Thursday, May 26, 2011

University of Manitoba, Faculty of Medicine

I graduated from the University of Manitoba Medical School in the 70's and from my speciality in Psychiatry residency in the 80's.  There was alot of abuse and chaos at the end of my residency given a divorce, abortion, exams, personal threats and  betrayal. I felt generally  overwhelmed.   There were so many conflicting and confusing events which I contributed to and were beyond my control.  Suffice it to say, other than the completion of psychiatry residency, that year was rather dark. Not surprisingly I left Winnipeg and the University under a cloud. I was in no shape to work. Yet,  medical school itself had been an extraordinary time of learning and comraderie. The brilliant Dr. Arnold Naimark had been Dean and we all benefitted from his genius.
Surgical residencies are hard work.  They are physically demanding. I'd done the first year in a surgical residency and knew this.  A familial tremor raised concern and as at the time it wasn't known if the tremor would worsen. I chose to respond to a friends request to  I join him in country family practice to keep the hospital there open.  I did the credentialling for membership in the College of Family Physicians and began work as a country gp.
Subsequently I was approached by Dr. Jack Hildes who heard of my desire to work as a missionary doctor.  "Why go overseas when there is as much need for doctors to serve in the Canadian north, " he asked me. He'd been unable to get a doctor to work with the Northern Medical Unit from Canada and had to recruit an Irish and English doctor.  They'd come on board after me and despite the three of us the north was woefully undermanned.  The nurse practitioner program had started fine but because of government administration problems the original nurse practitioners had all left, all but one.  They'd been replaced with regular RN's who needed medical back up and consultation.  I agreed to do this as part of a Community Medicine Residency.  I did 2 years of Community Medicine and Public Health. a year into which I  started my psychiatry residency.  I continued to fly north as physician and psychiatry resident till near the end of my program. .
Most of the problems I was seeing were psychosomatic.  Anxiety and depression and family problems had dominated the country pracdtice.  There was also violence and job stress. Then in the north it was isolation, problems with government and major addiction issues.  I worked Churchill, and Island lake but I also doctored in Shamatawa, a name some might still remember for the lead poisoning from gas sniffing addiciton that so hurt this community.   I 'd seen that physical illness was as often as not a product of psychosocial problems which were the originating cause. Psychiatry at the time was the speciality that dealt specifically in biological psychological and sociological systemic perspectives.  It wouldn't stay that way.  As a result I've not been able to use roughly half  my training.   Psychiatry was once the study of the mind till over night it became all about the brain and a weak sister to the robust field of Neurology. Overnight, it seemed, science was out and pseudoscience was in. That's another story.
Psychiatry residency wasn't physically exhausting. I was even able to maintain a part time clinical practice as well as doing psychotherapy out of my home, continuing as an an occasional flyin doctor in the north as well as doing occasional locum work instead of having holidays or weekends.  I felt I needed  to get extra money for my marriage.  There were so many demands on me at the time. Today there are too but  today I can say 'no' more easily.     I moonlighted for the doctor in charge of the Winnipeg Detox in those days, too.  I never knew at the time that that experience would be a precurser to my later subspecialization in Addiction Medicine.
I recount all this here now because I  toured my old medical school this last trip to Winnipeg.  I'd not been back in the medical school for decades despite many visits to Winnipeg to see my parents. The fact was I carried alot of shame about my last year there, the divorce, abortion, the abuse, andthe betrayal,  all  the seeds that would 10 years later fuel a diagnosis of alcohol abuse, binge pattern    At the height of my success I felt a failure.
I did spend 6 months talking to Dr. John White intermittently about my journey in life. As a Christian psychiatrist he was kind enough to invite me into his office and listen and talk with me about my own feelings about my practice and study in pscyhiatry.  He always said my problem was spiritual rather than psychiatric. It was a decade at least before I understood what he meant.  I saw Dr. Zloty as part of my training in psychoanalytic psychotherapy. He said  I was normal except for a bit  more anxiety than others might have.  Indeed,  I was a golden boy.    In the last 6 months of my psychiatry residency my life as I knew it collapsed.  I found myself looking into an abyss.  At the time I was very fortunate to be working under Dr. Falconer.  Dr. Bebchuck, Dr. El Guebaly and so many more were there when I needed them.  I completed my residency, passed my exams.  I was even offered a position on faculty and began to work as associate professor and  staff psychiatrist.  But I wasn't there.  My heart was broken. I later wrote in an article for the Journal of Health and Religion, "a broken heart for a pscychiatrist is like broken hands for a surgeon."  Physician heal thyself.
Psychiatry isn't hard on residents physically. It does challenge one psychologically though. It's brutal socially.  I'd hardly thought of suicide yet daily I was with patients who may as well have been trying to sell  nihilism.  While I was  trying to sell   life they were giving me every excuse for ending it.  Everything I held dear and near seemed to be questioned in the crazy world of psychiatry.  Naturally patients are psychotic and question reality.  Worse psychopaths, almost like the snake in the garden of eden  whispered always, that their 'way' was the best way.  Why not 'cheat' ,'steal', do harm, destroy? .  It would also take me years of maturity to appreciate the men and women whose teaching wasn't as appealling at the time but turned out to become the cornerstone of what made my own clinical practice successful.   The frank narcissism of others  wore on me and wore  off on me.  Part of the problem of idealism is that altruism can be a castle built on sand.  I questioned God, morality and ethics.  I found myself all torn up inside.
