QMR - Volume 14, Issue 1 (2020)

FALl 2020

ISSUE 14.1

Turning New leaves

QMR Au contraire Is social media a good platform for social justice advocacy?

Juris Doctor How has COVID-19 impacted medical policy and our legal system?

Skincare Some helpful tips to help you establish your very own pandemic skincare routine.

UP FOR GRABS Be the first to finish the QMR crossword and win a Starbucks giftcard!

TURNING NEW LEAVES

in medicine

In This Issue Content Contributors Linda Archila Apoorva Bhandari Nancy Chen Mike Christie Ivneet Garcha Julia Green Morgan King Nicole Krysa Sarenna Lalani Sean Leung Grace Lin Taylor Mouliakis Emma Spence Charles Wicks

Design

Gabby Jagelaviciute Kiera Liblik Sigi Maho Suffia Malik Amanda Mills Jessica Nguyen Kaitlyn Rourke Kimberley Yuen Kendra Zhang

Editors

Apoorva Bhandari Edward Cui Colin Faulkner Mary Foley Ivneet Garcha Sarenna Lalani Grace Lin Aidan Pucchio Ally Soule Grace Yin Kendra Zhang

Managing Team Kiera Liblik Grace Yin

Cover Art

Morgan King

3 Letter from the editors 4 meet the team 6 JURIS DOCTOR: Medico-legal issues 8 The US election 10 Au contraire: Wounded not woke 12 Abortion pill policy 16 medic(in)e: Politics in Medicine 18 Zoom fashion 20 qmed Plant(ar) Fascinated 22 a pandemic skincare routine 24 REcIPES: Turning new leaf-y greens 27 Workout of the issue 28 Poetry 30 The only constant 32 Unexpected time and timely perspective 34 TIME CAPSULE 36 Rising stars Horoscopes 38 Qmr crossword

Letter From the Editors Turning new leaves has a diverse spectrum of meanings and can be interpreted in a multitude of ways. When taking into account the COVID-19 pandemic, the continuing advocacy surrounding racism against Black and Indigenous lives, and the American election, “to turn a new leaf” gains various new conceptualizations. Wanting to remain sensitive to the ongoing struggles and challenges faced in this tumultuous time, we thought the theme “Turning New Leaves in Medicine” would provide an opportunity to reflect on the current climate and what it means to be a medical student in this day and age. In this issue, you will find a broad range of content from our talented contributors. Grace Lin covers the OMSA’s “Day of Action,’’ and shares numerous reflections by QMed’s own students on the topics of advocacy, action, and leadership. Mike Christie remarks on change as a constant in the dynamic life of a medical student, and we can totally relate. In a debut collaboration between QMR and QMed Plant(ar) Fascinated’s Nancy Chen and Taylor Mouliakis, you will find tips on keeping your sprouts lively and, well… green! We can say with certainty that our plant babies are very grateful for the tips. As a friend of QMed, Julia Green writes a thoughtprovoking piece on the abortion pill and why it’s legalization doesn’t necessarily equate to access for women across Canada. It certainly gave us some serious food for thought. From nifty lifestyle tips, to brave opinions on current events, to deep existential reflections, we are sure that this issue has something that will pique your interest! We have two big thank-yous that are in order. First, we are so grateful to you, our readers, both new and old, for your support. We truly would not be here if it weren’t for you! We know that picking up a copy doesn’t look the same, and we too miss the days where we could leaf through the magazine (pun-intended) and feel the crisp pages turning beneath our fingers. However, thanks to some pretty neat softwares, we hope you are able to enjoy this issue nonetheless! Second, we have some enormous gratitude for our amazing team who put countless hours into the creation of this publication. From writers who transformed ingenious ideas into phenomenal pieces, to artists who generously shared their works (special shoutout to Morgan King for the stunning cover art!), to illustrators and photographers who ensured this issue was nothing short of an aesthetic accomplishment, to a layout team that brought everything together in perfect harmony, it is no secret that our crew is filled with incredible amounts of talent and dedication. We truly feel privileged to have the opportunity to work with each of you, and we cannot wait to get to know you better as the year progresses. We know that the WFH life is not always easy, and we cannot thank you enough for your tireless commitment to QMR! Without further ado, we invite you to take a peek at this issue. Meet QMR Volume 14.1: Turning New Leaves in Medicine. Enjoy!

Sarenna Lalani & Jessica Nguyen Editors-in-Chief 3

Meet Our Team Sarenna Lalani

jessica nguyen

Editor-in-Chief

edward cui Editor

grace lin

ivneet garcha

Kiera Liblik

Managing Illustrator

Writer & Editor

Mary foley

apoorva bhandari

Kassandra mcfarlane

Sean leung

Aidan pucchio

emma spence

colin faulkner

Kendra Zhang

Kaitlyn Rourke

Crossword Connoiseur

Kimberley yuen

Gabby Jagelaviciute

Amanda mills

Andrew Lloyd-Kuzik

Illustrations

Managing Editor

Writer & Editor

Writer & Editor

Illustrations & Design

grace yin

Editor-in-Chief

Design

Photographer

Writer & Editor

Editor

Writer

Illustrations

Editor & Design

Joshua Lowe

Sarah sloss

Photographer

Photographer

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Writer

Editor

Sigi Maho

Illustrations

jehan irfan

Photographer

Mike Christie Writer

ally soule

Writer & Editor

Suffia malik

Illustrations

corey forster

Photographer

Artwork by Morgan King, Meds ‘23

Photgraphy by Andrew Lloyd-Kuzik, Meds ‘24

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JURIS DOCTOR: INJECTING LEGAL CONVERSATIONS INTO MEDICAL ISSUES

COVID-19: A Disruptive Force and Catalyst for the Implementation of National Licensure

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Written by Ivneet Garcha, MPH JD, Meds ‘24 Artwork by Suffia Malik, Meds ’24

OVID-19 has served as both a disruptive force and a powerful catalyst for change in the Canadian healthcare system. Amidst concerns of health system capacity and the distribution of human health resources, longstanding conversations about national physician licensure have reemerged, but with an increased sense of urgency for action. There is no question that Canada has a national health human resource distribution issue. Access to care, particularly for those patients living in rural and remote communities in Canada, remains a challenge. There are a number of medicolegal and policy responses available. But the one that seems to hold the most promise is the implementation of national licensure to create a physician workforce that is responsive to changing population needs, can be redistributed efficiently, and redresses inequities in access to care. However, there are challenges. The Canadian healthcare policy and regulatory landscape poses a number of uphill battles for the implementation of a national license. First, is the issue of jurisdiction. Sections 91 and 92 of the Constitution Act, 1867 divides legislative powers between the federal and provincial governments respectively. However, health does not fall into a neat box and courts have stated that, “health is not a matter which is subject to specific constitutional assignment but instead is an amorphous topic which can be addressed by valid federal or provincial legislation, depending on the circumstances of each case and on the nature or scope of the health problem in question”.1 While much of healthcare has been regulated provincially, the need for federal intervention to support a pan-Canadian approach to human health resource distribution is needed. Each level of government must be held accountable for their specific role in implementing national licensure. In other words, provincial action taken regionally cannot be a substitute for the federal governance and policy support needed at a national level. Second, while a provincial-territorial regulatory licensing regime exists, it is fragmented and the legislation that supports the regime is inconsistent. Each province has its own licensing requirements, fees, and required documentation. As such, anytime a physician enters a different provincialterritorial jurisdiction, they are required to obtain an 6

Illustration by Suffia Malik, Meds ‘24

OPINION additional license in order to provide care to patients in that province. Obtaining these additional licenses requires physicians to go through a lengthy, time-consuming administrative process that creates financial obstacles in the form of additional fees. The implementation of a national license would create a regulatory regime that is consistent and allows for greater mobility of physicians nationally.

“

The one that seems to hold the most promise is the implementation of national licensure to create a physician workforce that is responsive to changing population needs, can be redistributed efficiently, and redresses inequities in access to care.

COVID-19 has had a significant impact on the conversations around national licensure. With the need for an agile and coordinated response, we have seen the law become fast-tracked with the implementation of portability agreements, emergency orders limiting physician liability during the pandemic (i.e. scope of practice, concerns related to practicing in other jurisdictions), and expedited administrative processes allowing for the rapid deployment of licenses to support the influx of physicians entering new provincial and territorial jurisdictions. In essence, the halted conversation around national licensure was revived as physicians, policy-makers, regulatory bodies, insurers, and the public at large saw how quickly the law could be adapted to meet the short-term needs of an over-strained healthcare system. As we look forward, we can begin to consider the longterm positively-disruptive impacts COVID-19 has had on our existing healthcare policy regime. The COVID-19 response represents a step forward in terms of expedited licensing processes and increased physician mobility. There is no question that health system stakeholders can see the utility of having a healthcare system that has a flexible and adaptable physician workforce. However, this progress is insufficient, and as we look to the post COVID-19 context, we must consider what is needed for a more sustainable solution. Our health system has received a much-needed shock, and it is time that policy makers and physician regulators reframe this unfortunate event as an opportunity to breathe life into a stale, outdated health system. Law and regulatory policy has a chance to make a real, meaningful impact on inequitable access to care challenges in Canada. Federal and provincial governments can no longer choose to offload responsibilities to the other level of government. Each must recognize the role they have to play in implementing supporting legislation for health system change. To ignore the incredible impact that national licensure can have on the health system would be negligence feigning as ignorance. • 7

1

Schneider v. The Queen, [1982] 2 SCR 112.

