Truer North

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Nunavut.

The word evokes such longing and mystery, perhaps in part because I actually remember the announcement of its creation as a territory (also perhaps because that memory occurred while I was sitting in a junior high science class, a location that also evokes feelings of longing [but to leave] and mystery [but of acids and bases, which I still don’t fully understand]). While both the sara and the tree authors of this blog are titillated by the thought of any travel, the far North of Canada holds an especially strong fascination for each of us.

Which is why, when an inspiring physician mentor asked me rather out of the blue if I’d be interested an elective in Rankin Inlet, I couldn’t stammer out my acceptance fast enough. It turns out that she was offering an elective that did not quite exist yet: While the site took pre-clerks for summer early exposures and resident physicians for part of their Family Med specialty training, Rankin had never before been a part of the electives list for Med 4 students. Like so many other decisions I made this fall, trying to apply for an elective we were creating on the spot made my elective application process exceptionally interesting!

Hiccups (like finding out only a few weeks ago that one apparently needs a special educational permit to practice in Nunavut which normally takes months to procure… but I got that bad boy with days to spare, thankyouverymuch!) and weather advisories (apparently the day of my flight here was one of the few days this month they didn’t have a blizzard!) aside, it has actually been a remarkably smooth transition to this, my last out-of-province elective of these crazy 3 months away. After a rapid-fire but perfect 36 hours home in Winnipeg (huge thanks to Tree and our lovely roommates Scott & Laura for making that happen 🙂 ), I repacked my bags, traded my spring jacket for my new long down parka, and climbed aboard a tiny plane for a bumpy ride north.

Serendipitously (although the more remote you wander, the more frequently serendipity seems to become the norm), my host’s son and an indeterminate amount of cousins were on the same flight from WInnipeg as me, so I was welcomed at the airport by a bevy of friends and relatives who all seemed to pile into the car with us for the drive home. After a late night supper of delicious homemade ribs (my host apologized that they had just run out of caribou meat, but assured me her dad is going hunting this weekend!), I crawled into bed and had already drifted off by 10PM… when suddenly at 10:30 a crashing knock at my door sent me bolting upright. “Sara!! We’re sorry to wake you, but there are bears at the dump!!”

My host had seen her friends posting on Facebook pictures of a momma polar bear and cub meandering through the town, a rare sight in this town that is normally too far inland for bears to venture. We hopped into her truck and tore along the rimy roads to the dump, where we were greeted by the lights of 20 other trucks already sitting for the show. (Un?)fortunately, the wildlife rangers had chased the bears from town by the time we arrived, so we had to content ourselves with the ominous beauty of a massive harvest half moon, and the thrill of trying to back the truck down a narrow ice ridge lined by looming piles of snow and trash.

ᖁᔭᓐᓇᒦᒃ / qujannamiik / quana / ma’na (just starting to learn the difference between Inuktitut dialects!) for the first memorable day of many…

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The Revolutionary Practitioner Manifesto

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My electives adventure all started by securing a spot with the University of Toronto’s Health of the Homeless elective, and building the rest of my schedule around it. Even knowing what we do about the connection between social determinants (such as income, housing, race, and gender) and health, I had never seen another medical elective specifically designed to address the populations most in need of medical services.

Inner City Health Associates (ICHA) is a group of over sixty physicians dedicated to providing care to those who truly need it most – those without housing, without income, without identification, and often with complex health struggles for which they have been repeatedly refused care. Our existing system has been carefully built to ensure that those who could stand to benefit most from health care are effectively barred from accessing it. For example, even in our “free” Canadian healthcare system, care is extremely difficult to access if you do not have proper identification, like a provincial health card. However, in order to access a health card, you need proper identification… Hang on a second. Something isn’t adding up…

ICHA docs see this paradox and work to correct it through education and advocacy at all levels of the system (the public, policy makers, and other healthcare professionals), reminding people of the undeniable connections between things like income, housing, and health.

Higher income and social status are linked to better health. The greater the gap between the richest and poorest people, the greater the differences in health.
World Health Organization

I say remind because we first learn about the social determinants of health as early as UNICEF Halloween presentations back in Grade 1 (or if you’re evangelical by trade, then World Vision sermons before you were even out of the womb), where we are taught that poor kids are sick and need our help. Crude and incomplete, but built around an important truth: Poverty contributes to a lack of health. And many factors contribute to poverty. “The social determinants of health are the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power, and resources at global, national, and local levels” (World Health Organization, 2017).

When I am one of the privileged wealthy (and by that, I mean I can read, have stable housing, food in the fridge, safe drinking water, and a physician who won’t refuse to see me because of my housing/sexual orientation/age/illness), I need to look at how I am contributing to – or at the very least, not working to change – those factors contributing to other people living in poverty.

And this is what moved me most about the ICHA docs. Their ultimate goal is for public perspective and the Canadian healthcare system as a whole to shift towards a system that is truly equitable, accessible, universal, portable, and comprehensive (hmmm… sound familiar?) So ICHA docs are dynamic teachers in the hospital, devoted mentors of medical students, passionate advocates on Parliament Hill, and constantly working with policy makers to encourage systems level change (I myself had the privilege of attending a breakfast meeting with the Law Commissioner of Ontario to discuss a new policy of palliative care). But in the meantime, if they cannot convince others to join them in providing quality care to those who need it most, they just go out and do it themselves.

