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.

The Cloud Messenger

" I wouldn't blame someone for assuming that the concept of "true love" was just a myth invented by Hollywood. In the real world, relationships often fail. But my idealism about love, which spills over page upon page of this blog, is grounded in a true story that sweeps across the world, across racial and cultural boundaries. It's the story of how my mother and father met and fell in love.

In 1981, my mom was fresh out of her third year at Dalhousie Medical School. Filled with a sense of adventure, she set out for an international summer elective at the King George Medical College in the city of Lucknow, India. After 30 hours of travel, she finally arrived in the city - it was sweltering hot, dirty and crowded. Navigating her way around the college, she bumped into the Chief Resident of Pediatrics, who her directions and invited her to dinner. Feeling uneasy in these new surroundings, she gratefully accepted.

The Chief, who also happened to be my father, felt enamoured with this young woman and was eager to impress. He borrowed money, a scooter and a kurta (a knee-length shirt for men) from his friends. Their date that evening was replete with rich food and conversation, easily blossoming into a summer romance. Three weeks later, my father whisked my mother away on a breathtaking trip through the Himalayas, a vast mountain range that stretches across South Asia. They rode along winding roads by day and slept in small roadside cabins by night. In their own words, they both fell "madly in love".

Despite this, they were faced with a seemingly insurmountable geographic and cultural gulf between them. Neither of their families supported the relationship. When my mom boarded the plane for Canada, she thought she had seen the last of my dad.

Little did she realize that she was dealing with a most stubborn of creatures: a young Indian male, an individual born and bred in a culture that is fixated on the idea of romantic love. Over the next four years, my father wrote two letters to my mother every week, each one brimming with flowery reminiscences of their trip and dreams for their future together. He was inspired by "The Cloud Messenger", the famous poem by Kalidasa, in which a subject of King Kubera (the god of wealth) was banished from his homeland for neglecting his duties. Missing his wife, the subject convinces a passing cloud to carry special messages to her.

Every time my mother began to doubt the practicality of their cross-continental romance, another package would arrive from her own Cloud Messenger and assuage her concerns.

On the banks of the River Ganges.

In 1985, my mom and dad married one another in a traditional Indian wedding outside of New Delhi. It was a classic Indian production, replete with vibrant decorations, hundreds of guests, a dazzling variety of foods and even a white horse to carry away the bride and groom. The strength of their connection had overcome the reservations of their families , who in the end celebrated the wedding.

Soon after, my parents settled in the remote mountain town of Pauri, providing healthcare to the poor. They faced incredible challenges, including an earthquake that killed thousands. My earliest memories were forged in these mountains. I remember bathing on my front porch in a tiny blue tub with snow-capped peaks as my view, and eating hot roti bread fresh off the stove. While life may have been difficult for my parents, it was thrilling for my 3-year-old self.

Twenty-five years later, my parents still share a cup of tea every morning over wide-ranging philosophical conversations. They plan to move back to the Himalayas after they retire, to serve the poor once again. While their lives have been unpredictable, one thing has always been certain: Their bond is unbreakable.

Being a witness to this story has convinced me that true love is achievable, but that it requires effort and some degree of risk. As I move through my twenties, I can't help but wonder if I'll be so lucky as my parents ... or whether I'll end up a lonely bachelor who collects stamps and drinks his tea in the company of his cat.

I'm going to press "Publish" now and send this post off into the clouds. 

Rhythms of Life

Last week, my clinical supervisor called me into his office to deliver my final evaluation. He wore a stern expression on his face as he looked it over. “You did terribly,” he said in a frustrated voice before adding “Just kidding!” with a big smile. I shook his hand, and with that, wrapped up the third foundation of my medical studies.

For the last two months, we’ve been knee-deep in the renal and reproduction systems. Surprisingly, the kidneys are some of the most complicated organs in the body and inevitably a challenge for those trying to master their physiology. They involve a seemingly endless number of intricate mechanisms and functions, including the regulation of blood pressure, electrolytes and acid-base balance. It took several grueling study sessions before these concepts finally “clicked” in my brain. As part of clinical skills training, we’ve learned how to do a Pap smear on a model and watched a rather graphic video about childbirth.

