QMR Rising stars Ever wondered how the stars aligned at QMed and what astrological signs dominate each class?
QUARMS A socially and morally important commentary on the history of Black students at Queen’s and the new QuARMS application process
A.i. in medicine A historical perspective on the beginnings of artificial intelligence in healthcare
Embrace it Poetically reflective, personal piece on finding a new home here at Queen’s Medicine
Beginnings in medicine
In This Issue Managing Team
Sigi Maho Mahshid Hosseini
Content Contributors Sarenna Lalani Jessica Nguyen Helen Lin Jehan Irfan Anna Tran Devyani Premkumar Meghan Jenkins Imran Syed Mili Milivojevic Colin Faulkner Amelia Boughn Annie Kang Kaitlyn Rourke Kassandra McFarlane
Jessica Nguyen Fiona Raymond Tanya Narang Colin Faulkner Molly Cowls Kaitlyn Rourke Suffia Malik Joshua Lowe Andrew Lloyd—Kuzik Jehan Irfan Sarah Sloss Helen Lin Kiera Liblik
Amelia Boughn Sarenna Lalani Helen Lin Haya Abuzuluf Anna Tran Annie Kang Meghan Jenkins Mili Milivojevic Colin Faulkner
3 4 6 8 10 12 14 16 18 22 24 27 28 30 32 34 36 38 40 43
Letter from the editors meet the team Pre—Hospital Emergency MEdicine A History of Cataract Surgery quarms program change the beginning of ai in medicine anesthetics before anesthesia the fight against poverty origin stories barriers to contraceptive care k health art making sense better days history of medicare in canada embrace it pilot season DSCLOTRAAAP—ing Your Emotional Pain rising stars horoscopes qmr’s playlist
Letter From the Editors We are proud to introduce Queen’s Medical Review Volume 15.1: Beginnings in Medicine! The start of a new edition begins right here. Beginnings are often thought of as the point in time or space at which something starts. But these points also interface with the closure of an end. For Issue 15.1, we wanted to choose a theme that both paralleled the close of a chapter and the start of a new one. Here at Queen’s Medicine we are seeing many new ‘Beginnings’ — the start of in—person classes, the inception of an Equity, Diversity, and Inclusion Action plan, the shift towards radical collaboration and the creation of new interprofessional interconnections, our newest cohort of clerks entering the wards, etc. We are all immersed in the dawn of a fresh start — one that also forces us to consider a new reality. While there is much discussion about a post—COVID world, the beginning of normalcy is still very much linked to the end of things as we know them. Not just at Queen’s Medicine, but in the world more broadly. Whether it’s the increased implementation of virtual care, COVID passports, changes in access to care etc., COVID—19 has forced upon us the dawn of a new era and perhaps the beginnings of transformative change. In choosing this theme, we wanted to capture this point of transition, as a time capsule of where the current state ends and the future state begins. In this issue, you will find a broad range of content from our talented contributors. Kaitlyn Rourke provides a historical perspective on the beginnings of artificial intelligence in healthcare and describes its utility in relation to the data we have available in the clinical context. Imran Syed narrates the origin stories of four members of the Class of 2025 and the life paths that brought them to medicine. Devyani Premkumar crafts a poetically reflective, personal piece on finding a new home here at Queen’s Medicine. Meghan Jenkins writes a socially and morally important commentary on Queen’s School of Medicine’s history with Black students. We found this commentary not only relevant, but a necessary pause as QuARMS embarks on its new mandate of selecting exclusively Black and Indigenous students. From poetry to Spotify playlists to hard—hitting takes like the ones above, Beginnings in Medicine is an issue packed with thought—provoking discussions, light—hearted reflections, and diverse conversations. We have many thank yous. First, a huge thank you to all of our contributors. What you have created and shared is honest, thoughtful, and worthy of immense recognition. We cannot thank you enough for your effort and the bravery you demonstrate sharing a small piece of your heart and mind with us. Second, we would like to take the opportunity to thank our incredible production team. To our sharp editors who read through each piece with a fine tooth comb — thank you for your attention to detail and keen eyes that help make each article perfect. To our design team who give QMR life — thank you for the creative lens you bring to each edition and the artistry you demonstrate in doing your work. Without this incredible team, QMR would not be possible. And last, but most certainly not least, a sincere thank you to our readers. Your unrelenting support and encouragement is the reason we are so motivated to make QMR the best it can be. Without you, there would be no QMR — so thank you. And with that, we invite you to begin ‘Beginnings’ — an issue that is all about new starts.
Ivneet Garcha & Gabriele Jagelaviciute Editors-in-Chief 3
Meet Our Team Ivneet Garcha
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meghan jenkins Writer & Editor
imran syed Writer
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Andrew Lloyd—Kuzik Photographer
Photography by Jasmine Ng, Meds ‘24
Photography by Sarah Sloss, Meds ‘24
Is There a Role for Physicians in the Field in Can Written by Kassandra McFarlane, Meds ‘23 Artwork by Sigi Maho, Meds ‘24
or many patients in Canada, entry into the medical system begins in the pre—hospital setting. Patients are managed in the ambulance en route to a facility, before receiving treatment from a physician—led team, often in the Emergency Department. Most of the Emergency Medical Services (EMS) in Canada are based around the Anglo—American model in which the patient is brought to a physician in a hospital.1 In this model, ambulances are staffed by Paramedics, Emergency Medical Technicians (EMTs), or Emergency Medical Responders (EMRs) who have varying levels of skill in managing medical emergencies. While there are some EMS systems that have physicians available as part of their air— response (ex: Alberta air ambulances)2 , the majority of EMS response vehicles do not. In contrast, the Franco—German model of EMS is common in Europe and integrates physicians into the EMS teams onboard the ambulance.1 In these systems, physicians are brought, alongside paramedics, directly to patients at the scene and are able to offer advanced and specific treatment immediately. 1 Controversy exists about which of the two models is optimal for EMS and the evidence about the benefits and drawbacks of each is largely mixed. 3 The ultimate goal of EMS is to optimize the system in order to provide the best care for patients, inherently saving as many lives as possible. Would further integrating physicians into the Canadian systems of emergency response bring us closer to that goal?
Benefits to Patients Physicians generally have access to a greater number of intervention and treatment options than other EMS staff,4 as well as greater autonomy to make clinical decisions beyond standard operating procedures.5 While the skillset of pre—hospital teams with and without physicians are comparable in many emergency situations,6 physician—led teams utilize a greater number of interventions more frequently (ex: medications) which can lead to overall increased patient survival rates.7 Furthermore, there is evidence of improved survival rates for trauma 6
nada? patients when attended to by an EMS physician, especially when the injuries are severe.8 Another potential benefit from incorporating physicians into pre— hospital EMS is the ability to triage in the field and treat minor emergencies, thereby diverting patients from the emergency department and helping to reduce overcrowding.9 While this does not directly impact patient care, it could alleviate some of the pressure on an already overwhelmed system and create downstream positive impacts that would improve the overall functioning of the emergency department.
Financial and Practical Obstacles While the integration of physicians into the EMS system may appear straightforward at a glance, there are some economic and logistic considerations to the decision. One of the challenges may be that incorporating physicians could increase the economic burden on the pre—existing EMS. Already, many EMS face financial challenges, and the prospect of overhauling the system while simultaneously hiring costly physicians may outweigh the potential benefits.3 Evidence regarding the cost— effectivity of including physicians in EMS is varied,3 and the decision would have to be region—specific. Another potential challenge is that insurance policies would have to be re—written in order to ensure physicians have adequate coverage for their activities in the field as part of EMS. This would require consultation with lawyers, and discussions with both hospital and EMS administrative staff.
What should we do? While the evidence regarding the optimal model of EMS is mixed, it seems to support the inclusion of physicians, especially for managing severe trauma or critical illness.3 However, the integration of physicians into pre—existing Anglo—American EMS in Canada may prove financially and logistically challenging. Rather than every ambulance crew having physician presence, it may be more economically practical to selectively dispatch physician—staffed EMS vehicles to incidents where a greater likelihood for serious trauma or illness exists as they are more likely to improve the outcomes of those patients.8 Executing this would involve detailed triaging at the call— taking and dispatcher level. Another option may be to blend the two systems: instead of integrating physicians directly into the EMS, a nationwide adoption of programs to facilitate telephone advisement of paramedic teams by a physician on—call could allow for maximization of physician expertise without the financial costs. This program could function similar to the British Columbia Emergency Physician On—Call program 10 or the Ontario Base Hospital Physician patch program.11 Involvement of a physician in clinically complex or challenging circumstances can improve patient care as they are able to suggest or guide further interventions to be implemented by the paramedics in the field.10 Like all of medicine, pre—hospital emergency medicine is an ever— evolving field. While there are no 7
clear—cut answers for the optimal model of EMS, continuing to strive for improvements in pre—hospital service will only improve outcomes for patients. ⚚
References 1. Dick WF. Anglo—American vs. Franco—German emergency medical services system. Prehospital and disaster medicine. 2003 Mar;18(1):29—37. 2. van Wijngaarden M, Kortbeek J, Lafreniere R, Cunningham R, Joughin E, Yim R. Air ambulance trauma transport: a quality review. Journal of Trauma and Acute Care Surgery. 1996 Jul 1;41(1):26—31. 3. Kapustin D, Shah S. Physicians in prehospital care: A review of the clinical and economic evidence. University of Toronto Medical Journal. 2019 Aug 31;96(3):48—52. 4. van Schuppen H, Bierens J. Understanding the prehospital physician controversy. Step 1: comparing competencies of ambulance nurses and prehospital physicians. European Journal of Emergency Medicine. 2011 Dec 1;18(6):322—7. 5. Timmermann, A., Russo, S. G., &amp; Hollmann, M. W. Paramedic versus emergency physician emergency medical service: role of the anaesthesiologist and the European versus the Anglo—American concept. Curr Opin Anaesthesiol. 2008;21(2), 222—227. 6. Olasveengen TM, Lund—Kordahl I, Steen PA, Sunde K. Out—of hospital advanced life support with or without a physician: effects on quality of CPR and outcome. Resuscitation. 2009 Nov 1;80(11):1248—52. 7. Dickinson ET, Schneider RM, Verdile VP. The impact of prehospital physicians on out—of—hospital nonasystolic cardiac arrest. Prehospital Emergency Care. 1997 Jan 1;1(3):132—5. 8. Knapp J, Häske D, Böttiger BW, Limacher A, Stalder O, Schmid A, Schulz S, Bernhard M. Influence of prehospital physician presence on survival after severe trauma: systematic review and meta—analysis. Journal of Trauma and Acute Care Surgery. 2019 Oct 1;87(4):978—89. 9. Holroyd BR, Bullard MJ, Latoszek K, Gordon D, Allen S, Tam S, Blitz S, Yoon P, Rowe BH. Impact of a triage liaison physician on emergency department overcrowding and throughput: a randomized controlled trial. Academic Emergency Medicine. 2007 Aug;14(8):702—8. 10. BC Emergency Health Services Annual report 2012/2013.http://www.bcehs.ca/about—site Documents/annual—report—12—13.pdf 11. Base Hospitals Ontario. https:// ontariobasehospitalgroup.ca/index.php/ elementor—91/
t’s been said that our eyes are windows to the soul. With our eyes, we notice the festinating gait of our patient with suspected Parkinson’s as they shuffle into the room. With our eyes, we realize the sorrows of a loved one and comfort them by reciprocating their tears shed. For physicians, looking at our patients is one of the most powerful tools we have in diagnosis, and the ability to visualize our operating fields clearly is critical to surgical success. For humankind, our eyes are the means through which we partake in the communion of many shared experiences—the gradient of orange leaves in the fall, the glistening snow as it floats from the sky in December. We often take healthy eyes for granted and fail to cherish them until our vision deteriorates. The frightening haze which rolls in like morning fog when we step outdoors, the blinding streaks of light from car headlights which threatens to overwhelm. The longer we live, the more likely it is that we will experience changes to our vision. As of 2021, more than 36 million people are blind worldwide, and 1 in 3 cases of blindness are caused by cataracts.1 While the prevalence of cataracts is 16% in the 65—69 years old category, this increases to more than 71% in those 85—years old and above.2 In the global West, cataract surgery has become the most common elective surgery performed.3 With advancements in technology and techniques, definitive surgical treatment of cataracts has evolved to have one of the highest success rates out of all surgical procedures in the 21 st century.4 However, it has not always been so, and one needs only a quick look into ancient society to appreciate how far it’s come. Throughout most of human civilization, cataract surgery as we know it did not exist. The precise origin of cataract surgery is debated among historians, with some suggesting its birth during the Bronze Age, or immediately before the beginning of the Iron Age.5 Historical artifacts found in the tombs of King Khasekhemwy in Egypt and Skar near the Saqqara pyramids suggest that attempts at a form of cataract surgery may have existed since even before 2700 BCE.5 However, the precise dates and details with which cataract surgery was first attempted unfortunately cannot be ascertained with certainty using the current ancient texts available to us.
