Showing posts with label mary fernando. Show all posts
Showing posts with label mary fernando. Show all posts

13 September 2020

Wearing Masks During COVID19: How Neuroscience Can Help Us.


Never have lives depended so much on getting a buy in from the public to wear masks. The evidence that masks protect us from COVID-19 is clear and unequivocal. In terms of scientific evidence, that is. Where it all falls apart is when emotional arguments are made against wearing masks.

Many argue that we should avoid the emotional aspect of COVID and simply concentrate on the rational arguments for mask use. 

However, this argument falls apart too, because all decisions involve emotions and we can’t keep people safe without appealing to them. Why? Because that’s how our brain works.



In the 1990s, the neuroscientist and physician Antonio Damasio wrote a groundbreaking book, Descartes’ Error: Emotion Reason and the Human Brain. Through studying people with brain lesions he demonstrated how decision making necessitates emotional input: decisions cannot be made without emotional input. 



Much research has supported these findings and this has been taken into the political arena by authors like Westen and Lakoff. The basic conversation in both these books is how all political decisions involve emotional input. 



Some may feel that decision-making that necessitates emotional input is not a good thing. They will side with Descartes and claim that purely rational decision-making exists. Like everything in the human body, from kidney to heart function, one doesn’t get to chose how organs work. The vast amount of evidence from lesion studies proves this to be the way the brain works.

I understand the concern with the idea that decisions are emotionally based - I grew up with scientists who felt emotions should never enter decisions. Emotions were seen as out of control and in need of control. 



Perhaps it would be reassuring to look at the areas of the brain that are involved in emotions - there is a complex, interconnected system that is utterly beautiful. A glance at some of the players may inspire you: these areas respond directly and indirectly to bodily and sensory inputs and coordinate, like a symphony: orbitofrontal cortex, dorsolateral prefrontal cortex, anterior temporal lobe, ventrolateral prefrontal cortex, dorsomedial prefrontal cortex, anterior mid-cingulate cortex , amygdala, anterior insula, anterior cingulate cortex, dorsomedial/dorsolateral prefrontal cortex, medial temporal lobe, retrosplenial cortex/posterior cingulate cortex and periaqueductal gray.

So, although emotions are often viewed as the basest form of human reaction, they involve complex cascades of brain activity that are crucial for synthesizing social, empathetic and protective aspects of a decision.

This impacts mask wearing because different countries have different emotional narratives to which they generally respond.

All governments are using narratives to explain the spread of COVID-19. In Canada, the narratives of the federal and provincial governments are largely in line with each other and all appeal to a sense of helping others. This narrative has high emotional salience in Canada, where helping others, working together as a country to help each other is the basis of everything from our universal healthcare system to our investment in schooling. It is a core value. Not for everyone, of course, because no country has a homogenous set of values. However, most countries do have some values that are widely shared. 

Even some of the anti-maskers in Canada protest under the banner of “Hugs not masks”. Appealing to a sense of community well-being while spreading the virus may be odd, but it encapsulates the emotional weight of community in Canada. 



South of our border, COVID-19 infections and deaths are mounting, and masks would help limit the spread of this virus. There are many factors involved in this but one factor is the conflicting messaging coming from the federal government and the states. Another factor may well be the emotional weight given to the idea of individual decisions - much of the messaging has actually been against the community well-being by arguing that individuals can’t be forced to do things by others, particularly governments. We have some of that in Canada, but not in such large numbers because the narrative in Canada is that taking care of others is valuable and putting yourself above the health of others is generally frowned upon.

I have thought long and hard about how to encourage people to wear masks south of the border. Many of my colleagues in the United States spend their days and nights caring for COVID patients and then spend their free time on twitter encouraging people to wear masks. 


When I think of appeals that have been made to Americans, this comes to mind:




Or this as a mantra for today:





So many fine and civic minded Americans have called upon Americans to follow their better angels. These appeals are emotional - heck, I’m Canadian and they move me to the core.

Some of my American friends have argued that the population of America has changed and that appealing to better angels will not work because many are driven by anger and fear. The division of people into those who are angry and scared verses those who are rationally following public health measures is a fallacy. We are all scared and we are all angry. These are difficult times and we would be completely detached from reality if our responses to this drastic situation were not intense: remember our emotional systems are nuanced, coordinated and work with reality because they are dependent on input from our senses.

Directing our fear towards its source - this virus - drives many of us to wear masks, wash our hands, keep our distance from people and allows us to stay safe. Anger? That's a great energizer for fear and enables us to fight paralysis by driving us to action. We are seeing governments and others trying to direct anger when infections increase towards those who are infected and, these days, this is often young people who are painted with the narrative that they are selfish and irresponsible. When we direct anger towards our own, it's rarely productive and always divisive. When young people have heard inaccurate information that they are largely unaffected by this virus, we should look to the source of their behaviour and perhaps correct the information they were given, using that anger to drive us, energetically, to educate them and appeal to the values of community and empathy that we have raised them with. 

History has taught us that citizens who have been complicit in terrible things can and have turned things around - think postwar Germany. Surely, we can give our young and our fellow citizens the benefit of the doubt and appeal to their better angels - to their more noble emotions such as empathy. 

One of the bright spots - maybe - is the response Canadians have seen to mask mandates and this might help in America. “An overwhelming 95 per cent of the survey respondents say they now wear a mask on public transit. In mid-July, those numbers were as low as 45 per cent.”  In cities all over Canada, we are seeing similar response to mask mandates. Not certain if this would work with our southern neighbours given the violence that has accompanied masks refusal and the lives that have been lost. But maybe this provides some hope. Along with an emotional appeal to civic duty grounded in empathy. 

I don’t know if this will work. I’m just hoping that we can all turn the rising infections around by standing on the shoulders of scientists, who explained how we make all decisions, including whether to wear masks or not: facts without emotional appeals will simply not work to help people make the right public health decisions. 

09 August 2020

Nipping it in the bud because old men cry.



In February, an elderly man was collecting recyclables in San Francisco when another man threatened him and taunted him. A video shows the elderly man crying while onlookers laugh at him. 

In March, a man yelled at an elderly man suffering from dementia in a convenience store in Vancouver. Then the elderly man was shoved by the other man, he fell and hit his head. 

Both of the elderly men attacked were of Asian descent and, in each case, the men attacking them hurled racist remarks at them. Both of these elderly and innocent men were victims of the heinous crime that’s on the rise: hate crime. 

In the United States and Canada, hate crimes are increasing  Although the number of hate crimes in Canada remain lower than in the United States, we don’t know the actual numbers in either country: hate crimes remain underreported in both countries and, because hate crimes are defined differently in various regions of each country, counting cases accurately is difficult.

Crimes of hate thrive and grow in times of intolerance and certainly we are living through difficult times. Many of the attacks against those of Asian heritage are accompanied by accusations of somehow being blamed for COVID-19 infections. 

Social media is one of the main vehicles that transports racism through society and fuels hate crimes. One tool Canada has to fight this is illustrated by the conviction of James Sears. 

In Aug 2019, the Canadian editor, James Sears, was sentenced to one year in jail for “wilful promotion of hatred against women and Jews..[the judge] lamented the fact that he couldn’t give Sears 18 months, saying the circumstances were more severe than a 1990 case where a 22-year-old self-described racist received a year in jail for antisemitic graffiti including spray painting swastikas on a Toronto synagogue.” 

Canadian hate laws do limit free expression. David Butt has an elegant discussion of this:


“Does freedom of expression as legally defined in Canada provide the right tools for expression challenges in a fragmented and largely angry 21st century social media world?
Canadian freedom of expression law, like so many things Canadian, embodies compromise… our constitution protects not only free expression, but multiculturalism and equality as well. So to read the constitution holistically, we cannot permit one protected freedom to undermine other rights and freedoms enjoying equal status."

