Monthly Archives: April 2019

Philippe Barrette is a psychotherapist, workplace facilitator and former Assistant Clinical Professor at McMaster University, Department of Psychiatry.

David Streiner is Professor Emeritus in the Department of Psychiatry and Behavioural Neurosciences, and the Department of Clinical Epidemiology and Biostatistics at McMaster University; and Professor of Psychiatry at the University of Toronto.

 

 

Halfway through, Roma, the set in the early 1970’s, the audience is suddenly confronted with witnessing a stillbirth. The scene elicited audible gasps from some viewers in a screening we attended, when the perfectly formed, dead baby was removed from its mother’s womb.

In the film, Cleo, the nanny and domestic worker for a middle-class family living in Mexico is rushed to hospital following an emotionally draining 9 months. Cleo’s boyfriend abandoned her shortly after learning of her pregnancy, and the family have endured marital tensions and a separation.

After an initial examination the assisting physician at the birth says, “I can’t hear a heartbeat," ...continue reading

Brianna Cheng is a MSc Epidemiology student in the Class of 2020 at McGill University.

 

 


is it possible to mourn the living?

 

time’s grasp on youth seems ever loose

while draining those already

shaking

dithering

moaning

clutching that metal receptacle

you cursed and swore

words you would never use

begrudgingly accepting this fifth, sixth appendage

that appear with age

(which I swear the developmental anatomy textbooks

did not include

not because their ink ran out

but because there is still a deep fear within us all

about what it means to be old and frail)

 

what happened?

i mean, besides a few creaks

you were the picture of health

you’d cry “1000 steps a day”

and diligently proceed to walk

up and down home’s narrow halls

up and down

up and down

a steady force within our walls

learning tongues and news

with sharp wit and humour

an independent spirit

who had inspired my love of

good literature, medicine,

and above all,

people.

 

you were a life force,

and especially

mine

 

i know im not a doc (yet) grandma

but

i know we need to

confront this together

and acknowledge this together

sometime

when we’re both ready

 

for now,

maybe it’s better

we both just allow ourselves to

feel and sulk and be at odds

if only to remind ourselves

we’re both still here

even as some lonely, disjointed echoes of

who we both used to be.

we can mourn together.

Michael Scaffidi is a medical student in the Class of 2022 at Queen's University

 

 


Listen to the Michael's composition here: , and read about it below.

"This is a piece that I wrote for the 2nd Annual Jacalyn Health and Humanities Conference at Queen's University and decided to later publish. "Sonata in C, Journey Through the Valley" tells a story of what a patient experiences when given a serious diagnosis. Specifically, I strove to show how disruptive this event can be through the use of a highly dissonant "diminished chord". In addition, in contrast to the peaceful, almost indolent first theme using triplets, the second theme uses the infamous theme of "Dies Irae" (Day of Wrath), which is derived from a Latin hymn that is often used throughout classical and film music to signpost death or an ominous event. ...continue reading

Parisa Selseleh is a medical student in the Class of 2022 at the University of Manitoba

 

 

Dear you,

I must be honest, I was not looking forward to seeing you in the gloomy October day that coincided with my birthday. Despite my eagerness to learn about human illnesses, I was not ready to shatter my ignorance of human mortality and the hearts that give up. I slowly walked the long hallways leading to your current resting place, the Gross Anatomy Laboratory. Then, I saw you covered by an orange body bag, and in the blink of an eye, I became a medical student.

I had a vague understanding of what it meant to be in the business of mending bodies and minds, but I felt the gravity of my role the moment I saw how. I did not have much medical knowledge when I first met you but slowly, you taught me. How lucky I was. ...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. Follow his writing : .

 


 

ventricular septal defect

you would not understand

what it means to fall in love

with the blue

to come to pour it

to read it in the cracks of light under heavy spines

to see it in green marseille waters ...continue reading

 Austin Lam is a medical student at the University of Toronto.

 

 

 


 

In a session on narrative medicine in medical school, a clip from the film (2001) was shown in which Vivian Bearing (portrayed by Emma Thompson), an English literature professor, was told that she has Stage IV cancer by Dr. Harvey Kelekian (portrayed by Christopher Lloyd). In this scene, he was, to put it mildly, less than considerate of the gravity that the discussion had for Vivian. He was Efficient. Domineering. Self-interested.

As Dr. Kelekian lectured her on the experimental treatment regime, he emphasized how she would be contributing to “our knowledge." In response, she repeated the word knowledge in a state of disorientation, seemingly to both him and herself.

What struck me the most was a question that came to mind: even if he had communicated in a gentler and more compassionate manner, even if he had mastered the art of breaking bad news, why would I still be left with a visceral feeling of discomfort?

At first glance, a fulsome sense of niceness would seem to be the answer — the answer to the power imbalance between patient and physician, amongst other problems, demonstrated in this movie scene. In fact, has been emphasized as an integral factor in treating patients.

The problem is that even if Dr. Kelekian, or his non-fictional ilk, were nice — maybe even counting amongst the nicest people in one’s life — there remains an ostensibly irreconcilable gulf between his stance of epistemic objectivity (“our knowledge”), , and that of so-called subjectivity in Vivian’s phenomenological reality, grounded in her experiences. The divide is not a Manichean duality. It is not that there is an inherent ‘rightness’ or ‘wrongness’ in one or the other.

