Preamble

It has been one year and I find myself back here, wondering where to begin. It is the feeling we know too well, the one where you have so much to say and do that it is difficult where to begin. And I have been feeling that way for the past year.

It is not writer’s block. My mind is not blocked. Rather, it is overflowing. The thoughts have dribbled and trickled their way into journals, poems, rants, tears, and refocused energy. The thoughts and memories are still engraved and filled up to the brim of my mind. But like a dam if we open the gates there will be a massive flood, and the results will tear apart the beauty of what is being kept inside. Like a slow stream we can appreciate the beauty of the flow, and the sounds of the current.

Now I have twisted the handle and the release of the mementos begin.

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Memorable Preceptor Quotes #2

“I want to do family med, and it would just be so embarrassing to not match to it because noone ever thinks of not being able to match to it.”

“If that happens, then it is a good thing, because it means your talents should be used elsewhere and you just don’t know it yet.”

I Still Don’t Know

As my first year of clerkship (aka my second year of medical school) comes to a close, I have come to the realisation of a simple fact: “I still don’t know.”

When I wrote my last reflection entitled “I Don’t Know”, I foresaw clerkship as being this roller coaster ride with an unknown ending. This time I’m going to very confidently say, I still don’t know how it’s going to end. But it’s still okay.

When I had imagined myself as a clerk by this stage, I imagined myself as someone who was very put together and knew what they were doing. Maybe to some people I look like I know exactly what I’m doing. Sometimes I do, and when I don’t , I ask for help. But that’s okay. I imagined myself as being able to retain in the best fashion the vast amount of knowledge required for this time of my life. The truth is, I’m still having difficulty, but I’m making progress. And that’s okay.

When I had imagined myself as a clerk by this stage, I imagined myself as being confident in my residency application. I’m not. I’m as scared as those who are applying to extremely competitive specialties. I’m scared that I won’t match. And that’s okay.

Okay?

Being okay is probably the simplest concept that I have adopted in my life, but it’s been one of the best. I suppose some credit goes to “The Fault in Our Stars”, but the majority of the credit goes to an upper year tell me that things are going to be tough, and that’s okay. We live in a time where we are so consumed by not being okay, it’s almost impossible to be okay. When we meet up with an old friend, we often talk about how stressed out we are, how things aren’t going the way we expected it to be, how this is a bit out of line, how our schedules are off track… It almost seems taboo to be okay. The point I’m trying to bring through is that it is possible to find comfort in the midst of discomfort, albeit difficult. The only advice I have in doing so, and how I have done so, is by accepting the possibility of falling.

I am still afraid of failing, and failing is not exactly my top option. However, in accepting the possibility of falling, I have come to terms with the fear associated with it. I am okay.

I still don’t know, but that’s okay.

Snapshots: #1

“This is it,” he said. “He’s fallen asleep, and he’s not going to wake up again.”

“Yes, this is it,” I agreed.

And although neither of us used the D word, we both knew that, given his rapid decline and laboured Cheynes-Stokes breathing, he was dying. So by his bedside we both sat, I, with my hand comforting him on his shoulder, and him, crying in sorrow, watching his father rest in comfort.

Orchestra of Care

When I was little, my parents asked me what kind of instrument I wanted to play. I told them violin or guitar.

They signed me up for piano lessons.

Naturally I resented them for many years as I cried through hours of training because I was absolutely miserable and had to endure Royal Conservatory of Music examinations. Interestingly enough, by some twist of fate, I fell deeply in love with the piano. I think it came with the acceptance and mutual understanding with my parents that I was never going to be incredibly gifted in this talent, but I was good enough to pass. Music became a huge part of my life. When I was in high school, I learned to play the flute and joined the school band. I devoted myself to the endeavor during those awkward years, and had a lot of fun along the way.

When I started university, my parents asked me what kind of extra-curriculars I wanted to join. I told them probably a music ensemble of sorts.

It never happened.

Naturally I resented myself for not pushing myself out of my comfort zone and auditioning for something, if anything at all. Instead, I played occasionally in the comforts of my room and would have sore fingers or be short of breath after a few songs. Each time I played, it was a sad reminder that a piece of me was slowly disappearing, and that it would soon be gone.

When I reflected the other day, I realised I had never really lost the music in my life; it just became so entwined in my life, I almost lost sight of it. Now I see it in the orchestra of care.

