QMR - Volume 12, Issue 3

QMR QUEEN’S MEDICAL REVIEW

S P

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C E IN MEDICINE

T abl e

of

Cont e nt s

I s s ue 1 2.3 S p ace in Med icine K i mb e r ly Yu e n

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O h, the p laces you’ll d iscover !

B r ya n F r a nc o

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L ooking to S p ace

A no ny mo u s

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Q ueen S tation

Ni c o l e K r y s a

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A Dar k S p ace

S h u b ham S har ma

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O ne S m all S S T EP for P r ecler ksh i p. . .

M i c hae l Chr i s ti e

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T he Most U nd er ap p r eciated S p ac e in Med icine

Produ c t i on t e a m E dit o r s -in -c h ie f M a n a g in g e dit o r W r it e r s

Layo u t Gr a ph ic s

Shakir a Br aithw ai te Shannon Tang Ni col e Kr ysa Ki mber ly Yuen Br yan F r anco Ni col e Kr ysa Shubham Shar ma Mi chael Chr i stie Daniel Huang Ki mber ly Yuen Angela Wan Ki mber ly Yuen

Le t t e r

f r o m t he

Editors

Dear readers, Welcome to our third issue this year! We are very excited to share this issue with you as we explore our theme of Space in Medicine. As a student-run publication, we hope to provide a platform to share our ideas and act as a creative outlet.

In this issue, we explore the concept of space from varying perspectives. For example, Michael Christie (2021) describes creating space in your thoughts, and how we can use this as a way to decompress. We had an anonymous contribution that discusses sharing space with those who may be marginalized in our society.

Shubham Sharma (2021) explains how the QMed student-run SSTEP is a very effective learning space. Students new and old alike may benefit from hearing about some of Kimberley Yuen’s (2022) recommendations for spaces to check out in Kingston. We delve into the idea of dark spaces as Nicole Krysa (2022) brings to light the complexity of depression in dementia. Bryan Franco (2021) reminds us of the importance of humanism in our daily practice of medicine, and invites us to look at space for inspiration.

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/).

This is a special edition that was created during the summer months by our hardworking team, and we thank them all for their help. 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), graphics team of Angela Wan (2021) and Kimberley Yuen (2022) and layout team of Daniel Huang (2021) and Kimberley Yuen. We’d also like to send a warm welcome Nicole Krysa and Kimberley Yuen to the role of Editors-in-Chief this coming year.

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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Places to Go Waterfront Trail Do you prefer being active outdoors? Run alongside the St. Lawrence River on the Waterfront Trail! This trail boasts breathtaking views that’ll make you forget that you’re running. cityofkingston.ca/residents/recreation/parks-trails/ waterfront-pathway

Toast & Jam / Bread & Butter Outside of the core boasts a cute bustling brunch spot, situated beside their bakery (appropriately named Bread & Butter). Their cheddar and herb biscuits are a must! toastandjamcafe.ca 1530 Bath Rd

? w o n k u Did yo Stone City Ales Calling all craft beer lovers and patio lovers! This is the place for you. They tend to have daily specials so make sure to ask ($5 classic beers on Mondays anyone?). stonecityales.com 275 Princess St

Kimberley Yuen Meds '22

"Kingston restaurants

Cute Cafes

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The Elm Cafe Located just on the "outskirts" of downtown Kingston lives a cute and hip little cafe to plug in and focus. They also have great playlists consisting of funk, jazz and indie. theelmcafe.com 303 Montreal St

Grocery Basket (rooftop!)

It’s like taking the stairmaster to the top but the 360 view of downtown Kingston is worth it. The Grocery Basket is a cute little local grocery store/cafe/study spot. thegrocerybasket.ca 260 Princess St and 172 Ontario St.

Crave Crave is probably THE study spot. They have an assortment of baked goods, handcrafted lattes, and killer cinnamon buns. cravecoffeehouse.ca 166 Princess St

Northside It feels like you’re in Toronto here. This is the place for your insta-worthy brunch photos and pretty ambience.

Closed on Mondays. northsideespressoandkitchen.com 281 Princess St

O-Week Food Tour Mio The. Best. Gelato. Period. Whether you just finished your first exam, failed it, or want gelato just because, Mio will make everything better. miogelato.ca 178 Ontario St Pan Chancho A homestyle brunch place and bakery.

