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

14 November 2021

Fear and Silence


A little while ago, I was asked by a reporter to speak about the escalating threats against doctors on Twitter. Since then, that conversation has been meandering, and at times galloping, through my mind. It’s kept me awake at night.

I have written previously about attacks against others and myself on Twitter while advocating for simple things like wearing masks and getting vaccines. However, attacks and threats are very different things. It’s far more worrisome when people tell me they will find me and ‘make me pay’ because that makes me look at our wall of windows overlooking our backyard and wonder who is in the woods looking in. What I said to the reporter is just that: ordinary people have no security so threats are worrisome. There are escalating threats against doctors but the real problem is far worse. Nurses, professors, psychologists and journalists have all had threats made against them, including death threats for speaking factually about COVID-19 and measures to help save lives.

From what I’ve observed, it’s often journalists who get the largest number of threats. Writing factual information on the pandemic isn’t the only thing that engenders threats, but it certainly begins large pile ons from the anti-science groups. Imagine having death threats or threats of violence against you but also having your face well-known, because it’s published with your articles or seen in TV appearances. Then imagine taking said face downtown, into stores, out walking with your dog or, worse, walking with your children.

While people are asking why people are becoming more violent, one very important piece of information needs to be brought to the table. Canada’s intelligence service, CSIS, has warned that foreign actors are using COVID-19 to sow discord in Canada:

“It is important to note that disinformation, originating from anywhere in the world, can have serious consequences including threats to the safety and security of Canadians, erosion of trust in our democratic institutions, and confusion about government policies and notices including information on the COVID-19 pandemic.”

Anything that sows discord in a democratic country weakens that democracy. The free press, as a cornerstone of our democracy and threatened in authoritarian countries, would certainly be a target. As would doctors, nurses and scientists who can speak in our country unlike in others, and stand as a testament to the freedoms we enjoy in a democratic nation. This is not to suggest that foreign bots are the only ones attacking journalists or others, but we must remember that their purpose is to inspire domestic threats with the volume and character of their attacks.

Regardless of who begins or escalates these threats, the consequence remains the same: fear, possible physical harm and silencing.

The avenues of help when you’re threatened are somewhat convoluted. A successful report to Twitter results in a thank you. Not sure what that means.

Wandering through the internet looking for help led me to Cybercrime that helpfully suggests “To report abusive behaviour, such as harassment, cyberbullying, threats, and impersonation, or other incidents that occur on social media, contact the social media provider directly through their help centre.”

Tried that.

Then there’s the labyrinth that take you to a report to your local police - but can they do anything from threats coming outside your local region?

One of my late night thoughts: could there be an avenue to create new methods of reporting threats made on social media, that allow quick reporting and maximum impact, like immediate and permanent bans from Twitter and quick attempts to find and prosecute these people?

The reason I’m bringing this up as a solution is that those who threaten are emboldened because they rarely pay a price for their actions. Some are actually dangerous, some are not, however, their threats have an impact of silencing or frightening people. What if they knew that people are quickly banned, quickly found and prosecuted? That would send a chilling message to them.

It would also reduce the sense of helplessness we all feel in the face of these threats.

Mind you, these are the late night thoughts of someone who never studied law and law enforcement. They are also the simple thoughts of someone who sees a new and large problem emerging that urgently needs new solutions.

Certainly, what we have now is not sufficient, because those threatened are increasingly frightened and those who threaten are increasingly emboldened. Why not do something to turn that pattern around?

If we don’t find innovative solutions to nip this growing problem in the bud, we’ll have a larger problem. If scientists, doctors, journalists, nurses and others fear speaking out factually on this pandemic, their increasing silence will just make our society much more dangerous by yielding the information space to those who will not keep us safe in a pandemic.

It is unequivocally a public safety issue.

10 October 2021

1977


“The hangman asked if Turpin or Lucas had any last words. "Nothing," they answered… The hangman yanked on a lever and the trapdoor fell open with a crash that echoed through the jail…On their way down, the men made no sound.”

These events took place on` December 10, 1962, the last time a Canadian would die from capital punishment.

“The death penalty was abolished July 26, 1976, with the passage of a bill barring its use introduced by the government of Pierre Trudeau.” 

A short year later, a gruesome rape and murder would test the resolve of Canadians to support this ban on capital punishment. 

On July 28, 1977, Emmanuel was shining shoes at Yonge and Dundas streets in Toronto. His family had immigrated to Canada from Portugal three years earlier and, the family all worked to support the family, including 12 year old Emmanuel. 

He was lured away from his shoe stand with an offer of $35 to help move some equipment. This money was important to Emmanuel because it would allow him to buy dog food for a puppy he wanted.

Instead, for “12 tortuous hours, he was held captive and raped by the men in the third-floor apartment,” and finally murdered.

“The biggest thing that happened was a protest … on Aug. 8, where members of the Portuguese community came out and called for … bringing back the death penalty and they called for the eradication of homosexuality.” 

The protest was accompanied by angry articles and letters concerning the death penalty, but  capital punishment remained banned in Canada despite this pressure.

Unfortunately, this also fuelled a rise in homophobia and that had many consequences.

In June 1969, Parliament had passed the Criminal Law Amendment Act, 1968–69, which decriminalized sexual activity between men, but, “The murder of Emanuel Jaques put this idea into people’s minds that homosexuality was somehow associated with pedophilia … This sort of association that homosexuals were dangerous, perverted and somehow a threat to children.”

This attitude towards the LGTBQ community was echoed in the press, by the public, by police, and eventually resulted in the bathhouse raids of 1981, where four bathhouses frequented by the LGBTQ community were raided and the occupants were treated viciously. These raids resulted in “growing politicization and support of the gay community [and] fueled civil rights activism, made homophobia less acceptable, and have led to Pride becoming one of Toronto’s largest annual public celebrations.”

Ultimately, the LGBTQ community and their supporters prevailed. Their rights are stronger now with “anti-discrimination, anti-harassment, gay marriage, homoparentality, blood donations, transgender rights and outlawry of conversion therapies.”