The 2020 U.S. Election:

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Image sources: www.independent.co.uk/life-style/women/jacinda-ardern-quoteschristchurch-shooting-coronavirus-motherhood-a9634056.html www.dailysabah.com/opinion/columns/last-chance-for-angelamerkel?gallery_image=undefined#big news.sky.com/story/brexit-eu-thanks-joe-biden-for-clear-support-amiddispute-over-uks-internal-market-bill-12140557 www.nytimes.com/interactive/2020/us/elections/donald-trump.html www.vicnews.com/tag/justin-trudeau/

OPINION

Finding COMMON ground Written by Anonymous

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’m writing this article on the eve of the most anticipated U.S election in recent memory (update: morning after, still undecided) and musing what the country, and by proxy, the world, might look like when the election is decided. Elections are a lot like New Years — they offer the vision of a fresh start, where grandiose promises and resolutions are made, many of which will go unfulfilled in the year(s) that follow. However, they both inspire hope that we are capable of growth and are, on rare occasions, catalysts for true change. It is clear that the U.S remains dangerously divided. Intransigent monologues from both parties reflect a failure to listen, and only poison the society against its candidates. This is not an isolated problem; populist governments with extremist policies are popping up across Europe and South America as well. These governments are litmus tests for how increasingly polarized our world has become. Does any of that change if a new president is sworn in? Will large-scale systematic changes be implemented to make the country more equitable and tolerant? I’m hesitant to definitively say yes.

Regardless of the winner, I still see a silver lining to all of this uncertainty. I believe we, as a society (yes, even in Canada!), are on the verge of a tipping point. Ahead is a fork in the road where we can either lean into the manufactured division or resolve to reject it and move towards a future no longer manipulated by partisan misinformation. I genuinely believe that most of us are weary of North America’s contentious politics. We want to see collaborative efforts from our leaders to serve us, the people that elected them, rather than attempts at furthering their own agendas. How can we influence this change? We can start by no longer listening to partisan media sources of information: find a source of information that is both reputable and (mostly) objective and stick with it. We can also enhance our knowledge of marginalized minority groups and listen to sources approved by these groups themselves. Most importantly, we can use this election as our fresh start, where we collectively decide what we stand for and loudly demand change. We, as young professionals in medicine occupy/ will soon occupy a position in society where our opinions are valued and can galvanize others to act. Many of our classmates have already acted in this position. Hopefully more of us follow their lead and help define the future we would like to see emerge from this divisive era. •

9

Au Contraire...

Wounded Not Woke: Why social media may be leaving social justice movements worse for wear

Artwork by Kiera Liblik, Meds ‘23

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efore anyone gets too bent out of shape over what I am about to say, let me preface this piece by saying that I fully and firmly believe in the power of debate and discussion. My upbringing strongly instilled two fundamental beliefs in me: 1. Knowledge is power and 2. The pen is mightier than the sword. These beliefs have culminated in me drawing the conclusion that words are the most compelling tools we have to share information, and thus, power. However, I also believe that words have to be used in the appropriate context to be efficacious. Quite frankly, I am not sure we are doing it right at the moment. Let’s dive into the topic at hand. Over the past few months, the parallel trajectories of covid and the BLM have created an interesting climate for discussion to take place. With the election adding another layer to the conversation, I think it’s fair to say there has never been a dull moment nor a lull in the conversation. My reintroduction to the BLM movement this spring took place in early April, with the publicizing of Ahmaud Arbery’s murder, accompanied by a widespread mass media disapproval of the injustice his family faced at the hands of the judicial system. The video of his murder circled social media platforms, rousing varied reactions from its viewers.

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OPINION On May 8th, Ahmaud’s birthday, a run took place across North America — champions of his cause ran 2.23 miles and spread awareness through the hashtag #IRunWithMaud. Two weeks after this, another act of brutality against the Black community received mass attention on social media. A police officer named Derek Chauvin killed George Floyd, a 46 year-old African American man. I associate this event with the circulation of artwork captioned #ICantBreathe. On June 5th, Breonna Taylor’s story was brought into the limelight. On her 27th birthday, vigils to commemorate her life were held, and social media is enveloped by another hashtag movement — #SayHerName. These events were big wake-up calls for a lot of people, myself included. While I knew about the history of injustices against BIPOC, for too long I had been turning a blind eye to the ongoing barriers, both in the US and here at home. The pain, the struggle, the systemic oppression faced by marginalized groups is not just a problem of the past and is not simply a them (read American) issue; racism is current and topical and demands attention here in Canada, in our own social spheres and our present political landscape. As the summer months rolled on, my social media continued to blow up with articles and posts about educating oneself on allyship, on the history of BIPOC in Canada, and even on the aches and pains of the current socio-political culture and justice systems. It seemed that everywhere I turned, there was something new to take in — another post to slide through, another article to read, another book to buy. I too shared posts or stories I found to be informative. But the further along we got, the less impact I found each post to have. The oversaturation of Instagram, Facebook and Twitter somehow made each word feel less valuable…

Then came the arrival of cancel culture. I was aware (and if I’m being completely honest, quite fearful) of the potential of being cancelled should I opt out of participating in this mass sharing of information. If my feed “returned to normal,” I was warned that I could be labelled as both passe and part of the problem. Personally, I found the sheer amount of content in my feed to be overwhelming. I can appreciate that, in a sense, maybe it was part of the point — the struggles faced by BIPOC are surely overwhelming and inescapable; however, I don’t find recreating that experience via social media to be of particular benefit to the goal of educating others and fostering an environment where individuals feel compelled to educate themselves. In my case, I found myself inundated with information and, ashamedly, less motivated than ever to educate myself. This was worsened by the constant fear of being canceled. The more others shared on social media, the more I felt like I was being left behind.

The oversaturation of Instagram, Facebook and Twitter somehow made each word feel less valuable. . . I think that there are a few issues with the way we engaged with the BLM movement on social media. For starters, we have created a toxic environment where you either join the masses or you get left behind. If you think about it, the people most likely to take part in the movement, be it via vocalizing their opinions or sharing resources, are probably people who believe in it to begin with. By cancelling those who do not take part, we effectively exclude the people who most need to be engaged. Furthermore, however, the increased

pressure to post and share resources opens up the opportunity for virtue signaling to take place. Virtue signaling is the social media equivalent of paying lip service to an idea. It is characterized by disingenuous sharing of one’s morals to create a facade of righteousness. The more we corner ourselves into a false dichotomy of posting or being part of the problem, the more likely we are to engage in virtue signaling, and I think that is a serious problem. The less candid we are about the flaws in our logic and our perceptions, the less open we are to learning and changing our mindsets. I would argue that the more we virtue signal, the more we become part of the problem. The last notion I want to leave you with is one about the context. I mentioned this earlier, but I do think that the milieu in which we engage in discussion is important. When I think about Instagram, the first thought that comes to mind is not that it is an intellectual platform for advocacy. I associate the growth of social media with the rise to fame of the Kardashian clan or the America-wide hunt for “Alex from Target.” I am not saying that it’s impossible for social media to become a platform for academic discussion, I just hope social media’s past doesn’t serve to dilute the movements of the present. Just some food for thought! As future physicians, we ought to consider how to best advocate for our patients. Quite clearly, part of that advocacy involves challenging existing socioeconomic and sociopolitical disparities. The question I pose to you is how do we best engage in that advocacy? How should we be taking a stand for BIPOC and demonstrating our allyship? Is social media an appropriate platform for us to be investing our energy in in order to affect change? •

References: Al Jazeera. (2020, June 11). A timeline of the George Floyd and anti-police brutality protests. Retrieved from https:// www.aljazeera.com/news/2020/06/timeline-george-floyd-protests-200610194807385.html The New York Times. (2020, May 08). Ahmaud Arbery Shooting: A Timeline of the Case. Retrieved from https://www. nytimes.com/article/ahmaud-arbery-timeline.html 11

So Close, Yet So Far: How Canada Must Continue to Refo “Research shows that the greater the distance a woman has to travel for an abortion, the more likely she is to carry an unwanted pregnancy to term, get an unsafe abortion outside the healthcare system, or have an abortion at a later gestational stage”

Julia Green is completing her combined BCL/JD with a Major Concentration in International Human Rights Law & Development at McGill University. She is interested in the intersection between gender, human rights, and the law. She would like to thank past editor Nicole Krysa for introducing her to the QMR and encouraging to submit her research on Mifegymiso.

