It has been a year since I have written anything on Manu et Corde. It has been quite a year. The privilege I have experienced and joy I have found in caring for patients is beyond anything I expected when I started PGY1. The life circumstances that I have bore witness to and become a character in are sometimes beyond comprehension. While using my hands and my heart each day, I have felt clever, I have felt blue, I’ve felt instrumental, I have felt loved, I have felt used, I’ve felt alien, I have felt optimistic, I have felt irrelevant, I have felt euphoric, I have felt lonely, and I have felt [insert adjective here]. I’ve not written much because I just can’t seem to find the words.

Moving forward I will be using this space, if the words become less elusive, to explore forays into anthropology and medicine. I have started my Master’s in Applied Anthropology and I know that the study of human behaviour will nicely dovetail my ongoing training in emergency medicine. Margaret Mead, an accomplished cultural anthropologist, can explain why much more eloquently than I am able to right now!

“Anthropology demands the open-mindedness with which one must look and listen, record in astonishment and wonder that which one would not have been able to guess” – Margaret Mead


Your Medical School Narrative.

Four short years ago I nervously met a soon-to-be classmate for the first time. It felt like a blind date. We had met on Facebook, through our class group and we were both anxiously awaiting the next day, our first day of medical school orientation. I recall the evening started with half sputtered, nervous conversation as we exchanged standard pleasantries awkwardly over sushi. But now, I can’t help but look back on that evening with a smile. I smile as I remember an immediate bond developed with a complete stranger. I smile as I remember sharing our histories and our dreams. I smile as I remember the pride I had about entering the profession. I smile as I realize I had no idea what I was getting myself in to.

A blog post cannot prepare a new medical student for what lies ahead. The seriousness, silliness, belonging, exhilaration, loneliness, disappointment, fatigue, love, responsibility, and joy that you will inevitably feel in the next four years will shape your experience. Your narrative, like the humbling narratives of your patients, will be unique. Pay attention to the narrative. There will be a variety of characters, and believe me they will be characters, that are central to the plot. Learn from them, become friends with them, care for them. The settings of your tale will include lecture theatres, ORs, emergency departments, wards but also basketball courts, bars and back country roads – each projecting its unique beauty and imprinting some lasting memory. Hold on tight to those memories for when the time comes to illustrate your pages. There will be tangents to your story but the plot will realign, it always does. Take stock of where your story is headed, if you like the direction and make changes as necessary. Find honest editors to give you feedback. The tale will eventually weave itself but the first person narrative that results must be your own. It has to reflect your purpose – a purpose only you can define. Let your narrative be all you have imagined.

The continuation of my story, started on July 1st as I began residency. Appropriately, on June 30th I shared dinner with the same classmate I had dined with on the eve of medical school.  We started our residencies together in emergency medicine the next day. Our dinner was less awkward but we were just as nervous, full-circle indeed.

Welcome to the family.

Discovering teaching by learning.

Over the next months and years Manu et Corde is going to shift to a focus on residents as teachers. As the newest member of the resident team, I am doing more learning than teaching so I thought I’d start by documenting a few things that teachers (more senior residents and attendings) have done during my first block that I have found especially helpful as a fresh resident in the Emergency Department. My teachers have:

  • Wholeheartedly embraced me as a member of the team. From match day onwards every resident, attending, nurse and support staff that I have worked with in the emergency department have welcomed me with open arms. I can sense the “ownership” and pride they take in learners. This feeling of belonging makes me want to work harder and learn more.
  • Pushed me to broaden my differentials. If I come up with three likely causes, they’ll push me for a fourth and fifth and sixth. My brain hurts by the end of a shift but the mental workout is sure to be a good thing.
  • Forced explicit clinical reasoning. When presenting a case if it’s unclear why I am headed in a specific direction or why I am considering a certain diagnosis/treatment it is helpful when my teachers ask “Why not this other diagnosis” or “Why are you deciding to treat with ____?”. When asked those questions I have to explicitly bring forward my clinical reasoning process. Which is sometimes reasonable and sometimes is not.
  • Made me sweat…a bit. Many times those teaching me had me make decisions, perform procedures and have conversations that pushed my comfort zone. I was technically prepared for them but the first time is always the first time. At one point my continuous HR monitor on my fitness tracker was up to 130! These are the moments that I feel I really learned the most from. Even though I sweat I bit my teachers ALWAYS:
  • Encouraged me to ask for help. There seems to be a fair amount of variation between the level of autonomy I have based on who I am working with, where I am working and the types of patients that I pick up. Regardless of how much independence (or illusion of independence) I feel l there is a baseline understanding that I ABSOLUTELY can ask for help anytime. This makes me feel supported and allows me to push myself in a way that feels safe.
  • Shared their vulnerabilities. Some teachers have shared stories of cases gone wrong, poor decisions they’ve made and things they would do differently. Every time this happens I am reminded that I will not be, I cannot be perfect. Their shared vulnerabilities have help me grapple with my own shortcomings in this first month and humbly prepare me for those I’ll face in the future.
  • Showed me their “tricks of the trade”. From shortcuts in using the EMR, to testing for fecal leukocytes, to everting eyelids I have picked up an incomprehensible number of answers to questions I didn’t even know I had.
  • Displayed their enthusiasm. Working with people who love their job and who care deeply for the patients and enjoy teaching is fun, fulfilling and energizing.

