "feel" of this city... the shallowness is disenchanting. The medicine is wonderful. The food is pretty awesome. The people (apart from the ones I already know and love, obviously!)... I haven't met enough yet, I think. But you know, it takes time to fall in love sometimes, or even in like. Even with a city, and especially when there's no spark from the outset. It does not mean that attraction is never possible. And I'm still getting to know this one a bit better before I commit.
And so on the eve of 26 years in the life of me, I took myself out for a very romantic, very indulgent dinner at Table 17 (yes, I am presently in Toronto). I started with a rosé wine of plums, rose petals, violets and orange rind. Some fresh bread with olive oil. Then came the beet salad with hazlenuts and arugula. I had steak-frites, with chimichuri sauce for my medium-rare sirloin (okay, in all honesty, they over-cooked it a little, and I prefer filet mignon to top sirloin... we probably get better in Montreal, easily, but it was still pretty good), and homemade-tasting mayonnaise for my divinely perfect french fries. For dessert, I had a sticky toffee pudding with Barchard Orchard apple butter -soft, warm, spongy comfort. It was fantastic -I relished every moment of that romantic 75 minutes of culinary pleasure. Yes, I would prefer to be blind, mute and deaf than lose my sense of taste (okay, maybe not blind because then I couldn't write... and I do love the Simon & Garfunkel playing nostalgically now in the background of these scrumptious thoughts...).
I must admit, that this last barely 2.5 weeks, I have been surprisingly impressed by my Toronto experience. Yes, we Montrealers who pride ourselves, snobbishly, on hating Toronto... but let's face it, over the last 15 years, at least in some ways (read: food and esthetic-quaintness of some parts of town), TO has stepped it up. I have delighted in the following restaurants since I have been here and recommend them all (especially if you're going for broke, but when you're a medical student in debt already, what's a little more debt...):
Spring Rolls (yes it is a chain, but truly fabulous and well-presented dim-sum)
The Wine Bar (tapas-style yumminess... highly recommend the apparently 'famous' fries, scallops and beef ribs)
Kalendar (more impressed by the soup and salad, than the main, but a lot of potential if I avoid chicken next time...)
Bonjour Brioche (buttery decadent breakfast / brunch)
Milestones (yeah, I know, it's a chain that you can find anywhere, but I happened to have such a life-changing cajun shrimp thing that I can't not include this experience on my list!)
Sushi Bar (Queen and Broadview... great food, great price... kamikaze kicks dynamite's bum if you have to choose, and you get a miso soup, beansprout salad and tofu tempura piece included with your sushi, as well as a peach-orange sorbet to finish... so you can actually fill-up pretty well with a "mere" 8 pieces of sushi... or you can pig-out on double... like me ;)
Brassaii (fancy-shmancy supper club... but those scallops and that rabbit risotto were something else, followed by delicious red-velvet birthday cake brought from elsewhere, delicious birthday Veuve Clicquot champagne, dancing and good company)
Saving Grace (cute and tasty breakfast / brunch... banana-walnut buttery pancakes and poached eggs on black rice and shredded turkey sausage with this green chutney, buttery baguette slices, salad and roasted potato; their fresh ginger tea is also pretty yum)
The Canadian Pie Company (this pie will make you want to live on pie -i've tried the swiss chocolate-banana pie, the asperagus quiche and the apple-cranberry-brown sugar pies...), and now
Table 17 (described in great detail above)
I know. Did I come to Toronto for medicine or for food right? Well, I actually came to Toronto to figure out whether or not I could live here one day, since I'm seriously considering moving to this city for residency in a year and a half. The medicine has been great -today I got to see methadone therapy patients, do a couple well-woman exams (yay PAPs!) and I saw a few kids too, administered my first vaccine. And I found a subtle breast lump (a proud discovery, but I hope it ends up being nothing for the patient's sake).
So what's my assessment so far of this place? The food is great. It sucks that there are no coffee shops open 24 hours in this city (let's just face it, Toronto will never be Montreal). People here (or at least, too many people here, though not all people here) are way too obsessed with their image, with designers and money and being flashy, often without any sense of true, genuine big-picture purpose. Don't get me wrong, we all want and like things -that's just part of being human. But it's this obsession that I'm talking about, the lack of perspective and vision and the sense of something bigger and more important than oneself in young professionals. Or at least, my feeling is that there is a dearth of young people with substance here -maybe I just haven't met enough of them.
As a dear old friend said, so aptly, "Toronto tries too hard, whereas Montreal just is". She also quoted a former school-mate of mine who also very aptly described Toronto as "very good on paper -the diversity, arts, culture, sports, food, things to do, places to go. But when you actually meet it, eh, there's no spark."
Personally, I think this is related to that image-obsessed culture, the one-upmanship, the materialism, all those people lost in their short-term wants and needs without a sense of what's most important and true in the long-run (besides everyone being dead)... everyone's trying, trying, rat-racing. But who's just being, and thriving at just being? Maybe they exist and I just haven't met them yet, apart from the doctors I work for, who are truly amazing, wonderful doctors, teachers and people, with a lot of passion for the work they do and that I could not praise enough. I absolutely adore the clinic in which I've been working. Also the hospitals here kick falling-apart Montreal hospitals' bum (but the medicine practiced even in those falling-apart hospitals is pretty awesome, so in terms of quality of training, I have no complaints of my home-city).
