A Haunting Encounter

Today, I had a class on incorporating the humanities in medical education.  We were asked to write a short piece of prose or poetry on a patient encounter that haunts us.  Hearing what others wrote was way to much for my hormonal psyche.  I didn’t share mine because I was too busy trying not to let anyone see me cry about the ones that were shared.

I am not a poet, but it kind of has a poetic feel, I think… Here it is…

You did your best.  You knew something was wrong.  You were low risk, they said.  But, now, you are sit in clinic and don’t know how bad it really is.

You are angry and scared.  You cry when I review what is happening within your body.  I am gentle, but I am up front.  Medicine is so advanced, but so limited.  

Together, we bring you down off that ledge.  We have a plan.  You know what is likely to happen.  Then, I point out you need to meet my staff.  To keep in mind that a chance for second opinion isn’t gone.  

Gruff and curt, he approaches.  The plan changes and you are confused.  There is no explanation.  Just a closed door.

I try to help you understand.  I feel a sense of loss.  Like I am free falling in a place outside of my control.  It can’t compare to what you feel.

You don’t want another opinion.  You trust him.  Because you trust me.

In that moment, I don’t trust me.

I go home and review the literature.  I think and think.  I talk to another staff person.  I am right.  There may be more.  But, how does that get approached?  Who is willing to speak up?  

Everybody talks, but nobody deals.  That seems to be the way sometimes.  The questions are brought up, but I wonder if they were truly dealt with.  They get swept under rugs that some of us can’t help but look under.

This time, someone did say something.  This time, something did change.  Somehow, the suggestions were accepted.

I was relieved.  I want the best for you.  I want the best for all of you.  But still, the whole thing is unsettling.

In the long run, will it be enough?  Will you continue to get the care you deserve? 

If I hadn’t been there, if you didn’t trust me, would it be different?  Would you have made a different choice?

Maybe it is enough.  But, I wonder if we could do better.  I wonder if it is my fault.  That my being nice, that we “clicked” made you not question, not request that second opinion.

I won’t know.  I can’t help but wonder it is my fault.  And I’m not even sure what “it” is.

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A long New Years themed questionnaire

It is a few days after 2015 has started, but I have never been one to celebrate festivities conventionally (Okay, actually I did stay up until after midnight, saw fireworks as the clock struck twelve, toasted the new year (with sparkling apple juice) and kissed my husband… That is pretty darn stereotypical, I must say). I saw this 2014 in review questionnaire (one of many) done by a few of the lovely bloggers I follow and I decided to play along. Warning: it is long-winded and reflective.

YOUR 2014

What one event, big or small, are you going to tell your grandchildren about?

Tough one… Seeing Wicked on Broadway. Getting to see/hear “The Creature” for the first times.

If you had to describe your 2014 in 3 words, what would they be?

Emotional, blessed and nauseated.

What new things did you discover about yourself?

I learned that I am capable of depths of emotion on both ends of the spectrum (joy and sorrow) at levels that I previously was unsure were possible. I also learned that taking time to do the things I enjoy or spend time with the people I love is something that I too often put off, so I am gratefuly that I am now starting to do that more.

What single achievement are you most proud of?

Does being in the middle of growing a human count? I’m mostly serious. But, if we are going with tangible obvious things, it would be having completed my research project and presenting it at a national conference (although we are still editing it for publication… Ugh.).

What was the best news you received?

That “The Creature” continues to be growing and healthy. After a long wait for a baby and especially after losing Elim and knowing how many others wait and pray for well little ones, I can’t help but be so grateful.

What was your favourite place that you visited in 2014?

New York. Hands down. Best early 5th anniversary and partly free trip ever! I got to see musicals, Body World and eat a lot.

Which of your personal qualities turned out to be the most helpful this year?

My high-baseline optimism.

Who was your number one go-to person that you could always rely on?

Patrick, obviously.

Which new skills did you learn?

I apparently got pretty good at microscopy according to my Pathology evaluation.

My countouring skills are getting better. Bring on the head and neck cases!

I am getting better at transrectal ultrasound (I know, valuable life skills here, boys and girls) and inserting needles for prostate brachytherapy. Cervical brachytherapy seems to be a bit of a slower go for me, but it seems like whenever I’m on, the cases wind up being super complicated, so I get stuck not doing much.