In 2020, police chiefs of Canada issued a formal apology for oppressing and opposing LGBT rights.

This one grotesque and horrible murder of a child and the resulting protests, media coverage and anger threatened to topple decades of human rights progress. Eventually progress took its rightful place in pushing these rights further. 

They say history teaches important lessons. These are the days where the fabric of our rights, our scientific progress and our basic humanity feel threatened - nay, moving backwards. I find myself looking back often to turbulent times. Looking for hope. Looking for lessons.

08 August 2021

Chasing Healthcare Workers Off Twitter: Who are these people?


Those of us advocating for vaccines and masks on Twitter during this pandemic have had some rather interesting replies.

Here is one:


As you can imagine, many of my colleagues are asking- who are these people?

Certainly not the kind people you would meet at a dinner party - for those of us old enough to remember these much loved pre-pandemic events.

CSIS, the Canadian organization responsible for protecting us against security threats, has given one answer about who some of these people might be and by whom they may be influenced.

CSIS has accused “Russia, China and Iran of spreading COVID-19 disinformation to promote their strategic ambitions…COVID-19 misinformation has flourished since the start of the pandemic, fuelling what has been called an “infodemic” of conspiracy theories and falsehoods amid efforts to contain the coronavirus.

“Declassified documents obtained by Global News under the Access to Information Act show that CSIS has been monitoring the national security implications of the phenomenon.

“Threat actors have used the pandemic as an opportunity to spread disinformation online,” CSIS spokesman John Townsend said, “It is important to note that disinformation, originating from anywhere in the world, can have serious consequences including threats to the safety and security of Canadians, erosion of trust in our democratic institutions, and confusion about government policies and notices including information on the COVID-19 pandemic.”

It makes sense that undermining democratic institutions during a deadly pandemic includes undermining any health department both provincially and federally and their attempts to administer vaccines and make mask mandates. To be clear, this is about diminishing our government and nothing diminishes a government like portraying them as responsible for worsening deaths, providing inadequate solutions and flat out lying to the public. 

It would be wise to assume some of the social media misinformation comes from these foreign actors. It would also be wise to assume that discrediting healthcare professionals is one of their aims.

Some accounts on Twitter are influenced by this misinformation - created by foreign actors or concocted by people from our own country who genuinely believe it.

On Twitter, I have watched colleagues deal with anti-vaccine and anti-mask accounts, most of them anonymous. Some appear benign at first. An anonymous account will start with simple questions or tweet things that are incorrect but relatively innocuous. When you respond, it starts a long back and forth and at the end they accuse you of vile things - like killing patients.  This experience is like following a little bunny and getting your foot caught in a trap. 


Personally, I like to answer them with sassiness and I also block these accounts quickly now. Blocking is an important weapon against misinformation - these accounts can’t appear on your tweets and don’t have access to your followers. If more people blocked them, we would diminish their reach substantially. There have been days where even my sassiness fails me and I’m not amused at all. These unpleasant experiences have exhausted and chased many healthcare professionals off Twitter. There is only so much abuse one can take.

There are accounts that are also dangerous in many ways. I worry about my colleagues because of them. Some people behind these accounts spend a great deal of time reporting doctors, nurses and other professionals to their licensing bodies and filling rating sites pretending to be disgruntled patients. Also, some colleagues have had threats against them and their families.

There is nothing that enhances the spread of misinformation like chasing healthcare professionals with accurate information off Twitter, by bothering them, damaging their professional reputations and forcing them to defend themselves to their colleges.

Perhaps we should return to why this is happening. It’s simply healthcare professionals asking people to get vaccinated and wear a mask. If these healthcare professionals get chased off Twitter, who remains to educate and help? During a pandemic the most precious commodity is scientific information - this is what keeps people safe. Distributing false information endangers people’s health and may even kill them.

Everyone tries to figure out, for themselves, how to keep advocating during this pandemic. Personally, my Twitter account - you guessed it - is largely about stories. Not just stories about the pandemic, but stories about many aspects of peoples' lives - I try to highlight the stories others tell and, occasionally, tell my own. 

For the pandemic advocacy that I do, I try to keep my sense of humour, lift up colleagues by highlighting their work, and use my block button. Who knows if any of us individually makes a difference, but I do know that chasing reasonable, science based voices off Twitter is a bad thing during a pandemic.

11 July 2021

Dr. Kona Williams on Investigating Residential School Gravesites: It's Complicated.



Residential schools in Canada were set up in the 19th century, funded by the government and often run by the Church. Indigenous children were forcibly removed from their homes and taken to over 130 schools with the, “primary aim of assimilating Indigenous children” 

Stories of abuse at these schools have been told for decades. After another 751 unmarked graves were discovered at the Marieval Indian Residential School site in Saskatchewan, Canada, the Native Women’s Association of Canada (NWAC) demanded that charges be laid over the deaths of Indigenous children at residential schools. 


The NWAC asked that, “sites of former Indian residential schools be declared crime scenes and that an investigation into how each child buried there died — as well as into who is responsible for their deaths — be conducted…In Canada, we live under the rule of law. The law does not allow those who are responsible for the deaths of children to walk free with impunity.” This principle of investigating these deaths and charging anyone responsible has been widely discussed among  Canadians.


To address this issue, I had the honour of speaking with Dr. Kona Williams, the only Indigenous Forensic Pathologist in Canada. 


Forensic pathologists are medical doctors who are trained to autopsy bodies and come as close to the truth about the cause of death as is possible.


I asked, naively, why aren’t we investigating to charge people for the murder of these children? 


Dr. Williams explained that she has had many talks with the Indigenous leadership and her colleagues in the forensic world about how to proceed as more gravesites are found. While acknowledging the anger and grief these gravesites are engendering, she explained that it is very complicated. 


“We know that there are stories of children being injured and who died from these injuries, as well as children who died from malnutrition or not receiving medical care.”



