Growing Up

Today I did the normal attending staff physician thing of going to grand rounds.  Grand rounds are mornings of learning, with a few hours of interesting talks by residents, staff and visiting lecturers.  This morning, an old friend was our guest lecturer.

 

Fourteen years ago we began medical school together in the hallowed halls of an old building on the side of a mountain, and every day we climbed hills both physical and figurative as medicine poured itself into our minds and hearts.  For 18 months of clerkship, when medical students first interact with patients, we grew into being doctors.  On so many occasions, he saved me – and perhaps I saved him too.  I remember those days as if they happened yesterday; they were days full of excitement, emotion, and exhaustion.  Probably some of the most illuminating days of my life, I grew from a little wee baby medical student into a competent trainee physician.  But it was not an easy road, and it really helped to have a friend to lean on.  This friend stayed my constant, as somehow we ended up in almost every rotation together.  When medical school was finished, we went our separate ways into residency and our futures.

 

As he said today, “look at us now”.  Both of us ended up as Emergency Physicians, he in the US and me here in Canada.  All grown up, we have both been attending staff for years now.  We teach and train our own crop of medical students.  Listening to him give a dynamic and passionate talk, his words resonated with me.  The years melted away and I remembered why our friendship took root in the first place: our hearts are in the same place with regards to patients.  We both value our patients’ stories, the person behind the sickness.  We respond to our patients with patience, compassion, and an open mind.

 

Listening to my old friend helped me remember, today, the emotion and joy of what we do each shift, each patient encounter.  Seeing him, hearing his voice, brought me back to that day in Geriatrics, in 2006, when a little old lady refused to get in her bed because she thought there were cockroaches.  No one could convince her otherwise, as she was delirious.  But this young man, this third year medical student with not much experience but lots of compassion, hopped in her smelly sick bed and lay down to prove the absence of said cockroaches.  Wouldn’t you know it, she smiled and got back in bed as soon as he got back up.

 

So thank you, my friend, for being the confidante I needed when life kept throwing pain and fear and stress at us.  Thank you for giving the smiles and hugs I needed back then, when often life was so lonely even in hallways full of people.  And thank you, for bringing back memories and emotions that can hopefully knit their ways back into my daily practice, and help me find joy in the every day at work again.

 

Night shift love song 2

To my husband

 

When I leave you

You are alone

My car pulls out

The house is dark

 

Inside you sleep

But you are awake

You keep watch

You keep them safe

 

You are by yourself

The bed an empty space

No one to hold you

No one to keep you warm

 

I am awake

Wandering corridors at work

I care for others all night

But I am not with you

 

You are my strength

You guard our treasures

You are their rock

You are our foundation

 

But you sleep alone

I walk alone

Our paths cross so briefly

We live far apart

 

Yet our hearts are one

We work as one

Symbiotic organisms

Each half of the other

 

And our home is warm

A place of love

A house of peace

A source of joy

 

When I come home to your arms

My world is calm

You fill me up

Our hearts are one.

Night shift love song 1

To my children

At home

The lights are out

You sleep soundly

Your little hearts peaceful

Your bright beautiful brains calm

 

No doubt weaving dreams of adventure like quilts in the night

Soaring on air through wide spaces and light

Your breath like warm breeze quiet and sweet

Your hands open, your fingers reach, touch things I can’t see

Your hair tumbling on pillows softly caress

Your voices at times rustle like a flowing dress

 

Yet you sleep on, safe, warm, cuddled snug in your beds

 

Where I left you, when I left, closed the door to our home

Stepped into the night and out of your space

Now I walk through bright hallways, not free as you are

Awake, in the nightmares that my patients live out

 

I am here, taking care of strangers

I sit on their beds as I sat on yours

I hold their hands, as I held yours

I listen to their stories, as I heard yours

 

I am here

In the light, in the chaos

Wishing I were with you

In the dark, in the peace

Warm and snuggled in your beds

With healthy hearts beating close to mine

And happy souls holding mine.

A physician mother’s take on the news

When I went to bed last night and when I woke up this morning, I heard the reassuring sound of my children breathing in their dreams.

I went in their rooms, kissed their heads, smelled their scents, and walked away comforted.

I am blessed to be free and able to do these things.

I am lucky to live in a country where my life is not threatened, where my children are safe, where we are at peace.

