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

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.

14 July 2019

Undercover: Covert Work of Consular Officials




by Mary Fernando

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. 

22 April 2019

DNA Testing for Crimes by Twins


by Mary Fernando

Science is on the verge of distinguishing between identical twins. Consider cases of crimes where DNA material leads not to one person, but two: identical twins. Until now, no one could say with certainty which twin might be guilty. Here's why.

Each twin comes from the same egg, split into two, creating two eggs with identical DNA. Old DNA testing was unable to distinguish between identical twins, but there are two fascinating options on the horizon that might just help.

The first difference between identical twins begins immediately. Although each is endowed with the same DNA - “When a fertilized egg starts dividing, there’s a small chance each new cell will gain a new mutation. When the cells separate into twin embryos, one gets some of the mutant cells and the other gets the rest. Unique mutations will end up in cells throughout each twin’s body.”

“Such a test would be difficult, then — but it would also be definitive. Just a single mutation, confirmed by multiple analyses, would be enough to implicate one twin and exonerate the other.”

“It’s not something that’s going to happen every day in every laboratory,” said Dr. Krawczak (a geneticist who now teaches at Kiel University in Germany). “But once people become aware of this, there may be a lot of cold cases that come back to life.”

However, this testing is in its infancy and is both expensive and time consuming.

The next set of DNA changes are called epigenetic changes and happen during embryonic development and continues for the rest of our lives.

Dia Rahman, a PhD student in Public Health at University of Waterloo has a special interest in social impacts on health and, therefore, is fascinated with epigenetics. “We are born with our DNA but what is impacted by the environment is the dance between active and inactive genes,” Dia says. “That is what is impacted by our upbringing and experiences. That is epigenetics.”

“A common analogy used to describe the epigenome is to consider genes as instruments in the “symphony” of life. But they don’t play themselves. They need musicians. Epigenetics would be the musicians that help express (or silence) the performance of our genes. Exercise, sleep, trauma, aging, stress, disease, and diet have all shown significant effects on the epigenome.”

Detecting epigenetic changes is faster and cheaper than looking for mutations. Graham Williams at the University of Huddersfield, UK, has found that epigenetic changes alter the melting point of DNA. “When the team heated up the twins’ DNA samples, they found the melting points were different – allowing them to tell the twins apart genetically. The test was also much quicker than whole genome sequencing, says Williams. “It can be done in just a few hours.”

So, essentially, we are born with our DNA - an entwined gift from our mother and father. This is not immutable. Some of our DNA can be altered by mutations. Parts of our DNA is also turned off and on by how our life impacts us. As our DNA testing improves, we can distinguish between identical twins.

Perhaps the most important part of all this has nothing to do with crime. It show that our DNA we once thought never changed is actually impacted by the life we live. And that is fascinating.

10 February 2019

The New Playground of Criminals: Sexting and Phishing.


by Mary Fernando


Amanda Todd was in grade seven when an online stranger convinced her to expose her breasts. Then he attempted to blackmail her, saying he would send Amanda’s naked image to family and friends if she didn't provide him with more nudes. She refused. He sent her nudes and, from that point on, she was ridiculed and bullied. 

After making a heartbreaking video, Amanda took her own life at fifteen.

Research looking at 110,000 children, all younger than 18 and some as young as 11, found that one in four young people had received sexts, and one in seven reported sending them. 


This is the new back alley rife with predator crime: the internet.

Darren Laur spent 30 years of his life as an inner city policeman. He retired three years ago, got certified in Open Source Intelligence and now specializes in online investigations.

“To date we have saved 186 youth who were considering suicide and self-harm in response to bullying and a full third of these were because of sexting,” says Darren in a voice that marries authority and empathy in equal measure. “We have the resources to do these investigations and put a package together to bring to law enforcement.”



As a policeman he wants to do what he has always done - he wants to put the bad guys away. He also wants to continue the work he did in the inner city - to help people by steering them in the right direction. Through his company - White Hatters - he does outreach for teens. His research shows that 1/4 of teens have sent nudes by the age of 16, and the youngest one was in grade 4. 79% of them were pressured into sending these nudes - often in the context of relationship building.

So, while explaining the dangers of sexting, Darren also recognizes a painful truth: preaching abstinence will only work for some. Just like with sex education with young people, an abstinence-only message is not as useful as giving a more robust message of safe sex and protection. With sexting that is the message he offers. Safe sexting.

If you are going to sext- because young people will - Daren teaches harm reduction. Sexting should be done without your face, or anything that can identify you like tattoos, clothing, background. This way,  if it goes public it is not evident it is you and there is deniability. He also teaches how to scrub any metadata that identifies the individual.


Darren explains that safe internet interaction applies to a far wider area than sexting. Those of us on the internet might want to be aware of another internet crime: Phishing. 

