QMR - Volume 14, Issue 3 (2021) by Queen's Medical Review

SPRING 2021

ISSUE 14.3

Lines

QMR

LINES IN MEDICINE DEBATE

Where do we draw the line?

End of the Line

Be it resolved: Medical school applications would be better served by a lottery system

As Ontario’s vaccination rollout continues, who should be held accountable for misinformation?

QMed 2021 students reflect on fourth year, CARMS, and their time at Queen’s

In This Issue Content Contributors Linda Archila Jonah Buckstein Valera Castanov Mike Christie Edward Cui Colin Faulkner Ivneet Garcha Adrienn Goczi Katrina Jaszkul Adam Kulesza Sarenna Lalani Sean Leung Grace Lin Kassandra McFarlane Jessica Nguyen Iku Nwosu Chalani Ranasinghe Rae Woodhouse

Design

Corey Forster Olivia Ginty Jehan Irfan Gabby Jagelaviciute Kiera Liblik Joshua Lowe Sigi Maho Suffia Malik Amanda Mills Jessica Nguyen Kaitlyn Rourke Jordana Waserman 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

Opinion Juris DOCTOR WAISTLINES READING BETWEEN THE LINES: AGEIsM WHERE DO WE DRAW THE LINE?

4 6 10 12

ACADEMIC COVID-19 Vaccination in pregnancy infographic ONLINE IN THE EMERGENCY DEPARTMENT: Telepsychiatry

14 16

DEBATE medical school applications would be better served by a lottery system

COMMUNITY QMED PULSE COVID-19’S IMPACT ON Plastic Surgery MEDICINE: the line between research and medicine LINES OF WISDOM

24 28 30 32

REFLECTION LINES IN MY GRIEF CONNECTING PARALLEL LINES JUST A BIT OF EYELINER UNDERPREPARED AND OVERWHELMED END OF THE LINE

36 38 42 44 46

LIFESTYLE a killer BRUNCH LINE-UP

FUN Rising stars HOROSCOPES CROSSWORD

Kimberley Yuen 2

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Letter From the Editors S

pring has sprung in beautiful Kingston! We have certainly been basking in the sunshine, and have thoroughly appreciated the handsome tulips that have bloomed on campus. With summer months just around the corner, and the disappearance of the less-than-spectacular mayflies teasing, we hope that you are finding new and exciting ways to enjoy the outdoors; and, for when you are stuck inside on those gloomy rainy afternoons, we are excited to present you with QMR Volume 14.3. “Lines in Medicine” is a theme as alluring as it is vague, and that is the very beauty of it. We hope that your horizons (or sightlines, if you’re feeling particularly punny) are broadened as you dip into this issue. In this issue, our contributors interpret the theme of “lines” in a multitude of ways, from waistlines, to eyeliner, to palm lines, to urging readers to “read between the lines.” Jonah Buckstein reflects on his experiences in clerkship and asks, “where do we draw the line?” when it comes to COVID-19 vaccine hesitancy and misinformation. Our debate column returns with the prompt: be it resolved that medical school applications would be better served with a lottery system. Our soon-to-be graduates offer us some lines of wisdom that they have amassed over their four years at Queen’s. Two of our graduating students, Rae Woodhouse and Mike Christie, reflect on Match Day and the end of their time in medical school. Sean Leung returns with his everchallenging crossword, covering anatomical lines, intravenous lines, and more (we can’t give you too many hints!). And of course, our design team returns with their interpretations of the theme, filling our pages with beautiful artwork and line drawings. Big thank yous to both our layout and editing teams for their hard work in this issue — 14.3 had the largest number of submissions to date, and our teams worked tirelessly to ensure all our i’s were dotted and t’s were crossed! A special thanks to Kimberley Yuen for submitting her piece “Connections,” which is featured as this issue’s cover art — it is truly an aesthetic invitation to flip the page and see what’s inside. The close of this semester has been bittersweet for us here at QMR. We are saying goodbye to many valuable contributors, confidantes, and colleagues from the Class of 2021 who are starting new chapters both near and far. Thank you for your time, your contributions, and your support over the past four years. We wish you all the best in your new endeavours and we hope that you see QMR as a means to connect back to QMed and the goings-ons here in Kingston! On the note of goodbyes, it is with mixed emotions that we conclude our term as your Editors-in-Chief. With the charming spring backdrop, we have been fondly reminiscing on the experience we have had producing this magazine, and upholding the QMR tradition that is near and dear to our hearts. It has been both an honour and an absolute pleasure to work with our phenomenal team and to provide a platform for QMed to share their talents with each other and the greater Kingston community. Thank you for your readership, your responses and for engaging so thoughtfully and vulnerably with the content in our issues over the past year. We look forward to seeing how QMR continues to evolve and bloom in the years to come.

Sarenna Lalani and Jessica Nguyen Editors-in-Chief 3

JURIS DOCTOR

Recognizing Boundaries in the Patient-Physician Relationship: When Lines are Crossed and When Lines Must be DrawN Written by Ivneet Garcha, MPH JD, Meds ‘24 Artwork by Kiera Liblik, Meds ‘23

linical care finds its roots in the patient-physician relationship. Physicians sow seeds of trust in the hopes of harvesting a relationship with their patients that is grounded in mutual understanding, collaborative decision-making, and respectful communication. These ingredients lay the foundation for the patient-physician relationship to reach full bloom, where high-quality care is delivered and good health outcomes are achieved. But maintaining this relationship takes effort and ensuring it develops appropriately requires both physicians and patients to consider the confines within which the budding relationship must grow. Where the boundaries of the patient-physician relationship start and end are not arbitrary. They are not meant to stifle the compassion and humanity that is nurtured over the course of building a therapeutic relationship. Rather, these boundaries define when lines are crossed and when lines must be drawn, and ultimately when a patient-physician relationship is no longer professional and has reached its end.

In this article, I will provide an overview of some of the circumstances under which a physician may cross the lines of a therapeutic relationship and scenarios in which a physician might need to draw a line.1 The article will close with some practical considerations for how to appropriately terminate a patient-physician relationship, contextualized within a broader discussion about access to care.

When Lines are Crossed In any patient-physician relationship, there is an inherent power imbalance. Patients disclose sensitive health information, express their personal concerns, and share parts of their lives with the expectation that their care provider will use this information to act in the patient’s best interest — a fiduciary duty that the physician has under law.

Given the power disparity inherent to the relationship, patients might find it difficult to disclose this information and physicians must ensure they create an environment conducive to such disclosure. This is one of the reasons why professional boundaries are so important. Professional boundaries provide the framework within which a safe space can be created for the patient. It is a part of the physician’s duty to manage these boundaries so that lines are not crossed, and patient safety is not violated. There are a number of ways such violations might occur. The clearest example is if the physician initiates or reciprocates an inappropriate romantic or sexual relationship with a patient. In Ontario, the Regulated Health Professions Act prohibits any form of sexual involvement between physicians and their current patients. Under the legislation, “sexual abuse” is defined broadly and encompasses a number of acts that range from “sexual intercourse or other forms of physical sexual relations” to “behaviour or remarks of a sexual nature” made towards a patient by a physician. Under both law and professional guidelines alike, there are no circumstances under which a romantic or sexual relationship is permitted or acceptable between a physician and the patient they are providing care to. Physician engagement in such sexual activity evidently violates patient security. There is no way that a patient can provide meaningful consent to involvement in a sexual relationship with their physician when there is a clear power disparity between patient and physician. I think there is no debate that any such physical contact is nothing short of a physician crossing the line. But what happens when the boundary is less clear? What about physical contact that is offered in a nurturing and supportive way? A pat on the shoulder? Initiation of physical contact in any form requires the physician to exercise sound clinical judgment about whether that touch has the potential to push the limits of what is acceptable in the clinical context and what is respectful of the patient’s wishes and needs. 4

OPINION to the patient, and the physician must provide necessary medical services while the patient seeks a new physician. Prior to reaching this point, the physician must have engaged in reasonable attempts at resolution through clear communication with the patient and must have taken into consideration the feasibility of the patient being able to receive care from another physician. On this latter point, as much as physicians are bound by professional boundaries, they might also be limited by the constraints of the healthcare system in which they are embedded. For example, a physician who terminates a relationship with a patient in an urban centre can do so with perhaps more peace of mind, knowing they can likely refer them to other providers. The decision to terminate becomes more difficult when, for example, the physician is the sole practitioner in a community who is available to provide care to that patient. Such decisions are not easy, not all physicians will reach the same conclusions, and there is no formulaic approach to all scenarios.

Generally, however, the physician must be cognizant that even touch that is meant to be supportive has the potential to be misinterpreted. This discussion can be expanded to even greyer areas. For example, how much personal information can a physician share about themselves with their patients? What is the line between being friendly or fostering a level of familiarity that is more akin to friendship? While the latter is discouraged, the former might be an important part of building trust. My discussion does not attempt to answer these difficult questions, but what it is meant to highlight is that in any interaction with patients, physicians must reflect on the potential boundary issues that may be at play. Ultimately, if the physician engages in critical self-reflection, exercises sound clinical judgement, and asks themselves questions like, “Is this in my patient’s best interest? Whose needs are being served?”, they are less likely to find themselves in a situation where lines are crossed.

What this means for a physician is that as difficult a task as this might be, it is their responsibility to know where to draw the line. This ability requires empathy for the patient and respect of their autonomy, an awareness of their own ability to provide care, and ultimately an assessment of the very patient-physician relationship that started this discussion.

Where to draw the line It is evident from the discussion above that physicians play a crucial role in navigating the boundaries of the patientphysician relationship. They must ensure the bounds of the professional relationship are not compromised by any action on their part. However, the breakdown of the therapeutic relationship can stem from other considerations outside of the physician’s control, and in these circumstances, the physician must know where to draw the line. In these cases, physician inaction would mean the continuation of a patientphysician relationship that is no longer meeting the needs of the patient and perhaps creates insurmountable challenges for the physician providing care to the patient.

Staying in the Lines Boundaries are defined as the point or limit that indicates where two things become different, where one space ends and another begins. Sometimes boundaries can be stifling and impede innovation, forcing us to think inside the box. But other times, boundaries provide structure and clearly outline the confines within which we can grow. In the context of the patient-physician relationship, it is evident that boundaries delineate the lines within which a safe space can be created for the delivery of high-quality patient care. Physicians must navigate these boundaries to ensure that they do not cross any limits, and that appropriate limits are drawn when necessary. Thus, while we teach young children to colour outside of the lines, young physicians and medical students are best advised to stay inside of them. ⚚

Some examples of these circumstances include: a patient that is abusive or threatening towards the care provider, circumstances in which a patient crosses a sexual boundary, or any long-term conflict between the patient and physician that can lead to a breakdown of the relationship. All of these circumstances can ultimately compromise the quality of care being provided to the patient, and so physicians must develop the ability to reflect and acknowledge when such a relationship must be terminated.

But termination is not as straightforward and simple as it sounds. It is not the same as a physician ending a therapeutic relationship for reasons such as retirement, relocation, or a leave of absence. There are a number of considerations that must be factored in when a physician makes the decision to terminate a relationship.

2. 3.

The decision to end a therapeutic relationship stems from the physician’s assessment that there is an “irreconcilable breakdown” in the relationship. This breakdown can be for the reasons listed above or others; it must be communicated

Legal Disclaimer: Please note the information provided in this article does not, and is not intended to, constitute legal advice; instead, all information, content, references, and website hyperlinks provided in this article are for general informational purposes only. No reader of this article should act or refrain from acting on the basis of information in this article without first seeking legal advice from counsel in their relevant jurisdiction. “Boundary Violations” (2019), College of Physicians and Surgeons of Ontario, https://www.cpso.on.ca/Physicians/Policies-Guidance/ Policies/Boundary-Violations “Ending the Physician-Patient Relationship” (2017), CPSO, https:// www.cpso.on.ca/Physicians/Policies-Guidance/Policies/Ending-thePhysician-Patient-Relationship#endnote07; “Ending the doctor-patient relationship” (2015) Canadian Medical Protective Agency, https://www. cmpa-acpm.ca/en/advice-publications/browse-articles/2006/endingthe-doctor-patient-relationship.

