As I write this we are already half way through the summer, and I have spent a fair amount of the time on vacation. The other night, I woke up at about 2 a.m., and for some unknown reason started thinking about my first clinical rotation as a medical student during the summer of 1973 (in those days clinical work at U of Toronto started in fourth year with virtually no break after third year finished). It was in obstetrics and gynaecology at the Toronto General Hospital and I had an incredible time. I was able to do 8 deliveries all by myself, and the majority of the delivery in another 25, numbers that I suspect few medical students could match today. It was also my first introduction to the power of communication (or more accurately miscommunication) and how it affects patient care. I met one young Chinese couple who were furious because of their poor care. The wife spoke no English and her husband spoke only minimal English. They had sought advice about birth control at the hospital’s gynaecology clinic, but despite that the young woman was pregnant. The husband was particularly indignant, as he had taken the birth control pills as directed without missing even once! Another young woman had received a years supply of a sequential BCP with placebos for the last 7 days of the cycle. These pills thus came in three colours. She put all the pills in a large glass dish, and selected each morning the colour pill that matched her mood most appropriately. She too was indignant that medical science had not been able to prevent an unwanted pregnancy. I also had a great privilege on that rotation. In the previous 2000 years of recorded history only one immaculate conception had been recorded. I was privileged to see two in just two weeks in clinic.
Still unable to sleep, my morbid memory then moved to the suicides I saw while in training. That same year I was a fourth year clinical clerk, one intern killed himself, and one patient snuck out of her medical ward and cut her wrists in a closet on the radiology floor (to be discovered by a radiologist hanging up his coat the next morning). The most frightening episode was a double suicide that occurred in January of my PGY2 year. I had been in Florida for a conference followed by a vacation, and one of the residents on neurosurgery had been in Florida at the same time. The week after returning to work, I bumped into that resident and asked him how he was doing. He replied, I am depressed and without much thought I replied, yeah me too it’s tough getting back to work after a great vacation. Two days later a young woman was admitted to psychiatry after an overdose. Unfortunately, she conned the staff physician into giving her a four hour pass the next morning. She immediately went to the rooftop bar at the Park Plaza Hotel and jumped off, hitting the Avenue Road bus head first. The bus driver fainted (he was fine) and the girl (obviously dead) and he were brought to the ER. Despite the futility of the intervention, neurosurgery was paged stat to assess the woman. Unknown to all of us, the resident on call (the one I mentioned above) had just hung himself that same morning and his body was discovered by his three year old son. We did not know till later that in fact we were paging a dead man to minister to a dead woman. I still get the shakes to this day when I think of it. Enough of this morbid thinking, enjoy the rest of the summer.