Anatomy is a cornerstone of medical education. As such, thousands of medical students have passed through anatomy labs over the past decades and centuries. During my second week of medical school, I had the privilege of stepping into the anatomy lab for the first time.
Saying that I was overwhelmed, would be an understatement. My mind was inundated with a million thoughts, ranging from the enormity of the human body, to the pressure to remember the minutiae of everything I saw. But, more than anything else, I felt the weight of the donors in my soul. I knew that weight could only be the pressure I felt to honour the specimens for the gift that they truly were.
The anxiety I felt over having to remember everything quickly evaporated – my peers and professors are gifted and kind. Any question or qualm that I have, they are ever quick to facilitate my learning. The thing that has not left me though, is the immense responsibility I feel when engaging with the anatomy lab. I know that it is my duty to honour the extraordinary gift made for the sake of my learning.
As I held the very first specimen, I was awash with humility. Who was I to be given the distinct privilege to hold a piece of someone in my hands? As I marvelled at the trachea in my hands, I was amazed by all the things that clicked into place in my head.
As the wheels started turning in my head, I was beginning to understand so much more than I thought imaginable. Then, all at once, I understood so little. While I could see how air made its way into and out of the body, I could never fully understand what made this person whole. Did this trachea once carry a laugh? Maybe it was the kind of laugh that leaves you gasping for air? Or the kind of laugh that you feel in the depths of your belly, because you laughed so hard it hurt. That was something no amount of time working in the anatomy lab could ever teach me. I’d never know their love, light, and kindness. I’d never know.
It’s incredible to recognize that I am learning from the best teachers that the world could ever offer me. Teachers, who will never utter a single audible word, and yet who will speak immeasurable truth and wisdom into the fibres of my soul. As I move forward in my medical career, I will never forget the first time I bore witness to the best teachers life had to offer me, and I can only say thank you.
Thank you, for the final gift. Thank you for your kindness that has long outlived your last breath. Thank you, for touching the lives of thousands of people, simply because you have touched mine.
What is wrong with me?
I wake up and I am more tired than the day before.
I can feel my body getting thinner and weaker and I don’t know why.
I start getting confused sometimes and I can see it is tough on my family.
What is wrong with me?
I came to the hospital hoping they would know.
They wheeled me through the halls and into different machines.
Each time wondering whether to hope for an answer and the potential grim outlook that comes with it.
What is wrong with me?
They say they’ve found multiple lesions.
One in my spine and some in my brain.
But when I ask if this is cancer and how long I have left, they can’t tell me.
What is wrong with me?
They suggested I get a biopsy of my spine and start steroids to maybe shrink the lesions.
They say this might give the answer.
They are doctors, and so I listen.
What is wrong with me?
It has been a month now, and still I am waiting.
The first biopsy was sent to the wrong place, and the second is pending.
Good news is the brain lesions are shrinking and I am a little less confused.
What is wrong with me?
Now the second biopsy was of insufficient size.
And the neurosurgeon refuses to biopsy my brain due to lesion shrinkage.
I’m told there can be no definitive treatment options until a positive biopsy.
What is wrong with me?
I think I have bad luck.
My throat and tongue are so sore from thrush; I can barely speak now.
I am slowly becoming more trapped in this bed and in my body.
What is wrong with me?
I’m back from the ICU after a GI bleed.
I think someone broke into my room last night and attacked me.
And now they tell me I have a UTI as well.
What is wrong with me?
It has been three months now and no answers yet.
I seem to see the students much more than the doctors these days.
I wonder if they have given up on me.
What is wrong with me?
I just want to know something, anything.
Is it cancer or not?
How much time do I have left?
What is wrong with me?
Should I go home or stay?
It doesn’t seem like there is much left to be done.
All this time spent in hospital, when it is getting more precious with each breath.
I was good with patients, I could put them at ease, likely because I was only interested in putting them at ease. So I’d introduce myself, sit back, and start a conversation. I’d open my eyes —not just the lids themselves, but the meaning, the world behind them, to open myself —an invitation to engage in an attempt to better understand one another.
