Archive | January, 2015

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CaRMS Tourrrghhhhh

Posted on 31 January 2015 by Jimmy Yan (Meds 2015)

I finish my interview, quickly changed out of my clothes, and pack my things. As walk down the stairs my phone buzzes, a reminder that my flight later is on-time.
That’s weird, I think, my flight is supposed to be on Friday.
I then check the date at the top of the screen. Friday. January 30th.
Right, yes. We’re interviewing in London now, so obviously it’s January 30th, that’s when it was scheduled.
Oops.
With the end of today’s interview, I’ve hit the halfway point (cue some Bon Jovi) on this interview circuit, and boy arethedaysjustblurringtogether.
Seriously, where did the time go?
It all started off pretty easy enough, last week started with two interviews only: Memorial on Monday and Dalhousie on Tuesday. Since I didn’t have any interviews in Quebec I had a few days to rest and relax before reaching the first big obstacle. Ontario.
5 days, over 800 km of road travel, late night socials, and 4 interviews in 4 cities, I felt as if I was caught up in riptide that just dragged me through the days. I didn’t even have it that bad – I didn’t interview in either Toronto or NOSM, my admiration to my colleagues that were able to manage these cities as well. Even more intense were some of the Quebec applicants who virtually had no break as they spent the whole of last week going through Laval, Sherbrooke, and the 2 Montreal schools.
I can see that it’s affecting my fellow applicants as well. Ties hang a little looser. What were immaculately cleaned and pressed outfits are creased and salt stained by the road. Earlier this week I heard one person mistakenly say he was enjoying being in Ottawa while at the Queen’s social. Someone told me he no longer keeps track of time by day of the week but by whichever city he’s currently in.
One of the residents I met along the way likened the CaRMS interview circuit to being on a rock tour: every day in a new city, constantly meeting new people, up late in the bars only to wake up early the next day, to go perform the same gig to a different audience.
It feels like I’ve been on the road forever, but that’s not necessarily a bad thing. It’s a good time to just go with the flow. Next week will be a whirlwind through Western Canada, but it’ll be spent either interviewing or traveling. The actual day of the week, heck, the city I’m in, doesn’t even matter. It’s a weird and wonderful transient state to be in, and, pretty soon all over. Soon I’ll be grounded and back in a lecture seat, with just the worn out boarding passes and unused drink tickets to assure me that it all happened. Until then, I’ll be enjoying the fun.
Well, time to head out and catch my next flight. The tour must go on!

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Dine While You Dash!

Posted on 02 January 2015 by Erica Hoe (Meds 2016)

How often do you want to eat a full breakfast, but have absolutely no time to make it, let alone sit down and eat it? For me, that’s every morning. That’s why I’ve taken to making smoothies in the morning. I use my trusty blender, toss in the ingredients, press “blend” and then start getting ready for the day. By the time I’ve gotten dressed, my breakfast awaits. How perfect. I’m living the life.

Seriously though, you can guzzle it down in the car, on your walk to work, while you’re waving to passersby, or cleaning your stethoscope. Whatever. The point is, it’s the fastest breakfast and it has all the right nutrients.

The idea is to pick some of your favourite fruits (you can freeze them before they go bad so you can use them instead of ice cubes), pick a vegetable like kale or spinach, add some honey if you want it sweeter, invest in some chia seeds and almond milk, and toss them in the blender until it’s smooth. Here are a few of my favourite smoothie recipes.

 

Monday:

Let’s start off simple. Like they say, the first five days after the weekend are always the hardest. So, let’s not get ahead of ourselves and make too many elaborate smoothie plans. This one is super simple, and you can pretend you are still out having a drink with your friends. The weekend’s not over, I refuse to believe it!

 

Strawberry Pina Colada Smoothie

Erica Hoe - 1

 

 

 

 

 

 

 

  • A handful of strawberries
  • ½ frozen banana (keep them in your freezer, and snap them in half when you want to use them)
  • 2 tablespoons of coconut Greek yogurt
  • 1 tablespoon chia seeds
  • 1 cup coconut almond milk (or just almond milk)
  • 1 tablespoon shredded coconut (in the smoothie and for garnish) – you fancy huh?
  • Ice cubes
  • Honey

 

Tuesday:

Monday was tough. Tuesday isn’t going to be any better, so let’s just make a smoothie filled with all the most delicious berries.

