BALANCE
IN MEDICINE
QMR
QUEEN’S MEDICAL REVIEW
Table of Contents
ISSUE 12.1 BALANCE IN MEDICINE
Letter from the Editors
Opinions
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Cash rules everything around medicine 3 Bryan Franco (Meds ‘21)
Poetry & Creative Pieces
28-year-old female presents with 13 Lyndsey Gott (Meds ‘20) The tightrope 15 Alex Morra (Meds ‘21) The heart of the ICU 16 Malak Elbatarny (Meds ‘19)
Balance in the borderland 5 Sara Brade (Meds ‘21) Hardcore and metalcore 8 Evan Lusty (Meds ‘21) From me to you 10 Shubham Sharma (Meds ‘21)
Others
Off Balance 17 Mike Christie (Meds ‘21)
This clerkship life 11 Yannay Khaikin (Meds ‘20)
Is your time ever truly "free"? 19 Nicole Krysa (Meds ‘22)
#QmedKeepsMeWell 23 SGL horoscopes 25 Call for submissions backcover Jacalyn Duffin Health and Humanities Conference
Production Team
QMR EDITORS-IN-CHIEF Shakira Brathwaite & Shannon Tang
WRITERS MANAGING Sara Brade EDITOR Mike Christie
Nicole Krysa Malak Elbatarny Bryan Franco Lyndsey Gott Yannay Khaikin Daniel Huang Nicole Krysa Angela Wan Evan Lusty Alex Morra Shubham Sharma Martina Heinelt Angela Wan Kimberley Yuen Alan Huynh
LAYOUT
ILLUSTRATION
EDITOR
The views and opinions expressed are of the original authors and are not necessarily representative of the views of Queen’s Medical Review, the School of Medicine or Queen’s University Please address all correspondence to: Queen’s Medical Review c/o Undergraduate Medical Office 80 Barrie Street Kingston, ON K7L 3J7 Email: queensmedreview@gmail.com
Letter from the Editors
Article type
Dear Readers, Welcome to the first issue of Volume 12 of the Queen’s Medical Review! We are honoured and excited to embark on this journey with you and our amazing creative team. In this issue, we break down some of the themes and ideas we associate with Balance in Medicine. This entirely student-run publication always endeavours to be a safe-space that encourages the free expression of opinions and diversity. A commonly encountered theme in this issue is how the authors strive to maintain balance, whether it be in their daily lives or in their understanding of the medical field. These candid pieces tie in the challenges of the medical field with personal experiences and daily lives, and we are proud to share with you the hard work of QMR. In this issue, we begin by discussing the balance of remuneration in medicine with Bryan Franco (2021) and then discovering spiritual balance with Sara Brade (2021). Evan Lusty (2021) then shares how hardcore and metalcore music have shaped his development as a medical professional, followed by Shubham Sharma’s (2021) open letter, entitled “From me to you”. Next, we are introduced to stories of clerkship in a promotional article by Yannay Khaikin (2020) about the podcast, “This Clerkship Life”, created by our very own QMed students from the Class of 2017 and continued by a group from the Class of 2020. We also explore the themes of balance through poetry, and we meet Lyndsey Gott’s (2020) “28 year old female presents with” and Alexandra Morra’s (2021) “The Tightrope”. Malak Elbatarny (2019) rounds out our creative pieces with the short story “The Heart of the ICU”. Mike Christie (2021) shares another perspective on living a balanced life, suggesting that the focus should be on not maintaining balance at all. Nicole Krysa (2022) writes about her own journey to find meaning in balance during the transition from a premedical student to a “pre-residency” student. In addition, we share some photos from the Wilderness in Medicine Interest Group, Wellness Committee, QMed Huge Squad, Hippochromatic Notes, WHIM Historical Society, Aesculapian Society and our peers. Finally, we hope you find some truth and humour in our “SGL Horoscopes”. This issue and past issues can be found online at https://issuu.com/queensmedreview/stacks, as well as in print. If you’d like to reach out, give us a shout (#QMR) on our brand-new Twitter account (@queensmedreview) or Instagram (@queensmedreview)! We want to extend a sincere thank you to the amazing hands and minds that made this possible. We could not have done this without our incredible writers, diligent editors, talented graphics team and our exceptional layout team. A special thank you to those who have worked behind the scenes - our managing editor Nicole Krysa (2022), sectional editor Alan Huynh (2021), graphics team of Martina Heinelt (2021), Angela Wan (2021) and Kimberley Yuen (2022) and layout team of Daniel Huang (2021) and Angela Wan (2021). We hope that you will enjoy this issue as much as we have enjoyed making it!
Shakira Brathwaite & Shannon Tang Editors-in-Chief, 2018 - 2019
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CASH RULES EVERYTHING AROUND MEDICINE:
Finding a counterbalance to fee-for-service Bryan Franco, Meds'21
committing robberies for money). C.R.E.A.M. ends with Inspectah Deck reflecting on the influence of money, for better or worse, on individuals’ actions: “[people] got to do what they got to do to get through, know what I'm sayin'? Because you can't just get by no more.”
"Fee-for-service implicitly values quantity over quality and, most importantly, the provision of services over helping our patients. "
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n 1993, the Wu Tang Clan painted a vivid picture of their life in New York City, where “stayin’ alive was no jive”, in C.R.E.A.M. (an acronym for “Cash Rules Everything Around Me”) (Wu Tang Clan, 1993). The song is littered with examples of how their days revolved around attaining the financial means to survive—for example, Raekwon recalled how he was “runnin' up in gates and doin' hits for high stakes” (i.e.