“Reflecting on the past critically helps us recognize how far this surgical technique has come and appreciate the enormous impact that cataract surgery has had on millions worldwide.”
It was thought that what we now call cataracts are forms of inspissated humor that had leaked into the eyes from the brain.6 One of the ancient methods of treating cataracts 8
uity to Modern Holocene: A History of Cataract Surgery Written by Grace Yin, Meds ‘24 was through a common procedure called couching. In this procedure, the cataractous lens is dislodged into the vitreous cavity through use of thorns 7 or rods, such as the “needle—like thorn of a babul—tree.”7 Couching as a practice could be traced all the way back to at least antiquity, and since its origin, evidence of couching has been found all over the world, including China, Europe, India, Africa, and the Middle East.7 Directly rubbing the eye was frequently performed prior to couching to prepare the cataract and/or to determine its maturity.7 Often, it was performed outdoors in a bright place, with the patient and doctor on the ground in a squatting position, and an assistant positioned behind the patient to stabilize their head.8 Alternative approaches to treating what we now call cataracts were through discission, or aspiration (of both lens and humour) through a hollow rod after an inferior incision on the cornea.7 In the 18th century, the first intracapsular method was carried out, whereby the entire lens (with the capsule intact) was expressed through putting pressure on the globe with one’s thumb or an instrument. However, this led to a high rate of vitreous loss, and alternative means of removing the lens were explored. Exactly 20—years after this first method, a means of pushing the lens out using a needle by impaling
its posterior pole through the sclera was attempted. More than 100—years after this, Alexander Pagenstecher reportedly removed the lens using a spoon. Following, more attempts to extract the lens while minimizing damage to the rest of the globe structures were carried out, but the successes of cataract surgery as we know it was not realized until the 21 st century. There are several modern approaches to cataract surgery, including phacoemulsification, femtosecond laser—assisted surgery, intracapsular cataract extraction (ICCE), extracapsular cataract extraction (ECCE), and small— incision extracapsular cataract excision.8 Out of these, phacoemulsification remains the most common choice, with the primary intraoperative complication being posterior capsule rupture.7 Phacoemulsification can be broadly broken down into 5 steps: i) implanting the intraocular lens, ii) constructing the incision, iii) removing the cortex, iv) continuous curvilinear capsulorhexis, and v) nucleus fragment emulsification.8 With many countries experiencing rapid increases in their aging population, phacoemulsification currently stands near the top of the list as a key means towards safe cataract care.8 The safety, effectiveness, and techniques of cataract surgery has come a long way since the old days, where
restoration of sight without grave complications were rare. Reflecting on the past critically helps us recognize how far this surgical technique has come and appreciate the enormous impact that cataract surgery has had on millions worldwide. With rapidly aging populations in many countries, the incidence of cataract surgery is projected to increase. While cataract surgery is one of the most common procedures performed worldwide, it’s important to remember that access to cataract surgery is not equal across all communities. The incidence of cataract surgery performed correlates proportionally with gross domestic product per capital (GDP/P) and gross national income per capita (GNI/P) at a country level, with low—resource communities disproportionately lacking access to cataract surgery despite a high level of need.9 As our approach to cataract surgery continues to evolve in the centuries to come, may we strive to ensure that access to cataract surgery – both locally and globally – keeps pace with surgical advances. May our zeal for surgical innovation, however important, never eclipse the worthwhile goal of equitably bringing these techniques to communities who need it most. ⚚
1. Hashemi, H., Pakzad, R., Yekta, A. et al. (2020) Global and regional prevalence of age—related cataract: a comprehensive systematic review and meta—analysis. Eye. https://doi.org/10.1038/ s41433—020—0806—3 2. Reidy A., Minassian, D.C., Vafidis, G., et al. (1998) Prevalence of serious eye disease and visual impairment in a north London population: population based, cross sectional study. BMJ 316 (7145), 1643—1646. 3. EuroStat. (2020, September). Surgical Operations and procedures statistics. Surgical operations and procedures statistics — Statistics Explained. Retrieved November 16, 2021, from https:// ec.europa.eu/eurostat/statistics—explained/index.php?title=Surgical_operations_and_procedures_statistics#Increasing_and_decreasing_surgical_operations_and_procedures. 4. Considering cataract surgery? what you should know. Harvard Health. (2020, October 13). Retrieved November 16, 2021, from https://www.health.harvard.edu/diseases—and—conditions/ considering—cataract—surgery—what—you—should—know#:~:text=What’s%20involved%20in%20cataract%20surgery&text=It%20offers%20good%2 long%2Dterm,successful%20and%20 free%20of%20complications. 5. Leffler, C. T., Klebanov, A., Samara, W. A., & Grzybowski, A. (2020). The history of cataract surgery: from couching to phacoemulsification. Annals of translational medicine, 8(22), 1551. https:// doi.org/10.21037/atm—2019—rcs—04 6. Jaffe N. S. (1996). History of cataract surgery. Ophthalmology, 103(8 Suppl), S5–S16. https://doi.org/10.1016/s0161—6420(96)30760—4 7. Isawumi, M. A., Kolawole, O. U., & Hassan, M. B. (2013). Couching techniques for cataract treatment in Osogbo, South west Nigeria. Ghana medical journal, 47(2), 64–69. 8. Yulan, W., Yaohua, S., Jinhua, T., & Min, W. (2013). Step—by—step phacoemulsification training program for ophthalmology residents. Indian journal of ophthalmology, 61(11), 659–662. https://doi.org/10.4103/0301—4738.120224 Wang, W., Yan, W., Fotis, K., Prasad, N. M., Lansingh, V. C., Taylor, H. R., Finger, R. P., Facciolo, D., & He, M. (2016). Cataract Surgical Rate and Socioeconomics: A Global Study. Investigative ophthalmology & visual science, 57(14), 5872–5881. https://doi.org/10.1167/iovs.16—19894
Ethelbert Bartholomew’s expulsion letter from 1918.
QuARMS Program Change Written by Meghan Jenkins, Meds ‘25
egarding the recent statement: “In alignment with the Queen’s University Academic Plan, the goal of QuARMS is to offer a carefully selected group of up to 10 outstanding Black Canadians and Indigenous peoples that are graduating high school, an exciting and innovative 2—year pathway that culminates with application for admission to the first year of Medical School at Queen’s University.“ Before understanding the gravity behind the new QuARMS stream, it’s crucial to explore Queen’s School of Medicine’s history with Black students. In 1918, a motion to ban students of African descent was passed at the Queen’s School of Medicine; this motion continued until 2018, despite the School of Medicine’s beginning of admission of Black students in 1965. White medical students and staff supported this ban due to the treatment from black students expressed by wounded soldiers. The difficult chapter in Queen’s history concerning the inclusion of students of African descent resulted in Principal Daniel Woolf and Dean Richard Reznick signing an official letter of apology; the letter acknowledged the responsibility Queen’s Medical School’s decision in 1918 had on racial inequality in the medical profession today. The hostile campus climate created for the black students who remained at Queen’s after the ban’s passing included racist threats and degrading mockery. Dean Reznick and Principal Woolf commissioned apologies to family members and created curricular changes to promote inclusivity and diversity in the medical school. The public and personal apologies marked the first in a long series of necessary steps to address this historical injustice. These curricular changes promoted first—year medical students to be taught, for the first time, about the school’s decades—long ban on admitting Black applicants to the program. Ethelbert Bartholomew, a Black medical student, expelled when the ban came into effect, was a centerpiece of this curricular change. His great—niece, gastroenterologist Maria Bartholomew, agrees with Queen’s curricular changes, stating that the “most important thing is to start the conversation.” Additionally, Queen’s established a mentorship program in March 2019, through which Black faculty members could volunteer as mentors to Black medical students throughout their clerkship, residency, and careers. To further promote these principles, Dean Jane Philpott of the Faculty of Health Sciences announced the creation of the Office of Equity, Diversity, and Inclusion in September 11
2020. Supporting student development of a sense of belonging in the Faculty of Health Sciences while encouraging equity concerning student experience, the EDI office has helped students from various intersecting identities to see themselves at Queen’s University. As the most recent effort to reduce systemic barriers to medical education, a revision of the QuARMS candidate requirements was confirmed. Beginning in the Fall of 2021, the Queen’s University Accelerated Route to Medical School (QuARMS) pathway changed its criteria for applicants. Previously open to all Canadian high school students, QuARMS now considers exclusively students who identify as Black African, Black Caribbean, Black North American, those who are multi—racial and identify with their Black ancestry, or those who are Indigenous Canadians. This new pool of applicants must still meet the academic requirements of the eligible programs—BAH, BSH, BCSH, BLSH, and BHSH—and be enrolled in their final year of high school (or first year of CEGEP) to apply. In addition to the QuARMS program, there are four seats in the MD program designated for Indigenous students each year.
When QuARMS was launched, it was designed both to attract exceptional students to Queen’s and as a pathway for students who face financial, systemic or social barriers to entering medicine through the traditional medical school application process. This change to the pathway is very much in keeping with its original vision of bringing students from underrepresented groups to Queen’s,”
says Hugh MacDonald, Assistant Dean of Undergraduate Admissions, Queen’s School of Medicine. “To further reduce barriers, we are also actively exploring options to provide financial support to QuARMS students.” As part of the ongoing work of the Faculty of Health Sciences, this decision was supported by Dean Philpott, who recently announced the formation of the Dean’s Action Table on Equity, Diversity, and Inclusion. Comprised of students, staff, and faculty from all schools within the Faculty of Health Sciences, the table hopes to implement reformation concerning EDI in staffing, mentorship, support resources, and curriculum design. ⚚
The Beginning of AI in Medicine 10 years of data on a physician’s experience with high blood pressure, volume status, diuretic—use and mortality. The machine would be able to calculate the best treatment for high blood pressure while optimizing the lowest mortality rate. This is much more efficient than coding endless if—then statements to cover every situation. In the 1960s, these AI algorithms were applied to general problem solving rather than clinical—decision making. For example, a famous algorithm in 1959, Newell’s General Problem Solver, could successfully solve a game of checkers.
Written by Kaitlyn Rourke, Meds ‘23 Artwork by Kaitlyn Rourke, Meds ‘23
rtificial intelligence (AI) is an overarching term used to describe the use of machine—learning algorithms and software to mimic human cognition in the analysis, presentation, and comprehension of complex medical and healthcare data. In other words, AI is the ability of the computer to take a large amount of data and make approximate conclusions based upon this information (1). Physicians have come to embrace the potential AI brings to medicine. AI can make our healthcare system more efficient, ease the paperwork burden and avoid medical errors. However, AI had to surmount many past limitations to be as efficient as it is today. This article will outline the historical perspective of the beginning of AI in healthcare. At its core, AI seeks to mimic human intelligence; exploring its history will allow us to uncover what is unique about a physician’s clinical intelligence. The origin of the concept of using computers to simulate intelligent behaviour came from Alan Turing in 1950. Turing described a simple test, which later was known as the “Turing test” or “imitation game,” to determine whether computers were capable of human intelligence. A machine would be deemed intelligent if a human observer could not distinguish the machine from another human player (2). Six years later, the term artificial intelligence was officially coined by John McCarthy as “the science and engineering of making intelligent machines”.
In 1970, Dr. William Swartz from Tufts published a visionary paper in the New England Journal of Medicine entitled “Medicine and the Computer: The Promise and Problems of Change”. In this paper, he wrote: “Computing science will probably exert its major effects by augmenting and, in some cases, largely replacing the intellectual functions of the physician”. Dr. Swartz outlined the potential application, as well as limitations to AI in medicine, sparking fuel for future research.
