Being seen in the worst of times

I walk into the Jewish General Hospital, past the clinic where I used to work, heading towards the radiation suite. It is weird to come back after eight years away, and to walk in as a patient instead of a doctor. Five people stop me as I walk down the hall. “Oh you’re back! Can I be your patient again?” I smile, non-committal. Would I ever see patients again? My first five years living in Toronto were the best of times. I was working as the director of the family medicine teaching program at a large community hospital, a job I had long coveted. The chief of my department was a kind and brilliant man. He was also a fiery lead guitarist in a semi-pro rock band. Married to one of the most prominent family medicine researchers in the country, I was pretty sure that he was not intimidated by smart women. He found me an intelligent and devoted program assistant, let us call her Maria, whose administrative skills compensated for my ADHD. In those first five years I helped write the CanMeds communication skills role. I then helped developed University of Toronto’s family medicine competency curriculum. Apparently, I had a talent for a well-turned phrase and translating ideas into practical and doable tasks. I loved teaching the residents and organizing their program. They told everyone that I was a kick-ass teacher, and they thought that my purple hair was cool. They reported that I was there for each of them when their lives were hard, when they had conflicts with preceptors, unexpected pregnancies or failed their rotations. They appreciated my high standards, because they knew I wanted them to be the best family docs they could be. Maria and I would work hard to give each of them the best possible residency experience. They enjoyed the parties we had at Christmas, where I encouraged them to create satirical skits, videos and songs in the longstanding Medical Education tradition. I too felt like a rock star. I won a hospital teaching prize that first year. They saw me.Then things fell apart. The administration changed, and my champions were replaced by people who were much less charmed by my line of chat or even actively disliked me. I felt suddenly politically isolated. At the first Christmas party with my new chief, there was a video of one of the male residents as a drag version of me, with enormous balloon boobs, purple hair, quoting “Perle’s Pearls” while eating handfuls of raw vegetables. “Why do you let them disrespect you like that?” Where she saw disrespect, I saw affection. The real problem though, was that my family was not doing well. My father was becoming more demented every day. My mother was worn out caring for him. Then my father died, and the day we got up from Shiva, the seven days of mourning, my sister found a lump that turned out to be cancer. A complication of chemotherapy which had a 50/50 chance of death put her in hospital. Soon after she came out of hospital our mother was diagnosed with lung cancer, and then she died just a few months later. I should have taken medical leave when all this started, but I hung on. In the face of the lack of support from my superiors, I tried to cope by working even harder. I put in longer hours, because the program had increased to a size that could not be managed by just one person. I was too proud to admit that I couldn’t cope. There was no one I trusted enough to confide in, and no one cared enough to ask me why I was not myself. No one saw what was happening to me. Despite my husband and children begging me to take leave, I just doubled down.The strain was showing though. I was snappy, lost my temper often, yelled at my staff with frustration when things went wrong. I was disrespectful at meetings and really childish. Who was this Perle? Maria took the brunt of my dysfunction, and I could see her respect and esteem dwindling, but somehow, I couldn’t stop myself. Unsurprisingly, they terminated my contract. For the next few years my friend Alan took me into his clinic, let me make a living and saved me from total humiliation. Then I attended a medical education conference in Montreal. While in town, I realized that my daughter was suffering from a serious postpartum depression. She was miserable, and her family needed me. I had been oblivious, because I was far away and mired in my own misery. I needed to come home.Then I ran into my former resident, Marion, who was now the program director. “I wish you were here” she said. “We are writing our competency curriculum, we could really use your expertise!” It was like a ray of sunshine piercing through the clouds. “Make me an offer,” I said.Half an hour later another old friend was there with a job offer. It was so good to be seen and wanted. Before I left Toronto I thought “I might as well get my mammogram done.” When the radiologist came into the room and wanted to do an immediate ultrasound, I knew what was up. Six weeks after cancer surgery, I met the radiation oncologist in Montreal. He was not impressed by the fancy genetic testing done in Toronto that said my tumour was low risk and needed no chemo. He was going to make sure that there was no cancer left and “sterilize the breast.” The treatment was gruelling! That rad-onc fried me so hard that my skin fell off and I had wounds on my back. You never want a radiation nurse to say, “Oh my God!” when she takes your shirt off, but she did. As I looked in the mirror, looking at my red, oozing breast, I really saw myself. I had let things go too far. I had blocked out the needs of those I loved most. I had lived in a state of denial, willfully not seeing what I was doing to harm those around me. I finally owned up to what I had done to harm my children, my colleagues and myself. I learned that I didn’t always have to tough it out, that sometimes quitting is the right thing to do.The burns healed. Slowly, my relationships with my children healed. Even more slowly, my heart healed. It has taken me a long time to write this story, to accept and deal with this failure. Eventually, I was able to go back to work and teach again, to heal other people. I was left scarred, but still strong. I am happy.There is a coda to this story. I sent it out to the people named in it as I always do. My former rockstar chief wrote back to me and asked me if Maria knew about this story. I said she would probably not welcome me contacting her. In his wisdom, he sent me her phone number. I sent her this story, we spoke, we forgave each other, we reconciled. This is the magic of storytelling!

Being seen in the worst of times

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Perle Feldman

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