The trouble lies in how the manner of approaching the patient’s concern(s) is framed: to explore that which is objective, and to this, adding considerations of the subjective (or the reverse in some cases). The conceptual divide between objective and subjective is not and cannot be solved by niceness. A change in attitude hardly substitutes for what is needed, namely, conceptual/philosophical sensibility, and corresponding epistemic humility.

One can imagine a hypothetically transformed nice Dr. Kelekian who nevertheless works under the guiding principle that his set of meanings, those belonging to “our knowledge,” are the ones that are objectively correct — and that when his patient’s meanings align, then all is well; but when they do not, then something has to give. An area not only of mis-understanding, but of non-understanding emerges between the ostensibly nice physician and the patient.

The patient may have a differing position that is judged to be ultimately misguided. It may be seen as a tolerable position or maybe even one with which the physician sympathizes but nonetheless sees as wrong — possibly accompanied by perceptibly nice phrases such as “I hear you, this is what I think…”. The physician may ultimately be ‘right,’ but in what sense? And so, here lies my discomfort: the . Equally, however, this discomfort does not necessarily translate into an espousal of untethered subjectivity.

What follows is not the demand that medicine requires expertise in academic philosophy. Rather, there ought to be a recognition that meanings can have truth, and that this does not require the meanings to be processed, subsumed, or translated into one objective account, the one taken-up and assumed by medicine. This kind of singular account has been as the following position: “the condition of my understanding you as you think and act in your terms is that I construe you as making sense in my terms most of the time.”

The underlying stance is that of ‘observer to object’ — the medical gaze — a notion introduced by philosopher Michel Foucault in . The medical gaze has been “how doctors modify the patient’s story, fitting it into a biomedical paradigm, filtering out non-biomedical material.” Despite many criticisms of Foucault’s ideas, his notion of medical gaze galvanizes further refinement in conceptualizing the constitutive forces in the patient-physician relationship.

The objectifying medical gaze necessitates a correction. However, this cannot be one of plastering ‘subjective’ elements onto ‘objective’ elements nor one of unbridled relativism for fear of losing grasp with reality and ending up with an impoverished category of ‘inner appearances.’ An account of understanding that transcends objective and subjective is needed. Philosopher Hans-Georg Gadamer provided this in his book .

Summarized by , Gadamer’s argument is “ontologically based: human beings are in contact with the real … Gadamer makes central the paradigm of a ‘conversation,’ in his understanding of human science, rather than that of an inquiring subject studying an object. Success comes, not with an adequate theory of the object, but with the ‘fusion of horizons.’” In essence, he challenged the subject-object dichotomy with his ‘conversation’ paradigm.

Again, elegantly wrote:

“If understanding the other is to be construed as fusion of horizons and not as possessing a science of the object, then the slogan might be: no understanding the other without a changed understanding of self … Real understanding always has an identity cost.”

The necessary identity cost cannot be paid for by niceness per se, it demands something more: an authentic conversation, where authenticity involves heeding the call of in a Heideggerian sense.

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Ally Istl is a senior General Surgery resident at Western University

 


 

The concept of Wellness in the professional medical arena has become a contemporary Gargantua that we are perpetually seeking to satisfy, but never able to sate. As other disciplines seek to make their trainees ‘Well’, wellness has also become a growing subject of exploration in surgical disciplines.

Wellness means different things to different people and formal definitions provide no clarity in the context of the medical profession: ‘the state of being in good health, especially as an actively pursued goal’ only provokes more ...continue reading

Tharshika Thangaraa is a fourth year medical student at the University of Ottawa.

 

 


The sound of her alarm pulsated through her room. Startled, she awoke. It was just another day. As the fog of nighttime cleared, she felt the weight of everyday resurface. Gradually, they claimed their spot, perched atop her shoulders. She sunk deeper into her bed.

What would she wear?

How would it flatter her figure?

What would they think?

She managed to pry off the covers and make her way downstairs for breakfast. She poured herself a bowel of cereal and set the coffee to brew. She barely noticed the happy chirps of the morning songbirds or the vibrant petals of the summer flowers starting to bloom.

...continue reading

In this next "Med Life with Dr. Horton" podcast, Dr. Jillian Horton chats with Dr. Allan Peterkin about creative arts and playfulness as related to medicine and as tools to help balance out a stressful life.

Dr. Horton and Dr. Peterkin talk about:
- music, writing, theatre, improv groups
- the time Dr. Peterkin was on The Tonight Show with Jimmy Fallon because of one of his books about beards
- how learning to interpret a painting is related to diagnostic skills
- how a practice in creative arts can influence the way doctors approach patients and can help prevent burnout
- finding a balance between pleasure and purpose in life
- the absence of play in medicine
- practical tips for picking up that long forgotten creative practice again
- and much more

...continue reading

 is an Internal Medicine Resident (R1) at the University of Toronto. Check back the last Thursday of each month for a new featured piece as part of his series (Doc Talks: Reflections to Reality)!

 


 

No S1Q3T3

on the waveforms of her ECG,

but nobody turned to check

for signs of right heart strain in me.

 

Alarm beeping cuts through cold silence

only to leave the same void behind on cue;

my mother, ‘the patient’, is fading away,

and I, ‘the bystander’, am too.

...continue reading