Issue 1 • Fall 2015 by The Muse

ISSUE 1 • FALL 2015 TITLE PAGE

-11 -8 -5 0 2 CONTENTS 3 From the Editor 4 The Shadow in the ER 6 Interview with Danielle Ofri, M.D. 7 Misgivings in Undergraduate Research 8 Intern Year: Beginnings in the Coronary Care Unit 10 In the Heart of the Amazon 12 Fearful and Feckless 14 Surprise, surprise! The realities of volunteer travel 16 Putting the Heart into It 18 A Day in the Life with Amber Posner, M.D. 20 Staff 23 26 28 32 34 37 41 46 47 48 Cover art by Kelly Dong 51 and Shawn Khan 58

FROM THE EDITOR

he idea of The Muse began to take root in my head toward the end of last year, when I read What Doctors Feel, a phenomenal book by Dr. Danielle Ofri documenting the effect of emotions on the practice of medicine. One line in particular really struck me:

“A thread of sorrow weaves through the daily life of medicine…” It is a heart-wrenching line with a message that rings true to not only medicine, but the healthcare community at large. For every achievement, there is an awareness of the scope of just how much you are unable to do, be it due to your own limitations, those of modern science, or the time and resource constraints of an unfailingly pragmatic society. And, from my interactions with those who are active members of the healthcare community, I know that this can cause feelings of inadequacy. Frustration. Regret. I certainly don’t want to convey a disheartening message; there is much to be celebrated within healthcare and how much it’s progressed in the past few decades. What I do mean to say is that many untold stories abound, buried under the fast-paced nature and heavy workload of a career in this field.

I wanted to give voice to these stories, because they erase the commonly perceived image of the healthcare professional as distant and composed, and humanize them. However, I also wanted to give a voice to students just like myself, who exist in a state of uncertainty. We would like to be major determinants in patient care, but cannot due to a lack of knowledge and skills. The question then becomes: how can we make meaningful contributions? There are no easy solutions, and offering conclusive answers isn’t the purpose of The Muse. In spearheading this initiative, my goal was not to showcase phenomenal writing or novel research. I wanted this magazine to be a platform for a community to share its kaleidoscope of perspectives. And now that this happening, after months of planning and working and reaching out, I’m excited to share the inaugural issue of The Muse! Thank you to everyone who submitted a piece. Your submissions have made for a diverse issue featuring stories that span the field of healthcare from research to clinical work to journeys abroad. And thanks to our interviewees, Dr. Amber Posner and the very same Dr. Danielle Ofri whose ideas laid the foundation for mine. With immense gratitude, I’d like to give many thanks to my collaborators for helping this project come to life! This is a proud moment, and I look forward to continuing to work with all of you to share any and all stories that those in the healthcare community wish to make known. I want this to be a medium to express every struggle and success, and the tumultuous inner flux that is an inescapable part of any journey. With this first issue, I think that we’ve achieved what we set out to do.

Anna Goshua Editor-In-Chief

(Photo courtesy of Irina Sverdlichenko)

The Shadow in the ER F

ar too many times in my life, I’ve found myself thrown into a situation where I had no idea what I was doing. I was left to flounder about until I somehow found my bearings. Volunteering in the emergency department of a small-town hospital was probably the most notable of these directionless experiences. After a brief one-hour training session, which essentially consisted of my superiors giving me a map of the emergency room and the “Sparknotes” version of how to operate a wheelchair, I was thrown into the labyrinthine corridors of the emergency department and left on my own. Now, I’m quite proficient at figuring out how to do things, and I’m far less likely to take a trial-and-error approach to learning. What I do can directly affect other people, particularly those I’m supposed to be helping. Luckily, I found myself a mentor who had been working in the emergency department (ED) for a while and and who gave me a rundown of ED essentials, such as the location of the stockroom and how

to use the EMR. But there are some things, especially in the ED, that you only learn through experience. So, with my newfound knowledge, I walked straight into the intensive cardiac unit – and found a patient who looked like they were having a heart attack. For a second I stood there, unsure of what was happening. Surely someone wouldn’t be having a heart attack when I, the highly trained volunteer, was the only person in the room with them. A heartbeat (mine, not hers) later, I came to my senses, turned around, and grabbed the first person in scrubs I could find. Everything turned out okay, particularly as the floor staff had been electronically monitoring their patients anyway, but this was my first frighteningly real experience in the medical world. Working as a volunteer in the emergency department is not a glamorous job. In terms of necessity, you are the lowest of the low. As a result, no one really pays attention to you. You fill in the cracks that the nurses, residents, medical students, emergency medical technicians, pharmacists, and support personnel leave behind, and let me tell you; there isn’t much room there. I spent my time attending to the comfort of patients and families

both on the floor and in the waiting room. Paradoxically, for a department with “emergency” in the title, there appears to be an awful lot of waiting. I brought blankets and soft drinks, gave out Wi-Fi passwords, moved stretchers, and fluffed pillows. Nothing that people would die without, but, at least in my mind, some things that made the stress of being in the emergency room just a tiny bit more bearable. I didn’t learn how to take care of patients, nor did I have any real responsibility. However, I found that the most useful qualities I could exercise to be a competent volunteer were observation and attentiveness. Often, people are too shy to ask for what they really want or need. By looking for signs of discomfort, you can figure out the right questions to ask people in order to help them out to the best of your abilities. It’s amazing how many people were oblivious to this – one of my colleagues, another college student who had been doing this for at least a year, went around the waiting room offering pillows and blankets to people who were sitting comfortably on chairs using their phones or reading magazines. As I watched, I wondered how doing this could possibly make sense to her. It looked like these people could benefit more from a Wi-Fi password than a pillow. But these are the most obvious cases. Perhaps you have someone wearing their own overcoat, and their husband’s jacket as well. This would be a case where offering a warm blanket would be more appropriate. Or sometimes you

might notice a patient has cracked lips. You may then find out that this patient isn’t allowed to drink water, but could maybe use some ice chips or a small wet sponge. And finally, there would be times where you see a vomit bag on the counter – perhaps then it might be kind to offer the patient a toothbrush and toothpaste! Attention to detail was the easiest way to ensure that I was helping patients feel comfortable. A year later, I don’t think that many of the patients I interacted with remember me, nor would I expect them to. I still remember many of them, but I’m sure these memories will fade with time, especially as I develop new ones in medical school. I don’t want to pretend that being a volunteer in an emergency department was a transformative experience for me or for the patients. But it let me see the grittier side of medicine – the side far from the ivory tower that some build the profession up to be. Amid the chaos, there exists humanity, both within patient and provider, and inside even the darkest moments can small instances of humour be found. Perhaps most importantly, the relative ineffectuality I felt has led me to believe that going to medical school was the right decision for me. My experience made me want to take on more responsibilities in patient care. A suburban emergency department is not the best example of what medicine is truly like, but it’s a first glimpse into a larger world. This small glimpse made me even more excited to have the full picture and truly integrate

myself into the medical profession as a practitioner (or at least on my way to becoming one). With any luck, the next time I step into an emergency department, I’ll be able to do more than merely hand out blankets.

