QMR - Volume 15, Issue 2 (2022)

Metamorphosis in medicine

18.2

CONTENTS 5

Letter from the Editors

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Waves of Medicine Painting by Jaskarn Dhaliwal

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Can You let Go? Short Story by Alex Chen

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To Speak or To Suffer: Truth, Silence, and the Plague Poem by Alice Y.S. Li

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Etude No. 11 pour les arpèges composés - C. Debussy Annotation by Alice Y.S. Li

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Illustration by Alex Chen

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The Medical Education Revolution: Learning by Doing Essay & Painting by Hassait Hilawe

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empty nest Collage by Annie Liu

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scarlet letter Reflection by Anonymous

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How to Stop a Tsunami with a Human Chain (Step 1: Don’t) Essay by Alyssa Reddi

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When We Choose to Ignore Poem by Enoch Yu

Beneath the Bloom Illustration by Mona Golmohammadzadeh

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Fear In The Face of Uncertainty Essay by Cindy Wen

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The Cabin Poem by Jake Howran

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Sunset Factory Artwork by Maggie Liu

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Revolutions Illustration by Amireza Nikzadfar Goli

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9-2: Hypotension Reflection by Saloni Aggarwal

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Slipping through her memories, in due time Semi-Fictional Piece by Anonymous

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A Study in Discovery Photograph by Rihana Kukkadi

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NOSMO KING and the Behaviour Change Paradigm Personal Essay by Tim Song

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Work in Progress, Working Together Photograph by Ivan Quan

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The Away Elective Odyssey - as prompted by ChatGPT Poem by Jessica Morris

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Dr. Samsa?

Short Story and Illustration by Alex Pipchuk & Sarvesh Ramlochun Our Team Legacy x Metamorphosis Launch Party Back Cover Painting by Sarvesh Ramlochun

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LETTER FROM THE EDITORS Dear reader, Following our first volume, 18.1: Legacy in Medicine, which prompted the reflection of identity, heritage, and the stories that shape our journeys, we now present its companion edition with volume 18.2: Metamorphosis in Medicine—an interpretation of dramatic flux, growth, and shift in healthcare.

In this issue, we extended a playful invitation to artists and writers alike: to explore transformation, dreams, catharsis, dissonance, and evolution. While we may feel isolated in the uncertainties of the future, this aspiration for change and novelty is something we all share.

In turn, the writers and artists reflected on their journey in medicine: How has this path transformed them? How can we, in turn, inspire transformation in others? Beyond personal growth, this issue also shines a light on those who dreamed bravely despite resistance. Through stories and artworks from the Queen’s Medicine community, we hoped to reignite the creativity, curiosity, and humanity at the heart of our profession.

We were met by an overwhelming outpour of thoughtful submissions from the Queen’s Medicine community, spanning essays, poetry, visual art, photography, and reflections that capture the spirit of metamorphosis in its full splendor and light.

This volume also contains glimpses from our launch party, held on April 24th, 2025, at the Isabel Bader Centre in Kingston, Ontario—a vibrant gathering of collaboration, vulnerability, and imagination. It was an evening where the greater Queen’s Medicine community gathered to celebrate the voices in the ever-evolving symphony of art, literature, medicine, and life.

On behalf of the Queen’s Medical Review, thank you for leaving your mark, marking your future, and inspiring a year beyond anything we could have imagined.

From the bottom of our hearts,

Alex Pipchuk

Alice Li

Precious Adekoya

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Sarvesh Ramlochun

Zier Zhou

Waves of Medicine

By Jaskarn Dhaliwal, Class of 2027

Can you l e t g o ?

By Alex Chen, Class of 2027

Ev e r y c e i l i ng sh o u l d b e p ai nt e d w it h sh e e p,

short walk burdensome. Every breath, heartbeat, and movement from the baby felt ten times louder in the early morning’s silence.

Nora decided, as she stared up at the empty white expanse. In the corner of her eye, she caught the unforgiving LED glare of her clock: 3:14 AM. Pi.

Already, she regretted it. It was a silly request. The grocery store was closed and the nearest 24-hour superstore would be who knows how far. It’d felt like an emergency, a do-or-die demand, but the impulse was already gone. She reached for her phone, but Lawrence’s, forgotten on the counter, vibrated first.

Her stomach churned as she remembered the fragrant honeyed apple pie Lawrence’s mother used to bake every fall. Nora would run over as soon as school was out, not caring for the mud or mess she trekked in. She’d been a menace, tearing away the books he loved so much and running off so that he’d chase her outside. But he always forgave her, the saint he was, and they’d talk for hours under the stars about how they would change the world.

They were so naive back then, starry-eyed kids with heads above the clouds—adherents to the faith that hard work transcended all. She couldn’t help but laugh at the memory.

An extreme weather alert flashed across the screen.

It was early in the season, but the weather was never predictable in this town. Outside, a thick carpet of snow already blanketed the world, only marred by a single set of footsteps. At this rate, those too would be buried soon.

The alert flashed red again before disappearing.

What if he’s stuck in a ditch somewhere without a phone to call for help?

The little kicks in her abdomen were a reminder of how many years had passed. They were no longer children, but the thought of apple pie was still irresistible. Beside her, Lawrence’s steady breathing faltered, hitching into a groan as he roused from his slumber.

What if the wolves got him?

What if he’s grown sick of her demands and left? She could almost hear the words, shouted from a hoarse throat after hours of argument: a final goodbye and good riddance.

“What time is it?” he asked groggily.

Nora took a deep breath. 3.1415926535… The world of numbers was a safe refuge, a way to drown out the frantic thoughts. Walking also helped. She wandered from room to room, before stopping in Lawrence’s home office. The open blinds were as good as closed in the whiteout.

“3:14,” she replied, before lowering her voice. “Honey. Do you think…”

It was an unreasonable request, she knew, as the guilt sank in. But at this hour, at this time, and with the weight she was carrying between them, it felt justifiable. The craving was undeniable; there was no chance of falling asleep without it.

It wasn’t the first time he’d driven through a blizzard. The day she first realized what he meant to her was one such dark and snowy day, when time felt like it had frozen for two foolhardy teens stuck on a country road for hours waiting for assistance. And there were flurries too, on the morning after graduation when he gifted her a lovely silver Montblanc Starwalker fountain pen. Its flight was charted to sign off on court cases and appeals defending

Wordlessly, he tossed on a winter jacket and stumbled out of the room. The slam of the front door echoed through the house. Knowing from experience that lying in bed was a futile exercise, Nora found a seat in the living room. The shift in her center of gravity made even the

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the defenseless, but now lay gathering dust; criminal law wasn’t stable the way corporate was.

appreciate you.”

“No—”

A framed portrait of their third anniversary in Houston sat squarely on one corner of Lawrence’s desk, flanked by mini planetary knick-knacks and NASA toys. The sheer joy in his eyes was a stark contrast to the tired gaze she’d grown accustomed to. He should have been there, would have been there, on the forefront of the final frontier— changing the world. They’d been together when he opened the email. They’d celebrated and talked until the sun rose for the first time in ages, like teenagers whose parents were out for the weekend. It was the kind of offer that he worked his entire life for, the sort that no one ever declined.

A quick kiss shut him up.

“I know all of that… and that’s why I’m sorry,” she continued. “Sorry that you’re with me, that I’m asking these things of you, that I’m treating you this way, or that I’m still thinking about that one singer who you—” “Don’t apologize—” “I can’t promise that I won’t ask for something like that again, but I swear, I’ll make sure to—“

But Lawrence turned it down. Nora’s mother collapsed that weekend, and no matter what she told him, he refused to leave. He knew how distraught she was. He knew he was her support system.

“Nora, I’ve never regretted a thing,” he interrupted again.

“I’m sorry if I haven’t shown it enough. We promised to change the world… and you are my world.”

A thousand words swam through Nora’s mind but not one felt right. She could feel Lawrence tense up as the silence drew on, until she couldn’t hold in her laughter any longer. The stress and strain melted away.

“Another opportunity will come”, he’d said with a smile and a bouquet of comforting words.

That was four years ago. Now he was a remote contractor in a small town, splitting time as the joint-caretaker of his mother-in-law, and forced to drive for hours at 3 am during a blizzard for an apple pie that Nora no longer cared for. A hollow numbness gnawed away at the edges of her vision, but no tears came. It was time for a serious talk.

