It’s Not Over

Dear neighbours, community members, friends, family:

Covid has not gone away.

I just drove home from my shift as an emergency physician at my site which is a Covid center, to my home here in Montreal (which happens to be the Covid epicenter in Canada).

I was saddened and frightened to see many of you out, gathering in groups without masks or social distance between you. In fact, who I really saw were your children, teenagers, in throngs on the sidewalk. On Saturday on my way home I saw groups of sometimes 20, 30 people, men women and children, all close together without masks. Yesterday driving home I saw people in restaurants picking up take out, no distancing, no masks.

My husband and children went to throw a frisbee in an open field, and had to navigate on their bikes by an outdoor bouncy castle party on the street with a dozen small children playing, and in the park another group of ten women sitting side by side on a picnic table without masks.

Perhaps all of you believe that because the premier of Quebec said parks, pools, stores, daycares can open, that this means that there is no risk.

I PROMISE YOU THE RISK IS REAL.

You or your friends, or your children, will catch this virus. You may not get very sick, you may remain asymptomatic. But you will breathe on, talk to and spread droplets, hug or otherwise interact with someone who will end up in the ICU or even dead. That person could be your husband, your mother, your diabetic best friend, your neighbour with metastatic cancer.

That person could be your child.

Or that person could be you.

When that person comes to my hospital, we will care for them. The hardworking mothers, fathers, brothers, sisters, children, grandparents who are nurses, orderlies, paramedics, housekeepers, respiratory therapists, security guards, doctors and clerks, will then be exposed and the cycle will continue. We go to work every day and risk our lives and the health of our family members, in order to make sure you and your loved ones are cared for when you fall ill. But don’t be fooled – we aren’t seeing less cases right now. We are seeing many. And we are at risk every single day.

When you choose to go out and interact with others without a mask or social distancing, you are not only affecting your own health. You are throwing yourself like a stone in a lake, with ripples that spread outwards in ever expanding circles. Your actions affect others, and can in fact affect the whole world.

Please, I implore you: stay safe. Keep yourself, your families and therefore me and my family, safe.

The fight is not over and the road will be long. Patience.

#stayhomestaysafe

#wearmaskssavelives

#socialdistance

Goodbye Daycare

You run to me, arms outstretched, as I drag my weary limbs to the garage door.  You have been anticipating my arrival, and burst through the backyard gate upon hearing my car door close.  Sunkissed and joyful, the two of you delicious little people want nothing more than to be scooped up in mommy’s arms and snuggled.  “Stop!” I call, “Stay back, wait till I have my shower!”; alarm rings in my voice as you hang precipitously before me, a few feet from possible contamination.  Your faces fall when you realize that, yet again, mommy can’t hug you right when you need it most.

 

This is the toll that the pandemic is taking on my family, and on so many families like mine.

 

Today, I am in mourning.  I grieve the loss of our daycare; ten years of joy, friendship, warmth and love stolen away in a flash by sickness.  Covid destroys so much more than we know – besides killing hundreds of thousands, besides overwhelming health care systems and hospitals worldwide, besides tanking economies globally – the worst part for me is the effect it is having on our children’s wellbeing.

 

On June 1, the government of Quebec is forcing daycares to reopen to the general public, after two months of being a safe refuge for children of essential workers like me.  Though they are putting in place safeguards like small class sizes, masks and visors for teachers, and increased sanitizing, as a health care professional I know that none of this is enough.  The likelihood of one of the children or parents transmitting Covid to the group is not negligible.

 

So today was my son’s last day at the daycare that raised my two children, nurtured them, loved them.  These were his final moments in his, and our, second home.  It was going to happen anyway at the end of August, but with a graduation ceremony and joy instead of sorrow and pain.  Luckily, being so young he will be very unlikely affected by the arrows that pierce my heart at this separation, and I know we will ensure he has a wonderful summer at home with us.  But the end of this phase of life, daycare, in this way, hurts.

 

My daughter, ten years old and blossoming, is suffering.  She, like all kids right now, misses her friends with an intensity of emotion that only the young can feel.  The hardest thing I’ve had to do so far during this crisis, is the one I did a few weeks ago when I had to collect her belongings from school.  On March 13 we had come to school only to be told the doors were shut, and home we went with the most important of her schoolbooks.  Two months of online learning later, and the decision was made that schools would not reopen until September.  I pulled up in front of her school, which had been my high school, and felt ill as I donned my mask and headed in the doors.  One parent at a time was allowed in, and I spent twenty minutes wandering the hallways of her innocence, opening her locker, touching her big girl belongings and stowing them carefully in a bag.  Going through her desk and her classroom to collect the rest, my heart felt ripped up as I, for her, said goodbye to grade 4.

