I suppose this was inevitable, but as much as I love writing in this blog, I feel that it is no longer as rewarding for me as it used to be. It currently feels more like an obligation than an opportunity, and as such, I am going on hiatus, in hopes of trying to preserve whatever quality this blog had, and in hopes of not writing until I feel inspired and motivated to do so. I also haven’t quite figured out how I will navigate blogging about patient stories while maintaining respect and privacy, so perhaps it’s best to wait before I blog again.
Anyway, here’s to focusing on living life fully right now, and perhaps writing about it later.
FOMO is a widespread disease. As the world becomes ever faster-paced and we respond to every email and news item when our smartphone vibrates, incidents of FOMO grow exponentially.
FOMO is, of course, the dreaded affliction also known as Fear of Missing Out.
With the advent of technology, many of us feel like we need to know everything and be everywhere every hour of every day or else we are behind in the latest gossip and the newest fad and just life in general. Somehow knowing things first has almost become the equivalent of being intelligent, as if just getting the information first means that we are smarter, better.
What ever happened to sitting back and reflecting and writing and connecting ideas and creating new realizations based on one’s thoughts alone? Where is the emphasis on the importance of our individual observations and beliefs and perspectives separate from external validation and what the media think and want us to feel.
But in any case this post isn’t about human FOMO. It’s about cat FOMO.
Our cat, Molly, has come down with a serious case of FOMO. Perhaps all cats are this way. Or even all animals.
As long as she thought I was still sleeping in bed, she was content in her cat nap, too:
But as soon as she hears any sign of me waking up, she does her morning stretch and starts circling me:
Molly never wants to miss out on what I might do next. Maybe he’ll pet me, maybe he’ll feed me, maybe he’s going to rearrange all the furniture so that it becomes one big scratching playground for me.
She’s right. Maybe those things will happen.
So what is my point? Well, the truth is I don’t always have one. But if I were to try and make one up, I guess Molly’s behaviour justifies my own FOMO.
You should always be alert and ready just in case. Maybe that email at 4:34 AM in the morning is from the sister you never knew you had. She knows you are in Montreal and she’s here for a trip, but has been back and forth about contacting you. Finally, she musters up the courage to email you, but her flight leaves at 7 AM so you just have enough time to catch her at the airport if you read the email right away. She’s headed to Uganda for a yearlong project with MSF so if you miss her today, you may not see her for at least a year. What then? What if you didn’t get yourself out of bed to check that email at 4:34 in the morning? I would personally be sad if that happened.
So you see: you never want to miss out on something potentially amazing.
You never know when someone’s going to rub your tummy.
After watching Totem at Cirque du Soleil in Montreal, I was speechless.
Yes, I was speechless because it was incredible, but I was also speechless because I didn’t know how I felt or what to think about the performance.
I was not really sure how I could categorize my experience there. I was, and still am, a wee bit confused about the whole shebang.
Cirque du Soleil, for those who may have not been, is a circus taken to unprecedented heights. I did not know what to expect, so I had the same expectations going in as I would have had had I gone to a show at the theatre, and my expectations were simultaneously unmet and greatly surpassed.
In many ways, Cirque du Soleil taps into a visceral, primitive response that theatre rarely does. When trapeze artists were lifted 40 feet into the sky, or when young ladies rode on unicycles four times their height while kicking bowls onto each other’s heads, or when acrobats performed tantalizing feats of amazement without using any safety harness, it was exhausting to watch.
It was exhausting because there were so many moments when I felt like I was in the performer’s shoes, so my adrenaline was pumping strong because my empathy made me feel like I was 40 feet in the air and about to fall, or that I was about to screw up in the act and disappoint myself and my colleagues. At times, I could even feel fear for what might happen if the performer made a mistake and it cost them their job.
There was also an amazingly designed set – complete with a sliding main stage that could turn into a trampoline and a platform that could move like a scorpion tail; live musicians playing beautiful original music; and perhaps most impressively, an incredible use of technology and dazzling lights to help create illusion and wonder that constituted genuine treats for my senses.
The problem is I did not expect that. I was used to seeing a different type of show, which thrilled me in a completely different way: by making me think about the story and characters in the play or musical or film, reflecting the themes and metaphors of the show onto my own life.
Not to say that one is better than the other, but I went in expecting one and got the other.