So anyway, there are pluses and minuses to every place in this world... just have to weigh what's most important. I remain undecided for now. Perhaps I pass harsh judgment on this city too early. Just to be clear, I am not talking about any one person that I have met while I've been here. I'm talking about the overall "feel" of this city... the shallowness is disenchanting. The medicine is wonderful. The food is pretty awesome. The people (apart from the ones I already know and love, obviously!)... I haven't met enough yet, I think. But you know, it takes time to fall in love sometimes, or even in like. Even with a city, and especially when there's no spark from the outset. It does not mean that attraction is never possible. And I'm still getting to know this one a bit better before I commit.
Saturday, January 22, 2011
Taking Stock... with love and gratitude :)
This is one of those life moments that gives one pause for gentle, thoughtful reflection. Falling maddeningly in love with obstetrics & gynecology, craving change, and discovering a beautiful, serene joy and natural "knack" as I begin this Inner City Health family medicine elective in a different city, where life is nicely balanced. What do I want? What is important to me? I have once again had the time to write and to submit my writing for publishing... we'll see where that goes. One day, love will also come knocking on my door and all the blessings that accompany it. Where will I be then in my life? Will I still be the me that I know now?
Sometimes this kind of unknown and uncertainty throws one off-keel. Especially for us control-freaks right. But there is also so much excitement and beauty in all that unknown -it's a realm of infinite possibilities, pure universal potential. Just have to remember your worth, as an eternal, spiritual being, as a physically capable individual, as a philosopher, healer and lover. And trust that everything will work out, I suppose, especially in those areas where we have the most insecurities (and we all have them).
I love where I am now.
Old, reassuring brick inside my bedroom with comforting coffee-coloured tones on the other walls and my bedspread, the sofa chair and this leather window seat, embossed white ceiling tiles from another century, antique-style gilded mirrors, modern Japanese "zen" lamps. I want to live in a place with bedrooms like this. I go to the clinic on the streetcar.
At the clinic, I see patient-types I've never seen before: HIV, transgender issues, highly educated refugees who were victims of torture in their country of origin, young healthy people with their normal, existential concerns whose lives you can still change. I love the variety. But I get so totally, over-the-top excited when I get to do a speculum exam / PAP, or see a newly-pregnant young woman. I would have been ecstatic if the adolescent who just had sex for the first time a couple weeks ago would have let me see her, with all her worries about the consequences, grappling with the emotions, questions about her sexuality and hidden secrets about what that first experience is all about in real life, without all the fake-Hollywood lustre. I was made for that conversation and would have loved the opportunity to take that time to talk with her about it (but not everyone is okay with talking to the medical student so it happens... actually very hard for me to deal with that situation this week; gotta remember that it's not personal).
Oh these girls, these women, these sweet, slowly-dementing old ladies... my heart has a soft spot for all of them... almost universally not well-understood by the people in their lives, under-appreciated, under-loved, frankly. We are complex beings, full of passion, heart, sorrow, grief and joy -and so many are punished for that, and so many more struggle to harness all that. So much for us to learn, us women, yet so many do not have the support for this evolution, so that their strengths may flourish and that they may show to the world the goddesses that they really are. We are all Athena, Lakshmi, Aphrodite, Kali, Aceso, Saraswati... I love my women patients and their babies. But I also loved seeing that gay man with his traumas of not being accepted for what he is in his old country with new-onset psychosis. I am less fond of the alcoholic who does not perceive his drinking as a problem, but even he needs a place to go and be safe and cared for. These are all people that need our support, our compassion, and our applied medical-knowledge.
I love medicine these days. I love going to work and the work that I get to do. Life is pretty good too -good food, good company, catching up with new and old friends. Having the time to want to pray and to pray a bit more mindfully. Enjoying the exhilaration of independence and self-determination. This is what it's all about. I just have to remember that more often... I guess we all do, in our more 'human' moments.
p.s. a good friend sent me this link, and in light of reflections on women and their place in society and this world, i think the following TED talk is apt, with truth and good advice: http://www.ted.com/talks/sheryl_sandberg_why_we_have_too_few_women_leaders.html
Sometimes this kind of unknown and uncertainty throws one off-keel. Especially for us control-freaks right. But there is also so much excitement and beauty in all that unknown -it's a realm of infinite possibilities, pure universal potential. Just have to remember your worth, as an eternal, spiritual being, as a physically capable individual, as a philosopher, healer and lover. And trust that everything will work out, I suppose, especially in those areas where we have the most insecurities (and we all have them).
I love where I am now.
Old, reassuring brick inside my bedroom with comforting coffee-coloured tones on the other walls and my bedspread, the sofa chair and this leather window seat, embossed white ceiling tiles from another century, antique-style gilded mirrors, modern Japanese "zen" lamps. I want to live in a place with bedrooms like this. I go to the clinic on the streetcar.