 

Who would have thought, at this time last year, that our world would be so changed?  That coming home from work would be an ordeal of decontamination, that I wouldn’t be able to hug my children at a moment’s notice, that I would fear for my own and their safety every time I entered my Emergency Department?  How could we have known that grandparents would be isolated, families unable to touch eachother or have Sabbath dinners for fear of exposing each other to a fatal disease?  Thankfully my parents taught me very early in life to love and love hard, like tomorrow would never come.  I am so glad that we had dinners with my parents and my sister every week, for years, before covid.  We are blessed to have had so much time to be happy, to be together, so that we could save up those memories and get ourselves through these hard times.

 

For now, we will continue to be strong for our children, to love them, and have them love us, as fiercely as possible, as if the world is ending.  Because it is not, and one day we will remember how much we loved and how much we pushed so that we would stay safe, and keep eachother safe, so the world will go on.

 

So for now, run to me, my children, but stop a few feet away.   In half an hour when all the fomites have rinsed off my body and many tears have spilled in the shower, we will snuggle and reassure each other that we are still here, we are still alive.  One day this will all just be a time we lived through; we will tell your children about how “once upon a time, when your parents were just little kids like you, the world changed – and changed back.”.

Pandemic

I am a front line health care worker.

I am an Emergency Physician.

I am also a mother to two glorious, growing, miraculous children and wife to a handsome triathlete stay at home dad.  Additionally, I am one of three daughters to a pair of still practicing exceptional pediatricians in their late 70’s, and sister to two strong, beautiful women.  I am also a severe asthmatic well controlled only by being on puffers and a medication called a biologic, which can compromise my immune system.

And now, I am one of the hundreds of thousands of physicians trying to stand between a monster of a virus, and the citizens of the worlds’ countries who are vulnerable to it’s fangs.

The people I work with are heroes; doctors, residents, nurses, orderlies, xray technicians, unit agents, registration clerks, security guards, respiratory therapists and so many more.  They come to work each and every day with fear in their hearts but passion in their souls, and devote themselves to caring for patients.  In the background the defenses are being laid by remarkable people who have been working day and night preparing protocols, simulations and contingency plans for us all to fall back on when the enemy breaches the gates.

And that enemy is coming for us quickly.

Going to work in my hospital used to be enormously pleasant.  We worked hard, all of us, because we had the highest volume of patients in the surrounding regions yet our flow was exceptional due to the intense devotion of our group.  The social banter was always there, smiles and jokes happening all around.  We were a family.  We still are.

But coming into work these days is like entering a war zone.  There are barriers that come up randomly and block movement, so that a covid patient can be transferred without risking contaminating others.  There are signs on patient doors that say “STOP” “CODE C”; reminding that the patient within can pass the contagion to anyone that comes in unprotected.  Pandemic carts sit open in each section of our department, with N95 masks, impermeable gowns, long gloves, hair covers, plastic stethoscopes, and the material to urgently resuscitate covid patients.  The mood is different; eery silence permeates the empty hallways and waiting rooms, and the lively conversations of before are muted.

Fear thickens the air, causing me to wade through curtains of anxiety each time I leave my car.  I steel myself for what’s coming by closing the door to my heart as I close the door to my vehicle.  By the time I reach the elevator I am ready to face the shift, though deep inside I am teetering.

When I don my armour and prepare to enter a room, it is a dance such as a surgeon does when she scrubs.  Gown, and tie at neck and waist.  N95 mask, two straps, make sure they don’t cross.  Mold to face, breathe, breathe out and feel for air escaping.  Face shield, then hair cover on top, tuck in the braid or ponytail and ensure no whisps creep out on the sides.  Long gloves, pull up and straighten over the wrists of the gown.  Plastic stethoscope in hand.  Walk to the door, sign the sheet to show you’re entering the room.  Breathe.  Enter.  Breathe.  Speak with patient, examine as best you can.  Time to doff.  Make sure someone watches from outside that you don’t screw it up.  Wash gloves, peel off gloves, wash hands.  Peel off gown and discard.  Wash hands.  Exit room.  Hair cover off, wash hands.  Face shield off while leaning over, wash hands.  Last and most dangerous; the mask.  Lean over, pull bottom strap over head, hold down straight, take other strap off over head.  Pull mask away from face slowly, drop in garbage.  Wash hands.  Wash again.  Breathe. Breathe. Breathe. Walk away.