Undoubtedly, though, my best learning has taken place in the clinic. I spend ten hours a week doing electives in Family Medicine, Hematology and Pediatric Neurology, which, in my opinion, are far more immersive and interesting than the monotonous pages of any textbook. Surprisingly, I’ve had several minor accomplishments. I counseled a woman about quitting smoking. She’s now trying out Champix, an effective new drug that diminishes nicotine cravings. I’ve also done my share of physical exams, finding a couple suspicious lumps on a routine lymph exam last week.

It feels good to immerse myself into a steady rhythm of life, a rhythm that involves solid study sessions, clinic time, lectures and tutorials. The day begins at 7 with a hot cup of tea and ends with a trip to a yoga studio, where I do plank poses and Downward Dogs in 40-degree temperatures.

I'm currently reading Dr. James Orbinski's "An Imperfect Offering", a fascinating glimpse into his life as a doctor with Medicins Sans Frontieres. I enjoy reading medical memoirs because they give me some perspective; that, despite seeming like I'll be in school forever, one day I will indeed be a trained doctor and able to pursue my dreams. 

Tomorrow we start bright and early with our fourth foundation, which will cover immunology and neoplasms. I'm looking forward to meeting my new tutorial group and tackling "Janeway's Immunobiology." By this point, I've learned how to study well and have become quite comfortable in the curriculum. I feel an urgent desire to get as much knowledge under my belt before rotations begin in November, when the real challenge begins. 

Somewhere

The old woman lies in her hospital bed room, emaciated and feverish. There are steel spikes in her throat, the consequence of a strep infection that makes it almost impossible for her to swallow solid food. Exhaustion soaks into her bones ... even sitting up leaves her tired. Days and nights blur together and time means nothing. Her only task is to sleep and eat, sleep and eat until she finally passes away.

Despite all this, she says that she feels a deep sense of contentment. She is surrounded by people she loves and always has a niece or nephew around to entertain her. Beside her bed is a large, double-paned window that looks out onto a street dotted with quaint stores and coffee shops. She remembers playing along this street as a child, when six hours could so easily be swallowed up with simple games.

But things are different now. As she moved from childhood through adolescence and finally into adulthood, her outlook on life steadily changed. She has become more of a realist. She doesn't see the world as boundless, but rather quite limited by the realities of flesh and blood. She has seen friends come and go, family members pass away. She has had profound personal experiences with aging, suffering, illness and now, finally, death.

And yet while many languish in pain and loneliness in the final chapter of their lives, she feels satisfied. Her life has been full of friendship and love. She followed her dreams, married the man she loved and raised a beautiful family. She devotedly took care of others for many years. Now, her children and grandchildren, nephews and nieces - and all the others whom she touched with her kindness - come to the hospital to be at her bedside. Now they take care of her, doting on her with small gifts and kind wishes.

Her faith in God sustains her. It's easy to look down upon another's religious or spiritual beliefs, to question their logic ... but for this woman, at this moment, her faith gives her great strength and optimism. She does not see herself just as a dying, physical being, but rather as a soul ready to escape its material confines and ascend to Heaven.

She will go somewhere where there is no suffering, somewhere where she will be rewarded for a lifetime of faith and service. 

True Love

My next-door neighbors are a beautiful young family with three small children. One parent has a natural green thumb, planting her flower seeds in such a way that her front lawn blossoms into vibrant hues of orange and yellow every spring. The other is an expert cook. She never fails to bake us a delicious blueberry pie on Christmas Eve.

My neighbors seem to go all out for every special occasion; on Hallowe’en their house is decorated with cotton spider webs and Styrofoam tombstones; on Christmas they place an enormous blow-up Santa near their front steps; and on Easter, their kids dress up as rabbits, dashing around in a frenzied attempt to find hidden chocolate eggs.

This beautiful, loving family would never have even existed fifty years ago. Because, despite their dedication to their children, the parents would have been socially ostracized for the simple fact that they are both women.

