Dancing on the Edges of Burnout

Note: any identifying patient details have been removed to preserve confidentiality. 

Last week I met my first patient ever. She was an elderly woman with shortness of breath and swollen legs. McMaster's medical school is famous for getting their students to see patients within the first month of classes. But in reality, at this point we know next to nothing about medicine. So I and a classmate were assigned the fairly straightforward task of taking a medical history.

The patient was sitting upright in her hospital bed being pumped with oxygen and an IV drip. We proceeded to ask questions over the next half hour, trying to build up a complete picture of the patient's medical history. I felt very out of place, shuffling through my notes while trying to figure out what to ask next. But the woman was patient and understanding. She also had a very dry sense of humour that made us laugh several times. 

It was likely her heart had become too weak to keep pumping enough blood to sustain her body. The clinical term is “congestive heart failure”. I felt sad, but the woman’s cheery mood and humour lifted my spirits. At the end, my supervisor thanked her for taking the time to speak with us.

“Oh yes, because I have a very busy schedule,” she deadpanned, alluding to the fact that she was in her hospital bed almost 24 hours a day. 

The only complication came early in the interview when the nurse changed the soiled diapers of a patient nearby. I have an extraordinarily sensitive nose and the smell hit me like a truck. Even if I was blindfolded in the morning, I could probably still sniff my way from class to class. This supersonic sense of smell can be a problem, since medicine is usually a smelly profession. But fortunately I got used to it quickly and it stopped bothering me. First test passed.

Although the clinical encounter was a high point, I feel like I've been rapidly burning out over the last two weeks. I’ve become overwhelmed with classes, extra-curricular commitments and studying. 12 hour days are becoming common place, and even once I get home there are countless more readings to do. 

Unfortunately this is very much self inflicted. I seem to have signed up for every extracurricular opportunity available - last week I registered myself for two medical conferences and a semester of hip hop classes. Facing a deluge of opportunities, it's too easy to say "Yes" to all of them.

Best show ever

When the second season of "Battlestar Galactica" arrived at the library, I knew I was doomed. Watching the riveting story of the power struggle between the Cylons and the remnants of humanity has eaten up the last bits of sleep that I enjoyed.

Fortunately the turning point came a couple nights ago, when I was watching a National Geographic documentary on the human life cycle. The narrator was talking about menopause when my eyes suddenly welled up with tears. This came out of nowhere; I was actually in a good mood. I guess our bodies start to do unpredictable things when we push them too hard. 

I dried my cheeks and reached for my sister's bottle of skin cream sitting on the desk. Smearing the cream over my face, I immediately grimaced - it was full of tiny, sharp particles. Exfoliator.

So here I was, exhausted and crying over a documentary about menopause while inadvertently exfoliating my face. I shut off the TV and went to bed.

Waking the next morning after a long rest, I felt determined to restore my sleep cycle and take better care of myself. Armed with this new determination, and with skin as smooth as a baby's bottom, I'll soon be ready to take on the world again. 

From Africa to Ancaster: A Fascinating Life

Nine candles sit on the enormous white cake at the front of the hall, their flames flickering as the chattering in the room quiets. Almost all at once, sixty voices begin to sing “Happy birthday” together. All eyes are focused on a dignified, elderly woman at one of the tables near the front; Bernice Trollope, my grandmother, or as I affectionately know her, “Nana”. They are celebrating 90 years of a remarkable life.

In 1921, Bernice was born in a tiny Norwegian settlement in South Africa. Her father, a Christian missionary, was often away on missions in Madagascar, leaving her mother to raise four children. There was no running water or electricity, and her family was so poor that they couldn’t afford shoes for her until she was five years old. But education promised a way out of these dire circumstances. Bernice hitched a ride with several other kids from her settlement on a horse-and-buggy that drove them to school every day.

Classically Norwegian, Bernice was a plump-cheeked, big-boned girl with auburn hair, ivory-skin and green eyes. She was very gentle and obedient, and her Grade 1 teacher remarked in her report card that she was “An excellent and disciplined pupil who takes herself too seriously.” Bernice fell in love with languages, becoming fluent in Norwegian, English and Afrikaans. She chose to become an English teacher.

Then, on September 4^th, 1939, the Union of South Africa declared war on Germany following Hitler’s surprise attack on Poland. The declaration of war changed the life of every South African, and my grandmother voluntarily joined the army. She was trained to operate supply vehicles and monitor radar, and was promoted to Sargeant. 

During the war, she met a young engineer named William Trollope. He was skinny and rather awkward-looking but was charming, brilliant and had a fantastic sense of humor. He courted Bernice, but on a trip to Norway after the war ended, she became engaged to a Norwegian man. For some reason, the engagement fell through and Bernice returned to South Africa. A gregarious and successful man that she had known since childhood began to court her, but she reconnected with William and accepted his marriage proposal instead. 

