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This month's word:

Awakening

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My Path to Pathology

7/22/2016

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Andrea Bakker, MD Class of 2017

It was a regular afternoon after class. I didn’t feel like studying just yet so I wandered from room to room looking for an interest group talk to attend. I walked by a talk about hematology – arguably a specialty that I am considering - but the talk had one major flaw – no free lunch. Alas, I continued until I smelled the sweet smell of pizza. I looked into the room only to read a PowerPoint slide entitled “Pathology Interest Group”. I cringed a little and preceded to sell my time for free pizza – shameful I know but it happened. I expected to be bored for an hour, however this was good pizza so I decided to stick it out. The fact is pathology has a bad rep among medical students. Pathologists are caricaturized as doctors that hate people and lack social skills; but this talk was about to prove me wrong.

As I sat, I listened to two residents talk about their love for the specialty. I was even more surprised to hear from a resident who switched from family medicine into pathology. In the medical world this is like moving from Earth to Mars. Nonetheless, these doctors loved so many unique aspects that pathology has to offer: reasonable hours, a lack of challenging (and sometimes frustrating) patient interactions, a wide scope of practice and the ability to make diagnoses. And pathologists were not antisocial, the resident explained, they just didn’t crave the type of interactions one has with patients; instead, they preferred interacting with their colleagues.

This stuff sounded pretty good or maybe I was in a stupor from the food, so I decided to try it out with an elective with Dr. Grynpsan at the Children’s Hospital of Eastern Ontario. For those of you who know Dr. Grynspan, his enthusiasm is infectious; he responded to my email in about 7 minutes.

And so the elective began, first with a brief session discussing neuroblastoma. In class, it can be difficult to comprehend pathology – it tends to look like a whole bunch of pink and purple, however Dr. Grynspan was excellent at pointing out the key features to look for. At the end of the day, once you know what to look for, pathology makes a lot of sense. You are basically looking at the connection between structure and function as is unfolds right before your eyes; for example, cancer cells are overactive, therefore their nuclei are darker.

At the next session, I attended general surgery rounds. These rounds involve surgeons, pathologists, residents and more who review interesting cases from the past few weeks. I loved seeing how pathology interacted with other aspects of medicine. Seeing a case all the way from symptoms, to diagnosis, to treatment, is fascinating and connecting the pathology to the clinical presentation is something that we are not always exposed to in the lecture hall.

At another session, I attended the autopsy of a fetus that had suffered intrauterine fetal demise (IUFD). I have always wanted to attend an autopsy because medical students don’t have many opportunities to do so in medical school. I was a bit concerned as to how I would react to such a young patient, however the experience was very informative. First, we discussed the case by reviewing the charts of the mother and fetus. This brings me to another benefit of pathology – there is always a connection to the clinical presentation. For example, we looked for factors that might have contributed to fetal demise, such as gestational diabetes, slowed growth rate and the presence or absence of screening tests. All of this helped us form hypotheses before starting the autopsy.

The autopsy itself was captivating. We discussed the ways bodies decompose, which allows one to theorize about when death occurred. We started with an external exam looking for fetal deformities and other obvious signs, then we moved on to the internal exam. This was a great opportunity to practice anatomy because one was able to see how tissue layers interact in real life. It was also interesting because we could look for changes that would suggest a certain etiology of the IUFD. 

I proceeded to go to several different rounds and what struck me was the huge scope of knowledge that Dr. Grynspan possessed; whether it was urology, general surgery, pediatrics, radiology or oncology, he had a complete understanding of the diseases affecting that population and could talk in detail with his colleagues about the cases. I noticed this phenomenon in class as well – pathologists have a thorough understanding of almost every system in the body. In this sense, I think that completing a pathology elective is a fantastic idea. Learning pathological concepts on real specimens and working with a pathologist to understand the basics makes pathology more interesting and more intuitive. In addition, pathologists have connections to almost any specialty in the hospital, therefore they serve as a great resource to observe other areas for example, Dr. Grynspan suggested that I observe a neurosurgery and then follow the biopsy specimen through to pathology – how cool is that! Finally, pathologists posses a wide scope of knowledge, and are therefore excellent people to chat with to help integrate knowledge learned in various areas. Forget the whole “that’s beyond my scope of practice” – pathologists seem to know it all!