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Nowhere is the concept of C.R.E.A.M. more apparent than in the predominant physician payment model of our healthcare system: fee-for-service. According to the latest data available, fees for services account for 72% of the physician payments, albeit this proportion has decreased from 90% since 1999 (Canadian Institute for Health Information, 2017). In the fee-for-service model, physicians are paid for performing certain actions (e.g. a catherization of the right heart or an intermediate assessment by a family physician) according to a “Schedule of Fees and Benefits” (Tu, Cauch-Dudek, & Chen, 2009). Unsurprisingly, the Schedule of Fees and Benefits is a contentious issue in Ontario as the Ontario Medical Association negotiates its terms with the provincial government. The Ontario Medical Association plans to renegotiate fees in such a way that narrows the income gap between physicians from different specialties (Boyle, 2018). The widening gap was created in part by advances in technology that allowed certain specialties to bill OHIP more prolifically. For example, ophthalmologists benefited from technological advancements in the last few decades that enabled them to perform procedures faster than when the fee schedule was originally developed.
Opinion This is not to say that specialists are at fault for benefiting from the current fee-for-service schedule—they, like all physicians, must work within the same antiquated remuneration model. At the core of the many criticisms of fee-for-service is the perverse incentives associated with it (Lewis, Donaldson, Mitton, & Currie, 2001). Fee-for-service implicitly values quantity over quality and, most importantly, the provision of services over helping our patients. This model of remuneration fails to capture a central—perhaps naïve—truth in medicine: most doctors do not work to perform services, but rather to improve people’s lives. In other words, the services that we provide, from diabetes management to hysterectomies, are simply means to an end: reducing morbidity and mortality. In contrast, a fee-for-service remuneration model operates under the premise that all medical care deserves to be compensated, regardless of its impact on outcomes. We, as a society, have decided that faith in the medical profession is enough to justify public expenditure for all medically necessary care (as per the Canada Health Act). However, certain movements have recognized this fallacious premise and aim to change the landscape of our healthcare system. The Choosing Wisely c ampaign aims to reduce care that at best is unnecessary, and at worst, harms patients (Levinson & Huynh, 2014). Similarly, pay-for-performance models in the United States aim to reward high quality care rather than only focusing on the provision of services (Davis, 2007). Nonetheless, these post hoc efforts have yet to be explicitly integrated into our healthcare system. There needs to be a counterbalance to the perverse incentives created by fee-for-service. Society’s trust in the medical profession is built in part on our ability to critically assess the value of our actions—evidence-based medicine allows and creates the expectation for us to systematically appraise the care we provide. In contemporary medicine where evidence reigns supreme, we have the tools to question the underlying assumption of fee-for-service—that all medical
"If medicine is to claim to be an evidence-based profession, a corresponding evidence-based physician payment model is needed." care has equal merit—and strive for a payment model where impact on morbidity and mortality is also considered in remuneration. Evidence-based medicine provides us a way to tip the balance away from fee-for-service in its current form towards “fees for outcomes.”
"It is worth striving for a model where physicians are remunerated for improving the lives of their patients rather than simply providing services because after all, doctors—like anyone else— got to do what they got to do to get through", know what I'm sayin'?" If medicine is to claim to be an evidence-based profession, a corresponding evidence-based physician payment model is needed. The physician remuneration model should reflect the purpose of physicians and our health care system: to reduce patients’ morbidity and mortality. It is worth striving for a model where physicians are remunerated for improving the lives of their patients rather than simply providing services because after all, doctors—like anyone else— got to do what they got to do to get through, know what I'm sayin'? References: 1. Boyle, T. (2018). OMA leaders back plan to narrow pay gaps between medical specialties. Toronto Star. 2. Canadian Institute for Health Information. (2017). Physicians in Canada, 2016: Summary Report. Ottawa, ON: CIHI. 3. Davis, K. (2007). Paying for care episodes and care coordination. N Engl J Med, 356(11), 1166-1168. doi:10.1056/ NEJMe078007 4. Levinson, W., & Huynh, T. (2014). Engaging physicians and patients in conversations about unnecessary tests and procedures: Choosing Wisely Canada. CMAJ, 186(5), 325-326. doi:10.1503/cmaj.131674 5. Lewis, S., Donaldson, C., Mitton, C., & Currie, G. (2001). The future of health care in Canada. BMJ, 323(7318), 926-929. 6. Tu, K., Cauch-Dudek, K., & Chen, Z. (2009). Comparison of primary care physician payment models in the management of hypertension. Canadian Family Physician, 55(7), 719-727. 7. Wu Tang Clan. (1993). C.R.E.A.M. On Enter the Wu-Tang: 36 Chambers. Loud.
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BALANCE IN THE BORDERLAND:
Marshall McLuhan, media, and sacraments Sara Brade, Meds'21
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bout a week ago, I attended a conference held in Brennan Hall of St. Michael’s College at the University of Toronto. One of the speakers, a Catholic priest1, took the location as an opportunity to reference Catholic convert, Marshall McLuhan – a famous St. Mike’s professor who wrote about media and technology, from the Greco-Roman alphabet to the Internet that did not yet exist.
March 25, 1937 – Holy Thursday of that year. He remained a devout Catholic for the rest of his life.