I

n Canada, an estimated 1 in 3 women will have an abortion in their lifetime.1 Studies have shown that a woman’s ability to choose whether or not she can terminate a pregnancy has huge economic impacts. Women who are pregnant and raising children often have a reduced capacity for political, social, and economic participation, which can have a negative effect on their socioeconomic status.2 Some women have abortions to avoid becoming single mothers, a group which in Canada has the highest poverty rates of all family types.3 For many women, particularly those who have not yet completed high school or post-secondary education, having a child will significantly disrupt their education and impact their future earning abilities.4 While the demographics of abortion seekers are not available in Canada, in the United States studies show three out of four women who seek an abortion are already low-income. Poor women who are not able to access an abortion for an unplanned pregnancy are more likely to remain poor for years after.5 For these reasons, it is critical that all women in Canada have the choice to give birth to

children only when they feel they are personally ready to do so. Since the 1988 decision of R v. Morgentaler which decriminalized abortion in Canada, many advances have been made to make abortion more accessible for Canadians, though many barriers still exist. The Canada Health Act guarantees that abortion services are insured in all provinces and territories, but there are still limitations in some provinces. For example, Ontario will not fund abortions at every clinic, and New Brunswick will only fund abortions in hospitals. Prince Edward Island only established its first abortion clinic in 2016 and does not provide any provincial coverage for travel if a woman must go elsewhere due to lack of availability within the province.6 The PEI example highlights one of the main challenges for abortion access in a country as big as Canada. In most provinces and territories, there are less than five abortion providers total (including clinics and hospitals).7 Most of the abortion providers that do exist are within 150 km of the US border, and typically are concentrated in urban centres.8 This means that many women must travel far distances to access abortion, which can be costly and require them to take time off work. The cost of travel is almost never covered by provincial health insurance. The limited availability of abortion in some areas can also create long wait times for appointments, which causes issues with a health matter that is so time sensitive.9 This is especially concerning because research shows that the greater the distance a woman has to travel for an abortion, the more likely she is to carry an unwanted pregnancy to term, get an unsafe abortion outside the health-care system, or have an abortion at a later 12

gestational stage.10 The result of these combined policy gaps are that many women in Canada cannot access safe, timely abortions performed by licensed medical professionals.

Mifegymiso: A Potential Solution

In 2017 the medical abortion drug mifepristone became available in Canada. It is sold under the name Mifegymiso, and costs between $300 and $450. Mifegymiso is a combination of mifepristone and another drug called misoprostol, which essentially work together to induce a miscarriage and flush the contents out of the uterus a day or two later. It is very effective, with data showing that once mifepristone is taken, an ongoing pregnancy occurs only in 1.1 per cent of patients with more serious complications occurring in only 0.4 per cent.11 It can be taken up to 9 weeks into a pregnancy.12 Women may prefer medical abortion over surgical abortion because it is less invasive and avoids anaesthesia, allowing the woman to “take charge” of her own abortion in the comfort and privacy of her own home.13 Women’s health advocates hailed the decision as a positive step towards improving abortion access in Canada.14 Mifepristone has been available in France and China since 1988, and the United Kingdom since 1991. Most other European countries had it on the market by 1999 and the United States has offered the drug since 2000.15 The World Health Organization has also included mifepristone on the WHO Model List of Essential Medicines based on its efficacy, safety, and cost effectiveness.16 It is therefore surprising that Canada took so long to approve the drug, though Health Canada is known to have more onerous requirements

OPINION

orm Abortion Pill Policy

Written by Julia Green

for regulatory approval of reproductive health medications than Europe and the US.17 Because mifepristone can be prescribed by family physicians and dispensed at regular pharmacies, it has the potential to increase the number of abortion providers in Canada significantly, especially in areas far from regular abortion service providers. It does not require the labour or infrastructure needed for surgical abortion, which frees up procedure rooms and helps reduce wait times for women who do opt for a surgical abortion. While it does require some follow-up with the doctor to ensure that the abortion was successful, these follow up appointments can be done over the phone, which is helpful for people for whom travelling multiple times to a doctor may be burdensome.18 Prior to the availability of mifepristone in Canada, the only non-surgical option Canadian women had was an induced abortion using methotrexate. Methotrexate is cytotoxic, meaning it is toxic to cells, and is used for chemotherapy, the treatment of autoimmune diseases, and ectopic pregnancy. The administration of methotrexate is more cumbersome and its time course is less predictable, which means it may take several weeks for the abortion to occur after taking methotrexate.19 If the abortion is not successful, methotrexate could cause serious deformities in the infant. For this reason, the WHO does not recommend methotrexate for abortions. When methotrexate was the only option, only 5% of abortions in Canada were medical.20

criticized for implementing so many regulations around its administration that it was effectively as difficult to access as a surgical abortion. It was initially required for patients to take the pill in front of a physician, and it could only be dispensed by doctors themselves as opposed to regular pharmacies. It was also mandatory for patients to have an ultrasound before it could be prescribed, which would extend the time before they could get the pill and also potentially require more travel and time off. Additionally, doctors had to complete a mandatory training program before they could write prescriptions for the drug.21 The beauty of mifepristone is that it can be prescribed by any family physician regardless of whether they provided abortion before, however it appears these extra restrictions discouraged many doctors from offering it to their patients. Health Canada has since changed its regulations on Mifegymiso significantly. Doctors are no longer required to go through special training in order to prescribe it, and ultrasounds are not necessary in cases where the doctor feels they can safely estimate the fetus’ gestational age and rule out ectopic pregnancy without one.22 Mifegymiso can now be dispensed at regular pharmacies, eliminating the challenge for family physicians who may not have had the infrastructure to dispense it themselves.23 In many provinces, nurse practitioners may also prescribe mifepristone.24 With all of these changes to regulation, abortion should theoretically be more accessible to Canadians. However, several evaluations of the current state Remaining Obstacles to Abortion Access of abortion access in Canada show that When Mifegymiso initially became the abortion pill is still far from reaching available in Canada, Health Canada was its full potential. While abortion pill

“The World Health Organization has also included mifepristone on the WHO Model List of Essential Medicines based on its efficacy, safety, and cost effectiveness.” 13

1 Sheila Dunn and Rebecca Cook, “Medical abortion in Canada: behind the times” (2014) 186:1 CMAJ 13 (NCBI). 2 Jessica Shaw, “Abortion as a Social Justice Issue in Contemporary Canada” (2013) 14:2 Critical Social Work 4. 3 Ibid. 4 Ibid at 5. 5 Scott Horsley, “Abortion Limits Carry Economic Cost for Women”, NPR (23 May 2019), online: < https://www.npr.org/2019/05/23/726294656/alook-at-the-economics-of-ending-a-pregnancy>. 6 Mark Gollom, “Abortion barriers in Canada are back in spotlight following passage of abortion bans in U.S.”, CBC News (18 May 2019), online: < https://www.cbc.ca/news/health/abortionaccess-canada-us-bans-1.5140345>. 7 “Access at a Glance: Abortion Services in Canada”, online: Action Canada for Sexual Health & Rights < https://www.actioncanadashr.org/ resources/factsheets-guidelines/2019-09-19access-glance-abortion-services-canada>. 8 “Unequal Access to Abortion Across Canada”, online: Action Canada for Sexual Health & Rights < https://www.actioncanadashr.org/news/201907-25-unequal-access-abortion-across-canada>. 9 Ibid. 10 Carly Weeks, “Abortion-pill obstacles: How doctors’ reluctance and long-distance travel stop many Canadians from getting Mifegymiso”, The Globe and Mail (13 July 2019), online: < https:// www.theglobeandmail.com/canada/articleabortion-pill-obstacles-how-doctors-reluctanceand-long-distance/>. 11 Supra note 1. 12 Ashley Bancsi and Kelly Grindrod, “Update on medical abortion”(2020) 66:1 Can Family Physician 42-44. 13 Sheila Dunn and Ellen Wiebe, “Providing Mifepristone Abortions: What You Need to Know” (October 2019) at slide 8, online (PowerPoint): The College of Family Physicians of Canada < https://fmf.cfpc.ca/wp-content/ uploads/2019/11/W229_ProvidingMifepristone-Abortions_What-you-need-toknow.pdf>. 14 Carly Weeks, “Abortion-pill inequality: How access varies widely across Canada”, The Globe and Mail (12 October 2018), online: < https:// www.theglobeandmail.com/canada/articleabortion-pill-inequality-how-access-varieswidely-across-canada/>. 15 Supra note 1. 16 Liza Gibson, “WHO puts abortifacients on its essential drug list” (2005) 331 BMJ 68. 17 Supra note 1. 18 Supra note 13 at 43-44. 19 Supra note 1. 20 Supra note 13 at 6. 21 Sharon Kirkey, “Home abortion pill about to hit market in Canada, but has already garnered criticism”, National Post (19 April 2016), online: < https://nationalpost.com/news/canada/0420-naabortion>. 22 Health Canada, Health Canada approves updates to Mifegymiso prescribing information: Ultrasound no longer mandatory, Information update, (Ottawa: 16 April 2019). 23 “Dispensing Mifegymiso in BC”, online: College of Pharmacists of British Columbia < https://www.bcpharmacists.org/mifegymiso>. 24 Supra note 13 at 12.