“That’s such a bad line.”

“I know.”

“I can’t believe you said that.”

“My bad.”

All the while, the falling snow continued. …

“Don’t tell me you planned that out years ago in case I ever asked. You dork.”

The sun had risen by the time the front door opened.

“I did.”

“I’m home!” Lawrence called out with a freshly laid crown of snow atop his head. “And I brought the pie— woah!”

Without looking up, Nora knew that a shit-eating grin was plastered across his face.

“I love you.”

Nora squeezed him tightly, ignoring the chill from the open door.

“I love you too. Now, I hate to say this but…” He jiggled the box in his free hand, wafting the nostalgic smell of apple through the air.

“Thank you so, so much. I love you. I—sorry,” she stammered out, as the fatigue of the all-nighter finally struck. “I know you gave up your dream for me. I know how much you sacrificed. I want you to know how much I

“Can 8

you let go?”

To Speak or To Suffer: Truth, Silence, and the Plague

By Alice Y.S. Li, Class of 2027

Prelude: This poem draws inspiration from Albert Camus’ La Peste, a novel that explores the devastating impact of disease as both a literal and metaphorical plague on human organisation, challenging the fragility of moral integrity. Camus argues that cycles of complacency and dishonesty, not viruses, are the greatest threat to our physical well-being and sociopolitical structures—issues that remain strikingly relevant nearly a century later.

As Camus famously writes, “La seule façon de lutter contre la peste, c’est l’honnêteté/The only way to fight the plague is with honesty.”

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Did you hear of the tale? Of the one who cried wolf, and indeed there were wolves?

The township of Oran, not yet enlightened clung to the false lifeline of ignorance — like goldfish, with their frail memories “La peste, it’s here!”, the doctor cried.

Contrary to what they would like you to believe, Death is seldom random.

Alas — out of sight, out of mind.

But nothing is without a price, and the ignorance that lined the pockets of few was paid for by the lives of many…

That was in 1947.

As time passes, even parasitic dynasties spread and grow and conquer— and with truth and uranium sparkles— they fall with deathly beauty.

Following this, we vow to learn from the err in our ways, from the lives lost “out of necessity”, and cheekily, we replace sounds of warfare with baby booms.

Today is March 17, 2025 You wake up, and your greatest worry is that it’s Monday.

The virus knocks, pleasantly, on your door with a wink (to turn a blind eye,) and a promise (of riches).

At least in medical school, we seemingly learn to tame such viruses, to not be tempted.

So, you engage in obligatory pleasantries, and continue with your morning coffee and the weekly copy of the Kingston Whig-Standard, until one day, this headline appears: You must have heard! A pandemic, that we long foresaw from a distance, has spread beyond repair.

And when this happens, what we desperately need are two miracle drugs: One to take off the edge, and another to restore empathy.

The time will come when outbreaks echo a siren song in every hospital corridor, And we labour on in the wards and the streets, like Sisyphus and his boulder.

Will we wield truth or let silence reign?

Blade by blade, we stand — but a scalpel unused is no sword at all.

If honesty is our only cure, then who will dare to hold the knife?

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Etude No. 11 pour les arpèges composés - C. Debussy Annotated by Alice Y. S. Li, Class of 2027

By Alex Chen, Class of 2027

The Medical Education Revolution:

Learning by Doing

By Hassait Hilawe, Class of 2027

O

nce upon a time, medical school in North America consisted of approximately 35-36 months of intense academic training regarding the physiology and pathophysiologies of the human body in every single organ systemalong with zero months of formal responsibilities to patients or within healthcare teams.

Medical education approximately 40 years ago was based on a highly severed curriculum. The roles and responsibilities of medical students were limited to just that- study. In their training, they had meager exposure to the highly applied nature of the responsibilities of care providers, despite the fact those responsibilities would be immediately put in their hands upon receiving a degree for textbook knowledge. These new practitioners were habitually slaughtered in this transition. The adjustment periodfrom key feature questions on a typical disease presentation to the emotional burden of being with sick people and bearing some form of responsibility for their care was beyond that of a steep learning curve. This time in North American medical education is marred by intern and resident burnout and PTSD, the likes of which are immortalized in medical fiction through the guilt, loneliness, and gory struggles of characters like Samuel Shem’s Potts.

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As medical students in this generation, we are beneficiaries of that suffering. Clinical skills courses serve us the opportunity to frame every missed question upon history taking, every awkward and incorrect exam maneuver, and every missed differential diagnosis as a customary step for healthcare students. Clerkship permits students a defined space in healthcare settings to develop the identity of the healthcare provider with real patients experiencing real conditions. Medical education has evolved to give students these opportunities to bridge their knowledge and duties as students with that of healthcare workers without the added pressure of significant responsibility for patient care. It has swung in the direction of its learners, and as a result, has made for a more sustainable care environment.

Medical education and medical practice have never and will never be without significant challenges and obstaclesthat is the nature of successfully learning any skillset. Despite these advancements, burnout is as common as ever. It is a near-universally accepted truth that the residency period includes certain cruelty to its learners in all medical fields. But the integration of student and practitioner identities is a small step towards building more resilient and effective learners and future physicians.

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empty nest

By Annie Liu, Class of 2028

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scarlet letter

By Anonymous

im sorry here i am again, how can this be? i thought i was better, i thought i was free. past my crimson eyes, what do i have to show for the struggles i faced, will anyone know? im sorry. that when a light push came to brutal shove i failed, i disappointed all those i love. i slipped back into my old selfish ways i forgot how to dream of brighter days. im sorry i just cant stop apologizing but what if thats compromising what rose-tinted truth lies beneath it all: i just keep going, even when i fall. im not sorry that the pain and fear have changed me altered my very brain chemistry im not the same as i once was and ill tell you why, because im not sorry that in my darkest doom-filled days when the world had pushed me to the frays i found the spark from somewhere deep within and nursed it back to the flame it had once been im not sorry that i never did fail, nor did i forget that every tear shed pays off a debt that i never owed nor ever will that my mind is strong though not still. im not sorry i change and i change and i change and although it may seem a bit strange every step is a step towards better and you can keep your scarlet letter.

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(Step 1: How to Stop a Tsunami Don’t) with a Human Chain

(Step 1: Don’t)

By Alyssa Reddi, Class of 2028

I

am afraid of death.

have been changed by the field and who themselves have changed it, and who are devoted to sharing their wisdom.

I interviewed three physicians, one each at the beginning, middle and end of their careers, and asked them about their experiences.

Not of my own – I’m strangely comfortable with the prospect of my life being cut short – but that of others. Of loves ones, of acquaintances, of people I hear about but whom I do not know personally.

Dr. Lori Minassian is a third-year psychiatry resident who graduated from the MD/PhD program at Queen’s in 2022. I asked Dr. Minassian what drew her to medicine.

“I’ve always been the kind of person that has been curious about the human experience. You might laugh at me when I say this, but I’m a huge reality TV fan, because they’re just displays of the human experience and how we interact and communicate with each other. Psychiatry is all about the human experience, and I like that”.

I have experienced loss many times, but still, it continues to be a fear that threatens to swallow me completely and suffocate me from within. I am so deeply afraid of losing someone, anyone, and not being able to do a single thing about it. I am afraid even to write this down, in case it comes into existence.

At this point, you may rightly be thinking: Alyssa, for you to actively seek to enter the field of medicine, in which our roles are inevitably intertwined with death, is a very timeconsuming, expensive, and elaborate form of self-harm.

I did not laugh at her. I have made a note to watch Big Brother for the purposes of my medical education. And I also asked Dr. Minassian what she thought medical school and residency would be like before she started: “I had a much more serious perspective on what I thought it was going to be like. But I was surprised at how kind of relaxed it all felt. I felt like I could actually find a really good balance.”

And perhaps it is. But the way I see it, I sought to become a physician because I want to help people. It is the answer we all have when asked why we want to be a doctor, but isn’t quite eloquent enough for a medical school interview.

Maybe I can’t do a single thing to help whoever it is I seek to help. But I can try, and every day I try not only to help people, but to become comfortable with the uncertainty that comes with this lofty goal – the idea that perhaps I can’t help at all – and that this is ok.

