Black Box

What happens when memories are triggered when you least expect them? In my current life, practicing psychiatry, I usually think of triggering as something negative and difficult, but what happens when something positive and affirming is recalled?

This week, I was in Montreal on a cold November evening for the first time in thirty years. I walked around the Lower Campus of McGill University, again something I have not done for thirty years. Through the windows of buildings that I had known too well, I saw young people pouring over their work, as I had done. McLennan Library was bustling, a sign that there is less than one month before exams and papers are due. I shuddered with the memory of all that work, wondering in the moment how I had ever gotten everything done.

I was reminded of a long-forgotten schedule and I hastily turned up McTavish Street, heading from Sherbrooke Street toward Dr. Penfield Street, toward the Students Society of McGill University Building and the Players’ Theatre. Forty years ago, I spent more time with the Players’ Theatre than I did on any of the things I was supposed to be doing, like reading Harrison’s Textbook of Internal Medicine or reviewing anatomy for my surgical clerkship. The time I’d spent there had meant that I’d barely managed to pass anatomy, but, on the other hand, the time I’d spent there had helped me to survive four years of undergraduate medicine. I could never understand how medical studies could be so much more sterile and heartless than the English and Theatre from whence I’d come, but they were.

Players’ Theatre was founded in 1921, operated completely by undergraduate students at McGill, funded completely by ticket sales. I remember selling tickets to plays, although I don’t believe I ever sold one ticket to my medical school classmates. Theatre was my shameful secret and, even now, I feel I am confessing a weakness as I write this.

Buildings such as the Students Union Building are open at 7 p.m. and I walked in to the building and into the theatre. Players’ is a Black Box Theatre, a simple performance space with plain, black walls and sets are always minimal. It is a space where actors and audience can imagine freely what the scenes might be. As I looked at the space forty years later, the scenes I recall are vivid. I am experiencing flashbacks, I realize. This plain space, so ordinary and unremarkable, had kept my mind open as everything I had to remember in medical school threatened to close off and close down my imagination. The space had not saved my life, but it had certainly saved my mind.
I watched myself running from the space, after a performance, rushing to get back home to study such things as how the Loop of Henle works or the layers of the retina. How could I remember soliloquies, but not remember the layers of the retina?

I am sitting on the steps, and a young woman approaches me, “Can I help you?”

“Oh, no, I’m just remembering. I used to act here, when I was a student, forty years ago.”

“What do you do now?”

“I’m a doctor.”

The young woman stares at me. Slowly, she says, “Do you know that we’re doing Fables now? It seems odd, you being here tonight after forty years and being a doctor, like you’re coming full circle or something.” Fables is a play by Jackie Torrens with four characters, one of whom is a doctor – a traditional, male doctor, but wasn’t that the case forty years ago?

I stand to bid farewell to the young woman and to the space. For now as then, I must rush off. There is something I must do. I had forgotten this healing place, but I must not forget again. I am not sure I will be able to return in forty years to be reminded.

(A Typical Black Box Theatre)

Reflection of a Life-Long Learner

One of the most appealing aspects of a medical career is that you are always learning. In my field of Psychiatry this has been especially true, although perhaps I say this in ignorance since I am not nearly as familiar with the developments and discoveries in specialties other than my own.

Ongoing self-education is so important to a medical career that all educational colleges require their members to be current in their chosen field. In the Royal College of Physicians and Surgeons of Canada, of which I am a Fellow, there is a five-year cycle of learning in which I must participate. I must also prove that I have completed the elements of the cycle on an annual basis. Over the 30 years that I have been a Fellow, this system of establishing that I continue to participate in Continuing Medical Education has developed and modernized. The Royal College strives to promote that Fellows must be current and knowledgeable.

This is not even a new concept in medicine. Sir William Osler told medical students: The greater the ignorance, the greater the dogmatism.” Osler’s love of learning was reflected in the vast library he accumulated. His original library of 8,000 volumes of medical and other books was donated by Osler to McGill University, in gratitude for his medical education. That collection formed the original collection of the Osler Library of the History of Medicine at McGill University. (http://www.mcgill.ca/library/branches/osler) The collection has grown to over 100,000 volumes. When I was a medical student, I spent a great deal of time in the Osler Library. When anatomy and physiology seemed incomprehensible to my English-honours trained brain, Osler’s library was a wonderful reminder that I had years, a whole lifetime, to learn my craft. Osler loved teaching medical students and residents ( albeit only male medical students and residents) and he certainly instilled the idea that medicine was a career of life-long learning.

I am committed to the principle that a doctor must continue to study, observe and learn. Because of this, I am very much troubled by the current fashion to call medical students and residents “learners”. It seems to exclude the rest of us from the category when, in fact, we likely all want doctors to continue to be “learners” throughout their career. I have looked through the websites of the educational colleges to have an idea of when this practice began. It seems to be one of those trends that just snuck up on us, but it does seem to be sticking. In general, I hate to mention my dislike of this usage for fear of insulting both residents and students since this is the term that all student and resident leaders use to describe the collective of medical students and residents. I never use “learner” when I mean a resident or a medical student, for the reason I have set out. I do not want to be excluded from those who must continue to study.

I would also never want to give the impression that learning in medicine (or any worthwhile career, for that matter) stops. My life-long effort to learn medicine is ongoing. This was proven to me very definitively about three years ago when I found myself describing exactly where the hypothalamus is located in the brain – something I could never have done as a medical student. There is still hope that I will learn the physiology of the Loop of Henle.