“We know that some of these graves may be older than 50 years so we don’t have the legislation for those over 50 years on how to deal with these deaths.” 


Deaths over 50 years ago are considered not ‘forensically relevant’ in Ontario because prosecuting deaths over 50 years ago is - in most circumstances - unlikely to yield convictions. 


Dr. Williams then went on further explain how complicated the process of any investigation would be. “It’s going to be hard for families and communities to decide what to do. Some will want to let them rest, some will want it investigated… It’s up to the families and communities.

“These are difficult discussions. This can’t be forced. it has to be driven by what the communities want. 

“We might not be able to find all the children, or identify all of them or even maybe not even find the cause of death. What do you want us to do then? 

“The investigation is more complicated if we only have bones. If they died of pneumonia - bones aren’t a lot to go on. If it’s malnutrition or blunt trauma, that’s easier. 

“It’s going to be hard for families and communities to decide what to do. Some will want to let them rest, some will want it investigated.


“Also, with my work, generally we have records that we compare to the body, for example, dental records. Here we only have bones so we could get DNA but we would have to go to the community and ask if they would provide DNA samples to compare…the ethics around this are huge. How do we ensure that the information is kept securely and not used for anything else?” 


When I asked how would they even know which body to exhume if some families and communities don’t want an investigation and some do? 


“We need to ask the communities about how to proceed. I’m happy to provide the expertise, but I’m not going to do it without the permission of the people involved” 

When I asked if there were about 150,000 children in these schools, Dr. Williams said, “That’s an estimation, because we really don’t know. The records kept by the government and church aren’t always clear. The Catholic church has never provided the records that they have…do we have the authority by law to get these records? I asked [someone recently] do we have the authority to subpoena the Catholic church?”



Then Dr. Williams added, “There is something I’ve been chewing on. There is a ‘death in custody’ if the person is being held against their will, they may be some responsibility on the part of the people whose care they’re in…legally this is an interesting question. The custodians and institutions can be held responsible…Can this be put under “death in custody”? 

Would this allow these people to be charged past the 50 years?

Dr. Williams replied, “Potentially. The legislation doesn’t exist - it might still be limited by ‘forensically relevant’.


“My colleagues and I have been discussing how to investigate these sites. People will get traumatized and re-traumatized, digging up bones is traumatic, and the proper ceremony, protocol must be followed. 



“Some people have been asking about the cost - how can we put a price on this? We don’t know how many children there are, and we don’t know the cost. When people ask how much is this going to cost to dig up these kids, I say - I don’t know, how much would it cost to dig up yours if they were your kids? Would you not want everything done? Would you not want to know what happened and would you not want someone to pay for this? The last school closed in 1996 - it’s not ancient history.” 


How to proceed, whether to proceed in some cases, in investigating the gravesites at residential schools is indeed complicated. I thank Dr. Williams for giving us a glimpse into the difficulties and how to proceed respecting the Indigenous community because surely, the utmost respect must be given to these children, their families and communities. 
















































13 June 2021

Dr. Josh Trebach and his Tox Murder Mysteries


I usually interview people and write articles, but not today.

First, let me introduce you to Dr. Josh Trebach, an emergency physician and toxicology fellow at NYC. You can follow him @jtrebach on twitter and following him is a treat for anyone interested in the lovely combination of medicine and mystery.

Second, let me explain why I didn’t interview Dr. Trebach. He writes murder mystery threads. They are so perfectly written, that I asked him for permission to put them, largely unedited, in an article.

So, here’s how he introduces his mysteries: Buckle up - it’s tox murder mystery thread.

Without further ado, here are two of his mysteries. 

Tox murder mystery #1.

A 45 year old man is found dead in the orthopedic room of an emergency department. He has no signs of trauma and no past medical history.

What do you think happened?

Clues

  1. The man was hired by the hospital to clean drain pipes blocked by plaster washed down the sink by silly residents. (Stop washing your plaster down the sink! I see you!! STOP DOING IT! It's nasty and gross)
  2. The material used to make the splints was Plaster of Paris. This product is still used today.
  3. The man was using sulfuric acid to clean the drain and dissolve the clogged up Plaster of Paris. I'm a toxicology fellow, not a drain declogging expert, what do you want from me? I don't know why they used that.
  4. What happens to Plaster of Paris when its gunked up in the pipes?  It gets chewed up by bacteria. Under anaerobic conditions, the bacteria can make a nasty, thick (thicc?) calcium sulfide sludge.
  5. Sulfuric acid + Calcium Sulfide = ??? UGHHHHH chemistry.

Yet, the answer is in here. These two combine in the following chemical reaction, giving us our answer.

  CaS + H2SO4 → CaSO4 + H2S  

The culprit: Hydrogen Sulfide gas was formed by the chemical reaction above and it caused the man to die pretty quickly. Perhaps the only thing abnormal on the patient's skin exam was his silver wedding ring that had tarnished after reacting with the gas.

Hydrogen sulfide is a colorless gas that classically smells like rotten eggs . It gets inhaled into the body and interferes with oxidative phosphorylation and causes cellular hypoxia. What does this translate into? Rapid unconsciousness and cardiopulmonary arrest.

Hydrogen sulfide is scary. People will die in groups because whenever someone (not wearing PPE) goes to rescue the victim, they become exposed to the gas and then pass out/die… and the cycle continues.In fact, at ~1000ppm, breathing will STOP after just 1-2 breaths.

Treatment: Moving the victim to fresh air and giving oxygen, in addition to good supportive care and respiratory/ventilatory support, is key. Antidotes such as sodium nitrite work by inducing methemoglobinemia which scavenges the hydrogen sulfide.

Tox murder mystery #2.

A 33 year old woman is found dead in a bank vault. She has no signs of trauma and no past medical history.

What do you think happened?

