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I wanted to be a writer since I was five years old, but I was afraid of starving to death, so I decided to become a doctor. Oh, sure, I'd have to go to school for most of my life and possibly sell a kidney in order to afford the tuition, but then I'd get to Help People. Plus, I'd have so many stories to write about, I could be a doctor and a writer instead of just a writer!

I also had vague ideas about running a clinic while wearing my baby in a sling on my back.

Fast forward to 2011. I am now an emergency doctor, which means I get to save lives in the most immediate way possible ("Everyone...clear!"), but I also deal with the most visceral, vulnerable people around at any time of day or night. That teenager puking up two liters of vodka and his stomach lining at triage? Yup. Blood pouring out of a terrified pregnant woman? Call me. And, of course, the patient who no longer has a nosebleed screaming at me across the department, "YOU are the most UNFEELING DOCTOR I have EVER MET!"

Even if I wanted to subject my children to that, I can barely carry my infant daughter on my back for an hour, let alone ten to fourteen-hour shifts. (At five months, she weighs 15.5 pounds.) So yes, I'm a tiny bit more realistic nowadays. Still, by working part-time, I have managed to juggle medicine, writing, mothering, and fun stuff like hula hoop workshops. I even see my husband once in a while.

Whenever I meet new people who are not doctors and I mention that I work in an emergency room, they usually say,

1. Are you a nurse?

2. Wow. That must be really hard.

3. What's it like?

This is what it's like.

Obviously, this is the truth as I see it. As Grace Paley observed, "Any story told twice is fiction." These are fiction-ier than most, since I also changed patient details and, you know, tried to make myself into a gorgeous young superheroine wherever I thought I could get away with it.

Let me peel back the curtain for you. It's not an iron curtain. In the emerg, it's most likely a crummy fabric curtain that too many other people have sneezed on.

Come on in.

PART I: BREAKING INTO THE BUSINESS

THE DOOGIE HOWSER DILEMMA

As a new physician, you’re worried enough about killing a patient, getting sued, and then getting thrown into debtor’s prison for unpaid student loans without one more stress: patients think you look too young to be a doctor.

Yes, it’s a compliment that they don’t think you need Botox or even Oil of Olay just yet. A French woman put it more poetically, saying I had “l’air d’une jeune fille.” But sometimes you can hardly start the history because they won’t let it go.

I enter the emergency department examining room. “Hi, I’m Doctor--"

The patient’s eyes widen. "You're the doctor?"

I smile and wave the clipboard. "Yes. I see here you've been having chest pain--"

He shakes his head, looking me up and down. "You look awfully young to be a doctor."

I clear my throat. "Well, I'm not. Don't worry about me. As for your pain--"

"You look like you're still in school."

“I’ve graduated.”

"Well, you don't look it. How long have you been doing this?" It took me a while to realize the last question, on its own, can also mean "You look too young and incompetent. Are you sure you know what you're doing?"

For my first locum, I prevaricated. I’d say, “How long have I been a medical doctor? Three years.” I had the M.D. degree to prove it, along with two years of residency and one of emergency medicine. I thought it was kinder not to say, “Hey, it’s my first summer. How am I doing?”

I had some experience bending the truth, starting with my first clerkship rotations. On family medicine in northern Ontario, the doctor took me aside and discussed how to excise a mole with an elliptical incision. She’d handle the scalpel work, but I’d get to close an incision for the first time. Maybe we didn't talk quietly enough. The patient regarded me in horror. “This isn’t your first time doing this? You’ve done this before, haven’t you?”

I hesitated. I’ve always been a very truthful person, but it was clear she didn’t want to know it was the first time I’d held a needle driver over a real, live patient.

I checked the doctor for a clue. She finished excising the mole with a silent smile.

“It’s not your first time?” The patient repeated.

Finally, I said, “No, I’ve done sutures before.”

Mollified, she settled down and I picked up the 4-0 Prolene suture without telling her I’d practiced on a cadaver. Once.

Fortunately, my sutures turned out just fine.

I expected the doubt as a medical student and resident. When Phoebe was in labour on the TV show Friends, she demanded a "grown-up doctor" and I knew what she meant. I started wearing a white coat as a resident to try and cut the questions off at the pass. But I always reassured myself that once I was fully licensed and could reply, "No. I am The Doctor," these comments would disappear.

Instead, I kept getting them and not handling them well. I tried a few different strategies:

1. I ignored them and plowed through the history, hoping they'd rather talk about their aches and pains. Instead the patient would repeat, “You look too young” and stare at me as if I were hard of hearing as well as a juvenile offender.

2. I tried passing it off as a compliment. “Oh, ho ho, you flatterer! Now let’s talk about your dizziness.” That patient also repeated himself and looked like I was insane, especially when I added a jocular tap on the shoulder to emphasize our camaraderie.

Hmm. Obviously, I needed a new strategy. I asked my friends how they handled it. One said she answered, “I’m older than I look.” That made sense, but my favourite suggestion was from one of my best friends, a non-doctor:

Humor. She even offered me the line to use.