25 Supra note 14. 26 Ibid. 27 Supra note 13 at 14. 28 Supra note 14. 29 Supra note 13 at 14. 30 Supra note 6. 31 Pamela Fayerman, “Penalties reduce federal transfer payments to B.C. by $500,000”, Vancouver Sun (19 February 2015), online: <http://www.vancouversun.com/health/ penalties+reduce+federal+transfer+ payments/10824574/story.html>. 32 Supra note 6. 33 Ibid. 34 Supra note 12. 35 Jennifer Yoon, “30 years after Morgentaler ruling, future doctors say medical schools neglect abortion training”, CBC News (11 October 2018), online: < https://www. cbc.ca/news/canada/montreal/30-yearsafter-morgentaler-ruling-future-doctorssay-medical-schools-neglect-abortiontraining-1.4857929>. 36 Rebecca Renkas, “Female doctors better for health care, but experience gender pay gap, discrimination and depression: U of T expert”, U of T News (30 October 2019), online: < https://www.utoronto.ca/ news/female-doctors-better-health-careexperience-gender-pay-gap-discriminationand-depression-u-t>. 37 Supra note 14. 38 Supra note 14. 39 The Association of Faculties of Medicine of Canada, “The Future of Medical Education in Canada (FMEC): A Collective Vision for MD Education” at 23, online (pdf): Council of Ontario Universities < https://cou.ca/ wp-content/uploads/2010/01/COU-Futureof-Medical-Education-in-Canada-A-CollectiveVision.pdf>. 40 Manas Mishra, “Medical abortions can be safely supervised via telemedicine: study”, Reuters (14 August 2019), online: < https:// www.reuters.com/article/us-health-abortiontelemedicine/medical-abortions-can-besafely-supervised-via-telemedicine-studyidUSKCN1V41IM>. 41 Supra note 13 at 49. 42 Becca Andrews, “The Coronavirus is Making the Case for Abortion Via Telemedicine”, Mother Jones (18 March 2020), online: < https://www.motherjones. com/coronavirus-updates/2020/03/case-forabortion-telemedicine/>.

access has not been tracked in Canada, data from the individual provinces and major abortion clinics have shown that the majority of abortion pill prescriptions are still coming from abortion clinics in large cities. For example, in Alberta the bulk of all mifepristone prescriptions in 2018 came from a single abortion clinic in Calgary. In New Brunswick, 72 per cent of prescriptions came from three urban hospital-based abortion clinics.25 Some provinces like Manitoba will only cover the cost of the abortion pill when it comes from three specific abortion clinics, which means women will still wind up having to travel to either Winnipeg or Brandon, the province’s largest cities, to access it.26 The majority of mifepristone prescription providers are in Ontario and BC.27 In Quebec, which has the most abortion providers in the country, 90 per cent of abortions are still surgical.28 Evidently, just because more medical professionals can prescribe the abortion pill does not mean that they will. As of 2019, only 8 per cent of family physicians now prescribing mifepristone work in communities with no prior abortion service.29 Surgical abortions still greatly outnumber the use of mifepristone, which suggests that it has not yet reached its full potential within the Canadian market.

How To Increase Mifegymiso

Access

to

Universal Coverage Under the Canada Health Act, abortion should be insured in all provinces and territories. However, in practice, abortions are still not universally funded across the country. As of 2019, Saskatchewan still does not provide universal coverage for the pill, and in Manitoba women can only get the pill for free at three specific health centres, 14

otherwise they must cover the cost themselves.30 Thus, one of the first steps that can be taken towards making Mifegymiso more available is ensuring that all provinces and territories offer universal coverage of the pill without any strings attached to which clinics or hospitals the prescription comes from. When a province does something that does not comply with the Canada Health Act, the federal government can penalize that province by withholding transfer payments meant to cover other health services. For example, in 2015 the federal government deducted $500,000 from the money they sent B.C. to cover healthcare procedures as a penalty for extra-billing charges that patients alleged they were asked to pay at private and public hospitals.31 Yet, the federal government has not penalized provinces that are not complying with abortion coverage rules. It must do so to ensure that universal coverage is properly instituted.32

A Change Within the Medical Community Now that the regulations surrounding mifepristone have been loosened, it appears the main obstacle to prescribing the pill is doctors’ reluctance. For some primary-care providers, refusing to prescribe the pill is a matter of ethical objections. In Canada, if a medical practitioner has a religious objection to providing an abortion, they do not have to carry it out.33 However, the larger obstruction appears to be a professional reluctance to be seen as an abortion provider, and a perception that the abortion pill is very complex to administer.34 Part of this perception likely comes from the aforementioned regulations that accompanied mifepristone when it first became available in Canada.

The reluctance may also be due to a general deficit in the medical community’s understanding of abortion procedures. A study conducted in 2016 showed that 57 per cent of family medicine residents in Canada had received no formal education on abortion throughout their entire medical education. When respondents in the study had received training, it was extremely brief. Only 20 per cent of residents reported having more than one hour of instruction on abortion throughout their entire medical school career.35 It is also interesting to note that 78 per cent of people currently providing the abortion pill are female, despite the fact that women make up only 42 per cent of all doctors in Canada.36 To remedy this problem, the medical community has a responsibility to educate potential providers in a way that makes it clear that mifepristone is accessible and uncomplicated to prescribe. The College of Family Physicians of Canada issued a statement in January 2020 that declared “primary care practitioners are well positioned to provide patients with education and access to medical abortion.”37 The College offers a training course for doctors interested in prescribing the medical abortion pill. However, provincial regulatory colleges are responsible for maintaining physician practice standards. So far, many of these colleges have said they are not responsible for ensuring doctors are familiar with the abortion pill and how to prescribe it.38 The next step in ensuring better access to abortion in Canada therefore lies with provincial regulatory colleges and those who design medical school curricula. The Association of Faculties of Medicine of Canada put out a report in 2010 which recommended that medical schools must make an effort

to “address the hidden curriculum.” The hidden curriculum is defined as what students learn outside of the formal curriculum, which is pervasive, complex, and deeply instilled in institutional cultures.39 Discomfort with abortion likely falls into this category of societal norms that have seeped into the medical profession’s ability to regard abortion as a common and necessary medical procedure. Medical schools and provincial regulatory bodies must take steps to ensure that all primary care providers are being taught about abortion so that the perception of it can shift enough to increase the number of physicians who opt to provide it.

they may face harassment from prolife advocates who strategically protest close to these buildings to intimidate women into changing their minds. In the time of COVID-19 the case for the abortion pill being prescribed via telemedicine becomes even stronger. Abortion is a health matter that cannot wait for social distancing to end, so ensuring patients can access it without having to go into a hospital or doctor’s office is essential. During a pandemic, medical facilities are also forced to prioritize infected patients which results in the deprioritization of procedures like abortion.42 COVID-19 has shown Canadians that many things we typically did in person can be done remotely, Telemedicine and the essential healthcare need of A final way that abortion can become abortion should be no exception. more accessible in Canada is if providers begin to offer more telemedicine options Conclusion for mifepristone. Because the abortion Abortion is a basic healthcare need, pill no longer requires an ultrasound and and Canada has an obligation to make a physician does not need to supervise sure that it is accessible to all women patients while they take it, it can be regardless of their geography or their easily administered through phone income. The federal government has an or online consultations. Studies have obligation to take steps which ensure shown that virtual supervision from a universal provincial and territorial clinician when prescribing mifepristone coverage for the pill. Provincial regulatory is just as effective and safe as doing so colleges and faculties of medicine must at a medical facility.40 After acquiring also educate healthcare providers on consent for electronic communication abortion in a way that ensures they from a patient, doctors can do the initial become more comfortable with the consultation and the requisite follow ups procedure as a means to increase from a distance, and either have the pill the number of prescribers. Finally, an couriered to the patient or dispensed at increase in telemedicine options for a pharmacy closer to their home. Some people looking to acquire the abortion clinics in Canada are already offering this pill would make it more accessible, service, but the numbers are generally particularly if they live in remote areas or low.41 are otherwise prevented from going to a Making the medical abortion pill more medical facility in person. Making these available via telemedicine is necessary, changes will ensure that all Canadian particularly for people who live far from women are able to make choices abortion providers. It is also useful about their body and better increase to women who prefer not to go to a their chances of achieving healthy and known abortion provider in-person for economically stable lives. • reasons of privacy and safety, given that 15

Advocacy MEDIC

Written by Grace Lin, Meds ‘23 Artwork by Sigi Maho, Meds ‘24

IN

Picture this: Queen’s Park flooded with 60 medical students from across Ontario, advocating for solutions to prevalent healthcare and medical education issues. This is what Ontario Medical Student’s Association (OMSA)’s “Day of Action” looks like. Or rather, looked like. But even a pandemic is no match for motivated medical students when it comes to health-related inequities and this year saw the shift of “Day of Action” onto an online platform. Over the past week, delegates and participants attended a star-studded training weekend and were assigned to one of the 16 Member of Provincial Parliament (MPP) meetings to advocate for public health structure and funding. Specifically, delegates presented some pertinent problems our current public health system faces, such as increased burden of cost placed on municipalities, outdated IT systems, and loss of local voices with projected public health unit reductions. During their meetings, the delegates pitched these three asks to their MPPs: 1. Review public health cost-sharing models of funding to ensure that it accounts for population adjustments, inflation rate, and emergency response work. 2. Explore public health IT infrastructure that it is up-to-date, reliable, and fits the needs of Ontario Public Health. 3. Commit to collaborating with, including the voices of, and following recommendations given by public health units, municipalities, and local stakeholders when restructuring public health units. With much of the political climate revolving around COVID-19, it seemed the perfect time to advocate for increased public health spendings and many delegates had successful conversations with their MPPs. Advocacy is listed as a core component of the CanMEDS framework that most medical students are very familiar with. Yet students are often faced with the difficult task of unraveling what health advocacy really looks like in practice. What are the steps to becoming an advocate? How can an issue be successfully advocated for? What preparations and training must be undertaken? Often, these skills are not taught to medical students to the extent of the other components of the CanMEDS framework, if at all. While the provision of formal advocacy training may be scarce, one way students can learn is from each other. To facilitate this, Queen’s delegates who participated in the “Day of Action” were asked to provide some of their insights and learnings for this issue’s “MedicINe”: 16