At the clinic, I see patient-types I've never seen before: HIV, transgender issues, highly educated refugees who were victims of torture in their country of origin, young healthy people with their normal, existential concerns whose lives you can still change. I love the variety. But I get so totally, over-the-top excited when I get to do a speculum exam / PAP, or see a newly-pregnant young woman. I would have been ecstatic if the adolescent who just had sex for the first time a couple weeks ago would have let me see her, with all her worries about the consequences, grappling with the emotions, questions about her sexuality and hidden secrets about what that first experience is all about in real life, without all the fake-Hollywood lustre. I was made for that conversation and would have loved the opportunity to take that time to talk with her about it (but not everyone is okay with talking to the medical student so it happens... actually very hard for me to deal with that situation this week; gotta remember that it's not personal).
Oh these girls, these women, these sweet, slowly-dementing old ladies... my heart has a soft spot for all of them... almost universally not well-understood by the people in their lives, under-appreciated, under-loved, frankly. We are complex beings, full of passion, heart, sorrow, grief and joy -and so many are punished for that, and so many more struggle to harness all that. So much for us to learn, us women, yet so many do not have the support for this evolution, so that their strengths may flourish and that they may show to the world the goddesses that they really are. We are all Athena, Lakshmi, Aphrodite, Kali, Aceso, Saraswati... I love my women patients and their babies. But I also loved seeing that gay man with his traumas of not being accepted for what he is in his old country with new-onset psychosis. I am less fond of the alcoholic who does not perceive his drinking as a problem, but even he needs a place to go and be safe and cared for. These are all people that need our support, our compassion, and our applied medical-knowledge.
I love medicine these days. I love going to work and the work that I get to do. Life is pretty good too -good food, good company, catching up with new and old friends. Having the time to want to pray and to pray a bit more mindfully. Enjoying the exhilaration of independence and self-determination. This is what it's all about. I just have to remember that more often... I guess we all do, in our more 'human' moments.
p.s. a good friend sent me this link, and in light of reflections on women and their place in society and this world, i think the following TED talk is apt, with truth and good advice: http://www.ted.com/talks/sheryl_sandberg_why_we_have_too_few_women_leaders.html
Friday, December 17, 2010
Ob/Gyn: mid-rotation evaluation and loss
I am half-way through the big, potentially life-altering experiment that is this Obstetrics & Gynecology rotation. Over 14 vaginal deliveries, 8 Cesarian-section assists, a few 24-hour calls, many a pelvic exam, Pap smear, antepartum, post-partum, dilatation & curettage (for both spontaneous and voluntary abortion) and even assisting in a gynecological surgery later, I have officially completed the "Obs" part of this "Ob/Gyn" rotation.
Honestly, I love it. It's medical, it's surgical, there's variety, it's all about women and some of the most beautiful, horrendous and distressing moments of their lives. It's intimate, sacred. Except that once you deliver that baby, you don't really get to follow it. Family doctors can do both, but if there is failure of labour to progress, then they turn their patients over to the obstetrician. If a woman in a poor village in some African or Central Asian country for whatever reason could not push her baby out, and I was the only doctor around, I would not be able to save her life by performing a STAT C-section right there and then. And she might die because of that. But I would also be at a loss to adequately help her 6 other kids with diarrheal and respiratory disease, treat her newborn baby's complications post-premature delivery with growth restriction and appropriately treat her father's angina and her mother's dementia if I'm not a family doctor. Sigh. What to be? What to do? What do I love more? Do I want the breadth or the depth? Do I want to be able to treat anyone's anything? Or do I want to be able to operate and be an expert in one particular field? Tough choices. However, I do think it definitely boils down to these 2 choices for me, so at least I've narrowed it down.
The most touching moment this past month was with the lady with the flowing strawberry-blond hair. A beautiful, rosy-cheeked mother-to-be, full of excitement, joy, anticipation of the little darling soon to be the center of her universe, if it wasn't already. She anxiously lay on the table as one of the sweetest, vibrant obstetricians on the team slid the ultrasound probe over the patient's belly, back and forth, up and down. There was no fetal heart beat. The placenta looked a bit weird. Baby wasn't moving. It's morphology and size told us that it had actually died in utero 2 weeks earlier. The doctor took the patient's hand in hers and shook her head, her eyes glistening as they filled without brimming over. The husband looked down at the floor, his wife up at the ceiling. There were no words. We gave them some time to be alone together, to take stock of their world as it fell apart before them, too quickly to be understood, too painfully to possibly be real. And then they went home to gather some belongings before returning for this strong, beautiful woman to deliver her lifeless angel.