Another Kingston classic/favourite.

Make sure to ask what scones they have (baked daily). So good and buttery… panchancho.com 44 Princess St

Choi’s Roll Think every meal has to take a bite out of your wallet? Think again. Choi’s Roll offers affordable and delicious sushi options. You can typically get a roll to satisfy your craving for $5. choisroll.com 326 Princess St

SanTur Brewing Inc. Another hot spot to catch up with friends over some cold craft beer! santurbrewing.com/ 177 Princess St

Mango If you’re looking for some tasty and affordable Thai food, Mango is the place. Their portions are pretty generous too. mangorestaurant.ca 161 Princess St

has the most per capita."

Things To Do

And so much more!

The Pier (Gord Downie Memorial Pier) Soak up the last days of summer at the pier. Grab some friends and play spikeball, jump into the water, or get your tan on!

300 King St W KBC - Kingston Bouldering Co-op Hey climbing enthusiasts! KBC is a great little co-op to try bouldering for the first time, or challenge yourself with a difficult problem. It’s $10 to join and it’s good for life. Every visit after that is $10. Check the schedule for climbing times. kingstonboulderingcoop.com 12 Cataraqui St Unit #4

Amaranth Stoneware Looking for a new hobby or to get into pottery? Amaranth Stoneware offers classes of different levels for your creative side to indulge in. It’s a bit far from the core so you’ll definitely need some kind of transportation to get here. amaranthstoneware.com 745 Development Dr #7 Rock Dunder Grab a buddy and grab a car or join the annual family medicine first year class hike to Rock Dunder. The 2022s would highly recommend. visitkingston.ca/see-and-do-kingston/rock-dunder/ Rock Dunder Hiking Trail, Lyndhurst Waterfront Trail

Get to know the hot spots in Kingston. Welcome 2023s!

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The pale blue dot Looking to space for the humanity in medicine

Bryan Franco Qmed ‘21 5

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eferring to the pale blue dot—a pixel on a sunbeam from a photograph taken by the Voyager 1 space probe—that represented the Earth from 6 billion kilometres away, Carl Sagan said:

“From this distant vantage point, the Earth might not seem of any particular interest. But for us, it’s different. Consider again that dot.

That’s here, that’s home, that’s us.

On it everyone you love, everyone you know, everyone you ever heard of, every human being who ever was, lived out their lives. The aggregate of our joy and suffering, thousands of confident religions, ideologies, and economic doctrines, every hunter and forager, every hero and coward, every creator and destroyer of civilization, every king and peasant, every young couple in love, every mother and father, hopeful child, inventor and explorer, every teacher of morals, every corrupt politician, every “superstar,” every “supreme leader,” every saint and sinner in the history of our species lived there—on the mote of dust suspended in a sunbeam.”

The practice of medicine is composed of interactions. From the mundane— greeting patients with a welcoming smile—to the seemingly profound—like breaking bad news—physicians’ days are filled with interactions. The only constant in these interactions is that they will inevitably affect the participants.

Clinicians can feel satisfied in a job well done or be disappointed by a less than ideal interaction. Similarly, patients will either have their suffering alleviated or worsened. The sum of these interactions— the disappointments to the triumphs and everything in between—is medicine.

Fortunately, advances in science and medicine have allowed us to do a lot for patients. We can prescribe antibiotics for infections, and barring increasing resistance, we can usually expect this to help our patients. When a patient has an occluded coronary artery, physics and human ingenuity combine seamlessly to allow for cardiac catherization. In medicine, we are privileged to be able to—and expected to—use the sum of humanity’s advances and ingenuity to help our patients. To paraphrase Isaac Newton, one of the “giants” themselves, we stand on the shoulders of giants to see further than ever before to care for our neighbours on the pale blue dot.

It is unsurprising then that there is a frustration among physicians when unable to help their patients. Despite standing on the shoulders of giants, medical professionals facing heart failure, cancer, complex co-morbidities, and advanced age, often feel helpless.

