Blog Contest!

Hi everyone, we’re going to have another contest!

All submissions and publications between the dates of May 30 to June 24, 2016 will be automatically entered into the contest. We will have two winner: Best Reflection Piece and Best Non-Reflection Piece (detailed below). Both winners will receive a $10 Starbucks Gift Card. The Best Reflection Piece will also be published in the Fall issue of The Muse Magazine.

Best Reflection Piece

  • Clinical reflections
  • Personal reflections
  • Poems and stories outlining clinical or personal reflection
  • Other pieces specifically outlining a clinical or personal reflection

Best Non-Reflection Piece

  • Poems (non-reflection based)
  • Stories (non-reflection based)
  • Photo essays
  • Opinion pieces
  • Book Reviews
  • Other non-reflection based pieces

As always, submissions can be sent to macmedplacebo@gmail.com along with any questions.

Contest Winners of Jan 2016

We received many amazingly thought provoking pieces during the past two months, and now we’re excited to announce the two winners of our Dec 2015 – Jan 2016 contest. We will be in contact regarding your prize.

 

Best Reflection Piece Winner:

Karen Ngo (c2018) – “Over Dragon Fruit


Best Non-Reflection Piece Winner:

Beerpal Plaha (c2018) – “I used to lie


Over Dragon Fruit

Copyright Karen Ngo
Writing and Photo by Karen Ngo, c2018

I had not seen nor spoken to my grandfather in twenty years. I had occasionally written letters corresponding with him during my childhood, but we gradually lost touch during my teenage years. While the rest of my extended family in Viet Nam had prescribed to the Western advances in communications technology, connecting via various smartphone apps and instant messaging, my grandfather still stuck to his trusty house phone, calling cards and snail mail. He lived alone with his dog, walked to the market every day, maintaining his balance with a long bamboo cane, and asked the family to call at the house for dinner instead of having shouting matches through the phone. The only change in the last twenty years was that the river and the canoe we had taken to reach my grandfather’s house was now replaced by a paved road and a four-wheeler – the canoe had sunk in one of the back rivers ten years ago.

After the usual pleasantries and small talk in the front hall of his house that twenty years of absence warrants, my grandfather and I sat down next to each other at the dinner table. My attention was fixated on the insistent buzzing of the flies around the buckets of cooked chicken on the table. My grandfather abruptly broke the silence.

“So, grandchild, tell me, do people in Canada buy their burial plots in advance? Are they expensive?”

I was taken aback. Had I heard him correctly? Surely he meant buying a plot of land for building a house. I had not heard these words being used since my grandmother’s death – nobody I knew spoke about burial plots, tombstones or coffins in casual conversation. I looked around the table at my uncles, aunts and cousins for clarification.

My cousin cleared her throat and repeated, “He was asking you if people in Canada buy their burial plots in advance.” I told her I understood his question but was making sure I had not misheard him.

“Grandfather, I don’t know. I imagine that they aren’t too expensive though,” I answered. He gave me a pensive look and pressed further, “Yes, but I thought that only people who can afford to be buried will buy land to be buried in, while those who can’t afford it probably get cremated, right?” I mumbled a half response and he nodded in agreement, picking up a piece of dragon fruit.

In Viet Nam, tombs and graves are situated near the home where those who had died are buried, often in the front garden or in the rice paddies. Altars in the house are filled with black and white portraits of deceased loved ones, their half smiles almost coming alive in the flickering light of burning incense, hiding behind porcelain bowls of fresh fruit and rice placed in front of them every memorial day. Chairs at the table are left empty for them to fill at their leisure if they choose to join the feast during holidays such as the Lunar New Year.

After dinner, my grandfather directed the entire family outside to take a family photo among the dragon fruit trees. He showed us the work that was being done on the front of the house. Then he proudly pointed towards a large bandstand-like structure in front of the house. Again, as if we were two friends meeting over coffee to discuss politics and the weather, he turned to me and explained that it is the tomb that he and our grandmother are going to be buried in when they die.

Something From Nothing

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Written & Photograph By Megan Schlorff – c2018

*To protect patient privacy, names were altered in the retelling of this story.

I entered the room behind Dr. McDonald and introduced myself to John and his wife. They were an older couple – likely in their 70s – who seemed pleasant. Dr. McDonald hadn’t briefed me about John’s background and history before we entered, so I listened and watched attentively as the appointment began.

John’s wife, Claire, responded to the questions and guided the direction of the interview while he sat quietly opposite her, providing only the rare nod. Claire inquired about a trial for a new Lewy body dementia treatment, and I was made aware of the reason for John’s visit today.

Claire had brought hope with her to this routine appointment in the form of a piece of paper with details about a medication trial. The knowledge of this trial instilled Claire with the idea of possibly stopping the progression of the disease and perhaps even bringing her husband back home to her.

