ISSUE 4 â€¢ WINTER 2016
CO NT EN TS
From the Editor
The Medical Spotlight
Dancing on Clouds
06 Monthly Q&A with
07 An Interview with
26 Mindfulness Q&A:
an Infusion Nurse Diana Meredith
Heed the Healing
This is Africa
31 EFRT Interview Series:
14 A Medical Musing
17 Dr. Jay Children’s
An Interview with diana meredith page 7 On painting, writing, critical thinking, and the importance of the body and the medical humanities
Dr. Jay Children’s centre interview Providing palliative care for children
Staff Cover Artist Alice Lu
Table of Contents
THE MUSE • WINTER 2016
FROM THE EDITOR
of healing and sickness, including but not limited to philosophy, history, literature, gender studies, and visual art. Given their broad scope, the foundation of the medical humanities lies in diversity. Diversity in experience. Diversity in issues. Diversity in perspectives on these issues. Tensions pervade the landscape of medicine -- be it a disconnect between patients and providers at the bedside, controversial issues such as opiate addiction that have caused ruptures within the medical community, or disparities in accessibility and treatment quality across demographics. On a broader scale, we are witnessing the dissemination of divisive and hateful rhetoric worldwide.
Dear reader, It has been just over a year since the first issue of The Muse launched. Last summer, when we first began planning our inaugural release, we had a core group of 10 people. Now, our staff has grown to 41 individuals across three different faculties, spanning both undergraduate and graduate programs. Moreover, we are now working with Dr. Ellen Amster, the Hannah Chair of History of Medicine, who is a wonderfully supportive and insightful advisor. The influx of new voices has brought along a wave of fresh ideas and an expansion of our initiatives. In addition to the two issues that we will be bringing to you this year, we also regularly feature the stories of individuals and organizations with a passion for healthcare work, education, and activism across our social media and blog. Come the New Year, we will be launching an educational workshop series to provide an introduction to the multifaceted scope of the medical humanities, including applied drama and music therapy. Above all, what we aim to bring to you is diversity. The medical humanities are comprised of an interdisciplinary range of fields that intersect with ideas
THE MUSE â€˘ WINTER 2016
These divides run deep and are fundamentally rooted in dialogue that is troubled at best and nonexistent at worst. With their capacity to serve as a unifying platform for the voices and stories of individuals from a host of different backgrounds, the medical humanities are more relevant than ever to the practice of medicine. Accordingly, medical humanities education must begin at the baccalaureate level and be integrated into into curricula nationwide. On our part, we are working to support the launch of such a course at McMaster University next year. In celebration of diversity, our print Spring 2017 issue will have the theme, Beneath the Surface. We welcome stories from all willing to share the nuances of their personal narratives and how that has shaped their experiences, or that of their families and friends, within the healthcare system. It is my hope to see The Muse continue to serve as a platform for open and respectful dialogue, from which empathy and mutual understanding can flourish. Take care,
Anna Goshua Editor-in-Chief (Photo courtesy of Irina Sverdlichenko)
Dancing on Clouds By Beatrice Preti email@example.com
e had finished the OR list early that day, and I’d run to the university library to find some books. As I was walking towards the check-out desk, I tripped over my own feet (typical me), scattering the books everywhere. A boy nearby helped me collect what I now realise was an excessive number of books, even for me. My cheeks were burning as I accepted the few he passed my way. Maybe next time I’d only take as many books as I could safely carry. “Are you a medical student?” he asked me. The question was polite; I supposed it was obvious. The medical scrubs, the messy hair that had been in and out of caps all day, the ID badge hanging around my neck, the stethoscope in my pocket. Not to mention the first book in my stack was titled, The Complete
Review of Orthopaedics, Sixth Edition. “Yes,” I said, suddenly feeling my energy drain. Why was I so tired? I’d only worked nine hours that day and hadn’t been on call last night. “Yes, I am.” “Wow,” said the boy. “And you go to the regional campus? The McMaster one?” “Yes,” I said. If I checked these three books out, I could probably cram them all into my bag, which meant that I could carry these two back to the car, leaving my left hand free to grab the keys. Yes, that could work. “Wow,” said the boy again. “That’s so cool.” He was looking at me with a mix of awe, respect, fear, and admiration that I reserved for my
mother, Taylor Swift, and one particular surgeon who’d never shouted at me once during the four weeks I’d worked with her. What a silly boy. I was just a medical student. He’d probably done more impressive things with his life than I had. Thinking that our conversation was over, I continued walking to the circulation desk. But the boy followed me. “I want to go to med school,” he said. “I think I want to be a surgeon, maybe. Or a psychiatrist. Have you done any psychiatry? What’s it like?” “It’s interesting,” I said, glancing at the clock. Five-fifteen. If I could get home before six, eat and change before six-thirty, maybe I could get a chapter or two in of reading before I
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5 school and all.” “Mmmm…” I said, as I started to check out the books. Smart? Me? Last week alone, four separate people (three of them nurses) had called me stupid. The other was a John Doe I’d bumped into in the carpark after a fifteen-hour shift so exhausting I could barely stand. “Can I shake your hand?” said the boy. “Please?” “Shake my hand?” I said. What an odd request. “I guess…?” “Oh, thanks! You’re so nice. Oh, geez, I hope I get to be a med student just like you one day.”
fall asleep at my desk. Maybe. “This is so cool,” said the boy. “I’ve never met a real med student before. It’s such an honour to meet you.” Why was he looking at me like that? I was just a medical student. Always in the way, never knowing enough. The bottom of the totem pole. Just today, three doctors had been arguing about who’d be stuck with me tomorrow. They ended up pulling straws. The unlucky winner had already warned me twice not to touch his drugs. Or his tools. Or his stool. Or the door. “You must be so smart,” said the boy. “To get into a Canadian med
Just like me? Why would anyone want to do this? Was I ever like this rambling pre-med, so bushy-tailed and starry-eyed? I looked at the books in front of me, remembering the first time I’d seen someone with scrubs and a coloured backpack walking around the library. I’d hidden behind the bookshelves and watched, my mouth hanging open. When we were undergraduates, the medical students were our idols. They were gods. I’d never have dared to speak to a medical student before I became one. This boy had the gumption to come over and speak to me. It must have been because I dropped my books; somehow, that had made me more approachable. More human. But being a medical student was nothing to be proud of. We do nothing useful, as we’re often reminded. We’re just ripening crop, sitting tight until the day that we can add our contributions to the system which raised us. Yesterday, one of my classmates was in tears because the surgeon she was courting for
a reference letter told her that she would be a terrible surgeon, or a terrible doctor, really, regardless of which specialty she pursued. This morning, a different classmate was told by three separate families not to touch their children because they wanted the “real” doctor; later, the “real” doctor reprimanded her for not acting more “confident” and “inspiring trust”. These are not isolated incidents; they are our lives. Every week, at least one of us is ridiculed, bullied, or derided. There’s nothing to be done about it, as it’s the nature of the system. Throw a group of untrained, unqualified children into one of the most stressful and high-stakes environments in the world, and you’re virtually guaranteed to form a strict and frankly tyrannical hierarchy. It’s a wonder that there aren’t more tears than there are now. We’re useless in the face of the dying, the grieving, the suffering. We don’t belong in hospitals. We don’t belong anywhere. But, as I leave the library, I glance back at the boy. His grin is so big it looks as if it will split his face in half. Not only has he seen one of his idols, but he’s actually spoken to her. And received a response. A lifetime ago, this would have made me dance on clouds for days. But now I wonder why. Why is he so impressed? Because I’ve been chosen by a system (which no one really understands) to do a job one day that has one of the highest suicide rates in the world? Ludicrous. Maybe if the traffic isn’t bad, I’ll be able to get three chapters done tonight.
ABOUT THE AUTHOR - Beatrice Preti is a current McMaster medical student at the Niagara Regional Campus (Class of 2017). She enjoys reading and writing in all genres, including poetry, fantasy, science fiction, thrillers, short stories, and literary fiction. THE MUSE • WINTER 2016
Any changes in medication?
Some days I take more, some less. But you all never ask about chard or kale or spinach.
Have you had any worsening symptoms?
I’ve been dreaming of Victorian picture frames nailed into my thighs and my kneecaps. I doodle muscle inside the lines to cover up the Naproxen bruises climbing through windows.
Have you had any relapses in the last month?
Shouldn’t have told my neurologist—the steroids burned through three days of REM: drunk adrenal glands. Make a note to have patience. To let the body practice putting out its own fires.
Are you having any pain today?
Only since you asked. Define pain. Define having. I have stored memories in the burst veins of my thighs, in the entry point scars on my left wrist.
In my neural connections—in the electrical signals through the branches of my nervous system. In my amygdala.
Rate your pain on a scale from 1 to 10.