I’ve found that to be true. The workload is not impossible.

I personally have yet to encounter a Scrubs-esque, verbally abusive preceptor. And perhaps best of all, our class has had several lecturers bring us a variety of treats, and a papier-mâché red blood cell-shaped pinata, also filled with treats. I have high expectations of the secondyear lecturers. This effect has been so strong that when a lecturer says they have a treat for us, and it’s not edible, I must admit that I am a little bit disappointed.

This personal growth that I seek is yet to come. I will admit that I hoped it might come just by being immersed in the field of medicine. Unfortunately for me, that’s not really how change works. Even the uncertainty of not knowing if I will achieve one day this is bothersome to me.

But the non-edible treats are great too. It was during a “Pearls of Wisdom” talk that I first came across Dr. April Swoboda. She is a breast medical oncologist at Kingston General Hospital and a career advisor at the Queen’s

But in times of uncertainty, we turn to others for guidance.

I am fortunate to be in a field in which there is no shortage of physicians who have walked this path before us, who

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School of Medicine, and graduated from Brown Medical School in 2010. When asked about why she wanted to become a doctor, she shared: “My dad is a doctor, and I remember patients would come to our door at home and bring him things. He had a patient who brought him handmade shoes, someone brought him a ham, people just brought things to express gratitude. And I remember thinking, ‘whatever he does, I want to do that.’”

honest to god truth.”

When Dr. Moffatt graduated from medical school, she was one of only 18 women in a class of 78 people, which fascinated me. It was not so fascinating to her. “I think it’s hard for present-day women to appreciate how typical it was for men to be the majority in any professional or leadership position. It was normal. Certainly, in the classrooms, there were things that were sometimes hurtful, and oftentimes insensitive. I did get called some pretty ugly four letter names. But I was always able to say, ‘this isn’t ok.’”

I’d say she’s done it. Dr. Swoboda’s office is decorated with things that her patients have made for her. There is an incredibly intricate handmade table runner laid across her desk, a painting sitting on the shelf with her name on it, and a reusable Starbucks cup with different sizes and shapes of hand-drawn breasts on her windowsill, among many other things. Her workspace is a beautiful tribute to those whose lives she has touched. “...I’m a huge reality TV fan, because they’re just displays of the human experience and how we interact and communicate with each other. Psychiatry is all about the human experience, and I like that”.

- Dr. Lori Minassian

Dr. Swoboda said that when she first started medical school, she had no idea what her career was going to look like day to day – and it’s still changing. “Six years ago, I was a different person. I could not imagine that I would be doing what I’m doing now. The further I go, the more I realize you can make it what you want it to be. It’s part of the reason why I’m a career advisor.”

I asked her how this impacted how she moved through her career. “You weren’t expected to be as smart or to do as well, and that totally annoyed me. Where the rubber hit the road was having to defend my thinking, my clinical thinking. To some degree, you had to do better to be ‘as good’. I had to learn how to present myself in a way that was convincing, not offensive, not aggressive and such, but assertive and believable.”

This reminded me of that emotional scene from the Barbie movie, where America Ferreira recites her monologue about how impossible it is to be a woman. But at the same time, I did not feel badly, and Dr. Moffatt certainly doesn’t feel bad for herself – she is not a “fainting lily”, as she put it. No, it’s not ok, but as I looked at the person before me, I saw someone confident and capable, who helped pave the way for young women today, and that, to me, is incredible.

It is difficult for me to imagine having to do what Dr. Moffatt did – to mold herself to be more “acceptable” early on in her career, so that she could get to where she is now. She did not have an option – it was, and still can be, difficult to be a woman anywhere, in any field: “that was the society I grew up in,” she said. She was able to do the best with what she had.

Another faculty member at Queen’s that piqued my interest is Dr. Susan Moffatt. She graduated from Queen’s Medical School in 1978 and recently retired from her practice as an intensivist and respirologist, and from her numerous roles at the medical school. She is one such physician that bestowed Oreos and smarties upon us during her lectures on the mechanics of breathing, clad in bunny ears (if you know, you know).

Sometimes, there are other options, but they can be painful to arrive at. Dr. Swoboda practiced medicine in the American healthcare system before moving to Canada with her husband and children. The decision was one that came out of years of working in a deeply racist environment and system. “I was the only black oncologist that has ever worked at my institution, at Rush in Chicago.

When we had tumour board meetings, you could tell the race of the patient based on how my colleagues talked

We have Ben Casey to thank for bringing Dr. Moffatt to the field of medicine. “He was a neurosurgeon on TV. He had terrible communication skills, which I did not recognize as an 11 year old, but I thought he was amazing, and he saved people’s lives. And I thought he was handsome. And I just decided, that’s what I was going to do. That’s just the

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about them. They couldn’t see them the same way that I see them. I was watching my black patients die because of poverty, and mental illness, and systemic racism, and a lack of access. I kept trying to just put my head down and do what I’m told. But I couldn’t subsume my humanity, and my personality, and everything to conform to that system”.

those limits. And also, thank god it’s a learnable skill.

When I asked her what the biggest change she’s undergone has been since starting medical school, she said she has learned how to meet people where they’re at. I politely told her that I’m pretty sure it takes people years of therapy to learn how to do that, but she assured me that learning this skill has been gradual.

I have thought a lot about how fortunate I am today, to live in the time that I do, and to go to school in the place that I am. I think my life would have been exponentially more difficult if I was in the class of 1978, or if I went to school in Texas, where I was born, as a woman with brown skin.

Racism and sexism are certainly still a problem anywhere you go, and it truly wasn’t that long ago that Drs. Moffatt and Swoboda were students and fellows.

It is a skill that has helped her navigate her life outside of medicine as well, whether that be facing the challenges that came with coming out later in her life or managing times of change and uncertainty, like the transition from medical school to residency. “Whether it be patients, coresidents, friends, or family, it brings me a lot of comfort, because if I can just accept who you are and what you have to give to me, then I don’t stress about trying to get more than that.”

But, only speaking for myself, I see it and feel it much less than those who came even a decade before me. Dr. Minassian and I talked about this. “I think it comes hand in hand with social connection. When you’re isolated, you might accept that this is just the way it is. When people start talking to each other, and when people rally around them, we can say that we don’t accept that stuff anymore.”

“I can’t control other people. I can only control myself. When you actually stop and decide how you’re going to live your life, you realize that you have so much power.”

One thing that strikes me about Dr. Minassian is how confident and easy going she is. The first time we were planning to meet, she suggested we skip the menteementor mixer on campus and go to a brewery with our dogs. When I met her for this interview, she was about to go on a trip to Costa Rica. She has emphasized to me on multiple occasions that I should not study too hard, and especially not at the expense of my well-being. None of this was in alignment with the picture of a “double doctor” that I had conjured in my head.

Dr. Swoboda echoed Dr. Minassian’s sentiment about letting go of control: “I can’t control other people. I can only control myself. When you actually stop and decide how you’re going to live your life, you realize that you have so much power.”

This is easier said than done. Dr. Swoboda and I talked about the fact that many people don’t make profound changes to their life until they’re at rock bottom, and she is no stranger to this. After having her second daughter in 2019, the moral injury of working in a system that violated her beliefs so strongly had caught up to her, and she was having suicidal thoughts.

I wondered if she’d always been so balanced, and how she maintained it in what is often described as a very overwhelming, rigorous career. She told me, “You learn quickly that there are only certain things that are in your control. This might sound bad, but I don’t think it is, because it’s the truth. We’re not god, we’re not saviors, we’re a small cog in people’s lives. You have limits, and that’s okay.”

“I remember it was Memorial Day weekend, and George Floyd was murdered, then the American Society of Clinical Oncology Annual Meeting was a couple of days after, and it was virtual because of COVID. Everyone was posting pictures of themselves watching ASCO, and I wore my Black Lives Matter t-shirt, and I posted it on Twitter.

And I thought, is this too political, or this or that? And I couldn’t do it anymore.”

I hadn’t thought of it like this before – that being comfortable with uncertainty can mean knowing and acting within your limits, and letting go of what is beyond

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Dr. Swoboda took a leave of absence from work that summer and laid out her options with her family, and they ultimately decided to move to Canada. I’m thankful that she decided to come here, to Queen’s. “My husband says all the time; you can’t stop a tsunami with a human chain.