The early AI algorithms focused on replicating a simple human thought process. The first type of AI algorithm followed an “if, then” sequence. For example, if blood pressure is high, then order a blood test. These algorithms can become more complicated by adding in more conditional statements. For example, if blood pressure is high and there are signs of volume overload, then start diuretic therapy. A more evolved algorithm, “supervised learning”, uses data from human experiences to decide what to do. For example, providing the AI system with
One of the first prototypes to demonstrate feasibility of applying AI to medicine was the development of a consultation program for glaucoma, called the CASNET model. The CASNET model is a causal–association network, meaning it learns by taking a large amount of data and identifies a cause and effect relationship. When using CASNET, the physician inputs information about the patient’s history of presenting illness; CASNET then computes the probability of the patient having glaucoma. It was developed at Rutgers University
This paper fostered the development of The Research Resource on Computers in Biomedicine by Saul Amarel in 1971 at Rutgers University. Furthermore, the Stanford University Medical Experimental–Artificial Intelligence in Medicine, a time—shared computer system (computer at a central location shared by many people), was created in 1973. This fostered a productive sharing and cross—fertilization of ideas between researchers in clinical medicine and AI, including the development of the first healthcare prototype: CASNET and MYCIN.
Academic and was officially demonstrated at the Academy of Ophthalmology meeting in Las Vegas, Nevada in 1976.
of diabetic retinopathy that is 94% sensitivity and 98% specific; identification of nonmelanoma and melanoma skin cancers comparable to experts; prediction of cardiovascular risk in a cohort population, improving the American College of Cardiology guidelines (4). With so many applications, it might seem surprising at first why many algorithms are not part of routine care. Often, the missing piece is interpretability, or the ability of a model to explain why it has given an output. “Black box” models, or models that simply provide a prediction with no explanation, are likely to face challenges in building user trust, even if their performance is shown to exceed that of humans. People have difficulty trusting what they don’t understand, and rightly so in machine learning, given that models are often not learning what their developers intended. This is especially important to address in medicine, where stakes are much higher, and lives are literally on the line. Interpretability is a growing area of research, but not all machine learning architectures lend themselves well to interpretability, and interpretability can come at the cost of performance (4).
The other early AI system was known as MYCIN, an algorithm that diagnoses the causative bacteria in an infection. MYCIN would receive the infected patient information and provide a list of potential bacteria causing the infection, along with the probabilities. It could also recommend antibiotic treatment adjusted for the patient’s weight. The algorithm was sensitive, with a physician agreeing with MYCIN 65% of the time. Both these algorithms employed “if, then” inferences based on rules (ex All frogs are green. If Fritz is frog, then Fritz is green). Due to the long list of conditional statements and rules, these systems required a large, central computer. Thus, despite their effectiveness, they were not accessible to a primary care physician, who would have to go to a central location to use the algorithms. Nonetheless, it proved to researchers that AI could be a tool in clinical decision making. During the 1980s—1990s, the proliferation of microcomputers brought on new levels of network connectivity. Now, computers were available to individuals, rather than requiring a large, central computer. This improved processing power led to the advent of a new method of AI, known as deep learning (DL).
From the beginning, AI algorithms attempt to model human cognition. From building systems that mimic human conversation, to “if—then” rules to deep learning, researchers attempt to unravel the mystery of the human brain. While AI has been able to find patterns in large amounts of data, it has several limitations. Firstly, it does not have generalized intelligence, the knowledge of random things. If a patient has a feature that is not coded into the algorithm, it will not know what to do. Secondly, AI can only use medical data. It cannot consider how a patient feels, perform a subjective assessment of their well—being, or factor in what the patient’s goals of care are. Finally, an AI system cannot demonstrate empathy, a crucial factor in the physician—patient relationship. In the attempt to mechanize human intelligence, AI has emphasized how unique we all are. ⚚
Instead of using a linear path, deep learning (DL) uses convoluted pathways to reach its inclusion, which is known as neural networks. Neural networks were inspired by how our brain processes information. For example, if we see the number “1” the following layers might occur: We perceive it with our occipital lobe, our temporal recognizes it is something we have seen before; a specific area recognizes that it is composed of a straight line; our frontal cortex takes in the context. All these layers are processed in our brain, leading us to recognize the “1” as “one”. A neural network applies the same mapping to recognize patterns in data. The final outcome is produced by the combination of all features by the fully connected layers.
References 1. Kaul, V.; Enslin, S; Gross, A. History of artificial intelligence in medicine. Gastrointestinal Endoscopy 92(4) (2020). Pp 807—912 https://doi. org/10.1016/j.gie.2020.06.040. 2. Turing, Alan (October 1950), “Computing Machinery and Intelligence”, Mind, LIX (236): 433–460, doi:10.1093/mind/LIX.236.433, ISSN 0026—4423 3. Amisha, P. Malik, M. Pathania, et al. Overview of artificial intelligence in medicine J Family Med Prim Care, 8 (2019), pp. 2328—2331 4. Heckerman, D.; Shortliffe, E. (1992). “From certainty factors to belief networks” Artificial Intelligence in Medicine. 4 (1): 35–52. CiteSeerXdoi:10.1016/0933—3657(92)90036—O.
DL can be applied to detect lesions, create differential diagnoses, and compose automated medical reports. Some modern applications of DL include a screening
Anesthetics Before the Advent of Anesthesia Written by Tyeren Deacon, Meds ‘23 Artwork by Suffia Malik, Meds ‘24
hen we think of anesthesia and pain management, we often conjure up visions of propofol hanging from an IV pole, syringes of lidocaine, and ampules of fentanyl. But before these pharmacological agents were discovered, anesthesia and pain medicine looked quite different. In 1846, Dr. William Morton successfully anesthetized the first human subject with ether; however, much less is said about the relentless cultural pursuit for pain control that happened long before this moment. Although these historical medications were not true “anesthetics” in a modern definition, they did serve to make surgery palatable to patients and accessible to physicians across the world. Without these early advancements in anesthesia, current surgical practice may not look as it does today. Hyoscyamine, scopolamine, and atropine are tropane alkaloids that were used in early medicine for their deliriant and anesthetic properties. These anticholinergics work by competitively antagonizing acetylcholine receptors in the parasympathetic nervous system.1 These alkaloids are found naturally in plants that are relatively widespread, making the compounds available to many cultures across the world. Mandragora officinarum (Mandrake), Hyoscyamus niger (Black Henbane), and Datura stramonium (Jimson Weed) are a few of the plant species that quickly
became known for their medical effects.2 The Greek surgeon Dioscorides in 50 AD described a wine he brewed with Mandrake to lightly anesthetize patients before surgery or wound cauterization. This and many other concoctions were published in De Materia Medica, a famous pharmacopeia that was used in Greek and Roman medical practice. 3,4 In Medieval times, specifically the 12 th – 15th century, the English created an anesthetic concoction called ‘Dwale’ to “make a man sleep whilst men cut him…[which contained] three spoonfuls of pape [opium], three spoonfuls of henbane...”5 Compared to the historical use of these agents which aimed to have effects such as amnesia, disorientation, and sedation, modern medicine employs these medications for very different uses. For example, scopolamine is routinely used as an antiemetic agent to treat postoperative nausea and vomiting, whereas atropine may be given alongside reversal agents for neuromuscular blockers to attenuate side effects such as bradycardia and increased secretions. The side effects of anticholinergics include dry mouth, urinary retention, and tachycardia.6 Tetrahydrocannabinol (THC) along with other cannabinoids found in the plants Cannabis sativa, indica, and ruderalis are not necessarily modern agents when it comes to pain medicine. In 400 BCE, 14
the ancient Hindu medical text Sushruta Samhita advocated for cannabis incense and wine as use for an early anesthetic during surgery. Shushruta, often referred to as “the father of surgery”, conducted many procedures at this time including rhinoplasty and treatment of fractures. To Shushruta, anesthetics were invaluable as they allowed surgical practice to experience an age of revolution which would not have been possible otherwise.7 Cannabis was also used in China for early abdominal surgeries. Hua Tuo, a physician from the Han Dynasty, created an anesthetic he called “mafeisan” which is thought to contain the ingredients alcohol, cannabis, and datura and was consumed before surgery. 8,9 When looking to the present day,
Academic cannabis is a subject of substantial research. Controversial evidence suggests it may be beneficial in certain health conditions such as chronic pain, neuropathic pain, and for preventing weight loss from conditions such as AIDS. In addition to using the plant in its raw form, there are many relatively new agents such as Cesamet (Nabilone) and Sativex (THC and Cannabidiol) that are pharmaceuticals prescribed for pain relief in those with advanced cancer, or to treat chemotherapy induced nausea and vomiting.10 These cannabinoids work as partial CB1 and CB2 receptor agonists.11 Although the biochemical pathways are still being understood, stimulation of CB1/2 receptors is associated with analgesic, anti—inflammatory, anti—emetic, psychogenic, and anti—epileptiform effects. Despite a promising medical outlook, cannabis is not without its risks. Physical and mental impairment, tolerance and dependence, and cannabinoid hyperemesis syndrome (CHS) have all been linked to the use of marijuana products. In addition, there is an association between cannabis and early onset schizophrenia for at risk individuals. Cannabis can similarly worsen schizophrenia in those already diagnosed.12
In current anesthetic practice, many of the agents we use daily in the operating room are closely related to opium. Fentanyl, hydromorphone, and other medications are used to provide analgesia, blunt sympathetic responses, and in large doses can contribute to the anesthetic effects of other drugs such as propofol. These opioid receptor agonists generally inhibit the release of neurotransmitters in the nervous system. Although opioids are an invaluable tool in modern medicine, they also possess a side effect profile including nausea, constipation, respiratory depression, opioid—induced hyperalgesia, euphoria, and tolerance. 17 The addictive potential of these medications alongside their widespread availability and use has contributed to an epidemic in Canada causing 1018 deaths in the year 2020 alone.18
Opium is the dried sap collected from seed pods from the plant Papaver Somniferum, commonly referred to as the opium poppy. The sap contains opioids such as morphine, codeine, thebaine as well as other non—analgesic alkaloids that are released when the seed capsule is scarred. 13 The opium poppy has a long history with its earliest known roots in lower Mesopotamia where it was cultivated for its euphoric effects in 3400 BCE. The Sumerians referred to it as “Hul Gil” which translates to “Joy Plant”. 14 There were many middle eastern physicians in the 9 th and 10 th centuries who started using opium for its analgesic and anesthetic properties when caring for patients. Rhazes, a Persian scholar, was the first physician recorded to use opium as an anesthetic. After this initial discovery, the use of opium took off in the field of anesthesia and pain medicine. Abulcasis, an Arab Andalusian physician, learned that combining opium’s effects with other agents such as the Mandrake plant made a potent sedative and dissociative concoction that was well suited for surgical application. 15 Later in 1150 CE, physicians such as Nicholas of Salerno used opium in the form of sopoforic sponges which was an early attempt at inhaled anesthesia.16
“Just as we look back now on the rudimentary approach to anesthesia outlined above, anesthesiologists of the future may well look back at our practice in a similar light.” ⚚
From the alkaloids present in mandrake to the opioids found in the sap of the opium poppy, physicians throughout history have been anesthetizing patients and thus helping pioneer medical procedures.
