Ignore and Override?

The house is asleep, and I can’t turn off my brain. I just cried my way through an episode of Seal Team, especially the part where two Seals are opening up to a psychologist about feeling broken. One says he’s tired of pretending he’s ok, that he has PTSD and needs help. Later he breaks down and his wife folds him in her arms, and tells him she’s there to pick up the pieces.

I feel like that Seal. Maybe that’s why this show resonates with me. After all I’m not one for gratuitous violence and warfare; I’ve often asked myself if I only watch it because I have crushed on David Boreanaz since he headlined Buffy and then Angel. But no – now I see, the hell they go through reflects the hell we go through in medicine.

These days it’s really hard to self-reflect, and to allow others to read my words or feel my emotions. There’s just too much pain in our world now, and everyone is suffering. What makes my pain more important than my neighbour’s? Nothing. But I’m going to allow myself to write about it and let others read it because maybe it will give you, the reader, license to sit with your own grief by feeling mine.

Every day I go to work, it’s a minefield. I never know what or whom I will meet and maybe destroy, and be destroyed by. When I pick up a chart for an ankle sprain, that patient could be the woman whose husband pushed her down the stairs and that’s why she sprained her ankle. Or the chest pain in a 20 year old man could be lymphoma. Or the constipation in the 40 year old exceedingly kind looking man with the soft accented voice could be new rectal cancer.

After a minor car accident a few months ago, the X-ray of her ribs was normal and my patient was sent home by the physician she saw at a community hospital in Ontario. She was still in pain three months later, so she presented to the ambulatory side of our ED. I figured, when I saw her, maybe a small fracture was missed and it’s not healing well, or perhaps it’s all just muscular pain. My clinical assessment found tenderness along one rib in particular. Repeat xray showed something not quite right, so I ordered a CT. Before even reading the whole report, in my haste to keep going and see new patients, I called her into the reassessment room. She met me smiling and thanked me for the analgesia, that had dramatically improved her pain. Reading the concluding statement of the report as I stood across from her expectant face, I took a sharp breath and without the ability to self edit I said “oh no, I’m so sorry”. Then “let’s sit down”. Her face froze. I had fucked up. I had stabbed her in the heart with my stupid words. Thankfully her husband was there and guided her to a seat. A harbinger of doom, I read the words aloud that sealed the fate not only of herself, but of her lover and her family, forever changing their lives.

Metastases. Multiple. Unknown primary.

Her eyes, wet. Her husband’s eyes meeting mine, knowing. The world shifting.

It was however, as if she already knew. The gnawing bone pain waking her and keeping her from sleep could only be one thing. And she knew. She just knew. And she tried her best to be strong for her husband. Together, they accepted the words, the plan, the further CT scans that found a large lung cancer. Together, they stoically met the dangers with swords in hand.

And me – I am devastated. Crushed. Heartbroken. Not only by the diagnosis and knowing what comes next, but by my failure. My failure to keep my mouth shut, to hold, to wait. Maybe it’s burnout, exhaustion, sleep deprivation. Maybe it’s stupidity. Maybe it’s delirium. No matter what, it’s awful.

So I know how those soldiers felt, in their moments of emotional agony. I feel it too. Emergency Medicine, medicine in general, hurts my soul in ways I never knew it would. Sometimes I wish I didn’t know what I know. Walking into a room after reading a triage note, and already knowing what I’ll find. Knowing the diagnosis and the denouement of my patients stories way before they do. Prophecy of sorts, based on training and experience. And prophets have never had it easy. Foresight is a curse, a crutch, a needle always stabbing just that right spot where the pain is always fresh.

Medicine also lifts me. Sometimes. But lately? Nope. It has drowned me.

And I feel broken too. Hoping somehow to mend the pieces, sew them together like the wounds I’ve fixed at work, stitch them or crazy glue them until it’s possible to continue. The Seals on the show say “ignore and override” – this can be said for physicians and nurses as well. But it’s not the right thing to do.

I hope by reading my story and hearing my struggle it can help you with yours. Don’t let Medicine crush you. Fight back, with all your strength. Talk about it. Write about it. But let it out. In the space between people there is healing – there is space for all the hurt inside to come out. Though you may be scared to burden others, if they care for you, let them be your parachute.

Mark: One Year

March 5, 2021

3:07 a.m.

One year later and this pandemic rages on. These days I’m more and more taught, my muscles reflecting my mind as they ache and pain.  Work gets more frightening each day as those I work with get sick.  Now I get phone calls for contact tracing (“did you work closely with so-and-so last week? Did you take your mask off at all during your shift?”) and more of my “cold zone” patients end up hot. The stress rises and sometimes peaks; I erupt volcanically with tears, raising my voice to my family at any little offense when really the problems lie outside our home.