For example, I worked with 2 physicians at a refugee health centre, a tiny room nestled within a shelter for newly arrived refugees. For many who have arrived in Canada fleeing persecution, there is a lag between when they arrive here and when they have their court hearing to actually receive their refugee status (ironic, because these individuals have been experiencing persecution for years, but are only recognized as a refugee once they are safe in a country defined as free from persecution). This lag, which can be many months, is a time of immense vulnerability for these folks, since they are not only fleeing immense trauma, not only adjusting to a new culture and climate, and not only trying to accomplish the daily tasks of living we all must do (families have to eat, kids have to get to school, spouses occasionally want to talk), but if they get sick, accessing healthcare can be immensely complicated (remember the ID/health card shenanigans described above??) Furthermore, it’s not just the usual pneumonias and UTIs that can get them down. Many come from countries where immunizations were unreliably accessible and where certain infectious diseases and genetic conditions are much more prevalent. When you are focused on daily survival in a refugee camp, screening for genetic blood conditions may not seem high on the list of priorities. But when you trying to live peacefully in Canada with hopes of surviving past age 45, suddenly that condition takes on a new importance.

In every new clinic I worked in (and I had the privilege of working in many… too many for a single blog post!), I made a point to ask the physician “How??” How did they end up here? How did they get the funding, the building, the equipment organized? How did they make it a reality to provide care to a population where literally no care existed? And their answer was almost always the same. They’d shrug and say something along the lines of, “Well, I knew it had to be done… so I just did it.” For the incredible docs at the refugee clinic, “just doing it” included rummaging in the basement of the major TO teaching hospital for discarded but still usable supplies. It meant 2 docs carrying each end of an old examination table to get it up the street from one clinic to this one. It meant these same 2 guys coming in at midnight after their workday to paint the new clinic room themselves. It meant them going to hospitals and administrative boards and other physicians and saying, “It would help so much if you could provide funding and staff. But if you can’t, we’re going to be doing this work anyways.” They continue to volunteer their time one day a week to provide healthcare to undocumented refugees who simply could not receive care anywhere else, and they also donate their money earned on other days to an emergency fund for their families who cannot afford their prescription medications.

I met psychiatrists who literally went into ditches and bus shelters to provide emergency mental health care where it is so desperately needed most. I worked with a palliative care doc who zips around Toronto in his little car, bringing comfort, dignity, and company to beautiful people who would otherwise be dying alone in back alleys and basements because they were refused care everywhere else. I carefully stepped around and over bodies jam-packed into a shelter common room to get to a woman so ill with uncontrolled diabetes that she could not come up to the clinic to be examined. On my first day working with one doc, they handed me a copy of their own personal Manifesto of a Revolutionary Practitioner.

“I only realised at age 60 that I needed to articulate my vision for practicing Medicine,” they told me. “I hope you will write your own much sooner than that.”

As a skilled professional, so much has come to me – opportunity, education, mentorship, social standing, income (one day!) Have I worked hard for it? Absolutely. But me working hard is not the point. We have put barriers in place to stop people who need care from coming to us. So the time has come for us to go to them.

What can we practically do? Most importantly, start to notice our own reactions to people who are homeless, poor, struggling with health problems. These are not the people we should be uncomfortable having in our hospitals – these are the people who most need care. Next, take the opportunity to start conversations with friends or families who may talk about the vulnerable people in our communities less than kindly. Heck, send them to read this blog! When you vote, look at how your representative talks about things like housing, access to clean water, autonomy for Indigenous populations. We know that upstream action ultimately is most profitable for all involved (sorry guys, “trickle down economics” isn’t a thing; actually, the opposite is true**), so make sure we’re supporting policies that will support all of us. And ultimately, I want to remember the ICHA docs: If something needs to be done, maybe we just need to do it.

In other words, if you find yourself painting a clinic at midnight, give me a call – I’d love to join you 🙂

Getting to a new clinic every day meant a LOT of public transit adventures…

A much needed evening of renewal at a BYOM Poetry Open Mic (Bring Your Own Mug for tea!)

** The IMF and the OECD have found that there is an inverse relationship between the increasing income share of the wealthiest and overall economic growth. If the income share of the top 20 percent increases by one percentage point, GDP growth is actually 0.08 percentage points lower in the following five years, suggesting that the benefits do not trickle down.
Shimman & Millar, 2017

Caring For & About

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Rewind one month ago to my final week of Med 3, a week that naturally included me hosting a family party, two band practices, a live radio interview, a final call shift, an NBME, an out-of-town house guest, and an album release.

Celebrating Annie’s 60th, with love

Heathen Eve’s radio debut on UMFM’s “Made You A Mixtape”! http://www.umfm.com/programming/shows/episode/43586/

Album Release!! “Reconcilable Differences” now available on Spotify, iTunes, Google Play, Bandcamp, and local music stores near you 😀 https://heatheneve.bandcamp.com/releases


12 hours after our show ended, I hastily shoved some clinic clothes and my stethoscope into a backpack and climbed onto a plane to Sudbury for my first Med 4 elective – a three-week placement in Addictions Medicine. My weeks were spent in a vast variety of community services aimed at helping patients recognize and manage their substance use disorders (SUD). One of the clinics I worked in specialized in “opioid replacement therapy,” which some people may recognize by names like “methadone,” “MMT,” or “Suboxone.” This is a treatment option for people with opiate use disorders (morphine, hydromorphone, Percs, Oxy, etc.) that provides a carefully-prescribed amount of medication (either Methadone or Buprenorphine/Naloxone) that acts in a similar way to opioids in people’s systems, helping them to safely reduce the amount of opioids they need to take and avoid crippling withdrawal symptoms and/or overdose. Harm reduction houses are another valuable service in the Addictions field, where individuals at risk for or experiencing homelessness are offered assistance in securing housing, while also addressing alcohol use disorder through harm reduction strategies such as monitored alcohol administration. Residential treatment programs are a major component of Addictions, ranging from abstinence-based programs (where clients cannot use any substances for a period of time before entering treatment) to harm-reduction programs (where clients are able to be actively using substances while seeking treatment, and efforts are made to minimize the risks associated with using), to anywhere on the spectrum between the two.