I am fortunate to have never been uprooted, never had to leave all I know and love to find a safe place for my family.

 

Today, I am troubled, shocked, dismayed, and viscerally enraged when I think of families being separated at the border of another ostensibly safe and free country; the United States of America.  All I can see in my mind are the arms of mothers reaching for children who have been ripped, crying, from their bosoms.  All I can hear are the screams for parents taken to detention without having been given time to say goodbye or comfort their little ones.

 

While my children slept peacefully with mother and father only a few steps away, thousands of children just like them have been drowning in a sea of uncertainty and fear.

 

My heart breaks to imagine the tiny child lying in a strange room, in a strange cot, surrounded by strangers and a strange language.  I wonder how my three year old boy would cope, without the parents he so depends on and loves.  I can hardly do it, visualize that pain, without feeling my soul slashed within me.  To consider my eight year old daughter, alone, at risk, in danger, spins my mind in ways I would rather not go.

 

And what about the parents?

 

If I were suddenly faced with my children being dragged off, crying for me, with no way of knowing what happened to them or if I would ever see them again, I’m not sure how I would survive.  We are talking about the children, and their trauma, but let’s also consider that their parents (who are only trying to find better lives for their families) are going through a different but equal trauma.  Who will soothe their pain?

 

Today, I find myself a part of a movement of people of equal minds, equal wills, who are trying to make a change for good.

 

Let us hope, pray and wish that these families will be reunited and that the pain they have suffered will eventually be calmed.

 

And let us also hope, pray and wish that enough of humanity will continue to take a stand against evil, so that we are not thrown backwards in a wormhole of time to another place, another face, another monster long dead.  Let us not repeat history; let us forge anew a world where children are safe with their parents and no one fears that their safe haven will be instead hell on earth.

My mentor

Dear Dr. X.,

I am writing even though you will never see this letter.

I am writing because in the trauma room of the hospital you trained me at, you taught me to be an Emergency Physician.  You took me, you molded me, you showed me how to teach and how to be taught.

You helped me reach a strength inside of me that I knew was there but couldn’t always grasp.

You took my weak, and made it strong.

Watching you work so hard to save the lives of some of life’s worst people, showed me how to turn off the judgement, and turn on the medicine.

Working side by side with you on a 14 year old gang member, shot in the torso, you guiding my hands to compress his heart inside the open chest, that made me grow.  Finally giving up and letting go, you telling me to let go – that taught me that often, all we can do is let go.

So Dr. X., thank you for guiding me to strength.

Thank you for not being easy on me.

Thank you for all the support, a hand in the small of my back in the worst of traumas.

I still feel that hand every day.

The River

These days, my work feels like a place I go to for money.

Sometimes, all I want is to get home and rest, read a book.

But then, with a rush, the shift starts and soon enough a patient’s story will draw me in.

Suddenly work turns into a journey, a choose your own adventure tale where every choice I make as a physician spins me down a new river.

Without warning, one story ends and I am thrown off the falls into a brand new place, a new space, a new raft with a new patient.

Abruptly, work becomes whitewater, with everything rushing by; pieces of stories like driftwood hitting me if I’m not careful.

Then, as fast as it began, the book finishes and I give the now empty pages over to the next doctor, the next ship’s captain.

I clean my stethoscope, put my pens and my oars away, and strip off my dirty scrubs.

Naked, I pull on my new uniform and head home to the next raging river, where I’ll most certainly be carried away anew.

The Wheel

I remember the time when work was full of wonder.

Every day was amazing.

I woke up each morning with a spring in my step, so excited for what the day would bring.

Where did all the joy go?

Why is it hard to access the happy in my days?  It can’t be for lack of it; I know I smile and laugh at work.  Could it be because work is too hard?  Unlikely – I don’t find it hard at all.

The joy is lost, because these days work feels like someone else is running the show.  It’s all about seeing as many patients as I can, using as few system resources as I can, making sure to press all the buttons and do everything right.

This is not why I became an emergency physician.

I became a doctor in order to help people who are hurting.  These days I feel like often my patients are secondary – they are just cogs in a wheel.

How can I find that joy again?

Only from my patients.