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The priest at the conference I was attending referenced McLuhan’s insights into the challenges faced when proposing a sacramental faith to an anti-sacramental world. The Catholic Faith is sacramental in its very nature – ordinary materials are transformed to become visible and tangible signs of grace. Take the Eucharist as an example: Catholics profess that ordinary bread and wine, when consecrated during the Mass, become the Body, Blood, Soul, and Divinity of Jesus Christ – the material is used to make present the immaterial. Our technological world is always finding new ways to do just the opposite. We transform material realities into increasingly immaterial constructs. For example, radio, television, and social media all take communication out of the realm of the physical body and into the realm of the digital world. We have transformed communication in this anti-sacramental way so much so that I have access to the world from my apartment as long as I have my phone and a charging cable. The consequence of living in a world dominated by a digital anti-sacramental ethos is that it requires a paradigm shift to propose or to practice a sacramental faith. To read more about this idea from the article that this article is based on, search for Fr. Raymond J. de Souza’s, “Marshall McLuhan and the Divine Message.” For me, striving to live a sacramental faith in an anti-sacramental world is a challenge – while there are certainly benefits associated with our technological world, there are also
" When I find myself caught up in the distractions and burdens of my "We have transformed anti-sacramental world, a trip communication in this to St. James grounds me in the anti-sacramental way so much sacramental reality of God’s so that I have access to the personal love – that He gives world from my apartment as Himself to humanity under long as I have my phone and a the guise of bread and wine." charging cable. The consequence of living in a world dominated by a digital anti-sacramental ethos is that it requires a paradigm shift to propose or to practice a sacramental faith."
McLuhan was raised Protestant, though by the time he was exposed to Catholic thought, through his studies and through a friend, he didn’t believe in anything. At Cambridge, studying the history and conflicts surrounding the nature of human understanding, McLuhan encountered the works of Origen, the Church Fathers, and St. Thomas Aquinas, to name a few. It was also at Cambridge that a good friend gave McLuhan a book by Catholic convert, G.K. Chesterton, entitled What’s Wrong With the World. Convicted of the Truth of the Catholic Faith, McLuhan was baptized and confirmed on
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Opinion
Eucharistic Adoration at St. James’ Chapel of St. Mary’s Cathedral in Kingston, ON
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burdens. I think the benefits I experience from the digital world can be summarized by the word convenience. It’s convenient to see what old friends are up to on Instagram. It’s convenient to FaceTime my parents when I’m away at school. It’s convenient to Google things instead of having to flip through reference texts. In contrast, there are two burdens of note that I encounter related to our anti-sacramental world. First, it often feels like I exist in a state of perpetual distraction – with Newsfeeds for days there is always an app to open that can fill the spaces in my day and take me away from the present moment. Second, this kind of communication overload doesn’t usually leave me with a feeling of joy like I would have after meeting a friend for coffee; rather, it leaves me with a sense of dissatisfaction.
" Living in this borderland reminds me of St. Paul’s promise that God works all things together for the good for those who love Him –
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in St. James’ I experience the reality that God works through the Sacraments, but He is not bound to working through the Sacraments alone. " Finding order and balance in the two worlds I inhabit – the sacramental and the anti-sacramental – has taken time and effort. In Kingston, I live close to St. James’ Chapel – just off of Brock St. across from the Fire Department, it’s a small chapel attached to St. Mary’s Cathedral. Over the past year or so, I’ve tried to make a habit of stopping in to pray there everyday for about half an hour. It’s quiet, smells faintly of incense, and Jesus is there exposed in the Eucharist for Adoration everyday. When I find myself caught up in the distractions and burdens of my anti-sacramental world, a trip to St. James grounds me in the sacramental reality of God’s personal love – that He gives Himself to humanity under the guise of bread and wine. Sometimes I experience St. James as a borderland between the sacramental world and the anti-sacramental world – for example, in the presence of Jesus in the Eucharist, I’ll use
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my phone to listen to a talk or a song that reminds me of how much I am known and loved by God. Further, there have been many instances in my life, from YouTube videos to text messages from friends, where God has used the anti-sacramental world to communicate His love in a personal way. Living in this borderland reminds me of St. Paul’s promise2 that God works all things together for the good for those who love Him – in St. James’ I experience the reality that God works through the Sacraments, but He is not bound to working through the Sacraments alone. At the end of an introduction3 to a collection of essays by Marshall McLuhan on religion and media, his son notes the following: My father had made a date to give a talk, at the outset of the fall term, 1979, on the topic of “Discarnate Man and the Incarnate Church,” to a class at St. Michael’s College… Just before he was due to give the talk he had a stroke that took away his power of speech. That topic, however, plays a large role in the essays that follow. The reader might be interested in piecing together, from remarks in the chapters below, the probable text of that talk – The Talk He Never Gave. “Discarnate man” could be another way of saying anti-sacramental man. Communication in its anti-sacramental forms is divorced from its source in a physical body in all kinds of media – books, radio, social media, etc. While we can certainly enjoy anti-sacramental forms of communication and use them for the good, we know that there is something, or more appropriately, someone missing. For example, no one would mistake a book for the author himself. We know that a phone call with someone we love and miss isn’t the same as getting a big hug from them in person. I wonder if part of “The Talk He Never Gave” went even further. I wonder if McLuhan pointed to the restlessness and the yearning for Truth, Goodness, and Beauty in every human heart that even our closest personal relationships don’t satisfy. I wonder if he proposed that God Incarnate who entered into our humanity as Jesus of Nazareth is the source of and the answer to the restlessness that persists even in the hearts of modern and advanced “discarnate” men and women. This is the same Jesus who comes to us in the Sacrament of the Eucharist – who waits for us in the quiet borderland of St. James’ Chapel. Perhaps it is our anti-sacramental world, with its immaterial innovations and isolating instant communications, that stirs up in us an even greater desire for the sacramental – for tangible signs that make visible the reality of God’s presence in our lives. References: 1. de Souza, Raymond J. "Marshall McLuhan and the divine message." National Post, (Canada) July 19, 2011. 2. Romans 8:28 3. McLuhan, Marshall. Medium and the Light: Reflections on Religion. Eds. Eric McLuhan and Jacek 4. Szklarek. Toronto: Stoddart Publishing, 1999.
