And So It Begins

Tomorrow. Tomorrow I am officially in 3rd year. I will have responsibility for patients. I know I will be supervised, but still, they will be MY patients. I'm both excited and terrified. The learning curve is going to be steep and although I know I am prepared for what lies ahead of me it's hard to feel like I am actually prepared. As of tomorrow, I will be working about 12 hours a day in hospital as part of a team. I can't remember the last time I truly felt like I was part of something greater that really made a difference in peoples' lives. I look forward to experiencing everything that this new life will have to offer, both the beautiful and painful moments.

To my friends and family reading this, you knew this time would come. No matter how busy I get, you still hold an incredibly important place in my life. I wouldn't be here without your love and support. I'm going to need that love and support more than ever. You know I've never been the most confident person but having you all in my life has helped me find muster up enough confidence to move forward. You have helped me regain my footing when I feel like I have slipped and am falling uncontrollably. I am so sorry that I will have to miss important life moments of yours. Parties, weddings, etc. I'm sorry I won't necessarily have the same amount of time to give to you as before. Please understand that I do not value any less our relationship and that if you really need me, I will find a way to be there and make time for you. It may be at some weird hours but I will find a way.

To my colleagues, now we are going to need each other more than ever. We will all be in the trenches together; fighting for our patients, fighting against the negative aspects of the culture in medicine, and growing into the professionals we all want to be someday. I look forward to getting to know so many of you in a greater capacity and learn from you. We are all in this together.

The house is almost clean, the laundry is almost done, all food for the week is almost ready. I stare at my freshly washed white coat, still pristine, white with inexperience. Never in my life have I more looked forward to wearing out a piece of clothing.  

Selflessness vs. Selfishness: Where to Draw the Line?

Nearing the end of my five months exposed to the clinical environment, this theme of selflessness has come up in almost every rotation. "To be a good doctor, you need to be there for your patients 24-7" my surgery mentor had said to me. This resident sleeps about four hours a night for the last four years, surviving on four large coffees a day and two large meals. They explained to me that only when you are are there almost all the time can you truly monitor your patients' statuses and capture deterioration early. But what about their health?

During neurology I watched in awe of an incredible, compassionate doctor that was there for their patients at least 12 hours a day and took money out of their own pocket to open their own clinic to care for even more patients. Despite unimaginable hardship in their personal life, they handled it with grace and continued to give their patients exceptional treatment. But what about their health?

In my rotation through ophthalmology I watched numerous doctors push through 60 patients in one day when they were only supposed to see 40. Between emergencies and other people handing off patients, the workload was insane. To accommodate everyone, the average appointment time was between 2-5 minutes. Even with these short appointments, most patients wait between 5-6 hours for to be seen because of delays. The regulars know to bring books and food to last them the day. For the doctors, it is the norm to start at 8 am and not get to eat lunch let alone use the bathroom until 4pm. When I asked one physician why not just cut spots to plan ahead for emergencies, they replied: "I could cut spots but then these patients wouldn't get seen. Some of these patients have glaucoma and need regular follow up. If they can't get an appointment, they get lost to follow up and without proper care could go blind. I could take my lunch for 30 minutes at noon but I can't bring myself to do it knowing some of these patients have already been here for 3 hours". Many of these delays are due to failure in equipment - scans not working, instruments being out batteries, etc. With budget cuts they are not allowed coloured printers to so they cannot make copies of patient scans (and they do not have scanners). What about everyone's health here? I asked what the biggest issue was and they said a lack of staff. However, no one wanted to take a paycut to hire another staff member.

We know the system is broken. But at what point should it become an individual doctor's responsibility to compensate for it? The lengths they go to for their patients is incredible but at what cost? To what point should we praise people for sacrificing their own health for the good of others?

When I think about that lifestyle and making those kinds of sacrifices, I don't know if I want to do that. Does that make me selfish? Heck I don't know if I can do that. Is it wrong to want to give 110% in every interaction but when I need to eat lunch, stop for a 20 minute break leaving my patients waiting? Or would that make me less of a good doctor? As a young medical student preparing to enter clerkship I am scared of this choice that I will inevitably be facing; who is more important? Them or me? I suspect the answer is some sort of middle ground, but will the culture even allow me to make that choice? Even more worrisome, will I be penalized for it? For the time being, as I sit surrounded by textbooks and notes, I will stop everything and enjoy my dinner. Savour every bite, every spice, and try not to think about it.

Just like real doctors

As I look in the mirror of the hospital locker room, the figure adorned in a white coat, stethoscope, and more IDs than boy scout has badges stares back at me. Pens and granola bars are shoved in every possible pocket, bulging in all directions. I feel like a child trying on my mother's high heels and dress; it is almost comical how much growing there is left to do before these will fit properly both inside and out. After getting lost in the dimly lit labyrinths of the hospital basement for 10 minutes, I finally find my way to emergency room and spot the top of my attending's head above a pile of charts. Hurriedly I rush towards him and he says "Neurology consultation, room 7. Go!" and hands me a chart. All that is written is "40 year old female with headache, blurred vision, and difficulty speaking. Please assess". A fellow medical student and I approach the ER waiting room and call her name, beckoning her to follow us. Just like real doctors.