So I opened my eyes. I’d always keep a slight smile on my face, just the corner of my mouth on the left side slightly upturned —not enough for my one dimple to really come in but enough to make you guess at it if you hadn’t seen it. A smile that I’d hope would convey willingness to hear, but not presumption, not my own world but a request to enter theirs for a while. Hands clasped right now, but undoubtedly will be waving around when I speak.
I’d sit in a chair, or on the edge of the bed, look around at a uniform little compartment,
decorated here and there with bits and pieces of their life —a picture of them at another time, an award, a diploma, a small bag of chocolates, a phone charger, a card, flowers, or in some cases, an absence of all of those, replaced only by a frown and what I can only describe as the truest facial expression of melancholy, heartbreak, emptiness. It emanated from their eyes, like the light out of a flashlight, except black, like the world behind it has long fallen away, eroded.
I’d feel around for something that would bring the light into their eyes, that would awaken the world behind them, like bringing back the power after a blackout, the wave of brightness, vigour rolling through them, rejuvenating—because unfortunately some of them seemed to have blacked out their belief in having that again. And we’d dance. The first steps of conversation cautious and guarded, a rally, step for step until our moves, our responses would become more fluid, more natural, more spontaneous, more in tune and we’d be laughing, joking, shocked at some things, completely not so at others —a warmer smile on my face, my dimple is showing, but that’s okay. I am satisfied at hearing their
happiness, or at least what I perceive to be happiness, to hear their own personal investment into the dialogue, for that to affirm that they were indeed willing, no longer cautious, no longer guarded. What a contrast, such light in an environment that was rather desolate, plain, whitewashed walls and curtains with meaningless print on them, placed there —it seemed— just to remove the regularity, to add some rhythm, however mundane.
I fell into a rhythm of meeting my patients, my friends. I was able to befriend a stroke patient who refused to talk or interact with anyone, including their speech pathologist and so I was asked to see another patient. No problem. I’ve done this a million times.! !
I’m walking into the room, there is a man in a wheelchair, staring at the wall as if it were a puzzle he couldn’t figure out. A few things on the desk behind him, nothing memorable. He was tall, gaunt, legs sticking out relaxedly from his chair, dressed in blue sweatpants that were comfortably worn, enough that the little grey lint balls were visible, a few food-coloured stains sprinkled here and there. A white shirt loosely fitted on the thin man. His face showing the lines of old age, his mouth a flat line, liver spots speckling the sides of his head and a few white hairs poking out of his ears, the only ones on his face. His eyes though, were infused with a restless fire, still trying to figure out the puzzle.
I’m seeing all of this. I’m walking —still— into the room, past the empty other bed in the room, the 3 and a half meters and the 7 seconds it takes to cross them.
Then I see the other person. I see a woman, older too, a ring on her finger —his wife? He has a ring too. Maybe his wife. Maybe not, do not presume. Someone in such a vulnerable state, already being told what they are, who they are, who they will be —never presume.! !
She wears a baby blue sweater-t-shirt thing, loose too, black loose pants billowing around her slight frame. She has a warm, old, oval face, short hair, her smiling eyes squinting, her inviting smile welcoming me into the room. She sits in the chair, I walk towards the pair of them. She greets me “Hello”, a kind voice, but a faint one, I can almost hear it falter, on the cusp of it. He says nothing, she greets me on his behalf. We exchange names and converse. I am an experienced dancer, even with two partners, this will be fine. I am excited to learn about them, to give them someone to talk to, and make them smile.
We speak, same moves, same caution, same guards. I try to converse with both of them. She speaks for him. Moving through the dialogue is like navigating shifting streets, the focus is dynamic, the speakers are dynamic. You move and things move, you move again. I want to show him that he is not an object to be spoken of, but it is difficult as making such moves would be grossly inappropriate for my state of rapport with them.