Waistlines:

Written by Sarenna Lalani, Meds ‘23 Artwork by Jordana Waserman, Meds ‘21

waistline. For some, this term may bring up images of the unforgiving and impliable corsets of the 1800s. For others, this may be associated with thoughts of glamour or memories of Audrey Hepburn and her infamous 22-inch waist. For some, waistline may be a dysphoric term, triggering a wave of negative emotions. If you are in medicine, however, a waistline may be a biomarker too. We know that waist circumference is the easiest measure of abdominal obesity, a risk factor in so many of the chronic conditions that predominate in North American society: diabetes, hypertension, cardiovascular disease, stroke and even certain types of cancer. Over the past few decades, the discourse surrounding obesity in medicine has undergone quite the overhaul. In 1997, the World Health Organization (WHO) declared obesity a global epidemic. Today, the WHO estimates that nearly 1.9 billion adults live with obesity. In addition to this, in 2013, the American Medical Association declared obesity to be a “complex, chronic disease.” In essence, the past 25 years have culminated in a complete metamorphosis of the term obesity: from its declaration as an epidemic (which surely has new meaning in today’s day and age), to the pathologization of the state, a lot has changed in the medical dialogue that surrounds it.

in adolescence and into adulthood. This suggests that psychosocial factors have a role in the development of obesity too, perhaps due to chronic inflammatory states caused by stress. While the jury is still out on the exact scientific causes of obesity, obesity is certainly multifactorial with environmental (including socioeconomic and psychosocial factors), genetic, and behavioural contributors all playing a unique role in pathogenesis. On the note of pathology, I feel it important to mention the social context in which obesity is discussed today. Social media and the North American cultural context have an interesting hand in the way in which we construe obesity both within and outside of medicine. The body positivity movement began in 1969 when American engineer Bill Fabrey created the first fat rights organisation as a response to the way individuals treated his wife. Through a number of subsequent waves, the movement evolved to include corporate campaigns from Dove’s RealBeauty campaign to American Eagle’s lingerie brand unveiling #AerieREAL. Companies have stopped photoshopping the models pictured on their advertisements, and have begun to include models of many shapes and sizes on their websites and within their marketing campaigns. Lululemon even increased their size range for women’s clothing to include plus sizes for some of their most popular items. From a consumer standpoint, it seems that the “body posi” movement is in full force, with inclusivity at the forefront. Meant to counteract the unrealistic expectations placed on women (men seem to be largely excluded from this movement), the movement endeavors to normalize differences in body type. My question is, what does this mean for the medical community?

Despite the WHO’s declaration, the parley surrounding whether or not obesity ought to be pathologized continued, and still continues to this day. Some vehemently advocate against it, insisting the etiology of obesity is more behavioral than genetic. Meanwhile, other literature, including Adverse Childhood Experiences (ACEs) studies suggest other factors are at play; children who have experienced violence and abuse are much more likely to be overweight or obese 6

A Socio-medical Commentary

on Obesity

in the 21st Century 7

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How simu prom activ with certa

1. 2. 3. 4. 5.

The history of the body positivity movement - BBC Bitesize. Accessed April 21, 2021. https://www.bbc.co.uk/bitesize/articles/z2w7dp3 Body positivity - Wikipedia. Accessed April 21, 2021. https://en.wikipedia.org/wiki/Body_positivity Davis L, Barnes AJ, Gross AC, Ryder JR, Shlafer RJ. Adverse Childhood Experiences and Weight Status among Adolescents. J Pediatr. 2019;204:71-76. e1. doi:10.1016/j.jpeds.2018.08.071 Kyle TK, Dhurandhar EJ, Allison DB. Regarding Obesity as a Disease: Evolving Policies and Their Implications. Endocrinol Metab Clin North Am. 2016;45(3):511-520. doi:10.1016/j.ecl.2016.04.004 Haththotuwa RN, Wijeyaratne CN, Senarath U. Worldwide epidemic of obesity. In: Obesity and Obstetrics. Elsevier; 2020:3-8. doi:10.1016/b978-012-817921-5.00001-1

As fat activists continue to advocate for inclusion, the medical community still has a responsibility to practice preventative medicine, and to try to limit the progression of chronic disease, before it shows clinical signs and symptoms. But how does a medical professional reconcile this epidemic all the while maintaining principles of inclusion and body positivity? How do we simultaneously promote healthy and active lifestyles, without stigmatizing certain body types? There are a lot of unanswered questions when it comes to body size and medicine, and this article is testament to that. When writing the word fat, should I put it in quotation marks to remain sensitive? Is the o-word too stigmatizing to use to refer to patients with high BMIs? As a medical student merely entering the world of healthcare, I certainly don’t have the

There are a lot of unknowns in the realm of obesity and medicine — the pathogenesis, people’s individual weight stories/struggles, and how to best broach the topic are all particularly muddled. Perhaps we can take solace in our awareness of our lack of knowledge, and try, at least, to approach patients without judgement and with the explicit intention of not inciting shame. While this approach may tide us over in the short term, one thing is for certain — more research needs to be done in this realm so we can advise patients with confidence in our approaches and have science that backs our recommendations. So… anyone up for the challenge? ⚚

answers. I do know, though, that regardless of the field of medicine I choose to pursue, be it anesthesia, obstetrics, internal medicine, pathology, surgery, or family medicine, obesity is bound to be an important conversation topic. With its own unique risk to certain procedures and the impact it can have on prognosis/ progression of disease, the topic seems important to bring up, even if only for patients to be able to have the appropriate information to provide informed consent. How I bring it up, however, is a mystery to me, and is something I would appreciate some clarity on. With weight being such a touchy topic, and oftentimes an emotionally-charged one at that, how do I ensure I do not project my own weight biases/experiences/ expectations onto patients? How do I create a safe space while still advocating for my patients’ health?

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do we ultaneously mote healthy and ve lifestyles, out stigmatizing ain body types?

OPINION

Reading Between the Lines: Survival, National Identity, and a Rise in Ageism Written by Colin Faulkner, Meds ‘24 Artwork by Kaitlyn Rourke, Meds ‘23 Frontier, Island, and Survival,— the respective identities of America, England, and Canada,— have predicted each state’s response to COVID-19. Despite these differencesis, ageism has permeated each system and, but this revealsprovides opportunities for progressing towards a reified national identity.

n the 1970s, there was a significant postmodern effort to define a national Canadian theme. Through film, literature, and foreign policy, our neighbour to the south seemed to have their theme firmly rooted in Frontier — The American Dream. The corresponding symbol for England was considered the Island — a self-contained, hierarchical, and insular structure that bears little weight on the priorities of surrounding nations. It was Margaret Atwood who proposed a contender for our national identity: Survival. In Survival, she posits that the Canadian experience is based on surviving, whether that be from hostile climates, threats to French culture, or colonization.1 With the arrival of COVID-19, 50 years after her writing, we are seeing these national identities represented in our pandemic response, particularly in how we are treating our older adult populations. 10

OPINION Inherent to the Frontier is a discarding of the old order, a sentiment reflected in how America has approached the pandemic. American officials sought to ensure that individual freedoms — however small — came before the actions advised by health experts. This libertarian approach demanding few personal sacrifices led to a surge in deaths, prompting a shift in rhetoric that placed older adults in the crosshairs. Former President Trump urged American “warriors” to selfsacrifice for the economy. Any doubt of who these warriors would be was gone when Texas Governor Dan Patrick said “lots of grandparents would rather die than see health measures damage the US economy”.2 These sentiments are examples of overt ageism, where not only is age the only risk factor considered, but the value of older adults is discarded. The UK adopted herd immunity as their approach, with the caveat of isolating older adults in the name of protecting them. This is fundamental to the Island identity, as it signifies an ingrained hierarchy, and a desire to preserve utilitarian order. Once COVID cases rose, nursing homes were affected by numerous outbreaks. Herd immunity was criticized as a pro-market move by the Tory government, one which sacrificed the older population. The intent to isolate based solely on age is an example of benevolent ageism, where incompetence is inferred and the autonomy of the older adult is undermined. The theme of Survival predicts Canada’s pandemic response, with a few exceptions. As a nation, we rejected the notion of herd immunity and prioritized the lives of the most vulnerable. Instead of solely relying on isolating older adults, we attempted to encourage personal responsibility among everyone, including maskwearing, social distancing, etc. However, contrary to our informal system of beliefs, we fell short at preparing long-term care facilities for the pandemic. Over 80% of deaths occurred in nursing and retirement

home settings, much higher than proportions in other nations, indicative of an infrastructural deficit.3 Canada has also been susceptible to ageist conversations around triaging the old in worst-case scenarios as well as circulation of hashtags in social media like #BoomerRemover. Older adults are the most heterogeneous age group, with distinct life experiences, cultural backgrounds, genetics, and health histories. They also contribute significantly to the volunteer workforce as caregivers and charitable donors. With the pandemic, ageism has seen a marked rise, affecting how older adults internalize negative attitudes about aging and the value of their own lives.4 Significant experimental, longitudinal, and cross-cultural studies show that negative age beliefs adversely affect a broad spectrum of health outcomes.4

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for booking systems and clinics that accommodate those with cognitive or sensory impairments, better access to individualized resources that explain how to access health resources, and volunteer programs for those who need transportation during the pandemic. It is also vital to reinforce proven measures like social distancing while fostering online and telephone communications to prevent social isolation. Ageism can be overcome by underlining that our collective health is a priority, rather than suggesting that age is the sole consideration. ⚚

1. 2.

The intent to isolate based solely on age is an example of benevolent ageism, where incompetence is inferred and the autonomy of the older adult is undermined.”

In a contemporary sense, our Survival identity may suggest steps we can take to address the needs of older adults. From Atwood: “Having bleak ground under your feet is better than having no ground at all... a tradition doesn’t necessarily exist to bury you: it can also be used as material for new departures.” Survival hasn’t always meant survival as a whole, but it can be used as material for a new departure, one towards better outcomes for all. Social media can be a great source of opportunities for change. From Twitter, a chorus of requests can be found

Atwood, M. Survival: A Thematic Guide to Canadian Literature. (House of Anansi, 2012). Lichtenstein, B. From “Coffin Dodger” to “Boomer Remover”: Outbreaks of Ageism in Three Countries With Divergent Approaches to Coronavirus Control. The Journals of Gerontology: Series B 76, e206– e212 (2021). November 17, C. F. & 2020. The year of the pandemic has busted the myth that Canada values its seniors. Macleans.ca https://www. macleans.ca/society/health/the-year-ofthe-pandemic-has-busted-the-myth-thatcanada-values-its-seniors/ (2020). Ayalon, L. et al. Aging in Times of the COVID-19 Pandemic: Avoiding Ageism and Fostering Intergenerational Solidarity. The Journals of Gerontology: Series B 76, e49– e52 (2021).

Where do we draw the line? Written by Jonah Buckstein, Meds ‘22

Photo by Daniel Schludi on Unsplash 12

OPINION

raining as a clerk in the age of COVID has been challenging. From the four month delay, to telemedicine, to shortened rotations, it has been one adjustment after another. With the licensing of the desperately needed and much heralded Pfizer, Moderna, and AstraZeneca (AZ) vaccines, it looked like we were finally on the way out of this quagmire. There have been positive changes. 11.8 million Canadians have been vaccinated, and we finally have a glimmer of hope that we will be able to resume some semblance of our previous lives next year. Unfortunately, there has been a dissident faction that continues to doubt and undermine the reported safety of these vaccines, most notably the AZ vaccine. Working in a Family Medicine clinic in Collingwood, I have been shocked at how many patients call in to discuss their vaccine hesitancy and unwillingness to get the AZ shot. The clinic has posted countless resources, posters, and informative pamphlets on their website for their patients, and yet the problem seems to persist. I’ve had some interesting conversations with patients, and to no surprise, the majority of them have read the bad press and are terrified of vaccine-induced prothrombic immune thrombocytopenia (VIPIT) despite the fact that there have been only two cases in Canada out of the hundreds of thousands of administered doses thus far. I have tried positive framing to change their perspective, asking, “Did you know that the vaccine has a 99% rate of preventing hospitalization and death from COVID-19?”, to no avail. Recently, I tried to use a bit of situational fear to galvanize my pregnant patient to get the vaccine. “Did you know that there are numerous pregnant patients on ventilators at Mount Sinai and Sunnybrook hospital?”, I asked. But sadly, this too failed to get her to budge.

Photo by Obi Onyeador on Unsplash

This dilemma makes me wonder: how and why are we as humans, so incredibly irrational and inconsistent? Where do we draw our lines in the sand and say, “this is too great a risk?” Why is this not consistent? Take the opioid epidemic. There has been exhaustive coverage in the media on the dangers of opioids, their additive properties, and damaging effects on our health. There were 12,000 opioid-related overdoses between 2016 and 2018 alone. Yet, patients with good regularity continue to ask for it, and accept it willingly when there is an indication for it in our hospitals. Why is the public afraid of the rare and fatal but not the common and fatal? I certainly can’t answer that question, and the irrationality of it seems to perfectly summarize the human condition. What I can advocate for is for our media to take some responsibility and stop using clickbait and sensationalist journalism to discredit and destabilize the public’s trust in our vaccines. In an ideal world, there should be a mandatory disclaimer at the top of any article detailing VIPIT, the risks of vaccines with the actual rates of these complications, as well as the net benefit of these vaccines. Hopefully, with the adjustments to the age cut-off for the AZ vaccine, more and more people will get their first doses and crowd mentality can help push the in-betweeners over the edge. ⚚ Artwork by Kaitlyn Rourke, Meds ‘23

Why You Should Get The COVID-19 Vaccine If You Are Pregnant Frequently Asked Questions with Sources

Check out this infographic, made by Iku Nwosu, Meds ‘22!