NE

COMMUNITY

“I just want to share that I think that all of us as medical students can get involved with advocacy, no matter the extent of experiences we’ve had. Politics is a lot like medicine in that it’s all about forming connections and framing information in personalized ways. While traditional advocacy may be thought of as lobbying for policy change, I learned through the Day of Action that there are many other mediums, such as social media, community projects, broadcasting avenues which we as medical students can also use to make our voices heard.” (Peter Lee, 2024) “When speaking to politicians, you must strike a balance between too much and too little preparation. It’s crucial to know your stuff — you are the content “expert,” after all — but you also have to be comfortable with improvising and adapting your talking points to the interests and priorities of your audience, which you may only truly understand while IN the meeting. Finding out a little bit about what issues matter to them and their constituents can be the most highyield and impactful preparation that you do!” (Angie Salomon, 2023) “I was initially hesitant to apply for Day of Action because I did not have that much advocacy experience, but I’m very glad I did! I learned about the importance of framing an argument to suit your target audience and learned more about the intricacies of health policy. I would highly encourage other medical students to get involved with a Day of Action at the municipal, provincial, and/or federal level because it is a very engaging way to learn about health politics and policy, and there is the opportunity to make a meaningful impact on the community.” (Olivia Mendoza, 2024) “I’d always been a bit intimidated by the idea of getting involved in advocacy, but the DoA training weekend provided me with the tools and confidence I needed to be excited for my MPP meeting. There were so many engaging speakers and workshops, and I left feeling inspired by the work medical students are doing to make tangible change. Some key advocacy takeaways: do your research, know your audience, advocate locally and tell good stories.” (Ally Soule, 2024)

“Through the OMSA DoA training weekend and MPP meetings, I’m grateful to have strengthened my understanding of political advocacy and of the impacts of public health funding on community health outcomes, particularly in the context of COVID-19. As a medical trainee, I recognize the unique responsibility we have as future healthcare providers to advocate for and amplify the voices and perspectives of our patients, their communities, and public health stakeholders in the political decisionmaking processes. Many thanks to the delegates, the OMSA DoA organizing team, and to the speakers and MPPs we had the opportunity to learn from and engage with this week!” (Abby Christi, 2024) “Having no previous advocacy experience, and limited knowledge of the current context of public health in Ontario, I was definitely intimidated by Day of Action. Fortunately, I signed up anyway and discovered that becoming informed on political issues and practicing advocacy is much less difficult than I had originally thought. The training weekend provided a fantastic opportunity to hear from a number of amazing speakers and meeting with an MPP was an invaluable learning experience. As medical students, we’re incredibly privileged to have opportunities like Day of Action, and I would strongly encourage taking advantage.” (Mike Arnason, 2024) “In anticipation of my group’s meeting with the MPP, we conducted thorough research on her political priorities. We learned that she represents the Cambridge region and has been leading an effort to expand broadband access to her constituencies. Using this information, we adapted our pitch for better health IT infrastructure to incorporate how her push for broadband access can facilitate better health technology such as Telemedicine. Understanding the interests of the individual to whom you are advocating a cause can aid in your pursuit to accomplish legislative action.” (Jamal Tarrabain, 2024) “My big takeaway from this experience was that, in addition to doing the research and showing up prepared, it’s also important to take a moment to pause and reflect on all the facts. What does it mean to you? See if you can connect it to a personal experience or story. Politicians are inundated with information all day, every day. Sharing a story to drive home a point will make your meeting more memorable and impactful.” (Chantal Burnett, 2023)

Advocacy is an intimidating and daunting task for anyone without experience; but, as these delegates have shared, the skills can easily be learned with training and practice. The practical advice shared here, such as using our knowledge of medicine and understanding politicians’ interests, are great places to start when thinking about how to advocate. As well, take advantage of the opportunities to gain advocacy training and experience, whether that be through organized events or your peers. The steps taken now to build advocacy skills will not only enable you to help future patients and communities but will also allow you to act on the social responsibilities that come with the title of a physician. As German physician and pathologist Rudolf Virchow once said, “Medicine is a social science, and politics is nothing else but medicine on a large scale.” We, as physicians and physician-to-be’s, all have a part to play in the politics that shape medicine. • (For more information on OMSA’s Day of Action, visit their website at: https://www.doa2020.com/)

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How to. . .

ZOOM FASHI Written by Nicole Krysa, Meds ‘22

By this time of year, the Zoom school fad is tired, but your on-camera style need not follow suit! Even on-screen, the way that you choose to present yourself sends a message, so why not take ownership over what you are putting out there? After all, it is one of the remaining things you have control of these days. The key to putting these looks together is to be realistic about sustainability — I can guarantee that these styles will only endure if you pair them with stretchy bottoms (remember when quarantine started and we all tried to wear jeans for ~a day?). I have made some suggestions; however, as seasoned Zoom veterans, you know very well that you can literally wear whatever you want from the waist down, so carpe diem, and (try) to have some fun with fashion in these dark times!

the classic

the Minimalist

In-person or not, you truly cannot go wrong with the traditional sport coat and button-down pairing. If you want to project that you are on-the-ball and can weather any storm, this is the look for you. Try a sport coat with a relaxed fit for comfort. For a fashion forward spin, choose a double-breasted model. Practical pairing: black yoga pants or joggers in a neutral colour

For those who want to project that they are polished, but also desperately do not want to be called on by the guest lecturer, this look is for you. Pick a simple, tailored, longsleeved top or cashmere sweater, and pair it with subtle accessories (think a watch, glasses, or a pendant necklace), or nothing at all. Professors will appreciate that you are showing up on camera but will also get the message — don’t call my name unless my SGL singles me out. Practical pairing: sweatpants

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Lifestyle

ON the peacock

You are the star of a show that will never be aired. You continue to dazzle while everyone else has dimmed. You have 15 new pieces collecting dust in your wardrobe because you have nowhere to wear them anymore. My proposal: rip off the band-aid, and don them all-at-once! This look says: I have an over-extended line of credit, and I am not afraid to show it on camera. An eclectic statement for sure, but hey, your brand has always been your eccentricity — why let a pandemic get in the way? Practical pairing: who are we kidding – you are not practical.

the Business casual

Capitalize on the athleisure trend (and the relaxed dress code that remote work affords), and pair a billowy cotton dress shirt with sporty accessories. This look will work double-time for you, showcasing both your scholastic and adventurous sides simultaneously, all while you eat ramen in your living room. To make a real statement, wear the cap associated with your home team, or take it to the next level by rocking atypical gear associated with your favourite sport. Even those who are apt to forget a face will remember the person who sat through an entire cardiology lecture in a rock-climbing harness. Practical pairing: running shorts

the Camera-shy

Let’s face it — most of us don’t go on camera at all, but that does not mean that you cannot make a chic, subtle statement. Just by changing the font of your screen name. Observe the transformation that occurs below. In mere moments, Joe Smith shifts from everyday Joe to “Joe seems so aloof and mysterious. I cannot wait to see what he might type in the chat function”. Practical pairing: literally anything. Regardless, people will assume that you are reading Nietzsche in a black turtleneck, or something equally artsy. Très French, très chic!

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QMed Plant(ar) Fas Written by Nancy Chen and Taylor Mouliakis, Meds ‘23

Meet the plant babies of QMed Plant(ar) Fascinated, a blossoming group of plant parents who share tips on how to best care for their babies and show off their plants’ latest leaves! Join the group here: https://www.facebook.com/ groups/1219725384891900/permalink/1390476011150169.

HOW MUCH SUN DOES MY PLANT NEED?

Orchids only need one ice cube per week, so Monday has become Oriana’s favourite day!

This depends on what kind of plant you have. However, you can look for signs that your plant is getting too much or too little sunlight. Like humans, plants can get sunburnt too, and this means your plant is getting too much direct sun. Some plants like cacti and some herbs love to bake in the sun, but others like ferns will burn up like a vampire if they get hit by too many rays. If you notice that your plant isn’t producing much new growth, has lost some of its colour or has new leaves that are smaller than they used to be, this may mean your plant isn’t getting enough light. Another sign your plant isn’t getting enough light is called etiolation, which is when your plant is stretching its head to reach for the light. This may look like the head of your plant turning towards the light or an elongation of the stem with less leaf density.

ORIANA,

Mini orchid Parent: Victoria Lee-Kim, 2022

WHAT KIND OF POT SHOULD I USE FOR MY PLANTS?

You can choose from a lot of different types of pots including terracotta, plastic, ceramic, even metal! The material of the pot can affect how quickly the soil will dry out. For example, terracotta is porous, so water can evaporate through the pot, whereas this wouldn’t happen with finished ceramic, plastic, or metal pots. The most important thing to look for in a pot is that it has drainage holes. This prevents your plant’s roots from sitting in an excess of water and potentially developing root rot. If you have a really pretty pot that doesn’t have holes, consider leaving your plant in its nursery pot and just put the entire thing in the pretty pot.

Lithops only need to be watered a few times a year because they store so much water in their leaves. They also flower!

ROCKY,

Genus Lithops Parent: Taylor Mouliakis, 2023

HOW OFTEN SHOULD I WATER MY PLANTS? When Marika got Albert, she was told, “Good luck caring for that; figs never survive.” Albert has done nothing but thrive!

Albert (R) and Baby Albert (L), Fig tree Parent: Marika Moskalyk, 2022

All plants enjoy a really thorough watering, however, the difference between plants is the frequency of watering they need to thrive. Some plants like cacti like to dry out completely, others can’t tolerate being dried out at all (ferns and calatheas), and most are somewhere in the middle. Do a little research about what your plants need and figure out a watering schedule accordingly. Just make sure to adjust for seasonal changes!

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JADE,

Jade is oh-so resilient, surviving both spider mites & soil gnats. She also has many babies who are now in loving homes.

