How would you talk a male diabetic out of smoking? Dude, you’ll get impotence. Buuuut that’s not really respectful enough, like, dude I just met you let me talk about your penis. So instead, I go: let me explain to you how smoking and diabetes affect the body. I explain things, and then I say, what you may not know is that smoking causes constriction of blood vessels and prevents the flow of blood through your circulation. So you may not be able to have an erection or have sex when you’re in your 40s. See that’s much better. And then when you see these diabetics with amputated feet, that’s another opportunity to scare them.

I would rather always talk to patients over their heads than under their heads. Just like I’d rather be talked to over my head than under. Give them a little bit of credit.

Unsolicited Advice re: using feedback and doctoring
  1. not everyone who shits on you is your enemy, 
  2. not everyone who gets you out of shit is your friend, 
  3. and when you’re in deep shit, it’s best to keep your mouth shut! 

During clinical year, learn how to be a doctor and decide what kind of doctor you want to be.

  • everyone is teaching you something
  • learn to judge yourself 
  • patients are medical students
  • pick a realistic reading plan and do it 
  • learn some version of “There but for the grace of God go I” and say it often
  • people do what makes sense to them
  • it is a privilege to be a physician
  • you get to decide what kind of doctor you want to be

As you walk around the wards, beg, borrow, and steal everyone else’s best stuff. 

- ED doc, on getting started with clinical year

sand art by Kseniya Simonova, winner of Ukraine’s Got Talent

I went to a Narcotics Anonymous meeting

I could feel the eyes.

My compatriot and I had girded our loins and strode with purposeful steps towards the main entrance, somehow managing at once a sense of assuredness while we clearly had no idea what we were doing or where we were supposed to be. A friendly woman who was walking up behind us must have sensed the confusion, because she shouted out, “where you girls lookin’ to go?” and then very helpfully directed us to the right entrance. For a minute I was relieved—she seems like a nice person, perhaps this won’t be so bad—and then I walked in.

I was definitely hypersensitive, but walking into that room struck a high-strung chord of social anxiety that reverberated cacophonously over my baseline key of introversion and self-imposed solitude. The one I usually manage to keep silent and under control with a generous dollop of avoidance of all situations involving a population of n>3 and—when absolutely necessary—aplomb. Large groups disturb me, and I start suffocating under a stimulus overload by all of the bodies and voices and unique-yet-all-really-the-same identities asserting themselves in a space that grows smaller and smaller the longer I spend in it. And the group that gathered at “[NA meeting]” was definitely of an n>3. So as we walked into the room, I felt the eyes of everyone swivel towards us, picking apart the fact that we—with our skin and clothes and youth and BMIs—were strange folk who did not belong.

The fluorescent lights flickered off a wide expanse of linoleum floor in the center of the room, ringed by plastic chairs organised into four concentric rectangles. It was a stage, and we made sure to skirt far along the periphery as we searched for two seats together, in some inconspicuous place. We stiffly sat ourselves down, and I tried to surreptitiously scan the room and the faces while making sure not to linger too long or to make eye contact. I found myself starting to slouch, as if poor posture would somehow help me fade into the background, to observe without betraying myself. Excepting the two of us and save perhaps four other individuals (all white and all male), everyone was black, obese, hovered around the age of 35-55yo, knew what THC was before hitting 12yo, familiar and belonged.

Someone (the leader/director/chair/committee member?) called the meeting to order with several general announcements of conference, activities, and planned events. An almost empty basket with loose bits of cash was passed around the room, for fellowship funds of some sort. Off to the corner was a table of liquid refreshments like coffee or juice. It was the town meeting assembly of my imagination. Another person went to the center of the room, held up what looked like a chain of key tags or chips, and began to call for individuals who were newcomers, folks who had reached hallmarks in their abstinence, or people who had perhaps fallen back into old ways and were just returning to try anew. He was often met with silence, but occasionally a bark of some number wrenched from some voice in some corner of the room, and then a smattering of weak applause. I knew nothing and did not know what to expect, but everything just seemed so much more tired and sad and forced than I had imagined. The bodies looked small, worn, chronically ill and collapsed onto themselves. The visages were closed and gazes deadened. The voices sounded ancient and exhausted. I felt myself dissecting the details, these strangers for whom I felt nothing but separation and hypervigilance, and was faintly aware that I was disappointed.

Then the stories started, and each story shared seemed to breathe a bit of life into the room. There was a 17yo white boy in a loose tank top and heavy-rimmed glasses slouching on the opposite side of the room. The glasses hid his eyes, but I imagined I could feel a sort of sullen, defiant gaze. His outward appearance belied just how much he belonged. From a face that still hadn’t lost all its baby fat came a lethargic, occasionally inarticulate voice speaking a story I couldn’t understand: of triple C and spending nights out on the streets getting high and jail, of doing all of that and then doing all of that again, just because he was bored, because all of his ‘good’ friends were still in school. I felt a morbid fascination and complete disconnect towards this kid. As much as I can empathise with patients, [struggle to] understand motivations and those messy human parts, I just could not empathise with this boy and his choice. It was as if trying to understand what he was saying intellectually was so difficult, it made impossible any other connection. I wondered if he actually thought he could do it now, when it seemed like he had failed to quit so many times before. I wondered if any of the other members of the audience thought the same, that this was such a typical sad story, doomed to repeat itself like so many others. Oddly, this sensation of an inability to integrate, almost like a disturbed internal equilibrium or processing, was specifically to this one boy and his story.