Today, I have realized I have also become pretty stealthy at putting on Jeter’s harness.

What, or who, are you most thankful for?

I am most thankful for the many friends and family, particularly our extended church family God has stuck in our lives. They have loved us through a lot this year and keep putting my focus back on what really matters (sometimes with some laughs and healthy distraction on the way).

If someone wrote a book about your life in 2014, what kind of genre would it be? A comedy, love story, drama, film noir or something else?

A dramedy? I think that might be a genre.

What was the most important lesson you learnt in 2014?

It is not my story, it is God’s story.

Which mental block(s) did you overcome?

The perception or belief that I’m not “good enough.” Its an ongoing struggle, but grace is the gift that keeps on giving.

14.What 5 people did you most enjoy spending time with?

This is challenging, there are many people with whom I enjoy spending time. I’m going to say C&C, A&P, K and M from our old small group (I know, that is 6). We got to have some special quality time with them for the first time in a few years and it was really enjoyable, meaningful quality time, even if it was brief. That doesn’t downplay the time we spent with many other very important people in our lives, it was just some of the most special time.

What was your biggest break-through moment career-wise?

When I started realizing that I could answer questions intelligently in teaching sessions and during my treatment planning exams and that I totally couldn’t have done that last year. I didn’t notice at first, but looking back, I can see how much I am learning.

How did your relationship to your family evolve?

I find myself more attached and concerned for my family and extended family as I get older. Probably because I keep learning how fragile life is and how important those people are.

What book or movie affected your life in a profound way?

The End of Your Life Book Club by Will Schwalbe. I don’t know if profound is the exact word I would use, but it made me think about my relationships with family, with patients and how I share my love of reading with certain people. It made me want to check out more books and to actually discuss them (instead of reading being a solitary activity).

What was your favourite compliment that you received this year?

It wasn’t a compliment. It was the most heartfelt hug and simply “thank you” from a patient’s husband.

What little things did you most enjoy during your day-to-day life?

I love coming home to Jeter who immediately “flops” and expects me to give him a good rub as soon as I walk in the door. I also love the time Patrick and I have when we do our individual Bible reading, pray and just cuddle and talk about our days before I go to sleep at night.

What cool things did you create this year?

I’m not that creative. Probably a knitted mug cozie (and then I lost the mug it fit on).

What was your most common mental state this year (e.g. excited, curious, stressed)?

I’m a resident, so stressed.

Was there anything you did for the very first time in your life this year?

I ran for 20 minutes straight. Brachytherapy insertions. I played Munchkin, Gloom, Love Letter, and several other games. I saw Wicked.

What was your favourite moment spent with your friends?

I’m torn between kayaking with L, C, Child and D in the summer or playing games and having a BBQ with C&C, A&P and K this summer.

What major goal did you lay the foundations for?

I’m continuing to be a resident, so a suppose that is working towards my major goal of one day having a real job as a staff physician.

I would one day like to run 5k straight. I know for many people that does not seem like a big deal, but I am NOT an athlete by any means. Before I got pregnant and super sick, I was up to somewhere between 1.5 and 2km without a walk break and didn’t need too crazy long for a break. But now, I went for my first run again last week and I can barely run for 3 minutes without starting to get hot and out of breath (it has been about 12 weeks). I know that I can’t push myself excessively now, but I want to at least maintain (or improve) my fitness, so that after baby gets here, I can keep moving in that direction.

Which worries turned out to be completely unnecessary?

Patrick always tells me worrying won’t make me taller. And he is always right. So, all of them.

What experience would you love to do all over again?

New York. The time we spent with our old small group friends. Our cabin adventure with most of the BIFFs.

What was the best gift you received?

I’m going materialistic on this one. Mr. Holland’s Opus, which was a surprise from Patrick who remembered me mentioning it was one of my all-time favourite movies, so when he stumbled upon it, he bought it and watched it with me.

How did your overall outlook on life evolve?

That is a deep question. I think I’m getting better at seeing how grace really plays out in our world and in our lives in all kinds of ways that are sometimes more challenging to see.

What was the biggest problem you solved?

I fixed our broken drawer. I know it sounds trivial, but Jeter broke that bloody drawer trying to get to the treats a couple years ago and I finally fixed it! Maybe not the biggest “problem” but definitely the best fix.

