Wednesday, March 31, 2010
Last week, I had lunch with an old classmate who now practices Family Medicine in Ontario. It was a treat to sit and reminisce about a time when life was simpler and the world of medicine was full of optimism and possibility. We laughed and the conversation was a lighthearted walk through each of our practices.
We talked about the things we love about our jobs; about the challenges that face us as women and as doctors in the new century. There was the old idealism in our voices. The hope of contributing to a better world and the plan to make a difference at the bedside twinkled in our own mind’s eye.
We talked about the loss of respect facing our profession and the changes both good and bad that are transforming our vocations at an almost unrecognizable speed. I read an article in the Globe and Mail last month about how the health care system is “emotional fire from patients like never before”. Doctors, Nurses and health care providers have never been more disrespected than in this the information age.
My classmate confirmed my worst suspicions when she told me that last year she performed a pap and internal exam on a patient all while she text messaged on her Blackberry. While the patient was having her cervix examined she was (OMG) updating her Facebook page and planning her evening events. If this does not bring a whole new meaning to the word TWITTER…. Well. Enough said.
I am indeed a fan of multitasking as much as the next girl. I am also in favour of anything that can “pass the time” during any Gynecological exam. That being said… when did we as a species evolve to the point where we can not even pay attention when someone has a speculum in hand? Are we that important that the text message can not wait until the doctor has put the instrument down and “stepped away from the vehicle”?
I myself have had to ask patients to put away their books, phones, and Sudoku puzzles over the years. I recall more than a decade ago, well into my residency being asked to see a patient who was having a heart attack. His electrocardiogram confirmed the diagnosis, his bloodwork verified the fact and I was unable to share the news with him as he would not get off his cell phone long enough to chat with me. In fact each time I opened my mouth to “play doctor” I was met with his hand firmly in my face in a “just one minute” motion.
Make no mistake, I have very little etiquette when it come to my i-Phone. I routinely delight in listening to music at all times. I have full-on conversations with people while walking the streets. I can email and check my messages and download my boarding pass all from the train on the way to the airport from the comfort of my own telephone. It is the dream of every woman to do six things at once while talking to her friends AND shopping online.
The question is when does the multitasking become a full time job? Have our lives all become so insanely important that we need to update perfect strangers about what colour underwear we are wearing? Do daily social interactions need to be interrupted on a whim in order for us to seem more important than we really are? When did common decency die such painful death? When did so many care so much bout so little?
I had to ask: Can this service be used for the advancement of our health and not our demise? Who am I to make such demands? Will this Blog cure cancer? Will Girlfriends everywhere start a new movement? Can Text messaging be the key to our salvation and not our demise?
Last month, the White House Office of Science and Technology Policy announced the "text4baby" campaign aimed at promoting the health of mothers and children.The service offers free text messages as often as daily to three times a week to pregnant and new mothers on topics such as Nutrition, Prenatal Care and Immunizations. The program aims to prevent premature births caused by poor nutrition, excess stress, smoking and alcohol consumption.
Studies in developing countries suggest texting programs can help reduce such unhealthy behaviors in pregnant women.
Studies have shown the benefits of text messaging in asthma control and smoking cessation among teens.
And so as with all things, I must accept the rain with the sun, the bad with the good, the stirrup pants with the little black dress and the texting during doctors appointments with better asthma control.
WE can all see things from a different point of view and perhaps I was too quick to judge the young woman who interrupted her regularly scheduled Pap test to update her Facebook page? No, I don’t think so….. Twitter is bullshit. You heard it here first.
Tuesday, March 30, 2010
A day late and a dollar short? Is this the real saying? If so.... am off to bed dear girlfriends and alas my blog is left undone due to the late hour and my fondness for making pear tartlets instead of witty banter. Tune in tomorrow (should there be a tomorrow) and I promise to enlighten you all once more. Sweet dreams...
Wednesday, March 24, 2010
I bite my nails in a way that is truly offensive. Truth be told, I come by it honestly. My mother bites her nails as well. I can remember as a child her perfect long finger, with elegant fingernails polished to perfection. She sat in the front of the 1975 Oldsmobile cutlass while my father drove. She chewed on her cuticles as if she was manicurist on a mission.
And now more than 30 years later, I chew my hands with a vengeance. It used to be a nervous habit and now it is just routine. I have tried everything. I have tried bitter nail polish and gloves, acrylic overlays and weekly manicure. I have bitten through it all like a fanatical rodent.
