There is a place for people with disabilities in medicine

Medical Leave - I had a feeling this was where I was going, it was only a question of when not if. After struggling throughout the entirety of my medical degree, I was diagnosed with ADHD and another learning difficulty - both which had been missed my whole life because I was smart and externally appeared to compensate.

But the inside never matched the outside. People saw good grades and conscientiousness on the outside; whilst anxiety and impostor syndrome because of my difficulties lurked on the inside. People used to compliment me on how organized I was with my to do lists and notes; little did they know that I would be completely dysfunctional without them. The streamlined conveyor belt that is medical school allowed no room for learning differences. You were expected to learn in certain ways, meet milestones at certain times, and all the feedback I received was "compared to others at your level".  While I understand the challenges faced when trying to train hundreds of doctors in a timely fashion, this system did more harm than good for me. It made me feel like I didn't deserve to be there and I gradually developed anxiety about trying to "be like everyone else". 

Being diagnosed in my final year of medical school did not afford me much time to deal with these challenges before starting residency. The bar was raised, responsibility increased, hours increased, yet I had few more insights on how to work around my limitations.With each passing month, I felt myself falling ever more behind. The same criticisms day in and day out. "Your performance is not where we would expect it for someone at your level". The anxiety continued to grow as I became more and more fearful about not meeting others' expectations. After months of crippling anxiety, the negative feedback slowly started to infiltrate deeper and deeper. The sun shone a little less brighter, exercise gave a little less high, each day I had a little less energy. But it all seemed to so justified, I mean who wouldn't feel that way working 80h work weeks? When you are working crazy hours, anything you are feeling seems justifiable. Too tired to cook, too tired to go to the gym, too tired to eat, too tired shower. But it wasn't until I got physically sick that I realized how unwell I'd actually become.

I took a few weeks off to recover physically, emotionally, and spiritually. I decided behavioural intervention was no longer sufficient and made the difficult choice to start medication to treat my ADHD and the associated comorbidities. I saw a quote somewhere that really stuck with me "If you can't make your own neurotransmitters, storebought is fine". Like anything else it was trial and error until I found something that worked for me. I'm not out of the woods yet and I still don't have all the answers but if my time off has taught me anything it is that there is a place for people with disabilities in medicine. We add a whole new layer of insight, wisdom, and diversity to the field. These differences should be embraced instead of being seen as a hindrance or inconvenience.

Not everyone will experience their disabilities the same way, but for many of us it may take longer to get where we need to go. You have to throw away your timelines, disregard comparisons to others because it is like comparing apples and oranges. You will meet those milestones but in your time and in your own way. Don't be afraid to ask for help, try medication, and take time off if you need it. It's no longer about making the outside match the inside; it's wearing the inside on the outside with pride.   

Losing your "favourite" patient

*All descriptors of this patient interaction have been changed to protect their identity*

When I met Mrs. J we instantly bonded over our sarcastic sense of humor and common heritage. Knowing a few words in her mother-tongue language solidified that doctor-patient relationship almost instantly. Having had a healthcare background herself, she knew all too well what was happening with her breast cancer. She tread that fine line between staying optimistic in the face of dying vs denial. And it didn't help that her husband believed she could still be cured despite CT scan after CT scan showing tumors spreading throughout her body, like lights on a macabre Christmas tree.

Mrs. J had a lot of pain from her metastases that made it hard for her to sit, eat, and drink. Having previously worked as a head nurse, this immense loss of independence troubled her greatly. She had gone from being in charge to needing a two person assist to use the washroom. After several days of following her on another floor I felt it was time for her to be transferred under palliative care.


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When I went to see her in her room, there were yellow flowers at the bedside. The half eaten remains of her pureed food sat on the tray table to the left of her hospital bed. She sat up and smiled at me. She always found a way of smiling. I asked how she was feeling, how her pain was, and if there was anything she needed that day. With heartbroken acceptance, she opened up woefully about her pain and everything she had lost. She told me everything. Everything but the elephant in the room, the question that has been plaguing her since she was diagnosed. "What will happen next? How will I die?". No words were needed to express what was on her mind, I just knew. I sat with her and we held that fear together.

Apart from adjusting her pain medication, she asked if I could do something for the diarrhea she had been having. When I examined her abdomen, I could feel the rock hard tumor that lay beneath, notably bigger than two weeks ago. I told her I would do what I can and that we might run a few tests. With the guidance of my staff, we adjusted her medication, ordered basic blood work and a CT scan. "To follow up tomorrow" I jotted down on my to do list.

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"How are you feeling today Mrs. J?"
"Oh I feel good, so much better. Whatever you did with my medication has really helped. This is the first day that I am pain free and my appetite is good too!"

