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. 

You Are My Sunshine

Check out this article in the March issue of Incite Magazine. Thanks to Jeremy Henderson for editing this. 

On Hallowe’en Night 2006, I dropped by Shoppers Drug Mart to pick up some candy for the slew of trick-or-treaters who’d soon be arriving at my door. I tied up my dog, Sunny, to a post outside. Unfortunately, my mind was so preoccupied with candy and costumes that I returned home without the dog. Suddenly realizing what I had done, I raced back to the shop… only to find her gone.

No one – not my neighbours, the shopkeepers, nor Animal Control – had seen a trace of Sunny. She had simply vanished. That’s when I launched a major search and rescue operation, plastering the whole neighborhood with “LOST” signs and offering a $250 reward for her safe return. About three days later, a woman called me, reporting that she’d seen a young man walking Sunny on Dalewood Avenue. I zeroed in on the neighborhood, leafleting every house with signs. Finally, I got a call from a man who said that he had picked up the dog because he’d thought she’d been abandoned. Within minutes, I was at his house and recovered my pooch, who nearly knocked me over with excitement..

This whole ordeal proved to me the strength of my connection with Sunny. We had been through everything together. When I first arrived as an immigrant from India, she was my only friend for a while, and never failed to comfort me with her wagging tail. When I would have a tough day, she’d always lick away my tears. Sunny woke me up in the mornings with the cold tip of her snout, demanding food and patting, and would later run with me through the forests.

By all accounts, it was a miracle that Sunny was ever born. Her mother was a huge German Shepherd, while her dad was a tiny spaniel. But somehow they mated and produced a perfect blend of their genes – a beautiful, medium-sized golden pooch with a very sweet temperament.

Nowadays, I find myself thinking more and more about Sunny. It’s been a year since she died of a stroke at age 14, and the urn of her ashes sits desolately on my bookshelf. Beside it lies a big silver spoon that I used to feed her sips of water as she lay on her deathbed.

As the frosts of winter thaw and the spring comes in, my family plans to plant a small tulip garden in our backyard, where Sunny loved to play. My mother wants me to sprinkle her ashes all over this garden. A part of me feels like holding on to the urn forever, and that losing the ashes would mean finally letting go. But I know in my heart that Sunny’s ashes are not her lasting legacy. The person who I am today was shaped and molded by her constant presence throughout my childhood. She helped teach me the meaning of play, of joyfulness, and most importantly, of unconditional love.

And so I will go out this spring and spread her ashes, watching with a mixture of sadness and joy as the barren soil blooms into vibrant reds and yellows.

Chasing Dreams

“So where do you see yourself in ten years?” asked my supervising resident pointedly. It was a Friday afternoon and we were sitting across from each other at The Barton Bean, the main coffee shop in the Hamilton General Hospital. Exhausted from a busy afternoon clinical shift, we were happy to cap off our working day with steaming lattes. Since our conversation thus far had been fairly light, this question struck me by surprise.

Medicine offers over fifty different specialties and sub-specialties, ranging from heart surgery to nuclear medicine. Before graduating, McMaster medical students complete five foundations in the study of the body and disease, followed by an 18-month “clerkship” period that, in my case, starts this November. As clerks, the students work full time in the hospital, rotating through various specialties to narrow down their own area of interest.

Then comes the “CaRMS” process, the bane of every med student’s existence, whereby they compete with one another for limited specialty spots. They have to fly all over the country, interviewing at different hospitals and clinics with the hope of being accepted into their first choice. Some specialties like plastic surgery and dermatology are highly competitive, while others (like psychiatry) generally accept all their applicants.

As a high school student, I was sure that I wanted to be a surgeon of some sort. The challenging and stimulating environment of the operating room as well as the opportunity to directly fix problems appealed to me. But as I’ve progressed through my first year at medical school, my interests have shifted to neuroscience. The brain – the hardware of the mind and soul – is by far the most complex, indecipherable and fascinating organ of the body.

A career in neurology, the study of the brain and nervous system, would obviously be the most logical career path. And yet, in my experience, the real clinical work of a neurologist consists mostly of treating a narrow set of conditions over and over again; migraines, seizures and strokes. It also requires the completion of the internal medicine residency, probably one of the toughest available. This residency involves several difficult years of stress and sleeplessness borne out of regular 28-hour shifts. Then come additional years of training specifically in neurology.

When I try to envision my future, I'm not sure I would want to continue training in the hospital past the age of 30. By then, I’d like to be settled in a beautiful red-brick house somewhere in Toronto with a big, overly-friendly dog, a loving spouse and maybe even a kid or two. For me, the true substance of life is family and friendship, adventure and exploration. I'd want to be sure that whatever career path I chose allowed me enough flexibility to cherish these aspects of life. 

Lately I’ve begun to consider family medicine as a possibility. Its flexibility and broad scope of practice appeal to me. I could imagine myself running a busy clinical practice, as well as doing some teaching, writing and travelling. Undoubtedly, I have many tough decisions ahead … But if I make these decisions based on true values and interests, then I think I’ll be just fine.

Heart to Heart

"Raman, it's time to see your first patient. Interview and exam," my supervisor said firmly, placing a thick file in front of me. It had already been three weeks since I started my hematology elective, and although I'd relished every moment, I had kept declining to see the patients on my own. The very thought of it made my stomach queasy. But now my supervisor, convinced that I was ready, was throwing me in the deep end.

I slung on a stethoscope and headed to Exam Room 6. The patient, an elderly woman in her 70s, was suffering from a rare blood cancer. Her chart had informed me that she'd recently come back from a skiing trip to the States, and so I broke the ice by asking her about her trip. Both she and her husband enthusiastically recounted their adventures on the slopes.

Flipping back to the medical interview, I started off with open-ended questions that became more and more focused. There was a beautiful moment in our conversation when I forgot my anxieties and fell completely in lockstep with the patient. Each question flowed naturally and spontaneously one after the other until I gained a deep understanding of her case. For those few minutes, I was fully immersed in the interview, all my attention focused on her words and expressions.

Communicating with others has not always come naturally to me. As a little boy I immigrated to Canada with my family and was at first painfully shy. Every time I tried to talk to someone outside my immediate family, I would become consumed with my own fears. As a result, conversations with strangers were uncomfortable and I would avoid them, becoming isolated and lonely. Someone in Grade 3 called me a "loner" ... racing home, I looked up the definition in the dictionary, hoping it was something good. After realizing what it really meant, I just lay on my bed feeling sad and frustrated. 

Once I hit middle school, I finally started to make more friends. But I've never forgotten the pain of shyness, and still consider the ability to connect with another to be one of the most miraculous aspects of life. In the clinic that day, I felt a strong connection with the patient, turning what could have been a series of routine questions and answers into a heart-to-heart discussion. While a mere medical interview is scripted and emotionless, a true "heart-to-heart" is spontaneous, imbued with trust and mutual respect. It builds the foundation for a productive and rewarding doctor-patient relationship.

After I completed the interview and physical exam, my supervisor walked in. "So how did he do?" he asked. 

"Oh he did just fine," the woman said. Her face lit up into a warm smile. The doctor nodded approvingly and handed me the next patient file. This time, I felt genuinely excited. 

By the end of my shift, dusk was falling. I had to hurry home to have a bite to eat before heading out to a medical school party. Over the course of the next four hours,  I managed to make new friends and also master the art of "beer pong". The hostess, a second year med student, affectionately dubbed me "Noodles" after the popular "Ramen Noodles" soup brand. As I chatted with my friends, we connected easily through laughter and stories ... person to person, heart to heart.