July 6, 2016

Today we had the letters we wrote to ourselves at the beginning of residency returned to us:

Dear Me (at the end of residency),

As I begin my journey in residency and start having clinical and academic experiences as a physician, my expectations are grounded in optimism and desire to improve. No matter what feedback, positive or negative, I have heard from colleagues ahead of me, I hope to build and create this experience for myself.

In the case presentations and analyses that will follow, I am again thrown into a state of vulnerability as I had experienced as a medical student. However, this time I promise myself I will have no fear of judgement and worry, for I know I possess the tools within myself, and the ability to improve can only be achieved with the feedback of others – my preceptors, tutors and colleagues. I look forward to the challenge.

Currently, I am settling into the physician title. I am still stumbling to introduce myself as Doctor. But this is the mere start to becoming a CANMEDS encompassing clinician.

In two years I know reading this letter will bring forth a reminder of how I will carry this grand title with a humble soul.

Sincerely Me (at the start of residency)

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Snapshots #6

She suffered a devastating intracranial hemorrhage with signs of coning. She was 92 years old.

Her family was all on the same wavelength, all aware of her previous wishes of comfort care, all understanding of the implications of this diagnosis.

When I met my patient, she was unaware of my presence, her eyes closed in soft slumber.

Her prognosis was guarded, and the family was prepared to say their goodbyes.

Somehow the bleeding stopped, and her brain scan findings remained stable. She became more alert and awake, and even started to consume thick fluids. But she was no longer her previously independent self.

Now the discharge planning became difficult, because she hated hospitals. She also hated long-term care facilities. “I would die before I go there”.

Her family member confided in me, “Part of me wishes she did die. She would be less distressed, and likely happier with the outcome.”

When a part of you agrees with the darkest thoughts a family member has confided in you, does that make you a terrible physician or a patient-centred one? That boundary is blurry, and I wonder if our mind and heart allows for the co-existence of these two extremes.

Sakura

Chinese New Year brings about vibrant decorations: lion dances, red envelopes, pussy willows, colourful flowers, posters of holiday greetings and wishes and cherry blossoms on display. They used to remind me of my childhood and family gatherings. Now they remind me of her.

Beautiful in bloom I can only imagine that was what her life was like. Her hospital room forever filled with decorations, children and grandchildren buzzing like bees in the spring. They would sing songs from church while the radio played choral music in between.

I met her on the ward, and noted her unique name. I must have met her before. She reminded me of a flower in a storm, being drowned in her heart failure. And yet each day, her body kept on fighting, and we kept on giving her medications to help her fight.

“She’s a fighter my mom.”

But as flowers do, they eventually wilt away. And slowly she did. I watched as her full cheeks became sunken, her eyes no longer communicating as she was before.

Her heart continued to fail. Her kidneys continued to wither.

Days passed. “Do you think she would think this is the right time now?”

“I think it is.”

And so we stopped fighting, for the stem was already broken, and the petals fallen away.

The next day the ward was flowerless.

Amid the music of the strings and woodwinds, I hear a distinct choral hymn. In the buds of the cherry blossoms, I remember the patient I had, one that I will always remember each Chinese New Year.

Snapshots #5

I am losing control. 

STUDENTS FEAR THE 3 C’s I think to myself as I dropped my pen and cellphone down onto the table where I was charting.

I feel the sweat emerging from within the folds of my skin, the clamminess in my hands. My heart is pounding, my chest is aching, my stomach is churning. I feel lightheaded, unsteady as I tried to stand up to leave the charting room. It was going to happen here, much to my embarrassment, in the public setting with my preceptor submitting a referral on the computer beside me. Wait, where was I again? At work. I was at work. 

“I’m sorry,” I announce to no one in particular.

I try to pick up the pen and cell phone again, and it drops from the trembling of my hands. Chills engulf me. I can’t breathe. I roll in the chair away from the table, and bring my knees to my chest. I’m holding myself in brace position.

“I’m having a panic attack,” I choke.

I hear my preceptor say something. “I just need a few more minutes I’m sorry.”

A few more minutes is all I need. And then it will be gone. Like all the other ones I’ve had before. STUDENTS FEAR THE 3 C’s, that’s all it is. Just symptoms. Then they will stop. 

I force myself to take longer breaths. I force myself to count. I count as I box breathe.

I feel my heart rate slowing. The pains subside. I roll back to the desk. I pick up the pen and cell phone. They stay within my grasp.

“It’s gone,” I announce to no one in particular. I go back to the task at hand.

I am in control. 

 

奶茶

I walked past the cafe where you would sit every morning, drinking a cup of 奶茶 (Hong Kong style milk tea), eating a 沙翁 (Chinese sugar egg puff), chatting with your friends, until your friends all passed away, and your hearing deteriorated, and you began to people watch instead.

The last time I was there was after your funeral. I didn’t want to go – the wound of your passing was still fresh. But I went anyway, and had a cup of 奶茶 in a paper cup. I expected it to taste bitter and tasteless – I was sad after all. But the familiar taste coated the inside of my mouth. The taste of black tea hitting me, the creamy evaporated milk warming me up, the slight sweetness I asked for, and the memory of you.

