Tag Archives: med school

Gradtirement begins!

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My maternal side of the family is incredibly close knit, and I grew up surrounded by cousins who were as close as siblings. We are also incredibly Ukrainian, clinging fiercely and proudly to a culture that first Russians and then Germans attempted to wrench away from us. It wasn’t until Grade 2 that I realized “goomkah” wasn’t the English word for “elastic band,” and that other kids didn’t spend most holidays hanging out at their Ukrainian church until midnight.

I am literally “first generation and a half” Canadian, with a mom who was born in Canada but whose older siblings were born in German camps during the war. We knew the stories of the family in Ukraine and Belarus who had been lost during the war, and the miraculous reconnection thanks to the tireless work of the Red Cross with aunties and cousins presumed dead, but until the dawning of the age of easy internet access, we never dreamed of actually connecting with these faraway loved ones on a regular basis. But eventually connect we did, and now with an epic celebratory trip looming in need of a destination, I couldn’t imagine a more amazing destination than going ‘home’ with my mom.

However, there was no need to hurry straight there! While I have had the privilege of roaming throughout Europe before, my mom has never traveled in Europe outside Ukraine. So, while sitting in my apartment in China, I took the plunge and booked us flights arriving in Rome and leaving from Lviv three weeks later. Now we just had to plan all the fun things in between!

When you travel with the same someone as often as saratree tends to do, you inadvertently develop roles to expedite the planning process. I have definitely become the “things to do and eat” person, while Joshua is the “accommodations and public transit” expert. Realizing that I would need to step into the role of all of the above on this trip was, to put it mildly, freaking terrifying.

While I did have more travel experience than my mom, I felt woefully inadequate in the role of navigator (Josh seems to think my philosophy of “I always get to where I need to go…. eventually!” is amusing rather than functional, and let’s just say that my mother’s sense of direction is even more… ethereal than my own). Moreover, my mom was struggling with a chronic ankle injury that limited her mobility and caused her fairly constant pain. Was a cross-European backpacking trek really the smartest idea?

Maybe not smartest, but definitely most awesome.

A word about my mom. My mom is, as I alluded to above, a first generation refugee who grew up in the culturally and geographically challenging rural North of Canada. Her family didn’t speak English and she had never seen a city or running water until she was 14. She has faced unimaginable hardships in both her personal and extended family life, and worked for decades as a nurse where she was expected to cope with other people’s grief and pain on a daily basis. As a child, she suffered numerous health problems, including damaged veins in her legs that left her with constant and painful swelling in her left leg, and a ruptured eardrum that left her half deaf, caused by a drunken doctor attempting an ear exam.

I confess that because I’ve grown up with these things, I have taken them for granted for most of my life. Mom’s leg that was a different colour, or the fact that she wouldn’t hear you when you talked to her on a certain side, well… those were just normal parts of her, like her collection of matryoshka dolls or her hazel eyes. But living in very close quarters with her during this trip (and planning daily activities that pushed the physical limits of her normal relaxed retired life!), I saw the extent to which she is affected on an hourly basis by these things: whether it’s in the ankle swelling that causes sandal straps to not fit properly, or the careful selection of seats to ensure she can hear the waiter, or even something as simple yet tiringly constant as the quick glances towards and away from her “rainbow leg.”

And yet in spite of (or because of?) all this, my mom is the most gracious, compassionate, generous, and life-loving individual I have ever met. She has instilled me with a sense of joy in the everyday occurrences of life, as well as a sense of healthy respect towards suffering: it happens, it’s hard, so we need to support each other and learn from it.

Also, did I mention that she’s just super fun?

My mom seemed thrilled to have the chance to visit Italy (apparently she has been captivated by the idea of Pompeii since high school, of which I had no idea!), and I was equally thrilled to have the chance to play host in one of my favourite countries, despite all my worries about her well-being. I knew that if anything happened to her, not only would I feel horrible, but I would face the wrath of my three older siblings. It was one thing for ME to go irresponsibly gallivanting across the globe, but to drag along my respectable mother who was supposed to be relaxing in her much deserved retirement??