Sometimes, on a night shift when the rest of the world is sleeping, I sit on the side of my patient’s bed and really listen to their story.  When I do this, I can feel that wheel inching to a stop.  It’s like a ship, straining at anchor, and I just have to strain back.  I sit, I listen, and I allow myself to feel some joy.  The joy of being a good person, a good doctor.

But then – the wheel turns again and the joy fades away.

When I loved Surgery

Before I became an Emergency Physician, there was a part of me that fell madly in love with Trauma Surgery.  I did many electives in that field, and even applied to Surgery (along with Emerg and Pediatrics) during my residency applications.  Sometimes, I still miss the art of it. 

October, 2005

Surgery is like art: fluid, the dexterous surgeon’s hands paint the knot they tie onto a canvass of the human form, supine beneath.  Musical, the anethetist’s machines tap the patient’s heartbeat like distant drumming on a beach in the afternoon; any change and the heart catches in me until the rhythm is back in step with my breath.

In the ICU I lean at the foot of the bed watching rapt as sunlight streams onto the blank page ahead of me; the patient’s abdomen open and ready for the surgeon’s thread to piece it back together like a long-scattered puzzle.  They gown up with ease, a dance of sterility as they cover every inch of skin and prepare to approach the man lying before us.  One on either side they prepare their instruments as I assist from my position at the patient’s feet.  Needles poised they begin to sew, and like an old dress being refitted the skin begins to take back it’s once anatomic position.  Soft concerto plays in the sunlit room with soft conversation over the quiet form of the man we are trying to heal.  My mind takes it in and my heart feels something like a butterfly stirring from it’s cocoon, pulsing, pushing to fly free.  In another day I find myself back by this man’s bedside, and it is I who holds the needle while my resident holds his, and together we stitch the remainder of my patient’s fragile skin.  A first glimmer of a new world, I have now sewn my first sutures that will hold a man’s body together.  Awestruck I feel the sun on me and hear my own words in conversation with concerto and sterile procedure and surgeon’s tools in my hands – I hold the needle, I thread the suture.

In the trauma room they wheel him in quiet; he says not a word as we inspect the stab wound to his side.  I take the history, I get his consent for surgery, he is my patient.  In the OR he goes under the knife with ease, anesthesia a gift, and when we are done he comes to agitated, fighting the tube.  Nurses try to hold him down, orderlies call for restraints, and I push through to the head of his bed.  Calmly I take his hand, use my other hand to grasp his chin and firmly turn his head towards me.  I tell him to look at me, look in my eyes, calm down, you were stabbed and now you’ve had surgery, you’re in the operating room, remember me?  Relaxing he lies back quiet and the nurses can’t believe it; but they must know all it takes is compassion!  Later I go to his room to check on him, and he asks me “where have you been?  I’ve been waiting for you!”.  Two days ago, healed, we parted ways and he went home to recuperate.

Another night, another young man stabbed.  In good shape with no need to operate, instead we must suture his long slash wound to the flank.  With instruction from my resident, I set up, prep, drape the patient and begin to sew.  Outside the trauma bay his friends gape through the windows, to them it’s like ER, it’s like Grey’s Anatomy, they watch me suture their friend.  But I don’t see them; I am lost in the art of the needle, the skin, the blood and the knots.  I am watching the future scar under my hands take shape, the close approximation of the tissue, the tiny holes my needle makes as it glides in and out smoothly.  My hands dance with eachother like swans intertwining their long necks; out of their waltz comes beauty and elegance, little square knots millimeters apart. 

Surgery is like art; unknowing I have become part of the canvass yet also one of the painters.  I am a fresh white page waiting to be written, as is the patient I tend, as are the stories yet untold.  There are now some doodles on my self-portrait, and so much more yet to be drawn.  Surgery is magic, surgery is beauty, surgery steals your soul in months of sleepless call that is so wonderful somehow that you almost forget you ever needed to rest.  And when you do rest – sleep is heaven and my bed is a cloud.  But surgery – it beckons again before sunrise and with no reluctance whatsoever I walk to the hospital with a skip in my step and a pale moon above.