In respect of the author’s wishes, their identity will be kept anonymous.

Art by Amy Ajay 5

INTERVIEW WITH DANIELLE OFRI Interview by Anna Goshua

Danielle Ofri, M.D., Ph.D., is an attending physician at Bellevue Hospital Center, the oldest public hospital in the United States with a diverse and often socially troubled patient population. She is the Editor-in-Chief of the literary journal, the Bellevue Literary Review, and a New York Times bestselling author. Her most recent book is entitled, What Doctors Feel: How Emotions Affect the Practice of Medicine. Site: danielleofri.com Email: dofri@giantsteps.com (Photo courtesy of Joon Park)

What is a typical day like? My days are a mix of patient care, teaching, and writing. Every day is a little different, but medicine takes up most of my time, and I try to squeeze in writing and editing the Bellevue Literary Review when I have time. Are you the physician that you imagined you would be when you began training? I was an MD-PhD student, so I was expecting to have a life based in the lab with some clinical work on the side. I certainly did not expect to be writing or editing a literary journal. I don’t think my perception of self or of a “good physician” has changed, it’s more that I’m striving for these from a different angle. How has working with Bellevue’s uniquely challenging patient population shaped your development as a physician? It’s forced me to think beyond the illness at hand. So many of my patients face economic and social challenges, in addition to issues of immigration status and often past histories of political torture in their home countries. By definition, these 6

things have profound impact on how we treat their illnesses. The so-called social history is really part of the medical history.

What do you appreciate the most about your patients? I love hearing the stories of their lives. For my many immigrant patients, I’m always intrigued by their stories of how they came to America. How do you maintain empathy with “difficult” patients? It’s not always easy, but I try very hard to reframe their “difficultness” as their pain and suffering. I know that their behaviour is not directed at me personally, but has instead been built up over a lifetime of illness and social challenges. What’s the hardest part of what you do everyday? Feeling rushed is the worst feeling. Cutting corners in order to stay afloat on a busy day saps the soul. And it makes me terrified that I might miss something crucial. If I could change any aspect of medicine, I would allot more time for the doctor-patient visit. So much of what ails medicine and the doctor-patient relationship

(and the patient!) could be mitigated by extra time to probe all the issues.

How would you define success in your field? No matter how hard the day, I always feel invigourated by patient care. The opportunity to help someone, even just a little bit, is so gratifying and incredibly motivating. Keeping patients engaged in their medical care and helping their illnesses be a little less bothersome—I’ll count that as success. What do you wish you knew when you entered this position? I thought it would all be about the science. It would have been nice to know how much of medicine is just about human interaction. What’s the most important piece of advice that you pass on to your students? Try to hang on to your interests and passions. It’s so easy to lose what defines us over the course of medical training. Even if you just have five minutes a day to weave in your hobby or interest, it’s worth it. You’ll appreciate it at the other end.

Misgivings in Undergraduate Research

nstructional methods and pedagogy in undergraduate science In evaluating a community-based complex intervention, education are increasingly seeking to cultivate academic we had to consider the influence of interacting components, such research skills. This progression and change in practices seems as community context, the population’s culture, and the role of natural for those involved in medicine and in allied health decision makers. I was responsible for much of the project’s data professions, as the tenets of evidence-based practices and the entry. Endless hours of entering data into a database for analysis need to formulate and disseminate evidence have widely altered seemed archaic to me. I continuously questioned why things the dynamics of all health systems. As such, when you ask a were done the way they were. Why we couldn’t collect electronic cohort of undergraduate students in science programs of their data, for instance, or just design a scanning program that would summer plans, the answer is more common than you might transcribe the paper data to electronic data? Tasks such as calling think. For aspiring scientists and budding health professionals, participants to complete their forms could be automated, and the answer is obvious: research. databases could be automatically updated. It pained me that my For students hoping to gain entry into the competitive work could easily be replaced by a computer program, and that professional or graduate program of their choice, relevant perhaps, I could be spending my time elsewhere, learning things undergraduate research may appear to be nothing but a box on a I wanted to learn at my own discretion. grander checklist. I can admit that this is how I first approached To my foolishness, I had not expected administrative the research application process. After all, when I began to pursue tasks, like organizing folders, or photocopying d ocuments. This my first research experience, I had just completed my first year. gave me insight into where I stood in the broader scope of our The incessant pressure put forth by my peers to seek “research team. I was not someone involved deeply in the production or experience” as an unspoken obligation for any implementation of the research project – I was an of my future plans began to consume me. extra set of hands. Often relegated to mundane Neither equipped with necessary professional tasks, I found myself rarely brainstorming connections nor focused passion in a field or thinking about the research process. of study, I found myself in limbo. Unlike I followed a predetermined set of steps. the select few of my peers who pursued Nothing more, nothing less. Disillusionment research during their high school summers, with my role in the research process was my I found it foolish to spend my vacation on source of frustration, and there was no one anything outside of Netflix or video games. to blame but myself. Enamoured with the A short year later, my peers and I would feel prospect of working in a research project, I an unwarranted obligation to pursue research never saw the position as that of a secretary. opportunities– at any cost. I was initially keen to offer suggestions to I’ve heard some outrageous Do I have to declare a major? Couldn’t I just be a stem cell? expedite our group’s data collection, but this application stories. Some submit hundreds of applications to would change as my supervising research coordinator became prospective investigators in a broad host of disciplines for discouraged by the prospect of a radical change in approach. I competitive and prestigious programs at Sick Kids Hospital then realized that adapting research practices to newer technology and St. Michael’s Hospital. Others keep detailed documentation would be a slow and difficult overhaul. Both my group and I regarding opportunities in a number of local research groups. felt stifled by the host of efficiencies we wanted but could not Some express immense frustration when they can’t seem to introduce to our research process. land a wet lab position, due to lack of resources, or training, or Few experiences offered in class can compare to perhaps because they started their applications too late. Many the dynamic and culture of a research environment. Various end up finding positions working full time volunteering hours, or types of research opportunities exist; my folly was choosing pursuing two or three simultaneous research volunteer positions one that didn’t suit me. My naivety, and sheep-like pursuit of to pump out relevant experience for their CVs. In light of these research opportunities inclined me to pursue research to check considerations, how much weight does research experience off an imaginary box, rather than out of interest. As such, my actually carry? As of now, I don’t really know. What I can expectations of the role poorly aligned with my responsibilities, describe though, are my thoughts about my research experience and led to a disconnect between what I wanted to achieve, and this summer, and what I’ve come to learn about the research what I felt I needed to achieve. I now know that I shouldn’t jump frenzy. at the first opportunity to come my way, but rather spend time I accepted a position in a large, interdisciplinary group thinking about my passions, my personality, and my temperament, working on a participatory action research project. This kind of so that I may find work in a group fitting of those expectations. research differs greatly from both clinical and wet lab research in a number of ways. In respect of the author’s wishes, their identity will be kept anonymous. Art courtesy of J.P. Rini