As it so often turns out, my fears were groundless. Every day, my mom astounded me with her strength, humour, and resilience. She was wonderfully encouraging to me in my newfound travel agent role, offering generous amounts of much appreciated reassurance and excitement. She appeared charmed by the vast assortment of accommodations I found for us, embracing the shared bathrooms and hostel breakfasts with aplomb. She bravely tackled Rome’s metro guarded by machine gun-toting militia, the scorching heat of the Foro Romano, the endless staircases of Venice. Most notably, she never complained. She would request to sit for a minute, or accept my offer to lug her suitcase for awhile, but she would never complain.

Our charming conglomeration of accommodations. I was VERY pleasantly surprised (read: relieved!) at how lovely they all turned out to be… I chose them mainly for price and location, and was keeping my fingers crossed for all the rest!

Our biggest hurdle… the infinite bridges & staircases of Venice (aka the city where my respect for my mom’s chutzpah quadrupled)
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Planes, trains, automobiles… and vaporettos

Life is hard. Challenges get thrown our way (sometimes more due to our choosing than other times!) But how different could our experience of challenges be if we simply stated what we needed, or what could be helpful, rather than resorting to ineffectual kvetching.

El Foro Romano: never fails to be utterly awe-inspiring

Hey Joshua… “[El Foro] is a good place to find a thumb.”
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My perennial favourite of the Foro – the Temple of Romulus (AD 307), with the original bronze door and the lock that STILL WORKS
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Mom taking her role as traveller-tourist seriously and not missing a thing!
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Views from Venezia

All life lessons aside, it was also just pure fun to play tour guide to my mom in bella Italia, a country I have now had the privilege of visiting for the third time and that still leaves so much to be discovered each time I arrive!

Amazing new discoveries with Mom, such as our blissful Santa Marinella beach day

First time in the Pacific!!!
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The rainbow puzzle box of Burano
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Late night strolls down to our favourite neighbourhood landmark
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And then, with coins thrown into Trevi to guarantee yet another return (it’s only had proven success thus far for me!), it was ciao! to the Romantics and hallo! to the Germanics as we boarded our Schlafwagen to Vienna…

(To be continued!)

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Piqhiqpaa? Piqhinngittuq.

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ᐱᖅᓯᖅᐹ? (Blizzard; Is there a … ?)
ᐱᖅᓯᙱᑦᑐᖅ. (Blizzarding; It is not .)

When one kind of accidentally realizes they’re going to be away from home for 3 months, the option of trying to see one’s spouse occasionally comes to mind. Josh and I tossed around endless possibilities, trying to find what made most sense: Should he come to Toronto, about the halfway point of my travels, which would also give him the chance to see his cousins? Should he come to Ottawa, getting to stay with my family and one of his best buddies, but then would that be silly if I was going to be in Winnipeg (albeit very briefly) the next weekend? At the back of our minds in all these discussions was the dream of him visiting me in Rankin, but it remained firmly in dreamland. While I knew his intrigue for Nunavut was at least equal to my own, we also knew that flights to the Territories are prohibitively expensive at the best of times, let alone for a brief weekend visit.

Air miles, on the other hand? Apparently cheaper to get to Rankin than Ottawa.

And suddenly our complicated decision-making got a whole lot simpler!

His flight blew in Thursday night, just hours ahead of a blizzard that would shut down the town the next morning, leaving us with an open day to explore Rankin in the daylight. With sunset sweeping the skies by 2:30PM, extra daylight hours are not something to take for granted!

11:30AM

2:30PM

Josh’s welcome feast of leftover birthday kwak and maqtaq… I assured my host he most definitely would NOT mind leftovers, particularly of this variety!

Josh trying his hand at the ulu, under Aanak’s watchful eye

Aanak’s expert ulu wielding

Sadly leaving Josh at home, I blindly made my way to clinic through the gusting snow on Friday morning, only to be informed an hour later that we were now shut down. Apparently there’s an Environment Canada gnome who sits on high and makes the call of Blizzard or Non… and apparently he slept in on Friday. Gnome needs to get his act together!

