My Black Scrubs

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.

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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.

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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.

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.

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.

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.

It’s been a busy week of evening shifts, working from 4 pm to 1 am and home by 2, asleep by 3, up at 6.  Doing this four times so far in the last six days has completely wiped me out, but the daytimes spent in the sun and with my kids have helped bring some joy to the mix.  Working so much with so little down time and minimal sleep does unfortunately affect how one approaches cases at work; picking up a new chart often feels like lifting a leaden object that I would rather just leave alone.  Never mind the negative vibes I feel, the resentment, leaving my home yet again on a summer afternoon to take care of other people when all I want to do is take care of my kids and myself.

Walking into the department with this angst in my heart, I enter the locker room, strip and pull on my scrubs.  I become someone else, the other version of me, the Physician.  I have described this before in my writing; the sensation of snakeskin, a smokescreen I conjure to Become another self.  It calms me, helps reduce the frustration, as I sling my stethoscope around my neck and fill my pockets with what I need for the day.  I take a moment, breathe, center, and reframe.

I walk from the quiet into the chaos and am met with hellos and smiles, colleagues, nurses and even sometimes patients from the day before all greeting me.  This feeling of friendship and collegiality pulls me higher out of the lake of regret in which I have been wading, wishing I were home with my kids.  The faces of patients expectantly waiting to be treated remind me why I am here.

Every now and then I meet someone who makes my doctor day worth doing.

A little while ago, I met one, a young woman who should have been enjoying her youth, waiting in a room for me to assess.  On my approach she was sitting in the stretcher in no apparent distress.  Without much emotion she described to me how she was assaulted by a client who wanted sexual services.  When she denied this, he picked her up and threw her; she slammed her head and lost consciousness briefly.  A friend saved her and brought her to the ED, dropping her off at the door.  After a thorough, gentle examination I quietly asked her if she has any social support.  She began to cry, admitting that she has no one.  No family, minimal friends, she lives alone and has no one to turn to in times of need.  I asked her if I could help find her support, e.g. with social services, or if she wanted to report this to the police.  She declined, as I expected.  Girls like this, so beautiful, so fragile, so vulnerable, they usually refuse the help offered.  It breaks my heart; she is someone’s daughter, and even if not appreciated by a parent, she is a soul, a person, and she matters.

Even in my line of work, where I see awful things often, it still shocks me that a person can harm someone else intentionally.  Call me naïve, innocent, idealistic, but I don’t understand how a man would pick up a woman and throw her into furniture.

I say this, but then intrusive thoughts make their way to the forefront and remind me of the unstable angry men I often see in my emergency department.  I have met scary people; men (and sometimes women) that I would run from if encountered on the street.  This young woman works in a place that exposes her to harm, and as a physician, there is nothing in my power to help prevent pain to her in the future.  All I could do when she was in my emerg, was keep her safe for a few hours; give her support and succor until she decided she wanted to leave.  I gave her a stretcher, pain medications, a blanket, and an ear to listen.
Tonight, tomorrow night, she may get harmed again or worse.  It pains me, as a doctor, a woman and a mother, but her choice is her choice.  Her life is her life.  I only wish the best for her and hope for her one day to get out of the life she is in and into a safer one.

So, coming to work even when work is the last thing I want to do, is important.  It teaches me, it opens my eyes.  It takes me out of my existence and into the lives of others; it gives me compassion and understanding.  It reminds me that there is so much more going on in this world than most of us see; there are so many layers, so many spaces, so many worlds within worlds that we as physicians are privileged to witness.  It might hurt, it might change us in ways we don’t expect, it may gnaw at our insides when we see the pain that is experienced by others.  But it can also enlighten, and brighten, and enlarge our souls.  For that, I thank this work, and the heavy load that it sets on my heart.  Without it, I would not be me, and my children would not learn what I, and only I, can teach them.

It’s peaceful out here,

sitting at a picnic table,

the breeze over the water lifting my hair.

It’s quiet out here,

children’s voices as they play on a sandy beach,

flapping of grasshopper wings,

ducks honking at each other as they swim.

A dragonfly lands on my shoulder, and starts to walk up to my face

until I gently tap him away.

It’s joyful out here,

a father takes his son out in a canoe to fish, they wave and say hi,

continue on their way.

It’s pleasant out here,

waiting for my daughter to finish her day at pony camp,

sitting in sunshine with nothing to do but read and write.

Physician wellbeing, something we search for,

something so intangible much of the time.

Yet here it is:

I worked until midnight, went to bed around 1, up at 6 with my kids

and working again at 4

 – but I am sitting in peace by water and wind.

Wellness is this;

taking a moment,

a few stolen hours between responsibilities,

to do what makes one happy.

My summer feels as if a thief caught it by the tail

and yanked it out from under me.

Running, the burglar trails happiness away

and laughs when I reach out for it.

Sometimes, we have to steal back what is taken.

These brief minutes are just that;

leaning out further to snatch what seems gone.

