QMR - Volume 13, Issue 2 (2020)

WINTER 2020

ISSUE 13.2

LOVE

QMR BROKEN HEART SYNDROME What does it mean to suffer from a broken heart (literally)?

PATENT FORAMEN OVALE A beautiful poem that speaks to what it means to have a heart that is open

Patient Centered Care?

While Electronic Patient Records might make things more efficient, they can also serve to create barriers between patients and care providers

Love

DEAR QMR Anonymous upperyear students answer questions submitted by members of the QMed community

in medicine

In This Issue

4

Patient Centered CARe?

6

Humanity, Love, & Medicine

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SPECIALTY LOVE MAP

Content Contributors Alexandra Morra Amanda Mills Andriy Katyukha Christine Moon Emma Spence Harry Chandrakumaran Iku Nwosu Jessica Nguyen Karthik Manickavachagam Nicole Krysa Sean Leung Dear QMR Team

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HEART ON YOUR SLEEVE

12

PATENT Foramen Ovale

14

BROKEN HEART SYNDROME

16

Love & HUman Connection

Design Jessica Nguyen Andrew Lee Doan-Nghi Dam-Le Amanda Mills

18

LOVE CROSSWORD

20

FIRST PATIENT

22

dear qmr

25

WELLNESS ILLUSTRATION

26

horoscope

27

Mnemonics WE LOVE

Editors Jessica Nguyen Grace Yin Zoe Hu Sarenna Lalani Managing Editors Christine Moon Grace Yin Editors in Chief Nicole Krysa Kimberley Yuen Cover art by Simran Sandhu, Meds ‘23

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From the Editors Dear lovely readers, Welcome to our Love issue. We are so thrilled that you have decided to pick up a copy of the QMR and give it a read. We are very proud of the content that our entire team (writers, editors, layout, and artists) have brought forward to this issue.

For this issue, we challenged the Queen’s Medicine community to interpret the theme of Love (in medicine) in various ways. Given the dynamic spread of talent in the QMed community, it should come as no surprise that the results were wide-ranging.

In The Importance of Love and Human Connection in Medicine, Karthik Manickavachagam speaks to the human element of medicine and explains how we can facilitate more meaningful interactions in the hospital setting.

Meanwhile, Andriy Katyukha presents the argument that while Electronic Patient Records might make things more efficient in the hospital, they can also serve to create barriers between patients and care providers in Patient Centered Care? In Humanity, Love, and Medicine, Iku Nowsu encourages us to challenge constructs about how we express and speak about “love” in medicine. We also are offered insight into the experience that two students shared with their First Patient in a deeply touching article about “Stanley”. In addition to reflections on love, we also offer up conversations about the heart as its own entity. Emma Spence takes a literal look at what it might mean to suffer from a broken heart in Takotsubo Cardiomyopathy/Broken Heart Syndrome while A Case for Wearing Your Heart on Your Sleeve explores what it means to bring your heart to the forefront in a metaphorical sense. Alex Morra also renders a beautiful poem, Patent Foramen Ovale, which speaks to what it means to have a heart that is open. This issue is ripe with deep and meditative insights on love in medicine, and we also offer up some light and fun fare. We have another thematic crossword for you, with a prize for the person who completes it first (contact qmreditors@gmail.com)! Additionally, Christine Moon has curated a number of helpful Mnemonics We Love to aid with memorization during the dreaded second semester slump. If you have been feeling introspective, you can check out the Specialty Love Map, created by Jessica Nguyen, which might guide you toward your career soul mate, or you could also check our your Love Horoscope, if you are wondering about compatibility with a real life mate. Once again, we are so excited to share another round of Dear QMR, wherein anonymous upper-year students and residents answer questions submitted by members of the QMed community. We are so thankful for the contributions from all of you. We hope that this column is both fun, powerful, and emotional all-at-once!

A special acknowledgment goes out to our hard-working managing editors, Grace Yin and Christine Moon, who have been pulling strings behind the scenes for the past couple of months, our content editors, Zoe Hu, Jessica Nguyen, and Sarenna Lalani for making sure we have all crossed our t’s and dotted our i’s (and also for making us all sound better), and to our phenomenal artistry and layout team: Amanda Mills, Doan-Nghi Dam-Le, Jessica Nguyen and Andrew Lee who have done a stellar job making the QMR look lovely. A special shout-out goes to Simran Sandhu for her amazing collage piece that is featured as the cover of this issue!

Whatever it is you seek out - we hope there is something for you in this issue. We thank you for taking the time to support our creative endeavor, and to all of those who have contributed in their many ways. It takes a village, and we happen to reside in the best one out there.

Nicole Krysa & Kimberley Yuen

Photo by Vladimir Kudinov from Unsplash (top) Photo by Jesse Orico from Unsplash (bottom left) Photo by National Cancer Institute from Unsplash (bottom right)

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Patient Centered Care?

