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

28 October 2018

Hell hath no fury...


Imagine being so ill that you cannot even get out of bed. Or being too sick to spend time with your family and friends. Now imagine being too frightened and ashamed to tell anyone you are ill. Being so humiliated by your disease, that you can’t even tell your own doctor that you are ill.

One out of five people, 20% worldwide, have a mental illness. Many often go through this scenario. Some bravely ask for help. Some hide in the shadows. Some hide in alcohol or drugs.

When I was a young, inexperienced doctor, I was certain that the unfair stigma of mental illness would and should be eradicated in my lifetime. I felt that mental and physical illness were both simply illnesses to be treated. Now, after treating mental illness for decades, I know that I was correct. 

The suffering of those with mental illness is real, and as varied, as patients suffering from anything from a broken leg to heart disease. Just as there is nothing shameful in having cancer, there is nothing shameful about having a mental illness.

Where I might have been a tad optimistic was in my hope that all the stigma of mental illness would be eradicated in my lifetime. However, since I am not dead yet there is, indeed, time. I have seen a lifting of the stigma of mental illness, a willingness to talk about it and reach out and get help. 

What we still need to do is reach into the dark corners, the places where this stigma grows, and open the curtains and let the light disinfect the place. 

The one prevailing myth that needs some attention is that the mentally ill are dangerous. This comes from articles about murders or violent crime, where mental illness is brought up as a possible cause. Also, from the books where murderers are often mentally ill: yes, I mean novels about crime.



If there is a disinfectant for myth, it is fact. 

Since the U.S. has one of the highest incarceration rates in the world, with 666 citizens in jail per 100,000 of the population, we can assume that most of the dangerous people do end up in jail. However, if all those who are mentally ill were dangerous, that would mean that 20% of the population, more like 20,000 per 100,000 population, would be in prison. 

How about an analysis of those who are in prison? Large scale reviews have shown that, in the prison population, less than 4% have psychotic illnesses. 

The myths of mental illness and murder arise most frequently with the worst offenders: mass murderers. 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. 

Even analyses of those who are mentally ill and commit crimes shows that only 7.5 percent were directly related to symptoms of mental illness. 

So, is there NO connection between mental illness and crime, particularly violent crime? The answer is that there is a very small connection, and one that is present largely in those who are not treated and who also abuse alcohol/drugs.

Those who are depressed are three times as likely to commit a violent crime. However, 60% of people who kill themselves have a mood disorder and suicide is the tenth leading cause of death in the US overall, and the second leading cause of death of 15- 34 year olds. Since there are twice as many suicides as homicides, the most likely violence done by depressed people is to themselves, not to others. 

With schizophrenia, the risk of committing a violent crime was 3-5 times greater, but this was found largely in those not on medication. This research on violence and mental illness also showed that those who are mentally ill are more likely to be victims of violence than perpetrators.

For a final look at mental illness and murder, I present the full quote from the title of this article: “Hell hath no fury like a woman scorned.” Most of us would say that scorn is a good motivation for murder and that Shakespeare was insightful for writing this. However, Shakespeare didn't write it -  it was written by the playwright William Congreve. Further, this isn’t even what was written - the actual line is ‘“Heaven has no rage like love to hatred turned / Nor hell a fury like a woman scorned.”

Common, widespread ideas can be wrong - like the origin of this “Shakespeare” phrase and the idea that those with mental illness are inherently violent. Certainty is meaningless unless it can be backed by facts, and in this case the facts do not support the certainty that most people feel.

Sometimes our first impression is wrong. Even with things we feel that we know, such as Shakespeare or mental illness.

14 October 2018

The High Passion of a Woman: Men Are Victims Too


“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


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.

21 September 2018

My Father Died Today


My father died today and I am left here, with my keyboard and memories. 


My father was born in Ceylon in the 1930s, but he had no sense of the place or time he landed on this planet. He was always immersed in books -philosophy, the classics and his beloved biology- and he had little regard for the social norms that were simply invisible to him.