As we all traverse this world of social media and the spread of hate based on race, religion and sexual orientation, it remains an open question whether Canada’s compromise of balancing the right to freedom of speech with other rights, will curtail hate crimes. I won’t dwell on the legal problems of enforcing the laws Canada has, the limit of those laws and the complications of all this. Why?

What I will do is join the many voices condemning hate crimes. There can be no civil society when old men are humiliated to the point of tears and then are simply laughed at, when people are spit on, beaten and humiliated simply for their race, religion or who they love. The internet has become a place to spread hate in dark corners that radiate out to infect us all. 

We can prosecute hate crimes after they happen, but we must find ways to stop the propagation of hate in the first place. Some social media platforms are trying to manage hate speech online. However, curbing hate crimes with laws or even regulations on social media may feel like a Sisyphean task and many have asked why bother because the problem is too large? Others ask why do this and curb free speech?

I ask - would we say this about any other crime? Would we say there are too many murders, so why bother trying to stop them? Would we say that trying to stop physical assault may lead us to also stop holding hands and hugging? Surely, we can distinguish racist or homophobic rants from gardening advice. Again, I'm not a lawyer and know that these issues can be very difficult. However, as a physician, I can tell you that treating head injuries in an old man thrown to the ground can also be difficult - but you would be hard pressed to find a doctor who walked away from that task. 

So, it's time we found solutions to hate crimes and the first step is to take them seriously enough to come up with solutions.

12 July 2020

Writers: Get Thee on Twitter


When I told Leigh Lundin that Twitter is a great place for writers, he balked and then told me to write that story.

When Leigh gives me marching orders, it’s always a fascinating journey.

Writers often use Twitter to promote their work. I use Twitter to hear stories because writers are addicts. All of us. We are addicted to people. We watch people in cafes, in our homes and on the streets. We listen carefully to the stories people tell us and, as readers, we read stories. Even if the article or book isn’t about people’s stories - we ferret them out anyway.


Can anyone tell stories within the restrictions of Twitter’s 280 characters? I would have once answered that it was unlikely but, after a few years on Twitter, I’m now of the opinion that the best stories are often told in 280 characters - or less.

The story of the this time is COVID-19, and what you read on Twitter is very different than the news.

In the news - online, print, TV and radio - the infection rates and deaths are presented and often experts discuss the issues. You can find these articles and even follow these experts on Twitter.

However, many of the important stories of COVID-19 aren’t in the numbers - they are stories from the frontlines. Not just the stories by doctors, nurses and other healthcare workers, but the stories of patients who find themselves fighting this virus.

There are stories of worry and outright fear, frustration and courage, advocacy and defeat.

When people write about these times, I hope these many voices find their way into those books. I understand that some people prefer the view from 30,000 feet - looking at the numbers and the spread, the policies and the politics.

For me - and I hope for many of us - the real stories are those of people. Each and every one has a world they live in, people they love and who love them. The tragedy of COVID-19 rests in these stories, whether they are healthcare workers putting their lives on the line, living away from their families to stay at the bedsides of patients or whether they are patients with  COVID-19 and are battling against it from the other side of the bed - these are the stories that matter.

A tragedy is often defined in two ways:

1. An event causing great suffering, destruction, and distress, such as a serious accident, crime, or natural catastrophe.

2. A play dealing with tragic events and having an unhappy ending, especially one concerning the downfall of the main character.

I prefer the latter definition: great suffering is only understood from the perspective of one person - the nuances, the thoughts, the feelings, the impact on others  - and life is not a play but each and every person is a main character in their own life.

Twitter has helped me understand the lives of those in the United States during COVID-19 - those who are pushing for opening up the economy and get back to work - to return to normal. Some people use the hashtag #COVIDIDIOT for these people, arguing that they are ignoring the science and putting people’s lives at risk. However, if you read their stories, you will see that these people often live on the margins, have no savings and have no way of feeding their family without working. They risk losing their homes, being evicted even from rental homes, and their fear of homelessness and hunger seems more real to them, more tangible, than a virus they can’t see. They are not idiots. They are people struggling. 

There are scientists using their graphs, their studies, trying so hard to educate us all on the dangers of this virus, the need for measures such as masks to limit its spread and save lives. They are struggling too, trying - often for the first time - to turn their academic understanding into something that everyone can grasp.

There are doctors and nurses, often posting pictures of the scars on their faces from masks, telling us how they have no more ICU beds and begging us all to stay home and wear masks.

There are politicians, giving their story of caution or throwing caution to the wind, with policies they hope will help.

This time is a complicated time. Everyone has a perspective and a story.


Part of Leigh’s marching orders were to also explain how to DO Twitter.

Every story has a main character and on Twitter, you are your main character. Whatever you try to say or do, people will figure you out - so I suggest you simply be the person on Twitter that you are in real life.

In fact, do all of Twitter the same way you do real life. If Twitter is a place you spend some time in, then follow people because you find them interesting, just like you would invite the most interesting people for dinner.

Like a dinner party, where you listen more than you speak, on Twitter, read more than you tweet. Read people’s comments, go to their profiles and read their tweets if you like what the say but also if you don’t.

If you interact with someone and like them, treat it like your own private dinner party and enjoy. If you have an interaction that is unpleasant - also treat it like your own dinner party and don’t put up with it - block or mute them and carry on. Or better yet - if you know there could be trouble because the views are so upsetting to you, then just read and learn.

So, my advice? If you are feeling you need to hear the stories of our times - go on Twitter.

14 June 2020

Please Don't Upset Racially Mixed Children


The protests in the United States has people in many countries including Canada asking, “What can I do to help end racism?” My approach has been to listen to the stories from south of our border and within our borders: this is the birthplace of the solutions we need. However, I’ve realized that these stories weren’t addressing my concerns about my children and that’s a story I want to write.

My husband is white and our son and daughter are mixed race. I would say bi-racial but that isn’t true. My parents were from Sri Lanka—my mother’s grandfather was French, somewhere in my father’s family there was someone African but we suspect other ancestors as well, including a Chinese one. My husband has roots in Ireland, Scotland and Wales.

There is absolutely no doubt that people are suffering in the United States and—to a lesser extent in Canada—from racism. I have no interest in diminishing this suffering—we should all be amplifying those stories. However, the way we discuss these stories are adversely impacting children of mixed marriages and that is where I want to focus: I want you to imagine being one of those mixed children while you read.

The research on implicit racial biases, often based on the Implicit Association Test (IAT), has provoked some people to state—with puzzling confidence—that all whites harbour implicit racist attitudes. To be clear: for my children, this is their father that we are talking about. When our children have their feet in at least two worlds, sometimes many worlds, telling them one of their parents could dislike them because of their race is not merely the height of cruelty, it is also untrue.

But the IAT, that measures beliefs and attitudes people may be unwilling or unable to report, has numerous problems. For a test to be relevant it has to be replicable—give the same result each time you take it—and valid so measuring what it purports to measure: “Greg Mitchell, a law professor at the University of Virginia (stated) the replicability of the IAT is extremely poor. If the test suggests that you have a strong implicit bias against African Americans, then ‘if you take it even an hour or so later you’ll probably get a very different score’. . . . More fundamentally, there appears to a very tenuous relationship between the IAT and behaviour. That is to say, if your colleague, Person A, does worse in the IAT than another colleague, Person B, it would be far too hasty to conclude that Person A will exhibit more discriminatory behaviour in the workplace. In so far as there is a link between the IAT and behaviour generally, it is shaky.”

If we ignore the fact that IAT is neither reliable nor valid and look at the results—even they do not show that all whites have implicit biases: 18% don’t. Since there are serious methodological questions about this test in the first place, it shouldn’t be used as a justification for saying stuff that would upset mixed race children.

