QMR - Volume 12, Issue 2 (2019)

QMR Queen’s Medical Review

failure in Medicine

Table of Contents Issue 12.2 Failure in Medicine

A July 2002 Mystery 3 Sara Brade (Meds ‘21) A Library of Failures 6 Evan Lusty (Meds ‘21) A Few Notes on Failure 10 Mike Christie (Meds ‘21) Thinking Metaphorically 15 Daniel Huang (Meds ‘21) Failures in Medicine 19 A (small) Public’s Perspective Kimberley Yuen (Meds ‘22) Love in the Time of Chronic Illness 21 Nicole Krysa (Meds ‘22) Why we Need More Failure in Medicine 26 Bryan Franco (Meds ‘21) SGL Horoscopes 29

QMR EDITORS-IN-CHIEF Shakira Brathwaite & Shannon Tang

WRITERS Sara Brade Mike Christie Bryan Franco Nicole Krysa Evan Lusty Daniel Huang Kimberley Yuen

EDITOR Alan Huynh

MANAGING EDITOR Nicole Krysa

LAYOUT Daniel Huang Angela Wan

ILLUSTRATION Angela Wan Kimberley Yuen

Letter from the Editors Dear readers,

Welcome again to our second issue of the year! We are very excited to share this issue with you as we explore our theme of Failure in Medicine. As a student-run publication, we hope to provide a platform to discuss topics in an open and honest way.

In its many forms, failure is something that we have all faced and will face in our lives, and we hope that this issue brings a new perspective for how you consider it in your life within and beyond medicine.

We start this issue with a reflective piece by Sara Brade (2021), where she shares some wise words from Pope John Paul II. Next, Evan Lusty (2021) explores how we can normalize failure and his own experiences with it, along with a powerful and diverse collection of “failure stories” from our peers. Mike Christie’s (2021) article is an honest and poignant retelling of what he calls an “epic, public, and spectacularly disastrous” failure, and he goes on to consider why we fail and what failure really means.

Daniel Huang (2021) pushes us reconsider how we phrase our thoughts and the origins of our sayings in his article “Thinking Metaphorically”. We then take a tour through what failure in medicine means to those who work and live outside of the medical bubble with Kimberley Yuen (2022). Nicole Krysa (2022) tells a deeply personal story about her experience with her friend, Jehangir, a bright young man who battles with premature organ failure due to cystic fibrosis. Bryan Franco (2021) discusses the need for more failure in medicine, and suggests that we highlight our failures as opportunities for growth rather than brushing them under the rug. Finally, we end off this issue with a lighthearted collection of “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 Twitter account (@queensmedreview) or Instagram (@queensmedreview)! We can also be found on our Facebook page (https://www.facebook.com/queensmedicalreview/).

We want to extend a sincere thank you to our amazing team 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 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

A

midst many reasons to fear, St. John Paul II knew that fears lose their

clout in the hands of the loving Father

who has given us “more than we could ask for or imagine� in the gift of our lives and in the gift of His Son, Jesus.

image credit: https://www.flickr.com/photos/archer10/

A July 2002

I

Sara Brade, Meds'21

Mystery

n 2002, Toronto played host to World

were “liberated” from the Nazis by the Soviets. This was the

Youth Day (WYD) – a pilgrimage held

climate in which Karol Wojtyla became a man, a priest, an

every few years that brings togeth-

archbishop, a cardinal.

er young Catholics from around the

world. This tradition began in the

bishop of Krakow, was elected pope. His papacy – the docu-

1980s with Pope John Paul II. Perhaps

ments he wrote, the homilies he delivered, and the legacy he

one of the greatest mysteries of my

left – was necessarily informed by his first-hand experiences

life will be whether I attended WYD

with suffering and political evil. George Weigel, author of

2002 or not, specifically the closing Mass at Downsview Park

Witness to Hope: Biography of Pope John Paul II, makes clear

where around 800000 pilgrims were present. My sister seems

that John Paul believed flawed anthropology was at the core

to remember me being there. My mother has no idea, which

of what led to the great horrors of the 20th century. These

is forgivable as she had three small children at the time. And

flawed anthropologies that left God out of the picture denied

I have no recollection of being there as I was one of the three

the sanctity of every human life and militantly rejected man’s

aforementioned small children.

freedom, especially related to matters of faith.

This mystery pains me so because I love Pope St. John

On October 16, 1978, Karol Wojtyla, Cardinal Arch-

Pope John Paul II recognized that these anthropolo-

Paul II. He’s one of my heroes and it would be nice to know if

gies, whose horrific effects he experienced first-hand, did not

I ever got to participate in the last international World Youth

satisfy the deepest desires of the human heart but instead,

Day he attended before his death in 2005. One of the most

wreaked havoc on the human family. In his life and in his

remarkable things about John Paul was his capacity for hope

teaching, John Paul offered anew to the world what the Church

that grew amidst great personal suffering and political failings

has offered for centuries – that Jesus, God who became Man,

around him. Karol Wojtyla, who would later become Pope

is the One who satisfies our hearts. On August 19, 2000, John

St. John Paul II, was born in Wadowice, Poland on May 18,

Paul addressed a large crowd in Paris at World Youth Day

1920. By his early twenties, he had experienced the deaths of

saying:

his mother, brother, and father. The year after he started uni-

versity, the Germans invaded Poland. It was during the Nazi

happiness; he is waiting for you when nothing else you find

occupation that Wojtyla entered the underground seminary

satisfies you; he is the beauty to which you are so attracted; it is

in Krakow studying to become a priest. Horrors and suffering

he who provokes you with that thirst for fullness that will not

in Poland did not end when the Germans left Poland in 1945.

let you settle for compromise; it is he who urges you to shed

Some Poles call World War II the war they lost twice as they

the masks of a false life; it is he who reads in your hearts your

It is Jesus in fact that you seek when you dream of

most genuine choices, the choices that others try to stifle.

It is Jesus who stirs in you the desire to do something great with your lives, the will to follow an ideal,

our suffering, whether we suffer from the failures of others, failures of governments, or even our own failures. We can be assured that “God works everything together for the

"We are not the sum of our weaknesses and failures; we are the sum of the Father's love for us and our real capacity to become the image of his Son3"

the refusal to allow yourselves to be grounded

good for those who love Him.”4 First, we are assured

down by mediocrity, the courage to com-

by the fact that God took the worst thing that

mit yourselves humbly and patiently to

could have ever happened – man murdered

improving yourselves and society,

his God – and used it to give us the

making the world more human

greatest gift we could ever receive

and more fraternal.

Pope

John

Paul II’s experiences of great suffering at

the

hands

– forgiveness of our sins and

of

others make his

hope of eternal life. Sec-

“witness to hope”

I will close with one more quotation from St.

John Paul II. At Downsview Park in Toronto, he told the crowds (that could have included a nearly 5-year-old Sara): You are young, and the Pope is old… But the Pope

still fully identifies with your hopes and aspirations. Although I have lived through much darkness, under harsh totalitarian regimes, I have seen enough evidence to be unshakably convinced that no difficulty, no fear is so great that it can completely suffocate the hope that springs eternal in the hearts of the young. You are our hope, the young are our hope.

Do not let that hope die! Stake your lives on it! We are

not the sum of our weaknesses and failures; we are the sum of the Father's love for us and our real capacity to become the image of his Son.