My father got his PhD in Biology at Oxford University, at Christ Church College, in the 1950s. When my son asked him about Oxford, my father - one of the few non-whites there - did not comment on the prestige of Oxford, or the lack of diversity. That was not my father’s style. He was unfailing honest, so he talked about what mattered to him: how, as a poor student, he was able to buy so many of his beloved books at second hand stores and how he had his first sexual relationship there. Yes. That is what he said. That sealed the deal for my son - he was going to university.

My father was born into a wealthy family, one of a long line of doctors and scientists. Growing up in Ceylon, a country with a rigid social stratification, he had a servant whom he chatted with and respected. My father took him on collecting trips and was amazed at his fine mind. We knew him only as ‘Dr. Johnson’ because that is what my father called him. Whenever we returned to Ceylon, Dr Johnson would accompany my father on his collecting trips and lectures.  It was not until I was older that I realized that Dr Johnson was not a professor and he was different than the famous scientists that I often met. Dr. Johnson had no qualifications - not even a high school diploma - and as an adult I found out that my father had given him some family land, helped him build a house and sent him money every month to allow him to educate his children and live a life of ideas. ‘Social justice’ wasn't in my father’s vocabulary - he just did what he felt was right. Whether he was sitting with Maasai in the plains of Africa, or world famous scientists in the halls of a university, he was the same - it was people that he loved and he remained blind to the differences that others saw.

He fell in love with my mother, and stayed in love with her for 62 years. In my mother he found someone as oblivious of norms as he was: she was an MD/PhD with a passion for Parasitology. My father - with his eyes on science -  missed the chauvinistic memos of the 1950s. In my mother he saw a mind that he thought was finer than his. He supported her through her career. He also felt he was a better cook, so he cooked for her all his life, leaving her free to do her work. He supported and fought for many women in science in his lifetime - it was their minds, not their sex, that he focused on and championed.



He took our family around the world, through Africa, South East Asia, the Americas and Europe. He felt at home wherever he was, as long as he could talk bugs and fish, eat good food and share stories and laughter.

Deeply moved by democracy and fairness, my father had no tolerance for political despots. I know this not from what he said but from what he did. He took our family - often at young ages - through dangerous countries in search of fish and bugs. He faced men with machine guns and machetes with equal calm. He had a job to do and we simply went with him. Nothing speaks of his boldness as well as when he was in Singapore, on his way to the Philippines. We were not with him but called to tell him that the Philippines was in the middle of a coup. He said: If I stopped my work for every coup, I would never get anything done. My father felt strongly that political despots, dictators, and even civil war, were transient. Science, that careful, meticulous work of men and women around the world, that is what would endure and he would do his small part to contribute. Looking back - he was right. The despots are now dead or overthrown. The work of the men and women of science has lived on.

My father’s sense of fairness, and his support of my mother, occasionally made his life miserable. We were traveling during his sabbatical year, were in Malaysia, and my mother asked my father to bring some samples from chickens when he visited Burma (now Myanmar). In my father’s mind, if you took anything you paid. So, he offered to pay to collect chicken feces - chicken shit -in an isolated village.  As he was depositing samples into carefully labeled bottles of formaldehyde, he looked up to see many villagers, all carry bags, some of them in various states of degeneration, all filled to the brim with various animal feces. The word must have gone around the village that there was an odd man paying for shit. My father could see how poor these people were and so he did what few people would do - he left with his biological van filled with shit and his wallet empty. He told us this story over a meal, coupled with laughter.

Oddly, for a man of science, one thing my father would never accept is the death of people he cared about. He refused to go to any funeral. Ever. He simply could not bear it.

My father taught me to eat a good meal with people I care about and find a good book to read - every day of my life. He taught me to find every person, in every country, as comfortable as home. He understood - ahead of his time - that the world is a very small place. He taught me that chauvinism and racism are to be ignored in the face of larger, more important pursuits.

