One of the most rewarding experiences I have had in the medical program so far has been in the interviewing skills course. The introduction of this course allowed me to feel like a “real doctor”, which was very exciting after having worked towards my goal of a career in medicine for many years. It was encouraging how open and honest the patients were to me and my colleagues in answering our questions about their current and past medical history and social history. I have always been very open with my family doctor about any issues I have had, but it was different being on the other side, acting as the physician and listening to the patients’ concerns. As the weeks progressed, and I interviewed more patients, I became much more comfortable and confident to ask the patients various personal questions. There was also one particular time where I was surprised by the information that a patient told me and prompted much reflection on the role of physicians in the therapeutic process.

My patient was a gentleman in his late 60s, who had just had a total knee arthroplasty. He was a happy and healthy individual, and did not inform me of any medical problems besides the osteoarthritis in his knees. I asked him about whether he drinks alcohol and he replied that he drinks 10 ounces of liquor a day. He blushed when he answered and looked a little embarrassed. I myself was taken aback by the amount of alcohol he consumes on a daily basis and because his expression I did not ask any further questions on the subject and continued with  the standard interview questions. After the interview was over, I thanked the gentleman for his time and participation. As I walked back to meet my interviewing group, many thoughts were going through my mind. My initial reaction was disbelief over the amount of alcohol he consumes on a daily basis. Then I realized that one of our important roles as physicians is to not judge patients, and I quickly realized that more must be going on in this man’s life that is driving him towards his high alcohol intake. I was left with many questions – was he able to drink during his recovery in the hospital and if not, was he experiencing withdrawal? When did he start drinking? Did he think he had a problem with alcohol? Had anyone ever confronted him about his drinking? Does his drinking interfere with his daily life? Has he ever tried to drink less? Is there something difficult going on in his life that he is using alcohol as a means of escape? Does he have any other substance problems? Was there a family history of drinking? I knew that with more experience in interviewing patients I would have been more comfortable and capable of coming up with appropriate follow-up questions on the spot.

Since this experience, I have also thought about physicians recognizing their own biases, and not imposing them on the patients. As a future physician, it is integral to appreciate that we all come from unique backgrounds and have different value systems. Consequently, we cannot judge our patients on the life choices they have made; rather our job is to provide them with the best care possible. This experience also provided an opportunity to reflect on the importance of honesty and trust in the doctor-patient relationship. This gentleman knew I was a medical student, practicing my interviewing skills but did he know that I had just started medical school less than 2 months before when he shared that personal information with me? It was amazing how honest he was about his drinking with someone he barely knew. The patient obviously felt comfortable enough to be honest because of the trusting and therapeutic relationships he has had with his other health care professionals during his current and past hospital visits. This experience taught me the value of developing trusting relationships to better understand my patients’ history and to provide the highest quality of care to them.

Today I attended a lecture entitled “Ethical Aspects of End of Life & Palliative Care”. Initially, I thought I was just going to be lectured about the ethics of euthanasia, but it was much more than that. Two patients who had life threatening sicknesses and their spouses participated.  One of the patients who was thought to have ALS started to describe how his life had changed. He went from running, cross-country skiing, and playing squash to not being able to go to the grocery store without taking a break in his car. As he started to describe his new limitations, he started to become emotional. I could see how much this disease had already affected his quality of life and the course of the disease was only beginning. You could tell his passion for life had declined.

 When asked if he had put any limitations on his treatment if a critical episode were to occur, he responded by saying he didn't want to be intubated or on life support ever again. But what really affected me was the way he said "I'm not afraid of dying from ALS but from living with it"

This simple statement really changed my view on treating terminally ill patients. As an eager medical student who wants to learn all the newest treatments, I could never understand patients that had lost hope or had come to terms with dying. I used to think that my patients should want to try all the newest techniques and never give up hope, that any life was better than no life. However, my thoughts have since changed.

The man had, to some degree, already lost his life by losing the ability to do the things he loved. I also have come to understand that with terminally ill patients, at the beginning of their diagnosis they may still want all the treatment possible, but this may change as they progressive through their illness.

As clinicians, I think we really need to try and understand what life really means on an individual basis with each of our patients. Life to me may mean the ability to breath but to another it may be to play basketball. We have to respect the wishes of our patients and help in making their last moments in life as comfortable and enjoyable as possible.

After 3 days of palliative care lectures, it's interesting to look back at this post. I can already notice as I gain more clinical experience and come into contact with more professionals my insight increases greatly. I look at this post and I think - How could I have thought that just "breathing" was enough to want to stay alive. In my future practice I hope to truly listen to my patients’ needs and concerns. In order to treat them properly I need to know what their most important health concern is. 

However, I do believe that it is still my responsibility to keep the patient completely informed if they have a terminal illness or not. Therefore, if I think there is a treatment that could help their disease or decrease their pain then I would obviously inform the patient of the treatment. An exception would be a terminally ill patient who had already expressed no desire for more interventions and was close to death. I would not bother the family at this time with a new idea.  Every treatment has side effects (even nasal prongs for oxygen), and at some point no matter how good the possible outcome, the side effects are not worth it. Once an individual and family has accepted the idea of death, to the best of their abilities, I would feel rude to disrupt their last few days together.

This is a very challenging area and I’m sure as my education furthers my understanding will evolve even more.

Nervously riding the bus to Dr. L’s Cosmetic Surgery clinic, I reminisced about my journey to medical school and how badly I've wanted this since I was 12.

I remember it like it was yesterday...

My father, a brilliant man with a stern look, cold enough to turn any of my potential suitors away from me, was a well-respected and highly recommended Dentist in Toronto. He loved his work, from the time he woke up in the morning, till when he came home - Dentistry was his ultimate passion.

When I was 8 years old, my family took a weekend trip to a friend's cottage. Swimming, laughing, boating, skiing, tubing, barbecuing; the weekend was just what we all needed.

Sitting in the car, waiting for my father to say his final goodbyes, my sister and I heard a scream. Jumping out of our seats, we raced towards my dad who had this point was lying on the ground holding his right eye with hands bloody red.

A bungee cord.

The difference between my father being a Dentist and no longer being able to practice was a bungee cord.

The story, as we would later learn, would read as a horrifying nightmare. My father was helping our family friend cover the boat, when the bungee cord being pulled taught by my father's friend had slipped out of his hand and ricocheted right into my dad's eye. And just like that, his career had ended.

Everything that had ever given my father meaning was stripped from him in milliseconds. Now, blinded permanently, my father works as a "business man" at a start-up company which produces the most depressed and miserable employee I have ever seen. I barely remember my father being either happy or satisfied.

This story, in my opinion, epitomizes "health". We do not practice medicine in one realm of physiological well-being, but in multiple frameworks which overlap and run interdependent to one another. My father didn't just lose his eye-sight that day, he lost his well-being as he had known it in a financial setting, a psychological setting, and a social setting. The cascade affect seen by one's own physiological state stretches on beyond quantifiable measures, each with individual variations of impact and emotion.

Stepping into Dr. L's office, I am introduced to one of the most charismatic, passionate, and kind Doctors I have ever met. He explains to me that today, I will not be seeing fancy reconstructive surgeries as he spends most of his time helping patients with carpal tunnel syndrome and tenosynovitis. Waiting to see a disappointment in my eyes, I never give him what he's looking for. I smile, nod my head and say "I'm not here for "excitement". I'm here to help people. And that's the most exciting part about this opportunity." Dr. L smiles, nods, and hands me a change of scrubs.

And for the first time in years, in my mind, I see my father smile.