Queen's University Initiative. Infographic by Iku Nwosu, Medical Student. Reviewed by OBGYNs: Dr. Olga Bougie, MD, MPH, FRCSC; Dr. Graeme Smith, MD, PhD, FRCSC; Dr. Laura Gaudet, MD, MSc, FRCSC. Graphic edits by Stephanie Jiang, Medical Student.

"Why are doctors becoming more concerned about pregnant people contracting COVID19?"

In Canada and across the world, the burden of the pandemic has rapidly increased due to the highly infectious variants. An increasing number of pregnant patients infected with COVID-19 are being admitted to intensive care units (ICU). ICU care is for a hospital's sickest patients. It entails life-sustaining measures including intubation, ventilation, oxygen, medications that maintain blood pressure, and extensive monitoring by teams of health care professionals.

While most people from the general population with COVID-19 experience mild illness, otherwise healthy pregnant patients with COVID-19 are getting very sick, very quickly.

30%

As of April 20, 2021, 30% of Sinai Health ICU patients were pregnant or postpartum patients. (Dr. Wendy Whittle, Sinai Health)

In cases of severe illness, emergency C-sections are being performed in the ICU for both maternal and fetal safety.

"The vaccine has risks. How much do we even know about it? I have enough going on with my pregnancy as it is."

"COVID-19 is usually a mild illness, and I have a healthy pregnancy. Why should I be vaccinated?"

The Society of Obstetricians and Gynaecologists of Canada (SOGC) supports the use of all available COVID-19 vaccines approved in Canada in any trimester of pregnancy and during breastfeeding in accordance with regional eligibility.

No clots in > 99% of vaccine recipients.

99%

Arterial and venous thrombosis associated with low platelets events following the adenovirus vector COVID-19 vaccines (AstraZeneca, COVISHIELD, Janssen) occur in as few as 1 in every 125,000 to 1 in 1 million people.

Preliminary findings do not show obvious safety concerns among pregnant persons who received vaccination. 14

Academic The vaccine has now been shown to: 1) Increase maternal vaccine-specific IgG antibodies. These can get across to help protect baby after delivery as long as you get the vaccine at least 3 weeks before delivery. 2) Increase vaccine-specific IgA antibodies which in breast milk provides mucosal protection from COVID19 for your baby.

"Are there any benefits from the vaccine to my baby?"

There are other vaccines recommended in pregnancy for similar reasons. These include: Influenza, Tdap (Whooping cough), and more.

The Bottom Line Every medical decision should be made after weighing the risks and benefits for yourself with the input of a medical professional. However, with widespread community transmission of the virus variants, understand that the risk of getting very sick with COVID19 is peaking.

GET VACCINATED. Take the first vaccine you are offered.

Especially if you are pregnant. Sources 1. SOGC statement regarding pregnant woman with COVID-19 in ICUs in Ontario: https://sogc.org/common/Uploaded%20files/Latest%20News/EN_Statement-COVID19_PregnantWomen.pdf 2. Toronto critical care doctors are sounding the alarm on the mounting number of pregnant COVID-19 patients in their intensive care units: https://toronto.ctvnews.ca/video? cid=sm%3Atrueanthem%3Actvtoronto%3Atwitterpost&clipId=2184430&taid=607e66dbc18bb900010d31bf&utm_campaign=trueAnthem%3A+Trending+Content&utm_m edium=trueAnthem&utm_source=facebook 3. The BMJ - Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis: https://www.bmj.com/content/370/bmj.m3320 4. SOGC Statement on the COVID-19 vaccines and rare adverse outcomes of thrombosis associated with low platelets: https://sogc.org/en/content/featurednews/SOGC_Statement_on_the_COVID-19_vaccines_and_rare_adverse_outcomes_of_%20thrombosis.aspx 5. American Journal of Obstetrics & Gynecology - COVID-19 vaccine response in pregnant and lactating women: a cohort study: https://www.ajog.org/article/S00029378(21)00187-3/fulltext 6. New England Journey of Medicine - Preliminary Findings of mRNA Covid-19 Vaccine Safety in Pregnant Persons: https://www.nejm.org/doi/full/10.1056/NEJMoa2104983 7. CDC - Information about COVID-19 Vaccines for People who Are Pregnant or Breastfeeding: https://www.cdc.gov/coronavirus/2019ncov/vaccines/recommendations/pregnancy.html 8. Vaccination and pregnancy:: https://www.canada.ca/en/public-health/services/vaccination-pregnancy.html

Online in the Emergency Department: The Role of Telepsychiatry in Improving Access to Urgent Mental Health Care

Written by Kassandra McFarlane, Meds ‘23

he incidence of mental illness in Canada has been increasing in recent years. During any one year period, up to 20% of Canadians will experience mental illness and roughly half of the Canadian population will have experienced a mental illness by the age of 40.1 As access to psychiatric services is becoming increasingly difficult, many patients turn to the emergency department (ED) when faced with mental health problems.2 An overall increase in patient visits to the ED contributes to overcrowding which can lead to delayed care and negative health outcomes.3 Individuals with mental health issues are frequent ED users and the provision of care in an appropriate and timely manner for patients with psychiatric presentations is both challenging and complex.4,5 Providing psychiatric telemedicine, or telepsychiatry, in the ED is a feasible way to address the lack of psychiatric services, reduce wait times, and reduce overcrowding.

Impacts on the Emergency Department Crowding

Emergency department overcrowding is an all-too-common phenomenon in hospitals across the country.3 Many factors contribute to this problem, including a deficit of inpatient beds as well as population growth that increases ED traffic.3 In addition, about 20% of Canadians are without a primary care provider, and this number has been found to be higher for those presenting to EDs implying that some element of primary care is being sought in the emergency department.3 Unfortunately, the resultant delay in the delivery of care due to overcrowding negatively impacts the overall health outcomes of all patients.2,3

Frequent Users

Frequent users of the ED exacerbate overcrowding.2 A variety of chronic health issues have been linked to frequent ED use and mental health disorders are common in this population.2,4 Between 10 and 15 percent of emergency department visits are related to mental health presentations, potentially suggesting that current patient needs are not being met by other services in the community.2,4,6 This may be especially true when individuals are in a psychiatric crisis.6

Psychiatric Crises

Mental health crises and emergencies are primarily managed in non-specialized EDs.6 A number of systems-level barriers challenge the optimal management of psychiatric patients and their conditions in the emergency department including delayed access to appropriate care and prolonged wait times.7 Timely access to treatments and supports are needed for the population of patients who frequently use the ED for mental health reasons because of an increased risk of leaving without being seen by a medical professional due to extended wait times.3,8 This could have potentially disastrous outcomes including harm to self or others. Many emergency departments struggle to deliver mental healthcare for psychiatric concerns while patients wait for placement.2 Providing psychiatric care through the use of telemedicine technology (telepsychiatry) in the ED can help to alleviate many of these problems.2

Telepsychiatry and Patient Care

Telepsychiatry is a psychiatric intervention using videoconferencing technology and has been implemented in a variety of clinical settings.6 Telemedicine-based therapy has

ACADEMIC been shown to have similar outcomes as in-person therapy, and the clinical assessments made via telepsychiatry are comparable to those of in-person assessments.6,9 Not only can the use of telepsychiatry provide remote psychiatric evaluations and therapy, it is suitable for most clinical populations, including those in the emergency department.6 Telepsychiatry can play a unique role in alleviating the relative lack of psychiatric services available in many EDs.2 It is a method of delivering mental healthcare to patients using real-time interactive videoconferencing and, by allowing psychiatric service providers to appraise patients from a remote location, it increases the accessibility to mental health services.2,10 The use of telepsychiatry can reduce wait times, thereby improving access to psychiatric care in a mental health emergency.6 Utilizing telepsychiatry in the ED can also help reduce overcrowding by facilitating admissions decisions.2 Patients who receive telepsychiatric services report similar satisfaction to those receiving face-to-face care and patients have a generally positive opinion about the use of telepsychiatry in the ED.2,9

Limitations

While telepsychiatry can provide many benefits to patients in the emergency department, there are some potential disadvantages. An important disadvantage is that it is not suitable as a treatment for all psychiatric presentations and caution is advised when determining who would best benefit from treatment by telepsychiatry.9 Individuals who are experiencing hallucinations, delusions about monitoring or technology, and other psychotic presentations would not be ideal patients for telepsychiatry.9 Another disadvantage is potential issues arising from internet disruption, hardware or software problems, or video/audio quality concerns.9 Also, there is a concern about the extent of rapport established between patient and provider when using telemedicine for mental health services.9 However, despite these potential concerns, the overall benefit to patients seeking mental health services in the ED outweigh the possible limitations of this technology.

Mental Health Commission of Canada. Making the case for investing in mental health in Canada. London (ON): Mental Health Commission. 2013. 2. Freeman RE, Boggs KM, Zachrison KS, Freid RD, Sullivan AF, Espinola JA, Camargo Jr CA. National study of telepsychiatry use in US emergency departments. Psychiatric services. 2020 Jun 1;71(6):540-6. 3. Rowe BH, McRae A, Rosychuk RJ. Temporal trends in emergency department volumes and crowding metrics in a western Canadian province: a population-based, administrative data study. BMC health services research. 2020 Dec;20:1-0. 4. Urbanoski K, Cheng J, Rehm J, Kurdyak P. Frequent use of emergency departments for mental and substance use disorders. Emergency Medicine Journal. 2018 Apr 1;35(4):220-5. 5. Innes K, Morphet J, O’Brien AP, Munro I. Caring for the mental illness patient in emergency departments–an exploration of the issues from a healthcare provider perspective. Journal of Clinical Nursing. 2014 Jul;23(13-14):2003-11. 6. Reinhardt I, Gouzoulis-Mayfrank E, Zielasek J. Use of telepsychiatry in emergency and crisis intervention: current evidence. Current psychiatry reports. 2019 Aug;21(8):1-8. 7. Dombagolla MH, Kant JA, Lai FW, Hendarto A, Taylor DM. Barriers to providing optimal management of psychiatric patients in the emergency department (psychiatric patient management). Australasian emergency care. 2019 Mar 1;22(1):8-12. 8. Moe J, O’Sullivan F, McGregor MJ, Schull MJ, Dong K, Holroyd BR, Grafstein E, Hohl CM, Trimble J, McGrail KM. Characteristics of frequent emergency department users in British Columbia, Canada: a retrospective analysis. CMAJ open. 2021 Jan 1;9(1):E134-41. 9. Donley E, McClaren A, Jones R, Katz P, Goh J. Evaluation and implementation of a telepsychiatry trial in the emergency department of a metropolitan public hospital. Journal of technology in human services. 2017 Oct 2;35(4):292-313. 10. Hughes MC, Gorman JM, Ren Y, Khalid S, Clayton C. Increasing access to rural mental health care using hybrid care that includes telepsychiatry. Journal of Rural Mental Health. 2019 Jan;43(1):30.

Conclusion

The incidence of mental illness is increasing in Canada and because psychiatric services are difficult to access, patients resort to the ED to address their mental health concerns.2 These increased patient visits worsen the problematic overcrowding present in many regions, further straining the system and resulting in delayed care and adverse health outcomes.2 Because patients with mental health problems are frequent users of the ED, focusing on methods to expand access to care, while improving patient flow, will help to alleviate this problem. The use of telepsychiatry in the emergency department has the potential to reduce overcrowding, resulting in greater access to care for all patients.6 As well, the use of telepsychiatry can improve outcomes as it reduces the barriers of access to mental health services.10 ⚚ Photo by Luis Sanchez on Unsplash 17

Be it resolved that:

medical school applications would be better served by a lottery system NAY! YAY! Ch ris ti e M e ‘21 ds

Sare nna Lal an i, M ed s‘

Mik e

YAY

DEBATE with a passion for learning, and an altruistic spirit that will not burn out after countless nights on-call. But, really, does a 4.0 GPA and a three-digit number tell you that? I would argue not. It’s a horrible case of selection bias where we are, potentially, selecting for the wrong baseline characteristics. And, what’s worse is that it seems that this “study” doesn’t seem to have consistency in the way it selects. It takes some people years of med application cycles before they receive a treasured acceptance letter, but are we really to believe that that individual was any less deserving when they first applied three years prior? Or that such a substantial metamorphosis occurred between application cycles that an individual was transformed from sub-par to med-ready? I don’t think so. Our system has come down with the selection bias blues, and I think it’s in need of some real fixing up. Overall, the system has reduced people down to a formula, and what seems to be a rather faulty one at that, and I think that this defeats the purpose of the application cycle.

