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

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.

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?

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.

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?