However, Totem was confusing not because it was completely the opposite of what I expected, but because it was a mix of both physical thrill and thought-provoking beauty. There was a particular scene that stands out quite vividly in which a young man tries to seduce a young woman, who is resisting his advances, and their whole scene takes place high in the air on a trapeze, but they never lose their character’s intention during the beautiful choreography. In a lot of ways, I think that is what I expected the entire show to be: a cohesive story being told through physical movement and athleticism, but only some of the acts were stories, and it did not all fit into the greater theme of creation and evolution, which Totem is supposed to be about.
Like Montreal, the Cirque du Soleil’s place of origin, the show is truly one-of-a-kind: full of rare, curious, and talented individuals who simultaneously fit together for a purpose, and yet at times clash and seem to be off in their own isolated worlds.
The transitions between acts were not always smooth, and the acts were at times chaotic, nonsensical, silly, and seemingly out-of-the-blue, but never was it boring.
And that’s exactly how Montreal feels to me: full of surprises, with so much going on (e.g., three festivals happening on a Thursday night), sometimes inherently contradictory, sometimes seeming to be without purpose (other than for a good time or simply because they can), but always full of passionate and delightfully strange individuals (myself included), who push boundaries of what is expected and acceptable, and truly celebrate uniqueness while looking down on conformity.
In fact, I was at the Just for Laughs festival and two young ladies were dressed as tongues – with complete make-up, taste-buds in front, and blood vessels on their back – and by golly they were the proudest, most confident tongues I have ever seen. I would have been more than a little embarrassed had I been in their shoes, but they were running around actually making fun of other people in their flamboyantly rouge outfits.
Prelude: As seems to have become a habit of late, I am again cramming all of my month’s blog posts into a matter of days. Although in theory I suppose I should rejoice in what appears to be my dedication to spending more time living life than writing about it, the truth is this blog is important to me and my personal reflective process, so in practice, I think I simply need to concentrate on posting more consistent, but shorter posts.
Let us see how long this can last…
A little while ago I was at the hospital with the privilege of shadowing the Esophageal Clinic, consisting of four doctors who jointly saw patients one after the other, providing a superb level of patient-centred care that I had yet to witness firsthand in Montreal.
The team consisted of a gastroenterologist, a general surgeon specializing in the thoracoabdominal region, a thoracic surgeon, and a surgical resident specializing in minimally-invasive surgery.
Four extremely talented and competent doctors in one room meeting one patient at a time, spending, in one case, an hour explaining all the options to deal with a particular patient’s achalasia (i.e., difficulty getting food to pass from the esophagus into the stomach).
It was incredible.
I believe the patients are referred to this clinic only if their case is particularly difficult, and I think the idea is that the team of doctors comes to an understanding of each patient together, and offers the best options based on the situation. For some, maybe all that can be done at the moment is a nitric oxide prescription to try to increase gastric motility. For another individual, perhaps there are a range of options (from Heller myotomy to balloon dilatation of the lower esophageal sphincter).
I appreciated that the team discussed each individual before seeing them, so that they can provide a professional, united front for the patient. Each doctor took turns taking the lead at different moments, and they supported each other while joking with each other as well.
In particular, I appreciated that they always asked this: “If you could only choose one symptom that you want to improve after today, what would that be?“
I thought it was a beautiful question for so many reasons.
For one, it made care tangible. Because many of these patients were referred because their diseases were particularly challenging to treat, many of them had multiple illnesses and symptoms that were bothersome. To focus on the chief reason why the patient came to the clinic today meant that they could focus on trying to improve that one symptom, and perhaps continue forward in a stepwise fashion when the patient comes back in three months. I think this piecemeal plan is rightly cautious and likely prevents the risks of overmedicating while allowing for better understanding of the nature of the individual disease based on how each treatment helps or fails to.
Perhaps more importantly, though, I think that understanding the principle symptom helped the team much better understand that patient’s perspective. There can often be a great difference between what is physiologically wrong with someone’s body and how that problem manifests in and bothers the individual patient. So for example, physiologically, there may be a sizeable diverticulum in one’s esophagus, but if the top concerns of the patient have nothing to do with the diverticulum, is it worth the risk of surgery to remove it?
It was eye-opening to hear firsthand how the same mechanical problems in the esophagus can create such a range of symptoms depending on the patient’s life circumstance.
In short, in our first year of med school, we were assigned to describe what the difference is between the “disease” of a patient and the “illness” in the individual.
For one of the first times since starting medical school, I genuinely believe that I see that difference influencing the action of practicing physicians.