3

5

phrase was, “Be not afraid!” Amidst many

reasons to fear, St. John Paul II knew that fears lose their clout in the hands of the loving Father who has given us “more than we could ask for or imagine”6

2

John Paul II, and

be impossible.”5 St. John Paul II’s catch

like gold in the furnace He tried them…

fore us, like St.

grace – “for with God nothing will

words in the Book of Wisdom: “…

have gone be-

ings into powerful avenues of

ible. His life is reminiscent of

ble.”

of those who

transform even their suffer-

Gospel all the more incred-

forth, and will run like sparks through the stub-

by the examples

have allowed Christ to

and his witness to the

in the time of their visitation they will shine

ond, we are assured

We can be assured that God does not abandon us in

in the gift of our lives and in the gift of His Son, Jesus. 

References: 1. https://w2.vatican.va/content/john-paul-ii/en/speeches/2000/ jul-sep/documents/hf_jp-ii_spe_20000819_gmg-veglia.html 2. https://www.biblegateway.com/passage/?search=Wisdom%20 3:6-8&version=NRSVACE 3. http://w2.vatican.va/content/john-paul-ii/en/homilies/2002/ documents/hf_jp-ii_hom_20020728_xvii-wyd.html 4. https://www.biblegateway.com/passage/?search=Romans+8%3A28&version=NRSVACE 5. https://www.biblegateway.com/passage/?search=luke+1%3A37&version=RSV 6. https://www.biblegateway.com/passage/?search=eph+3%3A20&version=RSV

A Library of

Failures.

image credit: https://www.flickr.com/photos/gaelvaroquaux/

F

Evan Lusty, Meds'21

ailures in the pursuit of a medical education

the failure dialogue. Their hope and mine is that we can create

often feel like skeletons in the closet waiting

a “failure library” where ideas can be shared and learned from

to redevelop musculature and affix themselves

allowing us to become better people and better physicians for

to your gluteus maximus. You worry that med

the future. My failures I will break down into everyday failures

school admissions teams will find out about

and failures that are more grievous to me, failures of the ego.

them, or that your CaRMs application will be

I will then share some of the failures of my classmates and I

destroyed because you messed up “their, there, and they’re”

encourage you to reflect on them.

when you were learning the alphabet of a foreign language in utero. This often leads us to avoid our failures or attempts to

Everyday failures for me often involve physical pur-

cover them up. Unfortunately, by doing this we do ourselves

suits. However, the lessons I learn from them are more meta-

a great disservice. We shut ourselves off from others lest they

physical. At the QMed Huge Squad (the weightlifting club

find out about our weaknesses. This stops us from helping

Martina Heinelt and I started) I fail all the time. Whether it is

ourselves and one another by discussing our failures and

being unable to deadlift 315 lbs for multiple sets of ten or not

learning from them collectively. It is with this in mind that

benching 225 lbs for five sets of five, every week I show up to

myself and several of my classmates have decided to share our

fail publicly again and there are many reasons for this. Firstly,

failures in this article and in doing so hope to start rewriting

I enjoy the rush of challenging myself to achieve a goal and

Queen’s Medical Review | 12.2 take pride in the fact that I can get closer from week to week.

a while I became pretty confident in my skills, my fitness level,

However, I also think it is important to show others in a very

and I wasn’t always expecting new challenges to present them-

public way that on a day to day basis I fail to achieve my goals.

selves. However, one day my coach ordered me to spar another

This can normalize failure in a profession where perfection

student who had about twenty pounds on me. I thought well,

seems to be valued above most other things. However, one

I will probably be a bit faster so I will just stay on the outside

day I will not fail to achieve my goal and this will be because

of his reach and hit him when I can. This was great in theory

each rep to failure made me stronger but when that day comes

as my opponent was not the most proficient ranged striker,

failure will start over as new, more insane, lifting goals will

however he was unbelievable in the clinch (imagine stand up

be made. In a lot of ways I think this mindset towards failure

wrestling with punches, knees, elbows and the occasional fall

and the inevitable success that comes with just being willing

onto a hardwood floor). I got annihilated. This guy used his

to work harder will benefit me in medicine. This is because I

superior skills to neutralize mine and wear me down like no

know there is always going to be some facet of my practice that

other opponent I had before. When a 240 lb man is hanging off

needs improvement and that often I will fail publicly just like

your neck and kneeing you in the belly and you can’t breathe,

I do with the Huge Squad. However, my practiced failures at

your ability to do a flying spinning back kick doesn’t matter.

a leisurely activity will allow me to improve professionally as I

I left that session with bruises on my whole body but also a

have the framework of fail, pick up the pieces, work hard, try

bruise on my ego. However, what stung most was that I was

again already figured out. Moreover, in medical practice, like

too foolish to consider what my opponent was capable of when

in weightlifting, you can always get better, therefore I know

implementing my plan of attack. So, this loss was painful on all

that even though I may be a great doctor by the time I am 50

fronts, physical, mental, emotional, and psychological. It may

I can always set a new goal to be a better one by the time I am

not sound like much but this made me reassess years of training

60. Lastly, I hope that my medical failures will be public so

and helped me recognize that I had failed to train the mental

that fellow healthcare workers can learn from them or at the

aspect of my martial ability as much as I had the physical. That

very least the idea of mistakes can be normalized for them. I

failure is still something I think about before rushing into

think this will be a better tool for normalizing failure than a

problems where I can be overcome or overwhelmed. It helps

professor saying “one day you will fail a patient” at the front

me to remember to take a step back and look at the problem

of a classroom, looking at everyone, and then moving on with

from unique angles, to consider not only what I bring to the

the lecture without acknowledging the gravity of what they

table but also what circumstance brings as well. This approach

have just said. While the everyday failures I spoke about above

to failures is sure to be helpful in practicing medicine because

are relatively benign, there are failures that are more grievous

as a doctor I will have a unique set of skills. However, these

F to me.

unique settings because I don’t consider all the intricacies of

ailures that stem from my ego are something that

the situation. If I can bring the tamed ego of a beat up martial

I am particularly afraid of, damages to a fragile

artist to medicine I think it will help me pause before jumping

sense of self pride often do not present them-

into situations that can cause harm. Moreover, if I can learn to

selves as harmless and are often not expected.

teach others this lesson in a way that does not involve grown

For instance, as a martial artist I studied Muay

men sweating on each other I think it could really benefit the

Thai fighting for 3-4 years and coached it for 1-2 years. After

7

skills will be useless if I am not able to implement them in

practice of medicine overall!