Residential treatment programs such as Benbowopka aim to address SUD by helping clients re-establish balance in their mental, physical, emotional and spiritual health

In particular, I spent several days working with Monarch Recovery Services, an “Addiction Centre of Excellence” that offers treatment programs spanning individuals who are managing active withdrawal, who are acknowledging their SUD for the very first time, who have been living in a recovery home for a year, who have started work again and require some help with housing, who have an SUD and discover they are pregnant, who have five kiddos and are struggling with an SUD, who have been abstinent for 10 years and continue to come to Aftercare for support with their SUD.

Getting familiar with Sudbury’s core downtown areas

I know for some this is a hard topic to read about, hear about, or even think about. I know addictions and substance use have not, historically, been topics that have been treated with the greatest grace. But the fact of the matter is that addiction is a chronic health condition. The Canadian Society of Addiction Medicine (CSAM) defines addiction as “a primary, chronic disease of brain reward, motivation, memory, and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social, and spiritual manifestations.” But with that definition comes hope: As a recognized medical entity, addiction is now recognized as “a preventable and treatable disease, helping to shed the stigma of misunderstanding that has long plagued it.” In other words, addicts are not necessarily “bad” or scary people. They are people with a serious health condition that, like any health condition, requires a balance of external support and personal action in order to prevent (ideally!), recognize, and manage it. More often than not, addiction co-occurs with trauma, since “addictive behaviours [are] a way of coping with emotional pain, a way of self-soothing that is not appropriate.”

An individual I spoke with eloquently summarized all of the above: “I know I have an addiction. But the question is – why do I have it?” A crucial component of recovery from an SUD is learning healthy life skills and effective coping mechanisms to replace the destructive dependance on substances as a means to attempt to handle challenges. But, as stated by Dr. David Marsh, a NOSM Addictions Specialist, “A drug user is never going to come to treatment if they die of an overdose.” In other words, while modalities like wet shelters or opioid replacement therapy do not address the underlying why? of an addiction, evidence shows without a doubt that they reduce the number of overdose deaths (see page 21), thus allowing patients the chance to stabilize to a point where they can enter further treatment to address the root causes of their addiction.

As someone who is both a professional in the medical looking to help clients with addictions, as well as an individual who is personally affected by people with addictions, this has been a difficult topic to approach. It has been challenging to recognize that I feel able to offer a very different type of support to clients who are struggling with addictions compared to those I know personally who are struggling. Does this make me a hypocrite? Am I callous towards those I claim to love?

But I have come to recognize that “caring about” and “caring for” are two very different things, and are fulfilled by different people occupying very different roles in the client’s life. Unconditional love is the role of a family member or friend. It proclaims, “I see you as a human being worthy of love, and I care ABOUT you.” But unconditionally loving someone does not mean you can or should care FOR them.

Caring for someone’s withdrawal symptoms, assessing the need for counselling through past trauma, helping them recognize and address a dearth of essential life skills – these are needed roles for professionals such as physicians, social workers, therapists. Caring for someone with a SUD requires a certain level of neutrality and distance. As the healthcare professional, I am not living with the individual struggling with an SUD or affected personally by their finances/relationships/housing/behaviours. Therefore, I am able to advocate for that individual 100% without compromising my own health or safety – as is often the case with family members or partners involved.

In the last several decades, we have made amazing advances in our understanding of and ability to manage chronic diseases like diabetes and arthritis. Let us open the door to understanding the world of addictions in order to start breaking down barriers to effective care.

Taking time for personal wellness with Thanksgiving swims at favourite park #1

Golden afternoon walks through favourite park #2



Adios for now, Sudbury. Next stop, Toronto!

Bike Gear 101 for the Casual Diehard 

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Biking has been a huge part of my life ever since we moved back to Canada and got rid of Josh’s car, making cycling our primary form of transportation. I love the physical act of biking, as well as all it represents: transportation that is better for our earth, better for my body, and much much better for the wallet. But for all my diehard convictions regarding biking, I often feel intimidated talking to other members of the biking community because I never feel like I quite fit in. They  blithely argue the specs of their $2000 hybrid road bikes, standing in their $300 custom bike shoes, while I sneakily wheel my Canadian Tire special past them all. The same holds for all the gear. Sure, it looks awesome, but I manage the streets of Winnipeg just fine in my old soccer shorts and a t-shirt.

I had never needed anything fancier because I had never biked longer than the 30 km or so that commuting around our lovely flat little city demanded of you. I was also skeptical of the need to spend tons of money on things that I wasn’t convinced made a practical difference to outcome. Did cyclists really need those spandex jerseys and fancy shoes? What were the things that were worth the investment for a good ride*, and in which cases could the borrowed/second-hand/super sale piece of equipment work just as well?

*”Good Ride” – A saratreetravels special term denoting a challenging but satisfying, exhausting but exhilarating cycle

Hence, this little guide to the gear needed for a good (& long) ride, of which cycling the Cabot Trail was the first of hopefully many for us. This guide is for all the people out there who are also “Casual Diehards” like me. Who love and believe in cycling passionately, but aren’t crazy about spending a ton of money simply to have new stuff if it isn’t going to make the ride. Who make cycling part of their everyday life because it makes sense to their everyday life. Who have never really thought to “train” (dear Lord, the number of people who sagely nodded and asked me if I was “in training” when I would mention we were going to cycle the Cabot. Training?? I would often nod sagely back and Josh-Bergmann-mumble the hell outta there).

“Josh-Bergmann-Mumble” – A classic maneouvre of extricating oneself from a tricky situation by muttering incomprehensible sounds under your breath while slowly inching away from the questioner and smiling.

My version of “training” – cruising the hills around Notre Dame de Lourdes, MB while on my rural Family Med rotation

You may note that every single piece of gear here is from MEC. I’m sure there are many other great places to find stuff out there (particularly second-hand, which would be even more awesome), but we tend to stick with MEC because we like their co-op mentality and their industry accountability, not to mention their quality and selection. And it’s within easy biking distance from our place 🙂

Soo, without further ado…

BIKES
We rented our bikes (Norco Hybrids, which were AWESOME) from Framework Fitness on Cape Breton Island, for many reasons: Our home bikes were definitely not up to mountain climbing, the logistics of bringing a bike on a plane escape me, and Framework was super cheap to rent from and then drove us right to the start of the trail from our Airbnb. They also provided helmets, pannier racks, and repair kits.