I hear the bodies down the hall holding 6’s and 7’s in their cheeks—no hesitation. Do you remember when you weren’t taking inventory of bad and better and worse? Could you tell me how to zero out? Where the lines are? Rate my pupils. Rate the angles of my shoulders. Rate the shaking of my hands on a scale from unremarkable to Vicodin detox. I dreamt of hell again, of pitchforks. Woke up with three hot coals burrowed in my spinal cord.
Monthly Q&A with an Infusion Nurse Hannah Baggott
ABOUT THE AUTHOR - Hannah Baggott is a poet and Lecturer of English at University of North Carolina at Pembroke. Diagnosed with Multiple Sclerosis in 2007, she writes primarily about the body and its relatbionship to medical language. Her work can be found on her website: hannahbaggott.com.
Kelly Dong THE MUSEArtist: • WINTER 2016
An Interview with Diana Meredith Interview by Irina Sverdlichenko
Did the decision to depict your journey with cancer come readily to you? I had started a series of ink drawings just before my diagnosis, and I was going to include text as part of them, but I wasn’t quite sure what the text was going to be. I was feeling quite lost at that time about the project and what I was doing artistically. And then suddenly I got my cancer diagnosis and was thrown immediately into the hospital. Now, getting the “cancer” word is very daunting, but it was through that diagnosis that the project came together in my mind. That process of diagnosis
Diana Meredith works as an independent artist, writer, and critical thinker. The body is at the centre of her practice. As a person living with cancer, she is interested in challenging the dominant medical and pharmaceutical narratives of that experience. Her work is informed by second wave feminist ideas about embodiment and medical humanities. In 2013 she received an MFA from OCADU for her thesis exhibition, Age is Written on the Body, an investigation of the experience of middle age. Until her cancer diagnosis in 2015, she taught digital art at Humber College. She lives and works in Toronto. Visit www.dianameredith.com or contact Diana at firstname.lastname@example.org.
here do you find inspiration for your artwork, and how has that evolved over time? There are many different influences for my art, but probably the core of it comes from my own experience with my body. And I would definitely ascribe that to how my thoughts were shaped as an 80’s feminist. Second-wave feminism very much said that the personal is political, and as I was developing as an artist I was also embracing those ideals, such that the story of my body became the central piece in my art. For example, back in the 80’s, I was making art about sexuality because that’s how I was experiencing my body. And at some point later I was making art about what it was like to be middle-aged. So I have to say that that’s where the main influence really comes from. Do you ever find it difficult to come face-to-face with your body’s experiences on such a visual platform? Yes, and that’s profoundly who I am. It’s terribly hard, but it’s how I know my way in the world and untangle my experiences; through the making of art. Prior to my diag-
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nosis, there was a note on my wall that read, “I’ve saved myself yet again”. And that’s because I tend to be a person who, as I cycle through the learnings of life, finds myself through the visual representation of my experience.
An Interview with Diana Meredith just catapulted me into a new body of art, and I was no longer lost. So I knew I had to speak. And do you hope your art speaks to people in similar situations? More than just similar situations. Of course I want to speak to people in my situation, people with cancer. But I want to speak far beyond that. It’s why I’m interested in the medical humanities — I want to speak to people within this wide medical infrastructure. And I also want to reach people that are currently outside of the bounds of the healthcare system, but will get there eventually because illness hits everybody.
to paraphrase Michel Foucault, he would say that the text of society is written on us. And I think that’s an amazing idea, so I realized that I could actually bring text directly into my work. I did it first with my MFA Thesis, “Age is written on the Body”, and that was not only about the body experiencing middle-age, but what society’s expectations are of that experience. I apply the same idea tocancer. It’s not just my body’s experience with cancer; it has to do with cancer’s agenda, which has been dictated by society. And it seems to me that bringing text directly into the work spoke to those things.
What do you want to say to people within and outside of the health system? One of the things I noticed when I entered the health system, which is so large and so dominant, is that it tells the story of the illness. For example, when I ask someone, “Tell me about your illness,” what I hear are the technicalities of the illness; pharmaceutical regimens, survival rates, statistics, and the like. But that isn’t the story! That isn’t the story of how I experience my body, or how I experience what cancer is in this society. Cancer is such a loaded word in this society, and actually living with cancer is very different from the story told by medical professionals. So I feel that part of my job as an artist is to speak to at least one person’s experience of living in an embodied cancerous body.
What sort of text did you use in “Mortal Selfies”? I’ve worked hard to incorporate a variety of text into the pieces. For example, the text in “Loss” includes the letters that I was sending out to people, letting them know about my diagnosis and progress. But I also used graffiti as part of the text. I wanted to deface the pieces with it. Typically, graffiti is perceived as an illegitimate form of street art; so I wanted to include the violence of that in the pieces. The defacing became a metaphor for my journey with cancer.
Tell me how you came to the decision to integrate words into your series, “Mortal Selfies” and “Cancerous Body”? Text has a number of different facets. It is a visual element, and can be used to make shapes. But also, so much of our understanding in the western world is made through language. And we bring agendas to our understandings. If I were
Can you speak specifically to the work “Cherish” in the series? What was your inspiration for the piece? When I was diagnosed, I immediately started sending out letters, telling people what was going on with my diagnosis. I was amazed at how many wrote back, sending me very loving letters. I felt cherished, which was great because you tend to feel pretty vulnerable just after you’ve been diagnosed. People did a lot of things for my husband and I during that time, like walking our dog, bringing us food, and driving me where I needed to go. It was very wonderful to feel so held by a
community and this inspired the work. It is about the notion that there truly is an upside to this difficult experience. With respect to the “Cancerous Body” series, can you describe your piece “Treatable but Not Curable”? The face at the bottom of the image is a bald head, because baldness is such a cultural signifier of cancer. The background, as with all the images of the series, is the inner world of the cells or the blood they swim in. This points to the idea of the cellular matter, because that’s where all of this is taking place. The text used, “Treatable but Not Curable”, refers to the type of cancer I have. It’s a profound idea to live with, and I have to deal with that daily. So I am made of that text. What was the reason for the unique contortion of the body in this case? Well, I didn’t want the image of the body to just be pathetic. I wanted it to be a stronger body, as I dealt with the journey of cancer. And there was something about this position that appealed to me. It’s as though the body is floating, but it appears powerful at the same time. Can you explain the thematic distinction between the series “Mortal Selfies” and “Cancerous Body”, and how those series came about? “Mortal Selfies” began with ink drawings of my face. Moreover, I often do art in a series so that I can explore it further. Through reflecting on the art, I decided that I wanted to fracture the drawings. Fracturing is a very central part, both visually and metaphorically, to the work. It represents how my identity has been fractured by the experience of cancer. So “Mortal Selfies” really became an overture of my cancer journey.
THE MUSE • WINTER 2016
An Interview with Diana Meredith Then I decided that I needed to speak to the body as a whole, because that’s how I was experiencing cancer. The pieces “Cancer Body” and “Cancer Body Afloat” were a continuation of the ink drawings, because I took photographs of myself naked and then applied text. I later realized I could make the entire body from just text, which opened the door to the other pieces, “Treatable but not Curable” and “Cells”, which were even larger, to speak to the whole body. These images are also made of broken pieces of text. This represents broken cells and broken bits of chemotherapy that are hitting the cells. They make up my fractured identity. What
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have you received from people within and outside of the medical community, with respect to your series? People who have experienced cancer really see and react to the pieces in a very powerful way. It speaks to their experience, and seems to say something to them that hasn’t been articulated elsewhere. To my delight, many young people who might not have experienced cancer directly say the work has spoken to them as well. People have been surprised by the openness of the art and moved by the depth of it. So that has been very satisfying. Is there anything that you’ve learned through the process of depicting your journey with cancer, through your art?
The process of finding visual forms and manifesting them has forced me to articulate my journey. I like doing that. I find that it helps me with the fear of the situation and it helps me understand it. I want to continue talking to people who are interested to know what living in a cancerous body truly means. The work continues this conversation. What is something you want people to take away when they look at your art? I hope that people look at my art and their experience of the world is deepened. Much of our world operates on a fairly superficial level, and I hope my art takes people to a greater depth of thought and experience.
Heed the Healing By Michal Coret email@example.com
How scary it is to claim myself to be a writer. How critical I am of myself, of my writing. How little I feel I can base my judgements on. Writing is not relaxing. It is not pleasant. The process of writing is painful, reflective, harsh, and honest. It turns you over onto your head to look at yourself in the mirror upside down and wonder what is wrong; with you; with the world. I heal through writing. But what am I healing from? Do I have enough scars to claim myself wounded? How scary it is to claim myself to be a broken person. But aren’t we all? Isn’t this declaration of pain a declaration of human life? Of recognition and realization of truth? Can I be alive and whole at the same time? Are writers, then, just broken people who know that they are broken, how they are broken, and why? I feel egocentric. I am always writing my thoughts, my feelings, my stories. Even if I write someone else’s story, part of me leaks out and latches onto it, no matter how hard I try to rearrange the words to escape from myself. And what makes me think others would read my words? Why would they read my writing? Why would I? Writing is the only way I can bridge an inherent loneliness from myself, and through sharing, from others. Is the healing process the writing or the reading of that writing? What are we all healing from? Ourselves? What are we all healing towards? Ourselves? How scary it is to claim myself to be a healing person. Indeed, how scary it is to claim myself to be anything at all.