The medication trial was news to Dr. McDonald, and he searched it online to learn more. Claire waited in eager anticipation, and Don continued to sit contently in his chair wearing his freshly pressed clothes, tied shoes, and ball cap – all signs of Claire’s love for him.

“You know, he’s started calling me Larry,” Claire said as Dr. McDonald scanned the reports about the drug in question. “He’s not remembering my name anymore.” She didn’t seem to expect a reply; she just needed to share.

And with one sentence from Dr. McDonald, Claire’s hope vanished from the room. “It doesn’t look like this new drug is an option for John,” Dr. McDonald said softly, knowing the impact of his words. He allowed for silence as Claire processed the statement and reflected.

“There’s only been a single twelve person clinical trial so far and recruitment is only happening at large hospitals in the States,” said Dr. McDonald, gently providing additional information and answering Claire’s questions.

I looked at Claire and John and the only question on my mind was: Why them? This disease was something they had never asked for, never expected, and almost certainly didn’t deserve. It was a single diagnosis changing the entire course of their story as it continued to progress.

I’m typically the type person who smiles my way through the day and waits until I’m behind closed doors to let the emotions flood out. However, that day, I sat in the exam room feeling tears form behind my eyes as I witnessed this couple’s journey and felt their heartbreak. Today, John was sitting in that chair, but the reality was that it could have just as easily been one of my family members or friends. So many of our lives are woven with stories of medical inflictions experienced by us or our loved ones for which relief is unattainable.

The appointment was near complete. John didn’t have any major changes, and there weren’t currently any new options to try. Dr. McDonald would see him again in three months.

“Oh, does John want to get a flu shot today?”

A vaccine was all we could offer him.

“John, do you want one?”

Sure, we had conveyed empathy during the check-up and the reassurance that nothing new had developed. But, medicine could offer nothing more – just a flu shot with varying effectiveness and potential side effects.

I briefly left the room to retrieve a vaccine from the fridge and returned to administer it. All of ten seconds, and the inoculation was complete. The extent of our “deliverables” had been reached.

All we administered was a flu shot. Would John benefit from it? Perhaps he would be shielded from the wrath of some untimely pathogens and subsequent illness and discomfort. But it would do absolutely nothing to help him – and Claire and their family and friends – better live with Lewy body dementia. It wouldn’t help him remember his wife’s name.

I felt useless. Medicine felt useless. In this field, we rejoice in the discoveries and interventions. What happens when there simply isn’t anything else to do or try?

It’s reflexive to repress the moments that don’t offer us hope.

But, those unhopeful moments, they need to be recognized; they are innumerable in medicine. I don’t think we have to fight back tears every time they happen, like I, the inexperienced and naïve medical student did. I think we can find beauty in the unhopeful moments – the beauty of humanity evolving in all of its imperfect forms. We bear witness to stories of all kinds; regardless of whether there is hope or positive news, these experiences are real and provide us with a glimpse into someone’s life. There are few things more beautiful than that.

This is all easier said than done. We strive for medicine to be equal parts comfort and care but, if required to be described by one adjective alone, could probably be summed up as uncertain. But, so is life and the stories of the patients we encounter.

I’m learning that our practice as physicians extends beyond providing treatment and striving to attain results. We are behooved to enter into the sacred story and personal narrative of each person. Our patients, and their families, are living with a diagnosis, not necessarily suffering from it. What a privilege to bear witness – as they continue living – and observe all that their life encompasses: families, friends, hobbies, jobs, and homes, among others.

In the cases when we can do “nothing” there is indeed something to do. Yes, that something could be a seasonal flu vaccine, which is an important suggestion to help prevent infection. But, after meeting John and Claire, I think that “something” is multi-faceted and involves much more. For each patient we care for, it’s acknowledging limitations, emphasizing listening, making space for connections, and, most importantly, honouring the human experience.

I used to lie

By Beerpal Plaha – c2018

I used to lie with shifty eyes and fidgeting hands,
with monarchs in my stomach
and worms in my gut

With a shaky laugh and pounding heart, I stammered
half-truths that were half-lies
uttered fictions with ears flushed red,
prickling like thistle on my arms that day I picked tomatoes

Once, I stumbled through deceit,
Wove fact and falsehood with strings of clumsy words,
left crescents in clammy palms,
bitten nails imprinted on hands clenched tight

I thought I would crumble under the guilt,
that truth would spill out like milk boiling over,
the pan coated with a scorched mess
an almond odour lingering in the air

I did not think it would become easier

Deep Breath

By Kelly Lien – Class of 2018

Deep breath. Nearly time to go.

Before heading downstairs to clinic, I remembered to ask about where I could borrow a white coat. It looks just like a lab coat, like the kind I would wear to teach organic chemistry labs at school. But, in the hospital clinic, it means that people might think you’re important.

Man, I hope no one asks me anything. I’m not even a med student. I know nothing.

My first shadowing experience ever leads me to finding my supervisor, a medical oncologist specializing in GI cancers, perusing his clinic schedule. He’s in a rush, like always. I’ve caught him between cases.

