May she be well

In the end, it was her eyelashes that broke me.

Impossibly long, feathered midnight against pale skin. The tips, crescendoed upwards with perfection. Those eyelashes, masking the horror of what lay beneath.

As the solo physician covering our local ER overnight, I was called to her bedside by the triage nurse. “The on-call worker brought her in,” reported the nurse. “She said she’s been sleeping the whole time she’s been in care since last evening.”

The first alarm ringing pressingly in my brain.

Laying on her back, her chubby arms and legs splayed across the parchement-like paper covering the ER gurney. Her chest rose and fell gently, seemingly unperturbed by the chaos of the nightshift playing out around her. Cherub-like cheeks lay slack, her expression serene. Her posturing reminded me of those long, torturous nights when Alice and Henry had been babies too – endless rocking, bouncing and shushing to coax them into dream-filled sleep. Then, finally, with a sweaty, sore back and a successful transfer to the crib, I wouldn’t be able to tear my eyes away from them. So captivated by their trusting, peaceful slumber.

Clutching the ER chart, her bruises immediately told me a story that wasn’t necessary to speak in words. Gently pulling back each eyelid, her pupils gazed unfocused beyond my penlight. Black inky pools. Transfixed in another world. My left hand, tenderly caressing the crown of her head, confirmed what I already knew. Underneath the downy softness of her wispy hair, her scalp was stretched taught, bulging outwards over the diamond-shaped opening between her unfused skull bones – pressure rising dangerously within. The natural soft-spot accommodating the volcano inside her brain.

A hustle to the trauma bay, an IV, a breathing tube, medications dripping into her veins. Alarms beeping, the ventilator bellyaching resonantly as always. ‘Breathe, baby, breathe’, squeezes the Ambu bag, driving air into her lungs. My iPhone hot against my cheek, I direct the orchestra of the ER with one ear listening to specialists hundreds of kilometers away circuitously debate which centre would be best to receive the transfer. Which plane? Which crew? What equipment? I grit my teeth, impatiently.

Hours later, the glass entranceway to the ambulance bay sweeps shut with a definitive air. Beyond, the doors of the ambulance are flung wide as if in expectation of an embrace. I watch as she’s loaded into the back in a carefully, premeditated dance of cords, monitors, tubes and personnel. Then she’s gone.

It’s 4:45 am now. A man hollers from a stretcher in the hall. I hear someone else retching nearby. I imagine myself walking out into the night. Crickets chirping, the birds warming up their morning ballads. I wonder how long it would take for anyone to notice that I was gone.

Instead, I plod into the doctors’ charting room, closing the door against the hustle of the central ER nursing station and rip off my mask and protective goggles. On the desk, the upturned mask cradles a slurry of tears and snot that I hadn’t realized had even been there. The hospital-grade tissue scratches my nose as I attempt to mop up the mess that is my face. “Fuck”, I spit out. “I need a goddamn hose!” Flopping into my chair, I spit out a soliloquy of expletives. Face tight with rage, I curse feverishly – railing against no one and everyone. My curses fall vehemently on the systemic dysfunction and generations of trauma left behind in the wake of hundreds of years colonization and assimilation practices. I cuss out an overwhelmed, ineffective child welfare systems that time and time again fails to keep children safe and who had failed massively to keep her safe. I despair with fury at the hopelessness of it all – the vortex of addiction, suffering and violence.

Beside me, my anesthetist colleague and friend sits silently, expectantly and unhurried. Out of breath, I finally meet his eyes. He says little and we don’t touch, yet I feel connection deeply. I know he understands fully. It’s enough comfort for me to pick up the next chart, see the next patient and numbly, continue on.

I close my eyes. Those goddamn perfect eyelashes.

In my medical training, I learnt much. Into my brain I crammed the intricacies of the nephron and the flow of blood through the heart, looping through each ventricle and across each valve. I mastered how to advance the spinal needle millimetre by millimetre through spaces of the vertebrae until it popped through the ligamentum flavum – the shock and joy of clear cerebrospinal fluid dripping into my specimen tube like sap running from the sugar maples during the syrup making-adventures of my childhood. I memorized the diagnostic criteria of Psychosis NOS while my hands learnt the pathway into a woman’s womb to gently coax the afterbirth to come, a lifesaving maneuver as blood swamped my shoes, a syrupy puddle around me on the floor.

Interestingly, without instruction, I also seamlessly mastered the art of dissociating, separating effortlessly from my body. Pushing through sleep deprivation, ignoring my bladder’s plea to be emptied, surviving on saltine crackers and peanut butter packages from the patients’ snack area on Labour and Delivery – all were engrained deeply within the culture of medicine and thus were accepted to be normal behaviours. It didn’t even occur to me to question it and more curiously, the more I disregarded my own wellbeing, the more I was rewarded and praised for being hardworking, a selfless team player and a better doctor.

“We split from our bodies so we can learn to be doctors. Isn’t that ironic? We deal with corporeal failures, but we think we can program bodies, our bodies, to run without sleep, or food, or hydration. We learn to work through utter exhaustion. We dismantle the safety valves evolution built to keep us from doing anything important or dangerous on too little sleep… Medical education says: You know why that ancestor of yours needed sleep? Because he was an ape. And by extension, if you can’t function without sleep, well, that can only mean you’re an ape too.”

Dr. Jillian Horton, We Are All Perfectly Fine

To counter medicine’s age-old practice of eating their young during their training, occasional offerings of ‘Resident Wellness’ were enforced during my medical education, but these random half days of mental health lectures and guided meditation felt like throwing someone a life vest in the middle of a Tsunami. I was going to drown anyway and I could never stay awake past the introduction of those mindfulness sessions, I was so desperately spent.

Continuing the drift away from normalcy, throughout medical school and residency, I was schooled rigorously in pathophysiology and pharmacology, astutely memorizing each disease entity and its treatments. Yet no one ever tutored me in ways to cope with the inevitable trauma of a lifetime career in witnessing and carrying others’ suffering.

Instead, without an alternative strategy, I continued the trend of blind dissociation and began to package each experience into its own Uhaul box, labeled and stacked perfectly onto tiered shelves. Tucked away neatly in the shadowy basement of my mind, lest anyone realize that I couldn’t cut it in medicine. Truthfully, it was only a matter of time before it was discovered that I didn’t belong and that my entrance into medicine had been a result of a glitch in the system.

That time I feel asleep on my General Surgery rotation, assisting in the nauseating wee hours of the night, exhausted from being awake for god knows how long. My head nodding down into the surgical field, the retractors going limp. The scathing words from the surgeon. The shame, the feelings of inadequacy. Shoved into a Uhaul box. Duct tape closed, labeled with a perfectly pointed Sharpie.

The time on a Trauma elective at St. Mike’s, I was called to assess a gentleman post-operatively who was labouring to breathe. I didn’t know what I didn’t know. I failed to recognize how his heart was rapidly failing him, fluid backing up into his lungs and drowning him as he lay in his ward bed. I ordered a chest x-ray and medication, but didn’t reach out for help from my senior resident who was endlessly in the OR and who had explicitly requested not to be bothered with ward issues. That was for me to figure out. By the time I checked on my patient again, his face shone with the effort of each breath. I neglected to see he was clearly in what we call ‘Impending Respiratory Failure’ – his body skirting the edge, the Reaper hovering close by. My fingers on his wrist in a panicked grip, his pulse thready until I felt it slip away altogether like a glimmering walleye – gliding silently back towards the lake’s murky bottom. Ribs splintering under my hands. Code blue. PEA arrest. Another box, taped tightly, pushed high up on the shelf.

Over time, I began losing track of the stories and experiences. A practiced response over and over, the boxes piled higher, soon hastily stacked haphazardly with no time for labeling.

Once released as a staff physician, working full-time as a family doctor in a rural centre, I had learnt no other way to cope. I was so focused on learning the ropes, getting established in my practice and staying up-to-date with my knowledge. One foot in front of the other, grab the next chart, see the next patient. Each day, I collected stories of sorrow, violence, despair to be dumped into a box at the end of the day. A neonatal death after running a Code Pink – into a box. Cradling a 22 week fetus in my heads, dead before it had been granted the ability to breathe – into a box. Stitching deep scalp and face wounds and stanching the flow of crimson after a woman had been beaten violently with a bat – into a box.

Something in me had been completely undone during my training. Looking back now, I wonder if that thing had been my humanity. That ability to dissociate which had served me so well in medical school and residency also had left me fractured. On a cerebral level I understood the diagnosis of PTSD but deep down, I couldn’t understand why those affected by PTSD couldn’t simply push on like I did. It never occurred to me that I was the one who might be broken.

“Most doctors look fine, perennially, until the day they don’t. That’s because doctors are excellent at compartmentalizing. We are also compliant and conscientious and rigidly perfectionistic, characteristics that put us at risk for choking to death on our own misery…”

Dr. Jillian Horton, We Are All Perfectly Fine

This summer, I read a memoir written by a Winnipeg Internist, Dr. Jillian Horton. I devoured her words, like I ate donuts on the way out of the ER after a nightshift, gulping down their stale sweetness without bothering for air. She introduced the concept of medical education as trauma using metaphors like her pager as an explosive device involuntarily strapped to her body and the medical ward as her own ‘personal Vietnam’. Not capital ‘T’ trauma, but a series of daily events and distressing experiences that exceeded her ability to cope. All of those boxes, taped tightly shut, piled sloppily on shelves.