Standing precipitously on the mountain of human knowledge that we tirelessly climbed, there is a visceral pain that comes with the realization that there is nothing at the summit to be able to help our patient. Nonetheless, most astute physicians successfully navigate these experiences—with the positive interactions outweighing the negative, thus making medicine a meaningful and worthwhile endeavour.

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The challenge comes when the meaning and value of medicine become eclipsed by the negative interactions. These repeated eclipses eventually lead to physician burnout. As empathy becomes depleted, physicians begin to draw on their health, both physical and mental, as a very limited resource during their interactions with patients. Harmful to patients, physicians, the health care system, and society, physician burnout is one of the most pressing problems in contemporary medicine.

Space offers a solution. The stars, until relatively recently, have been a ubiquitous and endless source of awe and inspiration. Space inspired the many giants whose discoveries formed the foundation for medical advances that we use everyday. Perhaps one of the most important medical advances gleaned from looking to space is the realization that there is one humanity—our sense of connectedness. Our collective empathy comes from understanding our place in the universe, the pale blue dot. Ironically, the physician’s view of the stars is often obscured by city lights, by pagers, and by the ceilings under which they care for patients. Modern physicians—who necessarily search for empathy and inspiration—are paradoxically physically disconnected from what has inspired thousands of generations before them.

When the spectre of burnout looms, when searching for the last vestige of compassion and empathy, it is reflexive to look inward. However, amidst the suffering, the sleep deprivation, and the suffocating demands of medicine, perhaps the most useful thing physicians can do is look up into space. This can remind us that every patient and physician, every disease and

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birth, every death and mourning, that have ever been and ever will, is on one pale blue dot in the universe—a pixel in the wallpaper of space and time. Taken with a bit of hope, this perspective can lessen the burden of medicine on the shoulders of an individual physician by sharing it among the generations of giants that previously stood in the same place. In the sum of interactions that is medicine, perhaps the most important one is also most often neglected—the physician’s interaction with the universe and humanity.

Reference Sagan, C., Pale blue dot: A vision of the human future in space. 1997: Random House Digital, Inc. Photo credit NASA Jet Propulsion Laboratory, jpl.nasa.gov

QUEEN Queen Station Anonymous Love, reconciliation, and healing require vulnerability. I was reminded of this truth in a particular way through an unexpected encounter at Queen Station a couple of months ago with a man I’ll call John. I’m grateful to John for teaching me that I don’t always have to hide my wounds and struggles from those around me. Vulnerability creates space for real connection. It is only when the masks come off and our hands are outstretched – wounds and all – that we enter the space where we can love and be loved. For me, this encounter is a call to reveal all of my wounds to the “Wounded-Healer” who makes “all things new.”

At the top of the Queen Station stairs, John asked me

for subway fare. No one was helping him, he said – he had just gotten out of the hospital and was trying to get home. We walked down into the station and made our way past the fare booth onto the Northbound platform.

Looking at John, seated on a red plastic TTC bench, I noticed the tattoos on his forearms. A cross inked on one arm and praying hands on the other. I asked if he was a Christian, but I only made out the first few words of his answer before the noise in the tunnel drowned him out.

The conversation continued as he added something rather abruptly. Sounding embarrassed, he apologized for hiding his hand from me. I hadn’t even noticed. I told him as much as he held out his hand. I saw then what he had tried to hide – rows of pink wounds obscuring the blue-green veins on his hand.

Sitting there beside John, I couldn’t help but recall another scene from earlier that day. It was Sunday and I had spent most of the weekend at a conference. One of the closing speakers, addressing the topic of suffering, referenced a story in the Gospel where Jesus heals a man with a withered hand. In order for the man to be healed, Jesus tells him: “Stretch out your hand.” The woman speaking noted that vulnerability is necessary for healing.

In order to be healed, we must first show our wounds to the One who longs to heal us.

I knew the story I heard earlier that day wasn’t meant just for me. I told John this story about the man with a withered hand and asked if he wanted to pray together, but he said, “No – I’m high. I can’t pray when I’m high.”

He spoke with sincerity and sadness.

Before we got on the subway, I gave John a bookmark I remembered I had in my purse. A few months ago, a friend of mine had given it to me as a gift. The words on the bookmark – “Stretch out your hand.”

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A Dark Space.

“A lright, Hank?”