This is the use of a phishing link on twitter, email or texts, where a simple click can open you up to identity theft and fraud. Fraudsters will use social engineering to assess our likes and dislikes and use them to fool us into clicking links.

“According to Symantec’s 2018 Internet Security Threat Report (ISTR), a whopping 54.6% of all email is spam. Even more to the point, their data show that the average user receives 16 malicious spam emails per month”

“There were two bits of very bad news for consumers in the recent annual survey of identity-based fraud. First, there were 16.7 million victims in 2017, easily the most ever, fuelled in part by a series of high-profile data breaches. But even worse, criminals are migrating to more sophisticated, multistep frauds, with the rates of new account fraud and noncredit credit card fraud soaring. Why should you care? Those are the crimes with the most potential to hurt your credit score.”



Darren explains, “We can strengthen internet security, but the weakest link is always the human link.”

Every day, I join many others in clicking sites on searches, opening emails and texts and clicking interesting URLs on Twitter - oh, a cute dog video! Click. Click. 

 I agree with Daren. I’m a weak link. Wandering around like Bambi in the wild west of the internet. 



 I’m grateful that we have Darren Laur and investigators like him to educate us and – if we become a victim of identity theft or a number of other crimes – we have someone to fish us out.

Pun intended. 



14 October 2018

The High Passion of a Woman: Men Are Victims Too


by Mary Fernando


“I’m embarrassed. I’m supposed to be the man of the house, and these things don't happen to a man.”

I’ll call him James because he doesn't want his real name to be used. However, James wants his story to be told: it is a story about a woman he was living with.

“She was charming. Sexy. Everyone wanted to be friends with her. My parents loved her, but her own mother was a nightmare. I felt sorry for her.”

The escalations were small, each a little more violent. Each incident was followed by abject apology. At first, her abuse was just verbal, then it became physical. She was a mean drunk. She would put away a litre of wine and then scream, throw things and hit and kick. Once she drove her car into James.

Out of his depth, he determined to leave, but each time, piteous tears and wretched apologies reopened his heart. One day at work, for example, he found a note from her with a little cartoon that said “Every child deserves love, especially when they don't deserve it.” His heart broke for her; it would be quite a long time before he recognised manipulation.

At first, James felt he could put his own needs on hold, compensate for her terrible mother and lend her some of his strength. He soon realized that the violent escalations were too much for him: “The constant dripping of water creates a gorge.”

One day he watched a T.V. show with a woman talking about her husband’s abuse. She said he had a dead look in his eyes when he would start abusing her. Afterwards, he would promise never to do it again.

“I understood that,” said James. “A dead look would come into her eyes and I would think that this was going to be one of those nights… Like the girl on the parapet, I'm convinced a kind of self-deluding madness overtakes the perpetrator. Like in a Russian novel, they can't change their behaviour no matter how mutually destructive their actions are… The language of perpetrators indicate they're at the mercy of outside forces– this or that event 'made' them do it.”

The next time she turned physically violent, James called the police. “She was in such a rage that she took it out on the cops. They warned her that this was a warning and there would be consequences.”

James found that there was no place in domestic abuse shelters for men. He started to spend time away from home. Eventually, she departed.

Looking back on this relationship, and one with a similarly needy and violent woman in college, James said, “I felt I was bigger, tougher and could outlast the hardships. But the difficulties didn't go away and, instead, became emotional black holes. My sympathy for her turned into my own misery.”

Once, in response to an email request by a research student on assault, he answered the questionnaire but had trouble with some of the questions because they were geared to women, such as “Who was the first man who assaulted you?” When James explained that he was a man and had been assaulted by a woman, the student said “Women don’t assault men. You’ve got to be lying.”

In fact, studies estimate that about 2 in 5 victims of domestic violence are men. They are less likely to report than women and less likely to be believed.

“Does stuff that happens in childhood affect what happens later in life?” asks James. He points to his parents, who loved him but also believed in physical discipline.

Raised by a extremely strict parents, James’ mother would use a switch to punish him, which is a branch with the leaves removed. It was painful and left large welts. This history of harsh corporal punishment in childhood is strongly linked with developing relationships in later life that involve domestic violence.

To date, 53 countries have banned corporal punishment because of the lasting impacts on children. I know this is a contentious issue for many who believe in corporal punishment, however, the evidence is unequivocal.

I am deeply moved that James told his story. It is a story that shows that men can be victims of domestic violence. Men are less likely to come forward and more likely to be dismissed when they do. Let’s change that.

I’ll leave you with another story about James. He met a very intriguing woman. She was sexy, smart and funny. She swore at him a few times. He asked her never to speak to him like that. She continued. She tried to sleep with him but he had concerns, so he refused to sleep with her. When he left her after she swore at him yet again, she said “If you slept with me, you wouldn't be leaving me now.”