What was the funniest moment of your year, one that still makes it hard not to burst out laughing when you think about it?

When we were in New York, there was a voice on one of the subway trains that said “Please stand clear of the closing doors” who just sounded so happy while saying it (and also like a CBC sports personality). Patrick thought it was hilarious and would mock it and get even more excited if it was the voice on the train we were on. After getting back, we would still periodically announce “please stand clear of the closing doors” in that voice and crack up. Then, we noticed the elevator they are replacing in our building has a small automated sign that says that exact phrase. We lost our minds laughing at that.

What idea turned out to be the best decision ever?

Choosing to work Christmas Eve, so that we would have Christmas day to ourselves and more time to spend with family/friends at home over the New Years half of the break. We got to rest and relax, enjoy our alone time and our time with people (and even saw almost everyone we wanted to) and it was the best break we’ve had in some time.

What one thing would you do differently and why?

I would have accepted more help from people. I’m often reluctant to admit that I need help, but there were points this year where I was so sad or so sick that I probably should have taken people up on offers of breaks or a hand with things around the house or at work than I should have. I realize now that the past few months would have been a bit better had I maybe taken another couple of sick days or evenings to myself.

What do you deserve a pat on the back for?

I finished my off-service rotations in one piece and made it through the first difficult 6 months of core Rad Onc in one piece (half of which I spent drowsy and barfy) with people somehow thinking I am keen and have a good attitude.

What activities made you lose track of time?

Board games with our lovely gamey friends. I can lose hours playing good games with good people. Also, as always, reading. And I will admit, because I am a big dork, clinic prep and contouring are huge time sucks for me and often lead to me losing track of time.

What did you think about more than anything else?

Having children and not having children. I know it is so cliché for someone in my age and stage, but this was a seriously consuming issue for me this year in both the good and bad.

What topics did you most enjoy learning about?

I love my job and my field, so I enjoy learning most about oncology and everything that goes with it from how people (on both sides of the desk) cope with cancer and live with it, to how it works to the technical side of treatments. I have also been really excited to be learning more about God this past year.

What new habits did you cultivate?

I was doing decently at going to the gym before the morning sickness took me out. Hopefully, I can get back to that. Patrick and I have been doing better with prayer together. I have also been trying to be more intentional with being “social.” I’m not saying I am a social butterfly, but I am trying to have meaningful (or at least some) conversation with people more often in situations where I would otherwise have tried to hide out.

What advice would you give your early-2014 self if you could)?

I don’t know. I’m not always a good advice heeder. I would probably remind myself to be patient and know that tough stuff is good for growing and learning and that worry isn’t going to make me taller (even though Patrick did tell me that).

Did any parts of your self or your life do a complete 180 this year?

Not especially. My caffeine intake is probably a quarter of what it was previously, but that is the fault of mind-numbing nausea.

What or who had the biggest positive impact on your life this year?

Getting back to some important things. Like playing music again. Seeing and staying in touch with people who have been important in my life. Most importantly, seeing the thread of grace that God has woven in our lives.

YOUR 2015

What do you want the overarching theme for your 2015 to be?

Growing.

What do you want to see, discover, explore?

I’m excited to do my Med Ed elective and improve/develop my teaching skills. I can’t wait to meet “The Creature” and figure out all that good stuff that comes with parenting. I am always happy to go on adventures anywhere, even if it is just close to home for the next while.

Who do you want to spend more time with in 2015?

Our families/extended family. We see them more now than we did our first few years of marriage, and I want to keep that up. Plus, their presence is going to be super important as “the Creature” grows up.

What skills do you want to learn, improve or master?

I need to learn how to be a parent at some point. As I said before, I want to work on my teaching and I just plain want to keep working on my clinical knowledge and skills. I always can improve on how well I love my husband and others. Plus, I want to be more fit, you know, the whole running thing, as I mentioned. If I could finally learn to play guitar, that would be great, but probably kind of a lofty goal given everything else.

Which personal quality do you want to develop or strengthen?

I’m not sure exactly how to word it, but I want to continue to work on my time spent with others. I want to be more open to people and more loving towards them and less afraid of interactions.

What do you want your everyday life to be like?

I just want to find joy in the mundane. Because that is what life is made up of, those ordinary moments that add together to make up our days.

Which habits do you want to change, cultivate or get rid of?