Like most mixed race children, my children have a wide range of looks: they get very dark in the sun and by the end of a long Canadian winter, they look almost white. Once my son and I were grocery shopping at the end of a long winter and we encountered one of his high school classmates. My son told me that this young man asked him afterwards what race he was. My son cheerfully listed my husband’s European roots and my Asian and African ones. When he was finished his classmate said, “No wonder you’re an alpha male in our school. You’re seriously the master race.” Never before had I heard this horrible term being used in this way and it tells you a great deal about the hope I have for this new generation.

This young man—who is white—might go on and have racially mixed children. I can guarantee you that many of this generation will do the same.

For them, and for my children, I have a simple ask: don’t tell racially mixed children that one of their parents is biased against them. It’s cruel.

What my children know, to the core of their being, is that their father would lay down his life for them without a second thought. His love for them is unconditional, deep and one of the most important truths of his life.

Please don’t make generalizations that mess with the family we have created and the children whom both my husband and I love. You can’t stop the damage of racism by ignoring the reality of mixed race children. Keep them close to your heart and don’t say anything to suggest that both their parents have anything but deep, unconditional love for them.

10 May 2020

COVID19 in America versus Canada


Anger is the biggest difference between America and Canada’s response to the coronavirus pandemic.

Many people have been discussing the difference between the response to the coronavirus pandemic by the United States and Canada. “When you look at per capita cases and deaths across the course of the entire outbreak, the comparison looks even worse: the United States has over two times as many confirmed coronavirus cases as Canada and roughly twice as many deaths.”

The factors impacting coronavirus infections and deaths in the two countries are complicated and will, I’m certain, be analyzed for years.

What I find impossibly sad is the level of anger in the United States that is not directed at this virus - because we should all be furious at this virus - but at each other.

While both countries are grappling with how to open up the country and help the economy recover, the stories in the two countries couldn’t be more different. As they say, a picture is worth a thousand words. 



In America: 



In Canada:



One obvious difference is that in Canada, we are not allowed to openly carry guns. However, aside from the guns, the differences are crucial and it is in the level of anger and intimidation in the United States.

In Ontario, my home province, the Premier responded to the protests by saying: “Ontario Premier Doug Ford says he’s furious at the “bunch of yahoos” who decided to flout physical distancing measures and emergency laws to protest outside Queen’s Park Saturday afternoon, calling them “irresponsible, reckless and selfish.”

For those who don’t speak Canadian, this is a very, very angry statement by a Canadian Premier. Also - he suggested consequences: “He said he hoped Toronto police would ticket them.
Not keeping at least two metres apart from someone not in your own household currently carries a fine of $880 in Toronto.”

In the end however: “A spokesperson for the Toronto police said no arrests were made and no tickets were issued following the protest, saying the crowd was compliant and exercised good social distancing.”

In other words, fairly polite and compliant protesters. 

It is more than not carrying guns. 

The politeness of Canadians has long been a joke among Americans. Although generalizations are never universally true, there may be something to this. However, there is one picture that explains a great deal:



In the United States, people are out of work and losing their healthcare and the financial assistance given appears to be piecemeal -both federal and state assistance- and many appear to be falling through the cracks.

In Canada, our universal healthcare system means that everyone remains covered for healthcare regardless of their employment status.

The federal government has delivered a strong set of financial protections for employees, self-employed, seniors and students. For example, if you are self-employed and have lost your job, you receive $2,000 per month for 4 months. These financial safety nets during COVID19, allow people to put food on the table. The provinces have all stepped up with other financial supports for citizens. 

In short: it is far easier to be less angry about the financial impacts of COVID in Canada than in the United States. 


There is more though. In Canada, there has been coordination between all levels of government in another area: information.

Our press conferences have been focused on Medical Officers of Health (federal and provincial) giving updates on infections, looking at models and doing the crucial work of informing the public about the new knowledge of this virus. This serves to increase scientific literacy in general. For example, prior to this pandemic, some Canadians did not understand that a virus cannot live outside of a cell for long and that is the reason for physical distancing.

The news in the United States has covered the politics of this pandemic and the disagreements between levels of government and within government. This type of coverage in Canada would be rather short - because there is general agreement about the need for physical distancing and to stay at home to defeat this virus.

So the difference in the two countries could not be more striking. In the United States the coronavirus has been a magnet for political anger. In Canada there is some of that certainly, as evidenced by the protests, but they have been small because, largely, our politicians are not fuelling them.

A virus has no politics, knows no party affiliation. It simply infects and kills. The wartime analogy has been used to describe the fight against this virus but this appears to be a strange war in the US, where there is little agreement if the enemy is dangerous, how to fight it or whether to bother fighting at all.

So, while Americans are dying, they appear to be very angry with each other. I wish they would get angrier at the virus.

12 April 2020

Surviving COVID19


COVID19 is a dangerous adversary and everyone is discussing how stressful they are finding living in the age of COVID19.


There have been many excellent recommendations on how to reduce stress. Many of these recommendations have focused on stress reduction strategies like exercise.

Given my area is mental health, I would like to add to the conversations on stress by presenting a different lens.

First, let’s talk about what stress is and is not, because to tackle something one must always know what one is getting into the ring with. 

In 1936, biologist Hans Selye described a common physiological response in rats subjected to harmful factors and he named this the stress response. “The main features of the syndrome were suppression of the immune system, ulceration of the lining of the stomach and small intestine, and activation of the two … stress-response systems.”

Over the last 80 years, there has been extensive documentation of the widespread damage of stress on our body and brain.

So stress doesn’t just feel bad - it is really bad for you. Reducing stress can save your life and a sense of control is the one way cortisol and other factors provoked by stress can be reduced and the health impacts minimized.

What is crucial is that stress is not just bad things happening to you – it is bad things happening with a sense of having no control over these things.


You might be thinking: if control is crucial to managing stress, how on earth can you control a global outbreak of a virus? How can we control not only the illnesses and deaths but also the economic consequences on such a large scale. Control? It seems like a rather ludicrous word in the face of all this.

All true points. Thank you for making them.

My answer is to introduce some people whom I have known that belong to “The Greatest Generation”- those who lived through World War II. They earned their name because of their tenacity and 'can do' attitude. They did not enter the war with these attitudes but, rather, they were forged by the hardships they faced.

My father-in-law, Bill, and his twin brother were pilots in World War II. Bill’s brother died when his plane went down in Europe and he was never able to speak of him again – it was as if the grief of his loss had torn out his heart. Bill went on to get an engineering degree, marry, have children and live a life of laughter and love.

My mother-in-law, Verna, stayed home and helped in many ways the war effort. She told me stories of how they would try to get butter to make her beloved pastries, how they would save things so they could send packages to those who were fighting along with letters. The volume of letters diminished over time because many of the young men she grew up with died.


Neither of them had any ability to stop the war or save those they loved. Both were irreparably broken by the losses they sustained. Both walked into life after the war with a strong stride. They survived the war by small acts and large ones that were all acts of resistance. Bill was a man who embraced competence – taking care of his family and being the one who got things done – and Verna was loving, taking everyone under her wing. Perhaps those characteristics were their tribute to those they lost and a way to ensure that they would keep those around them safe.

Let me introduce you to Lili. She was Jewish and was sent away from her parents as a small child into hiding. She lost her parents and everyone in her family. I learned later that she had anxiety and many difficulties all her life in response to this, but what I remember about her was that she was one of the kindest people I have ever known. If the world robs you of so much through cruelty, kindness is the ultimate act of defiance.

None of them had control over global events that ended up at their door. What they did was to take control during and after in small and large ways. Ultimately, their characters are a testament to how they became known as the greatest generation, because it was not what they endured but how they endured it that defined them.