“Burnout isn’t a clinical diagnosis, right? It’s a phenomenon. But you take a bunch of people who are altruists and perfectionists and have the same baseline predisposition to mental illness as the rest of the population And then you put the in ‘jail’ for five years, and you script everything they do right? You limit their sleep, you limit their food, you cut them off from their loved ones; they kill a few people by accident and you tell them everything is their fault, but if they keep their mouths shut maybe nobody has to know what they did. But in return, they have to take over running the prison. Do it to the next generation.”

– Dr. Jillian Horton, We Are All Perfectly Fine

Unapologetically, Horton points to the destructive way in which we are trained to become doctors, revealing the glaring connection between these experiences to not only the excessively high rates of physician suicide and burnout, but also, simply, to our inability to practice self-compassion and to be well ourselves. I was rapt. Could this be indeed possible? Had I missed this the whole time?

“…doctors look fine until the very end. This is a silent emergency, and even if the people around me can smell something burning, none of us has made the connection that the thing on fire is me.”

– Dr. Jillian Horton, We Are All Perfectly Fine

“Medicine dose something to us,’ describes Horton. ‘It teaches us another language, one only other doctors can understand. Eventually it scripts our emotions, neutralizing them whenever they threaten to overwhelm the senses. This also happens to police and firefighters, coroners and soldiers and paramedics, a misguided Clockwork Orange rewiring of the motherboard. But it’s not by accident.’

Each story in Horton’s book resonated with me deeply. Her anecdotes, so similar to mine, and likely to many others, clung to my brain. I read and re-read her words, desperate for an answer. But Horton’s memoir was not a self-help book with a step-by-step guide in becoming whole again. What Horton strongly preached, however, was meditation and mindfulness practices as way of ‘rewiring the motherboard’.

Ugh, mindfulness and meditation? It always seemed so futile to be offered these strategies as a way of coping in medicine. Breathy instructors urging me to ‘just notice… just be aware…'(why, goddamn it do they always need to start every sentence with ‘just’?!) in a whispy and irritating air. Meditating always made me feel impatient and angry, to be truthful. It felt like there was a gaping chasm between what I was experiencing in day-to-day life at work and the seemingly fruitless act of asking me to breathe repetitively. I AM BREATHING, damn it!

I also abhorred meditative practices because asking me to sit still and notice my thoughts was akin to requesting that I walk headlong into a massive bonfire to be slowly and painfully burned to the core. There is a reason that I have a strong aversion to ‘just sitting down and relaxing’, as my husband Blake is constantly requesting of me. Being still in mind and body gives space for all of those images and stories, all of the times that I wasn’t perfect, all of the cases that I messed up, all of that shame and suffering packaged tightly away. After a decade of stuffing it all into dark corners, I wasn’t even sure anymore what exactly might be released to haunt me. My dreams were already haunted enough.

https://www.cbc.ca/news/canada/canada-residential-schools-kamloops-faq-1.6051632

In late May, news headlines across the globe screamed of the atrocities of the Indian Residential School System in our country as remains of 215 children (and now, not surprisingly, so many more) were found on the grounds of the former Kamloops Indian Residential School in BC. Nightly, I laid awake, imagining Henry and Alice being ripped from my arms by force, loaded onto a float plane to some unknown destination, abused and violated in unimaginable ways without my ability to protect them and end up underground before their tenth birthdays.

I was already drowning in hopelessness and despair over our collective inhumanity when the baby with cherub-like cheeks and perfect eyelashes was brought into the ER and forever into my brain. At 4am, in the back doctor’s room in the emerge, I felt something give way.

Too immense was this suffering of the intergenerational trauma left behind by the legacy of the Indian Residential School System, so blatantly in front of me during that shift, and frankly, every shift before and after it. So overwhelming was the hopelessness of broken systems of government, of child welfare and of mental health care that were supposedly in place to heal. All of this, could no longer be put into a box.

This fall, I no longer will be working at the Meno Ya Win Health Centre in Sioux Lookout, my medical home over the past seven years. With a locum job set up at the local family medicine clinic in Kimberley, BC, a small town in the Kootenay mountains, I am taking a year of leave. Although awash with guilt for literally running to the hills, without a taxing clinical schedule, my hope is that this stretch of time may eventually be one of self-healing. It’s easy to have compassion for others but much more labourious to direct loving kindness inwards. As Horton explains, “My training was an apprenticeship in the art of self-immolation. I excelled at it: I strove to master it the same way I applied my full self to everything. You don’t just undo that overnight. If you ever undo it at all.”

The work is not easy. I struggle, resist and sometimes even resent walking toward the bonfire. However, with help from a physician therapist who specializes in using focused mental practice, I am learning how to be still, to let the pain come and to hold space for the suffering. Daily when I sit, her eyelashes always come into focus but less and less I am overcome. I imagine her safe, cuddled in her mothers arms, babbling with bright eyes. ‘May she be well, may she be happy, may she be free of suffering,’ I hear my therapist soothe. I breathe in for me, out for her. In for me, out for her. In for me, out for her…

For Joyce

“Hey there, you the doc coming with us on this medivac?” a young pilot throws out casually through my open driver’s side window.

It’s 3am. The lights from the ER ambulance bay cast shadows across the deserted hospital parking lot. His long, dark eyelashes frame deep, brown eyes that crinkle as his face folds into a wide grin. He chomps unceremoniously into his Tim Horton’s sandwich as easily as if we were at a church picnic.

I nod and smile weakly, my fingers reflexively reaching to finger the pile of medical supplies on my passenger seat as if hoping they would provide the reassurance that I needed.

I follow the pilot’s truck through the vacant streets and out of town towards the airport. The dark, seemingly impenetrable walls of black spruce flanking the highway race by as I try to keep up with the speeding company truck. Soon, we are inching through a muddy yard towards the hangar. Deconstructed planes are stacked neatly like Henry’s Hotwheel cars in his pretend parking lot – a tower of wings piled high beside an assortment of propellors and skeleton-like cockpits lean against a groaning chain-linked fence. Rain thrums against the car roof.

Soon, I’m aboard the plane, crouched in the cramped space with the medic. “Do you have a neonatal bag valve mask?” I ask. “If we need to do the delivery en route, where is the best place to set up?” I slip my backpack off my shoulder, heavy with supplies: a field delivery kit, IV equipment, lifesaving hemorrhage medications, impossibly tiny tubing to slip into the neonate’s umbilical vein, sterile gloves… I run through scenarios in my head and practice their sequences as I used to do with organic chemistry equations back in my pre-med days at Queen’s – tiny plastic molecules flipping through my fingers, over and over.

Against the driving rain, the force of the engine pins me to my seat as the familiar, overwhelming smell of engine fuel pushes my 3am nausea up my throat. Hand pressed against my masked face, the small plane convulses as it becomes airborne, tossed side to side in the April storm. I can’t help it, but all I can think of is Alice and Henry, snug in their beds. I imagine what it would be like if they woke up to a reality of life without their Mom. It’s morbid, I know.

I squint intently at the pilots’ silhouettes in front of me in the cockpit. Framed by the light of the flight deck, I scrutinize the tension in their neck and shoulders. Are they worried yet? When should I start truly panicking? I had never been good at flying.

Earlier that evening, after a long, busy clinic day, I had just settled into bed for the night. Through my cellphone, my colleague spoke: “The weather has finally cleared, but ORNGE only has a basic crew, no advance-care paramendics available. They need a doc to go with them. Could you go?”

For days, we had been trying to transport a woman from her home, fly-in community to Sioux Lookout for delivery. Close to her due date, there were no scheduled flights to safely bring her to hospital. As COVID cases raged through her community, all flights in and out had been cut off. A medivac was the only way, yet freezing rain had held up her transfer and now she was in labour. The nurses in the station were edgy – they were used to dealing with all sorts of harrowing situations, yet birth in the North was what scared them the most.

“In what circumstance would I consider doing a c-section here if I thought she was rupturing?” wondered the community physician and friend of mine during a conversation about the situation earlier that day. Once a womb had been scarred by a number of previous c-sections, like a ticking time bomb in labour, there was always a chance the scar would give way. Uterine rupture; rare, but catastrophic. A c-section would be lifesaving for both the mom and babe, but in the Station, without equipment, blood or training, it would be a futile and traumatizing maneuver.

“You wouldn’t,” had been my response. “The fetus would likely die.”

15 hours later, I limped out of the hospital. Sitting, parked in my driveway, I inhaled my now cold lunch. It was already past dinnertime and I was desperate to see the kids but needed a moment of quiet to pull myself together. I had been awake now for 36 hours; a full clinic day, the night spent on the plane, returning to the hospital to attend a delivery before then assisting at a c-section, managing a sick neonate and transferring the babe off to the nearest NICU by medivac before finishing the next clinic day.

The work was never-ending – the asks and demands falling heavily on our nurses caving shoulders. I could see the exodus happening. Already we were losing our best but who could blame them? When would we stop exclaiming in mock surprise at how busy things were today on our Maternity Unit! The torrential, unpredictable work flow was our daily normal.

With my forehead pressed against the steering wheel, I exhaled, finally letting the tears smear my face. As physicians, we are literally trained in our medical education to keep it together, push through and always do more with less. Don’t feel.