You have to put on your oxygen mask first. You have to take care of yourself,” she said.

able to meet the demands of the increasingly strained healthcare system: “There are always crises. The sense of impending doom and not being able to cope doesn’t help.

I think the trick is to be good at your job now. If you’re good it at it now, you’re the best you can be – and you’re not going to get worse.”

It truly did not occur to me that people don’t spontaneously get worse at their jobs.

I asked Dr. Moffatt if she had a sort of “turning point” moment in her life as well. “I thought watching was the same as knowing. It’s not. There’s a difference between voyeurism and experience”. She shared that during her early career, she had multiple miscarriages. “That taught me what it was like to be a patient. I had never really been sick, and I learned how important communication skills were. And then I decided I need to learn how to do this better.”

Dr. Swoboda told me something that she tells her patients: “my goal for you is to live as well as possible for as long as possible, in that order. You say that to enough people over and over, and you’re like, why don’t I do that for myself?”

I do think that, as people in a field that has a propensity for attracting perfectionists and very dedicated people, we tend to delay happiness. We tell ourselves, “I’ll be happy once I get into medical school” (or residency, or a fellowship, etc.), or “once I finish residency, I’ll have more time to start doing x” (insert whatever hobby you’ve always wanted to try or habit you’ve wanted to start but tell yourself you don’t have the time to). But life is happening now, and we should at least try to live it. I think that if we don’t set that foundation now, it will be more difficult to do it as life goes on and we acquire more responsibilities.

I think that Drs. Minassian, Swoboda and Moffatt are all exceptional people. Their titles, academic accomplishments, awards, and the fact that they also, simultaneously, manage to be incredibly kind and genuine people are what medical student dreams are made of.

So, I took note that they only really mentioned these achievements as context in our interviews.

When I asked what experiences have changed them most profoundly, it was not necessarily an MD/PhD, or a fellowship at a prestigious institution, or a position as director of the ICU. They do not identify themselves by their titles. The most important things they have learned were not from their degrees. I think that the difficult experiences that they shared with me are things that can break someone. But they did not break them.

Dr. Minassian shared her advice for me: “You never know what you’re going to be interested in, and I think just being open to seeing what you can gain from every experience is really important. Whatever you’re going into, think about what you can take from it and how it’s going to serve you.

That, and forming connections.”

So, the tsunami will still come. That is the only certainty.

There could be multiple tsunamis. Perhaps they will be present in both my personal and professional life, and possibly at the same time.

There are some things that you can’t learn in a classroom.

They come with time (longer than the 6 months I’ve been in medical school, I’ve learned) and experience. In speaking to these three physicians, I have reflected on the fact that growth, especially the kind that I seek, is slow. It is not something that happens all at once, or something that starts and ends. It is continuous. It can be uncomfortable, even painful. It requires effort, and reminding yourself, and then reminding yourself again, what you’re doing this for.

But maybe I’ll find higher ground and go there. Maybe I’ll evacuate the moment I get the warning. Either way, I need to remind myself that I won’t try to stop it, because I can’t. It probably won’t get easier, but I will get better at handling it, and I’ll take things from it. I can get through it and carry on.

Dr. Moffatt gave me a pearl that was so simple yet immensely helpful when I shared my fear of not being

Thank you to Dr. Lori Minassian, Dr. April Swoboda, and Dr. Susan Moffatt for sharing your experiences and insights for this article.

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When We Choose

It begins as sparks. A gentle flicker, disturbance.

Nothing too serious. We all brushed it off.

An insignificant change, pointless worry— Because it didn’t impact us, we felt no need to care.

That it would handle itself. That we could leave it there.

0.06 degrees per decade, researchers report.

Barely anything, we reason.

Any sunny day is hotter than that.

We sit in our houses, complaining about the cold, Simply unaware of stories and experiences untold.

To Ignore Poem by Enoch Yu, Class of 2028

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Beneath the Bloom Illustration by Mona Golmohammadzadeh, Class of 2028

A fisherman returns to his home.

It’s torn.

Ravaged by a typhoon. He senses that he’s losing grasp Of safety. Family. Community. His ground.

This wasn’t the first. Each time, more profound.

A maize farmer counts her crop yield.

There’s not enough.

She thinks back to droughts she’s been through.

Increased warmth. Less arable land available.

She feels like it’s her fault. Yet, we know—there’s more on the table.

A group of hikers exit the clinic, troubled Over conditions they never thought they contract: Lyme disease, from tropical ticks.

Heat caused their northward expansion, And now, they caused something we wish we took earlier action.

As countries cut pledges for change and hesitate, As executives balance profits and our fate, I sometimes wonder: how much do we need for global action?

How many extreme weather events must we tour?

How long can we overlook its impacts—one’s others across the world endure?

We’re the first to witness the cracks in our eyes, First to hear the silence, the first to question why.

With knowledge and care, we must take a stand, No longer bystanders, but of change at hand.

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FEAR IN THE FACE OF UNCERTAINTY

By Cindy Wen, Class of 2031

S

ometimes, I am scared to change.

Maybe that’s a bit of a generalization but let me explain.

Medicine has been defined by its rapid metamorphosis and ground-breaking innovation, which reflects a commitment to scientific inquiry while standing as a testament to human resilience. From the development of lifesaving medications to advancing new models of care delivery, we can consistently expect advancements in this field.

As I slowly navigate my journey to becoming a physician, I know that I am committing to a lifetime of embracing change, especially since the one constant in medicine is that we know it will never stay the same.

But does that mean I should change with it?

Yes, to an extent. It would be unrealistic and naive to say that I shouldn’t change. My fear isn’t inherently rooted in the development that naturally comes in parallel with practicing medicine. I look forward to developing strong clinical aptitude, hands-on skills, and feeling more prepared to serve people and my local communities. This inevitable change is what excites me and I will undoubtedly continue to welcome it in the future.

Rather, what truly terrifies me is losing sight of myself and my ‘why’.

In my undergraduate years, I spent a lot of time self-reflecting on what kind of person I wanted to be and which values I wanted to reflect. I engaged in activities that allowed me to explore my emotions while dissecting my lived experiences to find a sense of purpose. This ranged from artistic pursuits, community advocacy, to scientific research – I did anything and everything to find the invisible string that tied everything together.

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The accumulation of these experiences then sparked a deep desire for a career working at the forefront of vulnerability, human connection, resilience, and storytelling. I wanted a space where I could be challenged intellectually while also centralizing this curiosity on connection. This is what medicine means to me. The immense privilege of being able to ask: how are you feeling? What is your story? How can I help heal your body and mind to make you feel well equipped to continue forward? And what matters to you?

Losing sight of this shared humanity is what frightens me.

With the ever-changing landscape of social and political uncertainty, these system-level drivers will begin to insidiously seep into our healthcare system and fundamentally change the way medicine is practiced.

We are seeing historical changes in our social environments and leadership, both within our country and beyond it. As much as we hope to separate medicine from these factors, they are unfortunately deeply intertwined. In our system, personal health experiences and a physician’s scope of practice are predominantly governed by the intersection of socio-political, economic, cultural, and environmental circumstances.

Hallway medicine, our aging population, increasing complexities in caring for equity deserving communities, the primary care crisis – just a couple of problems on a growing list of burdens to our healthcare system. They will continue to accumulate until our broken system can no longer hold everything together, leading to a cascade of downstream harmful effects on providers and patients.

Everyone is tired – burn out, compassion fatigue, staffing shortages, and poor patient outcomes are pervasive problems at the tip of the iceberg. The future transformations of this field are unknown.

How will I hold up in this system of uncertainty? Will these factors weigh heavy on my heart and dim the light of my compassion? Will I disconnect from part of my humanity?

It’d be easy to say that navigating this system will never change me, but how truthful will that be?

Just as I can’t predict how medicine will change, I can’t predict how medicine will change me. I can only hope that in the midst of this ambiguity, my heart remains tender and that I will become more resilient in my kindness. I will continue to reflect on my values and place my ‘why’ at the forefront of my mind.

I hope as a profession we will rise above these adversities and uphold the central values of empathy, humanity, and curiosity, while collectively unwavering in our commitment to care.

Although I am still afraid, I am comforted knowing that I am not navigating this metamorphosis alone.

