The Wounded Healer

I am taking a class called "Psychosocial Oncology" and today's lecture was about palliative care. The two instructors giving the lecture were what most people would consider in medicine to have opposing jobs. One had a doctorate and was a member of the spiritual care team, the other was a physician and the director of the acute-intensive palliative care unit. Together, they helped me to redefine my notions of adult palliative care, and I was astounded by their abilities to interconnect their roles. Needless to say, I learned a lot about the process of dying, both from a medical perspective and spiritual one. 

5 things I learned today about dying:
1. 93% of palliative care patients ranked maintaining a sense of humour to the end as one of the most important things
2. 0.5% of people in Oregon choose physician assisted suicide despite it being a readily available option
3. Palliative Care physicians are often more influential and important in the life of a person who is dying than any of their "active treatment" physicians
4. Palliative Care medicine actually involves a lot of "real medicine," its not just about pain control
5. Most people who are dying have little desire to confess their sins or wrongdoings  at the end, people do not consider them to be important to them any more.


When we were discussing the importance of physicians and members of the palliative care team to let down their barriers, show their emotions and connect with patients, this quote was on the slide:

"The doctor is effective only when he himself is affected. Only the wounded physician heals." - Carl Jung

I'm not sure how I have made it almost 21 years now with out ever seeing this quote from Carl Jung. I have been beginning to doubt whether or not I can make other well if I am not entirely free of illness myself. But I now feel again that strong sense of purpose, and what I guess you could label as "my calling" to medicine. I don't believe that everything happens for a reason, but I am grateful that this quote was on the slide today, it was exactly what I needed. Perhaps me being in pain, will allow me to heal somebody that others cannot. 

I will someday be a Wounder Healer.

Still Concussed

My last Medical Monday's post was back in August, and it was about the "little" crash I had at a local bike race.

I still have symptoms of an "acute concussion." I don't quite understand how it can be considered "acute" when it is over 2 months past the date of injury. But I'm not a doctor (yet). I can't ride a bike, or do any form of exercise, and school is more challenging than it should be. (Although, I think I did pretty well on my anatomy peripatetic today.) This is a really bad way to be starting off my final year of undergrad, with applications to finish, scholarships to apply for, 4.0s to maintain, a conference to plan and oh yeah, this thing called an Honour's Thesis.

Its going to be a long semester of headaches, concussion physio (I didn't even know that was a thing, and you think with this being my 6th concussion, somebody would have told me about this by now) and trips to the sport medicine clinic. I have a referral to "complex concussion physiatrist," I didn't even know that was a specialty. (Look all the things I am learning about medicine by having a concussion!!) The not exercising part is the worst because exercises is how I deal with pain, no exercise, worse pain, worse pain, worse grades. Apparently physiatrists have solutions for these kinds of dilemmas? I'm not sure if I will ever race a bike again...but I have other plans if I can't.

I hope you are all having a bettter Medical Monday than I am, one not filled with headaches and cadavers with pins in them and pages of anatomy questions. Now back to studying for the written portion of my anatomy exam which is on Wednesday (don't y'all just miss school??).

This is almost exactly what my concussion looked like (but with a helmet), conveniently thanks to Anatomy class I can identify all the structures in this diagram. Yipee!

Everything is happening at once!

I hoped that by submitting my AMCAS application on June 28th that I would have it verified by mid to end of July...It was verified this past Thursday, August 22nd. Now I have the issues of having to complete all of my secondaries for US schools, plus finish my application for Canadian schools...everything is happening at once!!!!!!!!!!!!

Arg. I planned it so that I wouldn't have multiple applications to complete at the same time, but the world has slammed that plan 500m below the earth's crust.

Here is to staring school and medical school applications at the same time! (Oh, and I also haven't finished my summer research project, so I have got that going on too...)

The Crash and the Road Rash

I went to a local criterium race last Tuesday, like I do every Tuesday, only this time, things went horribly wrong. I was working late in the lab trying to finish up nerve conduction on my mice and didn't finish until about 6:30. I debated whether or not to go to the race because it started at 7:30, and I didn't have much time.I ended up deciding to go, because I have been feeling pretty down lately and trying to internally work things through as they relate to cycling. I ran home, scarfed down a bowl of cereal, changed into my kit, and jumped on my bike.

Well, folks, on the second lap of the race, I crashed. And it wasn't just a little crash. I don't really remember what happened, but I know my wheels just went out from underneath me, I don't know why, or how, but they did. I hit my head pretty hard and smashed the front of my helmet in. All I remember is that sickening feeling when your bike starts to move out from underneath you, sliding along the pavement, and then sitting up to check my helmet. Then somehow was lying on the grass with all of these people looking around me. I don't know if I just can't remember how I got to the grass, or if I lost consciousness...either way, I ended up being surrounded by about 10 people lying on the grass at the side of the road.