But in this moment now I feel, I feel it fully. And I feel sick. I feel sick because I am full of anger. I’m angry at our nursing staff justifiably voicing complaints about their workload (‘Just get on with it! I think). I’m angry at COVID for making every logistical step in patient care immensely more challenging. I’m angry at the 30 plus patient clinic list on my desk every day. I’m angry at myself for doing this job, a job that has trained Alice to ask every night – “Mom, are you on-call tonight? Where will you be if I need you in the night? Sleeping with Dad? Or downstairs [in my home on-call room]? What if you’re not in bed and I hear a scary noise?”

Mostly, and shamefully, I’m angry at my patient for going into labour in her community. Angry that she didn’t come to Sioux Lookout weeks ago. Angry that she lived so remotely. Angry that her situation had lost me yet another night’s sleep.

I used to think that since I had devoted my work and subsequently so much of my self to serving Indigenous patients, families and communities, I could not possibly be racist myself and, in fact, I considered myself to be an ally to Indigenous Peoples. We are all born into a dominant culture ripe with biases but I had been raised differently. I had spent my whole adult life working with Indigenous organizations, volunteering and learning. Taking extra university courses about Colonialism and the Residential School system. Attending feasts, sweats and pow wows. Reading Indigenous authors. Going out of my way to place myself in remote Indigenous communities for my residency training. I was not a racist, I had maintained.

“I believe that white progressives cause the most daily damage to people of color. I define white progressives as white people who think they are not racist, or are less racist, or ‘in the “choir,” or already “get it.” White progressive can be the most difficult for people of color because, to the degree that we think we have arrived, we will put our energy into making sure that others see us us having arrived. None of our energy will go into what we need to be doing for the rest of our lives: engaging in ongoing self-awareness, continuing education, relationship building , and actual antiracist practice.

White Fagility, by Robin DiAngelo

In the Fall of 2020, like most, I couldn’t unsee the sickening and heartbreaking iPhone video that Joyce Echaquan streamed over Facebook from her hospital room in Quebec before her tragic death. Hurtful, horrific, racist words blaming her for her pain were the last things she heard before she died. A woman and a mom, like me. But unlike me, subjected to overt systemic racism that undoubtedly contributed to her death. Her story winded me. And it should have. It should have because Joyce Echaquan could have been a patient of mine.

“Systemic racism is when the system itself is based upon and founded upon racist beliefs and philosophies and thinking and has put in place policies and practices that literally force even the non-racists to act in a racist way.” – Senator Murray Sinclair

Calvin Murray Sinclair is a member of the Canadian Senate and First Nations lawyer who served as the Chairman of the Indian residential schools truth and reconciliation commission from 2009 to 2015.

In the wake of George Floyd’s death and now since the conviction of Derek Chauvin in Floyd’s murder, conversations about racism have flooded social media streams and dominated dinner table discussions the world over. Systemic racism, however, is not a problem contained south of our borders and we cannot pretend otherwise. More specifically, racist, inequitable treatment of Indigenous peoples has certainly been interwoven within our nation’s healthcare system since its inception and continues today.

How many times, as a green MD, straight out of residency, did I stay silent when the nurses refused to provide care to Indigenous street people struggling with substance abuse on those lonely night shifts in the ER? The most vulnerable people in our community. And I said nothing.

Or more subtly, how often have I heard fellow health care providers – my colleagues and my friends, make off-the-cuff remarks about Indigenous patients, blaming them for their health issues and rolling their eyes when their names came up daily on the ER roster. And I said nothing.

My silence – an armoured privilege.

I recently attended a lecture on Allyship by two of my brilliant, courageous colleagues, Dr. Becky Neckoway and Dr. Claudette Chase. It has given me much to reflect upon*. I know there is much for me to learn and unlearn, to examine biases and sit with the discomfort in the process. Knowing is not enough, it is what we do with our knowledge and our voices that allow us to truly work towards allyship.

Why did I stay silent when observing racist behaviours? Because I wanted to avoid conflict? Because I wanted people to like me? Because I wanted to ‘fit in’? Because being silent was just plain easier than standing up and using my voice? Of course, I wish I could have acted with courage and today, I wish I could promise that I will never be complicit again. But what I have come to understand, is that the journey towards allyship is a lifelong process of learning; making mistakes and trying again and again to get it right. As my friend Dr. Neckoway says, “there is no impossible goal, only impossible timelines.”

Back in my car, I think of my patient’s face. A smile between us as we sat together on that flight through the matte of the blackest of black night sky. A woman and a mom, like me – a fierce love for her children, a protective hand on her belly. But unlike me, to simply give life to her unborn babe, she faced innumerable barriers that I, as a white woman, would never have even needed to consider. My anger dissolves into shame and sadness. It was absolutely her right, her human right to have equitable access to quality, culturally safe health care, regardless of where she lived. My feelings otherwise most certainly contribute to the ongoing systemic racism that Indigenous people (including my patient that night) face at every turn, just in simply accessing health care. It is the broken, racist system, not the patient who is to blame. By turning my anger towards my patient, I am no different than those whose lips spoke unthinkable things about Joyce Echaquan a year and a half ago.

Alone, without support, her face blocked by the blue drape separating us in the OR, I can hear my patient giggle at the first cry of her newborn. I am quietly humbled by her courage. I know I need to do better. We all need to do better. It’s a privilege that we need to take responsibility for. It is uncomfortable and messy and fraught with inevitable blunders but as we examine our biases and continue to self-reflect upon our motivations for avoiding difficult conversations and defaulting to blaming others, together we can ensure that Joyce’s story will never again be repeated.

A woman smudges during a march to demand justice and raise awareness for Joyce Echaquan, an indigenous woman, who recently died while subjected to insults, at a Quebec hospital, in Montreal, Quebec, Canada October 3, 2020. REUTERS/Christinne Muschi

Join a movement that’s already in motion: (a list by Dr. Neckoway)

  • Learn! (Read, listen to podcasts & lectures, watch documentaries and films. Audit who you’re learning from. Be selective! Who’s voice are you hearing? Prioritize BIPOC voices)
  • Donate (your time, your money, your ear)
  • Protest
  • Join (you don’t have to recreate the wheel). Ask permission.
  • Listen, listen, listen. Stop, and listen some more.

Resources:

*Even in writing this piece, I am critical of my voice here. Is this performative allyship? What does it look like under the surface - the actions that aren't transferrable to a blog or to a social media platform?

Covid anniversary

One year ago. Just twelve months, but seems like a lifetime.

A year ago, Alice was ripping the slopes at Whitewater. A year ago, the kids hugged their babysitter without reservation. A year ago, Blake and I had apres-ski beers at a packed pub, shaking hands, passing around drinks. A year ago, at the library LEGO club, Henry scooted between twenty other snotty-nosed kids scouring for that perfect LEGO piece to complete his creation.

A year ago, Henry didn’t have a mullet and my husband wasn’t sporting a COVID beard – a beard of protest and mourning, he says.

The COVID beard in all of its glory. Honestly, I am the world’s most accepting and patient wife.

A year ago, we were happily tucked away in the heart of the Kootenay Mountains on our annual trek to BC. Our month of uninterrupted family time cut short by a rapid escalation of fears and innumerable unknowns. An email from our hospital’s CEO crashing into my blissed out state: “All contract MDs, please return to Sioux Lookout as soon as possible. You will be required to remain in the Region for the next foreseeable future.” A hasty cancellation of plane tickets and an unplanned road trip across the country.

Remember those first few weeks? Email inboxes flooded with minute-to-minute updates, ever-changing protocols, rapid organization of virtual meetings. An Torontonian ICU doctor teaching us family physicians how to treat COVID-19 pneumonia – a seemingly futile race against overwhelmed air sacs filling with fluid, rapidly drowning their patient. Could our hospital’s post-op recovery area be a suitable improvised ICU? Where would be the ideal locale of a temporary morgue? The local Rec Centre? Perfect.

Blake’s 3-D printer grinding out face-shield after face-shield in our basement.

Daily anxiety grumbling in the background while Blake and I negotiated exhausting, non-stop, NASA-level decisions. Could the kids have indoor playdates? Could we see Uncle Johnny? Is it safe to exchange books with other families without disinfecting each page?

March 23rd. Alice, Henry and my To-Do List 🙂

Our storage room overflowing with dried chickpeas. Blake chastising me for putting two sources of protein in the curry. Ration. Consider the supply chain. Groceries quarantined to the garage before being invited into the fridge. Fear simmering, ever-present.

My first days back at work – confusing and cumbersome. Like I was back in medical school, awkwardly following my staff into the bathroom. A beast of a machine occupying the corner of Labour Room 3, sucking air through a ham-handedly installed ventilation system. Now it be used as an OR for c-sections, just in case! Neonatal resus equipment individually placed in ziploc bags. Have you memorized which type of N95 mask you were fit-tested for? Would there even be one if you needed it?

I once loved to dress up for work. As my dear friend and colleague Megan Bollinger always said, ‘No one will ever tell you you look tired if you’re wearing a cute dress!’ But scrubs were now the daily, mandatory uniform, stripped off while standing in an improvised, plastic drop-sheet anteroom, then placed directly into the wash like toxic waste. Full shower before welcoming tiny hugs. Repeat times a hundred every time you enter and leave the hospital.

Ah, but the thing about being a parent is that despite the fact that the world is literally imploding, kids’ ever-constant needs are always at the forefront. Pulling you to the present. What activities do I have planned for tomorrow’s makeshift homeschooling shit-show? Alice, why did you take off Henry’s pants? Henry, it’s not even 7am yet. Why the hell are you on top of the refrigerator?! The current death toll in Italy is irrelevant if you don’t have a plan for dinner and the kids are advancing into the hangry zone.