I want to keep working on our prayer time and devotions as a couple. I also want to get back to/get better at being more active.

What do you want to achieve career-wise?

I really want to pass physics and radiobiology this year (lofty dreams), so that I can just sit in on them when I come back from mat leave without feeling the pressure to have to write the exams and pass them with a toddler in the house. Doing adequately well on my other in-training exams would be great too. I also want to finish all of my rotations up to the start of maternity leave, so that I only have one 4 week block left of third year when I get back.

How do you want to remember the year 2015 when you look back on it 10/20/50 years from now?

I hope I remember it as a good year, but really, it is just a drop in the bucket.

What is your number one goal for 2015?

Read 67 books. Just kidding. That is a goal, though. I guess it is just to love and serve well.

Waiting, Anticipation, Hope and Gifts

‘Tis the season of anticipation.

Anticipation of holidays, anticipation of time with family and friends, of presents and for some of us, for anticipation of a celebration of the birth of our Saviour.

Anticipation is a part of waiting. Waiting can be hard. But, sometimes the wait is well worth it.

Look at the Jewish people in the Bible before Jesus’s time. They waited a long time for a Saviour. So long that some had given up hope and many had ideas of how He should look or be.

And of course, in the way God only can do, Jesus came in an unexpected fashion. In a way that defies our human expectations. I think that is so cool.

Sometimes God makes our lives like that. The things we anticipate, that we long for sometimes come in ways that we don’t fully look for or expect. I think it is a good lesson when I look at the way the world is headed or when things aren’t going according to plan. God’s plans sometimes get a bit weird or outside our expectations.

I think anticipation and hope is a form of worship. As we look forward to the Christmas season, I see hope in all kinds of ways, and really if our hope is in the right place and our anticipation is looking forward to celebrating well, it is a good thing.

Our life has recently had some moments where our anticipation and waiting turned into a more discouraging time. As we waited and hoped for a baby to come into and stay in our lives, we began to learn what hoping and trusting looks like when things start to fall away from what we anticipated, when pain keeps creeping in. Sure, we trusted, but I can relate to those who started to think otherwise when waiting on God to do something big. Who let bitterness and distrust sneak in. Because it can be easier to let that happen sometimes. Even though so many awesome things happen every day.

But, cool stuff happens when God is involved. I found out about “the Creature” the day before Patrick’s birthday. I told him as a part of his birthday present. Because after this long waiting, news of a baby really is a birthday present. “The Creature” is due just a few days before my birthday. Pretty cool.

I was thankful for the nausea, for the fatigue. Because that meant something was happening. It was affirming what we had been waiting for. That being said, I then started hoping for it to stop, but continued to (oddly enough) thank God everyday for the barfing (but confirming that it could stop anytime).

Laying in bed one night praying, I came to the realization that so many people had been praying for us, for a maybe baby and how lucky we are to have so many people in our lives who support us and intervene for us. It blew my mind how this was planned by God and seemed so intentional now, even though for so long it just seemed like we were forgotten.

We had our first (and only) ultrasound so far just a couple days before what should have been Elim’s due date. Seeing a flickering heart and a tiny human at a point when my heart was breaking was a big gift in and of itself.

On Friday, we got to hear “the Creature’s” heartbeat galloping along. Merry Christmas. There really still is a tiny human in there who will eventually come out.

So the anticipation continues. For this child, probably for others and all kinds of other things.  And I know it will persist the rest of my life.

The wait was worth it. I see that now. I see the trust that grew from that wait, the witness that it was and the growth we experienced. We learned practical lessons about suffering well and waiting well. In retrospect, I’m glad for the wait. It has taught me about how to love others in the midst of waits.  I think it is helping me to celebrate well.

Sometimes the best gifts come in ways that weren’t planned or expected in our human put-things-in-a-box way. Sometimes our anticipation makes things even better. Although my baby pales in comparison to the epic beauty of the Christmas story, I can see how lessons in waiting and hoping and not putting God into my human realm box can parallel the story and make me get how big it really is to an even greater.

My love-hate relationship with Christmas hospital

The hospital is a funny place at Christmas. I kind of have a love-hate relationship with Christmas hospital.

One part of me loves Christmas hospital. I love that everyone tries so hard to make it festive and that each floor or section have a different décor scheme (or lack thereof). I love that some people really rock the decorations. I get excited for the treats on the nursing units.