Pothos Parent: Hannah Lee, 2023

scinated WHY IS MY PLANT LOSING LEAVES?

Unnamed plant baby and Jiji (cat),

Jennifer made a 3-hour round trip to get her Hoya kerrii splash!

Hoya kerrii ‘Splash’ Parent: Jennifer She, 2020

HOW DO YOU KEEP TRACK OF WHEN TO WATER YOUR PLANTS?

Get a watering app! Especially as your plant family grows, it can become difficult to remember when to water which plant. A watering app will help you keep track of your watering schedules. Keep in mind that your watering needs may change depending on the weather and/or season. Some watering apps will let you skip a watering or ‘snooze it’ so that you can be reminded a few days later! I’d recommend Planta for iOS users and Vera for android users (#notsponsored).

Q

Lifestyle

Losing leaves isn’t always bad and is often a normal part of a plant’s growth and development. That being said, sometimes when leaves start to drop this can be a sign your plant needs a little more attention. Here are some red flags to look for if your plant starts to drop leaves: leaves are dropping very fast, leaves look soggy and mushy, and/or signs of a pest infestation. It is hard to give a blanket statement about all plants, but if you think something looks off, google it! There is a lot of good species-specific information out there to help you on your plant journey.

WHAT ABOUT PESTS?

A

&

The war against pests is one that waxes and wanes but is ever omnipresent, so it’s important to inspect your plants carefully, including the undersides of the leaves, every few weeks or so for signs of bugs. Some common pests that may infest your plants include aphids, mealy bugs, spider mites, fungus gnats, and thrips. When inspecting your plants, you should be on the lookout for bugs themselves (small white or black spots), signs of leaf damage including bites (these might look like small spots of leaf thinning), or the remnants of insects (in the case of spider mites, you’ll see thin webs). If you see bugs, consider giving your plant a shower! Using running water to rinse your plant will wash off a lot of the bugs; just make sure to rinse and repeat for a week or so to get all the bugs off. For more serious infestations, you could also consider using an insecticidal soap or making your own mix of diluted neem oil. Another good practice to avoid infestations is to quarantine new plants before bringing them near your other plants. This way you’ll only have to treat one plant instead of your entire collection.

WHAT ELSE DO MY PLANTS NEED?

MOE,

Jessica was told Moe would only need to be repotted every two years, but this guy has been outgrowing his pot every two months!

Genus Monstera Parent: Jessica Ho, 2023

Your plant friends like all other stationary things in your home can get dusty. This is especially the case for plants with large leaves like monsteras and fiddle leaf figs. As such, it’s important to clean them off every now and then to make sure they’re able to photosynthesize properly! This can be done with a damp cloth or paper towel and by giving the leaves a nice, gentle wipe. I can say personally that I find this process extremely therapeutic and rewarding! It really helps your plant friends put their best leaf forward; not only will they look prettier, they’ll also grow faster (trust me, it makes a difference!). • 21

String of Hearts love to grow. You can even see some Sarah Jr. vines propagating there on the left!

Sarah and Darwin (cat),

Ceropegia woodii aka “String of Hearts” Parent: Nancy Chen, 2023

nd

A Pa

o R e n k c r i a S c i m e

- - With the ongoing pandemic, mask-wearing has become the norm to everyone’s benefit — except, perhaps, our skin. For many, the rub and grub of mask-wear has resulted in a trip down memory lane to those hormonal teenage years. Whether or not daily mask-wear has resulted in an acne outbreak for you, the pandemic could be a great time to discover a personal skincare routine. Here is a simple AM to PM routine that anyone can follow and build on (with affordable and simple-to-find suggestions) to help you work in some self-care and prevent those pesky pimples from popping up. Written by Grace Lin, Meds ‘23 Artwork by Kimberley Yuen, Meds ‘22

(All products mentioned are *suggestions for reference only* and based on personal research, not sponsored in any way)

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e n

Wash up

LIFESTYLE

• •

CeraVe Hydrating Facial Cleanser (for Normal to Dry skin) La Roche-Posay Effaclar Purifying Foaming Gel Cleanser (for Oily Skin)

A.M.

Washing your face in the morning is an important first step to cleanse the grime and oil your face has accumulated over the night. When choosing a face wash, some things to keep in mind are whether it is gentle and of a low pH. Here are two suggestions of gentle, low pH face washes that are easy to find at a local drugstore.

Nourish!

While this step is easy to skip, nourishing your skin may be the missing link between you and glowing skin. Two easy to add nutrients to a morning routine include: niacinamide and vitamin C. Niacinamide serves to protect the skin barrier while vitamin C can protect skin from harmful UV exposure and lighten pigmented spots. • •

L’Oreal Revitalift Derm Intensive Vitamin C Serum The Ordinary Niacinamide 10% + Zinc1%

Moisturize

Whatever the time of the day, keeping your skin moisturized is a key step to keeping those wrinkles at bay. A smear of a gentle moisturizer can go a long way to repair, restore, and maintain good skin. • •

CeraVe Daily Moisturizing Lotion (Normal to Dry Skin) Bioderma Hydrabio Serum (Oily skin)

Protect

Sun protection is arguably the most important step to a morning routine. Add in a bit of brightening with your sunscreen and you’re bound to look awake and ready to go for that early zoom class or meeting. Dr. G Brightening Up Sun (for all skin types)

P.M.

•

Rinse off

At the end of the day, the routine starts again by wiping off dust and grime from the face. Here, you can use the same face wash from the morning. If you wear makeup, a double cleanse, involving an oil-based clean followed by a soap-based one, can really get that makeup out of your pores. •

Clinique Take the Day Off Cleansing Oil

Nourish

Nighttime nourishment is a great way to target some of your personal skincare concerns. Starting off with another application of the niacinamide (same as the one mentioned from the morning) is a great first step in maintaining a healthy skin barrier. If you are concerned about acne scars, try out a vitamin A & E rich oil, such as Bio-Oil, for exfoliation and fading scars. For anti-aging, a retinol serum is always a good idea! • •

Bio-Oil RoC Retinol Correxion Deep Wrinkle Facial Serum

Moisturize

Our skin can lose a significant amount of moisture through the night as we sleep so a heavier nighttime moisturizer can help reduce those impacts. • •

CeraVe Skin Renewing Night Cream (Dry to Normal Skin) CeraVe PM Facial Moisturizing Lotion (Oily Skin)

A three to four step morning and night routine may seem daunting to work into your schedule at first, but what better time to try it out than during a pandemic, with extended hours at home? Remember, however, that skincare is unique to the individual, so something which works for one person may not always work for another. Read the instructions and precautions on product labels before using, and be sensitive to any reactions you may experience. Finding a good routine that works for you takes time and experimentation, but it can all be worth it if it helps you feel more comfortable in your own skin — literally. Here’s to happy experimentations and to coming out of this pandemic with glowing complexions! • 23

LINDA’S BUTTERNUT SQUASH SOUP INGREDIENTS ~6 servings (depending on how hungry

TURNING NEW LEAF-Y GREENS Written by Linda Archila, Charles Wicks, & Sarenna Lalani, Meds ‘23 Artwork by Kiera Liblik, Meds ‘23 & Sigi Maho, Meds ‘24

When the chilly weather does away with the copious amounts of fresh produce available for consumption here at our local Farmer’s Market (or FoodBasics, we don’t judge!), we are challenged with finding creative ways to incorporate veggies into our daily diets. Gone are the days of sprightly summer salads, and the times of crockpots, Instant Pots, and Dutch ovens have arrived. We yearn for healthy soups and stews to keep our hearts and insides warm and toasty. Here are a few of our fave fall and winter recipes, sure to feed your souls and tummies. Enjoy!

you are!): 2 cups vegetable broth (chicken could also work) 6 garlic cloves, peeled and roughly chopped 1 carrot, peeled and roughly chopped 1-2 apples (any type), cored 1 medium butternut squash, peeled, seeded, roughly chopped 1 white onion (or shallot), roughly chopped 1 small piece of ginger (~ 4 cm long), peeled Salt and pepper to taste (~½ teaspoon salt, ¼ teaspoon black pepper if you want a measure to start, though be mindful for salt in the broth) ⅛-¼ teaspoon cayenne (depending on how spicy you would like it to be, you can always add more later) ¼ teaspoon cinnamon Pinch of nutmeg ½ cup canned, unsweetened coconut milk More fresh parsley, to garnish

INSTRUCTIONS:

Add broth, garlic, carrot, apple(s), butternut squash, onion, and spices to your slow cooker (small or large is fine). Toss ingredients together to distribute spices. Cook for 7-8 hours on low or 4 hours on high, ensuring squash is tender enough to poke through. Once cooked, add coconut milk. Puree until smooth, adding any additional spices as needed. Soup can be served with yogurt, extra coconut milk, or garnished with seeds Options? If you have a smaller squash, you could supplement it with sweet potato (or another type of squash) You could add herbs like thyme or sage into the slow cooker, but ensure you remove sprigs before blending Soup can be garnished with yogurt, additional coconut milk, parsley, or seeds You can roast the seeds from your squash as a tasty snack or to top your soup. After scooping seeds out, rinse with water and pat to dry. Toss in savory spices (e.g. garlic powder, cayenne, salt) or sweet spices (e.g. cinnamon, nutmeg), and bake at 300 degrees for ~45 minutes until golden brown.