Those early pandemic days. Moving slowly through the hours, day by day.

Blake’s puppet show 🙂

It’s been a year for all of us. We’ve pulled together in so many ways as a community and as a family. However reflecting on these past twelve months and all we have been through, what I most proud about is here we are, a year later and Blake and I are still together, facing the uncertainty, the highs and lows and everything in between. You don’t have to be a psychologist to hypothesize why divorce rates have been steadily increasing during this pandemic. Start with a high-stress job, throw in geographical isolation and two insanely loud and active kids, remove all supports like childcare and help with housecleaning then add in a total lack of routine and predictability while trying to exist together in a the same physical space 24/7. It’s an obvious recipe for a goddamn disaster!

Things have been broken, words have been said (well, let’s face it – screamed is a more accurate descriptor) and sometimes stone-walled silence has been the adult equivalent to the childhood cereal box barricade. But we’ve gotten through and although I’m hesitant to say this, maybe, just possibly we are closer and our relationship is stronger for it. For the past year and a half, Blake and I have dutifully sat down in front of my laptop every other week to meet up with our couples therapist. Of course Blake rolls his eyes with every reminder that we have a session coming up, but recently, he described marriage counselling to a friend as ‘not that bad’! I’ll take it!

So, happy COVID anniversary Blake. Thanks for not divorcing me. Thanks for carrying me through those times when I was drowning in anxiety. Thanks for riding out the scariest moments with more steadfast grace than I ever thought you could possibly embody. Thanks for parenting these crazies with me and for all of those quiet, touching parenting moments that no one ever sees. Thanks for being my touchstone through all of this. Here’s hoping we will only ever have one COVID anniversary to celebrate. I love you.

Just good Enough

At the bathroom sink, I stand motionless, my toothbrush poised mid-air. Minty foam slides down from the bristles onto my hand, ignored as a silent sob catches in my throat, pulling at my chest and stealing my breath. I stare hard at my reflection as tears inevitably spill from my red-rimmed eyes. Anger and shame take hold. “Shit, shit shit,” I hiss at my tired face. What the hell had I done?!

Behind me, Blake casually saunters in, nudging me aside for real estate at the sink. “What’s up with you?” he mumbles, brushing his teeth. “Why are you crying now?!” he teases. I abandon my toothbrush and cover my face with my hands, sobbing fully now. “I fucked up, Blake. I’m such a shit parent,” I bawl. “I snapped at Alice tonight, putting her to sleep. She was screaming at me and refusing to get into bed. I yelled back at her. In her face!” I cry harder. There is more, but I can hardly bring myself to form the words. I feel nauseous.

Blake pulls me towards him and I bury my face in his chest. “I yell at Alice all the time!” he laughs jokingly. “It’s fine. She’ll be fine!” I grimace, forcing the words. “There’s more though… fuck, Blake. She hit me and I… I swatted her back. In the face. Not hard, but I hit her! In the face! On her birthday! I’ve never done that before. I don’t know what happened. I just snapped! And now I’m going to have to live with this forever! What a fuck up I am!” I’m sobbing again, streaming muffled words into the refuge of Blake’s now damp hoodie.

“It’s ok,” Blake reassures me gently. Without looking at him, I can tell he’s holding back a smile. “Man, kids will do that to you. Push you so hard, so hard until you break. It’s ok, Celia. She’ll be ok. But yeah, that’s bad. On her birthday!” he laughs teasingly. I smile fleetingly, rolling my eyes before spilling tears anew.

Today was Alice’s birthday. My charismatic, obstinate, fierce, rough and tumble force of a daughter is a baby no longer – a milestone pushing Blake and I officially out of the baby/toddler/preschool parenting phase forever. Her fifth birthday – an occasion I had now royally messed up. As usual, my expectations of a fun-filled, relaxed family birthday night had resulted in two overtired, screaming kids complete with the slamming of doors, the stomping of feet and the refusal of any cooperation whatsoever in the late-night, post-movie bedtime hustle. Typical. All the best laid plans…

Later that night, in the darkness of Alice’s room, I lie on the floor, resting my cheek next to hers watching her chest rise and fall. Silently, I apologize to her relaxed, chubby face. “I’m sorry Alice. I lost my temper. I ruined your birthday. I’m so sorry”. I fight the urge to fall down the hole of self-shame and, instead, repeat my well-worn mantra: “You’re good enough parent. Today, you messed up, but give yourself grace. Alice is resilient, she will be ok.” As always, like a beacon of light during a storm, I hold tight to the idea that as parents, we simply cannot be perfect. Mistakes will happen and as long as we reach for self-forgiveness rather than self-shame while showing our children how to make amends, they will not be forever broken.

Laying there in the purple glow of her nightlight my mind wanders through the haziness of the past five years of Alice’s life. It’s hard to comprehend – the compression of infinitely long, lonely, sleepless nights, nursing Alice hourly through weeks of colic, the slow days of parenting two littles under 18 months, the elation and anguish of returning to full-time work leaving a four month-old and a twenty month-old home with Blake. Those early years, so dear yet so incredibly difficult all melded together in my mind. It scares me, truthfully, how little I distinctly remember.

Recently, as I prepared a lecture for my colleagues, I had come across a photo of myself with baby Alice at work. It caught me off-guard – the overwhelm of emotion for that young woman in the photo. I wish I could reach back through time to reassure her she was a good mom, to hold her and tell her that she would get through. I wish I could grab her by the shoulders fiercely and say, “You’re doing it! You ARE doing it!” Grinding through those long workdays to stay established in her practice, balancing the demands of a young family, navigating a marriage through a tough, long season of parenting of littles – there was so so much on that young woman’s shoulders. So, so much.

‘Hang onto your kids, the years, they go so fast,’ they say.

”The days are long, but the years are short. Don’t blink, you’ll miss it all’

Back in Alice’s bedroom, dripping silent tears onto Alice’s sweet face, I hold that photo in my mind realizing that although it was anger that forced its way to the surface tonight, it was truthfully the result of immense grief simmering just below. Had I blinked? Had I missed it all? Had I done it right? Those cherished first years of my child’s life – had I lost them forever? Never would I hold my baby to my breast. Never would I celebrate those precious firsts – first steps, first word, first day of school, first tooth. Never would I feel the weight of my sleeping babe on my chest, rocking softly in the wee hours of the night. I was a parent of littles no longer.

Yet, although the days of sweet toddler kisses and newborn snuggles may be through, like the change of seasons, a new stage of life, of parenting, of marriage is upon us. When the days are consumed with the demands of keeping two energetic, wild, red-headed toddlers alive, there simply is little time for anything else. Within those early years, I have lost so much of myself – sucked into the vortex of parenting and just keeping afloat. Parenting through those young years has also been the most difficult season of our marriage, without question. There is good reason that they say to never consider divorce until everyone is sleeping through the night and all kids are over the age of five. Before that, can you even hear what your partner is saying to you above the constant barrage of ‘Mommmmmmmmmmms!!!’, endless crying, constant whining and seemingly incessant meltdowns?

These days, although the meltdowns are still ever-present, Blake and I find time to enjoy each other’s company, to play, to become friends again. I also have slowly and deliberately carved out more time for myself to figure out who I am and what brings me joy. Losing myself in my book, learning to strengthen my body at the gym, grounding myself in nature, connecting with girlfriends and often just sitting alone have been novelties for me as our kids grow and need me less. Recently, I even began playing the piano – something I haven’t done in twenty years!

In moving through this parenting milestone, although I feel the loss of those early years so heavily, I look towards the next journey as a mother, a wife and as a person with more self-compassion, empathy and forgiveness. I am not a perfect parent, but I can be good enough. And tonight, that will just have to be enough.

Just Listen

“Please start by telling me your name and what you do,” the woman requests in a clinically-intoned, French-Canadian accent.

“Well, my name is Celia Sprague and I’m a rural family doctor, ” I reply hesitantly. “I primarily do maternity care and acute care in our ER. I work for mostly Indigenous families and am employed by a First Nations Health Authority here in Sioux Lookout …” I trail off.

A pause.

“Right, and do you provide care for COVID patients?”

“Not directly. I mean, fortunately because of how isolated our community is, we are geographically protected. Our numbers are quite reasonable.”

The social worker continues. “This is a mental health program to support frontline workers affected by COVID. How do you foresee this service applies to you?” She sounds uncertain or perhaps I am fabricating the skepticism in her voice. Do I deserve mental health support? Presumably the focus should be on my southern Ontario care counterparts who are in the thick of the pandemic.

I falter. How do wrap up my clinical life, the stresses at home, the serrated edges of my ability to cope into a tight, clinical sentence that she can enter into the prescribed box on my intake form?

Weeks ago, when our Medical Director had forwarded around a flyer offering extra virtual mental health and psychiatry support services for healthcare workers amidst the pandemic, I had immediately signed up. In my six years of practice, not once had a similar offer been presented to me. Paradoxically, it was absolutely mandatory to maintain acute life-saving skills of various course acronyms: ACLS, ATLS, NRP, ALARM, etc. in order to be allowed to practice medicine, however, no one seemingly gave much consideration as to how physicians were to actually cope with the fall-out of these dire situations that we were being trained to manage. I always thought it quite bizarre that physicians weren’t similarly mandated to attend mental health sessions to shoulder the day-to-day burden of our clinical lives.

