Adulthood Autism

Temple Grandin and Oliver Sacks.jpg

Last week, Medicine & Literature partnered with the Queen’s Student Interest Group in Neurology to host a discussion about the topics of adulthood autism, Oliver Sacks, and Temple Grandin.

An overview on these two remarkable individuals:
Temple Grandin is a professor of animal science at Colorado State University, world-renowned autism spokesperson and consultant to the livestock industry on animal behavior. She is an architect known for her revolutionary design of animal slaughterhouses, her activism with regards to resources for adults with autism, and her invention of the “hug machine.”

Oliver Sacks was a British neurologist, naturalist, and author, known for his many books detailing the incredible encounters he had with his patients over his career. He is probably best known for the story in “Awakenings” (which has been adapted into an Academy Award winning movie). In it, he describes the unfathomable journey of his patients with encephalitis lethargica through the newly discovered L-dopa treatment. 

Our discussion was based on selected articles written by Temple Grandin, an overview of the various manifestations of Temple Grandin’s autism, a chapter on Temple Grandin from Oliver Sack’s Anthropologist on Mars, the last interview given by Oliver Sacks, and a beautifully written piece by Bill Hayes on “What It Was Like to Love Oliver Sacks.”

Some of the questions we raised included:

  • Narrative voice and story-telling are important features in the pieces we read. How do writing styles differ between Oliver Sacks and Temple Grandin when they discussed the same stories?
  • Were descriptions of autism, from first and third person perspective, helpful to us in understanding autism?
  • Will you approach your care for patients with autism differently given what we’ve learned?
  • What strategies could a physician use to create a more welcoming environment for patients with autism?
  • How might the imposed self-reflection that many patients with neurological or mental health issues are exposed to manifest itself in a patient’s well-being?
  • Looking to the history of public perceptions surrounding autism (refrigerator mothers, and Freud’s psychoanalysis), how does Oliver Sacks bring a sense of humanity to autism? Does he perpetuate any stereotypes?

All in all, it was a fascinating discussion sparked by two very gifted writers.

I’ll leave you with an excerpt from Oliver Sack’s Anthropologist on Mars which I found particularly moving. In this excerpt, he describes a touching encounter with Temple Grandin:

 

Temple, who was driving, suddenly faltered and wept. “I’ve read that libraries are where immortality lies… I don’t want my thought to die with me . . . . I want to have done something . . . I’m not interested in power, or piles of money. I want to leave something behind. I want to make a positive contribution – know that my life has meaning. Right now, I’m talking about things at the very core of my existence.”

I was stunned. As I stepped out of the car to say goodbye, I said, “I’m going to hug you. I hope you don’t mind.” I hugged her – and (I think) she hugged me back.

 

– AA

 

Advertisements

No Conflicts of Interest to Disclose

 

Conflicts of Interest: None.

 

For those professors who include this disclosure within their slides, I always wonder about what defines a conflict of interest, and if these interests can also present outside of industry funding. Our lecturers are pioneers and experts in their field. They all come from unique background and career paths that have lead them to the front of our lecture hall. But – are the majority of them markedly free of bias?

This thought came to mind after receiving a lecture by a professor who only presented his own research on obesity. He emphasized the benefits of weight loss and activity independent of weight loss on biomedical parameters. He also presented weight maintenance and body positivity as fallacies and scientifically flawed. Weight maintenance was not encouraged, and obesity was discussed as an evil entity where people just simply needed to move more. From a humanistic standpoint, I found myself torn between the words of this expert and science, and what I have experienced in my life, the lives of my family members, the expectations of society, and the non-medical determinants of obesity. Thankfully, a Medicine and Literature session on weight bias in healthcare coincided with the lecture from this professor who spoke in absolutes.

Conflicts of interest: none, but how do we navigate personal biases and beliefs that affect our education? As a medical student, I find myself constantly bombarded by new information and ideas. The thought of trying to critically appraise every single piece of information we have is unimaginable – laughable, even. Additionally, I’m so eager to learn that we can sometimes forget to be critical or question the words of the experts in front of us. I focus on harnessing this new knowledge and being able to apply it in my future practice. I focus on my ability to help the people who will be relying on me to know the answers, to have been critical of the answers, and to provide the best and most appropriate care to them. What personal biases will I bring into these encounters, how will they affect my patients, and how will I manage them?

unconsciousbias3
image source

 

More broadly, I think this uneasiness stems from wanting to learn black and white answers in a field that is extensively grey. The more I learn, the more I am able to question, and the better I am able to form my opinions and thoughts regarding a certain subject. The better I am able to apply these, one day, to a patient. To end with in a relevant, albeit cheesy, manner, I found this quote to echo and further provoke my thoughts:

“In seeking absolute truth we aim at the unattainable and must be content with broken portions.”

