Welcome to this week's edition of Dear Dr. Horton. Send the anonymous questions that keep you up at night to a real former Dean of Medical Student Affairs, Dr. Jillian Horton, and get the perspective you need with no fear of judgment. Submit your questions anonymously through this form, and if your question is appropriate for the column, expect an answer within a few weeks!
Dear Dr. Horton,
I've experienced the death of patients before — but this one feels different. I can’t help but think of small things we spoke about, like their dogs and their season tickets to the theatre. How do you navigate the intersection of professionalism and mourning another human you felt connected to?
Sahil Sharma is a medical student in the Class of 2020 at Western University
It was my first week on service for internal medicine as a third-year clerk. I had finally begun to figure out the labyrinth of charts, forms, and computer apps that went into my interactions with patients. I still had four of the eight pens I’d started with and had managed to misplace my sacred “pocket guide” only twice — so, all in all, I was off to a good start.
I was told by my senior to go see a patient who was in ICU step-down and had recently been transferred to our care. I hurriedly went to the computers and started reading up on the patient’s history.
Mr. C had a long and complicated history. He had initially presented to the hospital with signs of cholecystitis but later developed multiple complications landing him in the ICU. After a flurry of resuscitative measures and close monitoring, Mr. C was finally deemed stable enough to be transferred to the ward. ...continue reading →
Giuliana Guarna is a medical student in the Class of 2019 at McMaster University
I pulled back the large door and stepped into the room. It was early in the morning — just after 6 am. She was lying in bed, awake, with a smile on her face despite the fact that she was post-op. The evidence of surviving rounds of chemo were borne out in front of me. Her hair was peach fuzz, peeking through a silk turban wrapped around her head. Her cheeks were like little Timbits, but her frame was swallowed by her hospital gown.
“Oh, hi. Come in. Let me turn on the light.”
I walk to the foot of the bed. The sun had not yet peeked out from under the shades. The room was illuminated by a yellowish-white hospital glow as she pressed the switch.
Mitchell Elliott is a medical student in the Class of 2019 at the University of Toronto
Doctors are amongst the intellectual elite of society. In many cases, with decades of training and continuing education in clinical practice, our expertise grants us the opportunity to do things that would be deemed invasive and inhumane if performed outside of the context of medicine. Selectively poisoning people with chemotherapy; carefully dissecting fascial planes and removing organs; asking invasive and personal questions... all in the name of symptom management, remission of disease, and prolonging the inevitable: death. For physicians, these daily rituals become almost routine. In many cases, we have spent the majority of our lives training for the uncertainty of each day, rigorously memorizing each disease presentation and management principle, habituating to these processes and procedures. With the heavy clinical demands on physicians, it may be difficult to fully realize the impact of our actions on each patient. ...continue reading →
Sarah Hanafi is a Psychiatry Resident (R1) at McGill University
I started my Geriatrics rotation on the Restorative Care unit. Having trained mostly in acute care, I found myself perplexed by this care model. On the surface, many patients seemed to suffer from maladaptive personality traits that hindered their graduation to primary care. It felt like a bizarre blend between an internal medicine ward and a long-term care facility; this mirrored the disorientation I felt in managing patients who had few medical problems, per se, but lacked the means — whether intrinsic or extrinsic — to cope. ...continue reading →
The HIV/AIDS Care Unit (Unit 371) at Chicago’s Illinois Masonic Medical Centre was founded on a heartbreakingly simple observation. “We are all just people taking turns being sick,” stated Dr. David Blatt, one of the founders of Unit 371, in MK Czerwiec’s newest graphic novel — the aptly named Taking Turns: Stories from the HIV/AIDS Care Unit 371. Czerwiec was a brand-new nursing graduate on 371 during the height of the HIV epidemic, and Taking Turns is in many ways her tribute to the unit’s extraordinary spirit. The intention of the unit was made clear from day one: this would be a place where the most stigmatized and ostracized patients could be cared for with empathy, understanding, and love. ...continue reading →
Zeenat Junaid is a medical student in the Class of 2020 at Bahria University in Pakistan
I checked his file again and looked up to see the patient with a tube hanging off his shaved head. Mr. Taj Saboor, 48 years old, had brain cancer —glioblastoma multiforme. It had been removed twice in the last six months, and each time it had returned with pugnacious insistence. If cancers were little shoots and plants, or even weeds or bushes, then glioblastoma multiform would surely be Jack's colossal beanstalk of lore spurting straight up to the sky. It is fast; it is monstrous. Even when meticulously removed, one never knows where else in the brain the beans have been strewn and where hell may again break loose. It surely is the grand master of all stealthy and lethal cancers. ...continue reading →
Arjun Sharma is a medical student in the Class of 2019 at the University of Toronto
Picture a physician on a hospital ward at the day’s peak.
He jumps from one task to the next: patients being careened off for tests, colleagues who wish to discuss care plans, progress notes that need documenting, and piles of orders that need filling. Add to that the tune of beeping pagers, ringing telephones, and clattering keyboards, and not a single minute is spared of its full economy.
I’m watching all this during my first stint on a hospital ward. As a newly minted clinical clerk caught in the professional purgatory between classroom-cocooned medical student and ward-flying physician, I’m asked to do much of the work of the latter. But having only two years of study under my belt means much of medicine still remains beyond my intellectual reach. ...continue reading →
Iris Gorfinkel is a General Practitioner and Founder & Principal Investigator of PrimeHealth Clinical Research in Toronto, Ontario
I’d been attending this particular patient’s medical needs as her GP for the past five years. Enid dressed impeccably, was a young 85 years of age and had the amenities that most elders dream about. She had her health, financial security, education and a strong intellect. What she was missing was companionship.
“If only I had someone to travel with,” she lamented.
Hardly 24 hours later, I was asked to see Fred who had been my patient for 7 years. He was a robust 87 year old, financially secure, well educated, and possessed a marvelous sense of humor. He had remained active despite having lost his partner to lung cancer the year before.
“I miss having someone when I travel,” he told me.
Carrie Ladd is a part time general practitioner in the UK National Health Service, a spare time RCGP Clinical Fellow in Perinatal Mental Health, and a full time mum…doing overtime!
Despite all the pressures, challenges and daily frustrations of working in the NHS, I still feel being a General Practitioner in the UK is the best job in the world. Well, second best to being a mum to my incredibly fun and loving two young children. But which role is truly the more challenging? Those who have children will know instantly what I am talking about and those without may well know from friends that this question has serious ground for debate. Despite 13 years of further professional development in the form of continued education, assessment and appraisal since leaving Southampton Medical School, there are many difficult moments I deal with as a mum where I feel as unsure and inexperienced as any other parent. People often generously assume that of all health professionals, medics in particular will know what to feed their fussy baby, how to discipline their child in front of the grandparents and what to do when their “spirited” toddler throws a tantrum in a supermarket. I write to correct this misconception. ...continue reading →