James said “She was right. It’s easy to get sexually besotted and then emotionally unable to walk away. Enticing as she was, I realized she wasn't going to change. I felt I had grown up just a little. It is the high passion of a woman that draws me in, but that highly charged, highly sexual passion can be a cover for a whole lot of problems.”

Yes it can.

07 October 2018

Talking Turkey


by Velma

Tomorrow Canadians celebrate Thanksgiving and, in case you wondered, Liberia celebrates Thanksgiving the first Thursday in November. The time or place matters little to bachelors who celebrate the holiday much the same no matter when or where.


A Bachelor Thanksgiving
in honour of the Canadian holiday
arrangement in ironic pentameter
by deservedly anonymous


Thanksgiving cornucopia
I think I shall never sniff
A poem as lovely as a whiff
Of turkey and mashed po—
tatoes and frozen snow–

Peas in vast disproportion
As I gulp another portion.
Cranberry sauce, count me a fan,
Maintains the shape of the can.

Cheap beer and cheaper whiskey
Makes the shallow heart grow frisky.
Three litre jugs of screw-capped wine
First tastes horrible, then tastes fine.

Deli turkey, cellophane wrapped.
Processed ham and all that crap.
Sherbet, ice cream, anything frozen,
Packaged cupcakes by the dozen,

Ruffled chips and onion dip,
Reddi-Wip and Miracle Whip,
Maple frosting found in tins
Hide the worst culinary sins.

Seven-fifty millilitres of
Grain vodka labeled Scruitov,
Cheap brandy and cheaper beer
First smells awful, then tastes queer.

Pumpkin pie and store-bought cake,
Anything I need not bake.
If it’s boxed, if it’s canned,
I’m no gourmet, only gourmand.

Chorus    

Baseball, football on the TV.
One spilt bowl of poutine gravy.
This little poem with each verse,
I give thanks if it grows no worse.
vintage post card wreath turkey

vintage post card children, turkey, pumpkin

We admit nothing except Happy Thanksgiving. Graphics courtesy of Antique Images, The Holiday Spot, and Spruce Crafts.

12 August 2018

He Had Plans for Her (Part One)


by Mary Fernando


“He laughed a lot, but not loudly. Other people naturally deferred to him. He was a skilled communicator,” she said, in that famous voice, like smooth whisky with a touch of honey. “We married very quickly. I was very young.”  



After they were married, he began to reveal his plans for her. By humiliating and belittling her daily, he made her feel small, unimportant and made it easier for her to be controlled. It taught her that she was no match for him. If she disagreed with him, embarrassed him in any way, there would be consequences. There would be beatings. She learned to never disagree. Never to say anything he would disapprove of. She learned to avoid other people. To become isolated, because that too, made her easier to control.

She learned his rules. In the midst of fear and humiliation - she knew if she followed his rules, the beating would be less. And the beating would stop when she was pregnant. And he didn't beat the children.

She didn’t go to the hospital to give birth to her first three children, because he didn't want her to say anything when he couldn't control her.

When she was nine months pregnant with her fourth child, she said something that upset him. He threw her down the stairs, broke her coccyx and sent her into labour. He took her to the hospital.

To keep her in line, to make it clear how unimportant she was, he parked and made her walk, bleeding and in pain, the long distance to the hospital doors. 

When the x-rays showed her broken coccyx, she told the nurses and doctors that she had fallen down the stairs. No one, no nurse, no doctor, asked her if she had been beaten, if she felt safe. When she went into full labour, she refused all pain meds, fearful that she would say something she shouldn't if she was drugged.

After she delivered her baby, she began to realize that there were no rules that could keep her safe. Before, her pregnancies had protected her from severe physical violence. Now she knew that he was eventually going to kill her. And then who would take care of her children?

That provided the impetus to get help from a women’s shelter. Here she voraciously read their literature on abuse, found solace in those who cared for her and her children. 

But he still had plans for her. 


Before she could escape and build a life for herself, he kidnapped her children. To get them back, she had to go with him. She went with him.



For three days, he tied her down and he tortured her. Beat her. Humiliated her. Raped her. She still remembers that moment during those horrific days that she caught a glimpse of herself in the mirror. She was filled with loathing for the woman she saw in the mirror. She hated what she saw. What he had made her. 

“I now know I was just doing my best,” she said, whisky voice turning soft. “I was being extraordinarily brave to take the only path forward I could see for my children. For myself.”

That path was to get her children back, escape him and make a life for herself. 



You probably know her as Eve, or by her twitter handle @BrowofJustice. She is a nurse who is fierce about the care of her patients and the raising of her children. She is fierce in defending others. You can’t scare her, because she has been to hell and she walked out. On her own two feet. And she has other things that terrify her.

