As a paramedic, our training was heavily geared towards managing acute, emergency situations. Most of the time it was to deal with chest pain, shortness of breath, and trauma. But, another skill that all paramedics receive training in, is how to deliver a baby. Today, this is not a very common call for a paramedic as most expectant mothers get to the hospital long before they would ever need a paramedic to deliver their baby. In fact, other than their inhospital training, most paramedics will never deliver a baby. Nevertheless, all paramedics are trained to deliver a baby, as well as manage complications such as breech delivery, problems with the umbilical cord, neonatal resuscitation, etc. The thing to remember though, is that although they call it delivering the baby, it is the mother who does all the work. For the most part childbirth is an uncomplicated process, and mothers have been having babies long before any doctors were around. Usually you will just be there to “catch”. Now onto the story…

Around 7 years ago now, it was around 0630 and I had 30 minutes left in my 24 hour shift when the emergency tone went off for a woman in labor. Soon my partner and I were in the ambulance on our way to the scene receiving updates like “Contractions are every few minutes” and “Delivery is imminent”. After around 15 minutes we arrive at the house, we grab our gear, and make our way up the stairs. Unfortunately the stretcher couldn’t make it up the small stairway and into the house so we had to leave it outside. At the door we were met by the husband, who was holding a 2 year old girl, and a 5 year old girl. They were Chinese, not overly important to the story at this point, but more relevant later.

Anyways, we ask the husband where his wife is and he says she is in the very back bedroom, furthest from the door. Of course she is I thought, where else would she be?!! So my partner and I make our way down the very narrow hallway in single file with the husband and kids following us to the last room. I entered the room to find a woman (in her late 30s I think) laying on a mattress on the floor and the first thing I saw was part of the non-ruptured amniotic sac protruding from her vagina. Immediately I knew this delivery was going to be happening here. So I ruptured the membranes and at this point my partner asked me what I wanted to do. I said we should try to get her to the ambulance in case there were any complications and that way we could just leave for the hospital. I also said we needed a second ambulance with 2 more paramedics, standard protocol for an at home delivery as soon we were going to have a second patient. The only problem was there was no second ambulance available. So who did we call for extra help, the fire department. All we needed was some extra people to help lift, etc, but apparently it became the “big story” in this little community that the fire department was called to a woman in labor!

So my partner leaves to take to some gear back to the truck and to try and figure out a way for us to get this pregnant, soon to deliver, woman out to the ambulance. At this point the little 2 year old girl is now clinging around the neck of the mother on the floor, so I tell the father that he needs to take the little girl out of the room to let the mother have her space and not be stressed further. Now it is just me in the room with the mother and 5 year old girl. I then look back to the mother on the floor only to now see the top of the baby’s head! Things had progressed so quick to this point that I didn’t even have a chance to open the obstetrics kit, so with only my 2 gloves on, I started to put gentle counter pressure on the baby’s head to prevent an explosive delivery and supported the perineum so it wouldn’t tear. At this point the “inquisitive” 5 year old asked me “Is my Mom having the baby?” and I said “Yes, your Mom is having the baby! Do you remember the other guy who is wearing the blue coat like me?” She nodded yes. “Go find him, and tell him I need him right now” I said. So the little girl runs off to find my partner and a minute or so later I hear my partner coming down the hallway saying “Yeah the little girl said you needed me to come back right away…” just before he entered the room to see me delivering the head and then he said “Oh my God!”. I then asked him to open the obstetrics kit to get set up for the delivery in progress. Now these obstetric kits are wrapped in plastic, and when my partner ripped open the plastic, in the heat of moment, the plastic bag popped open like a bag of chips and its contents went flying everywhere.