When I come home to a full bed as I did tonight, two kids, a puppy and hubby all snuggled and at peace, it reminds me why we chose this path of true isolation. I remember why my kids aren’t in school, why I pulled out of the hot zones back in May, why we remain so strictly alone. This is my family, these are my loves, pieces of my soul. Their health, my health, are paramount to all of our mental health. Keeping them all safe is my responsibility; worrying that I could bring this raging beast home to them is the most scary thing of all.  So I work in the cold zone, sacrificing some of my favourite parts of emergency medicine, to keep them safe. I sit with the kids all day, distance learning grade 5 and kindergarten, so that they will be educated and stimulated even if not in the physical classroom. I drive hours twice a week to bring my girl horseback riding, and another day each week to go ski, because they need the distractions and the outdoors. 

I’ve come to understand that this time is not for me. It’s not about me. It’s about ensuring my children make it through to the other side of covid intact, happy, strong and sweet. They are the most important pieces of my puzzle, and their health is all that matters.

Friday evening stroll

Scenes from my neighborhood, walking my dog on a warm, wintry Friday evening before curfew during a pandemic:

A bus brushes by me

Police settle in to wait for their prey

A mother and child play I spy on the sidewalk

Twinkling lights on trees, homes, posts

Empty, dark parks void of play

Pedestrians give each other a wide berth as we pass

Children play hockey on their backyard rink lit by street lamps

Elderly couple says the sabbath blessing over wine on a back deck separated from the family inside by a sliding door

The Rabbi on our street smiles and says “Good Shabbos” walking by

Empty streets

My dog’s breath

Quiet steps in the night.

Covid daydreams

By now I’m sure most of us have had the Covid dreams, as I have. The ones where I am going about my usual activities and suddenly I realize I’m not wearing a mask. I freak out, like I used to do in dreams when I realized I was in class naked, or wearing only underwear at work. Now it’s mask and distancing anxiety manifesting at night in dreams.

But I also have Covid daydreams. I wonder how many of us do. Each time I enter the parking garage at work I can almost see the covid zombie jumping out at me from between two parked cars. I clean my hands, phone and ID tag as fast as possible, change my shoes and hop in the car quickly, always sensing some horror just outside my peripheral vision.

Then there is the one about one of my closest friends getting sick, and I can see myself kneeling by the bedside as they struggle to breathe, me in PPE and alone as no other visitors are allowed. It’s devastating and frightening, and I’ve been seeing this vision since about a month before the pandemic set in.

Dreams and daydreams used to be safe spaces to let imagination roam; this beastly virus has taken that soothing place from me and likely from many others. If only sleep would give peace, if only my waking meanderings of thought were pleasant.

Let’s hope once this thing ends that I return to flying over landscapes and adventuring through time when I close my eyes.

Vaccinated

Second wave

Deep into it

Kids are distance learning

I am working cold zone

On December 16 I received my Covid-19 vaccine! First dose of two, and I feel stronger already.

I feel weaponized.

Hardened.

A bit safer.

Less vulnerable.

Relieved.

But I also feel sad, frustrated and impatient, waiting for my family to gain the protection that was handed to me.

Until Elie is immunized we won’t feel safe sending the kids back to school; until my parents are vaccinated I won’t feel safe enough visiting them. I can still catch and transmit this awful virus, and God forbid my family’s safety is jeopardized because of me.

But I feel so much less afraid.

For the first time in 9 months I believe I will survive this pandemic.

For the first time, I live my days without a waking nightmare of myself on a ventilator.

I can see the end of this, and the days beyond Covid.

And it gives me so much hope.

Second wave

Another late night, another return from work, another exhausted walk naked from garage to shower.

9 months later and this pandemic isn’t close to being over; long enough for a baby to be born but not for a demon to be destroyed.

9 months of solitude and sorrow, spliced with joy and family.

9 months of being forced into a real, tight, exclusionary nuclear family.

9 months of being hugged and touched only by the three I love most, but distanced from the others I love equally strongly.

When will this end?

Human Touch

1:17 AM

The emerg locker room, in my dirty scrubs

“Can I touch you?” she asked, as we faced each other.

Would it really have been right of me to say no?

Standing there I felt naked, feeling my bare arms exposed to the room, anticipating the touch and dreading it at once, wishing for the protection of the yellow gown worn in the examination room.

We were standing in a room full of recliners stuffed with patients, by the nursing desk. Unclothed in my armour, wearing but my short sleeved scrubs, mask and safety glasses, feeling vulnerable – and in my discomfort I felt sharply her raw need.

I did not refuse.