Anonymous Failures from

E. Lusty ‘21

Queen's Medicine Log 1

O

H

specific reasons why the loss hit me hard and personally. In

survive and move forward. From the perspective of a third

2013 I was recovering from a traumatic brain injury after get-

party, this focus may seem delusional, but for some it is ther-

ting hit by a car, and preparing for the GRE (an exam that

apeutically necessary. For me, this was the fact that the vast

is necessary for entry into graduate studies programs in the

majority of students in Harvard's neuroscience PhD program

US). Preparation was going well, but I was having difficul-

didn't have a first-author paper within 6 years of study, and

ty with processing speed. Despite the setback, I was hopeful

I figured I would have better production opportunities at U

that I could still pull this off and use my previous research

of Toronto, but I knew it had been my mediocre GRE scores

output to make a bid for a spot at Harvard. The personal de-

that had been the real problem, and I became increasingly

sire for this was because my fiance lived in Boston, and af-

frustrated that I wasn't healing faster from the accident. I felt

ter years of separation we desperately wanted to be together.

helpless and as if my intellect had been ripped away from

The reason Harvard was important was because there was

me. I also had no promise that it would ever return, or if it

a specific type of technology that I was using in my current

did, when.

ne of the biggest failures of my life was not getting into the neuroscience PhD program at Harvard. This

sounds like a high-reaching goal, and it was, but there are

graduate studies at the University of Toronto, which I wanted to build on, and Harvard was one of the only other schools in North America that had access to this. So, as I started to prepare my applications I reached out to potential super-

owever, there were a few things I learned from this.

Firstly, there is always a silver lining, and however

small it may be, sometimes focusing on this allows you to

N

ow I find myself in a career where I will interact on a daily basis with people who have had dreams, hopes

and plans destroyed or impeded by illness. Here are my per-

visors from Harvard, and asked if I could come meet with

sonal insights after this: 1. Grief does not have a formula.

them when I was next in Boston. A few of them agreed, so

For some people delusional optimism is what they are go-

I prepared my questions and "elevator pitch" and got ready

ing to need, and for others it may be the other extreme. Let

to meet with them. The meetings went phenomenally well.

them have this, and roll with them as best you can. Good-

After the first, the potential supervisor went out of their way

ness knows they're doing their best. 2. There is no standard

to convince the relevant vice dean to meet with me, as well

scale of how much something should affect a person. For

as the neuroscience program director. I was full of hope, and

some, they'll be devastated by the slightest insult, while oth-

realized what this could mean not only for my relationship

ers will be comparatively tough as nails. Gauge your reaction

with my fiance, but for my career. Everything lined up, the

as a physician based on how they are feeling, because what

proceeding interviews all went well, and despite a mediocre

actually happened doesn't really matter and doesn't dictate

score in one of the GRE sections, I let myself believe I had a

how they will cope with this. 3. If there is even the smallest

good shot at this. In the end, I wasn't offered admission. I was

amount of medical hope, let the patients have it. I'm not say-

beside myself. I felt like an idiot and a failure, and mourned

ing lie to them, or over-promise, but especially in chronic,

the life that could have been.

variable conditions such as a brain injury, hope can go a long, long way.

8

Log 2

Log 3

Failure is hard to swallow especially when we all

During the third year of undergrad, I was participating in the

strive for success. However, failure is often relative

student spaceflight experiment program (SSEP). In this, students

to the goals you set out to achieve. This was especial-

design an experiment and the winning team’s research would

ly true of the MCAT. Failing to achieve a competi-

be conducted aboard the international space station (ISS). My

tive score in my first three attempts was frustrating

group was focusing on the impact of microgravity on the effec-

as I actively sought to blame extrinsic factors such

tiveness of an angiogenesis inhibitor (which is relevant to cancer

as the timing of the test and the lack of resources,

biology). After submitting a report, our proposal was selected as

whether it be monetary, or academic. However,

part of the top seven. However, a few days before our scheduled

once I had nothing else to blame, I finally blamed

presentation, we were informed that we had been disqualified

myself! Reflecting helped me acknowledge mul-

as the key angiogenesis inhibitor we proposed was carcinogenic

tiple aspects of my failure. First, I acknowledged

and hence not allowed on the ISS.

the dark clouds of pessimism that loomed over my future…what was my backup plan? Will I ever be

This disqualification gave me a chance to reflect on the value of

able to do something useful with my life or be able

paying attention to detail. Despite carefully planning our exper-

to help out my family? Second, I acknowledged

iment into the required 10-mL silicone tube and ensuring the

the value of humility given the negative outcome

ingredients were heat-stable for at least 6 months, we overlooked

despite my best efforts. Third, I acknowledged all

a key detail and payed the price.

the things I did well for the MCAT as there was always one section that I was unable to succeed in.

Whether conducting clinical trials or managing patient care, I

I called most of my friends who wrote the MCAT

aim to implement this attention to detail in professional practice.

and asked them what their areas of ease and difficulty were. I compared them to my weaknesses and found reasonable solutions. I gave myself a year to re-try the MCAT and I couldn’t help but

Log 4

During high school, I took the National Lifeguard (NLS) course

cry when I finally succeeded. From this whole or-

which consists of multiple items that test fitness, knowledge, and

deal, I learned that failure is a great teacher who no

judgement. I failed.

one actively intends to get lessons from, but whose lessons offer insights into the best path to success.

I was unsure how to react. I took time to think about what had

In a career where I will assist patients break un-

gone awry. In the last few months, I had my vision tested and was

healthy habits, my experiences have taught me to

told that I needed glasses. However, I had not yet adopted them

never frown upon the number of failed attempts;

in the pool and so my communication across the pool during the

they have taught me that a “keep trying” attitude

lifeguarding scenarios was poor to say the least. I realized, I just

is only helpful after one successfully identifies bar-

needed to wear glasses to actually see what my teammates were

riers and makes appropriate changes. Indeed, to

signalling from across the pool! A little while later, I took the

move forward in life, you have to seek success even

course again, with glasses this time and passed with relative ease.

in failure, because one is bound to trip over an ob-

Looking back, I see this humorous failure as a means to learn

stacle if one moves forward while looking back.

that it is easiest to first look for simple solutions to simple problems (rather than designing a complicated approach).

9



A few Notes on Failure

Mike Christie, Meds'21

I failed miserably in front of five hundred people. Every sin-

ing a deep breath, and trying it again. Suddenly it became a

gle one of them saw it, and regrettably had the great misfor-

labour of love, a minor obsession. My brothers nearly went

tune of hearing it, too. It was epic, public, and spectacularly

mental putting up with the sputtered, mangled cacophony.

I

disastrous.

But I refused to give up. I listened to every recording of it I could find, trying to feel my way through the piece. I played

t was my school’s Remembrance Day ceremony, I

it sitting and standing and lying on my back. In my lessons

was a lanky ninth grader, an absolute science nerd

we faced the octave changes head on – I remember one ses-

(some things never change), and I also happened to

sion where we spent forty-five minutes switching back and

play the trumpet. The head of the music department

forth between the same two notes. An observer would have

had enthusiastically come to me a few weeks prior

called it absurd, yet with these exercises the piece gradually

and asked me to play the Last Post for the occasion*. It’s an

began to take its proper shape, to sound like it was meant to

intimidating piece for a novice player, which is exactly what

sound. Sometimes I would go into the school theatre when

I was at the time. It was written to be played on a simple,

no one was around and let the notes reverberate off the walls

valveless, battlefield-esque bugle, meaning that a trumpeter

of the big empty room. They would bounce back to me and

does not use the trumpet’s valves when performing it. Press-

send shivers down my spine. A family friend gave me a lift

ing valves somewhat helps a trumpeter to hit the desired

to one of my lessons and sat in. Gareth had me perform for

notes, gives a sort of “lifting” sensation into the right pitch,

her and she cried because she said thought it was so beauti-

so playing without them can be challenging. In the Last Post,

ful. For the first time in my career as a musician I had really

switching between notes is instead accomplished solely by

pushed myself, and I finally felt like I was ready.

the subtlest change in the angle, airway diameter, and buzzing of the lips. This becomes especially difficult in the higher octaves when the lips are mere millimetres apart. The Last Post, as eloquent, sombre, and emotional a piece of music as it is, also happens to be categorically unforgiving to trumpeters with limited experience.

