Reflections

Abhishek Gupta is a medical sub-intern with CAMH, who graduated from Windsor University School of Medicine.

 

 


Hear Ye, Hear Ye

A song of mental health for all,

In dark times and vanishing grace,

Give light and cushion a fall,

Where suffering is hidden,

And discourse forbidden,

Now, to change rules unwritten,

I pray, lend your ears to listen!

 

Where actions and mood were once controlled,

Now, fits of mania, blues, highs and lows, ...continue reading

In a first "Med Life with Dr. Horton" podcast, Dr. Jillian Horton discusses CaRMS, the Canadian Resident Matching Service. In this episode, she is joined by Dr. Moneeza Walji.

They answer these questions:

  • What are some strategies for choosing and ranking programs?
  • Should I have a back-up program in my ranking?
  • What should I do about conflicting interviews?
  • What are interviewers looking for in a candidate?
  • What should I do when I can't think of an answer to an interview question?
  • Should I change my strategy when being interviewed by a resident versus a program director?
  • How does the panel score the interview?
  • Should I disclose a mental health diagnosis or personal struggles?
  • Should I talk about my partner, kids, or family?
  • How do I handle the stress related to CaRMS?
  • And more.

...continue reading

Kacper Niburski is a medical student in the Class of 2021 at McGill University. He is also the CMAJ student humanities blog editor.

 

 


The heart is open and I wonder if my feet smell. Much of the room seems too busy to notice. The surgeon is making a joke about the shaky season of the Toronto Maple Leafs. The attendants laugh in unison. The perfusionists look to their dials, turn one, turn off another, and gaze my way with a nod. Do they smell it too?

Two hours earlier held no scent. The morning swam with sun. I arrived early to the Hospital to shadow the lead cardiac surgeon. I was told via email to dress light. To arrive early. To be ready.

I was. The night before saw me donned in recycled papers of anatomy, reviewing structure after structure, medication after medication. Any heart sound I’d be prepared to listen to knowingly. Any condition studied could be recited as though from a pleasant dream too pleasurable to forget.

I try to share that pleasure now. I smile back, failing to remember that my face is blocked with a mask. My clothes too have been changed. I am adorned in green, a naïve look against the shadow of yesterday. Only my socks stick out of their wrapping. They look like a left-over meal stuck in a fridge too long.

The surgeon makes another joke. Another chorus of chuckles follow. Blood is pooling out of the myocardium. “Suction please.” The whirl drowns out the sounds while the heart suffocates with air.

When I met the surgeon, I seemed to do the same. I whispered my name while shaking his hand. Then I sat quiet while the cardiologists spoke. The case was difficult. The 42-day old child had a type b coarctation, aortic stenosis, and now, only presenting the day of the surgery, a hematoma. One as large as the left ventricle. One as large as a life.

What would you do, the surgeon asked a cardiologist in the room. I am not sure, she replied. In thirty-one years, I haven’t seen anything like this. That shit is scary. The black mark on the screen seemed to absorb the light and the conversation. They all stared at it in silence.

The OR bursts in another bustle of laughter as the extracorporeal membrane oxygenation begins to tumble. The heart now pauses to a near standstill. Each beat appears forced, slow. I take twelve breathes before each one. I take another ten sniffs. The smell is getting stronger. I take nine the next cycle. Stronger yet. Eight the one after.

Meanwhile, the hands heave life. The surgeon is busy cutting and stitching and suturing and joking and cutting again. Bits of flesh fly into the vacuum. One hour passes. And the smell only worsens.

What could it be? I changed my socks. Washed my feet. My boots were new too. But in the morning, one of the cardiologists told me I could not wear them. Salt ate away at their integrity.

They were not allowed in the OR. You’d have to go in your socks, he said. He was wearing unblemished leather shoes.

With them, we walked to see some of his morning patients. Each case was riddled with complexity. Dr. K, is the heart rate stable? Dr. K, what was the correct dosage applied? Dr. K. Dr. K. Dr. K. His name was called everywhere while I stood beside him like a lost dog. My name was not asked once. Only until after my feet hurt and I was lost in a stew of medication names was I called. Kacper, I was told, this is the room. This is the patient who will have the surgery.

The room was thick with a deep, hugging black. The parents were huddled over a small incubator. From the doorway, they looked like stars.

The light of the OR is aggressive now. It weeps it. I think of them and that idea – the family as stars, celestial bodies watching the world. At first, I was comforted by it. I was brought back to period faraway from this standing where I was sitting in a canoe, trees whispering around, unshoed like I am now, and looking at a universe that could not look back. I could recognize the beauty. I could become it too.

But now, standing on my toes, trying to get a better view of each slice, watching as the screen is tipped forward and then away in a window of opportunity no larger than bundle of grapes about to ripen, I am reminded that stars are long since dead. They are no more. Only their light is forced to stay. The heart hasn’t beat in a while.

What will happen? I try to think, but I am nervous. I shift heel to heel. The wrong facts come back from the bridge to yesterday’s nowhere, to when I studied under the silence of a life. Move around, excite the sympathetic nervous system, get more blood from the heart, heat the body, sweat more. I spell out the conclusion once more in my head.

I try to stop moving in a dry attempt at survival, but these simple watered-down facts make me more anxious. Maybe the smell is me, I begin to think. Maybe I have reached a threshold of no return. Maybe I cannot stop sweating now and I will become a pool of water. First at my feet. Then my knees. I will get shorter and shorter, soon seeping into these white floors, climbing up the exhaustion of a lifetime, extinguishing these expensive machines, filling up the closed room in a smell that cannot be avoided now, that was all that was, all that is, all that will –

I am tapped on the shoulder. Dr. K asks how I am doing. I tell him okay. Pretty interesting, eh? Absolutely, I answer in what I imagine sinking sounds like.