At this point the head was fully delivered so I said just give me the bulb syringe and I suctioned the mouth and then the nose. Next I had to check for the umbilical cord around the baby’s neck. So still supporting the baby’s head, with 2 fingers I pushed back the labia and felt around the neck for the cord. The cord was tightly wrapped multiple times around the neck. There was no time to waste. We told the mother to stop pushing, but she didn’t speak English or at least not very well, and I don’t think she fully understood what we were telling her to do. I first tried to loop the cord over the head but it was wrapped too tight. Next I tried to clamp the cord where it was and cut it before the rest of the baby delivered. But the cord was so tightly wrapped that I was having trouble getting the clamps around the cord. At this point I thought we were going to end up having to try to resuscitate this baby.

Unfortunately despite our pleas, the mother kept pushing and the rest of baby delivered right into my arms. Now, if you recall from earlier I said I had to rupture the membranes. That is true, but as the head had already descended into the birth canal, all the amniotic fluid was still trapped behind the baby. So once the baby came out, so did all the amniotic fluid, and guess who was in the “line of fire” so to speak? I’ll leave it at that. With the baby now free, I quickly unwrapped the cord from around the neck and rapidly dried off the infant with towels. Then I suctioned the mouth and nose again and gave the baby a few slaps on the foot and the baby started to cry. A huge weight was off my shoulders. I then did a quick visual inspection and told the Dad that they now had another baby girl. I then evaluated the infant’s respirations, pulse, and skin color and all were fine. I then asked the Dad if he wanted to cut the umbilical cord but he said no, so I clamped and cut it.

At this the point the fire department had showed up so it was now pretty crowded in the bedroom. There was the mother, the father, the newborn, the 2 sisters, 2 paramedics, and a crew of firefighters. Now that things were under control, we were able to move the mother and newborn to the ambulance and we had a nice, calm drive to the hospital. I monitored the mother and newborn on the way, but the mother never delivered the placenta before we arrived at the hospital. After dropping off the Mom and baby, we said congratulations, packed up our gear and left.

Shortly after the call, my paramedic partner that day and I both received stork pins for our delivery in the field. Months later, the family invited us to attend the baby’s baptism which we did.

This certainly is one of the most unique calls I have ever attended, and I am sure will forever be

So we have an alphabet right? But what have we been doing to improve it? I’ll tell ya what. Nothing. We have had the same basic alphabet since….. well I have no idea how long, but given that it’s called the roman alphabet (or at least I think it is), I’m gonna guess we’ve been using the same alphabet for some time. Now that’s not to say that there haven’t been attempts to update it, let’s not forget Saturday Night Live’s attempt to promote a metric alphabet a fair few years back, but let’s be serious, LMNO can NOT be a single letter, it just doesn’t work.

What we need here is not a pared down alphabet. We need an all new and improved (read expanded) alphabet. And I humbly submit what I think is a suitable first extension. It came to me like a winters storm. All seemed so calm, and then suddenly… epiphany.

Here’s what happened. Last week, or possibly two weeks ago, it’s really not important, let’s just say it wasn’t this week, I was sitting in my living room with my flatmates (I hereby refuse to revert to the north american roommates, as I have my own room) discussing theories on the meaning of life, the existence of God and the Everafter and…. ok, we were talking about if the salary cap in the NHL is making the league better or worse. The correct answer is better, as was being posited by yours truly. However my flatmate Ben disagreed, saying that it was making the league worse. His main argument was that the Leafs were good when there was no salary cap, and now they suck with a cap. Whilst I couldn’t disagree with his argument, I felt it was slightly misguided. Somewhat akin to saying that since there are no bears in downtown Montreal, my Bear Patrol must be doing a good job. The giant badger or possibly racoon patrol is not doing such a good job however. But I digress.