“Alright as ever, Jim. All I can say, is thank goodness it’s Friday.”

“Teeell me about it. My back is sore from yesterday’s dig. And staying past 5:00 PM to blow open that channel? Do they think we’re paid by the hour or somethin’?”

“Whooee! You’re tellin’ me! Oh well. Today’s case is a good one.

This lady has 89 life years. I love these types of brains. Goodness knows that most of them synapses will have been pruned away by this point, so our path should be nice and clear. Whaddya say we take a slow day today, and make some stops to watch some of them memories along the way?”

Hank and Jim were memory miners, employed as part of a big data governmental initiative that sought to characterize the internal structure and storage patterns of the human brain at different life stages. The two were especially small, which allowed them the ability to pass between cells and skull layers, rappelling into brains. For these two, weekdays involved taking field notes while burrowing through sulci, climbing gyri, and sliding down axons (with the occasional wellness break thrown in).

“You speak my language, Hank. Let’s start at the rear then and make our way forward?”

And so they went. Hank and Jim entered through the occipital lobe, and it was not long before they got distracted.

“Gee. Come take a look at this memory, Jim. It’s completely blocked. I would bet any money that this is a dementia case.

Would you come and help me dig it out?”

“Ah sure. Why the heck not. I hope not too many of them memories are lost to her though, or it sure is gonna be a long day.”

Hank pulled a well-worn shovel out of his pack, and began to chip away at the massive mound of fatty tissue that was obscuring the memory from view.

“Aint it funny, Jim? All of this modern day technology, mapping brains and the like, yet we here are still using old-fashioned shovels. Sometimes there's just no substitute for brute force, wouldn’t ya say?”

“I sure would, Hank!”

Jim, who had been sticking his foot between two tightly packed brain folds, yanked it out suddenly, and stumbled over to where Hank dug with clumsy enthusiasm. With the two working together, the tissue soon became transparent enough for the memory to be appreciated.

“Wow! This must be one of the first things she ever done saw. Who do you think that man is? It must be her dad. And he is giving her a box. Oh, ain’t that nice. Is it...shaking? Hank, I’m scared!”

Jim clung onto Hank’s arm with such fervour that his fingernails began to make indentations in the heavy canvas that was Hank’s sleeve.

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“What in the name?”

“Sorry Hank, I just wasn’t expecting a cat to jump on right out of that box! Ain’t that the sweetest thing though? And they’re hugging.”

“Personally, I’m more of a dog kind of guy. And not those little pocket dogs either. I like real dogs. The kind that protect your family.”

“Is that a tear coming from his eye? I love that. It’s such a shame that she don’t remember that no more.”

Motivated after uncovering a viable memory so early in their day, Hank and Jim carried on with uncharacteristic vigour toward the left temporal lobe, where memory was stored as audio clips.

“Jim, at this rate, I think we can get out of here before the department store closes up shop. I told my wife I would get her up a pair of them fuzzy slippers today. Alright, put them earplugs in there, Jim. The memories here tend to come up quickly.”

SCREEEEEEECH “What was that?”

“WHAT?” “What was that?”

“I can’t hear you, Jim! That pitch done made me near deaf! Speak up, son!”

"The dynamite excavation revealed an empty space with a large multi-sensory memory vibrating at the center."

“Oh gee. I think we found ourselves another memory, and this one don’t sound so good. Sometimes, I think I am just too squeamish for this kind of work, Hank. I shouldn’t have listened to Pa. He always wanted me to be practical. I could be a real famous actor today, you know that?”

“Quit your babbling, Jim. Give me a listen.”

The two listened in silence to the distinct sounds of two cars colliding, accompanied by shrieks, and exclamations as a father was lost and a daughter survived.

“Wow. That’s rough.”

“Yeah.”

“Hank, I’m not liking these memories so much no more.”

“I know, Jim. Let’s just finish excavating this lobe, and then we can move on up to the front.”

“Okay. I’m glad you’re here, Hank. We make a good team.”

Click, click, click…reeeneeeeeeeeiiiigh “Ah, Hank! I found one right on over here. It’s horse sounds!”

“Oh yes. Good find, Jim. This memory seems well-preserved too.

Since we don’t have to dig this one out, why don’t we take our lunches and give it a listen?”