Moral of the story: Save yourself a ton of hassle and just rent bikes from these guys (or someone like them)!

SHOES
I biked using my New Balance runners I bought back in high school, and I had no complaints. Yes, my feet did occasionally slip forward on the pedals and required readjusting, but nothing that actually affected the ride. The one issue with runners is how soggy they get if it rains… which it did. Often. And generously. However, the one perk with biking by the sea is that you are blessed each night with stiff winds that managed to dry our shoes out by the next morning. In addition, we chose to take a break day between each biking day, which gave our shoes more time to dry. Biking with runners also gave us the flexibility to hop off the bike and go hiking (such as the gorgeous hike up the Skyline Trail midway through Bike Day 2) and have another pair of useful footwear for break days.

Skyline Trail:

Drying au naturel in Pleasant Bay:

Moral of the story: Clip-on bike shoes are not necessary for a good ride. Waterproof bike shoes would be amazing, but are crazy expensive and are not necessary for a good ride (but put on the Christmas list for rich Uncle Bob!)

SOCKS
When we shopped for Argentina, we found these socks at MEC that looked comfy and promised to somehow not get too smelly. And we have fell head over heels (punny!!). Super light and breathable, nicely padded, and with a new ankle guard at the back (and now in fun new colours!!), these socks are amazing. Also durable – our pairs have been hand-washed in many a river stream, and are still holding strong.

Moral of the story: BUY THESE SOCKS. In all seriousness, for a good ride, you need good socks that are light and breathable and that don’t slip down as you ride. WrightSocks are highly recommended.
Link: https://www.mec.ca/en/product/5026-380/Double-Layer-Coolmesh-II-Quarter-Socks

SHORTS
Ohhh man, everyone’s favourite topic – the padded shorts! Are they actually necessary? Are they just an excuse for cyclists to look even weirder and more pretentious than ever? In my opinion after this experience, there are 3 components to bike shorts to consider: the length, the fit, and the padding (fun bike fact for you: the bum and groin area shall henceforth be referred to as “chamois” by us casual diehards).
i. Length – A good ride needs longer shorts. I didn’t realise how much the edge of the seat rubbed against one’s thigh until we did a quickie bike to our sea kayaking meeting spot and I just wore my regular city shorts.
ii. Fit – A good ride needs a snug fit. You don’t want to have to re-adjust loose shorts or pick out wedgies every time you hop on or off or put a foot down to steady yoursef. In addition, there is so much wind billowing in your face as you’re flying down the side of a mountain, and the last thing you want is that same wind billowing up your pants and creating a sail out of your butt.
iii. Padding – Truth be told, I have never done an extensive bike trip without padding, so I really have nothing to compare it to. But our padded shorts were super comfortable and my tailbone didn’t hurt at the end of a long ride like it does at the beginning of the city (read: non-padded) biking season.

Moral of the story: Good bike shorts are a good investment for a good ride. Make sure they are long enough (mid-thigh), snug enough (no bunching around the groin or gaping around the butt or legs), and comfy enough to sit for hours both on and off bike. Note that “good” does not equal “most expensive”! We bought the most basic MEC pair (on sale, booyah!) and were very happy.
Link: https://www.mec.ca/en/product/5040-474/Mass-Transit-Shorts

Josh resting comfy on his padded bum

JERSEYS
Like our favourite topic (padded bums!), a good bike top has 3 components, just slightly different from the previous three to keep y’all on your toes and vaguely engaged in this long and highly opinionated post: length, fit, breathability.
i. Length – The reason there are special “cycle jerseys” is in part how they are shaped, with a back hem that scoops down farther than the front and is lined with a grip to keep it from riding up your back. Also fun fact: Bike jerseys come with back hem pockets that are weirdly secure and can fit everything from sunglasses to granola bars, and are completely unobtrusive while riding. Very handy place to stash your bike gloves when going to the bathroom.
ii. Fit – Bike jerseys should be snug. Much like the aforementioned shorts, the last thing you want while struggling up a mountain is to have so much wind surging up and under your shirt that you become a human parachute who literally triples your efforts to get up said mountain.
iii. Breathability – Biking is hard. Hard work makes you sweat. Sweat, if collected and hugged close to your hard-working body, is very uncomfortable. Get a jersey that is light and breathable and quick-drying. The drying bit is necessary not only for while you’re  biking and working and sweating (as previously outlined), but also for at the end of the day when you want to rinse out your jersey because you’re travelling only with 2 panniers and so have brought a very limited amount of clothes (and also you’re wisely frugal and not going to buy more than 1 or 2 expensive bike jerseys).

Moral of the story: See the Moral of the Shorts. Invest in a good cycling jersey or 2. You really don’t need more than that, unless you’re planning on biking daily up a mountain for the next 6 years.
Link: https://www.mec.ca/en/product/5035-483/Bolt-SS-Jersey

RAINGEAR
While cycling, the main concern for me isn’t getting wet (trust me, if it starts raining on a bike, you’re going to get wet no matter how snazzy your gear is), but getting cold. On Deluge Day 1, I was SO chilled by the rain and wind, and the last 2 hours of the ride would have been unbearable without the wind protection and extra layer of my raingear.
i. Top – Raingear is expensive and takes up relatively a lot of space, and here is where I don’t feel I can justify buying a specific “cycling” rain jacket that is then pretty useless as an everyday rain jacket (a cycling jacket is SUPER thin, doesn’t have a hood, etc.) I found a pretty perfect jacket on sale (of course!) at MEC – thin and waterproof but with a light lining so it can also be worn as a regular jacket for chillier nights, with a rain hood (I feel that a rain jacket without a hood is pretty useless!) My previous multipurpose jacket was bought 6 years ago to go to Argentina and only this year – after travelling through South America, Europe, Mexico, and Cuba – did the zipper break and the water-resistant coating wear off. So in my experience, MEC jackets are worthwhile investments 🙂
Link: https://www.mec.ca/en/product/5045-436/Aquanator-Jacket

ii. Bottoms – This is one item I borrowed (thanks Joanna!!). If I was at a point in my life where I was doing big bike or hiking trips every weekend, I would definitely invest in a nice light pair of rain pants for myself. But at this point, going on an annual trip doesn’t make it worth it to spend $60 on pants I literally wore once.