OPINION

By Andriy Katyukha, Meds ‘22

Cursory

it is accessed by an over-worked, idealistic resident working an overnight shift in a busy academic centre. The record in the EPR is sacrosanct, and oftentimes not questioned because questioning leads to inefficiency, thus undermining the very goal of this “invaluable system”. The amount of times that incomplete and inaccurate information is scribed into the EPR is too many to count. Our superior communication system quickly deteriorates into nothing more than a broken telephone.

It is quite obvious that decisions made on seemingly correct, yet wildly inaccurate information, lead to dismal patient outcomes.

assessment would lead one to prematurely, and dare I say, erroneously, conclude that the Electronic Patient Record (EPR) plays a positive role in improving patient care. Dissenters would be chastised by the majority of people who see the EPR as a centralized reservoir that contains vital details pertaining to a patient’s journey through the healthcare system. It is argued, that such details are important in understanding medical presentations and collating the summation of interpretations by practitioners far and wide. I would be remiss to not acknowledge that details and facts are the basis of medical reasoning, and following that logic, a complete electronic account would lead to increased accuracy in the treatment of patients.

This reliance on the EPR limits the need for a proper patient led account of an incident, as the information needed for diagnosis has already been collected and rehashed by multiple providers. Why ask the same questions again, if you already have a complete account of the issue presented to you? This function fundamentally undermines what healthcare providers are taught to do— talk to their patients. Conversations become abrupt, and the EPR fills in the details. The model of patient-centered care is slowly eroded and what is left in its place is EPR centered care. This care is detached, hollow, and predicated on a “patient-less” experience.

I argue, however that a complete account is not synonymous with an accurate account.

In the most elementary sense, I equate the EPR to a telephone system, via which information is transmitted. Let’s now add some complexity to this system. Each entry in the EPR represents a transmission point, where information is hopefully sent across in its totality to create a sufficient account of “the patient experience”. It is then propagated down the system until

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HUMANITY, LOVE, & MEDICINE 6

Iku Nwosu Meds ‘22

Reflection

“I love our patients” is a routine statement from healthcare professionals and students. It is a statement so common it rarely packs a punch.

Love is funny in medicine. Funny because we will hopefully love our patients, and love what we do; love can define that feeling of fulfillment we yearn for. Yet, love can also seem so indisputably inappropriate.

on their best and worst days, or somewhere in between. To be impactful on any of these days, anywhere on this spectrum, people need to feel like you feel something. People respond to love.

Despite this natural unease that can surround the concept of love, people accept it.

Medicine is filled with anecdotes; the experiences we have in healthcare become the stories we talk about. Growing up, I watched my parents love seeing our family physician. Their need to get a prescription refilled also came with a true desire to catch up with someone they considered a friend. These impressions made by a healthcare professional are seen across patients, from the most debilitating illness experiences to the ongoing relationships in primary care.

We very unsubtly do a disservice to those who cannot share the same sentiments. Not everyone loves going to the doctor – we see that for many the system can feel unwelcoming and rooted in hostility. Our feelings about a place and its people, and our perception of their feelings towards us will direct how often we go to it.

Spin love differently - by telling a patient you love them. The thought can leave you tongue-tied. Suddenly it feels so wrongly direct, across a line that we have created for ourselves.

Now, I am not denying the importance of this line and the problems that would arise without it. And no, I do not foresee or encourage a future where we express our love to patients explicitly in the wards. I am simply acknowledging love, humanity, and medicine intertwined. Given love plays such a transformative role in medicine, perhaps we should challenge this boundary we have created for ourselves in pursuit of better patient care.

“Pearls” in medicine are almost never about medicine in the literal sense - or at least the really good ones. Some great ones I’ve received are simple lessons: be generous with your patients; remember the reason you chose medicine; do not make assumptions of patients and their stories. It is uncanny how many of them relate back to virtues; kindness, compassion, and remarkably - love. People show love in medicine as part of an unconscious routine. It speaks to the humanity that persists, and lacking in it is just not an option. Medicine catches people

Acknowledging this tongue-tied feeling around a concept like love in medicine, is acknowledging a part of our humanity. It is unlikely much will ever change about how we talk about love in medicine; in many ways these boundaries keep people safe. Perhaps, in the future we will play with these boundaries as humans, as we slowly recognize what complex beings we are in a world changing so quickly around us. Love and medicine cannot be separated because love and humanity cannot be separated.

“Acknowledging this tongue-tied feeling around a concept like love in medicine, is acknowledging a part of our humanity.”

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RT A ST It’s T-5 hours before your

exam and you are grinding hard. What’s your study style?

I’m going over my notes thoroughly.