The couple was placed in a room with a blue butterfly on the door so that all the nurses and doctors and hospital staff would know to be especially gentle and sensitive. The occasional screams of labour and the cries of newborns could be heard in neighbouring rooms, as this mother was induced, eventually delivering the fetus, and after requiring additional dilatation and curettage, the placenta, in pieces. I had put my hand on her shoulder as the doctors went through the necessary procedures to evacuate what was left. I had told the couple that even though I was just a medical student, I was here for them, if they needed anything, I was here. "It's just a lot of emotions" they would repeat, and I would nod and hold her hand. Her body relaxed slightly as I held her hand, not letting go, patting her arm, just being. This too is the human experience, and these tragedies accompany every few dozen joyous miracles. But that thin white, shimmering face, and those long curly strawberry-blond locks, those pleading green eyes. Who could forget.
Honestly, I love it. It's medical, it's surgical, there's variety, it's all about women and some of the most beautiful, horrendous and distressing moments of their lives. It's intimate, sacred. Except that once you deliver that baby, you don't really get to follow it. Family doctors can do both, but if there is failure of labour to progress, then they turn their patients over to the obstetrician. If a woman in a poor village in some African or Central Asian country for whatever reason could not push her baby out, and I was the only doctor around, I would not be able to save her life by performing a STAT C-section right there and then. And she might die because of that. But I would also be at a loss to adequately help her 6 other kids with diarrheal and respiratory disease, treat her newborn baby's complications post-premature delivery with growth restriction and appropriately treat her father's angina and her mother's dementia if I'm not a family doctor. Sigh. What to be? What to do? What do I love more? Do I want the breadth or the depth? Do I want to be able to treat anyone's anything? Or do I want to be able to operate and be an expert in one particular field? Tough choices. However, I do think it definitely boils down to these 2 choices for me, so at least I've narrowed it down.
The most touching moment this past month was with the lady with the flowing strawberry-blond hair. A beautiful, rosy-cheeked mother-to-be, full of excitement, joy, anticipation of the little darling soon to be the center of her universe, if it wasn't already. She anxiously lay on the table as one of the sweetest, vibrant obstetricians on the team slid the ultrasound probe over the patient's belly, back and forth, up and down. There was no fetal heart beat. The placenta looked a bit weird. Baby wasn't moving. It's morphology and size told us that it had actually died in utero 2 weeks earlier. The doctor took the patient's hand in hers and shook her head, her eyes glistening as they filled without brimming over. The husband looked down at the floor, his wife up at the ceiling. There were no words. We gave them some time to be alone together, to take stock of their world as it fell apart before them, too quickly to be understood, too painfully to possibly be real. And then they went home to gather some belongings before returning for this strong, beautiful woman to deliver her lifeless angel.
The couple was placed in a room with a blue butterfly on the door so that all the nurses and doctors and hospital staff would know to be especially gentle and sensitive. The occasional screams of labour and the cries of newborns could be heard in neighbouring rooms, as this mother was induced, eventually delivering the fetus, and after requiring additional dilatation and curettage, the placenta, in pieces. I had put my hand on her shoulder as the doctors went through the necessary procedures to evacuate what was left. I had told the couple that even though I was just a medical student, I was here for them, if they needed anything, I was here. "It's just a lot of emotions" they would repeat, and I would nod and hold her hand. Her body relaxed slightly as I held her hand, not letting go, patting her arm, just being. This too is the human experience, and these tragedies accompany every few dozen joyous miracles. But that thin white, shimmering face, and those long curly strawberry-blond locks, those pleading green eyes. Who could forget.
Tuesday, November 9, 2010
Med-bubble floats to the Reservation
Today I spent the day with a family doctor at an Algonquin federal reservation, seeing all the pediatrics cases. Now normally, we know I am not the biggest peds fan, but I absolutely loved working with this family doctor (she is so amazing), I got to actually do so much independently (she was not re-checking my histories and physicals in great detail, unless I told her I wasn't sure about something, which really gives one so much confidence!) and I loved working in that small, intimate setting, seeing this patient-population in their own community.
Everything was so open, people were very friendly and the people working at the clinic were just so positive and motivated / passionate about working there and working with the Native population, without any condescension, judgment, etc. that unfortunately is much more prevalent in the city-centre hospital, even if only subconsciously. For example, I actually saw one of my previous hospitalized babies at the reserve clinic today and I noticed that my own ideas about the patient, the patient's parents, etc... was so different. The love and empathy for the baby was always the same, of course. But today, I was much more sympathetic and caring about the parents too, and much less tainted by the opinions of other staff and their disdain for this unfamiliar style of parenting (some of which, I will admit, is probably valid, but there are such complex social, cultural and economic issues at play when it comes to all of that, so you have to take it into consideration... alcoholism, suicide, substance abuse, boredom, lack of motivation, lack of education and employment... these are the real problems that are not solved by throwing money at them... so anyway, of course teenage mothers and drunken fathers with too many kids are not going to be the best parents in the world, but that would be the case, regardless of whether or not they are white, black, yellow, red, or blue!) And basically, by working on the reserve itself, it's so much easier to maintain this balanced perspective when dealing with these difficult cases, which is so important if you want to actually help anyone and learn anything from them.
So that is my schpiel for the day. But yet another baby with seizures -my goodness, the poor darling! Really, as my little cousin says "I feel bichari for them!" (bichari means "poor thing" in kutchi / gujarati and is usually used as a response / exclamation to witnessing something like a little baby having a spastic seizure). I love newborn babies, I really do. I could easily spend the rest of my life being a doctor of little neonates... except the lifestyle thing for neonatologists really is scary too.