Into my iPhone, I exhale deeply and then launch into a description of the massive burden of social disparities that our patients face every single day: lack of running water, over-crowding, food-insecurity, sexual and physical violence. I tell the social worker about the pervasive addictions issues and disproportionate mental health diagnoses in our communities related to historical and intergenerational trauma. I speak of the social isolation of our patients and the multitude of challenges they face, exacerbated many-fold by COVID.

I can’t stop myself now.

I go on to describe caring for women whose charts are pock-marked with suicidal attempts and assaults throughout their lives. I describe the sleepless nights, haunted by the faces of women and their children stuck within the cyclical vortex of trauma and addiction. I share a recent story of a woman whose delivery had been high-risk, with multiple complications and her tiny newborn had required hours of life-saving intervention before being whisked off to Winnipeg’s NICU by medivac. I describe to the social worker how my patient had turned her pale face to the wall and had simply closed her eyes, shutting me and my words out when I had gently attempted to described how her little one was struggling to breathe. Freshly recovering from surgery, she hadn’t even had had the chance to meet her son before he was placed in an isoylet for transport to the big city.

Barely pausing for a breath, my voice is tight as I explain further that, no, I am not directly caring for COVID patients, but every single day myself and my colleagues bear witness to so, so much. Our job is an honour and I am grateful to be able to do what I do, but how can I continue, if I can’t even hug my colleague, console her with touch and care when carrying our patients’ stories in our heavy hearts?

I’ve finally run out of words and the space left hanging is filled quietly by the French-Canadian stranger on the other end of the line, worlds away in the nation’s capital. “Well,” she responds gently, “I do, in fact think you qualify for services. I can schedule you for your first session this week. It will be a series of six sessions of grief-focused therapy.”

Grief therapy? Not therapy for depression or anxiety? Grief. Presented matter of factly without any other option. I’m puzzled for a moment. In my clinical mind, I have always reserved bereavement or grief therapy for those who have been affected by loss of a loved one – my patient reeling from her second miscarriage in a row, a young man mourning the death of his grandfather, a family grappling with the end-of-life care of their mother. But me? Grief therapy?

“I’ve wondered if grief is transferable or whether, as physicians, we’ve witnessed and internalized so much secondary trauma that it simply takes a high-pressure situation (like a pandemic) and a slight nudge toward guilt and shock to completely undo us.”

Lalita Abhyankar, M.D., M.H.S., AAFP

Yet, in the seconds that my mind processes this proposition, I feel a surge bubbling through my body, erupting inexplicably and suddenly, I begin to weep. I cry non-stop for what seems to be a long, uncomfortable time. Each time I try to pull it together, I can only manage to squeak out an “I’m sorry”, before sobbing anew. Thankfully, my intake interview was scheduled for a full hour and so I cry for a large proportion of that time. It feels good, a relief to have someone else give a name to what I feel.

Grief in the form of anguish that I feel for my patients and their immeasurable suffering and the sensation of utter hopelessness that I can do so little to change it. The pain, in turn, related to the secondary trauma that I am drowning in. Sorrow over the loss of the little things that shape our social existences that this pandemic has ruthlessly stolen. Heartbreak in the absence of visits with our extended family and close friends. Sadness at the loss of Holiday rituals. Despair over the state of our environment as political and economic priority lists are topped by the pandemic. Grief, so acutely, hangs at the corners of every aspect of life – not so fully that the view is obscured completely, but heavy enough to pull at the edges.

As we prepare for the holiday season, of course, I feel that it is important, maybe more now than ever, to celebrate what we can. I celebrate that each day, I am awoken to tiny hands on my cheek and sleepy hugs. I celebrate my health by moving my body, building strength and relishing in the power that that euphoric feeling brings. I celebrate that each day I enter the hospital, I am honoured with patients’ stories and access to the most intimate moments of their lives regardless of whether I have known them for five minutes or five years, all based on the privileged, inherent trust between patient and physician. I celebrate the resiliency of our patients, families and communities and hold on to those witnessed, simple moments of joy between partners, grandparents and siblings as we help welcome new littles ones every day to the world.

Yet, acknowledging our good fortunes will never fully ease that tension, tugging at the corners, threatening to pull darkness over our vision. The holidays, at the best of times, are often fraught with difficult memories and recognition of those who are no longer with us. So if you, like me, find yourself unexpectedly splashing tears onto cheery Christmas wrapping or are struggling to lean fully into the presumed merriment of this season, put a name to those feelings and reach out for help. As for me, there is hope – my first grief session begins next week.

https://www.cbc.ca/life/wellness/virtual-therapy-how-to-find-the-online-mental-health-care-provider-that-s-right-for-you-1.5551424

https://www.ccmhs-ccsms.ca/mental-health-resources-1

Let’s Play

“Mommmmm!” Alice exclaims giggling. “What are you doing?!”

Eyes wide, with a huge smile plastered onto her face, Alice watches me in wonder. Her expression is caught between utter surprise and jubilation. Uninhibited and undeterred by Alice’s giggling protests, I shimmy across the hardwood floor, my sheepskin slippers moonwalking, twirling and prancing around the kitchen island in ridiculous imitations of the Funky Chicken and the Camel Walk. James Brown blasts from the speaker as my hips sway side-to-side to the beat. Just like my Dad, (nicknamed the Duke in his young life for his musical and dance-floor moves) who used to embarrass us as kids to no end with his guitar renditions of the Dukie Blues combined with his enthusiastic dance moves, I raise my spatula microphone to my lips and let out exuberant “Ohhh’s!” and “Yeah’s” while pointing to my audience of one. Alice responds in peels of laughter, unable to contain herself in witnessing the apparent unravelling of her mother. I laugh too, out of breath from my funk-induced impromptu dance routine. It’s a simple moment, unmentionable and insignificant to the casual passerby but means everything to me.

In this moment, I am wholeheartedly and completely present. Only a single thought surfaces into my brain: “I feel so happy!” It’s a curious thought in its rarity. I see it, feel it and turn it over in my mind with wonder. What is this thing that Alice and I are doing that has caused such joy?!

For those who know me, you know that I am often inspired, moved and challenged by the work of Dr. Brene Brown. Recently, I have been following her new podcast entitled, Unlocking Us and last month, Dr. Brown discussed a smattering of relevant and timely topics. As we all grind past the six (now seventh!) month mark of this ongoing pandemic, I don’t believe that I am alone in feeling COVID burnout. I couldn’t quite name it or put my finger on it, but certainly the past two months have felt like a slog to beat all slogs. Brown, however, nails it on the head with a gentle reminder of the concept of surge capacity.

In the world of medicine, surge capacity refers to the measured ability to provide care for a rapid influx of patients. Pre-COVID, this was a recurrent aspect of our practice. With far greater patients than hospital beds or other finite resources, as health care workers, we often have to find creative and innovative ways to not only create space but to continue to stretch resources to ensure care provision for the duration of the surge, be that until the end of your ER shift or the end of a multi-casualty trauma.

When we think of own lives, without a doubt, this idea must similarly resonate. You bring home a newborn into the fray of life with an already needy toddler and a busy kindergartner. A co-worker leaves unexpectedly and their portfolio lands in your lap without warning. You get sick, but the day-to-day running of the household remains on your shoulders. Demands outweigh resources time and time again. Often, though, this is temporary. You hire a housecleaner or a babysitter to lighten the load. You delegate tasks at work. You lean on friends and family for support. Balance eventually is restored again.

Brown reminds us that, “Surge capacity is a collection of adaptive systems, mental and physical, that humans draw on for short-term survival in acutely stressful situations such as natural disasters.” What is strikingly different when we consider the pandemic is that our natural coping mechanisms, such as social connections and the usual rhythms of day-to-day life which anchor us, have been unmercifully and abruptly eliminated. As Brown describes, “It is like as someone who lives on the Gulf Coast and has been through my share of hurricanes, it’s like the wind is breaking the windows and we’re in clean up at the same time. It’s too much to ask some days. So, our surge capacity is maxed out and we need to find a new source of energy.”

Our surge capacity is maxed out.

Over this past half-year, we have all grieved, then rallied and have mustered the energy to cling to resilience. But now, we face a six-month wall. How can we cope? How can we continue forward? For how long? How can we find light in the looming winter months?

Not to spiral here, but I struggle personally when widening my perspective. When grappling with major issues such as climate change, the political scene south of the border, decades-long boil water advisories in Indigenous communities in our Region, not to mention the current pandemic, it can just be too much.

While I am not advocating for anyone to put their head in the sand (although, I have to be honest, many days I wish I could), we absolutely need new ways to cope in order to continue to fight injustice, to advocate for others or to simply get out of bed in the morning.

Brene Brown’s suggestion is simple. Play.

Ok, stick with me here. If you’re like me, this is the part where I started to tune out. Play? Who’s got time for that. Sorry, I’m busy over here adulting. In Brene Brown’s podcast, she reminds us that play is defined as “time spent without purpose”. Time spent without purpose?! Are you kidding me?! Honestly, when I listened to this, I had a whole body cringe. It’s like the time Blake recently challenged me to sit on the couch and ‘do nothing’ for 20 minutes. He stood up, set a timer then watched me squirm for 20 full, uncomfortable minutes.