Psychiatry residency isn't physically exhausting but it can be emotionally, psychologically, socially, morally and ethically devastating.   Residents commonly had divorces and breakdowns and many over the years dropped out. Some suicided. Others ended up in hospital beds.  I made it through barely.
I left the University of Manitoba. I left my faculty position. I left my broken marriage.  I left my family and friends.  I barely escaped with my saniety. Maybe I didn't escape with my saniety.  Maybe it took the next 10 years for me to find the lost bits of myself. Those bits I'd not held dearly or those bits others had chosen to steal. The next ten years were a roller coaster. I drove a beat up Baha Bug I'd named Pendergast to California. I did my American medical examinations. I had to relearn all the basic sciences and physical clinical medicine after years of focus on psychiatry.  Subsequently I  was offered staff positions at Stanford and Berkeley but instead returned to Canada. I was actually planning on taking a position  offered to me in Carolina. I liked the magnolia blossoms.  I'd intended  to drive across Canada. But my car broke down while I was visitting Expo. Friends took me skiing.  Next thing I knew I was a clinical lecturer at UBC..
My parents lived in Winnipeg.  I don't know if I'd ever have returned to Winnipeg were it not for them.  When I did return, I rarely visitted anyone, but them.  My visits were brief almost clandestine affairs until recently.  There was a rumor I died. I did take pleasure in making an appearance. .I  returned to lodge a formal complaint one winter through blizzards in a recovery car without heating.  I did that because I was told it was the right thing.    It wasn't.   It helped me with prayer though.  In the end I was visitting my mother in Deer Lodge Hospital, thankful for the wonderful care she received.  Her internist was one of my early teachers, a godsend.  The nurses were saints.
I  never regretted my medical school training. What I learned at University of Manitoba allowed me the priviledge of serving countless lives in family practice. Delivering a hundred babies, setting Rodeo fractures, and dislocations, being the only doctor in a meningitis epidemic on a reserve, doing a myriad of things all hours of day and night, thankful to my teachers for the skills I'd received.   I am forever thankful to theUniversity of Manitoba Department of Medicine and Surgery. To my mind they are unsurpassed. My work with the Northern Medical Unit under the mentorship of Dr. J. Hildes was unforgettable. I am simply  so very very grateful. I am thankful too for the patients who allowed me to join them on their healing journeys. Much of the medical school training was functional and technical.  Medicine is very much an applied science.  Most of my real learning was on the wards with small groups or individually with leading staff men. I had the thorough priviledge to learn from the giants of medicine late nights in corridors or at  the bedside of patients.  My greatest teachers were the humblest of men who always thanked the  patients for their many clinical lessons. Many spoke of God.
The same is true of  the department of psychiatry, headed by  Dr. Harry Prosen.   There are regrets though. Much of this revolves around the abuse and stigmatization of the mentally ill.  The remarkable men and women who were my teachers struggled at those edges of reality beyond the safety of the  physical.  The very best touched my heart and soul..
I mention this solely because it all contributed to my  returning to my alma mater, University of Manitoba, this year.
I'd not been to any University of Manitoba Alumni events, reunions or even walked through the halls I once lived in till then.
Every visit home I'd pass by the University of Manitoba, Faculty of Medicine door at the Health Science centre. .  I'd sit in the rental car outside the old entrance  and remember. Often I'd just cry.
This last time I was in Winnipeg attending the Christian Medical and Dental Society Meeting, more than a quarter century after I'd graduated.  This time I actually entered the university and walked through the halls, curious. I walked around those halls for hours. feeling good, so very good about being a student there, once so long ago. I'm a grey haired man today.  Yes, the students looked like children.It reminded me of my clerkship and internship when  some old fart like me said, "Go find  me an adult, sonny, I'm too old for children playing doctor."
On the second floor outside the lecture hall entrances I  found the picture of my class on the wall.   Everyone I remembered was there and then some.
There are pictures of every graduating class of doctors going back more than a century.  I was so very proud standing there after my own life time in the practice of medicine.   I let myself swell with  the pride of belonging.   I've earned my place so many times over.   Somewhere I stopped acting a doctor and became one.   The abuse of younger years holds little sway these days.  I'm still as confused as ever some days but my faith is stronger.  I'm  heavy with experience.  So many thousands of patients,  lives, illness and deaths.    As a doctor and clinician I know  today I have nothing to be ashamed of.   Others may. But I'm not alone anymore. I've paid my dues and I've  paid my respects.
Walking through those hallowed halls of higher learning,  I was touched by grace.  University of Manitoba Medical School, Community Medicine, the Northern Medical Unit and Department of Psychiatry are all sacred to me again.
It's been a long journey with too many sleepless nights.   It was good to return to the beginning.  Looking at the picture of my class I remembered  the comaraderie, and especially the humor.  In the midst of all the seriousness we still found time to laugh.  I heard Dr. Ronald say,  "I'm just an internist. All I have is pills and love. "   Standing alone in the halls of the University of Manitoba, Faculty of Medicine I felt the love from all those years ago.   Thank you to all my teachers, classmates and patients. DSC 0567
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your a sensitive person

and that isn't bad

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