Artist: Amy Ajay ABOUT THE AUTHOR - Hi! Thanks for reading The Muse. My name is Michal and I’m a third year Bachelor of Health Sciences student at McMaster University. That’s what I am, sort of. What else am I? Who knows? I love used books, reading and writing poetry, playing music, over-thinking, learning math, swing dancing, and...so much more. THE MUSE • WINTER 2016
This is Africa By Emily Bryson
were nothing like what I had expected. A patient I thought was only six months turned out to be nearly two years old. He was undersized as a result of his mother stopping breastfeeding early when she became pregnant again, which was a common occurrence. My roommate and I arrived in Dar Es Salaam and travelled several hours to Iringa. We arrived at the Gap Medics house jet lagged but excited for the first day of our placement at the Iringa Regional Referral Hospital.
ince I was young I dreamt of travelling to Africa with hopes of working in a hospital. This dream became a reality when I discovered Gap Medics, a company providing students with the experience of a lifetime— shadowing doctors all over the world. I was just excited to check the number one thing off my bucket list. Little did I know that this trip would be one of the most amazing experiences of my life.
“Little did I know that this trip would be one of the most amazing experiences of my life.” THE MUSE • WINTER 2016
During my first week, I was on a pediatrics rotation. The week consisted of rounding on patients with a variety of illnesses, such as pneumonia, malaria, and sickle cell anemia. One of the more interesting cases was a boy who had lost sensation in his lower extremities and was having constant back pain. X-rays were normal, but he was referred to the closest hospital with an MRI machine in Dar Es Salaam, 9 hours away. We saw HIV-positive patients, or immune-compromised as they called them in the hospital to reduce the stigma around HIV and prevent others from knowing patient statuses. We also saw severe cases of malnutrition, which
While in the pediatrics ward, we visited the neonatal intensive care unit (NICU), which is where they send babies who have low birth weights (as low as 1kg), as well as those with medical conditions such as birth asphyxia (lack of oxygen to the brain). As we entered the unit there was a wall of warm air that reeked of sour milk and unchanged diapers. Along the wall were heaters that kept the babies warm because there was no incubator available. One of the first things I noticed was how many bassinets there were, each filled with two babies. Along the back wall were new mothers breastfeeding. We left the room to visit the kangaroo room, where mothers use skin-to-skin contact to help their newborns gain weight. When we returned to the NICU, I knew something was wrong. The room felt colder, the heaters were off and the hum of the oxygen machines was gone. The power had gone out. I looked at the two babies who had been on
This is Africa oxygen and it broke my heart to see that one of them had not survived. I called the doctor who told me that it wasn’t uncommon for this to happen when the power went out. I would have never thought that a power outage, a minor concern in Canadian medical facilities, could do so much damage. In the hospital in Iringa, they didn’t have generators to keep the machines on nor did they have the equipment to save all of the babies. At night, there was only one nurse available for 40 babies and if the power were to go out, that nurse would have to divide herself amongst all of them to keep alive as many as she can. The mere thought of being in that situation was overwhelming. For me, this was a harsh process of coming-to-terms with a reality that is so drastically different from home. When we asked another doctor about this, his response was T.I.A. — this is Africa. This became one of the most important lessons that I learned on this trip. I was not at home. I was not observing the smooth workings of a privileged hospital with many supplies and resources. I was in a hospital in Tanzania, Africa.
In my second week, I was on surgery rotation. This was a crazy and exciting week that allowed me to apply knowledge from my anatomy courses. We saw post-operative femoral fractures, intestinal obstructions, tumor excisions, colostomies, and more. We shadowed surgeons in the operating room (OR) for two days and saw amputations, fractures, and hernia repairs. We were also lucky enough to be able to spend time with surgeons and ask questions about the procedures. An interesting case was an emergency procedure performed on a woman who had an ectopic pregnancy, wherein the fertilized egg implants in the uterine tube. It was a whirlwind to see it happen right in front of us. One minute we were taking a break between surgeries and the next we were rushing into the OR as they wheeled in this woman. Before I could grasp what was going on, the surgeon had already made an incision and was searching for the uterine tube. The entire procedure took 30
minutes from start to finish. The days that we weren’t in surgery, we rounded on patients and saw burn victims who had suffered severe burns across large portion of their bodies. Most of them were women and children whose dresses had caught fire from the flames that they were using to cook. Those cases were the hardest for me because you could see the sheer pain in their eyes as they winced at the slightest of movements. It was on this rotation that I learned the most. I was taught how to make incisions and sutures. I also was able to see the the living human anatomy, as opposed to the cadavers I had seen in anatomy lab, a rare opportunity for an undergraduate student. In my final week, I was on an obstetrics
was not observing the smooth workings of a privileged hospital with many supplies and resources. I was in a hospital in Tanzania, Africa.”
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This is Africa and gynecology rotation, which was far and away my favourite. This week made me fall in love with this specialty because it’s the best of both worlds; working in the OR, as well as in a clinical setting. I really enjoyed the Caesarean sections and I was fortunate to scrub in on six of these procedures. Our first C-section was a blur; I wasn’t expecting to see the baby as quickly as we did. It was a matter of minutes before the doctor passed the baby off to be cleaned and wrapped up. It was truly a beautiful thing to watch, if you have the stomach for the OR. It was amazing to have the doctor narrating exactly what he was doing, pointing out specific structures, and asking questions about their functions. After the first C-section, I turned into a bit of a junkie and was always keeping an eye on the OR for the next pregnant mother to go in because I knew I wanted to be in there learning. I was excited when we had our first mother ready to deliver naturally. When I asked the doctor about epidurals for natural births he repeated the same mantra that I had heard from the others: T.I.A. Almost no one receives epidurals for natural childbirths. It was not a necessity and the goal in Iringa is to conserve as many resources as possible. I was astonished at how strong the wom-
en were to bear the pain. One of the most fascinating cases of the week came when we were sitting around on a slow day. A woman came running into the ward yelling something in Swahili. All of a sudden, the doctor looked at me and said there is a woman in her car giving birth and she couldn’t make it into the hospital. We all grabbed as many supplies as we could get our hands on. With our hands full and scrubs partially on, we ran out to the car and were met by men carrying a woman in labor down to the ward. We watched as the doctor prepared the woman for delivery and guided her throughout the birth of her son. Despite all of the time I spent at the hospital, we also had time to tour and absorb the culture. We spent countless hours in the village, at the market, and eating at local restaurants. We also went on a safari and saw tons of animals in the wild. My favourite part of the trip, aside from the hospital, was climbing a rock called Gangilonga. It was reaching the top of Gangilonga that truly put into perspective the saying that had reared its head at every corner of my trip. This Is Africa. I was here, in one of the most beautiful places I have ever visited, where everyone was so happy regardless of their wealth.
T.I.A. meant that people in Africa just make the best of what they have. Their resources are far more limited than ours, but their lives are enriching. I know it is cliché to say that this trip changed my life, but it truly has. I have returned with the utmost respect for doctors and patients in low income hospital settings. The doctors truly do all that they can with the supplies and tools they have available to them. They are some of the strongest people for being able to come to work every day knowing that someone may die on their watch because of something that could have been easily prevented, had they had the means to do so. No class will ever teach what this experience has taught me about medicine, culture, and life in general. If you ever get the chance to do anything like this, do it. It is a priceless experience that no one can ever take away from you. The lessons that I have learned on this trip will stay with me throughout my career and my life. “ No
class will ever teach what this experience has taught me about medicine, culture and life in general.”
ABOUT THE AUTHOR - Emily Bryson is a third year Bachelor of Health Sciences student at McMaster University. She is very passionate about working with children through various educational activities such as teaching swimming and mentoring primary aged kids. In her spare time she likes to swim, downhill ski, waterski, and spend time at her cottage. In the future, she hopes to get more involved in global healthcare initiatives. Read more about the trip from her blog at twogirlsabroad.wixsite.com/twogirlsabroad
THE MUSE • WINTER 2016
THE MUSE â€¢ WINTER 2016
A Medical Musing on Music By Kevin Chen
Artist: Katherine Tang
I have just entered a white, sterile, and sunlit hospital room. Carrying the electric piano, my arms are sour with lactic acid. The patient whom I am supposed to visit is slouched in her bed, her sheets covering half her face. She is not asleep, but her eyes appear dull from exhaustion. She then notices me. Mustering all her strength to sit up, she says in a thin voice, “Hi sir, is there anything I can help you with?” “Hi ma’am, my name is Kevin, and I am here as a volunteer with the Toronto Western Hospital for music therapy. Would you be interested in hearing some piano music?” I say. Playing piano was like breathing oxygen for most of my life. Ever since I was 6, the idea of donning a coat-tailed tuxedo and playing Beethoven’s Für Elise intrigued me. As I learned more pieces, discovered more composers, and gave more performances, this intrigue transformed into passion. Whether I was performing or practicing piano music, I felt free. It was a privilege to revel in the ingenious craftsmanship of composers like Bach, Chopin, and Brahms, and to be ensconced by a spellbinding world of sound while playing my instrument. This experience of music encouraged me to become a pianist, so that I could share those moments of bliss with other people.