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THE CABIN

By Jake Howran, Class of 2027

In the same way Pine is sculpted by tender Tactful Intentional glides of the plane

Bold is the beauty of change Undercurrents Underkept Overwhelmed

In the same way Sap fossilizes to amber To hold the gentle hand of time

Be it by nature Be it by choice

Why don’t we see the old cabin The same way we see the ruins of Pompeii?

Be it the bark peeling from the logs The mossy eutrophicated sunken roof The goodness of the air The shyness of the rot

Why do we appreciate the aged body less Than the metamorphosis of the butterfly?

The cabin is a body

When change is now When change is later When change was before

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Quiet is the subtlety of change

In the same way Woodfire is stoked by sturdy Sleepy Aching swings of the axe

Under wraps Unspoken Overseen

In the same way Nails decay to rust Against the calm whisper of rain

Be it by necessity Be it by grace Be it the fractals of light Glinting off the dusted broken glass The kindness of the sun The pride of the roots

Why don’t we laugh together When this air is shared between us All? Why do we offer less to those Who we will soon one day become?

The cabin is a body In the same way Woodfire is stoked by sturdy Sleepy Aching swings of the axe

The cabin is a body The cabin is a body The cabin is a body

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Sunset Factory

By Maggie Liu, Class of 2028

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Revolutions

By Amireza Nikzadfar Goli, Class of 2027

9-2: Hypotension

By Saloni Aggarwal, Class of 2025 RL64, POD2 admitted for cecal volvulus secondary to adhesion…

RL64, POD3 admitted for cecal volvulus secondary to adhesion…

RL64, POD4 admitted for cecal volvulus secondary to adhesion…

RL was the first patient I ever met in clerkship. It was 6:15 am on Kidd 4 – general surgery. The first time I saw her, I was taken aback. She did not look well. Her skin was pale and waxy. Her eyes were sunken. Her voice was weak. Her smile was gummy. I did not want to touch her. I never even spoke to her. I scribbled the obligatory note as my senior asked her questions. I charted the labs, signed my name sloppily, and ran behind the team to see the next patient. It was not an impressionable learning experience.

RL was discharged midway through the third and final week of my rotation. She had been asking about discharge every morning. When she was told that today was the day, her husband picked her up immediately. RL saw herself as a youthful person, full of life – and in that moment, maybe she was. She left before anyone could even give her the discharge summary. I started my emerg rotation the next week, and I did not think of her again.

My emerg rotation was slow. My preceptors pre-screened the patients, and had me see the stable ones. I did thorough histories, less thorough physicals, and did not present plans. I logged my encounters carefully, keeping track of the mandatory cases I was missing. By my eighth shift, the only thing left on my list was hypotension. My preceptor and senior resident said they’d try to find one for me.

After my first patient, the resident got me to see someone in a-fib with soft hypotension (100/75). By the time I finished the H&P, the repeat BP was 125/85, but I figured, close enough. I hovered at the desk, waiting for someone to review with me. Then I heard my staff on the phone – “I have a patient for you. R- L-. I’ll give you the CR. She was admitted last month for an enterocoelic fistula….”

I was shocked. Was this the same RL?? I wondered what had happened. I was going to ask him if I could see her. She was my patient. And then a VSA rolled in (about as hypotensive as you can get) and I had no time to think about RL anymore.

The resident was excellent. She prepared the trauma bay and told me that if appropriate, she’d have me do compressions. I steeled myself. I hoped she would forget. I tried to make myself invisible in the room when the patient arrived. Instead, the resident had me get a stool and go to the bedside. I started compressions. I lost any sense of my speed. Faster-faster-faster was all I could think. My arms hurt. My abs hurt. My elbows were definitely bent.

After 25 minutes, the staff called the time of death. The resident took me into the hallway. She told me about her first resus experience. I told her about my grandfather. I didn’t feel like she understood. I did not know how to make her understand me. We went back.

The staff was in another room, and we joined him. It was RL. She was hypotensive. I was 3 for 3.

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RL did not look well. Her skin was pale and waxy. My staff had me pull the skin on her hip, so he could get femoral line access. He was teaching me. I was interested. I wanted to know what brought her back to the ED but this did not seem like the time to ask. Her blood pressure was still dropping – 60/40. Another staff stepped in to start an IO. This too was interesting. RL was in pain. Her husband was hovering. My staff reassured her. I did not.

I wanted to tell her, or her husband, that I knew her. That I had seen her every day for 2.5 weeks in September, and written her note every morning. That I was so sorry to see her here again. But I didn’t. She wouldn’t remember me – I had never spoken to her. I had never met her husband previously. Compared to her, he looked young and healthy. A stark contrast.

Once the situation stabilized, the team stepped out. My staff handed over to another staff, who was going to write the note. I listened to him explain the history. The enterocoelic fistula. I was confused. I wanted to tell him about the volvulus, the adhesions, the poor wound healing – the hemicolectomy in July. I wanted to tell him that I knew her. That this was my patient.

“Goals of care?”

“Unsure.”

“Let’s go ask.”

I hung back. I went to sit. The resident brought me back in. “You should hear this,” she said. “It’s a good learning experience.”

My staff presented the options clearly and without bias.

“They’re asking you if you want to die,” her husband shouted at her.

“No!!” she cried.

“NO. No. This is not what we are asking,” my staff said. He tried again. He explained to her that she was very sick, that she was going to ICU. RL opted for full code. She wanted everything to be done for her.

I wanted to shake her. I wanted to ask her if she understood what that meant – the tubes, the lines, the procedures. How awful it would be to experience. She was sick. She was dying. She was not going home. I would have signed my own DNR in that moment. RL did not understand. She did not see herself as a dying woman. She saw herself as the vibrant woman she once was. We left the room.

I looked her up a few weeks later. EXPIRED, the top of the chart read. The last note in her file was from an ICU physician, explaining that she continued to decline. The family then opted for comfort care only, and 48 hours after her presentation to the ED, she passed away. I read her previous discharge summary. She had indeed returned to the hospital in October, for an enterocoelic fistula. She was a sick woman. She was only 64.

I looked for her obituary a few days ago, but could not find it. I will never get to know the real version of RL, the woman who she was eager to be when she left Kidd 4 in September. Being in the hospital had changed her role and her place.

But RL taught me that patients are not cases. They are people – even when they are dying. Especially when they are dying.

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S lipping through her memories, in due time

By Anonymous This is a semi-fictional series of brief journal entries written by a young woman whose mother has early-stage Parkinson’s disease. The daughter records her thoughts and emotions in the several months following the diagnosis to process and cope with this life-altering event.

March 29, 2007 The neurologist at the hospital called me this morning to confirm her diagnosis: Parkinson’s. It made me think about how countless calls like this are made to families every day. So, this is what it’s like. I just stared out my office window for several minutes, my mind as blank as my stare, and eventually back at my computer screen. I thought I’d shed more tears like they do in the movies. Maybe it hasn’t fully hit me yet.

I’ve always been slower to process news, of all sorts.

March 23, 2007 So far, I’ve called one friend. Not my closest friend, but I trust her. Her mother is currently going through rounds of chemotherapy, so she understands what it’s like to care for a sick parent. She suggested that I try journaling. I can’t imagine wanting to reread and relieve the inevitable moments ahead, but I suppose this process of letting my thoughts out can be cathartic.

By the time I called my mom, she already knew. She sounded calm and unsurprised. “It’s just the way things are,” she said in a flat, monotone voice. Older adults often say that they’ve learned to care less, and I suppose it’s good

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that she’s carrying on. Part of me still wishes she cared more about what’s happening to her though. Another part of me suspects that she cares a lot and just doesn’t show it. She always changes the subject whenever our conversations turn serious or existential. Maybe it’s easier that way.

April 15, 2007

also wondered what life is going to be like when she’s gone. To be honest, it feels like parts of her are already gone. What am I going to do with all her belongings?

What’s going to happen to my dad? I wish I had a sibling or more relatives around. Family seems so fragile right now. Everything feels heavy and empty at the same time.

July 24, 2007

I’ve noticed my mom’s hands trembling more than usual. Her body has also gotten weaker since the last time I saw her. My dad mentioned that she’s been walking more slowly and lying down more frequently.