So as I was trying to use handsignals to demonstrate what I thought of his salary cap as a negative, I got stuck between signalling “Whatever, Loser”. and the somewhat harsher, ‘Whatever, Wicked Major Loser”. For those unfamiliar with these signals, for the former you form a W by touching your thumbs together and pointing your index fingers up while holding your hands in front of you with the palms facing whomever you are signalling to. You then drop your left hand to your side and stick your right thumb out to the side, while leaving your right index finger pointing skyward. I know it doesn’t look like an “L” to you, but it does to whomever you are pointing it at. If you don’t believe me, check in a mirror. (I think that works, one sec, I’m gonna check…. actually it doesn’t, so I guess you’ll have to take me word on this one). The former (Whatever, Wicked Major Loser) is made in a similar style, but turning the “W” over to make the “M”. For those of you keeping score, yes I am eight.

In any event, as I was saying, I got caught between an “M” and an “L”, with my right hand in the “L” formation, but my left going to “M”. And it was at this moment that all became clear. What I was left with is my proposal for the newest letter. I call it….. “lightning bolt”. It was a stroke of genius. I think that “lightning bolt” will really spice up the alphabet. I’m not sure what it’s phonetic sound will be yet. Potentially “Boom!!” or maybe, “PGHwhssshghghghgh”. I have decided on the placement however. It should go in between “O” and “P”. It’s a tribute to yours truly since my name starts with “P” and further, it flows with the song. ABCD EFG HIJK LMNOlightningboltP QRS… and so on.

The benefits of lightningbolt are almost beyond fathoming. Onomatopoeia would take on a whole new level. Imagine, a letter that makes its own distinct sound! That would blow whoosh, boom, pow, and most of the rest of the Batman words next to obsolete. They would be the eight track to MP3, leaded gasoline to the hydrogen fuel cell, the vacuum tube to the microprocessor. It would be revolutionary! And that’s not even getting into the potential for new dictionary entries. Websters would experience a renaissance unlike any ever seen in the modern world.

I know what all of you detractors are saying, Dewey Decimal would roll in his grave if he heard of this. Well, too bad. There are always going to be those who champion the status quo because they’re afraid of progress and what it might mean to their bubble wrapped existance. We need radical thinkers such as myself to push the bill, explore the limits of the human mind. People thought Darwin was crazy, he couldn’t even publish, “On the Origin of Species” until after he died for fear of public reaction. Galileo was put under house arrest for proposing (some believe correctly) that the sun, not the Earth is the center of our universe. Well I will not be repressed! Lightningbolt is too powerful. It is not just a letter, it’s a revolution. Lightningbolt is poised to be one of the great discoveries / made up letters of the 21st century.

So get behind it! Get in on the ground floor. I guarentee you won’t be disappointed. I predict that in fifty years time, Paul Morrison will be to the alphabet, what John Lennon was to songwriting, what Steven Hawking is to physics (and voice replicators) what Nobel was to blowing stuff up. A visionary. A radical. A dreamer. A genius.

Sincerely

Dr. Paul Q. Morrison Esq.

(Doctor of nothing in particular)

5K – Mat Kiberd, John Morash, David Conrad, Kate Read, and Claire Hamilton
10K – Tiffany O’Donnell, PJ Rasmussen, Shasta Moser, and Alex Nelson
21.1K – Jon Chung, Annie Colwell, and Arpun Bajwa
42.2K – David Sibley

Training for this event turned out to be a success for many reasons. To begin, everyone who ran this weekend achieved the distance they set out to run. Also, preparing for this event helped us all to become more physically active which is an important part of maintaining a healthy lifestyle. It got people out training together and sharing an experience other than studying. Last, it helped promote that balance that we all need in medical school.

So I just want to say congratulations to all those who ran this weekend. Well done! The effort put forward by everyone in training for this event was well worth it. Also, a special congratulations to PJ who finished first in his event. Way to go PJ! Thank you as well to those who were able to get out and watch some of the events. Your support was certainly appreciated by those running.

As you can see from the list above, we had a good turnout for this event. If I am missing the name of anyone who ran please add your name at the end of the blog. Of course, I believe it would be even better if next year we could have even more runners from our class.