Clues

  1. The woman was a bank employee doing normal bank employee things. Unfortunately, when she went into the bank vault, it locked behind her. Whoopsies.
  2. She waved at the camera. She banged on the doors. She pulled the fire alarm (but nothing happened?). She tried her phone but had no service and couldn't even tweet. Imagine the horror.
  3. She figured she would wait an hour or so until someone else opened the vault… yet, over the course of 30 minutes, the woman slowly dropped to the ground and suffocated to death. What happened? Why did she die so quickly? Let’s learn about asphyxiants!
  4. Asphyxiants cause harm by suffocation. There are two categories of asphyxiants– chemical and simple. Chemical asphyxiants (like hydrogen sulfide) interrupt the body's ability to deliver or utilize oxygen.
  5. Simple asphyxiants displace the oxygen in the air, making it so there's less oxygen around for you and your body. Thus, when you take a deep breath, you get a mouthful of NOT OXYGEN. Your body/mitochondria are like "ew seriously?"… and then you suffocate.
  6. But what does any of this have to do with our case? Well, ask yourself--why is there a fire alarm in a bank vault? Most times when you pull a fire alarm, you trigger a water sprinkler system...but then that would cause the money to get nasty and wet. Gross.
  7. So the fire alarm doesn't trigger the release of water. But how else can you put out a fire? By using a CARBON DIOXIDE-BASED FIRE EXTINGUISHER SYSTEM! By releasing carbon dioxide and displacing the oxygen, the combustion reaction cannot occur and fire is put out!

Unfortunately, this woman sealed her fate the moment the fire alarm was pulled. Carbon dioxide filled the bank vault and she suffocated from this simple asphyxiant. Education about the risks with these extinguishers is key– these are preventable deaths.

Simple asphyxiants are everywhere. Virtually every gas (except oxygen) can act as a simple asphyxiant– the dose makes the poison. There are even cases of people dying after being in a room with a bunch of dry ice (sublimation reaction leads to lots of carbon dioxide).

Treatment: Get away from the simple asphyxiant. Get to oxygen. This seems remarkably simple, but unfortunately, can be very challenging in some situations (like when you are trapped in a bank vault).

09 May 2021

Drugs, rugs, and dogs


I’m now suspicious of my carpets.

First, I should explain that I’m a huge fan of Persian carpets. When I was a poor student, I bought one at a flea market and got hooked. No pun intended.

When I had a bit more money, I bought some more from a lovely local store and became even more enamoured with them. I even gifted them to my children when they moved out.

I was wandering the internet late at night - we are on lockdown, so my late night amusements are limited these days - and I found out that some rugs have drugs.

“Sniffer dogs at the Manchester Airport aroused suspicions for a large import of beautiful carpets, and upon further examination the security personnel found the drugs “hidden inside thread-like sheathes that look like carpet yarn to the naked eye”.

These smugglers literally managed to create little malleable ‘tunnel containers’ for heroin that look like rope, then wove them into the fabric of gorgeous, completely inconspicuous carpets of commercial quality. 46 of these hand-made knotted carpets were in this particular shipment, and they found around 50 kilograms of heroin hidden in them so far.

The sheer size and sophistication of this operation is just mind-blowing. This particular shipment would be worth several millions of dollars, and while this one was miraculously sniffed out by highly trained dogs, there could have been dozens more that went completely unnoticed.”

It’s a marvel, really, that someone would be able to think of, let alone implement, a process where heroine was hidden in carpet strands and then woven into a rug.

Apart from admiring the technical brilliance of the plan, I was worried. When I read that I looked at my sleeping bouvier, Kai. Surely, if our rugs had drugs, Kai would have found them. I came to my senses and realized that Kai is not a trained sniffer dog and unless a rug smelled like meat or cheese, she would ignore it completely.

I then went down the rabbit hole of drugs in rugs. I wondered if rugs with drugs have been found near where I lived?

Apparently so.

“The joint investigation between provincial and Toronto police as well as the Canada Border Services Agency began in June 2010, when border services agents at Pearson airport found 15 kilograms of heroin hidden inside 27 carpets that arrived from Pakistan.

The drug had been put into the main support strands and the carpets were woven around them, likely by people who were paid almost nothing for their labour, police said.”

Who doesn’t love the totally Canadian statement about the poor pay of those who made the heroin laced rugs?

However, I must admit this alarmed me. Did I buy a rug around that time? I might have.

Then I realized that a heroin laden rug would be promptly picked up by whoever organized it and it was unlikely to end up on my floor.

In case you’re wondering - because of course you are - I did ask Kai to sniff our rugs. In the middle of the night.

Kai is a very reasonable dog. She is also inordinately fond of me for no reason I can ascertain, and generally puts up with my odd request. I can be a handful.

After a curious look at the carpet, she simply lay down and promptly went to sleep. She may live with a crazy woman who goes down crime rabbit holes late at night, but she needs her beauty sleep.

I also found out that they have made dinner sets out of compressed cocaine. Is it out of line for me to ask Kai to smell my dishes?

Did I mention we’re in lockdown?

11 April 2021

Anti-Asian hate crimes


If I told you that there’s a crime spree going on and you can stop it, would you? 

The rise of anti-Asian hate crimes in Canada - yes, Canada, the land of the multiculturally smug – are crimes we can all stop. The first step is always understanding it.

Many have blamed the former U.S. President Trump for the rise of anti-Asian racism because of his racist rhetoric, but he was simply repeating a long historic tradition of targeting Asians. Kim Yi Dionne, a professor of political science at the University of California-Riverside, explained that “America has a long history of immigrant exclusion on the basis of disease.”

Trump was feeding into the biases that some people already had and doing it to restrict immigration certainly, but also to deflect blame for any illness or death of Americans. As those deaths increased, so did his rhetoric.

Canada also has a long history of restricting Asian immigration and using anti-Asian rhetoric to do it.

In 1885, Canada imposed a head tax on Chinese migrants before admission into Canada, the purpose of which was to discourage more Chinese coming to Canada. The anti-Asian sentiment was in full force in the 1902 Royal Commission on Chinese and Japanese Immigration that stated that the Asians were "unfit for full citizenship … obnoxious to a free community and dangerous to the state.”

