The Origin and Insertion of Life and Death

I'm almost done classes in my first semester of medical school (hooray!). I have a few exams to get through before I am able to take some time off and decompress. I sat down at my desk, as often do, grappling with what to study next. I settled for anatomy. To brush up on things I may have forgotten, I started re-watching some cadaver videos and I felt the familiar sinking feeling welling up inside of me. A profound discomfort, like an elephant sitting on my chest (and not the angina kind). I should be desensitized to this, why do I still feel this "crainte"? Why do I still find it so uncomfortable to look at? Am I the only one who has this? I paused the video and pushed aside my oatmeal to really think about this. All that came to mind was "I'm staring inside a human". And then it dawned on me how detached we are from death in society. How non-normalized it is to see death, and even more, a dead body. We have become experts in the experience of death and loss, and grieving and all the customs and feelings that come with it; that is something we know.  But we never SEE death. Even at open casket funerals, the bodies are neatly dressed and wearing more make-up than a super model on a runway to look as much alive as possible (or as fake as possible). But there is still something eerie and raw about staring at a body. The terrifying serenity of just how still it is. How the chest doesn't rise and fall rhythmically and the fingers don't gently bob with each pulse from a vibrant beating heart.

I think what I hate most about anatomy is how it deconstructs you into parts, taking all the humanity out of you until you are reduced to nerves, muscles, organs. Until all your uniqueness is gone (aside from the occasional individual variation in positioning, size, and location of your components). How can people be so similar on the inside and yet so radically different on the outside? The same parts with a few alterations in the brain can change you from Mother Teresa to a school shooter. To want to save our world or destroy it. Even more terrifying, to think that these same parts are found with you and me, within people we love. That the diseases that won the battle against our donors could one day take us too. And that we all someday will look like the cadavers on that metal table. Exposed, vulnerable, and that spark that makes us us completely extinguished. I'm not sure what about peeling back the pectoralis major or staring into the left main bronchus brought about these feelings but I know one thing for sure from everything I've learned so far and that's how fragile and strong life is. How cruel and precious it is. And how often doctors and nurses and frontline healthcare workers are standing in that profoundly terrifying and humbling nebulous grey area between life and death. And hopefully with  a little more training (who am I kidding, A LOT more training),  I can give life a fighting chance. 

Why I had to fail before starting med school

Now this may seem like an odd title, but with a few months of medical school under my belt I can reflect on how things are going. I can check in within myself and see how happy and stressed I am. Overall, it is good news. I'm really happy (I can't remember the last time I felt this intellectually satisfied), have still kept up almost all the activities I did before medical school, and for the most part, am not too stressed (most of my stress in fact comes from things that have absolutely nothing to do with school).

A week ago I walked out of a midterm with that sinking feeling that I didn't do as well as I had anticipated, and maybe even went as far as failing. I later found out that I did just fine but at the time I couldn't shake the feeling of foreboding. Looking back on my high school and college self, who used to cry at any grade below 80, I've realized how far I've come to be very content with simply passing; a complete redefinition of success. During my undergrad, I encountered a few little speed bumps but still always pulled it together and never really had to deal with failure. It wasn't until I struggled with impostor syndrome in my Master's did I completely fall apart and put myself back together in a different way. A better way.

As a pseudo retired perfectionist, perfectionism is an ideal I strive for but within the realistic limits that life imposes on it. Instead of an end goal, perfectionism is now a driving force inspiring me to do my best, whatever that may be, and never at the expense of other important variables in my life. My strategy for exam studying is no longer to know as much as possible to get the highest grade I can, but to UNDERSTAND as much as possible and retain as much important clinically relevant information as I can that will serve me well in my future practice. I feel like this strategy has made these last few months more pleasurable. I take breaks, nights off, full days off, and sometimes even full weekends off if I need it. Self care is now more important to me than anything and even though I will forever be below the class average with this attitude, I'm more than okay with that.

Although I have had sustained academic success since starting med school, I have failed in other areas of my life, especially my relationships. When anxiety reared its ugly head in the face of a tsunami of tasks to complete, my relationships suffered until I adapted. And I know this isn't the end. I have many more things to fail at, especially before I make it onto the wards where I'm seeing patients and lives are literally in my hands. And even then, I will still fail at times and that's okay because I've learned that how you handle failure and learn from failure is a form success. And I've been feeling pretty successful lately :)

Hands

Med school does funny things to you, like make you think about the little things at night (like hands). I really hope I'm not the only one who has this. So far one of the many beautiful things I have learned about (and thought about probably too deeply) is the importance of hands.