Each day is a performance. The preceptor asks me a question, and suddenly I’m in sympathetic overdrive. The spotlight shines on me. My heart races, and my face blushes. In the operating room, my hands tremble as I stitch and everyone is waiting for me to finish so that they can go home. I try to ensure everyone has an everlasting impression.

Each day I’m listening. I’m listening for the right notes, in or out of tune. I’m listening to the heartbeats, listening to each breath, listening to each percussive response, listening for each instruction, and listening to each lesson given. I’m hoping I pick something up. I’m looking for the right quality of sound. I’m keeping track of the rhythm.

Each day I’m asking. I’m asking for stories, for clarification, for feedback, for demonstrations, and for ways to improve.

Each day we are collaborating. Much like the orchestra works together to deliver an amazing performance, we work together to deliver amazing care.

When people ask me if I still play music, I smile and tell them I do, in my own little way.

I Don’t Know

I’ve spent the last year of preclerkship on the greatest roller coaster of my life. It’s been filled with ups and downs, and it’s been an incredible thrill.

But as I sit back and really think about it, I don’t know if that would be the best way to describe it anymore.

Pre-clerkship felt more like the initial entrance into the amusement park. You’ve waited in line buy your tickets, and you are excited. Finally, you get a well deserved reward for all of your hard work. Your hard earned money and time off… it all went into this one ticket into the park. Once you enter, it’s a whole new world. You pick a ride, and you go for it. But first, you have to navigate to the ride, make a couple of wrong turns, get a little sidetracked, and then wait in line. Finally you get there, and you’re excited. You are ready for this! I mean, that is why you’re here after all. You get ushered to the seat, and you buckle yourself up. There’s someone who tugs on your belt to make sure it’s secured, and then you are off. Pre-clerkship was the learning experience, trying to figure things out. Things start to culminate, and there’s an intensity building in your chest. The coaster is climbing up the highest point, and your heart is pounding. You know it’s coming, but you can’t help but feel scared. You’re so high, you know the fall is going to be exhilarating. In that split second, you can see everything below you, and you admire the beauty you have come face to face with.

Clerkship, I think I would describe that as the initial fall and the rest of the ride. It is horrifying. It’s going to be exciting and enthralling. I know that there’s going to be ups and downs and twists and turns and sometimes I don’t even know where I’m going. I’ll scream and I’ll laugh. Maybe I’ll cry (probably, I’m quite emotional), get a tension headache or terrible neck pain. Maybe I’ll doubt myself, then quickly realise I shouldn’t be doubting myself because this is awesome.

And this is the part where my comparison ends because I don’t know how it’s going to end.

I don’t know, but it’s okay.

 

Grief

Serene sea waves
I am content
Then the quake begins in my mind
Shaking, shuddering as the memory appears
Explosion of thoughts
The emotions spread
Receding waves taking the happiness away
Wrenching pain tugs at my heart
Tsunami crashes and the emptiness comes
Pangs pounding in my chest
Destruction, dragging me away from shore
Joining you soon
A gift from the sea


The DSM V describes grief as having feelings of emptiness and loss, dysphoria occurring in waves, and preoccupation with thoughts and memories of the deceased. The waves are also known as “pangs of guilt”. Naturally I thought of the waters, and how the tides typically recede before a tsunami. I imagine grief as a tsunami, so horribly destructive. Yet somehow, the deceased hide in this tsunami, and as terrible it is, we are drawn to it, and lose ourselves in the waters.

Standardized Patients

Standardized patients (SP) are people recruited by the medical program to act as our patients to practice on. The tasks range from taking a history (they are given a binder script), to completing physical examinations. I remember reading an article or two about the possible ethical dilemmas associated with this job. There was also this one story about how an abdominal aortic aneurysm was discovered and the SP’s life was saved. Sometimes they have findings, sometimes they don’t. I don’t know much about the paperwork they have to do, or the training they receive with regards to us making accidental discoveries (which I do hope is present). But I’ve had many encounters with SPs that I’d like to share.

In my undergrad, I took a communications course which allowed us to work on our interviewing skills with standardized patients. The acting was impeccable. During the interviews, I forgot that these were actors for the 12 minutes, and felt like I was submersed in a whole new world. Seeing these actors around later was very strange. It was hard to dissociate them from the context in which I knew them… the girl with diabetes, the abused housewife, the suicidal boy… And I would wonder if any of their stories reflected their own lives. It’s almost like forgetting that your favourite actors on the movie screens are simply actors. Like teenage girls who associate the on-screen romantic heartthrob with the person’s personality.

