Memory and medicine: A deep look into the eyes of our profession

I read with interest Dr Pankratz’s article regarding his experience with appendicitis (Appendicitis--a bad experience. BCMJ 2009;51:26-27). Dr Pankratz’s story reminded me of the best medical advice my father (a retired orthopaedic surgeon) passed on to me: “Maggie, get their damned clothes off and examine them!” 

This statement rings in my mind daily as I see patients and am tempted to save time on their exams. Dr Pankratz’s story also brought to mind some of my recent medical experiences--experiences that have been very humbling and a good reminder of what is important in what we do. It’s easy to forget what a critical role we play in people’s lives and in their memories; it’s easy to forget why we got into this business in the first place.

Almost 3 years ago our third son was born by elective cesarean section in my own community hospital in Duncan. What could be difficult about that? Get up in the morning, have surgery, instant baby. This would be nothing like those two previous labors and eventual emergency C-sections that my colleagues who were caring for me agonized over. 

Little did my husband know that 3 days later he would be wearing the same set of clothes and would be praying for our new son’s life in the Special Care Nursery at BC Children’s Hospital--at that moment he was the sickest baby in BC. That next month and the individual moments that went together to make it up still sit close to the surface of our minds. When our son pinches our cheeks with a “teeny hug” it’s hard to believe that he is so perfect and that his life was in the balance for several agonizing weeks.

Coll had persistent pulmonary hypertension of the newborn, a condition I had learned about previously but had not paid a lot of attention to. Thankfully, it is a disease of transition, which he was supported through and survived without a scratch. Not all have been so lucky.

A number of experiences still come back to me: I will never forget the care and attention that we were shown in Duncan in those early hours by OBs, pediatricians, anesthesiologists, and nurses. I will never forget the comfort that I felt when my own GP (another colleague), came in late at night to give me the news that Coll was not doing well and would need to be transferred to Victoria. I will never forget that frightening and incredibly painful ambulance ride to Victoria. 

I will never forget having to beg my nurse for basic medications such as colace and a PPI to save my stomach from the NSAIDs. I will never forget the same nurse’s indifference to my postoperative pain and complete lack of interest in my emotional pain. 

Having spent a good part of the day in the neonatal intensive care unit agonizing over our son (on C-section post-op day 1), she told me to wait another 30 minutes for my measly Tylenol 3 as my dose was not due. I will also never forget her not allowing me to use the computer at the desk to print out an “Up to Date” search that I desperately felt I needed to read to get a grip on the situation.

If I close my eyes, I can still feel the warmth emanating from the Victoria neonatologist’s hands as she held my hand and discussed transport and treatment options for our baby. I will never forget the disconnect I felt between what I thought I should feel for this new baby who I really had no connection to yet and this medically paralyzed and floppy little being hooked up to every support system imaginable, struggling for his life. 

I will never forget the heartbroken look on our friend Laura’s face when she came to meet us in the middle of the night in Victoria--sneaking away from her on-call duties in the ICU. I will never forget my sister stepping out of her busy life and coming to Victoria to be with us. I will never forget the pediatric cardiologist discussing the ominous ECHO results that really made no sense to my addled brain. 

I will never forget the neonatology fellow breaking the bad news to us that they would need to fly our son to Vancouver, that there was probably no room for us to accompany them, and that he may not survive the flight. I will never forget the same doctor working tirelessly with the RTs and transport team to rig up a way to plumb in the life-saving nitrous oxide to the high-frequency ventilator. 

I will never forget the relief we felt as we watched the numbers on the oxygen saturation monitor climb and climb as the nitrous oxide was turned on. I will never forget the flight over the black waters of Georgia Strait under clear skies and a full moon. For many months I would count the full moons since that ominous flight. 

I will never forget the exhausted air ambulance attendant drifting to sleep (twice) as he manually ventilated my son on the flight to Vancouver and the powerlessness I felt as I saw his head nod and his hand go slack on the ambu-bag. There was no way to reach over and shake him awake as I was strapped into my seat next to him with the incubator between us.

I will never forget the Vancouver neonatologist pushing my wheelchair up to the bedside amid the chaos in the treatment room off the SCN after our arrival and taking no notice of whether I was in the way. I will never forget the hilarity when my other sister and I realized that the postpartum staff at BC Women’s had mistaken her for my (life) partner. 

I will never forget the expertise and care we were shown in Vancouver during our stay there and the commitment of the team to keep us informed by including us in bedside rounds. There were many tense moments during that month. I will never forget the Mother’s Day card that the SCN nurses made for me with Coll’s footprint. 

I will never forget the old friends who materialized at the hospital to show their support and the many e-mails we received. I will never forget how my 75-year-old mom scooped up our two older boys and took them off our hands for a month while we focused our attention on Coll. 

I will never forget when our new friends in the next bed decided to withdraw care to their son and how we realized how close we had come to that moment. I will never forget being present with them as their doula 2 years later when they delivered their healthy baby girl at BC Women’s and thus completed the circle of life for all of us.

What did I learn from this? Many lessons. It has made me a better person--doctor, patient, wife, mother, sister, teacher, colleague, and friend. It taught me that the family holds the thread of the medical story--a thread that can easily be broken as teams pass off to each other as they come on and go off service and over long weekends. 

We need to always keep our ears open to what our patients and their families have to say. It has taught me to appreciate the precious moments of life that can pass unnoticed. I think of all these experiences as I watch our perfect little son learn to swim, or ride his tricycle, or stand up to his brothers, or give me a “tiny hug” on my cheek, or whisper “lub you Mommy” in my ear as he drifts off to sleep. 

I think of these experiences in my practice as I deliver bad news, or when I am there for families struggling to make sense of what is happening to them, or when I hold a hand, or ease the dying into the next world, or bring each slippery new life into this world.

hidden


Dr Watt, a family practitioner in Duncan, is the VIHA medical lead, CDI Central Island.

Maggie Watt, MD, CCFP,. Memory and medicine: A deep look into the eyes of our profession. BCMJ, Vol. 51, No. 7, September, 2009, Page(s) 326 - Back Page.



Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

About the ICMJE and citation styles

The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.

An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.

BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:

  • Only the first three authors are listed, followed by "et al."
  • There is no period after the journal name.
  • Page numbers are not abbreviated.


For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org

BCMJ Guidelines for Authors

Leave a Reply