The pair removed their ear plugs, and sat down to eat their lunches on a particularly squishy myelin sheath. As they listened to the memory, they gathered that following the passing of her father, the girl whose brain they now occupied had been taken in by an aunt who resided in the country. Though still distraught and lonely, she was able to fill the void at least in part by caring for a large work horse, named Dungaree.

“Well, there’s no way around it, it sure is sad when a kid loses them parents too young, but at least there was still some happiness.”

“Yeah. It’s true. Alright, I guess we should get a move on. Shall we head on up to the prefrontal cortex?”

Jim and Hank made their way to their final destination of the work day – the notoriously complex prefrontal cortex.

“Oh darn. Look at this one, Hank. It is blocked to the roof!”

“I told you it was dementia. This will take a lot of work to access.

We really should not have taken such a long lunch break.”

“Ack. You’re right. Maybe we should use the dynamite for this one, if we want any chance of making it out of here by 5:00. My back is still too sore for digging anywho.”

“Alright. Let’s do it.”

The dynamite excavation revealed an empty space with a large multisensory memory vibrating at the center. After a long, uncomfortable pause, Hank cleared his throat and spoke first. “...Well, what are ya waitin’ for, Jim? Go on and open it up now.”

“Uh, yeah. Sure thing, Hank.”

Jim and Hank tenderly approached the pulsating memory with pliers of a sort, meant to unfold complex materials. Prodding it caused a rebound effect, thrusting them backward. What they saw next was a flurry of memories that seemed to move in and out of focus. The first memory was filled with uncertainty. The two miners saw life from the perspective of the young girl, as she peered up nervously toward her aunt’s new boyfriend. He gave her a toothy grin, and tugged on her pigtail, telling her that she was a very pretty young lady. This was soon followed by uncomfortable hugs and unwelcomed bathroom visits, with the man explaining all the time that they were family now. Finally, Hank grabbed Jim’s shoulder, and Jim covered his eyes in distress. They watched as the man made loud casual

conversation, for the ears of anybody who might be near enough to hear, as he pinned down the slight girl, and shielded her mouth. Her eyes ballooned with terror as he forced his hand up her dress. The memory halted abruptly, and the two miners were left in a dark space. “…Hank? Where do we go from here?”

“I really don’t know, Jim.” For the excavation had left a wall barring the path that had led the two to this point, and all that remained was darkness.

Author’s note: Depression is the most common treatable illness seen in the elderly1.

Due to its relationship to dementia, which has yet to be fully understood2,3, depression in older adults is often missed and perceived by caretakers as being a by-product of cognitive impairment, rather than an independent illness4. Although the processes of long-term memory storage are still being characterized, some believe based on the work of Lashley5 that memories are not encoded and stored in one specific region of the brain, but rather, that they span the entire brain, with particular aspects of memories being localized in the neurons that fired to create the original experience. More recent theorists have provided evidence to support a theory that recent long-term memories are stored in the hippocampus, while as memories age, they move toward the prefrontal cortex6.

References [1] Saikia, A. M., Mahanta, N., Saikia, A. M., Deka, H., Boruah, B., & Mahanta, R. 2016. Depression in elderly: a community-based study from Assam. Indian Journal of Basic and Applied Medical Research; 5(4):42-48.

[2] Heser, K., Bleckwenn, M., Wiese, B., et al. 2016. Late-Life Depressive Symptoms and Lifetime History of Major Depression: Cognitive Deficits are Largely Due to Incipient Dementia rather than Depression. Journal of Alzheimer’s Disease; 54;185-199.

[3] Wang, C., Gao, S., Hendrie, H. C., Kesterson, J., Campbell, N. L., Shekhar, A., & Callahan, C. M. 2017. Antidepressant use in the elderly is associated with an increased risk of dementia. Alzheimer Disease & Associated Disorders; 30(2):99-104.

[4] Wang, S., & Blazer, D. G. 2015. Depression and Cognition in the Elderly.

Annual Reviews of Clinical Psychology; 11:331-60.