Lifestyle

CHARLES’ SOPA DE LENTEJAS (ANDALUSIAN LENTIL SOUP-STEW) Aside from being a renowned physician, surgeon, and philosopher of the Roman Empire, it seems Galen was also proficient in the kitchen. Galen believed that a good physician should also be a good cook (Grant, M. Galen on Food and Diet. Routledge, 2000.) This lentil stew comes from Andalusia in southern Spain where it could be found being cooked outdoors over slow-burning, glowing charcoal fires heating copper pots identical to those that the Romans used over 2000 years ago (adapted from Luard, E. The Old World Kitchen: The Rich Tradition of Peasant Cooking. Bantam, 1987). I started making this soup to include kale anywhere I could in our meals when my spouse was pregnant with our son. It has since become a staple in our house and my son, now a toddler, is a big fan! I think you will be, too. This is great for meal prepping; if you plan on freezing portions, just omit the fresh greens until you plan on serving. Trust me, they are best stirred in and gently cooked when the soup is reheated. Enjoy!

INGREDIENTS:

450 g brown or green lentils*, washed and picked over 4 garlic cloves, whole 3-4 slices good quality bacon**, chopped 150 g smoked chorizo sausage**, cubed 1 medium-sized onion, diced 2 medium sized carrots, diced 2 tsp paprika (or to taste) 2 small potatoes, peeled, washed, and cubed 450 g greens, chopped: Swiss chard, kale, cabbage, spinach 1 tomato, diced into large chunks (or a handful of fresh grown cherry tomatoes when in season) 4 tablespoons oil 2.5 litres water (or chicken/vegetable stock) Salt and pepper to taste

INSTRUCTIONS:

Gently heat the olive oil in a large pot (a cast iron Dutch oven works well). Fry the bacon and chorizo in the olive oil. When the fat is rendered from the pork, add the diced carrots, diced onions, and whole garlic cloves to fry gently until soft. Stir in the paprika to cook briefly, just enough to release the aroma. Add the lentils and cover with the water or stock. Stew gently for 40 minutes. Add the potatoes and cook for another 20 minutes. Add the greens and tomatoes and cook for 10 minutes more. When the vegetables are tender, stir in salt to taste (it will take more if you used water rather than stock) and pepper to taste. Serve with a thick slice of hearty bread for a perfect fall meal. Notes: *Sometimes, I’ll also throw in a handful of washed and picked over red lentils to thicken the broth, as red lentils dissolve rather than hold their shape like green or brown lentils. **This can be made vegetarian/vegan by omitting the bacon and chorizo and seasoning to taste with paprika, salt, and pepper.

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SARENNA’S INSTANT POT (OR NOT!) CHICKEN CABBOODLE (CABBAGE NOODLE) SOUP INGREDIENTS (makes 6 hearty servings):

1 tbsp olive oil 1 cup yellow onion, diced 5 cloves garlic, minced 2 large carrots, peeled and diced ½ head of green cabbage (around 1 kg), shredded 1 tsp salt 1 tsp pepper 2 tsp dried thyme ¼ cup fresh curly parsley, chopped 2 tsp dried oregano 2 cups broccoli florets A handful of green beans, cut into 2 inch pieces 6 cups chicken broth 1.5 lbs boneless skinless chicken breasts More fresh parsley, to garnish

INSTRUCTIONS:

This recipe is easily adaptable to a large pot or dutch oven, so if you don’t have an instant pot, don’t fret! If you don’t love cabbage, or want to add noodles in, toss them into the soup at the end and allow them to boil until they are cooked to your preference. In saute mode on your instant pot, or on medium heat on the stove, heat the olive oil. Add the onions and garlic and saute until the onions are translucent. Add the carrots, cabbage, salt, pepper, thyme, oregano and parsley. Stir and allow to cook down slightly. Add the broccoli, green beans, and chicken broth. Place the chicken breasts into the pot and push them down until they are fully submerged. Close the lid, and cook, using the soup setting, for 7 minutes. If you are not using an instant pot, simmer until the chicken breasts are tender and cooked through. Manually release the pressure. Remove the chicken breasts and shred them. Add the chicken back to the soup. Serve with fresh ground salt and pepper, garnished with fresh parsley. •

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Lifestyle

Workout

of the Issue Written by Apoorva Bhandari, Meds ‘23 Artwork by Amanda Mills, Meds ‘23

A few notes:

Workout 1 requires equipment and Workout 2 is a bodyweight workout The sets and reps are indicated for each exercise as: ‘sets x reps’. A rep is the number of times you perform an exercise. A set is the number of cycles of reps you complete. AMRAP stands for ‘as many reps as possible’

1 2 Warm-up however you like! This could be 5 minutes of cardio or light stretching.

WORKOUT ONE 5-minute warm up

Back squat 4x8 Romanian Deadlift 5x6 Overhead Press 4x8

AMRAP for 10 minutes: 20 push ups 20 dolphins 20 flutter kicks Stretch to cool down

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WORKOUT TWO 5-minute warm up Body weight squats 4x25 Reverse lunges 4x12/side Wide push ups 4x10 AMRAP for 10 minutes: 10 burpees 20 dolphins 20 flutter kicks Stretch to cool down •

i’m afraid, no, i’m excited i’m afraid, no, i’m excited. have taken scissors to my brakes: cut the wires, cut the controls relinquished fears, two halves one whole. what if things don’t work — go awry? simple answer to many why’s why not? i ask, what if they do? when the standard is fear we remain lost, haven’t a clue. leaping into oblivion no beginning was due to trepidation. first toes dipped, no, a dive, head first, with great risk. failure or success, equal an adage to true love’s sequel. i’ve lost the ability, to separate you from me, when my eyes are shut, light still passes through projecting the image of you. i’m afraid, no, i’m excited that i’ve lost the ability to distinguish space and time — not in seconds, minutes, hours nor in inches, feet, meters, miles. whichever system we might use have all been rendered worthless because of you. erased, swept away, and replaced by one of my own creation: time spent with or away, space filled or not, lost at sea or safe inshore; insatiable: i must have more. currency has lost its value; mere shiny metals, paper bills unable to purchase, to fill to simulate that which i feel. wondering whether false or real but nevertheless here i am: safety off, seatbelt unattached full speed ahead, racing to you holding my breath, into the blue tie me to a powder keg, ignited. countdown is on: i’m afraid, no, i’m excited

Written and illustrated by Morgan King, Meds ‘23

i took a day off writing

poetry

i took a day off writing and chose to live instead; took a break to play outside my head. blankets off, jumped out of bed i took a day off writing and listened near and far heard a group of girls whispering speaking a foreign tongue about my dress. had a laugh, really many full and heavy, from the belly. kissed the cheeks of an old friend, so good to see a wave of warmth washing over me as we discussed years past, drank tea admitted i’d hoped to be your lover, just a dream, not necessary, but i’d quite enjoy to know you wholly. i took a day off writing but now i lay back in bed, reliving this day. seems i’ve been collecting an anthology of short films, vignettes; your face in supercuts, flashing behind my eyes. i close them and dream of the lines i follow muddy watercolor splaying from my brush adding dimension, texture, crow’s feet from years of laughter from when we shared the day, today i took a day off writing but it felt incomplete. as i do now, out of your vicinity.

bouillon cube painted pink and blue, as the sun rises in the sky the sun’s risen in my life. it’s been days since i’ve done much of anything. as heartbreak creates fuel, gas it brings to light a fire of creativity. but without the pain, the aches i find it difficult to make pieces of writing, paintings, really anything. so i sit here and ponder relax in elation with wonder, i question is sadness a necessary ingredient of creation? simmering salt pepper seasoning the bouillon cube of imagination. without it, bland tepid water stray vegetables floating about not sure what to say if i am without the blue flame of blue days a sincere inquisition: does serenity have a palatable flavour? with bad times comes good art i’ve heard it before and since i’ve changed i seem to fall short. •

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The Only

Constant Written by Mike Christie, Meds ‘21 Artwork by Kaitlyn Rourke, Meds ‘23

S

uffice it to say that our world, at the present moment, is a much different place than it was a short while ago. Like the rest of society, Clinical Clerkship has been swept up in the ensuing tsunami of change. This includes the cancellation of visiting electives, abbreviation of core rotations from six weeks to four, writing examinations while someone watches us through a camera in our living room, and a whole lot of PPE. Taking things to the next level, there have even been changes to the residency application process, and we are now in what is quasi-officially being dubbed the “Virtual CaRMS Era”. The sun might as well be rising in the West.

At least some managing with turmoil has to the fact that quite frankly, we do.

Medical students are notorious for being high strung, and I won’t disagree. There are probably days where if you bumped into me I would twang like a banjo. Given the unexpected and sudden nature of all the changes to Clerkship, one would expect absolute panic and chaos. Yet beneath the surface, I’d argue that there is a relative calm amongst the Clerks. So, what’s helping us keep it together?

part of all this do with change, is what

Certainly we have each other, our families, our friends, and our mentors to help us along. Everyone has days where the gravity of the pandemic weighs on them. In our own ways we are each bearing witness to great tragedy, and that can be hard. As with the rest of our journey through Medicine, there are people there to support us, and it is difficult to embody the depth of our gratitude.

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reflection It’s also true that some of the uncertainty from earlier in the pandemic has been alleviated through an utterly Herculean effort on the part of several stakeholders to get us back into the hospital. Plus, the folks at the UGME have a wellcommunicated, logical plan for moving our training forward. Yet as of press time, the data tells us that the second wave has just made landfall, and all of these carefully laid out timelines could be washed away like lines etched in the sand. Realistically, there is a serious possibility of further disruption. With this in mind, I think there’s another element at play in the Clerk’s response to all of this change, and it has to do with something inherent to our training that I hadn’t quite keyed in on before. At least some part of managing with all this turmoil has to do with the fact that change, quite frankly, is what we do.