Moral of the story: You don’t need to spend money on a fancy cycling jacket. Buy a light rain jacket you could wear both on or off bike. Specific rain pants are nice to have on rare occasions, but ultimately just make sure you have a pair of light, wind-resistant-ish pants (eg. Even track pants) for those cold days on or off bike.

Rain jacket highly effective while cycling in a downpour…

…aaaand while dining on oysters!

GLOVES
Let me tell you, nothing makes you feel more like a badass than sporting biking gloves. And, best of all for us casual diehards, they are also amazingly practical. Like so much (read: all) of our gear, we opted for the MEC option on super sale, and were not disappointed. They kept our palms from blistering, dried quickly and didn’t smell horrific, and had handy little areas on which to wipe your sweaty brow or nose. Our one complaint was that the area of most padding was over the lateral side, which would maybe make sense if you had bullhorn handlebars, but we would have preferred more padding around the thumb.

Moral of the story: Get some badass gloves for a good ride. Don’t spend big bucks, but if you find some reasonably priced ones with additional thumb joint padding, let us know.
Link: https://www.mec.ca/en/product/5035-499/Metro-Cycling-Gloves

Dayum, that guy could take on any storm with those badass gloves!

MIRROR
I look forward to the day when bikes start coming with mirrors and lights and panniers, rather than having to piece them together yourself, since all those elements are not fun extras but are necessary pieces of a good ride. Our mirrors were (surprise!) the cheapest we could find at MEC, but they were perfectly adequate. Because we were renting bikes out there and weren’t sure of the frame specifics, it was very handy to have a mirror with an easy-to-apply velcro strap that could be adjusted to any handlebar. They did have a tendency to slide around and required frequent readjustment.

Moral of the story: If you were buying a mirror for your daily commuter bike, I’d recommend buying one that attached more firmly than this one. But for a travel mirror, this did the trick (and did I mention it was cheap!)
Link: https://www.mec.ca/en/product/4011-495/Mountain-Cycling-Mirror

PANNIERS
Buying a second large pannier was the biggest investment we made for this trip. Panniers are unfortunately not cheap, but a good pannier is absolutely unequivocally inarguably necessary for a good ride (/for even the shortest commute). Let’s return to our Rule of 3s, Pannier Edition: size, waterproofness, portability.
i. Size – For our 2 week trip, Josh and I both had a 30L pannier, and one 15L pannier to share, which was more than enough room.

ii. Waterproofness – My daily pannier is literally a canoe drybag with a pannier hook attached, and it’s fantastic. Unfortunately, it does not seem to be in existence anymore. Our new pannier (dubbed “Big Blue” because, well, we’re super creative like that) is not waterproof, but did come with a rain cover that was put to the test immediately during Downpour Day 1, and proved very effective. Our 15L (aka “Junior”) is not at all waterproof and has no rain cover, but that obstacle was surmounted by keeping only our rain gear and our plastic bag of toiletries in him.
** Practical packing tip: Rolling up clothes and packing them in empty tortilla bags not only keeps things super organized, but also dry in case of an unexpected deluge!

iii. Portability – I include this component not because any of our panniers were particularly comfortable to shlep around off bike, but to publish my bewildered rant about WHY DO COMPANIES NOT MAKE PANNIERS WITH BACKPACK STRAPS?! WHY NOT?!! ARRRRRRRGH.

Moral of the story: Every good ride needs a good pannier of adequate size with some form of waterproofness – if the shell itself is waterproof that is much preferred, but the covers do work well. And for the love of bikes, if you find a pannier with backpack straps, let me know IMMEDIATELY.
Link: https://www.mec.ca/en/product/5035-448/World-Tour-30L-Pannier

Meet Big Blue:

Junior & Red, respectively:

UNDERGARMENTS
**Are there still people squeamish about TMI? If so, maybe skip this bit. Lots of info ahead re: anatomy and chafing**
i. Top half – Before leaving, I actually tried so hard to research what to wear under my jersey before leaving because I had NO idea what protocol was, and couldn’t find anything helpful. So in the end, I did not wear anything under my jersey. I realise this doesn’t apply to everyone, but I do not need bra support of any kind to avoid backaches or whatnot, and I don’t subscribe to the idea that nipples are inherently evil. Some people apparently wear a light tank under their jersey to help with sweat / avoid nipple chafing, but neither Josh nor I found this was necessary. Top commando all the way!

ii. Bottom half – Here’s something I just found out on this trip (thanks Velodonnas!): Bike shorts are meant to be worn commando (whaaa?) and chamois (pronounced “shammy,” dear casual diehards) cream is to be liberally applied to both short-chamois and human-chamois to prevent chafing of your sensitive bits. Dutifully before leaving, I purchased my very own Hoo Ha Ride Glide Chamois Cream and divvied it up into carry-on-friendly containers for the flight over. However. I feel unfit to give an accurate review of Ride Glide’s efficacy since our first bike day was also a day of torrential, unrelenting downpours, and therefore all bits of me – chamois and otherwise – were thoroughly purged of any hint of cream, with no hope of reapplication in the rain. And my sensitive were pretty dang sensitive during subsequent rides. Nevertheless, I did use Ride Glide daily with reapplication after 3-4 hours of riding, and found it helped especially to reduce chafing in the inguinal crease.