References: 1) Renner, U. D., Oertel, R., &amp; Kirch, W. (2005). Pharmacokinetics and Pharmacodynamics in clinical use of scopolamine. Therapeutic Drug Monitoring, 27(5), 655—665. doi:10.1097/01.ftd.0000168293.48226.57 2) Mandragora. (n.d.). Retrieved February 06, 2021, from https://www.sciencedirect.com/ topics/pharmacology—toxicology—and—pharmaceutical—science/mandragora 3) Randolph, C. B. (1905). The Mandragora of the Ancients in Folk—lore and medicine. American Academy of Arts &amp; Sciences, 40(12), 487—537. 4) Peduto, V. A. (2001). [The mandrake root and the Viennese Dioscorides]. Minerva Anestesiol, 67(10), 751—766. 5) Carter, A. J. (1999). Dwale: An ANAESTHETIC from old England. BMJ, 319(7225), 1623—1626. doi:10.1136/bmj.319.7225.1623 6) Atropine. (n.d.). Retrieved February 06, 2021, from https://www.sciencedirect.com/topics/ neuroscience/atropine 7) A, K., &amp; BN, K. (2020). The principles of Surgical Practice: Sushruta Samhita and its importance to present day surgery. Journal of Surgery: Open Access, 6(2). doi:10.16966/2470—0991.207 8) Zuardi, A. W. (2006). History of cannabis as a medicine: A review. Revista Brasileira De Psiquiatria, 28(2), 153—157. doi:10.1590/s1516—44462006000200015 9) HUA TUO. (n.d.). Retrieved February 15, 2021, from http://www.itmonline.org/arts/ huatuo.htm 10) Medical cannabis. (2021, January 14). Retrieved February 06, 2021, from https://www. healthlinkbc.ca/medications/medical—cannabis 11) Starowicz, K., &amp; Finn, D. P. (2017). Chapter Thirteen — Cannabinoids and Pain: Sites and Mechanisms of Action. Advances in Pharmacology, Volume 80, 437—475. 12) Canada, H. (2018, October 12). Government of Canada. Retrieved February 06, 2021, from https://www.canada.ca/en/health—canada/services/drugs—medication/cannabis/ information—medical—practitioners/information—health—care—professionals—cannabis— cannabinoids.html 13) Marciano, M. A., Panicker, S. X., Liddil, G. D., Lindgren, D., &amp; Sweder, K. S. (2018). Development of a Method to Extract Opium Poppy (Papaver somniferum L.) DNA from Heroin. Scientific Reports, 8(2590). 14) Opium throughout history | the opium kings | frontline. (n.d.). Retrieved February 07, 2021, from https://www.pbs.org/wgbh/pages/frontline/shows/heroin/etc/history.html 15) Dabbagh A, Rajaei S, EJ Golzari S. History of Anesthesia and Pain in Old Iranian Texts, Anesth Pain Med. 2014 ; 4(3):e15363. doi: 10.5812/aapm.15363. 16) Philippe Juvin, Jean—Marie Desmonts; The Ancestors of Inhalational Anesthesia: The Soporific Sponges (XIth–XVIIth Centuries): How a Universally Recommended Medical Technique Was Abruptly Discarded. Anesthesiology 2000; 93:265–269 doi: https://doi.org/10.1097/00000542—200007000—00037 17) Ferry, N., &amp; Dhanjal, S. (2020). StatPearls (Vol. Opioid Anesthesia). Treasure Island, Florida: StatPearls Publishing. 18) Preliminary Patterns in Circumstances Surrounding Opioid—Related Deaths in Ontario during the COVID—19 Pandemic (Rep.). (2020, November). Retrieved February 15, 2021, from Public Health Ontario website: https://www.publichealthontario.ca
New beginnings in the fight a Written by Meagan Wiederman on behalf of Grace Manalili, Ishita Aggarwal of KHealth, Meds ‘23
It has been estimated that 3.8 million Canadians live below the poverty line 
his population faces challenges such as food insecurity, deep income poverty, unmet housing and health needs, and chronic homelessness, all of which are reinforced by gaps in service provision and societal stigma [1, 2]. Systemic barriers, such as discrimination and disparies to access (e.g., transportation, clean water, affordable healthy food, higher education, etc.) continue to exist that perpetuate the cycle of poverty. People with mental and/or physical disabilities are twice as likely to live below the poverty line due to various barriers, including stigma and discrimination, that make securing adequate education and employment difficult . Furthermore, in Canada, Indigenous and racialized persons are more likely to live in poverty due in large part to historic practices of colonialism and associated system—wide barriers . We also know that poverty affects health and wellbeing. Many people living in poverty cannot afford their medical prescriptions and struggle to put food on the table . Those who experience food insecurity are more likely to develop chronic health conditions, such as diabetes and high blood pressure . Food insecurity is often perpetuated by food deserts (areas lacking grocery stores, farmers markets, and healthy food providers), which are often found in low—income communities. Consequently, poor neighborhoods are shown to have a lower life expectancy than wealthy neighborhoods . In addition, low—income patients report not feeling welcomed within healthcare institutions, which imposes further barriers to wellness .
KHealth is an interprofessional student organization consisting of medical, nursing, occupational therapy, and physical therapy students. We aim to support the health and wellbeing of vulnerable populations in Kingston through volunteering initiatives and interprofessional collaboration. As a group of student healthcare professionals, KHealth is committed to empowering and supporting those in our community living in poverty. As healthcare professionals, we play an important role in bridging gaps in service provision and improving health outcomes for this population.
One of KHealth’s main interdisciplinary portfolios includes the Interprofessional Community Health Program (ICHP). The ICHP team is made up of a group of medical and Occupational Therapy (OT) students whose role it is to create opportunities for interprofessional collaboration among
against poverty the Queen’s Faculty of Health Sciences’ (FHS) three main schools: School of Medicine, School of Nursing, and School of Rehabilitation Therapy (including theOccupational Therapy and Physical Therapy programs). One of the ICHP’s major initiatives is a monthly Speaker Series, which brings in experts from diverse educational and professional backgrounds to discuss a wide range of topics withFHS students. In November 2020, the ICHP speaker series event featured Dr. Carrie Ann Marshall who works and conducts research with people experiencing homelessness or living in social housing. More than 30 students from various healthcare fields attended to learn about homelessness and how we, as healthcare practitioners, can support this population. Systems have failed this population many times, highlighting the need for client—centred and trauma—informed care. Therefore, educating ourselves and our student peers, such as through our Speaker Series, is imperative to best support our clients living in poverty. In March 2021, the ICHP team collaborated with another interdisciplinary group at Queen’s FHS, named OSLER, to host the first virtual OSLER x KHealth Case Competition. This year’s topic was Housing and Homelessness. The event provided an opportunity for students in medicine, nursing, OT, and PT to come together and brainstorm possible solutions for a complex case relating to homelessness. The event was a roaring success and students were thrilled to have a chance to get to know and learn from their peers. Student feedback was overwhelmingly positive and the ICHP and KHealth hope to make this collaboration with OSLER an annual event.
Furthermore, those in poverty have been disproportionately impacted by COVID—19, widening pre—existing inequalities and injustices.
because public spaces with Wi—Fi shut down. Traditional grocery delivery services can also be quite expensive. Our Community Carts program fills this gap in the community by offering free grocery deliveries to those who feel unsafe to leave their homes, but do not have sufficient resources to have their groceries delivered. We can be reached over the phone to reduce any barriers in accessing our free services. Social isolation is also a common experience for those living in poverty due to factors such as stigmatization and low sense of community in social housing, which has been aggravated by COVID—19 restrictions. KHealth’s Community Calls aim to reduce social isolation in Kingston by offering regular phone check—ins. This way, we can help maintain social connection while physically apart.
Of course, there is more to be done. As a student group, we are limited in what we are able to do. Before we can be equipped to support and advocate for our future clients, we need to take the time to learn from their lived experiences to understand their needs and identify the gaps that exist within our systems. Evidently, poverty has profound impacts on health and wellness. KHealth provides a unique model as not only do we try to address community needs, we also aim to educate ourselves to work with vulnerable members of our community. Our hope is that we would be better equipped to support this population in our careers through an understanding of systemic barriers and lived experience. As future healthcare professionals, breaking the cycle of poverty should be a part of our mission to enable health and wellness for all. ⚚ References
Many have not been able to access their community services during the lockdown, such as support groups, public internet access, and soup kitchen programs. Throughout the pandemic, grocery delivery services have been essential especially to those who feel unsafe leaving their homes. However, grocery delivery services impose many barriers to access as they often require online registrations. During lockdowns, those in poverty often did not have access to the internet 17
Government of Canada SC. Dimensions of Poverty Hub [Internet]. 2018 [cited 2021 Apr 16]. Available from: https://www.statcan.gc.ca/eng/topics— start/poverty Loignon C, Hudon C, Goulet E, Boyer S, Laat MD, Fournier N, et al. Perceived barriers to healthcare for persons living in poverty in Quebec, Canada: the EQUIhealThY project. International Journal for Equity in Health [Internet]. 2015 Jan 17 [cited 2021 Apr 16];14(1). Available from:https://link.gale.com/ apps/doc/A541485897/AONE?u=queensulaw&sid=AONE&xid=ec49245e Neidhart L. Just the Facts — Poverty in Canada [Internet]. https://cwp—csp. ca/. 2017 [cited 2021 Apr 16]. Available from: https://cwp—csp.ca/poverty/ just—the—facts/ Bloch G, Rozmovits L, Giambrone B. Barriers to primary care responsiveness to poverty as a risk factor for health. BMC Family Practice. 2011 Jun 29;12:62–62. Available from: https://go—gale—com.proxy.queensu.ca/ps/i.
Our Origin How the
S YED 18
AR R AN B LOG
Stories: four of us ended up at QMed Written by Imran Syed, Meds ‘25
hen the QMR Executive Team told us this issue’s theme is “Beginnings in Medicine”, I won’t lie… the geek in me immediately thought of superhero origin stories. How about the origin stories of our newest QMEDs, the ‘25s?
There were 109 amazing examples of unique triumphs, heartbreaks, pathways, and adversities leading up to when we received those orange bags this September. While it was difficult to narrow it down, I asked three of my peers that come from vastly different backgrounds to share their stories with me.
JA M IE
ER K C ZU
What did you do before medicine? Can you describe your journey?
“I was simply an Environmental Science major at Queen’s for two years. My journey looked a little bit different coming through the QuARMS stream — no fancy degrees to my name quite yet. —Jamie Zucker is one of QuARMS pathway students who I work closely with in a small learning group. Like so many in his pathway, he is remarkably mature for someone his age (I was not at 20), while still processing youthful energy. “I’m from Kingston, born and raised! I first entered Kingston Health Sciences Centre (KHSC) as a high school student completing mandatory volunteering hours for my diploma… KHSC is a truly special place, with people who care deeply about the wellbeing of patients. I knew even as a high school student that learning at KHSC would be a privilege!” —Logan Barr, like myself, are starting medicine in our mid— late twenties, him in process of completing his doctorate as he begins in medical career, me having worked for two years in a health consultancy prior to medicine. Similarly, Natalie Mezey is one of our superstar students who donned the non—traditional route, having worked for the UN, and in politics, as well as being a parent, before pursuing medicine: “I had a few different careers before I went for medicine. My first degrees were a Bachelor’s of Political Science and Master’s in French linguistics. I worked for the UN, for immigration reuniting families after the Haiti earthquake, worked in Politics for City Councillor, and taught University French. Medicine was always on my radar but I always thought it was “too late” and I was “too old”. But I kept getting re—exposed to medicine through several family tragedies and sick loved ones, as well as through my distance running races for the neuroendocrine cancer community, and as a medic with the Canadian Ski Patrol. So once I let go of my BS excuses, I quit my full—time job and decided to take on a 3rd degree in Neuroscience (lol, #foreverastudent) all while awkwardly wearing the two hats of University instructor and University student at the same time…”
Can you describe how your last (final) cycle went, before you got in?
Similar to our journeys, our acceptances were no less unordinary. In the case of myself, Logan and Natalie, we were all granted deferrals for various reasons. Logan: “I did an undergrad in Kinesiology at Queen’s, then decided to go to grad school! ... I applied during my Ph.D. in 2019 and ultimately got in, with a deferral granted to finish up my studies.” Natalie’s reasons were more personal: “My Queen’s acceptance came last cycle on May 12th 2020. That same morning my husband and I found out we were pregnant with our son Edmond. Needless to say that was a double jackpot day and May 12th is a day we will celebrate every year. Thankfully, Queen’s allowed me to defer a year so that I was able to spend the first 9 months entirely focused on our son. I also had personal reasons to defer: I prepared for my virtual MMI in March, 2020, as the world shut down of COVID—19. What I didn’t expect is that someone in my family, my dad, would wind up in an ICU only days before my interview. I am incredibly grateful to the admission’s committee for granting me a deferral in my time of need and have done my best to seize every opportunity since, within my medical journey, in his memory.” Jamie was the youngest of us to interview for medicine: Jamie: “Interviews for me were in April of my grade 12 year in high school and took place in the School of Medicine Building
What did your friends and family say?
Logan: “Everyone in my life demanded to see proof that I’d gotten in. Not trying to think too hard about what they meant by that!”
Is there anything about Queen’s that makes it unique from other medical schools?
Jamie: “Queen’s is all I have known since I left high school, but in my extremely unbiased and humble opinion there is no school that even compares. It is one thing to hear about the tight—knit community and family that exists here at Queen’s; it is an entirely separate thing to live within it and feel the support each and every day.”
Jamie: “My mom broke down in tears. I don’t think I got a real word out of her for a few days. My dad on the other hand just didn’t believe me until I showed him the proof… I don’t blame him.”
Natalie: “I love the diversity in our group. We have everything from military students, parents and people who had previous careers in completely different fields. Queen’s has an amazing anatomy museum and I also love all the early clinical exposure that we get.”