 

Very Berry Smoothie

Erica Hoe - 2

 

 

 

 

 

 

 

 

  • A handful of blackberries, blueberries, raspberries, and strawberries
  • ½ frozen banana
  • 2-3 kale leaves (use the leafy green part) – The bitterness of the kale is masked by the berry medley; also the colour of your smoothie won’t be that scary green colour!
  • 2 tablespoons of Greek yogurt
  • 1 tablespoon chia seeds
  • ½ cup coconut water or orange juice
  • A few mint leaves
  • Ice cubes
  • Honey

 

Wednesday:

It’s the middle of the week. That means you’ve been working really hard for the past two days and you deserve to celebrate with a tropical drink. Yes, that means mangoes. This is one of my favourites.

 

Mango Coco-Loco Smoothie

Erica Hoe - 3

 

 

 

 

 

 

 

 

 

  • 1 mango
  • 1 frozen banana
  • 1 tablespoon coconut Greek yogurt
  • 1 cup almond milk
  • 1 tablespoon chia seeds
  • Ice cubes
  • Honey

 

Thursday:

You might not have time to bake a cake, but this tastes just like it. It might even improve your vision without expanding your waistline.

 

Carrot Cake Smoothie

Erica Hoe - 4

 

 

 

 

 

 

 

 

  • 1 frozen banana
  • 1 carrot (chopped)
  • 1 tablespoon chopped walnuts
  • 1 tablespoon shredded coconut
  • 2 teaspoons pumpkin pie spice (cinnamon, nutmeg, ginger, cloves)
  • 1 teaspoon vanilla extract
  • 1 tablespoon chia seeds
  • 1 cup vanilla almond milk
  • Ice cubes
  • Honey

 

Friday:

It’s Friday, treat yo self. Indulge in this chocolatey goodness. Lather your intestines in sweetness. Too visual? Too bad. This smoothie is THAT badass.

 

Chocolate Almond Smoothie

Erica Hoe - 5

 

 

 

 

 

 

 

  • A handful of spinach
  • 1 tablespoon almond butter
  • 1 frozen banana
  • 1 cup chocolate almond milk
  • 1 tablespoon chia seeds
  • 1 teaspoon vanilla extract
  • Cocoa powder (optional) – if you want it even more chocolatey or if you’re using plain almond milk
  • Ice cubes
  • Honey

 

I hope you like these just as much as I do. May you now power through the morning without your stomach growling with hunger. Bottoms up!

 

Erica

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His Basis For Morality

Posted on 02 January 2015 by Lester Liao (Meds 2016)

A refresher of our approach – humility and an open mind.  Don’t reject it because it is bizarre – this is poor scientific thinking and lacks inquisition.  Germ theory turned out to be right after all!  Don’t jump onto it because it is new – this is foolhardy.  Just because aseptic surgery has been developed don’t go cutting everything out of the abdomen!  Both are dangers.  And remember to keep our chronological snobbery in check.  They were not idiots “back then.”  Not all epilepsy was attributed to the demonic.  Just take a look at what Matthew wrote in his Gospel close to two thousand years ago about distinguishing between those oppressed by demons and those who were epileptics (Mt 4:24)!  If you thought that was what they thought back then, it may be a good indicator that you’re actually the ignorant one!  Let’s always be willing to learn.

Now let us continue to set up the groundwork for learning from Hippocrates.  We need to recognize our own worldviews and how they inform how we understand practicing good or bad medicine.  How we understand moral knowledge is informed ultimately by our worldview.  Our worldviews inform four fundamental questions: What is my origin?  What is the meaning of my life? How should I live my life?  What is my destiny? Whether you believe in God or gods or nobody or do not know, whether there is life after death, whether there exists truth or not, and so on, will inform your answers to these fundamental questions.  How you understand morality (or the third question) then is also influenced by worldview.  For the sake of learning from Hippocrates, we will focus on the morality issues.