Unlike my father, I do go to funerals and I will go to my father’s funeral - my second this year. Why? Because my father - literally - gave me the world.

12 August 2018

He Had Plans for Her


“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


“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.”

08 April 2018

Hell hath no fury...


Imagine being so ill that you cannot even get out of bed. Or being too sick to spend time with your family and friends. Now imagine being too frightened and ashamed to tell anyone you are ill. Being so humiliated by your disease, that you can’t even tell your own doctor that you are ill.



One out of five people, 20% worldwide, have a mental illness. Many often go through this scenario. Some bravely ask for help. Some hide in the shadows. Some hide in alcohol or drugs.

When I was a young, inexperienced doctor, I was certain that the unfair stigma of mental illness would and should be eradicated in my lifetime. I felt that mental and physical illness were both simply illnesses to be treated. Now, after treating mental illness for decades, I know that I was correct.


The suffering of those with mental illness is real, and as varied, as patients suffering from anything from a broken leg to heart disease. Just as there is nothing shameful in having cancer, there is nothing shameful about having a mental illness.

Where I might have been a tad optimistic was in my hope that all the stigma of mental illness would be eradicated in my lifetime. However, since I am not dead yet there is, indeed, time. I have seen a lifting of the stigma of mental illness, a willingness to talk about it and reach out and get help.

What we still need to do is reach into the dark corners, the places where this stigma grows, and open the curtains and let the light disinfect the place.



The one prevailing myth that needs some attention is that the mentally ill are dangerous. This comes from articles about murders or violent crime, where mental illness is brought up as a possible cause. Also, from the books where murderers are often mentally ill: yes, I mean novels about crime.

If there is a disinfectant for myth, it is fact.

Since the U.S. has one of the highest incarceration rates in the world, with 666 citizens in jail per 100,000 of the population, we can assume that most of the dangerous people do end up in jail. However, if all those who are mentally ill were dangerous, that would mean that 20% of the population, more like 20,000 per 100,000 population, would be in prison.

How about an analysis of those who are in prison? Large scale reviews have shown that, in the prison population, less than 4% have psychotic illnesses.

The myths of mental illness and murder arise most frequently with the worst offenders: mass murderers. 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. 

Even analyses of those who are mentally ill and commit crimes shows that only 7.5 percent were directly related to symptoms of mental illness.


So, is there NO connection between mental illness and crime, particularly violent crime? The answer is that there is a very small connection, and one that is present largely in those who are not treated and who also abuse alcohol/drugs.

Those who are depressed are three times as likely to commit a violent crime. However, 60% of people who kill themselves have a mood disorder and suicide is the tenth leading cause of death in the US overall, and the second leading cause of death of 15-34 year olds. Since there are twice as many suicides as homicides, the most likely violence done by depressed people is to themselves, not to others.

With schizophrenia, the risk of committing a violent crime was 3-5 times greater, but this was found largely in those not on medication. This research on violence and mental illness also showed that those who are mentally ill are more likely to be victims of violence than perpetrators.

For a final look at mental illness and murder, I present the full quote from the title of this article: “Hell hath no fury like a woman scorned.” Most of us would say that scorn is a good motivation for murder and that Shakespeare was insightful for writing this. However, Shakespeare didn't write it - it was written by the playwright William Congreve. Further, this isn’t even what was written – the actual line is ‘“Heaven has no rage like love to hatred turned / Nor hell a fury like a woman scorned.”

Common, widespread ideas can be wrong – like the origin of this “Shakespeare” phrase and the idea that those with mental illness are inherently violent. Certainty is meaningless unless it can be backed by facts, and in this case the facts do not support the certainty that most people feel.

Sometimes our first impression is wrong. Even with things we feel that we know, such as Shakespeare or mental illness.



The US has the highest civilian incarceration in the world. — Ed.

