Author Archives: CMAJ

The new season of "Dear Dr. Horton” is here! Send the anonymous questions that keep you up at night to a real former Dean of Medical Student Affairs, Dr. Jillian Horton, and get the perspective you need with no fear of judgment. Submit your questions anonymously through , and if your question is appropriate for the column, expect an answer within a few weeks!

Dear Dr. Horton,

How do you address concerns with friends over questionable coping methods, when they are highly educated nearly-doctors too? My roommate has always had body image issues, but I did not know how deep they were rooted. In fact, after a recent psych block, I am pretty sure she has an eating disorder. I'm just not sure how to address it.  Nothing seems to be falling apart in her life.  Any tips on how to address uncomfortable suspicions that are unconfirmed?  Without offending my friend?


Tip Toeing


Dear Tip Toeing,

Have you ever heard of the invisible gorilla?

In a famous psychology experiment, participants are asked to watch a video clip of two basketball teams and count the number of successful passes. (1)  Most people get the right number of passes.  But they miss the person in the Gorilla suit who literally moonwalks through the game.  Why?  Because they’re not looking for a gorilla.  And we have a hard time seeing what we are not expecting.

My colleague Ron Epstein uses this concept to help physicians go off autopilot and become more observant (2).  It’s a helpful construct for understanding cognitive error as well.  But I think it has another, more personal application.  When it comes to physician suffering, I think there are a lot of invisible gorillas in the room.

The first thing I want to commend you for is noticing.  Too often in medicine, we’re blind to the suffering of our peers. Sometimes this is because we are struggling to contain or manage our own suffering.  Sometimes it’s because we assume that nobody struggles the way we struggle.  And sometimes we assume our colleagues are “smart” enough to be able to identify when they are in over their heads, and we share the fallacy until things have spiralled totally out of control, or worse, until it’s too late.

This is a fundamental paradox of life in medicine...that being a doctor means you always have insight into your own health.  It’s true that being a doctor can be helpful if you are trying to decide if you have a virus.  But there’s no reason to think it’s particularly helpful if you are trying to decide if you have an illness that is characterized by cognitive distortion.  Meanwhile, the people around you may mistake your intellect for insight…words that are not synonyms.  And before you know it, the invisible gorilla has pulled a Godzilla and torn up not just the basketball court but pretty much everything else in your life.

I had some very hard times in my residency, times when a gorilla followed me into every room.  For years afterwards I used to wonder: didn’t my friends know I was in over my head?  Didn’t they see my suffering?  Wasn’t I worth the discomfort of saying something?  I grieved this abandonment; it was a sadness that stayed with me for at least a decade.  But then, in the years that followed, I missed these same signs in my own friends, and sometimes in my residents and students, and I wondered how I could have been so blind.

Life has taught me that my friends didn’t abandon me.  In fact, they were often watching me closely…closely enough to know I never missed a pass, that I always kept catching the ball.  They thought performance was the metric that would measure whether I was alright.   That’s how they missed the gorilla.

It doesn’t absolve them, or me, or any of us of the responsibility for taking better care of each other.  But it helps give us a framework for how we have failed so miserably as a profession when it comes to judging the wellbeing of people around us.  We have to start looking for gorillas.

Tip toeing, you’ve noticed something amiss.  There’s a moonwalking gorilla in your rented apartment.  Maybe you’ve talked to it a few times and it laughs and tells you it’s not a gorilla, it’s a seahorse.  Or maybe it’s barked like a dog, in the hopes of throwing you off its trail.

You have a choice.  You can pretend it is a seahorse, or a chihuahua, and you can become party to the cognitive distortion.

Or you can sit your roommate down.  You can show her this post.  You can tell her you wrote this letter, because you’re worried sick about her.

Be prepared for anything.  Gorillas are unpredictable.  Enlist the help of friends, family, trusted faculty, and school resources, to help get through to her.   Will that make the gorilla angry?  It might.  But my experience is that in processes that don’t preclude a degree of insight, most people welcome true expressions of caring and concern.  Some people have been wrestling the gorilla on their own for so long that it is a relief to know that backup has finally arrived.

Even if things go the other way, would you rather have an angry friend or a dead friend?  And what would any of us want or expect our friends, family and teachers to do if we had an illness that could impair our judgment, insight, willingness, and ability to seek help?

I think we would want them to be brave, to step up, to help us send that gorilla packing, so we could get on with our lives.


Dr. Horton



  2. Epstein, R.M. Attending. Scribner, 2017.  P 17

Dr. Jillian Horton is a general internist in Winnipeg, Manitoba. She was the Associate Dean of Undergraduate Student Affairs at the University of Manitoba from 2014–2018 and now directs programs in wellness and medical humanities at the Max Rady College of Medicine.

She writes a column for CMAJ Blogs called Dear Dr. Horton: 

 Grace Dao  is a second year medical student at Dalhousie University.



From the beginning of medical school, we are taught about balance --the balance between each individual’s autonomy and the public well-being, the balance between focusing on the present and always being asked to plan for the future, and the balance between investing our time and energy into becoming skilled practitioners and the famously important, ever elusive “work-life balance”. Yet despite the mentioned importance, each lesson often ends with the thought that “well, you just have to find the balance…”. ...continue reading

Beatrice Preti is an R2 in internal medicine at the Queen's University.