INTERN YEAR

Beginnings in the Coronary Care Unit by George Goshua

george.goshua@yale.edu

Art by Michael Sun

ometimes no amount of training and orientation can fully prepare you for a new role. I started my internship as an Internal Medicine resident at Yale-New Haven Hospital on what is called a “Jeopardy Block”. Essentially, this means carrying around a pager every minute of the day and night during your daily activities, as you wait to see whether you’ll be paged to fill in for one of your colleagues. Any time. Any service. I was never called in. Thus, I immediately transitioned to my role as an intern on the Coronary Care Unit (CCU), not having benefited from being eased in to the workflow of a new hospital environment. I was the only addition to four one-to-one intern-resident teams that had already been in place for the past 10 days of my Jeopardy time. Having to learn a new electronic medical record (EMR) on the fly in the high paced environment of the CCU is a setup for failure for a new intern. By failure, I am referring to the feeling of incompetence stemming from slowing down your colleagues and the pace of patient care. Not to mention learning how to perform very basic tasks, such as monitoring

which medications a patient took the night before. You see, I went to medical school at the University of Kentucky and trained at the clinically rigorous, high volume, level I trauma center of the Albert Chandler Hospital, named for the twice-former governor of the state. That is to say, I knew my clinical experience in caring for one of the sickest populations in the countrythat of destitute Appalachian Kentucky- was second to none. The truth, however, is that no amount of rigour in medical school can prepare you to seamlessly become a new resident physician. Especially so in a hospital that you don’t know and with an EMR that you have never used. My first day as an intern was filled with actions that were a testimony to my tumultuous inner state. This is why it is not surprising that before I even started my first patient presentation of the day, I dropped my handwritten notes- handwritten because I couldn’t get my electronic notes to print- all over the floor. As I hastily picked these up, the only word I could think of was, inadequate. I proceeded to follow this up with commenting on the positive neurological prognosis, as per the belief of our Neurology colleagues, of a cardiac arrest patient on our morning rounds with family members present. This is something that I have never done in similar situations in medical school and something that should never be done, as a neurological prognosis is subject to drastic change at any given time. Needless to say, I “survived” my first day of internship only to come home and have a cathartic cry given the feelings I harboured toward myself. At that very moment, I questioned whether I was cut out to be a physician at all, let alone the kind of physician I have long aspired to be. However, throughout my life I have learned that a positive outlook and approach in the face of personal challenges often helps you overcome your struggles. A few hours of sleep and a fantastic morning in the CCU thereafter concluded my best day of internship to date. Mrs. X was the first patient I had the privilege of admitting and seeing through to transfer to a stepdown unit from the CCU. Her case was a complication of a catheterization procedure, termed a coronary dissection. She did well throughout her stay in our unit and, like with all my patients, I got to know her as a person. A former retired nurse of 50 years at a major academic hospital, a born and raised New Yorker, understandably uneasy about the complication, and

most of all, a warm individual beneath the strict facade. Together, we reflected on the rigours of internship and how, at her former institution, the transition from medical student to doctor could have been made significantly easier if only the new interns had been received into a more supportive environment. Suffice it to say, we had a long embrace as she was being wheeled out of the CCU onto a less intensive floor and then, hopefully, back home. I told her that I hoped our paths would cross again one day, but that I never again wanted to see her in a hospital. She told me she would never forget the young doctor who took care of her. The day continued with a similarly long embrace with the sisters of one of my sickest patients, Mrs. C, who had suffered a cardiac arrest and was currently intubated and sedated. French being her native tongue, I made sure to try and throw in a sentence or two in the language I adored growing up. Mrs. C had a significant family presence at the bedside and I spoke at length about every step in her care with whomever was watching over her. The reason for the embrace was a strongly positive neurological exam: thumbs up, legs raised, and toes wiggling on request. There was still a long way to go in her care and both of her sisters felt conflicted as they had flown in internationally to be with their sister and now had to go home. I told them I hoped they would be able to take that positive piece of news with them during their long travels that sometimes offer too much time for reflection and overthinking. They did not know it at the time, but they thanked me for what would be my weeklong vigil at her bedside as she recovered enough to be transitioned out of the CCU and I daresay has left the hospital feeling well with appropriate follow up. Continuer à se battre. That would be my daily early morning sermon that week. I have always prided myself on taking care of my patients as if they are my immediate family and am thankful to be part of the Yale Medicine family, which places a great deal of emphasis on humanism in medicine, in theory and practice. In short, my second day of internship was a hugging and loving kind of day, with good and interesting medicine to be had. In the emotional, roller coaster world of internship, you quickly learn to savour these little victories.

ABOUT THE AUTHOR - George

is a first year resident physician in internal medicine at Yale-New Haven Hospital. He has previously published in the realms of neuroscience and quality improvement. In medical school, he had an opportunity to work in the student branch of the American Association of Medical Colleges and had the rare privilege of being inducted into both the Gold Humanism Honor Society and the Alpha Omega Alpha Society as a junior inductee.

his past June, I had the opportunity and privilege to travel to the community of Mondaña, in the heart of the Amazon in Ecuador as a participant on a Me to We University Volunteer Trip. What an incredible experience… the memories, the friendships, and the feeling that I was working to contribute to the betterment of a community in need will always be something that I cherish. I embarked on this journey with the belief that I would assist in the construction of a school, which I was quite excited about. However, when we arrived in the community, the project coordinator for Me to We informed us that we would be building a healthcare centre. Having always been particularly passionate about healthcare, I felt a new flow of exhilaration and anticipation. I couldn’t wait to get started on the project and, by the end of the trip, I never wanted to leave the community of Mondaña. During the trip, I had the honour of working alongside 26 other Canadian volunteers, two team leaders from Me to We, a phenomenal guide and locals employed by Me to We, as well as community members from Mondaña. Together, we assembled to form a minga, a group of

individuals working to accomplish a common goal: building the healthcare centre. I was also able to assist the local school’s senior class in completing their own community project, which entailed building new paths and digging trenches that would make treks through the village much easier during the frequent rainfall. My fondest memories from this trip stemmed from my interactions with the members of the community. I have never met such happy individuals. They were always smiling and they never failed to make me smile as well. I enjoyed playing with the younger children, but I was specifically able to develop strong and lasting friendships with the older students in the community. While working together on the construction site and during my breaks, I tried my best to hold conversations with each of the students, and I was able to get close to five boys between the ages of 16 to 20. Four of the five spoke very little English. As I could barely speak Spanish, communicating was difficult. However, through hand gestures, drawings, and Spanish words that I improvised from my Italian and French background, we were somehow able to understand each other’s ideas. My