I was walking home after getting take-out from my favourite restaurant close to the corner of St. Catherine and St. Mathieu when I saw a public transit bus stop right in the middle of the intersection with no signs of moving. I thought maybe the bus had somehow ran out of gas right in the middle of the intersection, but that seemed unlikely. I then saw all the people gathered around to watch, and I feared maybe the bus had hit someone. I dislike it when people stick around to watch accidents, but I thought maybe I could help, and I also wanted to ensure my personal safety, and let’s face it I was also curious, so I tried to survey the scene quickly to see what was going on.
I finally saw a young lady of Asian descent lying in fetal position on the side of the road with someone supporting and holding her head in place. It turns out the bus driver stopped the bus in the middle of the intersection to ensure that the lady had some room to breathe without fear of being run over. I watched from across the road and I literally froze. I felt so ashamed as I stood there, motionless, wanting to go across the road and help, but I had no idea what to do. I had no idea what I could do. I racked my brain before I fell in shock at the realization that up to this point, we haven’t learned very many practical skills. I didn’t know what I could do for the patient lying on the side of the road, when it really mattered.
I watched, as time seemed to stand still, at the woman on the other side of the road, to make sure that she was well taken care of. Someone was holding her head and someone else had just put on purple latex gloves and looked prepared to get involved and help the young woman. I figured that the patient either had a seizure or a car accident, and when I saw that she was able to move her right hand and her right leg (she was lying on her left side), I felt a bit of relief. When I heard the ambulance siren traveling towards us, I finally felt that the situation was in control, and I left the scene.
I literally froze across the road because I wanted to help. I didn’t walk across the street because I didn’t know how to help. In a way, it perfectly captured where I am in my medical career: filled with the sense of duty, obligation, and desire to help, but not knowing enough to do so. To be fair, I later asked one of my medical mentors, and she told me that there really wasn’t much I could do for the patient in that particular situation without any tools, but still, I felt a bit in limbo and it was not a good feeling.
My first year of medical school is about to end in two weeks, and I really can’t believe it. It has been one of the best years of my life, and I have my med school colleagues, theatre friends, and significant others to thank for that. I’ve been fortunate enough to have had a lot of time to enjoy Montreal and all that it has to offer extracurricularly, but the accident that I saw reminded me that I am here, ultimately, first and foremost, to become a doctor. We’ve had one year of lectures, and we have another 4 months to go in the fall, but after that, we will be in the hospital every day, and it will be time to step up.
The accident that I saw reminded me that I never want to feel so helpless ever again.
The only way to do that is to make sure that when January comes, I will put all of me and my focus into learning those skills that will make me a great medical doctor for my patients.
Warning: Certain details in this post concern a disease and may be a little bit graphic in description. Reader discretion is advised.
We had an interesting discussion in class once, about whether as medical students we should try a watered-down version of the liquid concoction that patients drink to clear out their bowels before a colonoscopy. There were opinions on both sides, and mine generally sided with those who believe that as doctors we can’t possibly experience every procedure to understand what it might feel like for the patient, and even if we did, the experience may actually make us less empathetic. One of the doctors admitted that he tried the solution and found no ill effects, so he really couldn’t relate to why his patients kept complaining about it!
That class, though, made me consider the importance of experiential learning – when is it appropriate? And useful?
While it may not always be true that you have to experience something to understand something, sometimes it may help.
In med school, we are often told that our job is:
“To cure sometimes, to relieve often, to comfort always“
Truth be told I had some sense of what those words are getting at, but I think I didn’t quite understand the whole picture.
That is, until a recent bout of sickness.
I think it was a combination of stress from shows and school, the viruses and other microbes that had been stewing in me all winter, and my immune system constantly being weakened by the unfamiliar cold of Montreal that had finally given me the worst flu I had ever experienced in my life.
I felt so sick that I didn’t want to eat (which is as serious as a symptom can get for me, because that’s one of my primary methods of enjoying life), and then I felt chills and headaches so bad that I couldn’t even get up to walk 2 minutes to the pharmacy to get drugs that might have helped. The worst of it, of course, is that I didn’t have people who could take care of me, and I had never really learned how to take care of myself during an illness like this.
I remember doing my research online to confirm that my symptoms were definitely caused by influenza viruses, and then I knew that the flu would be gone in five days, so my main plan was to just wait it out (with fluids, rest, Advil, etc), without going to the doctor, because he would tell me to do the same thing.
I took as few drugs as I could for the flu symptoms, both because I couldn’t make myself go buy them and because I didn’t want to spend the money. I knew that I just had to wait five days. It’s nothing, right? Absolutely nothing.
Boy was I wrong.