She glared at him because she doesn’t want me to worry, but it’s obvious that her disease is progressing.

I woke up late today, dreading the appointment that would reveal more information about my mother’s prognosis. I held her shaking hand when the neurologist told us that patients at her stage have on average 10 years left to live. It was evident that the shaking was simply due to her disease, as there was no fear on her face. She’s already accepted the circumstances. I’m still trying to.

I hate seeing her like this because it’s not who she is.

She’s stubborn by nature and doesn’t let people see her struggle. The other day, my dad was on the phone with one of his friends and let it slip that my mom was diagnosed with Parkinson’s. She was so upset, and I could understand why. Not only was it so incongruent with her sense of self, but it was not his news to tell.

We spent the rest of the afternoon wandering the local shops and farmers’ market downtown. There wasn’t much to say, but we commented on our surroundings here and there. We bought more baskets of figs and apricots than we needed. She took over a minute to open her wallet. I pretended I didn’t notice and made mindless conversation with the vendor about the fresh honey on display.

May 28, 2007 My mom was watching a medical documentary on TV this evening. I have no idea why she would want to when she’s going to the hospital more often than anywhere else these days. At least she looks forward to her appointments. Her doctors and nurses have all been kind and professional.

“You should’ve gone into healthcare,” she said, “They seem really happy.” I wanted to roll my eyes and reply that things aren’t always the way they seem on the outside looking in, but I smiled tightly and stayed quiet instead.

July 6, 2007 Lately, I’ve been swamped by this unspeakable sense of guilt. I don’t always look forward to seeing my mom. I’ve

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A Study in Discovery

By Rihana Kukkadi, Class of 2027

NOSMO KING AND THE BEHAVIOUR CHANGE PARADIGM

By Tim Song, Class of 2028

O

ne of my key childhood memories is spending hours at my local library reading a children’s book series called “Ramona Quimby” by Beverly Cleary, which features slice-of-life stories from a young Ramona and her family’s life.

reading “NOSMO KING” instead.

This story was relatable to me, and probably all the other kids out there with heavy smoking fathers. The smell had always upset me even before learning that it could make your ‘lungs turn black’, and I made it known apartment-wide that I was not about this smoking business. Second-grade Tim thought that Ramona’s idea was genius! Attributing Ramona’s failure to her inability to space out her letters well, I made sure to plan ahead to avoid any unfortunate spacings and wrote up signs to place all around my living room. As if a simple spacing error was all it took for me to succeed where Ramona had failed! I had even tried implementing new strategies – hiding my dad’s cigarettes, putting his ashtrays in the cupboard, and writing on every single birthday card since age 6 that I wanted him to stop smoking. I tried all that I could.

To a young, impressionable child such as secondgrade Tim, Ramona was the top dog in informing me how children in North America act their age. I thought she was so cool with her American older sister and American parents – something I seldom saw in the Korean immigrant enclave where I was raised.

A scene that particularly stuck with me for years was when Ramona tries to get her dad to stop smoking.

Upon learning that smoking can make your lungs turn black, a horrified and worried Ramona begins writing signs to put around her house as a form of anti-smoking propaganda. Unfortunately, her poor planning while writing her sign leads to it comically

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Out of spite, ‘no smoking’ retained its place in my dad’s birthday cards for years to come.

a year. I was excited to see where this role would take me, and who exactly I would help get motivated to get on their feet. ‘I’d never done this type of work before,’ I thought to myself.

Behavior change was a lot more difficult than I had expected. General reception to the program (and obviously my stellar performance as a research coordinator!) was extremely positive. My participants raved about how they enjoyed doing gratitude and perseverance exercises, and how much they found them helpful to support their wellbeing. One of my participants enjoyed the program so much that he passed it along to his golfing buddies, and another woman had her mother and sister try to sign up because she found the program entertaining. I felt like a successful salesman; look at how many customers the program had gathered! Awaiting study follow-up data from some of my biggest program enthusiasts, I eagerly awaited to see great improvements in their activity. It thus came as a shock to me when I extracted one of these enthusiasts’ study data only to find that he had logged very minimal physical activity.

This left me to ponder the program’s efficacy. Clearly there were psychological benefits to this program; but where was its impact on motivation and our most important outcome measure of physical activity?

Unfortunately, Ramona’s tale ended up being more idealistic than my own situation. While Ramona’s father began to slowly make his way toward smoking cessation, I was punished for touching my father’s things – and my carefully and correctly spaced NO SMOKING signs made their way to the recycling bin.

Out of spite, ‘no smoking’ retained its place in my dad’s birthday cards for years to come. I was resentful.

My plan was supposed to be perfect and miles better than Ramona’s – what had gone wrong?

As years passed, I eventually moved out for college, and with distance came a kind of forgetting that slowly eased my disdain for the scent of tobacco smoke. Moving away from home meant I was no longer exposed to the smell of burning a cigarette on the daily. The hustle and bustle of independent living gradually replaced the memories of my father sitting outside of our house after dinner, listening to the chirping sounds of starlings with a lit cigarette in one hand – and the rancid odor of the offending device along with it. On the off chance that I walked past a dorm party and caught a whiff of cigarette smoke, I cringed to myself privately and went on with my life. As easily as smoke dissipates in the wind, my memories of being a junior smoking cessation warrior faded from my memory.

As I cycled countless participants through my program, I quickly learned about the widespread distribution of how ready people were to make a commitment to increasing their physical activity. I encountered patients who were initially extremely motivated to begin the program, but would ultimately end up dropping out of the study before they even scheduled their first session with the study trainer.

On the other hand, I also had a participant who was already planning on getting back on their feet after a long history of inactivity, followed by recovery from a recent injury. The grueling recovery process had motivated this participant to exercise more regularly, and they used the program as a springboard to truly

After finishing my undergrad degree, I found myself working full-time in a clinical research lab, where my job was to launch and coordinate a brandnew motivational interviewing program designed to promote physical activity. After recruiting and screening potential candidates over phone, I would guide my participants through the program and follow-up with them intermittently over the course of

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take action. In one of my coworker’s similarly designed projects for patients with heart failure, a participant even lost almost 15 pounds from adherence to a healthy exercise and diet routine.

Amidst the range of participant readiness levels, I consistently received generally positive reviews from healthier, happier participants.

body’s own health limitations, he was desperate to get back to exercising – but his responsibility as a caretaker ultimately came first.

Those actively experiencing moderate-to-severe depressive symptoms were excluded during screening calls, as the program’s motivation-based techniques weren’t as effective in this population.

This proved to be true when one of my participants diagnosed with clinical depression (who had been feeling positively on the day she was screened for the program) ultimately ended up dropping out without finishing the program. She remarked: “How can I complete this gratitude exercise, when I have absolutely nothing to be grateful for?” Though she wished our team well, it was clear that the program didn’t resonate with her lived experiences with depression. Some declined to join the program simply because the program’s focus on well-being just didn’t align with their values, highlighting the impact of mental health stigma and the mind-body connection. Conversely, I also encountered patients who declined to join as they already had their needs met by mindfulness-based or yoga/meditation programs through their care homes or workplace benefits. Though community-based phone outreach was tricky and relatively low-yield, it brought precious moments of pleasant surprises when those who just needed that extra push to get started found value in the program.

Social determinants of health played another key role in how my participants engaged with this program.

One of my favorite participants was an Uber driver; there was not a lot of room in his day to get his exercise in, especially when he was stuck within a mechanical box for most of his waking day. He began parking further from his house to force himself to get more steps in - a recommendation given by one of our clinical psychologists, who similarly would run up 12 flights of stairs to her office every day instead of taking the elevator. Another participant worked a time-intensive office job, where his tumultuous schedule meant he needed to improvise with time management and multitasking – for his weekly phone sessions in the program, he would take the calls during his lunch break while taking a walk around outside his office block. This way, he was able to fit in his session calls while also getting in his steps. He often scheduled gym sessions at dawn and dusk hours to avoid being called into work, where he also had a standing desk.

However, these creative liberties were not available to everyone. Eventually, I had a participant apologetically withdraw due to how unfeasible it was for her to fit in the program into her schedule, never mind any extra time to increase her physical activity.

The additive effects of physical and emotional stress in working two different full-time jobs took its toll; this participant’s health unfortunately began to decline, until she inevitably had to take time off work.

