Issue 8 • Winter 2018 by The Muse

ISSUE 8

Â·

WINTER 2018

Table of Contents From the Editors

Creative Arts Mental Health Program

3 Wishes: Delivering End-of-Life Care

Arts Health Antigonish AHA!

Bandaid Solutions

How Does it End | On Illness and Craft

Murmurs

Zines as Curriculum, Method and Activism

An Interview with Dr. Sarah Fraser

It's Not About Me

Dichotomy of Death

Staff

From The Editors

FROM THE EDITORS ve accessibility and convenience for our audiences. We also wanted to put faces to the names of our members who work tirelessly in order to achieve the The Muse's shared vision, and give them an opportunity to tell their stories too.

We are excited to present to you the eighth issue of

Last but not least, perhaps the most evident change is this very magazine that you are reading right now. With the new year, our creative vision of The Muse saw with it a shifting change to cater to an ever-evolving audience as well. Our new featured logo was selected after holding a campus-wide logo design competition and we are ecstatic to showcase our winner, Amy Zhu's design.

The Muse and the milestone that it carries with it -a year since the first issue we published in our roles as the Editors-in-Chief. We have been blessed to have gained so many novel experiences that have surely left their mark on our personal journeys of growth and refinement. Yet, this season of growth is not just limited to ourselves; this year marks many new beginnings for The Muse and we are delighted to be able to share them with you.

However, this is not to say that The Muse is straying from its original vision. We continue to advocate for the illumination of stories in healthcare and the use of interdisciplinary mediums to share these hidden voices. Despite the different artistic directions that The Muse may take, what will remain constant is this space for the voices of those who strive to remind those around us of the humanity in medicine that is so often forgotten.

Just this past summer, we had the honour of presenting at the national medical humanities conference, Creating Spaces VIII, in Halifax, Nova Scotia. At this conference, we networked with a variety of like-minded healthcare organizations and professionals -some of whom we have featured in this issue. Although, the most significant aspect of this issue is that it marks our very first international submission from the United States. With our ever-expanding repertoire of writers, The Muse will be better able to capture wider ranges of diverse perspectives, fulfilling its goal of being a platform accessible to all.

Through all of these milestones, we would like to thank our faculty advisor, Dr. Amster, for her guidance and support. We also would like to thank all of the members of The Muse, for being the solid foundation that holds this initiative up. And as always, we thank you, reader, for being here and stopping by our medical humanities home. Sincerely,

In addition, we have officially launched our new website, where we combine every aspect of The Muse -from its Nikki Wong and Katherine Kim blog, magazine, events, and more- in an effort to impro

The Muse Âˇ Winter 2018

Creative Arts Mental Health Program Authors

Feny Pandya, Olivia Mendoza, Annemarie Antunes, Melissa Yang Art by Alice Lu

ver the years, mental health and wellbeing have consistently been understated, looked down upon, and stigmatized in Canada. However, it only took one voice to inspire change. A McMaster Bachelor of Health Sciences graduate and UofT Medical student Muskaan Sachdeva has begun to pave the way towards creating a supportive and nonjudgmental society for individuals struggling with their mental health. The Creative Arts Mental Health Program (CAMHP) is on its way to becoming an incredible reality in Canada. During an elaborate discussion with the founder, Muskaan Sachdeva; the VP Administration, Yilin Zhang; and the VP Project Development, Ananya Pathak, we learned that this national program aims to provide creative learning opportunities for children and youth by introducing varied mediums of art. Youth benefit greatly with this platform, as they establish strong foundations of healthy coping skills from an early age. Muskaan believes that, "Everyone possesses a creative ability that re-

mains unique to them." Building off of this insightful idea, CAMHP hopes to allow young adults and children to explore themselves and use the novel mechanisms they learn to face challenges in a manner that is safe and protective of their mental health.

â&#x20AC;&#x153;Everyone possesses a creative ability that remains unique to them.â&#x20AC;? Without inspiration, no vision turns into a beautiful reality. Likewise, CAMHP was founded in response to the several stressful obstacles Muskaan faced throughout her life. According to her experiences, she realized that "taking the time to express [her] thoughts in a diary and releasing [her] pent-up emotions through yoga allowed [her] to relax and face these challenges in a mature manner." To move this idea forward, Muskaan introduced CAMHP to Yilin, a McMaster graduate and UBC medical student, who also believed in the perspective and goals of CAMHP. He knew right away "that it was an amazing initiative," and that CAMHP has "the goal of introducing others to the benefits

that [the] creative arts bring." The long-term mission of CAMHP was created to garner international recognition and involve the inclusion and collaboration of people from all ages and cultures. Yet, like all ventures, CAMHP is taking baby steps towards its goal by beginning its journey through the involvement and recognition of local communities. "We hope CAMHP will touch and leave its imprints in all Canadian provinces," said Muskaan. "We will not check off our "goal accomplished" section until every individual has had the opportunity to explore different creative arts through local workshops and events held by CAMHP." These workshops will directly conduct activities pertaining to a specific creative art, coupled with conversations concerning mental health. CAMHP also plans to host events and sessions where guest speakers are able to share their personal experiences and influences on these topics. Through these events and workshops, CAMHP plans to create a model that schools can follow to enhance the mental wellbeing of their students. It is essential

Creative Arts Mental Health Program

that students recognize the importance of their mental health, especially in cultures where academic standards are set high. "We wish to establish a strong presence within our communities to encourage active participation in creative arts," said Yilin. Likewise, Ananya hopes to start a mentorship program or a helpline that "gives those in need one-onone attention but with a creative twist!" Additionally, Muskaan is very excited to feature a magazine showcasing the artistic skills of all active executive members, as well as those impacted by CAMHP. The term 'creative arts' can lead to various interpretations and it is this openness that allows individuals to design their own creative paths. Music, visual arts, and dance are only a few mediums through which one can explore the creative arts. Every individual has the freedom to explore as many mediums as they want, and in doing so, are able to release negative emotions in a healthy manner. Muskaan finds that writing, Zumba, and yoga are her mediums of choice. "[They] provide me with the capacity to make rational decisions in emotionally charged and stressful situations," Muskaan explained. "With every word, every Zumba move, and every yoga posture, a little bit of my stress dissipates every day."