This dance is repeated many times each day now.

At the beginning, our team ran a simulation one day to see how such a scenario would go.  We learned to don and doff.  We got the hang of it.

Slowly, our board that shows the patients in the rooms began changing colours.  It used to be full of pink, orange and purple squares, signaling new patients or patients leaving, etc.  Suddenly a new colour began to creep in, and has now taken over most of the board.  Poop brown, or puke coloured, fitting, signaling to anyone looking that the patient whom that square represents is being tested for covid.  First there was one square.  A couple of weeks ago.  Then a few more.  A few more.  Suddenly most of the board turned shit coloured and it’s stayed that way.

We are also working in our ambulance garage, triaging rule out covid patients.

We are running simulations on how to intubate a covid patient while wearing our personal protective equipment, and how (if) to do CPR on these patients.  We are learning to stop CPR.  We are learning to change how we approach each case.

 

And here we are; officially in it.

The pandemic has made it’s way to us, and within a week or two we will be overrun.

The enemy will breach the gates, of that I am certain.
It remains to be seen how our secondary defenses will hold; how our shields will protect us individually, how many of us will fall.

We know this is a war we may not entirely win.  We will take heavy losses.  But we are fighting it every day.  We are fighting not only for survival of individual patients, but survival of our way of life.  Our world has changed drastically in a matter of days to weeks, and may change much more in the near future.  It is up to us to make sure that the world we knew is there waiting for us on the other side.

 

So the Emergency Physician superhero goes to work, but the Mother superhero comes back at the end of each shift.  Mommy and Daddy don capes and fly to rescue our children from despair.  We take them outside and bike, scooter, play frisbee.  We do arts and crafts. We play board games.  We home school them.  Most of all we shower them with love and make sure they know that this world is going to be there when all is said and done.  School will resume, one day.  Friends will still be there, and can be chatted with over facetime or zoom until they can once again play side by side.  Pools will one day re-open, tennis lessons will resume, piano will be played, horses will be ridden. Grandparents will be hugged, and kissed, and loved.

Life will continue.

Yet when I close my eyes at night the darkness grabs me by the throat.  When I drive home from work the empty streets yank sorrow from my soul and it’s all I can do to see through walls of tears.  Remembering childhood innocence and wishing my kids could play at the park feels like a punch in the gut.

And I am left reeling, shaking, gasping for air in a world that wants to steal my breath.

So I go to work, each day, both at home and in the Emergency Department.  I risk my life.  I work for you, for our future, for the future of our children, and the future of our world.

#stayhome.

Covid 19

 

You are new.

I dress

Slowly

Under watchful eyes

I don my armour.

 

Walking in,

We meet.

Your presence crawls

I feel it

My patient is sick.

 

You are an enemy.

A new one

A snake coiled

I keep you at bay

Knowing your danger.

 

I sense it

The spectre

Lost, in the wrong host

Searching

Taking life

 

I challenge you, breathless.

Darkness

Illness

Novelty

Pandemic

 

My patient’s eyes

Search me.

“Will I survive”

They say.

I don’t know.

 

Slowly, carefully,

I wash my gloves

Strip off the protection

Gloves

Wash

Gown

Wash

Hat

Face shield

Wash

 

Leave the room

Antechamber

Wash

Remove one band of the mask

Pull down

Remove the other

Hold straight

Don’t shake

Drop into trash

Wash

Wash

Wash

Exit

 

Wash again

Breathe

Move on.

Birthday

It’s my birthday today.  I am 41.  How did that happen?  In the mirror I can see silver in my hair.  It shines like the gold my hair used to resemble, when I was seven and the world was a magical, beautiful place.  Now the sparkle in my tangles reflects the life I have led until now, the highs and the lows, the love and the pain.  It becomes steel that guards me until the workday ends, and I come home to my safety.

When I get home from a long shift these days my head aches with the stories of others.  It used to be that my heart was shielded by a wall that I erected, when I worked as an ambulance medic through times of terrorism and fear in Israel.  I built that barricade when I realized how soft and sweet I was, how young and innocent, trusting and naïve.  I kept it up so that no one could interpret my emotion as weakness; I girded myself against judgement.  That fence around my heart became a dense thicket that kept the reality of medicine at bay; it forced the daggers of others’ suffering to turn away from injuring my soul.

