T Minus 11 Days

On the desktop background of my Macbook Pro, I have a little countdown program running; counting down the days until our Objective Structured Clinical Exam or "OSCE". In 11 days, all the med students at McMaster will be tested on our clinical skills. It is the final exam before clerkship begins.

This semester has been incredibly stressful. My grandmother in India passed away in early October, which convinced my parents to fly to New Delhi immediately to handle the burial ceremonies. Indian funerals have complicated rites and rituals in which the eldest son of the deceased plays a prominent role (my father is my grandmother's eldest son). 

As a result, I've had to manage my parents' household (and our dog, Maya) while also managing my own apartment. Meanwhile, schoolwork has been piling on, ranging from the musculoskeletal system to neurology to psychiatry. Somehow I've managed to keep everything afloat, but it means that I haven't had the mental energy to update this blog in quite some time. I apologize for that; I love this blog and all the connections I've made through it, and I promise to update it every week from now on. I know there are going to be many, many fascinating stories to share in clerkship.  

I've been sustained through this difficult time by my two lovely roommates, Perry and Manreet. Perry is an enthusiastic and energetic first year who has been elected president of his class. He keeps inviting me to awesome social events, including the 2012 American election celebration event at the Phoenix (Gobama!), pub nights and "Screemers", a terrifying haunted theme park. Perry has also taught me how to cook; last week we prepared a delicious honey-mustard chicken dish together. Meanwhile, my other housemate Manreet is a second year opthalmology resident. His knowledge of retinal complications is eye-popping (sorry...). 

As clerkship draws closer, I look forward to starting my first rotation in Emergency Medicine. Then onto a short Christmas break before plunging into four weeks of child psychiatry. I hope that you (friends, relatives and random blog readers) are all doing well. 'Til next time! 

The Countdown Begins

Dear loyal readers of "Reflections",

Thanks for accompanying me on this incredible journey (through medical school and through life in general) over the past year. Many have contacted me wondering when the next update will be; to be honest, right now I am so bogged down in schoolwork that it's been difficult to muster up any creative energy. Fortunately, I am starting a new chapter in my life soon, a chapter that we can call "Clerkship". This will see myself and my fellow medical students become immersed in the hospital full time, rotating through a dozen or so specialties. Besides being an incredible learning experience, it will also be rich in creative inspiration, and without a doubt, I will begin blogging fervently again then.

Clerkship begins in late November. I'm counting down the days. Look forward to seeing you all then!

Death of a Beloved Mother

written by my mother, in regards to my Indian grandmother's recent passing. 

My husband and I were getting ready for bed in our Canadian home, when we received an unexpected phone call from India. It was our brother-in-law, who gave us the shocking news that Mummyji had suddenly collapsed and died. We were horrified to hear this, as Mummyji had always enjoyed excellent health.

Pradeep immediately began to make plans to leave for India, and I followed him three days later. The news of this unexpected death spread rapidly through Pradeep’s large extended family. Over the next few days, I joined my Indian family in the rituals surrounding the death of a beloved family member.

Yesterday, the main ceremony to honour Mummyji was held. The pundit came to our home and performed a havan that lasted more than two hours. Pradeep explained to me that each part of this ritual has layers of symbolism embedded within it, reflecting cultural meanings that date back thousands of years.

At the gathering that followed, I met members of Pradeep’s large extended family. Mummyji had been a much beloved member of this family, and so people came from far and wide to honour her. Many of the guests were well known to me, since I had lived in India for eleven years after our marriage. But some of them had not seen me since our marriage, nearly twenty-seven years ago. How much we’d all changed!

As I participated in the rituals surrounding Mummyji’s death, I reflected on the special relationship I had shared with her. I wondered how she felt when Pradeep originally told her that he had fallen in love with a girl from Canada. This match was so different from what she’d imagined for her eldest son. She and Papaji had already been searching for a suitable bride for Pradeep, but he’d refused to consider any of the young women they suggested. Now they understood why – he was determined to follow his heart and marry me.

We had a traditional Hindu wedding in Ghaziabad, where my parents-in-law lived. Mummyji didn’t speak any English and at that time I didn’t speak any Hindi. But she welcomed me to her home with a warm hug and a blessing for happiness.

I used to love to watch Mummyji prepare food. She would cut vegetables at lightning speed, with never a wasted movement. The meals she prepared were nutritious and delicious, and somehow she always made just the right amount. In the early days of her marriage, she and Papaji struggled to make ends meet. She became an expert household manager, stretching the family’s resources to the maximum.

Pradeep and I settled in Rishikesh, working as doctors in the hospital attached to Sivananda Ashram. After the birth of our first baby, Mummyji and Papaji came to stay for a few days and help out with our newborn daughter. I remember being quite fascinated by the way Mummyji took care of Sonia. To give her a bath, she’d squat in the bathroom with one leg extended, and then balance Sonia against her foot. After the bath she’d massage Sonia’s tiny body with oil.

She took care of me as well, cooking delicious food that followed Ayurvedic principles. After a pregnancy, a woman’s body is thought to be susceptible to dangerous cooling, and so foods that are heating to the system are given. One such food was a special form of laddu, made with the gum of a particular tree.

In 1996, after living for eleven years in India, Pradeep and I decided to move to Canada. I wondered if Mummyji would feel disappointed that her eldest son and his family were moving so far away. But she accepted our decision, and said that she wanted what was best for us.

At this sad time of Mummyji’s death, I find myself thinking about the relationship that we built. We were two women with such different backgrounds, but we were able to bridge the gap of culture and language through a bond of love.

A Letter from Paris

There’s nothing like a trip to Paris to give one a pounding headache. Not a headache induced by stress, but rather by a whirlwind of sightseeing and socializing. I’m sitting here, at the Alhambra Hotel, on a small bed with my Macbook on my lap and a bottle of Tylenol at my bedside.

It has been an intense but enjoyable trip, beginning last Friday night with a 7 hour plane ride to Paris. It was followed by a journey into the town of St. Hilaire in the province of Normandy. My mother, sister, cousin and I rented out a small villa surrounded by vast stretches of farmland. Over the course of the week, we explored ancient castles and towns. We also visited the beaches captured by the Allies on “D-Day”, a turning point in World War II. From our clifftop vantage point, we gazed down at the beaches stretching out on both sides of us. It was calm and peaceful, making it difficult to imagine 150,000 troops storming through blistering enemy fire. 

After our stay in the countryside, we headed to Paris and tried our best to absorb this massive, intricate city in the span of a day.

Despite the frenetic pace of the trip so far, I feel calm and content. These feelings are likely to vanish soon as I head into MF5, the final foundation in our curriculum. MF5 is notorious for having a grueling pace, packing in the musculoskeletal system, neuroscience, and psychiatry into twelve weeks. McMaster is famous for adopting an accelerated curriculum, but I can’t help but wonder whether three months is enough to adequately study these complicated topics.

I was given a colourful reminder of med school when I logged into Medportal, the interface we use to access our course information. The system has been totally redesigned, with this graphic at the top: 

Don't be fooled by the monsters' happy expressions; within a couple of weeks they'll be devouring us all. 

My mission now is to get back into "study mode". I'll wake up, go to lectures, and study. On the weekends, I will study. At night, I'll probably dream about studying.

Yet there will be those pockets of time, perhaps few and far between, when I'll indulge myself in some of the wonderful things about life: Hanging out with friends, going clubbing, blasting baddies on my X-BOX and taking my dog for a walk ... a dog who, in a short seven months, has blossomed from a tiny pup into a rambunctious adolescent. Unfortunately she has been struggling in her training. Both of us, Maya and I, have much learning to do. 

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.