Stories in Family Medicine

I wrote this for a competition this summer on stories in Family Medicine. Sadly it was not selected...but I thought I would share it with you anyway :) It is a compilation of many things I have written about on the blog before, and really summarizes my years of training. Thank you all for walking this road with me!

Lots of love
Pamela

What a privilege I have had over the last 5 years of training, to be included in the beginnings, the endings, and the often dramatic middle days of my patients' lives. What a gift from them to allow me, a bystander, to know them so deeply. As I near the end of my residency I often think back on several important "firsts" in my medical career and the way they have shaped me.

There are of course many amusing firsts - like the first time I tried to inject freezing around an infected cyst, which quickly shot straight back into my face, teaching me to always wear a face mask. The first, and second, and third times that children threw up on my shoes, teaching me to be quick on my feet and quick with a basin! The first time I was awake the whole night on call - teaching me the importance of naps at any time you can catch them. The first time I reduced a fracture and felt the nauseating crunch of bone. The first time I was peed and pooped on during a newborn exam, teaching me the importance of diapers. The first time I gagged during an unfortunately foul smelling vaginal exam. The first time a stressed surgeon yelled from across emerg - "There are only two contraindications to a rectal exam - no finger, and no anus!". Or the first time I got a shoe full of amniotic fluid during a cesarean section.

And then there are the soul altering firsts. On Tuesday September 19th, 2006 at 3:20am I caught my first baby.

Sure, I had been to lots of deliveries. I had watched, helped, coached, clamped cords, taken blood, and given congratulations....but I had never been the one in charge. On that day, I delivered a new life into the world.

At the time, it was all fun, and adrenaline, and blood and goo and excitement and to be honest I didn't really think about the magnitude of what had happened until I tried to go back to sleep in my call room. Then the next day it kept hitting me a little bit at a time. I delivered a baby. I felt its sweet little cone shaped head. I held its mom so that she wouldn't tear. I clamped and cut the cord around the baby's neck, and then as she came out I held her up and passed her to her mom. I held a tiny little girl and felt her take her first breath.

I remember feeling this way on my first day in anesthesia as well - when a patient started to breath on their own as I was bagging them and I could feel the bag move. It was as if I could feel them live.

On Wednesday May 3rd, 2006 my first patient passed away. I was terrified to go to work that day. I was so afraid that I would find out he was gone by seeing the irreverent - expired - beside his name on the computer. He was such a sweet man, and had been so kind and gentle with all his family and staff, even throughout his final hours of breathlessness. When he did pass away, he looked so peaceful. I cried when I told his family and I felt so ashamed and so unprofessional for allowing this outburst of raw emotion. But I realize now that sharing those emotions together is what helps us all to heal. I often wonder if the patients and their families know how much they touch us, and how they change our lives.

There is something so powerful about life on the brink - just beginning, just ending, or being held in the balance. Life, to begin with, boggles my mind. The more I learn, the more I'm amazed that anyone and anything is alive and functioning! But in these cases it is even more powerful. In family medicine I have so many opportunities to feel this every day in different ways - feeling the heart beating beside my hand as I assist in surgery, feeling the air moving in and out as I ventilate a patient in Emerg, hearing the blips of fetal heart rate on a doptone in the office, seeing the wonder on a young child's face when you let them listen to their own heart for the first time, seeing the lightbulb of understanding when you finally find just the right way to explain and teach a patient about their health, or holding someone's hand as you midwife their dying. It's as if I can feel the hand of God on them, and on me. And let me tell you - it is intoxicating.

Incidentally - I don't mind the smell of birth anymore. Now it kind of reminds me of the magic.