I’m doing a practice exam on the Google Drive.

Spill. What’s your favourite diagnostic imaging technique?

The x-ray. Easy, breezy, and beautiful. What’s not to love?

The MRI is my one true love.

The tea is piping hot!

Which device would you rather have as your physical exam go-to?

POCUS ftw. Being a walking diagnostic machine would be awesome.

There’s only one right answer, so choose carefully. How do you pronounce “jejunum”?

Easy. It’s JEJ-uhnuhm.

DUH! It’s je-JUNEum.

INTERNAL MEDICINE

EMERGENCY MEDICINE

You need a specialty that allows you to be well-rounded and learn a little about a lot (or a lot about a lot). Internal Medicine is that special specialty that lets you explore!

Internal Medicine will stand by your side as you learn EVERYTHING!

Do you feel your heart racing? Good! We found the match for you! Emergency Medicine! Get ready for some excitement with a true love this fast-paced. I hope you’re up to date on a wide range of topics because this specialty match is sure to test you!

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ad th

Fun

Make your Match!

Which specialty is right for you?

By: Jessica Nguyen, Meds ‘23

There’s no SGL today.

Where do you sit during class?

Closer to the front. You’ll catch me nodding along to every word and diligently taking notes.

I’m a stethoscope dvocate through and hrough. She’s classic,

Near the back. I pay attention but will send a good meme to the class chat every so often.

Flashforward 20 years and you work in the OR. What’s your OR style?

Catch me in some fly OR clogs.

I wouldn’t be caught dead in clogs. Bootie covers exist for a reason!

FAMILY MEDICINE

GENERAL SURGERY

ANESTHESIOLOGY

Family Medicine is your one true love! You have extensive knowledge in every area of medicine and love to spend time getting to know your patients.

Enjoy the ride! This love is in it for the long haul.

You would rather DO than spend time studying.

You need a specialty that understands that about you. General Surgery is all about hands on tasks and will stand by your side ( pretty much 24/7), clogs or no clogs.

Hello Sleeping Beauty!

Your one true specialty match is Anesthesiology!

This specialty will allow you to see the results of your work right before your eyes (even if that is just a peacefully sleeping patient!).

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A Case for Wearing Your Heart on Your Sleeve

Nicole Krysa, Meds ‘22

Y

ou may not know this, but you can actually wear your heart in one of two places. In the usual spot, buried deep in your chest, or right out in the open on your sleeve. If you are familiar with this latter practice, then you have likely observed that it is often discouraged. While I seek to make a case for wearing your heart on your sleeve, I will concede that it is not without reason that those who are invested in your wellbeing may caution against it.

The most obvious cause for concern is that when you remove your heart from the protective cage of your ribs, it becomes highly vulnerable to insult. This is frightening for certain, and I would acquiesce that your heart will inevitably experience some bruises (at the very least) when it is donned in this way. However, removing your heart from constraints also allows it to grow to its maximum capacity. When your heart is able to flourish and expand, those demarcations on its surface, the character-building nicks and bruises experienced previously, seem to shrink in comparison. Some insults might be so penetrative that they never fully fade. However, with a heart so big and robust, you may just find that you have a newfound strength to cope with, acknowledge, and conquer those former stresses.

On the other hand, society informs us that we should not be so forthcoming with our hearts.

Many feel that if we are too frivolous with the information that we display, it can be utilized in a negative way to harm or humiliate us.

This is yet another reason why the practice of wearing your heart on your sleeve is not well-advertised and certainly not frequently advocated for. I have observed, however, that if you are forthcoming with your feelings and experiences, and do not perceive them as ill10

Photo by Omer Salom on Unsplash (Right)

Photo by Stephanie Greene on Unsplash (Left

t)

OPINION

advised or shameful, others will also lose the ability to see them as such. Although this notion may be foreign or frightening to you, I invite you to wholeheartedly try it. After all, words can only be utilized as weaponry if you endow them with that power.

Another great benefit of wearing your heart right out in the open is that with time, others will feel that they can do the same. You might feel that it is flashy or obnoxious to be so brazen about how you wear your heart, but it is actually one of the strongest and most inspiring things that one can do. Watching you liberate yourself to be free with your emotions will not put off others as you might believe. Rather, it will empower them to do the same. As with any great change, it is difficult to be one of the revolutionaries, and you will certainly be subject to scrutiny and criticism long before widespread acceptance occurs. However, once you, and perhaps a few other bold individuals start to proudly put your hearts out on display, it will only seem natural for more to do the same.

Eventually, people will forget that this was not always the way things were. You can see where this will lead, I am certain. With so many hearts displayed so boldly, the pool from which to give and receive love becomes infinitely larger and more accessible. Not only are you more readily able to give yourself emotionally to those who need it (and everybody does from time-to-time), but additionally, when you are in need of support, you may just find that you do not have to look far at all to acquire it.