As many of know from my previous blog entries, I trained for the full marathon, which is a distance of 42.2km. A couple of weeks before the date of the marathon I started to get some significant inflammation in my right knee. Rest, ice and naproxen seemed to eliminate the pain and inflammation, but going into race day I had a lingering fear that during the marathon the pain and discomfort would return. Fortunately, I had no return of pain in the right knee, and during the entire race all my joints felt fine.

Now most Nova Scotians know that traditionally, the weather for the Bluenose marathon has always been cold, rainy, and windy. Fortunately luck was on our side this year as Sunday, race day, turned out to be a very good day for running. The sun was out and the temperature was nice and cool.

The first half of the marathon took place on the Halifax side. The route was mainly flat which allowed me to pick up the pace a little bit and finish the first 22km in 2 hours. This was important for me as I knew the second half had a lot more hills and it would be tougher to maintain a faster pace. Coming back into the split area, there was a gate to the left for the half-marathoners to finish and a gate to the right to continue the full marathon. The guy asked me if I was still going. I nodded and kept going to the right and said to myself “Here we go”.

For the second part of the marathon we crossed over the bridge to Dartmouth. This is where the hills began. Up Nantucket to School, across School to Woodland, up Woodland to MicMac Mall and then into Shubie Park. Once into the park we followed a windy trail through the woods and eventually we came out onto Waverly Road. We followed Waverly until it changed to Prince Albert Road and we continued by the Dartmouth Lakes. Unfortunately, the wind was blowing in off the lake right into our face.

Around Lake Banook (37 km), I knew I would probably start to get tired, and I was. My longest training run prior to the marathon had only taken me up to 35km. That’s when I brought out the secret weapon. Before the race I had told my family to wait for me near the canoe clubs. So as I ran by it was nice to get some encouragement to keep going.

That then brought me to what I think was the absolute hardest part of the marathon, Maple Street. It was about a kilometer long and started at about a 30-35 degree incline and half-way up the hill it increased to almost 45. As I started up the hill I could see people stopping and starting to walk up the hill. Somehow, with my legs burning I managed to keep running all the way to the top where it made a left hand turn and leveled off.

From there, it was back to the bridge to head back to Halifax and finish with a 2km stretch down Brunswick Street back to the Town Clock. My goal for the marathon was to try and finish under 4 hours and when I came off the bridge and turned onto Brunswick Street, I looked at my timer. I still had a chance to clear 4 hours. My muscles were aching and burning, and I really wanted to walk a little, but instead I just looked inside and somehow found the energy to keep pushing forward to the finish line. With the end in site I knew it was going to be close so I just put my head down and pushed my legs to go as fast as they could. When I crossed the finish line I recorded a time of 3 hours 57 minutes 55 seconds.

So that concludes my experience in training for and running a marathon. Someone has already asked me when I am going to run my next one. I can honestly say that running a marathon is something I never want to do ever again. Don’t get me wrong, I enjoyed training for the marathon, and by running it I proved to myself that I could push my body to do it, but now that I have done it once and achieved my goal, I really see no reason to ever do it again. Next year I could see myself cutting back to the half-marathon but I guess we’ll just have to wait and see. I plan, however to continue to keep running shorter distances around 10km to maintain my cardiovascular fitness.

So I’ll end here with an invitation to the other runners and those who came out to cheer us on to respond with your thoughts and experiences from the Bluenose Marathon.

I suddenly looked back this year and realized that I can’t remember the last time I sat down to write just for the fun of it. But it had been too long; I was too intimidated to start something I knew I’d probably never finish. And where to start? What to write about? Then, hallelujah! One day I saw a poster for the Cynthia Davis Prize for Writing. It wasn’t even so much the prize that enticed me, but it was just the perfect excuse to get back into writing. It beckoned to me. I started to work away furiously at a story outline that day and typed long into the weekend. But then somehow I got busy, and let my writing go by the wayside (I’ll admit, my old friend writer’s block had a wee bit to do with this as well!). I realized it was the last week, and the due date happened to fall on the same day as our pharm exam. So much for that. I sighed. One more unfinished story. Sigh again. Another failed attempt to write. Add one more sigh.