Everything was so open, people were very friendly and the people working at the clinic were just so positive and motivated / passionate about working there and working with the Native population, without any condescension, judgment, etc. that unfortunately is much more prevalent in the city-centre hospital, even if only subconsciously. For example, I actually saw one of my previous hospitalized babies at the reserve clinic today and I noticed that my own ideas about the patient, the patient's parents, etc... was so different. The love and empathy for the baby was always the same, of course. But today, I was much more sympathetic and caring about the parents too, and much less tainted by the opinions of other staff and their disdain for this unfamiliar style of parenting (some of which, I will admit, is probably valid, but there are such complex social, cultural and economic issues at play when it comes to all of that, so you have to take it into consideration... alcoholism, suicide, substance abuse, boredom, lack of motivation, lack of education and employment... these are the real problems that are not solved by throwing money at them... so anyway, of course teenage mothers and drunken fathers with too many kids are not going to be the best parents in the world, but that would be the case, regardless of whether or not they are white, black, yellow, red, or blue!) And basically, by working on the reserve itself, it's so much easier to maintain this balanced perspective when dealing with these difficult cases, which is so important if you want to actually help anyone and learn anything from them.
So that is my schpiel for the day. But yet another baby with seizures -my goodness, the poor darling! Really, as my little cousin says "I feel bichari for them!" (bichari means "poor thing" in kutchi / gujarati and is usually used as a response / exclamation to witnessing something like a little baby having a spastic seizure). I love newborn babies, I really do. I could easily spend the rest of my life being a doctor of little neonates... except the lifestyle thing for neonatologists really is scary too.
Thursday, November 4, 2010
Shorter Reflections: Kids love 'em rollercoasters
Today was a better peds day: I saw a kid with croup who was getting better, happy, sweet, playful and cooperative. I saw a baby with herpes on its face (poor thing really -what jerk with a cold sore goes around kissing babies' faces!) and I saw a case of mesenteric adenitis / questionable Gilbert's syndrome. Our lecture was on adolescent cases, which was a welcome, far-more interesting change (and an unfortunate rarity). I was present for a delivery in which a healthy baby was born -we did not even have to suction, her cry was so good. All in all, a very non-typical day in pediatrics. Of course, it helped that I am finally getting over this viral infection and I could actually show my face at work today after staying home, sick for two whole days.
The roughest was the psych case a few days ago -cute little kid with behavioural problems, ADHD, tics, oppositional defiance, self-mutilation, tantrums, hypersensitive to touch, possible absence seizures, has been overdosed on meds by accident because a family member was taking the same drugs in a higher dose, does not distinguish between strangers and family / friends, has trouble with social interaction and play (autism spectrum disorder suspected). Now there are the challenges in medicine that one loves, and then there are... these. It's awful. It's unfair. Why. She's just a kid -couldn't the evolutionary gods spare her and her family all this suffering? It's not a case of autism. This is comorbid to the power of a billion. That was a heartbreaking day.
But today was a better one. So this is what it's like in this little med-world of mine -up, down, up, down, up... sigh. As my neonatology supervisor's 7 year-old kid said, "I work very hard at school. It's enough, [Mommy]! I need a vacation!"
So that is what Harvard-Yale will be for me, in a couple weeks -a much needed vacation before getting started on the rotation that may or may not determine the rest of my career path -Ob/Gyn!
The roughest was the psych case a few days ago -cute little kid with behavioural problems, ADHD, tics, oppositional defiance, self-mutilation, tantrums, hypersensitive to touch, possible absence seizures, has been overdosed on meds by accident because a family member was taking the same drugs in a higher dose, does not distinguish between strangers and family / friends, has trouble with social interaction and play (autism spectrum disorder suspected). Now there are the challenges in medicine that one loves, and then there are... these. It's awful. It's unfair. Why. She's just a kid -couldn't the evolutionary gods spare her and her family all this suffering? It's not a case of autism. This is comorbid to the power of a billion. That was a heartbreaking day.
But today was a better one. So this is what it's like in this little med-world of mine -up, down, up, down, up... sigh. As my neonatology supervisor's 7 year-old kid said, "I work very hard at school. It's enough, [Mommy]! I need a vacation!"
So that is what Harvard-Yale will be for me, in a couple weeks -a much needed vacation before getting started on the rotation that may or may not determine the rest of my career path -Ob/Gyn!
Wednesday, October 27, 2010
Pharm Carrots. And mixed feelings about Peds wards.
So. I just came back from a lecture on menometorrhagia. It was a "lecture"... you know, where a big pharmaceutical pays a medical expert money to talk about a topic that interests them, and said doctor will genuinely believe and advocate for everything they tell you, including a plug for some drug or device that the pharmaceutical happens to supply, and we all get wined and dined as fancily as can be. I knew this is what they would do, so why did I go?
