Capturing the Essence of Medicine…

For a long time Silvy and I had this thought to share with the public the many stories of our profession. We all do and see so much, but for us it is normative. Doctors are not heroes, they are dedicated ordinary people who are often put into positions where they push the envelope and act in small “h” ways.  We feel that showing our friends, peers, colleagues and the public what we do as physicians will help people understand the beauty and pitfalls of Medicine and Healthcare in general.

Sandra Landolt

 

When you train in medicine, you are repeatedly told “Medicine is an Art not a Science”. Of course you need to know the science. To be a good physician however, you need to be able to practise the art.  Every physician learns how true this is as they pass from training into clinical practice. And we learn that our interactions with patients, our relationships, and our stories have profound impact on each other’s lives. This website was created to help express that human connection–to remind us all that that is what ties us together at the very root. In our words, in your words.

Silvy Mathew

 

Blog: www.healthcareandhumanity.wordpress.com

Facebook: https://www.facebook.com/healthcareandhumanity/

Twitter: @healthnhuman

Instagram: healthcareandhumanity

Losing her mind…

She was one of my first patients.  She was tall, strong, witty and kind…and had a gentle touch. They had married for 50 years, never had children.  They were an exemplary example of a loving, respectful partnership.

elderly-couple

Unfortunately, Louis had delayed her first appointment with me, as she had experienced an “episode” and had been hospitalized for a mini-stroke work up.  When we finally met, she had been discharged from the hospital, as she was now stable, and was being followed by the neurologist and cardiologist for a full battery of tests.

We sat and chatted, reviewed her results, and got to know one another.  I immediately felt close to her.  I was not surprised that although they did not have their own children, Louis and her husband had an extensive network of support.  They were very active. We joked, we laughed and we bonded.  They were coming back to my office the following week for a health review for her husband and to follow up some of her pending results.

A week later her husband was concerned.  She was frustrated he was smothering her.  This time, she spoke a little slower, her hands trembled. She didn’t seem as strong.  She was not as confident.  She was seeing her neurologist again.

I called Louis a few days later to update her on some of her results.  She answered the phone but couldn’t complete a sentence.  I was worried. Very worried.  I asked her husband to bring her in.  I trembled after I put the phone down.

The woman in front of me now was not recognizable. She was holding her hands together to stop them from moving.  She could not even open her lips to make a word.  She could only nod her head for yes or no.  I panicked.  She tried to smile, as tears flooded her eyes from frustration.

I called her neurologist and she was hospitalized.  Her CT scan showed inflammation of her brain-cause unknown.

Her husband called me every other day for an update.  At first he seemed positive–he had not understood the initial results.  I tried to explain, tried to brace him.  Very soon, she was deteriorating.  Her husband said she refused to eat, refused to get up.

We discussed death softly.

What to expect, how to prepare for that which one cannot prepare.

He felt she was suffering, she was losing her mind.

One day she didn’t make eye contact with him.  She didn’t hold his hand. She only cried.

A week later she was gone.

Her husband had called the clinic and left me a message.  When my receptionist told me, I thanked her and closed my office door.

I wept. Wept for the lovely, active, charismatic and smart woman who I only had the joy of knowing for less than a month.  A strong, independent woman who had to live her final days trapped in her body, unable to express herself, unable to communicate.  Only able to cry.

 

 

Stories written on my soul…

ER doc crying

“18 year old VSA en route, pedestrian hit by car”.

The paramedics are coming with a young patient, no vital signs, who had been struck by a car.

The double doors swing open, a paramedic on top of the patient–doing CPR.

We scramble to help. Within seconds of her arrival, I know she isn’t going to make it.

“She was out with her friends and they crossed in the middle of a busy street. Her friends all made it to the other side. She didn’t. She was thrown 30 feet down the street.”

But we try.

We try to restart her heart with medications and compressions.

But the gaping head wound from her skull fracture makes it unlikely she will recover to a meaningful life.
“Has anyone reached her parents?” I ask.
“The police are on their way to her home,” a nurse reports.

We continue the resuscitation.

At least we will give her parents a chance to say goodbye.

The sadness is immense. This could be anyone’s daughter, any of our daughters.

Her parents arrive.

They enter the resuscitation room which is strewn with bloody gloves, monitors alarming, while the team does compressions and artificially breathes for their daughter.