I

Or at least that’s what I thought. f I close my eyes (I’m doing so intermittently as I write this) I can transport my mind back through time and space to that room packed full of people.

Even now, if I pause for an instant, I can feel my

All of this aside, I said yes. My instructor, Gareth, a trumpet guru retired from the Calgary Philharmonic, was thrilled.

He felt it was a challenge I could work hard on and use to advance my abilities as a trumpet player. So that’s what I did.

anxiety building as the moment approached. I sat

there in the massive cafeteria – the audience was so large it exceeded the capacity of the school theatre – and realized I wouldn’t have a chance to warm up. I had not anticipated

I practiced it every day, sitting in the basement of my family

this. I glanced over my shoulders, caught a glimpse of the

home at night, screwing it up over and over and over, tak-

crowd behind me, and my stomach dropped. I had never

*(Believe me, you’ve heard it before and will recognize it with solely the first two notes, but if you need a refresher listen to it online before reading on. Set the stage in your mind!)

10

M. Christie ‘21 played in front of this many people before. My heart started

all I noticed was that everyone was staring, gawking, at me.

to race, pounding in my chest. Everyone would be watching!

Plowing on, I violently hacked the musical score in my head

What if I messed up? And why was I just realizing this right

to pieces, realized I was lost somewhere ten bars into the

now? My apprehension worsened, and I fidgeted with the

piece, and wished nothing more than that the episode could

valves on my trumpet to try and distract myself. It did not

mercilessly come to an end. Time, instead, was standing still.

work. I could feel by body temperature rising, and my neck

Notes screeched here and there as I fuddled forward. Disas-

tie suddenly gave a suffocating sensation around the collar of

ter had struck, and there was no one coming to the rescue. I

my dress shirt. The ceremony went on, a few sad poems and

had waded out into the deep, and I was on my own. I heard

a performance art display and a sobering talk on the brutal

someone muffle a laugh, and at that moment I simply wanted

reality of war by an octogenarian veteran dressed in full mili-

to evaporate.

tary regalia. I continued my spiral into nervousness. Nothing was helping. At last I closed my eyes and took a deep breath,

And with that, I failed. The ceremony ended, and despite sev-

a desperate attempt to calm myself, and when I opened them

eral wonderfully compassionate teachers doing their best to

realized I had been called up to the front.

console me I ran off. Keeping my head down I fought back tears as I wedged my way through the dispersing crowd. I

The medical student in me wonders how I didn’t vasovagal

knew they were still staring at me and I fled faster. More than

right then and there, but somehow I stood up, nervously

anything I wanted to be alone, and the next thing I knew I

paced forward, and turned to face the audience. With trem-

was in the most distant, secluded, quiet corner of the school.

bling hands I raised the trumpet to my lips, sensed the cold

No one would find me there. I was still holding my beloved

of the mouthpiece press against them far too firmly, and took

trumpet, and of all things at that moment I felt that did not

one last-ditch attempt to try and settle down. It was like rear-

deserve to be holding it. Gingerly, carefully, humbly, I set it

ranging deck chairs on the Titanic. I took a woefully shallow

down so that it was standing upright with its brass bell as a

breath in, maybe a tenth of the required inspiratory reserve,

base on the floor in front of me. For a moment I sat in silence.

and released it.

Then I buried my face in my hands, and I cried.

N

othing happened. My lips did not buzz, their angle

Why do we fail?

and resulting airway diameter completely incompatible with the generation of sound, and all that

Is it personal inadequacy, deficiency, or lack of capacity to

went through my trumpet was air. I panicked and

achieve? To this day I have never felt so ashamed or embar-

tried to push air out even harder. The room was

rassed of myself than during those two minutes. They were

closing in on me. I took a gasping breath and tried again.

brutal. My father had been there to video record and I re-

Something vaguely resembling a note, an octave below what

member watching what was caught on tape (he had promptly

it was supposed to be, finally, painfully, came out. My legs

stopped the recording) and thinking to myself “Was that the

nearly gave way beneath me. I was panicking. My body trem-

worst experience of your life?” (A decade later I can now say

bled. Then another awful, horrible, note. Then another one,

that it was not, but it definitely remains in the top three).

itself cracking and lacking resonance and choppy and awk-

Admittedly there are times when for whatever reason I hap-

ward. This was followed by several missed notes in a row. I

pen to think of the occasion and still feel awful about it. The

simply could not create them. It was as if I had never picked

aftermath was not pretty. A cloud of negativity had hung over

up a trumpet before. I tried to close my eyes but couldn’t and

my head for weeks, even months afterwards. I thought I was

12

a failure, that I was never going to be good enough to play

critically unacclaimed but phenomenally fun student led

music again, and worst of all that I had let everyone who be-

ensemble “After Hours”. It was a blast. Together the ten of

lieved in me down. My confidence to do anything was prac-

us made music that washed over many an audience with a

tically non-existent.

vibrant wave of sound. We would dim the lights and pre-

A

tend the concert hall was a jazz club like somewhere in New nd yet, when I think about this failure, these are

Orleans back when the genre was in its heyday. Our recom-

not the only things that I feel. A moment or two

mendation to have a bar installed and permit the smoking

after the negative thoughts pass, I can reflect back

of cigars was quickly vetoed by administration, but we didn’t

on those two minutes and paradoxically say I am

let that disrupt our vibe. Upon our encouragement people in

glad they happened. Those one hundred and twen-

the audience would stand up and dance mid-concert, clap-

ty seconds, as difficult as they were, taught me something

ping or snapping their fingers or singing along as the band

profound. It took time to process, but experiencing such a

roared late into the night. We would hand out tambourines

massive, undeniably colossal failure revealed to me that fail-

and drumsticks and hype them up so they could jam right

ure itself is conceptually radically different than we perceive

out with us. It was exhilarating.

it to be. It is not indicative of an inherent limitation in our potential, nor deep routed inadequacy, nor the incapacity to

And the best part? I was able to prepare myself ahead of time,

succeed - much to the contrary, failure is growth.

to use performance strategies so that I was ready to get up alone on stage and play even more audacious, exquisitely

I won’t claim to be the first to come up with this idea. It’s a

technical trumpet solos to crowds even bigger than ever be-

message I’ve heard in many ways from several people that I

fore. I was so alive in those moments, so perfectly able to let

look up to in my life. Yet I think there is value in reiterating

my soul project out into the open. Sometimes I would step

it through an admittedly cathartic reflection on a personal

slightly off stage and stand there for a moment, snapping my

experience. The fact it has taken me ten years to write about

fingers along with the snare drum and piano and bass, once

this episode strongly lends itself to the point that no one likes

again in disbelief, and know my failure had allowed me to

talking about failure. It is an uncomfortable endeavour and

become capable of something I had never achieved before.

there are traumatic emotions that justifiably come along with

My failure made me grow.

it.