Multiple reasons. Firstly, I am a medical student away from home with long(ish) days who will take the nice free meal, thank you (shame on me, probably). Don't worry I felt a nice bout of guilt pretty much the whole time. Secondly, I'm all over the Ob/Gyn stuff, especially issues like menorrhagia which so many women live and suffer through and genuinely wanted to learn more about it. Thirdly, I mean, this was my big opportunity to see what all this "unethical pharmaceutical wooing" and "doctors getting sucked in" was all about. Now that, how could I pass up? We discuss the ethics and the awfulness of this kind of thing all the time since... pretty much high school, right through university undergrad and now in medical school. Really. Even an individual of the highest moral breed must be at least remotely curious about what that world is really all about, in terms of the very stereotypical medical marketing ploy experience, that, whether or not we like to admit, is incredibly successful at selling the good (ahem, this being the reason why they persist in their excellent sales strategy... no critical thinking can stop the wiley ways of our subconscious and all those positive associations with delicious food and other pleansantries like free samples, or that great conversation you had with that other doctor sitting next to you... am I wrong?)
So yes, I took the carrot. And like any other self-regarding medical student or resident or physician, I was so pleased with myself at taking careful and conscious note of that moment of recognition of the pharm plug exactly 2/3 of the way through the "lecture". And Intro to Clinical Sciences can give itself a pat on the back because when they said "this is not statistically significant" my first reaction (internally of course) was, "but is it clinically significant?" Of course, I will probably end up prescribing this intra-uterine device (IUD) at some point or another in my career. The question to ask is whether I would have prescribed it anyway, which I know is a resounding "Yes!" because we have been learning about this one by its trade name since our Basis of Medicine lectures as first year med students. Pharm is everywhere. You think you'll escape it by escaping a dinner?
Now, don't get me wrong, I do not think this means that one should just stop feeling guilty and attend all the dinners, stock up on freebees, melba toast packets and start binge drinking on pharma's dime (for the record, I did not touch a drop of alcohol... that would just feel too much like someone trying to get me drunk so they can take advantage of me... I know, I know, it's a total contradiction for me to feel this way about that, yet rationalize the rest, but just read me out, okay). I'm just saying that it's important to very realistically recognize that you will not get through medical school untainted by avoiding every luncheon and free pen available to you. Ideally, I would like to keep my distance from these as much as I can anyway. But recognizing that I've actually already come to think of trade names of a lot of different drugs as synonymous with the generic -I am already 'tainted' as it were -then the additional harm done by further exposing myself to more advertising is not as great (though probably still not negligable, so yes, be judicious if you decide to go down this path because it probably snowballs, etc).
But, so then if you genuinely think the topic is particularly interesting, and you don't think you know enough about a subject you would like to learn more about, and you're tired of searching PubMed and UpToDate to learn more about it because your eyes are tearing from doing this all day long, everyday, then why not. For example, today's lecture really was intersting. I didn't merely learn about the IUD being marketed, I also learned about the use of antifibrinolytics and specific oral contraceptive protocols for women with excessive blood loss during menstruation, surgical interventions and even what exactly some of the current definitions are -and all the wiggle-room within them -of 'irregularity' and 'too much blood loss', all of which are very practically, clinically useful... stuff that is always good to get exposed to multiple times if you ever want to actually remember it. Don't kid yourself -medicine itself is a brain-washing process, that's how we eventually come to remember so much stuff, only because we get exposed and re-exposed to variants of the same information enough times first theoretically and then in a clinical context, then get examined and re-examined on it... this is the reality of continuous education in medicine, especially early on! See at the end of the day, we all know Tylenol, Valium, Prozac, Pedialyte, Diabeta, Metformin, Micardis... trade names, trade names, trade names. How much do you think you'd be affected by going to a talk where there's a plug for Prozac? And what if you went to a talk about psychoactive drugs and that's where you got an 'aside' refresher on the use of chlorpromazine for intractable hiccups? Aren't you more likely to remember that than skimming past it in a 1000-page volume about all the antipsychotic drugs?
So you know, maybe ideally, we just need doctors to give lectures to other doctors without Big Pharma sponsorship... but what doctor do you know who can afford the time or lack of payment (especially in Quebec, let's be serious) to give the lecture, and how many less people would attend if there was no free food (free food, whether it is a lobster tail or McDonald's will always attract more people, no matter what the context and that is the cold, hard truth). Anyway. I know. This is a big bag of sweet and sour grapes, with a few rotten ones, no doubt. And I'm kind of tired of exploring the various arguments for and against all this.
But yes, for now, I'll say I felt guilty tonight, but did that guilt come from a real ethical place or from exposure to a lot of extreme opinions on both sides and the 'type' of person I want to associate myself with or emulate? Probably from both. Tricky (you can roll your eyes now because this is getting a bit too "meta" -I won't judge you for it). And I understand the whole ethical quandry. But I am also just putting it all into perspective -there are pros and cons and ignoring either is rather dangerous. Okay. Enough about that for now.