Despite the drop in Chinese and other Asians entering Canada, there were many violent anti-Asian riots on several occasions to protest Asians in Canada.

During the 1918 pandemic, Asian Canadians were once again targeted as disease ridden and were even excluded from treatment at “white” hospitals.

During World War II, the federal government put Japanese Canadians in internment camps and sold all their property.

It was only in the 1960s that Canadian immigration legislation and regulations were changed to allow Asians to immigrate to Canada on equal footing with whites.

This history explains why anti-Asian racism has risen so rapidly: the narratives and attitudes fed into prejudices some people already had and, although Canadian politicians have largely avoided xenophobic blaming of Asian Canadians, we are not immune to these narratives. The pandemic has given rise to all sorts of conspiracy theories and the internet knows no borders. Canadians so inclined have been drinking in anti-Asian rhetoric and spewing it out against Asian Canadians.

Of the 1,150 instances of anti-Asian racism reported between March 10, 2020, and Feb. 28, 2021, it was, “found that elderly people, young people and those in low-income jobs or who did not speak English were more vulnerable to attacks. According to the data, most incidents occurred in public spaces such as parks, streets or sidewalks. Restaurants, grocery stores and other food-sector locations were the site of nearly one-fifth of the incidents. Nearly ten per cent of the reported cases took place on public transit.”

This is crucial: these incidents occur in public spaces. In plain sight.

The worst message we can send is that verbal or physical harassment of Asian Canadians is OK. This is why the Government of Canada “offers bystander intervention training on their website, with safe and positive options to prevent harm when there is a risk of violence.

The goal of this training is to send a message that hate, including racism and xenophobia, is unacceptable in all of its forms.”


Since this problem started with the Government of Canada and the citizens of Canada condoning and augmenting anti-Asian rhetoric, it is fitting that together we end it.

It is also fitting that the internet – used to promote anti-Asian rhetoric – can also be used to fight it. The same principle applies, don’t let Asians be harassed. If this happens, report the account and say something too.

Ultimately, like hate against any group, the only way to stop it is to learn about the history, understand what to do if we see it and support organizations that are helping.

Canada should not be a country in which Asian Canadians feel unsafe and unwelcome. Multiculturalism requires the actions of each generation to protect it.

14 March 2021

COVID-19: Lessons learned and justice are not the same


The World Health Organization declared a pandemic on March 11, 2020 and by March 11, 2021, 2.6 million people have died from Covid-19.

On the news and social media on March 11th, 2021, passing the year mark of this pandemic was the subject of numerous discussions. There were many honouring those who died. Many pointed to the tsunami of grief, the bravery of our frontline healthcare workers, the generosity of neighbourhoods, friends and family.

As I was falling asleep that evening my thoughts went to crime and justice. 

When people die or are harmed by the actions of others, they want justice.

Elderly parents have died in Long Term Care Homes where families felt they were not cared for or protected. Doctors, nurses, personal support workers, paramedics and other have been infected because they did not have adequate personal protective equipment – some have died and others are still suffering from Post-Acute Covid Syndrome. Many others have been infected and died because they were told that they didn’t need masks to protect them from COVID-19, until they were finally told to wear masks. Many are now waiting for available Covid vaccines but some are getting infected and dying while they wait. 

Who is brought to justice when it is clear that deaths are clearly cause by the actions of others? 

There will be commissions on how we care for and protect the elderly. There will be analysis on why aerosol and asymptotic spread were not identified earlier. There will be some form of reckoning on the lack of PPE for healthcare workers who were forced to work without proper protections. These will all be filed under lessons learned to maybe influence how we move forward. And maybe is the operative word.

What I worry about most is whether those who lost loved ones, those who still remain ill from post-acute COVID will feel that justice is served? Lessons learned serve those who come after us, but what about those who bear the scars of this year? What do they need to move forward?

Here I came to my worst conclusion in this line of thought: those responsible for true harm, whether they be politicians, organizations that said they would care for our elderly or those who made decisions that killed our health care workers-will not be held to account. They will be responsible for a large number of deaths through their actions and nothing will come of it. There will be no justice.

Let’s roll back to the beginning: if someone harms another, we demand justice. How does it work if many people make decisions and take actions that harm hundreds if not thousands of people. Under the cover of group work, apparently nothing.

Crimes are punished in part as a deterrent for future crimes. I hope we don’t learn that mistakes that cost lives can be done with impunity if they are done by governments, organizations like Long Term Care Homes and those who are responsible for safely equipping healthcare workers. 

So, at the end of a painful year full of death and suffering, of course my mind turned to crime. The worst kind: those that are not punished. 

As I fell asleep, I thought about how, in a pandemic, we can discuss the bad things that happened. We cannot really get justice. No one is really responsible. We will simply have some large files on lessons learned that may simply be ignored anyway. 

Now, late night thoughts are sometimes morbid. I hope I’m wrong.

14 February 2021

The Pandemic: Babies and Stories


With so much time together with our lovers, many expected a pandemic baby boom, but it is looking more like a bust.

I get it.

My writing fantasy is to have stories - the ones that reveal the places we live and breathe, the dark places, the places of joy - and also the time to write them. 

I now have the time but the onslaught of stories is just too much. The edits on my book are not a boom but a bust. A total bust.

Normally, when I work I shut out the world. Ignore it. However, this is a time in history when absorbing what is going on in the world is needed.

When I sit down to write, my head swirls from the page outward. Perhaps my characters are talking on the phone - I think of all the people isolated by #COVID19 who can only talk to those they love by phone. When my characters sit for coffee, I think of all the lonely people unable to gather and the small coffee shops struggling to survive in this pandemic.

Then there are the elderly in long term care homes, isolated and at times suffering with dementia - how do they make sense of the long days when no familiar faces come? Do they forget them? Do they remember them in their dreams?

The children who once rushed up to playgrounds to do what we have forgotten to do - play with abandon with children they have just met. Now, they are masked and are asked to keep their distance. Will they play with abandon when the virus is gone or will they grow up too soon into the far more distanced adults that surround them? Hell, we are asking them to keep their distance so it would be a small wonder if they don’t.