I

It is demanded of medical students that we push ourselves.

f I learned one thing from my debacle, though, it was to

We are put in unfamiliar environments and scenarios and

confront failure, to own it. It took me a long time to pick

examinations where we have to apply vast volumes of knowl-

that trumpet up again. My next lesson was more like a

edge and use complex skills to solve challenging problems

therapy session – neither of our trumpets left their cas-

that, until we are presented with them, often do not exist to

es. Gareth and I just sat and talked. We worked through

us.

what happened, identified what went so horribly wrong.

Then we talked about how I was feeling, and I cried again.

Basically, we have to fail. It is part of the process of our learn-

I strangely felt better after. I took some time and looked in-

ing to not get everything right the first time, or the second,

ward and found that I could not let music leave my life. It

or the third, or so on. These things can’t all be put together at

was a gradual process, and as a self-conscious young man

once and require us (within educational reason and in accor-

at the time it took extensive mental training and visualiza-

dance with proper supervision and the highest standards of

tion techniques to build up the confidence to put myself back

patient safety) to push our boundaries. Being perfect means

out there. On a whim I joined a jazz band at my school, the

that we have mastered something, which is great, that’s what

13

M. Christie ‘21 we strive for, but in our line of work it is necessitated that we always be willing to learn more. I get exam questions wrong all the time. Surgeons quiz me in the operating theatre and occasionally I look like a complete buffoon when for whatever reason I blank on my anatomy. Sometimes, despite endless preparation and practice on ever-so patient classmates, I still miss check boxes on OSCEs. There are topics in clinical medicine (the brachial plexus jumps to mind) that I find overly intricate and confusing and have to go over repeatedly before anything sticks. Antibiotics are magnificent but there are too many of the damn things for me to keep straight and I sometimes mix them up in my head. And that’s okay, because every time I have a “mini-failure” I use it as an opportunity to learn. My classmates or residents or staff doctors are always there to help me understand where I went wrong and how to be better. The next time it comes around, I get it.

I

t’s taken me a while to understand failure for what it is. I will make mistakes while I learn this art form, but Medicine is part of who I am - just like music was - and failure is going to make me really, really good at it. We require failure to become the best we can be, and it would be fantastic for the culture of medicine to openly acknowledge that none of us got here, or are going to go anywhere, with-

out it. Our work may perhaps be looked upon as divine, but we, its practitioners, are certainly not. As such, I humbly propose that as a profession we look at our failures not as human fallibility, weakness, or inadequacy, but as a necessity. By doing so we can better understand each other, leave room for the human emotion that accompanies failure, and support each other’s growth. Because when we fail, we become more than we were before, and for those who place themselves in our care - that’s exactly who we’ll need to be.

https://www.flickr.com/photos/gotovan/



14

Queen’s Medical Review | 12.2

Thinking metaphorically

by Daniel Huang QMed’21 Source: Wikimedia Commons

C

onsider these recent newspaper headlines about the anti-vaxxer movement:

Racism is a virulent form of bigotry Some people are susceptible to conspiracy theories.

“Anti-vaxxers spread a plague of ignorance”

The politician is using inflammatory rhetoric.

“…An epidemic of medical misinformation”

He’s not immune to criticism

“Anti-vaxx propaganda has gone viral on Facebook”

Machismo is endemic in sport.

A catchy tune is an earworm.

Or these articles about politics: This set of metaphors is not just wide-ranging “Left unacknowledged and untreated, antisemitism

but also internally consistent. Dangerous ideas

festers and grows.”

are described as infections and our responses to

“Frustration breeds bigotry”

them are described as immune reactions, nev-

“Post-Brexit Britain contains a strain of nationalistic

er the other way around. For instance, allergy

fervour”

is a concept of host response, so the metaphor of allergy is applied to the person, not the idea.

These articles use a certain kind of language that

We usually don’t say that the idea is an allergen.

is typical of the way we talk about the spread of

Rather, people are allergic to the idea. Converse-

(dangerous) ideas and information. When we say

ly we could say his optimism was infectious, but

misinformation is spreading or disseminating or

not that he responded infectiously to optimism.

being suppressed, or when we inoculate ourselves against it, we are using the language of infection

We can describe the spread of ideas and our re-

and immunity. Here are some other examples:

actions to them with other metaphors too. Ideas

15

D. Huang ‘21 can be transportation, as in the information su-

that must also be true. In other words, they are not

perhighway, or ideas that take off, or news chan-

only internally consistent, but externally consistent

nels that are vehicles for political viewpoints. Or

as well. For instance, if truth = down then it follows

an idea can be related to fire, like when it fuels

that lies = up. And indeed, we engage in flights of

a debate or sparks a revolution. And sometimes

fancy, or tell tall-tales, or make things up (not down).

the plain language is more commonly used. We don’t say that communism went viral in the 1940s.

The authors argue that we use metaphors to link concrete experiences that we can well-describe

Sometimes, the metaphorical language of infection

to more abstract concepts that we cannot, which

and immunity is hard to spot, since it connects to

makes it easier for us to talk about them. This might

a deeper metaphor that is widespread in our lan-

explain why we use infections and immunity to de-

guage, that words are objects. This is the basis for

scribe the spread of misinformation. The experi-

keeping secrets, hurling insults, and spreading mis-

ence of physical infection—fever, pain, and inflam-

information, like we spread germs or butter. In oth-

mation—is clear in our mind’s eye, and we have

er cases, like the newspaper articles above, the met-

precise words to describe it, while the experience

aphors are more obviously connected to the concept

of being manipulated by lies or misinformation is

of infection and immunity.

not. However, the two share the same underlying

Finally, we might encoun-

concern (of bad things spreading), so we can use

ter an odd or novel met-

the concrete concept to describe the abstract one.

aphorical pairing, as in quarantining a dangerous

An important implication of our deeply ingrained

idea or inoculating against

use of metaphor is that by shaping how we describe

lies and misinformation,

things, metaphors also shape how we think and act.

used for literary effect.

Lakoff and Johnson give the example of our extensive use of the metaphor, argument = war. We

The groundbreaking 1981 book, Metaphors We Live By, by Lakoff and John-

engage in a war of words or defend a position or Source: Amazon.in

kill off a opponents argument. By describing arguments this way, we come to think of them as adver-

son, makes the case that much of our language, es-

sarial and competitive. And by thinking this way,

pecially when describing abstract concepts, is sys-

our goal becomes to win and discredit the oppo-

tematically based on metaphor. Just consider the

nent. Tactics of argumentation begin to resemble

phrase “groundbreaking book”. Lakoff and John-

tactics of war. We work to misdirect the other side

son suggest that this language reflects a coherent set

with red herrings, we conceal our side’s weakness-

of metaphors where thinking = digging and truth =

es by quoting selective data, and we try to under-

down. That’s why an argument is grounded in the

mine the opponent’s position by questioning their

facts, research delves deeper into the subject, new

veracity. Now, consider if our metaphor for argu-

information is unearthed, and there is an underly-

ment was dance. We might imagine a totally differ-

ing (but not overlying) truth. These metaphors are

ent world where a debate is an act of coordination

systematic because they create certain entailments

instead of competition, with the ultimate goal of

16

Queen’s Medical Review | 12.2

Source: Wikimedia Commons

aphor anymore. After all, we learn early on that the basic function of the immune system is to target and destroy pathogens and to protect the body. Even the scientific language suggests this: Neutralizing antibodies Immune surveillance Danger hypothesis Killer T cells Tumour invasion Immune evasion Checkpoint inhibitor

performing and delighting the audience instead of beating the opponent. The issue with argument =