Opinion
HARDCORE AND METALCORE
Evan Lusty, Meds'21
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ardcore and metalcore has been a way of expressing myself for as long as I can remember. It follows then that for as long as I can remember I have been playing it, writing it, going to concerts, and dreaming about being a professional musician. However, as time wore on, I realized that the music I loved was pushing me in a different direction and that the lessons I learned from it could help me in a radically different profession. Consequently, my journey from the stage and mosh pits of local concerts into medicine then began. This journey was enriched by bands like Stick to your Guns, The Ghost Inside, and Polaris, who all wrote beautiful lyrics about the lived experience. To date I have been incorporating their lyrics into my approach to medicine and carving out a balance between an artform I love and a profession I will soon enter. It is my belief that this will help me practice medicine well, understand illness, and optimize my own performance. Hardcore and Metalcore to me has always been about accepting other people for who they are, as they come, and uniting in song to help the spirit. Medicine, though I have not practiced, should be the same way and it should also take into consideration the needs of a patient’s corporeal form. The perceived similarity between hardcore/metalcore and medicine is one of the reasons I gravitated towards medicine in the first place and is exemplified by lyrics from With the Wolves by The Ghost Inside.
"Like a flame burning out, but I have a light When you’re in the dark and out of doubt, find me!"
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With the Wolves – The Ghost Inside This song communicates that when people come to you looking for help, you should help them. When someone needs a guide, if you can, you should guide them. This also applies to medicine where we see on a daily basis that all that ignites is bound to decay and people need you when this is
happening. This is one of the reasons I wanted to become a doctor, so that when someone is potentially having the worst day of their life, I can do my best to be a person they can depend on even if I don’t always have all the answers. Dark days can come in many forms. Having a special interest in addictions medicine has made this all too clear. This message was made clearer still when I heard the music of Polaris and a song called Relapse. They give a beautiful description of why they believe their loved ones have turned to using dangerous drugs.
“The poison in my head’s become the poison in my veins”
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Relapse – Polaris
This simple line delivers the message that social, and psychological factors coalesce to influence the human experience of illness. It reminds us that things like loneliness, feelings of worthlessness, and depression influence almost every facet of a patients lived experience. It is for this reason that these are the feelings I hope to challenge with my future patients so that we can build for them a life that they want and can control. Interestingly, they used the word “we”, implying a partnership between future physician and future patient. I believe Hardcore has helped me learn how to become a better partner. While With the Wolves and Relapse have helped me understand why I would like to be a doctor and an aspect of one illness, Stick to your Guns has affected every aspect of my approach to medicine. In their song D(iam)ond they talk about the balance of self, an incredibly important subject if I am going to be the best doctor I can be. This is because as a future professional I think it is important to see that I am human being that can only be human (with all the flaws that come with that package).
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“I am a brave man, I am a coward I am the tiger, I am the flower”
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D(iam)ond – Stick to Your Guns
This song refers to the beastly side within us all, but then matches it with the unparalleled beauty we are capable of. It implies that there are times that we will be brave and do the right thing but there will also be times when we fail. This has motivated me to recognize that despite the failures I will endure, I have to be brave enough to face my humanity and be more like the flower and less like the tiger. This song reminds me that self reflection can be painful and difficult but I, like a diamond, am valuable and have to polish away some grit before a shine can be seen. Moreover, I have to do this if I am going to be my best self for future patients. While hardcore and metalcore are often described as harsh artforms, they are mediums capable of promoting endless self reflection, sharing wisdom, and can inspire you to be the best you can be. Therefore, medicine and alternative music need not be mutually exclusive -- an interest in alternative music can enhance your understanding of medicine. However, regardless of the medium from which you take inspiration, take inspiration from something, as there will come a time when you need it and it will balance you and enhance your pursuits drastically. Balance your chosen medium with your work to become the best you can be. That is what I am trying to do with hardcore and medicine. I would like to leave you with a quote to think about (or not think about). It is a song lyric that has continued to inspire my thoughts for over a year and I feel it is rich with potential meaning as applied to the practice of medicine.
“Of all the patterns that I could create, I built a labyrinth with no escape To keep my ‘self’ under lock and key I am my own worst enemy”
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Gone With the Wind – Architects
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Opinion
FROM ME TO YOU
Shubham Sharma, Meds'21
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want you to stand up and feel the ground under your feet. Slowly lift one leg off the ground and find your balance – you can adjust your hips and your arms, if you need, but try to find that position where you can just stay still. Now, close your eyes. Chances are, if you are like me, you started swaying when you closed your eyes. This made it harder for you to keep your balance on just the one foot and your other foot came down to keep you from falling. It is hard to find your physical balance with your eyes closed.
"we chose a profession where we will always be transitioning, always learning, and always growing.