Another participant was a caretaker for his wife with deteriorating health conditions. Recognizing his

In an alternate universe where research coordinators somehow reached out to my dad about a smoking cessation program, I wondered how far my dad would have made it in the research process through the theoretical program. It was a shame that even having access to research initiatives came from a position of privilege; my family never experienced psychological proximity to Canadian healthcare systems, never mind a big research hospital with health-based programming. Phone-based outreach

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would never have worked for us anyways, my dad only has a work phone and doesn’t pick up unknown calls.

As a young child reader, one detail I (understandably) overlooked was that just prior to Ramona’s declaration of war against cigarette smoke, her father had been laid off from his job. I don’t think that 8-year-old me had any idea of what that even meant. As both my parents worked late, I was in agreement with Ramona in thinking that it was great to have dad at home for longer. At my grown age of 24, I now recognize how unbelievably stressed Ramona’s father must have been to be jobless while responsible for his wife and two young daughters.

Cigarette smoking was probably one of his few outlets of release, and yet he was shamed by his daughter for attempting to take refuge hiding within the fiery fumes. Despite potentially being placed in a humiliating, frustrating position – Ramona’s dad is able to rely on the strong social support that he has in his family in order to make baby steps towards progress, despite the hardship that he is facing with job insecurity. It would be impossible for me to draw parallels between Ramona’s family and mine when it came to individual circumstances. Having freshly immigrated to Canada and working long hours at a sushi restaurant for the first time, my father had absolutely no one to rely on within a 10,000 km radius.

His Asian cultural values further perpetuated a lack of emotional openness, meaning that there was no hope for whatever little social support 8-year-old me could offer to provide any help for my father. Prior to immigration, my dad used to work in an office setting in South Korea, where smoking culture is commonplace and even socially necessary to make career advances, key transactions, or networking connections. It was odd and off-putting to be a non-smoking Korean man in the 1980s-early 2000s.

Navigating this culture and knowing it as truth for his whole life meant that smoking cessation brought cognitive dissonance to my dad. He could barely speak English as it was – now he had to adapt to the cultural norms as well? Ultimately, my father’s priorities were on making sure that we had enough

While pondering how my enthusiastic research participant had logged so little steps after the program, I received an email from the research coordinator collecting self-reported data from that same participant for their follow-up timepoint. The email stated that my participant had sustained an injury, which had prevented him from being on his feet as usual. With a nod of understanding, I logged the account into the adverse event tracker. Everyone experienced setbacks, which were normal and to be expected. For some in my program, walking 15,000 steps a day quickly (and impressively) became a norm. For others, they celebrated walking 3,000 steps because it was nearly double that of what they had when starting the program. Then for some, signing up for the program, even if they ended up dropping out, could have been a step towards change as well. One participant that I tried to schedule ended up rescheduling his appointment countless times until I eventually was unable to get ahold of him. He had attended his original appointment with his son; I instantly recognized the familiar scent of heavy tobacco smoke on his jacket as he entered my research office. I couldn’t help but return to that alternate universe, to ponder if I could have similarly taken my father to a research study to enroll him for a smoking cessation program: What would have been his reaction to doing very individualistic, well-being focused exercises, coming from his background of a very collectivist mindset?

Ultimately, my father’s priorities were on making sure that we had enough money to live another day, not quitting smoking when it was his only source of release.

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money to live another day, not quitting smoking when it was his only source of release. He wasn’t ready to make a change – emotionally, culturally, or socioeconomically. Nothing that I could have done at that point could have changed my father. My dad will just have to excuse my poor timing as I was an impressionable young lad who was just afraid of black lungs and hated cigarette smoke.

smooth transition from Korean to Korean-Canadian values, and his smoking drastically reduced. My dad still occasionally smokes here and there when I visit home, but I know that he’s trying his best to cut down. Ultimately, behavior change is much more complex than a simple step-based model that we learn in medical school; and one-size-fits-all programs can be as fruitless as Ramona’s ‘NOSMO KING’ signs were. For Ramona’s family, it was the unconditional support for her father in between the lines of the signs that brought about change. For my family, it was the small steps toward progress that were backed with many social and cultural sources of support. At the end of the day, identifying these avenues of unconditional care, wherever they may be rooted, may be what truly plants seeds for behaviour change amidst whatever life circumstances that may be placed in front of our future patients and loved ones.

As we eventually settled into a more stable life in Canada, my dad slowly began making changes to his smoking habit. My mother helped him slowly make a transition to e-cigarettes through a (forced) Christmas gift. Getting a wiener dog for our family, who kept getting allergic skin reactions, also meant that air pollutants needed to be few and small.

The biggest push was joining a Korean-Canadian church community that didn’t support smoking.

Finding a new cultural community adjacent to what my father was used to meant that there was a

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Work in Progress, Working Together

By Ivan Quan, Class of 2028

ChatGPT: make a poem about away electives in medical school, how you never have badge access, no access to scrubs, your computer login for whatever EMR you’re needing to use does not work even though you had to attend a 6 hour training for it your first day, how you get lost, you never know you you’re looking for, your stuff is shoved into the corner of a random room that you don’t know if youll ever find again, youre living in the most random air bnb basement apartment and youre eating the weirdest combinations of foods

The Away Elective Odyssey

- as prompted to ChatGPT

Disclaimer: The following piece, “The Away Elective Odyssey,” was created with the assistance of ChatGPT and is intended purely for literary and artistic purposes. It is a playful, imaginative interpretation of the away elective experience and should not be taken as a factual or personal account. Authorship is attributed to the collaboration between the user and ChatGPT for creative expression.

By Jessica Morris, Class of 2025

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Oh, the away elective, a trial by fire, Where dreams of learning and growth inspire.

But tread lightly, for chaos reigns, In hospitals’ labyrinths and far-off domains.

No badge access, you're locked outside, Peering through doors with patience tried.

Scrubs? A mirage, elusive and sly, As you wander the halls with a questioning "Why?" The EMR looms, a digital beast, For six long hours, its quirks you’ve pieced.

But day one arrives, and what’s the decree?

“Your login’s broken—call IT.” Lost in corridors, signs lead astray, “Am I even in the OR today?”

Faces abound, but none are the one, The attending’s a phantom—your search isn’t done.

Your bag sits exiled, in some hidden nook, In a room you once found, but where did you look?

It’s tucked by a desk with a forlorn chair, Will it remain when you return? Who’s to care?

And the Airbnb—oh, what a delight, A basement abode with questionable light.

You dine on creations both odd and bold, Rice with ketchup, and beans gone cold.

Yet through it all, you persevere, Learning, adapting, pushing through fear.

For this is the crucible, the med student’s plight, The chaos that shapes you, the forging of might.

So raise a toast to this rambling quest, For in the absurdity, you’ve done your best.

One day you'll laugh at these tales of yore, The legend of electives forever lore.

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DR. SAMSA? Short Story by Alex Pipchuk, Class of 2027 Illustration by Sarvesh Ramlochun, Class of 2027

A

s Gregor Samsa awoke one morning from troubled dreams he found himself transformed in his bed into a renowned doctor.

without fault. The room gave him attention as he eloquently described the details of each patient’s presentation and the nuances of his proposed surgeries. “How did I get here?” Gregor thought. He looked around and saw that his colleagues were nodding along in response to his proposed treatment plan.

“This is weird,” Gregor thought. Only last evening he had been a medical student. He explored his newfound body and discovered that his hands were calloused and strong.

He felt coordinated in his movements and in his mind he sensed vast knowledge without recollection for having learned a single fact. On the walls of his room were hung numerous awards, diplomas, and framed certificates from prestigious institutions.

His presentation concluded and few questions were asked, which he addressed with confident and rational responses to the approval of everyone. The team began to disperse and he found himself in conversation with 2 of his fellow attending physicians. His thoughts searched for something more but from his mouth he heard only medical jargon, sensible and perfectly delivered and understandable, but to Gregor’s mind it sounded like the chitter of a giant insect.

When he met the gaze of his reflection he felt a sudden feeling of regret and longing.

“I’m just a student …” he thought. Although he felt no sense of imposterism – his skills and knowledge were apparent in this form – he had begun to experience an overwhelming sense of dread at his predicament. As his 2 colleagues dismissed themselves, he tried to explain the situation but instead from his mouth came more chitter and they left the room.