And so in the end, on that seemingly regular Wednesday in February I got much more than I expected from the Pathology Interest Group – not to mention some really good pizza.
 
Addendum: I wrote this piece in my second year of medical school. I am now coming to an end of my third year and am planning to apply to Anatomical Pathology. Who would have thought that such a coincidence would lead me to my future career? It just goes to show that there is so much out there to discover, so don’t be afraid to follow your gut – or your nose. 
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The See-Saw

5/27/2016

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Maija Robinson, MD 2017

Buzzword #1: "Person"

Person describes the physician whom should be sure to take time for themselves, maintain their health, their relationships and generally master other things that are, by many, expected to suffer in a life in medicine.

Buzzword #2: "Work-Life Balance"

The seemingly intangible equilibrium where the individual has their sh*t together in every aspect and whom, therefore, is both a source of inspiration and frustration to those around. 

And when you picture this all in your mind, you see a scale with big WordART style letters shouting "LIFE!" on one side, and "WORK!" on the other, and magically they are at the very same level. Must be because they are both four-letter words. 

More accurately I think we should use the term work-life see-saw, or work-life teeter-totter. Symantics, perhaps, and the goal is even the same. But have you ever tried to balance one of those with your friends in the playground? Not so easy. Constantly falling one side to the other, and just when you think you've got it, someone throws a soccer ball at you, and your arms and legs flail in attempt to regain balance, or at the very least, not fall. And even as a child, the concept of a fine balance is so craved, yet it continually evades you. 

But maybe our thinking is off. Maybe our approach needs to change. Maybe the attempt should be more child-like, where you embrace the rises and the falls because you love the fun, and the challenge of getting back to center. Maybe we need to take all our expectations of balance and instead, turn them into embracing the change.

​Maybe, sometimes, it's all we can do to just hold on tight.
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Jamaica: Land of Wood and Water

5/25/2016

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Johnathan Lincoln Lau, MD 2019

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Snapshots of Jamaica, the land of wood and water. Connecting with nature is to disconnect from our society, and being unplugged at times is fundamental for balance. Ignoring all the medicines, design, and utilities we derive directly from nature, just being in nature itself is another type of medicine - one we should definitely preserve in this increasingly technological world. 
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​Oh, and just one of my favourite dishes of all time - Hellshire escovitch fried parrot fish with festival (fried sweet dough) and bammy (fried cassava cake). Can't give you some snaps of Jamaica without that. Mi will nyam Hellshire food til mi belly burst, zeen?

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Symbiotic

5/4/2016

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Kayla Simms, ​Founder of H.E.A.L.

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Acrylic on canvas
We live not by compartmentalization, but by collaboration. We are a part of something much bigger than ourselves.

​When I think of transforming training for modern care, I imagine an institution epitomized not by its dissemination of exclusive knowledge, but a reconstruction of the patient-physician dynamic - to unify, not divide. Compartmentalization is the bread-and-butter of medical knowledge. Patients, divided into sub-types. The body, separated by systems. The caregiver, detached from the care. In rediscovering medical training, we must learn again what we have always known - that life does not exist in a vacuum, and the body does not divide.

The culminating interplay depicted between the lungs and the trees reminds us to see similarities where we have been told there are differences. The air we breathe, merely a gift from Mother nature. The body's lungs, merely a mimic of Earth's perfection. We must remember this symbiosis when treating our patients. Love and respect triumph, for only an arbitrary line divides us at the bedside.