The lovers, the ones that had planned romantic trips, weddings and parties - what happens when none of that is possible? Do they put that spontaneous side - the most romantic moments - on hold. Can they return?

And then there are those who don’t return at all.  Their families watch them disappear into the bowels of an ambulance or hospital and then can’t see them, hold them before they die. 

I’m bombarded by stories of my colleagues in the #COVID ICUs. They have so many tools to save people but now, their tools are often useless against Covid-19. Death after death. It's everything they've been trained to fight and yet they lose the battle constantly. They are tired and demoralized when one patient dies, the numerous deaths are just too much for them.

And, perhaps a few blocks from these ICUs, people are gathering without masks, perhaps in homes, to have a drink, laugh and spread this damn virus around another room.

Will all the pandemic stories raging around demanding attention finally settle when the worst of this pandemic is over? Will we have time to write them when life returns to normal?

My hope is that these stories will be written and we will take the time to pay tribute to each person we can. There have never in my lifetime been so many stories crying out to be told. There are also so many people who are now no longer with us to tell their story and we need to honour them by telling it.

I have practiced medicine. I have written. Both involve a similar process.

In medicine, the key to a diagnosis is always the story - the more fulsome the story, the more likely the diagnosis will be accurate. And after diagnosis, following the story allows us to assess the treatment and, more importantly, how the patient is doing. 

With writing, the key is always the story and the more fulsome, the more accurate. 

With the pandemic stories that will be written, I hope that that they will be about how we recover, or don’t, from this terrible time in our history. Like a medical story, we need to follow this up. 

At this point in time I have no idea how the story ends for us all.

Oh, and babies. We need to see more babies please. We need a new generation to whom we pass on our stories, because this has been a time of such important stories. But until we pass on our stories, we need the joy of a new beginning.

10 January 2021

B2020 and A2020: How 2020 has influenced what we want to read and what we will write.


As we are bombarded with news of COVID-19 deaths, the rising unemployment and the latest attack on Capital Hill - many of us wonder how this can happen and why do some people not care?

More and more we are hearing stories from the frontline, from the unemployment line, from lines at food-banks and, from homes where seniors live. We are hearing about policies that thoughtlessly harm others and we ask - didn’t they even think about these people’s lives?

After living through 2020 – and face it, 2020 might just be a prologue to the book  “The Horrors of 2021” - we will never be the same and I suspect that what we want to read is forever changed. 

Literature changes because readers change. 

When I was a child, I would often rummage through my father’s extensive library. I remember some old books, where the room would be meticulously described, from the sun dappled curtains to the chair with slightly worn arms. These descriptions would often be a page long. I remember wondering if I was simply less observant than most people or if these descriptions were simply overdone. Being a curious child, I watched my friends and family carefully. I decided that none of them spent enough time observing to be able to write a page of details and that the people in these books had a different life, were different people or the author just made up stuff. I would still read some of those books but with a stern skim over the sun dappled this, the intricate patterns of that and any other such useless info. 

There are many takes on the immense suffering we have seen in 2020, but I suspect many readers will be drawn to different writers. Just as none of us have patience for a page long descriptions as characters enter a room, I believe we will have less patience for characters who wander the world doing things, noticing things but failing to empathize with people. Let’s face it, Sherlock Holmes was delightful, but who is going to write a book today where the characters notice the hair, that came from a rare species of cat, owned by only two families in the city, coupled with a smudge of brown dust from a particular type of stone, found in the statues of lions that sit by the doorway of one of those families? Yep. No one. Most of us read it, but we don’t write like that anymore. 

I think that many readers who have lived through this year - and the worse year that is coming - will demand characters with empathy. Not sympathy, but empathy. 

The definition of empathy is: the action of understanding, being aware of, being sensitive to, and vicariously experiencing the feelings, thoughts, and experience of another of either the past or present without having the feelings, thoughts, and experience fully communicated in an objectively explicit manner.

This stands in contrast to sympathy defined as: sympathy implies sharing (or having the capacity to share) the feelings of another, while empathy tends to be used to mean imagining, or having the capacity to imagine, feelings that one does not actually have.

If 2020 has made many of us yearn for anything, it is for people who have empathy and can imagine and feel what someone else is feeling - without having to be explicitly told and without having to have felt it themselves. Why? Because we are not all 90-year-old women, living alone in a care home, unable to see anyone. We are not all a single mother, with children to feed but with no money to feed them after we lost our job. We are not all ICU doctors, struggling to cope with losing patient after patient nor are we those who have to transport body after body to refrigerated trucks. We are not any of these people but we want someone, any one, to care about these people and tell us about them. 

What about sympathy – understanding the feelings that we actually have? This feels a little self-centred and, these days more than ever, the self-centred are at best unpopular and at worst, the villains of 2020: from anti-maskers to those who care only about staying in power.

I suspect many of us, who read voraciously,  and who have lived through this time , will want books with more characters who understand and feel what others are feeling and put us in their shoes. Detective novels highlighting not merely action but also empathy might become much more popular. I suspect this is true for all types of writing, from news stories to medical writing. I suspect we might have had our fill of self-centred characters, and I also suspect that they will often be cast as villains because, goodness knows, it feels ugly now. I have found that news stories, articles and - one could argue - political choices seem to already incorporate empathy more than before this dreadful year.

One could argue that good writing has always put us in the shoes of others, immersing us in their worlds. Somewhat true - but it is about the weight one gives to certain things. Do we devote pages to describe a room when a character enters it? Not anymore. So writing may have many elements in common but weight given differs. Weighting empathy heavily would change what we read. 

This may just be my new perspective but I doubt it. However, from a personal point of view, I am eager to read the new types of articles, books and characters born from 2020. I also look forward to new ways of telling the news, writing medical articles - any type of writing that tries to reach people who have lived this terrible year and await, with some trepidation, the unveiling of 2021. 

