Arnav Agarwal is an Internal Medicine Resident (R1) at the University of Toronto. Check back the last Thursday of each month for a new featured piece as part of his series (Doc Talks: Reflections to Reality)!
Shubham Shan is a medical student in the Class of 2019 at the University of Toronto
She arrived on an inclined stretcher, grasping her Venturi mask like a child holding on to her favourite toy. Flanked on both sides by paramedics, her eyes were splinted wide open by shock and her chest heaved up and down rapidly. She was a queer shade of purple — like spoilt red wine diluted with water — and her gaze flitted around the emergency department as if looking for someone familiar. The paramedics passed her off to the doctor then left, shaking their heads. I remember watching the doctor take the patient’s puffers. The patient swore loudly and snatched them from his hands; first the orange, then the blue. She cocked the puffers like guns, inserted them into her mouth, shot the mist deep, and inhaled. She coughed for what seemed like an eternity. She was what we called a “blue bloater.”
When I saw her again, she was lying on a tattered mattress with bright blue sheets in a freshly bleached acute care room in the emergency department. Her condition had gotten much worse. Her abdomen caved in paradoxically whenever she breathed in. Her eyes were bloodshot. Every time she exhaled, it sounded like an infant's rattle. ...continue reading
Beatrice Preti is an Internal Medicine Resident (R2) at Queen's University
The list is long, but I know your name
Each day before, its spot was the same
Second from the top, the second room on the right
The one with three windows and a broken bathroom light
But today something’s different; the list I have’s bare
I looked for your name, but it wasn’t there
Something has happened, and, in my heart, I know
That though I fought to keep you here, you found a way to go ...continue reading
Jenna Webber is a Public Health & Preventive Medicine Resident (R2) at Queen's University
It’s 1 AM. The call comes in: VSA en route. Your team assembles.
Efficient, empathic, skilled — the team prepares for arrival. Roles are assigned, facts are reviewed, and questions are posed. The team is ready. You wait.
The patient arrives. Pulse check — asystole. On to the chest. Transfer the patient to the bed. The team knows what to do — whether through simulations or past cases, everyone knows the algorithm. Everyone knows their role. With heads, hearts, and hands, everyone works on.
The clock marches. Tick. Tock.
The skin is mottled. Bagging is going well, but intubation is tricky. Paeds and Anesthesia are on their way. Keep bagging. ...continue reading
Michael Gritti is a medical student in the Class of 2019 at the University of Toronto
“To induce asystole as needed.”
Looking the decision in the face
wasn't as simple as I'd thought, I conceded.
But, simply, was it right? Was it just?
Eighty millimoles of potassium chloride: ...continue reading
Dilshan Pieris is a second-year Masters Candidate in the Health Science Education program at McMaster University
When Breath Becomes Air
(Random House, 2016)
When Breath Becomes Air begins with Dr. Paul Kalanithi’s childhood life in Arizona, where he developed a passion for English literature and biology that provided the foundation for his desire to pursue medicine. During the first half of the book, Dr. Kalanithi writes about this journey, which notably involved attending several internationally-esteemed universities: Cambridge, Yale, and Stanford. Not only did he graduate from these schools with honours — he was also pursuing the notoriously demanding specialty of neurosurgery. Despite the rigour of residency training in this discipline and a blooming relationship with his partner, Lucy, Dr. Kalanithi was not merely managing; he was gradually rising to prominence in the field as a clinician-scientist. ...continue reading
Beatrice Preti is an Internal Medicine Resident (R1) at Queen's University
It was the strangest of days when I met him first
Everything jumping from awful to worse
People were shouting and crying and seizing
Coughing and choking and retching and wheezing
It was nearly twelve hours before I could go home
But the attending doc called direct on my phone
And asked me, please, could I see one patient more?
Well, I couldn’t say no, so I went back to the floor
And met him there, though, then, he was alive,
But looking so dead I knew he hadn’t long to survive
Yet I took the history, and wrote everything thing down
Signed the orders, made the calls, and finished my rounds
Tucked him in for the night, and was just about to leave
When he said to me, “Doc? How much time do I have, please?” ...continue reading
Sahil Sharma is a medical student in the Class of 2020 at Western University
Nearing the end of my first year in Medical School, I am amazed by the wealth of knowledge acquired during such a short time. There have even been several moments throughout the year where picturing myself as a fully licensed physician seemed slightly less daunting. I have become comfortable with routine physicals, certain diagnoses, different drugs, and management of a wide range of illnesses. I have no doubt I will encounter each of these facets of healthcare during my career. However, there is one unavoidable aspect of medicine that has been discussed very little: death.
The discussion of death is, understandably, quite sensitive; thus, discussing it with such a diverse demographic of students requires a certain amount of skill and reserve. But after learning about concepts such as palliative care and patient-physician relationships, it seems unjust to gloss over one of the most vital roles of a physician — the ability to comfort patients in their most troubling times. ...continue reading
Zeenat Junaid is a medical student in the Class of 2020 at Bahria University in Pakistan
“How do you make leukemia visible?” Jo Spence asked herself.
A British photographer and educator, Spence was a transforming voice in the arts of the last century. Her documentary-style photo albums dealt with themes of class struggle, conformity, and feminism. In 1982, she was diagnosed with breast cancer. A few years later, leukemia also set in. This cancer was not just in her blood and bones — it had seeped into her existence. It hijacked her arteries of security; it exiled her into grey plains of isolation she had never known before. Her whole career, she had sought to catch that special look — that nuance in a scene that told another story. But could she capture this tyrant phantom of disease now in her photos? How to express something for which words falter? ...continue reading
Tyler Murray is an Internal Medicine Resident (R1) at the University of British Columbia who graduated from medical school at the University of Toronto in 2017
Fortunately, I found myself starting medical school unacquainted with death. I had only been to a single funeral, all four of my grandparents were still alive, and my entire extended family was relatively free from chronic disease.
Our first exposure to death in medical school was in the anatomy lab. At the end of the first week, we were brought down to the morgue and introduced to our cadavers. A small card with a simple line about who they were hung at the foot of the table: "54y male. Cause of death: lymphoma.” Over the next two months, we became intimately familiar with these bodies. Each day, we crossed a new boundary in a process of uncomfortable, progressive desensitization. I wonder now if this was intentional. ...continue reading