In the

Heart of the

Amazon by Alessandra Ceccacci ceccacat@mcmaster.ca

other friend from the community, Johnny, spoke English impressively well, having learned the language by listening to American pop music. He told me that his favourite artist was Katy Perry! In addition to their perpetual cheerfulness, I can easily say that I have never met such hardworking people my age. They never took breaks, never stopped working until they had perfected something, and they always offered to do my work on the building site so that I could take a break, even after I had told them that I wanted to keep going. They were dedicated to their schoolwork, and they never missed an opportunity to improve their English and to learn more about North America. These boys all come from families with at least five children; Johnny is one of 13 in his family. There is so much to be learned from them. I’m still trying to learn more and am ecstatic to have the opportunity to continue communicating with them over social media. We are able to communicate now much more easily than we did in person. Thanks to the help of Google Translate, I can finally “speak” Spanish! I couldn’t be prouder to have made such remarkable friends, and I look forward to keeping in touch with them in the years to come. To give a bit of perspective about the current state

of healthcare in Mondaña, the healthcare centre that is currently in use is temporary and was created in the small home of a local doctor. The original centre was crumbling and needed to be torn down a few months ago. This current centre consists of only four small rooms, including a filing room, doctor’s office, dentist’s office, and pharmacy. The basic medical and dental equipment is also extremely outdated. One of my friends volunteering on the trip went to the local dentist and later told me how the dentist continuously apologized about how uncomfortable his dental chair was. He told her that he had been trying to get a new one. The new healthcare facility that our team was helping to build will have completely new equipment and will be much larger. It will be able to cater to the needs of over 2000 individuals in the region, providing services to not only Mondaña, but to 13 other surrounding communities. I could not be more ecstatic that I have helped contribute to the well being of these communities. Before we began our work on the healthcare centre, our group had the opportunity to learn about the major health concerns in the area. To begin, pulmonary infections are very common. There are cases of tuberculosis, as well as other pulmonary problems. The children are barely ever

dry. When I was there, there was a heavy downpour every day unlike any I had ever seen. There I was, in my dry fit outfit made to dry quickly in the rain, and I was soaked and uncomfortable. I imagined the struggles of these poor children, who are only given two sets of cotton uniforms to wear to school. One thing that I discovered about cotton material is that it rarely ever dries in the Amazon. I left my cotton clothing outside to dry under a covered porch and they were still wet three days later. The constant dampness and incredibly high humidity are factors that play a role in the cause of infection. Furthermore, other environmental conditions are also at play. For example, I played soccer with some of the children in a local stadium that has a concrete floor and metal roof. The children play here every day during recess; the stadium was built by the government, and provides a good form of shelter from the rain. However, I noticed that the floor was completely covered in a thick layer of dust. Within an hour, I started to have coughing fits and trouble breathing. I could barely bring myself to consider the effects that it has on the children who run around there for hours every single day.

Another concern is that most of the children under the age of five have parasites. When I first arrived in the community, a young boy with a distended stomach walked past us; I later found out that this was the result of parasitic infection. I began noticing that many of the young children I saw also had protruding bellies. One of the main causes of these cases of parasites is the water that the population is drinking. The Napo River, which borders the community of Mondaña, is contaminated, and the water is not safe to drink. However, before Free The Children recently implemented a clean water system, the community members were using the water to cook, clean, and drink. Some individuals still use the river water, as this is what they are accustomed to. The children are also constantly walking through wet mud, and their clothes are often dirty. To give some perspective, I wore rain boots during the whole trip and, during and after heavy rainfall, mud would climb to above my calves. The fungal infection, mycoses, is another prevalent issue. People commonly become infected through swimming in the contaminated river to cool off after being sunburnt. It is a problem within the community as the medication

needed to treat it varies depending on the fungal strain and is scarcely available. There is only one dermatologist in the entire region that is equipped to treat the various infections and the community members will often only make the trek to see the doctor when their condition is horrible. Snakebites and machete cuts are also concerns, and proper medical attention is rarely sought. There is simply a lack of awareness regarding many health related issues. As such, health education is one of the most important tasks undertaken by volunteer organizations such as Free the Children. In conclusion, the time that I spent in Mondaña was incredible in so many ways, yet I definitely was not ready to leave the community when I did. I, like my fellow volunteers, wanted to oversee the construction of the healthcare centre to completion. We were so dedicated to the project and we wanted to directly witness the benefits of our work when the centre opened. Although this isn’t possible, I can’t wait

to see pictures of the finished product, and the community members’ reactions when they see the interior of the amazing facility to which they will have access. Having learned about the health concerns, as well as the current quality of healthcare provided in the community, I am confident that our work will truly improve the lives of the individuals that I had the privilege of meeting. I would be lying if I said that I didn’t shed a few tears as soon as I left. However, the countless pictures that were taken and the journal that I kept helped capture many details of my experiences that I will carry with me forever. I plan to continue to share stories and raise awareness about Mondaña, and I hope that one day, I will be able to return to this wonderful community.

About the author - Alessandra is in her second year of the Bachelor of Health Sciences program at McMaster University. She enjoys working with children, participating in physical activity, and immersing herself in new cultures.

tension, and diabetes. They have been experiencing chest pains, shortness o kles. Common symptoms of heart disease include pain, numbness, weakness meties. The patient is experiencing pain in the neck, jaw, throat, upper abdom presents with chest pain, tachycardia, shortness of breath, lightheadedness, is experiencing swelling in the legs and easily tires during exercise or activit ue and irregular heartbeats that feel rapid, pounding, or fluttering. The pati ty of symptoms, including a fever, shortness of breath, a persistent cough, ch heratbeat. The patient has been experiencing dizziness, and has an allergy t ents with a history of hypercholeresterolemia, hypertension, and diabetes. T g chest pains, shortness of breath, swelling in the ankles. Common symptom pain, numbness, weakness, or coldness in the extremeties. The patient is ex neck, jaw, throat, upper abdomen, and back. The patient presents with chest ss of breath, lightheadedness, and dizziness.The patient is experiencing swe res during exercise or activity. The patient reports fatigue and irregular hea ounding, or fluttering. The patient presents with a variety of symptoms, incl breath, a persistent cough, chest pain, and an irregular heratbeat. The patie g dizziness, and has an allergy to Lipitor. The patient presents with a history ia, hypertension, and diabetes. They have been experiencing chest pains, sho ling in ankles. Common symptoms of heart disease include pain, numbne artist bythe Anna Goshua Sama Anvari n thegoshuaam@mcmaster.ca extremeties. The patient is experiencing pain in the neck, jaw, throat, ck. The patient presents with chest pain, tachycardia, shortness of breath, li Some of the details in the following article have been so I have no idea how it is that scores upon Navigating an electronic medical record fictionalized to protect patient identity.is experiencing swelling in the legs and easily tires durin zziness.The patient scores of patients emerge with their sanity (EMR) can be ridiculously painful, but this hen I was applying for this position, intact and helpful medical advice in hand, EMR isn’t all that bad. I mean, it does have patient Ireports fatigue and irregular heartbeats that feel rapid, pounding, o can’t say that I ever really expected or how the cardiologist-let’s call him Dr. W- its own little quirks, like freezing every so to be useful. tolerates it all. He must be a saint. often, and shortness sometimes during a of patient inpresents with a variety of symptoms, including a fever, breath, terview. When this happens, I stop the inpain,“Taking and an history? irregular The has terview beenandexperiencing dizzine a patient Presenting heratbeat. a pa- Perhaps I’m grab one of the secretaries or a tadpatient melodramatic. tient? What is this?” I murmur to myself as another volunteer. Stopping someone in the pitor.I peruse Thethepatient presents a history of hypercholeresterolemia, hypert training manual that I received with I arrive about a half-hour early on my first midst of speaking isn’t entirely polite, but upon acceptance. I flip through its twenty chest better that than an incomplete patientin file.the a ey have been experiencing pains, shortness breath, swelling day, carrying my volunteer manual and my of or so pages, growing increasingly incredu-