As I struggled back home and was swept in through the door by the winds, I was greeted by my host and her friend having coffee. “Pshh” they scoffed. “This isn’t even a real blizzard. You can still see the car in the driveway.”
…I’d love to know what Toronto would think of this system.

Josh’s visit fortuitously fell on a Flea Market weekend, where the whole hamlet gathers at the arena to hawk traditional felted banners, sealskin gloves, hand-sewn parkas, and spring rolls from the Filipino family in town. We continued our shopping expedition by combing through every inch of the tiny but packed craft store Ivalu, stocked by artisans throughout Nunavut.

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We then holed up at The Matchbox Gallery for a few hours, hearing the fascinating history of the ceramics studio from the artist-teacher gallery owner Susan Shirley. After the original nickel mine closed in the 1960s, Matchbox was first opened as a government-run program to train ex-miners in a new craft: sculpting and ceramics. When government funding ran out, Jim and Sue Shirley took over the gallery and continued coordinating art classes and studio space for local artists, “preserv[ing] the reputation of Rankin as the only community producing Inuit fine-arts ceramics in the world.” You can find Rankin work at the National Gallery of Canada, the Winnipeg Art Gallery, and throughout Europe and the USA.



Sunday however, was my favourite day, when we finally did what I’ve been wanting to do since I first arrived: Venture out of town and onto the land.

Perfect weather for an adventure!

Sea ice waves still struggling to surge in the tide of Hudson Bay

Dabbing at Char River … inevitable when one of your hosts is 9 years old

Photos could not begin to capture the ethereal beauty of this deep port bay

Classic Canadian method of warming up frozen toes and fingers

This time, it was only a weekend. But we will continue to seek out those beautiful and wild places we may one day call home together!

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For anyone who read to the end of this most momentous post, congratulations!!! Thank you for sharing in saratreetravel’s ONE HUNDREDTH POST!!! The first person to post a comment containing a limerick or haiku about their favourite travel adventure will be contacted personally by saratree and receive a Northern prize (that may or may not be fermented walrus, depending on the rest of Calm Air’s passengers feel about that… but I have a feeling they’d be down).

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ᖁᕕᐊᓱᒃᑐᖓ (quviahuktunga!)*

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Being the youngest of four kids with nine years between my older sister and I, the (almost) youngest of a large extended family, and a December baby to boot, I am in the unique position of having a long period of observation of others celebrating birthday milestones before it is my own turn. This year in particular has seen high school friends one after another celebrate / bemoan / shrug off / enthusiastically embrace the big 3-0.

30 seems to strike more significantly than 20. At 30, many people around me have long graduated from post-secondary training, are more settled in long-term relationships, are starting to gain confidence in their current career… and sometimes more importantly, are truly starting to question if they are comfortable where they are and what they want to do about it if not. At 30, we are in the unique position of having gained some essential life perspectives, and are now wanting to go back and apply that needed perspective to all the important decisions we made during our 20s!

For myself, I am still in school (and damn Med still makes me call it an “undergrad”), having taken a number of years between my first undergraduate degree and entering Medicine. I have already had one life-changing career as a biochemical technician in an interdisciplinary research lab, but even at the time, I knew it was a career that would not be permanent. I am in a relationship with the same individual I have been with since I was 20 (!!!), but both him and I have changed so much and spent just as many intense days living our individual lives apart from each other as together that it sometimes seems as though we have had a number of different unique and life-changing relationships with each other. And through everything, I have never stopped questioning if I am comfortable where I am at, and what I should do about it.

My difficulty in making decisions is a running family joke, whether it’s ordering ice cream at BDI or choosing a university degree. I’m often tempted to succumb to the general mantra that I should be done university already / have a permanent career already / have bought a house already / have kids already / spend more time with my husband already. But I am thankful that I was raised with a joy of pursuing the unique and the unknown.

Talk about people paving their own way… who needs a road when a field is right there!