â&#x20AC;&#x153;With every word, every Zumba move, and every yoga posture, a little but of my stress dissipates every day.â&#x20AC;? Yilin also advocates for the creative arts and cites how his experiences with music have left a positive mark on his mental wellbeing. "Creative arts, especially music and guitar playing, helped me overcome and cope with many challenges over the years," he told us. "Regardless of what life threw at me, I always depended on music." Likewise, Ananya uses mediums such as songwriting and singing as healthy creative outlets to release her emotions and express her thoughts. "The imagination of the creative mind is powerful beyond measure," she said. "[The] creatives arts are unique to every person, and can help you tackle any problem by thinking outside the box." Abundant funding and hours of research have been invested in deepening society's understanding of mental health, as well as factors that may harm it. Despite these significant advances, many aspects of mental health remain a mystery. It is well-established, however, that the mental wellness of children and youth in particular can be vulnerable due to bio-

logical changes associated with puberty, as well as stressful life events that may accompany adolescence. Creative arts can serve as a valuable tool to cope with these stressors. The stories of Muskaan, Yilin, and Ananya demonstrate just a fraction of the strength of the creative arts. Many prominent celebrities and local artists have cited creative arts as integral parts of their lives; for some, creative arts even saved their lives. Thus, by providing opportunities to explore the arts, children and youth may discover unknown potential in themselves while learning to use art as a healthy coping mechanism. It is inevitable that people will face obstacles in life that may seem daunting or even devastating. However, CAMHP hopes that by sharing the power of the creative arts with youth around the world, engagement in the arts may act as a source of strength to overcome these difficulties. Creativity and its impacts are limitless and powerful beyond measure. The only restriction is a lack of accessibility, but through CAMHP, youth across Canada will soon be given an invaluable key to a door of opportunities. Creative Arts Mental Health Creative Arts Mental Health Program 5 The Muse Âˇ Winter 2018

5 About the Authors: Feny Pandya is a second-year student in the Honours BioPsych program at McMaster University. She has experienced the benefits of the creative arts from her involvement with singing, dancing, writing, and playing the keyboard. Through CAMHP, Feny hopes to encourage others to value and be cognizant of their mental health and well-being. Olivia Mendoza is a second-year student in the Health Sciences program at McMaster University. Her main interests lie in mental health and its social determinants. Through CAMHP, she hopes to level the playing field for marginalized youth across Canada. When she isnâ&#x20AC;&#x2122;t studying, she is most likely swimming or sleeping!

Melissa Yang is a third year student in the Life Sciences program at McMaster University. Following her passions for mental health, she is minoring in Mental Health and Addiction and wants to pursue a career researching psychopathology. Through CAMHP, Melissa hopes to bring more awareness to the importance of taking care of your mental wellbeing.

Annemarie Antunes is a second-year Honors Biology student at McMaster University. She is passionate in learning about the brain and its diseases. Through CAMHP, Annemarie hopes to advocate for mental health wellness, as well as inform the community on mental illness.

Delivering End of Life Care: An Interview with the 3 Wishes Team

Delivering End-of-Life Care: An Interview with the 3 Wishes Team Interview with Deborah Cooke, France Clarke, Neala Feli, and Alyson Takaoka Art by Jordan Chin

3 Wishes is a project that focuses on patients receiving advanced life support in the intensive care unit (ICU). End-of-life care in this setting can be impersonal for everyone -for patients, for families, and for clinicians. It can be difficult for healthcare workers to create a hospital environment that is less alien to patients and to provide comfort for family members visiting their loved ones. The 3 Wishes initiative aims to overcome these challenges. By carrying out at least three final wishes for patients in palliative care, the 3 Wishes Project was designed to celebrate lives and support those left behind in grief.

About the 3 Wishes Team: Dr. Cook is a Professor of Medicine, Clinical Epidemiology & Biostatistics at McMaster and has been practicing critical care medicine as an intensivist for 30 years at St. Joseph's Healthcare. She has been recognized for her accomplishments in research, education, and mentoring with many local, national, and international awards. Her academic interests are in preventing complications of critical illness, life support technology, and ethics. She has a longstanding interest in compassionate care and founded the 3 Wishes Program.

Ms. Clarke is a Respiratory Therapist and has been practicing at St. Joseph's Healthcare for 22 years. She has been working with Dr. Cook in critical care research for 17 years, coordinating multiple clinical trials. France has been involved with 3 Wishes since 2013 and now coordinates the 3 Wishes Project in many centers. Ms. Clarke looks forward to helping other clinicians take the spirit of 3 Wishes back to their own setting.

The Muse Âˇ Winter 2018

What did 3 Wishes look like when putting familial and financial afthe project first began? fairs in order; musical and prayer rituals; and traditional practices in In January 2013, Dr. Cook in- the ICU such as turning off alarms troduced the 3 Wishes Demon- on the monitor and liberalizing stration Project in our ICU at visiting times. St. Joseph's Healthcare as a pilot research project to improve the â&#x20AC;&#x153;Once something quality of the dying experience extraordinary like this for our patients and their famiis in the making, donâ&#x20AC;&#x2122;t lies. The project was envisioned ever let it go.â&#x20AC;? after viewing the movie 'Bucket List, where two terminally ill men were able to find peace with their The wishes quickly expanded, and impending deaths by pursuing several other categories emerged. experiences of profound signif- Examples include connections icance. The notion that humans such as pet visitations and finding search for meaning and closure in estranged family members, as well the anticipation of death inspired as environmental enhancements Dr. Cook to pursue this research such as flameless candles and soft project. blankets. Dr. Cook and her team proposed the 3 Wishes Demonstration Project with the purpose of fulfilling a set of three requests. These requests are not limited to those of the patient. They could also come from family members, and sometimes clinicians, in the hopes of bringing contentment to the final days or hours of a patient's life and easing the grieving process. This individualized approach to endof-life care acknowledged that the dying person and their family members were uniquely human. The project team initially reflected on interventions that they had observed or engaged in with patients and families at the end-oflife, including saying goodbyes;

terview 90 caregiving ICU clinicians. We aimed to uncover the common wishes of patients and families and to understand the experience of end-of-life care clinicians. We believed that this step would provide enough experience to decide whether to continue the project. It would also help us determine how we could achieve the overarching goal of improving the quality of the dying experience for patients and their families. Have there been any significant barriers in expanding 3 Wishes either within the hospital you work or in aiding others to start similar projects elsewhere?