A Not-so-arbitrary Line in the Sand What is more alarming, however, than the haphazard and arbitrary system of admissions is the not-so-arbitrary line it has drawn in the sand. Getting a high GPA, studying for (and writing) the MCAT, and MMI prep sessions are all financiallylimiting factors. Heck, even getting into post-secondary education is a reflection of some level of privilege. On one hand, people in the medical profession and within medical education are eager to acknowledge that the makeup of their medical student bodies is not reflective of the general population and that there is much work to be done in the realms of equity, diversity and inclusion. Yet, the very

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hile getting through Zoom University amidst a global pandemic is certainly a slog, nothing quite compares to the arduous pain of medical school applications. The mention of applications probably brings you back to (*shudder*) the dozens of reference letters, endless hours of MCAT studying and MMI prep, and the obligatory reading of “Doing it Right,” the premed manifesto. I would dare to say that the med application process has been reduced to somewhat of a formula: a high GPA + a decent MCAT score + community involvement/ volunteering + someone/some people who can attest to your character (or, if we are being completely transparent here, someone whose writing is proficient enough to make your character glow and your positive attributes shine… not that you aren’t a star). I dutifully acknowledge, however, that Queen’s does have some streams that are looking for unique applicants; the Canadian Armed Forces stream, the MD-PhD program, the Indigenous applicant stream and the newly-minted QuARMS pathway for Black-identifying and Indigenous applicants are a few less “conventional” routes to medical school. But within each of those streams, plus or minus some other qualifications, I am willing to bet it all boils down to a similar formula. Regardless of how you got to QMed, however, as Dr. Sanfilippo said in the first week of orientation, we all deserve to be here. In some ways I agree with this statement — no matter how we got to QMed, we should be able to self-validate enough to overcome our imposter syndrome — but in some ways, I couldn’t disagree more. Perhaps none of us really deserve to be here at all.

Med Admissions: A Line of Formula?

Our med school application process has drawn a line in the sand, one where people from privileged backgrounds have a serious leg-up, and I think that is a serious problem.

processes by which they select medical students inherently exclude those with the least amount of privilege. To prove this further, I’ll give you a few examples of how this might pan out. Black families, for example, are more likely to qualify as low-income, and Black youth are half as likely as their nonBlack counterparts to receive a Bachelor’s degree.1 Before we even touch med school applications, there are increased barriers that prevent Black populations, for example, from

Okay, so now that I’ve got you riled up, let’s unpack that a little bit. What I mean by that dashing statement is that I think the med admissions process has become a rather arbitrary system. I mean, surely the goal of the admissions process is to filter out the best applicants — we want our doctors (and ourselves) to be kind, compassionate communicators

even reaching the point where they are eligible to apply to medical school. These barriers are multiplied if you are both Black-identifying and if you are in a situation of financial instability. In this scenario, the chances of you pursuing post-secondary education over work are much lower, and if you are somehow able to balance the demands of work and school (which is no easy feat), the likelihood of you achieving a GPA that would render your application competitive to medical schools is decreased significantly. I mean, just put yourself in the hypothetical shoes of this student — you finish off an eight hour day of classes (be they Zoom or otherwise) only to have to get ready and travel to your parttime job. From there, you work a four-to-six hour shift. You return home, and now have to do your life stuff (cook and eat dinner, do your laundry, clean, shower, this list goes on). The time you have to study is greatly diminished, if present at all, and I am willing to bet you are completely spent. Medical school admission systems are inherently skewed against racialized individuals and those with low income. We see this reflected in the populations accepted to med school (or even better, in those excluded entirely). As a society, we are already failing our Black and low-income youth, and med school applications only exacerbate this further.

Lining the Pockets of Big Med Prep Companies Not only do we disadvantage certain groups of people, but one of the consequences of formulating an application process is that we have created the perfect opportunity for companies to line their pockets helping (or “helping”) students get in. Further exacerbating the already substantial disparity between the financially stable and unstable students are the abundance of MMI/MCAT prep materials, courses, and coaching, some of which may seem like a necessity in order to stay competitive. We have turned med applications into somewhat of an industry, one that can capitalize on the deep desires of students to get into medical school. A lottery system would effectively abolish the utility of these med prep companies, rightfully disempowering them and disincorporating the med prep industry. I think this is particularly important, because the capitalization of the application process by BigMedPrep, I think, inherently undermines the intention of the current application process — to get to know, and select, the candidates that are going to make the best physicians. While I clearly don’t buy that the current process is entirely effective at choosing candidates, I think that the present issues are further exacerbated by BigMedPrep and its ability to profit off the vulnerabilities of hopeful premeds. Preying on the weak and making money while doing it… sounds awfully predatorial does it not? Is that really what we want for our med application process?

While I use the example of Black and low-income groups, the sad and harrowing reality is that our system is not built to include less privileged groups, period. Be it BIPOC, those with low income, those with disabilities, those who come from unstable homes or another underprivileged population, the system was not built for you. Getting an education, let alone through a process as competitive and gruelling as the medical school application, is exponentially more challenging for people from these groups. That’s not to say it’s not doable, but it certainly is significantly harder, and if you look at the classes of MDs in the past, I think you can easily see that reflected in the demographics of the graduates. Our med school application process has drawn a line in the sand, one where people from privileged backgrounds have a serious leg-up, and I think that is a serious problem.

The Bottom Line Some may say that a lottery seems blasphemous, but I would argue that it is, at the very least, no worse than the unpredictable and unsubstantiated system that we have now. In order to truly create an equitable system, we have to break down the structures that so ardently uphold our presently broken one. In order to give everyone an opportunity, to level the playing field, perhaps we ought to leave it to chance… After all, if we can teach circuit boards and hardware to make diagnoses, surely we can teach any eager human being to do the same. 1.

New StatCan data shows how Canada is failing new generations of Black youth | The Star. Accessed April 28, 2021. https://www.thestar. com/opinion/star-columnists/2020/02/29/how-canada-is-failingnew-generations-of-black-youth.html

NAY

The Lottery Ticket We Don’t Want to Buy

he Lottery. We all want to win it — the easy, get-richfast chance of a lifetime. It sounds great, and for the millions left over after taxes, it is. The exhilarating part about it is that everyone who buys in has an equal chance of winning it all. At face value, applying this scheme to medical school admissions seems fair. Your application fee is like buying your ticket, and an acceptance letter is the same as discovering you’ve picked the right numbers. It’s equally life changing. Yet in considering a lottery system for selecting medical students, we need to go a bit deeper. In this article, I’ll illustrate the pitfalls of replacing critical thought with random chance in medical school admission. It’s a lottery ticket that we don’t want to buy.

the career. Our current system cannot perfectly predict who will be successful, but it’s a much more certain approach than randomly accepting applicants. Implementation of the lottery system would be the easy way out, and it would be irresponsible to our profession if we didn’t do our best to ensure the people we pick are a good fit. Imagine hiring a pilot who is afraid of heights — that move just wouldn’t fly.

Hiring A Pilot Afraid of Heights Are you sure about this? What does it take to be a doctor? It’s a massively philosophical question. To answer it, the Royal College of Physicians and Surgeons of Canada developed its “CanMEDS Roles” framework. This framework “...identifies and describes the abilities physicians require to effectively meet the health care needs of the people they serve.” The RCPSC goes on to state that “...a competent physician seamlessly integrates the competencies of all seven CanMEDS Roles.” These roles include being a professional, a leader, a collaborator, a scholar, a communicator, and a health advocate. Schematically, they are arranged as the petals of a flower around the central role of being a medical expert. I don’t think it’s unreasonable to say that the framework presents a demanding set of roles.

Medicine ain’t for everyone. It’s not like what you see on TV (and if it was, my jaw line would not be chiseled enough to make the cast). The drama and excitement are wildly overrepresented, meaning people expecting crashing patients every five minutes might be ever so slightly disappointed. I am not saying medicine is boring, because that similarly couldn’t be further from the truth. There’s a fascinatingly diverse spread of subdisciplines that each offer worlds within themselves to explore. Being interested in the content is necessary to engage with the behind-thescenes, utterly unglamorous work involved. Wanting to be a doctor because it sounds cool won’t cut it.

Medical schools are responsible for selecting candidates who have demonstrated capabilities within these roles and who have the potential to expand upon them further. The current admissions process serves to identify these candidates by examining written applications and then meeting candidates in person to get some idea of who they are. The challenge is that lots of people would make great doctors, and that’s why picking medical students is so damn hard. Lottery system proponents suggest that because so many candidates are relatively similar in their potential to become successful physicians, we might as well just go with a lottery system that does the choosing for us. The problem with this line of thinking is that these strong applicants could easily become diluted by other less qualified applicants who simply apply on a whim. It therefore risks the selection of candidates who do not have the skills or personal qualities required for

Physicians in Canada generally make more money than the average person, and this undoubtedly attracts some interest towards the field. This pay, however, is hard earned. It requires medical school, residency, and fellowship (which can be a total training time of over ten years in some cases). This training is incredibly demanding. It involves early mornings, weeknights, weekends, and holidays. Free time outside of work is often spent studying or conducting research. Once in practice, overhead, insurance, long hours, and the stress of being the most responsible person for patient care are part of the job. I strongly contend that without an intrinsic source of motivation, a career in medicine is not sustainable, and that’s what I’m getting at when I say the career isn’t the best fit for everyone.

Furthermore, it’s important to state outright that becoming a physician is not a get rich quick scheme. If money is what an applicant is after, there are far easier and more lucrative career paths to follow. Yet with the chance to be selected and little consideration of the realities of medicine required, why wouldn’t they apply?

random process: What if it backfires? What happens, for example, if our random group of selected applicants all look the same, have the same life experience, and think the same way. What if this happens multiple years in a row? If we so strongly value diversity, is this a risk we are willing to take? A major risk of using a lottery to select candidates is that all of our progress on diversity could quickly be erased. I argue that forfeiting control of admissions to chance and assuming this will result in diversity is not worth any of the theoretical but non-assured benefits. Furthermore, the lottery does not address the issues of why applicants might not be able to apply in the first place, such as expensive application fees, limited post-secondary educational opportunities, and lack of mentorship or social support.

The consequence could be large numbers of medical students deciding, after finally seeing what medicine actually entails, that it’s not for them. Suddenly a class of 100 could be cut in half, and the downstream effects of this on the physician workforce could be grave. Not to mention, the government funding of these seats would ultimately be wasted. The point is that with the convenient opportunity to simply throw your hat in the ring and take a chance on trying out medicine, applicants may not have fully thought through what the training and career looks like. There has to be a mechanism that coreces applicants to pause and think critically, Is this really for me? As the gatekeepers to the precious resource of medical training, it is our professional responsibility to understand why a candidate has applied. Using a lottery, no such checkpoint exists.

Losing Ticket There’s no question that the way we do things now is far from perfect, however I am optimistic that by addressing systemic barriers to medical school applications we can make the process more accessible and equitable. Change is needed, but employing a lottery system is not the way to do it. The Lottery potentially sacrifices the selection of qualified, dedicated, and diverse candidates. The case against it is irrefutable: the lottery system just isn’t a winning ticket. ⚚

Worsening Medicine’s Diversity Problem The longstanding existence of systemic barriers preventing specific groups of people from becoming physicians is undeniable, and as a profession it’s not something we’re proud of. We have definitely come a long way on this issue, however we have much further to go in our efforts to improve diversity amongst our ranks. Admissions programs across the country are working on this topic to ensure we are headed in the right direction. This involves considering everything from an applicant’s race, ethnicity, gender, sexual orientation, socioeconomic status, and life experiences, and this list is non-exhaustive. We are critically evaluating who applies to medicine, who gets an interview, who gets selected, and perhaps most importantly who is unable to apply in the first place. Understanding the barriers for this last group of people is especially essential to developing targeted, specific measures that ensure a truly equitable process. Adversaries of the current admissions system argue that although the previously discussed CANMeds Roles are fundamentally sound, due to current inequities, how we assess candidates for them is not. Some then argue that the lottery process is the perfect solution for medicine’s diversity problem because it eliminates any systemic influence on candidate selection. I concede that the lottery might work on this front, picking a diverse group of people for each class as the next generation of doctors. However we have to ask an important question of proposed our 22

Implementation of the lottery system would be the easy way out, and it would be irresponsible to our profession if we didn’t do our best to ensure the people we pick are a good fit. Imagine hiring a pilot who is afraid of heights — that move just wouldn’t fly.

Compiled by Edward Cui, Meds ‘24 Logo designed by Kiera Liblik, Meds ‘23 Photography by Corey Forster and Jehan Irfan, Meds ‘24

nce again, QMR is taking the pulse of QMed and showcasing a few of the impactful initiatives that students have been working on. We interviewed the creators behind four diverse projects, which tackle topics ranging from homelessness in Kingston to excess consumer waste, and asked them about the process of bringing these initiatives to life. It is our hope that you will, like these students, also seek opportunities to take action on a cause that resonates with you no matter how big or small!

COMMUNITY

This Clerkship Life

Written by Carter McInnis, Meds’22 Can you describe the initiative to our readers?

‘This Clerkship Life’ is a student-run podcast that is dedicated to the experience of clerkship and everything it entails. Hosted and produced by Queen’s medical students, we hope to capture the unique transition that students experience each year as they begin their clinical training. Nearly 3000 students across Canada start clerkship each year, representing an often-overlooked transition that is underscored by a number of professional and personal challenges (not to mention triumphs of course!). Our goal is to give a voice to this experience, or at minimum, provide our own take on the process as we try and figure it out ourselves.

What impact do you hope the initiative will have?