I grew up with a conservative small-town Ukrainian Baptist mom… who eschewed all norms and moved to Flin Flon on her own for her first nursing job. A cousin who, when I wistfully talked about wanting to take a trip after graduation, asked, “Well, where are we going?” and sent me an email the next day with flight itineraries to Rome. Inspiring preceptors who see their role as physicians to recognize inequity and take action now to address it, no matter how unpopular it makes them with more mainstream medical colleagues. A best friend I met at camp when I was just 14, who also loved spontaneous road trips and was willing to move to Argentina for a year to live in a tent and wanted to learn firsthand from Northern Manitoba populations and threw himself wholeheartedly into recording an album when he already had a full-time job.

And yet another of my heroes: The Nunavut Cyclist

As I sat down on the eve of my 30th birthday to contemplate life and things (as I felt one should do on the last day of their 20s), I realized just how thankful I am to have surrounded myself with people who not only recognize the life-shaping value in pursuing the unique and unknown, but have embraced it for themselves.

With pursuit of the unique and unknown as my guiding philosophy for the last 3 decades, it seemed very fitting to celebrate this decade turnover in Nunavut, living with an Inuit family, learning a craft that inspires and terrifies me (aka Medicine), and surrounded by one of the most beautiful landscapes in the world.

Impromptu breakfast performance by my host and her “throat singing soulmate”

The morning of my birthday, I heard my host yelling to her 9-year old son, “Run to annanaqa’s (auntie’s) and grab the maqtaq for tonight!” After a busy day at the health centre, I walked home and found cardboard already spread on the ground, graced by 2 massive chunks of frozen meat: maqtaq (beluga) & tuktu (caribou). My host busily laid the cardboard table: uluit at the ready for slicing thin strips of tuktu, small dishes of soy sauce and hot butter and onions for dipping, Greenlandic Aromat spice. It was enlightening chatting with my host’s sister the other night, who told me, “I hate it when Southerners assume we’re all poor because we eat on the ground. We always eat on the ground for certain foods, even if we have a table. You can’t cut maqtaq on a table.” Or as my host put it, “People with food on the floor are rich.”

“These Pampered Chef knives have a lifetime warranty. I’ve already had 3 replaced. The last time, the customer service rep asked me what I did to the knife, and I told him I was trying to cut a caribou head open. He told me, ‘Ma’am, you probably shouldn’t do that again.’”

Aftermath!

I still catch myself looking for a restart button on my decisions. Yes, I could have been graduated from Med at this point and been an attending physician already for 3 years. But then I wouldn’t have toured Great Britain with my chamber choir while at Prov for a year, igniting my passion for music and travel. I wouldn’t have built on my French at CUSB. If I didn’t work at camp all those summers, sacrificing some connections in the city, I never would have been on the drama team, wouldn’t have been at FRBC that night, wouldn’t have asked Josh for a ride or Michelle for her mom’s contact information for a lab job. If not at the lab, then I wouldn’t have learned about social determinants of health or interdisciplinary collaboration, or first been challenged by my own racism. If not for those 2 years in Nursing, I wouldn’t have built my interviewing skills, wouldn’t have taken Economics or Native Studies. If not for all my university wanderings, I wouldn’t have run into Josh again at Fort Garry campus – so no band, no Argentina, likely no learning a third language, definitely a lot less love. I wouldn’t be me, with all the experiences and empathy I can offer to my future patients.

I also struggle with the trap of worrying about how much time I’m ‘wasting’ before getting to start living my life. The only thing that is a waste of time is that thought. A life does not start once I start receiving a regular paycheque or making regular down payments or having a regular address that my bills can be sent to. All these things that I’m doing or have done – studying, arguing with MPs, putting my thoughts in order on this blog, exploring new locations for a week or for 8 months or for 10 years, putting in sutures for the 1st time and the 50th time, going to my mom’s for supper, going to Nunavut for supper – This is my life and I’m living it right now!

While hard to see in the moment, it was an incredible exercise to sit down on December 4 and trace the path where my decisions have led me thus far, all I would have missed if I had chosen differently, and all the unknown opportunities still open before me. I am so thankful for this life, shaped by the pursuit of the unique and unknown!

* “Quviahuktunga” (ᖁᕕᐊᓱᒃᑐᖓ) = Happy (I am…)

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…

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!