What sparked that decision to be- Once we started 3 Wishes, it begin collecting data and creating came impossible to stop. Family publications on 3 Wishes? members encouraged us to keep going. One of them said to us, Compassionate, inexpensive, and "Once something extraordinary generalizable healthcare practic- like this is in the making, don't es focusing on the dying process ever let it go." Clinicians told us have been remarkably limited. that the project reminded them While many interventions have of why they pursued a career in been developed to prevent or de- healthcare. lay death, far fewer interventions have been developed to ease the Over the past five and a half years, transition from life to death. The the 3 Wishes Project has transi3 Wishes Demonstration Project tioned into an ICU end-of-life iniwas developed to fill that void. tiative, facilitated by patient-family engagement, research and Collecting data and writing pub- clinical team collaboration, frontlications built the foundation for line staff leadership, and communext steps and future work. The nity donations. goal was to enroll 30 ICU patients and their family members and in-

Delivering End of Life Care: An Interview with the 3 Wishes Team

The publications generated by Dr. Cook and the 3 Wishes Project team have sparked interest among clinicians and media all over the world. Many people have reached out to start the 3 Wishes Project in their own settings as a clinical program, assisted by our team members: Project Coordinator France Clarke, Chaplain Feli Toledo, Bedside Nurse Neala Hoad, and Masters of Science Student Alyson Takaoka.

The wishes that have the largest impact are usually individualized. They are not extravagant, but rather a simple expression of desire, need, or hope that is intimately personal. These wishes are very inexpensive. Across thousands of wishes, the average cost of a wish is less than $3.00. As the project unfolded, the types of wishes diversified further, from early birthday celebrations to final toasts in the patient's room.

â&#x20AC;&#x153;A wish is a vehicle that gives a voice to patients.â&#x20AC;?

A wish is a vehicle that gives a voice to patients. Soliciting wishes is a way to allow patients and families to express what matters most, as opposed to waiting for them to approach healthcare providers with such desires. For family members, a wish provides an opportunity to become involved in their loved one's care and create meaning at the end of the patient's life. For clinicians, a wish is a tangible way to honour a dying patient and connect with the patient and their family.

In addition, there is now another research component in collaboration with several other research colleagues. The Multicenter 3 Wishes Project is ongoing to demonstrate the feasibility and transferability of the project from hospital to hospital across ICUs in Toronto, Vancouver, Niagara, and UCLA. Dr. Cook's team has confirmed the sustainability of this project in their own ICU. They have developed efficiencies and created start up manuals as well as a step-by-step guide to help inform clinicians and provide them with the tools to begin their own 3 Wishes Project.

A Word Cloud is a special legacy wish that has had a powerful impact on families and staff. They were initially created by the 3 Wishes team as a way of honouring the patient and as a gift to the family. The 3 Wishes team invites families and friends to Are there any particular types of come up with words that describe wishes that you have seen to have their loved one. This process frethe biggest impact for patients quently reminds families of funand/or their families? ny moments. Generating words

for the Word Cloud allows them to remember, share stories, and honour their loved one. It forges connections among family members, clinicians, and team members by reflecting on relationships and life journeys. These stories are the heart of the Word Cloud, illuminating the concept of 'patient-as-person, and humanizing patients for everyone involved. What are your aspirations for 3 Wishes in the future? We hope that the efforts associated with enhanced end-of-life care will become encoded into practice -not as a formal research enterprise, and not necessarily in the precise format of the 3 Wishes Project, but with respect to the spirit of the initiative. To know someone simply by their medical condition or their social determinants of health is not enough. We need to change the lens of the camera and look at our patients as individuals. This perspective encompasses an understanding of who they are and what is important to them. Here, we practice 'hospitality of the heart' with patients and families. This is important throughout the lifespan of the patient and within the healthcare system, but especially so at the end of life.

The Muse Âˇ Winter 2018

Arts Health Antigonish â&#x20AC;&#x201C; AHA! H

By Janette Fecteau

ealth practitioners and researchers worldwide know that health and wellbeing are strengthened by participation in creative activities. More than recreation, art forms like singing, storytelling, dance, and painting can increase self-esteem, foster meaningful relationships, and reduce anxiety and depression. In a small town in Nova Scotia, this strategy is being put into action in ways munities and individuals for that are abundant, flourishing, whom art may be less accessible, and bordering on magical. including youth, seniors, and those in the hospital. The orgaAntigonish is a town of 4300 peo- nization has also reached artists, ple in northeastern Nova Scotia, family members, and caregivers. and is home to St. Francis Xavier University and St. Martha's Re- AHA! believes that the health of gional Hospital. It is a cultural and the community and its individual economic hub for the surrounding members are inextricably linked. rural county (the combined town Referencing the four pillars of susand rural population is 19,000 tainable communities, co-founder people). Arts Health Antigonish, Liz Brennan noted that, AHA! known as AHA!, is a partnership marries the cultural pillar (arts/ between people working in arts, creativity) with the social pillar health, and education. The group (health), while also respecting the began in early 2013 to foster cre- economic pillar (paying artist faative expression for community cilitators) and the environmental health through arts-health pro- pillar (being cognizant of our engramming.1 vironmental footprint).2 Since then, AHA! has designed numerous programs using visual, literary, and performing arts to promote wellbeing for com-

Numerous AHA! programs focus on individual wellbeing as it contributes to a healthy community. Vanessa Currie, an arts-health re-

searcher, wrote: "These facilitated, interactive, arts-based sessions take participants on a journey of self-discovery and creation." Health benefits from AHA! stem from increased self-discovery, confidence, engagement of the imagination, social inclusion, relationship-building, and laughter participants experience in the programs.3

â&#x20AC;&#x153;We wanted to find a way to inspire empathy and decrease bullying and substance abuse in youth.â&#x20AC;? AHA! leadership team member and writer Anne Simpson explained, "Thundertales (2013) was our first program. We wanted to find a way to inspire empathy and decrease bullying and substance abuse in youth." 4 The program

Arts Health Antigonish - AHA!

