1st Year – That’s a Wrap!

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Last week during my observerships, I couldn’t help but introduce myself as a first year… even though technically that label no longer applies. But I can’t quite call myself a second year yet. That feels too strange, too surreal. I’d like to hold on to the safety and blissful ignorance of my first-year status as long as I can. But the reality is slowly sinking in that first year is over – and it has flown by…

MedLit has had an exciting year! We’ve had a table-read, film screening, we’ve listened to cool podcasts, read graphic novels and so forth!

Here’s a quick recap of what we’ve been up to most recently:

  • Collaboration with the Queen’s Psychiatry Interest Group
    • We discussed cartoonist Ellen Forney’s graphic memoir, “Marbles: Mania, Depression, Michelangelo, and Me” in which she shares her experience with her bipolar disorder. Her memoir explores her fears that medications would stifle her creativity and her journey to find a medication regimen through which she could retain her sense-of-self.
  • Narrative Medicine “Funshop”
    • We were lucky enough to have an incredible workshop on narrative medicine hosted by Dr. Hamer. We learned skills and tools for interpreting and writing medically-inspired texts — all while enjoying some delicious pizza.
  • Aging and Caregiver Fatigue
  • Stories of QMed: MedLit “Keep Me Well”
    • MedLit collaborated with the Wellness and Mental Health Committee to have a casual evening of storytelling at the Grad Club. We had a great turnout, with everyone seated in a circle – with nachos and salsa and drinks. This event became a space for us to talk about vulnerabilities – about the difficult transition to medical school, about self-doubt, about questioning our place in medical school, difficult experiences at observerships and so on. We heard prose, poetry, and readings of old childhood writing excerpts (always so fun to hear!). All in all, this was a space of sharing and listening – a wonderful end to the year.  Journals were given out by the Wellness Committee – and writing prompts and poems – inspired by the narrative medicine workshop – were given to all in attendance to carry the evening onward.

1st year may be over for us, but MedLit most definitely is not! Maggie and I will keep posting on the blog over the summer — and we’re working on some exciting upcoming projects:

  • We are expanding MedLit to Health and Humanities 
    • We want this to be a space exploring the human experience through a diversity of mediums: music, art, literature, drama, history etc… and in the wider and interdisciplinary context of health
  • Academic Enrichment Program
    • We are expanding MedLit to a Health and Humanities certificate. This has been a long-coming project — more details to come!!
  • Humanities Conference in the Spring of 2018
    • We are SUPER excited about this — more details to come so stay tuned!!!

Any ideas/suggestions for events or projects you’d like to see — let Maggie and I know! We’d love to hear from you!! 😊😊

– AA

 

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Holding Fast

The incredibly talented Grace Zhang has been giving us shivers with her spoken word poetry all year. She was kind enough to let us post her work here today- if you get the chance, please go watch her in person!

 

Holding fast

 [For my Grandmother]

we don’t talk much these days

(which is mostly my fault, I know)

but if we were on the phone

right now,

I’d tell you how

when we sat in lecture learning about

tests like MOCA, and MMSE

that at the time, I could not see

the connection between

drawing a clock showing 11:10

and having a grandmother

who might no longer recognize me.

I don’t think I really understood medicine then.

and I still struggle to explain

how the brain that housed

such selfless resilience,

that your brilliance,

could be compromised

by mutant tau proteins

and amyloid plaques –

a ruthless attack

and though you may try to battle back

to even the score –

it always wins the war.

but can I just say

that even as age chipped away

at your mind

there was never a time

where I would think of you

and see anything but strength;

you were so stubborn,

that it nearly drove us crazy,

but come hell or high seas

you were hell-bent on holding fast

to your identity.

so call me naïve, but

I have this overwhelming belief

that even on the day you wake up

and no longer recall

who you are

that you will still somehow

be standing tall

holding fast

to who you are.

(and I am so sure of this because I will be holding fast to who you have helped me become.)

Roasts

I don’t write this to seek attention or to whine. What is in the past is in the past. What I hope to do is give perspective on actions, and to encourage my future physician colleagues to reflect upon and consider the weight of their actions and words.

Shortly after moving to a new province and leaving my social support system three provinces away, I was roasted at an Orientation Week event. It was not a light playful roast as had occurred with other students, comparing them to celebrities, or changing words in their Facebook statuses. It attacked my character and my integrity, even going as far as to compare me to Donald Trump. What was meant to be a satirical post on Facebook to my friends and family, ended up being misconstrued and taken to be pretentious and ‘disgusting’. Just prior to this, my orientation week leader told me to “be prepared to be roasted”. In all honesty, I don’t think anyone could’ve prepared for that. A hall of 200 people to be laughing at your character is not an easy recovery.