Eve is not alone, not only because she now has friends and colleagues. She shares the same story as the one out of every three women worldwide have been the victims of physical and/or sexual violence by an intimate partner or sexual violence by a non-partner at some point in their lives. Less than 40 per cent of the women who experienced violence sought help of any sort. Less than 10% sought help from the police.

Healthcare providers - doctors, nurses, nurse practitioners, PSWs - all need to be trained to see the signs of domestic abuse. We need to ask - do you feel safe? We are trained to recognize heart attacks and strokes. We need to be trained to help curb the epidemic of domestic abuse. 

Eve is the voice of these women and her story is their story.

One of the reasons women don't speak, don't escape, is that they are frightened that their ex-partner will eventually find them and make them pay for breaking their silence. They are scared that they will never be free. Never feel safe. 

When I write the rest of Eve’s story next month, it will become clear why Eve, like many women, is justified to have these fears.

17 June 2018

Someone Else's Nightmare


by Mary Fernando

“Some men hear the word ‘no’ from a woman, and they push harder with a side of violence,” says Dr. Sampsel. 

As a Clinical Forensic Medical Examiner, Dr. Kari Sampsel is the only Canadian physician with a fellowship in Clinical Forensic Sciences. Dr. Kari Sampsel is an Attending Staff Emergency Physician and the Medical Director of the Sexual Assault and Partner Abuse Care Program at The Ottawa Hospital. As the Medical Director of the Sexual Assault and Partner Abuse Care Program, when victims of  sexual violence come into the emergency room, she is in charge of the rape kit, assessments of sexually transmitted disease and pregnancy as well as setting up long-term physical and mental health care for these victims.

She states that statistics show that one out of every three women will be sexually assaulted in their lifetime. Although those who come into the emergency room are overwhelmingly 18- to 24-year-olds, women of all ages are raped, even those in their 80s.  Since 85% of rape victims know the attacker, Dr. Sampsel says that one of the crucial questions to ask is,“Do you feel safe?” and that this should be a screening question for all rapes. 

Interestingly, Dr. Sampsel says that younger woman are more likely to come into the emergency room to prevent disease and pregnancy, but it is women in their forties who are more likely to complete the evidence kit. Older women want justice but younger women may only want physical safety. 

During the ten years Dr. Sampsel has run the unit, she has seen a marked rise in the number of rape victims coming for help. However, she points out that it is only 10-20% of rape victims who seek help immediately. Some rape victims don't come in because stigma and shame keep them from reporting the rape. Interestingly, Dr. Sampsel says that after being raped, many are confused about what happened. This is only in part because of the use of alcohol or drugs. More often it is that trauma makes it difficult to remember. Later, they may get snippets of memory of the event.

A large proportion of rape victims develop recurrent symptoms like headaches and abdomen pain. Dr. Sampsel’s work is also to educate doctors in the emergency room and family doctors’ offices to recognize these symptoms and ask the right questions. 


I asked Dr. Sampsel how we can decrease the incidence of rape. She hones in on education. On three fronts.

The first thing we need to do to reduce the incidence of rape begins with our children. Young people should be educated in the need for consent on all levels. You don't have to give a hug unless you consent. If you are uncomfortable, you should walk away and adults should support this rather than be embarrassed.

In the emergency rooms and doctors’ offices: there needs to be an education campaign by those in the field, clarifying what to do with rape victims who seek help immediately and also those who come in later. Protocols for treatment need to be in place and these have to be adequately funded to mean anything.

On a societal level, Dr. Sampsel would like to see a public campaign, perhaps like the one that educates people on the signs of stroke. One piece of this would obviously be about consent and how it needs to be given in every circumstance of physical contact. This might seem extreme to some; however, if I rephrased it and said that every person entering your home needs consent and an invitation, it seems like common sense, does it not?

The other piece of this is what Dr. Sampsel calls a social contract: what is done privately between people should be up to the standards of what is allowed in polite and civil society, where we all adhere to the basic principle that how we treat others is how we would like to be treated. This has the perfect makings of a public campaign. 


With one in three women being assaulted, this looks like a healthcare epidemic to me. It rivals the chance of getting cancer or having a stroke. So, perhaps the same steps to reduce the problem are in order. The steps outlined - prevention, identification and public awareness - seem long overdue.


One final and haunting statement from Dr. Sampsel: “People need to realize that their flirtations may be the makings of someone else’s nightmare.”


11 February 2018

A Voice for the Dead


by Mary Fernando

“I don't believe it, and none of us believe it.”[1]

That was the response to the police assessment of murder-suicide from one friend of billionaires Honey and Barry Sherman. This was followed by a chorus of agreement from many prominent Canadians, and subsequently by an expensive independent investigation which resulted in a revised new assessment of double murder.