When I became a mother, my carefully constructed mechanisms for shelter crumbled.  Exposed, I could no longer hide behind my shields.  I had to become open, available, unguarded.  My children needed access to all of me, so the armour fell away with a shiver.

Now, I am defenceless.  I am vulnerable.  My patients’ pain finds its’ way into me, and though I may not show it nor feel it during the moments I care for them, their journeys weave silver tendrils into the twists of my ponytail.

So, here I am at 41, and the weight of my life’s choices sit heavy on my heart.  I know I do what I do because I am good at it, and it makes a difference in peoples’ lives.  I save lives.  But I also change lives.  I am the face they see when a diagnosis is given.  It’s my voice that echoes in their nightmares.  It’s my hand that sits hot on their shoulder as I give a life sentence.  They meet me once, and I destroy their souls.  I know, it’s not me, I don’t cause the illness.  But I introduce them to their destiny.  In so doing, I chip away bit by bit at the parts of me that still believe in a higher power.  Every time I see a young person, an innocent, struck down with the lightning of fatal illness, I question.  When I read a radiology report of a new ovarian cancer in a thirty year old mother of three, I feel sick; when I used to raise my eyes to a heaven and ask why, I now look inside and wonder who I was asking to begin with.

41.  At the cusp of losing my faith, at the cusp of gaining my faith. It seems that life is not what I thought when I was seven.  It’s not simple.  And sometimes I wonder what it is at all?  Does what we do each day matter?  When I ask myself those things I feel a real fear, that all that I believed and all that mattered to me meant nothing.

Then, I look at my children.  My incredible, spectacular, interesting, innocent kids.  And I remember – they came from somewhere.  Somehow.  They make 41 the best age of my life.

Haunted House

When I was a medical student, I spent two months of my clerkship at a psychiatric hospital that sits atop a small mountain, rising up from the rocks, a place that to this day sends shivers down my spine.  It may not sound like a place one would enjoy, but the time I spent there was in fact both interesting and alluring.  Encountering patients in the midst of their struggles with mental illness opened my eyes to another existence; one that I did not recognize from having lived it, but that I understood somehow deep within my soul.

 

The Hospital is a behemoth, a nightmare come to life, the monster under the bed.  Within its’ walls stories are told verbally, emotionally and physically.  I remember sitting in group sessions with senior psychiatrists and a room full of patients in the throes of psychosis, depression, mania, all interacting or withdrawing at their own level of comfort or ability.  We would listen attentively to complex, colourful and vibrant delusions; these tales woven by the psyche of a patient were tangible to them and as a clinician it was often hard to tell reality from confabulation.  Some believed the radio or television spoke to them directly; others believed magically that the world turned just for them or that a higher power spoke through them.  Others were dark, and told frightening accounts of what they had perceived had happened to them that night or early morning when supposedly alone in their beds.

 

I was assigned patients throughout the two months, and during my time on the inpatient unit I remember very specifically one young woman whose illness terrified me.  Interviews with patients were done privately, either in clinical, white walled spaces, or in a patient’s own room.  I entered her room; she was eighteen, tall, thin and devastatingly beautiful.

But her eyes were wild, if you looked carefully.

 

At first, she sat, calmly, on her bed.  She spoke with me, like any young woman would with a person of around the same age.  Not much older than her, I related to her situation. Here she was, in a stark cage meant to keep her safe, to help her heal; trapped in her own mind she had multiple locks to shatter before she could fly out.  Suddenly in the midst of normalcy she threw her head back and shrieked at the ceiling; she hurled her lean body down on the bed and suddenly I was in The Exorcist.  Speaking in tongues she had become a demon; no longer but yet still the girl who had sat softly on clean sheets.  Arching her back, fighting with someone inside her mind she sent ice through my veins as she tried to pull me into her encounter; as I struggled to guide her back to me she yanked my mind just as thoroughly towards a place I did not want to go.  We separated as I backed quietly out of her space and fled slowly down the hallway to find my attending staff.

 

First episode psychosis, was the official term for this presentation.  She had never had any psychiatric issues before, and over the last few months had been withdrawing from her family.  She had isolated herself in her room at home, refusing to go to school, talking to herself, at times frightening her family in the same way she scared me.  Prognosis?  Unclear.  I left her to her possession and spent the years since meeting her still unsettled.