 

After the roast, I would go to chat with new people at the school, and I would be given the cold shoulder or be talked to differently because I was “that facebook douche”. One fellow student, shortly after introducing myself, even said “yeah you’re that really fucking douchey guy”. I became nervous to attend social functions, but I was even more nervous about what would be said of and in my absence. I thought that this would die down, but with every event we had with students from upper years, it seemed to regenerate. In some instances, I tried to ‘own’ the title of pretentious dude. It would get a laugh, but it wasn’t who I was.

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I thought about leaving. I strongly considered leaving the program and moving back to BC to work for a year and reapply to other medical schools. My transition to Ontario and to medical school was exponentially more difficult, in part, due to this. I have had struggles with my mental health, and I’ve had issues with self-esteem because of it. I have attended counselling, and I am very thankful for the people around me who have been supportive and have inspired the resilience that was necessary to be reflecting upon this.

 

Ironically, two hot topics of this year have been physician bullying and medical student mental health. I have experienced (future) physician bullying, and it has contributed to struggles with my mental health as a medical student. Neither topics are surprising to me, as seem to be surprising to the media, the general public, and to medical students themselves.

Looking forward, please take a moment to consider your actions and reflect on how these might have rippling effects. Please consider the accuracy in assessing character that you obtain from a snapshot of someone. Please do not contribute to a mob mentality, and to make decisions for yourself. Humour is not always humorous.

SW

Learner’s Guilt

I am sitting in a global health lecture while a woman who recently immigrated speaks about her experience navigating our healthcare system. She describes her struggles with the language barrier, highlighting how impossible it can be to get even over the counter medicine in somewhere so foreign. These patient-facilitated lectures always get to me, and I can feel myself getting a little emotionally carried away. It is during  moments like these that I begin to understand what a gift patients can be and I start to ruminate on the resiliency of the human spirit. I am brought back down to earth by her next anecdote. She describes how difficult it was to retell her story to many different residents and clerks at a local practice, and how she had yearned for a consistent face that would care for her. Immediately, she adds that she recognizes the importance of learning, and expresses her gratitude for the care she received. But those words resonated around in my mind, for they were confirming something I have felt since my first patient encounter. By learning, I am taking. Taking awkward histories, taking time, taking away. And in the end, it is patients I am taking from.

I now refer to the heavy, sinking feeling that occurs after one of these encounters as my learner’s guilt. It sets in at the moment between when the physician asks the patient if I can observe and when they invariably say yes. Because at that point, we are already in the room, and they have been waiting- who would say no? I feel a pang of it in my chest when the patient answers a particularly intimate question and their eyes dart towards me, the intruder, before answering. And it thrums loudly in my ears when I attempt to do any physical exam maneuver and take double the amount of time their doctor would. I’m sorry, could I do that again? Would you mind lowering your gown one more time? Thank you, I’m sorry, thank you.

Learner’s guilt can feel overwhelming because it is inevitable. I will never be able to provide care as skilled as a patient’s physician at this stage in my career- I need to, well, learn.  But I have to make some mistakes to learn. I have to go back and take a more thorough history because I forgot to ask the patient’s age. I have to listen to that murmur one more time because I haven’t heard one before. I have to stumble through sensitive questions to learn to never ask them that way again. While this is understandable and expected, it is also the patient’s who bear the burden of these first mistakes.

They also bear the burden of being studied. To be whittled down to your biology by your caregivers is not comfortable, and it can feel incredibly alienating. However, as a learner, this is also somewhat inescapable. To learn effectively,  I need to see actual sick people, and talk about their actual problems in front of them with an actual physician. Yes, these patients have volunteered and given consent to be examined by a learner. But there are threads of guilt woven into any questions I ask about a patient that aren’t directed towards that patient. It can feel like a tightrope walk with compassion and curiosity balanced at either end.

Of course, it’s not all guilt. After my immediate anxiety fades, I am generally left with an overwhelming sense of gratitude. Patients and doctors alike have given me their time, their knowledge, and their trust, all with the expectation that I just learn. The kindness and empathy I am shown as a student blows me away. They say it takes a village to raise a child- it could also be said that it takes a village to teach a med student. This gratitude goes both ways- patients have expressed that volunteering can help give a sense of purpose to an illness or experience. And studies have shown that teaching facilities have better patient outcomes than non-teaching facilities- so having learners around must be good for something. In the end, I know I will be a learner for a long time- some might even say a life time. I hope I don’t lose the guilt or the gratitude along the way.

MH

Poems to Get You Goin’

Hello fellow prose enthusiasts,

We’re still riding the high of Poetry Night here at Medlit. We got to hear from students across all years (shout out to Trevor and Jon for making that sentence possible) and it was so refreshing to be able to share and express art with our peers. Thank YOU to everyone who came out, shared work, or expressed support- it means so much that this initiative was supported and appreciated. It was one of our favorite events this year and something we hope to bring back every term for 2017/2018 school year! So don’t fret if ya missed it this time around.