My nails have born the brunt of every nail fad known to women. In the 1980’s I wore Lee Press on Nails. They were plastic nails that were self-adhesive and pre-polished. They came in a variety of colours and sizes and promised in a half an hour to transform any hands into movie stars.
My Press On’s were not available in Canada and were thus bought typically on trips to the United States with my family. We drove from Winnipeg, Manitoba to Fargo, North Dakota (it was 1983- there was little else to do for fun) and there in a Target I was introduced to the fabulous world of fake nails. I could bite my fingers to my heart’s content and within 30 minutes in the safety of my hotel room, my nails could instantly be polished and perfect again.
There I sat in the Holiday Inn in Fargo packet of LEE PRESS ON’s in hand anticipating the magic. I looked down at my stubby, bitten nails and imagined my long perfectly polished future.
Make no mistake; my future was perfectly polished, but lasted only 12-14 hours. The nails rarely stayed on for longer than THAT day and were no match for the chlorine content at the Holiday Inn pool. I loved my nails, but I loved the water slide even more.
In the 1990’s I fell victim to the craze of the Acrylic French Manicure. These fake nails are now popular among the adult film industry stars and Intensive Care Nurses in Alberta. This is not an association but merely an observation.
I spent most of my 20’s in the hands of various women of Vietnamese descent as they painted my nail beds with acrylic based products in pink and white in order to mimic a French manicure. They then took what can only be described as miniature bench saw to may nails and sculpted them into my own Sally Hansen advertisement.
My chewed up nail stubs were replaced by perfect long nail beds that smelled like acetone and looked like a dream. I was on a contact high from the chemical fumes and deliriously happy from the visual effects.
But when the look and the fumes wore off, my sober self bit through the acrylic and the pain like a beaver from hell. Ten days and ten fingers later and I was back where I started.
Now another decade has passed. CHANEL comes out with a new nail polish every season that is the “must have” of the moment. Each winter I paint my nails a dark blue or black or red and promise to stop biting. I last a week perhaps two or three and the polish is gnawed upon over and over again. I make resolution after resolution and each one is broken as I bite back my promises... one finger at a time.
In spring I paint my nails a pale pink or pearl or nude colour and at $20 per bottle; the promise is renewed. I have paid for Karl Lagerfeld’s car with the amount of CHANEL nail polish that has been purchased in an attempt to banish my bad habit and to no avail.
A study published in 1971 in the Journal Of Child Development and Neurology showed that there may be a genetic component to nail biting. According to the authors, nail biting is a frequent habit in children. It usually appears between 4 and 6 years of age. About 35% of children bite their until puberty when the rates increase to 40-45% of adolescents. The majority of nail-biters give up the habit during their teens and it is only occasionally observed in adults.
The habit is markedly familial. In a large percentage of cases a history of nail biting during childhood by one or both of the parents can be obtained. It has been suggested that the children learn to bite the nails by imitating the parents, but this cannot be the case since parents usually stop the habit before their children are born.
The study in the journal looked at identical and fraternal twins and found that identical twins were twice as concordant for the habit of nail biting (both twins biting) compared to fraternal twins. In severe nail biters, identical twins were more than four times more likely to be concordant for the habit than fraternal twins.
This points to more than a learned behaviour because logic would argue that fraternal twins would both learn the same behaviour.
Spring has come once again. I have bought CHANEL’s now sold out colour (it is a puke brown but apparently fabulous) and have piled on the paint and the promises once more. My genetics will conspire against me as soon as I finish typing and I will stare at my fingernails with wanton abandonment in preparation for my next chew….
And now, I only have my mother to blame….
Tuesday, March 16, 2010
I’m sleepy. I can feel my eyes shutting at about three in the afternoon on a daily basis. It has come to the point where I can now set my watch by my yawns. Coffee helps and on certain days it becomes a mandatory means of maintaining consciousness.
I love sleeping. I try to get eight hours a night at least. In fact I would argue that I am somewhat militant about my slumber. At almost 40, I still have a bedtime. My friends will attest to my almost seniors attitude towards this. I like to be in my pajamas by nine and spend the next 30-45 minutes in a getting ready for bed ritual.
I wash my face, pick out my clothes for the next day, read, surf the net, watch television. By ten o’clock, I am usually out cold. It is my favorite part of the day.