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It is as important to grow as a person during this time as it is to grow as a professional" You can get back to your seat. Be comfortable. Take a deep breath in. Close your eyes. And think – about anything. Isn’t it so much easier to think and focus when you don’t have all the distractions in the world in front of your eyes. It is easy to find your mental balance with your eyes closed. It was hard for me to write about balance in this issue, because I felt like I could not tell you anything that you didn’t already know. So, I closed my eyes and thought about what I would want to tell myself – what I would want to hear. I can tell you that it is important to maintain your work-life balance now and always, but I cannot exactly tell you how – I am still figuring that out. I can tell you to find some time for yourself when it may seem like you are spending your days trying to live up to others’ expectations. I can tell you that it is important to think about yourself so that you can make time for people and things that really matter to you. Take a break. Do something you enjoy. Pick up a new hobby. Call
your friend and go out to that movie you have been wanting to watch. Or just talk – about anything. Call your parents. And your grandparents. Make the time to do things that matter to you, and the things that make you who you are – do not lose that spark within you. We will be entering clerkship next year, and then residency, and then maybe fellowship…and then this, and then that – we chose a profession where we will always be transitioning, always learning, and always growing. It is as important to grow as a person during this time as it is to grow as a professional. A recent report titled “Rates of burnout, depression reported by doctors, residents concerning,” was published in The Globe and Mail by Sheryl Ubelacker. It talked about the significant proportion of the country’s physicians reporting burnout, depression and thoughts of suicide, citing the Canadian Medical Association’s (CMA) survey of over 2,500 physicians and 400 residents. This is not news anymore, with the ongoing conversation regarding physician burnout and the CMA survey being widely publicized by several media outlets. Interestingly, but maybe not surprisingly, residents were 48% more likely to report burnout and 95% more likely to be positively screened for depression than physicians. Dr. Gigi Osler, the CMA president, recognizes that this is a systemic issue, but the big system changes may be slow to come. In the meantime, there are resources available for wellness, such as physician health services, but most of those in need either
“We are in this profession to help others, but in order to do so, sometimes we need to help ourselves first.” feel like their situation is not severe enough or are ashamed to ask for help. It is natural to feel overwhelmed. And it is okay to ask for help. We are in this profession to help others, but in order to do so, sometimes we need to help ourselves first. So, from me to you – you are just as important as anyone else, and don’t you ever forget that.
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Promotional
A podcast about the untold stories of clerkship Yannay Khaikin, Meds'20
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n April 2016, a pair of students from the class of 2017, Trevor Morey and Jon Cluett, started a podcast to connect medical students at Queen’s, across the province, and maybe even the country. They called it “This Clerkship Life”. Their goal was to bring to light and normalize the experiences of clerkship. They asked themselves what it would sound like to take private conversations about the best and worst parts of clerkship and put them up on the internet for everyone to hear. Jon summarized it perfectly in their introductory episode: “let’s have some real chats and put a mic between us”. And that’s exactly what they did. In the summer before clerkship, I found solace in their conversations. Thirteen conversations to be exact. One about the C word (CaRMS), another about the dying patient, a third about what it’s like to start a new job every two weeks (being a clerk now, I appreciate that last one all the more personally). The episodes were insightful, casual, non-judgmental, open to criticism, humble—the kinds of conversations I aspire to have. Then again, podcasts have defined my 20s: Radiolab, This American Life, Reply All, The Savage Lovecast, White Coat Black Art, and I’m not even getting into the more technical medical podcasts that make grocery shopping or doing laundry infinitely more “productive”. If you haven’t discovered podcasts yet, I’m excited for you. There is so much amazing work out there for you to learn from, enjoy, feel. I guess I’ve built a kind of reputation over the past few years of sharing podcasts on rides to and from Toronto (thanks for the lift, by the way). You know, after all of the minglers, social dinners, and mentorship escape rooms, I still find that the best way to get to know each other is through a three-hour stuffy car ride during a blizzard with an episode of White Coat Black Art about burnout (check it out, it’s a real episode with real staff being real vulnerable). It seemed a natural turn of events that we should start the podcast up again after more than a year-long hiatus (spoiler: Jon and Trevor graduate—they are now residents in
Obstetrics & Gynecology and Family Medicine. Way to go, guys!). With their blessing and the help of my good friends and classmates, Lyndsey Gott and Harry Chandrakumaran, the podcast is back in full swing. Our goal is very much in line with the spirit of the original show: to create a community through a show that puts some of our most private conversations about what it’s like to be a medical student on the record. There’s no better example of this than our first guest, Maggie Hulbert, who told us her very personal story of deferring her first year of medical school because she became depressed. Maggie shared the lessons she learned from her depression and the steps she takes today to manage her mental illness amidst her busy clerkship life. We have lots of episodes in store, including our next one about a phrase that many medical students might hear in the clinic: “that’s not my job”. Lyndsey tells a story about a doctor who felt that treating a patient’s other concern was outside their scope of practice. Was that doctor wrong? Are we, as students, too idealistic? In another upcoming episode, we revisit a classic med student dilemma: choosing a specialty. And stay tuned for a very special guest interview from south of the border. But most importantly, we want you to be a part of This Clerkship Life. Every week we are going to include your stories and ideas. You can send us your thoughts about the show, your medical school experience, your favourite patient, your greatest struggles (or anything else really) to clerkshippodcast@gmail.com. If you’d like, you can send us a message on Facebook or fill out our Google form which keeps you completely anonymous. You can find the show for free on Apple podcasts, Stitcher, or SoundCloud. We release shows on Fridays, just in time for that stuffy ride to your weekend getaway.
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28 YEAR OLD FEMALE PRESENTS WITH Lyndsey Gott, Meds'20
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atery eyes, red face - No known allergies Crushing chest pain - No changes on ECG Short of breath and dizzy - No asthma or COPD. Stomach in knots, racing heart, racing thoughts Oversleeping, undersleeping Underperforming, overthinking. What’s your differential? This diagnosis feels like a referendum on my potential. All these symptoms and signs, are they malignant or benign? I can't trust my own body and mind, they lie Feelings distort, thoughts whir, reality blurs. Here I am, Ashamed. Ashamed of a brain aflame that I cannot tame. Ashamed. And so I blamed Myself. Why can’t I fix this? How did I miss this? Now I enter a revolving door of counselors and doctors; We begin the treatment dance of two steps forward, one step back. Exercise, socialize, meditate, appreciate, medicate. But what if it's a monumental chore just to get up and out the door?