I could hardly wait to try it out. On my very next shift, an 83-year-old woman frowned at me and said, "You don't look old enough to be a doctor."

I paused, leaned forward and whispered confidentially, "Shh. I'm not."

She reared back and regarded me with horror. "What did you say?"

So I never used that joke again. Instead, I tried another line from another friend: "Just call me Doogie Howser." I've also tried, "Don't worry, I'm legal," which evokes a different kind of fear response.

I haven't needed any lines at all recently, since I've only done a few shifts since my maternity leave and no one has carded me. Maybe it’s because my baby's sleepless nights have etched new wrinkles on my face and whitened a few more hairs.

Or maybe I just haven’t seen enough patients yet. A few months after my son's birth, one acquaintance looked at me and said, "You know what? You don't look old enough to be a mother."

Let me rewind the clock to my first few days of medical school: a day in the life of a neurologist, as witnessed by a total newbie.

THE ORIENTATION: INTENSIVE CARE

"I have a lot of problems," said the middle-aged woman.

I shifted in my seat, nodding and smiling. This was my First Patient Ever.

"Like bruises," said the patient. "Here, look at the one on my hand. They turn red, then purple, then green."

I took notes in tandem with the other medical student, Rowena. I was still secretly amazed that the neurologist let us interview her on our own. A week ago, I was just another 22-year-old student; now I wore a short white coat and I was on my road to doctordom.

One study that found first year medical students were better interviewers than third years, because they listened more. When I heard that, I swore I'd always listen to patients, 4ever. I'd never call them gomers ("Get Out of My Emergency Room"), no sirree.

The neurologist re-entered the room. We described the bruises. The doctor's brow pleated. "What about the reason she's here?"

Whoops. She was a schizophrenic woman who had seizures. As a brain doctor, he wanted to know about the seizures. It was my first lesson that what the patient wants to talk about and what the doctor wants to know is not necessarily the same thing.

In the afternoon, the neurology resident brought us to the Intensive Care Unit.

I squeezed Rowena's hand, thrilled. Now this was medicine! I imagined a few rooms with patients on beds, attached to respirators.

The neurology resident turned out to be a well-dressed brown guy with a painfully firm handshake. In the elevator, he whispered an explanation for the Glasgow Coma Scale. "A corpse gets three, so you can't go any lower than three. The best score is fifteen. You can get four points maximum for opening your eyes on your own, five points for talking coherently, and six points for moving spontaneously."

The ICU turned out to be a lot bigger than I thought, almost a warren of large rooms, each one containing multiple patients side by side. I had to hustle to keep up with the resident, who made a beeline for one comatose patient and asked her family to excuse us.

One family member compressed her lips and shook her head before she moved off.

The neurology resident yanked the curtain around the bed. The patient was a thin, grey-haired elderly man in a baby blue gown. "Okay, so we have to see how responsive he is. Michael. MICHEAL! OPEN YOUR EYES! OPEN YOUR EYES, MICHAEL!"

He didn't.

"SQUEEZE MY HAND, MICHAEL. SQUEEZE MY HAND. No response," he noted to us. Then he started rubbing his knuckles hard against the patient's breastbone. Michael winced, eyes still closed, but his arm snaked up, as if to push him off.

"That's localizing to pain, so that's five out of six. He never opened his eyes, so that's a one. He moaned--a two. Eight out of fifteen."

I nodded solemnly. I didn't understand why this man was in a coma, but the resident had explained the Glasgow Coma Scale well.

It was my first lesson that what they teach you and what you want to know is not necessarily the same thing.

At the University of Western Ontario, you can do electives (shadowing real doctors) right off the bat. I decided to do family medicine with a doctor who did deliveries, a no-holds-barred Dr. McKean.

I DON'T KNOW NOTHIN' 'BOUT BIRTHING BABIES

In my first month of medical school, the family doctor I was doing an elective with got a call to deliver a baby. On the elevator ride up, Dr. McKean said, "This woman's a primip (first-time mother), so we'll probably have lots of time before she delivers. We can grab a bite to eat."

I hadn't realized that we were allowed to eat.

In the delivery room, the woman lay on her back with her feet in stirrups. Her husband stood by her side. Dr. McKean whipped on a pair of gloves and examined the patient. She said to the nurse, "You know what that is? A head." To me, she added, "No supper. This baby's coming out sooner than we thought."

"Great!”

"You need a pair of gloves. What size are you?" She coached me into a sterile gown and gloves, chatting with the nurse about the epidural.

The patient was semi-sitting with her legs spread wide open. It was somewhat shocking to see her vulva all stretched out, with Dr. McKean spraying brown iodine over the area and saying matter-of-factly, "Yes, you have hemorrhoids."

The door opened and a girl walked in. "Hello, my name is Oksana, I'm a third-year clinical clerk, here to help Dr. McKean--"

The nurse replied icily, "Dr. McKean already has a first-year clinical clerk here to assist her."

I winced. The third year med student outranked me. There was no such thing as a first year clinical clerk. Clerkship starts in your third year, when you rotate through the hospitals. I was a first year no-name. Still, the clerk ended up leaving.