Seeing the same SPs as a medical student helped. When they are recruited for physical examinations, they become less of a character, and more of a person to practice on. (Unless you count examination situations, then I don’t even have time to process my own feelings towards them in the midst of being incredibly nervous.) For tests they will have make up on or some “findings” put on by the school, but in the practice setting, they are who they are. It is like practicing on my classmates, except they are paid by the school. Sometimes it is just that simple. Sometimes thoughts creep into my mind, and I start to wonder about their own stories.

Depending on the group, we sometimes pair up and practice on each other, and the odd person or group can also practice with the SP.

One time, I was practicing the musculoskeletal exam on an SP. It was of the upper limb and back, and they were wearing a T-shirt. I went through the examination, then I noticed wisps of scars laid across her forearms. They were faint, but they were present. I would be able to recognize that anywhere. I had a couple of friends who practiced self harm in high school, and over the summer, I had an elective in Psychiatry where I had seen this practice in the extremes. I had flashbacks of the girl lying on the bed in the hospital, her arms filled with so many scars you could hardly find a spot that wasn’t scarred. At first, I thought they were blonde strands of hair on her arm. I don’t think I will ever forget that image. This SP, her scars were faint, from years passed. I don’t know if she knew I noticed them. I didn’t ask her about them. I think I may have asked if everything was okay if the scars were fresh. But they were so faint… What if they were just an impulsive decision that she wanted to forget? I didn’t have any actual conversation with her, and in the busy clinical exam room with pairs of students practicing was not the best place to ask. That night I went home, and I slightly regretted my choice to leave it alone. Would it have been intrusive or relieving for her? Sometimes I wonder how she is doing now. I haven’t seen her again since then.

Another time I was practicing my fundoscopy exam on an SP. I am not very well versed in the exam, as are most medical students, and it took me many tries until I was able to find the optic nerve. When I pulled away, he asked me if something was wrong, and I explained to him that it was quite difficult. He apologized and explained that he had been crying today, and wondered if that could affect it. I quickly reassured him that it wasn’t him, it was me. Then I asked if everything was okay. He told me there was a death, and he was quite upset with that, among other things. I told him we could stop if he wanted to go home, that I could practice on someone else. He told me he was okay to proceed, and I asked him if he was feeling okay. He smiled and responded that he is doing fine. Then we continued the exam. I think after that point I made a conscious effect to be more vocal and dynamic. I told more jokes, I tried to make him laugh (and he did). Sometimes I wonder how he is doing now. I haven’t seen him again since then.

Sometimes thoughts creep into my mind, and I wonder how the next chapters of their stories are going.

Starting Second Year

I cannot believe I can finally call myself a second year medical student. As I see the pictures and posts pop up on my Facebook newsfeed, it feels like just yesterday when I was in their shoes.

The past year was one of the most amazing experiences I could ever ask for. I’ve grown tremendously as a person, and I don’t ever want to stop this process of learning. I haven’t been documenting the process throughout the many units since I’m already writing reflections for school. In other words, I was pretty dry of words. Now I think it’s a good time to look back.

Having the summer months in a clinical setting was quite the change. Instead of studying constantly, wait, no, I was still studying constantly. But this time, it was reading about things I saw during the day (or night), and filling in gaps in my knowledge. It sounds even more exhausting than being in school all day, but it didn’t feel that way. After a long day seeing patients, I would come home and read some more. If I had a long day, I had some time in between to read up about things before managing their care. Don’t worry, my supervisor kept a good watch on me at all times.

I’ve been on a constant journey to try and better myself. Each day, I’m pushing my limits even further. I’m speaking my mind when I want to, and I have become a more daring person. I challenge people when I don’t understand, I ask questions and I take criticism.

I wish some things had gone differently. I wish I spent less time on academics and more time on extracurriculars. I wish I had more time for my hobbies. I wish I took on more leadership roles. I wish I did earlier placements. I wish I networked more. I wish I had more hours in a day. But all of that doesn’t matter, because wishing isn’t going to change anything. This year, there’s going to be more doing. More acting. And if I can’t do it all this year, I’ll keep going, and I won’t stop. I’ve got my foot on the gas pedal and I’m revving up. But I’m still a responsible adult so I’ll be cautious of the speed limit and other traffic on the street. I don’t want to crash and hurt anyone.

I haven’t had any breaks, but that’s okay because I’m happy. I’m happy doing what I do. My preceptor told me I’ll never be as interesting as I am right now. I accept the challenge. I don’t ever want to stop learning and being interested in all this.