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Poetry So, I zombie walk through life, Wondering if others can tell I’m half dead A shadow, a shell Can they see I’m in hell? Better yet, would they care? If I were to break how long would it take for them to realize I’m no longer there? Trying to navigate this emotional labyrinth Doubting myself at every turn, Afraid I will never escape, will never learn. Maybe I'm just a type O RBC looking for some universal acceptance from AB: Type AB - not antibody, anybody How many times do I have to donate before I realize, too late, I'm doomed to hemolyse? Type, screen, crossmatch Fight, mean, mismatch. And just like that, I'm 9 years old, back on the playground Sticks and stones may break my bones and names can really hurt me Standing 6 feet tall, I foolishly thought I had outgrown them all, But I was wrong. They grew up and put on white coats and stethoscopes They criticize and try to legitimize, maximize… themselves And I’m left feeling small, at fault, and unwell; Thrown overboard into the swells, a sea of misery, I cling to my textbook driftwood Surely my intellectual life raft will keep me afloat While I wait to be rescued by a passing boat. At last, I wash up ashore, Pre-clerk shipwrecked behind me. Relieved it’s over, afraid it’s not Hoping I’m not washed up and have more, More within me to give and more to live.
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THE TIGHTROPE Alex Morra, Meds'21
High above, suspended by a razor thin wire, She sighs deeply, knowing what lies ahead. Smile, her inner monologue berates, A flawless visage for all to awe Every lash weighted into submission, Every inch of skin, powdered and blended, Every flaw carefully concealed.
The crowd roars as she glides across, Mesmerized by the optical illusion, Of An effortless mastery. The gravity of burden exponentiates, Its force inescapable, Shattering the perfectionist veneer, An imbalanced performer, In a balancing act.
Photo by Graeme Maclean
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THE HEART OF THE ICU
Creative
Malak Elbatarny, Meds'19
T
he surgeon’s already there in the ICU. His expression is, to the untrained eye, neutral. Gaze fixed on the monitor. You’ve come to recognize that look as the one of a man who’s grown accustomed to being almost perpetually a little on edge. Snap, snap, snap. His jaw clamps down on the chewing gum, another signature hallmark. Almost synchronously, the heart monitor beats back in obedience, egged on unrelentingly by electrical pacing and drugs.
The nurse catches his eye and grins broadly.
Outside the sun beams, seemingly oblivious to the precarious predicament that has consumed the attention of so many staff, trainees, and family members. And this was only one of who knows how many cases like it in the unit, today alone. Anyway, the room doesn’t let much daylight inside. “Well, I think we’re moving in the right direction,” the surgeon announces. Snap, snap, snap goes his jaw. “I’ll update the note and go speak with the family.”
The nurse gives a cheery nod of consensus. Soon the room clears. Now all that can be heard is the steady beep and constant hum of the monitors, lines, ventilators, and drips. “How’s the lactate now?” The surgeon’s voice The patient lies motionless throughout. A man doesn’t betray the presence of concern in the room. barely distinguishable from the tangle of wires, cables, tubes, tape, gauze, and sheets. The eyes flutter into sem “It’s not all the way down yet,” she admits. It had blant awareness every few moments, noticeable if you’re been dangerously high just hours ago. In the cardiac ICU, watching for it. things had a threat of changing on a dime. The lactate was just one of those feared harbingers. No one, of course, is watching. Perhaps the patient himself doesn’t notice. In any case, in a matter of hours, The adjoining room and the rest of the unit is even he won’t remember. deserted, which is odd, even for a Saturday morning. “We’ve come down a bit this morning.” On the drugs, she means. They’re the only life line for a sick heart in recovery after a brutal 8 hours of surgical abuse. It had been a relatively complicated case—and a long one.
Photo by MilitaryHealth
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OFF-BALANCE
An alternative view on a modern wellness topic Mike Christie, Meds'21
I don’t believe in living a balanced lifestyle.
T
here, I said it. It’s a broad, overarching quasi-existential concept I’ve grappled with inside my head throughout undergrad and into medical school. I finally understand it, though, and I just don’t think it’s for me. Balance in day to day life is a nebulous construct. It’s a topic that comes up constantly in discussions surrounding health and wellness, but I can’t say I’ve ever heard anyone try to define it. It can’t possibly be literal, there aren’t enough hours in a day to do everything. Yet even as an approximation or guiding principle – dedicating time and effort to a few major life categories each day – the notion can be unrealistic, especially in medicine. I used to spend a tremendous amount of time meticulously scheduling in as many aspects of life as I could for each day so as not to neglect them. Yet alas, the funniest part about my organized attempt at avoiding the dreaded state of imbalance? It was absolute chaos. It never worked. Inevitably something unexpected came up that threw my schedule out the window, and items almost always took longer than I had anticipated. I tried adjusting to doing items a few days a week, but even then, certain tasks would get bumped back by weeks. I was trying so hard to maintain balance, to tick off checkboxes of major life categories, and stay on top of everything. In the midst of all this, I never sensed I’d even come close to hitting any sort of balance. I could never keep up, most days felt overwhelming, and I felt really bad about it. So what did I do? I gave up trying to be balanced. It was a major leap of faith towards a different philosophy that involved an ultimate triaging of my
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Opinion to-do list. There were tasks that I would pour myself into while others were parked. All I had to do was roll with the punches when it came to getting done whatever was the next big knockout on my list. It was a go with-the-flow strategy as opposed to a checkbox one – and it worked. Which brought me to the realization that in today’s society, balance has largely become a trendy buzzword, a proverbial hashtag used mostly without consideration for
and over that balance is supposed to be good, and it's the constant repetition of that message that make us feel like we have to achieve it. But then we can’t possibly maintain it, and our mindset is that it’s because there must be something wrong with us! It’s easy to see how balance becomes forced, counterproductive, and an added stressor. I recognize now that when life ramps up there are days when the only thing balanced about me is my
"Balance has largely become a "I recognize now that when trendy buzzword, a proverbial life ramps up there are days hashtag used mostly without when the only thing balanced consideration for whether it about me is my blood pH" may be harmful to imply that such a lifestyle is a necessary blood pH. And that’s okay. Because although I don’t beone." lieve in living a balanced lifestyle, I do believe in having whether it may be harmful to imply that such a lifestyle is a necessary one. Sure, there might be some folks out there who can make it work, but for many of us balance is simply not possible to achieve in day to day life. A career in medicine has periods of time that are highly, if not completely, demanding of our time and energy. Call, for example, is call. What you are doing while being on call is being called, and that means, naturally, that other things don’t get done for that period of time. The problem with pressuring ourselves to be balanced all the time is that it becomes a slippery slope when we feel like we’re failing because we’re necessarily out of balance in the first place. We have been told over
perspective. Some might argue that perspective is balance on a macroscopic scale, and I might concede that, but it is different than the notion of the daily balanced lifestyle. It’s a longer term, broader understanding – a forest from the trees view on life. Accepting that the week before finals will mean the majority of time goes into studying, for example, is decidedly unbalanced, necessary to be well prepared, and helpful to understand because once that week is over then time can be used for other things that had to be pushed back a bit. An unbalanced, perspective-based approach to life is efficient, realistic, and a much kinder way to treat ourselves. When I weigh that option against the pursuit of an impossibly elusive everyday balance, it’s clear which side the scale tips towards.