Yes I will try and stay up later on weekends. But it has become less and less of a thrill. I LIKE going to bed early. I LIKE getting up early. Given my love for rice pudding and green jello and old movies I will make one hell of a seventy-five year old woman.
I remember when I was a kid never wanting to go to bed. I can close my eyes and see the scene in my bedroom. It was a summer night in 1978. I was seven. It was nine o’clock at night and still light out. I could hear the older kids still playing in the streets and how I envied them. There was this massive sense that I was missing something.
And now more than 30 years later… I can’t wait for 9 o’clock to come so that I can go to bed. I love the summer months when the light streams in my bedroom window as I am falling asleep. When the windows are open and I can hear the perfect summer night on the streets below. I can smell the ocean air and hear the city life as I drift off and let my brain literally unplug from this world.
Perhaps it’s the job. Maybe medicine has robbed me of a proper “sleep-wake cycle”. Could years of being woken at all hours of the night have fully derailed my brain so that I now have a justified and somewhat self diagnosed sleep disorder? Could it just be that as we age, we like to sleep more? Or could it be the ever present argument that one always wants what one does not have?
I rise easily in the morning. I am not one of those people who hits the alarm several times and contemplates calling in sick between each snooze button. I don't jump out of bed with a swing in my step, but sometime around six am, I wake up without an alarm and try to take on the day.
The days are full and overall quite good. There are the amazing days which you wish would never end. The days that are perfect and life is truly technicolour and you stop for a moment and hope to freeze things in your mind's eye for a time when things lack such high definition. We all have handfuls of these days from morning to night when sleep seems like an unwelcome end and we're eight years old again listening to kids play in the street envious that a perfect day has ended without our input.
Then there are the less than perfect days; the terrible days; the days where the world shits on me and all I want to do is go to bed early. I come home from work, put on my pajamas at 6:30pm and crawl into bed. I skip dinner, take a sleeping pill (if needed) and fall asleep.... and the shittiest day ever is officially over. This is my solution for the unnecessarily awful days that plague us all. I am aware that this pattern of behaviour may be somewhat unhealthy. It may constitute avoidance of the world in which we live. It may be sad way to escape my troubles. But it works for me and no one gets hurt. Enough said.
The mortality risk associated with different sleeping patterns was assessed by use of the 1965 Human Population Laboratory survey of a random sample of 6928 adults in Alameda County, CA and a subsequent 9-year mortality follow-up. The study was published in Sleep (yes it has a journal!) in 1985 by Dr. Winograd and associates. The analysis indicates that mortality rates from heart disease, cancer, stroke, and all causes combined were lowest for people sleeping seven to eight hours per night. Women who slept less than six hours or more than nine hours had 1.6 times the total age-adjusted death rate of women sleeping seven to eight hours per night.
The comparable relative risk for men was 1.7 times the death rate. This increase in mortality rate was found to be independent of self-reported trouble sleeping and self-reported physical health status at the time of the 1965 survey. When the study adjusted for age, sex, race, socioeconomic status, physical health status, and a variety of other risk factors the increase in death rate became 1.3 times more for people who slept less or more than seven to eight hours.
And so science strikes again. My coffee is good for me. My shoes will not kill me and my pajamas will indeed save me from a stroke. I would continue this discussion further, but to coin a cliche... it's almost my bedtime. If you need me, I'll be upstairs washing my face, brushing my teeth, picking out my outfit for tomorrow and getting ready to save my life for the next seven to eight hours.
Tuesday, March 9, 2010
It's official. I have Post Party Depression. I am a resident of Vancouver. I live two blocks from Robson Square and I miss the drunks who took to the streets with spontaneous bursts of Oh Canada. It was sixteen glorious days that even the greatest cynical minds (yes Britain I am talking to you) could not put a damper on.
And now, the crowds have pulled of their red hockey jerseys and red fluffy mittens. My sixteen fabulous Olympically themed outfits are now back integrated into everyday pieces in my wardrobe as if nothing ever happened. The cauldron is out and I wear my patriotism back on the inside. My make up is again tasteful and there is no maple leaf temporarily and artfully tattooed on my cheek like a diamond of pride.