Even if the time course of an illness is well delineated based on past evidence, such as in the case of the flu, while you experience the disease, it can be the most horrific experience of your life. Even though I knew it would be over soon, I was so frustrated during those few days that felt like eternity, because my headache and hot/cold flashes prevented me from being able to sleep, and my illness completely annihilated my desire to eat. Despite my belief that my mind could control the situation (i.e., mind over matter), I became very depressed and so frustrated because I knew I needed to eat and sleep to recover, but I could not do it, no matter how hard I tried.
And then, of course, it got worse.
I started getting bumps on my lips. At first, it was just one little bump, and it was annoying, so I kept breaking the blister every time it would form. Little did I know, but I think that blister was actually a cold sore, and by bursting it repeatedly, I let the herpes simplex viruses get out and about. The result was that one little bump quickly turned into, and I’m not joking here, fifty bumps all over and around my lips. I thought maybe I needed to go see a doctor at that point, but I felt so hideous and so lethargic because of the continuing course of the flu that I had even less desire to go outside.
I knew that the majority of the general population is carrying this herpes virus on their lips, but the reason why we don’t all have cold sores all the time is because our immune system is strong enough to suppress the symptoms of the virus. Unfortunately for me, my immune system was under severe attack by the influenza viruses, and thus, it allowed for the opportunistic expression of the herpes virus on my lips.
I thought maybe I just needed to wait it out until my immune system fought off the influenza virus, then the cold sores would naturally resolve themselves. Thus, my strategy remained the same: starve out the diseases.
Unfortunately for me, everything just got worse. I continued to feel horrible from the flu, and the cold sores on my lips got so bad that my lips were just bleeding everywhere all the time, with pus and constant inflammation. And worse yet, my gums and other oral mucosa were starting to get inflamed as well from the virus. I didn’t know the virus could affect the inside of my mouth as well as the outside.
I felt awful and looked hideous, and I didn’t know what to do. I felt so helpless, and thinking that it would all be over soon did not help me at all. In fact, there were moments when I thought I would never get better. I was no longer thinking logically. I was no longer able to detach myself and think like a medical student.
I had completely become the patient, and it was only then that I finally admitted that I needed help.
I went to a walk-in clinic and waited for hours with bandages all over my mouth to try to cover up how awful I thought I looked. I finally saw a doctor, and he prescribed valacyclovir for the cold sores. He said that this medication is preventative so I should have seen someone earlier instead of waiting until this stage in the viral infection. The funny thing is that I knew that fact already, and yet I still couldn’t motivate myself enough to go see a doctor before I felt like I absolutely had no choice.
Ultimately, and thankfully (knock on wood), I made a complete recovery, and I ended up, surprisingly, learning quite a few lessons about medicine.
My experience with the flu taught me that symptom management is extremely important. Regaining functionality despite having the disease is what it’s all about (even if the disease is supposed to be short-lived). When we can’t do things that we normally take for granted, like swallowing, life’s joys, including singing and eating for me, are greatly diminished, and that is extremely detrimental to a patient’s mental health, which further impedes recovery and healing, no matter how short the disease trajectory.
A really “mad case of the herp” – on my lips – taught me that part of what’s damaging is a disease’s attack on someone’s self-image. My lips were like mountains of pus and swollen yellow on red, cracked canvas. I couldn’t look myself in the mirror without cringing, and again, it did not help my recovery in the least.
Even though curing a disease is nice, and sometimes it’s possible, the most important lesson I learned as a patient is that the journey matters. No matter how long or short the time a patient spends with a disease, how the patient is treated in the meanwhile – how they look and feel during the disease – makes all the difference.
Even if we think we know the endgame of a disease, the uncertainty is devastating, and the wait, as I found out, can be deadly.
And that’s why our goal as doctors is to relieve often and comfort always.
A family physician who returned to McGill for a 30-year reunion told us a few wishes that are fulfilled by becoming medical doctors. Really, though, it’s more like three needs of ours that gets fulfilled:
1) The Puzzle-Solver. Just like House, M.D., medical students are, by nature, curious creatures who like to understand and explore the human body, figure out illnesses, and navigate the uniqueness of human beings and our diseases.
2) The Fixer-Upper. We like to help. And feel needed. =).
3) The Soap Opera Star. Have you seenGrey’s Anatomy? It’s all about drama. As doctors, we will have the privilege and responsibility of knowing intimate details about patients that very few, if any, others know, including close family members. Medicine deals a lot with life and death considerations, serious repercussions, ethical dilemmas, and the complexities of interpersonal relationships, so it can be an intense career in those ways, and that’s sometimes just what we crave.
In short, medical students are individuals with needs, desires, and issues. And we deal with our issues the only way we know how: by becoming doctors. =D.