She went to hold my hand and I hesitated, blushing with embarrassment. Breakfast was a long way away and my hands were ice cold. Exactly the kind of hands you don't want your doctor to have. She took them none the less and exclaimed:
"My goodness are you alright?!?! Why are your hands so cold??"
I reassured her that I was fine but she insisted that I sit down so she could warm them up. I sat at the edge of her bed and she slowly eased herself towards me. Her grip was firm but gentle. She warmed my hands between hers, her hospital bracelet every so often tickling my wrists. When she was satisfied, she let my hands go and went on to talk about how she used to do the same for her kids. We exchanged a few laughs and I let her know that I would be back later to check on her. As she waved goodbye, she gave me the brightest smile I had seen in nearly two weeks.

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As I sat at the computer going through my to-do list, I noticed that the results for Mrs. J's CT scan were back. I opened the labs first and they were abysmal. I was surprised she was even conscious with lab results like that. Next I opened the CT results - and just as we had suspected - a bowel obstruction. The tumor had now invaded her bowels. The obstruction was only partial for now which explained why she was having diarrhea. This is something known as overflow incontinence - where not yet fully formed stool passes around the obstruction. But eventually this obstruction would be complete, resulting in intractable vomiting and ultimately palliative sedation during her final days. It broke my heart to know what this sweet, courageous woman might have this in her future. She had survived war, raised a family against all odds, and started her own business. How could I possibly maintain this person's dignity with what lay ahead. In that moment I decided that for as long as I could, I would always make her smile.

My staff and I discussed our approach to management and he got up to go explain to the patient the next steps in her care. I stopped him: "Please, let's not give the results today. She finally feels good. Let her have today". When I went back to check on her she was in her chair enjoying her evening soup. She asked about the test results and I lied, saying that they weren't in yet. She didn't care, she felt good and hummed to herself gleefully between spoonfuls.

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She had grown substantially weaker and now spent most of the day lying in bed sleeping. She sipped some juice from time to time, but no longer had the energy to sit in her chair and eat meals.
"Mrs J? Good morning, sorry to wake you. I just wanted to see how you were doing."

She gently opened her eyes and looked at me. She shrugged her shoulders.
"Any pain? " She shook her head no.
"Any appetite?" She shook her head no.
"Anything else bothering you?" She shook her head no.
"Ok well I'll let you get back to sleep" I took her hand. She held mine gently, nodded, smiled at me and said "Thank you"
She was already asleep again before I left the room.

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"Mrs J? Hi, how are you?"

She weakly opened her eyes and held my hand. From her chart I read that she has not eaten in several days, only a few sips of juice here and there. I sat at the edge of the bed and asked the same questions I did each day.

"Mrs.J remember yesterday I told you that today would be my last day?"
She let out a deep sigh and squeezed my hand tightly. I squeezed her hand back and said:
"You are such a strong, wonderful woman. You have done so many great things in your life and you should be proud of that.  It was a pleasure to meet you, and I wish you all the peace and comfort you deserve."

She gazed up at me, her eyes filled with tears and she softly whispered "Thank you, thank you for everything".  I sat in silence smiling at her, holding her hand for several minutes until I had to leave to go check on another patient. Neither of us wanted to let go but we both sorrowfully accepted that this would be the last time we would see each other. I walked slowly out of the room, her hand lay at the edge of the bed exactly where I left it.

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It has been several weeks since I last saw her. I haven't found her obituary but I suspect that she must have passed away by now. I don't know when or how it may have happened, but I hope she suffered no pain.  I feel a sense gratitude for having had the privilege to play my part in her dying process. Every so often when a crisp breeze rolls by and my hands grow cold, the thought of her passes briefly through my mind. Her smile and her strong grip still as vivid as the yellow flowers she kept at her bedside.

Declaration of Death: First Day on Call in Palliative Care

*Disclaimer - all identifiable characteristics have been changed*
*Trigger warning - description of examining a dead person and what happens to a body after death*


My first call. Pager? Check. Stethoscope? Check. White coat? Check. Granola bar? Check. Confidence? Well you fake it till you make it so "check"

At a gentle walk, I moved through the corridor of the obstetrical ward. My white coat trailing in the wind like sails of boats venturing through uncharted waters. The distant newborn cries echoed until I crossed into silence. I had made it to the Palliative Care ward. Ironic to have life and death in the same hallway, but in the wake of construction that's how it worked out.

I went to the nursing station, introduced myself and asked if there were any unstable patients requiring my attention. The head nurse replied, " Oh well thank goodness you are here, could you please declare a death? He's been dead for two hours now, the family is waiting for you."

I gingerly stepped into the room with the nurse and introduced myself to the family. I offered my condolences and support, and then explained the necessary steps for the declaration of death. They were offered the opportunity to stay for the exam, but they chose to leave.

There are three criteria used to declare someone dead, you must have at least two of them:
1) Pupils dilated and non reactive to light
2) No palpable central pulse (such as the carotid pulse in the neck)
3) No respiratory effort or breath sounds for 1 minute

Thank goodness I had the teaching on this the day before. We were also taught that despite meeting the criteria for death, the body can remain in many ways "alive" for hours after. From muscle twitches to sounds of digestion, these and many more processes may occur as the various parts of the body break down. Death is not instantaneous despite turning peoples' world upside down in an instant.