 

Another sparkling memory that pokes it’s sharp teeth to the forefront of recollection is perhaps the most physically disturbing of all.  On call in a psychiatric institution at night is not a place one particularly relishes being.  At least not I.  In the basement of the Haunted House we had a call room, with lockers, a land line phone that sometimes worked, a couch, a washroom.  It was locked with a key.  Down those stairs my heart fell like stone, eyes always searching, feet quiet, in the cavern of that deep dark space.

Reaching the door and closing it quickly behind was always a relief.

 

One night, the hairs on my neck tingled and suddenly I saw a man looming out of the darkness.  Not far from the call room door I froze, unsure, whether to run for it and lock myself in or turn back and try to make it to the stairs.  This man was not a physician, not an orderly, not a nurse; he was not even a harmless patient who had gotten lost.  This was a 6”4 criminally insane, violent, rapist.  He was supposed to be in the locked inpatient unit upstairs, and in and out of an institution where criminals with mental health issues are sent.  Instead, here he was, and I can still see the shadows on his face as he perceived my fear.  Lunging for the room I flung myself inside after fiddling with the key, slammed the door, and called upstairs to notify security that there was a very dangerous patient lurking in the basement.  His quiet, calm, fearsome demeanour still haunts my nightmares to this day, as I feel him stalking the dusky corners of my thoughts.

 

And yet, this Hospital taught me so much about medicine, my patients, and the mind.  It was a fertile ground for growing the crops of my learning.  When I work, I carry the nuggets of insanity in the back pocket of my scrubs and draw on all that those patients taught me by allowing me into their intellects.  Sure, cavorting in the unstable psyche of the human brain is a startling experience; but it expands one’s own understanding of the way we all think.  Comprehending abnormal allows me to better recognize normal, and to better identify with my patients who are caught in a world we cannot see.

 

Writing Retreat

Last week I participated in a Writing Retreat for physicians, in Banff, Alberta.  I was inspired and learned an incredible amount about the creative writing community in medicine, as well as about fiction, poetry, non fiction, publishing and more.

Here are my before and afters.  There is a lot in the middle, but that can come later.

_______________________________________________________

On the way

I am somewhere in the sky over Hudson Bay (as per the flight map), on my way to Banff for a writing conference.  I’ve been looking forward to this for months, and can’t believe the day has finally come.

Flying alone, without my husband or kids, is a strange but somewhat welcome feeling.  It’s a freedom I don’t often get; I am carrying only my own bags, my own passport, my own snacks.  I am not lugging and schlepping, not constantly looking behind me or ahead of me, not calling out for someone to wait or hurry.

It’s quiet, and calm.  That’s a good thing, but I do miss the little hands and upturned faces.  However, as much as my family has become my whole world, I am also allowed and allowing myself to rediscover the rest of me.  I have so much inside me, so many stories yet to tell, so much to experience for me.  The more happy and peaceful I become this short trip, the better a wife and mother I can be when I get home.  They deserve all of the best of me, and often I feel that I selfishly deny them much of that – in order to give myself breathing room.  My days are constant go-go-go, give-give-give, love-love-love.  It’s nice to not do that.  Even for only a brief moment in time.

Looking forward to peace.

_______________________________________________________

On the way home

Outside my window snowy peaks sleep behind a veil of black night.  I sit cozy in a bed just big enough for stretching ones arms out in repose, snuggled in warm blankets and ready to sleep.  In my mind’s eye bears lurch through dark woods on the hills all around, elk wander softly along grassy paths, and birds rest in stupor awaiting the dawn.

Tomorrow, I will leave this place of beauty and wilderness.  The shuttle will take me, drifting, to meet the plane that will take me, floating, back to my life.  I will come home to you, my little ones, and to you, my life’s partner, but I will leave a small part of me back here.

Mountains inspire me, and forests soothe me.  Landscapes, vistas that make the heart sing and the soul blaze in fire – these call me to them.  All I want to do is walk out of this room in the cool morning and wander into the forest, up the path I can see from this window, and melt into snowscapes as the flakes do in a storm.

Yet I don’t, my tether to you strong and solid, I feel it grasp me.  We travel through time together now, borne of my strength you now bind me as firmly as I once held you.  Love, need, joy, desperation; we move to each other as magnets once more.  I bid goodbye to the peaks, the bears, the elk and the birds – they will wait, and greet me when I return, with you, to meet them.