There were things I meant, but didn’t say
As I heard your heartbeat fade away
My stethoscope was on your chest
When you drifted off to eternal rest
I’d spent the whole night by your side
There was nothing left we hadn’t tried
But the drugs and tubes and shocks and lines
Bought you little extra time
Your path was clear right from the start
I had no cure for your sick heart
Yet you asked me to try, so I did my best
But, despite our efforts, things progressed
When the new dawn broke, your life did, too,
You never heard what I said to you
How I begged forgiveness, my quiet prayers,
You stared straight ahead, as if I weren’t there
Close to the end, you’d opened your eyes
Looked up with desperation, as if the skies
Would rain down mercy for your plight
But no salvation came on that fateful night

This was never our initial plan
We’d all seemed to understand
That you were dying and wanted peace
A soft and gentle, graceful release
But as your time was drawing near
You changed your mind. That much was clear.
You told me you were afraid to die
I said I’d help, but that was a lie
I didn’t share my other thoughts
That tied my stomach and heart in knots
I knew then that it was too late
Yet I donned my gloves, and fought with fate
I wrote the orders, increased the dose,
Pulled up a chair so I could be close
You had no family to stand by your side
Your rocky end was a solo ride
As the night grew thin, your breaths grew shallow
Your once-ruddy face turned blank and sallow
I never said I was sorry to you
By the time I could say it, the end was through
The dawn broke cruelly on the brand-new day
And all the things I meant, but didn’t say

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 : .



as if you’ve already known

that it must be i

quiet i looking i

holding the heavy love

for us both


these giant holes of light

these hands wrecked with the small

and the insects that sit on bony branches

like lesser gods dissolving in the leaves

that too know

how to pray

or kill a man


my brother is tickling my feet

my sister is wanting to wrestle us both

air laughs between then and then in the sweet pardon

of excuse me child

have you heard what rumi said

about this

let the beauty we love be what we do


are you done

is this night

where i dream in the slop of your inhale

with persian on my tongue

the split fruit of books on the carpet

where i am trying to swear more often

because of that damned poet reminding

each day is a tinier day

each body is becoming less of a body

by being with others


on a ripped page is an entire life

in a word there the worried universe


the scalps understand

the scallops even more so

you lick your fingers with childhood

meat full of meat

like my grandmother who taught her

earth brown cat

a persian i think

to tickle

to hold

to love the unknown


 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)!




time tests our resilience.


We struggle with the urge to

no longer put ourselves second,

when every other second

is spent putting others first.


But we are reminded –

...continue reading

 Shez Kassam is a medical student in the class of 2019 at the university of Alberta



Across, eye to eye

Armchair, arm’s length


The heart suffers—pathologic

No monitors or stethoscope to be seen

...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.



meta static
food undigested on the chest
breasts already pancakes
they will laugh when reaching under
the napkin of my body

they the strong
they the knowledgeable

will the question caught on my throat
survive the morning ...continue reading

 Sarah Silverberg is an R1 in OBGYN at UBC and an intern at St. Paul's Hospital.



Please let me take your history.

I know the triage nurse and the emergency physician already asked you many of these same questions. But humor me -- let me ask them too. After all, I was asked to see you by the emergency doctor who saw you. They knew I would ask you these questions, and felt it was necessary. They referred you to me, and like it or not, you’re now under my care.

I am the resident that was asked to see you. You ask me if you could see the real doctor. Unfortunately, I am the real doctor. At least, I am a doctor; one of the country’s medical institutions has granted me an MD. And while I know what you mean – that you don’t want to see the resident, and that you want to skip ahead directly to the attending – at this moment I can’t make that happen. My attending sent me down to see you because I’m the one on consult service. My staff is in the operating room, or managing the ward, or reviewing the three other consults we’ve been asked to see this evening with other residents and students. You’d be waiting a while longer if I didn’t see you.

...continue reading

 Ashleigh Frayne is a Family Medicine (R1) at the University of British Columbia.”



The pavement darkens as the chill of the night settles

Stretched across the lap of the day, a shadow cat

Moving swiftly down the street, between pools of light

Cast by warm windows, freeing the damp of evening

To reach long fingers down my spine, the sigh of today.

I rub my eyes, crusted with the dread of tomorrow.

...continue reading

1 Comment

 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)!


We are challenged to embrace frailty and a disarray between mind and body when we encounter patients at the end of their life. As we seek to nurture a place of comfort and wholeness for them, we are tested to bear witness to their helplessness, to appreciate their intrinsic values not only as patients but also as people, and to preserve their dignity. Moreover, we are presented with an opportunity to appreciate the internal struggle of their loved ones as they are confronted with a disconnect between the person they have known and loved, and the patient we provide care for in times of declining health.

Penned based on the reflections of numerous families I met on the wards, this piece strives to give a voice to the struggles many encounter alongside their loved ones in the end of life.


Our voices echoing ...continue reading