 


Note: This is a work of fiction. Any resemblance to actual people, living or dead, is purely coincidental, similar to how a flower described here would not smell as good as the real.

1 Comment

Pat Rich is an Ottawa based medical writer and editor.

 

Cometh the hour, cometh the man.

It would be the very height of pretentiousness to apply this phrase to Dr. Liam Farrell, an author and former family physician from Rostrevor, Co. Down, Ireland and I am sure he would be the last person to do so.

But at a time when family medicine seems to be at its lowest ebb, if not globally then very much here in Canada, there is much to be said for having a physician who can so eloquently write about both the rigors and the ...continue reading

Hillel M. Finestone is a Physiatrist at the Elisabeth Bruyere Hospital and Professor, Division of Physical Medicine and Rehabilitation, University of Ottawa.

 

My 52-year-old patient took his BP at a pharmacy on 6 separate occasions.  Systolic BP values were high, ranging from 150-177. When I take his BP in the office it’s 168/98.  Yup, he has high BP.  He’s 10 pounds overweight, doesn’t have diabetes, doesn’t smoke and thinks that he was told that his BP was “probably high” 5 years ago, but he didn’t feel that medications would make a difference.

We talk about weight loss, healthy eating and reducing high sodium foods, that we don’t know why BP elevates but that medications really work and help stop strokes and heart attacks from occurring.  He agrees to my prescription of one medication and we discuss its side effects.  A drug information sheet is provided. ...continue reading

1 Comment

Keegan Guidolin is a General Surgery resident at the University of Toronto

Han Yan is a Neurosurgery resident at the University of Toronto

 

 

Much attention has been paid of late to the phenomenon of social echo chambers - situations in which people’s beliefs are amplified and repeated in a closed system as no dissenting opinion originates from within the group. Echo chambers on social networking platforms such as Facebook and Twitter were identified as a factor contributing to the outcome of the 2017 US Presidential Election. We believe that social echo chambers exist in the real (non-digital) world as well, within social groups whose members may interact outside the group in general, but who discuss particular subjects only within the group. ...continue reading

Dr. Dhruvin Hirpara is a General Surgery resident at the University of Toronto

Dr. Nancy Baxter is a colorectal surgeon at St. Michael's Hospital

Dr. Fayez Quereshy  a surgical oncologist at the University Health Network.

 

Colorectal Cancer (CRC) is the second leading cause of cancer-related death amongst men, and the third leading cause of cancer-related death in women in Canada. Although screening has contributed to declining incidence in the elderly, recent epidemiological data reflect a rise in CRC among young adults. Data from the Canadian Cancer Registry suggest a steady increase in young-onset (15-49y) CRC, from 745 cases in 1969 to 1475 cases in 2010. In Ontario, the incidence of CRC has been increasing in young adults (30-49y) since 2005, from 6.17 per 100,000 to 9.08 per 100,000 for colon cancer, and 4.31 per 100,000 to 6.29 per 100,000 for rectal cancer. Evidence from other jurisdictions, including France, Australia, and the United States reflects similar trends in the rise of young-onset CRC. Why this apparent increase in CRC among younger people? We don’t yet know the cause but theories point to an interplay of several potential factors.

...continue reading

Alastair McAlpine is a fellow in paediatric infectious diseases at BC Children's Hospital in Vancouver

 

People sometimes ask me, "What’s the difference between medicine in Vancouver and medicine in Cape Town?" The answer is, quite simply, Everything.

But let’s rewind a bit. In July of this year, I flew the 20 or so hours it takes to get from South Africa to Vancouver. I arrived in the city by myself with 2 suitcases, knowing hardly a soul, and feeling completely overwhelmed. A few months earlier, I had been accepted into a 2 year paediatric (even the spelling is different) infectious diseases program at BC Children’s Hospital. Before coming I had filled out endless paperwork, done a million online courses ...continue reading

1 Comment

Dr Margaret Rundle is a Family Physician practicing in Scarborough, Ontario

 

There is little dispute among care providers that a person’s dietary habits influence preventative and treatment outcomes. Every year, there is more research validating the role of food and therapeutic diets for chronic disease management and prevention. However, basic education around the role of nutrition and lifestyle for a long time has been a blind spot in the Canadian medical school system. ...continue reading

1 Comment

Kevin Lam is a third-year medical student at McMaster University

Lawrence Loh is Associate Medical Officer of Health at Peel Region, Ontario, and Adjunct Professor at the University of Toronto Dalla Lana School of Public Health

 

Suburbs, and later exurbs, became central to the Canadian lifestyle during the automobile boom in the 1960s and 1970s. Cars were sold as the future and urban planners created suburban neighbourhoods that quickly became the primary venue where people lived and learned. Suburbs were touted to be cleaner and safer spaces, far away from “derelict” urban cores, where people went only to go to work. From this idyllic image, suburban built environments have since developed various distinct characteristics, typically defined by "commercial strips, low density, separated land uses, automobile dominance, and a minimum of public open space."

Having reshaped many cities in North America, the suburban model has gone global. Around the world, the suburban forms of major cities such as Mississauga (Toronto), Surrey (Vancouver), Limert Park (Los Angeles), Footscray (Melbourne), and Prospect Park South (New York) share these similar characteristics. But it’s becoming clear that suburban living doesn’t necessarily promote wellbeing. In fact, urban sprawl is not healthy. ...continue reading