Leigh Lundin asked me to look at this now high-profile Canadian crime being played out, blow by blow, in the news. So here I am looking at it. But with Canadian eyes.

Honey and Barry Sherman
Honey and Barry Sherman
My question isn't about what happened in this particular crime. I feel confident that it will play out in the investigation, and that the truth will emerge. My question is this: What would happen if a family disagreed, but did not have powerful friends or the money to conduct their own investigation? What if the family were poor, but still vehemently in disagreement? What if a murderer was on the cusp of getting away with it? Who would stop them? 


I brought this up with Dr. Coroner – not his real name but it would be a good one, because he is indeed a coroner. He is called in if a death occurs outside a hospital, and occasionally in it. His job is essentially to assess the manner and cause of death. Is this death natural, an accident, a suicide or a homicide?

The body can be photographed but cannot be touched until he is finished his assessment and releases the body. He looks at the story, told by the body, of the manner and timing of death. There is also the story told by the place of death, and the question for him is whether it is consistent with the story the body tells.

My question: If the family disagreed with a murder-suicide verdict, but were neither educated or moneyed – what would he do? What if the family was unable to articulate a story as well as the friends and family of the Shermans? What if they were angry and threatening, or in general made themselves unsympathetic?

He said often his job is to help reconcile the disbelief with the reality. Some counselling is often part of what he does with families.

Also, he argues that marriage – by the nature of the long term relationship – can lead people to kill each other, even if they look to others like they are happy. Marriage itself can be the reason for murder.

Those caveats aside, Dr. C. said there was enough from the story of the “murder-suicide” of the Shermans to make him suspicious, largely because the story is wrong. Domestic murder is often more violent, angry. Hanging is not what he would expect as a means of murder or suicide in this case. Hanging is more often seen in cases of mental illness or extreme distress. Further, why would a man who has copious drugs available to him choose this manner of death for himself and his wife?

If the stories of the body, manner of death and family assessment make Dr. C. suspicious in any way, he has many options to augment the evidence he gathers.
  • The authority of the coroner overrides privacy of information, so he can seize records from sources such as the family doctor, psychiatrists, and psychologists. This could provide a more fulsome picture.
  • He can seize all radiological and dental records, to see if there is evidence of previous abuse.
  • He can order a post mortem, or a forensic autopsy and refuse to complete the death certificate or even provide the funeral home with a warrant to bury, until he is fully satisfied.
Ultimately, the story must hang together. Regardless of the ability of the family to articulate their concerns, or their resources to investigate on their own, Dr. C. relies on having a coherent story told by the manner of death, the body, the family and the records seized. If there are inconsistencies – then a further investigation is warranted.

If a family were unable to mount the same vigorous objection and investigation as the Shermans have, it could be the coroner who stands between the constructed truth of the murderer and the actual truth of the victim.

Ultimately, all crime writing is social justice writing. And the poor have a voice – the coroner. The story of the body, uncovering the life lived, the manner of death, might be the key to catching a murderer. The background knowledge and tenacity of the coroner is what most of us rely on when our bank accounts are meagre.

Dr. C. said that the job of the coroner is to provide a voice for the dead, to listen carefully to the story they tell. This is the first step towards social justice for those without money and connections. They do this by asking the simple question:
Does the story of this death make sense?

07 January 2018

Radiology and Murder



by Mary Fernando

Doctor John Doe (DJD) is a radiologist. That is not his real name, but it is his real profession. DJD is the doctor who reads CTs, MRIs and various other images that help diagnose illness. He is dedicated, competent, and once said a line which should be famous: ’When life hands me a lemon, I put it in a bag, find the person responsible and hit them over the head with the lemon.’ I adore him because feisty is always the way to go in life.

I asked him about his thoughts on murder:

DJD: I would be interested in seeing a two victim murder, in which the murderer uses the first victim as a pawn, believing that their death will cause such a deep grief for the the second victim, who is the person the murderer really wants dead, that their staged suicide will appear plausible. To the murderer, it appears like an undetectable crime. The murderer gives the first victim  a blow to the head and then throws them down the stairs or in front of an oncoming car, making it look like a terrible accident.

The second victim is someone who deeply cares about the first. They could be murdered by numerous means made to look like a suicide resulting from grief. Often people are prescribed sleeping pills or anti-anxiety meds to cope with a grievous loss. DJD suggests one easy way to kill them is to get them drunk and grind a deadly dose of the pills they have on hand into one of the drinks. At first blush, this looks like a drinking binge of a depressed person who decided to kill themselves because of grief. The murderer simply has to leave the staged evidence of a booze bottle and an empty, opened pill bottle. 

Could the chain of murders be unraveled, starting with a critical examination of the first, apparently random act? The radiologist could first examine cutting-edge radiological evidence postmortem.