Mom crumples to the ground sobbing.
Dad screams in anger “Why? Why?

We have no answers, silent tears falling as the adrenaline of the resuscitation gives way to sorrow at the young life taken too soon.

“Time of death: 7:02pm” I say.

The parents sit in shock.

I fill out paperwork and speak to the coroner.

I still have hours to go in my shift but I am numb.

To get my mind off the tragedy, I go to the discharge waiting room to write a prescription for a patient waiting to go home.

On the TV in the lounge, the news channel pronounces that the body of a mother, a family physician, had been found murdered.

I stare in shock.  I nearly crumble.  Her name familiar to me.  I’ve spoken to her.

How could this be–two young lives gone in one night?

Somehow I get through the rest of the shift.

But as I turn the ignition in my car, I stop and I weep.

It is well after 2am. I go home and return the next day.

I am an emergency physician and I deal with life and death every day.

My patients lives write their stories on my soul.

 

 

“You are my sunshine”

mother-daughter-love-sunset-51953I was greeted by the sound of a screaming baby as I started my ER shift.  My stomach immediately knotted, especially now that I’m a father.  But the truth is, if the baby is screaming, she’s usually gonna be just fine. Screaming means awake, angry and very much alive. 

I walked into the room.  A woman was holding her baby, sobbing. The baby in her arms, perhaps 15 months old, had been burned. Skin on her arms, neck and face was blistering or peeling depending on where you looked.

The mom looked up at me, distraught.

“The s..s..soup.” she sobbed “She grab…she grabbed the boiling soup and it spilled…it spilled all over her. I let my baby get burned. Oh god…my little girl…I…”

I moved closer.

“Everything’s going to be ok…accidents happen…it’s not your fault…let’s look after your baby, ok?”

No help. The mom was lost in her anguish.

“Mommy?” I asked a little more firmly “Mommy, listen please–we have to do our best to be calm, ok? If you’re calm, your baby will feel it, and she’ll calm down too, ok?”

The mom finally looked back at me through tears

What about a song? Does she like songs?”

She nodded. “Um..I…ok..”

She took a breath

“You are my sunshine, my only sunshine”

“Great!” I said. I joined in

“You make me happy when skies are grey”

The nurses hadn’t been allowed to get close. The unit aid was on standby too.

I looked over to them encouragingly…and they started joining in.

“You’ll never know dear, how much I love you. Please don’t take my sunshine away”

Mom and the baby had started to breathe easier. The nurses approached, all of us singing together, and gently set the baby on the stretcher. Medically she was going to be ok, but the pain must have been terrible. She was going to need some fluid and some pain medication through an IV.

The unit aid, a big, burly fellow, likely weighing in at 250lbs was leading the vocals on the third run-through as he gently held the baby’s arm so that the nurse could get the IV in.

Within 5 minutes the medications were in her and the baby and the mom had settled.

I found myself humming “you are my sunshine” the entire rest of the shift.

Sometimes it’s enough…

I received the pathology report in the middle of my clinic day. The patient was not my patient–but my mom.  As I read it, my heart stopped.

B cell lymphoma.

My brain couldn’t register.

“Can you please look at this report?” I asked my colleague. “That means cancer, right?” She nodded and asked if I was okay. I clearly wasn’t thinking straight.  I picked up the phone and called my mom’s specialist.  He had just finished telling her and my dad the news.

“What exactly does this mean for her?” I asked, afraid of the answer I wasn’t ready to hear.

“It’s not curable, ” he said, “but it’s slow-growing. She can have chemotherapy and it will help her feel and breathe better.  Life expectancy is about 10 years but that’s a long time and new treatments may be developed…”

My brain turned off again.

Her time is limited, that’s all I heard.

A wave of emotion came over me.  I ran to my office with tears in my eyes; my heart racing. I called my husband. I washed my face.

Ten minutes later, I had composed myself and was seeing my next patient, apologizing for the delay.

I made it through that work day. I smiled, listened, encouraged and advised my patients just like I would on any other day.

No one would ever know how much my heart ached at that moment in time.

The stark reality of the situation felt like a slap in the face.  I’m a physician but I can’t fix this.  I can’t make her cancer go away.  I can’t stop the inevitable from happening.  But I can support her.  I can be a good listener.  I can help make her journey less frightening.  I can help her navigate through the complexity of our healthcare system.  I can advocate for her when necessary.  Just like I do for my own patients.