Lastly, I encourage you to take your fragile heart out from time-to-time and bravely tack it to your sleeve for one vital reason. This is especially imperative as you move through your journey in this trying yet noble career path. In the coming weeks, months, and years, you will be challenged in ways that you never have before, and your innate ability to offer empathy and compassion will be threatened many times over.

Photo by Stephanie Greene from Unsplash (left) Photo by Omer Salom from Unsplash (right)

Perhaps the most important reason of all to wear your heart on your sleeve is so that you can catch a glimpse of it from time-to-time and remember that it is there.

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Watercolour (middle) by Michelle Dirkse & Mya Kerner 12

Poetry

Patent Foramen Ovale

Eyes locked Hands wringing, Your soul begging to be pried, Your brain - terrified.

Her stare exudes intensity, Passion, yearning, Piercing through my walls, My insecurities tumbling, No barrier left to climb.

My heart valves, Rusted from decades of tears, Surge with feeling, Lubricated by emotions, Flowing, Freeing, I am open.

-Alex Morra Meds ‘21

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Takotsubo Cardiomyopathy

Broken Heart Syndrome Emma Spence, Meds ‘21

W

hile we may not be able to physically “laugh our head off” or “cry our eyes out,” can someone really “die of a broken heart?” Perhaps the answer is yes.

Broken Heart Syndrome, or more formally Takotsubo Cardiomyopathy, is described as transient dysfunction of the left ventricle (LV) in the absence of significant coronary artery disease. On echo, the resulting regional myocardial dysfunction leads to a systolic ballooning

appearance of the LV apex. The etymology of the term “Takotsubo” stems from a Japanese pot used as an octopus trap, the shape of which is similar to the echocardiographic or radiographic appearance of the LV abnormality in the most typical form of the condition.

But how did this disease earn its melancholic alias? Well, while there remains uncertainty as to the exact etiology and pathogenesis of this phenomenon, emotionally stressful

Source: UpToDate. Reeder, G.S., Prasad, A. Clinical manifestations and diagnosis of stress (Takotsubo) Cardiomyopathy. In: UpToDate, Post, TW (ed), UpToDate, Watham, MA, 2019 DynaMed. Takotsubo Syndrome. In: DynaMed, Ipswich, MA, updated Nov 30, 2018 Image: http://blog.memorialhermann.org/chest-pain-octopus-broken-heart/

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ESSAY

Image: http://hqmeded-ecg.blogspot.com/2010/12/takostubo-stress-cardiomyopathy-with.html

events such as a traumatic break-up or unexpected sudden loss of a loved one are commonly associated triggers.

coronary artery disease or acute plaque rupture (though it is possible to have co-morbid CAD that may or may not be contributing to the presentation).

Ventriculography or echo will demonstrate the LV wall abnormality (the octopus trap), and the latter is performed in serial fashion to follow along for resolution.

The presenting symptom is most often retrosternal chest pain, but patients can present with dyspnea or syncope. Symptoms of heart failure may also ensue. Auscultation may reveal new murmurs pointing toward acute mitral regurgitation or dynamic LV outflow tract obstruction. Cardiac biomarkers and ECG findings are often similar to STEMI with elevated troponins, ST elevation, T wave inversion and abnormal Q waves. However, angiography will not show significant obstructive

Given that stress cardiomyopathy and its complications can be life threatening, perhaps we really can die of a broken heart. However, the events themselves do tend to be transient, meaning that perhaps our mothers are, as always, right – only time can mend a broken heart.

Image: https://www.health.harvard.edu/heart-health/takotsubo-cardiomyopathy-broken-heart-syndrome

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The importance of love and human connection in medicine Karthik Manickavachagam, Meds ‘22 16

Reflection

W hen Mother Theresa visited the

United States, she gave a speech in which she emphasized the importance of love and human connection. She reflected that in developing countries there was indeed poverty - a poverty of money, however she noted that in developed countries there was a greater poverty – a poverty of love. She explained that when she visited nursing homes in developed nations, she found the residents wanting for love and human connection. As doctors in training and future physicians, we have the power to address this issue within the realm of healthcare. In addition to addressing the physiologic ailments of patients, it is important that we foster a human connection based on love and compassion, because after all patients are not machines that we fix but humans that we heal.

One powerful tool, which we can use while striving to heal patients is the human smile. I learned this poignant lesson from a dying cancer patient, previously as a second-year nursing student. I was nervous and unsure of how to interact with a dying patient.

However, the patient put me at ease with her smile and small talk.

Even now, years after this incident, I remember how a simple smile made the interaction more comfortable and meaningful.