[5] Lashley, K. 1950. In search of the engram. Society of Experimental Biology Symposium; 4:452-482.W [6] Costandi, M. (2009, February 10). Where Are Old Memories Stored in the Brain? Retrieved from https://www.scientificamerican.com/article/ the-memory-trace/

Nicole Krysa Meds '22

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One small SSTEP for preclerkship, one giant leap for clerkship

Shubham Sharma, Qmed ‘21

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hose aren’t really the iconic words uttered by Neil Armstrong some 300,000 km away from home but I figured I could get creative on the 50-year anniversary of what is arguably humankind’s most memorable moment in space exploration. For those of you who don’t know what SSTEP I’m talking about, it stands for Surgical Skills and Technology Elective Program. SSTEP is QMed’s very own week-long surgical and procedural skills bootcamp for pre-clerkship medical students, available in the summer immediately after one’s second year of medical school. The program has been very well-received by students and has nearly doubled in size, from 22 spots in its inaugural run 5 years ago to 40 spots this year. This is a direct result of increasing demand from preclerks who are keen on getting a taste of some of the technical skills important for clerkship.

The 40 students were divided evenly into 4 groups, with each group having their own schedule throughout the day to eventually cover the same material throughout the week.

QMed does a great job providing technical skills training as part of the curriculum throughout the year, which is tested at the end of the year in a procedural skills OSCE. I already had experience with suturing, biopsies and Foley catheterization because of it.

There are also ample opportunities available through events organized by various interest

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groups to gain exposure to and practice some of the other skills that are not part of the curriculum, although both the instructors and students agree that some of these additional skills should be incorporated in pre-clerkship teaching in the near future. I had experience with POCUS and laparoscopy because of this.

And finally, there is the week-long experience in a rural community at the end of first year of medical school that provides students a variety of opportunities based on their location/ preceptor – this part of the training cannot really be standardized. I had experience with suturing, hand-ties, and chest tubes because of this.

Despite having previous exposure to a lot of the skills covered during the week of SSTEP, it was a welcome review for me before clerkship, especially because I had not seen/practiced a lot of these things in almost a year. On top of that, in the safe environment of SSTEP amongst my peers and familiar instructors, there were a lot of skills that I encountered for the first time that I will no doubt see soon enough in my rotations in clerkship. Over the past few years, SSTEP has been cultivated into a space where learning occurs through guided practice. This has not only helped consolidate the skills learned throughout pre-clerkship, but also equipped me and my peers with a toolkit that will help approach clerkship with a little more confidence. 

Schedule To give you an idea of what the week entailed, my schedule looked something like this, sandwiched between a written pre-test and a post-test to gauge the impact of the program: Day 1: suturing, pre-operative/postoperative notes Day 2: point-of-care ultrasound (POCUS), biopsies, incision/drainage Day 3: Foley catheter, anastomoses, cystoscopy, fractures Day 4: suture hand-ties, laparoscopy, chest tubes Day 5: laparotomy, episiotomy, endometrial biopsy, delivery, IUD insertion

Legend Clockwise from top left: Fracture repair Anastamoses Anastamoses diagram Laparoscopy Chest tube insertion Laparotomy Fracture repair

Photo Credits Shubham Sharma

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THE MOST

UNDER APPRECIATED SPACE IN MEDICINE

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By Mike Christie Qmed ‘21

hat are you thinking about right now? Medicine both creates and occupies a fascinatingly diverse range of physical spaces. There’s

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the hum of the wards, the strict and precise sterility of the operating theatre, or the frenetic frenzy of the emergency department – just to name a few.

The work that goes on in these spaces is unique.

Almost instantly we become woven into the very fabric of our patients’ lives, an overwhelmingly great privilege to be entrusted with. To uphold this responsibility requires, even if in a quiet way, a tremendous intensity from its practitioners.

Millimetres matter, fractions of decimals have consequences of epic proportion, and an offhand comment in a history can turn out to be a vital piece of information. Attention, focus, and awareness are paramount, no matter the setting or field within medicine. There must additionally – indeed centrally – be a vast space left for the expression and understanding of human emotion and social being, each of which are accompanied by their own set of complexities. When you blend all of these components together, the proper practice of medicine is undeniably demanding on the human mind.

As a consequence, there is one space in medicine that I feel often doesn’t get the appreciation that it deserves. It’s universal, exclusively our own, and we take it everywhere we go: It’s the space inside our heads!