Fearful and Feckless W

lous as I see a list of diseases, their corresponding symptoms (most cardiovascular diseases have pretty much the same symptoms apparently), and a list of common medications. I was told that this volunteering experience would be unconventional. I can see that, and I should be happy about it, I suppose. To some extent, I am, but in all honesty, I’m mostly terrified. My clinical volunteering shift is every Friday for four hours. That’s four hours’ worth of intermittent awkward silences during patient interviews and opportunities to input haphazard notes into someone’s medical record, I estimate. The clinic is volunteer-run,

anxieties. The afternoon rush has hit and Dr. W is tucked away in his office with patient consults; I don’t get to meet him until later on, when I present my first patient. For now, I announce myself to the secretaries, who have me sign in and hand me off to another student volunteer that looks almost as disoriented as I do.

“I’ve only been here once. I don’t really know that much,” she says with a worried look. “Oh good,” I remark, “neither do I. We’ll figure it out together somehow.”

***

Well, I’m not really one to talk. Filling in a medical note is an art form, the intricacies of which aren’t yet second nature to me. I like to think that I’ve become somewhat proficient at describing the history of the presenting problem, but I still struggle with the assessment and plan section. It’s a hitor-miss in that regard, as are my presentations of the patient cases to Dr. W. “This patient presents with a history of hypercholesterolemia, hypertension, and diabetes,” I announce. “They have been experiencing stabbing chest pains with sudden onset lasting for several minutes. They also have shortness of breath. Oh yeah, I should

of breath, swells, or mention coldness that they have an allergy to Lipitor. doesn’t protest. I withhold a sigh of a relief. *** Uh, they also have swelling in both ankles. men, and back. They have some questions about filling out Some of these patients are really sick and ei- The fact is, I’ve been on the other side of ther they or their family is often quite angry this situation with family members. I un, andtravel dizziness. insurance forms for you.” too. Sure, you’re made aware of that going derstand the stress and I’ve witnessed more ty. The patient “Alright, let’s see what we have here,” he in, but nothing is really going to prepare than one explosion at one of the hospital or says after I finish my spiel, turning to the you for such an encounter. clinic staff members. I’ve judged staff memient presents patient. He places his stethoscope at severbers to be seemingly apathetic or unhelpThe patient is an elderly woman, accompaal different points on the chest and one on ful. Having chosen to place myself in this hest pain, and the back. Then he’s back at the computer, nied by her middle-aged son. The moment position, I’m suddenly empathetic to their to Lipitor. Thelab work and test results. I see the both of them, I can tell that what- plights. It’s hard. It’s really hard to commuflipping through I’ve never seen someone move and speak ever time we were going to spend together nicate your sympathy without it being misTheyashave been quickly as he does. I snap to attention as would be rough. She can barely walk and construed as condescension. I know that he addressesdisme: “You want to give a lot of her gaze is unsteady. Her son steps in time patients want to hear more than “I’m sorms of heart beside her, tense. His face is red. ry”, but sometimes, there’s just not anything xperiencing more that we can offer. “Hi, I’m Anna,” I introduce myself. No repain,I’ve tachycarjudged staff members to sponse. After a brief pause, I usher them When I inquire more into the details of the be seemingly apathetic or un- into the interview room and close the door patient’s case, it’s unlike anything that I’ve elling in legs ,noishelpful. nethe trep yh ,achosen imelortoetbehind sereus.loI continue, hcrep yahstudent fo yvol-roever tsiheard h a(though htiw stneserp tn Having “I’m take that with a grain place myself in the position W.b I’llfbe few artbeats experience). ehT of .se lthat kna eht ni gnillewunteer s ,hwith taDr.er oasking sseyou nta r ohofssalt, ,sgiven niamyp limited tseh c gnicTheneir a staff member, I’m sudden- questions and once we’re done, I’ll open the variance in her blood pressure is extreme, luding aiw fever, ih a ly htempathetic stnetosetheir rp tplights. neitapdooreand hTwe’ll.rgoointitopseeiLDr.oWtwhen yghe’s relwith la her nasystolic sahmeasurements dna ,satsetimes nizzi It’s hard. It’s really hard to available. Are you alright with that?” An- exceeding 200, and, at other times, coming ent been iaphas tcommunicate seh c gnicyour neirsympathy epxe ne ebpause. evThe ahladyynods ehweakly. T .setebainiatdbelow dn100. a She’s ,nofallen isn etrepyh , other multiple times, without it being misconstrued most recent ym ofuhypercholn condescension. ,niap edulcI know ni es aes“Look, id trwe’ve aebeen h fwaiting o smhere otfor pm ysandnhurt omhermhead oCupon .sthe elk na eht n as that over fall. None of their previous appointments hear ortness three Alle we orhtpatients ,waofj ,kwant centoeh t nmore i niap ghours. nicn irdoeispwait! xeWait siintthe neiortER apvisitseh Toffered .seany iteconclusive mertin-xe e have than “I’m sorry”, but some- ER, wait here…She passed out and hit her formation. I hate to admit that the consult ess, times, there’s il ,hweakness, taerb fo ssjust entnot rohanys ,aihead dra cyhcWe’ve at ,answered niapalltstheehwith c hDr.tW iw stoutnthe essame erway. p tneitap yesterday. turns thing more that we can offer. questions you’re going to ask more than upper xe gniabdorud serit ylisae dna sgel eht ni gnillews gnicneirepxe si tneitap once. What I want to know is why that doc- “We can’t really do much. I hesitate to tamightheadedpressure medications tul f ro ,gnidnuop ,dipar ltor eeoff yours tahthinks t stit’saacceptable ebtratoekeep h raperluwith geherrrblood i dn a eu gitaf str details and that’s fine, I understand that. It’s patients waiting this long. What are we, a because that’ll just make her more dizzy,” ng srexercise epgreat. a But ,hthe taor erb can fokind ssofeget ntlostroh s of,rcattle?” eveher fa niduI stare lcnati ,hesm tp mheryhealth s focardyand temediirav a herd song exclaims. message says.o So, with him, taken aback. I think back frantically to cation list in hand, the patient and her son when the details are all over the place. You ordn fluttering. ahave ,ss enizzid gnicneirepxe neeb sah tneitap ehT .taebtareh raluger to try to clump together information, the part in the manual that addresses this leave. empathy. a Understand?” ,npersistent oissonthateit’s trcohesive. epyh ,aimeloretvery sertype elofosituation. hcreShow pyh fo yAc-rotsih a htiw stneserp tn knowledge the situation. “Thanks, Doctor,” her son grunts out. I look ess, oCand elhas kna” an ht n i gdisheartnillews ,htaerb fo ssentrohout s after ,snthem iap tsdisappear, ehc gsubdued. nicneir “I.s understand, Ie repeat, a little as they “I’m sorry for your wait, sir. That must be Dr. W looks at me. ened. It’s good advice, undoubtedly. It’s just tension, T .sethat, iteatand m ertxe eht ni ssendloc ro ,ssenkaew ,ssenbmun ,niap edulcni this moment, putting together that really difficult and frustrating,” I respond. outd tob the of easily frustrating, ankles. serkind p tThe norganized eitpaapandeh T understand.kcab d“Dr. naW,gets necalled mo ahospital repsomepu ,t“Itacan orbeh t ,wa” he j ,tells kcme.e“Some n epaht ni times, which can cause the schedule to back tients we can’t do anything for. But for others, able presentation seems impossible. justnneed questions andthwe xe si tneitap ehT.ssenizziup.dI d a ,tossaskeanfewde daeh gcan il ,change htatheir erlives. b fRemember o ssenthat. tr” ohs “My brain can’t take in all that info at then we’ll get you in to see the doctor as a eonce, ug”ihetatells f me stinraolighthearted per tnmanner. eitapsooneh .ytIsivthatitokay?” ca rHeocrosses esicrexe gI’ll nirdo ud my serbest. it ylisae as T possible. out an angry breath, but save fo y“Back teiatrit.aLet’s v ago h tisome w smore tnlives!” eserhisparms tnand eihuffs tap ehT .gnirettul f ro ,gnidnuop ,dipa areh ralugerri na dna ,niap tsehc ,hguoc tnetsisrep a ,htaerb fo ssent neserp tneitap ehT .rotipiL ot ygrella na sah dna ,ssenizzid gnicneir gnicneirepxe neeb evah yehT .setebaid dna ,noisnetrepyh ,aimeloret ulcni esaesid traeh fo smotpmys nommoC .selkna eht ni gnillews ,ht en eht ni niap gnicneirepxe si tneitap ehT .seitemertxe eht ni ssendl ntroABOUT hs ,THE aid racyhcat ,niap tsehc htiw stneserp tneitap ehT .kcab dna , AUTHOR - Anna is a second year student in the Bachelor of Health Sciences program at McMaster University. She heri favourite second. e dnloves a stogtravel, el ethough ht n gnillplace ewtos explore gnicisnhereimagination. irepxeMiami si tisna close eita p ehT.ssenizzid dna , ar leef taht staebtraeh ralugerri dna eugitaf stroper tneitap ehT .yti 13