With control he swung his feet onto the plush carpet of his bedroom and moved to a mirror where he examined his new form. His reflection was unmistakably an older version of himself, weary and tired, but well puttogether and handsome. His forehead was creased but not overwhelmingly so, his cheekbones high as usual and his jawline well-demarcated, his face overall taut and somehow hollow. When he met the gaze of his reflection he felt a sudden feeling of regret and longing.

“Good morning Dr. Samsa” they said.

Alone, Gregor felt his body begin to tremble. He stooped and felt uneasy on the ground as his hands began to tremor subtly. Frantically he tried to recollect the happenings of the previous weeks that may have contributed to his sudden metamorphosis. To his great frustration, Gregor could recall nothing except the contents from his last month of lectures. “What had happened?” he thought with increasing uncertainty. A nurse entered the room and told him that his first patients of the day were here and would be ready for him shortly. His thoughts cleared, his posture righted itself, and once again he felt somewhat soothed despite his unresolved crisis.

“Good morning.”

“Of course. I’ll be right there, thank you.”

Gregor’s legs took him to the meeting room where he greeted his peers and began to prepare the materials for discussion of today’s cases. When he spoke, he found that his words were precise and that his presentation was

Automatically his body began taking him through his clinical tasks – today he had several urgent surgeries booked and was covering any new cases in need of emergent assessment and intervention. He settled at

An alert on his phone told him that grand rounds were beginning in 45 minutes, and that he was to lead. He dressed and ushered himself to the hospital parking space designated for his exclusive use. The hospital staff greeted him with respect as he entered his workplace.

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his desk and began reviewing the details he would need to perform his duties. His fingers deftly navigated the computer system as he took in the information from his charts, noting each patient’s clinical history, exam findings, and investigations and triaging the order of his day. He noted in his new mind a supreme ability to process this type of information, and he felt a strong satisfaction which lie in stark contrast to the terror of a few moments ago.

His first patient was Mr. Prázdny, a 67-year-old Czech man who had just come in with a dissected aorta. If there was any chance of saving this man’s life, he had to be first.

“Hello” he said as he entered the room. But instead from his mouth came “Good morning Mr. Prázdny. My name is Dr. Samsa, I’ll be the surgeon taking care of you today.”

Throughout his day at the hospital, Gregor was impressed with his newfound medical mastery. On the wards, he assessed patients with stunning efficiency. In his intuition a perfect solution presented itself to each new medical puzzle – diagnoses came quickly as he drew upon extensive knowledge to identify subtleties in his

patients’ presentations. He nodded empathically as the patients explained their concerns and reassured them to their great satisfaction, but surprisingly he felt little by way of a genuine emotional response. Hospital staff seemed to marvel at his abilities and trainees watched on in admiration from a respectful distance. As far as Gregor could tell, he was practicing perfect medicine.

In the theatre he operated with uncanny speed and precision. His hands remained steady and in his chest he felt a strong beat that was undeviating. He moved with intention in coordinated and detailed maneuvers while directing his team with appropriate, respectful instruction.

No one questioned his requests; there was no need. As the room whirred around him Gregor maintained complete focus on his procedures. He felt as though he operated with 3 sets of arms, noting an almost godlike quality to his actions. Blood spurted from the patient as he made his incision, movement and anxiety escalating within the room as frenzied staff went about their duties. He removed a ruptured spleen and sutured his surgical window.

Mr. Prázdny awaited him in the post-operative ward.

Gregor had treated him with great skill, deftly navigating

He had sacrificed himself wholly to his profession, thrown himself into a pristine river and had never resurfaced to return to shore, swept away by its alluring current and sustained by it in itself. the heart and great vessels as he reattached the man’s split aortic wall, saving his life. Mr. Prázdny had been a music teacher in Prague before following his granddaughter to Toronto, where she performed as a violinist. She was playing the instrument softly for him now as Gregor entered the room.

In his training he had neglected to attend to his soul, and it had since shriveled and was now maintained only by the meaning found in his work which was undeniable and true, yet he yearned for something more. He had sacrificed himself wholly to his profession, thrown himself into a pristine river and had never resurfaced to return to shore, swept away by its alluring current and sustained by it in itself. But he had since lost an appreciation for its beauty; he could no longer admire the flowing water as he once did and was left with an unshakeable feeling of emptiness only numbed by submerging further.

“I want to thank you,” the man said, “for giving me the opportunity to hear Naděje play once more.” Gregor accepted the thanks and expressed his contentment that the procedure had gone well and that Mr. Prázdny had a good outcome. He spoke regarding the plans for postoperative management as the man and his granddaughter smiled at him, relieved and grateful to be reunited. As he continued, the Czech man watched Gregor carefully, as if he saw deeply into the entirety of his being. The admiration on his face slowly turned to careful contemplation, and then … a twinge of disappointment?

In him he searched but could not find the strength of character required for individual moral thought. Dr. Samsa was a good man but only insofar as his environment encouraged him to be good. Another river, another time could have carried him, unquestioningly and with the same allure, in a more sinister direction. Had he truly become the person he chose? Or was he merely a creation of his trajectory followed unthinkingly, shaped beyond remolding into the aggregated and faceless representation of an ideal?

The expression quickly faded as he turned back to his granddaughter, the light of his world. He reaffirmed his deepest gratitude and smiled knowingly at Gregor as he left the room. Naděje rested her chin against the violin and tilted her head sideways, resuming the elegant strokes as her eyes followed the music intently. Something stirred within Gregor as the chaconne of Bach’s Partita No. 2 faded in the distance. Was he truly lost, that music could move him so?

He pondered as he drove home. As he neared his abode, the pager placed in the passenger seat beeped to him and he was called back to the operating room. The MVA victims were stabilized and thanked him profusely for his skill and dedication to his craft, now able to return to their families and experience all of what their regained life held for them. When he entered his bedroom late that evening, he searched briefly for signs of his old life but found nothing except his medical awards and certifications.

Exhausted, Dr. Samsa collapsed on his bed and resigned himself to his new predicament, contented for now in the satisfaction of competence and reassured by the impact of his work. He would return to the hospital in a few hours.

His day was done. He finished charting the results of his surgeries and began the commute home, contemplating his predicament. Had he indeed been a medical student just yesterday? His hands navigated the rush-hour traffic as he returned to his apartment, his mind deeply lost in thought. A realization crept its way slowly into his consciousness.

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OUR TEAM CONTENT

DESIGN

Editors-in-Chief

Editors-in-Chief

Alice Li, 2027

Zier Zhou, 2027

Alex Pipchuk, 2027

Precious Adekoya, 2027

Managing Editor-Illustrator

Layout Designer

Sarvesh Ramlochun, 2027

Jillian McGroarty, 2028

Editors

Media Coordinators

Bhargavi Venkataraman, 2027

Jake Howran, 2027

Nabeelah Zaman, 2028

Maggie Liu, 2028

Sonia Persaud, 2028 Shangari Vijenthira, 2026

Photographer

Sebastian Kondratowski, 2028

Danna Ellner, 2028

Utkarsh Chaudhry, 2028 Alex Chen, 2027 Jasmine Candeliere, 2028 Hassait Hilawe, 2027

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CONTRIBUTORS

EVENTS

Artists

Coordinators

Saloni Aggarwal, 2025

Nikoo Aghaei, 2027

Alex Chen, 2027

Juliette Mojgani, 2027

Jaskarn Dhaliwal, 2027 Hassait Hilawe, 2027

Volunteers

Rihana Kukkadi, 2027

Alex Chen, 2028

Alice Y.S. Li, 2027

Nabeelah Zaman, 2027

Annie Liu, 2028 Maggie Liu, 2028 Ivan Quan, 2028 Sarvesh Ramlochun, 2027 Cindy Wen, 2031 Writers Jake Howran, 2027 Alex Pipchuk, 2027 Jessica Morris, 2025 Alyssa Reddi, 2028 Tim Song, 2028 Enoch Yu, 2028 Anonymous Anonymous

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LAUNCH PARTY LEGACY x METAMORPHOSIS | 4 . 24 . 2025 @ THE ISABEL BADER

QMR extends a warm thank you to all independent contributors, writers and artists, and supporters of volumes 18.1 & 18.2