No wonder he’s always late to our meetings. His patient is 20 minutes late. And it’s not like he can just skip them.

A nurse comes in to tell us that the patient has arrived before he has a chance to tell me their history. Walking over to their room, he enters. I wait outside the open door, not knowing whether or not I’m allowed inside.

Shouldn’t he ask them if I’m allowed to observe? I guess he’s had so many students throughout the years that it’s normal to just enter.

He finally asks and relieves me of my awkwardness. Two women – one probably in her 60s and the other who looks to be 30, are inside.

Oh man, I really hope it’s not the younger one.

After some small talk, I breathe a sigh of a relief as he begins directing questions to the older lady. It’s a case that he’s been following up on for a while, since they’re comfortable with each other and waste no time on pleasantries.

“As you know, this is your third line of treatment – unfortunately, you progressed on the first two,” he says gently. The lady nods her understanding. “Looking at your lab results and from what you’ve told the nurse, it seems like you’re feeling worse. Is this true?” Again a nod.

“Do you still work? Who do you live with?”

“I take a half-hour bus ride to work at the grocery store most days. It’s getting more difficult though. I’m living on my own, but my daughter,” she gestures to the lady beside her, “lives in the next town and visits often.”

This lady has done multiple lines of chemotherapy and is still working? That’s insane. I wonder if she’s supporting herself, or if she just feels the need to continue on with her life, or both?

My train of thought is derailed with his next response.

“I’m afraid that at this point, there are no other treatment options available for your type of cancer. I think it might be time to start thinking of palliative measures and making plans for end-of-life care. It might be worthwhile to you to discuss a do not resuscitate order – DNR, for short.” All of this is said even more softly, as if to lessen the blow. It takes a second for what he has said to register in our minds.

Oh my god. What do I do? Crap, I can’t stop looking. Okay, stare at the floor instead. I hear a sniffle. Oh no… she’s crying. Nope, now it’s both of them. What do I do? My supervisor hands them tissues and places his hand on hers.

He continues to speak after a few moments of silence. Of course he has to. Someone has to keep the conversation going. I’m sure he’s had to give this talk for many, many years.

“I know that keeping busy with your work is important to you, so you don’t need to stop. But I will tell you to be careful. If you feel yourself getting weaker, please consider taking a break. In regards to your living situation, it’s important to start considering your options in terms of long-term care. Is your daughter here or anyone else you trust capable of having you stay with them?”

I’m not sure if either of them are absorbing his words at this point. They haven’t said anything – the only sounds they make are those of a woman coming to terms with exactly how fragile life can be.

I wonder what’s going through her mind. Has she had time to do all the things she’s wanted to? Is her daughter realising that she may be losing her mother soon? It’s only March – will she make it to the summer? Does she have grandkids? Will she be able to see them start school again?

I forget to look at the floor. She remembers I exist. Our eyes connect, mine trying to block out my weakness, hers tear-stained and wide open. She’s staring into my soul. In that moment, I know exactly how useless I am – unable to save her, unable to comfort her, only able to stand there and remain quiet.

Afterwards, in a brief moment of reprieve in the consultation room, my supervisor asks me if I’m doing okay. I tell him the truth – I’m not sure. Before going off to talk to the charge nurse, he says this.

“Before you get too deep into your training, understand sympathy and empathy. My definition of the two is that sympathy entails sharing feelings with a patient – their pain and sadness – whereas empathy is understanding their feelings, but not necessarily sharing them. It’s hard to separate the two, but I’ve learned that you must, or else you won’t be able to make it through the day. Those feelings will tear you up and limit your ability to help those that you can.”

I say thank you for taking the time to talk and for allowing me to observe. As I head upstairs, there is one thought on my mind.

I’ve always been good at compartmentalizing my feelings. But just this once, I want to embrace my sympathy. So that maybe one day, I’ll remember how I felt, and how I wouldn’t want anyone to feel the same way. My humanity will pave my way to becoming a professional.

her tears

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By Beatrice Preti – Class of 2017
Photograph by Darwin Chan – Class of 2018

when she cries, the sides of her eyes
crinkle, and she frowns, just a little.

there’s no sobbing or shrieking
like the young ones do. she sits there
alone, as the tears line up to fall,
pausing politely so they don’t collide.

You have broken her.

but she is still speaking. her voice trembles,
of course, but her words are clear. they
make sense. she asks the right questions.

but you can’t help but notice
how different it is when the old folks cry.

there is no passion or regret or surprise.

they are tired. they have seen too much.

she is not crying for the man cooling
off on a stretcher in a trashed trauma unit.
she is not crying for the little girl by her
side who will go home fatherless today.
she is crying for all the scars she has earned
from a lifetime of living, the scars that burn
as a new member joins their ranks.

she cries because her heart is broken.
life has broken it.

You have broken it.
just a little bit more than it was before.