– Sir William Osler

-SW

The Value of Medical History

Over the Family Day weekend, a group of passionate and curious medical students chose to venture to Ottawa instead of visiting their families.  A group of equally passionate curators and assistant legislators to Elizabeth May also gave up time to give us private tours of:

  • The Preservation Centre in Gatineau, which houses vaults filled with paintings, media and lots of important archives.
  • Parliament (Justin unfortunately did not give up any time to come see us…)
  • The Museum of Science and Technology’s Storage Facility (which is apparently cooler than the museum itself)

 

This year would be the final year that Dr. Duffin organizes a history of medicine trip, making the fate of future trips uncertain.  So instead of telling you how cool everything was (hopefully the photos can show that), I thought I’d share the value I see in keeping the tradition alive.

 

  1. Cool Architecture: The Role of design, décor and architecture in medicine

 

Image Credits: Dr Jackie Duffin

Arriving at our first stop, the Gatineau Preservation Centre, what stood out most was the architecture.  The vaults were inside a huge cement box that looked like the set of a parkour film; while the top floor, where restoration was done, resembled a Lego village complete with primary colour paints and street names for corridors.  Whether you cared about the science behind restoring artifacts or not, the design was very hard to ignore.

On a day-to-day basis, physicians not only interact with patients, but with their environment as well.  While it’s not practical or financially viable to have an architect design each hospital as a unique piece of art, the impact of space is large enough to warrant investing some thought.  There are already lots of examples of environment helping with patient or doctor experiences:

  • having windows in the ICU rooms to help with delirium
  • having paintings/magazines in waiting rooms to make wait times seem shorter
  • having healing gardens to reduce stress for patients and health care workers
  • having cartoon characters on walls in children’s hospitals
  • having the nursing station in the middle of a room, visible to all patients, to reduce anxiety
  • decorating your office with pictures of family to make working there more enjoyable.

(for more evidence of the importance of environment in health- check out this NYT article here!)

Obviously, during an emergency, it won’t matter how aesthetically pleasing the sheets or walls are, but the vast majority of hospital interactions with patients and among health care workers aren’t immediately urgent.  In these instances, a little interior design can work its subtle magic on people’s mood and their interactions because we all (I think) appreciate pretty things.  It’s why chefs create garnishes and why companies invest in packaging.  In the long run these small effects can add up to increase overall wellbeing and happiness.

 

  1. Studying History is humbling and reminds you that your actions might outlive you
img_3764-1
The Apology: Commemorates the legacy of the former Indian Residential School students and their families, as well as the Prime Minister’s historic Apology in 2008.

If you’ve ever been to a really old place, you’ll know that you get a strange surreal feeling, like you are experiencing something bigger than yourself (hopefully it’s not just me). When I was 16 and my mom took me to the ruins of Persepolis (wiki: “the ceremonial capital of the Achaemenid Empire”) and I felt it for the first time while trying to imagine what it looked like thousands of years ago before Alexander attacked it.  It reminds you at once of how insignificant you are and how capable you are of creating something that can last for generations after you are gone.

The profession of medicine can be demanding:  long hours, bad news, on call shifts, high stake decisions and emotional fatigue to name but a few.  It’s in these moments when remembering that you’re working towards something bigger helps.  One day when we’ve all left this planet, curators, historians and medical students may look through the ultrasound machines, pacemakers and lounge room coffee machines we used and try to uncover the story of our daily lives.  We can’t predict which of the thousands of items we see and use in our lifetime will survive as artifacts, but we can choose what kind of story they tell.

 

  1. History is full of lessons and wisdom

 

Finally, most important of all is that history is an endless resource of wisdom and lessons.  We constantly look to our tutors, teachers and mentors for guidance for medicine because it’s easily accessible; but why stop there?

 

From history you can learn to be creative, and to draw inspiration from new places.  Over the course of the weekend, we saw multiple examples of technology from other industries being adapted to medicine.

  • The cloth used to make sails being used as a backing for fragile paintings
  • Ultrasound machines being used to detect aircraft defects and in the navy before being applied to medicine
  • The Fibroscan for the liver coming from cheese manufacturing (I technically learnt this in class after the trip but it helps prove the point)

 

History’s mistakes teach us to not just accept what we’ve been told but to dig deeper and ask questions because things may not be what they seem.  During our visit to the Storage room, the curator’s personal research on artifacts in the storage revealed that Sir William Osler – a great Canadian medical teacher – may have used the remains of aboriginal bodies for research purposes.  Another inquiry led the curator to discover that models of babies with syphilis were used to promote eugenics and not medical education as previously believed.  If we remain passive in our learning and acceptance of new information, it’s often the patient who will pay the price.