Learning

Many of you know, and many don’t, that sixteen years ago I spent a year and a half volunteering as an ambulance medic for Magen David Adom, the national ambulance service in Israel.  It was a time of terror, fear, and death, but also a time of incredible joy, discovery and growth.  The people I worked with, the patients I met and took care of, prepared me in unexpected ways, for my career as an Emergency Physician.  Here is a piece I wrote back then, about a patient who affected me, tore at my heartstrings, and helped me become who I am today.  Many of my patients teach me not only about medicine, but also about myself and my place in this world.  I hope that this young woman that I met so many years ago can perhaps teach you something as well.

_________________________________

January 29, 2002

Beit Hanina, Jerusalem, Israel

The second call of our day was one of the most distressing I’ve had to deal with.  My other hard calls – bus bombings, major trauma (car accidents), attempted suicide (two weeks ago, a young mother, OD’d on pills), DOA (man who fell/jumped/was pushed from a roof in Haifa and his brains were on the sidewalk) – were hell as well.  But today’s call was painful for different, deeper, reasons…

We were taken by police escort to Beit Hanina, in East Jerusalem, where we followed a car of men who took us to a residential building.  We climbed the six flights of stairs to find a locked door and a woman screaming behind it.  One of the men (a cousin of the patient) had keys, and unlocked the door.  Inside was a 17 year old girl in her second month of pregnancy.  She was hysterical, crying and screaming.  In the other room lay the heavy black bat that her husband had beaten her with – it was obvious that he had obtained this weapon with the pure intention of hitting his wife with it.  There was no other use for such a bat – it was hewn off at one end and covered in duct tape; the perfect length and size for a strong man to handle as a club.  The young woman was beaten all over her body, from head to feet.  He had punched her repeatedly in the back and in the face, and hit her with the bat in the legs, arms, stomach…even pregnant.  This was not the first time; apparently a similar incident had occurred last year but the police didn’t do anything to the husband.  So the girl stopped calling the police, figuring that her husband’s repeated beatings would just be shrugged off.  This time however, he didn’t only beat her and kick her and step on her – he took her passport and her 1.5 year old daughter’s passport, and dragged the child from the house.  He ran off with her, and the police are out looking for them.  This poor girl, Arab American, far from home and parents, now beaten badly and with her daughter kidnapped by an abusive man.  What a horrific situation.

The girl only spoke Arabic and English, so I became the primary caregiver.  In the apartment I tried my hardest to calm her down, regulate her breathing, and prevent her becoming even more hysterical.  When we finally convinced her to come outside with us, there was a group of men waiting who began to laugh and point at her – these were her husband’s friends.  A bunch of sick, twisted animals, reveling in the pain of a woman.  We took her in the ambulance and while the other medic took her blood pressure and pulse, I held her head in my hands and tried to keep her breathing slowly.  I treated her like I would my sister, stroking her hair and cheek, reassuring her.  She began to calm down, and lay there quietly, crying.

Once at the hospital, we put her in a bed and her aunt was there with her.  I can’t express how incredible a feeling it is to be able to communicate non-verbally with someone – her aunt only spoke Arabic, and she thanked me.  I understood the intention behind her words, and the kiss she blew me from her seat by the bed.  I connected with the look in her eyes, and I felt the emotion behind the hijab she wore.  Those last few moments in the emergency room were intensely beautiful, because I truly felt that connection between people that overrides any cultural, religious, ethnic or political walls that we’ve constructed between us.  Working in Israel in this time of conflict and unrest is amazing because of these moments of connection.  I feel my soul working through my hands when I put those latex gloves on; I can feel my innermost spark reaching towards every person I help.  There is a link forged between souls when my gloved hand touches someone; with healing I reach past concrete and steel walls to touch goodness on the other, hidden, side.

What I felt when I touched that girl today tore me up inside.  I felt the agony of a child stuck in a cage she cannot escape, tormented by the animal of her nightmare world.  I sensed the raging of a captured lioness, unable to free herself or strike back at her oppressor, and incapable of finding her stolen cub.  How helpless she felt, her daughter in the hands of a sadist and her own body hijacked by his fists.  There is only so much I can heal when I come to a scene; I never learned and will never know how to fix wounds of the soul.

My young patient reminded me of my little sisters, and I wanted to take care of her like I take care of them when they cry and need my strength.  I wanted to take her in my arms and rock her like a baby, stroke her hair and tell her ‘everything is going to be all right’.  Unable to reach out to her like that, I settled for stroking her hair and cheek, holding her hand, and making sure she knew I was there and taking care of her.