Not only are they unique to each individual, but in my eyes are one of the most important components of a patient interaction. You shake a patient's hand to greet them when they step into the room. Simply observing someone's hands can tell you so many things about possible medical conditions they may have and give subtle but important signs about their overall health. The ridges, lines, calluses can you tell you about the kind of life they have lived and perhaps where they work.The rings they wear tell you where their passions lie. Hands can be used to tell you about a person's strength in all senses of the word. They communicate various feelings, thoughts, fears; people talk with their hands. And what better way to send a message than by holding someone's hand, bringing them comfort, and demonstrating compassion. Never underestimate the importance of hands.

First Tough Patient Experience

I've started to see more and more complex and interesting cases in the clinic as the days go by, and already I feel my moral compass being tested. You never really know how you would handle a situation until you are faced with it, because until you are faced with it, it wouldn't even occur to you that it could even happen. I feel like there is this part of me that goes into autopilot when I  have to make quick decisions. Obviously, these decisions are not about anything important at this point in time as a first year student, but I'm learning to trust myself and follow my initial gut feeling to wherever it leads me. It's as though I am equipped with this invisible meter that that whenever I'm faced with a situation, I go through all the options in my head at light speed, and the arrow immediately tips to "yes" or to "no". No hesitation, no looking back. Later on I reflect on how I handled things and am often happy. However, there are times I realize "whoops, shouldn't have done that, this would have been better", and feedback from my preceptor validates these thoughts. Either way, I'm definitely learning things about myself and where I stand on certain issues.

Once again, I cannot reiterate how amazing it is that we are all walking around without too many problems. But when things go wrong, boy do they go wrong. While alone with the patient suffering from a slew of illnesses, (the doctor went to find a nurse to  draw blood) I tried to talk about cheerful subjects like grand children to take their mind off the situation. Happy at first to talk about the subject, the patient suddenly expressed sadness in not being able to watch them grow up. Completely caught off guard, all that came out of my mouth was "aww". The patient looked at me sternly, repeated the initial statement, and explained how fed up they were with feeling sick and that they could pass away at any moment.

 At this point I had no idea what to say. I just let the words linger, both of us alone in silence. Sometimes you just have to let the silence happen and appreciate the moment for what it is. A moment. A moment of complete vulnerability. A moment of fear. A moment of life. A moment that shook me, but at the same time, I got to be apart of it and for that I am thankful (and the patient seemed to be grateful too). 

Just Breathe

I have successfully completed the first month of med school and I have definitely felt the volume and complexity of the work increase now that I am further in. Needless to say, the most notable experience of October so far was the cadaver dissection, which has triggered many thoughts and emotions that I will describe below, sorry for the longer than usual entry! I have some feels to get out. (WARNING: some descriptive content about death and internal organs - if very squeamish, skip ahead to closing thoughts).

Anatomy Lab 1
Cadaver dissection is truly a surreal experience. There is something haunting about walking into a chilled, large room only to see about 50-100 body bags on sterile metal tables, with metal buckets resting at the body's feet. As you walk through the lab, adorned in white coats, goggles and gloves, the smell of formaldehyde stings your nostrils and clings to you like unruly shower curtains until you almost forget what fresh air smells like.

Like inching your way to the edge of a diving board, I took baby steps to performing the dissection because deep down I was really nervous about it. I've never been good with knives or cutting things but I guess everyone has to start somewhere. When my partners and I approached the cadaver, we took our time to desensitize. First we touched the legs through the bag, then we slowly unzipped the body bag to reveal only the chest and abdomen. Next, we gently touched the chest and abdomen, feeling the oddly leathery and wrinkly texture of the person's skin until we were finally ready to make the first incision. Once we had opened up the skin of the thoracic cavity, I found it easier to detach myself from the fact that this was once a person with a life, a family, and a story of their own. I couldn't detach completely and was caught in this weird dichotomy of enjoying the surgical tasks while simultaneously thinking about the person whom I was cutting into.

The more human side of me felt compelled to talk to the body and explain what I was doing. And under no circumstance did I feel like it was right to leave the body alone so exposed and vulnerable. And when we put it away, I said thank you for donating your body so I could learn. One day I want to look at the face, but I'm not ready for that yet.

Anatomy Lab #2
Despite my best efforts to feel less "attached" to the body, all my hard work was countered when the preceptors revealed the cause of death for all the bodies in the lab. Another piece of the story that was interesting to hear but just made it harder for me to focus. I couldn't help but wonder how did the family react to this? Was the person conscious in their last moments? I tried to push those thoughts far out of my mind before I got back into dissection mode.