Donning the Healer’s Habit

Fourteen years ago I sat with my second year medical school class in the auditorium at the McIntyre Medical Building, the same room in which we learned anatomy, pathology, respirology, neurology, and a plethora of other things that formed the Basis of Medicine (as it was called back then, in my medical school years).  However, on the day to which I am referring, we sat decked out in our best regalia, hair done, fancy shoes, and parents, family and friends close by.  On the floor where our professors usually taught the intricacies of the human body, stood the Dean of Medicine and other important people in the Faculty.  The room smelled like flowers and champagne, and the whispers all around filled the air like butterflies in a meadow.

 

Why were we gathered like this, not even close to our Convocation day still years away?  In fact, we were celebrating a graduation of sorts; moving from our bookworm years into the world of clinical medicine.  We were about to be given our White Coats, the symbol of the Physician for at least the last hundred years.  Change was coming, and we were ready.  We stood, donned the coat, and emphatically spoke the words of an oath binding us to our training and this life we had chosen.  It was a day I won’t forget, because it felt momentous, life altering, and symbolic.

 

Today, I got to relive that special moment in time.  I was invited, along with many colleagues, to participate in the White Coat Ceremony for the second year students.  For the last year and a half I have been mentoring a group of six vibrant, intelligent, interesting students, who came into my life like a hurricane searching for land.  From day one they have felt like one of my most important responsibilities; at each of our meetings we not only enjoy each other’s company but discuss important topics at that stage of their learning.  As an Osler Fellow, I am meant to help guide them through these formative years.  I feel so blessed to have been asked to do so, because not only am I helping them grow, they are helping me as well.  Every time we meet, I feel excited.  I feel my world broaden, my perspectives expanded, and I am challenged.  I love it.

 

So today, as I sat in the second row of a packed ballroom full of family, friends and physicians, I reflected on how life comes full circle.  I watched my students each climb the stairs to where a faculty member stood, and I felt pride as each donned the white coat in turn.  I listened to inspiring speeches and a beautiful string quartet.  I remembered my own ceremony, the students who stood with me to recite the words of our oath, the innocence and anticipation palpable like a warm campfire in the room.  My heart also couldn’t help but think of the two students who stood with me that day, who no longer occupy a space on this earth, yet remain like a bright photograph etched in memory.  The rest of my classmates, scattered across the world, now practice medicine or some other field of work, raising families, chasing dreams we began so many years ago.

 

The faces before me, bright, young, open, joyful, inspired me again with a love of this work we all do.  Years ago I pledged myself as they did today, and I meant every word.  Today, they spoke words that I hope they will remember and take to heart.  They recited hopes to reflect humbly on the privilege of the position, “be guided by integrity, curiosity and humility”, recognize the limits of ourselves and of medicine, have courage to ask for help, focus on healing the person and not just the illness, hold dear the notions of trust and respect, and remember not to let the white coat itself separate us from our patients.  This oath is beautiful, as it encompasses so much of the sacred nature of being a physician.

 

However, by taking a white coat on their shoulders, these students are accepting a mantle of responsibility that does not come lightly or easily.

The practice of medicine is hard.  It is joy, light, invigorates us but can also destroy us if not approached with care.  Learning to Doctor also means learning to doctor ourselves, to seek help when needed, to find ways to balance our personal and professional lives.

Learning to heal also means learning to know when to remove the figurative white coat and separate oneself from one’s career, to go home and drop it all, be present in your life that is outside medicine.  Being a physician can be all encompassing, and for some this is the way life will go.  But physicianship can also exist in equilibrium with the rest of non-medical life, and I hope the students today remember this as they move forward in their training.

 

As I moved around the room after the ceremony, meeting and speaking with the families of my students, my heart swelled.  The smiles on the faces all around, the pride and happiness in the room, buoyed me as I stepped outside again and back to my own life.  I thank my students, as well as the Faculty of Medicine, for giving me these exceptional experiences that continue to mold me into the best physician, teacher, mentor and person I can be, and for allowing me back into the world of a learner, even for just a few hours at a time.

Discovery

Sometimes I forget how old I am.  I look at a worm on the ground in the rain and want to make a home for it in earth like I did when I was six.  I see the inviting grass in the park and want to lay down and search the clouds for shapes.  I walk into my parents’ home, my childhood home, and want to forget adulthood, sit in the living room and read a book on the leather couch while the sun splays warm egg yolk through the old window squares.

Then I remember, as my children start yelling in mom’s kitchen, that the worm can’t make a home in my mudroom because I don’t have one, and the grass won’t let me lie in it because I have too many places to be.