Whatever happens with various forms of writing, I believe that there will be fundamental changes in what writers write and readers read because we will never be the same after 2020.

08 November 2020

Protect your eyes from COVID19 infection.


There’s a saying: if you’re the smartest person in the room, you’re in the wrong room. I recently found myself in the right room—a masked, backyard get-together with close friends.

My husband mentioned he’d added a face shield to his mask in indoor public places, to protect his eyes during the second wave of COVID-19. One of our friends, Brian Foody, said that using a face shield with a mask wouldn’t protect eyes from airborne COVID-19 but goggles would.

This statement was very surprising. Public health experts have been clear, given the airborne transmission of COVID-19, that face shields and goggles protect the eyes equally.

For the public, Dr. Anthony Fauci said in an interview, “. . . you should protect all of the mucosal surfaces, so if you have goggles or an eye shield, you should use it.”

In healthcare settings, face shields are irreplaceable to protect against splatter during procedures, but face shields and goggles are recommended by public health as interchangeable eye protection.

For protection during aerosol-generating medical procedures, Canadian Public Health recommends, “eye, nose and mouth protection (mask and eye protection, or mask and face shield, or mask with attached shield) that fully covers the eyes, nose and mouth and ensures that no part of the face is exposed.”

The CDC states, “The PPE recommended when caring for a patient with suspected or confirmed COVID-19 includes the following . . . Put on eye protection (i.e., goggles or a face shield that covers the front and sides of the face) upon entry to the patient room or care area.”

If face shields don’t protect the eyes from airborne COVID-19, the definition of “adequate PPE” changes and this may save lives. A large study of healthcare workers showed that they accounted for 10% to 20% of COVID-19 infections and, even more worryingly, “even among frontline healthcare workers reporting adequate PPE, the risk for COVID-19 was increased . . ..”

Given the importance of this issue for the public and for healthcare workers, I interviewed Brian Foody, president and chief executive officer of Iogen Corporation and an MIT-educated mechanical engineer, who specializes in fluid motion.

The movement of COVID-19 infected air is at the heart of this issue.

“Imagine two people wearing face masks, one has on a face shield and the other is wearing goggles, walking into a closed room where the ambient air contains COVID-19 infected aerosols,” Foody explained. “Whose eyes are better protected? For our wearer of the face shield, with every breath, the clean air behind her face shield is ventilated and exchanged with the contaminated ambient air. Because of this ventilation, the air behind the face shield will have the same concentration of aerosols as the rest of the room within a matter of minutes. On the other hand, for our goggle wearer, the clean air behind her goggles is sealed off from the ambient air.”

The mixing of air behind a face shield is based on the basic scientific principles of fluid dynamics: if there are COVID-19 particles, they’ll be drawn into the face shield and up to the eyes.

This behaviour of aerosols is supported by a 2014 study. “Face shields can substantially reduce the short-term exposure of health care workers to large infectious aerosol particles, but smaller particles can remain airborne longer and flow around the face shield more easily to be inhaled,” it noted.

A review of the literature in March, 2020 stated that, “There is a lack of research on the effectiveness of different forms of eye protection.”

And yet, certainly the public health recommendations consider goggles and face shields as equivalent.

I am reminded of the early days when many of us recognized the pattern of airborne transmission of COVID-19 infections and advocated for masks, contradicting public health recommendations. Now the widespread use of masks is recognized as an important tool to limit COVID-19. This information on face shields is just as important: face shields protect from splatter but do not offer eye protection and public health recommendations for the public and healthcare workers must change.

Then Brian asked a crucial question: “What are the chances of getting infected through your eyes?”

To begin to find my way through this issue, I had to enter the right room, so I unabashedly called my friend, Dr. Sherif El-Defrawy, at his cottage on Thanksgiving.

Dr. Sherif El-Defrawy is an ophthalmologist who’s chair of the Department of Ophthalmology at the University of Toronto, before which he held a similar position at Queen’s University. He’s also president of the Canadian Ophthalmological Society and of the Association of Canadian University Professors of Ophthalmology.

In short, Dr. El-Defrawy knows eyes.

“If COVID-19 infects the conjunctiva of the eye, it could travel to the nose via the nasolacrimal duct and colonize the nose or throat,” he explained. “However, we would expect to see conjunctivitis. I find it highly unlikely that there would be enough COVID-19 to cause illness without seeing conjunctivitis.”

He explained that the number of COVID-19 infected patients with conjunctivitis wasn’t that large but it was unclear how many patients were checked for this. Finally, he expressed surprise that goggles were not universally recommended in healthcare settings along with face shields.

So, first things first, I’m not a fan of primate studies but there was one that answered many questions about COVID-19 infection via the eyes, so with great regret I present it here.

Three rhesus macaques were infected with COVID, two via their conjunctiva and one via intratracheal route. The conjunctival swabs were positive for the first day only, “indicating that the inoculated virus may transfer from conjunctiva to respiratory tract and other tissues . . . specific IgG antibodies against SARS-CoV-2 were detected in the rhesus macaques, indicating that the animal was indeed infected with SARS-CoV-2 [showing] that conjunctiva is a route of SARS-CoV-2 transmission.”

A literature review concluded, “The overall prevalence of ocular symptoms in patients with COVID-19 was 11.2%, which is not a common finding. Nevertheless, this reported prevalence might be an underestimation because patients with COVID-19 present with life-threatening clinical scenarios, which may preclude a detailed ocular examination or relevant history.”

Speaking of ophthalmologists, we should acknowledge with deep gratitude that it was the ophthalmologist, Li Wenliang, who was one of the first people who warned the world about the new disease we now call COVID-19. He later succumbed to the disease after contracting the virus seemingly from an asymptomatic glaucoma patient in his clinic.

So, how does eye protection play out on the ground in healthcare settings? Here I turned to information from Dr. Rick MacDonald, a community paediatrician on staff at Halton Healthcare hospitals where he takes call seeing paediatric patients and works in the NICU.