Some readers might now be shaking their heads and saying, “Oh but morality is totally subjective!  It is relative!”  If you hold this view, you must recognize that this is actually one of the views prevalent amongst people in our day and was not popular in the past.  Moral relativism has many faces, but broadly speaking it is an untenable position in reality.  Sure it may sound interesting and humble in theory (apart from the incoherent declaration that it absolutely says all things are relative and says it is right about that), but it brings problem into the practice of medicine.  If there is no set standard by which physicians should practice, how can we be “good” physicians apart from just feeling like we are?  Where is our moral standard coming from?  There are a few popular answers to this question in our day, and I will very briefly address three of the common ones with critiques that philosophers and scientists have offered.  I will focus specifically on morally relativistic views because these are the furthest from Hippocrates and his worldview.  These are not intended to cause you to abandon your viewpoint but to force you to think critically and rationally.  In line with all we have discussed, any viewpoint, including absolutist viewpoints (e.g. Kant’s categorical imperative, natural laws, divine precepts), will have critiques, and good thinkers must be able to appreciate critiques and re-evaluate accordingly.  Ultimately this will help us connect with Hippocrates’ understanding of morality.

The first position holds that morals are socially conditioned; it is our cultural structure that we agree upon that determines what is right or wrong.  When we consider the law and democracy, most of us can agree to this to some degree.  One major difficulty with this position, however, is presented by societies that have committed atrocities.  Is what is right or wrong just a matter of what people agree on?  Or what most people “vote” is correct?  Nazi Germany often serves as the litmus test for this position.  If social conditioning is where morality comes from, Nazi Germany must be understood as being right for that culture and it would not be our place to tell them otherwise.  Similarly, any society that accepted to mutilate, sexually abuse, and then kill babies would be “moral” if this was the cultural milieu.  This probably doesn’t jive too well with us innately. So while there certainly is an element of culture to what we see as right or wrong, many argue social conditioning cannot be our ultimate arbiter of right and wrong.

The second position appeals to a form of evolved morality.  We have evolved with moral capacities because it has helped us survive as a species over the ages.  This too sounds tenable initially but historically many issues have been raised with this train of thought.  If morality is evolved, it means it is an arbitrary product of chance (just like we could have evolved with three arms instead of two – neither is “right” or “wrong”).  The naturalist mindset renders everything meaningless because everything is a matter of chemicals mixed a certain way.  They are fascinating accidents, but they are still just chance occurrences.  To say that one way of thinking is right or wrong would be like saying that the way one pop can fizzes versus another is right or wrong.[1]  Additionally, the nature of this morality must be consistent with natural selection, but this has difficulties as well.  If morality is only about reaping returns and passing on genes, a simple situation should challenge us.  We would expect that we should never help an unrelated, dying lady with no money and nobody around to see our good deed if she needed someone to help her cross the street.  After all, why expend our resources for someone that will never increase the chances I will pass on my genes?  Yet this is an act we praise.  Finally, Darwin chillingly noted in The Descent of Man that if natural selection is the true driver behind morality, “the civilized races of man will almost certainly exterminate and replace throughout the world the savage races.”  This racist and eugenic mindset was the driving force of Nazi Germany, but if they were simply acting consistently with natural selection, we could not call their actions “wrong.”  I have designated this a relativist position because it has difficulty calling things truly right or wrong.  Many people in medicine will likely espouse this view and will be surprised to learn that there are atheistic/agnostic (unlike dear Hippocrates) scientists and philosophers that do not hold this view. David Berlinski and the late David Stove are two well-known names critiquing this position.

Finally, a third position suggests that morality is purely subjective and depends on the self alone.  Personally I think this is the least tenable of the positions (the most relative).  If morality is subjective, then your position doesn’t matter anyway because anybody can disagree and feel him/herself to be right!  Nobody is right.  Either that or tell me it is still subjective and valid after someone slaps you in the face ten times and says they just feel like it is the right thing to do.