Another way to enhance the therapeutic relationship is to listen with undivided attention and to be

‘fully present’ during our interactions with patients. This can be challenging with the multitude of demands placed on healthcare providers and smart phones and pagers constantly going off. However, a distracted physician who is not ‘present’, hinders the therapeutic relationship and leaves patients feeling unimportant and uncared for. One thing I have noticed good physicians do, is to excuse themselves to attend an important phone call and then return to attend to the patient with undivided attention.

This not only improves the patient experience but reduces medical errors as a bonus.

Often, the nature of our conversations with patients and their family members involves difficult topics such as choosing palliative care and forgoing futile aggressive treatments. During these conversations, many emotions arise, and people can get emotional.

While it is important that we do not become attached to patients, we need to support them and genuinely be part of the conversation. Holding their hand and sitting in silence (despite the urge to cover it up) are powerful techniques to support patients and build connection.

To conclude, human connection is integral to establishing a therapeutic relationship and providing good medical care to patients. Use of the above techniques and keeping an open mind to learn from others can help us achieve this important goal.

Image courtesy of @Akshar_Dave 17

LOVE CROSSWORD

Created by Sean Leung, Meds ‘22 - so you know it’s gonna be a challenge!

Be the first to finish this crossword and win a prize! Send a photo of your crossword to qmreditors@gmail.com

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FUN ACROSS

1

4 8 10 12 14 16 17 19 21 23

25 28 29 30 31 32

34

37 38 39

If this happens to your crush when you’re with them, it’s either dark, they’re

stimulated, or they have a crush on you too Karma for the most adulterous organ The anatomical juxtaposition of two orbicularis oris muscles in a state of contraction A 2022-2023 friendship bloomed from this argument topic A medium sized artery loving vasculitis Medical students’ “beloved” feline Cardiologists call them S1 and S2 but weebs call them this The eponymous tool used to assess your agreement with statements The way we exchange electrifying whispers with the heart Cooties Ruska was awarded a Nobel prize for creating this beloved technique for both molecular biologists and chemists alike Dr. Seuss did not use his medical terms when discussing the Grinch’s heart condition. But you can!

Lead I and aVF had a breakup Salicylic acid helps to combat this when preparing for a date “My parents aren’t home” but for water This diagnosis was removed from ICD-11 in 2018 due to dubious public health impact Apparently if injecting NMDA and D-Asp increases testosterone and progesterone in mice, eating this food may help you out on your next date This biologist will try to tell you that you’re horny because of an even-numbered chromosome and old laundry This substance’s heartbeat defines time as we know it (US spelling) Forbidden lovers that may get removed if they kiss and cause a UAO The endogenous nectar that draws epigastric Rhopalocera

DOWN 2 3 5 6 7

9 10 11 13 15 18 20

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26 27 33 35 36 40

When healthcare workers collaborate!

Light can literally be prescribed to cast away the darkness in this mood disorder Your go-to acute phase reactant investigation in SGLs The key to a man’s heart is through his …; The key to a ruminant’s heart is through its ________.

The psychologist’s strategy to trick someone into falling in love with you using clowns and catecholamines What do you call it when the alveoli support each other?

Finally, something all specialties can apparently agree on for patient care The aortic arch’s southpaw little spoon QMR is a marriage of this and medicine This fish is full of love and… milk ejection?

Osteomyelitic infections’ favourite route of administration If you didn’t get your flu shot this year, you probably got a few cellular kisses riddled with this deadly protease A pleasurable but involuntary nervous system discharge associated rhythmic levator ani contractions, random muscular spasms, and sometimes, vocalizations This heart string puller might quit its job if the path opposite a widow maker is taken (in 80-85% of individuals) This deity takes credit for why some people like to be kissed on the ears, the armpit, and the thigh pits You have 4 but only need up to 2 to give someone a high five It probably kills the mood if you call it this They’re coming home!

The name for Western culture’s anatomically inaccurate but metaphorically romantic vessel The bus every QMED knows

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First Patient To maintain the privacy of our first patient we have changed their name and our names.

First Patient Program.

The First Patient Program, as most of us know, is a program that matches a pair of first year medical students to a real patient who volunteers their time in order to grow our understanding of the patient experience. Through this program, you attend your patient’s medical appointments and get to know your patient as a person. If we recall correctly, the program requirement was something like a minimum of two appointment visits with your first patient.

In the early stages of the year, we had already heard of struggles coming from our classmates regarding reaching patients and having to travel far and wide to attend appointments. At the time, we thought we were lucky because our patient had regularly scheduled treatments, which meant that we could visit them whenever we wanted. What started as fulfilling requirements quickly blossomed into a relationship that we don’t think either party expected. Because we always knew when and where our patient would be for their treatment, we ended up visiting them somewhere between weekly and biweekly for the year.

Stanley.