We hope to infuse the often-arduous process of clerkship with storytelling and encourage students to reflect on their own unique stories. By identifying and amplifying the many experiences common to all Canadian medical students, it’s our hope that we can provide an honest account of being a clinical clerk. By tackling the many big challenges facing students, like the experience of going unmatched (Season 2, Episode 9), and highlighting the profound moments practising clinical medicine, including the moments where medical students can make a difference for our patients (Season 1, Episode 2), ‘This Clerkship Life’ aims to shine a light on the daily experiences of clerks.

How can our readers learn more about the initiative and/or get involved? Entering the third season of ‘This Clerkship Life’, we are ALWAYS looking for opportunities to amplify student voices and would love to get more people involved. If you would like to collaborate, for example by spearheading an episode on a particular topic or hosting an interview with a guest that you think might have an interesting take on clerkship, reach out to us at clerkshippodcast@gmail.com. You can catch up on old episodes or subscribe to hear new episodes through Apple Podcasts.

OSLER Kingston x KHealth IPR Case What was the inspiration for the theme of the case competition? Competition: Homelessness

We brainstormed a number of different themes for this case

OSLER Kingston (Alanna Jane, Christy Wee, Megan competition. It was important for us to select something Saad, Rachael Allen), KHealth (Ishita Aggarwal, Peter that was both relevant to the Kingston community and Lee, Brittany Ung) informative to students’ learning in healthcare. Homelessness

stood out as a particularly pertinent issue. Based on research and consultation with other students and professionals, the planning team worked to build a patient case study that presented important background information and details that would encourage teams to take on a nuanced and intersectional approach to solving it.

How did attendees interact with the theme of homelessness? Can you describe the initiative to our readers?

The IPR Case Competition took place on March 4th, 2021 and was a joint initiative between the Interprofessional portfolio teams of OSLER Kingston and KHealth. The event was initiated with the aim of promoting interprofessional collaboration between students in various healthcare disciplines, including medicine, occupational therapy, physical therapy, nursing, and clinical psychology. There is currently a significant gap that exists in inter-program education and collaboration at the preclinical level, so we saw this as a unique opportunity to forge those connections early on and encourage future professionals to continue to break the silo between disciplines.

Teams showed incredible motivation and inspiration to present thoughtful solutions. Over the 45 minutes, the mixed teams represented their ideas through creative channels such as an original art piece and slideshow presentation. The three panelists we invited as judges, Dr. Eva Purkey, Dr. Elaine Power, and Dr. Anthony Train, were all impressed with the caliber of critical thinking and teamwork.

We are so pleased with how the first case competition turned out and the feedback we received was overwhelmingly positive. It was inspiring to see students so interested and excited to enrich their learning experience at Queen’s with this style of event, and we hope to provide more opportunities in the future to tackle health issues in this proactive way. We also received feedback from attendees that it would serve students well to have collaborative sessions such as these become a permanent part of the preclerkship curriculum, and we couldn’t agree more!

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Kiera Liblik, Meds ‘23 26

COMMUNITY QMed Thrift

Environmental Advocacy In Medicine What is QMed Thrift?

QMed Thrift is a new initiative by the Environmental Advocacy in Medicine Interest Group (EAIM). This is a Facebook group to swap/trade/donate/sell unwanted items in an effort to promote a circular economy, the repurposing and reusing of items and an overall decrease in consumer waste.

What was the inspiration for your initiative?

QMed Thrift aims to fight against fast fashion. Fast fashion focuses on rapidly producing high volumes of clothing. Many fabric fibers are synthetics derived from fossil fuels, so if they end up in the environment they will not decay. In addition, microfiber plastics are released into our water bodies with every wash of synthetic fibers. Another thing to consider is the exploitation and poor work conditions of garment workers for companies who supply the large big-named branded stores across the world. We feel that as healthcare professionals we have the responsibility to think about how our purchasing practices affect the community whose health we provide care for, both from an environmental and health determinants perspective. QMed Thrift encourages accessible and functional sustainable practices in the QMed community.

What impact do you hope the initiative will have?

We hope that in the future QMed Thrift can become the default place for our community to post and search for items before disposal. Most importantly, we hope that our community starts to become aware of the impact of new purchases on the global community.

Anything else you’d like to share?

We want to thank QMR for showcasing us and we want to encourage all of you who are moving this summer to make the most of QMed Thrift! Our group has other initiatives regarding green healthcare and our environmental health curriculum, so make sure to follow us on social media to learn more about these!

Project Connect

Women’s Health Interest Group, KHealth Can you describe the initiative to our readers?

Project Connect is a used cell phone drive which aims to support survivors of intimate partner violence and other vulnerable groups in Kingston. We have partnered with local organizations including Interval House, Dawn House, Sexual Assault Centre Kingston and Street Health who have agreed to both receive items (cellphones, charger, SIM cards) and monetary donations and distribute them to communities in need.

What was the inspiration for your initiative/event/ project?

Project Connect is a nationwide initiative started by a group of medical students at Memorial University of Newfoundland (MUN) who organized a used cell phone drive for their local women’s shelter. They pitched the concept to other women’s health interest groups at medical schools across Canada (including us!) and the project resonated with our executives. We believed that starting a Kingston arm of the initiative would enable us to show our support for women and other vulnerable groups in our community.

What impact do you hope the initiative will have?

We are bringing Project Connect to the Kingston community not just for survivors of intimate partner violence but also for other vulnerable groups for whom access to a phone may be an 27

unmet need. As most medical students can attest, phones are critical for daily life in today’s society. In addition to social connection, one often needs a phone to access healthcare, financial support, shelter, safety, work and a fresh start. If we are able to rally the community together to improve the livelihoods of these individuals, then we will have done our jobs as both advocates and aspiring leaders.

How can our readers learn more about the initiative and/or get involved?

We are spreading word about the initiative at Queen’s and in the Kingston community! Information on how to donate can be found on our Facebook page “Project Connect Kingston” and questions can be directed to our email: projectconnectkingston@gmail.com. Stay tuned for our website, coming late May 2021! ⚚

The Impact of COVID-19 on Public and Private Plastic and Reconstructive Surgery Written by Adrienn N. Goczi, Meds’24, Katrina M. Jaszkul, Meds ‘24, and Valera Castanov, Meds ‘22

any provinces are reporting an increase in the number of patients registering for cosmetic surgeries since the lockdown began last year in March. We interviewed Dr. Alex Cooper, a plastic surgeon in Kingston, Ontario, about how the pandemic has affected her clinic. We sought to explore the changes in demand for plastic and reconstructive surgery, the impacts of remote work, the unique challenges faced by plastic surgeons, and the future of plastic and reconstructive surgery post-pandemic.

There they offer a number of aesthetic and reconstructive procedures aimed to improve patients’ quality of life, selfimage and confidence. Non-surgical procedures range from medical facials and chemical peels, to botox and dermal fillers. Surgical treatments include brow, face, and breast lifts, breast augmentation, tummy tucks, liposuction and other procedures. They also provide OHIP-covered procedures such as skin cancer excision, carpal tunnel surgery, trigger finger release, lipomas and cyst removal. Dr. Cooper splits her time equally between cosmetic and OHIP procedures. Dr. Cooper was interviewed over Zoom, and her answers are paraphrased.

Dr. Alex Cooper, Plastic Surgeon at the Cooper Clinic Picture taken from https://thecooperclinic.com/ Dr. Alex Cooper is a leading plastic surgeon in Canada. She successfully runs both a private and OHIP-based clinical practice in Kingston. She was born and raised in Kingston,completed her undergraduate medical education at the University of Edinburgh, and went on to complete a plastic surgery residency at McMaster University. Dr. Cooper also completed a 1-year fellowship in Breast Surgery and Reconstructive Microsurgery. In Kingston, Dr. Alex Cooper works with her husband Dr. Jim Cooper to run the Cooper Clinic, a private plastic surgery clinic.

Q: What are the current trends in plastic surgery in Kingston and nearby regions? Dr. Cooper: As the first wave of the pandemic hit Canada last year in March, Ontario began to slow down scheduled surgical and procedural work in order to create capacity for hospitals in case there was a massive surge in COVID-19 patients. The temporary suspension resulted in cancellations or postponements of important surgical procedures. Although procedures resumed early summer, many care providers were left tackling a massive backlog of surgical procedures that could take years to clear. As Canada is tackling the third wave of the pandemic, Ontario hospitals are again winding down elective surgeries in the wake of a record number of COVID-19 patients in intensive care units, as of April 12. Like many plastic surgery clinics, the Cooper Clinic was also affected by the temporary suspension and subsequent resumption of elective procedures. Q: Did you notice any changes in bookings or types of procedures at the start of 2020 before the onset of the pandemic? Dr. Cooper: The Cooper Clinic was quite busy before the pandemic, with cosmetic procedures starting to pick up considerably. In March 2020, all non-essential procedures were cancelled. In order to adapt to the new conditions, Dr. Cooper introduced changes to her practice, and she started 28

COMMUNITY seeing more OHIP patients. A large portion of the OHIP patients attending her clinic presented with skin cancer. As the months went by, she noticed that patients had worsening complaints and often showed up with advanced stages of skin cancer. This was partly due to patients delaying seeking care from their care providers and some were delayed when surgeries were put on hold in hospitals, causing a backlog in bookings. Once the initial lockdown ended, she noticed a significant increase in all cosmetic bookings and procedures. Dr. Cooper was initially surprised by the high patient volume since news outlets were reporting on workers being laid off due to the pandemic, impacting their financial stability. As the pandemic progressed and travel restrictions were put in place, she now believes that more people are seeking cosmetic procedures because they decided to spend the money they would have used for travelling. Also, more and more people began working from home and therefore spend more time on video conferences. Face elective interventions went up likely due to paying more attention to imperfections/aesthetic concerns. She also mentioned that clinic staff noticed a significant increase in Botox procedures, likely for similar reasons. Another explanation for the surge in bookings can be attributed to working from home conditions that allow for more optimal recovery conditions post-surgery. Q: What changes did you have to make to your practice during the pandemic? Dr. Cooper: Similar to many other healthcare providers, Dr. Cooper tried virtual care. She noticed it was difficult to assess her patients without being able to physically examine their skin texture. She only saw a couple of her cosmetic patients virtually before transitioning back to in-person

visits. However, she continued to see some of her OHIP patients over the phone for follow up. She did mention that she prefers to see patients with skin cancer in person as older people may not know how to take pictures on their phone and share them with their care providers. This can result in vital information about their cancer being missed when not assessed in person. In short, there was some transition to virtual care; however, the way she practices medicine has not changed significantly for cosmetic procedures since the start of the pandemic. Q: How did the pandemic impact your teaching and learning opportunities? Dr. Cooper enjoys teaching and mentoring medical and nursing students who show interest in both OHIP-covered and aesthetic procedures. Prior to the pandemic, her clinic was open to students, however, due to PPE shortages and public health guidelines, the number of students attending the clinic decreased considerably the past year. Although the pandemic limited Dr. Cooper’s ability to have medical students attend her clinic, she allowed them to attend as long as it adhered to public health guidelines. She was also able to involve senior residents at Queen’s University in aesthetic procedures since they needed exposure to cosmetic procedures that are more limited in the hospital setting. In addition to the burden the pandemic is placing on frontline workers, virtual conferences and online seminars have replaced live events. Due to the increase in patient volume however, finding time to attend these events in Dr. Cooper’s calendar has been challenging. Q: What advice would you give yourself if you could go back to the time when the pandemic started? Dr. Cooper: Dr. Cooper would recommend taking time off to other healthcare workers because her practice is now “very busy”. Even though cosmetic procedures were put on hold between March and May last year, there was a surge of OHIP-covered procedures since hospital access was reduced to allocate more resources towards managing the surge in COVID-19 patients. For this period, Dr. Cooper had her hands full with cancer patients. Since elective surgeries resumed last year May, she has been trying to catch up with her cosmetic cases with new bookings being made throughout the temporary suspension. Q: What will the practice look like post-pandemic? At this time, Dr. Cooper does not know how her practice will change after the pandemic is over. She anticipates that OHIP will no longer pay physicians for virtual visits and she will return to seeing all of her patients in person. In terms of the procedures, Dr. Cooper anticipates that there will be a decrease in cosmetic procedures as a result of increased travel and job losses that occurred over the pandemic. She also expects to continue to resume taking nursing students, medical students, and senior residents in her clinic once there are fewer restrictions around the maximum number of people who can be in the same room. ⚚

MEDICINE:

The Line Between Research and Medicine Written by Grace Lin, Meds ‘23 Artwork by Suffia Malik, Meds ‘24

n an era defined by rapid medical advancements, research may well be the most misunderstood part of our healthcare system today. Misunderstood in the sense that many understand its importance, but few grasp its gravity in advancing healthcare. Its long, often tedious, process renders the general public to often view research as background noise, irrelevant, until a breakthrough discovery is announced. However, this seems to have changed since the onset of the pandemic. The public’s attention to the development of the COVID-19 vaccine over the past year has brought research to the front line in many of our lives. Never has research seemed so important, relevant, and central to our survival. So then, it is now that we must turn our attention to understanding the intersections between research and healthcare and ask the question: where does the line lie between the two? For this issue of MedicINe, we invite Dr. Nicole Coverdale, a postdoctoral fellow at Queen’s University, to help us understand where research stands in healthcare today.