We’re communicating, making progress but the majority of the discussion is with her, albeit about him too. I learn he has dementia, I learn he hallucinates, I learn that he is most often not being in the same reality as his wife and myself —then again, few of us are all in the same reality, yet his seemed far more distant, somewhere in the puzzle on the wall.
This happens a few times. I wonder how strong this woman is to stay by his side —he is far off, to stay hopeful. I wonder how much of a fortress this woman is. I cannot help but think her hope is largely in vain.
She breaks. She starts to open. She is shaking, folding inwards. Her smiling squint becomes a grimace, her mouth turns downward. She is gasping, sobbing, her breaths and cries meshed together in a wailing, moaning and intermittently breathing stew. Her hands are folded inward, held close, her legs tucked under the seat. It’s almost as if she’s trying to fade out of the world. She is withering, unravelling, like a flower falling apart in a time lapse. The fortress she was, built on pillars of sand and salt, escaping with her tears, as she breaks down and collapses, “It’s so hard. It’s so hard.”
The air is thick with lament, with an inescapable sadness, in the truest sense of the word, simply an unwavering and paroxysmal loss of hope, as clear, present and yet untouchable as the light from the sun. It envelopes the room.
I wonder how the chair can support this woman’s heavy mind.
All the while, her husband looks on. Honestly, I am paying less attention to him, it appears that he is still entranced by the wall.
My eyes have opened wide, I’m staring. I’m trying to console her. The moment is a blur. She gathers herself and we continue somewhat. I leave the room. It is the last time I see her.
— Author’s note: This piece was written years ago about a volunteer experience on the restorative ward at St. Peter’s. —
We had finished the OR list early that day, and I’d run to the university library to find some books. As I was walking towards the check-out desk, I tripped over my own feet (typical me), scattering the books everywhere. A boy nearby helped me collect what I now realised was an excessively large number of books, even for me. My cheeks were burning as I accepted the few he passed my way. Maybe next time I’d only take as many books as I could safely carry.
“Are you a medical student?” he asked me. The question was polite; I supposed it was obvious. The medical scrubs, the messy hair that had been in-and-out of caps all day, the ID badge hanging around my neck, the stethoscope in my pocket. Not to mention the first book in my stack was titled The Complete Review of Orthopaedics, Sixth Edition.
“Yes,” I said, suddenly feeling my energy drain. Why was I so tired? I’d only worked nine hours that day, and I hadn’t been on call last night. “Yes, I am.”
“Wow,” said the boy. “And you go to the regional campus? The McMaster one?”
“Yes,” I said. If I checked these three books out, I could probably cram them all into my bag, which meant that I could carry these two back to the car, which would leave my left hand free to grab the keys. Yes, that could work.
“Wow,” said the boy again. “That’s so cool.” He was looking at me with a mixed awe, respect, fear, and admiration that I reserved for my mother, Taylor Swift, and one particular surgeon who’d never shouted at me once during the four weeks I’d worked with her.
What a silly boy. I was just a medical student. He’d probably done more impressive things with his life than I had.
Thinking that our conversation was over, I continued walking to the circulation desk. But the boy followed me. “I want to go to med school,” he said. “I think I want to be a surgeon, maybe. Or a psychiatrist. Have you done any psychiatry? What’s it like?”
“It’s interesting,” I said, glancing at the clock. Five-fifteen. If I could get home before six, eat and change before six-thirty, maybe I could get a chapter or two in of reading before I fell asleep at my desk. Maybe.
“Wow,” said the boy. “I’ve never met a real med student before. This is so cool. It’s such an honour to meet you.” Why was he looking at me like that? I was just a medical student. Always in the way, never knowing enough. The bottom of the totem pole. Just today, three doctors had been arguing about who’d be stuck with me tomorrow. They ended up pulling straws. The unlucky winner had already warned me twice not to touch his drugs. Or his tools. Or his stool. Or the door.