Surprise, surprise! The realities of volunteer travel By Joon Mun

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With very little experience in travelling and volunteering, Joon Mun embarked on a volunteer trip to Latin America and shares his insightful yet unexpected realizations.

s a university student who has seen little of the world, hitting pause on my life to travel to a poverty-stricken country for a month is neither exhilarating nor frightening. It is, in fact, a combination of both, along with every other emotion I could imagine contributing to a tumultuous mental state. Thoughts of an exotic land of surprises enticed me, but I was soon to learn that not all surprises are enchanting. Some background information: here we were, a group of McMaster University students about to embark on a trip of their lifetime to Peru under the guidance of two seasoned volunteer team leaders. The main goals of this trip were to immerse ourselves in the society and culture while learning about the various social justice issues in the communities we would be working in. More specifically, we directed our attention to the healthcare system and worked to reduce the prevalence of health crises, such as dengue fever. The majority of our team had minimal experience doing this; dedicating a trip to a different continent for the sole purpose of volunteering was just as foreign to us as the country we were going to be

Surprise #1:

Dichotomy between tourism & volunteering. nless you have previously been on a humanitarian or volunteering trip, your concept of travelling will blind you to what a country is really about. Sure, our team was given a full debrief on what our tasks would consist of once we set foot in Peru, but it was difficult to erase the images of Lima and upscale districts like Miraflores (hint: tourist spots) from our minds during our work. Why? Tourism does a great job of hiding poverty. And it is also due to the fact that the slum-like communities we worked in were one relatively short bus ride away from the bustling city. If you were to travel to Peru for vacation, you would see many beautiful beaches and tall, shiny condos by the ever-extending coastline (think Miami). Volunteering with the impoverished population begins to erase this picturesque image of a country and paints a drastically different one. Imagine communities with no running water or sewage, and houses constructed into mountains of dirt us-

ing various scavenged pieces of material that we would dispose of as garbage. This is what tourists, steeped in the luxuries that the country offers, donâ&#x20AC;&#x2122;t often get to see.

Surprise #2:

Overwhelming hospitality. uring our stay in Peru, we were personally guided by our contacts for everything we did, from meeting our homestays to working with the health promoters. The health promoters were volunteers who worked alongside healthcare providers to reach out to individuals in underprivileged communities. They inspected their homes and created educational campaigns. Out of all of these interactions, I cannot recall a single instance in which we were disrespected or neglected by any of the people with whom we were working. In fact, it was quite the opposite: every single person was extremely eager and motivated to work with us and build lasting relationships, despite the English-Spanish language barrier. It was their passion and dedication that inspired the team to push forward on even the hardest of workdays. Be-

ing surrounded by that kind of drive day after day, it was almost impossible to succumb to the relentless heat of the sun or the labourious nature of the work. I can credit these wonderful people for inspiring me, as well as the rest of the team, to keep our chins up during the month-long trip. It did make me wonder, however, how people with significantly fewer privileges and luxuries than Canadians could be so content. All I have to say is that, upon returning home, everything felt like a luxury. Well, just about everything but the hospitality; it was not comparable to Peruvian hospitality despite the familiar comfort of being at home.