Back to COVID19. We have no control over when we will have a vaccine and this nightmare will end. However, the reality is that we have never had control over large global events and this is no different. What we do have control over is our small corner of this planet and that is where we fight. 

Much has been discussed about the courage and tenacity of my colleagues during COVID19. When I speak with them, they talk about doing what they have always done; medicine with the patient in front of them. They read voraciously about this virus, they consult others for more information, they organize their homes to have decontamination zones to keep their family safe and do many other things to manage their corner of the planet.

Many of my non-medical friends are reading and watching the news to educate themselves, they are designing new ways to get groceries safely and clean them down. They are reaching out to friends and family to inform them, check up on them and laugh with them.

When we talk about the new normal – it is the ability of each of us to have small and large acts of defiance and resistance to keep those we love safe.

We will not recover without scars. We can only hope to minimize the number we lose and comfort those who have lost people. There will be anguish: times when we wake up in the middle of the night drenched in fear. When we emerge from this - we can do so with a character forged by how we responded to COVID and how we controlled our corner of the world.

08 March 2020

Coronavirus COVID-19: The Heroes and the Culprits


Dr Mary Fernando
Mary Fernando, MD
Every time a patient goes to a doctor with a new illness, the story of chasing down the diagnosis is like a mystery novel with one difference: everyone works hard to make the story short with as little excitement as possible.

In medicine, no one wants a long, twisted plot line and the best stories are the boring ones where the culprit is found quickly.

This desire for a short, boring story line has done what nothing else has been able to: it has united the world because citizens of every country want the story of the new coronavirus, #COVID-19, to end before they get a starring role in the tale of a new epidemic.



On December 30, 2019, Dr Li, a 34-year-old ophthalmologist in Wuhan, posted on Weibo that he had seen 7 cases of a SARS-like virus and warned fellow doctors to wear protective clothing to avoid infection. This sensible and medically appropriate suggestion resulted in Dr Li being summoned to the Public Security Bureau four days later and he was made to sign a letter confirming he had made false statements. Before his death from Coronavirus on Feb 7, 2020, Dr. Li explained why he warned people initially despite the fact that he knew he might be punished for it: “I think a healthy society should not only have one kind of voice.”


Like the Chinese government who tried to put a lid on information about COVID-19, we have had many others who have tried to do the same for political and financial reasons. There’s nothing wrong with trying to protect businesses, however, there is a great deal wrong with stifling information. The only thing that protects people and saves lives is the truth: if certain activities or places are unsafe, people should know this.

Through the evolution of this disease, there have been many kinds of voices speaking out and, just like in any mystery novel, each new crises reveals a great deal about the character of those involved.

There are some people who want everyone to stay calm – as if one smidgeon of worry will muck up their world. They came out in force at the beginning of this epidemic grabbing every straw they could to dampen down concern. I’m a huge fan of calmness but not when it is coupled with misinformation such as: this is only spread by animals, only spread by people who are symptomatic, the virus doesn’t live on surfaces for days and it is no more lethal than the flu.

Not one of those statements is true and people cannot protect themselves if they don’t know the truth. 


While some grasp at anything to calm people down, others have done the opposite and developed theories to fan all sorts of flames and even to start fires on their own. One theory floated around that this new virus was developed in a lab to destabilize the world. Right on the heels of this is another, very malignant theory that this is a virus that largely infects people of Chinese origin and that they are responsible for the spread of this. This has resulted in racist attacks on people around the globe.

There is another set of characters that have been emerging and speaking loudly: those who take a great deal of reassurance if they know things and even more reassurance if they know everything. Now this person who knows everything is a purely fictional character who has never existed but this doesn’t stop some people from emulating them. If this person who believes they have all the information has a large pulpit, they can spread information that is inaccurate and possibly dangerous.


Who is the biggest, baddest, scariest culprit in the saga of #COVID-19?
 Misinformation, spread by people whose need for calm, chaos or personal brilliance blinds them to the new facts emerging about this virus daily.

Some of those new facts are reassuring, some are worrisome and not one of us knows them all because it is an evolving story. For example, there has been some evidence that gastrointestinal symptoms such as nausea and diarrhea may precede respiratory symptoms during infection with this new coronavirus– this is crucial information that could lead people to seek medical attention earlier and therefore limit spread of the disease. Since we know that people without symptoms can spread the disease – unlike with SARS – we can’t assume we haven’t been exposed because no one around us was ill. 


Just like in any mystery novel, we should remain suspicious of all the characters - any one of them could spread misinformation – often not from malice but because their character compels them to engage in certain behaviours that increase misinformation. Bottom line – the only thing that will keep you and those you care about safe is information on how to avoid getting infected with coronavirus.

The heroes of this story? The first hero was Dr. Li  because he had a simple mission: to inform those around him with whatever information he had to keep them safe.

Inspired by the heroes in this coronavirus story, I recently told my children who were traveling with me that – given the fact that this disease can be spread by people who have no symptoms and the virus can live on surfaces for days – they could stay safer if they assume their hands are infected and not touch their face and food without disinfecting them first. This simple set of instructions was the best way I could summarize this disease to the people I care about the most in this world. I also keep telling them that we are in the midst of learning about this disease so I’ll keep them updated. My children must have confidence in me because they grin every time I say this.

As of the 7th of March, 2020, the World Health Organization reported that the number of confirmed cases of COVID19 has surpassed 100K. The doubling time of this disease appears to be around 7 days but the numbers, just like this disease, are fast moving. A peek at that study along with with data used gives an idea of why we need to take a deep breath and keep learning.

09 February 2020

Another world: Writing a Mystery Book



I wrote a new book. Except it’s not new anymore. I wrote it 2 years ago. Edited. Reedited. and yes, did that multiple times. Sent it to an editor and then another. Reedited.

Now it sits in my computer and I have a problem.

It’s not the book that’s the problem: it is the mystery novel that wanted to write.

The main character was written as a rebellion against the need to have a woman detective who is either a drunk or who sleeps around because she’s deeply damaged. Because, you know, that makes her interesting. I wrote her as someone who has lived a life with troubles – because that’s what life brings - but is like the women I know and love. They may be damaged by life but are not busy damaging others in their life. Women who I’ve looked up to. Women who make me laugh. Women who force me to think.

I wrote the things I have learned from friends, patients and my own life. There’s domestic violence to racial profiling of Muslims. I tried to write it as others had lived it. I told the stories that I have heard - the ones that had made me hold my breath in fear of missing a word.

I’m on my final edit. The problem is me.

During the writing and editing, my dearest friend was ill and then died. My father was ill and then died. My mother is now ill. All this has required time and energy to help during their illness. Time to deal with the loss.

Here is the crux of the problem: when I write I do little else. I enter this world and disappear for hours on end. I live it, breathe it and reality pales in the face of the world I’ve created.

Now, my reality has jagged edges, and cuts into this world. Sawing into it until it disappears like morning mist in sunlight. When it’s gone, I can’t get it back.

My ability to concentrate - to enter other worlds - was how I’ve done everything of value. It was as natural as breathing. It’s how I studied medicine, how I spent long hours with patients and trained, it’s how I parented by disappearing in the world of my children.

All the best things in my life were dependent on not having a reality so jagged that it sawed through every thought.

So, my book and I are now on separate worlds. I have no idea how we will live on the same planet again.

Recently, I decided to research writers block, thinking there may be suggestions that help. Unfortunately I found none. Advice like ‘Find the right surroundings’ mean little to me. I can write and have written anywhere. ‘Silence your inner critic’? That’ll be a cold day in hell. I’ve met her and write anyway.

 I could go on.

Except I can’t.

With the book that is.

Here’s the next problem: I write in my head anyway. I’m always revising and thinking of the book. Except when I sit with my book. That is the worst - to write but not write. 