Our interactions with Stanley consisted of conversations in the waiting room which transitioned into conversations in the treatment room.

Stanley had almost everything go wrong with him medically, but his approach and outlook on life was everything right. Stanley shared a lot with us; first his medical history, his triumphs and pitfalls with the healthcare system, his personal opinions on just about anything, and most importantly, his personal life. He shared stories from his childhood, his hobbies, his family life, and his weekend plans. We quickly learned that Stanley was very talented with woodworking and had a knack for creating realistic Halloween costumes. (He once tried to create an Ironman costume with a working core).

We quickly learned and saw how his chronic illness stood in the way of many aspects of his life. But Stanley wasn’t the type of person to let his illness control his life. He would happily chat away in his usual sarcastic demeanor, all while several needles and tubes traveled from his arms to the machine beside him.

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REFLECTION Stanley was very opinionated about the care he received. But he was fair as well. He clearly remembered all of the interactions he had with his physicians over the years. Our teachers often reiterated that “patients have excellent memories”, but this lesson meant much more coming from our patient. Stanley was sometimes critical of physicians who had dismissed him or treated him poorly, but also effusive in his praise of his care providers who took the time to listen to him and show him a little bit of empathy.

We really only knew Stanley for about a year - maybe less, but he taught us so much.

One of the things we remember most clearly about Stanley, is how his routine beverage poured by the circulating volunteer would remain untouched for the entire time we were visiting. We’d often question why he wasn’t drinking it, and encourage him to drink his beverage before it got cold. His answer was simple: “I don’t want to be impolite - if you guys don’t have a drink, I don’t want to drink this and make you feel thirsty!” This was coming from the man who already had to restrict his fluid intake for the day for his treatment.

From then on, we’d each bring a beverage and so we could drink with Stanley.

Stanley also had a sharp memory. He was always cautious and respectful of our time, reminding us that it was time for us to go to our intramurals, home to make dinner, study, whatever.

One of the first things Stanley told us was to stay the way we were - stay compassionate, caring, and curious about your patients. Take the time to talk to them and listen. He found that the best doctors not only listened to what he had to share regarding his medical history, but could take a step back because they knew he was the expert on his illness, not them.

It’s easy to forget the human side of medicine during the first two years of school. The relationship that we had built with our patient helped us stay grounded, and we learned how it feels to navigate the healthcare system with a chronic disease and a busy schedule.

Thank You.

We found out that Stanley suddenly passed away a few months ago. They say that your first patient death is something you will never forget. Stanley was our first patient, maybe not in the literal sense, but he was and will always be remembered as a kind and thoughtful soul with an unapologetically stark sense of humour. Stanley, thank you for volunteering your time so that we could learn from you.

We will never forget you.

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Dear

Is residency really that bad? I hear scary stories of burning out and a lot of crying.

Sincerely, Clerk and Afraid

I have a cute boyfriend in medicine, what are some tips I can use to maintain the relationship into residency?

Dear Clerk, Just like the rest of life, residency has good and bad days. You will finish some days feeling on top of the world, and you will also finish some days at your lowest. It’s okay – it happens to all of us. In your days at QMed, you will establish relationships that will last you a lifetime. Hopefully somewhere in this wonderful group of people (and among those in your personal life), you’ll find a few close friends that will support you through your worst days. Hold on to these people. To echo the wise advice of Dr. Murray, it’s not such a bad idea to have a “failure friend.”

Sincerely, Crazy in Love Dear In Love, Medicine is hard, but relationships can be harder. A while ago, my boyfriend transitioned from medical school into residency while we were dating (long distance with a sixhour time difference!). I wish I had a schema, or mnemonic, or magic shortcut that could guarantee your relational success, but at the core of all successful relationships are hard work and sacrifice — I don’t think there’s any way around that. They say relationships should be 50/50, but I think 100/100 is better. After all, we all go through different life “seasons” where we need different forms of support and care. My advice is: Sacrifice for each other regularly (nothing worth having comes easy!) Cliché, but true.

In addition, figure out the things that keep you well and set aside time in your day to make them happen. Whether it be yoga, rock climbing, running, swimming, innertube water polo, Dragonboating, reading, or your dog, don’t let these things fall to the wayside when life gets busy. It’s also a good idea to step back from time to time and actually ask yourself whether or not you feel well. If you do, reflect on the things that are helping to keep you well, because this way you’ll know what to fall upon in the future.

If you don’t feel well, you should actively work to change that -- recognizing when you are beginning to burn out and nipping it in the bud is key. Do you need a vacation? (You probably do.)

Be gracious and forgiving (even when you’re tired or frustrated).

Commit to reminding yourself that their dreams are no less important than yours, and make yourself available to be their shoulder to lean on.

Use every single one of your vacation, education, and lieu days. Get good sleep.