She placed her hand on my arm like a feather, a slight grip, enough for her to feel my humanity. Alone, solitary, her husband recently deceased and her children living out of town, this elderly lady needed what only human touch could provide.

The tears in her eyes like glass, the hand on my arm like a weight underwater, I let her stay there for a moment. Frozen, warm, I waited until she released. We parted, to meet again later.

Can I touch you?

Can you touch me?

These gestures, so simple before, so rare and even frightening now. We are living in a time of complex emotion, in a time of physical division, when what we all really need and crave is unity. Touch. Each other.

She touched my arm, and I was touched. And reminded, of the little moments that I can give my patients, that have nothing yet everything to do with being a healer.

Letter to my children

Letter to my children

I’m sorry you missed the first day of grade 5 today, my girl, and I’m devastated that you will miss your first day of kindergarten tomorrow, my big boy. This isn’t how life was supposed to go. You weren’t supposed to experience hardship in childhood. You were meant to have a peaceful and stress-less development. I was supposed to be able to protect you, as your mother, from sadness and distress.

But I can’t.

I can, however, protect you from sickness. I can keep you safe from disease. Your dad and I have chosen to keep you home with us to shelter you from this sweeping pandemic that has rushed like a wrecking ball into our world. We will help you learn at a distance from your peers, but connected by the same screens we often hate. We will sit with you, encourage you, emotionally support you. I vow to do this, to the best of my ability as a mother and a person.

When this is all over you will still have missed this special transition to new grades, new phases of life. You will be behind socially. You will have to work even harder than normal to integrate into a group. You will feel left out. You will cry. I know this. But I also know that you are both sweet, smart, friendly and are learning resilience. You are fighters, survivors, like I am. You will break through the barriers that covid has erected, and you will become the people you were always going to be.

Let’s enter this journey together, my loves, and we will come out the other end stronger as a family and as people.

Love

Mommy

Moving forward

Life has changed.  Will it go back to normal? Hard to say.  If, when, where, how?

 

Motherhood has changed.  Become better, in some ways.  Become harder, in others.  Keeping my children safe means something much different today than it did a year ago.  I keep them closer, rules are stricter, the leash is tighter.  And not by choice.  I would love to give them the freedom they need and deserve; to let them run gleefully in the park with friends, hold hands with others, climb playground structures and hang from monkey bars without worrying about who touched the surface just prior.  I wish I didn’t have to keep calling “keep your distance”, as they bike on our street with the neighborhood kids.  I wish I didn’t have to worry about the babysitter exposing the kids to a possibly fatal illness just by virtue of her having a new boyfriend.

 

However, I am thankful for the extra time with my children.  Spending days with them, talking, hugging, playing, swimming in the lake, discovering new experiences together, it’s a blessing.  Even the thought of homeschooling them come fall is exciting to me – and to my daughter.  We talk about the curriculum and how we will learn cooking, gardening, how to fix things, nature, and so much more.  What we can teach our kids at home far exceeds what a rigid school curriculum can encompass; we can focus on what is important while still making sure they get their core subjects.

 

But.

 

When I go to work, and watch the emergency department gradually fill again to bursting, I remember the danger lurking in the corners of our existence.  The serpent’s venom waits behind every contact; stealthy, it bides it’s time, ready to pounce if the slightest error is made.  While things look better here in Quebec, I see our board turning brown again with rule out covid cases.  I see our resuscitation room full of brown squares representing patients with respiratory illness going to ICU, who may or may not have the infection.  I observe many more cases of young people presenting through our hot zone garage, having symptoms quite likely to be covid.  This thing, it’s not leaving.  It’s here, it’s waiting to flow over again in a second wave of illness.  And scary to us as physicians, this tsunami may arrive in concert with the torrent of influenza and other respiratory disease, come fall.  Then what will we do?  Our department is overflowing now with regular patients, non covid, non flu – what happens in September, when kids go back to school, people go back to work, and the double edged sword of respiratory disease strikes?

 

My heart is full of love for my beautiful children, and full of dread for the future.  The calm surrounding me when I see so many people going about their daily lives, gives hope but at the same time fear.  I am writing this sitting outside a Starbucks, in a parking lot, at a table that I wiped down with an antiviral wipe.  I haven’t done this since February, and the only reason I allowed myself to do it now is because I’m the only one here.  I won’t step foot inside, however, but I see dozens of people doing so.  In they go, wearing masks, a new reality.  How safe is it?  I don’t know.  Nobody does.

 

So, we will wait, and hope, and survive.  There will be so many stories for our grandkids one day.  How their parents and grandparents and great grandparents lived through a pandemic, made the most of what we were given, and moved forward with more love than we had before, and more gratitude for eachother.

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