So, instead of my book I’m writing an article about writing my book, which is amusing but not even that coerces me enough to write.

The one thing that keeps me hoping is coffee. The night before I have a day with even one block of time, I go to sleep with visions of coffee and writing. It won’t be tomorrow because there is far too much to do.

Maybe Monday?

12 January 2020

Airbnbs, Gangs and Pimps.


My hometown of Ottawa is the capital of Canada. Most of us who live here consider it a small, friendly town disguised as a large city.

On January 8th, Ottawa had our first murder of the year. Four young people (ages 20, 19, 18 and 15) were shot inside a home and the 18 year old was killed.

On November 2019, the Ottawa City Council ‘endorsed new rules that will restrict short-term rentals on Airbnb and other similar platforms to primary residences in a bid to crack down on so-called “ghost hotels” run by absentee owners.’

These two things are related. The young men were shot in a ‘ghost’ Airbnb.

These Airbnb ‘ghost hotels’ are “…becoming havens for criminal activity.
Unlike traditional hotels that come with security video cameras, high traffic and paid security guards on the premises, ghost hotels are often cheaper to book and come with less eyes on what’s happening inside, police say. City police are finding that in instances where violence breaks out, the person booking the rental is rarely at the home and there is a degree of anonymity in the booking. Adding to the situation is that homes are often owned by people who don’t live in the neighbourhood, or are rented by property managers. Police say they find there is little allegiance to the communities in which they are situated. It’s a “perfect scenario,” says one officer.”

When I interviewed a Crown Prosecutor for an article, he had informed me that gangs in Ottawa are mobile and change locations often weekly to avoid detection. These ghost hotels are a perfect opportunity for gangs to move every few weeks with little or no scrutiny.

I only rented an Airbnb once. My family was going to an award dinner in Toronto and I was looking for a hotel near the venue. My children argued that we should get an Airbnb. My daughter is a vegan and wanted access to a kitchen. I said I wouldn’t cook. She said I wouldn’t have to but she wanted to at least have access to the means to cook and a place to put her vegan supplies, like oat milk. This went on for a bit and I gave in, which you would only understand if you’ve had the pleasure of arguing with my children.

My daughter carefully examined reviews of Airbnbs and found one that was close to the venue and had excellent reviews. When we pulled up to the place, it was a condo building in a shady area of town. Not deterred, we went in. I found I couldn’t breathe. This makes staying at a place difficult. My asthma only gets this bad when there is mold, so I went outside with my husband to get some fresh air.

The fresh air and a puffer somewhat resolved my breathing problem but presented a new one. Pulling up to the condo were a string a large cars decanting rough looking men, wearing street clothing and women in what looked like scanty clubwear.

Since I couldn’t breathe in the apartment, and I didn’t feel safe outside of the apartment, my husband booked a hotel.

I often wondered about that odd Airbnb experience, but writing this article clarified a few things: “Investigators have noticed an uptick in pimps using Airbnb rentals in recent years. That’s likely because they’re more anonymous, and it’s more challenging for police to get information about them, compared to traditional hotels and motels, said Det.-Sgt. Nunzio Tramontozzi.”

This makes sense of our unusual experience. If I wasn’t so breathless, I might have realized that the rough looking men might have been pimps. They certainly were frightening.

So, back to Airbnbs. They are a boon for many people - both the guests and those who rent them out. My children have had wonderful experiences in Europe, the United States and Australia. It is the modern version of the student hostels that were popular when I was traveling on the cheap in other countries.

It is unfortunate that Airbnbs are being used by gangs and pimps. I hope that limits on 'ghost' Airbnbs, similar to ones Ottawa is using will curbs this. 








08 December 2019

Maple Syrup Heist eh?


In Ottawa we celebrate maple syrup season by trekking out to a sugar bush, watching the maple sap being collected and indulging in large stacks of pancakes smothered in maple syrup at one of our many sugar shacks.

So, when Leigh Lundin suggested I write about the Canadian maple syrup heist, I thought ‘heist’ was a strong word for people running through the maple grove stealing buckets of sap.

It turns out that I was wrong, a heist it was: over twelve months, 3,000 tons of syrup, worth $18.7 million, was stolen. None of this was done by stealing buckets collecting sap. Worse, learning about this heist ruined all my lovely and naive sugarbush experiences and I’ll never look at another bottle of maple syrup the same way again.

The heist was possible because of three important facts that blew my preconceived notions about maple syrup out of the water.

 First, "maple syrup comes only from the red- and sugar-maple forests found in the upper right-hand corner of North America, just where you’d sign your name if this were a test." This means that Canada, particularly the province of Quebec, produces 71% of the world’s maple syrup.

Second, since 1966 the Federation of Quebec Maple Syrup Producers has instituted quotas and rules that have increased the price of maple syrup to be, in 2016, "valued at just over $1,300 a barrel, 26 times more expensive than crude"’

Third, to control the supply of maple syrup, "members of the federation—Quebec’s bulk producers are required to join—give their harvest over to FPAQ… Some of it is sold immediately; the rest is stored in the Reserve…In this way, the federation steadies supply, filling the coffers in banner years, satisfying demand in fallow."


So, maple syrup production is not a cottage industry, adorably ensconced in sugar shacks dotting our maple groves. It’s a large profitable industry controlled and managed much like the oil industry. Total value of all maple products in 2018 was $384.4 million.

To give a visual recap:


The maple grove where I thought they stole maple syrup from:






The Reserve is in Laurierville, Quebec, where they actually stole maple syrup from:





A total of $18.7 million dollars of maple syrup was stolen from the Reserve in Laurierville. The  thieves used trucks to transport barrels, siphoned off the maple syrup, and refilled the barrels with water and returned them to the facility. Later the thieves siphoned syrup directly from the barrels in the Reserve and left them empty. The stolen syrup was then sold in the United States and in New Brunswick, Canada, to distributors, many of whom were unaware it was stolen.

When the theft was discovered in 2012, the Sûreté du Québec police began an extensive investigation aided by the Royal Canadian Mounted Police (RCMP) and U.S. Customs. The police arrested two alleged ringleaders and 24 other people. A large portion of the syrup would ultimately be recovered.

However, this not the end of the story because it raises interesting questions about the Federation of Quebec Maple Syrup Producers.

One of the ring leaders was Étienne St-Pierre, a maple syrup buyer from Kedgwick, New Brunswick, who bought the stolen syrup.

"You can't prove what tree the syrup came from," St-Pierre told the jury.

“St-Pierre also admitted he had long been an opponent of the Federation of Quebec Maple Syrup Producers, and resented their control of the market.

“The Crown produced evidence suggesting St-Pierre considered the federation to be akin to the Mafia.”

Is the Federation of Quebec Maple Syrup Producers like a maple syrup mafia? It is “a powerful marketing board with almost absolute control over the provincial industry…all Quebec maple syrup must pass through the federation, which dictates how much each producer can sell, and penalizes unauthorized production and selling.”

So, not a mafia, but certainly restrictive.

Before his sentencing, this is what St. Pierre said: he’ll continue to ignore those rules. And he’ll keep buying maple syrup from Quebec’s scofflaw producers. “I will never stop. I didn’t steal nothing.”

Étienne St-Pierre was found guilty of fraud and trafficking in 2017 and sentenced to two years less a day to serve in the community, as well as a three-year probation.

10 November 2019

Phyllis


Stories from Canada and the United States are mirroring each other. In the United States, many patients have no access to doctors because they are either uninsured or underinsured. In Canada, our growing doctor shortage is leaving patients without access.

Please note that I didn’t say anything about the healthcare system, because talk like that is too impersonal; when it comes to patients, not having a doctor when you need one is very personal.