11 February 2018

A Voice for the Dead


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

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

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

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


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

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

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

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

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

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

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

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

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

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

07 January 2018

Radiology and Murder


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

I asked him about his thoughts on murder:

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

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

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

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

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

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

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

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

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

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

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

12 November 2017

Breathing


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

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

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

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

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

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

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

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

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

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

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

10 October 2017

Dietrich Kalteis and the Process of Writing


One of the things I really enjoy in the writing game is the process of writing. Both my own and other people’s. Everyone seems to do it just a little bit differently. Of course, there’s the big stuff like pantsters vs. outliners, but there’s also things like whether you try to write a specific number of words a day. And, whether I’m on a panel or reading a blog, I always find these little subtleties in the way various writers work interesting. I also often pick up pointers, so I might change how I do something or at least try something new. If it works fine, if not that’s fine too. But there’s always room to learn and grow.

To that end, I thought I’d talk to Canadian author Dietrich Kalteis about his process and his new book. Dieter’s fourth novel House of Blazes won this year’s silver medal for historical fiction in the Independent Publishers Awards. Kirkus Reviews hailed it a cinematic adventure. And Publishers Weekly called his third novel Triggerfish high-octane action that keeps readers on the edge of their seats. Crimespree Magazine said it satisfies the need for all things dark and leaves the reader breathless. The National Post called The Deadbeat Club a breakout for Kalteis, and his debut novel Ride the Lightning won a bronze medal for best regional fiction in the Independent Publishers Awards, and was hailed as one of Vancouver’s best crime novels. Nearly fifty of his short stories have been published internationally, and his screenplay Between Jobs is a past-finalist in the Los Angeles Screenplay Festival. He lives with his family in West Vancouver, British Columbia, and is currently working on his next novel. His upcoming novel Zero Avenue was released just this week through ECW Press.

So here goes, and maybe there’s something new here that will help your writing too:


Paul D. Marks: Did your new novel Zero Avenue end up as the book you anticipated writing from the start?

Dietrich Kalteis: I started with an early scene where the main character Frankie del Rey walks into Johnny Falco’s club. We learn she’s an aspiring rock star who runs dope for a dealer named Marty Sayles, and that Johnny’s club’s in financial trouble. Sparks fly between Johnny and Frankie which leads to a major conflict between them and Marty Sayles. From there, the first draft just flowed out scene by scene.

I don’t plot a story out ahead of time, so during the early chapters I never know where the whole thing will end up. As I’m writing and the story takes shape, ideas drift in for what’s ahead, and those ideas are better than anything I could come up with if I plotted the whole story ahead of time. Working this way makes writing more of an organic process for me. And these ideas can come from something I’ve experienced, or something I read or saw somewhere, and with just the right twist they find their way into the story.

It’s not the only way to write a story, but it works for me. Once I’m through a first draft, I create a timeline to make sure the sequence of events makes sense. I guess it’s a little like outlining in reverse.


Zero Avenue is your fifth standalone novel. Have you ever considered writing a series?

I love a good series, but I haven’t come up with one that I want to write. Right now I’m working on a story set in the dustbowl days of Kansas, and I have a first draft for the one after that: a present-day story about a guy on the run up in the Yukon. Usually by the time I finish one novel, I have the next one in my head, ready to go. I love creating new characters and dropping them in different settings and situations. Having said that, I did borrow a minor character from my first novel, and she became a main character for my second story, The Deadbeat Club, although I wouldn’t call that a series.


Your characters often come from the wrong side of the tracks, do you like taking an outlaw’s perspective? 

My characters have been bounty hunters, cops, ex-cops, criminals, ex-cons and then some. They often end up in that gray area — not all good and not all bad  — no matter what side of the tracks they’re from. Some don’t follow any rules while others bend them to get what they want, or catch who they’re after. I find this helps make the characters less predictable and somewhat more realistic.

Just like in real life, nobody is all one thing. And when I drop characters in a scene, I let them take their own course and develop as the story progresses, and I try not to interfere by imposing my own values or principles.