“You must be so smart,” said the boy. “To get into a Canadian med school and all.”
“Mmmm…” I said, as I started to check out the books. Smart? Me? Last week alone, four separate people (three of them nurses) had called me stupid. The other was a John Doe I’d bumped into in the carpark after a fifteen-hour shift so exhausting I could barely stand.
“Can I shake your hand?” said the boy. “Please?”
“Shake my hand?” I said. What an odd request. “I guess…?”
“Oh, thanks! Oh, wow! Oh, you’re so nice! Oh, geez, I hope I get to be a med student just like you one day.”
Just like me? Why would anyone want to do this? Was I ever like this rambling pre-med, so bushy-tailed and starry-eyed? I looked at the books in front of me, remembering the first time I’d seen someone with scrubs and a coloured backpack walking around the library. I’d hidden behind the bookshelves and watched, my mouth hanging open. When we were undergrads, the medical students were our idols. They were gods. I’d never have dared to speak to a medical student before I became one. This boy had gumption to come over and speak to me. It must have been because I dropped my books; somehow, that had made me more approachable. More human.
But being a medical student was nothing to be proud of. We do nothing useful, as we’re often reminded. We’re just ripening crop, sitting tight until the day that we can add our contributions to the system which raised us. Yesterday, one of my classmates was in tears because the surgeon she was courting for a reference letter told her that she would be a terrible surgeon, or a terrible doctor, really, regardless of what she went into. This morning, a different classmate was told by three separate families not to touch their children because they wanted the ‘real’ doctor; later, the ‘real’ doctor reprimanded her for not acting more ‘confident’ and ‘inspiring trust’. These are not isolated incidents; they are our lives. Every week, at least one of us is ridiculed, bullied, or derided. There’s nothing to be done about it; it’s the nature of the system. Throw a group of untrained, unqualified children into one of the most stressful and high-stakes environments in the world, and you’re virtually guaranteed to form a strict and (frankly) tyrannical hierarchy. It’s a wonder there aren’t more tears than there are now. We’re useless in the face of the dying, the grieving, the suffering. We don’t belong in hospitals. We don’t belong anywhere.
But, as I leave the library, I glance back at the boy. His grin is so big it looks as if it will split his face in half. Not only has he seen one of his idols, but he’s actually spoken to one. And received a response. A lifetime ago, this would have made me dance on clouds for days. But now I wonder why.
Why is he so impressed? Because I’ve been chosen by a system which no one really understands to do a job one day that has one of the highest suicide rates in the world?
Maybe if the traffic’s not bad, I’ll be able to get three chapters done tonight.
My father took his own life five months into my training as a medical student. His death was public; photos of the scene were shared on twitter before I even knew. On the morning of his death, I was working at my family medicine placement in Burlington. At the time, my main concerns were trying to remember the order of palpation and percussion as part of the abdominal exam and learning how to complete SOAP notes. My brother called me as I was walking into room 6 to take a history. During a trauma, heightened senses result in transposing those negative emotions to environments that are visually similar. I strongly associate the uniform design of family clinic examination rooms with loss.
My father’s work colleague gathered me from the clinic; I carried nothing but my white coat, stethoscope and McMaster clipboard into my hometown. The last note I had scrawled into my clipboard before I found out that my father killed himself was, “adrenal insufficiency.” A part of me, the young woman who was just starting to learn about Addison’s disease, died with my father that day. Only five months after his death, I’m unable to specify which part—I just know that I am no longer the same person.
Society’s response to suicide is one of self-fulfilling curiosity, awkwardness, and fear. I initially thought that these visceral reactions would not translate to the medical student world. In this world, I told myself, we are learning about mental health and self-care; in this world, I told myself, we are learning how to comfort patients and break bad news.
Yet, when I returned to school after missing only 10 days of classes, I entered a dismal maze of ostracism. It is a maze I have still not managed to exit. The walls of this maze were built not only by the same curiosity, awkwardness, and fear that I experienced outside of McMaster, but also by myself.