DJD is sometimes called in when the coroner has questions about the cause of death. For example, did the blow on the head occur before the car accident, or was the victim lethally struck on the head and then pushed down the stairs? Using radiological evidence, that distinction can be made.

Although the forensic autopsy still remains the gold standard for post-mortem forensic assessment, the ‘virtopsy’ is catching up, sometimes augmenting or even replacing the autopsy. When there are religious or other reasons for excluding an autopsy, the virtopsy is the only evidence available. Sometimes, even with a pending autopsy, a virtopsy will be used. 

A virtopsy is the pre-autopsy whole-body CT or MRI scan, used to identify cause of death. Some studies have shown that a CT scan may be more effective in detecting some causes of death, and that the imaging may be better than a full autopsy to detect such causes of death as intracranial pathologies (such as strokes) and pneumothorax.

If someone is killed first, say with a blow to the head, and then pushed into the path of an oncoming car or thrown down a flight of stairs, most people assume that the serious and extensive injuries of the fall or impact will hide the original blow to the head. However, careful examination for the radiological evidence can clarify the timing of the injuries. And again, this can be done even if the family rejects, for religious or other reasons, a full autopsy. 

Impact from a car or a fall may show multiple bone fractures of the skull, ribs, vertebrae and extremities, as well as damage to organs. However, these impact lesions will lack the relevant surrounding hemorrhage which would have been expected under these circumstances. In short, if you die before impact, the lesions of impact will bleed less because your heart isn't pumping blood. This bleeding pattern will help identify the actual blow that caused death because of the extensive hemorrhage at that site of injury. 

This new radiological post-mortem examination is a cutting edge means of identifying cause of death and timing of injuries that were sustained. We will, I think, hear more about it as the techniques evolve.

One interesting use of CTs is identifying those who have been poisoned and then hit by a car or who have sustained other injuries. The amount of blood from impact injuries is reduced when the victim is previously killed by any means, including poison. 

A complex chain of events, like DJD’s proposed double murder, can be unraveled by tugging at the simplest loose threads. For radiologists, a virtopsy provides a cutting-edge method to find these loose threads and exploit them.

12 November 2017

Breathing


by Mary Fernando

I still remember standing there, in that hospital room, decades ago. We had news to tell the patient and her family. Although at first it didn't look like it was going to be a bad diagnosis, it was indeed, very bad. That is medicine in a nutshell: we see behind and beneath and in the end the news is ours to tell, but not to craft.

As we told them the news the patient and the family held their breath. A whole room not breathing. Me too.

Afterwards, my supervisor, not fooled by my tough exterior - which I have found fools no one at all- gently said to me ‘When patients tell us their stories and let us help them, it is a privilege. Never forget that. Even if the story ends in tragedy, it is a privilege. Honour it by serving those who trust you.” Sometimes you are lucky enough to find people who define you, who are in your life and shape you to be better. This was the man and he shaped my approach to patients for the decades. It taught me to serve. To know it is a privilege. And that patients don't breathe when the news is bad.
I scuba dive. In the boat, at the dive site, the ocean stretches out, and there is a sense of glass and ripples. Diving in, there is coral, turtles and fish. I love that there is another world under the water. I love the beauty of it and how hidden it is. Most of all I love being able to breathe underwater as I move forward deep in the ocean.
Back to patients. There is nothing that prepares you for what medicine is either. What the surface of medicine looks like is nothing like the truth of the practice. Yes, you help. Yes there are medicines to offer but the reality is the stories. The ability and privilege to immerse yourself in the lives of patients where you see their hopes, their loves, their fears and finally, even their deaths. And this brings me back to breathing.

In many books, authors will say that, in response to bad news, people feel ‘punched in the gut’ or ‘their world collapsed’ In reality, what I have seen is that patients, and the people that love them, hold their breath. And I recently learned why.

I have had many people who have shaped me, made me better, because goodness knows, I have needed that, perhaps more than most people.

The person who shaped me most, I met when I was about 6 or 7. She had a blond pixie cut and bright blue eyes. We were the same age but she was much smaller than me. When the large school bully kicked the cello she was carrying, she grabbed his arm and twirled him around and around and sent him flying into a wall. She would wander streams, ride her bike in the woods, and strangely, at the corner store while the rest of us bought chocolate, she would buy a carton of milk. An original from start to finish. I did what any sane person would do: loved her for life.

In our teens she grew and became a 5’10” blond beauty, who towered over me. Which was fitting because she was built for the life she wanted to lead - bold and strong.