As far as application goes, I did not love the euphemistic instructions given by the chamois bottle (WHICH nooks and crannies?!), so here goes my own version:
**More TMI warnings ahead!! But if you’ve been okay with nipples and inguinal creases, you’ll probably be okay with the following** Apply a generous (at least loonie-size) dollop of cream to the perineal body, posterior labial commissure, and over both labia majorum. Then take another very generous dollop and spread over both inguinal creases, right down to the gluteal fold.

Moral of the story: Be comfortable. If you find wearing a bra helps your back and neck ache less, do it. If you find wearing a bra just makes you sweat more, get rid of it. If your inguinal creases are peachy keen but you are feeling itchy and sore behind your knees, try some chamois cream there. Our bodies are chatty and like to inform us of how they’re feeling – don’t be afraid to listen and look for solutions to address its specific concerns!

And now, just enjoy the good ride 🙂

Off the trail

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For this trip, while I was struggling to get through my first year of Clerkship (third year of Medicine), Josh outdid himself in travel agent mode and spectacularly organized all accommodations on the booked-months-in-advance Cabot Trail, as well as ensuring that we had adequate time between cycling days to rest our mountain-naïve bones. Our first rest day was spent in a state of relative shock. Having survived Deluge Day 1 on the trail – which consisted not only of 100 km of riding, but also approximately 100 litres of water absorbed into our bike shorts – we did little else in Chéticamp except consume large quantities of of donair pizza and poutine at Wabos Pizza Sub & Donair (not sure what it is about donair and Cape Breton, but it’s everywhere and it’s excellent), as well as Nova Scotian Jost Vineyards “Great Big Friggin’ Red,” which was much like the province itself: hilariously unpretentious on the surface, but addictively delightful once sampled. (Also, surprisingly elusive – while I faithfully trolled each wine list and LC for the rest of the trip, I have yet to track down another bottle of GBFR, much to my distress.)

Our peaceful porch at Albert’s Motel

Assembly line lunch-making, optimistically assuming we WILL be able to eat lunch without it drowning on the trail the next day:

Where we’ve come from, where we’re headed:

We rolled into Pleasant Bay, aka Rest Day 2, only moderately soaked this time: we nearly escaped the rain on Trail Day 2 except for our final half hour of riding, when we encountered our first mountain descent, highway construction, and a sudden downpour all at once. However, our Airbnb accommodations had not only a private bathroom with beautifully fluffy towels (real towels quickly become one of the greatest luxuries when using travel towels for any length of time), but also one of the largest and most comfortable beds ever known to cyclist-kind. We lay down just for a moment to talk about our evening plans… and woke up 2 hours later, ready for anything 🙂 Our Airbnb host Jeff had left not only a 20% off coupon for the restaurant where he worked, but tips on when the live music started – one of the many advantages to staying with a local! We ended up at The Mountain View Restaurant 2 evenings in a row to enjoy their enormously generous glasses of wine and literal toe-tapping local fiddle music and Highland dance. In between Mountain View visits, we spent our time on the Pleasant Bay beach, a mere 5 minute walk down the hill from our house. The mesmerizing sound of the waves dragging beach pebbles along the shore and the odd beauty of lobster traps piled against the harbour made for a delicious way to pass an afternoon.

View from the porch:

Pleasant Bay beach day:

Mountain View does not skimp on wine!

Of COURSE we would bump into a fellow Winnipegger staying at the same Airbnb… Judy, hearing your voice in the hallway was the best surprise of the trip! 🙂

Rest Day 3 was undoubtedly the pinnacle of the rest days, and in some ways, the pinnacle of the trip. To arrive at Hideaway Campground in Dingwall, our Trail Day 3 destination, we had to summit North Mountain, the most challenging ascent on the trail, made even more daunting by the fact that, for the first time, we had to cycle in blazing sun and the subsequent heat that accompanied this rare Cape Breton phenomenon, as well as manoeuvre through kilometres of construction over the slope of the mountain. Having successfully negotiated all the above, we rolled into Hideaway and made our way to our most delightful accommodations yet: The Lighthouse. (When our bike guy heard Josh had booked the Lighthouse, he went into rhapsodies of acclamation for Josh’s excellent planning, since apparently this is the most coveted spot to stay on the island).

Waking up to this view every morning made every gruesome turn of the pedals up North Mtn well worth it:

That evening, we walked the two kilometres or so to the “Secret Beach” whose existence had been hinted at by our previous Airbnb host. The Hideaway staff member had assured us that it was a sprawling white sand beach, “Just like Verrraderrro, Cooooba” (those are not rolled Latino Rs, mind you, but rather the piratey Nova Scotian variety). While not precisely like Varadero, it was beautiful, secluded, and the definition of restful.

The following morning, our actual Rest Day 3, was definitely the least restful of the rest days, but in the best possible way: We cycled 5 minutes down the highway (in city clothes, which just felt wrong after growing accustomed to padded shorts and jerseys!) to Eagle North Kayak, where we spent the afternoon with local sea kayaking guide Mike and 4 lovely tourists from Ohio. Together, we navigated the sea-bird strewn marshes and white-capped waves of the wild Atlantic. Then, to cap off an already-perfect afternoon, Mike offered Josh & I the use of his kids’ paddleboards to try in his harbour.


We had grand plans to go out for a lavish dinner that night, but realised no view could top the one from our own cabin porch. So, we cycled to the Red Store (aka the one store in the entire Aspy Bay area), artfully packed slices of Donair pizza and cold beer into our paniers, and enjoyed a delectable evening of star-gazing from the Lighthouse.