 

(In conclusion) I hope there will be many more history of medicine trips to come because there is still a lot that history can teach us (and lots of cities to be seen) before we begin our practices.

 

xoxo,

SA

Abortion in Fiction

Women have been fighting for control over their own bodies and reproduction for a long time. The need for women to maintain autonomy over their own bodies is important because women’s bodies are so often pawns in power struggles of larger institutions. With these larger socio-political issues in mind, the last MedLit event discussed abortion – the first in a 4-part series on abortion in collaboration with the Women’s Health Interest Group.

veradrakeposter
Wife. Mother. Criminal (source)

For this event, we held a film screening of Vera Drake, which is a 2004 movie directed by Mike Leigh. The movie portrays the story of Vera who, unbeknownst to her family and friends, performs abortions. The movie illustrates how her beliefs clash with the view of 1950s Britain. It’s interesting to note that Vera does not explicitly state that she helps perform abortions. In fact, she never utters the word “abortion.”Instead, when asked about it, Vera states: “I help girls out.”  In light of this, we posed the question: How does Vera’s statement (“I help girls out”) help us understand Vera’s perceptions on abortion? 

Other questions that we posed include:

  • How does class affect access to abortion services as portrayed in the movie? How does financial wealth affect access to abortion in Canada in present-day?
  • How does the film address archetypal roles for women in Western society including ‘woman as mother’, ‘woman as wife’, and ‘woman as lover’?
  • Media often portrays women who have committed especially violent crimes as “monsters.” Does the film portray Vera Drake as ‘mother as Monster’? What are some examples of this archetype that you have encountered in popular media?
  • The judge sentences Vera to two-and-a-half years’ imprisonment “as a deterrent to others.” What effect do you think sentencing like this has on access to abortion for women, and especially women belonging to other marginalized populations?
  • Forgiveness is a major theme in the film. How do the characters in the film choose or choose not to forgive Vera for what she’s done? How might you navigate sharing what you do as a doctor with friends and family that might ethically oppose a part of your practice?

Along with viewing Vera Drake, we also read Alice Walker’s “What Can the White Man Say to the Black Woman,” which was an address in support of the National March for Women’s Equality and Women’s Lives in Washington D.C, in 1989.

Walker begins her piece by stating:

What can the white man say to the black woman?

For four hundred years he ruled over the black woman’s womb.

Walker details the injustices faced by women – especially black women and indigenous women through her evocative and powerful prose.

The piece ends with suggestions on what the white man can say to the black woman:

What can the white man say to the black woman?

Only one thing that the black woman might hear.

Yes, indeed, the white man can say, Your children have the right to life. Therefore I will call back from the dead those 30 million who were tossed overboard during the centuries of the slave trade. And the other millions who died in my cotton fields and hanging from trees.

I will recall all those who died of broken hearts and broken spirits, under the insult of segregation.

I will remove myself as an obstacle in the path that your children, against all odds, are making toward the light. I will not assassinate them for dreaming dreams and offering new visions of how to live. I will cease trying to lead your children, for I can see I have never understood where I was going. I will agree to sit quietly for a century or so, and meditate on this.

This is what the white man can say to the black woman.

We are listening.

In regard to Walker’s piece, the questions we posed were:

  • Who is the intended audience of this article?
  • How does the shift in voice (from the use of “I” to the use of “We”) impact the message of the essay?
  • Walker uses the word children 32 times – what are your thoughts on this?
  • How does anaphora emphasize the speaker’s voice in this piece?

We are grateful to everyone who came out to our event to discuss this important aspect of women’s health. There has been a lot of noise surrounding the issue of abortion lately – but not a lot of listening or understanding. We believe that promoting open discussion on abortion – through literature as a medium, for example – is crucial. We invite everyone to join in on the discussion.

We are listening.

 

– A.A.

 

 

What is Bullet Journaling?

bullet

Here at MedLit we love writing, but sometimes it can be a daunting task. What do you write? Where do you start? Do you have to introduce yourself? (answer: up to you)

Bullet journaling is an interesting trend that aims to address these hurdles- it is a short, prompted writing activity where you answer specific questions. It helps get rid of the writer’s block, and cuts down on the time comittment required for writing. It is often used as a goal planning activity (like in the example above), but can also be used as an exercise in self-reflection – which I personally find much more relaxing, but it is entirely up to you!