Here are a few select poems that were read at the event-

Exclusively on Venus

Roses are red / violets are transsexual / welcome to womanhood / now get to work honey

Roses are performative / violets are biological / I have very sensitive breasts / and so do your breasts

Roses are biological / you have the nicest skin / I can’t stop kissing you / let’s read more nondualistic queer theory

Roses are fed up / with our binary fetishes / I fucked my doctors / and stole all the medication to hide it in a cave and share it with other trans people

Roses have got me / up against the wall / kissing my neck / which is socially constructed to be a super hot strong feminist neck

Roses are violet / violets are roses / I really like you / I like you tube

Roses are born this way / violets have a lesbian streak / something about your dry sense of humor and our soft intertwined limbs / feels transcendently female

Roses are blue / violets are violet / roses are nonviolet / blue is bluenormative

Roses are from mars / violets had the whole surgery / setting up camp / exclusively on Venus

Roses have gone too far / not to be what girls are made of / I’m coming out / to my academic colleagues as a poet and I bet they will run away screaming

Roses are roses / violets are born this way / someone’s got a hoard / of heteronormative transaffirmation porn you say?

Roses are cheeky / I want you to fuck me / drown violets like an accused witch / in your arms which feel like mine

Violets got a name change / roses changed a pronoun / we ate at a restaurant / and forgot to put the leftovers in the fridge

Roses are trochaic / violets have their original plumbing / let’s march in a protest / then go home and we’ll cook something delicious and eat it with a spork

Violets are permanent / roses are impermanent / thank you for becoming me / offering to embrace your form your fate

Flowerbeds are umbrellas / umbrellas are rubrics / I support your identification / and your disidentification

Men are from women / roses are from Jupiter / women are from men / I can’t tell which is softer, your lips or this pillow or the snow descending gracefully outside

Discovered a Medlit member wrote this collection of poems and have to share!!! Click the image to read the collection 🙂

If I could help you
If I could help you, buddy, I would
I really would
I’d pray for you
I’d make muscles appear on your back
I’d take you to a bridge
that people think is beautiful
if there were the slightest chance
that you’d like it
I’d get you that motorcycle
Id put your songs on the jukebox
if you were a singer
I’d help you step across
that crack in your life
I’d die for you on the cross again
I would do all these things for you
because I’m the Lord of your life
but you’ve gone so far from me
that I’ve decided to embrace you here
with my most elusive qualities
You always wanted to be brave and true
So breathe deeply now
and begin your great adventure
with crushing solitude

Leonard Cohen, Book of Longing

Aphasia

Noah Capurso

We are taught that the brain

Is a set of highways;

Corpus callosum,

Spinothalamic,

Optic radiation.

But there are other roads, as well.

Scenic neural backroads

That are hidden from view;

Dusty and seldom used.

Sometimes we can see them

When the highways are down;

From cancer,

Surgery,

Or a stroke.

Our patient had a brain tumor.

We tested her highways

With a feather drawing;

“What is this?” we asked her.

And the answer she gave

Came by the scenic route;

“A leaf

That fell

From a bird.”

Invictus

William Ernest Henley

Out of the night that covers me,
      Black as the pit from pole to pole,
I thank whatever gods may be
      For my unconquerable soul.
In the fell clutch of circumstance
      I have not winced nor cried aloud.
Under the bludgeonings of chance
      My head is bloody, but unbowed.
Beyond this place of wrath and tears
      Looms but the Horror of the shade,
And yet the menace of the years
      Finds and shall find me unafraid.
It matters not how strait the gate,
      How charged with punishments the scroll,
I am the master of my fate,
      I am the captain of my soul.
Lastly, we have a song by Mount Eerie that might make you weep. His newest album, A Crow Looked At Me, was written in honor of his wife, who recently passed away of pancreatic cancer. His insight into the grieving process is poignant and striking, and should be required listening for physicians.

“Do you know what a poem is, Esther?”

Sylvia_plath

There is an inherent vulnerability in the arts. The way I see it, you really need to open yourself up and lay your soul bare (or maybe I’m being too dramatic?) as an artist. This can be difficult in medicine where there is a certain emotional distancing that can be required at times. So what I keep struggling with is, how do you reconcile these two things?

Sort of in line with these thoughts, I’m reminded of the following excerpt from Sylvia Plath’s The Bell Jar  (this is my favourite part of the book) :

I remember the day he smiled at me and said, ‘Do you know what a poem is, Esther?’

‘No, what?’ I said.