I love how people try so hard to make it a welcoming and festive place, even if for many people it is the last place they want to be.

But, I hate that people have to stay in hospital over the holidays. I’m glad we have the option and that these people are well taken care of. But, this weekend, I seem to have spent a good chunk of my on call rounds talking to people about their hopes to get out, their dismay about not getting out and trying to help them see or find the bright sides in the situation. It comes up a lot. And it is important, so it makes sense that it comes up.

I remember when I was about 5 (it was the year I got a Troll watch for Christmas), my Aunt was in hospital over Christmas. And she swore never to be there at that time again. I am too young to remember what was so bad about it, but I do remember her saying repeatedly she would never go to hospital before Christmas.

That is something I won’t forget.

I don’t want that for my patients. Because, unfortunately for a number of them, this probably is their last Christmas…

Our service is pretty good in that if there is any way the person is stable enough to go out even for a few hours, we try to make it work if the person and their family is wanting, willing and able.

I have one person who has the most festive room ever and plans on having their whole family in for Christmas dinner, although the logistics are still being sorted out. They are pretty excited and encouraged about being around for the holidays at all.

I saw another who only just realized home isn’t going to be an option and just wants to not be alone. Another who is going to get someone to bring in decorations. And a third who was working on Christmas cards and gift wrapping with their spouse.

Its not all that sunny, though. Some people say it won’t be Christmas this year, or get upset when talking about not being home.

I can’t make it better. But I want to. We can treat pain or nausea, but treating being in hospital over the holidays isn’t easy.

The nurses on our ward are awesome and make the best of it. We all, for the most part try to. That is what humans do over the holidays. And that makes it kind of a cool display of how people are decent.

Thus my love-hate relationship with Christmas hospital.

Turning Tables – Treating Physicians

Today, one of the other residents and I had an interesting conversation.

Somehow, the topic of treating physicians came up.  And it is something that terrifies us both.  And not just for the reasons you might think.

I will confess, treating other health care people is always nerve wracking because you worry even more about saying something wrong or stupid because you always wonder if they are secretly judging your skills.

But the bigger thing is that when we see them, they are being faced with a cancer diagnosis.  And for some reason, most physicians and nurses get the bad ones and all the complications.   And that is horrible for anyone.

The issue is, they know too much.  Sometimes, having some uncertainty is a good thing.  But, when you have cared for people with the same thing.  When you understand the odds and get the treatments, it is a whole other level.  You know the worst case scenarios.  All of them. Sometimes the unknown bits of the known are the worst.  Especially when your whole world gets turned upside down.

That is the hard part.  The anxiety, the sadness, the anger and guilt.  The fact that sometimes, the person who knows too much coming in can’t be easily comforted.  That the numbers that scare everyone have too much meaning.

It also forces us to face our own mortality.

We both agreed that given we work in Oncology and given the odds in the world today, we will both one day have cancer.  And we will probably die from it.   Those are simply real odds.  And the “comedy” that is life.

And we know this and accept it.  In fact, we laugh about it in an uncomfortable kind of way.  Sure, I might have a heart attack or an accident, but it is more likely I get dementia or die of cancer… Or both.

Really, it is something I accept.  But, it is still something that is terrifying. And maybe that won’t happen.  Maybe I’ll just die in my sleep in old age.

Either way the reality of seeing people who dedicate their lives to healing others broken, afraid and unwell is terrifying.  They are “one of us” who became “one of them.  It is just too real sometimes.  Too close to home.

I just want to fix the hurt.  I want to prevent the hurt.  I want to be out of a job (kind of).

But I can’t.  So, we do the best we can.  With every person.  Because one day the tables will turn in one way or another.

The Christian “Look”

Sorry for the lameness in lack of posts recently.  I won’t make excuses.

I will, however share with you this awesome article from Relevantmagazine.com a few friends of mine just posted on Facebook called “Being a Christian Doesn’t Always Look Like You Think It Should.”

The article speaks well about how grace and “real” Christianity does not always look the way other Christians or society wants it to look.  Really, by looking for Christians to appear a certain way, we are putting God in a box.  Grace is a process, we are works in progress and we are made perfect only in Christ, but still exist in changing earthly bodies with personalities and characteristics that change and grow and may not always be perfectly Christ-like.  And maybe being Christ-like isn’t what we all imagine it is sometimes.