Across the span of history, gay men and women have often lived at the peripheries of society, shameful of their true attractions and fearful of being discovered. As a result, they have often married the opposite sex, foregoing the opportunity for genuine relationships and true love, aspects of life perhaps more celebrated than any others. How many relationships have been prevented by irrational stigma? How many soulmates have been kept apart?

I’m proud to call myself a Canadian because, on the whole, a Canadian has the reputation of being a moderate, someone who eschews the extremes for the middle ground… for common sense. We’ve allowed gays to serve in our military because we know that they are fundamentally just as brave and capable as anyone else. We’ve allowed them equal rights of marriage because we know that their feelings are real, that their relationships are genuine.

The world has no shortage of suffering. The Intensive Care Unit at the Hamilton General Hospital, where I train every week, is full of the sick and dying. While we may be young and healthy now – perhaps even feel invincible – we will inevitably be consumed by aging and illness.

Why then, in the midst of all this suffering, would we ever consciously choose to destroy the opportunity for love between two people? Love that might blossom and pass down through the generations, strengthening the fabric of our society.

We would only consciously make this choice out of ignorance and fear. Because once we truly make an effort to get to know and understand gay people, we realize that they love as deeply, feel as deeply and care as deeply as anyone else.

As spring arrives, I look forward to seeing my neighbours’ lawn blossom once again. I look forward to the excited sounds of children drawing chalk patterns on the sidewalk and playing their imaginary games. I’m not sure what the future holds for them; perhaps they will be very successful in life, or perhaps they will be hampered by failure and unmet expectations. Whatever happens, I know that they will be able to look back at their childhood, at their two moms, and say that they were truly loved. 

Maya

Day before yesterday, my sister, mom and I drove to Mississauga to pick up our miniature poodle pup from the breeder's home. A bubbly, middle-aged woman greeted us at the door and ushered us into her living room, where she brought out our pup. I was anxious for a couple seconds; what would she look like? Would she be cute? Would she be friendly? My questions were soon answered when the breeder came back into the living room carrying an adorable black female pup in her arms, with two soulful eyes and a tiny black nose.

Was she friendly? Definitely yes. The puppy leapt out of the woman's arms as she lowered them and literally attacked my sister and me with affection, jumping in and out of our laps and nuzzling her head into our open arms. She was a bundle of energy, a little spark of mischief that bounded back and forth across the room. I immediately felt a connection to her and a feeling that we'd chosen the right pooch. 

Of course, buying a miniature poodle pup (or any pup for that matter) may sound fantastic, but then comes the hard part ... potty training. Over the past two days, my mom, sister and I have taken tiresome shifts supervising the puppy and placing her on her special doggie pad right as she squats down to pee. I made the mistake of bringing her onto my bed with a full bladder - let's just say that my blanket went straight into the wash.

She also seems to enjoy chewing everything. A family friend came over with a Holter monitor strapped to his chest (for measuring heart function) and a long, thin wire that ran down into his pocket, where it attached to a controlling remote. Puppy didn't care that it was medical equipment - she grabbed that wire between her teeth and had to be forcefully pried off.

Then again, the advantages of owning a tiny, 8-week old pup far outweigh the negatives. This afternoon my Hematology shift at Juravinski was cancelled and I was feeling somewhat stressed and unwell. So I packed poochie into her crate and set off for Mac, where I introduced her to a bunch of friends. Never have I had so many people converge on me at once ... it was like I was carrying the Holy Grail. Even though the pup was quite shy, she didn't fail to make nearly everyone gush over her. 

But what about the name? We started with "Leela", an Indian name, and then jumped to "Kala", which means "Black" in Hindi before all deciding that "Maya" was splendid. 

All this weekend, friends are visiting one after the other to meet Maya. There's something about a puppy that is irresistible. Maybe it's the spontaneous energy, or the boundless curiosity, or the unbridled affection ... whatever it is, this furry little creature has injected fresh energy into our social lives. Within no time, Maya will be an adolescent. I plan to savour her puppyhood, and take her on several more trips to McMaster to meet new friends. I'm looking forward to being woken up in the morning by the cold end of her snout, and going on long runs together through Churchill park.

I feel a sense of connection and adoration for my new pooch, and I can only hope that she feels (or will come to feel) the same way.