Tonight we watched the space station fly over our house, with a sliver of yellow new moon shining nearby.  Wide-eyed the children listened to me describe the astronauts living inside, looking down at us from up high.  The wonder, the innocence of being so little and not knowing at all what the grown up next to you is telling you; imagining a reality you can’t even begin to perceive – it’s magical.

When I was a child, I believed in magic.  I trusted bees not to sting, carried ladybugs on my palms, sheltered worms in mud filled tupperwares in the backyard.  I thought the world moved around me, that somehow all was good and right.  When kids began to tease me at day camp and suddenly my world wasn’t safe and perfect, I still truly believed that if I was just nice, and kind, the boys wouldn’t push me off my bike at speed on the street.  If I was sweet, they wouldn’t hold my head under water at the pool until the lifeguard whistled.  If I asked them to stop, they wouldn’t spit on me or chase me down the street till I fell.

As I grew up those boys faded away; at eighteen I left for university and forgot them, left them behind.  They weren’t important, they were shadows in the past of a childhood that was light and air and sunshine around the corners of their nastiness.  I was a happy, free, innocent and playful kid with lots of other friends, so as I grew up the bullies occupied only the tiniest part of my memories.

But I never forgot their names.  Three, in particular, still sit at the tip of my tongue.  K., R., and J. were the meanest of the mean back then in those sun filled sticky summers, and every now and then I did wonder where they went.  Did they grow up good?  Did they end up in jail?  Who did they hurt after me?  Did they regret being the bullies they were?

Today, I learned what happened to one of them.

My day was somewhat remarkable at work; early in the day I encountered an old teacher of mine, from grade school.  A lovely lady, poised and elegant, always pleasant and warm in my memories, she accompanied her elderly husband for a relatively benign reason, to my emergency department.  Seeing them was a rose, a sweet moment in my day, lighting my morning with joy.

In the afternoon, a punch to the gut when I saw his name on the next chart to be seen.  No way, it can’t be, but I knew with a glance at his birthdate that it was.  The bully of my childhood, now a man, a troubled one, waiting to be assessed in the psychiatry back hallway.  He had been suffering for years with a psychiatric disorder, at times aggressive, at times psychotic; his disease made sense to the little girl inside me who suffered from blows and knocks off her bike.  A bad boy grew into a man with a mental illness; how long was his illness undiagnosed?  Was he sick when we were young? Is that why?

Prepared for anything I did what I always do when I go into the psych rooms: I removed my stethoscope from around my neck and placed it in a pocket, hid my pens in back pockets or underneath clothing, took all the precautions not to be injured by an errant patient.  My stomach in knots, doing back flips of nausea from recollections of pain, I pushed it all away and went to face my patient.

“Hi sir, my name is Dr. A., can we sit over here and talk about why you’re here?”

Calmly and quietly he joined me, meek, eyes cast downward, he spoke softly.

“I don’t feel right.  My heart feels weak.”

Slowly I drew out of him the story, learned he has been unstable, not well, needing help.

Stethoscope out, I touched my patient, one warm hand on his shoulder as I heard for the first time the beating of his heart.  The same heart, that beat when his fists hit me, so many years ago.  The same heart, that carried him from a troubled childhood to an even worse future.  A strong heart, a beautifully beating musical heart giving life to this tormented, beaten down, sad man seated with his health in my hands.  His heart knocked the breath from my own chest, and I planted my feet solidly so not to fall.

The magic of my childhood felt palpable in my fingers; the silvery string of time and fate shimmering between us as we spoke.

I wish I could feel like he deserves this life.

I wish I could feel vindicated.

I tried to feel like “karma’s a bitch”, I even said it to myself, but I couldn’t feel it.  I don’t feel it.

No one deserves to live a tortured life.  Mental illness, untreated likely in childhood, now eating him up inside – how devastating.

I walked out of that hallway feeling quite empty.  His sadness like acid in my mouth, his loneliness like stones in my belly.

So now I know where he went, when he dissolved to shadows in my frame of existence.  But knowing, and knowing what I know as a physician, only makes the memories even more sorrowful.  I wonder if anyone knew, when he was young, and if anyone could have helped.  It’s all speculation, hidden in the fabric of time, and I’ll never know.

Looking at the cosmos tonight with my children, watching their eyes sparkle in the moonlight, hearing their laughs and feeling the music of their souls, I made peace with that little boy in the past.  He sleeps quietly in my mind, and I pray for the same quiet in his all grown up soul, tonight and always.  If magic exists, I hope my hand on his arm passed some of it inside to heal him, in ways no medicine ever could.

“Every time I see you, I feel like I’m lost, wandering around aimlessly” says the young, fresh faced new resident as we bump into each other for the umpteenth time on this night shift.

He is lost in this place, and I am lost as well.

Lost, because this year, for the first time, I feel old.

I turned forty, and suddenly mortality hit me in the gut like a linebacker on a football field. The sucker punch of age left me reeling, unable to catch my breath.