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“Music begins where the possibility of words end” -Jean Sibelius
Unfortunately, my dreams for a career in music eventually dwindled. My parents, afraid for my future, recommended that I avoid pursuing that path. I could understand why. From prestigious conservatories such as Juilliard, Berkeley, and Tchaikovsky, there are many students competing against each other in world-renowned competitions, which meant one thing—jobs would be scarce. I realized that if I turned the very thing I loved into the job that brought home my bread, I would eventually hate it. So, as most would do when faced with this uncertainty, I went into Life Sciences at McMaster, with the personal choice to pursue medicine. Interestingly, dreams are sometimes fulfilled in weird ways. After deciding to pursue medicine, I thought I could compromise by playing piano as a hobby to relieve stress. To me, it was just a luxury I was privileged to have in life, without much practical use. But I had no idea how wrong I was.
This past summer, I volunteered at the Toronto Western Hospital. As I sat down with my volunteer resources manager to discuss potential volunteer roles, something on my resume caught her eye. She noticed that I had a performance diploma (ARCT) in piano from the Royal Conservatory of Music. Excitedly, she began to talk about the hospital’s new music therapy initiative. They were in need of some volunteers who could play music for patients. I decided to give it a shot. After setting up my keyboard, I glance somewhat nervously at the wall. Being worried before a performance about making mistakes is natural for me, but that isn’t the only thing on my mind. I am afraid she won’t like the music I am about to play. I tend to use easy-to-play and fun pop songs. For those music therapy sessions, I engage in some nervous last minute practice during my lunch break before my shift. But I brush those concerns off since, af-
A Medical Musing on Music ter all, I have a job to do. I announce that I will be playing Viva La Vida by Coldplay. Taking a deep breath, I mentally prepare to dive into the song’s energetic sound, and begin to play the first notes. Before I began my volunteer role at Toronto Western, I was already familiar with the concept of musical therapy. It was introduced to me through a Ted Talk by the aspiring medical student and violinist Robert Gupta. He had experienced personal struggles similar to mine with respect to choosing between music and medicine as a career. Instead of choosing one of them, he made an unorthodox choice: pursuing both. Gupta had conducted research with the Harvard neurologist, Gottfried Shlaug, whose work involved discovering how music can be used in therapy. The research in Dr. Shlaug’s lab seemed boundless, ranging from how the entire brain fired to how the tremors of Parkinsonian patients could stabilize, all from just listening to music (1). Gupta realized that “music [was] medicine, music [was] sanity” (2). He wanted to share this “medicine” with those who had limited access to music, and performed in the slums, penitentiaries, and mental hospitals of Los Angeles. The results were extraordinary. One woman with cerebral palsy came to him with tears streaming down her face. She described how she
stopped shaking for the first time in six years when she heard him play. During her time as a patient, nobody visited her; hearing his music was like a cathartic ray of sunshine (1). As I finish the closing chords, I tensely place my hands on my lap. I hear the beeps of the I.V machine tearing away what remains of the dreamy echo of my playing. I manage a smile as I stare at the patient, waiting for her response. Against the vexating sounds of the I.V, I suddenly hear clapping. A smile as warm as the sunlight entering the room flashes on her face. “Beautiful work! Bravo”, she beams. “I am glad you came here today, Kevin. Music was a passion of mine when I was young and your playing reminded me of my time as a musician”. All of a sudden, the two of us are locked into a conversation about our musical experiences. She was a guitarist and a vocalist for local bands across the Maritime Provinces. Performing music was something that allowed her to transcend time and reality. Just as it is for me, music was her oxygen. As we talk, I realize that after my performance, the patient who initially had dull eyes and a thin voice, who was slouched on her bed, is no longer there. At some point, she was replaced by a lady with glinting eyes, a soulful voice, and a lively presence.
Robert Gupta’s work not only resolved my career dilemma, but left me in awe of the possibility that two disparate fields such as music and medicine could be combined to achieve incredible instances of healing. Gupta himself states that the “synchrony of emotions we experience when we hear [music], compels us to remember our shared common humanity, that deeply communal connected consciousness, that emphatic consciousness…[is] hard-wired into us” (1). With this revelation, I decided to make it my mission to use both my talents in music and my education in the sciences to help heal people in my community. Composer Robert Schumann once said that “to send light into the darkness of [human] hearts, is the duty of the artist”. In addition to becoming a pianist, I will also become that artist. And I implore you all, who are also artists, who sing, who write, who paint, who knit, and who act, to share your gifts with those in need. Give the less fortunate the otherworldly experience of hope, healing, and humanity.
Gupta, R. Robert Gupta: Between music and medicine. https://www.ted.com/talks/robert_gupta_between_music_and_medicine?language=en (accessed 22 October 2016). Gupta, R. Robert Gupta: Music is medicine, music is sanity. https://www.ted.com/talks/robert_ gupta?language=en (accessed 22 October 2016).
ABOUT THE AUTHOR - Kevin is a person of many surprises. He is excited to be a first-time writer for The Muse and plans on filling its pages with his atrocious sense of humour and his heart warming stories about his time as a hospital volunteer. He once aspired to be a great concert pianist, but is now living the McMaster Biochemistry life as a second-year student. Being a person with many hobbies, Kevin enjoys cooking (when he doesn’t get poisoned by his own food), playing piano, composing music, writing poetry (you can tell he really thinks he’s artsy), reading books about neurology, and helping those in need (that’s not a joke).
THE MUSE • WINTER 2016
Dr. Jay Children’s Centre Interview Interview by Irina Sverlichenko
Artist: Adhora Mir Can you provide an overview of the work the Dr. Jay Children’s Grief Centre does? Judy: The Dr. Jay Children’s Grief Centre was established in 2006 by the late palliative care doctor, Dr. Larry Librach. The centre provides programs and services for children who are in palliative care, as well as children and their families who are either experiencing or have experienced the death of a family member. The children that come to the Dr. Jay Children’s Grief Centre are highly vulnerable. Without support, they are at risk of suicide, continued isolation, poor academic performance, depression. and drug and alcohol abuse. When children and families reach out to the centre, they know that they are not alone; that they have an entire community of support out there, which is important during this critical period. How did you get into the field of palliative care? Ceilidh: I did an internship at Sick Kids Hospital and found myself working with kids who were dying. I originally thought that it would be a terribly depressing experience, but it turned out to be an incredibly rewarding one. In the hospital setting, there is such a focus on curing the illness. But working with kids who are in palliative care, you begin to realize that just because you can’t cure the illness, doesn’t mean that you can’t make an incredible difference in their lives, and the lives of the families. Unfortunately, because of the focus on providing a cure, there weren’t many people in a position to support struggling families, so I saw an opportunity to make a difference in that sense. What are the most challenging aspects of working with palliative children? And conversely, what are the most rewarding? Ceilidh: To be honest, the
THE MUSE • WINTER 2016
Dr. Jay Children’s Centre Interview most difficult part is not so much the dying. I think that is a natural part of our experience as humans. The hardest part is when the families aren’t able or willing to accept the possibility that their child might die. Because then your options as a counsellor are limited, especially knowing that there’s so much you could be doing to provide support. As a result of this, we encourage families to have open conversations about all the possibilities that face the child. The death of a child is such a taboo topic, which we only talk about when we absolutely have to. So our goal at the Centre is to promote these conversations in families from the beginning, because it can make the process of providing support much more meaningful. On the other hand, the most rewarding aspect of the work is being able to help families have these conversations. I just ran into a mom whose child was one of the first kids I worked with at Sick Kids. Unfortunately, the child ended up dying. The mom told me that she remembered us encouraging her to talk to her daughter about the possibility of her death, and that she thought we were insane for suggesting this. But in the end she admitted, “As soon as we talked about it, I realized it was the most valuable conversation we could have had”. She was already worried about it, but talking about it allowed us to properly support her through it, and let her know that she was not alone. How do you find the discourse around sick children differs from the discourse around sick adults? Ceilidh: Children are seen as innocent and vulnerable beings, and there’s this idea that death isn’t supposed to happen to kids. You know, there are many physicians who work in palliative care who
don’t want to go within a hundred yards of a dying child because of this feeling that it’s a different situation, a different experience altogether. Doctors who enter the field of paediatric oncology go in with the mindset of wanting to save kids, and they’re not prepared in medical school to deal with the inevitable cases where the illness is incurable; that it’s not their fault, and that it’s not a failure of medicine, but that it’s just what happens sometimes. This lack of preparedness really disrupts the proper care of dying children.
munication with children. A lot of it is about dissociating our myths and misconceptions about dying and grieving so that we can be more effective clinicians and more effectively communicate with children.