I go to church at an inner city church plant.  The pastor call the congregation a “motley crew” and it is true.  We come from all walks of life.  There are hipsters and homeless people and wealthy people and young and old.  People are grappling with addictions, with difficult life circumstances with being students or stay at home moms or with growing up in this world in general.  We are all sinners.  Our thing in common is Jesus and what God’s grace is doing in our lives.

If someone walked in looking for people to look or act a certain way, they might be shocked.  People should know Christians because they are different.  Because of the love and grace the exude.  That does not mean they all have to be extroverts who dress and behave a certain way.  They can have tattoos and piercings or wear skirts and have long hair.  They all still struggle in one way or another.

I am guilty of it.  As humans, we all judge.  We compare and put people and things in boxes.

We need to stop putting God in a box.  And just as much, we need to stop putting what God does in, with and through people in a box.

The saddest airport

Today marks our last day visiting the city where I did med school and where we spent our first 3 years of marriage.  

It was a great trip.

I’m sad it is over.

I’m sure I will share more of the awesome stuff I learned and the places we visited.

But for now, I must share that the airport here is one of the most depressing airports I have ever been in.  It isn’t the ugliest, or the sketchiest, or the smallest or biggest or any of those.  I have been stuck here a few times but not as many as in other places.  But, to me it is always sad.  

Maybe it is because I arrived here too many times with nobody there to greet me (actually I did have friends pick me up sometimes, but often it seemed we were on our own).  Maybe it is because I was always dropping off people to leave .  Or sometimes I was leaving people.  

The airport is on two levels.  Arriving, you can see people awaiting those who they love.  It is great when you see your person from either end.  It stinks when you are on your own.

But worse is when you are leaving or having someone leave.  There is an escalator to the secure area.  So, it is like they leave slower.

I’m sad to leave today.  We had fun with great friends.  I nerded it out at a good conference.  But, now it is time to get back to real life.  And likely not see our lovely friends for at least a year or so.

This airport makes me sad.  Okay, it is probably the circumstance.  But, I blame the airport.

How Did That Happen: How I Got Through Med School Orientation

I realized today that it is about time for med school to be starting up again.  It blows my mind that about a 6 years ago, I hopped on a plane with 4 giant suitcases and my drugged mother (she was hopped up on cough syrup) to move to the town where I did med school.  Interestingly, I am leaving today for that same city to visit some friends and attend a conference.

I had been there twice before.  Once for my interview and once on a whirlwind room renting hunt.

To be honest, I was less scared of moving or even starting med school.  The thing that produced the most anxiety in me was orientation.

Yes, you got that right… Orientation.

I mean, yes, of course med school was terrifying and being told some of us WILL fail in orientation did not help.  Each first had its own level of terrifying… First lab, first exam, first standardized patient.  But orientation still wins in my books.

Thus for all of you shy, introverted (I say both because they are different) new to everything about a place people, here is my How Did That Happen? for the week.  How I Got Through Med School Orientation.stethoscopes1

I know some people love that kind of stuff.  Socials, dances, sporting events.  Not so much my scene.  I get that some people consider these sorts of events a highlight.  Or at least they don’t dread them. I dread them.  That’s just how I roll.

My med school took the whole orientation thing seriously.  I’m talking a full week of stuff.  And it was “mandatory.”

Seriously, mandatory “fun”?  Sounds like cadet camp all over again (seriously, they had these evenings where we were obligated to attend a “fun” activity like sports (ew) or the zoo (okay the first time, but it was a pretty lame zoo) or a movie (probably a bad one).  We called it mandatory fun night.  It was funny because it was by far not the most fun night of the week (dances or concert nights or parade nights won every time).

Events for this mandatory fun included whale watching (the best part by far).  An 80s mixer (ummm… I like the 80s, but when you stick them in a mixer, not so much).  Outdoor games complete with a slip n slide.  A pub crawl.  Various talks.  Photo scavenger hunt (epic, but not as fun when you don’t know where you are or who you’re with).  Dinner with some Med2s followed by a dance.

I was not pumped.  Except for the whale watching.

I knew one person I went to high school with.  Not well.

70% of people knew most everyone.  They all did undergrads together, they did their masters together, heck, they did all of their schooling together and they live down the road.

Just shoot me.