‘Doing Nothing’ is not a forte of mine. When Henry calls me to his room to play LEGO, after a mere 30 seconds of sitting on the floor, surrounded by blocks spilled in all directions, I often find myself sorting and tidying those millions of pieces rather than just creating. Watching Henry with his LEGOs, play comes so naturally; creating, spending time with no mind to the clock, uninhibited, just doing what he loves. I also remember a time in my childhood, when similarly, I would lose hours reading through stacks of books or endlessly painting abstract watercolours on rolls of newsprint. Where along the way did this childlike way of being slip away?

Henry’s room, at any given time 🙂

Recently, during a couples therapy session, Blake and I were circling a familiar conversation. Blake couldn’t understand why, after a full day of stressful work, I come home and start cleaning the house instead of falling onto the couch as he would do. In retaliation, I balked at the idea of letting the to-do list go – it would just be there for me to do in the morning! I turned to our therapist for support with a look that said, ‘Can you even believe this? Don’t you agree?!’ I was taken aback when he responded with a question; “Celia, I agree. It is hard to let some of these seemingly important things go. But I’m curious, what kind of a feeling in your home do you want to cultivate? For you? For your kids? For Blake?”

I thought back to a recent ER shift where a resident had been observing me in an encounter with a young, medically complex woman reeling from the sequale of advanced liver disease. It was a complicated case and her prognosis was poor. I had spoken to multiple specialties in trying to figure out the best possible medical management that I could offer her and had spent a great deal of time correcting the many imbalances of her breathing, her failing kidneys and strained heart. At the end of our encounter, I had ensured that she had felt comfortable, took a few extra minutes to tuck a warm blanket around her atrophied legs and collected an armful of snacks for her support person who had been by her side for hours. As I swished the curtain of her ER bay closed behind me, I turned to the resident. “You know, in medicine, it’s never what you did for the patient, but it’s how you made them feel. She will never know if I corrected her potassium appropriately or adjusted her meds as best as I could, but what she will remember was how I made her feel – hopefully, she felt heard, safe and cared for. It’s the most important thing that you can do.”

Shifting my focus back to our therapist, I began to understand what he was pushing me to realize. Of course we cannot shy away from the mountain of life’s responsibilities or the crushing realities weighing on our current global community, but when my children recall their childhood memories, like my ER patient, they will never recall if the counters were clean or if their LEGOs were sorted by size, but they will remember how they felt. Like all parents, all I want for them is to feel safe, happy and loved.

So, as we move into this next season with our collective surge capacity at its max, I have made myself a ‘play’ list – activities in which I can lose myself in, create a feeling of joy in our home and draw from for a new source of energy to get through this massive wall that I feel up against.

I’ll finish this post off with a quote from Brown, because she summarizes so eloquently the need for play for all of us right now:

“Play is this incredible source of energy that’s easy to forget about. And let me share something with you that’s really important for me, and we can have different opinions on this, we can… There can be dissent as long as it’s future thinking and playful. Some people might say right now, ‘This is no time for play. Our democracy is on the line. The world is falling apart. We’ve got work to do.’ Hell yes, I agree on all accounts, but… And I wrote about this in Braving the Wilderness, but our hearts are expansive and big, and as the poem goes, contain multitudes. We can’t fight on no energy, we can’t fight for love unless we’re experiencing it, we can’t fight for joy unless we know joy. And so I’m not saying back away from the revolution or the fight, because I don’t plan to do that, but I do need an energy source, not only for the fight, but just to get me through my day and keep me in loving relationship with the people I care about.”

Play on, my friends.

Summer Sisters

The moment my paddle hits the surface, everything changes. My muscles stretch and contract, lengthening and pulling against the glassy, indigo water. With every stroke, I feel the suffocation of my endless worries mercifully subside. Each apprehension is packaged neatly into its own droplet of water falling off my paddle’s tip,  outlining a perfect arc as I reach towards my next stroke. Stresses gripping my wakeful nights, now smoothed out into nothing but horizonless lakes, trees and granite. My breath aligns with my paddle’s cadence and calm takes the reins. Timidly at first, but bolder with each stroke, I lean into that small flame of joy that always awaits my soul in the backcountry. As my edginess mellows, the imagined catastrophe that never befalls brings new confidence. This warming always takes time, searching for someone or something to give me permission to truly let it all go. As the bow slices the velvety surface, the rhythm of my paddle brings peace and the lean of great white pines abound soothe my anxious mind. This is where I know I need to be.

Driven by my need to escape the busyness of life that can be all-consuming, I have heavily guarded a precious four days each July for our annual women’s canoe trip. Initially motivated by a yearning to restore a sense self during a time when I was held captive by cloth diapers and incapacitated by the constant demands of full-time work and the ceaseless needs of one-year-old Alice and two-year-old Henry, a group of my core girlfriends and I escaped into the wilderness for reprieve – Women in Wilderness was born. Since then, each summer, despite busy careers, commitments to partners and families and other competing interests, we have rallied in our canoes to paddle away from responsibility and back toward our selves. Our group has fluxed over the years, but our core group of women has remained constant, driving our escape to the backcountry

This year, after an extensive virtual group discussion, we settled upon a route which took us to Canada’s canoeing capital. An iconic and wilderness-class park, Quetico Provincial Park is recognized globally as the place for backcountry canoeing. Boasting over 2,000 pristine lakes and over 460,000 ha of (now) industry-free wilderness set aside strictly for canoeists, Quetico has a long-standing reputation for low-impact camping with bylaws that have stayed true to its original wild intention; no marked trails or campsites, no man-made structures, only the wilderness in its truest form with lakes so clean that a dip of the hand beside the gunnel to fill your Nalgene brings potable water. As each access point allows limited entry into the gargantuan space of undeveloped land, the magic of Quetico is allowing oneself to be intentionally and fully alone. Blake and I have been fortunate to have paddled in Quetico together over the years and have never been disappointed. This year, despite choosing an easygoing, popular route, our women’s trip was no exception; we had the park to ourselves.

For four blissful days, we paddled. Gone were our constant COVID worries – distancing outdoors in the expansive space was easily done. We laughed, we cried, we drank, we ate, we played and our cups were filled to the brim. Six fierce women with talents and strengths abound, all shamelessly putting themselves first and teaching me to lean fearlessly into that flame of joy. Thank you, my dear friends. I can’t wait to see what next summer’s paddling adventure brings!

Hitting the water on Day 1 on Pickerel Lake

Don’t let this picture fool you, just around the next point, we paddled into a super strong headwind for the rest of the day!

“The path of the paddle can be a means of getting things back to their original perspective.” – Bill Mason

On Day 2, we paddled through Pickerel Narrows through a few small portages to get to Buckingham Lake where we were the only souls around!

“Time is like a river. You cannot touch the same water twice, because the flow that has passed will never pass again. Enjoy every moment of your life.” – Author unknown

Starting Day 3 with cappuccinos made by our belle of a barista, Lucy. Ahhhh!

Portaging our way back into Pickerel Lake.

“There is magic in the feel of a paddle and the movement of a canoe, a magic compounded of distance, adventure, solitude and peace.” -Sigurd F. Olson

Rounding out our last day of paddling with this powerhouse!

Women In Wilderness: 2020, that’s a wrap!

“What sets a canoeing expedition apart is that it purifies you more rapidly and inescapably than any other. Travel a thousand miles by train and you are a brute; pedal 500 on a bicycle and you remain basically a bourgeois; paddle a hundred in a canoe and you are already a child of nature.” – Pierre Trudeau

back to school

Photo by Daniel Frank on Pexels.com

The shift is often subtle, but never unmistaken. The nights bring its refreshing cool air which then lingers past dawn like an unwelcome overnight guest. The vital rains that quench eager garden beds arrive more often, driving chubby beach babes indoors to smear glitter paint across counters. Evening ‘lake baths’ return to the confines of the lavender-scented, bubbling tub . School registration pops into mind. Pumpkin-spiced beverages top chalk-on-blackboard coffeehouse menus.

Ordinarily, I welcome the Fall; it is my preferred season. After hot, sunny days basking on the sand, I look forward to the colder, cozy evenings on the couch. While hastily, thrown-together meals featuring fare requiring as minimal dish ware and cutlery as possible have been the norm, I revel in the smells of one-pot meals, stewing in the slow cooker. Although I am not alone in my love for simple summer days, I excite in the shift in seasons and the second restart of the year. Long-sleeves and a pristine, crisp planner herald the launch of reenergized routines branching from our long, unstructured summer days.

This year, as the Northern Hemisphere tips away from the sun, my usual eagerness for Fall’s offerings are lacking. Much has changed for all of us during these past six months and the future stretches wide in a yawning abyss of more unknowns. Our kitchen hosts strained conversations as Blake and I struggle with decisions around our children returning to school. Laden with COVID-fatigue, these discussions repeatedly lead to tears as I try shed my grief and attempt desperately to come to terms with the forever lost image of Alice and Henry, walking hand-in-hand into their first day of school. Grade 1 and JK; what an important year! Hair brushed, skin scrubbed, backpacks gleaming, excitement bubbling and normalcy prevailing. I want this so desperately for them. And for me. Yet instead, Blake and I shout across the kitchen island, agonizing over every aspect of what lays in front of us, both of us hurling angry arguments while sadness simmers beneath. Should they do online school and ‘learn’, glassy-eyed in front of a screen? Should we try to homeschool with already stretched schedules and a long, isolated winter in front of us? Should they return to in-person school knowing full well that a second wave will surely befall us? Are we making the right decisions for them? For us? Kitchen conversations that are surely repeated in homes across our country.