The conversation begins as always: "What brings you here today?". As the story unfolds, I jot down everything that could potentially be relevant to the diagnosis. Facial pain, ear pain, no nausea/vomiting, so on and so forth. Thoughts and questions to ask appear like birds flocking to a pile of breadcrumbs; uncoordinated and chaotic. Did I forget anything? What else am I missing? We complete the neurological exam to the best of our abilities. Neither of us could elicit reflexes in the left knee or ankles. Is that just us? Or is there actually a problem there? But how does that relate to headaches? Think brain, think. We finish our examination and run back to find our attending.

He carefully sits down and reads through our chart; I'm happy to see we made less mistakes than yesterday on our first day. "Did you ask about a history of migraines?" Crap. I knew I forgot something. "What was her blood pressure? Always important to note the blood pressure when someone comes in with headaches". Where in their chart did it say her blood pressure? I can't remember. I jotted down a few more things to on my already exhaustive list of "things to read and study tonight".

We are babies taking our first steps into the medical world; surrounded by padded mats and watchful doctor parents excited to see our progression. Knowing all of this exists doesn't make it feel any less scary. Falling is just as scary when you can't fully see that the padding is there to catch you. Almost overnight I've gone from sitting in lectures learning about the different anatomical structures to looking in eyes and ears and suggesting tests. It's exhilarating and exhausting to be the newbie thrown into a sea of experts. But the good news is you learn how to steer that ship pretty damn fast and, most importantly, you learn to watch out for icebergs.

Change is in the Air

Today was the last day of classes in the conventional sense; the end of the course-based portion of my degree. Or as some people may see it, the ending of an era. In the new year there will be classes here and there but everything is changing. Gone are the days of being spoon-fed information from lectures and studying specific details for the sole purpose of passing exams. In the new year we study to heal. We study for the day that a nervous patient in the ER looks us in the eye and asks "What's wrong with me? Am I going to be okay?"

In January we start our transition into the hospitals. We will be asked to read and read and read some more to further enhance our knowledge base. We can no longer ask our instructors "Is this important to know? What's on the exam?" because that responsibility is now on us. We as individuals must decide what is important for us to know. There is no right or wrong answer. There is no set list of things to know. Small group cases are about to be replaced by real life people whose symptoms and experiences can't be summed up by any textbook or study guide.

The year of 2017 brings on the transition into real life. A world where things are not perfect; where the system is understaffed and people are overworked. And I know I am not alone in meeting these changes with mixed feelings, mostly a nervous excitement for the unknown. There is something comforting about routine. Over the last year and a half we all developed our own specific formulas for success. A little bit of A,  a dash of B, a lot of C, and boom we pass our exams; rinse and repeat. But now we are starting anew, having to adjust to new learning styles, social dynamics, and exam questions. Change is terrifying because it is so destabilizing. Having started over in so many ways throughout my life, I've come to know that the unknown can beautiful if you give it a chance. In the face of these new challenges I know that I will stumble, fumble, and likely fall. Yet, eventually I will adjust and regain my footing more stable than ever before.

Owls and Odds and Ends

Today I took a short nature walk to escape the tangles of axons and nuclei and cranial nerves that I am supposed have memorized. As chance would have it, I noticed a group of people with cameras staring up into a tree. Curiously, I wandered over only to see a large grey owl, perched on a great arched branched. As the crowd grew bored and eventually disbanded, the owl rotated its head 180 degrees, opened its eyes and stared right at me. We made unbreaking eye contact for a short while until it blinked slowly, resumed grooming, and then spun its head back around the other way and began to doze.  I stared in amazement for well over 20 minutes just admiring its beauty and unexpected comfort with my presence. Never have I seen a bird so close and so unfazed by the hordes of people stopping to photograph it. Despite being somewhat out in the open in broad daylight, it went on with grooming and sleeping as if none of us existed.

As I headed back, I realized that I am slowly becoming more like this owl: learning to complete my daily tasks and remain calm in the face of vulnerability, incessant observation and evaluation. Last week I dissected a human brain. It still boggles my mind that I held the closest thing to a soul in my own two hands. That brain once actively expressed thoughts, feelings, hopes, fears, memories. THAT brain was once a person - something I still haven't fully wrapped my head around. And I finally had the courage to stare death in the face and look into the eyes of the donors who so graciously donated their bodies so I could learn. This was something I was far from ready to do last year, and yet here I am. Ever nearer is the transition into working with real people and having to translate all that knowledge in my head into competent care. The mere thought of it sets my heart aflutter from both excitement and mild terror.

But like how I became comfortable in the anatomy lab, I have no doubt it will eventually happen in every stage as I advance in my studies. I just need to remember to be like that owl. Calm, poised, confident - words I would rarely use to describe myself but need to learn. Hopefully, one day I too will be at peace with my own vulnerability and the perpetual uncertainty that is medicine.