Surprise #3:

Romanticized Canadians. omething that we were constantly reminded of by our team leaders was to not think of the work we were doing as helping the people. In fact, one of our leaders absolutely despised that word and for good reason. Normally, helping someone insinuates that they need it in one way or another. This is a detrimental mindset that gets in the way of learning and building sustainable relationships, which was the goal of Team Peru. It is far too easy to pride ourselves on what we accomplish on foreign soil, especially when the general population has preconceived notions of us being the “heroes” that they needed. Sure, we were donating our money and our time to better their communities, but I do not see this alone as a means of making a lasting difference. Consider the adverse effects that the idolization of foreigners will have on the dynam-

ic of these communities. I do not want these people, especially the future generations, to believe that they are incapable of creating solutions to their own issues without foreign intervention. Rather than simply “fixing” all of the problems ourselves, we worked collaboratively with community members to reach mutual and sustainable goals. To think that we are better than others is a poisonous attitude to have, manifesting itself to anyone who comes in contact with it. This journey was certainly not the time to forget this.

Surprise #4:

Continuity is the key to success. e spent exactly a month in Peru. Half of it was dedicated to working closely with health promoters in the slum-like communities of San Juan de Lurigancho. The other half was used to work on a Fair Trade coffee farm in the forested districts of Chanchamayo. Some might say that dedicating a month to volunteer is quite the large commitment. To be frank, that was my expectation going into this trip, but by the end of it, my thoughts were the exact opposite. There were several points during the trip where I felt like we were not accomplishing anything for the greater good. The matter of fact is that one month simply is not enough time to make a significant difference. It was tough to come to a realization such as this on a trip of this magnitude, especially when I was fully expecting to leave a positive impact; I could not help but feel defeated and useless, which appeared to be a mutual feeling among the rest of the team. Slowly but surely, we

came to the realization that there was only so much that we could do on this trip with the volunteer organization. For instance, our insurance could not cover everything that we wanted to accomplish and besides, our team leaders had a responsibility to ensure our safety by keeping us in constant communication with organization headquarters. Realizing the limitations of this one trip helped us to recognize the moral of this surprise, which is the importance of staying motivated and contributing to a cause regularly. If we relied solely on month-long trips once a year to make this difference, it simply would not happen. Having some sort of continuing effort is how we can aspire to achieve some degree of success. I realized that the purpose of these trips is to provide the relationships and resources on foreign soil to give us the means of reaching larger goals. Most of these objectives will not be attainable during the trip. The only way to achieve them is to work towards them upon returning home, utilizing our updated database of new knowledge, resources, and experiences gained during this trip. In fact, I am still in communication with our Peruvian contacts in hopes of planning a trip in the future to continue my efforts. I hope to educate more people and recruit those that share the same vision as I do: making a significant and lasting impact in underserved communities.

ABOUT THE AUTHOR - Having lived the majority of his life in the small Ontario town of Orillia, Joon Mun first experienced the taste of independence and city-life while studying in the Bachelor of Health Sciences program at McMaster University.

Art by Nikesh Pandey

Putting the Heart Into It by Alex Florescu florea2@mcmaster.ca

t the age of six, I knew what I wanted to do for the rest of my life. I took ballet lessons but yawned my way through them, so being a ballerina was out of the question. And I was too old for dreams of princesses and castles. Instead, I ran around the house, bossing my family into playing a patient with a leaky heart, a patient with a broken arm – all so that I could play doctor. I strained to hear whispered diagnoses through a stethoscope, believing it was my job to hear them. One Christmas, the most exciting present I received was a human body model of the organs. Yet, over the years, I abandoned this model to a shelf, and buried my stethoscope in my closet (though most things in my closet could be described as buried). I no longer wanted to play

doctor, as I was getting enough of foreign over the years was right for that – or what I thought was that – me. Giving credit where it is due, my program, its teaching style and in school. the professors rekindled the same I laboured over chemistry, physics, passion that I was so certain of at and the biology of plants dutifully six. By the end of the year, I knew but passively, a means to an end that that I had to get over my dismaying was beginning to make me lose sight volunteer experience at the dialysis of the elusive end. A disheartening center and re-immerse myself in volunteer experience spent restock- a medical setting. This is how I ing carts for three hours a week for a ended up at a cardiology clinic, year in a dialysis center during high volunteering for a revered Hamilton school did nothing for my medical cardiologist. knowledge and dimmed my passion for a lifelong career in medicine. It My first day volunteering was spent was at this point that I first became shadowing a medical student that afraid that I was pursuing a career was picking up elective hours at the that should have stayed a six year clinic. It was among the most intimidating but exhilarating days to old’s pipe dream. date. There was so much information University was my last shot at to absorb that it was hard not to determining if a career prospect forget it all, but it was exactly what I that had grown convoluted and had been craving. I wrote frantically

Some patients are upwards of 80 years old and still punching weight in this world. Their resilience is warming, and their gratitude for the work done at the clinic even more so. At the end of the day, I am left with a sense of accomplishment, because despite being just a volunteer, I am given actual weight and importance. What I do matters. My actions have a direct cause and effect, which was lacking at the dialysis center. At the clinic, volunteers are given This can be scary and intimidating, the chance to interact one-on-one because I have a hand in shaping with the patients, a large part of actual human lives. But it is also medicine that I had been deprived incredibly rewarding. of until that point. Not all patients are the same, and some cases Over time I learned to interpret leave me drained. Emotions can cardiac testing results, medication run high and patient wait times lists, and blood work results. Most of can be frustrating. It is often the my learning occurs during my shifts, volunteers that bear the brunt of though I have put in a significant patient dissatisfaction, and it can be number of hours studying on difficult to deal with animosity and my own. Practical application of aggravation. Yet for the most part, concepts I have read about on paper conversing with patients with years solidifies the information in my of experience on me is enlightening. brain; I doubt that I could forget on the margins of pamphlets around the office, and have since transposed them into a journal that I carry around with me every time I volunteer. At the dialysis center, I spent my time checking my watch only to notice that mere minutes had passed. On the other hand, at the cardiology clinic, eight straight hours can pass before I realize that the sun is setting.

the common name for rosuvastatin (Crestor) any time soon. Another surprising outcome of my time at the clinic is that I am now able to actively participate in my parents’ and grandparents’ cardiac health. The medications that my grandparents are taking are no longer convoluted strings of letters with seemingly no sense or reason. And when a recent emergency required experience with cardiac symptoms, I was equipped with at least some of the knowledge needed to help. I can’t know for sure where I will end up in one year, let alone by the time I reach grad school. I only know that I started at the clinic to test whether or not the field was meant for me, and I stayed because I cannot imagine any other way that I would want to spend my Wednesdays.

“My actions have a direct cause and effect ... I have a hand in shaping actual human lives.”