When many other physicians’ offices were largely doing virtual visits, “we decided early on that if we were going to be a useful resource for our paediatric population. . . .We needed to see patients [and] to provide this service, PPE is the most important first step without which it could not be done.”

Dr. MacDonald spent hours sourcing PPE for his office, opting for an N95 and a face shield but now also wears goggles as well. “To [keep our office open] we need full protection. No skimping, no cheating, full attention to detail. . . . Overkill is better and no government official or cloistered ID staff will convince me otherwise.”

He’s correct: protection, including eye protection, is crucial. Doctors are often in closed examining rooms, crowded emergency departments or intensive care units, with potentially large volumes of COVID-19 aerosols. So are nurses, paramedics, respiratory therapists and many others.

Certainly, we could benefit from research on the fluid dynamics of COVID19 aerosols with people wearing face shields and masks. However, we are in the second wave of this pandemic and there are a frightening number of infections in the public and healthcare workers.

I’m asking public health, in light of the basic science of fluid dynamics of aerosols, to change their recommendations:

The public should wear eye protection if they are indoors with others.

Healthcare workers working with patients that are potentially COVID-19 positive, should use face shields for splatter alone. Goggles are the only safe eye protection for aerosols.

11 October 2020

Dr. Obenson: Doctor and Detective


Dr. Ken Obenson is one of only two certified forensic pathologists practicing in New Brunswick, Canada. He holds the distinction of being  first black pathologist certified by the Royal College of Physicians and Surgeons of Canada in forensic pathology. 

Although he investigates deaths in deceased of all age groups from babies to adults, it is with the death of babies where, “I often need to apply all the detective skills that I acquired through training and experience. Infants don’t have the usual stigmata of disease or injury unlike adults who tend to have well documented disease histories - and infants can sustain injuries that may not be as obvious at autopsy as adults.”

“My role, in the case of a natural death, is to make sure that I make the best effort to find the explanation for the death so I can allay some of the fears of the family,” Dr. Obenson explains. “When an infant dies, the parents almost always blame themselves. It can be heartbreaking for the parents when we are not  able to  provide a definitive cause of death. Unlike some other practice groups, we don’t use the term SIDS because it is a diagnosis of exclusion. SIDS or not, the cause death is undetermined and this is what they (the parents) worry about. Not just for this baby, but for others they may have in the future.” 

One case he investigated was particularly illuminating. It was the death of an infant who was only a few days old. The CT, X-ray, autopsy, toxicology, microbiology and other examinations found no cause of death. Information gathered by the police, revealed that the baby was visited by its’ large extended family who had all held the baby. On a preliminary examination of slides of the markedly autolyzed tissue that he had sampled at the autopsy Dr. Obenson found evidence of viral infection (suspected to be parvovirus) in one section of liver. Knowing exactly what to look for, he reexamined the slides more closely  and found  further evidence of the infection in several other organs. 

Because he was able to determine that death was the result of a viral infection, Dr. Obenson was able to allay the parents’ fears that something congenital was responsible for their baby’s death and reassure them that their next baby would not be at risk of dying. It also allows them to make different decisions about how many people their next baby comes into contact with while vulnerable and perhaps they may even insist on hand washing and other infection precautions in the future. Very importantly, it saves them from unspoken accusations that they might have done something directly to cause their baby’s death, like smothering, etc. 

Dr. Obenson was quite satisfied with the outcome in this case, knowing that the finding of a lethal viral infection probably helped  the parents in dealing with  their loss.  This is why he insists that as per international guidelines, a  thorough post mortem examination be performed in infants, after a comprehensive death scene investigation with review of  radiologic, toxicological, histologic and microbiological findings. 

“My role, when there is a homicide of an infant, is collect evidence such that the law is able to hold whoever is responsible to account,” he explained. “I have been qualified as an expert witness in court which means that because of my training, certification and experience, I am able to  give opinion evidence as to the cause and manner of death, unlike 'eye' witnesses who can only speak to what they have seen or heard.” 

Although for most of us, the murder of an infant is unthinkable, it does happen. Dr. Obenson explains that if there is an adult unrelated to the infant living in the house, like a new boyfriend, they are statistically more likely to kill that child. However, biological parents also do kill their babies, with fathers being more likely to do so violently than mothers. Unfortunately the less violent the trauma the more difficult it can be to detect physical evidence of foul play. For example, Dr. Obenson points out, if a baby is smothered, petechial hemorrhages in the eye  that are often seen in, but not exclusive to an asphyxial death are less likely to occur in infants- which is why these death investigations can be so complex. 

Dr Obenson takes his role as an impartial witness seriously and derives no personal satisfaction from a conviction. His only responsibility is use all available evidence from death scene, to social circumstances to post mortem examination and ancillary tests to arrive at a reasonable opinion on the cause of death. 
Dr. Obenson has practiced forensic pathology in the United States, in Jamaica and for nearly 20 years in Canada. He says, “We don’t have as many suspicious child deaths in Canada, particularly homicides. My theory is that the social safety nets in Canada alleviate some of the social stresses families feel.” 

This is the best argument I have ever heard for supporting families: protecting children.

13 September 2020

Wearing Masks During COVID19: How Neuroscience Can Help Us.


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

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

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



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



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



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

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



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

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

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

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

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



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

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


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




Or this as a mantra for today:





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

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

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

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

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

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

09 August 2020

Nipping it in the bud because old men cry.



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

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

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

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

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

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

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

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


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

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

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

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

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

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

12 July 2020

Writers: Get Thee on Twitter


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

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

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


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

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

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

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

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

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

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

A tragedy is often defined in two ways:

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

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

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

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

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

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

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

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


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

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

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

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

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

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

14 June 2020

Please Don't Upset Racially Mixed Children


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

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

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

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

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

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

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

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

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

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

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

10 May 2020

COVID19 in America versus Canada


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

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

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

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

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



In America: 



In Canada:



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

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

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

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

In other words, fairly polite and compliant protesters. 

It is more than not carrying guns. 

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



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

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

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

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


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

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

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

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

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

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