This original piece has appeared in The Body Electric at ICRE 2015 and the WHITE COAT, Warm heART Exhibit at CCME 2016.
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Sound Heart

3/31/2016

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Amina Allalou, MD 2019

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Painting for me is a deeply personal and spiritual exercise. This work was inspired by a similar painting of a heart I saw, which prompted me to explore my inner intentions behind each of my actions. I recalled a verse from my scripture, stating that when we stand before God our only accepted offering is 'qalbun saleem' - a sound, peaceful heart. 

This painting is an expression of my striving to cultivate such a heart.
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Tears & Puzzle Pieces

3/30/2016

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​Julie El-Haddad, MD 2018

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Digital Art 
​(Originally published in UOJM Volume 5 Issue 2)

With the changes in attitudes towards mental health in Western society, we have seen an increase in awareness of the biochemical basis of certain psychological disturbances. However, we shouldn't forget that the human component of mental health remains the primary focus.

Art électronique  
​(Original publié dans le volume 5, numéro 2 du JMUO)

Avec tous les changements dans les attitudes par rapport à la santé mentale dans la société occidentale, nous avons remarqué une augmentation de nos connaissances sur les bases biochimiques de certains désordres psychologiques. Toutefois, nous ne devons pas perdre de vue l'aspect humain de la santé mentale.
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Paint Night

3/29/2016

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Andrea Zumrova & Agata Dzwonek, Arts in Medicine Co-Executives (2014-15)

"The art of medicine is about finding the beauty in your medical experiences"
"Art helps you think empathetically."
"Art is intuitive."
"Art and medicine exploit each other."
Arts in Medicine Paint Night, 2015
Photos taken by H.E.A.L. founder, Kayla Simms

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Re:turn

3/29/2016

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Johnathan Lincoln Lau, MD 2019

Re:turn is my 2nd poem composed of haikus. This poem is an aggregate of haikus I've written after separate experiences in Canada and Jamaica. I love haikus as a medium of expression as it challenges me to write as a minimalist, and encourages the use of vivid imagery. Interpret it as you will, I'd love to hear about them!

For me, it deals with self-doubt that comes along with this increasingly competitive world we live in. It's a realization that our daily strife is a microcosm of thought patterns that develop in response to our surroundings. I hope, by reading the poem you can appreciate different microcosms of thought patterns. Having spent so much time in Toronto working on my career, nearing burnout, I decided to visit Jamaica and my old friends again. It was like taking sunglasses off at the beach - every time I'm awed at how vividly beautiful this planet is. 

I think we can all ride the rollercoaster of thoughts and forget we're on it. In a meditative sense, we have to realize we might be behaving or thinking in a way we may not like because of our physical, mental, and spiritual environments. If you don't like it, change it. I think that's crucial in moving forward with our careers in medicine. 

Note to future self: "John, jus' easy yuself and gwaan do yuh ting yute. You know seh yaad and all you brejjin and fam dem a guh tek care a you. Nuh watch no face; focus 'pon yuself, zeen?"
​
Jitters with the dawn;
Eyes bright open -- hopeful light
​Swallowed by grey clouds.

Surrounding shadows
Glancing with no time to stop.
Merely blood flowing.

Why even bother?
Transience governs this life,
Petals bud yet shed.

Withering away.
Hollow ideas warranting
Self-satisfaction.

Maple whirlybirds

pirouette, falling
On desolate winds. 

Hummingbird soars through

Undulating limestone skies.
Perched ‘pon ackee tree.  

Fiery lines appear;
Flickering strokes on blackness.
On the roof of hope,

You all by my side,
Concrete hard on our backs--

Touched by heaven's arms.

Hibiscus flowers
Fated dancing with gale winds,
In tune with sun beams.

Bountiful orchids
Swaying together carefree;
Contrasting vibrance.

To live life, nuh true?
Multichromatically --
Coexisting peace.

We, reunited
Breathing in guava vapours,
Exhaling burn out.

Luminous friendships;
Lovers return to clasp hands.
Refreshing changes
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    This section will feature work of any medium centered around a theme that will be specified each month.
    Cette section comprend des travaux inspirés du thème spécifié du mois

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