One of the initiatives that the Dr. Jay Children’s Palliative Care Centre undertakes is work with physicians and medical teams to provide sessions on how to talk to a dying child about death. And how to talk to the family about death and dying. But this is specific to medical teams and health care workers.
What kind of response have you received from people that participate in these training programs?
Can you describe in more detail the training that the Dr. Jay Children’s Grief Centre provides to physicians and other medical personnel on the topic of grief? Do you think this training might ever be integrated into medical schools? Ceilidh: We’ve been working very closely with the Medical Director of Palliative Care at SickKids Hospital, who has created some significant training opportunities for medical students aspiring to be palliative care physicians or paediatricians. We bring these students together and co-deliver very intensive, interactive training around supporting kids who are dying or kids whose parents are dying. We also run a SickKids interdisciplinary training course. In this course, we talk about understanding children’s grief, the importance of language, nonverbal communication strategies, and expressive activities involved in com-
The ultimate goal is of course to be able to get this training integrated into the curriculum of medical schools, nursing programs, and social work programs. However, it’s a very long process, so in the meantime we’re focusing on practitioners who are already in the hospital setting.
Ceilidh: We get a great response. When we do our evaluation forms afterwards, we have a lot of people saying that they’re grateful to know that it’s important to be open and honest. People tend to have one of two notions going into the training; either they have a wish to be open and honest with kids but they don’t know if it’s the right thing to do or they really want to protect kids by not talking to them about dying. They think it might be too difficult or overwhelming for the kids to know. But the message we try to get across is that by keeping kids out of the conversation, you’re not protecting them from anything. They’re experiencing all of it anyways, and you’re keeping them from having the opportunity to feel supported. For the most part, after one training course people still don’t feel completely confident in engaging in these conversations, but they feel more comfortable than they did before. Can you describe the experience of the weekend long retreat, Camp Erin, and the goals of this camp for the kids
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Dr. Jay Children’s Centre Interview and the families? Judy: Camp Erin is a weekend-long overnight camp for bereaved children and teens around the Greater Toronto Area. It combines traditional outdoor camp activities with grief education and emotional support, and equips children with the tools they need to help them through their grief and other difficult experiences that they may face in their lives. By giving them a chance to meet other grieving children and teens, it helps them understand that they are not alone in their experience, and this helps decrease their feelings of isolation and improve self-esteem. Ceilidh: It’s also incredibly important for the kids to know that it’s okay to express the emotions they are experiencing, whatever those may be. Parents try to protect their kids from their emotions, and this sends them the message that they should be hiding their own during the grieving process. During the camp we have a photo ceremony, where everyone is encouraged to bring up a picture of the loved one they lost and share a story about them. It’s an incredibly emotional experience. People start crying at the stories and once the ice is broken, the kids can feel comfortable crying for themselves. So many kids write on their evaluation forms that that was the first time they cried about their loss and that it was an incredibly important experience for them to have had.
We also do a lot of therapeutic activities during the camp. We hosted an amazing activity this year where kids wrote on balloons something that someone had said to them when they were trying to be helpful, that ended up being destructive. Then together, the kids popped all the balloons. Activities like this can be incredibly cathartic for the kids. Do you find that, in providing care to families in these very vulnerable times, you build long-term relationships with them? Ceilidh: Because it’s such an intimate time to be involved with a family, even if we don’t see them for a long time, the relationship built can be powerful. I recently received an email from a mom whose daughter I met once, eight years ago. And she expressed her gratitude to me because of the impact that this one meeting had on her and her daughter. After that meeting, the mother and daughter continued coming to family events for six years. We definitely want to make sure that this relationship remains available for as long as it’s needed, especially because grief is a lifelong experience. The relationship the person has to the individual who died is very complicated. Moreover, as kids grow up and their understanding of what death means and their relationship with the person who died changes, they might grieve differently at every developmental stage and may need to reconnect with us every few years over time.
What would you tell people about the importance of grief counselling? What are you most proud of, in terms of your involvement with the Dr. Jay Children’s Grief Centre? Ceilidh: Grief is natural, and we’re not here to fix grief, but to help it manifest it in a healthy way. Our role is to help build the family’s capacity to support one another over their lifetimes. The Centre is flexible enough to meets the needs of families who desire intensive psychotherapy or families who just need support. And the biggest thing I want people to know about grief in general is that they should try to counter that fear of, “if I don’t know what to say, better to say nothing at all”. It is not better to say nothing. So when you bring up something to a person who’s grieving, you’re not reminding them of something that they’re not already aware of. You’re acknowledging what they’re going through. Judy: I also want to say that our program is comprehensive, it’s free, and it’s offered by professionals who have vast experience in grief and bereavement counselling. We’re here to help children and families with their grief and bereavement. What I am most proud of is that we have a history of ten years of helping and working with families and children, and I’m proud of the team that provides these services because they have an expertise that few people do.
ABOUT THE INTERVIEWEES Judy Tobe - Judy was formerly the Executive Director of the Dr. Jay Children’s Grief Centre. Ceilidh Eaton Russel - Ceilidh graduated from the Child Life Program at McMaster University in 2001 and earned a Master of Science from the University of Guelph’s Family Relations and Human Development in 2013. She has been a counsellor with the program since its inception in 2006. She also conducts research with the Brain Tumour Program at Toronto’s Hospital for Sick Children, exploring family interactions with seriously ill children. For more information, visit drjaychildrensgriefcentre.ca.
THE MUSE • WINTER 2016
THE MUSE â€¢ WINTER 2016
The Medical Spotlight By Robert Dima
Artist: Kelly Dong
For most students, only two or three of these professions come to mind, and for the layperson, only a small fraction is recognizable. What does this mean? Simply put, healthcare workers who are not physicians or nurses tend to be out of the “medical spotlight.” This is not necessarily due to their lack of professional education or credentials. Many allied health professions are regulated, requiring licensure for practice, and some even require the acquisition of a graduate level degree. For example, physiotherapists in Canada require a professional Master’s degree physiotherapist or autotransfusion- in physiotherapy (1). The truth is ist are getting up to on a daily basis. that the medical doctor is the focus Take a look at this non-exhaustive of the layperson’s understanding of list of health professionals one might medicine since they are “the boss.” encounter in the average healthcare facility: Medical imaging technologists have been referred to as “button-pushPhysician ers”, physiotherapists mistaken for Registered Nurse (RN) masseurs, and who knows what an Registered Nurse Practitioner orthoptist does? What is not known (RNP) by the general population, and perRegistered Diagnostic Medical haps, sadly, even by their fellow Sonographer healthcare workers, is that medical Physiotherapist imaging technologists, physiotherCardiovascular Technologist apists, cardiovascular technologists, Anesthesia Technician and others are educated persons Occupational Therapist with a deep understanding of their Medical Laboratory Scientist respective roles. As the hospital enSurgical Technologist vironment changes, they too are reParamedic quired to possess higher and higher Medical Radiation Scientist standards of education. This gap in Diagnostic Radiographers understanding is detrimental beRadiation Therapy Technologists cause it compromises interprofesMedical Officer sional collaboration. This is worryPhysician’s Assistant ing, since interprofessional relations Lactation Consultant are important to the optimal impleOrthoptist mentation and delivery of healthcare (2).
ABSTRACT - The transition of the healthcare system from a traditional, physician-centred model to the collaborative healthcare model has been necessary to account for financial and temporal stressors on Canadian health facilities. A related and necessary feature of the organized model includes increased reliance on allied health professionals and interprofessional collaboration, which has been shown to improve patient-centred care. The rapid development of the “supertechnologist,” who assumes enhanced roles and greater responsibility, requires advocacy and transparent awareness of the allied health professions to which they belong. Advocacy is important for educational development, research initiatives, and collective action, to ensure the continued development of these professions. The author aims to increase awareness of the importance of allied health professionals’ roles as they relate to the long-term implementation of the collaborative healthcare model.
he ever-evolving nature of healthcare delivery presents a challenge to the hierarchy and social stratification of the average healthcare facility. Deeply ingrained traditions and perceptions regarding academic standing, competency, and judgement create a complex sociopolitical environment in our hospitals. This hierarchy may be thought of as a food chain, with physicians at the top and the rest of the somewhat less romanticized healthcare workers beneath them. This may be why, when someone thinks of the words “hospital,” “healthcare,” or “medicine,” their mind jumps to the white coat and stethoscope of the M.D. Very rarely will one make a comment on the wide variety of other healthcare workers, who have become grouped under the term “allied health professional.” Popular culture contributes to this widespread misconception. Medical dramas like “Grey’s Anatomy,” “House,” and “Scrubs” don’t particularly showcase what exciting things the THE MUSE • WINTER 2016
22 It is important to recognize the contributions of all healthcare workers because the healthcare system is changing. With the advent of patient-centred care and the collaborative healthcare model, as well as the financial and temporal stresses on the healthcare system, the nature of the patient experience has changed drastically (3). In the past, a patient could have been seen and handled by a single physician. However, with larger numbers of patients, increased incidence of chronic illness, and other stressors placing burdens on the system, patient care has suffered. To combat this, we have turned to the collaborative healthcare model and patient-centred care. This system features increased reliance on non-physician healthcare workers and enhanced interprofessional collaboration. In these models, physicians function “interdependently [and] in teams with physicians and other clinicians” (4). It has become necessary for healthcare workers to assume roles previously unexplored in order to alleviate some of the burden from the overworked, overstressed physician (5). It can now be said that the nurse, imaging technologist, porter, and medical lab scientist, among others, all contribute to patient healthcare in varying degrees instead of occupying a single role.