encouraged youth with mental wellbeing and other health challenges to express themselves through storytelling. Various media were used, and by telling their own stories, young participants strengthened their resilience, empathy, and confidence. For example, a songwriting project helped young women discover musical self-expression while developing stronger peer relationships and healthy wellness strategies. AHA! has also brought musicians into local schools to alleviate stress and assist with learning. A digital storytelling program created by Simpson asked teens to describe an imaginary place in full detail, and then to move through the space and 'create' it as they went. She reported that the results were startling, magical, and vivid, with the teens fully engaging their imaginations in ways that were personal to themselves; all without the intervention of screens or bland storylines.5 Arts Canopy is a program for small groups comprised mostly of seniors living with dementia. It offers 10-week sessions in painting, pottery, poetry, storytelling, creative movement, music, and improv. Rather than focusing on what has been lost through disease, Arts Canopy helps participants thrive by engaging and celebrating strengths still present within them: creativity, wisdom,

humour, and sociability. Artist-facilitators can also help the participants work through difficult issues in their lives. For example, one participant received help with processing the recent death of her father through writing a poem.

long-term care is a key goal for AHA!. "It's worth a million dollars," enthuses one participant of the Arts Canopy improv group. "You use your own creativity, you bounce ideas off one another, everyone works together, and it's hilarious. It gets your mind off In addition, participants gain a your troubles, because you are too sense of contribution to society: busy laughing.6 a collage of participant paintings was unveiled at a public ceremony Art Care at St. Martha's Regional with the local Member of Parlia- Hospital enables patients to enment present; the poetry-writ- gage in visual and musical arts so ing group was gratified to have that their health, well-being, and their collaborative poem read at recovery become enhanced. The an International Women's Day program was so successful that event; and the storytelling group permanent positions for music was keen to have their stories and art therapy were created; Hospublished in a book. Participants pital staff spoke of AHA! artists as emotional memory of the posi- colleagues and allies in helping tivity engendered in these groups support their patients, particularkeeps them coming back. To illus- ly [for] those they found difficult trate, [staff] at the seniors homes to reach.3 Rachel Power, who dereport that the good feelings cre- livers the Art Care program, said ated in the groups linger for hours that although the hospital can be and days afterwards.3 Improving an emotional, challenging place to living environments for those in

The Muse Âˇ Winter 2018

work, she values the people [she gets] to work with, creating art with patients and their loved ones to make their in-hospital stay better, and using art as a means of healing.7 Power also works with an outpatient cancer survivor group. One of their projects involved writing messages of hope or love on colourful pieces of paper, which were then folded into paper cranes. Power strung the cranes together to form a public, outdoor art installation. The whole process was healing and even transformative for participants, as it was an act of letting go of pain and anxiety. 7

tion resulted in 1784: (Un)Settling Antigonish, a popular theatre production about the first permanent European settlement in Antigonish county. The script was collectively developed in the spirit of truth and reconciliation by actors from the local Mi’kmaq nation and Acadian, Irish, Scottish, and African Nova Scotian communities. In their own words, they challenged the Eurocentric record of settlement. Another project, Imagine Antigonish, restores heritage photos gleaned from family albums, and reflects the cultural diversity of the area. Nova Scotia exists on unceded Mi’kmaq territory, with Peace and Friendship “Our community is treaties signed in 1725, 1752, and only as healthy as our 1760-61. Dorothy Lander, co-organizer of various AHA! comleast healthy munity-health projects, stressed members.” the importance of decolonizing In the words of Liz Brennan, “Our themes in community work, and community is only as healthy noted how participants connect as our least healthy members.8 across diverse cultural groups.9 AHA!’s programs for individuals contribute to a healthy commu- AHA!’s most recent program, The nity, while its various communi- Shoe Project, interweaves indity-health projects integrate health vidual and community wellbeing. promotion for individuals. The It is a collaboration with the local Eldertree musical theatre perfor- theatre, an adult learning orgamances in 2014 were the culmi- nization, and an initiative of the nation of a months-long project same name started by novelist pairing local musicians, actors, Katherine Govier in Toronto. For and writers with seniors to gather AHA!, a small group of immigrant stories. A 2015 partnership with women meet with an artist-facilithe Antigonish Heritage Associa- tator to write their stories of com-

ing to Canada. They use shoes worn on their journeys as inspiration. These women will share their stories with the Antigonish community in two theatre performances in February 2019. “The depth and breadth of AHA! is part of what makes it special for me,” writes Simpson. “It’s a community-based organization, with good people doing arts work at all levels in the community, and with so many groups of people.5 Funding for AHA! comes through community donations and project grants, but the people-energy that makes AHA!’s programs successful is fueled by compassion, belief in the power of the arts for healing, and by the arts themselves. The inspiring creations of hundreds of participants will spur on the work of AHA! in northeast Nova Scotia for years to come. References:

About Arts Health Antigonish (AHA!) Available from: https://www.artshealthantigonish.org/ [Accessed 2018 Nov 18]. Brennan, E. AHA! question [online]. E-mail to Janette Fecteau (jfecteau@stfx.ca) 2018 Oct 25 [cited 2018 Oct 26]. Currie V, Fox A, Brennan E, Clement C. Exploring arts-based programming in health & wellbeing. Available from: https://www.artshealthantigonish.org/wp-content/ uploads/2017/11/Exploring-Arts-based-Programming-in-Health-Wellbeing-AHA-Report.pdf [Accessed 2018 Nov 19]. Simpson, A. AHA! question [online]. E-mail to Janette Fecteau (jfecteau@stfx.ca) 2018 Oct 1 [cited 2018 Oct 26]. Simpson, A. AHA!. Handwritten note to Janette Fecteau 2018 May 1. Anonymous. Oral communication with Janette Fecteau 2018 Oct 27. Power, R. AHA!. Handwritten note to Janette Fecteau 2018 May 1. Brennan, E. AHA! [online]. E-mail to Janette Fecteau (jfecteau@stfx.ca) 2018 Oct 3 [cited 2018 Oct 26]. Lander, D. AHA!. Handwritten note to Janette Fecteau 2018 May 1.

See also:

https://artshealthnetwork.ca/ Cox SM, Lafrenière D, Brett-MacLean P, Collie K, Cooley N, Dunbrack J, et al. Tipping the iceberg? The state of arts and health in Canada. Arts & Health. 2010 Sep 1;2(2):109–24. Available from: doi: 10.1080/17533015.2010.481291. http://www.imagineantigonish.ca/ http://www.theshoeproject.online/ https://www.facebook.com/AntigonishHeritageWalks/

About the Author Janette Fecteau, MFA, is a writer, visual artist, and university art teacher from Antigonish, Nova Scotia. Her essays have been published in Our Times and Visual Arts News, and her poetry has appeared in various literary journals.