Aim to cultivate a shared dream of a future where your relationship has survived the dark tunnel of residency (or so I’ve heard) - what would your life together look like? Learn to yearn for it, and in hard moments, it will remind you that the present difficulties pale in comparison to future joys.

When that day comes, it will all have been worth it.

Attempt to outdo one another in being flexible and generous in showering each other love and care. After all, what better place to channel your inner type-A competitiveness?

Above all, remember this: you had a hard day today because medicine is hard, not because you are bad doctor.

I know it’s hard. I know it’s trying. But when it’s all said and done, there’s nothing more precious than looking to that special person beside you, knowing that all the mutual sacrifice, late night FaceTime calls, and weekend-getaways have finally gifted you with something worth having.

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Thank you to all our contributors to this column. All advice and opinions belong to our QMR contributors and do not reflect the opinions of the Queen’s Medical Review. If you don’t see your question here, check out our website, or look for your question in our next issue. Questions and answers may have been edited for length or clarity.

QMR,

FUN

I’ve heard medicine is a lonely career. How can I make sure I prioritize my relationships so I don’t lose them over time?

Sincerely, Don’t Wanna Be All by Myself Dear Don’t, Thanks so much for your great question. Regardless of whether we are trying to maintain relationships with friends, family or partners and whether these individuals are in our own homes, classes, cities or afar, relationships as a medical trainee take work! So here are a few tips and tricks to try to make that work more manageable.

1. Double-up: Certain items in our schedules, like hanging out with friends, tend to get cut from the roster more liberally than others. Try to circumvent this by integrating relationships into unavoidable components of your schedule. For example, call a family member while walking home, or have a friend join you to grocery shop or mealprep together.

Does having research in the specialty you’re interested in really matter? What do you think is the biggest difference maker for schools to pick you for residency?

2. Make it a date: It can sometimes be helpful to have a recurring event in your calendar to look forward to and (hopefully) stick to over time. Whether this is a weekly workout class with a classmate or a monthly brunch date with an old friend, having a regularly scheduled event can help to keep your relationships on track.

Sincerely, Researching how to survive CaRMS Dear Researching, Many schools consider research a “strong” asset [read: requirement]. However, the impression I get from many residents, preceptors and program directors, is that research is research. I would not [and did not] worry about doing research in a specific field. No one expects you to know in your preclerkship years which specialty you’ll end up in [except maybe plastics *sighs audibly*].

Just find a fun project and learn something new.

3. Patience: While balance in all aspects of our lives at all times would be ideal, we sometimes need to be patient with ourselves. Maybe we won’t be up for every class party or make it back in time for every family member’s birthday.

This does not make anyone lame nor does it mean we don’t care. It is ok to forewarn those important to us as to when a busy stretch is upcoming. In fact, it can sometimes be helpful for those who care about us to know that our radio silence is not us ignoring them, but rather is sometimes a signal that we may actually need a bit of added support from them. Having this conversation ahead of time can be really helpful.

These ideas are just a start, and while at times they may be tested, your most meaningful relationships will only grow stronger with the strains of Medicine!

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I want to provide feedback for my instructors and our classes, but I am not sure if the feedback forms on Elentra are anonymous. In addition, not all classes or professors have feedback forms available. What are other ways I can provide feedback that will be heard?

How did you deal with debt after medical school? Were you able to start paying back your loans right away with a resident salary, or does it all kind oF build up until after residency?

Sincerely, Feedback Freddy Dear Freddy,

Sincerely, No Money Mo Problems

The feedback forms on Elentra are kept anonymous.

UGME recognizes that students might feel uncomfortable giving feedback to instructors otherwise, often for fears of repercussion. You can rest assured that your feedback will not be held against you. Please fill out these forms – whether your experience has been positive or negative.

This feedback is taken seriously; you’d be surprised at how quickly some of the comments are addressed. Remember – problems won’t be fixed if they are not addressed.

Dear No, The key to smart financing is responsible budgeting.

Some residents will save over half of their earnings, while others will dig further into their line of credit. The sooner you are able to accumulate wealth and investments, the sooner you will be able to compound your earnings (aka “make your money work for you”). At the same time, if you ignore your line of credit, your debt will also accumulate and compound through interest.

Similarly, instructors want to know if and what they are doing well. This is especially true for newer instructors.

For classes or professors that do not have feedback forms, you can provide feedback in other ways. Your Academic Reps and Course Reps are good people to contact. They will collate information from many of your peers, and their ability to act as a third party allows for communication without putting you directly in the line of fire.

Realistically, most of us will make enough money once we start working to have no trouble paying back our loans. The people who may run into issues are those who live outside their means in medical school and continue this trend throughout residency. Remember that other expensive things (like cars, kids and mortgages) may also come up, so plan accordingly if these are part of your life plan.