The Medical Spotlight appreciated when considering the ness can be improved. After all, the sobering topic of preventable med- physician is only a single compoical errors. One study estimated that nent of modern medicine and colin Canada, out of 2.5 million hospi- laboration between competent and tal admissions, 185,000 will be asso- capable allied health professionals is ciated with adverse events, 70,000 of necessary to ensure better outcomes which will be preventable (6). Con- for patients. sider this quote from a 1998 Journal of the American Medical Associ- REFERENCES ation article titled “Promoting Pa- 1. Becoming a PT or PTA | Canadian PhysiotheraAssociation [Internet]. Canadian Physiotherapy tient Safety by Preventing Medical py Associated. 2016 [cited 2016 Sep 17]. Available from: https://physiotherapy.ca/becoming-pt-orError,” pta
“Modern healthcare presents the most complex safety challenge of any activity on earth. However, we have failed to design our systems for safety, relying instead on requiring individual error-free performance enforced by punishment, a strategy abandoned long ago by safer industries such as aviation and nuclear power. The medical imperative is clear: to make healthcare safe we need to redesign our systems to make errors difficult to commit and create a culture in which the existence of risk is acknowledged and injury prevention is recognized as everyone’s responsibility.” (7)
The collaborative healthcare model is important for maintaining patient safety and proper patient care. It also requires the contribution of all healthcare workers, though oftentimes there is a lack of recognition for the key roles that other members of the allied health professions ocThe importance of having estab- cupy. It is important to advocate for lished a more modern system of all allied health professionals so that healthcare delivery is perhaps best education, regulation, and aware-
2. Varpio L, Hall P, Lingard L, Schryer CF. Interprofessional Communication and Medical Error: A Reframing of Research Questions and Approaches: Acad Med. 2008 Oct;83(Supplement):S76–81. 3. Grol R, Wensing M, Eccles M, Davis D. Improving Patient Care: The Implementation of Change in Health Care. John Wiley & Sons; 2013. 525 p. 4. Principles of Practice and Duties of Physicians [Internet]. The College of Physicians and Surgeons of Ontario. [cited 2016 Mar 8]. Available from: http://www.cpso.on.ca/policies-publications/thepractice-guide-medical-professionalism-and-col/ principles-of-practice-and-duties-of-physicians 5. Friedenberg RM. The Role of the Supertechnologist. Radiology. 2000 Jun 1;215(3):630–3. 6. Baker GR, Norton PG, Flintoft V, Blais R, Brown A, Cox J, et al. The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada. Can Med Assoc J. 2004 May 25;170(11):1678–86. 7. Leape LL, Woods DD, Hatlie MJ, Kizer KW, Schroeder SA, Lundberg GD. Promoting patient safety by preventing medical error. JAMA. 1998 Oct 28;280(16):1444–7.
ABOUT THE AUTHOR - Robert Dima is level III Mohawk/McMaster student in the Medical Radiation Sciences program, specializing in diagnostic ultrasound. His research interests involve all aspects of medical imaging, professional development research and interprofessional research in healthcare. He is especially interested in increasing public awareness of the professional scope of diagnostic ultrasound and registered diagnostic medical sonographers in Canada.
THE MUSE • WINTER 2016
Panopticon By Mehdia Hassan firstname.lastname@example.org
here is a lot more in a gaze than can be seen — pun intended. A gaze can pathologize species. It can be powerfully “contagious.” Certain architectural structures in healthcare environments may promote surveillance and non-reciprocal acts of looking more than others. This leaves us to ponder whether the beings that are looked at are actually more “infected” by this disease of looking or the lookers themselves. Does this voyeuristic act of looking THE MUSE • WINTER 2016
Artist: Mehdia Hassan
dehumanize the patient? What does this say about how humans treat animals? These notions of how animality is able to enhance our understandings of health were explored in one of the most captivating courses I have taken during my undergraduate career at the University of Toronto Scarborough: home to Canada’s first undergraduate curriculum in Health Humanities. The trailblazing curric-
ulum, developed and taught by Professor Andrea Charise, includes the thought-provoking course HLTC50: The Human-Animal Interface, which is one of four unique Health Humanities courses of their kind for undergraduate students in the country. To learn more about the presence of Health Humanities at the University of Toronto Scarborough, check out SCOPE: The Health Humanities Learning Lab, an innovative research and education initia-
Panopticon tive that embraces arts-and-humanities-based approaches to health and illness at: www.scopelab.ca.
allow us to better understand health and illness through its portrayal of the pathologizing potential which the looker’s power can have. It depicts the first person view of a hospital unit from the panoptical nursing station, where the looker is able to see all of the hallways and patient rooms in a way similar to the objectification of animals that are looked at by humans or guards at zoos, with caged animals that are injured and disabled from this confinement. The Looker’s Disease demonstrates that power pathologizes both humans and animals.
Perhaps what amazed me the most was one of the lectures in HLTC50: The Human-Animal Interface which explored how “power can pathologize species.” This included analyzing Jeremy Bentham and Michel Foucault’s ideas of the panopticon, an institutional building where all of its parts are able to be viewed by the circular centre. The panopticon is commonly seen as an efficient structure of surveillance that is “required” in hospitals for effective control and observation. Foucault believed it to be a “diagram of the mechanism of power,” especially when compared to the nursing station at a hospital unit (Charise, 2016). Furthermore, Randy Malamud proposed that zoo spectatorship, the non-reciprocal and “contagious” act of humans looking at animals in zoos from a position of power and control, is encouraged by the panopticon as it is an “architecture of constant surveillance,” The painting separates the looker (AR, 24). and the beings that are looked at by portraying them at different parts It was these very powerful ideas of the painting to better depict this that inspired my analytical essay pathologization from power. The for HLTC50: The Human-Animal semi-circle, panoptical nursing staInterface and also inspired me to tion at the bottom is taking up alvisually explore Malamud and Fou- most a third of the painting and cault’s ideas by painting The Looker’s portrays the territory of the looker, Disease. The notion that my creative through the visual element of size. and critical exploration of these Moreover, the animals in the cagideas had started from an intellectu- es and in the hallways are much ally-stimulating Health Humanities smaller and remain in the top half course I chose to take, is something of the painting. This difference in I am deeply grateful for. size, combined with literal separation of the two parties, depicts the The Looker’s Disease provides the looker’s entitlement to power and viewer with important insights into constant surveillance over the inhow notions of animality are able to jured animals. This allows the view-
er to better understand the isolation and frustration that is created when spectators at a zoo are intrusively looking at the animals for “scientific insight, order, and truth” by contributing to the non-reciprocity of the looker’s gaze, imposing order (Malamud, AR, 24). The painting depicts how this separation is problematic in a healthcare setting by illustrating how patients and hospital staff are driven apart by the panoptical structure of the nursing station, similar to the guard or warden being separated from the animals in the zoo (Malamud, AR, 24). The viewer is able to better understand Malamud’s interpretation of Foucault’s suggestion that antagonism exists between the watcher and the watched, since zoos resemble prisons, due to their panoptical structures, which are also in hospital units (Malamud, AR, 24). The two horses in the middle hallway are attempting to resist this despite not being able to look back at the looker, due to their injuries.
“It is the looker that is casting a voyeuristic gaze on the hospital unit from their position of power.”