Each of the positions above has been very briefly critiqued – and I leave it to you to think them over (by all means contact me if you find Berlinski’s writing unconvincing!). So what then of Hippocrates?  What was his conception of morality?  While much critique of his thought can be offered, we will first focus on his foundations. We must remember that Hippocrates frames the entire oath and the question of morality by appealing to all the gods and goddesses of his day!  His appeal was to the transcendent.  This is foreign to many people today, but the rationale of it must be carefully considered for its implications on morality.  Hippocrates began his oath by making himself accountable to transcendent beings.  These were not only colleagues that had no real authority over him or a society that could grow corrupt.  These were divine beings with a higher level of authority and power to judge him for his actions.  This does not appeal to us today but we must think from Hippocrates’ perspective.  If there were people who believed in gods that would judge you for every morally wrong action in medical practice versus people who believed there was no punishment for wrongdoing, who would you trust to do the right thing more?  As the famous philosopher-theologian Jonathan Edwards says of the judgment, reality, and certainty of divine things, “those who are convinced of the certain truth of these things will be governed by them in their practice.”[2]  While not entirely the equivalent, we could think of the law as functioning in a similar manner – there are punishments to those who act outside of what is determined to be right or wrong.[3]

Hence we see two major factors in Hippocrates’ understanding of morality based in his polytheism.  Firstly, it provided for a foundation to morality that was beyond human opinion because the gods determined what was right or wrong, and hence it was something that everyone would be subject to. Secondly, these gods would then have the ability to judge those who acted in a manner inconsistent with that morality, so there were actual consequences to acting outside of this morality.

Regardless of whether you believe in a plurality of gods or not, it becomes apparent that such a belief had significant impact on what you believed was right or wrong and whether or not you lived consistently with that.  Some make this the distinction between ethics and morality, the latter being the practical branch of the former.  This distinction is helpful insofar as it is recognized that simply holding a belief of what is right or wrong does not guarantee actions consistent with that belief.  In other words, being a formal ethicist does not necessarily correlate with a moral lifestyle.

For those interested, however, it is worth noting that etymologically the two words derive from words conveying the same ideas in different languages.  ‘Morals’ comes from the Latin term moralis while ‘ethics’ derives from the Greek equivalent ethikos, both of which were drawn from root terms referring to manners and customs.  The former was translated from the latter by Cicero.  Hence our current distinction is more of an ideological development than it is a definite, literal one.

Random trivia aside, we see that we have begun to see the worldview of Hippocrates and how it informs how the oath is written.  We have also begun to consider our own worldviews and concerns raised against them.  Next time we will continue with Hippocrates’ framework and the significance behind the very idea of an oath.

[1] This is a wide topic, but one final note is worthwhile.  A difficulty of purely evolutionary morality is its implications on the deliberation process itself.  Thoughts would be accidental products themselves, and we would be using these accidents to make sense of the world of accidents.  As C.S. Lewis says, “I see no reason for believing that one accident should be able to give me a correct account of all the other accidents. It’s like expecting that the accidental shape taken by the splash when you upset a milk jug should give you a correct account of how the jug was made and why it was upset.”

[2] From an abridged version of Religious Affections in 1984, edited by Dr. James Houston.

[3] This assumes the law addresses every moral conundrum and is itself moral.  It is not uncommon, however, that the laws of a land actually appeal to the divine as the standard by which practical laws are then made.

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Across the horizon

Posted on 02 January 2015 by Jimmy Yan (Meds 2015)

So here we are, final year of medical school. Winding up (or to those lucky ones, already finished) electives, CaRMS applications submitted, and now just waiting for those interview offers to roll in. And according to Love Inc, because we’re all super stars, we should expect a bunch of interviews. This all means a lot of traveling, and because Canada is really big, that means a lot of flying.

Flying can be exhilarating, liberating, and luxurious all at once.

Okay maybe not this luxurious. At least in Canada

But it can also be highly rushed, stressful, and exhausting.

Okay so probably not this stressful either

Add in jam packed days full of interviews and the schedule gets even more harried. However, a few small adjustments here and there can help make this peripatetic existence as smooth as possible.

Below are some of those life hacks tips.