This second time unzipping the bag I was greeted by the familiar freckles, wrinkles and beauty marks on the body. This lab we were to remove the lungs which took a surprising amount of pulling. I can proudly say that I held a lung and did not accidentally drop it on the floor like I worried I would. It was a lot heavier than I expected and kind of squishy (however the texture and weight was most definitely altered by the preservatives). I was able to go to another table and palpate a tumor in the lung of someone who died of lung cancer (the tumor felt way more leathery and more firm than healthy lung tissue). I felt so privileged to have these experiences and grateful that someone donated their body to allow for this.

Closing Thoughts
Even though the workload is heavier I find myself managing, and most importantly, not neglecting my health, my friends, and surprisingly my houseplants. Having the privilege to learn and see the inside of the human body makes me appreciate even more how incredible it is we are all walking around without too many issues. I'm not particularly religious but it's hard not to think about the possibility of intelligent design when you appreciate how beautifully crafted we are.

In terms of the med people, I'm starting to narrow in on a few individuals and groups of people I feel like I fit in with, but I definitely still float around not quite sure where I stand. I feel like the awkward new kid in high school in your stereotypical coming of age movie trying to figure out where to sit at lunch. I'm just happy for now to have a few people where I can be my weird self.There have definitely been some people whose bragging and comments when I said I had trouble with something definitely didn't make me feel smart or good about myself, but I try to ignore it. Even though I'm not the brightest in this class, the more I go on, the more I feel my self doubt fading. I definitely deserve to be here and fully intend to stay. Just breathe, and never forget to wash your hands because eventually things always make it through the gloves. 

Exiting the Honeymoon Phase

During orientation, they warned us that our smiles would only last 2 weeks before reality sets in and the novelty of being in med school wears off. I've noticed it; the walls that people built during orientation are slowly coming down and people are starting to open up about the stress and about themselves.

Although for me the novelty has not worn off yet, the realities of the hardships and challenges of practicing medicine are slowly creeping in. Hearing horror stories from upper years about losing patients,  the stress of feeling powerless when working with patients in unimaginably difficult social conditions, and the challenge of working in a culture rampant with overworked staff leading to frequent and preventable medical errors. I've already encountered some of these themes in the few patients I've seen and hearing their stories can be pretty heartbreaking.

We all come in wide eyed and hopeful that we can make a difference on both an individual level with our patients and at a systemic level, but the system is incredibly complex, fragile, and constantly evolving. And people can easily fall through the cracks, and they do. Like a mountain in the horizon, as we get closer to it, the steeper, taller, rockier, and more daunting it becomes. The closer we get to providing autonomous front line care, the more the barriers and unfortunate realities of an imperfect system show themselves.

But this is what we chose. This is the career path we chose, and the noble goal of healing and promoting health is unfortunately closely intertwined with systemic barriers and emotionally difficult subject matter. And although I'm still a long way off from caring for patients, I have a greater appreciation of the Everest waiting for me two years from now, and I so far I still want to climb.

The First 2 Weeks and Seeing Patients

Well everything they warned us about the volume was accurate, there is a lot to do! But it is all interesting and a lot of it is review for me given my background so that helps. Naturally, I'm already behind because I was sick the first week and am still figuring out my organization system, but I'm confident I will catch up (at least I keep telling myself that haha).

I had my first day in the clinic with patients earlier this week (yay for early clinical exposure) and what an eye-opening experience it was! I saw 4 patients and was privileged enough to observe two vaginal exams (one on a woman in her 80's, and the other in her 20's who had an IUD removed). I did not expect to feel as uncomfortable as I did during these exams, yet it felt so surreal and like an invasion of privacy to spend 5 minutes briefly chatting with a stranger and the next minute to be staring into their cervix. There will certainly be an adjustment period of getting used to the intimate and vulnerable nature of these interactions. Thankfully, the patients were all incredibly friendly and patient with me. One patient came in with thyroid cancer that seemed to have spread to the lymph nodes and the patient kindly let me palpate the area a few times as my preceptor explained all the different things I was feeling.

I think the worst part of the whole experience was that my hands were either always cold (I was stuck sitting under the AC) or always sweaty; I think it made interactions with the patients more uncomfortable for me. All in all though, it was a really great experience and I look forward to learning more. I think the most interesting part was seeing how every patient has a story; they have unique thoughts, concerns, views on health, and health goals. And the true art of medicine was watching my preceptor tailor the treatment regimens to best fit with all the aforementioned components of a patient's story. 