So, enough whining… I’m supposed to be talking about getting through it.

First of all, I tried to embrace the fact there were other people as lost as me.  I found them.  Found the first one lost in a hall as ridiculously early as I was.  I stuck with them.  She fell asleep on the bus on the way back from whale watching.  I fought the urge to run away.  As it turns out, we sat togther through most of our classes.   The randoms I stumbled upon ended up becomign some of my best friends through med  school.  So, find someone looking as lost and sad as you and say hi.

Realize that med school is like high school.  There are cool kids and cliques.  It did not take me long to conclude I was not cool, nor would I be part of the key cliques.  They were already formed before I even came in.  That’s okay.  I’ve never been one of the cool ones.

Show up for events.  Seriously.  They said it was mandatory, but not everyone came and this ticked some people off.  When you are as shy as I am this is nausea inducing, but it was also how I actually was forced to meet people.  Nothing says get to know people than getting thrown in a 2 door car with 4 other people you have never met to tear around the city taking pictures (especially when we ended up breaking into a more senior med student’s (who I also didn’t know)  house…).

Have fun.  I mean, if you have to be there and people worked hard to plan it, there probably is some fun in there.  Some of our stuff was really awesome.  Other stuff was awesome for people who weren’t me.   Just try to have fun.  Fake it until you make it.  I was pleasantly surprised.

Find out what is okay to skip and know that it is okay to take a breather.  Yes everyone will question your decision.  At least the people who noticed you exist.  But mental health for the win!

Participate.  If everyone is doing something to make themselves look stupid, you might as well do it too.  It might end up being fun, or at least make for a funny story.  My team in these messed up olympics they held won.  We got gift cards for coffee or booze.  It was thrilling.

There is free stuff at some of the events.  Free reflex hammers (which is like gold when you are just getting started and anything “medical” is the best thing ever), free bags, pens and best of all, free food!  Moving and doing a million more years of school is expensive.  Love the free stuff!

There really is useful information in there.  You won’t remember it all.  But they do tell you some important stuff.

If your school is anything like mine, the dean of something or other will get up and tell you scary stats about failures, people crying and people quitting.  This really does happen, but it will be okay.  It is an important reality check, but it does really sting.  Especially when odds are you were already nervous.

Tell yourself it will be fun and okay and all that good stuff.  It will be.  At least some of the time.

Remind yourself that despite the social anxiety and such, this really is one of the most relaxed times in med school.  Embrace that.  The real work is coming.

Remind yourself it is just a week (or less, if you’re lucky).

If you’re from away, it gives a chance to at least kind of figure out how to get to and from school, where some key stuff is and get settled before the real work starts (although the hours were so crazy, it was still tough to get any real unpacking done).

Things like orientations are just a bit awkward.  They end and eventually you know people well enough, you kind of wish you could have done that with the same people a year later.  Not all of that stuff, but some of it.

As much as I think I could have done without so much mandatory “fun,” I really do think orientations are important.  I still say they are overwhelming.  But once it was over with, I had other stuff to worry about, so no need to dwell.

What was your orientation like?  Do you love or hate them?  Do you have any tricks to get through orientations and mandatory “fun.”

How Did That Happen?: Human

This week’s How Did That Happen? should have been posted, well, last week.stethoscopes1

I have had some busy days including journal club prepping, trying to spend time with friends, go to Patrick’s work party, volunteering, keeping a clean house and getting a cold (I blame Patrick’s grubby kids). I actually had a long weekend thanks to an in-lieu day left over from Easter weekend call, so I have had the chance to do some movie watching and all around procrastination.

For any number of reasons both work and personally related, I have been feeling drained and down and all around kind of blah. It happens. I have a high baseline, so it weirds me out, but I must confess that it has been a recurring theme.

My How Did That Happen? is that I am human despite what medical institution says. I have known it all along, but just for the rest of the world, I will point it out.

People in medicine still get tired and sick and depressed.

We still have relationships.

We struggle with things like loss, fear and anxiety.

We have big joys and big sorrows.

We have regrets and make mistakes.

People in medicine still often have financial struggles. Just because we are there doesn’t mean we still aren’t paying off loans.

People in medicine are still learning. No matter where they are in their career. If they aren’t, there is a bigger issue.

People in medicine sometimes struggle with things we have to do in our jobs. Sometimes decisions we make haunt us.

