Cancer

This is a question that unnerves most physicians- what if the disease that you specialize in treating is the one that ends up afflicting you? Here I have imagined an oncologist (cancer specialist) who gets diagnosed with the cancer that he has devoted his life to understanding and treating.

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I knew unnerving it would be

With tables turned, undoubtedly

Little though I was prepared

For the diagnosis that now stared

Me in my face- I shook my head in disbelief

And then had a sense of deja vu brief

Of myself pronouncing the same words

In what seemed like another world

To patients of mine, a novice I was not

To life-changing words, I had taught

Myself to break such news gently-

Now the same tone for being used for me…

 

In the next moment I felt as if the ground

Beneath my feet had moved, no sound

Would escape my lips, though I was crying

I knew not what, but something within me was dying

Even then, in the midst of all that grief

I could not help shaking my head in disbelief

That the cancer in whose treatment I specialized

Had in a twist of fate within me materialized..

 

How do you give yourself a prognosis

Was the question tormenting me after my diagnosis

I threw myself into research with greater zeal

Even as the cancer eroding me I could feel

Today, lying on my death-bed, at least I know

The seeds of research I planted will continue to grow

To explore more of the disease that gave me

A purpose in life, as well as my mortality.

(Image source: https://www.cancer.gov/about-cancer/understanding/what-is-cancer)

 

 

 

 

 

 

 

Hello, I am your doctor..

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I know you are worried I do not fulfil

Your criteria- I can see I do not instil

Confidence in you that  I am capable

Of  taking excellent care of you, that I am able

To diagnose and treat your condition-

You might not have chosen me of your volition

 

But you were forced to make a compromise

Between timely referral and me, I surmise…

Probably I am the wrong gender and size

The wrong accent, wrong physical attributes, I realize

I hardly resemble the image you have in mind

Of a distinguished middle-aged male with eyes kind

And a soft-spoken manner; with which he can claim

Your complete trust and respect- I do not blame

You for feeling that way- that is the stereotype

Perpetuated by media- yet there is no one prototype

Of a good physician; we happen to be as diverse

As the rest of the denizens of this universe.

 

So here I am, my petite frame stretched in attention

To your complaints, concerns, apprehensions

I know you are gravely ill, and in distress

Your condition is one I am equipped to address

I might have an accent but know what I tell you 

Is based on up-to-date knowledge, backed by experience too

Because I know you do not intrinsically trust me

Know that I shall be as thorough as a physician can be

Your preconceived notions challenge me to do my best

I know that on a perfect image I cannot rest

Let me tell you- since I do not conform to a stereotype

I’ve had to work harder to earn my stripes

I hope you look past my physical attributes and see

That you shall be treated as well as you deserve to be.

 

Ramblings of a doctor in the intensive care unit (ICU)

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Exhausted, discouraged, demoralized I feel

As I sit at the end of the day, rubbing my aching heels

Life and death in all their unpredictability

Get in the way of caring for patients, inevitably

And I question myself, that though my team strives

To make every single sick patient survive

Our efforts turn out to be exercises in futility

Sometimes, making me question the utility

Of using fancy drugs, gadgets, machines and more

All these resources without a second thought we pour

Into treating our patients, yet often we fail

On days like this, a sense of failure prevails

Over me- I keep trying to second guess

Myself, I try to find errors in my care- I confess

Sometimes I pick up some, myself I remind

Next time, to keep these mistakes in mind

Though I feel bad, I am satisfied too

To know that there is something better I can do

But more often than not, no flaw I can seem

To find in the care delivered by my team

Then I am conflicted- I cannot decide

Whether to trust a higher power- I do confide

That not getting answers makes me uneasy

My analytical mind is skeptical, naturally

To believe in something that cannot be explained

By scientific principles goes against the way I’ve been trained..

 

In lamenting all the things that go wrong, I forget

That there are days when this pessimism is reset

By miraculous recoveries, inexplicable turns

That are equally hard to explain in rational terms

 

Then I remind myself that I am merely an instrument

That gets used in fulfilling the destiny of my patients!