Arts Health Antigonish - AHA!

Cold Autumn Day The roof is falling. Needs fixing. The bushes are crisp orange. But the barn needs painting. No farm animals. The loft, open for hay, cold autumn day. Makes me nostalgic. Cold autumn day. The roof is falling. ~Poem by Arts Canopy participant

Excerpt from Hodge-podge Valentine to Life You are an afternoon of cooking, time spent quilting. You are old time music, Don Messer and the Islanders. A busy Saturday at the Market, selling oatcakes, bread, and pie. You are a chocolate chip cookie fresh from the oven. You are early evening, a new moon. You are wild strawberries, and green grass. You are fresh bread, and you are mac and cheese. You are a good talk with friends, the best laugh ever. ~The Ladies of the Briar Patch (participants of Arts Canopy) Arts Health Antigonish -AHA!

The Muse Âˇ Winter 2018

BANDAID

SOLUTIONS Poem by Sophie Zarb Art by Grace Huang

Bandaid Solutions

eyes glassed over the hum of the train masks any whimper bruising shields the eyes from the world around her reminders that her transition is almost complete into who she needs to be for him standing, towering over her he smiles and calls her beautiful her tears get caught in her gauze eyes glare at her as if looking into her soul why would she do this pain is beauty, they say she looks out the window into the darkness the tunnel ends she smiles and tears off the bandage the doors open as if they knew she was there royal, regal the world bows down to her still bruised, but no longer hidden finally

About the Author Sophie Zarb is a first year student in the Bachelor of Health Sciences Program with a passion for both creative and scientific writing. She is currently a MeduCollab mentee for the McMaster Health Sciences Journal, the Meducator, and loves to write short stories in her free time.

The Muse Âˇ Winter 2018

HOW DOES IT END? | ON ILLNESS AND CRAFT Poem by Hannah Baggott Art by Peri Ren

+END | A termination of a state or situation.

Diagnosis is a word that lives both as a beginning and an end. Poems live in-between, too. Does the poem launch into unexplored caverns? Or does it give an answer? Is it a tidy place to lay down plaguing questions? Beginnings and endings are not mutually exclusive. In each, there is always a termination of something, an exhale into fullness or blankness —in blinding light and dark, all at once. END | Death or ruin. Multiple Sclerosis is not, by definition, fatal. There is no cure, but it is chronic —unending. The rhetoric of hope: this will not affect your longevity. You will live just as long as everyone else. 80% of patients will experience disease progression to disability. So, death is not built into its prognosis. The good news is: you will live. The bad news is: you will live, ruined. There will be no end to your body’s implosion —there are invisible fires and nerve depletion. The first time you don’t know how you could’ve possibly lost your grip on the chopsticks. Your knees give out on the stairs again. The scars on your brain —creating pains. The ghosts on your pupils. The knots in

How Does it End? I On Illness and Craft

your speech —sticky stutters, simmering. But you will not die from these things. Write poems about them instead. I want to ask: isn’t ruin worse than dying? But we don’t have statistics for preferences between the living and the dead. The latter never respond to the questionnaires, so the data is skewed. END | A goal or result that one seeks to achieve. The goal is to find the language for this body. The intended result is for you to ask: am I making this up? How is the body capable of such self-destruction? These are my questions too. The poems try to swear the truth —to whisper: look, see? But the answers are not my goals. END | The furthest or most extreme part or point of something. Rate your pain on a scale from 1 to 10. If you say 10, they’ll think you’re lying. Bodies in that much distress shut down. The end of the scale is so far away; you shouldn’t be able to reach it. It lives arbitrarily —unknowable. END | In biblical use, an ultimate state or condition. Mark the perfect man, and behold the upright: for the end of that man is peace. - Psalm 37:37 But there is no peace for the poem or the imperfect body that constructed it. The antonym of peace is war. The soldiers of the blood declare it on the dendrites. Poems sing the declaration, structure the battles. The end of the poet and the poem is war, unwon. END | Limit; bounds. To reach a point and go no further. I can’t tell you everything. There are limits to language. There are limits to empathy. I used to write viscerally, cyclically. I liked that space —you cannot get too close. Now, my narratives try to let you in —try to show you those little moments of darkness, of living close to the cliff’s edge. But still, there is only so much I can write. I will reach a point and go no further with my attempt to explain. You will reach a point and be unable to go further in your empathy. END | A place that is linked to another by a telephone call, letter, or journey.

The Muse · Winter 2018

My poems often end in the voice of another —in a place outside of the body. What did you say, again? What does the Bible say, again? What did you whisper while I slept? Let me write it down. Let me follow that telephone wire, that long road, to the song in your mouth. END | The part or share of an activity with which someone is concerned. My husband’s end of the deal: live in my poems —sometimes like a column and sometimes like a whisper. Ground me —give me someone to talk to about all of this body, all of this fear and joy. Because inventing you is too close to talking to myself. My end of the deal? I will try not to write down everything he ever says or does, even though I want to. END | A small piece that is left after something has been used —remnant or fragment. It’s the “after something has been used” that bothers me. What has used up my body, my memory? Why are there so many words leftover? Poems are the small piece that is left, I suppose, however wholly formed. They are moments that bring the sunken boats to the surface, with planks bobbing in the waves of blood. END | Eventually reach or come to a specified place, state, or course of action. I wonder where my body will end up, where my poems will end up. It’s hard to keep both so close. They start to grow toward the surface, out of their dark roots in my body. END | The final part of something, especially a period of time, an activity, or a story. First, I imagine the story will never be over —that it will spend a great deal of time in the final part, without stopping completely. I will grow up and progress and shift and stay inside my body for a long time...taking inventory. Learning how to write down the sensations. Learning the language. But I also imagine the story will end abruptly —not in physical death, but in death of cognition. The lesions in the white matter —those bright spots of scarring— will turn black with lack. And I will stare at the blank page and think of nothing. I will doodle the same image of a branchless dendrite over and over. The words will all be trapped in the dark. This will be ruin. This will be death. This will be the end. About the Author: Hannah Baggott is a poet, Lecturer of English, and Literacy Commons Faculty Fellow at the Univer-

sity of North Carolina at Pembroke. She received her MFA in Creative Writing from Oregon State University; during her time there, she was honored with the Joyce Carol Oates Commencement Award in Poetry and the Lisa Ede Award for Excellence in Composition Instruction. Her work can be found in Calyx Journal, HOBART, The Intima: Journal of Narrative Medicine, [PANK], Tupelo Quarterly, and other journals via hannahbaggott.com. She is the recipient of the 2015 Marica & Jan Vilcek Prize for Poetry (judged by Major Jackson) through Bellevue Literary Review and has been nominated for Pushcart Prizes. Her poetic obsessions include medicine, the body, the American South, intimacy, and faith. She lives in Fayetteville, North Carolina with her husband, Max, and their cats, Nu and Martha. Find her on Instagram at @palindromepoet