In a sense, The Looker’s Disease portrays what Malamud describes to be a “zoo story” — where animals are caged and “impassively victimized subjects incapable of exchanging glances” (AR, 24). The non-reciprocity of this looking by the spectator demonstrates how zoo stories celebrate people’s power over animals and as a result, can disable them through this intrusive and constant surveillance that the panopticon makes possible (Malamud, AR, 24). The cages of the injured animals in The Looker’s Disease allow the viewer to better understand this notion because it regards them THE MUSE • WINTER 2016
Panopticon as subjugated objects that are being monitored and controlled by both the physicians, as well as the looker, who is watching from the nursing station. The animals in The Looker’s Disease, such as the horses and monkey on the stretcher with bandages on their eyes, in addition to the giraffe in the wheelchair, whose eyes are closed, do not know for sure whether or not they are being watched. However, there is the notion that they “could be” watched at any moment from the panopticon (Malamud, AR, 24). This “visibility trap” assures an automatic functioning of power by inducing this consciousness and permanent visibility (Malamud, AR, 24). It is the result of this zoo spectatorship, as symbolized by the black-rimmed glasses on the ledge of the nursing station, that disables the animals and pathologizes them as patients, making them even more submissive and subordinate to this powerful surveillance. The artwork contributes to the understanding of how zoo spectatorship is a “contagious” and “deviant” act, which can be attributed to the psychiatric characterization of voyeurism (Malamud, AR, 24). This is depicted by the panoptical nursing station at the foreground of the painting, which has the Diagnostic and Statistical Manual of Mental Disorders (DSM), containing the standard criteria for the classifica-
tion of mental disorders. According to Malamud, zoo spectatorship provides humans the opportunity to watch everything that animals do through this act of staring, which resembles the power and pleasure of voyeurism, a non-reciprocal action (AR, 24). It becomes an “addictive and obsessive behaviour”, which is driven by the looker, who has a desire to search for scientific truth, order and insight; the zoo setting provokes this in the looker (Malamud, AR, 24). This is also suggested by the glasses on the ledge of the nursing station, representing the voyeuristic and addictive desire of looking from the privileged position of the panoptical nursing station.
for its treatment (AR, 24). Even the name of the painting, The Looker’s Disease, suggests that there is hope for the treatment of the spectator’s intrusive gaze. This is further portrayed by the bottle of medication and prescription on the ledge of the nursing station, as well as the open bottle of pills scattered on the table, which are all meant for the looker. It is the looker that is casting a voyeuristic gaze on the hospital unit from their position of power. When this notion of hope is implied to the resolution or treatment of this zoo spectatorship, it provides the viewer with a worthwhile glimpse from both inside and outside the panopticon; this allows them to better see how problematic this way of looking The painting effectively puts the is, for it is not until society sees othviewer in the position of this look- er humans like animals in a zoo that er, as these medications and medi- we can realize the true pathologizacal treatments are suggested for the tion of power. viewer to ironically control their pervasive and “deviant” disease of This past May, The Looker’s Disease looking. The open bottle of scattered was showcased at The Broke Galpills suggests that the looker has at- lery, a Toronto arts exhibition for tempted to treat themselves using emerging artists, in hopes of inspirthe pills, but has realized that they ing others to think carefully about are not as effective. Similarly, the the impact of architectural power problematic zoo spectatorship in and the gaze in health care settings. hospital settings cannot be stopped until humans realize the impact of REFERENCES their contagious staring actions Charise, A. (2016). Week 9 - The Human - Animal Interface: How does power pathologize species? (Malamud, AR, 24). However, the idea that Malamud regards zoo spectatorship as a psychiatric disorder or disease of voyeurism implies that there is potential
[PDF document] Retrieved from Blackboard Portal: https://portal.utoronto.ca/bbcswebdav/ pid-5105717-dt-content-rid-31460947_2/courses/Winter-2016-HLTC50H3-S-LEC01/HLTC50%20 20Week%209%20Slides%281%29.pdf Malamud, R. (1998). Zoo Spectatorship. The Animals Reader. Kalof, L. & Fitzgerald, A. (Eds.). New York: NY. Berg
ABOUT THE AUTHOR - Mehdia Hassan is a visual artist and an undergraduate student at the University of Toronto Scarborough, completing a double major in Health Studies and Psychology. Her Health-Humanities-inspired artwork has been showcased at multiple venues. She is also an Undergraduate Learning Facilitator for the HLTB50: Intro to Health Humanities course, during the Fall 2016 semester. As part of SCOPE: The Health Humanities Learning Lab’s interdisciplinary team at UTSC, Mehdia helps bring to light the importance of studying Health Humanities at the undergraduate level, as well as the arts and humanities’ meaningful contribution to the critical study of health. THE MUSE • WINTER 2016
THE MUSE â€¢ WINTER 2016
Euthanasia By Annie Wu email@example.com
uthanasia. Endpoints. Sacrifice. These are the terms used during discussions and debates of animal research. The dreaded five letter word, only ever uttered with hushed voices, in dark alleyways. It is the Macbeth of the scientific world. While the handling of animals in research is a polarizing issue, its contributions to scientific advancement and the development of drug pharmacology is inarguable. However, despite the gravity of the subject, when my research supervisor asked me whether or not I was comfortable and willing to handle animal research for our lab, I fervently agreed. I was so eager to learn more that, in my haste, I never stopped to consider what I had actually signed up for. Months of training went by; we were taught how to recognize signs of pain and duress, how to care for the animals properly, and a lot of emphasis was placed on ethics. However, even during these months, the realization that I had to be responsible for the euthanasia of living mice never caught up with me. I dehumanized and deconstructed the process, approaching it with the same attitude as I would with any other scientific protocol. I only began to realize the magnitude of my actions as I was shadow-
ing a Masterâ€™s degree student who was isolating the murine femur and spine. We donned the long scrubs, booties, rubber gloves, and cap, and made our way inside. We proceeded to disinfect the biosafety cabinet and I handed him the cage of the two mice. He took the cage from me, effortlessly got hold of the mice, and
He moved so fast and so swiftly. His hands danced across the stage, enveloped by an elegant and unified air. placed them under anaesthesia. He swiftly made an incision in the abdomen and cut the main artery connected to the heart, before proceeding with the bone extraction. He moved so fast and so swiftly. His hands danced across the stage, enveloped by an elegant and unified air. It was a performance I did not want to see. The sight of blood never troubled me but at that moment my head was pounding. I could feel the hard beat of my heart and the clamminess of my palms. I felt faint. Even
27 I was surprised by my own visceral response. Perhaps I was ignorant to the burden of my choices or perhaps I simply wanted to reject the very notion, but it was harder than I imagined it would be. It was hard to look at these mice with the understanding that you were witnessing their last moments. It was hard to accept that you were the agent of their demise. It was hard to look at the lifeless body when, minutes earlier, the mouse was lively, running around, cleaning their fur, or eating lunch. It is hard to watch a life fade away. A life is heavy and my hands are too small. Whether or not you believe the use of animals in research is ethical is entirely up to you, but regardless of your beliefs, it is a heavy subject. This experience made me consider the responsibilities of healthcare professionals; they carry the burden of life every single day and it is both inspiring and frightening. As a student interested in medicine, my experience gave me a glimpse to the grittier side of medicine, stripped of its romance and glamour. It is a big responsibility, and I do not know if I am big enough. But for some reason, the realization of the immensity of life has only motivated me more to take the challenge.
Artist: Cathy Lu
About the author - Annie Wu is a second year student in the Bachelor of Health Sciences program at McMaster University. She enjoys art, working with children, and engaging in conversations on the multifaceted nature of healthcare through her Global Health specialization.