Some nice guy drove me to the hospital, which was less than 5 minutes from the race, and the race organizer called my room-mate to come meet me. (We conveniently live directly across the street from the largest trauma centre in Alberta.) I spent 7 hours in emerg, 5.5 of which I was waiting to be seen by a doctor. I just sat there, shivering, bleeding and trying not to throw up on the person next to me. Eventually, when I was seen, I was declared to have concussion (duh) and severe road rash (double duh). They gave me a Percoset, referred me to the burn clinic and sent me home. They didn't even attempt to clean my road rash or put any sort of dressing on it. Normally I am a big advocate of Canadian Healthcare, but I'm seriously a bit pissed off right now.

I am super thankful that the ER doc had the sense to refer me to the burn clinic, otherwise I would be in so much pain. When I went to the burn clinic on Wednesday, and the nurse saw that I didn't have any dressings on any of the road rash (which is covering 10% of my body) and that it hadn't been cleaned she went ape sh**t.  The two worst burns that I have are on my upper right arm and right hip/pelvic bone. Because they didn't clean anything, or really look at the burns, nobody noticed that I had bone exposed on my right hip. (Yes folks, I spent 20 hours with a bone exposed from road rash without it being cleaned or bandaged.)Lets just say that the cleaning of the burns definitely makes my top 10 list of most painful experiences (and I have chronic pain...).

Canadian healthcare has both failed me and saved me since my injuries on Tuesday. I am grateful that I get to wear $200 worth of silver bandages, and that I get to have them changed and cleaned everyday other day without paying a dime. But also super pissed off that the ER doc didn't do the job that I waited 7 hours for him to do.I get that they were busy, but come on, you still have to provide necessary care.

I also feel really awful about the fact that I caused the crash, and the the woman behind me who is an amazing bike racer broke her wrist and can't race this weekend. She didn't seem up set about the fact that I was the reason she broke her wrist, which is good, but I still feel awful about it. Crashing is an unfortunate part of cycling. 

For a long while I have been thinking about giving up cycling for good. It is insanely hard to try and train and race at the level I need to be at without having a functioning lower right leg. It is like I am riding on jello. I might be eligible for para-cycling, but I have essentially been waiting about 9 months to get medical documentation and a proper neuro assessment. I still want to ride my bike because I love it, (well, not at this moment) but racing is not something that I can do right now. (The Tuesday night criterium series doesn't count as racing because it's just for fun.) I am getting super depressed about not going to Canada Games (which are going on right now), as it has been my goal for the past few years, and that goal has essentially been crushed. I am not at the level I need to be to competitive at Canada Games, and I am fully aware of that, it just sucks that it is all because of a medically unnecessary surgery when I was 15. In a way the concussion makes me feel a bit better that I am not going to Canada Games, because even if I was set to fly to Quebec next Saturday, I wouldn't be able to compete with a concussion.

I guess all this time I am spending sleeping and not exercising will give me more time to reflect on what I want to do with cycling, and also time to finish up my application for UBC's School of Medicine. It's just unfortunate that somebody had to break their wrist, and I had to lose a lot of skin and smash my head into the pavement to take this time to reflect.

(This is also concussion number 6 for me, so I should probably get off this computer.)

I think I want to be a Surgeon.

To Spencer,

For a long time I have wanted to be a surgeon, probably since I watch the first season of Grey's Anatomy when I was 12. While Grey's Anatomy is pretty unrealistic (but a girl can dream right?), I still had difficulty wrapping my mind around how a person could operate for 10-12 hours straight. How is it possible to focus for that long without eating or going to the bathroom? I feel like I need to eat every 37 seconds and go pee at least once every 3 hours.  (Lets just say I find exams challenging...)

But this week I had to do 20 sciatic nerve crush surgeries on mice, and each one takes about an hour. For two days I did 10 hours straight of surgeries without eating or going to the bathroom. I got the lab at 8 am on Tuesday and left at 9pm, and on Wednesday I got there at 8am and left after 10pm. I have the new record for longest time a summer student has ever spent in the lab. I'm pretty sick of looking at mice and I still have to inject them until the 8th of July.

This experience has showed me that I actually might be able to be a surgeon. I really quite enjoy the tedious and fine motor skills aspect of doing surgeries on mice. I am the only one in the lab able to do it without aid of a microscope. I can see details that others can't see with a naked eye. Perhaps surgery is in my future.

This post is dedicated to Dr. Spencer McLean., who sadly passed away on June 24 from kidney cancer. He had just completed his orthopedic surgery residency and passed his boards two weeks prior to his death. He was my ski coach for 3 years as a child, and every year I hoped that I would be assigned to his group. Spencer was my absolute favourite coach, and he always will be for he taught me a lot more than just how to be fast on a pair of skis. He taught me that skiing makes you one with the mountain, it makes you a part of something magnificent. He taught me that you must first love what you do, be passionate about what  you do, and then you must work hard in order to become great.