Actually… same. My family demanded video proof of me accepting the button. It’s almost like they doubted us, guys. Natalie: “I called my dad on the way to the doctor’s office where my pregnancy was confirmed. My dad, who was one of the rare few who knew how long I had been dreaming of becoming a doctor, was literally screaming into the phone.”
Logan: “Even three months into my medical education, I’m seeing the benefit of a small class size. There are dozens of diverse people with whom I’ve already developed a special relationship, and I know will be friends for life!”
What I would pay to be a fly on the wall that day…
ancdur ible.om/ htps:/
I couldn’t agree more with the others. Even from our different pathways here, we are similar in that we are so unique. This is what makes me overjoyed to share a collective journey forward with these folks. Ours are four of many stories, but they reflect the vast diversity in who a QMED student is. My hope is that we can listen to and learn from each other’s stories in the years to come as we begin our medical journeys together. ⚚
Barriers to Contraceptive Care in K “Barrier methods may be effective for preventing pregnancy, but the barriers that prevent access to other methods of contraceptive care aren’t quite as efficacious.”
Written by Sarenna Lalani, Sydney Flatt, and Ishita Aggarwal, Meds ‘23
or the content of this article, we interviewed Dr. Ashley Waddington MD, MPA, FRCSC, an obstetriciangynaecologist practicing in Kingston with a fellowship in family planning. Dr. Waddington is also the co-director of the Contraception Advice, Research and Education (CARE)fellowship program at Queen’s University.
Do they stop working to access health benefits and risk not having food on the table? These individuals are faced with quite a catch-22, and it seems there is no winning in these predicaments. OHIP+ has seemed to help younger Kingston audiences, particularly students, but this still leaves the majority of reproductive aged individuals without financial aid.
In speaking with Dr. Waddington, Cove rContraceptiONKingston,astudent-run campaign advocating for universal, nocost contraception in Ontario, learned a lot about the challenges that individuals face when seeking out contraceptive care. Contraceptive care is stigmatized as it is; be it accessing something like ‘thepill,morecomplexprocedureslike IUD insertion or tubal ligation, or abortion services, there are inherent socio-cultural barriers to seeking this care. We wanted to know what physical and systemic barriers patients here in Kingston faced; as it turned out, there were plenty. From initiating the conversation, to financial obstacles, to stigmas that follow patients into the clinic where they will receive their contraceptive care, it seems that each step is riddled with new challenges. As if these barriers were not enough, the COVID-19 pandemic has only made things worse.
Moreover, Dr. Waddington says cost “isn’t only the actual cost in dollars and cents for a prescription, but also time and effort, [and] side effects, which [she considers to be] costs as well.” The time costs are further worsened by a lack of access — those seeking contraception often don’t have a family doctor or nurse practitioner who they see regularly. Specialists, who may be the most qualified to provide this care, often have long waitlists, leaving patients with few options to turn to. This means that people often seek contraceptive care in walk-in clinics or urgent care, both of which are spotty at best and make follow-up nearly impossible.
Dr. Waddington identified that cost is by far the most significant barrier individuals face in accessing contraceptive care. In Kingston particularly, financial barriers seem to have the greatest impact on low-income individuals who don’t quite qualify for the Ontario Drug Benefit (ODB). People who are making just enough to be disqualified from any social assistance but aren’t affluent enough to pay out of pocket for contraceptive care are the people that fall through the cracks.
In special populations, access to contraceptive care can be even more challenging. For example, in Indigenous populations living in remote communities, contraceptive care comes in the form of nurse practitioners and locum family doctors providing primary care to the community. Sometimes this can lead to inconsistent care, with patients needing to see a new provider every visit. While being able to access a primary care provider is crucial, there are also challenges in accessing more specialized care for patients with complex medical histories who may have limited contraception options, or for those who require surgical contraceptive options such as tubal ligation or vasectomy. Queen’s 22
has an agreement with communities in the James Bay region and provides gynecologic specialist care to this population quarterly. This care comes in the form of consultation with specialists like Dr. Waddington, who fly up to the community to provide medical services. Surgical contraceptive options remain difficult to access for rural and remote communities, oftentimes requiring travel to Kingston for the procedure, with a few days of pre- and post-operative care on either side. It is never easy for people to leave their families and support systems to undergo a surgical procedure — both for the patient and those who depend on them. Dr. Waddington also noted the importance of providing culturally safe care to these populations: “We must be aware of the history of forced sterilization of Indigenous populations, and be mindful of how we interact with these patients and ensure that we provide them with the information and knowledge to help them make the decision for themselves, while at the same time not limiting access to care based on a history of coercive contraception.” Unfortunately, a long and shameful history exists in Canada with the forced and coerced sterilization of numerous marginalized groups, including Indigenous, Black, and intersex individuals. The effects of this continue to haunt people today, thus impacting their access to contraception and trust of the medical system as a whole. Gender-diverse populations are another minority who face unjust accessibility concerns when it comes to contraception. For one, the Kingston-based clinic that provides abortion services is called the “Women’s Clinic.” This name can be grossly unrepresentative of some individuals seeking services, as all individuals with uteruses, who may
Kingston, ON not identify as female, need access to abortion care. While the hospital is changing the name, naming the clinic is a sensitive process, as terminology that speaks to abortion can be triggering and stigmatizing for some. The diction dilemma doesn’t end at the name of the clinic; terminology can prove to be an additional barrier within appointments, particularly when caring for genderdiverse patients. Dr. Waddington notes that “people often make assumptions about what types of body parts someone has based on how they define their gender, what types of sexual activities they engage in, and what risks they may be at for unintended pregnancy.” These assumptions can discourage genderdiverse individuals from seeking appropriate contraceptive care, further ostracizing an already marginalized group, who may be hesitant to access care in the first place. We are far enough into the pandemic to realize that COVID-19 has caused drastic overhauls in the domain of healthcare. From pauses on elective surgeries to nursing shortages, to changes in hospital screening questions, it seems that there is an ever-moving target when it comes to healthcare service provision in the pandemic. Unsurprisingly, contraceptive care is no different. At the beginning of the pandemic, specialist appointments at Kingston General Hospital were cancelled to ensure safe practices were put into place and all necessary personal protective equipment was available. For some patients, care was delivered virtually. For others, this was not possible. The Society of Obstetricians and Gynaecologists of Canada (SOGC) released a statement on contraceptive care early in the pandemic, highlighting that access to
contraceptive care is urgent and cannot be delayed. Dr. Waddington echoed this statement, insisting that “People should not have to suffer from unplanned pregnancies because of delays in access to care.” With this statement came some changes in recommendations — for example, certain IUDs were allowed to be used for longer as studies had shown more prolonged efficacy than the typical duration of insertion. This helped alleviate some of the burdens for individuals seeking access to services. However, individuals scheduled for elective contraceptive surgeries, including tubal ligations, are still facing the effects of the COVID-19 backlog. While specialists are trying to bridge the gaps between current contraceptive needs and surgical dates booked up to a year or more in the future, this is no easy task. The pandemic has, in some ways, taken away the patient autonomy that we future healthcare professionals (and patients!) so deeply value. Interestingly, Dr. Waddington notes that, anecdotally, she feels the number of abortions performed during the pandemic seem to be lower than before COVID-19. She says this could be due to seeking care in other places (either geographically or through primary care providers) but wonders if decreased access to care has a role in this. More investigation into the subject is warranted, but it is interesting food for thought… Were people unable to receive abortions due to lack of access to care? Did this encourage people to go 23
through with unplanned pregnancies? Will we see this impact families in the years to come? Overall, contraceptive care proves to be a challenge in the healthcare milieu, both for providers and for patients. Stigma, financial barriers, access, cultural concerns, terminology, and safety are just some of the barriers that prevent people from accessing this care. The topic needs to be broached more frequently, both in daily conversation, but also at the governmental level. Dr. Waddington notes, “We have excellent mathematical modeling to show that it would be cost saving for the provincial government to pay for all contraceptive options for all patients, because the cost of managing unintended and unwanted pregnancies is very high, and is a really common problem that can be easily avoided.” The jury is still out, but free contraceptive care seems to be a great first step in promoting access. Now, we just have to get the government on board! If you would like to take part in our grassroots campaign, please sign our petition at: https://docs.google.com/ forms/d/e/1FAIpQLSeccjcTnXJVC7Mt gZTpdl04MSP1CrVwoAFDBf99WKZi IRlJJQ/viewform. Follow us on Twitter if you’d like to stay up-to-date on our latest work! @CoverContraceptiON ⚚
Beginning an interdisciplinary collaborative health project:
KHealth Written by Meagan Wiederman Meds’23, with help from Justin Achat, Ishita Aggarwal, Grace Manalili, Kassandra McFalane, and Brittany Ung
Introduction to KHealth
Health is currently the largest student—led interprofessional community health initiative in Kingston, Ontario. At KHealth, students from medicine, nursing, occupational therapy (OT), and physical therapy (PT) programs at Queen’s University work together to improve the health and wellbeing of their local community. KHealth’s initiatives aim to support the elderly, disabled, vulnerable, and equity— seeking populations in Kingston and educate students through learning and volunteering. KHealth has two main interdisciplinary projects: the Community Cares Program and the Interprofessional Community Health Program (ICHP). KHealth’s Community Cares Program consists of two key initiatives, the Community Carts Program (CCP), where students deliver groceries to those in need, and Community Calls, where students call community member participants weekly to help decrease social isolation. KHealth’s ICHP is an educational program in the form of a set of interactive online modules, a speaker series of talks, and a culminating case—competition carried out in interprofessional teams. KHealth also hosts fundraisers and awareness campaigns to assist vulnerable and equity—seeking members of the Kingston community.
KHealth began as a medical student project and transitioned to an interdisciplinary student initiative KHealth is an organization that was founded by Valera Castanov and voted for and supported by Queen’s medical class of 2022 as a class project. The original aim of KHealth was to establish a Student—Run Clinic in Kingston supervised by physicians, nurses, social workers, PTs and OTs to provide support and health care to vulnerable and equity—seeking populations. From the beginning, with such an interdisciplinary goal as
running a clinic in mind, we knew KHealth would require involvement beyond just the medical school. In 2018, With the help of Minnie Fu, Adam Gabara and numerous volunteers, we laid the foundation of Kingston’s largest interprofessional student—run health initiative. The following year, a diverse, interprofessional executive team began running all KHealth’s operations. To transition from a medicine student project to an interdisciplinary executive, KHealth brought on representatives from each major health care field: Grace Manalili (OT), Justin Achat (PT), and Cici Siju (Nursing) to join Valera (Med). These representatives acted as experts in their respective professions and created a culture that fulfilled our initial goal of interdisciplinary collaboration.
Transition from Beginning to Current Executive In 2019 we transitioned to a leadership model integrating representation of each department at every level, including: 1. 2. 3. 4.
A Co—Director from each program (medicine, nursing, OT, and PT) A Department Representative from each program (medicine, nursing, OT, and PT) ICHP CCP
We are further supported by our communications and finance directors, though as single—person positions, these are not interdisciplinary teams.
Lessons from Beginning an Interdisciplinary Health Initiative 1. The Co—Directors reported that having a diverse and representative team helped them better learn about all of the interests of the various disciplines that make 24
up the members of KHealth. In learning to balance representation of the various departments, the Co— Directors employed a shared—decision making model. For example, when planning the holiday greeting card and hand—sanitizer donation, representatives from each discipline volunteered what they could do best: while OT was on practicum they were more suited to virtually write the cards, while medicine students got the hand sanitizer and card order, and PT students printed and delivered them. Together, the project was successful. 2. Department Representatives are experts for their respective programs. With this knowledge they advocate for supplementary curricular events for healthcare students to learn about other health care disciplines in the form of the ICHP and other interprofessional events. Additionally, the Departmental Representatives are necessary to ensure that all of our programming is accessible and to effectively target advertisements to students in each program. For example, the ICHP education program is currently under consideration for an accredited Academic Enrichment Program (AEP) designation for medical students, so we launched the program expecting the approval to come within a year or two. But since the OT and PT are shorter programs and thus these students would need their credit by year’s end, KHealth launched a miniature non—accredited version of the ICHP to ensure that OT and PT students still receive the same credit as the medicine and nursing students. 3. The ICHP team, which features members from medicine and OT, found great benefit in having an 25
interprofessional team to ensure that the educational program that they run suits an interdisciplinary audience. Because of the emphasis on interdisciplinary learning, the ICHP educational program has educators with diverse backgrounds create its online modules and deliver its speaker series of talks. This has led not only to comprehensive and unique learning materials and events, but has broken down the silos of the health professional programs and formed new partnerships. In collaboration with OSLER, KHealth helped run a case—competition where students competed in interdisciplinary teams made of students from medicine, nursing, OT, and PT. KHealth and OSLER ensured that each team consisted of students from different programs, provided a comprehensive case study appropriate for interdisciplinary care and relevant to the Kingston community, and asked open— ended questions that could be addressed from multiple perspectives. Participants expressed appreciation for opportunities to interact with future colleagues through the event. 4. The CCP, which features members from medicine and OT, recruited student volunteers from various health care professions to Community Carts and Community Calls grocery and phone services. To date there have been 25 one—time deliveries and 8 weekly recurring deliveries for ongoing support of vulnerable individuals, with a total of 113 deliveries to date. Over the past 10 months, KHealth has connected 28 community members with student volunteers who have completed a total of 350 phone calls to alleviate social isolationIn working together, we have been able to achieve so much more than a service from only one field could have.