When he ended, there was a loud round of applause, and many people stood up to both literally and figuratively welcome him [back] into the fellowship, with open arms and hearts. Strangers embraced easily and with great purpose, as if trying to imbue strength and will by touch. This repeated itself many times throughout the night, people sharing their individual lives and circumstances, yet all sort of sounding the same in the end. It was sad, but I suppose in a way it was profound. It was a microcosm of hope and human struggle.

I forgot the eyes. 


When Doctors Tell Patients What They Don't Want to Hear

what is this farce? I hate this. I’m filled with this intense discomfort, and I keep swallowing a huge urge to vomit. I want to vomit. huge, bilious, chunky streams of vomit replete with all the emotions I can’t express, but that are sitting on top of chest, lodged beneath my thyroid, suffocating me. it’s like a poison that’s thrumming through my veins, pulsing in my ears and through the rest of this carcass I call a body. 

I feel numb. it’s hard to breathe. I can’t breathe. I know I have this terrible expression on my face, but the only thing I can think of is that I’m getting wrinkles and I really don’t want wrinkles and god damn it I need to go unscrew my face and vomit before my awkwardness chokes me to death. I feel like I really, really, really need to drop a big, fat emoti-deuce but I just can’t, because some asshole has sewn shut my anal sphincters. and so now all I have is a rectum so impacted, my colon is getting backed up, and I’m just back filtering all this emote-shit into my system. it’s poisoning me. I am contaminated. kill me now. or just let me somehow expel this impacted bolus of emotion that’s making its way into my head. and now I have a throbbing headache and I’m just so god damn ready to kill something or eat something. but not all of these terrible, horrible, dark and twisted emotions. give me a shot of benzos into my soul because I am drowning drowning drowning in these thoughts and these feels and this horrible rush and welling of everything I want to say and feel but I don’t have any time I need time.

somebody euthanise me. 

trust me, I’m a professional

'profession' is defined as being of service to the public, a self-governing body, and a master of a specific body of knowledge. 

so during our crash course into the clinical year, we had a lecture on professionalism. just a little three-hour reminder that we’re to hold ourselves to the utmost highest in standards of behaviour, expression, responsibility, integrity, [insert more words]. and now that we’re to effectively enter the workforce, we have to be proactive about our learning whilst understanding that we are at the bottom-most of the totem pole. seriously. I can’t even bring myself to make eye contact with my superiors, I’m too busy introducing myself with an apology and fighting the urge to grovel.

what I imagine my intern/resident/attending sees when I open my mouth: awww you’re so lost it’s aDORable. but seriously, get out of that cup.

did you know that students can be on academic probation if we’re bad at answering communications? also, that it’s apparently one of the best predictors of who is going to end up in the red with their state medical board? O LOR’. doomed, I am. there goes my would-be-but-maybe-not-anymore-burgeoning medical career. my own honourable parents shoot me an email every once a month or so, with a lovely little ‘please give us a call or send us an email or shoot up some smoke signals or even just a goddamn text when you can, we love you and miss you!’ tinged with sadness. elicits all sorts of guilty feelings, because seriously is it that hard for me to just let them know I’m still alive? (yes, yes it is) there’s this preoccupation with staying constantly connected, be it through the fbooks, the emails, the twitter, the snapchats, the texts, and it’s exhausting. I mean, that doesn’t really apply to the whole ‘hi parents, I have not yet given up the good fight!’ message thing—that’s just cause I’m a jerk, I guess.


what I look like at the end of the day. and after talking to people. and after smiling for 9 hours straight. still alive? debatable. 

you may suspect that I have zero friends. that would be true. 

back to the professionalism shtick: probably won’t have an issue with respect for others cf. overly casual language or demeanour. thank you my overly developed sense of stranger danger; I’m more at risk of coming off as cold and aloof because of my crippling social anxieties. my dear grammy’s iron-fisted control over not letting me roll in my sleep—also the reason why I have a super flat head—tag teamed with father’s periodic warnings to never trust anyone because they’re always out to get you—pretty much made certain that I never reached that developmental milestone. also probably-maybe-hopefully won’t have an issue with “appears callous, dispassionate, or insensitive in the face of others’ suffering or distress” because I usually retreat into hello kitty, bug-eyed, dog-registered, accent-magically-comes-back-super-strong girly voice when I face hierarchy. again cf. stranger danger. and my growing up in a culture of self-deprecation and habitual undercutting of my performance per luck rather than skill pretty much guarantees that issues with ‘self-promoting or arrogant’ are nil. 

ahahahahehehehugh made of awkward.

but conscientiousness cf. not responding to emails and phone calls promptly, professional boundaries cf. ‘exhibits inappropriate use of social interaction, language, humour, physical contact or self-disclosure in interactions with patients, families, peers, team members or staff’…less clear. part and parcel is also romantic encounters in the professional setting. which may [not] be a problem. my last encounter with a man can basically be distilled to, “I’ve been hitting on you all night and you never even noticed!” and “wait you mean you’re NOT gay?!”


and even now, ‘makes inappropriate disclosures about self, patients, or institution on internet/social networking sites’…is that what I’m doing here? should I stop this? yes. yes, I’mma stop now and painstakingly comb through all my entries for unprofessionalism.

later kittens. I missed you. 

bam and I’m back.