When I step back and consider things on the macro, the importance of recognizing this adaptability is that it can be a powerful tool in navigating the world around us. We will be expected to help solve the current crisis, and looking even further down the line, prepare our society for the next one. Given the global impact, this is no small task, and it will require us to be flexible with how we solve our problems. Part of embracing this approach will involve reflecting on how innovation in the past aided us in arriving at the future. Of course, no one can definitively tell us where things are headed, but with our versatility we’ll be ready for whatever comes our way. Being forced to change has highlighted that change itself isn’t as foreign a concept as I thought. And for me, it all comes back to appreciating the fact that Clerkship is a heck of a lot like life itself — the only constant, is change. •

Every few weeks we switch rotations. A month is spent diving into the depths of a certain specialty, learning its lingo and intricacies, becoming completely immersed in its differential diagnoses and treatments. We eat, sleep, and breathe these disciplines. Then, just when we start to get the hang of things, it’s suddenly time to start anew in a completely different field. Environments can vary between the hectic rush of the emergency department, the strict sterility of the operating theatre, the busy hum of the wards, and the quiet focus of a clinic visit — sometimes within a matter of hours. On top of this, preceptors change from day to day, sometimes even from morning to afternoon. Each experience brings variations in expectations, preferences, and pace. Teams change as well, with different residents, fellows, and allied health professionals playing various roles in patient care depending on context. One can even find themselves in a completely new town or city for an away rotation. With this comes a flurry of new computer logins, electronic medical records, pager numbers, dictation codes, and, perhaps most importantly, cafeteria locations. Additionally there are unique call schedules and systems for each rotation, all elaborately detailed in a matrix of spreadsheets that must be carefully reviewed. All of this can be viewed as the background logistics required to facilitate a

actually learning how to be a doctor. clerk

In order to succeed in this system, the ability to change is crucial. Being a Clerk instills this high level of adaptability. Although we might not recognize it, handling change is simply part of our job. This approach to our current circumstance, I would suggest, is keeping our focus forward moving amidst tremendous uncertainty.

Photo by Ozzie Kirkby on Unsplash

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Image source: https://cdn.lynda.com/course/485650/485650-636413478194188790-16x9.jpg

UNEXPECTED TIME TIMELY PERSPECT Written by Emma Spence, Meds ‘21

Reflection

E& TI TIVE H

ow often do we lose the forest for the trees? Among other factors, perspective is often born from one’s experiences and beliefs. Therefore, it follows that an individual’s perspective of any given matter may evolve as life experiences collect and as varied viewpoints are gained. It often seems that the more far-fetched the experience, the wider the scope of perception is expanded. How, then, has the arrival of COVID-19 from the far left field impacted medical students’ perspectives? Insufficient time is often listed as a top barrier to change. Whether this change be in the realm of personal fitness or academic curricula, it seems equally true. Well, COVID-19 — at least initially — thrust upon Queen’s clerks an unprecedented amount of time. With this time, what was gained? As those familiar with the world of medicine, we had space to reflect upon large issues such as health, healthcare, structural determinants, equity, and mortality. On an individual level, we were perhaps reminded of the nurturing value of reading novels rather than strictly textbooks.

Many stepped back, and in recognizing how suddenly uncomfortable we felt having been removed from patient care, were reminded of our initial inspiration to pursue medicine, namely, an inherent drive to be of service to others. 33

Our curriculum has historically rolled forward quite successfully with a conveyor belt of eager clerks. With time to review the curriculum with fresh eyes, it has also found itself updated. This was in no small part because the pause button was hit and structures were able to be re-built the way things were wanted, rather than the way they previously needed to be. For instance, fostering learning and team-building by scheduling a clerk with the same one or two Emergency Medicine preceptors for the duration of their rotation, rather than working with different staff for every shift. While herein are outlined a few examples of how clerk perspectives have changed as a result of COVID-19, one cannot justifiably attempt to outline the breadth and depth of views gained or enhanced in recent months. Rather, the intention of this brief piece is merely to encourage us to take a moment of recently re-appreciated time, to reflect on how the experience of COVID-19 has impacted our outlook – on individual, school, community, national, and global levels. We may have been forced into challenging corners, approached our (new) reality from awkward angles, and looked longingly back to where things were seemingly more together — a point in the distance where the parallel lines used to intersect. We would be remiss not to embrace the new perspectives gained from this experience. Whether you are one to step back to see the forest or one to scrutinize every leaf, I hope we are all now able to see that, like the trees, we can bend before we break, stay connected with our roots, and seek out the light. Most of all, though, I hope we all see that there is much to be gained by turning over new leaves. •

T T II M M

Reflection

M ME E C CA A PP SS U UL LE E Made by Mary Foley, Meds ‘24 Photograph by Joshua Lowe, Meds ‘24

We asked QMed students to describe what life during a pandemic is like. Here’s what they said.

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Taurus No one knows how to thrive better than you. You choose pleasure in some form every day. Your taste is all about fine decor, fine wines, and fine cheese. But you find it really hard to digest the hard truth that you are also stubborn and lazy. Maybe you can stomach a career in gastroenterology.

Gemini As the sign of the twins, it’s no shock that you’re a twotiming, two-faced, talkse n o u g h - f o r- t w o - p e o p l e kind of doctor. But you’re intelligent, adaptable and quick on your feet. In keeping with the theme, I’ll give you two: emergency medicine and family.

RISING STARS Written by Ivneet Garcha, Meds ‘24 Artwork by Sigi Maho, Meds ‘24

Leo You are passionate and love people, no one more so than yourself. When you’re not thinking about living out your med influencer dreams, you are invested in making others feel as beautiful as you. Plastic surgery is your calling.

Cancer What’s in a name? For you, everything. Let’s be honest, I went with the low hanging fruit here. But we all know that you’re way, way, way too sensitive to take a joke. So let’s keep it wholesome with the Cancer cancer doctor energy.

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FUN Virgo It’s hard to be so hard on you when you’re already so hard on yourself. But let’s face it, you call it attention to detail… the rest of us call it being neurotic. I advise you to channel that nervous energy and sharp mind in neurology.

Sagittarius I know this might be hard to hear, but no, travelling is not a personality trait. But you’re smart and adventurous, and a specialty that takes you to new places will be good for your soul and your Instagram feed. So for you it will be infectious disease.

Libra We get it. Your aesthetic is effortless and unmatched. Your grace and class is poetry in action. We’re in awe. But you’re also a reminder that sometimes things only run skin deep. Why not give dermatology a try?

Scorpio You have incredible depth, and rely on that sixth sense of yours to understand people and situations. But if mind games were a sport – Kobe! Why don’t you put your Meredith Grey dark and twisty mind to work in psychiatry?

Pisces Sweet, sweet Pisces. Your soft empathy is really what medicine needs. You’re the astrological crybaby, so it’s no wonder that you speak the right language for peds. Keep a tissue box handy.

Aquarius You’re the visionary of the zodiac, even if you’re blind to your own hypocrisy. Despite being emotionally stunted, you have the unique ability to see eye-to-eye with people. So, it’s going to be ophthalmology for you.

Capricorn You work hard, you’re ambitious, and you perform well under pressure. But, gosh you’re boring. Not a single zodiac has more experience putting people to sleep than you. So, I’m giving you anesthesiology.

Aries I saved you for last because you’re so used to being first. No one needs a stethoscope to hear your voice. You’re loud and proud. You’re a natural-born leader, and you need a specialty where you can flex your failed athletic career and one brain cell. See you in orthopedic surgery. 37

QMR CROSSWORD

Created by Sean Leung, Meds ‘22... so you know it will be a challenge!

Be the first to email queensmedreview@gmail.com with your completed crossword to win a Starbucks giftcard!

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FUN FUN

DOWN

1. Decreasingly popular rodenticide repurposed to stop humans from clotting 2. Life is an example of _______; a phenomenon greater than the sum of its parts 4. The shock that frees the heart from lethal ventricular dysrhythmias 5. This pigment makes us gasp during autumn excursions and may also help with your age-related macular degeneration 8. The hidden tree in the brain 9. Chemical cousin of hemoglobin and myoglobin that marries magnesiums instead of irons 10. The action required to read forward in an RTL novel if using your right hand 13. Stage of change that starts the cycle all over

ACROSS

3. Amino acids and sugars reborn into a marvelous olfactogustatory experience 6. A somatic cell decides it no longer needs mitosis 7. Rite of passage an erythroblast must take to become a certified erythrocyte 9. A new leaf was turned on this smelly serrate leaf in 2017 11. Piaget says the end of this stage is when your child will not want to play peek-a-boo anymore 12. The most transitional epithelium in the human body 14. When leaves literally turn (to face the light) 15. This circulatory system gives our bile salts many new leaves to turn 16. Recycling center for irons, globins, and heme 17. The only monogamous leaflets in the symbolic love organ 18. The pharmacological pillar of smoking cessation 19. Uncommitted indefinite cells that regenerative medicine loves

Photo by Ozzie Kirkby on Unsplash 39

Photograph by Jehan Irfan, Meds ‘24

“It is not the strongest of the species that survives, not the most intelligent that survives. It is the one that is most adaptable to change.” - Charles Darwin

QMR