The Soul of Medicine

The Neuro Bootcamp is an intense 4 week program that immerses med students in the field of Neurology, a complex field of medicine focused on the brain and spine. The typical day ranges from 10 to 15 hours. Feeling discontented with the slow pace of Allergy Medicine, I signed on for the last week of Bootcamp, joining other students who had already been training there for three weeks.

It was unsettling, at best, to approach each patient with a sharp pin, with the intention of eliciting a pain response from their forehead, cheeks and chin. This was just one of a number of tests the neurologists used to assess the functioning of the major cranial nerves.

I've always had an interest in Neurology, and so it came as a surprise to realize that I am not meant to go into this field. While Neurology may focus on the brain, it focuses almost purely on the physical aspects of the brain - its electrical activity and chemical imbalances. We would see patients with acquired brain injuries, seizures, strokes, episodes of amnesia, and all kinds of problems that afflict the nervous system. Although I found myself fascinated by this at first, by the end of the week I sorely missed the human, feeling component of medicine. While we would ask patients about their balance and vision, we would rarely explore the emotional context of their illness - their fears, hopes, coping strategies and supports.

This emotional context is addressed primarily by the patient's family doctor or by a psychiatrist. This is done largely for efficiency: the Neurologist, as well as other specialists, face a large backlog of patients. They simply don't have time to delve deeply into the patient's feelings; their goal is to determine the physical defect and address it with medications or therapy, before moving on to the next patient.

I thought that I would like this - after all, I enjoyed reviewing my Neuro textbooks before starting Bootcamp. Unfortunately, the clinical reality of any given specialty often differs sharply from the student's interest in the subject matter. While the brain is fascinating on paper, in reality, Neurology means treating a narrow set of conditions on a "consult" basis - seeing each patient only once or a few times, excluding the development of a long-term patient-doctor relationship.

While I greatly admired the ability of the staff neurologists to "think through" their patient cases, I also realized that I would prefer a specialty with more emotion, more feeling. I think that my strengths are in connecting emotionally with people and being empathetic to their circumstances. These strengths are suited to a field that involves some aspect of psychiatry, which literally means the "soul of medicine". Although I'm not necessarily interested in becoming a psychiatrist, I do need to keep searching for a field that is naturally imbued with feeling and emotion.

Destiny's Call

A baby girl is born to a loving set of parents in a rural American town. She takes after her mother, with curious eyes and an infectious smile. Mom and Dad take their new daughter home, delighted that the arduous process of childbirth is over, and settle her into a room they’ve specially prepared.

At first, everything seems wonderful. The baby is responsive and full of energy. She giggles when she’s tickled and feeds without complaint. But after a couple weeks, her parents notice a slight tremor in her hands, which quickly develops into a jerking movement. The child becomes hyperactive, crying all the time and unable to sleep. A rash appears on her left foot and spreads rapidly upward, engulfing her leg in angry patches of red.

Mom and Dad, panicking, take their daughter to an Emergency Room after she has her first seizure. The doctors are unable to explain what happened, except to confirm that the girl’s brain is extensively damaged. Devastated, the couple take their daughter home and continue to devotedly care for her.

One year later, the mother becomes pregnant again. She wonders: Will this baby encounter the same problem? But this time her doctors conduct a blood test that confirms the presence of phenylketonuria, a rare condition in which the body cannot break down phenylalanine, an amino acid found in foods like milk and eggs. The baby is immediately put on a low-phenylalanine diet, escaping any damage to her body.

As the years pass, she grows up into a beautiful young woman and goes to college. While her dietary restrictions are frustrating, she is grateful to have avoided her sister's fate.

My class was shown a picture of the two sisters in a lecture last week. It was the younger one's wedding day, and she looked radiant in a beautiful wedding dress. Holding onto her arm was her sister, who wore a distant and unfocused expression. The simple existence (or non-existence) of a simple blood test had profoundly altered the destinies of these young women. While the married sister would go on to enjoy marriage, career, children, intellectual pursuits, the other would spend the rest of her days struggling with a severe mental disability.

We often frame our lives in the context of "destiny", the idea that certain events were preordained. But more often than not, one's destiny is determined by access to timely medical intervention; the C-section that saves a baby’s life, the antibiotic that kills a potentially deadly infection, or the vaccine that keeps influenza at bay.

One can't help but reflect on the millions of children ravaged by conditions that are now treatable, and wonder: What kind of lives could they have led? Who could they have become?

The Climb

On Friday afternoon, I finished up my elective in Allergy Medicine and headed back home, stopping by the Pancake House for a plate full of waffles. It had been an exhausting day - for some reason, I hadn't been able to sleep the night before. I've just moved out from my parent's house, and my apartment was an absolute disaster. Sitting there, staring out of the rain-streaked window, I felt like I was in a twilight zone - half conscious, not fully sure where I was. I also had a stomachache - by this point, I regretted the waffles big time.

It's been a challenging couple of months at med school, a relentless onslaught of training, tutorials and readings. Near the end of June, we all completed the OSCE, a clinical exam in which med students rotate between ten different stations. Actors pretend to be patients suffering from real conditions. Meanwhile, a doctor sits in the room and evaluates the student's performance. Some of the stations involve complicated ethical scenarios, a reminder of the Multiple Mini Interviews prior to med school.

At McMaster, our summer consists of 7 weeks of clinical electives and one week of vacation. My electives began in early July with Allergy Medicine - I've spent day after day performing skin tests, making tiny perforations on people's arms before applying small amounts of allergic substances. The Allergy team stores a vast variety of these allergens, from "horse epidermis" to a variety of tree nuts.

Yesterday morning the real challenge began with Emergency Medicine. I was fully prepared for some intense clinical action, but instead I spent two hours at the parking office trying to get a student transponder. Despite this initial setback, it was thrilling to step into the trauma unit for the first time. This is the heart of medicine, where doctors race against time to save lives. The unit is equipped with sophisticated equipment to rescue patients from the brink of death.

The day ended up being fairly productive. I improved my dictation skills, learned how to use the computer system, and interviewed a couple patients. At the same time, I felt intimidated by the seemingly endless medical details with each case, details that the ER doctors seem to have mastered. Sometimes, especially at the end of a stressful day, I look at the 5+ years of medical training in front of me and wish that I could just speed through it, somehow "zapping" all the information into my brain. It would be lovely to have a steady job and a regular paycheque.

Things that are keeping me sane: Playing with my dog (she's become quite a beauty), trash TV (namely "Desperate Housewives") and my family and friends.

All I need to do now is grit my teeth and keep pressing forward, step by step.