 

I am jarred back into reality, who I am today, the age, the years, the incredible life that has happened between ages six and forty.

 

Last week I spent an afternoon as I have many times before, in the medical simulation center.  No longer the learner, no longer reeling from performance anxiety and stress, I have now moved into the realm of teacher, supervisor, mentor.  It is my turn to sit on the other side of the one way glass and watch my students as they navigate the process of simulation.  This past session was about learning to take an “HPI”, or a “history of present illness”, from a patient.  When I was a medical student, we didn’t have such experiences.  We had no simulation center training until I was a resident.  We just got thrown into the real world with real patients, after book learning about the “HPI”.  My students now get to learn in a controlled environment, and after they attempt their own history taking, they get to debrief.  The discussion afterwards takes place in the same room as they just practiced in, and involves two or three of their student peers, myself, and the simulated patient.  The model goes like this: the student who did the simulation first tells the group how they felt it went, what they may have done well or would improve on next time.  Then their peers add in their own advice, followed by the simulated patient detailing their experience and how they found the student’s behaviour and questioning. Finally I, as the mentor/teacher, provide some of my own advice and insights.  The goal of all this is to help the students develop the skills of appropriate communication with patients; we discuss such things as the minutiae of open body language and avoiding distractions like fiddling with pens, the appropriate and inappropriate ways of asking questions, how to use a translator most effectively, etc.

 

During these sessions, I learn so much about my students (who I am mentoring for their entire four years of medical school), but I also learn about myself.  I dig deep inside me to find nuggets, pearls of information gleaned over the years of experience with patients.  I think back to who I was when I was in the position of second year medical student; how did I feel with patients? Was I comfortable, uncomfortable? Scared? Anxious? In fact, I was none of those things because I already had patient interview experience from my years as a first responder and then ambulance medic.  I was ahead of the game.  So then I find myself going even further back in time, to when I learned lifeguarding and first response.  How did I feel approaching strangers to ask about symptoms?  How did I overcome discomfort and stress?

 

Serving as a mentor to medical students is an exceedingly reflective and humbling role, and I feel blessed to have been recruited into this program at my University.  Someone thought I would connect well with the students, and I like to think they were right.

Every time I have dinner with these students, mentor a simulation session or bring them on observation shifts in my Emergency Department, I feel something special – pride, joy, the intensity of discovery, through their eyes.

Then, for a few minutes, I feel six again, discovering the world anew.

 

Looking back – the NICU

Periodically I like to reflect on the journey I took to become the physician (and mother) I am today.  Here is an excerpt from my time as a third year medical student working in the neonatal intensive care unit.  I can still feel, smell and hear the sensations described in this piece, and it reminds me of the passion and wonder of my early training years.

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2006: The NICU

For weeks I’ve been dreading this part of my pediatrics rotation – the Neonatal Intensive Care Unit.  Two weeks of psychological trauma and sleep deprivation, according to those who went before me.  Therefore I was understandably quite nervous on the morning I walked into the bright, loud, extremely full NICU.  I chose to take the first call shift, on the first day, because I wanted to dive right in and get the gist of things quickly.  So on Monday, with butterflies flapping up a monsoon in my belly, I donned my scrubs and took the call pager for the next 32 hours.  No regrets.

The NICU is a whole new world full of new sounds, smells, sights, tastes and touch.  Some of the babies are so tiny it’s hard to imagine that they are really there at all – one 24 weeker weighed only 530 grams at birth (imagine that, it’s barely over one pound!).  We have a baby that was born at 23 weeks – that’s below the usual threshold for survival (24 weeks, when the lungs start producing surfactant, a soapy substance that keeps your alveoli – air sacs – open).  We also have big babies born to diabetic moms, a baby born addicted to methadone and in withdrawal, some babies who were just too small at birth and need nutrition, triplets, and more.  Just the sight of the 24 weeker whose feet are the size of my thumb (and I have small hands!) and in whose body courses blood the equivalent volume of maybe ¼ can of soda, is something that takes getting used to.

Babies smell differently, as we all know, but they smell even more foreign when they’ve just been born and are lying under my hands as I wipe them down and suction goop from their mouths.  I can’t describe the smell – but not unpleasant by any means.  Taste is a sense I didn’t expect to experience in this rotation, but my lips have an icky rubbing alcohol taste to them thanks to all the handwashing I do every day – I guess somehow after I wash some of the stuff gets on my face (after seeing the baby, of course).