THE MUSE â€˘ WINTER 2016
Mindfulness Q&A: Melanie Tsesler Sama Anvari THE MUSEArtist: â€¢ WINTER 2016
29 Toronto based mindfulness pracToronto based mindfulness titioner and owner of practiMindful Betionerginnings and owner of Mindful turned her passion into Beginnings turned passion a business idea.her Melanie Tsesler is into amore business idea. Melanie Tsesler in love with learning and beis more in love learning coming a with better versionand of herself becoming better version of herself and everyaday through mindfulness everywants day through mindfulness and with to share her passion wantsthe to world. share her passion with the her We caught up with world. withshe herfinds to find to We findcaught about up what most aboutchallenging what she finds most challengand most rewarding ing and what she andmost whatrewarding she wouldand share with othwould other young profesershare youngwith professionals… sionals…
What exactly is Mindful Beginnings? Mindful Beginnings is a business I created out of my love for mindfulness, learning, and people. Its aim is to deepen the understanding and integrate the benefits of mindfulness practice into the daily lives of children and adults. We believe that, through mindfulness based training, individuals are better equipped to deal with the demands of everyday living and are inspired to implement their mindful learnings in all realms of their lives. What exactly is mindfulness? It’s the idea of purposefully paying attention to the present moment. In our hectic everyday lives, we are constantly searching for the next best thing or focusing on a past event in our lives; mindfulness allows us to really take each moment and not judge it. I also think this leads us to eventual happiness. What do you define as happiness? Funnily enough, I’m writing a children’s book about this right now – the idea that happiness is a destination to be attained. We, humans, are constantly looking for the next
best thing or thinking that we will be happy once we achieve a certain goal; this can be a career, a love interest, or money. Ultimately, we are constantly seeking to find what we do not have now. I call this the “I’ll Be Happy When” Theory. It’s the idea that “I’ll be happy when (fill in the blank)” – I get into school, I meet the love of my life, it’s the weekend... Whatever it is. This, I feel, is something that we learn when we are young and becomes increasingly prevalent in our lives as we age. Children constantly feel like they will be happy when it’s recess, when someone is their friend, or when it’s pizza day. We have all been there. I’m passionate about bringing these issues forward through a book for children so that they can understand the concept of happiness early on – that it’s not achieved by getting something. We have to find it within ourselves! Where do you see the value in this kind of work? To be honest, everywhere. Mindfulness is such a great practice for every workplace. I especially see the value in schools and businesses, along with fast paced professions such as medicine and emergency first response. In addition to being a proactive and preventative measure, this practice is also helpful for individuals that have had traumatic experiences. Do you have any advice for other young professionals? I am a huge proponent of asking for what you want and not taking no for an answer! I have had many opportunities come my way simply because I was bold and asked. I also have a personal theory that I like to refer to as, “Awesome, now ask one more time.” Oftentimes, people are afraid of asking and back down far too easily after receiving a negtive
response. Most of the time, there is another way to go about getting what it is you’re looking to get; all you have to do is ask! Do you also practice yoga? Does that have anything to do with mindfulness? Absolutely, it does. I’ve been practicing yoga for over 10 years. They certainly go hand in hand and are not mutually exclusive. Yoga is the practice of the mind and body connection, and mindfulness relates to the mental health aspect of it. This part is huge – without our mental health, we really have nothing. What is one major challenge that you’ve had to overcome so far? How did you overcome it? The desire to reach as many people as possible. Many businesses or schools want and understand the necessity of implementing the practice. They simply do not have the financial means to facilitate the process. I wish I could help everyone that is willing to give it a try. This is exactly why I want to reach more people by engaging them through a book and speaking at conferences. Given the numerous benfits of mindfulness, I want to be able to share this with everyone, irrespective of their financial resources. What else comes with the practice of mindfulness? What else is important to you? Mindfulness has many different facets. For me, it means being communicative, empathetic, and mindful of others – this includes being mindful of someone’s feelings, and mindful of someone’s time or space. This also takes work. It takes practice. To be mindful is a choice. It’s a constant conversation you have with yourself every single day.
By Anonymous Confined, contained– guilty without a jury, I did not realize it would come with such hurry. I can feel my soul start to evaporate as I lie, My body so still– slowly beginning to die. Accused, abused– arrested as I came out of my prime. Youth kept me innocent, but longevity is my crime. Now I am trapped– no chance for parole, Until I am freed, when put on death’s row.
My cellmate, an old love, will suffer the same fate. She curses the clouds whilst carrying my weight. Abreast, hearing my verdict, she softens the fall, But she will have no one when Death sends its call. Would you jump off the bridge– or walk its full length? To leap reaps less pain, but requires more strength. If not, be trapped in a body– life turned to grey, For it is the prison I suffer in, with each passing day.
Artist: Alice Lu
Emergency First Response Team Interview Series:
Alexis Karasiuk Interviewed by Samuel Wu and Joon Mun THE MUSE â€¢ WINTER 2016
EFRT Interview Series: Alexis Karasiuk
Alexis Karasiuk Q: What’s one thing that you want people to know about EFRT? A: I think I’d like them to know that we actually get more calls than people think. There’s also a great variety of calls. Often, people are very surprised that the calls aren’t just alcohol- and drug-related. We can’t talk about the specifics of our calls, but I can say that we get quite a lot of seizures, and I’ve even seen people get heart attacks. There are a lot of medical issues on campus that we get to be a part of. I think it’s really good that we have a quick response time and are able to provide primary care before the ambulance arrives and help with transitioning the patient when they do come. Q: What’s one misperception that people have about EFRT? A: The most common misperception is that we don’t sleep. People ask me, “Oh! You have night shifts that go all night long? When do you sleep? You’re a student after all.” We have bunk beds in the office, and we also have a couch. If it’s a really busy night, we can be up until 5 in the morning, so the job can definitely impact sleep. For the most part, however, we can sleep and do other things such as study or even get food. Essentially, we’re normal students. Q: Going into more about your responsibilities, what exactly is your role in EFRT? A: As the internal coordinator, I have a personal role and a general executive role. Being an executive
has its own aspects. Being one executive out of our team of five, we run shifts like regular responders and we also run executive shifts, where we have a radio on us at all times and we’re within 10 minutes of campus. This is to make sure that if the responders aren’t sure about a call, we can provide a second opinion. Especially if it’s a serious call, such as those involving someone not breathing, we’ll be called in and provide backup. We bring a lot of our past experiences to the table. When we’re not officially on shift, we plan training and orientation processes. As internal coordinator, I assign shifts based on the availabilities that are submitted to me. I also perform miscellaneous tasks such as cleaning around the office,
ordering clothing, and coordinating with other people and organizations around campus. Q: Having been on the team for three years, how do you see the role of EFRT as a whole evolving around campus? A: I think it’d be really good for more people to know about the services that we offer. Often what happens is that people with not-so-serious medical concerns call 911 because they don’t know we exist. We get dispatched regardless because 911 contacts security and security contacts us. Sometimes when we arrive, we find out that the person didn’t really need an ambulance; they just required some other form of care.
THE MUSE • WINTER 2016
EFRT Interview Series: Alexis Karasiuk Also, if people don’t know about the services we offer, they will call in about situations that aren’t relevant to our services. For example, we have been called for small cuts and scrapes that could have been taken care of by going to the pharmacy and getting band aids. Those kinds of situations aren’t what we’re here for. We deal with issues that an individual can’t handle alone. Q: Why did you choose to join EFRT?
of people, whereas in other extracurricular activities, you’ll often get surrounded by people who are similar to you. EFRT has an interesting community, is extremely supportive, and has been very beneficial for me. I don’t even know if I fully understand the extent of the impact the team has had on me; perhaps when I reflect on this experience in the future, I’ll realize how crucial my time with EFRT has been.
A: I’ve been asked if I was going hiking at least six times. Each pack is different, but they still share a lot of common equipment because we need to be prepared for when we get multiple calls at the same time. The types of packs have slight differences. The rookie pack has a lot of tools for pediatric patients. The soft pack has pieces of machinery called the Non-Invasive Blood Pressure Amplifier (NIBP) that allow us to measure blood pressure. The senior pack carries the Automated External Defibrillator (AED). You have to think about which responder goes to which call. Also, the severity of the call helps determine what packs will be involved in the dispatch. Other than that, most of our packs have oxygen and standard assessment kits like a blood pressure cuff, a temperature probe, and band aids. If you ever come to Clubsfest, we have a whole laminated model to show you all the materials in our packs.
“The club is great
A: Before I joined EFRT, I was working at a summer camp as a lifeguard. I really enjoyed being a part of the team environment, as well as being in charge of many of the safety aspects of camp. One of my coworkers was on the first aid team at Queen’s University and told me about the nature of some of her calls. I was really surprised by her experiences and I thought her job was fascinating. I thought I would be interested in a similar role that would expose me to a lot of real medical situations. So, when I went to Clubsfest, I looked specifically for a club that would give me this experience and I found EFRT.
because it forces you to get to know a diverse range of people...
Q: After being part of EFRT for so long, what’s the most satisfying part of being on the team? A: I think that there are two points that are satisfying. One is just being at calls where you feel like you’re making a difference. Even in the case of calls that weren’t that serious, it was good that the person really benefitted from our support and care. The other aspect is team cohesion. The majority of the close relationships I have made in university have been through EFRT. The club is great because it forces you to get to know a diverse range
THE MUSE • WINTER 2016
Q: Speaking of your experiences, how would you say EFRT aligns with your personal goals? How does it fit into the big picture? A: Most of the people I know want to pursue a medical career – doctors, nurses, occupational therapists, things like that. I don’t have an interest in going into healthcare. I just really like first aid, helping people, and being there in the moment. I don’t have to get involved in long-term care. I like being able to help people where they are and then connect them to further services. That being said, I don’t think it’s unlikely that I’ll do some first aid-related initiative in the future, but I won’t pursue it as a full time job. Q: We see responders walking around on shift with huge backpacks. What exactly are in those bags?
Q: Being a part of EFRT and the Arts and Science program, naturally you interact with many people. What’s the best piece of advice that you have ever received? A: One important piece of advice that I received from someone was more recently, during the summer. He and I did river boarding, which is when you go down rapids on equipment that looks like a body board. That guy was a huge fan of river boarding. He talked to me about how he hated University but still had a University degree. Afterwards I asked him why he chose to finish his degree. He said that it’s good to finish what you’ve started. I have the same mindset now; I think it’s vital to see things through.
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Amy Ajay Sama Anvari Jessica Blackwood Kelly Dong Mehdia Hassan Lauren Liu
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Events Coordinators Angus Lee Sarib Malik
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The Muse Magazine is the publication of McMaster University's medical humanities initiative, The Muse. Our goal is to provide an interdiscip...