Barrier function Source:WikimediaCommons

war is not so much that it is inaccurate, but that

Of course, this is not to say that these things do

it is incomplete. We risk obscuring other parts of

not really exist. Antibodies exist outside of what-

the experience that might be interesting to explore.

ever name we give them, and they do indeed bind and coat pathogens to prevent their interaction

Metaphors have been studied extensively in medi-

with other cells. But we could have called them

cine. For instance, many authors have described how

coating antibodies or surface-binding antibodies,

the metaphor of war (like the war on cancer) has

which is a more clear and plain description what

limited our behaviour as patients and practitioners,

they generally do. Instead, we call them neutral-

our therapeutic decisions and policy responses, and

izing antibodies because it better evokes the con-

ultimately our conception of disease and suffering.

cept of defense. It implies counteracting harm or danger. Neutralizing antibodies therefore have a

But, knowing that we often think and act in met-

nice consistency with other common immune =

aphors, we can also try to make deliberate use of

defense metaphors, like immune cells as helpers

metaphor to create new meaning and new perspec-

and killers or pathogens as invaders and coloniz-

tives. Much like the advice to ‘consider all sides’,

ers. Ultimately, we prefer metaphors that fit into

we could consider experimenting with new met-

a coherent, purposeful, metaphorical system. Of

aphors or expanding existing metaphors when-

course, to say that defense is just a metaphor is not

ever we encounter an intractable problem, with

to imply that it isn’t true. A large part of our im-

the hope that we will find new ways to respond.

mune system does indeed prevent microbes from infecting our bodies. It simply means that immune

A fascinating example of this is the metaphor,

= defense, like argument = war, is incomplete.

immune system = garden. This stands in con-

This brings us back to immune system = garden.

trast to the more typical metaphor, immune sys-

This metaphor suggests a nurturing process that

tem = defense, which is so deeply embedded in

better describes the immune system’s (increasing-

our thinking that it doesn’t even seem like a met-

ly appreciated) role as a cultivator of our gut and

17

D. Huang ‘21

Source: Wikimedia Commons

skin microbiome, and the emergent process of

Changing the metaphors we use can be powerful

immune responses that arise out of complex cy-

way to think (and act) outside the box. Going back to

tokine microenvironments. We can better refer to

our first example then, what other metaphors might

extrinsic factors that influence immune function,

we use to describe misinformation? What if we

like metabolic and psychological stressors, much

thought of it not as a virus but as a maze? How might

like a garden is influenced by the environment

our efforts to reduce the influence of anti-vaxxers

around it. The immune = garden metaphor better

change in this new metaphorical world?

ď Ž

emphasizes the symbiotic relationship between our immune system and the rest of our physiology, actively contributing to homeostasis (and not just being activated when things go wrong). Finally, with our immunity as garden metaphor, we might be more inclined to investigate aspects of immune function that are an awkward fit for the defense metaphor, like immune tolerance to food, interactions with self-antigen, and tissue regeneration.

18

Queen’s Medical Review | 12.2

Failures in medicine: A (s

By Kimberley Yuen, Qmed’22 A “failure” in medicine that comes to mind is the fact that movements such as anti-vaccination exists.

I think it highlights the lack of education surrounding the topic where some of the onus is on practitioners to increase awareness!

Market researcher, early 20’s

I remember a few years back when my family doctor was unavailable. We had to find another doctor to see us. Somehow, we found one in another location and when we went to see her she was not friendly and actually the entire medical office personnel there weren’t friendly at all.

Project manager, late 50s

It’s difficult to get a family doctor because many do not take new patients. And if you want to change your family doctor, say if you move to a new community or like I, want a female doctor, I cannot change. If I need to change, I would need my existing family doctor to sign the transfer, or otherwise I cannot do so. That means the choice is not in the patient’s hand which I don’t understand why.

Banker, late 50’s

Doctors here need more training and need to keep themselves up to date with world class medical technologies and procedures. They also need to read more! I saved myself and my son when I was pregnant with him. I had cholestasis of pregnancy. I also saved my daughter when she had intussusception. In both cases the doctor failed to diagnose. It was my own research and persistence that ended up saving us.

Homemaker, early 40’s

K. Yuen ‘22

small) public perspective My understanding of the field of medicine is a limited one, based solely from my own personal experiences as a patient. From these very experiences, moreover, I’ve witnessed multiple doctors and nurses hastily treat patients and myself without the deliberate thoughtfulness and care that is expected of medical professionals. While the profession is fraught with laborious tasks and seemingly endless people to examine, probe, and diagnose, the importance of good ‘bedside manners’ is undoubtedly an important one.

Poor bedside manners, in contrast, are not necessarily a failure in ‘medicine’ per se but are indeed a failure in the medical community and can have dire consequences for patients. What are the long term consequences for a patient if their pain is dismissed or their concerns repeatedly ignored?

Student, early 20s

Years ago, my grandma felt something in her heart, but the doctor failed to do or see anything. From her own persistence she eventually found out her arteries were >90% clogged and therefore had to undergo bypass surgery. This was completely up to my grandmother’s own diligence to ensure that she was looked at when she felt like something was wrong, even though every time the doctors said everything was fine.

Accountant, late 20’s

Doctors could try to find a different way for needles. Because even as adults many people don’t take needles because of their fear of pain. This isn’t good because it leaves many people unprotected. Instead of a way to help with their health, they see it as something they don’t really want to do.

Healthcare should be about trying different ways to get better.

12 year old

Queen’s Medical Review | 12.2

Love in the time of chronic illness (When our organs fail us prematurely)

by Nicole Krysa Qmed’22

M

y first patient preceded my time at Queen’s

confronting the ideas put forth by twentieth century

Medicine. I was a wide-eyed 18-year-old,

greats, as it was to meticulously tackling the most

living in the big city for the first time in

unpleasant icon of all – Death himself. At the centre

my life, and I was utterly clueless. I did not know

of this circle sat my dear friend, and the force that

how best to spend my time, or who to spend it

kept this unlikely motely crew together, Jehangir.

with, but after 17.5 years in the suburbs, I was keen to get out and explore. In hindsight, I believe

Jehangir was 25 years old when I met him and had

that this curiosity alone is what motivated me to

been suffering from cystic fibrosis his entire life. He

show up to a philosophy interest group meeting

also happened to be a pensive and brilliant student

on a Wednesday night in June of 2010. I did not

of philosophy (he was working on his Master’s at

know what to expect, but in line with my fashion

the time, when he was well enough to do so). While

student identity, I wore my best approximation of

Jehangir had almost too realistic expectations about

what I imagined a well-read liberal arts major might

his prognosis – he told me that he was going to die

look like – a take on Ali MacGraw circa 1970, and

soon nearly every time that we met up – he did not

rehearsed some lines from Camus and de Beauvoir,

let his illness hinder him. Jehangir was a beautiful

just in case. I quickly learned that none of this

spirit who decided early on to accept his limitations

was necessary. The group that I had unwittingly

and live joyously. Over the course of that summer I

stumbled into was not so much dedicated to

continued to meet Jehangir and friends at various

21

Source: pxhere.com

N. Krysa ‘22

corners of the city. We went to the gallery and

the women’s shelter that he volunteered at and St.