Why do people do such awful things to each other?  How can a man take a club to his beautiful young wife who is feeding his first child outside and his second child within?  Did the police find him, is the child all right, will he be punished?  Will she go back to him when the bruises fade and her humiliation is but a memory?  Did she lose the baby?

 

Today was a hard day, but also filled with sunshine.  The rain only started when my shift ended.  The wind woke me up this morning even before my alarm, and stepping outside I was greeted by a sliver of crescent moon and one bright star hanging over Jerusalem.  Perhaps the rain can wash away some of the pain shed on the streets of this city; perhaps the blowing wind can cool down the scrapes on the knees of a hurting nation.  This weekend is the first day of a new month, the new moon.  The month of Adar, the month of joy in our Jewish calendar; the first day of which is my Hebrew birthday.  I will be 24 years old on Sunday.  I will celebrate my birthday.  I will sing with joy at being here, in Jerusalem, in Israel, with my people and our cousins and extended family.  Yes, we try to kill each other, and there is hatred and destruction and murder; but I cannot stop it myself.  I cannot continue to work as a healer and at the same time take in all the pain; I must feel that agony and understand it, but not absorb it.  I must touch it, grasp it, examine it and recognize it; but then I must brush it off my skin like mustard gas.

Instead of putting it in the trash I have immortalized it on these pages.  You know what it is, you know that I have felt it and will feel it again; you are all my witnesses.

If one day I am heartless or cruel, place these words before me and remind me of my own testimony.  In such a way can I help this young patient and the others I will encounter.  My healing skills are not good enough to help them any more than that.

 

Leave them alone

What I do, it’s hard.

Even harder is when it intersects with my personal life, affects those I love.

When it’s someone else’s friend, family member, colleague, it’s easier.  It’s still tough, but eventually the emotions cool down and I can move on.

When it’s someone I know, have known, will know forever; that is when the intersection between work and life becomes a whirlpool and it’s really hard to swim to the surface.

The last month has been like this.

 

It’s hard to write about.

I worry I will traumatize the reader.

Read at your own risk, because no matter what you see on TV or the movies, life in the ER and the hospital is not all sex and drama and magical saving of lives.

 

Life in the ER is sometimes dark.

Life in the ER is sometimes light.

It can devastate

It can elevate

It can feel like torture, ripping out your guts as you fight and battle the system, the sickness, sometimes the patients and their families and even sometimes other health care workers.

It can feel like peace, rapture, working side by side with exceptional people who care deeply for the patients we all try to heal, seeing incredible outcomes at times.

 

But it’s never what you think it’s going to be when you start your day.

 

The last few weeks, medicine has been a maelstrom.  Some days I feel like I’m sleeping; caught in a hurricane in a nightmare I can’t free myself from.  My hair feels tangled and caught in barbed wire, my hands feel shackled, my heart feels squeezed inside a cage I can’t open.

 

People I care for have suffered, died, been diagnosed with conditions I can’t fix.

I am like an engineer with amputated thumbs.

A healer who can’t heal.

It’s devastating.

 

Death, I know you.  We are sometimes friends, we are often foes.  There are times I call you into the room with me to guide my patient to a safer, quieter, more peaceful place.  There are times I curse you and push you out with all my might, tell you that you are not welcome in my resuscitation room.  And then, there are times that I let my patient tell me which of these they want.

 

Some days, a sick woman who I could potentially save will hold my hand and say, “It’s ok. I want to go.  I’m done suffering. I lived a good life”.

Other days, a terminally ill man with dementia, with no real hope for cure, will have caregivers who are the substitute decision makers and ask me to resuscitate no matter the cost and no matter the suffering to the patient.

 

Death, there are days I beg you to walk away.  Withhold your promise of quiet days and calm nights.  Take with you the eternal void.  Let me do my job; let me heal.

I wish you would have listened this week.  You took someone very dear, vibrant, exceptional. You grabbed in your greedy embrace someone who was not done living, and by turning up the dial on her pain you made her ask for release.

I curse you for it.

I thank you for it, at the end, when it was too much for her to bear.

But I will continue to fight you for those we can save.

I promise, to be a shield against your reaching claws.

But I also promise, not to thrust you away when the patient before me needs you.

 

Just please, leave the rest I love alone.  For now.