If you are a medical student and you know someone who is grieving, I offer some insight on how to create a safe space:
1) Acknowledge how hospitals can be triggers
Following my father’s death, I spent a great deal of time around hospitals supporting family members as their bodies responded to the shock. For those who are grieving, hospitals may not be associated with just classes.
2) Acknowledge how a simple history taking can be a trigger
Whether it’s breaking bad news or asking about self-harm, these discussions are difficult and exhausting when grieving following a suicide. Keep in mind that these histories can include those taken from standardized patients or with clinical skills preceptors—this means that grieving students are routinely placed in environments directly related to their own negative life experiences.
3) Consider how their life at home has changed
As we know, outside of medical school we all have our own personal relationships. For a grieving medical student, the transition from home to school is exceedingly difficult. I would compare it to entering different dimensions that require completely unique versions of my personality. Simply inviting another student to share the challenges they face when transitioning between dimensions is a true demonstration of thoughtfulness.
4) Do not take a history of the dead individual
We, as medical students, are trained to dig deeper and explore health issues. Curiosity is of paramount importance in medicine. However, remember that the person sharing their grief with you is not a patient seeking formal assessment and treatment. Provide them with the space to share details when they are ready. When it comes to suicide specifically, asking about potentially missed signs instills a sense of guilt in the loved ones who are left behind.
5) Be sensitive when it comes to their social anxiety
Because of the public nature of my father’s suicide and how people responded, I developed extreme social anxiety. I could no longer attend large groups sessions/lectures. I was fearful of what people would say to me, how people would look at me, and what topics would be mentioned during lecture. Recognize that the grieving individual’s comfort with social interaction may or may not have changed. Ask them how to offer support in social settings. Check in with them weekly to gauge if their level of comfort is changing. Socializing outside of class when grieving is uncomfortable and awkward. The emotions that are synonymous with grief do not always allow someone to socialize in large groups with alcohol. Acknowledge that this may limit their ability to share their story and ask how you can accommodate. Furthermore, there are periods throughout the grieving process when social interaction is not possible. If someone who is grieving appears to have lost all interest in your usual activities, be patient and accepting.
6) Do not attach any timeline to their grief
While the stages of grief do exist, I would argue that they do not happen sequentially and are not required to exist separate from one another. Grieving is an individual process. Do not get frustrated with where they are in the process of grieving.
7) Encourage them to engage in self-care activities
Ask them what activities make them feel more balanced, rather than happy. It could be as simple as hitting the weights together, making a healthy meal, or going for a hike.
8) Create a safe space to discuss feelings of self-harm
These are difficult conversations to have. But the truth is that self-harm is a real concern after the death of a loved one. If you are not comfortable having those discussions, then ensure that they are aware of services they could utilize in times of need.
9) When you don’t know what to say, say exactly that!
Rather than anxiously uttering some sort of platitude that could be interpreted as insensitive, offensive, or both, simply admit when you do not know what to say. This honesty is appreciated. If words fail completely, offering a hug is not unreasonable. Before you speak, consider your motivations. If you are simply trying to get information, understand that your interaction with the grieving individual should be centered around their needs, not yours.
10) Be willing to learn
There may be times when you do or say something that is interpreted as insensitive, even when you had the best intentions. Take this as an opportunity to ask why it was insensitive and explain what you meant by your action or comment—communication is key.
Ultimately, grief is a deeply personal journey that becomes even more difficult to traverse while in medical school. Keeping these 10 things in mind may provide you with the opportunity to form a rewarding connection with a grieving medical learner. By applying a trauma-informed approach to your interactions, you may rescue a colleague from a maze they feel unable and too fatigued to navigate. For those reading who are grieving while in medical school, I comfort you with psychologist Carl Jung’s concept of a wounded healer: one day, your own hurt will allow you to better serve a patient; in fact, the depth of your pain may be a measure of your power to heal and connect.