meditated upon a Rothko painting in silence for 30

Michael’s hospital, where he now resided full-time.

minutes before dissecting its possible meaning(s) in

He also brought me homemade cake every time, and

a public park. We sat on a dock late at night observing

made an effort to make my roommates laugh while

the waves and discussing the repetitive motifs

he could barely breathe himself. He amazed me.

that are pervasive in nature (do we as individuals matter, or are we just elements comprising a larger

One night, we were chatting candidly in his room

pattern)? We celebrated his 200th consecutive day

at St. Michael’s. I remember the scene vividly – he

as a resident patient of St. Mike’s at a dive bar, with

had recently been allowed the privilege of keeping

a drink named after him. Even strangers joined

a beta fish in his room. This was a comfort, but also

in on the festivities. This

depressing – people usually get

was the nature of Jehangir,

pets when they are settling into

his energy was contagious,

a space for the long haul. The fish

and it was impossible not

swam around happily, taking

to want to be around him.

note of our presence, a highly polarizing survey on Jehangir’s

Luckily for me, Jehangir and

door wherein CF patients from

I stayed close after that first

the community were asked to

summer. We did regular visits

vote on the possible name was

throughout the city, and at the

magnified through the bowl. I

hospital over the years that

asked whether it ever bothered

followed. I was grateful for

him that he did not get to see

him, as he got me away from

the world, as travel had been

my desk, and showed me what

on my mind a lot lately. He

life was like through his lens.

was not bothered, he said. The

What struck me most about

only thing that he regretted

that time was the seemingly endless amount of love

in life was that he may never be married and have

and gratitude that Jehangir had to share with the

children. Giving himself to love fully, and leaving a

world. He asked online about what people living in

legacy in children was what mattered most to him,

Toronto would do “if they were dying tomorrow”,

he had realized. This is something that I still think

and he subsequently went on to bring these ideas

about now, as I observe patients gripping with the

to life for many of the individuals who responded.

concept of their impending death at the hospital.

One memorable outcome of this endeavor was

It seems that the profound love that we have for

a pop-up circus in a park in Toronto. Even during

one-another really is all that matters in our final

his decline, Jehangir would stop at my apartment

days. This also might explain why Jehangir almost

to lay on the couch and catch his breath for thirty

collapsed at the Eaton centre H&M about a week

minutes or so – my apartment was halfway between

later. When I showed up for a visit, he was in the

Source: Flickr.com

22

Queen’s Medical Review | 12.2

process of being berated by a concerned nurse, for

Jehangir did not have children as he had hoped to

he had been out for longer than allowed, and had

do, however, he has most definitely left his legacy.

missed some crucial life-sustaining procedures.

He is remembered fondly in the hearts of all of those

When I asked why he had taken such a great risk, he

who knew him, and who knew of him. Additionally,

cheekily told me that he had a date that night, and

an annual Jehangir Saleh Lecture is conducted at

his date had mentioned that she likes red v-neck

Ryerson. Topics explore ideas surrounding death and

t-shirts. He was indeed wearing a red H&M v-neck.

living with chronic illness. There is also a Random Acts of Kindness Day

That was one of the

in honour of Jehangir,

last times that I saw

who gave more than

Jehangir.

he

He

died

ever

received.

in 2013 at the too-

Finally,

young age of 28. His

memory was a huge

organs

driver

him

had

failed

Jehangir’s for

myself

prematurely.

while I was struggling

I wish that I could

to learn science after

say that I was there

leaving the fashion

every

leading

industry, so that I

up to that horrible

might one day be able

moment, but I was

to do my small part to

not. I was in the thick

make this world and

of exams, and did

the people in it better.

day

not even see the last message that he had

Below is a piece that

sent me until a year

I have been given

or so later. “Hey, I

permission

know you are busy,

publish

but I am not well”.

my

It said. He had told

Jehangir’s

me repeatedly that he would die soon, but I always

I

thought that I had more time. I learned so much from

nice insight into his personality.

Jehangir, but most importantly, I learned that love must supersede all. We as one-day physicians can become swept up in our obligations and personal stresses, but it is so crucial to give love generously and non-discriminately, because we never know when an opportunity to do so will be no more.

23

believe

that

it

offers

to

re-

alongside article some

by family. really 

N. Krysa ‘22

By: Jehangir Saleh Written: June 13, 2010 Dear lovely friends,

I wanted to say something about my health, since things have changed for now. I’ve been in the hospital for 55 days. This length of time is unfortunate, but not really new for me. What is new, however, is that I don’t seem to be improving. My lung function sits stubbornly at 55% (baseline: 70%). I am coughing up abstract art. My white blood cell count (a marker of infection) is bouncing around.

My lungs don’t feel great, especially at night.

One big problem is that the mucus sitting in my lungs is thick, murky and very infected. I have been trying new airway clearance techniques. It’s helping a bit, but I’m not winning. Clearly, this is not the kind of game where they are winners or losers. Rather, it’s the kind of game where the rules keep changing and no one tells you about it, such that you’ve been strategizing for an outcome based on rules that no longer apply. The space you’ve been moving toward has already become “somewhere else”, except your sister misplaced the little guide book that came with the game, so no one is telling you what that “somewhere else” looks like.

I feel a bit like I’m in a play where initial scene just repeats, and the dialogue is poorly written. There’s a lot of “yesterday is like today, which is going to be like tomorrow”.

I’m trying hard to figure out how to make sure this difficult, indeterminate period doesn’t generate addictions or make me stop bathing. I

24

Queen’s Medical Review | 12.2

was thinking about what might help. So starting today: MY HOSPITAL ROOM IS NOW A COFFEE SHOP (and, as long as the doctors aren’t around, an oxygen bar.)

Conveniently located in the heart of downtown Toronto, we serve really high quality tea and low-quality chocolates, have free wireless, are wheel chair accessible and sometimes have live music performances. Plus, immediate access to medical care should the need arise!

I’m bloody serious. If you’re willing, please bring your work or stuff or whatever you usually do in a library or other coffee shop, and come do it here, where your presence can my reason to take a bath in the little sink they let me do that in. There is free wireless.

I’m open from 8am to midnight. The number is 416 864 5454 x.

46811. It helps if you can plan ahead a bit, but recently, things have been pretty slow.

Seriously. Come here. I’ll make us tea. And then we can, in the same space, work on our respective projects or generate one together.

You’ll get company, chocolate and free tea. Or, if you want to and are able, you could help me with my mucus drainage therapies.

25

B. FrancoMedical ‘21 Queen’s Review | 12.2

Why we need more failure in medicine

by Bryan Franco Qmed’21

F

graduate

ake it ‘til you make it is a phrase that

failed” that trivializes our true failings—times when

permeates the entirety of medical training.

we do all the right things with the right intentions

From applying to medical school to post-

but still fail miserably. The only “lesson” left to be

training,

most

aspiring

physicians—

scavenged is the experience of failing. However,

knowingly or unwittingly—embody this attitude.

such examples of failure will seldom be used in an

Medical school applicants “fake good” or engage in

interview. We are coached to pick an artificial example

self-enhancement of “desirable” personality traits

of failure that displays how we’re able to harvest

(Griffin & Wilson, 2012). Medical trainees are steeped

important lessons whenever we fail—essentially

in the paradigm of “see one, do one”—often tiptoeing

spinning a story of failure into one of success.

the line between feigning confidence and terror when

"Today, the ability to maintain a façade of unwavering success is arguably a prerequisite to become a physician."

performing a new procedure. Fallibility is an aspiring physician’s best kept secret. Those who succeed as aspiring physicians are those who can best dismiss and minimize failure—a situation exacerbated by the competitive nature of medical training. Today, the ability to maintain a façade of unwavering success is arguably a prerequisite to become a physician.