Bernice envisioned a life in South Africa surrounded by her vast extended family. She despised Apartheid and opposed the nationalist government, but despite this, she loved the country passionately; its lush, tropical countryside and vibrant way of life. She didn’t realize that William did not share the same attachments. Shortly after they were married, he secured a two-year position at an engineering firm in Quebec, Canada.

This came as a shock to Bernice. Quebec seemed very foreign; a French-speaking province in a distant country with a cold, snowy climate. Most important, she was deeply connected to her family, and this would mean leaving them behind. But since it was only for two years, Bernice accepted the plan.

By now she and William had two children, including my mother. The little family arrived in Sherbrooke, Quebec to a small apartment, in the dead of winter. Bernice struggled to adjust to their new life in Quebec. Her body, especially her sinuses, couldn't cope well with the extreme cold. But she didn't complain and instead adapted herself, starting a small English school for French children. 

Bernice missed her family terribly during those years, especially her mother. Their only connection was through letters. And so it came as a huge shock when my grandfather decided that they would settle in Canada permanently. He didn't see a positive future for South Africa. Bernice was devastated by the decision, but she came from a generation where the husband made the big decisions. Sadly, she couldn't even visit her family for many years because of her family responsibilities.

Meanwhile, William fell into severe clinical depression that would last for most of the next two decades. Unfortunately, this was before the time of effective treatments for major depressive disorder. When he returned from work, he would immediately go to bed and only come out his room for supper. Bernice took on the responsibility for making family decisions, caring for the children and caring for William himself.

The family moved to Ancaster, but over the next years my grandmother's workload would only increase. William suffered through three different types of cancer brought on by a lifetime of smoking. When she was not taking care of him, she was volunteering at church. Her idea of Christianity is one of a loving, encompassing faith; last year, she voted in favour of allowing gay men and women to serve as priests within the Anglican church.

My grandfather died of leukemia in 2000. His depression had finally lifted in the last years of his life, and he enjoyed a relaxed retirement in his Ancaster home. Although it was heartbreaking for my grandmother, it also marked the start of a wonderful new phase in her life. She loved to travel but had always stayed home to care for her husband. 

And so we took a family trip to South Africa, crisscrossing the country. We celebrated Nana’s 80^th birthday in the city of Pretoria and over a hundred family members and friends attended. I met the other man who had courted my grandmother all those years ago. Once she married William, he went on to marry another woman, had several kids and led a happy life in South Africa. 

I can’t imagine how different her life would have been if she had accepted his proposal. She could have stayed with her family in South Africa and avoided the decades of hardship created by my grandfather’s depression. Now, in her old age, she continues to be a nurturing influence on our tiny Canadian family; making countless pots of jams and blueberry pies, hosting family dinners and lending out her car. As a boy I would sleep over at her house every Friday, playing ridiculous word games with her while eating delicious heart-shaped waffles. She has always been a rock of stability in my life and the lives of all those close to her.  

But now as I look at my grandmother in the church, I realize how heavily time weighs upon her. Where once she was tall and strong, she is now stooped over and fragile, as if even a gentle breeze would blow her over. Although I’m sure she’s in pain from her aching hip or from the severe arthritis that wraps around her spine, she doesn’t show any trace of complaint. She never does. Instead she smiles as she greets her guests.

For her, life has always been about grace, dignity and quiet resolve.

Love in the Time of Medical School

I’ve always been a romantic. In Grade 4, my friend had an enormous crush on a blonde girl in our class named Megan. He was desperate to think of a way to woo her, but too shy to approach her directly. When he asked me what he should do, I hatched a plan to write anonymous love letters on his behalf and deposit them in Megan’s locker. My friend agreed to the plan, and a couple times a week I dictated romantic messages as he scribbled them down on dollar store stationary.

As it turned out, the plan badly backfired. Megan’s friends, upon learning of the anonymous letters, teased her relentlessly and immediately suspected my friend. Megan implored him to stop writing the letters, killing off any potential for a steamy romance.

Despite this setback, romantic feelings simmered and bubbled under my surface as the years passed. I had my first dance in Grade 6 with a cute brunette and then my first date in high school. I planned our date to be dinner at a nice Indian restaurant. A couple hours before, I bought a long-stemmed rose from the local florist, washed my car and put on my nicest shirt and pants. Pulling in front of her house, I took a deep breath and knocked on the door.

Her father answered. Shocked, I hid the rose behind my back and proceeded to talk with him for 5 minutes. Please, please don’t ask me what I’m hiding behind my back. Then you’ll know how lame I am, I thought. Once the girl finally came out and her father disappeared, I gave her the rose and she took a good whiff… I think she liked it. It was a lovely evening.

Unfortunately, once I entered university and became hyper-focused on getting into med school, my romantic life quickly fell by the wayside. I think the most romantic thing I did in undergrad was watch a rerun of The Notebook with my mom. Sadly, this trend looks to continue in medical school, as I find most of my time consumed with respiratory structures, cadavers and freaky medical disorders.