Challenges of Beginning an interdisciplinary health initiative In working in such an interdisciplinary team, communication is key. We used Slack to collaborate on projects, take accountability for our duties, and better facilitate the division of responsibilities and an open line of communication. It was also challenging to ensure we had adequate representation from different academic programs. For example, we could not recruit a PT representative, which means that this role hasn’t been represented as heavily on our executive team so we must make a point of considering the PT perspective to ensure the PT voice is still heard. Moving forward, we may combine the OT and PT representative role into a rehabilitation science representative, since the two programs work very closely together.
Closing Remarks At KHealth, we are dedicated to collaborating in order to support the Kingston community. Our interdisciplinary team is always in search of ways to support the community with our unique volunteer—base. We are forever grateful for all the members of the KHealth team and volunteers who ensure these projects can continue being a success. We are excited to continue our collaborative projects, facilitating connections between students and uniting their power to innovate and create social change. For more information or to contact us, please visit: h t t p s : // w w w. k i n g s t o n h e a l t h . c a / ⚚
These solutions to the challenges that we face in being a society uniquely collaborating many departments we hope will encourage others to facilitate more interdisciplinary collaboration between the lines of health care students.
Importance KHealth has done important work connecting students in disparate lines of education streams who will eventually go on to practice together. Exposure to students in other health care professions early in their careers is important for understanding one’s own scope of practice and creating future collaboration. Often, our programs have limited opportunities to work with various health professional programs until clinical placements. Collaborating as a member of an interdisciplinary team like KHealth offers students an early opportunity to develop a foundational understanding for the importance of teamwork among health care providers before entering the workplace. It also encourages its members to recognize what they know and what their limitations are and grow within an environment that promotes shared—leadership, responsible decision—making, and the development of innovative solutions to community needs. KHealth unites us in our work to support community health and wellbeing in Kingston. Having the opportunity to work alongside like—minded students who are all committed to the vision of improving the health of Kingston’s equity—seeking populations has been a valuable experience, and exposes us to achieving success in a group dynamic ahead of entry into practice. We hope that the success of beginning KHealth and the lessons that we have learned from this initiative will continue to spark the beginnings of new collaboration between healthcare students. With the movement towards radical collaboration, we know that learning from one another the way that KHealth inspires is essential.
Artwork by Prashanth Rajasekar, Meds ‘25 Someone I once met at a shelter described how "methamphetamines colour his world." I found it intriguing and I talked to him about his addiction for a while before trying to recreate this.
making sen Written by Mobin Jassi, Meds ‘22 Artwork by Kaitlyn Rourke, Meds ‘23
I wish to make sense of you. So much pain and suffering. And sometimes I wish to shake you out of it. Wake you from it. Let you smell the infinite possibilities you have. More than your body, more than your mind. So many things to do, so many places to explore. A world awaits you, of sunshine and cinemas. Roadside shacks and beaches. So much love, so much warmth for you to have. How will you have it if you don’t nourish your body? It will collapse and wither away. It won’t be able to help you chase the sunsets. Why make it suffer so much pain? Your body is a vehicle for you to visit places, for you to love others and hug them and share smiles. And know in the moment that things seem bleak, but the gift of time is it keeps passing, it doesn’t stay still. Like you and me, ever changing, ever growing. And even though you don’t make sense to me, I get you. I get you with my whole heart, from the core of my being. This blurb was written when I first encountered a patient with an eating disorder in restraints being fed with an NG tube. I came home and journaled my turbulent thoughts coming to terms with this disorder and its critically ill patients. ⚚
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Written by Prashanth Rajasekar, Meds ‘25
I reminisce the better days, my remedy for disarray, A sheltered place to set our gaze on memories and get away, At tender age, we got engaged, arranged to have our vows exchanged, Palms interlaced, we took the stage of decorated white bouquets, When marriage came the war was waged, Her illness plagued us, weapons raised, Our fear explained how life would change, Priorities were rearranged, They say he plays in clever ways, I bought the bait, praised God the great, Kept begging in my letters, graceful Lord, with mercy let her stay, Tormented by her jaded state, unfed emaciated shape, depleted weight, sedated faith, to whom do I profess my hate? “I’ll be okay, don’t be afraid”, her whispers frayed, her breath delayed, Laid closely caged in my embrace, I held her safe, my saving grace, We’d fade away to sleep that way, our dreams defaced by terror’s play, Nightmares portray what life awaits, but dreams were fake, I could escape, But then I’d wake to real heartbreak, a conscious state I couldn’t shape, a wretched place with cruel fate, enslaved to ache for God’s mistake, Her broken plea “Just bury me, I’m begging no more therapy”, Though cancer may have set her free, it fettered me, cold tethered feet, We celebrated yesterday with desecrated white bouquets, Our vows cremated, set ablaze, our unpenned legacy erased, I keep her safe in years retraced, her immortality encased, It’s here I chase those clear eyed days, where she would stay my fiancé, To paraphrase, I was betrayed, she left me but her debts are paid, I now escape to better days, decaying where her sweater lays.
Looking back to begin again Reflections on the history of medicare in canada Written by Amelia Boughn, Meds ‘25 Artwork by Sigi Maho, Meds ‘24
erhaps because of the way we tell stories to each other, people tend to think of beginnings as singular events, things that happen once and set everything else in motion. But historians will tell you that there is no such thing as a singular beginning because there are always more beginnings to uncover. Such is the history of Canadian medicine, an institution that has had multiple beginnings over the years. The discovery of insulin over a hundred years ago was one beginning. It gave rise to a new era of medical treatments for people with diabetes. The Spanish flu set the stage for another beginning, ushering in a new era of public health and preventative medicine. The “beginnings” just keep coming. But what I come back to when I think of medical beginnings in Canada is the beginning of Medicare, the single—payer universal health insurance system that revolutionized health care in Canada. Often beginnings arise out of the possibilities opened by crises. In the 1940’s and ‘50’s, Tommy Douglas, then Premier of Saskatchewan, capitalized on the crisis that was the Second World War to create Canada’s first provincial public insurance program for hospital—based services, The Hospital Insurance Act (1947). This piece of legislation ultimately led to the creation of a national public insurance plan for hospital—based and diagnostic services in 1957 and, years later, the federal Medical Care Act, or Medicare (covering physician—provided medical services outside of hospital), in 1966. The first half of the 20th Century saw its fair share of crises (including two World Wars and the Great Depression), and out of these came an overhaul of Canada’s healthcare system and a yet another new beginning for healthcare in this country.
A whole lot of patience Medicare was a topic of discussion in Canada, and globally, long before the 1950’s. In the late 19th Century, during the Second Industrial Revolution, several European countries — including Germany, Austria, Norway, and Serbia — created universal health insurance programs after realizing that a healthy workforce meant industrial
productivity. The First World War brought conversations about the importance of universal healthcare to Canada after the military found many fighting—aged men to be unhealthy and unfit for service. The federal Liberal party of the day was so keen on the idea of a publicly funded health insurance program for Canada that they included it in one of their campaign platforms in 1919. Soon after, Tommy Douglas entered the scene. He toiled away in the backbenches of federal and provincial politics for twelve years before he was finally able to implement some version of a public hospital insurance plan in Saskatchewan in 1947. It was seventeen more years before his ultimate goal of a comprehensive, universal public insurance plan for medical services would be codified into Canadian law. Universal health care was – and is – a complex piece of public policy that took time to work its way from the factories of Europe into the collective social and political worldview of people in Canada.
The necessity of cooperation: for better and for worse Because Canada is a federation, cooperation was key for advocates of Medicare. While provinces hold power over healthcare (as outlined in our Constitution), the federal government holds most of the taxation power and therefore has most of the money. A provincial universal public health insurance plan would be unsustainable in the long—term without financial support from the federal government. Cooperation was also key because universal healthcare had staunch, concentrated, dedicated opponents that advocates of Medicare had to bring onside – or, at least, less offside – before the policy could become law. Physicians in the 1950’s and ‘60’s came out fiercely opposed to the project of universal public insurance for medical services. Until the 1950’s, physicians running private practices (outside of hospitals) had been able to charge patients as much as they wanted (or as much as the patients could afford) for services. While this model was 32
I hope that, looking back fifty years from now on today, we will see this decade as another new beginning; one where we finally began to address the defining problems of our healthcare system – eldercare, systemic racism, climate change, dental care, and drug coverage, to name a few –and transformed our universal “sick” care system into a universal healthcare system.
problematic for physicians during the Great Depression, when few patients could afford the fees, it was profitable during the post—war boom of the ‘50’s. Physicians, many of whom had moved to Canada from Britain after being forced into Britain’s public National Health Service, resented the idea of provincial and federal governments in Canada regulating their practices. In 1962, the day the Saskatchewan Medical Care Insurance Act became law, Saskatchewan doctors, outraged, almost derailed the entire project through the infamous Saskatchewan Doctors’ Strike. The Strike saw 90% of physicians in Saskatchewan walk out on the job in response to the new legislation. Douglas had to negotiate, eventually making concessions that protected fee—for—service billing and physician autonomy in the province.
We need to begin now. We’ve got a lot of work to do. ⚚
Author’s footnotes 1. Douglas has, historically, been held up as a hero in the Canadian collective memory for his role in creating Medicare. However, it’s also important to note his early career contributions to the eugenics movement in Canada. If you want to know more, the Canadian Encyclopedia has a good overview: https://www. thecanadianencyclopedia.ca/en/article/tommy—douglas—and— eugenics 2. This is the “Coles Notes” version on the creation of Medicare. For a more comprehensive look, I’d recommend Dr. David Naylor’s book Private Practice, Public Payment: Canadian medicine and the politics of health insurance, 1911—1966. 3. CD Naylor, Private practice, public payment: Canadian medicine and the politics of health insurance, 1911—1966. (McGill— Queen’s University Press, 1986), 27. 4. ibid, 53 5. “Making Medicare: The History of Healthcare in Canada; 1914—2007”, Canadian Museum of History, last modified April 21, 2010, https://www.historymuseum.ca/cmc/exhibitions/hist/ medicare/medic—1h13e.html. 6. “Making Medicare: The History of Healthcare in Canada; 1914—2007”, Canadian Museum of History, last modified April 21, 2010, https://www.historymuseum.ca/cmc/exhibitions/ hist/medicare/medic—1h13e.html. 7. ibid 8. ibid 9. RF Badgley and Samuel Wolfe, “Medical Care and Conflict in Saskatchewan,” The Milbank Memorial Fund Quarterly 43, no. 4, part 1 (October 1965): 463, https://doi—org.proxy.queensu. ca/10.2307/3348852 10. “The Fight for Medicare,” Canada: A People’s History, last modified 2001, https://www.cbc.ca/history/ EPISCONTENTSE1EP15CH2PA4LE.html 11. GP Marchildon, “The Policy History of Canadian Medicare,” Canadian Bulletin of the History of Medicine 26, no. 2 (Fall 2009): 255, https://doi.org/10.3138/cbmh.26.2.247.