What has your research journey been like?

My research journey began during my undergraduate studies. Prior to this time, I wasn’t aware that being a researcher was a professional option. I began research doing animal studies but quickly learned I did not enjoy basic science research. I then transitioned to clinical research, doing a study on children, and found it to be much more enjoyable. Although I enjoyed research, it was not until my anticipated medical career did not work out that I recognized a research career was a better fit for me. I realized that the main reason I wanted to pursue a medical career was to impact people’s health directly but I could do this through research as well. Since then, I have had such a satisfying career in being a researcher. I had the opportunity to ask interesting questions and constantly learn new things. Each day as a researcher is filled with a variety of activities, whether that is collecting data, analyzing data, or writing a manuscript. I also started working with clinicians during

COMMUNITY my postdoctoral fellowship, which brought the connection between research and healthcare closer for me. It allowed me to appreciate how essential research is to providing good patient care and how it is a more direct connection than most people think.

Where are you in your research career now?

I completed a Bachelor’s and Master’s degree in Health Sciences, mainly doing research related to blood pressure regulation and examining its links with obesity and physical activity in children. I also completed my PhD in Integrated Physiology of Exercise, studying different imaging modalities to measure cerebral blood flow. After my PhD, I began my postdoctoral fellowship with Dr. DJ Cook and now am an adjunct professor of Kinesiology. Recently, I have become more focused on research in women’s health, with a new project exploring the relationship between menopause and cognition. Additionally, I work for a start-up company, VOXEL AI, where we use MRI based markers to inform predictions of how patients will do after a neurological defect. Being involved in the research of this company has emphasized for me the importance of research in industry – that is, backing up a product to be used in healthcare. This is also an area in which healthcare and research overlap, since you need both researchers and clinicians to advise on how well a product might fit into healthcare practice. For me, the integration of the academic, clinical, and industrial world is essential when it comes to advancing healthcare.

What is one thing you wish healthcare professionals knew more about research? The amount of perseverance it takes to complete a project. People often underestimate the number of steps and troubleshooting required to complete a project from start to finish. There is no end of obstacles researchers may face throughout the research process and they deserve more recognition for the endurance it requires to overcome those challenges. Thank you Dr. Nicole Coverdale for sharing your perspectives and expertise with us! ⚚

What do you think is most different between research and medicine? What is most similar? And where do they overlap?

I think the biggest difference is that research has more flexibility. It is perhaps easier to follow a path of interest in a creative way while doing research than while practicing clinical medicine, where treatment paths may be more rigid. Medicine and research are similar, however, in that they both follow the scientific process. For the researcher, this would mean identifying a problem and then testing it to find an answer. For the clinician, this may mean suspecting a diagnosis and then testing to confirm if it is correct. As for overlap, research is foundational to medicine since all changes in medicine stem from research. In this way, research is necessary for medicine and overlaps in every way.

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Olivia Ginty, Meds ‘23 32

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COMMUNITY

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d our QMed graduates for “memorable lines” of advice they have received during their time at Here’s what they shared.

r greatest gift is that you resourceful — you may not w the answer now, but you w where to find it!

”

“

During the bad moments (there will be some), remind yourself of the good moments (there will be plenty of these, too!), because the good moments will definitely be way better than the bad moments are bad.

”

“ “

Go into every clerkship rotation and every learning opportunity with an open mind! You never know who you will meet, or what you will learn. Patients, residents, and attendings will change your world, and it is incredible to learn from each and every one of them! Rely on your classmates — these are some of the toughest times you will go through, and you need to support one another and be each others’ biggest cheerleaders! QMed is a family, and you will feel that wherever you go in the hospital!

In Sharbot Lake on a family medicine elective, I interacted with many patients who did not complete high school, resulting in low health literacy. The population here has a high burden of chronic disease and high smoking prevalence. Dr. Bell has been practicing in Sharbot Lake for 50 years. Rather than lining his walls with medical infographics, he proudly displays old photos of Sharbot Lake and its people. “If you want buy in from patients, they need to feel connected to their community,” he said.

“

”

“ The ABC’s of Medicine:

Accept nothing Believe no one Check everything/consult allied health

”

“Treat your patients like the way you would treat your family” - Dr. Yi Ning Strube. At the time, I don’t think I understood what she meant, because how could you treat everyone like your family? When clerkship gets tough, and you feel frustrated from the long hours, having to study after those long hours, and still have a personal life, the interactions we have with patients are a saving grace. That extra bit of eﬀort with each patient — to ask about their lives, their families, their hobbies — is what QMEDs are so great at, and it can make people around you feel like family. Clerkship is so much easier when you reframe the interactions you have. Also just wanted to give a shout out to Dr. Strube, for being one of the most supportive faculty at Queen’s and someone who emulates those qualities we all strive to have as future physicians — someone who is compassionate, dedicated, and truly invested in your students. If you ever see her, give her a shout!

”

Photo by Matheus Ferrero on Unsplash

“ “

“

In the wise words of a preceptor regarding expectation management: “Always expect to be consulted at 6 pm on a Friday — then the work is easier”.

”

Don’t take the little “run into” moments with your classmates in the hospital or in the Kingston community for granted, you never know when a pandemic will hit, and medical school just ﬂies by!

”

1. Arrive on time and with a pen. 2. Stay sharp, try to be aware of your surroundings. 3. Be a student who doesn’t need a preceptor to tell them twice. 4. You’ll learn a lot from the good times and twice as much from the bad times.

”

Lines in M

“Gratitude paves the path for selﬂessness, and selﬂessness — consideration for others — is what makes the world a better place.”

y grandfather passed away a month ago. Although I knew it was coming, it still felt like the world shifted beneath my feet, everything the same but somehow nothing as it should be. I’d drawn my line in the sand weeks before, vowing to call him everyday and prepare myself for the loss in advance — I did not do either as much as I should have. As future physicians, death is something we will inevitably encounter in our careers. We are constantly coached throughout our medical training about the importance of empathy, of remembering the human condition no matter how hidden behind disease it may be. It’s been a while since I’ve experienced a loss, and I’m reminded that it all is impersonal until it is not, that things are only as far removed as you are. When I heard, a million traits of his flickered through my mind. I vividly remember the crinkles of his smile, the fine snow white strands of his hair, the gentleness of his hands. Before leaving home this summer, I remember quietly tracing the flight path between us on the map in my room — just a simple straight line taken mere months before. Although I could follow it along with my hand, I had never felt further apart. A constant picture of him painted itself in my head every time we’d separate, almost as if from fear that maybe I’d forget. Distance is something we’ve all felt more keenly during the pandemic, and it is often a bittersweet

Reflection

My Grief truth of life. Separation spurs us to value singular moments together much more than we did before. The route from him to I (although far) reminded me that we were connected despite the distance. Lines make up our world. They are every physical corner and boundary, every emotional barrier and apprehension, every word ever read and every piece of beauty ever seen. Perhaps most stunning of all, lines also encompass all the possibilities we have yet to see in the future. Lines are his name on Facetime that I was always eager to click on a Saturday morning; they are the alphabet cards my baby niece is learning to identify; they are the research papers that I groan at upon opening; they are the pieces of artwork and sheet music and photographs that I love so much. But lines are also the figurative walls we put up to protect ourselves; they serve as the self-imposed barriers in all of our relationships. They are the too-sharp edges hit when someone toes the line, honed by all the different kinds of hurt and disrespect we’ve faced in our lives. It is a struggle, not only to see those lines crossed but also to breach them ourselves, and I find myself constantly at war between the pull of my heart and push of my mind. Although lines in relationships are often crossed without malice, careless words or inconsiderate

actions can be some of the things that sting most of all. My grandfather was a good man. He was unbelievably intelligent and always kind and giving, not only to us but also to those far beyond family. I talked with him often about compassion and fulfillment in life, of how much (if anything) is too much to give out of love. I learned more about empathy from him than most others — it is not diﬃcult to be kind and work hard, I remember he said once. How right he was. “Be kind and work hard,” these are the things I keep in mind when I’m feeling down — but it is arguably too easy to get absorbed within our own tangled web of problems. I think many of us (myself included) get weighed down by the monotony of routine and obligatory demands of life; to think about others beyond ourselves is an active process requiring willpower and work. Compassion is an easy undergoing but particularly during this time of strife, during this personal moment of struggle, I look around and feel acutely aware of all the people I take for granted. Realizing the value of those around you ignites a strong will to do better. Gratitude paves the path for selflessness, and selflessness — consideration for others — is what makes the world a

Written by Anonymous Artwork by Kiera Liblik, Meds ‘23 better place. Loss is a hard truth, but it is one I am slowly learning to cope with. The world still feels off but it continues to turn constant and true, giving me the push I need to adjust and move forward. Although some days are tougher than others, I am rebuilding myself piece by piece, particularly through the lines he loved so much: the strokes of pen (and for my Gen Z nature, the blinking cursor of blank documents). To conclude, lines are something we cross often, emotionally or physically: through callous words thrown out in anger, through jaywalking on Princess Street (congratulations if you don’t), through quiet thoughts that manifest everyday. There are always those lines, those boundaries in every relationship, whether it be friend-to-friend, lover-tolover, doctor-to-patient. But one sole thing remains true — compassion is a gentle way to breach that barrier, to cross all borders and remind the other party that we are here, that we can support them, that they are not alone. Especially as we’ve all learned and felt during this pandemic, that sometimes may just be the most powerful thing of all. ⚚

Connecting

an unlikely intersection of palmistry and pediatrics

Written by Chalani Ranasinghe, Meds ‘22 Artwork by Kaitlyn Rourke, Meds ‘23

n the summer before I started university, I travelled to Sri Lanka, my family’s country of origin, for the first time. My family and I spent six weeks in my mother’s hometown, a mid-sized oceanside district known for its fisheries and kite festivals. Trips to the beach became a daily activity, and one of the things I miss most now. On one of these outings, a woman with a child in tow approached my brother and I and offered us her services as a palm reader. As young adults desperate to immerse ourselves in the whole richness of our culture, we agreed to a reading. My brother placed his palm in her open hands and I stood by, eagerly observing. My run-in with the palm reader by no means illustrates a common occurrence in Sri Lanka, and to claim otherwise would perpetuate orientalist stereotypes that already harm so many of Asian descent. But palm reading is an important cultural motif in my life, both because of its brief appearances during my time in Sri Lanka, as well as the various ways that it presents itself in my everyday life here in Canada. The origins of palm reading, or palmistry, are not entirely known. Now a popular activity among those with mystical inclinations, this form of divination can be

Photo by @roadtripwithraj from Unsplash 38

REFLECTION

rallel lines:

traced back to many cultural and spiritual traditions, with early references in Jewish and Hindu texts. While its precise history is unclear, its underlying principle is fairly standard: one’s future can be predicted based on the patterns of lines of their palms, with the various creases supposedly providing insight to a person’s happiness, fortune, and health. At the time of writing, I am a quarter of the way through my pediatrics rotation where I find myself being reminded of palm reading more frequently than I would expect. One of the components of the neonatal physical exam is inspecting the palmar and plantar surfaces for variations in the appearance of their creases — a maneuver reminiscent of the occult tradition. A quick search of the literature yields an abundance of offerings on why this is practiced. Palmar and plantar creases develop between the 10th and 12th weeks of gestation, after the general shape and patterning of the hands have already formed. It’s thought that the creases function as anchoring points for our skin and soft tissues that allow us to hold our hands in various shapes. Like any physical trait, there are person-to-person differences in crease appearance that can be attributed to normal variability, but some are associated with derangements of physiology and genetics. 39

For example, transverse palmar creases, which are frequently inherited as a familial trait, have also been linked to a number of disorders, including Down’s syndrome, fetal alcohol syndrome, Klinefelter’s and Cri-du-chat. Conditions that arise later in life can also be associated with differences on the palmar surface: a meta-analysis from 2012 found that finger ridge counts are lower in people diagnosed with schizophrenia compared to controls without this diagnosis. From a more intuitive anatomical standpoint, individuals who have fused interphalangeal joints, known as symphalangism, can have complete absence of creases at the site of the impacted joints, reflecting their immobility.

The desire to analyze our physical realities to search for insights about ourselves that we cannot readily know permeates so much of our human endeavours.

Thinking about my experiences with palm reading and neonatal assessments, it’s not unreasonable to draw parallels between the motives underlying these mystical and scientific pursuits. The desire to analyze our physical realities to search for insights about ourselves that we cannot readily know permeates so much of our human endeavours. When the world we live in is constantly changing and unpredictable, we seek comfort in the idea that resolute forces, whether they be cultural notions of good fortune or modern understandings of genetics, epigenetics, and homeostasis, equip us with the ability to anticipate the future, guiding us to prepare for the worst and wait hopefully for the best.