That being said, the only thing you need to do at this stage is to make your best attempt at living frugally. Give yourself a budget every month and try to stay within it (you can try tools like YNAB or Mint). Carry this trend throughout residency and into early practice. If you live like a resident for the first two years of independent practice, you can be financially set for life.

While it really isn’t about the money at the end of the day, think about how much less stress you’ll carry if you’re working for fun when you’re 50, instead of working to pay off your mortgage. That said, don’t forget to enjoy your life too – if you want to travel the world, you should probably do that before you get that bilateral knee OA.

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ILLUSTRATION

Nothing a little mandatory wellness can’t solve.

Harry Chandrakumaran, Meds ‘20

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Love Horoscopes Created by Amanda Mills, Meds ‘23

Aries

(March 21 April 19)

Although this month may seem long and arduous, with resolutions to keep, and work to keep up with, you’ll have the ability to handle these pressures with relative ease. Make sure to continue to pay attention to those around you, they may need your love and support this month!

Leo

(July 23 August 22)

This month you will embrace your passionate side to stand up for what you believe in. Don’t be afraid! Just be honest with yourself and step into your thoughts, feelings, and opinions.

Saggitarius

(November 22 December 21)

Welcome to February, Sagittarius!

This month is all about warmth and positivity for you. Spread the love! You will find boundless energy, confidence, and interesting ideas you’ll want to share with those around you.

Taurus

Gemini

(April 20 May 20)

This February you’ll have increased willpower and persistence. Mercury in Pisces will allow you to improve your communication skills with those around you. Use your determination and these communication skills to have the conversations you want to!

(May 21 June 20)

Winter is almost over, Gemini!

Use your friendly and sympathetic attitude this month to stay openminded to the opinions of those around you. There’s no better time than this month to learn something from someone you love!

Libra

Virgo

(August 23 September 22)

You will be overflowing with ideas this month. Follow your heart and explore what these ideas have to offer! Enjoy this burst of creativity and write down anything that comes to mind. You may need these ideas later ;)

(September 23 October 22)

Libra, February is all about respect for you. Make sure you respect yourself and everyone around you as you make your way through this frosty month. It’s time to show some love to yourself and take care of YOUR needs!

Aquarius

Capricorn

(January 20 February 18)

(December 22 January 19)

With Mars in Sagittarius, you may feel inclined to throw yourself into your work this month, Capricorn.

That’s okay! Take the time to do what you love, especially when you’re feeling passionate about it. It’s okay if you take some time alone to focus – just make sure you keep checking in with your

Listen to your body this month, Aquarius! You may feel like you have endless energy this month, but make sure you take time to rest and catch up with those you love. With Mercury in Pisces, you will have the opportunity to deepen relationships this month – take it!

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Cancer

(June 21 July 22)

This month is all about romance for you, Cancer! For you, the strong influence of Venus in Pisces will allow for ease in getting along with others. Use this to your advantage and enjoy spending time with your loved ones!

Scorpio

(October 23 November 21)

You may find yourself distracted this month, Scorpio. Lean in! It’s okay to focus on dreams of the future this month. Stay true to your heart and think about what makes it beat faster. You’ll have lots of energy this month, so keep daydreaming!

Pisces

(February 19 March 20)

This is your month Pisces! We know you love to show your emotions, especially around Valentine’s Day. With Mercury in pieces this month you will meet new people very easily – maybe think about giving a new friendship, mentorship, or relationship a chance.

FUN

Mnemonics We Love

Curated and illustrated by Christine Moon, Meds ‘23 The first-year class (QMED 2023) has just finished our first semester of medical school! Here are some of our favourite mnemonics that helped us remember some important concepts in our first term.

7

12

5

Vertebrae, Superior to Inferior.

By Dr. Lorraine Jadeski (University of Guelph), via Olivia Ginty ‘23 I eat Breakfast at 7, Lunch at 12, and Dinner at 5.

There are 7 cervical vertebrae, 12 thoracic vertebrae, and 5 lumbar vertebrae.

The layers of the retina.

By Christine Moon ‘23 and Julian Rubino ‘23.

Rare Ponies Exist Only On Imaginary Icy Greco-Narnian Islands Retinal Pigmented Epithelium, Photoreceptor Cell Layer, External Limiting Membrane, Outer Nuclear Layer, Outer Plexiform Layer, Inner Nuclear Layer, Inner Plexiform Layer, Ganglion Cell Layer, Nerve Fibre Layer, Internal Limiting Membrane.

The sections of the small intestine.

By Niveditha Pattathil ‘23 DJ Ileum Duodenum, Jejunum, Ileum

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“Success is not the key to happiness.

Happiness is the key to success. If you love what you are doing, you will be successful.”

—Albert Schweitzer

QMR