Let me introduce you to Phyllis Smallman, a feisty and funny writer, mother, grandmother and wife of over 50 years to her best friend and high school sweetheart. Phyllis was the first recipient of the Crime Writers of Canada Unhanged Arthur Ellis award and wrote, among other books, the Sheri Travis mystery series. She won multiple awards for her writing. She grew up in Southern Ontario but, at an age when most people retire, she and her husband moved to Salt Spring Island, B.C. to be closer to her children and embark on a new adventure.

In October 2017, 72-year-old Phyllis found blood in her urine. Her family doctor was concerned but couldn’t get an appointment with a specialist to do a cystoscopy before the spring of 2018. Phyllis trusted that the system would keep her safe, but her family began to worry as she developed other symptoms. Phyllis, a self-described foodie with the personality of a small energetic terrier, was too nauseous to eat and was experiencing extreme fatigue.

My point of contact to this story was through her daughter, Elle Wild, another Arthur Ellis Award-winning writer. Elle was worried and wanted her mother to be seen sooner. Elle, her brother and father spent a great deal of time trying to get Phyllis into a specialist. They called everywhere and finally found a specialist who could see her before Christmas. When the cystoscopy was done there was too much blood for a definitive diagnosis, but an infection secondary to a previously-inserted mesh was thought to be the problem. Phyllis was put on a six-week-long course of antibiotics and then put in the queue for a second cystoscopy and a CT of the kidney.  The antibiotics did not improve Phyllis’s health. Her nausea became more severe, she lost weight and became so weak that she couldn’t even walk across the room. She slept most of the day.

Through conversations with Elle, the growing anxiety of the family was palpable as Phyllis, their lively matriarch, began to disappear into long sleeps and uncharacteristic exhaustion. Phyllis’s deterioration continued day by painful day, and by February, the family had had enough. Despite Phyllis’s objections, partly because she continued to trust that she would get taken care of in our system and partly because she was too exhausted to go to appointments, the family paid for a private CT and she was diagnosed with a kidney tumour.

However, there was another queue for a specialist to do the biopsy and yet another one to see an oncologist. It was only on April 16, 2018 that Phyllis finally received a definitive oncologist report: an advanced and aggressive form of cancer that had started in her bladder and had spread to her kidneys. She was given six months to live and offered palliative chemotherapy. Her daughter, Elle, moved with her family to Salt Spring Island to spend time with Phyllis and to provide emotional support to her distraught father.

Phyllis did her best to complete the course of chemotherapy, but was only able to do half of the treatment because of fatigue, nausea and her emaciated state. Phyllis Smallman died on October 1st, 2018.

In her obituary, her family wrote: “Those who spent time with Phyllis knew her as a caring person who loved fiercely, laughed loudly, and was always a friend to anyone in need. In keeping with her dark sense of humour, her last book was ironically titled Last Call, the final Sherri Travis mystery. The night Phyllis died, Last Call won a Reader’s Favourite Book Award. Our Phyllis knew how to make a grand exit.”
Tragedy is defined as a story involving a great person destined to experience downfall or utter destruction through a conflict with some overpowering force, such as fate or an unyielding society.

The story of how Phyllis spent her final year is a tragedy. The unyielding social truth she faced was that Phyllis simply could not get access to the doctors she needed: this reality met her faith in our healthcare system and made a mockery of it. The lack of physicians left her family alone in their growing worry for Phyllis and isolated as they watched her die, without a doctor to tell them what was happening and perhaps even intervene to help.

When people say that healthcare is a human right, I agree. There is nothing as inhumane as a patient unable to get the care they need.

08 September 2019

Mental Illness Is Not a Political Football


by Mary Fernando

I have previously written about the myth that those with mental illness are dangerous. Spoiler: they are not.

What is happening now politically is very concerning. Politicians are blaming mass shootings on mental illness and – as I cited before – Dr. Michael Stone, a forensic psychiatrist at Columbia University who maintains a database of 350 mass killers going back more than a century, has found that only one in five are psychotic or delusional. This means that 4 out of 5 mass murderers are people who are clinically sane.



Why do politicians blame mass murders on the mentally ill? Many agree with Fareed Zakaria that “turning immediately to the "sickness" of the shooter and piously calling for better mental-health care is, more often than not, an attempt to divert attention from the main issue: guns.”

This may well be true but it is damaging to label those with mental illness as dangerous to society. The prevalence of mental illness is difficult to nail down but “Around 1-in-7 people globally (11-18 percent) have one or more mental or substance use disorders. Globally, this means around one billion people in 2017 experienced one.”

This means that when we think of those with mental illness we should think of our family members, our partners, our children our friends and neighbours because that’s where you will find them. Or not find them because many hide their symptoms and suffering for fear of - you know - being labeled dangerous. That’ll certainly send someone into hiding.

Worse - mental illness is being used as an insult to those with political views we disagree with.


This is my tweet from this week:






tweet

The politician my tweet was directed at is not as important as the patients this politician’s tweet was directed at: those with mental illness have become the scapegoats of politicians.

Paraphrasing MLK gave me pause. However, his writings are filled with empathy for those suffering from discrimination and I thought that it might be appropriate to use this for this very maligned minority.

What I want to address is my dream: blaming and insulting (along with the unrealistic depictions in books and on screen) presents a very unrealistic portrait of those suffering from mental illness. After a long career of treating mental illness, I can describe them with some degree of confidence. They are just like you and your family, friends and children. They have the same wonderful qualities and the same vulnerabilities, the same bad jokes and the same hilarious ones. I could go on, but you get the picture.


I feel I must say this very loud for the people at the back: mental illness is a medical diagnosis no different than that for diabetes. It requires diagnosis and treatment and both should be given with care and compassion. Just like someone with diabetes or cancer - everyone with mental illness will have their own unique personalty but not the ones that politicians try to give them.

I was pondering - ok, I was fuming - about this issue the other day and thought about the origins of medicine. Originally all disease was thought to be in some way connected with the evil doings of those who are ill. So, diabetes, cancer and depression fell into the same category: “In prehistory, people believed that pain and disease originated from evil spirits. Disease resulted when these evil spirits entered the body. Witch doctors and shamans were employed to exorcise wicked beings…”

The belief that illness is caused by evil spirits taking residence in a patient changed when modern medicine discovered the actual etiology of physical illnesses. However, some still think that there is something evil in people who have mental illness.

Today many use the term ‘mental health’ “… to reduce the stigma surrounding mental illness, and said ‘illness’ reinforced prejudices against asylum patients because it implied segregation between the sick and the well. Focusing on health countered a persistent misconception that only some people are prone to psychiatric problems.”

This terminology is a double edged sword. Focusing on what is healthy in these patients is a good thing. However, there is value in identifying an illness. To tell a patient they have a physical illness is often a relief because they finally have an explanation for the symptoms from which they are suffering. They can explain this to those close to them, and get comfort and help when the symptoms flare up. The same applies to those with mental illness. I have found patients are immensely relieved to finally have a diagnosis and treatment plan. I have seen their relief when they can speak to those they love and get support in the same way those with physical illness get to lean on those in their life. 



 I’m comfortable with the term ‘mental illness’ and also happy to use the term ‘mental health’ if people prefer. What I want is to end the stigma, to treat each patient as just that: a person with an illness that can be be diagnosed and treated. The illness doesn’t define the person. Their character defines them.

11 August 2019

Canada responds to the U.S. on mass exportation of our drugs: Sorry.


Rarely does American primary politics impact Canada, but Senator Bernie Sanders’ ‘Insulin Caravan’ has certainly led to a situation that has ruffled Canadian feathers.

First, let’s be clear on why Sen. Sanders came: “By traveling to Canada, which has a single-payer, government-backed health care system, he was also making an implicit case for his "Medicare for All" plan, which would create a similar system in this country."