Musings of a doctor

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(Painting by Luis Jimenez Aranda- The ward in chief doctor visit. 1889)

I think in my daily life I crib enough

That life as a physician is pretty tough

Running at times purely on adrenaline

Assisted by a hefty dose of caffeine

Trying (and failing) very hard to squeeze

Sixty minutes of work in fifteen isn’t a breeze

 

I need to be efficient but doctor-patient interaction

Cannot be constrained by time, in any fashion

Need for documentation adds to my woes

I try to be meticulous, and there my free time goes..

I love challenges, but caring for sick patients can be

At times, an emotionally draining exercise in futility…

*

Then there are those days when I find

That the patients that had been occupying my mind

All of previous evening- being in a critical condition

With me unsure if my efforts would be brought to fruition,

Have turned the corner, their condition stabilized

This positive change again has me galvanized

Into action, I am ready for the challenges of a new day

I have adrenaline coursing through me in a good way

All the aforementioned issues pale into insignificance

I feel blessed to be able to make a difference

In people’s lives, ultimately that is the reward I seek

It serves as a reminder when my days are bleak..

(Image source: http://doina-touchinghearts.blogspot.com/2014/07/under-hippocratic-oath-paintings.html)

 

 

 

 

 

 

Final Diagnosis

Diagnosis is not the end, but the beginning of practice.  ~Martin H. Fischer

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The thrill of a rare

Diagnosis you made

You are suddenly aware

Of praise and accolades

You grin from ear to ear

You brim with a confidence new

Reading diligently year after year

Has finally been fruitful for you

Satisfied your inner clinician

Satiated intellectual curiosity

You stumped the average physician

You displayed your capacity.

***

Basking in the glory

Of a success that is yours

You suddenly feel sorry

When you realize the course

Of a patient’s condition

Has been altered forever

Now you proceed with caution

The monstrous news to deliver

Your diagnostic acumen

Suddenly loses importance

There is no curative regimen

You’ve given the death sentence..

Er…I do things somewhat differently, you see, I am a doctor…

No, I am not trying to prove anything here…I just want to give you a glimpse in to how being a doctor has irrevocably changed me….

  • My sense of right and left are distorted, because I always think of the anatomical positionNow this is fine as long as I refer to my left and right side, but becomes a problem when I name right and left according to the anatomical position for anyone in front of me….see the diagram below:4495541_origmontagepages.fuselabs.com
  • If you saw this image, you would say her left hand is on the right side of the image, but I would not. The concept of an anatomical position is drilled so deep in me that I will always label left and right in this position.
  • Needless to say, I also use words like medial and lateral, and proximal and distal quite commonly!
  • I routinely forget that normal people label sleeping positions as “sleeping on the back” or sleeping on the stomach”. Not me….I use the words “supine” and “prone” in common language..(makes it easier because my spouse is a physician too!)droppedImage_1www.paramedicine.com
  • Currant jelly” (sputum), “anchovy sauce” (pus), “nutmeg” (liver), “strawberry” (gallbladder), “cafe-au-lait” (skin spot), “watermelon” (stomach) are just some examples of what these food items remind me of. Each of these phrases listed above describes a pathological entity in the body. And I ask my patients on a regular basis if they have “iced tea” or “cola-colored” urine, which if present is suggestive of something ominous…
  • I have a legitimate reason to wear pajamas (read scrubs) to work…makes getting dressed in the morning much simpler!
  • I habitually postpone/ cancel my doctor’s appointments, while stressing to patients the importance of regular follow-up…
  • At the risk of sounding pompous, I would say that I can no longer relate to “Mrs.”… “Ms” is still better, because I heard that one before I became a doctor. Since I got married after completing medical school, I was already used to being called “Dr.”. So now I’m never paying attention when people call me “Mrs.”!
  • Happiness is…..not being woken up on call by the annoying ring of the pager..
  • Relaxation is…..being able to eat a whole sandwich without interruption..
  • Certain things that most women indulge in are useless for me….such as a professional gel manicure (nail-paint gets chipped the next day), maintaining long nails, wearing bangs on my forehead… the list is longer, but I am blanking on other stuff…maybe because I don’t even notice any longer!

