#physicianship

Dear twenty year old me, stay who you are.

Although you might have the impression that the goal is to become a doctor and give away bits of your personality, you should see this the other way around. Your origins will allow you to create a great therapeutic alliance to the 51 year-old male who did not want anybody else but you to touch his chest tube and eventually assure his return to his baseline function. You will feel, upon writing his discharge summary and handing over his exit prescriptions that you meant to him what he meant to you, a feeling of being home.

Dear twenty year old me, let them talk.

You might think this will never happen to you but it will. That urgency of interrupting a patient’s story to save some time just to squeeze in the questions that your residents will later ask you. It is not worth it. While a patient talks, smile and nod. Be present. This will allow you to get pieces of information nobody else might have gathered. Always remember that day a patient told you she was getting a “perfusion” once in a while when she was going to the hospital, which nobody knew about or assumed it to be homeopathy. Discovering that she was taking Remicade in another hospital for Crohn’s disease will flip your differential and will grant her an admission.

Dear twenty year old me, always ask yourself  “What else”

Even if there might not be 20 other things to do for a patient, or new blood test to order for them, repeating that sentence will make you forget less. You will always forget. There will always be too many things to know and to remember. Going late at the end of your shift to investigate how your 51 year old status asthmaticus lady is sleeping during the night will lead you to the Jackpot. You’ll find that her airway irritation, anxiety and persistent fatigue are not improving probably from the dry cough she has during the night and never told you. Nothing else but a Codein syrup PRN prescription will make her comfortable and back on her feet way faster than you thought.

Dear twenty year old me, be honest.

There will be many times in which you will not really know what to say. In some cases you will have to learn to express yourself with silence. Put simply, you need a silence that is more than the absence of words, a silence that allows everyone in the room to breath, to hold hands, to feel your hand through the bed sheets comforting their quadriceps as you sit at the foot of the bed. On December 23, you will find yourself telling a gentleman who presented to emergency with back pain that the origin of his pain are metastasis to many verterbrea of the lumbar spine seen on CT. You are allowed to tell him that it’s not fair. That this is horrible. Although we have to be optimistic and appropriate with our patients, being able to show your empathy and to be honest in a context of poor prognosis will put a band-aid on his compliance. It will be enough to have him come back to have a full metastatic work-up the next day, on Christmas Eve.

Dear twenty year old me, step out of your comfort zone

You will quickly realize your staffs are filtering the cases you can see. Their intention is to give you the straightforward and nice patients that are good learning cases. Even if you feel like this works well for you, there is a lot more out there. You will only learn by experiencing the “raw” unplanned interactions, the cases in which your presence is optional and where establishing a good communication channel is the priority. As you are coming to the end of your obstetrics rotation, ask if you can go see the Intra Uterine Fetal Death patient in the IUFD room, behind the double doors. While dealing with the happiness, the excitement and the actions of the vaginal deliveries, in that private room is a mother who gave birth to a child she loved and carried for many months. She will teach you that holding your child is one of the greatest gifts, even when they have not had the chance to see their parents. Upon discussing and passing around photos in that isolated room, you will find a sense of pride that is identical to the parents in postpartum down the hall. She will remind you not to give up on life.

Dear twenty year old me, follow your interest

Particularly in the pre-clinical years of M.D.,C.M. , take the time to do those extracurricular activities or attend talks in Thomson house or at the Annex. There is no need to know what you want to do in life just yet. You should aim to become a good MD before thinking of being a good R1 applicant in a given specialty. Those initiatives and student projects will lay the foundations of a lot of problem-solving skills and will allow you to come up with a better understanding of the big picture. Learning from experience always pays back.

Dear twenty year old me, enjoy the ride

You will have the tendency to look ahead. To criticize what you are doing now and envy the upper years. Don’t worry, it goes by fast. You will soon see your degree fly by and wished to still be at the stage you are at now. These should be some of the best years of your life. It is up to you to make it happen.

Although you might be tempted to focus on the end result and on the person you will be twenty years down the road, you should aim to make every day a pleasant day. Knowing how to enjoy the small things always go a long way.

Remember, life is a journey, not a destination.

  Olivier Gagné

M.D.,C.M. 2015

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