When I teach students these days I realize they could be my children. I am that old.

When I brush my hair, a thread of silver peeks out, laughing, from the most obvious part of my scalp, laying itself firmly in the sunshine for all to glimpse.

My hands, my face, showing weather and sun and the years of my life passing like the river that surrounds my city. The years pull away from me, stretched out behind like the shadow my son likes to make on the wall with my phone light at bedtime.  I play with my children and have to push myself back up to stand, partly due to obesity but also due to my old lady self.

Forty, I feel old, I feel sad, I see time speeding up and away and I don’t know how to slow it. And suddenly, this year, I no longer feel secure in what I always believed – that the end is comforting, present, that when we die our souls look down on family and friends and stay close. Out of nowhere I have started to doubt that anything truly exists when we die. Will the end just really be an end?

I watch his young back and unlined face as he strolls away down the hall, and I wish him many more years of youth and innocence and dark hair. I wish him joy and excitement and the wonder of discovery.
And I wish myself peace, as I kiss my own youth goodbye.

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Working a full moon night shift in a large academic tertiary care emergency department is an adventure.  The full moon brings out the worst in people, the crazy, the anxious, the sad. And those people bring all that to the EDs in cities across the continent, where people like me have to help them come to terms with and deal with what the moon brought out. Well, not the moon really, but that’s how it feels.

Doing what I do, I am confronted by mortality – my patients’ – but also my own – every shift.

Tonight, teaching young residents, I felt old. So old. I visited the darkness of age in my mind. Then a few minutes after composing an ode to my own angst while taking a bathroom break, I reassessed an older lady I have met multiple times in the ED. She, a strange cat, but kind, told me that every time she sees me here I grow better looking and get younger. Suddenly, my hair felt full, my face clear of wrinkles, my steps a bit lighter. In her own bizarre but sweet way of self she gave me a gift. Mortality moved further from me and quieted its steps on my soul.

Ruthlessly however the spectre returned later in the long night, when a psychotic, angry, awful man began screaming obscenities at me from his locked room. As he called me unrepeatable names and told me to get on a treadmill, I forced myself to type my notes and keep my cool.

When he yelled “I’ll remember your face”, and threatened to harm me, the knot in my gut twisted. Fear returned, took hold, solidly placed its’ teeth in my belly. This man and many like him walk our streets. We don’t know who they are. Tomorrow, he could be next to me in a cafe, or behind me on the street.  Him, or someone like him. Maybe he will remember my face, maybe he will just see a woman and want to hurt her. This man, and others like him, are the reason I fear. And I see them, every day. They come to me, where I work, and they demand to be acknowledged. Maybe they are sick, maybe they are just mean, maybe they should be in prison. But I, and those like me, must treat them with respect, kindness, like any patient who comes through the door. So I do, and I pay the price by hearing his abuse echo in my ears. I carry a “screamer” on my ID tag, an alarm that emits a high decibel siren if I pull it; it’s sad to think I as a doctor feel at risk enough to carry such a device. But just last week, a health care worker in my department was attacked in a horrific way, out of nowhere. So I take no chances.

Mortality. Death. I know it, I walk with it. I recognize it. I fear it.

When you tell me your story I often resist making you stop.

I hold myself back from truncating your words.  I stand by you or sit on the bed and I listen, as you say so much and yet so little.

Usually I get only a hint of what I need to know, as your physician, to heal your wounds (the physical ones).  But through your narrative I learn you; what drives you, how you think, where you come from, why you are really here.

If I stay silent long enough you will tell me of your uncle who died last year of brain cancer, and now I have a better idea of why you are here in my emerg at 4 a.m. with a mild headache.

Though I may stay with you longer than perhaps I should, for the sake of efficiency, I don’t sacrifice these moments because I am truly delighted to be someone you can trust, to tell me your story.

I will take your words and write them down, first in your chart and then in my heart, as I learn what it is to have fear.

Written at a wellness conference for Canadian women physicians.

Home is the heartbeat of my patient as they roll off the ambulance; rapid, pressured like the speech of the lady in the psych back hallway.

Home is chaos, a tumult of sea-salt smelling air rushing off the ocean as we arrive at the coast.

Home is warmth, a hot chocolate after a long ski day when the kids’ cheeks are apples and my hands are frozen meat.

Home is delicious, spicy, sweet all at once like moroccan salmon cooked by my husband after a long shift, the taste of my son’s cheek in bed in the morning.

Home smells like my daughter’s breath as she sings pop songs off key with such joy and lack of self-consciousness.

Home is pinks, oranges, greens of orchids and lettuce we planted last night, watermelon fresh cut dripping sticky juice on just washed counter.

Home is all of it, and when I stick out my tongue in the backyard to catch snow with my children, home is the hearts we have woven together that I can hear beating in the quiet of night bringing peace to my mind and joy to my heart.

Home is knowing, just knowing, that all is safe and right.

Written at a wellness conference for Canadian women physicians.