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IS YOUR TIME EVER TRULY "FREE"? Nicole Krysa, Meds'22
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hen was the last time that you did something that was entirely for your own enjoyment? Really stop to consider what that activity might have been. Okay, you have it in mind. It feels good to think about it in the middle of a busy school year, does it not? But wait. Are you certain that this activity was entirely for your enjoyment? I would argue that there exists a subtle, albeit important distinction between an activity that one enjoys, but that also bolsters their credentials, and one which solely satisfies the basic drive for pleasure. For example, when I asked myself this question, my first thought was painting outdoors this summer (on a dock, no less)! I truly relish in the tactile feel that exists as a brush glides along a canvas, even more so when the sun beats down on my unadorned back. However, (yes, there is a “however”), if I really stop to consider it, I must concede that even while spending hours devoted to self-care and the pursuit of painting the perfect abstract flower (a noble endeavor on its own, some would argue), a part of my mind was wondering what other agendas this activity could simultaneously address. “If I do a good job of this, I will not have to buy art for my walls”, I thought, “I wonder if this skill could work its way into a club activity once I start school”. I am certain that I am not alone in harbouring these sentiments.
all coalesced into one clear route, leading to the “it is all good, whatever happens now, you are going to be a doctor” land. After years of agony and uncertainty, this was an enormous relief. However, this feeling of exaltation lasted perhaps only a couple of weeks, as novel concerns rapidly sunk in, and new routes emerged once again. As a first-year medical student, one is bombarded with new expectations, and it can be difficult to sort through them and figure out where ones’ energy ought to be invested. There are clubs to join, friends to make, events to attend, leagues to compete in, observerships to register for, course material to learn, and on top of all of that, the ominous presence of the question mark that is CaRMS perpetually looms in the background. It seems that as one door closes, and we shed our skins as pre-medical students, we quickly assume the identity of pre-residency students. This new distinction comes with its own new set of expectations that seemingly really ought to be fulfilled if we really want to be competitive at all (and of course we do, we were pre-medical students just last season). I know that I personally have struggled to digest this new cocktail of options and opportunities. Several new concerns have emerged this semester that have often left me feeling anxious, confused, and doubtful in ways that I did not anticipate. Aside from the enormous task of choosing a career that truly suits me (and considering how this might figure into my family life one day – oh, I guess I should figure out what that looks like concurrently), I have considered everything from changing trends in the medical industry, whether computers might replace physicians in some capacity in my working future, things that I have heard from colleagues, and whether I will desire a work-life balance (or whether I am just exhausted now. Will I ever get bored in a given career?). I have thought about my friends – old and new. Sometimes I want to spend time with them and am simply too busy. It can be difficult to say no, when all the opportunities are so enjoyable and engaging. Then there are the other During the pre-medical school years, many of relationships that existed before this – significant othus sacrificed our personal interests in order to fulfill a ers, family…will my dog at home remember who I am? well-characterized checklist of criteria, in the hope that And what about those things that I mentioned at the we might be selected as future medical doctors. At this beginning of all of this? Those things that you do just for point, there were several diverging paths that were under you, that seemed like they might become available once consideration, as we dreamed that we might achieve our again, now that the barrier of medical school admission goal, but we also made sure to entertain other options. has been overcome. I would like to run a marathon, sit Eventually, our sacrifices paid off, and we all made it in my bathtub for an hour and read a novel, explore a past the metaphorical pearly gates. The diverging paths new city. Are these things that I now have the luxury of
"As a first-year medical student, one is bombarded with new expectations and it can be difficult to sort through them"
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Opinion enjoying? Am I too far gone that I cannot even separate myself from the inevitable thoughts that follow? Namely, “could I put that on my resume, somehow”? Reading this aloud, it appears as the ramblings of someone who has lost a few screws in this process, however, I know that many of my classmates are sharing the same sentiments, as I have heard them voiced in the halls of the Medical Building many a time. Of course, there seems to be an obvious fallacy in this approach to life: If you are willing to defy your nature in favour of your career – and I would argue that most of us have at one point or another – when does it stop? Once we do successfully surpass CaRMS, and begin our chosen careers, there will continue to be pressures to be involved with things that we think we should be doing. As physicians, there will be opportunities and pressures to grow our careers, start a practice, conduct research, stay informed, and continue to be well-rounded. One can see how things could go very wrong if one were to obsesses chronically over these matters. Even in the early years of medical school, if we allow ourselves to divide our attention across too many possibilities, we will not be effective at anything at all. One thing that strikes me as unusual in all of this, is that many of us seem to have forgotten that we have been admitted into
"If you are willing to defy your nature in favour of your career...when does it stop?" the “black box” medical school. Queen’s is a bit of a bubble in that many of us are not “conventional” medical students. I would argue, however, that when I look at my diverse classmates, it is the uniqueness of my colleagues that makes our school strong. We speak extensively in class about the different lived experiences that our patients
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might have endured, and how important these elements are in shaping identity, yet we often try to force ourselves into a (rather snug) cookie cutter mold. Inevitably, things will get chopped off. Also, we must not forget that we too have been, and will continue to be patients! Should the same rules and considerations not apply?