Over the last fifty years, she and I have talked every few days. When she headed off to Europe at 18, with a backpack and panache, I stayed in university and worried about her. When she wandered into the woods for long camping trips on her own, I would worry while writing my exams. She got a PhD and turned into a crack research scientists who still takes off for lone camping trips that worry the crap out of me. The real truth of who she is to me is that she was the first person who came when my children were born and the first to come every time I needed her. If she detected a tremor in my voice, I would find her on my doorstep even if we lived in different cities and she had to travel for miles.

This summer, while we sat sipping coffee on a patio of a restaurant, she gently told me that she had breast cancer. I stopped breathing. I looked at her, blond hair now darker and longer, lines around her eyes, and I finally took a breath. Because the not breathing was wanting to stop the world, to go back to before, when illness wasn't real. And the breathing part was because I knew that I had to breathe and move forward. Because she needed me. Because I needed to be there. Every step.

And I was. The mastectomy was hard, and I was there for that. I was there at the hospital, and when she was home, we laughed in our zany way about all things cancer related. Then after she had eaten the food I had made for her, she gently told me that that cancer had spread to her bones. I couldn't breathe. This time, my lungs simply refused to take in any air. Then I did. Because I had to be there for that too.

When tragedy hits, and in books it must, I think it is important to dive in and write about breathing. Because that tells the story. Of wanting to stop time, and go back. Of breathing and moving forward.

08 October 2017

Hospitals and Murder in One Step or Two


by Mary Fernando
“Hospitals are a great place to kill people” said MC, during our interview, “You can kill people in one-step or two.”
I would like to reintroduce MC – Mystery Cardiologist. He is a doctor who opens up blocked heart vessels with stents, puts in new heart valves and uses defibrillators to bring people back from the brink of death. He is also a voracious reader of mystery novels. What can be more delicious than a man who saves lives and ponders how to kill people? After he read my last blog, he felt it made him sound a bit ghoulish. So I would say, unequivocally, that he is a great guy. A wonderful husband, father, puppy owner who has never murdered anyone. He is safe to have over for dinner and introduce to your children.

Although his one-step and two-step murders are worth hearing about, what is equally as interesting is the character of a hospital murderer.
“There is nothing more creepy than someone like a nurse, doctor or paramedic who kills.” said MC. “That is the person with the most access to the patient, the knowledge to kill and the person everyone trusts.”
MC is right. The best person to know what drugs could kill and at what dosages, is a person who is medically trained. Further, they would know, for example, that in death, all cells break down, release sugar, and make an insulin overdose difficult to detect. However, a sample of the vitreous humour (fluid in the eye) could be a perfect way to catch this murderer.

Setting a murder in a hospital opens up avenues of murder but also allows for the creation of a complex character. What makes someone who has devoted a great deal of time educating themselves on how to save lives, who has a career of service to patients, turn themselves into a killer?  It could be a latent aggression finally coming to the fore, or it could be a character up against hard times who changes and becomes embittered. Or it could be a character who becomes a doctor or nurse to compensate for a sense of helplessness but gradually develops a sense of arrogance and invincibility, coupled with the a distain for those who are helpless like they once were.

One-step murders in hospitals can involve numerous methods. If someone is admitted to hospital for routine surgery such as an appendectomy or even for a heart attack that they survived, then finishing them off in hospital is an interesting option.

In hospital, people have IVs that provide a portal to inject them with something deadly. An overdose, of insulin, epinephrine, or potassium are some of MC’s suggestions.

A two-step murder is another intriguing option. Perhaps a murder attempt - a car accident, or bludgeoning on the head - has failed to completely kill off the victim. Bringing them to hospital provides an opportunity to try to kill them again.

Here a principle of reversing medical treatment is key. For example, if the victim has brain swelling after a thump on the head, in hospital they will give drugs to reduce swelling. They will also raise the head, using gravity to get rid of excess fluid in the brain. A visit during which the hospital bed is positioned to lower their head will send enough fluid into their brain to kill them. It is a gruesome way to die as the brain swells and pushes into your skull and again, it takes a certain twist of character to make a person trained to save lives, now take them.

Killing via an IV line is of course an option when a murder is botched and someone wants to complete the kill. Insulin injected could bottom out their glucose and put them into a deadly coma. Adrenaline could cause a fatal heart attack. And someone who has survived a murder attempt would be frailer and more susceptible to most drugs. Air injected into an IV is a perfect way to kill someone.

Once you have decided to set up a hospital murder, either in one or two steps, there is a wealth of internet info to look at. For example, if you are set on killing someone with air injected into an IV, I would like to recommend the blog by James J Murray, Prescription for Murder, as a great starting point. Another intriguing find is a book about murder by insulin.

For me, the intriguing part of my interview with MC was the hospital setting as an opportunity for murder with a necessity of developing the kind of complex character who would murder in a hospital. I truly think this hospital killer allows a writer to develop a character that embodies the saying: ‘As we get older, we just get more so.'

