Touch

We were out this weekend to listen to live music (the best way to spend the weekend in my opinion). I felt somewhat uncomfortable because so many of my partner's friends, and mine, were very touchy. Rubbing my back, my arms, holding my hand while they spoke to me. Even hugging these folks I hadn't seen in months felt strange.

Growing up, my family was not terribly affectionate. It was something I'm proud of cultivating with my younger siblings. We hugged, kissed and snuggled. Now when they talk to me on the phone they say they love me, we hug every time we see each other.

But I'm not that way with other people. My very good friend in the class mentioned that we don't hug because "I didn't think you were a hugger" - however when I recently met her mother, it was the first thing we did after saying hello.

My idea of touch has changed dramatically since entering medical school. There are several kinds of touch as I see it.
1. The "hand shake". Typically done at the beginning of a new experience with a patient.
2. The "my hand is on your shoulder now because I'm using my stethoscope" touch. It's mildly familiar, helps me know when the patient is breathing if there is too much consolidation to hear well and gently reminds the patient to hold still/not speak.
3. The "this is something I have to do clinically touch". Reserved for DREs, breast exams, pelvic exams, genital examinations. It's all business, get in, get out.
4. The "you're having a really bad day" touch. I'm comfortable with this one even though it's bordering on quite familiar. When I am chatting with a patient with some sort of terminal illness or who has been in hospital for a long time, or with whom I am sharing bad news, I automatically rest my hand on their leg or hold their hand. I worry sometimes that this is more paternalistic than it should be. It's not intended to be, it's how I deal with people having a bad day.
5. The "tickle fit". Strictly reserved for kiddos under the age of 3 who are mostly feeling well. I call it developmental observation.

It seems like my comfort level with touch is divided into two categories - family and non-family. Time to split the second group into friends and patients.

CaRMS is rapidly approaching.

While I know I should have no problem explaining why I want to be a family doc in my personal letters I still find myself lost for words. I blame not writing here. So this isn't procrastination it's work. M'eh whatever.

I've been working with docs who help Canadian newcomers and refugees. These patients are teaching me so much.

I'm learning to be patient. Our interviews take at least twice as long since all questions and answers are filtered through an interpreter. My vocabulary often doesn't match either the patient or their interpreter so I need to come up with new ways to describe what most Canadians are easily able to recognize (e.g. weight loss).

I'm learning that some things make language unnecessary. Making faces at children, laughing, smiling and drawing pictures of flowers, friends and homes.  

I'm learning to laugh. Try doing a cranial nerve exam on someone who has no idea what you're doing. Hilarity will ensue I assure you.

I'm learning that my life is brilliant. I've never been shot. My house still stands. I haven't watched while someone I love was beheaded.

Learning daily from my patients will be my favorite part of being a doctor.

oh no, I forgot to pack my lunch

guess I better treat myself to yummy Thai while I'm here in KW

have I mentioned how much I love electives?

family medicine elective

I am loving this elective. So glad I decided to apply to family. It just keeps getting better and better.

health clinic in a residential area

so cool

Uploaded - 05\10\2010-2

"Things will get easier, people's minds will change, and you should be alive to see it"

I know it's cliche, but our media is not doing teenagers any favours.

Ellen's talk about the teen suicides in the US that are following bullying is powerful and long overdue. Not just by her, but by adults and media in general. Everywhere they look, media is focused on teens and telling them what to do, how to look and who they are expected to be. Bullying isn't just taking place by other kids targeting children kids who are different, who may or may not be gay.

Idiots on the net are suggesting that the kids who are killing themselves to escape the bullies were mentally unstable before the bullying began, that being gay is a form of mental illness. They clearly forget how hard it is to be a teenager. It's incredibly difficult to keep your wits about you while figuring out who you are and dealing with surges of hormones. There are few teens who are mentally stable to begin with. Add bullying to the mix and it's surprising there are more episodes of suicide than there already are.

I was one of those kids who was teased about being gay before I had discovered for myself that I wasn't. To me though, this teasing meant nothing because I didn't see anything wrong with being gay, as long as they didn't call me fat or stinky I was OK.

Again, movies, TV and magazines tell us that if we do things perfectly -by wearing the right makeup, dressing in tight clothes, sleeping with whoever we please, drinking alcohol and still being brilliant at school, friendly, athletic and thin - we will have more friends than we know what to do with.

No pressure.

Hard to imagine why kids struggling to define themselves are struggling so much. Each teen is fighting this battle and has a difficult time recognizing that they have peers fighting similar battles. It results in them feeling isolated and ignored and trying to find a way to be seen. They become bulimic, goth or emo; buy crates of makeup and perfume; dress like sluts; slowly self destruct.

I've spent a few weeks with the child psychiatry team and these messages and how teens deal with them have been at the forefront of my mind. There isn't a fast solution to the problem which seems to be systemic. All I can hope for is a change in the content of the messages being broadcast to our youth.

Imagine you're a ten year old kid. Your thinking is still very concrete; sarcasm and shades of grey are completely lost on you. If someone tells you that you are too chubby you believe it. If someone tells you there's an obesity epidemic - that being fat is unhealthy - you believe that too. Then you start to pay attention to other messages from media, school, peers and adults. Foods low in calories, low in fat and sodium are healthier choices. Empty calories that you get from foods like the pop and chips you enjoy occasionally with your family are not good. Rules for eating and exercising begin to be formed in your head, all because you want to be more healthy.

Congratulations, you now have an eating disorder. Not because you think that you are too fat and need to look better, but that you are unhealthy and want to become healthier. Without countering the restrictive messages with messages of balance, enjoyment and the importance of certain nutrients like fat, this ten year old can become an eleven year old who is so malnourished, has a heart that is so wasted of muscle its SA node no longer function and an EKG tracing shows a junctional rhythm. The only option is to put this child into the hospital, provide him with nutrients at a rate that will not cause refeeding syndrome, and teach him the way to feed himself in the future - a balanced approach to be healthy.

Adults and especially health care professionals have a responsibility to keep the messages kids receive safe. Ellen is right. This is a crisis.