Being a prolific writer, do you set a daily word count?

I never have a word count in mind. Typically, I pick up where I left off the day before. Sometimes I back up and rework some of the chapter I was working on the previous day, and by the end of it I may only have written a couple hundred new words. Other days I charge through a couple thousand words. The only thing that matters is that the words that end up on the page are good ones.


Do you cut and save your unpublished gems? 

I used to keep a file for scenes and ideas I cut, thinking I might be able to use them down the road. That’s never happened so far, so I stopped keeping the file. Sometimes when I’m doing a second or third pass through a story, I find something that isn’t working and needs to be cut, and it’s not always easy to throw something out, but I’ve come to realize there are always fresh ideas coming.


You’ve written crime novels set in present time and some that are historical. What determines the setting?   

It comes down to what suits the story. For Zero Avenue I liked the anger of the punk rock scene, and Vancouver was this sleepy backwater town back in the late seventies. And that combination just seemed the perfect setting for the story I had in mind. Also the late seventies was a time before Google Earth and satellite imagery, making it easier to hide some pot fields, which was necessary to the story.

I’ve written stories set in present-day Vancouver, and I like the setting since it hasn’t been overused in crime fiction. Also, the city’s a major seaport sitting on the U.S. border, and that’s just begging for a crime story.

For House of Blazes I set the story in San Francisco in 1906 at the time of the big earthquake. It was a time of debauchery and corruption, and it also had a wild west meets a modern city feel to it. Some people rode into town on horseback carrying sidearms while others drove cars wearing three-piece suits. After the earthquake hit, the fires that swept the city for three days took on a character feel as they raged and forced people to run for their lives.


What’s coming next?

I’m pleased to have a story included in the upcoming Vancouver Noir, part of Akashic Books’ Noir Series, edited by Sam Wiebe.

The next novel to be released is Poughkeepsie Shuffle, due out next year from ECW Press. It’s set in Toronto in the mid-eighties and centers on Jeff Nichols, a guy just released from the Don Jail. When he lands a job at a used-car lot, he finds himself mixed up in a smuggling ring bringing guns in from Upstate New York. Jeff’s a guy willing to break a few rules on the road to riches, a guy who lives by the motto ‘why let the mistakes of the past get in the way of a good score in the future.’

Thanks for stopping by, Dieter. And good luck with the new book.

***

And now for the usual BSP:

Please check out the interview Laura Brennan, writer, producer and consultant, did with me for her podcast, where we talk about everything from Raymond Chandler and John Fante to the time I pulled a gun on the LAPD and lived to tell about it. Find it here: http://destinationmystery.com/episode-52-paul-d-marks/


08 October 2017

Hospitals and Murder in One Step or Two


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

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

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

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

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

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

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

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

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

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

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

10 September 2017

Murder, Magnets and Hacks.  


I am happy to introduce our latest SleuthSayer, filling in for Leigh who is single-handedly fighting off Hurricane Irma at the moment. 

Unlike all the other inmates of this asylum, Mary Fernando, MD, is not a professionally published mystery writer.  She was, however, a 2017 finalist for the Arthur Ellis Award for Best Unpublished Crime Novel (Canada). 

She is the first of what we hope will be a new class of SleuthSayer: the special consultant.

Mary will talk about medical mayhem.  She will also field questions from readers and writers about medicine as it relates to crime.  Please don't ask her about your rash.

We are still working at where her permanent slot in our monthly calendar will be, but this is a great chance for her to get started.  Let's give her a big SleuthSayers welcome!  - Robert Lopresti

by Mary Fernando

“Magnets are a simple way to kill someone,” he says, sipping his wine.

“How?” I ask, pen in hand, recording the conversation by scribbling illegibly in my notebook.