Looking back to move forward once again Medicare, like all things in healthcare, is a continual work in progress. But the policy today fails to recognize that crucial fact. It is stagnant, a close replica of the program as it existed in the 1960’s. It remains stagnant despite indicators such as wait times and overall spending that tell us we need to grow and adapt as our population ages and healthcare changes. But if crises breed new beginnings, then we are in a position to change that. As Winston Churchill famously said, “never let a good crisis go to waste.” The current pandemic has exposed many shortcomings and failures in our healthcare system, from the tragedy in long—term care facilities to vaccine hesitancy and public mistrust, to rising wait times for surgeries in the pandemic’s fallout. Like the history of medicine itself, the beginning of Medicare was not one single event. There were many beginnings that got us to where we are today. The policy took decades to write, re—write, and re—write again. It was weakened by opposing interest groups and then over time was strengthened by the nation’s collective memory. A policy that once seemed outrageously out of reach has become central to our national identity. But the struggle is far from over. We live in a world completely different from the 1950’s, and, because of that, extrapolating lessons and actions from the past and pasting them into the present is an unproductive exercise. We need to look forward and begin again. And again. While the crisis of World War Two opened a window for change to occur, the crisis itself did not guarantee a new beginning. It was the conscious and persistent effort of people who cared that made the difference.
embrace it Written by Devyani Premkumar, Meds ‘25 Artwork by Kaitlyn Rourke, Meds ‘23
f you are like me, then new beginnings are terrifying. Calling a new place home. When ‘home’ is my mom’s cooking wafting through the house, inviting me to eat a meal after a long day of studying. ‘Home’ is my sister entering my bedroom without permission, bouncing around, asking for my opinion on the most irrelevant of matters. ‘Home’ is my dad giving me directions to a grocery store I have been to a thousand times, but he can’t help himself; he always feels the need to guide me. Now I have to find my own grocery stores. Make my own meals that are not as appetizing. And hope I can catch my sister at a good time to have a conversation. It is not easy, the transition. I am very privileged to be so close to my family, however, it most definitely comes with its qualms. Being an older sister in a South Asian home, means a number of responsibilities, spoken and unspoken. Like making sure my mom takes her medications. Helping my sister figure out her OSAP account. Teaching my dad about technology, literally anything technology. Bless that man, he is the most intelligent person I have ever known, but cannot convert a word document to a PDF for the life of him. This was my home. Bustling, loud, always calling my name. I was…am…their go—to person, who now happens to be hundreds of kilometres away. Have you heard of that question; “If a tree falls in a forest and no one is around to hear it, does it make a sound?” That is what I struggle with. What if my family is still calling out to me, desperately needing my assistance, and I am just too far away to hear it?
Here I am now, entering this new space where the only person I answer to, is myself. It feels a little silent. A little lonelier. This isn’t supposed to be some “woe is me” piece about my privileged life, complaining about how I no longer get all the comforts I once did. But for anyone else who feels as if they are being pulled in all directions while trying to move forward, I feel for you. It can be exhausting. So, what do we do? Here’s something I’ll tell you (and myself . . . continuously): embrace it. Embrace your experiences as you transition; the good, bad, ugly — take it all in wholeheartedly and with open arms. Hang out with people that make you laugh like crazy, do activities that keep you on your toes, and take those beautiful walks by the water. Make those trips when you are missing your family and friends. They are worth it. You will make it work. At the same time, remind yourself that this is a transition for your loved ones as much as it is for you. Just as you try to adapt, trust that they will too. But most importantly, throughout this whole “embrace it” experience, listen to yourself. My body tells me when I am tired of travelling. My social meter cannot handle all the Tuesdays (you know what I am talking about). Take those moments to yourself. I love lighting a candle and reading a novel in my new bedroom. After a full day of classes, extracurriculars, and emails, it gives me peace to make a meal and just rest. This is how I get closer to calling this place home. ⚚
PILOT SEASON Written by Helen Lin and Meghan Jenkins, Meds ‘25 Artwork by Fiona Raymond, Meds ‘23
all is symbolic for back to school and pilot season, and I’m talking about pilot season for TV. We all know the shows I’m talking about — shows that might have piqued your interest in medicine. We’ve taken four all—time favourite medical shows, and reviewed their pilot episode. As first—year medical students, we feel as though we’re also going through growing pains similar to the shows during their first season. Let’s take a look at how these popular shows got started!
MASH (1972): “Pilot” [1x01] Helen: I will preface that I wasn’t even alive when this series was airing, let alone watch it. For those who don’t know, MASH is a war—comedy set in a mobile hospital during the Korean war. The series starts with Hawkeye, a womanizing surgeon, performing emergency surgery while rattling off how important his work is in a dry manner. Later, Hawkeye receives a letter from his alma mater informing him of the acceptance of his house—boy, Ho— Jon to medical school for the cheap price of $1000. How does Hawkeye and his friend, Trapper, come up with the money? By planning to auction off a date of a nurse within the army, Lt. “Dish”. She’s introduced by a montage of increasingly discomforting and unwanted sexual advances from Hawkeye. Even though the party they’re planning to raffle off the date is cancelled by Frank Burns, the temporary commander, Hawkeye and Trapper continue with their plan by sedating and wrapping Major Burns in gauze strips. At this point, their nemesis and head nurse, Major Margaret Houlihan (aka Hot Lips), discovers their treachery and have them busted by a general with whom she used to have an affair. Hawkeye and Trapper manage to get away with their deceit due to the sudden influx of casualties from the battlefield for which they needed to attend. I know MASH is a classic to many Americans in the late ‘70s, and I can see the dry humour, which was popular during that time, reflected in the writing. In my opinion, it doesn’t really hold up to the test of time, with countless misogynistic and deadpan jokes. I’m unable to comment on the verisimilitude of the show, but ultimately it’s a feel—good sitcom during an increasingly turbulent time during the Vietnam war. Would I personally watch more episodes? Probably not, but I can appreciate the role it played in TV history, being an iconic medical series well—loved by the previous generation.
Grey’s Anatomy (2005): “A Hard Day’s Night” [1x01] Meghan: “A Hard Day’s Night” is the pilot episode of the Shonda Rhimes masterpiece of Grey’s Anatomy. Airing on March 27th, 2005, some may call this episode a cinematic landmark in history, or at least the start of their lifelong love for Meredith Grey. The episode introduces the fundamental main characters of Meredith Grey, Cristina Yang, Izzie Stevens, Alex Karev, and George O’Malley. These interns are thrown head—on into what their future entails as they enter the competitive, gorgeously messy realm of surgery at Seattle Grace Hospital in Washington. The episode holds the iconic run—in between Meredith (played by Ellen Pompeo) and Derek Shepherd (Patrick Dempsey), where she learns of his new role of attending and chief of neurosurgery at Seattle Grace; in other words, she’d just slept with her boss. The interns meet “The Nazi,” Miranda Bailey (Chandra Wilson), and Richard Webber, introducing the show’s first iconic friendship. Diving into the first complicated intern—attending lust—filled connection, introducing the unique ‘007’ nickname of O’Mally, and revealing the secret relationship held between Meredith and her mother Ellis, this pilot episode is the perfect sneak peek into the world of Grey’s Anatomy.
Fun House MD (2004): Pilot [1x01] Helen: I’m not going to lie. This is not my first time watching this series, however, I don’t recall watching the first episode, but this show remains one of my all—time favourites. Some of my fondest memories are finishing high school and coming home on a Wednesday to eagerly await new episodes of House MD. The episode starts out with a teacher, Rebecca, suffering from speech problems followed by having a seizure. Then we are introduced to Dr. Gregory House, a sardonic infectious disease doctor, who is limping and using a cane. He is first heard sarcastically dismissing Dr. Wilson, an empathetic oncologist, who just so happens to be the patient’s cousin. We are constantly reminded of his pill—popping habit from his orange little prescription bottle throughout the first episode. The following scene introduces his three underlings, Dr. Cameron (the kind one), Dr. Foreman (the straight shooter) and Dr. Chase (the handsome one). All are very intelligent and extremely competent but seem to garner little respect from Dr. House. What strikes me in the first episode is his blatant dislike for patients, which becomes even more obvious as the season progresses, by first believing all patients lie followed by refusing to see patients in the clinic after being confronted by Dr. Cuddy, the ballbusting Dean of Medicine. Somehow the miracle that the show pulls off comes from how much we root for Dr. House to find the correct diagnosis despite him being so unlikeable. The contrast between the goodness and humanity of Rebecca, the patient, and the jaded and skeptical Dr. House is so deliciously juxtaposed, it’s almost too on the nose. Despite his mistrust of patients, he doggedly chases every symptom, every test result, and he coaxes his fellow doctors to break into the patient’s house to look for causes that would explain Rebecca’s symptoms. Dr. House finally meets Rebecca for the first and only time despite originally going out of his way to avoid meeting her when she refuses treatment, and they have a very blunt but honest conversation about his disability and her diagnosis. These are not attributes of a doctor who doesn’t care which intrigues the audience even more. At the end of the day, he does find the correct diagnosis (a tapeworm in the brain), but it brings him little joy. The pilot has an almost sombre tone to it in a way that’s totally different from later seasons, it definitely does set up the characters for more exploratory storylines further down the road. But the only critique I have is questioning the plausibility of such an immoral and callous doctor existing in the current healthcare system, but I guess that’s what makes good TV.
Scrubs (2001): “My First Day” [1x01] Helen: I’ve watched a couple of episodes of Scrubs a few years back, and enjoyed how lighthearted the characters are and the friendships between all the doctors and nurses in the main cast. I’ve heard from multiple sources that Scrubs is one of the most realistic medical shows, and I see that in spades within the first episode. My First Day starts with a monologue from the main character, JD, who is an internal medicine intern. He jokingly talks about how nervous he is for his first day as a doctor and immediately being confronted with the chaotic nature of the hospital. We’re also introduced to JD’s best friend, Turk, who is a laid—back and confident surgical intern, as well as Elliot, a preppy and pretty medical intern and Carla, an experienced nurse. One of my favourite characters is Dr. Cox who after being mentioned immediately appears and proceeds to test JD and make snide remarks about his lack of ability. At this point, I’m getting nervous about my own intern year as I watch Dr. Cox “teach” JD the ropes of medicine in a biting manner, but Dr. Cox’s gruff nature gives way to support when JD is truly in a stressful resuscitation. Later, JD is on his first night on call, and we can see how overwhelmed, unprepared, and unsure he is of himself — he is overworked and exhausted. The episode reaches a resonant moment when he is called to pronounce a dead patient and reflects on how shameful it was to think about how hard this was for him: “I just wanted to help people. The hardest part is how quickly you have to move on.” What I didn’t like about the first episode is how they’ve introduced the only female intern, Elliot, by characterizing her as a desperate over—achiever who’s out to sabotage everyone for her own benefit. Even though she eventually apologizes for her behaviour at the end of the episode, she continues to exhibit traits of narcissistic behaviour later on. There is also a hint of the male gaze during the episode, and the sexual portrayal of all the female characters on the show is slightly distasteful; as if Elliot and Carla’s only purpose is to serve as a romantic interest for their male counterparts, JD and Turk. While the first episode introduces the characters and establishes the humour for the rest of the series pretty well, I can’t say I enjoyed it as much as later episodes, which had, in my opinion, softer humour that was less cutting. However, I certainly do agree with how much realism the show portrayed in terms of being a hospitalist. ⚚
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Emotional Pain Written by Milana Milivojevic, Meds ‘24
e’re medical students. Clearly, we prefer logic above all else. Let’s come up with a rational, evidence—based explanation and treatment for everything—even our feelings. So, I present to you the clinical history taking tool that may be the logical counterpart to understanding your emotions.
How long have you been feeling this way? How long has it hurt?
Rate your pain on a scale of one to 10. One being the slight discomfort of submitting your Elentra assignment at 11:27PM and 10 being the excruciating pain as you refresh your inbox waiting for the email saying you failed CardioResp.
Does the pain feel like a living thing, moving around of its own accord? Where does it go?
What makes it worse? Tswift’s rerecords? Opening Elentra? Instagram?
Alleviating What makes it better? Friends? Family? Chocolate? Sleep?
Is it a sharp, positional pain? Does it feel better when you lie down, preferably on the floor— the only place you feel grounded? Is it crushing— as if an elephant of doubt is sitting on your chest? Another bout of imposter syndrome, perhaps? Or is it more of a dull, achey pain that seems to overlay your day as you go about it?
What else is going on? How’s your sleep these days? Your eating? Your hygiene?
Tell me the truth, is it your heart? Or is it your ego? Where have you been wounded? Point to it, hold a fist to your chest.
Can you track it back to a specific moment in time that you play over and over in your head, your own special purgatory? Or did it come on more insidiously? So slowly that you barely noticed it began, until this pain was the only thing you knew.