Interview with Murmurs Magazine

Interview with MURMURS Magazine An interview with Mimi Deng and Kelsie Ou from Murmurs Magazine Art by Alicia Tran

outlet for both good and bad days, But the arts inhabit a special place capturing my development as an in my heart and I’m willing to artist and as a person. fight to hold onto them.

About Mimi Deng (MD)

About Kelsie Ou (KO)

What is Murmurs?

I’m a 2nd year medical student at the University of Ottawa and I completed my Bachelors of Health Science Degree at McMaster University, specializing in Biomedical Sciences & Biochemistry. Growing up, I recall spending many hours at the kitchen table with my sister, our hodgepodge of coloured pencils (the erasable ones were all the rage those days), and markers, enthralled in the process of bringing our narratives to life on paper. Throughout the years, visual arts continue to serve as an

Hi there! I’m a 2nd year medical student at the University of Ottawa. Since grade school, visual art and writing have both played a big role in my life outside of school as avenues for self-expression, stress-management, and creative exploration. However, it can sometimes be difficult for me to maintain these pursuits amidst the rush of schoolwork, electives, and extra-curriculars. It often requires a conscious effort on my part not to leave these valuable aspects of my identity behind to gather dust.

Murmurs is an arts and medicine magazine by medical students, for medical students. The publication showcases visual art, photography, poetry, and prose created by medical students across Canada and abroad, and allows student contributors to earn credits with their local Medicine & Humanities Program. Murmurs serves to nurture creativity alongside a career in medicine -the result is a powerful reminder that the arts have a unique and legitimate utility in medical education.

The Muse · Winter 2018

What do you enjoy most about your work in Murmurs? MD: The most rewarding part of the whole process is seeing the publication come together. From the moment you open the first hard copy of the magazine, you know youâ&#x20AC;&#x2122;re holding in your hands the solidarity of a community that shares your passion for the arts. Although you may never meet all the contributors, who reside all over Canada, you still know something profound about them through their work. The mileage becomes irrelevant. KO: I share a similar opinion as Mimi, in that the sense of community is definitely one of the most rewarding aspects of working on the Murmurs team. I used to pursue both writing and drawing mostly on my own, but more recently, I have come to appreciate the value in building communities. There is truly something incredible and deeplystill know something profound about them What is the importance of art in through their work. The mileage Medicine? becomes irrelevant. MD: Where to begin. The psychosocial and physiological beneâ&#x20AC;&#x153;Art is integral to the fits of artistic engagement are behealing process and ing increasingly recognized. The creative arts has been shown to the practice of decrease anxiety, pain, and heart rate; it's also a tool to conceptumedicine.â&#x20AC;? alize distress, make meaning of experiences, and reconcile uncer-

tainty. Artistic expression offers introspection, catharsis, and community; it's integral to the healing process and the practice of medicine, more than we give it credit for. KO: Mimi pretty much covered all the key points! I would only like to add that art is a unique vehicle through which individuals can explore the complexities of empathy, ethics, and the human con-

Interview with Murmurs Magazine

dition. In this way, an individual may more profoundly understand what it means to feel, to care. And isn't that one of the most important principles of medicine? Are there any particular experiences/instances that have impacted you or the way you view medicine/health and the arts? MD: Drawing from personal experience (pun intended), I keep a small sketchbook that I doodle in quite regularly. The sketches are rough, but making time in my day to draw something, whether it takes 10 or 40 minutes, reminds me of the importance of doing something for yourself and looking after your own wellbeing. Not every piece has to be a magnus opus or even planned; in fact, I find it's the pieces I create on a whim that give me the greatest satisfaction. KO: Given the therapeutic benefits of art, it might not be surprising that many patients turn to it for comfort and self-reflection; this is something that warms my heart every time I witness it. As well, I am constantly amazed at the resilience of so many patients as they fight their own battles every day, and I try to capture that inspiring strength in my art. How can we encourage more healthcare professions to inte-

grate their artistic interests into cial to emphasize the benefits of their work? pursuing artistic interests on one’s personal wellbeing! MD: Firstly, we should remove the dichotomy between arts and Where would you like to see Murscience. With age comes an em- murs in the future? phasis on developing a career and building a pragmatic skill set. MD: I would like to see greater What often happens is that artis- involvement from coast to coast. tic expression becomes defined as Currently, submissions are fairly child’s play and takes a back seat. localized to Ontario and Quebec, What we should recognize is that but I’m confident that there are healthcare is about dialogue and more medical students who are introspection, and that the arts interested in showcasing their arfacilitate these critical activities. tistic talents. Each individual is so One way to advocate for the re- different and every submission is lationship between art and med- a story, and I’m excited to expand icine is to provide opportunities our story book, so all medical for medical students and health- schools are represented. care practitioners to revisit their creative hobbies. KO: Ditto on the expansion point. With more contributions across “Now is a more the country, the argument for pertinent time than the value of arts in medicine will be significantly bolstered. From ever to be vocal a practical standpoint, that will hopefully mean more funding, about this more attention, and more avenues important to get our message out there. I believe that together, we can make relationship a strong statement in support of between art and the vital relationship between art and medicine —one that will reach medicine.” people everywhere. KO: Agreed. And I think now is a more pertinent time than ever to be more vocal about this important relationship between art and medicine. With the growing interest towards physician and medical student wellness, it is cru-

The Muse · Winter 2018

Witnessing Experience: Zines as curriculum, method, and activism within healthcare By Dr. Paula Cameron Art by Gracia Chen