And sound – the NICU assaults my ears like no other place in the hospital so far.  There was only one moment of relative quiet today, at around 7:45 a.m., when the monitors for once were silent and the babies weren’t crying, and the nurses weren’t all talking.  Otherwise – imagine one large room full of over 32 crying babies, add in about 30 monitors all clanging and beeping away with alarms that generally mean nothing, then on top of all that add in the regular noises of a hospital ward with families and nurses and doctors all conversing.  Then, periodically, throw in some strange clanging followed by a hollow intercom voice warning of a code red (fire) somewhere in the hospital, and phones ringing, beepers going off and overall one big hullabaloo.  Next – imagine you’re a little tiny premature baby in an incubator, trying desperately hard to feed and grow and overcome your obstacles, and every moment of your day is full of an assault of noise.  So when I come home to the peace of my apartment, I try hard not to complain to myself about the headache – because I remember that I’ve left my patients, my babies, back in a room that never quiets, a land that never sleeps.

Finally, touching these little infants, these barely former fetuses (my Dad’s great expression that he uses about me all the time but that seems to fit these babies to a “T”) stirs in me something very human, very primitive, very womanly and motherly – call it maternal instinct.  My attending said to me today as we were watching a delivery of a premie, that he could hear my biological clock ticking.  I denied it, but inside I knew how true that was.  The skin of a baby, of a premie, is so fragile and shiny and thin sometimes that you almost fear to touch it because it seems like it should just melt under your fingers.  I am continually amazed that the infant stethoscope I am using on these teeny chests doesn’t rip a gash in their frail skin.  But then, the older babies (still premature but not extreme) are so soft and downy, warm and cozy that sometimes I just want to scoop them up out of their incubators like the nurses do, and comfort them in my arms.  Today my attending called Marc and I to come observe him doing a circumcision in the normal nursery (where the regular not-at-risk babies go), and he asked me to keep the little boy (2 days old) calm and happy throughout the procedure.  A daunting task – some strange man is looming over you with some strange metal apparatus, about to cut part of your penis, and some strange woman is trying to keep you from crying – is that going to work??  A trick they use in neonates is to give them some sugar solution before procedures, which gets their endorphins going and helps them feel less pain (theoretically).  So I gave the baby sucrose, then when it didn’t quite do the trick, I stuck my gloved finger in his mouth and let him latch on and suck.  The baby showed absolutely zero distress throughout the circumcision (performed with a local anesthetic) and actually fell asleep sucking on my finger while the physician was in the midst of cutting.  What a bizarre feeling, to have a tiny little baby sucking on your finger with incredible force.  I have to admit, it stirred up some strange unknown feelings inside, deeply physical sensations that only a baby sucking must be able to do to a woman.  But not unwelcome.

 

The NICU is a beautiful place – seriously.  I am loving my time there, completely unexpectedly.  The vulnerability of these little ones is astounding, and the teamwork involved in ensuring their survival rivals the multidisciplinary approach of the Saint Mary’s geriatrics ward.  The medicine of the place is complex physiology at it’s best and worst for a med student like me who needs to search her brain for the deep seated subconscious memories of first year.  Then there is the acuity of it all – and I love acuity.  I thrive on action, getting my hands into the thick of things, resuscitation.  That is why I love emergency medicine – and in the NICU I get a small flavour of this.  This evening before I left at 7:30 pm, I was rounding on some of my patients when my attending and I saw one of the nurses bagging a baby who had pulled out his own endotracheal tube (what we use for intubation, to help the baby keep his airway open).  We immediately stepped in, and it was so natural to me as I took over bagging the baby (giving breaths with a bag and mask).  He was so calm, my staff, and so was I because for me this is what medicine is all about.  As the baby started breathing on his own and just required oxygen by nose, inside I felt magic.  Watching his parents walking to the bus stop ahead of me upon leaving the hospital, hand in hand with sunshine in her hair and a smile on her face, I felt what it is I am here in medicine for.  We saved this baby’s life in a few short moments of breathing for him and cleaning his airway of vomit – and in those few seconds we gave hope back to a frightened couple who thought their baby was on the brink.  That is medicine at it’s best, saving a life, inspiring hope. As the Talmud says “one who saves a life is as if he/she saved a world entire”; by allowing a baby to live, you give it a chance to grow and one day have children of it’s own perhaps, and a whole new world around that little soul.

 

Yes, the NICU is a place of fear, but through it runs a river of magic.