Changing topics, for the second half of my pediatrics rotation, I am currently "en régions" (i.e. other regions of Quebec, generally more remote / "rural", like some people here actually drink well-water and their kids get Giardia from it... I refuse to specify location / hospital details in a blog because my vagueries in these matters helps protect confidentiality and also maintains some anonymity of events, people, places, etc...) Today was Day 3 and I am liking it better everyday (I expected that I would, so of course, I was greatly disappointed with how I felt after Days 1 and 2... but let's be serious, I have hated the first few days of any rotation so far because that is when you're at your moron-est and then it gets better). For example, my first day was super depressing and I hated pediatrics that day; you would have too, and this classic moment is why:
I walk into this room of viral plague (well, not really, but it feels like it). I have to see this kid with runny eyes and nose, hacking away, while intermittently sucking intensely on this blue terry-cloth (or as I like to say, “towel-material”) teddy bear. I go to examine him, talk sweetly and lovingly and all that jazz (don’t worry, I was sincere at the time, and I am being sincere now too). What does he do? He “offers” me his sopping-wet, soaked-up-with-drool-and-infectious-secretions toy, and by “offer”, I mean thrusts it enthusiastically into my cowl-neck, bare arm and face. I, of course, thanked him for it (“Is this a present for me? Thank you!” Yes. This is exactly what I said. Verbatim. What else was I supposed to say –“hey, Terrible 2, stop contaminating me and coughing in my eye!”).
Yes, I realize that I am becoming a doctor and have thus conceded to spending the rest of my professional life in a cesspool of germs. But this kind of special treatment is very particular to pediatrics okay. I don't mind getting blood splattered all over me in a delivery or a surgery -that shit just happens sometimes. But this is just poor parenting and there is no medical or personal gain whatsoever in me getting yucked-up here -there is no benefit to this relative 'cost'. Anyway, I am not the callous physician nobody wants to have. I felt bad for the kid and wanted him to get better and mustered up all the maternal love I could to cope with the yuck factor (and successfully at the time, might I add), but honestly the only kid who's saliva I won't mind having all over my face will be my own, one day in the future. I have decided that I don't actually mind pediatrics... but that's exactly how I feel about it -I don't mind it. I don't love it either.
Now NICU (which is part of pediatrics) I loved. I mean they're too small and frail and sick and helpless to do anything, poor things (it's my favourite part of wards, even here). How can you not love them and want to sell bits of your own soul to save their lives if it was possible? Really, I could physically examine and write about those little bodies, and little hearts and open fontanelles and grasp reflexes all day long forever. But towel-material goopy wetness just for the sake of it? For now, I'll say no thanks to that.
Multiple reasons. Firstly, I am a medical student away from home with long(ish) days who will take the nice free meal, thank you (shame on me, probably). Don't worry I felt a nice bout of guilt pretty much the whole time. Secondly, I'm all over the Ob/Gyn stuff, especially issues like menorrhagia which so many women live and suffer through and genuinely wanted to learn more about it. Thirdly, I mean, this was my big opportunity to see what all this "unethical pharmaceutical wooing" and "doctors getting sucked in" was all about. Now that, how could I pass up? We discuss the ethics and the awfulness of this kind of thing all the time since... pretty much high school, right through university undergrad and now in medical school. Really. Even an individual of the highest moral breed must be at least remotely curious about what that world is really all about, in terms of the very stereotypical medical marketing ploy experience, that, whether or not we like to admit, is incredibly successful at selling the good (ahem, this being the reason why they persist in their excellent sales strategy... no critical thinking can stop the wiley ways of our subconscious and all those positive associations with delicious food and other pleansantries like free samples, or that great conversation you had with that other doctor sitting next to you... am I wrong?)
So yes, I took the carrot. And like any other self-regarding medical student or resident or physician, I was so pleased with myself at taking careful and conscious note of that moment of recognition of the pharm plug exactly 2/3 of the way through the "lecture". And Intro to Clinical Sciences can give itself a pat on the back because when they said "this is not statistically significant" my first reaction (internally of course) was, "but is it clinically significant?" Of course, I will probably end up prescribing this intra-uterine device (IUD) at some point or another in my career. The question to ask is whether I would have prescribed it anyway, which I know is a resounding "Yes!" because we have been learning about this one by its trade name since our Basis of Medicine lectures as first year med students. Pharm is everywhere. You think you'll escape it by escaping a dinner?
Now, don't get me wrong, I do not think this means that one should just stop feeling guilty and attend all the dinners, stock up on freebees, melba toast packets and start binge drinking on pharma's dime (for the record, I did not touch a drop of alcohol... that would just feel too much like someone trying to get me drunk so they can take advantage of me... I know, I know, it's a total contradiction for me to feel this way about that, yet rationalize the rest, but just read me out, okay). I'm just saying that it's important to very realistically recognize that you will not get through medical school untainted by avoiding every luncheon and free pen available to you. Ideally, I would like to keep my distance from these as much as I can anyway. But recognizing that I've actually already come to think of trade names of a lot of different drugs as synonymous with the generic -I am already 'tainted' as it were -then the additional harm done by further exposing myself to more advertising is not as great (though probably still not negligable, so yes, be judicious if you decide to go down this path because it probably snowballs, etc).