Days 2-3 - Orientation

The talks over the last few days were the same: a mix of inspiring, eye-opening, and mind-numbingly dull. It has been overwhelming to meet so many friendly and bright people and I think my first challenge will be to learn how to connect and work with people from so many different backgrounds, and that's a challenge I look forward to. Already, I have come across people who've said things that were brilliant that I admire and can't wait to learn from, and others who have made comments that are borderline-insulting that I'm hoping were just the talks of nerves. But even if those were their true beliefs, learning how to appreciate the good in people will serve me well. I still don't fit in (but I've found 2-3 people who feel the same way and I  connect with), and I've grown to be grateful for that. I feel that some of the things that set me apart will help me stay happy and healthy throughout the next four years.

Following my initial gut feelings from the first day, the remaining 2 days didn't really seem all that different. But I feel different. Maybe it's the buzzing in my brain from all the information that's getting to me, but I don't think the speakers were wrong when they said I am now a different person having walked through these orientation doors. I don't feel any different having been enticed by different medical equipment companies to buy their stethoscopes, nor do I feel any more entitled having had more talk of prestige shoved down my throat than one would need for a lifetime. I think what has stuck with me from our lectures is that medicine isn't just a journey in learning clinical skills and how to talk to patients, but a personal journey of self discovery.

What kind of doctor do YOU want to be (and I don't mean just your specialty). And I've taken that to the next level of what kind of PERSON do you want to be. That is something I have an idea of, and I'm looking forward to using medicine to work on getting to closer to that person. I'm hoping that through all the things that will be thrown at me in the field I will learn to be a more patient person, less sensitive, more positive, and overall a happier person through this personal growth. Today we had to write letters to ourselves to read on graduation and I tried to get my future self to look back on everything I've just mentioned and to be proud of making it through this journey.

For now, to kick off the year, I've created a few mantras to live by that I hope will serve me well:

1. I only know different, not better than someone else. Everyone has something to teach you, even if they sound like intolerant idiots at first.
2. Physicianship comes with a status, which like any other career, is earned throughout a long and hard-working career. I have not earned anything yet and will never consider myself above any other career just because I'll be a doctor.
3. It's okay to make mistakes as long as you own up to them and learn from them.
4. Only plan one step at time and next steps. You have no idea what the future has in store so take things one day at a time.
5.  Quitting is not a sign of a failure but instead a gesture to respect yourself. If after an honest shot I really don't think medicine is for me, I will walk away from the profession.

Anyway, that's enough rambling for a little while. Time to rest and relax because classes started Monday and the real journey begins. Looking forward to learning more about myself and evolving into someone new :) 

Day 1 - Orientation

Day 1
Today was the day that we were all waiting for. The day where we could walk through those doors and receive a welcome package saying " Congratulations, welcome to med school". The day where all of our fears that we were let in via a clerical error can be forever subdued. We made it.

Piled into the auditorium, we listened to speeches about how we are great but not to let it get to our heads, and many other pro tips to being a good doctor and overall a good human being. I look around at the faces that will be my peers (and future colleagues) for the next 4 years. I think the people in my med class, and any med class really, can be summed up in one word: intense. From the several dozen students I've spoken to already, they are all extremely friendly, highly motivated and driven, bright, accomplished, and above all, fiercely competitive.

I was once all of those things, but have calmed down over time thanks to a bit of a travel and life outside of school. It really gives you perspective. I honestly worry about fitting in because I'm so different from everyone else. I'm 25 with life experience and life after school. I'm not up to date with pop culture and current TV shows, I'm not a beauty guru, I'm not a genius with a 4.0. I'm me: a really weird, cynical woman who enjoys being in nature and doesn't appreciate pub culture. Today I dressed in a way that I thought would mask my weirdness, but no matter how cute I looked in my little white dress and backpack my weirdness still came out and that was okay. People actually liked it; an experience I didn't have during past orientations.

So for tomorrow, I say screw it. I'm dressing to the full extent of my personality (within the limitations of my laundry basket). We had an aboriginal elder give a very inspirational talk after lunch (unfortunately much of it was lost give that no coffee was provided since 8 am and the room began nodding off). He said that we need to heal ourselves of the heaviness we carry, especially due to fear, and he really emphasized the importance of self care and preservation. So step one on the path to emotional weight loss is to stop caring about the things that don't matter and slowly let go of fear. Once you stop caring, the more you start enjoying.