”

At its most basic, clinical medicine teaches us to recognize patterns of bodily signs such that we may intervene to prevent future, or further, suffering. However, our clinical acumen also enables us to navigate the past — histories of signs and symptomatology suddenly make sense when given a name — and the present. We can communicate and explore what our new-found knowledge means with our patients, embodying the present moment, and, when ready, moving forward together.

our clinical acumen also enables us to navigate the past — histories of signs and symptomatology suddenly make sense when given a name — and the present.

My thoughts about the relationship between spirituality and science change day-to-day; in a world where pseudoscience is used to manipulate those with few medical options and modern medicine alienates many who are already at society’s margins, there is much to disentangle. I will say, however, that I do believe that there is true magic in both clinical medicine and palmistry. Laying hands on another, an occurrence growing ever-rarer in this socially distanced climate, and imagining what their futures may hold is an act of intimacy that feels sacred to perform. Many of these musings came together after I rotated through the NICU, where, for the better part of a day, I placed my gloved finger in the hands of newborns to assess their evolutionarily inherited reflexes. Before that, I made sure to glance at their palms to assess their unique lines and ridges. I can say with only the certainty of a medical student performing a physical exam they’ve only practiced once prior, but I did not note any abnormalities on exam. ⚚

1. 2. 3. 4. 5. 6. 7.

Harwood, William. Dictionary of Contemporary Mythology. Third Edition. New York: World Audience, Inc, 2011. Buda, Zsofi. “Written in Your Palm, Just Read It! - Asian and African Studies Blog.” June 1, 2020. The British Library Board. https://blogs. bl.uk/asian-and-african/2020/06/written-in-your-palm.html. McKee-Garrett, Tiffany M. “Assessment of the Newborn Infant.” UpToDate. Accessed April 26, 2021. https://www.uptodate.com/ contents/assessment-of-the-newborn-infant?search=palmar%20crease&source=search_result&selectedTitle=1~150&usage_ type=default&display_rank=1#H45. Freeborn, Donna, Heather Trevino, and Liora C Adler. “Gestational Age Assessment - Health Encyclopedia - University of Rochester Medical Center.” https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=90&contentid=P02671. Laub, Donald R. “Congenital Hand Deformities: Overview, Incidence, Embryology,” March 24, 2021. https://emedicine.medscape.com/ article/1285233-overview#a1. Golembo-Smith, Shana, Deborah J. Walder, Maureen P. Daly, Vijay A. Mittal, Emily Kline, Gloria Reeves, and Jason Schiffman. “The Presentation of Dermatoglyphic Abnormalities in Schizophrenia: A Meta-Analytic Review.” Schizophrenia Research 142, no. 1–3 (December 2012): 1–11. https://doi.org/10.1016/j.schres.2012.10.002. Slavotinek AM. Dysmorphology. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 128

Just a Bit of

Eyel

Reflection

To me, eyeliner was the solution to all of it. With eyeliner, my eyes were no longer the eyes of a girl whose grandparents did not speak English. My eyes were no longer the eyes of someone who was expected to be quiet and submissive. My eyes were big and full of opportunity, like those of my white peers. With eyeliner, I could finally be what I wished to be: white. And in university, I found other Asian friends who were the same as me. We tried our hardest to distance ourselves from our roots: we dyed our hair to be anything but black, we contoured our noses to make them look sharper, and we winged our eyeliner to make our eyes look bigger.

liner

That single line was what separated me from being “just another Asian girl” and an individual.

Written by Jessica Nguyen, Meds ‘23 Artwork by Amanda Mills, Meds ‘23

It’s funny to me how beauty standards cater to only one corner of the world. How Vietnamese women desire fair skin and a nose that resembles a certain member of the British monarchy. Or how wealthy, young adults in South Korea line up for double eyelid surgeries once they are eligible, simply because having a double eyelid has been deemed desirable. Where did these standards come from? Why would I want to look like Kate Middleton when I should take pride in the fact that I look like my grandmother? I wonder if there will ever be a time when my almond-shaped eyes become desirable too.

’ve always had a pretty interesting relationship with make-up. When I first started wearing it in high school, I remember feeling this huge boost in my confidence. Finally, I could interact with the world as the person I wanted others to see me as. It started off as mascara and lip gloss, and then I added eyeliner and eyebrow pencil, and then when I got to university, I would almost always wear a full face of make-up every day. I am very much a believer in wearing makeup for whomever you like — yourself, your friends, or the strangers you meet on a day-today basis. I’m not sure who I was doing it for back then. But I never left my house without a sweep of that black paint on my eyelids.

Now, as I sweep the eyeliner across my eyelid with a careful hand, I regret approaching the world of make-up intent on erasing my identity for so many years. I hope that someday, I can fully disentangle the relationship between beauty standards and my ethnicity. I am tired of catering to standards that I can never fit.

I never realized how much it haunted me, but as a young Asian student in a predominantly white school, I faced my fair share of microaggressions. Friends would pull their eyes back or ask me, “why do Asian people have small eyes like that?” At the age of nine, I became the spokesperson for an entire continent. At those times, I hated the colour of my skin, the shape of my eyes, and the texture of my hair. I laughed at all of their jokes at my own expense.

But for now, on days that my eyes look smaller, I am still tempted to reach for the liner. ⚚

Underprepared and Overwhelm Reflecting Written by Rae Woodhouse, Meds ‘21 Artwork by Kiera Liblik, Meds ‘23

hroughout the first few years of medical school, Match Day was something that I looked forward to. Initially, it was with wonder as I could not wrap my head around being that close to graduating. Then, as I began to understand more about what the Match meant, I was excited about the outcomes and what the statistics meant for my school’s reputation and for me as a future graduate. “Queen’s matched 7 people to EM?” Wow, we are so impressive. “Our match rate was 99%?” Queen’s is the best! “Someone couples matched to OBGYN and Plastics?” It’s because my school is great. It was like celebrity gossip. By the end of Match day, the news of the most impressive matches had trickled down through the years to the pre-clerks’ curious ears. Hearing about people not matching was always sad, but sad in the way that felt disconnected from reality, removed. I quickly understood not to ask any graduating students if they matched, or whether they were happy with their match. I knew that these questions could trigger various emotions, especially early on before the excitement of the next stage took over. However, I had no concept of the depth of emotional turmoil the Match and the months long process leading up to the day would bring. How could I? No other job application process rivals the psychological and emotional chaos that this process creates. Now, in 2021 as my own Match Day approaches, in the midst of a global pandemic that monopolized nearly every aspect of my class’ clerkship, electives and match experience, I feel woefully unprepared for the conflicting emotions to come, just as I was unprepared for the past few months. My peers and I have discussed at length the surprise we felt with the realization that Match Day isn’t the only challenging one. No one told us that the interview offer stage could rival Match Day in its emotional duress. No one ever talked about the disappointment of not being offered an interview at your top schools, or the sadness of receiving very few offers to interview for your top choice specialty and having to accept that your dreams of pursuing it are unlikely to come to fruition. And unequivocally, no one spoke about the devastating possibility of not receiving more than a handful of interviews, or even none at all. Perhaps it was our own ignorance, and we should have independently realized that these possibilities existed. Perhaps our collective pride blocked us from considering

these realities for ourselves or our beloved classmates. Or maybe, the 2021 Match is another casualty of COVID-19 and this year is an unfortunate anomaly. Throughout all the highs and lows of the 6-month marathon that is CaRMS, there has only been one thing that has consistently brought peace and joy to my life: my classmates.

I am incredibly privileged to be a member of such a caring, intelligent, and devoted group of future physicians. At every turn, I have been met with unwavering support, patient guidance, and sincere cheerleading from every one of my peers. I believe that the Class of 2021 is especially bonded because of the massive and unexpected hurdles that our COVID clerkship brought, and that this bond has been further solidified throughout this CaRMS process — the shared exhaustion from letter writing, commiserating over strenuous interview experiences, and sharing quick messages of support when lucky enough to interview (virtually) alongside a classmate. However, the downside to this class wide closeness is that my emotional response to my own match will be inseparable from the outcomes of my dear classmates. I don’t think anything can prepare you for the complexity of Match Day. The relief, sadness, joy, disappointment, and anxiety for yourself, but more prominently for the people you care so deeply for. The worst part of it all being that we can’t be together for the special moments that previous graduating classes likely took for granted; to console through hugs, express excitement for one another, or cheers to new beginnings. For most, Match Day will simultaneously be the end and the beginning. For the Class of 2021, April 20th marks the end of this grueling process. It marks the end of a period of intense uncertainty and constant second guessing. The final result of months of reflection, difficult conversations, 44

reflection

med: on the CaRMS Process and contemplating the various paths life could take. But it also marks the end of our time together as a class; the end of four years of laughter, tears, and memories. Conversely, it is also the beginning of this next stage of our training and our lives. These results will bring with them excitement and anticipation (and a healthy amount of fear). Unfortunately for some, Match Day will be neither the beginning or the end, but rather the middle, as the CaRMS process continues on for another month.

To the Class of 2021, regardless of the outcome tomorrow, please be proud of yourselves for having not only survived a tumultuous clinical year in a pandemic and a completely new CaRMS process, but for having thrived and continued to be the incredible people that I have had the absolute privilege of learning alongside for the past four years. You are all exceptional people whose potential for positive impact is infinite. I will be thinking of all of you tomorrow and throughout the months to come as we begin the next stage of our journey, together. ⚚

end of the line Written by Mike Christie, Meds ‘21 Artwork by Amanda Mills, Meds ‘23

Reflection

here to begin? The start doesn’t feel right for some reason, so I’ll work backwards.

I close my eyes and pause — just for a moment — before stepping briskly out into the cold. I’m met by a blast of frigid air and the silence of Stuart street. It’s 10:04 PM on a Friday, and for the time being the people of Kingston require no attention from their Orthopaedic Trauma service. My resident has sent me home at the end of my evening call shift. Usually at this point I’d be thinking about ordering a piping hot pizza from Domino’s. This night is a bit different though, and I have more on my mind. Tonight’s a big night — it marks the end to my last day of clinical duties as a medical student. After two years spending most of my time within its walls, I’ve just left Kingston General Hospital for what is more than likely the last time. Walking home, feet crunching on the snow and breath puffing clouds of steam, I find myself submerged by a pensive tide of thought. The stillness of downtown, glowing under a halo of street lamps, creates an oddly surreal atmosphere. For a moment, the vivid lucidity of my memories gives the sensation that I have transcended time and space.

just hoping I would fit in. The bonds that were built in those first two years, and how they have flourished further since, are more than I could have ever asked for. Even when the world had other plans for us and hit pause on life as we knew it, we were there for each other. Though they play as a highlight reel in my head, it would be futile to even attempt a formal account of the memories we’ve made together. There are too many to briefly recount and a simple history wouldn’t do it justice. For the sake of brevity, suffice it so say that we had a good time. And now, it’s nearly over. Turning the key in the lock, I step into the warmth of my home, and the gravity of the moment hits me. Part of me has a sense of accomplishment, while another part of me is really sad. I had to do something with these emotions, something to respect the conclusion of this journey and provide it with a sense of finality. And so, although I’ve done all the talking here, this letter isn’t about me. It’s about the people who helped me get where I am, the people who I have had the honour of working with shoulder to shoulder, and the people who I am privileged to call my classmates, colleagues, and friends. The older I get, the harder I find it to say goodbye to the communities that have taken me in and made me one of their own. So after all that, after four years of blood, sweat, and tears, what I can bring myself to say is thank you. Thank you for all that you have done for me, all that you do for each other, and all that you do for others. I promise to pay your kindness forward, and if you ever need anything, just give me a call. Don’t worry though, because when it comes to the work we have left to do together — making this world a better place — this isn’t the end of the line. We’re just switching trains.

Inside the walls of that hospital, I built upon my goals and dreams, was shaped into who I am now, and had my eyes opened to the depth of the human experience.