  1. Check-in ahead of time – It’s a basic tip, but needs to be said. Check-in starts at 24 hours before the flight, and you should do it. Why? Well it not only saves you time getting through the airport but gives you better options to choose seating.
  2. Go carry on – With both Air Canada and West Jet sneaking in the baggage fees this year it’s probably best to leave the big suitcase at home and start focusing on portability. Sure, $25 doesn’t seem too much, but as the interview tour continues that can start adding up. Plus there’s always the added time you have to arrive to the airport ahead of time, additional line to check the baggage in, and the extra time to wait around for the conveyor belt at the end. You do want to be able to hit up the socials after all. Not to mention there’s always that small but nightmarish risk of your suitcase not making the flight with you. Going with the carry-on saves time, money, and creates fewer items to keep track of, which can help ease some of the stress as we navigate through airports, shuttles, cabs, buses, and other unfamiliar areas.
  3. Efficient packing – Yes, again a pretty common sense tip (I’m not a certified professional life coach so I, unfortunately, can’t call them LifeProTips) but because we’re traveling for interviews, we have to bring formal suits/pantsuits, coats, shoes, which create necessary bulk to our luggage. Of course, knowing this, there are still a few things that we can do that channels our inner George Clooney.
    • Pick versatile items: neutral colours, multipurpose accessories, a lot of black items (jeans, t-shirts, blazers), a good set of multifunction shoes and your formal shoes, and underwear that can be hand washed and quick dried overnight (Tilly’s, Ex-Officio, Uniqlo, MEC all have these options). The internet has tons of lists to offer packing suggestions, even apps to help you minimize. Make use of them.
    • Wear the bulk: don’t pack your bulky boots, puffy parka, or dense denims (yeah that last one was a stretch). Wear the heaviest items, and make the most of the space for the lighter gear.

      You could also wear ALL your lighter stuff and pack your bulkier gear

    • Roll, don’t fold. Not only does this reduce the wrinkles in your clothes, but also has been scientifically proven (I think) to reduce the amount of space you need for your clothes.
  4. Tame the security line up: The lines in the airport are Christopher Wallace Notorious, and the worst of them is the line to security. A few things can help speed up this process.
    • Find a friend with status, they can get you through the faster ‘Priority’ line as one of their guests. Since a lot of medical students list traveling as one of their big interests, it won’t be too hard to bump into someone. Maybe it’s you!
    • If you do get stuck in line, use that extra time like Batman and prep! Empty your pockets for loose items/wallets/keys into your carry-on, get the belt and watch off, and have the boarding pass ready in hand. You’re only fighting yourself if you wait all the way to the front of the line and then have to empty and unbuckle then.
    • Nail the order of putting things onto the security conveyor belt. Personally, I find this one the most useful: belt & shoes, coat/jacket & personal bag, laptop, and carry-on luggage. I like it because when the items come back out of the scanner, it’s staggered in the right order. I can throw on my shoes and belt, then grab or put on my jacket, I have my laptop bag ready for my laptop when it emerges, and then finally grab the rest of my items and get going.
  5. Bring along a small pack of moist facial wipes

    Because moisture is the essence of beauty…or something.

    Okay to start off, hate the word “moist”, but in this context, it’s acceptable. Desposable moist (shudders) towelettes or make up wipes are great for a quick cleanse after a lengthy flight. After a long day of interviews, cabs, to running through an airport and then cramped in a pressurized cabin of recycled air, these wipes are an amazingly effective way of quickly getting rid of that grimy sensation and feel refreshed.

  6. Keep things fresh – The interview period is a long time on the road, upwards of 3 weeks. That’s a lot of time for things to be cramped into your luggage. Fend off the ripeness by packing some Ziploc bags to hide away dirty garments, splurging on the odd laundry service day, and packing a couple dryer sheets into your luggage will help keep things smelling like spring.

    If you don’t have dryer sheets, a sprig of sage will work in a pinch.

  7. Pack a small power bar in your kit (provided you have the space for it) and never worry about having your devices lose charge during your expedition. You’ll also become a legend among your fellow passengers at the gate and it’s a great way to break the ice to make new friends.
  8. If you are wary of becoming lost in an unfamiliar city and have a limited data plan on your phone, you can look up the area ahead of time on Google Maps and then save it for offline use by saying or typing “OK Maps” (“okay” doesn’t seem to work) in the search bar once you’ve pulled up a region you like. This will cache in a full version of the map (allowing you to zoom in for greater detail) and your phone’s compass would be working all the time even without data for a GPS connection.
  9. If some of the flights happen later in the night or you’re hoping to get some rest while on your flight, download a white noise app to help sleep and drown out noisy neighbours.

What are your favorite travel tips? Feel free to add them in the comments below.

-Special thanks to Tammy Wong, a consultant for Deloitte, for the help in accumulating, curating, and paring down these tips. For more on reflections of the life as a traveling consultant, check out her blog here: http://tyw2010lifestyle.wordpress.com/ 

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