It’s strange how humans form such habits. Every morning, rain or shine, you would leave your flat, hop onto the streetcar, and then trek the two blocks to the cafe. And when your mobility became impaired, the visits became slower, and before you ended up in hospital, less frequent.

And when I found out you were in the hospital, I was surprised because it was unexpected, but also not, because these things happen. I saw it happen everyday at the hospital. I didn’t expect you to leave the hospital, and you didn’t.

And part of me felt terrible and ashamed for thinking that you would be like the many I saw everyday, but I chalked it up to my evolving emotions. Had I progressed to the point where I was able to dissociate and be rational at last? But at your funeral when I broke down and cried harder than I had ever did, that was for me and you. I was so upset at myself for holding all these emotions in. I was so upset at myself for all the things I wish I did… all the things I told you I’d do for you.

So I’m sorry, for never giving you my graduation photo, for never introducing you to my boyfriend, for not coming to visit more often, and for not staying a little more involved.

I’m sorry I never told you I loved you. But you’ll never know.

So I walked into the cafe, whispered the words into the paper cup of 奶茶 whilst sitting at your spot by the window, and let the familiarity wrap its arms around me.

 

The Morning Tour

My mind races to the beat of my radar ears

Thrump thrump thrump
Ambushed within cylindrical inclusion
“Good morning! Please take a seat.”
Tired raspy waaas by the babe since two a.m.
Moans emerge from the huddled hunched-over housecoat
Hack hack cough ptoo muffled behind surgical masks

Beep! The automatic doors slide open
Ding ding ding di-! Heart rate 100 silenced.
“You can’t keep me in here! GOD IS GREAT!”
“ATTENTION MEDICAL STAFF. CODE BLUE-”
“We need to intubate now.”
Shaaaa close the curtains

Beep! The automatic doors slide open
Silence in the corridors; OR suite clamors next door
Whirring drills, thirsty suctions, buzzing cautery
Beware the happy wheezes on the pediatrics floor

Up the stairs to content coos and belches in the NICU
Versus late epidurals aaaaaaaaiiiiiiiieeeeeeeeesssssss

Medicine and surgical wards dominate the other levels
Beds shuffle rehabilitation shuffle visitors shuffle
Nursing station chatter, team meeting mutters, CTU rounds stutter
Deeeeep breath leery pause deeeeep breath
Gasp gasp wheeze shushhhh oxygen needs increase
Demolished deliriums hushed hallucinations

My mind slows to the beat of my mellowed thoughts

Snapshots #4

We were closing the incision, and the surgeon was trying to teach me how to close properly. After he finished, he commented, “Don’t worry, it’s just like sewing. You know how to sew, right?”

“No, I don’t actually.” It was a half lie– I could sew buttons on shirts, that was simple. I could hem my pants in a pinch, albeit creating a new design of slight diagonal one centimeter threads all around the circumference of my pant leg. But no one’s paying attention right?

“Oh well, fine, give it a try and I’ll watch.” I took the needle driver and forceps from him, and began to suture. I kept my focus on each stitch, knowing he was watching intently. “It looks good so far…” He paused. “Can you cook?”

I wasn’t sure what the relevance of this question was. Too focused on the task at hand, I quickly replied, “No.”

“You can’t sew, you can’t cook… What can you do?”

I nearly dropped the surgical equipment. I immediately looked at the nurse with a gaze that read, “You have got to be kidding me right now” which she mirrored. My face grew red behind my surgical mask. I cleared my throat and said, “I don’t know what I can do, but you can check your gender roles.”

There was an uncomfortable silence. Then he brushed it off his own words, saying it was a joke.

I knew that society had engraved this mindset into him without him even realizing. I knew that this was not a rare occurrence in his OR when the nurse gave me a high five after we scrubbed out.

At this point I knew that even in medicine, elements of sexism are still thriving. And that is just a shame.

Snapshots #3

We just finished removing the appendix in a laparoscopic procedure. The patient’s abdomen was still bloated from the gas we used for inflation during the surgery. The surgeon looks at me and instructs, “Push on the abdomen. We need to get rid of this air.”

I comply and reach over to press down when he stops me and says, “Push, but don’t push like a girl.”

“Excuse you?” I exclaimed, catching him and myself by surprise. Me, a medical student, on their first clerkship rotation, who pauses in uncomfortable silence when quizzed on surgery topics, exclaiming in such a manner.

He looked sheepish, and his cheeks flushed pink. “I mean, push hard. That’s what I mean.”

“That’s better,” I said, and I looked up to see the nurse’s eyes upturned. I knew that she was smiling underneath the surgical mask, but sadly I knew from the gaze that this was not the first or last comment that would be said in the operating room.

 

Snapshots #2

We came out of that meeting, my preceptor, the nurse, the patient and myself.

“Well, that went well didn’t it?” my preceptor chirped, as soon as we were out of earshot to the patient.

I found my words, meant to be inner thoughts, slipping into my speech. “You have got to be kidding me. Were we in the same place?”

He was taken aback, and look to the nurse for reassurance. She emulated my exasperated face and said, “She’s right.”

“But she consented!”

Once again, the stark words came out. “She consented? Did she? Did you really think she consented?”

He shot another helpless gaze towards the nurse, who, to my relief said, “No, that was not consent.”