Mostly, I can be her daughter.

And sometimes, that’s enough.

 

 

Baby’s breath….

 

A baby was born last night and was not doing well.

The Pediatric Fellow warned me: “It can sometime take days for a newborn to die. Talk to the family. Talk them through the process. Make sure they understand.”

She paused, “”make sure you understand too because it’s going to be very hard on them…and on you…and everyone”

I reached for my pregnant belly. The stark contrast between my own situation–a baby alive and kicking inside of me–and the baby who was dying–was heart-breaking.

I wanted to run. But I couldn’t walk away.

As the Doctor on call, I left my busy family medicine clinic that Friday afternoon to go help. The neonatal team from McMaster had been there and left. They had tried everything–and despite their amazing, heroic measures–the baby was still dying.

So I was called. My job description: provide comfort care until the baby died.

When I became a rural doctor, I knew I was taking on many roles.  I work as a family doctor. I do anasthesia in the local hospital. I do house calls for the very sick and frail. I see kids.

I provide full cradle to grave care.

Palliative care is about providing comfort, grace and dignity at the end of life. Dying is a process and often takes time.  The goal is to ease suffering–for both the patient and the family.

It is one of the most personal, essential and humbling jobs that I do.

She was different. She was the first baby I would palliate.

I was introduced to the family. We talked through the plan, went through expectations. I reviewed what I could and couldn’t do.

I met the baby: a tiny, seemingly perfect newborn with tiny fists, tiny wrinkled feet and a head full of black hair.

My heart squeezed.

I stayed with the family all day–preparing them for what was coming, helping them understand what a normal baby breath was and what was a struggling gasp.

I left them in the evening to be with their baby girl, with them calling me anytime they needed me. Midnight, 3 a.m. I came whenever she gasped or struggled–provided her with medication to ease her discomfort and stayed until her breathing eased.

After each visit, I would go home and hug my own babies. Grateful for whatever mercy had brought them to me healthy, alive and whole.

It was a Sunday.

I was sitting in a rocking chair, holding her while she slept. The sun was warming my neck.

She released her last breath.

I gave her to her dad. I touched her mom’s hand.

None of us spoke. But we all wept.

The sound of no heart beating….

pexels-photo-165746The sound of a needle driver (what we use to suture) opening and closing is barely audible.  In fact, if you ask most surgeons, they’ll tell you it’s silent.

But standing in the operating room alone that day, no radio on in the background, no nurses talking, the vital signs monitor off, the anesthetist gone…it was the loudest sound I had ever heard.

Each time I went to sew– open click, grab thread, close click, needle pass through the skin, repeat–the soft click made me cringe.

The noise seemed an affront to the baby in front of me. And I couldn’t stop thinking of him as a baby.  A baby that would never be a toddler. A child. Adolescent. Or adult.

A beautiful baby–stuck forever in this moment–an infant.

Open, grab needle, close, pass through skin, repeat.

I was a junior resident on a pediatric cardiac surgery rotation. In fact, I was supposed to be doing research but the hospital needed extra hands.  There was a heart transplant to be performed. It was a miracle for the receiving family.  Baby hearts are rare to find-having a baby born needing one is a prolonged death sentence for most.

You see, not only do the donor and recipient need to match blood types, they also need to match in size/age.

A heart too small won’t be able to grow fast enough, and will give up from fatigue. A heart too big won’t physically fit, and closing the recipient’s chest will squash it.

So finding a match is like winning the lottery–a baby destined to die gets a second chance at life.

Open, grab needle, close, pass through skin, repeat.

Except. Except the heart has to come from another baby. A baby like this sweet little boy in front of me.  I still don’t know his story. I only know that his brain had died hours before we opened up his chest and took his still beating heart out of it.

His parents had made the impossible decision and sacrifice to help another family and save another’s life–while they let go of their own son’s.

Their baby had left them with a beating heart.  Warm, huggable, kissable. But never to wake up again.  They let him go.

It was my job to put that tiny little chest back together. It wouldn’t matter if it was well done or not –it would never heal.

It wouldn’t matter what it looked like as no one would see it. Except me.  Alone in that room. Trying to honour that child. As best as I could.

Trying not to cry.

Trying to remember that this was a miracle.

Open, grab needle, close, pass through skin. No more repeats.