Greeting Henry off the bus from Kindergarten
Last year’s back to school poses 🙂

It has been six years since our move to Sioux Lookout. Me, six-months pregnant and newly graduated out of Family Medicine Residency, I was impatient to sink my teeth into my rural medicine practice. Blake, always willing to walk into the next adventure with me had been on-board, but we had had a five-year plan. Sioux Lookout, although endearing in many ways, was not to be our forever home.

Pregnant with Henry, learning to fish on Abram Lake

So last year, after many agonizing debates between us, Blake and I became the proud new owners of 34 acres of land outside of Thunder Bay; a swath of property stretched below the Norwester mountains, across a farmers field, a beaver pond fed by a snaking stream and flanked by acres and acres of densely-treed bush. It was here, we had planned, to build a home for our family.

After a year of planning, pre-COVID, we had been set to begin the construction of a passively-heated house in the Spring of 2020. Gone would be our reliance on fossil fuels to heat our home. Specialty windows to keep the solar-heated air contained without possible escape were on their way from Poland. Walls, four-feet thick to insulate against the deep cold of the North, were due to be constructed and shipped from Southern Ontario. A crew was on stand-by to assemble the pieces together like a gigantic gingerbread house. A move-in date was circled on the family calendar. By the beginning of the school year, we had been slated to kick off a new chapter for our family.

Now, as I write this, our move-in date has come and gone and only a rickety trailer holds space for our dream home.

Our family has been enormously fortuitous throughout this pandemic. Our livelihoods have not been pulled out from under us, our health has remained sound and our day-to-day lives in our remote community have been minimally affected compared to our urban neighbours. However, although Blake and I speak of our good fortunes regularly as we scroll through the CBC’s news headlines, I still sense a guilt-laden despondence over the loss of our family’s plans. Comparative suffering, however, seldom brings relief. This year was supposed to have been a big one for us and COVID has, of course, changed everything. I remind myself that it is ok to grieve. To shed tears for the bright faces that will be masked for back-to-school photos. To feel sadness over the lost hopes, best-laid plans and dreams of new adventures. As our collective community moves through this change of seasons, the cool autumn air bringing new uncertainties and fears, we can only cling to hope and lean into our resilience as the way forward. Best of luck to all in this time of transition.

Photo by Gelgas Airlangga on Pexels.com

Fly-In to the Boonies

500 feet above the ground, the floatplane is jostled by the gusting winds as we fly directly into a front of driving rain. My stomach pitches and I close my eyes, concentrating on my breath. A bead of sweat lazily wets a trail down the back of my leg as I welcome the onslaught of rain droplets against my face, pelting through the pilot’s cracked window which is the only source of air conditioning on the 1950s Beaver. The soft-faced, young pilot turns to nod his head towards our window, the engine’s roar filling the small space of the plane’s body. Below us, two adult moose stand nonchalantly, knee-deep in the bog, ambivalent to our presence overhead. Their massive outlines appear toy-like from our vantage point. Beyond them, the tree-lined horizon stretches infinitely, dotted with endless clear-blue lake and swaths of black spruce stands. Cliffs of mighty granite jut obtusely from the earth outlining the contours of the bush. As far as the eye can see, there is emptiness, without a singular trace of human presence, yet there is abounding life in the land’s natural form. I feel small, humbled and grateful.

Beside me, Alice’s small body slumps against my side, tucked sweatily under my outstretched arm. Her sunburnt cheeks jiggle deliciously in rhythm with the engine’s hum, her lips slightly parted in a state of deep slumber. I smooth her tangled hair and smile. Her image is summer perfection: dirty feet, mosquito-marked little legs, sandy hands and a suncreen-scented neck. I am reminded of my own childhood self spent running barefoot across the rocky Canadian Shield shoreline, slipping naked endlessly in and out of the water on backcountry canoe trips with my family. Without consciously planning it, I realize how similar our summer childhood experiences have been and I am glad. How fortunate we have been to be able to gift our children these memories.

After three days of disconnected bliss, Blake, Henry, Alice, Ada and I were en-route home via floatplane. While waiting for the bush pilot to come pick us up at our outpost camp, I had polled our crew for their staycation highlights:

  • Blake: ‘Late fishing’ with Henry and Alice
  • Henry: No work days for Mom and playing with quick sand
  • Alice: S’mores
  • Ada: Endless creature-chasing at the beach
  • Me: No cell phone service

Inspired by Bob Allen’s children’s book ‘Fly-in to the Boonies’, we had jumped at the unique opportunity to get off the grid for a family getaway at a fishing outpost, tucked about 50 kms from our home on the northeastern tip of Lac Seul. As the second largest body of freshwater solely within Ontario’s borders, Lac Seul is a massive, 240km-long, crescent-shaped lake widely known for its legendary, world-class walleye and muskie fishing which draws largely American anglers year after year to its outposts in hopes of landing trophy-worthy fish. For locals, this experience is largely made off-limits by the cross-border tourists who book years in advance to access these waters. During non-COVID times, I would always mark the official start of summer as Wisconsin-plated pick-ups towed expensive looking fishing rigs into town and our ER filled with fishhook-related mishaps. This year, of course, has been different. With our southern border closed to American visitors, the fishing-related tourism that many local people rely upon for their livelihoods has all but dried up resulting in rare opportunities for local ‘staycations’.

The red marker indicating the massive lake, Lac Seul, north and west of our town of Sioux Lookout
Lac Seul

For me, fishing has never been a passion, however, I do love evenings on the boat with Blake and the kids watching the sunset, spotting eagles and local wildlife all the while wrangling the kids to stay put on the boat, untangling snarled lines, breaking up fights, handing out snacks and managing the logistics of potty requests while on the water. There is never a dull moment while attempting to land a few walleye with a four and five year-old onboard!

A few weeks ago, when owners of Anderson’s Lodge (a local fishing lodge and family favourite dining spot just up the lake from our home) had mentioned they had availability for all of us to stay at one of their outposts for a family fishing staycation, we had jumped at the chance. With the ever-present demands of my work, even on my precious days ‘off’, I am often dealing with emails, phone calls and meetings. I was desperate for the opportunity to get off the grid and melt into the silence of the bush.

So, packed to the gills with snacks, smokies and s’more supplies, we had headed via floatplane to Pickerel Narrows on Lac Seul. Pristine and remote, the solar-powered cabin had been nestled on a sandy beach with not another soul to be found. Without Wifi or cell-service, we spent three full days of uninterrupted time with the kids. Our mornings were consumed with hours of leech catching, toad hunting, and chipmunk chasing barefoot on the mossy forest floor and sandy shores of Lac Seul. We munched on chips, read and napped in the quiet of the sunny afternoons and spent the evenings on the water as a family in (often retrospective) hilarity of walleye fishing with our crew. As parents of littles all understand, vacations are generally just time spent parenting as usual with a different view. As predicted, the highs were higher than high and the lows were intensely low, there were meltdowns and chaos but amid the normal pandemonium there was something so precious and rare in the moments of absolute stillness, expansive silence and the shocking realization that there was simply nothing to do – no laundry, no cooking, no emails, no meetings and no to-do list.

We are ever grateful to Meredith and Rick at Anderson’s Lodge and to Matt at Slate Falls Airways in enabling us to experience this slice of local paradise and to create so many lasting summer memories with the kids – sunburnt noses, tangled lines and marshmallow faces galore.

Daring to be

Standing at the kitchen sink, I stare blankly out the window into the blue-sky, spring morning. My fingers feel cool as they grip the edge of the dark, stone bowl. I am holding on for dear life. My chest rises against an unseen weight of three decades worth of emotional baggage, a global pandemic, stories of violence and sadness seemingly at every turn and I can’t breathe. I feel like I am crawling out of my own skin.

My breath comes quickly and shallowly as I will my body not to fall off the edge into full blown panic. Behind me, something crashes in Henry’s room and the inevitable wailing and ‘MOMMMMMMM!’ requests follow. My frenzied heart beats thunderously in my chest, matching the frantic desperation that envelopes me. Everywhere I look, I see chaos. It rudely stares me down in the coffee grinds of Blake’s last espresso, scattered across the counter. It shows itself in the hundreds of ant-sized bits of paper sprinkled all over the living room floor, matched with a forgotten pair of scissors cast down by small hands as imaginative minds have careened on to the next 4 year-old adventure. It makes itself known in the layer of crushed Goldfish left behind from snack time, in the trail of dirty socks that pepper the floor in vicinity of the empty laundry bin, in the powerful scent of urine emanating from the wall next to the toilet, outing a certain 5 year-old’s inability to aim. I am surrounded, overwhelmed and defeated. Try as I might, I am losing this endless war in which I am seemingly the solo defender.

I clench my eyes shut and try to focus. “Drop your breath, drop your breath,” I remind myself, echoing my therapist’s words in my chattering brain. Like a toddler, I hold my belly and force it to rise as I draw in air. I let it go slowly. “Again,” I command to myself. In and out, my belly protrudes and flattens, forcing my breath to slow. Despite the ongoing, incessant ‘MOMMMMMMs’, I stand my ground and breathe with my belly until the worst of it is gone. I am now at least one step back from the cliff’s edge.