Recently, we held a lunch time journaling session with the following prompts. We included them here so our lovely readers can participate – so go ahead and sit yourself down with some tea, light a candle, and indulge in some self-care

  • What do you most often recommend to other people?
  • What three things would majorly change your life?
  • What are your current priorities?

 

  • Write down three good things about today
  • What are some things you currently want? Why do you want them?
  • How do you relax after a long day?

 

  • What makes you feel fulfilled in your daily life?
  • Write a few qualities you admire in your best friends
  • What do you appreciate about your parents?

 

  • Write down your goals for this weekend
  • What is a hobby you’ve always wanted to learn?
  • What are some qualities you “wish” you had, but don’t? Do you want to work towards these qualities, or should you let them go?

 

  • What thoughts are you carrying around in your brain right now that you could let go?
  • If you weren’t in medicine, what would you do? Are there ways to incorporate elements of these dreams into your current life?

Hope you guys enjoy!

 

Why Poetry Matters

Last month the Kingston Whig-Standard covered a story on the sentencing of a 69-year old man who “brutally abused” his wife for most of their 45-year relationship.
“A Kingston Police investigation…revealed that [the victim] suffered several skull fractures over the years, at least one broken arm that hadn’t been set, and multiple healed rib fractures…She also had “cauliflowered ears” like an old-time veteran prize fighter, scars on her arms that appeared to medical personnel to be from cigarettes being stubbed out on her skin, relatively fresh similar burns on her feet, and brain damage. Her medical team found indicators of at least two untreated strokes.

At this point, she’s no longer able to speak for herself…

When two detectives visited her in hospital…they observed that the mention of [her husband’s name] did cause her to react physically, by recoiling.”

The horrific abuse faced by the victim is hard to fathom. But what’s so powerful about this case, I think, is that it demonstrates poetry in action – as Crown attorney Jennifer Ferguson presented poetry to the judge as an exhibit for the sentencing. The poetry was an excerpt from a poem written by the late poet and activist Bronwen Wallace based on her experiences working at Interval House – an emergency shelter for women and children facing violence. Ferguson argued that the character in Wallace’s poem was the victim in this case. This is the excerpt from Bronwen Wallace’s poem, Intervals:

This is for Ruth,
brought in by the police
from Hotel Dieu emergency
eyes swollen shut, broken jaw wired
and eighteen stitches closing one ear. This
is what a man might do
if his wife talked during the 6 o’clock news.
“And I knew better,” she tells us softly,
“I guess I just forgot myself.”
Tomorrow she may go back to him
(“He didn’t mean it, he’s a good man
really”), but tonight she sits up with me
drinking coffee through a straw.
“I can’t sleep,” she apologizes,
“every time I close my eyes,
I see his fist coming at me through the wall.”

 

The poetry was accepted by the judge as “a firsthand account” of the result of one of the beatings the victim suffered.

 

So why does poetry matter?

Because poetry is a form of resistance. Poetry is a form of mediation between one’s self and the world around us. It’s a means of shaping one’s identity. Poetry is a means of self-assertion.

Poetry – of all the art forms – is “the most economical,” as Audre Lorde writes. “It is the one which is the most secret, which requires the least physical labor, the least material, and the one which can be done between shifts, in the hospital pantry, on the subway, and on scraps of surplus paper… As we reclaim our literature, poetry has been the major voice of poor, working class, and Colored women.”

In this case, poetry can also give a voice to those who have been silenced.

This is what I would like people to understand when they ask me why poetry matters.

– AA

Obesity and Fat Acceptance in Medicine – Meeting Notes

The body positivity (#bopo) movement swept through instagram and tumblr and now seems to be finding a place in mainstream media. With plus size models gracing the cover of Sports Illustrated, and a fat, active women getting her own show on TLC, it seems like embracing one’s body, no matter the size, is slowly becoming more accepted. This of course has many connections to healthcare and the physician-patient relationship. Can patients be overweight and healthy? What does healthy really mean? How can you approach a patient about weight loss in a body positive way? Physicians are often looked to as health role models, and have a important role in determining “health” – and yet,  weight bias is rampant among health care professionals , which calls into question if mental health is factored into a physician’s view of “health”.

We recently explored many of these concepts in our Obesity and Body Positivity in Medicine Session. Typically, Medlit sessions are based around a series of readings. Themes are chosen by the club execs (although we are open to suggestions!), and facilitated discussions are held to highlight various themes in the readings. We plan to use this blog as an account of these meetings and provide our discussion prompts for those looking to analyze the material but cannot attend. Readings are underlined  and discussion prompts follow!