Thank you to all of those who have been patient and thoughtful in their teaching to new residents across the country this month. I’ll certainly pay it forward!

Thank You.

This will be my last post as a medical student.

As I prepare to walk across the stage this afternoon to receive my medical degree, I find myself overwhelmed by gratitude. I am indebted to my family, my mentors, my teachers, my patients, my peers, my online community of colleagues, my friends, and all of the cheerleaders who have supported me along the way. There are too many to count.

Please know that I will do all I can to pay forward the love and generosity I have experienced. Thank you, from the bottom of my heart.

My simple approach to becoming a doctor has been our Queen’s School of Medicine motto, “Medicus manu et corde” meaning, “A physician works with her hands and her heart”. These words will continue to be at my core as I transition to my new role as a resident in Emergency Medicine. As I transition, so will my blog. Check back in June for an exciting new direction!

Golf, Girls and Good Guys

I go to medical school with a bunch of amazing people, half of them are men. One thing needs to be absolutely clear- these are good, good men. They are the kind of men who will make wonderful physicians. They are the kind of men I would be proud to have as my brothers and the kind of men I am lucky to have as my friends. If you take nothing else from this article, please take away that Queen’s medicine is chock full of good guys.

We hold many sports tournaments at Queen’s Medicine, in fact, these tournaments have created favourite memories of my time here. We have inter-class basketball tournaments, volleyball tournaments and hockey tournaments. All of these events are open to both genders and very inclusive. Everyone who wants to, plays.

This afternoon on social media I came across a picture captioned “The #QMed Cup- congratulations to the 2015 champions” with a picture of a group of these good guys from each year playing in a golf tournament and the 2015s holding a trophy. I was surprised. I didn’t remember hearing about a #QMed golf tournament and certainly had not been invited. It looked like a lot of fun, I wish I had been there. I assumed, given the caption, that this was another of our many school run class tournaments  and posted:

Screenshot 2015-05-02 17.37.50

I have since learned that the event was not a formal inter-class tournament. It evolved into one when a bunch of guys from the pickup hockey team decided to golf together. The day morphed into a tournament and somehow a winner was declared and trophy awarded. Do those facts make me feel better? Sure. I’m very glad our student society didn’t run a male only golf tournament – that would have been a serious issue. I’m also glad that this organic game of golf evolved from a bunch of guys out having a fun time doing something healthy on a gorgeous day. I am a big fan of healthy competition.

One of these good men has approached me with the sentiment that my post on twitter was unprofessional. He felt I should have approached them with my concerns and not voiced my frustration on social media. Perhaps he is right. He is worried that my post paints #QMed men in a misogynistic and exclusive light. Again let me be clear, my #QMed peers, the men I work with on a daily basis are not misogynistic and they are not exclusive. They are good, good men. I am fortunate that the women before me in this profession have broken down barriers and created an environment in which I largely feel equal to and supported by the men that I work with. It’s not perfect, but it’s getting there.

However, the same destruction of barriers has not happened as quickly in the world of golf. Yes, I grew up playing and still often do golf with good men but despite their positive influence the game can still often feel like an old boys club. I remain piqued that I was not invited, not necessarily under this specific set of circumstances, but  because girls are rarely invited to join the boys when it comes to golf. It is acceptable for us to play on ladies night or with other women or with our male partners but that’s about it. Of course, I don’t always abide by such convention so I get strange looks when I hit the practice range or the course on my own. Many I meet are surprised to hear I play. Today I went to the driving range and while there I saw two other women. One was sitting watching her boyfriend practice, never once picking up a club, and the other was with her partner who would stand behind and “help with her swing” suggestively, as seen in the movies. I have felt awkward and uncomfortable many times on the course. I’ve heard phrases like “you’re the only woman I’ve seen that can actually hit a ball” and “women belong on the drinks cart”. I have been programmed to think the worst. Please read these two fantastic articles for in-depth look at sexism in golf:

So why do I stick with it? It’s certainly not because I am all that good. I stick with it because I like the feeling of the rare, well-struck shot, the sound of drained putt and the mindfulness required to get through each hole. I do it for the same reason men stick with it- because it is a devastatingly frustrating, wonderful game.

So next time you are about to hit the course with the boys, think about inviting the girls along. I would also be happy to help organize a #QMed Golf Tournament- like some of the best competitions, it’ll definitely be an Open.

As always, interested in your thoughts. Please feel free to share in the comments section below.