My Saturday night guest is a cardiologist. He opens up blocked heart vessels with stents, puts in new heart valves and uses defibrillators to bring people back from the brink of death. When my guest is not busy saving lives, he spends his time being a fabulous husband, a loving father to his children, a puppy-daddy extraordinaire and engaging in extreme sports. He is also a voracious reader of mystery novels, making him a wonderful combination of someone who saves lives and ponders how to kill people. Although I find this combination a delicious one, I am not sure everyone would share my opinion. So I am disguising my guest’s identity by a pseudonym, Mystery Cardiologist, or MC.

The illegible scribbles I use to record this conversation are the unfortunate side-effect of my own medical training.

Now, back to the magnets and murder.

MC understands that a writer wants to kill a character in a manner that doesn't draw attention to the fact that they are being murdered, and that the death should look, at first glance, like an accident or natural death. He also knows that it is always important to have a means of eventually discovering the murder.

“Using lifesaving devices like pacemakers to kill people is a great way to murder someone,” MC continues, nibbling on cheese. “Basically, these devices have failsafe mechanisms built into them and these can also be used to kill people.”

By the time he has finishes off his glass of wine, and eaten more cheese, he explains this in full.

A pacemaker is surgically inserted if the natural heart rhythm is not working. It keeps the heart going at the right pace, hence the name pacemaker. These electronic devices consist of a battery and computer circuitry inserted under the skin in the upper chest or shoulder with wires that extend into the heart. The pacemaker both detects the rhythm of the heart and, when the heart’s rhythm is wrong, it adjusts the heart rate by sending out signals to correct it. More that 3 million Americans have pacemakers. Generally they are inserted in older patients, over 65 years old. Less than 10% are inserted in those under 45. In older people, pacemakers are inserted when the heart rhythm is thrown off by aging or heart attacks. In young people, congenital heart disease or even unexplained slow heart rates are reasons for pacemaker insertion.

A means of turning off key functions of a pacemaker is needed, for example, in the event of surgery where electrosurgical cauterizing might confuse the pacemaker’s sensing system. So a magnet protects the pacemaker’s function when something could confuse its sensing system by going into a failsafe mode with often a very slow pacing heart rate.

So, back to killing with a magnet.

If a character needs to be killed and is dependent on a pacemaker, hold a magnet over their pacemaker, and when they are weakened by a slow heart beat, gently push them into an oncoming car or over a cliff. This creates an apparently accidental death. Sans screaming. This also has the added benefit of damaging the pacemaker, so the crime is covered because pacemaker function can be analyzed.

Now, when your detective comes in and starts questioning this death, they have a means of figuring it out. The pacemaker that the murderer thought would be damaged is, in fact, intact enough to be ‘interrogated’ - that means, the programming can be examined and it can be discovered that the heart rhythm was thrown off before the character’s death. Perhaps the magnet could be found in the murderer’s home.

MC explains there is another, more modern way to kill someone with a pacemaker that allows for murder from a long distance. A pacemaker needs to have a means of reprogramming it. This ability to reprogram a pacemaker makes it vulnerable to being hacked, that is, reprogrammed with a deadly rhythm. But if the pacemaker is hacked, you would want to remove the evidence of this hack, again by hacking the device while the victim is driving a car or climbing a mountain. The resulting accident would damage the evidence of the hack.

“Hospitals are a great place to kill people,” continues MC, popping a chocolate. “Sick people dying in hospitals are unlikely to be autopsied. Even if doctors ask for an autopsy, the family often says no.”

So, giving a character a pacemaker and using the failsafe mechanisms of the pacemaker to murder with magnets or hacking, provides an intriguing way to murder. The interrogation of the pacemaker provides the necessary means of discovering the crime.

This is just a snippet of my conversation with MC. He came up with other intriguing ways to murder people, many using failsafe mechanisms and, at times, using medical interventions to cover up a murder. I recorded it all in illegible scribbles, providing me with more info for my next blog.

22 August 2017

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


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

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

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

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

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


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


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

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

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

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

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

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

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

So I tried a few different tactics.

I read about how other people prioritize their family life.

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

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




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


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

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



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

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

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