Tell me I’m fat – This American Life Podcast  Click here to listen

The way people talk about being fat is shifting. With one-third of Americans classified as overweight, and another third as obese, and almost none of us losing weight and keeping it off, maybe it’s time to rethink the way we see being fat. A show inspired by Lindy West’s book Shrill.

This American Life  Questions:

  • In the opening segment, Lindy West states “its like no one accepts being fat as a permanent state of being, fat people are just failing at being thin”. Do you think physicians contribute to this idea? How?
  • Elna Baker describes how she found as a fat woman she had to be kinder, work harder and overall put in more effort to be valued in society than she does now that she is thin. This is often referred to as weight bias- thin people get things just because theyre thin. Can you think of ways that weight bias is reinforced by physicians?
  • The other side to weight bias is thin privilege. It has been proposed ( What’s wrong with fat, book by Abigail Saguy) that the intense hatred of fat people is a reflection of thin privilege- thin people want to believe that they are better and earned their thinness through good habits. This can only be true if being fat is “bad”. Do you think physicians are awarded thin privilege due to their status as health professionals?
  • Health Trolls – One of the most common retorts by fat phobics/anti fat acceptance proponents is “as long as youre healthy”. Ira glass refers to this as the third rail when speaking with Roxane Gay. How is health viewed as a currency in society?
    • What do you think this says about the importance of mental health and its validity as an illness in society? E.g Elna Baker is actually addicted to speed, but shes skinny, so shes seen as “healthy?
    • Do you think its possible for a physician to recommend a diet without endorsing an eating disorder? How?
  • Elna Baker played a recording of a conversation with her husband in which he admits that he would not have been attracted to her if she was still fat. This highlights that beauty standards for women play such a huge role in the course of their lives, and revolve much of the time around the physical body.
    • Do you think feminism plays a part into the fat acceptance movement?
    • Are there beauty and weight standards for other groups that could be affected by weight bias?
  • Ira Glass pointed out that we don’t even know how to treat obesity effectively, citing a study that followed a quarter of a million people over nine years which found only 5% maintained weight loss (Note: this study was not cited, but it could be this one ). There is evidence that backs this up- LOOK AHEAD study in NEJM 2013 found that losing weight did not change risk of developing type 2 diabetes or cardiovascular risks. 
    • What are the ethics to recommending treatments that are not fully understood? E.g recommending bariatric surgery when it may not treat root cause of weight gain and has many side effects? 

The Weight Inclusive vs Weight Normative Approach: Evaluating the Evidence 

A review of evidence surrounding weight inclusive and weight normative approaches to weight management. Pro-weight inclusive, with an emphasis on the Health At Every Size (HAES) movement. 

Click here

  • How is the role of physicians in confronting overweight patients different from confronting other patients with unhealthy habits (e.g smoking, alcohol abuse)? How is it the same?
  • The article challenges this idea by citing a study that indicated weight stigma itself may be attributed to weight gain- did you think this idea was well supported?
  • Do you think there would be a backlash against doctors who promoted a “weight inclusive” approach?
  • 2.4 Heightened Weight Stigma: The article states that “suggesting a diet to a patient that came in with a complaint unrelated to their weight” is a microaggression. This is, however, a practice that is recommended by the college of family physicians (all patients with a BMI over 30 should be counselled on nutrition/weight loss). What do you think?
    • A popular idea in the ‘weight normative’ approach is that weight stigma puts pressure on people to lose weight. What are some of the ethical issues with this idea if the stigma comes from a medical professional?
  • HAES/Weight inclusive approach: what are some of the pros and cons of adopting this approach in medicine?

Chicago Tribune Article: Can you be overweight and healthy? Click here

Fitness expert and bodyforwife blogger James Fell debates the merits of the HAES movement, focusing specifically on its aversion to weight loss. Interviews with obesity doctors included. 

  • What did you think of James Fell’s argument? What about the evidence used?
  • Is there a compromise somewhere between HAES and our current practices of recommending weight loss?
  • Does this highlight the confusing nature of obesity medicine

Follow up articles   Click here and here 

In the supplementary articles, Linda Bacon criticized James Fell and stated he took her words out of context to skew against HAES. He responded and wrote a follow up entry in his blog criticizing the HAES movement predominantly for its focus on not losing weight. Dr Yoni Freedhoff also wrote on his blog that he was walking away from HAES for the same reason.

  • How does this article challenge the previous reading? 

Please comment if you have any thoughts or feedback on our readings and prompts. Thanks for reading!