Dr. McKean and the nurse yelled, "Push! On count of ten! Pushpushpushpushpush. Push harder, now, Philomena. You can do it." The husband teased that she should deliver in time for Melrose Place.

The baby's head was hung up on her pelvic bone and couldn't seem to get out.

Dr. McKean kept saying, "You can scream, you know. You can swear. Don't hold back."

"No! I am--good girl!"

"Push push now," said her husband. At one point, he asked, "Are you pushing?"

"I'm pushingggggg!" she screamed, her voice rising into incoherence.

The mother turned bright red and bore down, a tiny squeal escaping her. She pushed out the baby's head.

The head was facing downward, so it was looking at the garbage can between its mother's legs, full of fluid and blood. This reminded me of a line from Sigmund Freud that had disgusted me when I first read it: "We are born between shit and urine."

The baby's head was purple/mauve, an ugly little squash of a face, and at the same time, so miraculous, I cried and hardly felt the tears coursing down my face. Even so, when brown fluid sprayed out at the same time, I made sure to dance out of the way.

Within seconds, the arms dangled, purplish too, and the little face puckered up. The baby's torso and legs slipped out.

The mom wept too. The dad looked like he wanted to.

Dr. McKean brought the baby right up on the mom's chest, in one smooth movement. "It's a boy."

"YES!" yelled the husband, dropping to his knees and pumping his fist at the sky.

The doctor beckoned me in to clamp the cord. I brought the clamp in place, but before I shut it, she said, "Make sure it's not around anything important, like a penis." It wasn't.

"Now, cut the cord, dad," she ordered, and he did.

After we checked and cleaned the baby and swaddled him in a warm blanket and a white cap with a blue pom pom, the father held him and crooned, "You're so ugly...you're so ugly..."

He was ugly, but I was astonished to hear the father say so. My friend Ranita later explained that in some cultures, you say that the baby is ugly to ward off evil spirits. Also, three years later, during my obstetrics rotation, I discovered that all newborns look like that.

The father whipped out his cell phone and started calling people. Whoa. I'd imagined the two of them would just hold the baby quietly for a minute.

The mother requested that they lower the bed railing so that she could see the baby. Her legs were shaking violently. "It's normal," Dr. McKean reassured her. "After all the work you've done!"

"Thank you," said the mother. "Thank you, all of you." She hugged me.

Dr. McKean was suturing the perineum. She made a face. "I should have done an episiotomy. This is a stellate tear." She glanced at me. "Here, you do a stitch--oh, wait. You're not sterile. Hugging the patient!"

I nodded. I didn't mind not suturing. I still had tears in my eyes.

The nurse accidentally moved the catheter so that urine sprayed all over Dr. McKean's leg. Although the doctor was wearing rubber boots, she was not amused.

The baby weighed 4.160 kilograms, or 9 pounds, 3 ounces. A big baby.

Dr. McKean wrote me down as the assistant for the case, "So they can sue you, too."

After the mother was stitched up and covered with a blanket and the baby was in the bassinet, Dr. McKean held her hand. "My mother makes booties for all the patients I deliver."

That night, I biked home, filled with new energy. Who cared about the anatomy bell-ringer tomorrow morning? This was why I'd gone into medicine!

Still, I remembered the nurse rolling her eyes while talking about the epidural and pain control. "We don't want any women without it. There was one 'natural' childbirth today, and you could hear her screaming down the hall."

That chilled me. I'd planned to have natural childbirth.

A PAIN IN THE TOENAILS

My first night on call ever as a clinical clerk, I headed down to the emergency room to see an 80-year-old lady with bloody diarrhea. She had just been discharged from UWO's University Hospital. As soon as they dropped her off, she promptly called another ambulance, which brought her to St. Finnan's Hospital and me, the clerk on internal medicine.

On the stretcher, Mrs. Ursel moaned and glared at her son, who was saying, "I'm leaving you, Mother, since the doctors are here. But I brought you a book. Chicken Soup for the Mother's Soul. See?"

She sniffed and turned her head away.

"I'll just put the book on your table. You can read it when you're feeling better." He dropped it there with an audible thump.

"You don't have to leave," I said. "You can stay until we decide what we're doing with your mother."

"No, that's okay." He bid her a hasty good-bye and left.

Hm. I interviewed Mrs. Ursel, a thin, elderly white woman. She was delighted to tell me about all her bloody diarrhea and how much abdominal cramping she was having and how worthless University Hospital was. She groaned and lifted her hips slightly. "Ah, there goes another one. I need a new diaper!"

I paged the senior resident on call and related the story. He said, "Her diarrhea isn't that severe. Her vitals are normal, and her blood work is okay. She could probably be worked up as an outpatient. But her son has abandoned her and she just got bounced out of UH. We'll have to take her."

In the morning, Mrs. Ursel received a colonoscopy and turned out to have ulcerative colitis. I asked her if she had any questions, but she cut me off to complain about everything from her untrimmed toenails to the pain in her second toe.

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