All our vulnerabilities, our fears and frailties, can be hidden under work and purpose. However, in the end we all become ourselves and more so. What haunts us eventually will consume us and that, in essence, is the making of a murderer.

22 August 2017

Mystery #1: How to Balance Motherhood, Work, and Writing


by Melissa YiPatreon

Hi everyone, I want to tread lightly as we mourn the great writer and friend, BK Stevens. I'd written this post three years ago, and tucked it away for an emergency day that didn't come, although I came close many a time.

Sleuthsayers have been very kind to me, but I've struggled to balance my 'big three': medicine, writing, and my children. This summer, I realized it would be best for my family and my sanity if I gave someone else the opportunity.

Next month, you will meet Dr. Mary Fernando. I first met her through Capital Crime Writers, the Ottawa writers' association. Her first novel, An Absence of Empathy, was nominated for the Unhanged Arthur for Best Unpublished First Crime Novel, sponsored by Dundurn Press. In addition to her obvious talents as a physician and a writer, Mary likes to laugh, and I think you'll have fun together.
Shoot. Her face is cut off (perhaps fitting in a crime blog?), but that's Mary Fernando, me, a skull, and Elizabeth Hosang.

Best wishes, everyone. Perhaps it's fitting that my last column is about family. Yesterday, my eleven-year-old son, Max, turned toward me. "You said you weren't working in August."

"I said I wasn't working [at the hospital] as much. But that means I'm writing more. You know that."


"I hate your writing. I hate it. It takes you away from us."


So I'll work on getting our family back on track. Today, we watched the partial solar eclipse. Tonight was their last, despised swimming lesson. Tomorrow they'll revel at a barbecue before I start back at the hospital again.

See you online, and at Bouchercon in Toronto!
Cheers,
Melissa
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Original post:
When I was in med school and residency, I knew I wanted kids, but I had no idea how I’d make time for them AND emergency medicine AND writing. So I used to corner parent-writers at parties and say, “How do you do it?”

Dr. Ilsa Bick, a writer and a psychiatrist, said, “You have an advantage. You started writing young.”

“What does that have to do with anything?” I shook my head, genuinely confused. Writing in my twenties wouldn’t help me stay up all night with a colicky baby.

But now I see a few advantages, like before I procreated, I’d already written my million words of garbage, I’d published a handful of short stories and won a few awards (including Writers of the Future, where I met Ilsa), I’d written a few novels, and I’d perhaps most importantly, I’d learned iron-clad self discipline.
From the Kobo office. Cool place.

Still, since this spring, I’ve been wrestling with the question of how to become a more attentive mom.

Over the past two years, I’ve doubled my emergency room shifts per month. I still need to write. So motherhood was sliding on to the back burner. Now that my daughter has enough of an attention span longer than a few minutes, it’s all too easy to foist both kids off on the electronic babysitter (Netflix and/or YouTube).

So I tried a few different tactics.

I read about how other people prioritize their family life.

I wrote about balancing medicine and my family for the Medical Post.

And I started doing video diaries/vlogs (video blogs), walking my dog with my kids while talking about writing.




Last year, the fearless fantasy writer, Michael La Ronn, introduced me to #walkcasts. Those are podcasts you record while walking. Walking is a good idea for writers, who tend to be sedentary. And podcasts are fun, as you can hear on Michael's podcasts here. So I recorded ten of them, but I never got around to putting them in order, labeling them, etc.
On impulse, at the end of August, I started recording videos instead. Just a minute or two. Just long enough to say a few words about writing and show people the neighbourhood and our dog Roxy’s hind end as she trots in front of me.


I can’t say my videos are blowing up YouTube. My son Max laughed and said, “Why do you only have two views?” But you know, for once I’m not as worried how many likes or views I get. This is my way to combine two of the big loves of my life, and if the rest of the planet doesn’t see it, well, it’s probably just as well for my kids’ Internet privacy.

No matter what happens, or how many trolls give us the thumbs down, I will love my kids. And I will love writing. This feels like a win to me. It makes me more present if I’m recording my walks instead of just getting lost in my own thoughts.



If a young’un were to ask me now, “O Great and Wise Melissa, how do you do it?” I’d say supportive partner is priceless. A tight circle of family and friends will keep you afloat. But it takes ferocious will to make time for multiple serious interests. Do you let the kids weep for a few minutes while you finish your word quota for the day, or do you let the words slip away because kids come first? 

Medicine waits for no one. Are you willing to scale back your career now for the sake of your writing, or go all-out doctor and pick the pen back up in twenty years? You decide.

You can see how writing can easily drop off the to-do list. That’s why I encourage you to keep writing no matter what. Even one line, one word a day. Just keep at it, and it will add up to a song lyric, a poem, a short story, or a novel. Something beautiful for you, and maybe for the world.