From what I have heard, he became an amazing surgeon, dedicated to his patients in every way. He loved what he did, he was passionate about it and he was great at it. I think I have always wanted to "be like Spencer," he was the perfect mentor. He is a person I will never forget and who I will think of often as I begin my journey to becoming a physician, and hopefully a surgeon.

Thank you Spencer for inspiring me to reach high, work hard and to enjoy the ride.

Sincerely,

A Yiper

Shadowing

I had a pretty impressive morning of shadowing last Wednesday, followed by a somewhat less exciting afternoon of looking at mice in square boxes, cleaning up their excretions and testing their grip strength. But I am sure, you don't want to hear about what I do with mice...back to shadowing.

I shadowed my PI in the neuromuscular clinic, and it was needless to say a really great learning experience. I wasn't too sure how good of a teacher he would be, but he turned out to be pretty great. He explained all the cases to me, what each part of the neuro-exam looks for, the EMG results, and patient histories (some which were more complicated than mine). The first patient we saw was a younger women (early 40's) who had massive file and extensive history. I empathized with her because it seemed like she had been through a similar experience as me when I first got sick. She has seen pretty much every specialist in the city (a neuroimmunologist? I didn't even know that existed), has had extensive testing, has been "combative" towards doctors demanding tests/medications, and at one point wanted to go to the Mayo clinic. Her story seems kinda like mine (I was never combative though, but definitely frustrated). I almost wanted to just give her a hug, and I really wanted to tell her that I truly understood what she was going through, but alas, I was but a mere shadow.

The last patient we saw was a woman in her 50s who had an ethanol induced neuropathy. She doesn't take the vitamins that she needs (B1) which can reverse the neuropathy, she continues to consume alcohol, won't go to physiotherapy and doesn't have a family doctor. She had so much muscle wasting that she looked like a person with muscular dystrophy, and she can no longer straighten her legs so she is wheelchair bound. Non-compliance has committed her to a death sentence from a curable disease. Because of her, I witnessed for the first time what it is like to tell somebody that they will die, and soon, from a condition that is in fact reversible.

It is going to be interesting when I finally become a doctor, I think I am going to see myself reflected back to me in the experience of patients. In almost every patient we saw, I recognized something of my own story in the story of the patients. I empathized with the frustrations of one, the research tenacity of another, the ability of one patient to push through the pain, and realization of a grim future of another. I hope I never lose this empathy. At the same time though, I would give anything for my condition to just disappear by taking some vitamins, most people would, so I don't know how I am going to react when I encounter non-compliant patients. I see non-compliance as selfish, and I feel it makes the role of a doctor almost meaningless.


Needless to say, shadowing was an enlightening experience, which motivated me to submit my AMCAS application on Friday (even though I am still waiting for one transcript to arrive at AMCAS). I also started my application for UBC and the rest of the Canadian applications open up in a couple of weeks. The ball is rolling, and I have started to have nightmares since I submitted my AMCAS application. Looks like it is going to be a long wait until May 15, 2014....


PS Happy Canada Day!!!

The Flood of 2013

My city is flooding.

This morning I went to neurology/neurosurgery grand rounds, and everything felt completely normal. They had two crazy cases they discussed, and I walked out feeling awesome. Then I went back to my lab, and saw what was going on in the city. I felt like I was being punched in the stomach. This can't be real. This stuff doesn't happen where I live, only on the TV in distant lands.

I have spent my entire life watching other cities all over the world crumble in natural disasters such as earthquakes, tsunamis and floods, but never have I ever had to live it, that was until yesterday. My city is flooding and there is nothing I can do about it. I live on top of a hill, or as they would say in Ontario, on top of an escarpment.  I'm safe, I don't think the river is going to rise over 100m, yet I also feel the panic. So many people have been forced to evacuate, and the entire downtown area has flooded. The upside is that I had to leave work at 11:30 because they shut the power off in our building (I still don't know why...), but the rest of the hospital is fine.

I went to go buy water at the store today...and of course its all gone. I then went to target, and thankfully got four 1L bottles. I didn't want to buy more than that out of fear of being too greedy in this time of disaster. I brought 2 L to my grandmother, along with an umbrella. As of yet, our water and power are all on, but I fear that it may change in a few days. I also bought more food, such as a dried goods, canned things, 4L of milk, a crap load of juice because I couldn't find anymore water, and some more fruit. I have never had to respond to a natural disaster before, so I am new at this stocking up on supplies thing...I was proud that I remember to buy a flashlight though.

I feel very trapped here. I get that feeling on a normal basis, but when I do, I just drive back to the mountains of BC to my parent's house or to one of our cabins. But those roads are closed and/or completely washed out. So I am trapped in Calgary. I HATE FEELING TRAPPED!

I just want to go home....(which is also flooding, but I feel safer in the mountains).