‘A piece of dust.’ And he looked so proud of having thought of this that I just stared at his blond hair and his blue eyes and his white teeth – he had very long, strong white teeth – and said ‘I guess so.’

It was only in the middle of New York a whole year later that I finally thought of answer to that remark.

Now, lying on my back in bed, I imagined Buddy saying. ‘Do you know what a poem is, Esther?’

‘No, what?’ I would say.

‘A piece of dust.’

Then just as he was smiling and starting to look proud, I would say, ‘So are the cadavers you cut up. So are the people you think you’re curing. They’re dust as dust as dust. I reckon a good poem lasts a whole lot longer than a hundred of those people put together…People were made of nothing so much as dust, and I couldn’t see that doctoring that dust was a bit better than writing poems people would remember and repeat to themselves when they were unhappy or sick and couldn’t sleep.

I like to think that the arts are a form of “doctoring” – a form of therapy. And so, for me – and a lot of other students – it’s MedLit that’s an outlet for creative expression, for discussion on literature, and exploring what it means to be human. The arts help us navigate complicated emotional landscapes, help us process what we’re feeling, and allow us to develop a stronger sense of empathy.

That’s why MedLit is such a valuable part of my med school experience. I hope it will allow me to keep that vulnerability and openness – and try to find a healthy way to maintain it throughout my medical training.

***

And …on the theme of vulnerability and being an artist — this upcoming Wednesday, MedLit is hosting a poetry night! Good timing because April is National Poetry Month!!! This will be a chance to share our own writing or poems/prose we love. It’ll be a chance to be vulnerable – and to bravely explore different facets of the human experience.

Come join us – it’ll be fun, I promise.

– AA

The Bubble

As an undergraduate student pursuing medicine, I had a distinct feeling of being on the outside, looking in. I did my best to understand what exactly I was trying to get into, but there is an exclusivity to medicine that is hard to describe. The application process is somewhat mysterious, and the sheer volume of applicants means that great candidates get rejected every year. Trying to make sense of the whole process without spending large amounts of money felt impossible. There is no handbook that comes with your interview invite saying “hey girl, you should probably know the CanMEDs roles”. I think this all rings particularly true if you’re the first one in your family to go to medical school- my parents wouldn’t touch my application with a ten foot pole and had less of an idea than I did. The only advice I was getting was from the internet*, which had its own share of misgivings. I remember googling “what is carms” the night before my interview because I was terrified they would ask me this seemingly basic question and my idiocy would finally be revealed by not knowing the answer.

*This is not 100% true- there is a very special resident at McMaster who, many moons ago, was my swimming coach and morphed into my life/medicine mentor. Her advice is invaluable and I would be remiss not to mention her, and her inspiring blog, here.

This is to say that from the beginning, the medical community felt like a bubble- separate from the “real” world, and only truly accessible if you were in it. And now that I am in it (albeit only for a few months), I can say that it still kind of feels this way. A large part of this feeling comes from the time commitment. My days are consumed by being a medical student- classes, assignments, group work, extracurriculars, etc. Spending all this time in the same building with the same people exacerbates the feeling of being in a bubble and I assume this only becomes more true as you progress through the ranks to clerk or resident. While I felt prepared to make this time commitment, I don’t know if I ever processed what it would mean to feel the resulting disconnectedness from my loved ones. As the months go on, I feel myself becoming more and more invested in medicine, both personally and financially.  It is simultaneously exciting and overwhelming. But it is also now a huge part of my life that my closest friends and I don’t share- the responsibility, the financial burden, the commitment, the relatively planned out future. These were all things I wanted, and chose, but I didn’t expect these differences to feel so tangible in my relationships.

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This reference just has to be in here somewhere (source)

Side bar: It’s important to mention the relationships that I’ve developed inside this bubble- meeting friends who share the same goals as me and understand these huge life changes has been quite literally the key to my happiness in medicine. A whole separate blog post could be written on the joy of discovering this little world of friends who are into the same stuff as me. But that is not this post. 

I recognize that it’s a transition, I’m only in first year, we’ll figure it out, etc. But there’s a feeling of profound sadness that comes over me when I think that medicine will take away from the relationships that matter the most. I think this speaks to a more deep-seated fear I have about being in the bubble- the fear that eventually I won’t exist outside of it. While the immense satisfaction I gain from finding a sense of purpose at school cannot be overstated, there is this parallel feeling of losing touch with the person I was before that has been on my mind a lot lately. Time spent “not being a medical student” is becoming a smaller fraction of my day to day life. And slowly, the part of me that is not a medical student will become smaller as well. Maybe someday I will achieve some kind of balance that I feel at peace with. Or maybe I’ll have to adjust my expectations and grow up a little more. Until then, I’ll deal with frequent identity crises and the irony of feeling like I’m now on the inside, looking out.

-MH