Our applications, curriculum vitaes, and

interview performances are carefully crafted to

As Canadian medical schools attempt to

only show our successes—effectively concealing the

reconcile the attributes that matriculants should

rest of who we are as a medical trainee, let alone

possess (i.e. admissions criteria) versus what should be

a person. This phenomenon is most obvious when

taught in medical school (Bandiera, Maniate, Hanson,

preparing for interviews and we rehearse a response

Woods, & Hodges, 2015), it is imperative to rethink

to the dreaded request to “describe a time when you

our perspective on failure. It is well-established

26

Queen’s Medical Review | 12.2 that medical professionals are fallible despite their

et al., 2012). I suspect this phenomenon is attributable

best intentions. Medical error, which can either be

to the obsession with success and neglect of failure

preventable or unavoidable, is perhaps the most salient

which biases towards the selection of a homogenous

example of failure for physicians (Weingart, Mc,

group of students. There is a limited number of ways

Gibberd, & Harrison, 2000). Medicine is a profession

to be a traditional and successful applicant because

where everything can be done correctly and yet failure

it usually means not failing significantly or and/or

remains inevitable—post-operative complications and

often—performing well academically, volunteering

adverse drug reactions are the norm not the exception.

whenever possible, and pursuing your interests.

Given its ubiquity, perhaps the most glaring omission

The “cookie cutter” medical school matriculant, by

in medical schools is the lack of “failure” in the

definition, did not experience many failures because

admissions criteria and the curriculum. As medical

they were never taken off the track to medicine. On

education evolves, it’s important to ask: should failure

the other hand, there are countless ways to succeed

should be an attribute that matriculants already have

as an applicant who overcame barriers to medicine.

or should (or can) it be taught in medical school?

Unexpected or non-traditional paths to medicine are

littered with valuable experiences of failure more so

One of

the most compelling reasons to

"Given its ubiquity, perhaps the most glaring omission in medical schools is the lack of “failure” in the admissions criteria and the curriculum."

than straight and planned routes, resulting in unique

introduce failure into medical school admissions

an important role in achieving one of schools’ goals:

criteria is the need to increase diversity among

instilling resiliency in medical trainees. Resilience

medical students. Despite “objective” criteria, such as

is one’s ability to grow and progress in the face of

cognitive factors (e.g. GPA, MCAT scores) and the use

challenges or adversity (Howe, Smajdor, & Stockl,

of the innovative interviewing strategies (e.g. MMIs),

2012). The growing problem with burnout in medicine

the medical student population remains largely

has put resiliency, with it’s touted protective effects,

homogenous and unrepresentative of the general

in the spotlight (Dunn, Iglewicz, & Moutier, 2008).

population—individuals from affluence and certain

Interestingly, failure—in the context of remediation

ethnicities are consistently overrepresented (Young

frameworks—develops resilient medical students

27

individuals—the opposite of a “cookie cutter” student.

Perhaps the best way towards diversity in medical schools is to embrace failure in the application process.

The case for injecting failure in medical school

does not stop at increasing diversity. It likely also has

"By embracing failure, we embrace the reality that is medicine."

B. Franco ‘21 (O’Callaghan, Hall, Cobb, & Jacobson). Letting medical students fail may be just as important as helping them succeed. However, failure is still perceived as an imperfection that weakens aspiring physicians, rather than something that inevitably strengthens them.

Ironically, medical schools’ emphasis on success may be failing medical trainees and the society they

hope

to

serve.

By

embracing

we embrace the reality that is medicine.

failure,



References Bandiera, G., Maniate, J., Hanson, M. D., Woods, N., & Hodges, B. (2015). Access and Selection: Canadian Perspectives on Who Will Be Good Doctors and How to Identify Them. Academic Medicine, 90(7), 946-952.

Dunn, L. B., Iglewicz, A., & Moutier, C. (2008). A conceptual model of medical student well-being: promoting resilience and preventing burnout. Acad Psychiatry, 32(1), 44-53.

Griffin, B., & Wilson, I. G. (2012). Faking good: self-

Source: Roberto Saltori, Flickr.com

enhancement in medical school applicants. Medical Education, 46(5), 485-490.

Howe, A., Smajdor, A., & Stockl, A. (2012). Towards an understanding of resilience and its relevance to medical training. Medical Education, 46(4), 349-356.

O’Callaghan, P., Hall, M. P. M., Cobb, L. N., & Jacobson, M. Chapter 7 Failure Can Lead to Success When Remediation Builds Resiliency: How Struggling International Medical Students Gain Entry into US Graduate Medical Education Programs Perspectives on Diverse Student Identities in Higher Education: International Perspectives on Equity and Inclusion (pp.

113-127).

Weingart, S. N., Mc, L. W. R., Gibberd, R. W., & Harrison, B. (2000). Epidemiology of medical error. West J Med, 172(6), 390-393.

Young, M. E., Razack, S., Hanson, M. D., Slade, S., Varpio, L., Dore, K. L., & McKnight, D. (2012). Calling for a broader conceptualization of diversity: surface and deep diversity in four Canadian medical schools. Acad Med, 87(11), 1501-1510.

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SGL HOROSCOPES DISCLAIMER: Our crystal ball broke so we used fortune cookies instead...

Group

1 2

Take a moment to appreciate the simple pleasures of life.

3 4

29

Rivers need springs. Channel Hooke’s Law and be the spring in your life.

The world is always ready to receive talent with open, abducted arms.

Remind those in positions of power to train their delts.

7 8

Stop thinking about the road not taken and pave over the one you did. It’s called spiral learning.

Stay true to those who would do the same for you. #inthistogether

5 6

Keep your eyes, mind and heart open to new opportunities.

Side effects may include sudden chest pain, and considering your increased risk of myocardial rupture, you might want to seek urgent medical attention.

All the water in the world can't sink a ship unless it gets inside. Life is all about balance though (QMR, 2018), so stay hydrated, friends.

Prosperity makes friends and adversity tries them. Adversity may present itself in strange situations… don’t forget the FSGL snacks.

Ph oto by C

har le s

Delu vio P HCA on

Uns p

plas h

9

Talk to yourself and you will be rewarded for being a good listener in the next week.

10 11

There is no “I” in team. Remember to turn on autocorrect.

12 13

Things may come to those who wait, but only the things left by those who hustle. If you didn’t hear the starting horn, take comfort knowing that one person’s trash is another’s treasure.

The man who waits till tomorrow, misses the opportunities of today.

14 15

Life does not get better by chance. It gets better by change.

If it bothers you that the grass is always greener on the other side, why not go with Astroturf? Life isn’t by the book, so you don’t have to be either.

Do not worry and you will have great peace.

16

The retrograde of Jupiter in the skies may foreshadow the retrograde amnesia that will occur abruptly when you cross paths with the star named Examplify...

Good luck on the rest of term!

30

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