But things seemed destined to align for me. For not only was the contest deadline extended, but for the first time in a very, very, VERY long time, I had the uncontrollable urge to write, and sat myself down at my laptop for seven hours straight (no breaks) and typed, not hesitating even once, my writer’s block all but gone, the story flowing from my fingers as fast as I could type it. Actually I think this has never happened before in my entire history of writing! I forgot how much I loved it, watching the characters develop and the story spring forth from my fingers, taking me to unexpected places, twisting the plot in ways I hadn’t thought of, exploring secret, long-buried corners of myself. For writing, as anyone who does it knows, is a deeply personal experience, whether you’re writing an autobiography or a novel about strange aliens on Planet Thoron. I had totally forgotten how gratifying it feels, the satisfying ache that penetrates to the very core of your being that you get when you can take a blank page and give it life that no one else could have. And you know what? I don’t even care if my story sucks. Considering I spewed most of it out in one sitting, it is probably not winning material, or even close. But just the satisfaction of knowing that I still have it in me, and the pleasure it gave me to write once more it makes it all worthwhile.

So tell me, what are your strange and buried talents? Things you used to do, but have long ago given up but secretly wished to restart? Take it from me, no matter how long it’s been since you’ve juggled, or knitted, or written poetry, or played with saws or a musical instrument or a baseball, no matter how dust-covered your old passion, it’s worth re-digging it up. Sure it may be rusty, but when it gets polished off, you’ll rediscover a side of yourself you’d long forgotten existed. Given the satisfaction and pleasure it brings you, you’ll wonder why in the world you gave it up in the first place. And if you’re lucky, you won’t let labels or lack of time let you bury it in the annals of “I used to be really good at…” ever again.

Needless to say by the time I got home my right knee was painful, a little swollen, red, warm to touch, and yes, there was, I guess you could say, some loss of function. All the classic signs of inflammation. Wow, I do remember something from PIM! So I started with the ibuprofen and the bag of frozen peas and then skipped a few runs. Things seemed to be calming down so on Thursday I decided to test out the knee with a short 10 km run. The swelling was down but during the run the discomfort and some mild pain returned. Being so close to race day I didn’t want to mess around, so after our pharm exam I went to the University Health clinic to have my knee looked at. Well, the good news is that there is no physical damage, but the subpatellar bursa is very inflamed. So no risk of injury, but things are going to be uncomfortable for a while. So I left with my prescription for Naproxen, which thanks to pharm I now know all about it, and went to the pharmacy. I must say that I found it very humourous at the pharmacy to receive from the third year pharmacy student a 5 minute description of Naproxen including the mechanism, indications, contraindications, side effects, drug interactions, etc, but I knew she is there to get her experience (we’re all students) so I let her continue, and she did do a good job.

So the plan now is to try and balance my running to keep my endurance up during this taper down period, with a little “damage control” which will include the Naproxen and icing the knee after my running sessions. I just finished another 10 km run today (Saturday May 3) and while there definitely was some discomfort, there was no pain. So I’ll keep up with the NSAID and the icing and hopefully things will continue to improve, but I may have to resign myself to the fact that it may be an uncomfortable 42 km run (but then again, is there such a thing as a comfortable 42 km run???).

Anyways, that is the latest status update. Again, good luck to everyone who is training. Keep it up and soon all your hard work will pay off!

David

ps. What is it with the Killam??

Whereas other children might have superheroes or sports stars as idols, Schroeder has musicians – specifically the three great “Bs” (Bach, Beethoven and Brahms), as well as Mozart and Chopin. It is unclear the how Schroeder’s fascination with music first started. His father was a self-taught classical guitarist and his mother frequently sang while doing household work. Both parents also had a deep appreciation for classical music and frequently played recordings on road trips. As well, the “Classical Kids” collection (which includes “Beethoven Lives Upstairs” and “Mr. Bach comes to call”) probably contributed to his musical development and appreciation.

