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.

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:

• White Fragility , Robin DiAngelo
• Indigenous Allyship Toolki, Montreal Urban Aboriginal Community Strategy Netword
• The Guide to Allyship

*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?