Reflections on Year 1

I can officially say I survived my first year of medical school, miraculously without failing any exams as I had expected. I can't help but look back on the person that I was before starting medical school and who I am now. I have to say I feel like I have both grown a lot and barely changed. I walk away from my first year with an immense and exponentially growing body of knowledge, and yet I still feel like I know nothing. In spite of a greater acceptance of my own inevitable demise after having held the hand of many a dead, I still feel unprepared for watching life leave this world. Deep in my heart I know I have found my career path and where my passions lie, yet I still feel lost and unsure that I am up for the challenge.

In the wake of everything in the news today, the fear surrounding the uncertainty of our collective future is at the forefront of my thoughts. From shootings to radical political decisions, globally I am scared.  I am scared for the world and I am scared for myself as a budding young professional; what kind of life can I expect to live? But of all the fears I have, the thought of being thrust into the medical world, already riddled with uncertainty, feels the least frightening of them all. Many of the "bad habits" picked up by society are even more pronounced in medicine; the need to be perfect and free of mistakes, to work long hours and show an almost altruistic level of devotion to your career, forgoing personal care. I had always made a deal with myself that if I couldn't take care of myself both in medical school and as a future physician, that I would quit, and that deal is still in place.

During our end of year wrap-up, my class unanimously agreed that finding a reasonable work life balance was the most challenging thing about medical school, and we were warned that it only gets harder as time goes on. Personally, I feel that this challenge stems from a fear failure; that if we need to take time off because we are going through a rough time or fail an exam because of a break up that we have somehow failed as people. In medicine, there is a culture that failure is not acceptable.  We are often held to unreasonable standards of perfection, and expected to maintain our grades and commitments to the medical community when we are hurting. There is less stigma about taking time off to grieve a loss in other careers, why is there so much stigma around this in medicine? What a beautiful irony we live in where we are expected to care for others by failing to care for ourselves.

We need to change our medical culture to be more tolerant of failure because, contrary to popular belief, we are not superheroes. We fail exams, we fail at relationships, and unfortunately we do make mistakes that can potentially have devastating consequences for other people. But collectively shaming individuals for being human, even by omission of support for people struggling, is not the right way to prevent mistakes. We need a system that is supportive of self-care, promotes growth from failure by helping us to learn from our mistakes, and has many safeguards in place to prevent tragedy in the face of human error.

With all of this in mind, I pledge to start off my second year by promoting vulnerability, and open and honest communication with classmates, using myself as a guinea pig. I promise to openly ask for help when I need it, support when I feel down, time off when I find it hard to function, and encourage others to do the same to hopefully start creating the culture of medicine that I want to work in. 

Invisible Disease

Yesterday I stood in the shoes of my patients. Although for a short period of time, it was a firm reminder of what some people struggle with everyday. Invisible disease is pervasive in our society, it is everywhere, and yet because it is invisible, it is nowhere. We as humans are flawed in that sometimes when we can't see something, we don't believe it is there. But for the person experiencing it, it is all too real.

I suffer from chronic knee issues from an overuse biking injury, worsened by having congenital flat feet. Most days, I keep it well controlled (thank you orthotics), but some days the pain makes it harder to walk. In and out of physio for years, I've never been able to be completely pain free. I never walk 100% pain free but I can usually get up to 95%. However, I can rarely stand for long periods of time without pain (I have trouble in the anatomy lab and yes this is something that worries me for clerkship). Yesterday, I needed to hop a bus go to the other end of the city and I knew that ride would take about 45 minutes. I tried to arrive at the bus stop 15 minutes early to guarantee a seat but the line was already stretching around the corner. When I boarded the bus, all the seats were full. After a few minutes of standing the pain began to escalate. I knew I wouldn't last the whole ride so I just kicked aside some of the dirt, sat down on the bus floor,  and just rubbed my knees to help alleviate the pain.To my surprise, the people around me just stared at me with this look of repulsion. No one seemed to be asking themselves "Is she okay?", but more like "Eww how can she sit on the floor, that is disgusting, what a weirdo". They averted my eyes when I tried to make eye contact, and of course no one offered me a seat (and after those looks, I didn't dare ask for one). Thankfully after 25 minutes a seat opened up, but this experience had me reflecting on how different this situation would have been if I had had a bandage around my knees or crutches.

While I sat on the floor I honestly felt a little humiliated, like I was less than human. All because of how people looked at me. Sadly, this is the kind of thing that people with invisible illness encounter everyday, sometimes many times a day. The moral of the story is something that Disney movies and cliches have been trying to teach us for years: you cannot judge a book by its cover. You cannot tell if a person is sick or suffering just by looking at them. Many people have become experts at hiding their invisible illnesses to further avoid unpleasant experiences like the one above. This may be especially true for people suffering from mental illness, which is even more stigmatized in our society than physical illnesses (this will probably get its own blog post at some point).

So the next time you see a young person taking an elevator up one floor, or someone who looks able-bodied using handicap parking, or someone who is asking for more time off work for mental health reasons when they look "fine" don't judge them. Yes there is always the possibility that they are lazy or "scamming the system", but those people make  up a small percentage of society. Step back for a minute and give them the benefit of the doubt, because there may be more going on than you realize.