In any case, Schroeder’s musical abilities to not go unnoticed. He is frequently called upon to perform at school assemblies as well as lead the school choir. Being one of the few available piano players, this can cause some him some consternation since this requires him to be present for all musical performances, in addition to preparing the choir for public performance. Apart from his musical talents, Schroeder is just like any other kid. He doesn’t like homework, is bored at school, and often day dreams about Robin Hood and exactly who would win if members of the first Viennese school (Hadyn, Beethoven and Mozart) met the members of the 2nd Viennese school (Schoenberg, Berg and Webern) in a dark alley.

I spent first semester feeling guilty. What was I doing here? Anatomy wasn’t my cup of tea, Metabolism and Function scared the bejeezus out of me. Long story short: I was not having fun. And I felt guilty because isn’t everyone in medicine supposed to love every second of it? Aren’t there other people out there who’d kill to be where we are? And seriously, we all worked our little tushies off to get here. I thought about quitting. I was pretty sure I’d made a mistake; there were bigger fish to fry in the world of global politics and health policy and I just was not cut out for all this technical stuff. Medicine was a recent decision for me – and clearly the wrong one.

I don’t know if it was just having a vacation to unwind and regroup that made January seem brighter, or if I’d, unwittingly, had an epiphany in my subconscious over the Christmas break. Either way, coming back in January, school seemed less like the bane of my existence and more like something I could perhaps tolerate. Euphoria reminded me of the good life outside my books, and a spontaneous realization – I mean a deep, honest-to-goodness, in my heart not just in my head realization – that the M&F exam would not determine my future helped me make the final step from tolerating school to maybe enjoying it a tiny little bit. I mean tiny.

Then, all hail the wonder that is PIM. Things began falling into place. Tutorials weren’t a place where I tried to hide because I didn’t have a clue, but a bright spot in my day (okay, not THAT bright… going home and eating supper is really bright). Pathophysiologies, causative agents, even a little global health were all coming together. Halleluiah!

I don’t know much about blogging, but this one has three components: a personal story, an intended audience, and some lessons learned. The personal story is done. Now the audience. Why a blog to say I had adjustment problems and love bacteria and parasites? Well, it’s because I don’t think I’m alone on this one. But I think the people who feel like this are afraid of admitting it. And maybe I’m talking to future first year medical students, as opposed to people in my class. Lots of people – I’ll even venture to say most people – come in to medical school with the 100% certainty that this is what they want to do and they love every minute of it. But there are a few people who don’t. And those of you who love it, and have wanted to do it since being in utero, don’t go looking wide-eyed at me like that. It is possible not to love medical school right away. It’s even okay not to love medical school at all. It’s okay to be holding on to school by a string that might snap at any moment, convincing you to drop out. My audience: other people who feel, or at some point felt, like that.

Now the lessons learned. Medicine, as a field, is immense. Seriously immense. Bordering on infinite. So there are lots of potential strings to hold on to. I finally found a little one, and I hope that sometime, someway, there will be other strings and eventually it’ll be a big-ass rope, complete with belay and harness (another element of this blog: ludicrous similes). Some Med IVs I’ve spoken to have said that might take until clerkship. Communication skills got me through first semester, and reminded me why I wanted to do this at all. People, dudes, it’s about people (please don’t vomit, it is true, even if it’s over-said). Now parasites and bacteria are looking pretty darn good – it’s about people (still about the people) with bugs. I feel super lucky I caught on this early. But if it’s not bugs and worms that turn you on, maybe it’s research or maybe it’s administration or maybe it’s policy or maybe it’s people, people and more people. It’s really okay to hate medical school; it’s just important to get rid of the guilt about that, and ignore the people who used Harrisons’ to learn to read. Let them be – they’re okay too. Something – even if it’s a fleeting concept, or a session that comes only once in first year – will get you, just hang on. I know now that I can make of medicine what will work for me. So: Lesson 1: find just one itty bitty thing you like, and don’t let go; it will (I’m fairly certain now) be worth it. Lesson 2: exams, shmexams. Lesson 3: Euphoria maintains sanity. Musical is pretty awesome too.