Today is a ‘home day’ as Henry calls it. A gift of time to be spent entirely at home with the kids after a series of gruelling, successive days and nights of call for our local obstetrics service. This day is what I had been looking forward to all week, but I am wound tight and overwhelmed, pushed to the edge in ways that I never experience at work.

My mind carries me to the night previous, where I had attended a delivery in our rural community hospital. It had been the woman’s first delivery and the excitement that she and her partner shared was palpable. Her pregnancy and labour had been straightforward but as she entered the pushing stage, her baby’s heart beat dropped precipitously with every contraction, heralding an ominous exit through the birth canal. As the babe was soon thrust to the outside world, sickly thick, meconium-stained water pooled between the woman’s feet; the babe had had a bowel movement in utero and now his lungs were full of turbid, tarry, particulate fluid. In a glance, I knew what was coming next. Severing the connection between Mom and babe, the cord was swiftly cut and the babe’s limp, pale body was silently placed into my hands to be carried to the nearby resuscitation warmer. “Heart rate less than 100”, barked the nurse as we worked to provide breaths into the babe’s lungs, my gloved hands slippery with the pea-soup coloured fluid that coated the baby’s body. “Heart rate less than 60 now,” continued the nurse. “Start compressions,” I responded. “Call a code. I’m going to intubate.” I grabbed the laryngoscope. The metal felt cold and hard in my palm as I passed the tiny tube into the baby’s airway. My hands were moving in a knowing, methodical way, but my thoughts floated far above me, distanced from the dire scene that was unfolding. “This baby is dying now,” I thought calmly. “He is dying in front of me.” The injustice of a life ending before it had even had had a chance to begin.

Days later, as I sit prickly with sweat in front of my laptop, I describe the neonatal resuscitation to my counsellor. 1,800 km away, she tilts her head subtly to the side, without responding. I know that she is urging me to continue. “I just cannot understand why I feel so calm in the worst possible situations at work, but the sight of peanut butter smeared across the counter makes me panic and rage! It’s so ridiculous!” I am angry now. Angry at myself and my need to vent over my god-damn inability to cope with the dirty floors in my house when rubber bullets are flying at protests, racial injustices scream from online news headlines, cities are literally burning while their tyrannical political leader responds with threats of military force against its own civilians, all during a world-wide pandemic that has lost the global community’s interest; apathy that will certainly result in more lives lost.

I’m ashamed, lost and confused. My desperate need for perfection in every realm of my life, including in my own home is eroding my relationship with my husband, interfering with my ability to enjoy my kids and is suffocating my home life.

“How did I get here?” I wonder aloud, but there is a quiet knowing underneath. I know. I know, because this perfectionism dance has been my armour for my entire life. It has been my hustle for as long as I can remember, a hustle for love, a hustle for acknowledgment, a hustle for validation, a hustle for self-worthiness. When life got hard, instead of calling out for help and revealing my struggle and vulnerability, I put my head down with the belief that if only I could work that much harder, all would be well again. But I am tired, so, so very tired.

A year ago, while mindlessly surfing through Netflix, I stumbled across a thumbnail linked to an on-screen lecture by professor, researcher and storyteller, Brene Brown. I had heard of her work before through an online network of fellow Canadian female physicians and I knew the main topics of her work were shame and vulnerability. Ironically, I had passed over recommendations to read her words because I didn’t think they had really applied to me. Why did I need to learn about shame and vulnerability? This didn’t seem to relevant to my life nor did it seem to speak to me in any way. I had been raised to highly value hard work and independence; ‘when the going gets tough, the tough get going’. No time to waste with fluff, if life got hard, you put your head down and you worked harder.

This familial culture had been I’m sure, in part, passed down by my maternal grandfather who had gone from a working-class farm hand to an accomplished lawyer, member of parliament and city mayor by sheer hard work and determination. These hardwired values were apparent to me from my early childhood. I worked doggedly on school projects with an overabundant worry about my report cards from the get-go. As a teen, I participated in every high school sport, played clarinet in the school band, ran student government, skated competitively in our community and stayed up late into the night hammering out study notes on our clunky family desktop computer. I expected only the best from my teammates and from myself. I was independent and focused. I graduated with multiple academic awards, acceptances into three Canadian Ivy League Universities and received the ‘Best All-Round Female’ award – a culmination of all of my high school efforts. These traits continued to serve me well as I pushed through an academically rigorous pre-med degree at Queen’s University while working to support myself, continuing to skate competitively, volunteering at the local hospital, working with student-run organizations in health education and in Indigenous health, as well as chairing an environmental advocacy group.

Yet below the surface, I was struggling; my mental health crumbling underneath the mountain of self-ladened, unachievable expectation of perfection. My parents would call, asking me how I was doing and I would respond with generic answers, fight back tears and hastily hang up the phone as to not show them what I thought was weakness. This only fuelled the fire and made me work harder. If I only achieved more, all would be ok.

Eventually, I was accepted into medical school then into residency. In the culture of medicine, where diligence, hard work and zero regard for self-care was dogma, my ingrained notion of work ethic were only more positively reinforced. There was simply no room for fragility, emotion, or vulnerability. I was spat out on the other side of my exhausting years of training as a newlywed with a baby on the way, starting a job as a rural family physician in an isolated community serving Indigenous patients.

I had achieved ‘success’ in all senses of the word in my personal worldview; perfect family, perfect house on the lake, perfect job that I had always dreamed of, a perfect life. It was the finish line. I had done it! Years and years of sleepless nights, tears, emotional turmoil and work had resulted in these achievements. I looked around frantically. Could anyone see me? Was anyone proud? Was this enough? Was I enough yet?

With Mom & Dad at my NOSM Medical School graduation in Thunder Bay, 2012
Blake and I at my UBC Family Medicine Residency graduation, 5 months pregnant with Henry, 2014
Ada and I hiking at in our new hometown of Sioux Lookout a week before Henry was born, 2014

Opening the door into Brene Brown’s research was like painfully holding a mirror in front of my face. After watching her Netflix presentation, I immediately powered through three of her audiobooks, then bought hardcopies to re-read them, underlining ‘Aha moments’ on every page.

Dr. Brown’s research speaks about human connection and communication, how we foster a sense of belonging and become shame resilient in our lives through courage and vulnerability while working towards what she calls Wholehearted Living. Brown is a master storyteller and presents her work with captivating hilarity, yet will bring you to you knees with the simplest of truths of how all humans so desperately need to connect and to be loved. It is not an understatement to say that Brown’s work has completely revolutionized the way I parent, lead at work and connect with Blake. But most importantly, it has been the impetus to begin the journey toward myself.

When reading Daring Greatly, Brown’s 2012 book on using the tool of vulnerability to inform how we live, lead, love and parent, the margins had become scratched up with a multitude of light-bulb moments as I saw myself in her words. I realized that somewhere along the way in my life, I had switched from working hard, striving for my goals for ME, to completely hinging my self-worth on my ability to achieve for OTHERS. I was a middle child, wanting everything to be perfect and everyone to be happy and I would work my damnest to make that happen. Don’t rock the boat.

Please. Perform. Perfect. Repeat. Please. Perform. Perfect. Repeat.

Daring greatly means the courage to be vulnerable. || Brene Brown. Quote.

What I have come to realize through reading Brown’s research, however, is in this debilitating dance, I have spent my whole life ‘armouring up’ and preventing myself from truly being seen. I knew that if I let anyone peek behind the curtain, I believed that I would be certainly subject to harsh judgement and criticism and my secret would be out; I just wasn’t good enough to be truly worthy of love.

“Perfectionism is the ultimate fear… People who are walking around as perfectionists… They are ultimately afraid that the world is going to see them for who they really are and they won’t measure up.” – Oprah, in a 2013 interview with Brown

“Perfectionism is not self-improvement. Perfectionism is, at it’s core, about trying to earn approval. Most perfectionists grew up being praised for achievement and performance (grades, manners, rule following, people pleasing, appearance, sports). Somewhere along the way, they adopted this dangerous and debilitating belief system: “I am what what I accomplish and how well I accomplish it. Please. Perform. Perfect.”

Healthy striving is self-focused: How can I improve?

Perfectionism is other-focused: What will they think?

Perfectionism is a hustle.”

– from Daring Greatly by Brené Brown

Almost forty years into my life, I am only now coming to this realization that I have, and continue to live with an outside focus. I have been hustling all my life.

Of course, changing one’s core belief system is not an overnight job. To dismantle the framework upon which you have built your entire existence takes an incredible amount of work and I am literally only just taking my first steps. It is uncomfortable to say the least! I still squirm in my seat during my therapy sessions – deconstructing and examining your true, unhidden self is sometimes paralyzing. Writing these words has been beyond agonizing, but I desperately want to live my life differently, to be loved by Blake and connect with him in a deeper, more authentic way and to regard myself with compassion and empathy. Most of all, however, I want my children to know that they are loved just because they ARE and not because they DO. I have realized that the most impactful way to do this is to model these behaviours towards myself and this will be the most difficult hurdle to overcome.

Finally, in the chaotic, uncertain, terrifying world in which we all currently live, it is not shocking that Goldfish crumbs are thrusting me towards near panic. I know that I am not alone in this. Now, more than ever, Brown’s work is relevant to all of us. We need to reach inside ourselves to be brave, choose courage over comfort, demonstrate authentic vulnerability to those we trust to bring hope, true connection, resilience and healing to our own lives, our families and our communities, both big and small.

Let’s get started.

10 Guideposts for Whole Hearted Living {free printable} | Brene ...