The people who came in the caravan didn’t come for political reasons but, rather, for heartbreakingly personal reasons: “Kathy Sego, who made a 7-hour trip from Indiana with her son, Hunter, who requires insulin and has rationed his intake, became emotional as she described choosing between paying a power bill or for the teen's medicine.”

What is the response in Canada? The average Canadian believes that healthcare is a human right and this compassion is best expressed by the Canadian mother of an eight-year-old Type 1 diabetic : "When I see headlines of people passing away because they're having to ration their insulin and they can't afford it [and] when you live with someone with Type 1, I can't imagine," she said. "What if it was your mother? Your brother? Any family member? I would give anything I could to afford the insulin to buy it — but we shouldn't need to do that.”

Then this happened: “[The Trump] administration said it was weighing plans to allow for the legal importation of prescription drugs from Canada to help Americans coping with skyrocketing drug prices in the United States.
The response from Canadians? Sorry, but back off.”

Why such a different response to the individuals coming for drugs and the American government promoting a mass importation of Canadian drugs? It is because Canada has a small population of 37M compared to the massive population of 325M. We already have drug shortages and cannot sustain a mass exodus of our life-saving drugs.

In fact, “the Canadian Medical Association and 14 other groups representing patients, health-care professionals, pharmacists and hospitals wrote last week to Health Minister Ginette Petitpas Taylor. The supply simply does not, and will not, exist within Canada to meet such demands…John Adams, the chair of the Best Medicines Coalition, an advocacy group for access to drugs that signed the letter last week to the health minister, said he’s not encouraged by the Canadian government’s “nonspecific” response to Trump’s proposal.
He called it “a clear and present danger” to the health of Canadians.
This is not the sort of thing that good neighbors do to each other.”

This is Canadian-speak for no, we won’t do that.

So, the consensus seems to be this: if you are in dire need, come here and we’ll share.

 If you want - as a nation - to pull drugs away from Canadians, then no. And no again. 

Perhaps it’s time that Americans use the Canadian method of price regulation. “The reason for the discrepancy is because Canada regulates drug prices through the quasi-judicial Patented Medicine Prices Review Board designed to prevent gouging...In the U.S., market forces are the lay of the land.” 


In speaking to the character of Canada, I would like to thank the Canadian who invented insulin: “Banting famously sold his patent for $1 because he believed his discovery belonged to the world and not for profit.”

I hope America takes Banting’s message and actions to heart and creates a system where citizens can access drugs at a fair price. However, when it comes to pilfering Canadian drugs on a large scale, Canadians have clearly said, sorry but no.

In case our response is misunderstood, translated into American speak, the answer is, “Hell no.”

14 July 2019

Undercover: Covert Work of Consular Officials



If you’re on vacation and get arrested and thrown into a foreign jail, how do you get word out about your situation and how do you get released?

There are stories in the news about attempts by governments to get their nationals back home - with more or less success. We usually hear Prime Ministers or Presidents discussing the progress of these cases. 


The names you will never hear in the news are the names of the people who will be informed of your arrest, arrange visits to ensure you are well treated and, often, will broker you release. These people are consular officials.

I had the privilege of interviewing one of these individuals – an experienced consular official who has worked internationally. Since her name is unknown to most people except those who work with her, I’ll call her Undercover. Many of Undercover’s stories – told over a leisurely dinner – can’t be shared. The details can be recognized and many are secret.

Undercover pointed me to a document, The Vienna Convention on Consular Relations, that is a multilateral treaty that codifies consular rights and obligations and is the cornerstone of consular relations. “The treaty makes it possible for [your country] to assist its nationals abroad while respecting the sovereignty of other countries”

Undercover points out that “You are subjected to the local laws in foreign countries.” This is a statement that one should not take lightly. The laws in foreign countries may be quite unexpected.

Take Singapore for example:

“Tourists that visit Singapore are allowed to bring chewing gum with them, but only a maximum of two packs per person. Any more than that and they will be susceptible to be charged with "gum smuggling" which carries the penalty of one year in jail and $5,500 fine. People that are caught with leaving chewing gum remains in the public space can be charged with the monetary fine, community work, or often - public beating with the bamboo stick.”

So, what happens when someone is arrested in a foreign country, when they may not even be aware of the local laws? “When a foreign national is arrested in a country, the country that detains them has to inform the embassy and request consular access. If there is no embassy, they have to inform an accredited embassy in the region.”

“Someone in the region has to start the process of consular access.” This is to verify the nationality of person and to determine whether the person is being treated properly and it is no small matter. We have heard of detainees in foreign countries who have been tortured and raped, so, consular access - and the knowledge that these people will be visited and watched over, is important protection for them. This access can be daily, weekly or monthly.

How is someone’s release negotiated? This is negotiated by consular officials, often based on relationships, with police and the officials of the host country. Many times the consular official will point out how this will cause bad publicity and it would be preferable to have the person released into their custody.

“Sometimes it is just saying ‘This is not a bad kid, let’s get this person out of your country’,” says Undercover. “Sometimes, there is another dimension to the crimes committed and the authorities are angry. In some countries, someone may be arrested for the human rights work they are doing but they are held onto because they are angry the person is gay.”

“A country can also take someone into custody on spurious charges like espionage, but they are using this person to achieve some political end. This could even be to get their companies considered for contracts.” Or to make a political point.

Lack of consular access and consular negotiations can be extremely dangerous. Take the case of Otto Warmbier, the 22-year-old student who was arrested in 2016 in North Korea for taking a poster from his hotel room and sentenced to 15 years of hard labour. After 17 months, he was medically evacuated from North Korea and returned home “in a state of unresponsive wakefulness” and died within a week.

So, when we travel, what keeps us safe, what saves us at the worst of times, is so often laws – in this case international laws. But it is the also personal relationships and contacts consular officials have in the host countries that are crucial. Without these personal connections on the ground, more travellers would spend more time in difficult situations. The people who find us and keep us safe and often negotiate our release are people whose names the public will never know.

After our long dinner hearing Undercover’s stories, I was left pondering how these consular officials and their often covert work has the making of a great novel. I was also left wishing that I could share some of the stories I heard. I hope one day these stories are written.

09 June 2019

How Long Does Grief Last?


by Mary Fernanco

In a few weeks it will be one year since Carol died. She was my dearest friend since childhood. I hesitate to write about Carol because using words to describe a friendship like ours is like trying to carve a sculpture from water. 

We met when we were seven years old and throughout our childhood we wandered our neighbourhood chatting and laughing. During our teens we talked intensely about every dream, every heartbreak and all the new feelings descending on us. As we became adults we discussed university - all our courses, all our insecurities and, eventually, our marriages. She shared her stories of students she taught in her lab and I shared stories of my patients.

When my children were born, she was the first one in the door. She spent countless hours with my children, wandering the woods, reading books and calling every birthday with her lovely rendition of Happy Birthday. My children were almost in their teens before they realized that their beloved Aunty Carol wasn’t related to them. 

Over our decades of friendship we never fought. We thought that was odd since we were both intensely passionate people. What we did do was to find the humour in every and all incidents in our lives - no matter how trivial or serious. The closest we came to fighting was when we had spirited discussions about who paid the restaurant tab. We discussed this intensely and decided it was not as serious as a squabble but also more serious than a quibble, so we named these squibbles. We found that so funny and even our restaurant tabs became hilarious.

Once as the tab arrived, I asked Carol if this was going to be another squibble. She said it was going to be an outright squabble. We were grinning ridiculously at each other and the waitress asked - as we were often asked - about our relationship. People were perplexed by this Viking Beauty and WOC with a mass of curls and how we were so impossibly close. Carol, completely deadpan, replied, "Twins." Then, without missing a beat when the waitress looked perplexed, Carol continued. She pointed at me and said, "The lipstick always throws people." I have no idea how funny the politely smiling waitress found this exchange but we chuckled about it all evening. 