The End.

I have vivid childhood memories of the time I spent as a patient with Crohn’s disease in the children’s hospital here in Halifax. I was 11 when I was diagnosed, and thus I’ve spent more than half of my life living with it. Medicine became important to me as a career during my third year of university, when I realized it is the perfect confluence of everything that makes me happy in life. Even still, I have spent far more time identifying as a patient with Crohn’s than I have as an aspiring doctor. This post is a reflection on my experience of moving toward equilibrium between these roles; patient and doctor in training. I reflect on the degree to which my previous experience as a patient affects my bedside manner and clinical judgment with regard to patients whose position reflects my childhood experience.

I had initially only the broad goal of observing my reflexive response to patients who, in my estimation, were enduring experiences similar to mine. I decided that doing an elective in the pediatric GI clinic where I had been a patient was the best strategy to see myself in action. Indeed, to illustrate how similar, for me, the environment was since I had been there, shortly after my arrival I was recognized by two staff members.

Initially, I was concerned about my ability to balance my emotions and reason while interactions with patients similar to myself at their age. It occurred to me, that making clinical decisions whilst comforting distressed patients was not going to be easy if I was in a similar emotional state. I think I’m making a fairly intuitive argument; if we are a sobbing wreck, a perfect reflection of the patient, how on earth might we comfort them? Profound compassion, on it’s own, would be an aspect of their practice I hope every physician struggles to reconcile. But, I reasoned, as a matter of circumstance, I would constantly be experiencing emotions equally salient to those of the patient, because I had, some 13 years ago, endured similar ordeals.

The dilemma I’ve outlined above, as I understand it, is about empathy, and its place in medical practice. Before undertaking this elective, I had always understood empathy to be the experience of shared emotion; that is, arriving at an emotional state as a consequence of observing it in another. I was further concerned, then, by the widespread belief that empathy was an essential part of compassionate clinical practice. As I began to try and conceptualize the application of empathy in practice, it seemed to me empathy could only compromise my ability to reason and make balanced judgments. I reasoned that one of two things had gone awry: either I, or the medical establishment, had totally flubbed the definition of empathy. If I had misinterpreted the definition, I was determined to discern by what inferential blunder I had internalized an ambiguous understanding of the term. On the other hand, if the medical establishment had appropriated the word as jargon and incorporated it’s own meaning; I would have to come to understand that.

To the dictionaries! My searches however, lead me to believe I would never know the solution. In keeping with (what seems like) the majority of English words, there are multiple definitions of empathy. And, even if the exact definition you prefer is lacking from the dictionary of your choice, it seems to be acceptable to start using the word the way you’d like to anyhow. The Oxford English Dictionary definition is: “The power of projecting one’s personality into (and so fully comprehending) the object of contemplation” (Oxford English Dictionary Online, 2008). And the slightly, but (I believe) not completely overlapping, unabridged definition from the 5th edition of Stedman’s Medical Dictionary is:

1. The ability to sense the emotions, feelings, and reactions intellectually and emotionally that another person is experiencing and to communicate that understanding to the person effectively. 2. The anthropomorphization of humanization of objects and the feeling of oneself as being in and part of them. (Stedman’s Medical Dictionary, 2005)

If we throw out the idea that a single definition is ‘right’, and think instead about appropriately pairing definition with application, the resolution to my original dilemma is nearer at hand; that is, I believe the second definition of empathy I mentioned above, from Stedman’s Medical Dictionary, is the more locally applicable. It allows for the empathetic physician to objectively observe emotion, but it also admits experiencing the patient’s emotion. The equation is balanced, I believe, by the degree of emotion we experience. Experiencing a small degree of emotion gives meaning to the intellectual recognition of another’s pain or joy etc. Letting that emotion govern us however, clearly negates the whole exercise. Thus, I reasoned that it is acceptable for me to feel, in manageable doses, the emotions the patient may be feeling. I believe the struggle for me will be in not letting those emotions overwhelm me.