Trail Days 4 and 5 were back to back, with no rest days in between. We detoured off the official Cabot Trail on Trail Day 4, following the serendipitous advice of a local we chatted with while buying ice cream, who advised us to veer off onto the Coastal Loop to avoid the horrendous construction that had taken over South Mountain. Not only did we successfully avoid all construction, but the Coastal Loop views and unavoidable encounter with the Neil Harbour Chowderhouse made the detour well worth it.

Trail Day 5 was beautiful and bittersweet, both looking forward to the triumph of completing the trail and dreading the end of such a spectacular journey. We stretched it out, enjoying a languid brunch of bacon-ginger pannekoeken at The Dancing Moose Cafe, celebrating not only our grand journey on the trail, but also our 6th wedding anniversary. When we got married 6 years ago, we had no way of imagining all the adventures we have since experienced and written about on this blog… so I can only imagine what we’ll look back on in another 6 years!

On the trail

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There are two maps one uses when cycling the Cabot Trail, and one is infinitely more useful than the other.

The first is a regular map that shows the trail (a paved, two-lane road shared by cyclists and motor vehicles alike) making a circle of the northern half of Cape Breton, with really no exits or intersections. There’s no way to get lost on this trail, so there’s really no need for this one.

The second map, however, is the elevation map, which essentially looks like the EKG of a mouse on steroids. It does not take long to learn that your sense of distance will not be measured by street signs, but rather by the number and steepness of ascents and descents left til your destination.

Here we go!!

Elevation treated us well for the first day. Tyler the Bike Guy drove us to the trailhead in Baddeck, from which we pedalled 97km. This is less masochistic than it sounds since this was the flattest leg of the journey and we figured it was best to make as much headway as possible.

Our “What have we gotten ourselves into?!” faces, when Tyler drove away from us in Baddeck and we realised we actually had to face the trail alone…

About a quarter of the way into the day, however, the clouds grew ominous.

They have a saying in this sea-battered part of the world that goes “if you don’t like the weather in Cape Breton, just wait 15 minutes.” Not to cast doubt on the local wisdom, but after 15 minutes of the skies opening up and casting off their icy burden of rain-bullets on us, we were starting to doubt the local wisdom. A lesser deluge may have dampened our spirits, but it was impossible not to laugh in the face of this frigid 4-hour baptism of precipitation. By the time we arrived at a dining establishment (we had packed sandwiches, but knew they would disintegrate in an instant if we took them out of their bags), we were squeaky-clean and smelled fresher than any cyclist ever has.

(Apologies to the Belle View restaurant in Margaree, however, for leaving such colossal puddles on your floor. Thanks for the hot chocolate!)

We arrived in Chéticamp that evening, wrung out our clothes and our bones, and rested in the satisfaction that it was all uphill from here (har har)…

Limbering up for Trail Day 2:

One blissful rest-day and one corny elevation pun later, we embarked on Trail Day 2. This was technically our shortest trail day, barring the fact that two mountains stood between us and our next stop in Pleasant Bay. We bid à bientot to Chéticamp, relishing the freedom of carrying nothing but the panniers that hung from our bicycles. And then the mountain came.

Leaving Chéticamp and facing the road ahead

My last experience with mountains was Cuba’s Pico Gayón, which for me was definitely a Pyrrhic victory. I technically made it to the top, but not without leaving every ounce of decorum, pride, and excess oxygen behind. Needless to say, I was nervous for this.

Fortunately, Sara had used her med-student authority (they don’t legally have any, except over their spouses) to get me to pick up a secret weapon before this trip, and for this I will be forever grateful. Armed with my nifty new inhaler, I could feel my lungs working their hardest without ever experiencing that familiar burn and tightness that would have previously forced me to pull over. As the incline steepened, I shifted to the lowest gear and hunkered down for the long haul. Progress was comically slow, but always steady, and every switchback revealed a majestic new cove or inlet filled with the sparkling Atlantic. It was a redemptive experience, to say the least.

Our first “real” ascent… oh, how innocent we were then!

These were the ascents. Day 3’s was undoubtedly the most brutal, with the blazing sun and a 13% grade (that’s a third steeper than the aforementioned Arlington Bridge…and for four unrelenting kilometres!). By Day 5’s ascent, however, we felt like naturals.



Then came the descents. While the ascents did feel less daunting as we became accustomed to them, we never became desensitized to the thrill of careening down mountainsides on two wheels, or that perfect balance of self-reliance and surrender.

Trail Day 1 graciously provided us with what I like to call our ‘training mountain’ (and before the deluge, no less!). Less than half the height of the next days’ mountains, we still pulled over after the descent to exclaim to each other about the drawn-out adrenaline rush we had just experienced. Such wonderful prairie innocence.

If you ever see a photo or postcard from the Cabot Trail, it’s probably of Day 2’s Mackenzie Mountain. Its harrowing switchbacks tumbling toward the ocean make for a fantastic aerial shot. They also make for a steep learning curve (pun inevitable) for flatlanders like us, especially when combined with a sudden downpour at the last minute and a lot of construction. This descent felt the most challenging, as we rapidly learned that switchbacks need to be taken very slowly, especially since it’s impossible to see more than fifty feet in front of you. Still, as the ground levelled out at the bottom we felt we had truly reached a milestone in our cycling careers.

Far be it from me to judge billion-year-old landforms, but in my opinion Day 3’s North Mountain is undoubtedly the best… both in the traditional sense of wonderful, as well as in the more masochistic sense of most challenging and therefore ultimately most rewarding. Its monstrous height (the tallest on the entire trail) combines with slightly gentler curves than Mackenzie Mountain that allow a rider to reach ludicrous speeds while fully taking in the vastness of the landscape. The momentary rush of adrenaline becomes a prolonged state of mind as the descent lasts long enough to alternate multiple times between shrieks of glee and deep contemplations of one’s own insignificance in the face of nature’s magnificence. I would do it again in a heartbeat.