We sometimes face our biggest fears in the eyes of others.

We don’t always have time to face those fears in ourselves.

Knowing that I am human is one of the best things I can know. Because it stops me from trying to be invincible all the time. Even when the world I am in sometimes acts as if that is not the case.

There is no fix for being human.

And for that I am glad (although, a cure for the common cold would be nice).

But, being human in medicine is a tightrope to walk with some of the pressures we all face.

Brian Goldman, an ER physician in Toronto and very talented speaker had this piece featured in the Globe and Mail today about physician burnout. I thought he voiced some of the common concerns about physician burnout today very well.

More accurately, the medical culture that fosters us is the problem. It’s a culture that implies you should strive to be perfect even though you’re human – one that encourages you to run from your feelings even though you can’t hide from them.

I don’t know how to fix burnout or how to fix our system. But, I think at least pointing out that I am human and treating the other humans I work with as human is a start.

During our first-year medicine exams, a classmate sent out this song to remind us that we are, in fact, not robots.

I still sing it to myself on days where I start being a bit too robot-like. It helps.

CAPO Review

It is the first Monday of the month and the last Medical Monday until September. Whoo. Time to check out some medical minded/affiliated blogs at the link below.


I am going to use this as an opportunity to expose you to some of the awesomeness I saw and learned about at the conference I went to this past week for the Canadian Association of Psychosocial Oncolology.

All last week, while at the conference, I was so excited, I wanted to tell the internet world about it, but resisted the urge in order to keep people from hating a million small updates about things that may not be as thrilling to everyone except me. But now, I will give a digest of some of the cool videos, tools and ideas that captured my attention at the conference and that I think might appeal to a wider audience.

First of all, every single keynote speaker pointed out that physicians are burnt out and that leads to poor communication, missing compassion and other issues. They also all cited a study of Internal Medicine residents showing that 76% displayed symptoms of burnout or depression. This made me feel depressed. Mostly because I know it is true. Also because I wanted to know what information was out there. So, I found a decent review article (IsHak et al. 2009) on the topic citing burnout rates to be anywhere between 25-76% and that self-care, counseling and system changes might help the residents and in turn improve patient care. Fascinating.

We have a system of health care, but not a system of caring.

Dignity is huge. Studies have shown that the factor that was seen as the make/break point in maintaining dignity was how the individual thought they appeared to others. Feeling dignity is supported if they feel they are being seen as a person and as a WHOLE PERSON, not just a disease.

One speaker talked about a thing they were doing at their hospital where they asked new patients to the palliative care service an additiona question, “What should I know about you as a person to help me take the best care of you that I can?” It changed care for many people.

Breast cancer risk is increased by smokng. But, interestingly, that risk is most increased when people smoke during periods of breast development. So, a group in BC designed videos targeting teens to try to make a change in this behavior. And it is working!

ReThink Breast Cancer is a nonprofit all about young women with breast cancer. They have support groups and events and all that good stuff. They even have a blog.  They also promoted a super cool publication in the form called Cancer Fabulous Diary, which is a book with coping tips and musings for young some with breast cancer.  It is written with the blogger from Cancer Fabulous, which is basically the experience of a young woman named Sylvia Soo who is a breast cancer survivor diagnosed at the young age of 24.

The Canadian Cancer Survivor Network has a webinar series on Thursdays about things like advocacy, drug funding and really relevant political/medical issues. Who knew? They aren’t the only ones though. Lots of other non-profits in cancer care have webinars with relevant topics.

No man is an island.

I went to a series of talks on decision making in older adults with cancer. About how they make decisions, how people get information and how they enroll in trials. Many people factor in their age, even more than providers sometimes expect. Family members are often divided into two categories, the super involved and the not involved. Both can have their pitfalls. Also, subtleties in communication with the provider influence the decisions a great deal. Sometimes the appearance of interest of a physician in a clinical trial will convince someone who was on the fence. Also, older adults cope better with a cancer diagnosis and treatment decision making than younger adults.

I saw a really cool video documentary on sexuality in young adult cancer survivors that addressed a lot of big issues.  The maker of the video is designing a website and taking the show on the road.  Unfortunately, it isn’t up yet, so I can’t show you.  But, it was very real and honest and not sugarcoated like a lot of stuff out there these days.

Psychosocial oncology is cool!