The proper practice of medicine is undeniably demanding on the human mind.

Upon entering the world of medicine, I learned almost immediately that in both the literal and figurative sense it is really hard not to take my work home with me. There are logistical items to keep track of, notes to write, questions that need answering, readings to be read, content to be considered, and – perhaps most importantly – the impressions left upon the emotional psyche by patient interactions and stories. These impressions can be especially challenging to manage.

Memories can pop to mind at the most unusual times – chopping carrots for a stir fry, in the shower, hitting bench at the gym, or out for a walk with my beloved on the weekend. It’s incredibly bizarre how the slightest external stimuli or brief wandering of thoughts can transcend time and

space and transport me back to one moment or another to the extent that I might as well actually be there! Often there are serious or difficult experiences that seem to linger in my conscious attention, even after a team debrief, commute home, and an attempt at relaxation. It’s normal, and I know it’s because I care, but I don’t think it’s reasonable to be unable to switch off some of these thoughts. Recently, I have employed a novel technique to do so.

I have begun to conceptualize my thoughts as occupying physical space inside my head. At first that sounds simplistically stupid - I know - but hear me out! And yes, I am acutely aware that in a way our thoughts arguably do already take up some space in the form of tiny neurons and their synapses in our brains (and that, for everyone’s sake, is as deep as I’ll dare venture into neurology).

For some reason, however, envisioning it in this way just doesn’t do it for me. It’s too minute, too nanoscopic. Instead, I view my “headspace” as my own physical property, a room of sorts into which thoughts must be permitted entrance, extended occupancy, and politely depart when asked. When I am trying to relax and enjoy myself - feet kicked up with some Alberta Premium on ice - and a work-related topic comes to mind, I have developed a habit of asking myself the simple question of whether or not it is really something I want to think about at the moment.

Sometimes it is. Sometimes it’s a necessary moment to take and appreciate my feelings on a matter, to reflect and understand what it meant, what I can learn from it, and how I can use it to make myself a better person. And let me be clear that in medicine there are some stunningly beautiful moments of humanity, joy, and compassion that make me shake my head in awe and go “This is what it’s all about!”. Those thoughts are usually permissible when uninvited, and to them I generally say “Come on in.”

But sometimes the thought that rolls into town is not a pretty one, an absolute shaker of a thunderstorm brewed on a stifling hot summer afternoon and menacing to fill my head with dark clouds. That’s when the method has been useful -

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I view my “headspace” as my own physical property, a room of sorts into which thoughts must be permitted entrance, extended occupancy, and politely depart when asked. pausing, acknowledging the thought, and filing it away to be considered when the time is right. It’s not so much about completely rejecting whatever it is, willing it out of existence, and never thinking about it again – it’s telling it to “Call again later.”

Now to be transparent, I will admit that the method has not been perfect. There are some experiences that are particularly powerful, and I have come to understand that in certain instances, irrespective of my efforts, they might kick down the metaphorical door of that space inside my head. I use this as a signal, however, that it’s probably something I need to talk through with a colleague, friend, or

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loved one. So, in a way, the headspace analogy still functions for these types of moments, too.

The spaces we practice in afford us the highest privilege of caring for others, and naturally these facilities and the patients within them deserve our utmost respect. Yet to be at our best while at work, we need to make sure we take time to recharge in the state of mind that we find restful. If that involves shop talk, then that’s quite alright. If it doesn’t, that’s just fine as well, and with an appreciation of what is sitting in the space between our ears, it’s possible. A great mentor of mine once advised that it’s hard to pour from an empty glass, and I believe respecting what occupies our headspace can help us achieve the fulfillment we require to do what we love.

So, allow me to close by asking you one last question: What are you thinking about right now?

 Source: bobistraveling at flickr.com

Welcome Class of 2023!

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Photos by: Victoria lee Kim, Rachel Trites, Andrew Lee, Hamza Asif, and Eva Bruketa

k Congratulations

to the graduates of 2019, we wish you all the best! To the Class of 2020 hang in there!

To the Class of 2021 don’t forget your stethoscope! To the Class of 2022 savour your freedom! To the Class of 2023 relax and enjoy the ride!j

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Source: pxhere.com