Is it the Clash— always having trouble deciding if it should stay or go? Are the mornings deceptively pain—free but the nights harder?
Is this a familiar pain? An old friend who shows up uninvited, and yet, always expects to be welcomed in with open arms? Now that you’ve DSCLOTRAAAP—ed, I promise things are looking up. You know what happens next, differential and investigations. Imagine a WNRS “dig deeper” card and find the source of this. We love answers, and this is exactly what you’re here for. It won’t be easy, but it just might be worth it. Once you’re ready, tailor your treatment to the individual— and who knows you better than you? Please remember to be patient and kind to yourself, these things take time. Make sure to follow up with yourself, and check in from time to time. Good luck with your recovery, friend. ⚚
RISING STARS Written by Ivneet Garcha, Meds ‘24 Artwork by Sigi Maho, Meds ‘24
elcome back to Rising Stars! At the dawn of a new school year, the stars have aligned to bring you another edition of hard hitting, self—reflection inducing horoscopes, astrology, and commentary. Earlier this month, your resident horoscope team launched a crucially important research endeavour– quantifying and qualifying the astrological profile of QMed. Over 120 of you decided this was an important enough academic exercise and submitted your responses. Together, you’ve produced a robust dataset to support some highly specific and definitely targeted astrological analyses. These findings might not be statistically significant, but they most certainly are socially significant. So read below to see what the astrological profile of your class says about who your year is and what it brings to QMed.
Queen’s Medicine: The All—Years Profile
Queen’s Medicine is known for its sense of community. You will know from personal experience that from our very first day of medical school, we were all adopted into the QMed Family. But every family has its characters, and Queen’s Medicine is no different. So let’s start by working our way down the family tree and seeing who the top five relatives are.
Highest Prevalence – Capricorn (13.2%) QMed family member: overachieving older sibling that literally cannot let anyone else win ever and whose entire self—concept is driven by work and career accomplishments Analysis: To absolutely no one’s surprise whatsoever, Capricorns rule their reign over QMed. You’re the last sign of the zodiac, but first place in the standings. You knew it would be you. Who else could match the unrelenting ambition and permanent can—do attitude? You’re the GOAT for a reason.
Second Highest Prevalence – Pisces (12.4%) QMed family member: the sensitive, artistic distant cousin that tries their best to understand everyone around them despite their morphed sense of reality making them feel constantly misunderstood Analysis: A surprising second place is our QMed Pisces. To be honest, I find this kind of fishy (bad pun absolutely intended). I could see how the soft empathy and mutable adaptability would draw you to medicine, but did this many of you seriously make it through your MMIs without crying? Shocked and confused. But honestly, we’re glad you’re here. If there were less of you, there would be more Capricorns and that would just be insufferable.
Third Highest Prevalence – Libra (10.7%) QMed family member: the attractive, aesthetically inclined younger aunt who can put together outfits, but not sentences Analysis: Libras. You’re so pretty!!! Who needs to deliver a great interview when so many of you can get by with just a flash of a smile? But you know what– sometimes you’re more than that. Fair, quick, logical. I can see why QMed has so many of you balanced beauties.
Third Highest Prevalence – Virgo (10.7%) QMed family member: helpful, focused, and obedient middle child whose crushing need to strive for perfection got them to QMed, but also got them an anxiety prescription Analysis: This is not even remotely surprising. Diligent, invested in your work and others, and an overall attention to detail that is unmatched, Virgos belong here. Even though the rest of us wish you would dial back the neurotic energy you bring to the QMed family, we respect that someone has to get things done. Like the middle child, you’re often forgotten, but the crucial intermediary that holds the family together.
Fourth Highest Prevalence – Aries (9.9%) QMed family member: the cool mom who is equal parts explorer with an unbridled thirst for adventure and Kris Jenner at her slightly embarrassing peak Analysis: Driven and ambitious, all of you Aries came to QMed ready to succeed. You’re kind of like the Capricorns, but with a few less brain cells. But what you lack in brain power, you make up for in a laid—back enthusiasm that makes QMed an infinitely more fun place to be (thank god because… Virgos). Not to mention you’re all probably the stars of every intramural team too. Stay winning.
Fifth Highest Prevalence — Leo (9.1%) QMed family member: the obnoxious youngest sibling who needs attention and validation 24/7 and will probably throw a hissy fit that they’re in fifth place. Analysis: Confident, bright, and beaming with positivity, Leos are the aspiring main characters of QMed. And we all know you Leos will make great physicians. Why? Because simply put, your empathy knows no bounds. If your patient has an MI, you have one too. No better way to relate to a patient than making their story your own.
Other trends For you ‘others’. You didn’t quite make the top five, so I’m going to have delegate you to the status of extended family. But I don’t want you to feel too left out, so here’s the whole QMed breakdown. Some notable trends: • Either Taurus was too busy sleeping or eating to fill out this survey or their love for calm, soothing, comfortable environments didn’t quite fit with the fast—paced arena of QMed – either way, they’re giving me the oldest sibling’s first born with lazy toddler energy. • Aquarius, I know you’re out there. You just didn’t want to fill out the survey because you really think you’re too unique and different to even be a part of this experiment – eccentric weird uncle vibes for sure. 41
Family Feud: The Class Profiles
And now we get to the juicy stuff. Families fight and it’s time to get into the unspoken feuds between the years. This is the family breakdown that I know you’ve all been looking for.
Class of 2025 – Contradictions Crew Top Signs 1. Pisces 2. Capricorn 3. Aries Missing signs: 1. Taurus Analysis: As the newbies on campus, the Class of 2025 is interesting and embodies a lot of contradictions. On the one hand, they’re giving me baby energy with the strong Pisces and Aries representation, but the Capricorn is giving me daddy. They are both soft and artistic, but also harsh and logical. They are ambitious and driven, but also lazy and disconnected. I don’t have a large enough sample size to tell you whether this means this class is balanced or there’s just a clear divide of two camps – those that end up at the Grizz on a Monday and those that have their DILs done before the scheduled time on Elentra. Family ties: Class of 2024
Class of 2024 – Brilliantly Balanced Babes Top signs: 1. Libra 2. Gemini 3. Aries, Leo, Virgo, Sagittarius, Capricorn 4. Cancer, Pisces, Scorpio Missing signs: 1. None because we lack literally nothing. Analysis: Now this is range. Honestly, I might be biased, but the astrological profile speaks for itself. The Class of 2024 has it all. Quick wit, intellectual curiosity, an inclination for fun, ambition, a sense of adventure, etc.– the list is endless. Unlike the 2025s, this class is the perfect balancing of all four elements, with relatively equal representation of all the signs. It’s not contradictions, but interconnections. Not to mention this class knows how to show up. With the largest sample size and greatest diversity, I am officially declaring this class the most statistically (and socially) significant.
Class of 2023 – Brainy Bunch Top three signs: 1. Virgo 2. Scorpio, Capricorn 3. Aries Missing signs: 1. Gemini 2. Libra Analysis: The first word that comes to mind when I see this profile is intense. There is not a single chill thing about the Class of 2023, which is its biggest strength and equally its biggest weakness. You don’t miss a question. You don’t miss a class. You just don’t miss… but you might miss out. In some ways, you are a juxtaposition of the Class of 2024 – you are missing the light airiness and chaotic fun that comes with a Libra and Gemini majority. But in the same vein, you are overwhelmingly sharp, focused, and driven. You might not be the most fun, but you are without a doubt the most competent. You’re the future doctors we all want and need. Family ties: Class of 2023 (tight knit families stick together after all)
Class of 2022 – Fiery Few Top signs: 1. Aries, Leo 2. Sagittarius
Missing signs: 1. Almost every other sign and the entire classes responses tbh Analysis: Shout out to the fire signs for holding down the fort for the Class of 2022. I honestly didn’t really expect a single one of you to fill out the survey. I know you don’t care and nor should you. You have infinitely better things to do. But from these results, you seem like a fun time. We’ll be sad to see you go. The QMed family misses you already. Family ties: Class of 2024 ⚚
Family ties: Class of 2025, Class of 2022
Queen’s Medical Review Playlist 1. Stars Align — Majid Jordan & Drake 2. Grateful – Mahalia 3. Cigarette Daydreams — Cage The Elephant 4. Chances — KAYTRANADA 5. Easy on Me — Adele 6. Surround Me — Leon 7. Dlwlrma — IU 8. Hey — Pixies 9. Damned If We Do — MAYBE 10. Rescue — Lauren Daigle 11. Softly — Thomas Day 12. She Hates Me Too — Mitchell Tenpenny 13. Girlfriend – MNEK 14. Balenciaga Dreams — Qveen Herby 15. Keep ya head up — 2pac 16. Diamonds Dancing — Drake and Future 17. Empire State of Mind — Jay—Z 18. Invincible — Pop Smoke 19. Moon — Kanye West 20. Waterloo — ABBA 21. Streetcar — Daniel Caesar 22. War with Heaven — Keshi 23. Memory — Kane Brown 24. Girls Want Girls – Drake ft. Lil Baby 25. Miss Independent – Ne—yo 26. Brightside — The Lumineers 27. I must apologize — PinkPantheress 28. Santé — Stromae 29. Somewhere over the rainbow — Israel Kamakawiwoʻole 30. Colorado — Milky Chance 31. Good 4 u by Olivia Rodrigo 32. Luckiest Man — The Wood Brothers 33. SCOOP — Lil Nas X 34. Drugs n hella melodies — Don Toliver, Kali Uchi 35. Smoke on the Water – Deep Purple 36. It’s U — Cavetown
37. Need to Know — Doja Cat 38. Astronaut in the Ocean – Masked Wolf 39. my ex’s best friend — Machine Gun Kelly, blackbear 40. Kids – MGMT 41. In the woods somewhere – Hozier 42. Holocene — Bon Iver 43. Little Lion Man — Mumford and Sons 44. Happier Than Ever— Billie Eilish 45. Friday (Remix) — Rebecca Black (feat. 3OH!3, Dorian Electra, and Big Freedia) 46. Mequetrefe — Arca 47. Replay — Lady Gaga (remixed by Dorian Electra) 48. Buzzcut — LoveLeo (feat. blackwinterwells)
49. Prenups — Mood Killer 50. B**** Bites Dog — Cecile Believe 51. U Can’t Touch This — MC Hammer 52. Crush — David Archuleta 53. Be Still — The Killers 54. All I want for Christmas is you – Mariah Carey 55. Somebody’s Watching Me — Rockwell 56. Nostalgic — Arizona 57. Love in the Dark – Adele 58. Waves — Kanye West 59. Woman — Doja Cat 60. La vie – Ichon 61. Valentine — Snail Mail 62. Dreaming — SG Lewis and Bruno Major 63. Don’t Lose Sight — Lawrence 43
64. Warning Sign — Coldplay 65. Space Ghost Coast to Coast — Glass Animals 66. F*** you tahm bout — Chance the Rapper 67. Closing Time — Semisonic 68. If I had $1,000,000 — Barenaked Ladies 69. Sad Girlz Luv Money — Amaarae 70. Drunk – Keshi 71. Way 2 sexy — Drake 72. Forget about the Party — Majid Jordan 73. Forrest Gump — Frank Ocean 74. 1985 — Bowling for Soup 75. Romeo &amp; Juliet — Peter McPoland 76. Wildfire — Cautious Clay 77. Love Again — Dua Lipa 78. Good 4 u — Olivia Rodrigo 79. Vossi Bop – Stormzy 80. Heat Waves — Glass Animals 81. Love Nwantiti — CKay 82. Praise God — Kanye 83. Guy.exe — Superfruit 84. Love Tonight – Shouse 85. I Love You So — The Walters 86. Chicago — Sufjan Stevens 87. Insane — Summer Walker 88. Coastin’ — Victoria Monét 89. Every Summertime — NIKI 90. Don’t Wanna Be Without Ya — Penny & Sparrow 91. All I Need — The Hip Abduction 92. Thugz Mansion — 2pac 93. All Too Well by Taylor Swift 94. INDUSTRY BABY – Lil Nas X, Jack Harlow 95. Physical – Dua Lipa 96. Wavvy – Lav 97. Signs – Yarah 98. Supercut – Lorde 99. Adore You – Harry Styles 100. DNA – Kendrick Lamar
Photograph by Andrew Lloyd—Kuzik, Meds ‘24
“Each new hour holds new chances for new beginnings… The horizon leans forward, offering you space to place new steps of change” — Maya Angelou