Alone in the room, grateful for the nurse at my side, I began to examine a man whom I had cared for for days. Whose labored breathing I helped to calm, whose grimaces of pain I helped to relieve, whose spirit in whatever sense you believe it was no longer there. I approached the patient's face and delicately opened his eyes. Criteria 1 was met. I place my hand gently along his neck, no pulse found. I listened with my stethoscope and watched for one whole minute. Criteria 3 was met.

I went out to inform the family and assist them with funeral arrangements. They expressed their gratitude for everything we had done and left a box of chocolates at the nursing station as a token of their appreciation. I carried on with my day as best as I could but I felt distracted. The events of the morning still lingered like hot coal in a christmas fireplace. I can't help but reflect on the way I see life and death now. It's not static, it's not black and white, it is just grey zones. One can be alive and not living. One can be dying but so full of life. One can be dead to those around them for decades and others can live on through those who loved them.

At the end of my shift, I walked through the same familiar hallway - the gentle wails of new life piercing through sadness of losing my first patient. As I stepped out into the afternoon sun, I sighed deeply. I made it.

A New Beginning

The gentle clamoring  of clammy hands clinging and flinging papers onto the floor next to my filing cabinet. I know it's in here somewhere. Brushing the beads of sweat out of my eyes, I continue my pursuit - the tiny white fan my only solace in the June summer heat. I continue to dig until I grasp the familiar tubular structure, folded upon itself just as I had left it: my stethoscope. Like a long lost friend, holding it felt exactly the same and yet different.

The last few months have been a whirlwind of activity; from the seemingly never-ending travel for residency interviews to the intense studying for the our licensing exams to an equally intense period of rest and untamed hedonism. To go from complete freedom to the impending rigid structure of residency is most certainly a shock to the system. From ID cards being made to sifting through mountains of emails, and meandering through a forest of new colleagues is both exciting and overwhelming. All the while I'm still trying to reconcile that my name appears on a diploma that says M.D.C.M. Doctor of Medicine, Master of Surgery. The title still feels foreign despite four years of work towards it.

As I embark on this new chapter in my medical training, I can't help but reflect on everything and everyone who has led me to where I am today. Growth paving the way for new growth. Here's to a new beginning, a new blossoming from old roots.

Changing the Culture of Medicine

We are months away from graduating medical school and starting residency. It doesn't feel real. In a delirious haze we have our heads buried in books and computers, our thoughts consumed by the upcoming exams. But today I was forced to reflect on how far we've come both as people and as physicians. I asked the question what can we do as individuals to change the culture of medicine? The reply was role-modeling. "Be the change you want to see".

Be kind in situations when you wished someone would have been kind to you. Show vulnerability to those in vulnerable positions so that they know they are not alone. Confront those whom you thought were your enemies, when in fact they are just as caring and loving as you. Friendship can blossom once you both remove the same disfiguring stress you both carry. Remove it together. Be present in times when you have felt abandoned. And lastly, speak up when there is something that needs to be said for your voice will carry in a sea of fearful silence. 

Just Let It Go

Tonight marks the final night before our residency selection lists become final. Tonight is the last night of agonizing over which program I want most, which city would I be happiest in, or which path would afford me the greatest opportunity in my chosen field.

I spent the night surrounded by friends at my medical school's Christian association at their first event in the new year. Faith is something that I have struggled with my entire life. Whether it be faith in myself, faith in others, or faith in the divine, I have tremendous difficulty in sustaining faith of any kind. As we went around and shared our experiences with residency applications, I was envious of my colleagues' sense of peace and the complete acceptance of the unknown.

My interview period was marked by anything but acceptance. Traveling from city to city nearly every other day, I felt increasingly lost in the vortex of choices, decisions, and opportunities. With each passing interview came a new challenge, further clouding my ability to know what I truly wanted. Instead of letting my horse run free, I gripped the reins even tighter. I must work harder, I thought, then I will know what I want. I spent hours calling people, making spreadsheets, and reading program descriptions.

Tonight, I felt the familiar call of exhaustion, and I had looked forward to an evening of exercise and relaxation. But that's not how plans work. By a series of seemingly random events, I got out of class late and ended up at this event instead. As I listened to the wise words of those around me, I had an epiphany. Be it the word of God himself, coincidence, or some strange combination, I felt a sense of peace rush over me for the first time in months. Like slipping your head underwater in the most perfect bath, all sounds muffled and all worries subdued. It's time to let go.

I have no idea what my future holds, and part of me still wants to bury my head in the dirt like a frightened ostrich. All I know is that no matter what happens, the outcome I get will be the right one. Now it is time to sit back, let the algorithm and all upstream forces work their magic, and finally relinquish control.