I have stopped drinking beer before noon at hockey games. I have stopped drinking beer completely. I have no interest in hockey. I was never a hockey lover. As a child my father told me it was "fighting on ice", and somehow that stuck in my head. But the Olympics brought out the hockey lover in me. There I sat at a game or on my couch or even in a Sports Bar (there is a first time for everything) watching our boys play for glory. I knew them by name and number as easily as if I had been fed the sport my whole life long.
I sat glued to speed skating as if my life depended on it; screaming at a television as frantic as if I was at a sale at a Prada outlet. I wore red and sang my national anthem in the streets. I watched Ball Hockey games played throughout the streets of Downtown Vancouver at all hours of the night and I yelled "CAR" just for the hell of it.
I "high fived" drunken twenty somethings on Granville Street, where previously I would have admitted them to hospital, judged them accordingly and let them sober up in Emergency before sending them home with a superiority speech and a prescription for Tylenol.
I met Lloyd Robertson in the street and he stopped to say hello. I sent my Beloved downstairs to the Starbuck's one morning and he came back with a coffee and a picture of himself and Queen Latifah. I watched Michael Buble run the Torch over the Burrard Bridge and had the best girl cry on record when K.D. Lang sang at the opening ceremonies.
I danced like a teenager with my childhood friend in a Mosh Pit at BC place while Burton Cummings belted out an encore that no one asked for but everyone wanted. I apologized with pride in being truly Canadian. I wept and I laughed and I sang and I loved it all from ceremonies to sports to the noise in the streets.
Mostly I just loved my city and the friendly way the world looked for 16 days in February; when optimism rained supreme and anything was possible. I have Post Party Depression. I imagine this is a common manifestation of extreme anticipation, extreme joy and then a resumption of regular life. I am sure there is an article somewhere about it but quit frankly I'm a little blue and I did not feel like looking into it.
I know small sorrow will pass eventually and I will drink in regular life again, enjoying its sweetness once more. But for now I sigh a little bit at the fact that there was "two weeks of wonderful in a lifetime of nothing special".
And now, I am back in my coffee shop. There is now always a table available and the much smaller line is easily tolerable. The latte is still fabulous, but there is no maple leaf design in the foam. The streets are a little quieter and the cars pass by with ease. The Paraolympics start on Friday and I know it will not be the same, but perhaps I'll get another glimpse of all things glorious. I am counting on it.
Tuesday, March 2, 2010
I graduated from medical school in 1996. The television show E.R. had been on the air for more than two years. IN fact I can remember my medical school class convening on a local pub in September of 1994 to watch this "brand new MEDICAL show"!! The show would speak to us. The show would guide us to through the maze of future inadequacies and insecurities and emotional landmines that would lay ahead. When we were feeling sad and lonely and just not good enough, NBC and the cast of ER would help us make it through.
And so we huddled around the pub television in Hamilton, Ontario and awaited our prime time salvation. Fortunately he appeared as he did every Thursday for years after in the form of George Clooney. Now, I have been in medicine since 1993 and it is safe to say that there are thousands of doctors nurses, pharmacists and support staff who have come into my life. It is safe to say that there has only been one George Clooney and we have yet to meet.
In fact I mean no disrespect to any of my medical colleagues past, present or future when I claim that no one in medicine looks like George Clooney. Now one could make an argument that things have changed in the television hospitals since the 1990's.
Let's take Grey's Anatomy for example. It is a show on ABC about surgical residents in a Seattle hospital. Examine the evidence please.... Meredith Grey is a babe. Lexi Grey is a hottie and Christina Yang has phenomenal hair. They are all surgical residents at Seattle Grace hospital with impeccable skin and all the right answers. They have a ton of friends and all get along famously. They drink like functional alcoholics and look remarkably fresh and stunning after 36 hours of sleepless call. One of the show's male leads could easily be considered the George Clooney of the 21st century. Dr. Derek Sheppard aka Dr. McDreamy is played by Patrick Dempsey.
The closest I have ever been to someone of Patrick Dempsey's hot-ness in any academic setting is that I had a tiger beat poster of him up in my junior high locker in 1983. Enough said.
I am not saying that doctors are not a good looking group of professional. Okay, I am. No seriously, it makes perfect sense that there must be some division of talent. Intelligent quotients of 140 and above do not usually come in genetically gorgeous packages. As a rule, God, or Buddha or Alla or whoever DIVIDES. Great skin; bad hair. Big eyes; big thighs. Big brain; small boobs. Nobel Prize winner for Medicine and a runway model..... not likely. The world works better when we all are allotted a certain amount of fabulous and are not too greedy in this regard. Well, at least MY world.