Now that we’ve traveled through this odyssey into the semantics of empathy, we should find it ironic that it didn’t matter at all, once I began spending more time with patients. I realized that my fumbling with the definition of empathy was irrelevant because I was seldom experiencing empathy while observing patients; I was rather only recalling my own experiences, a narcissistic conflation with empathy. In fact, upon this insight, I realized that dwelling in my own experience inhibited my ability to empathize. Allow me to offer an anecdote from my elective that illustrates my point. I was called over to observe the peri-anal exam of a young boy. I was suddenly struck by a memory of being in a hospital at his age. Under the watchful eye of my doctor several residents began a physical exam without ever having introduced themselves or asking for permission. This induced in me an extremely distressing feeling of objectification and complete loss of control. I now wonder if many children in a pediatric clinical setting feel similarly. In fact, in this case I was overcome with the need to return, what seemed to me, to be his lost sense of control. I couldn’t bring myself to approach him without his permission, so I asked if I could come over. Returning then to my exploration of empathy, I realized that in this case empathy played no part in my relationship with this patient. Regardless which definition one prefers, all definitions require a relationship between two beings. By dwelling only in my memory, I neglected to truly to consider the boy on his terms. I was not feeling what the patient was feeling; I was feeling what I felt in a similar situation. I couldn’t be sensitive to what the patient was feeling, so immersed was I in my own memories and emotions.

I’m not tying to make the argument that what I did that day was detrimental to the patient. I am however, sounding a cautionary note, about how deceptively easy it is to conflate empathy and compassionate narcissism. To react solely from your own experiences, while perhaps not harmful to the patient, certainly precludes a circumspect assessment of the patient’s experience. I think we can and should be sensitive to our patient’s emotional state – and reflect that at an emotional level – so that we can share a degree of their experience; I assert that doing so is essential to a compassionate approach to medicine. This experience has taught me to be careful not to substitute my own emotions for those of my patients. Hereafter, I will be introspectively vigilant; I will reflect upon my motives – emotional and rational – to ensure that my considerations of patients’ feelings are just that – their feelings.

Yes, Freudian psychoanalysis did improve certain people’s lives, but so does talking things over with a bartender after a rough day at work. As well, the underlying principles that were touted on Friday as truth (i.e. emotional instability is based on trauma at very young ages, etc.) have been quite successfully refuted. We were presented with this material like it was brand new, but the idea of psychoanalytic uncovering of emotions has been around for a long time, and has subsequently been dismissed as an effective treatment option for a long time as well. To be fair this wasn’t straight out Freudian (i.e. no Ego, Id, etc.) but it was textbook Neo-Freudian Psychoanalysis, which may not been as ludicrous as Old school Freud, it is still regarded as an inferior treatment option.

The lecturer highlighted the improvements that came about from therapy compared to no therapy but failed to compare it to the current “gold standard” therapies of psychology such as cognitive and behavioral treatments. Anybody else with a psychology degree has probably heard of plenty of meta-analyses that compare various psychological treatments, and while they often dispute which is the most effective (drugs vs. cognitive vs. behavioral), they all tend to agree on one thing, psychoanalysis (what we were just taught) is the LEAST effective. Yes, it is better than nothing, but since when do we base our treatment option as compared to nothing and not compared to the top treatment methods. This isn’t even getting into the issues of leading questions or coercive suggestions…

So after four years of learning how ridiculous psychoanalysis is, and learning about it as a humorous aside, it was quite odd to all of a sudden be in a class in medical school learning something that has been discredited for so long as if it was gospel truth.