I can almost feel myself walking into the hospital for the first time, a ball of nervous excitement with absolutely no clue what I was supposed to be doing or where I was supposed to be doing it. I can’t help but grin at all the gaffes of a green clerk, and appreciate that I have come a long way since. Inside the walls of that hospital, I built upon my goals and dreams, was shaped into who I am now, and had my eyes opened to the depth of the human experience. I remember the good days, and the bad ones. Memories of pure joy and excitement flow across my consciousness, blended richly with moments of failure and loss. People, faces, and stories form a vibrant mosaic of experience into which I feel deeply interwoven. All of the time I spent learning about what we look like on the inside has gifted me a better understanding of who we are as well. Time rewinds even further back to pre-clerkship, all the way to the first day of orientation. There I am, a shy young man several thousand kilometres from home wondering what exactly I had gotten myself into and

All of the Best, Mike Christie CC4 Queen’s School of Medicine ⚚

A Killer Brunch Lineup Sarenna’s toast 2-ways This breakfast staple can be easily adapted to satisfy whatever your brunch craving may be, be it your unquenchable sweet tooth or a savoury inkling. For people with Celiac or other gluten-sensitive needs, gluten-free toast is a great alternative, and equally as yummy if you ask me (highly recommend the brand Little Northern Bakehouse, if you are looking for a good gf toast!). Recipe 1: Speedy Smashed Avocado Toast (1 serving)

Recipe 2: Ooey Gooey French Toast Sammie (2 servings)

Ingredients: • 2 pieces of your favourite sliced bread (sourdough, glutinous or gluten-free… all are welcome!) • ½ an avocado • 2 fistfuls of arugula, washed • Small pad of butter (for frying eggs) • 2 large eggs • Couple pinches of chili flakes • Everything but the bagel seasoning (now available at FarmBoy) • Drizzle of olive oil • Salt and freshly cracked black pepper

Ingredients: • 4 (or more!) pieces of your fave toast: cinnamon raisin bread goes particularly well in this recipe, if you’re into that • 2 large eggs • ¼ cup of milk (almond or other non-dairy alternatives work great!) • ½ tsp cinnamon • Splash of vanilla • Small pad of butter • A few tablespoons of peanut butter (either smooth or crunchy, both work) • 1 banana, sliced • Drizzle of maple syrup, to serve • Fresh strawberries, raspberries, blueberries, to serve

Instructions: 1. Put your toast in the toaster, now the race is on! 2. Put the butter in the pan and crack your eggs in, cover them to steam/cook over easy (or whatever best suits your egg preferences). 3. In a small bowl, scoop out your avocado and smash with a fork. Add salt, pepper, and chili flakes. 4. Once your toast is out of the toaster, spread your avocado mixture on top, then place your handfuls of washed arugula atop the avocado. Drizzle lightly with olive oil. 5. Once your eggs are done, gently set them atop the arugula and sprinkle with everything but the bagel seasoning. Finish with salt and freshly ground black pepper, and it’s as easy as that. Enjoy!

Instructions: 1. Place your egg, milk, cinnamon and vanilla into a shallow bowl and whisk well. 2. Begin heating your pan, and once hot, add the butter. 3. Make a PB + banana sandwich:: a) Spread your peanut butter on the top sides of each piece of bread. b) Place the sliced bananas in a layer on top of two of the pieces and cover with the other piece of bread, peanut butter side down. 4. Place the sandwich in the egg mixture, ensuring you coat both sides. 5. Transfer the sandwich to the hot pan (you should hear a really satisfying sizzle as the eggy bread hits the pan). 6. Cook until golden brown, then flip and repeat on the other side. 7. Cut (on the diagonal) and serve with a drizzle of maple syrup and fresh berries.

Lifestyle Written by Linda Archila, Sarenna Lalani, and Adam Kulesza, Meds ‘23 Artwork by Sigi Maho, Meds ‘24

Linda’s Huevos Rancheros

Adam’s Weekend Mimosa

This dish blurs the lines between breakfast, lunch, and heck, even dinner if you are feeling it. It is a dish my family usually shares on those gloriously lazy weekend days, where you sleep in and slowly wake up over conversations at brunch. It is simple, unlike some of the lines we find in medicine.

Ingredients: • Fresh squeezed orange juice (substitute with blood oranges if in season) • Sparkling wine • A $12-15 bottle of Prosecco or Cava (substitute with sparkling apple cider to make it a mocktail) • Champagne flute or wine glass • Knife • Orange peel (optional)

Servings: 2 (easily multiplied for your desired number) Ingredients: • Olive oil • 1 small onion, sliced into thin rings • 2 cloves garlic, minced • ½ cup tomato sauce: You could use a pre-prepared sauce. If using an unseasoned sauce, consider adding herbs you have on hand (e.g. 1 bay leaf, oregano, or fresh/dried basil to taste) • 4 eggs • Chili flakes, to taste • Salt, pepper to taste • 6 corn tortillas Instructions: 1. Coat the bottom of a small-medium pot with olive oil. Once warm, sauté your onions. When they are translucent, add in minced garlic until golden. Add in tomato sauce. If the sauce is unseasoned, add salt, pepper and whichever herbs you have on hand (e.g. a bay leaf, oregano, fresh/ dried basil). Simmer on low heat for at least 10 minutes, stirring gently from time to time. 2. Add some olive oil to a pan for your eggs. Crack eggs directly into the pan. Add a pinch of salt, pepper, and chili flakes. I like a runny yolk best with this dish, so I cover the pan and cook just until the egg whites are set (~3 minutes). If you prefer the yolk to be a bit more cooked, flip your eggs over 1-2 minutes in, and cook to your desired consistency. 3. Warm the tortillas up. Any of the microwave, a toaster, the oven, a pan will do, but be careful to not over toast them because they become crunchy (e.g. ~45 s in the microwave, ~2 minutes in the toaster). 4. Time to assemble! Place the three tortillas on a flat plate, slightly overlapping to create your base (your years of drawing Venn diagrams will come in handy). Place your eggs on top. Then, add as much sauce as you like, coating the eggs and tortillas. 5. Enjoy alone, or with hot sauce, avocado, fresh cheese, and/ or a side of beans.

Instructions: 1. Peel the length of the orange (~2-3 inches) for as many glasses you are making and set aside. 2. Cut oranges in half and squeeze fresh orange juice. 3. Pop the bubbly and fill each glass half full. 4. Top off with fresh orange juice. Optional Garnish: 5. Cut the orange peel into a long rhombus shape (~0.5x2in). 6. Slice down the middle of the peel without cutting it in half. 7. Fold the peel and place the opening onto the rim of the glass. Notes: • The ideal ratio is 1:1 sparkling to juice, but play around if you prefer less or more alcohol! • Mix ahead of time in a pitcher if you are serving multiple portions. • Always add sparkling first and remember: cold sparkling mixes the best!

Rising Stars Written by Ivneet Garcha, Meds ‘24 Artwork by Sigi Maho, Meds ‘24

elcome to the third edition of Rising Stars! Last time, I gave you all some pick-up lines for your special sweethearts. This time I’m dropping different kinds of lines — “famous lines for the zodiac signs” courtesy of the Certified Lover Boy and 6 God himself, Drizzy Drake. So read below to find out what the Scorpion King has to say about your sign and which of his songs he definitely wrote about you. In the wise words of Drake, “Lessons that I learned before hittin’ my prime, confessions that I blame on the zodiac sign.”

VIRGO

Virgo, I really think Drake wrote this song as a selfhelp tool for you specifically. I know you probably don’t need a Scorpio interrupting your daily routine of overthinking and I know you would much rather listen to Girls Love Beyoncé in worship of your Virgo queen, but can you do us all a solid and just take Drake’s advice - “Don’t think about it too much, too much, too much, too much”. Song: Too Much

Bonus: Girls Love Beyoncé

PISCES

LEO

GEMINI

“I’ve loved and I’ve lost”. There is a 99% chance Drake is singing this about Pisces and Pisces is probably singing this about someone else. Pisces, Drake knows that “you’ve been hurt by someone else”. This entire song is just one big love letter to you. But I know you’re sitting there singing along to lines like “I’ll be there for you, I will care for you”, thinking about that random stranger you made two-second eye contact with once at Tara Natural Foods.

Leo, no one makes you feel more misunderstood and unappreciated than every single person who doesn’t give you the undivided attention that you want and need. I can totally picture you in all your Leo glory, dramatically singing along to Drake, “I’m too good to you. I’m way too good to you. You take my love for granted. I just don’t understand it”. To be honest, like Drake, now we’re all getting as high as your expectations.

When Drake said, “I got fake people showin’ fake love to me”, we all knew he was calling out you Gemini. With your “vibe switch like night and day”, you have Drake straight up stressed out. He couldn’t keep up with how quickly you juggled your personalities, nor how quickly you juggled him with your roster of other people. And when he sent you that text “Somethin’ ain’t right when we talkin”… you took that as a hint and left him on read.

Song: Take Care ft. Rihanna (a Pisces)

Song: Too Good

Song: Fake Love

TAURUS

SCORPIO

SAGITTARIUS

Drake knows that Taurus always likes the best things in life and Taurus was probably the best in Drake’s life too. When he crooned, “sweatpants, hair tied, chillin’ with no makeup on” — we all know he was talking about the time he and Taurus spent the afternoon napping in bed. Taurus might question the rumours about Aries, but Taurus — Drake promises, “never pay attention to the rumors and what they assume”.

Of all of Drake’s musical moments, there is no line more glaringly and classically Scorpio than “I’ve got my eyes on you”. Why? Whether it’s a Scorpio with a grudge or a Scorpio who is passionately in love, their intense eyes do all the talking. Scorpio, as a PSA from all of us; “you’re everything that I see” can be romantic but also can be horrifying. The good news is you understand Drake and Drake understands you, Scorpio. Keep the family close.

When Drake wrote Passionfruit, he obviously had a Sagittarius in mind. “Passionate from miles away”? Could he scream it any louder? We all know his Scorpio soul was devastated when Sagittarius called him up from an impromptu trip and said, “Harder buildin’ trust from a distance. I think we should rule out commitment for now”. To my saggies, were you running towards your next fun break, or were you running away from a clingy Drake?

Libra, when Drake caught you coming out of that exclusive restaurant, dressed to the nines, all things beauty and grace, he thought to himself “Oh, you fancy, huh?”. Libra you know with your “nails done, hair done, everything did”, Drake didn’t really stand a chance. You’re used to being noticed. Cheers — champagne for you and Champagne Papi! Hope the love lasts as long as you take to get ready in the morning.

Song: Hold On, We’re Going Home

Song: Passionfruit

Song: Fancy

Song: Best I Ever Had

CAPRICORN

CANCER

ARIES

LIBRA

FUN

AQUARIUS

Capricorn, Drake asked you for love, but I think he missed the headline. You were sure to remind him that when it comes to your love language, it’s “money over everything”. He says you’ll miss him. Fast forward years later — you roll into your large estate after a long day of seeing patients. You’re out on your terrace, glass of wine in hand. You think, “I guess it really is just me, myself, and all my millions”. You smile, blissfully content.

Contrary to popular belief, Pisces is not the only baby of the zodiac. The quintessential sad hours baby is actually you Cancer, especially when it comes to falling in love. But Drake really didn’t need to attack you with this highly directed, definitely-you line, “Put a bib on me, I’m just like a baby, drooling over you”. Please don’t cry. But if you’re crying, at least Drake wrote you this song to get you through the lonely nights.

When Drake said, “Last name ever, first name greatest”, he actually wasn’t talking about himself. He was just repeating what Aries screamed into his ear when he asked for their number at 1:30 am in the club. Drake can neither confirm nor deny whether Aries is in fact the Greatest Ever, but rumour has it Drake was overheard saying “They were the best I ever I had” (sorry Taurus) leaving Aries apartment the next morning.

Aquarius, you’re the type to stay friends with your exes, but sounds like Drake came on a little too strong. He was definitely putting you on the spot when he asked you, “I wanna know how come we can never slash and stay friends?” I don’t think he quite understands that you’re independent. There is nothing Marvin’s Room about your energy. Your motto is “I know how I wanna live my life, I don’t need no advice”, and definitely not from Drake (even though this song is so you).

Song: Headlines

Song: Jungle

Song: Forever

Song: Blem

Created by Sean Leung, Meds ‘22

Be the first to complete this issue’s crossword and win a gift card to a local business of your choice! Email us your completed crossword at queensmedreview@gmail.com.

FUN

Across

1. Geographic border separating the homes of internal and external hemorrhoids 4. The phenomenon responsible for zero order kinetics 5. The substance likely responsible for the last ‘pop’ when doing an LP 6. The key to binocular vision aka why things move side to side when you alternate blinking eyes 11. A test of ulnar and radial arterial companionship 12. The reference point of distal fibular fractures 14. Effacement of lines that probably cause some headaches 18. Person who poked multiple holes in cadavers to figure out the flow of collagen fibres 21. When P waves are wannabe R waves in the inferior leads they are called 22. A chiromancer uses this line to divine your health and vitality 23. Damage to this structure is an unfortunate complication to the provider of cunnilingus 24. The cystic artery is always hanging around in the center of this eponymous triangle 25. Becomes a vanishing line when exposed to too much pubertal estrogen

Down

2. Characteristic feature of incompetent veins of the lower limb 3. Who do you ask when you want to give some NAC? 7. Where volumes are read and also a commonly injured structure in sports 8. Someone poked a Q-tip a little too deep and now food tastes weird. What structure was injured? 9. That mysterious line running midline over the scrotum 10. Pulse oximeters have this neat volume change detecting feature built in 13. Where the guardians of the thigh compartments meet 15. This deep line gives access to the hidden cortex 16. Where Bowman and Descemet meet 17. The catheter used in the classic exam question to test understanding of circulatory anatomy 19. Melena and hematochezia tend to live on opposite ends of this anatomic fence 20. Person who paid really close attention to lines on chest films

Connections

Kimberley Yuen, Meds ‘22 53

Photograph by Joshua Lowe, Meds ‘24

“You have to colour outside the lines once in a while if you want to make your life a masterpiece.” — Albert Einstein

QMR