But, so then if you genuinely think the topic is particularly interesting, and you don't think you know enough about a subject you would like to learn more about, and you're tired of searching PubMed and UpToDate to learn more about it because your eyes are tearing from doing this all day long, everyday, then why not. For example, today's lecture really was intersting. I didn't merely learn about the IUD being marketed, I also learned about the use of antifibrinolytics and specific oral contraceptive protocols for women with excessive blood loss during menstruation, surgical interventions and even what exactly some of the current definitions are -and all the wiggle-room within them -of 'irregularity' and 'too much blood loss', all of which are very practically, clinically useful... stuff that is always good to get exposed to multiple times if you ever want to actually remember it. Don't kid yourself -medicine itself is a brain-washing process, that's how we eventually come to remember so much stuff, only because we get exposed and re-exposed to variants of the same information enough times first theoretically and then in a clinical context, then get examined and re-examined on it... this is the reality of continuous education in medicine, especially early on! See at the end of the day, we all know Tylenol, Valium, Prozac, Pedialyte, Diabeta, Metformin, Micardis... trade names, trade names, trade names. How much do you think you'd be affected by going to a talk where there's a plug for Prozac? And what if you went to a talk about psychoactive drugs and that's where you got an 'aside' refresher on the use of chlorpromazine for intractable hiccups? Aren't you more likely to remember that than skimming past it in a 1000-page volume about all the antipsychotic drugs?
So you know, maybe ideally, we just need doctors to give lectures to other doctors without Big Pharma sponsorship... but what doctor do you know who can afford the time or lack of payment (especially in Quebec, let's be serious) to give the lecture, and how many less people would attend if there was no free food (free food, whether it is a lobster tail or McDonald's will always attract more people, no matter what the context and that is the cold, hard truth). Anyway. I know. This is a big bag of sweet and sour grapes, with a few rotten ones, no doubt. And I'm kind of tired of exploring the various arguments for and against all this.
But yes, for now, I'll say I felt guilty tonight, but did that guilt come from a real ethical place or from exposure to a lot of extreme opinions on both sides and the 'type' of person I want to associate myself with or emulate? Probably from both. Tricky (you can roll your eyes now because this is getting a bit too "meta" -I won't judge you for it). And I understand the whole ethical quandry. But I am also just putting it all into perspective -there are pros and cons and ignoring either is rather dangerous. Okay. Enough about that for now.
Changing topics, for the second half of my pediatrics rotation, I am currently "en régions" (i.e. other regions of Quebec, generally more remote / "rural", like some people here actually drink well-water and their kids get Giardia from it... I refuse to specify location / hospital details in a blog because my vagueries in these matters helps protect confidentiality and also maintains some anonymity of events, people, places, etc...) Today was Day 3 and I am liking it better everyday (I expected that I would, so of course, I was greatly disappointed with how I felt after Days 1 and 2... but let's be serious, I have hated the first few days of any rotation so far because that is when you're at your moron-est and then it gets better). For example, my first day was super depressing and I hated pediatrics that day; you would have too, and this classic moment is why:
I walk into this room of viral plague (well, not really, but it feels like it). I have to see this kid with runny eyes and nose, hacking away, while intermittently sucking intensely on this blue terry-cloth (or as I like to say, “towel-material”) teddy bear. I go to examine him, talk sweetly and lovingly and all that jazz (don’t worry, I was sincere at the time, and I am being sincere now too). What does he do? He “offers” me his sopping-wet, soaked-up-with-drool-and-infectious-secretions toy, and by “offer”, I mean thrusts it enthusiastically into my cowl-neck, bare arm and face. I, of course, thanked him for it (“Is this a present for me? Thank you!” Yes. This is exactly what I said. Verbatim. What else was I supposed to say –“hey, Terrible 2, stop contaminating me and coughing in my eye!”).
Yes, I realize that I am becoming a doctor and have thus conceded to spending the rest of my professional life in a cesspool of germs. But this kind of special treatment is very particular to pediatrics okay. I don't mind getting blood splattered all over me in a delivery or a surgery -that shit just happens sometimes. But this is just poor parenting and there is no medical or personal gain whatsoever in me getting yucked-up here -there is no benefit to this relative 'cost'. Anyway, I am not the callous physician nobody wants to have. I felt bad for the kid and wanted him to get better and mustered up all the maternal love I could to cope with the yuck factor (and successfully at the time, might I add), but honestly the only kid who's saliva I won't mind having all over my face will be my own, one day in the future. I have decided that I don't actually mind pediatrics... but that's exactly how I feel about it -I don't mind it. I don't love it either.
Now NICU (which is part of pediatrics) I loved. I mean they're too small and frail and sick and helpless to do anything, poor things (it's my favourite part of wards, even here). How can you not love them and want to sell bits of your own soul to save their lives if it was possible? Really, I could physically examine and write about those little bodies, and little hearts and open fontanelles and grasp reflexes all day long forever. But towel-material goopy wetness just for the sake of it? For now, I'll say no thanks to that.
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