The other day, my dear friend emailed me that he is 3/4 of the way through season one of Nurse Jackie, a cable television show starring Edie Falco about an Emergency room nurse addicted to bad choices and Percodan. I find the show amusing and a revelation in character studies. He is finding it a bit too unbelievable and frustrating. In Nurse Jackie there is a character called Dr. O'Hara who is played by Eve Best. She is brash and stylish and I suspect her role in the show is to be a reality anchor for the lead character as well as a bit of comic relief. Dr. O'Hara wears Manolo Blahniks and has no verbal filter. She is enraged when blood spills on her $500 dollar shoes. In TV speak... her character is brilliant. Yes her footwear is fabulous, even in an Emergency setting, she smokes too much, drinks too much and her bedside manner is crap. In the real world, she is not the doctor I want to be.
So when my dear friend tells me that I remind him of Dr. O'Hara, I can't help but put up my defenses and say..... "It's the shoes". On the one hand, I should be somewhat flattered that I am compared to a woman of gumption and style who wears chanel nail polish beneath her latex gloves and can swim with the sharks in Prada Scuba wear so to speak. But on the other hand was I being reduced to a single image in a cable TV show? Was my entire career a parallel to a character on Showtime? Was it just a number game where 12 years of school and 10 years of practice been reduced to 13 episodes so easily?
And then it hit me. When people ask me what kind of doctor I am, I tell them,
"I'm a specialist in Internal medicine"
"what's that?" They say.
"You know the show HOUSE?"
"He's in Internal Medicine"
And for some reason that does it. No I am not a crotchety, damaged, lonely man with a fondness for Vicodin. okay, maybe damaged, but the rest.... no resemblance what so ever! It was then that I realized that television is our reference library for life. It allows us to get the headlines without delving into details. Of course if Life really is in the Details.... then as far as my Sony goes... I am missing out.
Research argues that glamorizing the profession on medical dramas is a contributing factor to increases in applications to medical resident programs, which increased from 4% in 1994 (the year ER began) to 5.2% in 1997 According to one study published in 1998 by Dr. M. O'Connor in the Journal of the American Medical Association. In essence, O'Connor argued that students watching weekly episodes of ER over 4 years is comparable to a medical student's time spent in a typical emergency medicine rotation. Taking into account television depictions of physicians along with physicians' and public perceptions of physicians, a similar study found that television portrayals and public perceptions of doctors' interpersonal style and physical attractiveness were more favorable than physician perceptions. Interestingly, network television depictions and public perceptions toward doctors' character and power were more negative than physician perceptions. These studies suggest that viewing medical dramas can impact perceptions.
And so like it or not, we all reach for archetypes. My lawyer friends have Law and Order to contend with. My Chef friends have Top Chef. Housewives have Desperate Housewives. Canadians have Corner Gas and we all have Sex and the City. My accountant has no show. Are these accurate comparisons of the lives that we lead and the jobs that we do or are they a sexy, compelling "sum-up-manship" that fails to capture our true vocational essence? I submit the latter but know that despite my protests I can thank all things Prime Time for at least some of the misperceptions the public holds when it comes to the nature of my work.
Let's clear it up people here and now. Medicine is not sexy. My graduating class was of average looks. I have yet to meet a doctor who looks like Eric Dane or Patrick Dempsey or George Clooney. We do NOT have sex in call rooms and I have never seen the boiler room of any hospital I have worked in. And after a long day of saving life after life after life every 15 to 20 seconds,we do not crowd into the same bar where everyone knows us to drink into the wee hours of the night.
The truth? Yah, it's hard work, yes people die. Yes, some of us are jerks and other try their best not to be. Yes, we make mistakes and yes sometimes we do not clean up after them. It's lonely and long and somewhat isolating but the value of the work is there and undeniably there is a commitment that can not be measured.
As for me? My hair could easily rival Dr. Christina Yangs and I do not have her stylist. I look like hell in scrubs and never wear a white coat (not my colour). I don't have nearly the friends in medicine as they do in Grey's Anatomy. I like my job, but I love my life outside of it more.
I'd like to think I am as honest as Dr. O'Hara but that my bedside manner is far superior. I try to treat each patient I see with kindness and respect, regardless of the hour. And as for my shoes? Blood stained or not... they are in a word.... fabulous