And yet I feel a constant undercurrent of desire for romantic love. It’s probably one of the most basic, primal needs one could have. Intellectually I know that I’m headed towards a nice career, and I live in a nice house with a caring family and great supports. I have many varied interests that I enjoy, like badminton and writing. I don’t want for any material goods.

But there’s something missing: the feeling of intimacy and closeness on a level much deeper than friendship. So many of our interactions on a daily basis are superficial and meaningless; the average “Hi! How are you?”

Love pierces this layer of superficiality. Two people in love know one other better than anyone else in the world; each other’s secrets, dreams and all the emotions, neuroses and vulnerabilities usually kept well hidden from the world. I believe a couple crosses the threshold of simply loving each other to falling in love when they form a powerful bond that is nearly unshakeable by any external force.

A man truly in love is the man who marries his fiancée even after she has been horribly disfigured in an accident. Or a woman who stays faithful to her husband through years of war.

The idea of establishing this deep connection with someone else seems like an incredible dream to me. One day I hope it comes true.

O-Week: It Begins!

Sunday, August 28th, 2011

I return at 4 am from a night of clubbing at Sizzle & Koi, a popular dance club in Hamilton. It's probably a bad idea to pull an all-nighter only a couple of nights before med school starts, but it's my last chance to see a couple of good friends before they take off to various parts of the world.

After four hours of restless sleep, I wake up with no hearing in my left ear. I figure that the loud, pounding music has temporarily deafened me. It's the day before school starts and I feel uneasy. I don't like being the new kid, even though everyone else is new as well. It's hard being thrown into a new environment surrounded by hundreds of people you've never met and expected to make friends, establish a routine and generally succeed.

Monday, August 29th

I file into a huge lecture hall in the McMaster School of Medicine at 8 am. Each administration member impart a few "words of wisdom". We get fitted into our new white medical coats and scrubs, the clothes you wear in the operating room. I hope that I don't have to wear scrubs too often, since seeing surgical procedures up close makes me a little queasy. The administrator implores us not to wear our scrubs while at the gym or out shopping - apparently it's happened before!

Next, our class of 207 is divided into teams and set out on a scavenger hunt. Our mission is to locate a list of places (eg: the fake goldfish bowl in Mills Library) and take funny pictures beside them. Since I know Mac so well, it's fun giving my fellow team-mates a little tour.

In the late afternoon, I collapse into bed exhausted. I'm sapped of energy and my hearing is still gone. I really didn't feel like going to the evening barbeque for the med students in the Dundas Driving Park, but the promise of free food is too much to resist. I should really see someone about my health. If only I was a doctor.

Tuesday, August 30th

The day begins with safety training and a lecture on financial management. These activities are followed by - SURPRISE - a huge bouncy-castle obstacle course! Two med students compete at a time, climbing over walls, throwing themselves down slides, and shimmying through narrow tunnels to get to the finish line. Even though I feel half-dead with whatever strange ailment is afflicting me, my competitive side kicks in and I win my match.

Wednesday, August 31st

We start with a thorough lecture on infection control. The speaker passes around a UV light that lets you see all the germs on your hands. Ew. From now on, I think to myself, I may carry around a bottle of Purell at all times. In the evening, I go with my family to "Little India" in Toronto to celebrate my dad and sister's birthdays. They happened to have both been born on August 23rd. Unfortunately, I discover that my favourite Indian snack has been banned from Canada by the government. That seems to be the fate of many imported Indian foods, which tend to be manufactured in unhygienic conditions. 

Thursday, September 1st

Medical class formal at Liuna Station, a beautiful former train station near downtown Hamilton that has been converted into a place for formal functions. It's also where my high school prom was held. I spend a lovely evening joking and laughing with my med school colleagues. Starting to make some friends.

Friday, September 2nd

Crisis. My left ear, which I've been neglecting for days, suddenly bursts during the night.The pain is so bad that I can't sleep or do anything. It feels like someone is dragging a serrated blade through the left part of my head. I finally see the doctor and she diagnoses a severe infection, prescribing a course of antibiotics. She tells me that this is one of the worst pains that the human body is capable of feeling. I somehow make it to the Niagara Wine Tour, the last event on the O Week calendar.

Since then...

Despite my ear problems, O Week was a great experience. Just like in Artsci, I found the people really interesting and friendly. I don't think there's such a thing as being a "nerd" in medical school, since every one is a nerd in some or other way. It's OK to break out into a conversation about classic novels or the merits of different voting systems without receiving a hostile stare. 

Even better, the days of cut-throat competition in medical schools are gone. The School of Medicine doesn't assign marks or rank its students, and instead students work collaboratively in groups. This fosters a trusting and non-competitive atmosphere. I appreciate that on an academic and personal level. I also feel excited to meet my first patients and begin to delve into the world of medical knowledge. In a profession where one has so many encounters - with patients, other med students, doctors - there are bound to be challenges. I plan to continue to use this blog to reflect on and share my experiences while on this incredible journey.