Over the nine months from her breast cancer diagnosis to her death, I visited, spent as much time as I could at her home. When she had her mastectomy, I was there and stayed for her recovery. We chatted and talked as we always did about everything. When we found out that the breast cancer had spread to her bones, we continued talking about that too. All through that time, we found so many things funny. Including cancer. When she was in hospital I stayed in her room when she was frightened.

Near the end, I had left to go home and her sister called and said she was asking for me. I went immediately and spent the last conscious night of her life with her. She lay there so quietly when I walked into the room that I pulled up a chair and held her hand. She said, “Mary! I would know that tiny hand anywhere.” We hugged. And then she slept. As I watched her sleep, I marvelled how, with her brain full of cancer, she still knew my hand. Still loved me. 

Many people have wondered when I’ll stop grieving Carol’s death.

A friend recently sent me an article that looked at a study where “They collected data from 26,515 people over 14 years, and found a range of negative consequences experienced by those who had a close friend die. In the four years after a death, significantly adverse wellbeing was found in people both physically and psychologically.”



This reminded me of a question I asked my supervisor when I started practice. I was trying to understand a patient who appeared to still be in mourning 15 years after the death of his child. I asked  about the length of the normal mourning period. I was young, didn’t have children but that question, quite frankly, was incredibly stupid. My supervisor kindly answered that the normal mourning period for a child was a lifetime. 

But what about a friend? Not just any friend, but a friend who forged me, who made me who I am and when there is nothing, nothing at all I have ever done that Carol wasn’t a part of? That kind of friend. My supervisor was a wise and kind man. If he were alive today, I would call and ask. I long for that conversation. 

There is something else about Carol and me. 

I was never the person I wanted to be. I wanted to be carefree, bold and irrepressibly confident. What I am is hopelessly serious, full of thoughts when I want to just be easy going. Carol was bold enough to climb apple trees without fear as a child and throw a knapsack on her back and head to Europe on her own after high school. She was far more carefree than I could ever be. She was a brilliant research scientist and a talented teacher. Maybe more so because she treated the meticulous and painstaking work of molecular biology like an adventurous journey with pipettes and gene splicing.

But we were also similar.  We both were totally honest, so we talked about our insecurities, our painful embarrassing incidents with ease. We also deeply loved kindness and recoiled from cruelty so we talked endlessly about the treatment of animals, children and people of all ages.  

For me to have someone as wonderful as Carol love me so deeply, so loyally 
for so long, made me feel better. Somehow less serious. Less hopelessly awkward. 

Carol was beautiful. Tall and blond. She was also strong. Until the last few months of her life. This photo of her as a young student leaving the apartment now is so poignant - it is her leaving me.

This year has been tough. My father died. My mother is now ill. I so needed to talk with Carol - these were the first hardships that I haven’t been able to share with her. Also, my daughter won a prestigious award and got a cat. My son went to Australia and published some exciting papers. Carol would have been eager to hear all of this and we would have chatted endlessly - and then she would have called the children for more details.

I miss hearing about the adventures of her life - her story was cut off mid-sentence. I want to know what would have happened if her story went on till we were old and ornery.

This was one of our last texts:



If there was ever a testament to the calibre of Carol, this is it. With cancer in her bones, spreading to her brain, unable to breathe and this, this is what she worried about: not being there for me. Steel in her spine. Pure steel.

This is the story of Carol and me, but each death leaves people with stories cutoff in mid-sentence. While some friends wonder when I'll get over my grief - my longing for Carol - my children and husband don't wonder. They share memories - sometimes we cry, sometimes we laugh - but always we miss her. We expect nothing less. 

Since I can’t ask my supervisor, I’m going to call this one. 

I will miss Carol for my whole life. 

When I die, missing her will be one of the last thoughts I have. 

12 May 2019

Epigenetics and Elephants


Most of the time I interview people and allow the things they ponder to guide my writing. This is not that article. This is about my late night pondering. Excuse the indulgence, but it’s been a a tough year and I’m prone to sleepless nights and thoughts.

Unable to sleep, I was ruminating on epigenetics and elephants. They may seem odd things to stay up at night about, but these are seriously important.


What epigenetics does is shake things up. DNA decides who we are but life turns our genes on and off - impacting everything from the architecture of our brain to the diseases we have. 

If you want to keep up at night too, just read about how this happens and how we can reverse the DNA changes that happened to your grandmother.

What actually jolted me out of a slide into a lovely slumber was a child. In a shopping cart. 

I was young - probably around 8 - and shopping with my mother. A child less than 2 in a cart passed by and she was sobbing. Her mother, her face clenched in that angry way that makes people truly ugly, slapped the child and said, “Cry again and I’ll give you something to cry about.’ As if that poor child didn’t have enough to cry about. I said to my mother, “Do something!” She said, “Shh.” Afterwards, my strong, well-educated mother told me that much as she would like to, it’s impossible to change how people parent.

There are many things that make us decide on our profession and making medicine my choice was about a series of decisions. All of them started at that moment. I was going to get an education that could help that child.


Choosing medicine would never have been something I did if I didn’t see a road to working with the damaged, the broken and, as I eventually did, stop the breaking and beating. I only went into medicine to work in mental illness.  

Let me tell you about mental illness and medicine and the place it has.  Many wonder why anyone would chose it. I have literally had people ask why I gave up medicine and chose to work with mental illness. Let me get this perfectly clear, I am a doctor who works with the mentally ill. As a doctor, I bring skills to the table because no brain tumour masquerading as depression gets past me. So, I am a doctor. Who works in one of the most important fields of medicine: with the mentally ill. I didn’t fall into it. I marched toward it, and went through medical training and 8 years of specialty training to have the privilege of working with patients that I wanted desperately to work for.

And that’s where epigenetic comes back in. Changing someone’s mental illness changes their genes. Leaving it does too. Those illnesses that all doctors battle, well I battle them too. In a different way, on a different battlefield, but it’s all medicine.

This all made me think of Dr. Fraser Mustard, who I had the honour of meeting numerous times. The last time I saw him was in his lovely home in Toronto, where his children lived in the apartment above him. After an illustrious career in medicine he had ended up pondering epigenetics and childhood trauma. He wrote about it brilliantly. He advocated for children. He was very old when i met him but this belief in helping children made him seem ageless. Children do that to you. In his apartment, so full of interesting things, was where I first thought of how he must stayed up at night worrying about children and that made it his life’s work at the end.



Sometimes, at the end of a career, you ponder the beginning. The thing that started it all. The work you have done and the value of it all.

Now I’m writing another book. It isn’t a departure from any of my other work. It is about the lost, the damaged and the suffering. I can’t change course because I simply don’t want to. It is what we see, truly see, that decides our course in life.

There is an African Zulu greeting: “I see you.” It is a haunting saying. When I was young, I visited many zoos around the world because my biologist father would meet other biologists and talk about the conservation efforts they were making at their zoos. I understand the conservation part. I do. But I really didn’t give a damn then, or even now. I hated zoos. Seeing the animals, really seeing them, in cages that were far too small or chained up - because that was the way zoos were then - I could see that the cages and chains around the elephant legs were truly like beatings. They diminished these animals, and their suffering was evident to anyone who bothered to look. In East Africa, where we spent many months on various trips, I saw wild animals on the plains. My first sight of elephants, not in chains but walking and taking such tender care of each other, made me fall in love. For the wildness of them. For the beauty of them. For the tenderness. I saw them.

Medicine or writing or elephants - it is all about seeing. All of it will keep you up at night if you let it. And these days I do.

And that child, being beaten in a shopping cart for all the world to see but not intervene. That too. That always. It shaped my life. I wish I could have told that tiny darling that.