Author Archives: CMAJ

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

 

 


The importance of mental health has rightly been emphasized in recent times. The stigma surrounding mental illness ought to be dispelled. However, I wish to take a closer examination at the conceptual elephant in the room: the mind-body problem — a philosophical issue that strikes to the core of continuing disparities between how the healthcare apparatus as a whole addresses “mental” versus “physical” health conditions.

As medical historian Roy Porter pointed out in his book (1997): “psychiatry lacks unity and remains hostage to the mind-body problem, buffeted back and forth between psychological and physical definitions of its object and its techniques.” This was a prescient remark. In 2018, the editor-in-chief of Dialogues in Clinical Neuroscience, Florence Thibaut : “recent advances in neuroscience make it more and more difficult to draw a precise line between neurological disorders (considered to be ‘structural brain disorders’) and psychiatric disorders (considered to be ‘functional brain disorders’).”

To begin, let’s analyze the statement — Mental health is health.  ...continue reading

This week’s edition of Dear Dr. Horton” is a general response to the many excellent questions that were submitted in response to the CMAJ call-out for the “Med Life with Dr. Horton” podcast. Find it originally here: http://wakiganavi.info/horton-podcast-carms-interviews/


Dear classes of 2019,

Ah, CaRMS…that beloved hybrid of Survivor and The Bachelor.  You want to be the last one standing, but hopefully that doesn’t mean accepting a proposal that will become your new personal definition of hell.

I’ve coached hundreds of students through the CaRMS process over the years. My approach draws on my experiences as a long-time clinical teacher,CaRMS interviewer, Associate Program Director, Associate Dean, Royal College committee member, Royal College exam coach, and my interest and expertise in communication, cognitive error and mindfulness.  One thing I’ve learned: there are wrong ways to answer questions, but there is no universally right way.

Some interviews start with a variant of that dreaded question, “Tell us about yourself.”  Too frequently, students use that precious first impression to regurgitate dry information that is already included in their CV.  That’s a sure-fire way to get lost in the crowd.

I counsel students to spend time considering how they will structure this question.  It’s always helpful to open with what I think of as an editorial statement.  “I’m so pleased to have the opportunity to be here with you today.  When I reflect on this question, I think there are three things that help give you a window into who I am as a person.  The first thing is X.  The second thing is Y.  The third thing is Z.”

How do you settle on the content of X, Y and Z?  I recommend looking for your three best positive anchors.  Perhaps you are from a small town, in which case X might be your deep sense of community.  Maybe you’re a runner, and Y is that you are a person who has a long game philosophy in life.  Maybe you’re a person who grew up in tough socioeconomic conditions, or you have spent a lot of time in volunteer roles, and Z boils down to your personal commitment to social justice.   ...continue reading

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

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.

 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)!

...continue reading

Welcome to this week's edition of Dear Dr. Horton. 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,

I've experienced the death of patients before — but this one feels different. I can’t help but think of small things we spoke about, like their dogs and their season tickets to the theatre. How do you navigate the intersection of professionalism and mourning another human you felt connected to?

Signed,

Mourning in Secret

...continue reading

Noémie La Haye-Caty is a medical student in the Class of 2019 at McGill University

 

Katy is sleeping on the exam table. She came in looking tired, talking with a weak voice, and walking with small steps. I tried to ask a few questions, but her lack of sleep was evidently preventing her from answering.

She is here today for a follow-up appointment. She was admitted two weeks ago because she wanted to end her life.

I try to gently wake her up. “How are you doing, Katy?”

“Better.”

“Great! What’s better?”

“I was confused, before.”

“Why were you confused?”

Katy is 24 years old and has three young children. She is now a few weeks pregnant. Two of her children were recently taken by the , while the youngest lives with Katy and Katy’s own mother. Katy tells me that the father of her kids used to be violent with her and has been in prison for the past week. ...continue reading

 is a medical student in the Class of 2021 at McMaster University

 

“Doctors are jerks.” It was a statement that I had always steadfastly believed to be true; a matter-of-fact statement, just like saying the sky is blue. Though I had no shortage of concrete personal examples to justify my belief, the irony was not lost on me as I stared out from behind the glass of the nursing station, ready to begin my first clinical experience as a new medical student.

I was in the child and adolescent psychiatric ward. From the nursing station, I could see the ward’s common area: the bolted-down tables and chairs, the colourful pictures adorning the walls, the patients scattered about the room—some in groups, some alone. It was a scene that was familiar, yet different. This was far from my first time in a psych ward, but it was my first time being on this side of the glass. ...continue reading

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 is a medical student in the Class of 2019 at the University of Toronto

 

It is well-known that workplaces strive for diversity and inclusion. Studies have shown that diversity improves productivity and contributes to creativity and new ideas. In medicine, this diversity is just as important. Having physicians from under-represented and marginalized communities provides unique views on what may be best for the patient. As medical schools continue to support new initiatives, such as specialized admission pathways for African American and Indigenous students, it is clear diversity is on the agenda. However, for those who are not of the majority ethnicity, diversity may not be enough. There also needs to be representation.

This idea was at the forefront of my mind during an elective rotation. After I had mentioned my interest in Indigenous health a number of times, I was asked by my attending whether I was of Indigenous background. I understood the hesitation, of course; sometimes it can make people feel uncomfortable to ask about your background or where you are from. Nonetheless, I was happy they had asked and I responded with a firm “yes.” ...continue reading

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 is a medical student in the Class of 2020 at Western University

 

It was my first week on service for internal medicine as a third-year clerk. I had finally begun to figure out the labyrinth of charts, forms, and computer apps that went into my interactions with patients. I still had four of the eight pens I’d started with and had managed to misplace my sacred “pocket guide” only twice — so, all in all, I was off to a good start.

I was told by my senior to go see a patient who was in ICU step-down and had recently been transferred to our care. I hurriedly went to the computers and started reading up on the patient’s history.

Mr. C had a long and complicated history. He had initially presented to the hospital with signs of cholecystitis but later developed multiple complications landing him in the ICU. After a flurry of resuscitative measures and close monitoring, Mr. C was finally deemed stable enough to be transferred to the ward. ...continue reading