Day 4 lacked any major mountains (though it did contain some major seafood chowder), which brings us to Day the Last, which included the talk of the proverbial town: Cape Smokey. Frequently, when we’d tell people our general itinerary, they would respond with “Oh, so you haven’t done Smokey yet!” Though not nearly as tall as Mackenzie or North Mountains, they were always keen to inform us about how steep it was. One Cape Bretoner in particular reassured us that “It doesn’t matter if I’m in a car(rrr) or a bike, I just close my eyes and hope for the best!”

And though we kept our eyes open the entire time, I can see their point. If North Mountain was thrilling on a spiritually-moving level, Smokey was just pure fun, a roller coaster with no seatbelts. The ocean felt closer than it did on any of the previous descents, and there were a few spots that zigged and zagged so wildly (and seemingly unnecessarily) that I actually laughed out loud. Yet just as the roar of the wind in our ears reached a deafening climax, the ground levelled out and it was all over. This daunting task that we had set for ourselves was complete, and besides some very sore knees we were undefeated.

Lakies Head

The last few hours on the trail were not unlike the last few hours of summer camp: calm, relatively uneventful, and bittersweet as we knew this adventure was coming to a close. The Englishtown ferry met us at the end of a long spit of land hardly wider than the road itself, a surreal iron barge after a week of tiny fishing boats. Our two bikes were dwarfed between SUVs and Winnebagos, and there on the other side stood Tyler the Bike Guy like an ode to narrative symmetry. As he kindly secured our bikes to the rack on the back of his car, we bid farewell to a place that had simultaneously tested and enchanted us more than most places could in less than a week’s time.

Home stretch, cradled by the ocean

Forever Heroic

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As I write this, I wonder whether the last part of Santiago’s slogan — heroica siempre — sounds a little too adoring of Fidel’s revolution. Cuba is not some socialist utopia, and Castro is no Gandhi or Mandela (though he certainly had some bromance with the latter). That said, there is a real heroic element about the David & Goliath story that is the Cuban Revolution. While Castro’s David is certainly not innocent (I guess the original David wasn’t either), he is the one leader who has stood up to America’s Goliath and succeeded.

You can’t listen to many Latin American leaders for long without hearing the phrase ‘el coloso del Norte’. This nickname for the U.S. (the Colossus of the North) is the result of the Monroe Doctrine, an 1823 American policy statement that declared the entire Western Hemisphere (aka: the U.S. and Latin America. Oh yeah, and Canada.) as part of the United States’ ‘sphere of influence’. It was essentially America’s declaration that they were now joining the big leagues of Britain, France, Spain, and the Netherlands who had ruled the colonization game for so long. In the two centuries since, this has manifested itself in the form of American-backed coups, assassinations, and manipulative free trade deals in Haiti, Honduras, Nicaragua, Guatemala, El Salvador, Chile, Mexico, Panama, Brazil, and, before 1959 at least, Cuba. These have left millions dead and hundreds of millions more impoverished.

But not Cuba. La Revolución has never negotiated with the U.S. on anything but its own terms. It has maintained a decent standard of living without owing (or losing) anything to the U.S, which is more than can be said for most of their Latin American neighbours. They have built industries (sugar, coffee, tourism, and, of course, rum and cigars!) that can and do compete on an international level, something that can’t happen when American companies flood the market. (For a more local example, think of how Canadian farmers struggle to compete with cheap American beef.) For this reason alone, the Cuban Revolution deserves to be called heroic. That, and the fact that Castro has avoided more CIA assassination attempts than anyone else in history. Well done, bro.

Che Guevara’s words, “Always towards victory,” remind us that the revolution is not something that happened once back in 1959, but an ongoing state of resistance against American military and economic control.
Hasta La Victoria Siempre

Debris from the American spy plane that illegally entered Cuban airspace during the Cuban Missile Crisis, unceremoniously placed on display on the side of the road outside of Havana, makes for a powerful symbol of resistance against ‘The Colossus’.
Fighter Jet Wing

Now, way back in Part One of these rather verbose politico-economic musings (to be fair, you were warned!), I wondered about the price of such a stable and egalitarian society. One doesn’t have to wonder long…especially when one lives in a country that is ‘glorious and free’, governed by the ‘charter of rights and freedoms’, and is constantly bombarded with media from the self-proclaimed ‘land of the free’.

I think the answer is obvious.

The freedoms that Cubans lack are disconcerting to Canadians and Americans, who value that much-debated f-word above all else. Cubans are not free to leave their country without a difficult-to-obtain visa, they are not free to form political parties, and freedom of the press is non-existent. We are right to be troubled by this, but let’s put it in the context of their other Latin American neighbours…

Cubans are free from debilitating poverty and unemployment. Cubans are free from organized crime and drug wars. Cubans are free to access quality education and health care, regardless of race, gender, or wealth. Cuban businesses are free from being acquired by American corporations, and their markets are free from being flooded by cheap American, made-in-China products. None of this can be said about the rest of Latin America.

Excerpts from Castro’s speeches adorn billboards in every city. This one says “We will begin the march and we will perfect that which we need to perfect.”
Perfect What We Will Perfect

So what, then, is it that needs to be perfected?

La Revolución has succeeded in breaking many of the bonds that keep the rest of Latin America down. What the Castros (or whoever inevitably succeeds them as they reach the end of their impressively long lives) need to do next is to find a way to merge those OTHER freedoms, the ones that Canadians and Americans enjoy, with the freedoms that they have fought so hard to win. They need to find an unprecedented way to be free from America while still granting democratic freedoms to their citizens. If they succeed, they will not only have provided a road map for other Latin American nations (heck, even Canada!) to follow, but they will have finally earned the title ‘forever heroic’.

Jose Martí, buried in his mausoleum here in Santiago, was the poet that united Cubans, of all races, to fight for Cuba’s independence from both Spain and the U.S. The next few years will see if his dream is fulfilled.
Jose Marti's Grave

Farewell, Cuba, and good luck going where no nation has gone before.
Havana nights