adulthood comes responsibility. Some things must be done, and some things should be considered, in the name of propelling one’s career forward. However, many things are not necessary, and can cause a lot of stress and agony if they are entertained for too long. What I would suggest is to figure out what truly matters to you (remember, we are all different), and to treat the rest like white noise. What might this mean? Well, I plan to pick a few things to focus my energy on in the coming semester: taking on observerships, so that I may figure out what type of physician I might want to be; writing for the QMR, so that I may have a creative outlet (as well as a handy resume builder); engaging with a volunteer role in the community, so that I may stay balanced and maintain perspective (also a handy resume builder); and focusing on exercise and self-care without any consideration for how that may or may not benefit my CV. This is already a lot, but it is a good amount for me. What is a good amount for you might look different. More opportunities will inevitably come up along the way, and some of them will be awesome, but I plan to put on my metaphorical What I mean to say is, if this uniqueness is our noise-blocking headphones when they do, and I invite greatest strength in the classroom and has additionally you to join me in the blissful silence and do the same. aided us in getting admitted into a recognized (Canadi- And hey, maybe I will even paint again this summer, an!) medical school, could it not serve us equally well in and not tell anyone about it. the medical world? Indeed, as much as I desperately tried to develop a perfect acumen tailored to the desires of a medical school admissions committee, it was ultimately the aspects of my being that had very little to do with medicine directly (the fact that I was a fashion designer in a past life, for example) that seemed to spark the most interest in my interviewers. Additionally, we are ultimately here because we care deeply about offering the best possible patient care. I believe that possessing different approaches will allow us as a class to interact with a wide breadth of patients. Most of the individuals that we will be interacting with in clinic are not physicians. Having a wide range of experiences and interests will allow us to better relate to and understand the needs, hopes, desires, and even senses of humour of those who we aspire to serve better. Innovation in medicine is also an extremely exciting field, and novel ideas often emerge when viewing a problem from multiple different angles, something which we will be more equipped to do if we preserve some of those interests that initially made us “us”. Since we are so diverse as a group, it is only natural that every one of us will have a different perspective on varying matters. As such, we cannot allow ourselves to become too distracted by someone else’s goals and perspectives, as is often easy to do in medical school. The only way to truly succeed, I believe, is to stay true to ourselves (hey, some clichés exist because they work). As I mentioned before, I am working through my own dilemmas, but I think that the following approach is beginning to work for me. I have realized that there does need to be a balance. We are adults now, and with
"We cannot allow ourselves to become too distracted by someone else's goals and perspectives, as is often easy to do in medical school."
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#QmedKee
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epsMeWell
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SGL HOROSCOPES DISCLAIMER: Our crystal ball broke so we used some fortune cookies instead… Group
1 2
If you refuse to accept anything but the best, you very often get it.
3 4
Hard work pays off in the future, laziness pays off now. Sometimes you just need to lay on the floor.
You learn from your mistakes... You will learn a lot this month. Accept your past without regrets. Handle your present with confidence. Face your future without fear.
7 8
A smile is your passport into the hearts of others. So is a free cup of coffee.
Ph oto by C
Your high-minded principles spell success. Do not seek so much to find the answer as much as to understand the question better. In fact, there are often only four answers - A, B, C and D.
5 6
It's up to you to create the peacefulness you long for. Ask yourself if what you are doing today is getting you closer to where you want to be tomorrow.
Meeting adversity well is the source of your strength.
Punctuality is the politeness of kings and the duty of gentle people everywhere. And remember, it doesn’t matter if you finished the quiz before the time was up if you didn’t submit it.
har le s
Delu vio P HCA on
Uns p
plas h
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If you feel you are right, stand firmly by your convictions. You already know the answers to the questions lingering inside your head.
10 11
Instead of worrying and agonizing, move ahead constructively. It never pays to kick a skunk.
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The most important thing in communication is to hear what isn’t being said. But if you didn’t hear it, it may be time to make friends with those who can use an otoscope.
Wise sayings often fall on barren ground, but a kind word is never thrown away.
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It’s amazing how much good you can do if you don’t care who gets the credit.
The greatest risk is not taking one. Never give up. You're not a failure if you don't give up.
Welcome the change coming into your life. But if you need to update your operating system, wait until after the exam.
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Keep it simple. The more you say, the less people remember.
Hope everyone has an excellent term and finds some truth (and accuracy) in their horoscopes!
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2019 CALL FOR SUBMISSIONS THE 2ND ANNUAL
JACALYN DUFFIN HEALTH AND HUMANITIES CONFERENCE PRESENTS
OF LIGHT & SHADOW WHEN:
SATURDAY, FEBRUARY 9, 2019
WHERE: 15 ARCH STREET, QUEEN’S UNIVERSITY, ON WHAT:
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SUBMIT BY: DECEMBER 31, 2019 www.healthcarehumanities.com
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