Witnessing Experience: Zines as Curriculum, Method, and Activism Within Healthcare 22

process. When Packard's husband involuntarily incarcerated her, she turned to independent publishing to enact change. While incarcerated, a sympathetic nurse smuggled her a pencil, which Packard used to record horrific inmate stories. Once escaped, she independentI survey the site: all set. ly published pamphlets, and later books, on psychiatric inmates On a bright January day, the Loch- -and women's rights. aber Zine Archive was launched in a field adjacent to my rural Nova Elizabeth Ware Packard drew on Scotia home. Zines (pronounced lived testimonies to raise awarezeens) are small self-published ness and advocate for change via booklets on diverse topics. To self-publishing. The results? The share my zine collection with state laws that allowed her inpassersby, I converted a cabinet carceration were struck down. into a tiny zine archive. Readers of Two centuries later, the developall ages gradually trickled into the ment of the Xerox machine made space, leafing through the zines, self-publishing more accessible talking amongst themselves about than ever. In North America, this zines they might make. accessibility manifested in the rise boots crunch through crusty snow. A plow-cleared rectangle in the field looms large as I approach. Stepping onto a bench, I secure the banner to a post on either end.

The North American origins of the zine can be traced back to the independent printing press popularized by Benjamin Franklin in the eighteenth century. These technologies made publishing more attainable to everyday people, in stark contrast to the financial and religious elite's historical dominance over the written record. As mass printing spread, radically new voices and perspectives began to circulate in the public sphere. Elizabeth Ware Packard was one such voice. In nineteenth century Illinois, men were legally allowed to incarcerate their wives in mental asylums without due

of 1960s fan-created zines on science fiction and punk rock music, mostly by white, suburban youth. Zines experienced further growth in the 1990s with the convergence of the grunge, punk, feminist, and DIY (Do It Yourself) movements. The zine maker community has since grown to include mad, racialized, indigenous, and LGBTQ+ perspectives and content, and more.

Creating and reading zines is about seizing the word to change the world, offering up tangible forms of self-expression to participate, see, and live in it differently. This is largely made possible be-

cause of their open format. Zine creation does not require artistic skill beyond cutting and pasting; this aesthetic openness allows for a greater range of voices and styles. Often, for the first time a creator is expressing their own perspective, story, and/or exploring a topic important to them in their own hand. This in turn makes reading a zine an intimate and enriching experience for audiences -one that can be accomplished anywhere, in brief pockets of time.

â&#x20AC;&#x153;Creating and reading zines is about seizing the word to change the word.â&#x20AC;?

Zines are important contributions to the medical humanities literature. They have always been about seizing the means of production so that a greater array of voices can be heard. Like Packard's self-published books and pamphlets, zines have long engaged creatively and critically with healthcare issues and social justice, often drawing from patient narratives of lived experience. They offer rich potential to inform multiple areas of healthcare, from better understanding how social determinants of health look on the ground for racialized LBGTQ+ youth to better understanding everyday patient experiences of chronic illThe Muse Âˇ Winter 2018

nesses such as diabetes. I have woven zines into my own practice in three key ways: as curriculum, as research, and as activism. Zines as curriculum. I made my first zine fifteen years ago for a class on globalization and education. Making the zine felt energizing and empowering. I've since used zines as a teaching tool within adult education and health education classes. This has included sharing zines as course materials and leading zine workshops. Zines can be obtained through zine distros, sites that list zines you can order online, zine libraries, or at zine festivals and fairs. Zines as method. Zines have been used as qualitative methods within qualitative research for decades. My experience making and sharing zines in classroom settings inspired me to use the zine as a method for my PhD research at OISE/University of Toronto. I worked with three young rural Nova Scotia women, Margo, Mag, and Elizabeth, who self-identified as having experienced depression in young adulthood. I invited each woman to participate in interviews, and to create a zine about the hard-won knowledge achieved from depression. I also made a zine myself.

The zines these women made were remarkable. Their styles ranged from monochromatic, text-heavy, and computer composed to brightly colored, hand drawn, 'messier' collages. Each participant chose motifs to weave through their zines to represent lived experiences of depression: Margo's depiction of a chestnut shedding its spiky exterior; Elizabeth's recurring themes of Mother Mary and a fairy tale princess to represent competing Catholic and romantic cultural influences; and Mag's use of historical and contemporary photographs to weave together her mental health with the colonial past and present. As these examples show, zines weave together visual and textual content in a way that can "show, not tell" -creatively using visual and verbal metaphor to express complex, difficult, and possibly traumatic experiences that can make both telling, and receiving, these stories easier. Zines as activism. Zine creation is an aesthetically and financially accessible way to share a message with an audience. As non-commercial, small circulation publications, creating a zine in itself can be considered an activist act. After all, zines grow from the need for self- and community ex-

pression. I've been fortunate to lead several zine workshops with diverse participants of all ages and backgrounds. Many of these workshops included people who self-identify as living with mental illness. In one community project, zines provided a space for sharing lived experiences of rural poverty. Mini-zines on topics ranging from affordable housing to food security were later used to spark brainstorming in community planning workshops. Zines offer rich insight through first-hand accounts of health issues. This is especially vital for indigenous, LGBTQ+, disabled, racialized, and rural communities. As material records of marginalized perspectives, zines communicate the needs, priorities, and experiences of these seldom-heard voices. Zines also raise important questions about what counts as evidence; creators and readers alike are encouraged to critically consider what is included and excluded within dominant forms of knowledge and expertise. Through these humble, roughedged booklets, patients can witness their experience with their own hands -sharing hard-won knowledge towards more inclusive, effective, and patient-centred healthcare.

About the Author: Dr. Paula Cameron is a Postdoctoral Fellow in Continuing Professional Development and Medical Education in the Faculty of Medicine at Dalhousie University. Her interests include equity, patient experience, medical education, medical humanities, and emotions. She has researched, written, and taught adult education and health for the past decade. Currently researching medical simulation, resident burnout, and gender equity in academic medicine, she lives with a lively child by a lake in Halifax, Nova Scotia.