That’s all I can think of right now….ciao!

Doctor Venus versus Doctor Mars

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Picture reference: www.lisairis.ca

I learnt a remarkable fact recently…Among the first licensed women physicians, there was an Indian woman named Anandibai Joshi, who studied Medicine in my current city, Philadelphia, Pennsylvania along with two other women, one from Syria and another from Japan. A photograph of the trio from the year 1885 has recently made its way to social media and is also being included in tours of the city. Sounds almost like the stuff fairy tales are made of, except that there was a tragic end to the story, with Dr. Joshi dying of consumption (tuberculosis) at the young age of 21.

This serves as a reminder that women have been around in this profession for a long time. Nearly 130 years later, women still find themselves clamouring for equality in medicine, in some fields more than others.

While I am convinced that competence as a physician has nothing to do with gender, there are differences in the way men and women approach various issues, and in a male-dominated world, women may not always conform to the norms that are defined largely by males, and unfortunately perceived as traits related to success.

Some of the differences that I have realized are:

(The operational word here is difference. I am not trying to say that women physicians are better or worse than their male counterparts.)

  • Women tend to be perfectionists more often than men, and therefore are too hard on themselves at times. I feel many of us try to be perfect at every step of the way and sometimes get caught in issues that are perceived as insignificant by our male counterparts. On the flip side, this attention to detail may translate in to better patient care and improved patient satisfaction.
  • Women are conditioned to stick to rules and regulations. I think that is largely a result of our upbringing that tries to fit girls in to molds right from the beginning, while boys are traditionally allowed more freedom. Thus women grow up to be really good at following steps methodically, but tend to be less willing to experiment than men.   Again, in medicine, a lot of what we do depends upon doing the right thing the same way every single time, and women in general excel at that. Not everyone needs to be an innovator, right?
  • Women are more compassionate than men. While that is a great asset when dealing with really sick patients, it also means that the stress of taking care of terminally ill patients affects us more than our male counterparts.
  • I know my male colleagues always make fun of females for being “hormonal”, but it is true! We women do go through an emotional roller-coaster with our menstrual cycles! Pre-menstrual dysphoric disorder, euphemistically known as PMS, is a real condition, and affects women to different degrees. Add pregnancy in to the mix and emotions really go awry…Not just that, dealing with children and their physical and emotional needs can sometimes make us irritable and grumpy. Men who are in a more stable emotional  state find it really hard to comprehend this and this emotional lability can be really detrimental to our professional lives. (I really cannot think of any positives here, and I think we really need to be cognizant of our emotional friability, and detach our actions from our emotions at those times.)
  • Women are wired to seek appreciation, therefore being appreciated by co-workers, patients and subordinates is extremely important to us. Not so much for our male counterparts. In general, they don’t try to please everyone, therefore it is a lot easier for then to maintain their priorities and their sanity. Another sad truth is that women are less likely to be liked by other women in the group, while men tend to be liked equally by men and women. I think it is great if a woman can manage to earn every single person’s appreciation, but trying to win everyone over may not be possible, and one should not sweat excessively over it.
  • Unfortunate as it is, women with demanding careers are still held to task for their competence as homemakers and mothers. The world never ceases to remind you in myriad, often discreet ways that you may be great at what you do outside of home, but that does not excuse you from striving to be the perfect mother..Men are not held up to similar standards of parenthood. (I am not implying that men don’t have societal norms to conform to, but overall they are judged less than women are.) Therefore, I feel it is extremely important to be clear about your career goals, and how they fit in with your aspirations as a parent. Not everyone is cut from the same cloth, and not every woman physician needs to bake cookies for her kids….

Having said all this, I must confess that I have constantly tried to emulate my most successful mentors, almost all of whom are males. Only recently have I begun to accept that I am a woman, and wired differently from men. I just need to be comfortable with these differences (with the caveats mentioned)….