ABOUT THE AUTHOR - Alex is currently in her second year at the Bachelor of Health Sciences program at McMaster University, specializing in Biomedical Sciences. Neurotransmission and the New York Times get her excited. She is always incredibly busy, but likes it that way. Still figuring out when to plan out her life, she’s essentially just stumbling through it, but has been lucky to learn one or two things along the way. She often has many things to say about a lot of things, and hopes that those things are worth hearing.

A DAY IN THE LIFE WITH

AMBER POSNER, M.D. Interview by Anna Goshua

Amber Posner is a first year resident physician in psychiatry at Yale-New Haven Hospital. (Photo courtesy of Yale School Of Medicine)

What is a day in the life like as a psychiatry resident? I started as a first year resident in psychiatry at YaleNew Haven Hospital on June 12, 2015. I’ve recently been doing clinical rotations in internal medicine, which is required for all psychiatry interns.

given time…I feel like I’m always surprised. One of the things that I was not anticipating was having difficulty adjusting to this new life in which I actually have a job. There aren’t any more exams that you prepare for; you’re working now. This is your career. Sure, I’ve had a part-time job before, but with this, it’s like you’re finally My typical schedule has me getting up at 5:30am to get an adult in the real world. And I’ve spent so much time to the hospital by 6:30am. I want to have the opportunity studying in medical school that now that it’s over with, I to see all of my patients before the attending physician don’t really know what to do with my evenings anymore. arrives and to have a general idea of a treatment plan before rounds start at 7:30am. What has been your most frustrating experience thus far? At that point, you meet with the medical team, which My first 28-hour overnight call. It was definitely my is often interdisciplinary. Though it depends on the most frustrating experience because I was the admitting service, we usually have medical students, residents, intern and all of the patients came in within a couple social workers, and the attending. We visit and discuss of hours. Picture this: the first patient is admitted and the details of each patient case, which takes several I go in to see them. I take my time-I really don’t like hours. My job is to present my patients and answer any to rush with patients- and by the time I get out of the questions. room, my supervising resident tells me that there are three more patients for me to see on the floor. In an After rounds, the other residents and I try to make ideal world, I would like to think about the patient case it to noon conference, which consists of lunch and that I just saw and to write out the medical note before I an educational lecture. The rest of the day is mostly forget what we talked about. It was quite easy to do as a spent behind the computer-organizing medical notes, medical student, because we only had one patient to see inputting orders and such-and taking pages from nurses. and it’s not like our boundless medical knowledge and If the page is particularly concerning, you go down to skills were urgently needed elsewhere. In residency, we see the patient. If your service is admitting patients, then might be managing up to ten patients at any given time. that makes up a large part of your workload because So it felt like an uphill battle because patients just kept you have to start a thorough medical note from scratch, on coming in. I ended up getting seven admissions. I history and physical exam and all. really felt overwhelmed; thankfully I had an awesome supervising resident who was helpful and patient with Have your experiences been in line with your me. expectations? In every step of this process of becoming a doctor, you What was your most memorable patient interaction never really know what it’s going to be like until you’re and why? doing it. In terms of the big picture of going to rounds I immediately think of a patient I had as a third year and taking care of patients, of course I expected all of medical student on my psychiatry rotation. She had that. But so many unexpected situations arise at any borderline personality disorder, which is a heavily 18

What’s your biggest fear? My biggest fear would be that I’m not helping people. My idea of success as a psychiatrist is to make a difference in people’s lives; to make them live and feel better on a daily basis. It’s hard when you send a patient home and you feel that you haven’t taken care of them to the best of your ability. Unfortunately, when a patient is admitted into the hospital, our job is to manage their most acute I think that I was one of the few that took genuine event-shortness of breath or psychosis or what not- so interest in her case. I don’t say this to cast blame on the that it can be taken care of on an outpatient basis and medical team; it is definitely hard to remain emotionally then discharge them. invested in a patient that seems to relapse constantly and besides, everyone else is just so busy. But it ignited What do you wish you knew when you entered this such a strong desire in me to help her and to get her to position? open up. Gradually, I came to learn a good deal about The media really glamourizes medicine and, having no her past, which included physical and sexual abuse family members in the field, I didn’t have a concept of during her childhood. I think that she appreciated the the mental and physical toll that it can take. Managing time I took to speak with her, and she really began to the workload keeps you busy constantly and can stress open up with me and the entire medical team. Seeing you out. I’m still learning how to balance personal this change in her incited by talk therapy made me see and work life. The one thing I will say is that, there’s psychiatry in a whole new light. And that was the start an emphasis on well being in our community. You of the journey that led me here. can certainly reach out and find a lot of support, and we’re always encouraged to do so. Your ego can prevent How do you maintain empathy you from doing this, however. and patience when dealing It’s like admitting to a personal These patients come to you with “difficult” patients? failure. On that overnight call You know, there are multiple for help. They come to you for shift I talked about, for instance, difficult patient populations I could have called for additional in psychiatry. In addition to something that others can’t help. But then I look to my upper borderline personality disorder, level residents and I see them give ... you very may well be there is a condition known as handle so much, so efficiently. So dependent personality disorder. their remaining hope. why shouldn’t I be able to take These patients don’t really want care of my comparatively meagre to get better. They dismiss all workload? It’s easy to forget that treatments as ineffective and even if you’ve had a very they have a year or more experience than you do. constructive conversation with them one day, they seem to forget it all the next time you’re speaking with them. What advice would you give to those that are It’s hard. But an attending once told me to consider that interested in going into medicine? how I feel about these patients is how everyone feels It’s easy to have a good bedside manner when a patient about them. For example, their family might be sick of is happy-go-lucky. But most aren’t happy. They’re sick. them. It’s a harsh way to put it, but it’s not uncommon to They come to you for help. Always remember that. Just see. These patients come to you for help. They come to be supportive and go in with a smile on your face. It’s you for something that others can’t give. So it’s important amazing how many patients appreciate and respond to to separate yourself from those feelings, because you that. (Image courtesy of Stuart Miles at FreeDigitalPhotos.net) very may well be their remaining hope. stigmatized condition. The lives and behaviour of these individuals are tumultuous and they’re typically recognized as a difficult patient population. Having been brand new to psychiatry, I had no idea of this stigma. This patient was frequently admitted for suicide attempts and, as such, the rest of the medical team didn’t make much of a fuss over her.

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STAFF EDITOR-IN-CHIEF Anna Goshua MANAGING EDITOR Irina Sverdlichenko CREATIVE DIRECTOR Michael Sun EDITORIAL TEAM Joon Mun Darwin Chan Michal Coret Bhagyashree Sharma Carolyn Tan Alex Florescu Marina Wang Ryann Kwann Lucy Luo GRAPHICS AND LAYOUT TEAM Sama Anvari Lauren Liu Amy Ajay Nikesh Pandey Samuel Wu Kelly Dong Shira Weiss Shawn Khan