Interview with Dr. Sarah Fraser

Interview with Dr. Sarah Fraser blog, Sinus Rhythm, and what im- With the growing use of social pact do you think it has made? media on so many different platforms, do you have any plans to When I originally began blog- expand your work outside of blogging in 2017, the inspiration came ging? Why/Why not? from a desire to share reflections on my medical experiences in a When I post a new blog, I share it way that provided meaning for on several social media platforms, other people. Over time, the blog but I don't use those platforms as evolved to include information the primary venues for my writon evidence-based medicine. This ing. I am currently attempting to was to communicate how patient expand my work into newspapers, care is being guided by up-to-date magazines, and journals. It's diffievidence emerging in the medical cult to communicate thoroughly field to the general public. in so few characters. I need space to fully develop and explore ideas, “The inspiration came nuances, and controversial issues, from a desire to share all the while maintaining an acCan you tell us a bit about your- reflections on my medical cessible language to reach a broad audience. self? Before medical school, I studied Biology at St. Francis Xavier University and then completed a Master's in Environmental Sciences at McGill, researching an unusual and endangered bird, the Loggerhead shrike. Subsequently, I held a position as a Scientific Writer; eventually my interests brought me to medicine. As a family physician practicing in Nova Scotia, I now have a special interest in sexual health, mental health, and addiction medicine.

experiences in a way that provided meaning for other people.”

Is there a specific blog post that is special to you? How come?

Earlier this year, I blogged about the link between Lyme disease and climate change in Atlantic Canada. It was a unique post because it integrated the environmental sciences (the subject of my previous background) with medicine. It was also published as a feature article in The Chronicle Herald in What inspired you to start your Nova Scotia.

The main limitation for expanding my work as a writer lies in the availability of our life currency -time. Though it may be difficult to reconcile the demands of medicine with those of other passions in life, it is imperative that we do. Doing so not only makes us better doctors, but also makes us better humans. Apart from your blog, you also recently published a collection of medical poetry called Humanity Emergency. Could you tell us more about that?

The Muse · Winter 2018

I wrote Humanity Emergency as a medical student. Writing the poems helped me to reflect and process the stressful events that I was experiencing as I was introduced to the field of medicine. Writing the poems was a coping mechanism. At the time, I also felt that there was an urgent need for more humanity in medicine, specifically on the part of healthcare providers in relation to their patients. Though I still feel this way, now that I'm further along in my career, I have more of an appreciation for the concept of "compassion fatigue." It can be challenging to remain compassionate when exhausted and working in a financially stressed healthcare system.

What is your writing process like and how do you think it helps you in creating your content?

Does it help in your career as a Before you became a doctor, what doctor as well? kind of impact did blogging and poetry have on your life? Were I write when I become inspired, there any changes to that after you usually by current events, social became a doctor? injustices, or seemingly simple human interactions. I admittedly At the risk of dating myself [reprefer the pen-to-paper process, vealing my age], blogging was especially for poetry and reflective not yet popular during my youth. pieces. More technical pieces usu- Poetry, on the other hand, has acally stem from an initial question companied me since I learned to that peaks my curiosity. I then re- read. I began writing it in my early search the issue and draw my own years. It was an attempt to interconclusions based on facts and sci- pret and understand what, at the ence. time, seemed like a complex and contradictory world. Now, as a Writing certainly helps my work doctor, it interestingly still serves as a doctor. If I write about a health the same purpose. issue that is important for patient care, I come to have a greater un- The link to Dr. Fraser's blog can derstanding of the subject, and I be found on her website: can use that information to better www.sarahfrasermd.com. communicate with my patients. Writing also continues to be a helpful coping mechanism for dealing with difficult medical and social situations.

It's Not About Me A Settler

Art by Angel Cai

The Muse Â· Winter 2018

There Sits a chair that's frozen to the ice Its sturdy wooden legs stuck, grasped by cold hands That don't relent. I hadn't even noticed the chair at first. In the middle of the frozen water, there I was Standing, staring Out into the emptiness hovering Over the dark lake. For a while I stood In my safe place on the ice. Giant cloud shadows crawled over mountains And down snow-filled valleys, Bruising the landscape. I then noticed the dark water lapping at the icy edge And roiling and churning darkly beneath my feet Just inches below the ice.

But Why should I get to sit? Some are much wearier than I And besides, the spot is not mine to take. There are others from the water Who have been treading all their lives. What do I know of that, Standing here, always held aloft? Not much. I could cry rivers But what good would that do? So I will do this instead: Stand beside the chair Ever through the seasons Gripping the arm with solidarity. Stand and listen. Listen.

Then I noticed others in the water Treading and treading and treading Working to stay afloat. Truths flow strong as a winter river under ice. Only then was I aware of the chair. Speak to their power It hadn't always been there, When their owners would be scorned for doing so. It didn't need to be. From the ice, expose That is until the lake turned thick and dark with oil Why the ice is even there in the first place, Pulling down and down. Why some are on top while others are not. (But not on me. I'm safe on the ice.) Break the ice, if need be. The lake needed guarding. I wanted Help make the water clean again. So much And most of all To take the place on the chair Remember When I first noticed it. My place is beside. From it, I would pull those from the water Because for once Who were struggling. It's not about me.

Dichotomy of Death Poem by Kashyap Patel Art by Amy Zhu

The Muse Â· Winter 2018

At the ghastly hour of your death, What will you fear, my dear friend? The processes of the dying breath, Or the nothingness after the end? When time comes for eternal rest, Will you go in peace and silence, Or will your faltering body protest, To show nature a last defiance? When time comes for infinite sleep, Will you perish alone with your fear? Or will you be with those who weep, With great love in every single tear? So tell me, my dearest friend, Where does your truest fear lieThe mystery beyond your end, Or when your aging faculties die?

About the Author I have been writing poetry since I was in middle school and I never intend on stopping. I enjoy exploring a variety of topics in my writing -nature, history, politics, death, relationships, love -nothing's off the table. I started writing because it helped me formulate my thoughts, obstacles, and aspirations into coherent pieces. My brain is chaotic and poetry gave me the opportunity to express myself in a creative and meaningful manner. For the longest time, I was not comfortable sharing my poetry because I feared being ridiculed by others. When I mustered up the courage to share, I was met with immense love and support -I even motivated some of my friends to start writing. I believe that there is a poet in all of us; we just need to take a leap of faith and give it a chance. Ever since then, I started writing regularly and it's been a great journey of self-discovery. I also have a poetry account on Instagram (@kashthepoet) where I post other pieces. So, give it a follow if you want to read more of my poems. I hope you enjoyed my poem. Thank you for reading it.