Eye-opening

Yesterday I had my first experience at getting a real good glimpse of some of the conditions of the First Nations reserves, especially in these remote settings. Yesterday morning I embarked on a two-hour boat ride with my attending physician to do a clinic at one of the smaller, even more remote villages than where I am already stationed. They only have a nursing station there full-time, and he's the only visiting physician at the moment.

Their health centre there is impressive; it looks like it was built within the last decade and is still in rather good shape. My clinic had its interesting variation - MRSA impetigo, uncontrolled diabetes, an incision + drainage, etc.... but it was the home visits that made the most lasting impression on me.

Without going into too many details, I saw some of the worst conditions of poverty that I can remember in my life time. I'd like to think I've had my fair share of exposure to seeing people live in dismal conditions given my mother is from the Philippines, and ensuring I witness the realities of living conditions there from a young age, and the summer I spent in rural Tanzania a few years ago. But some of the conditions I saw yesterday... I couldn't remember the last time I saw some situations that hopeless. One particular household, I don't think I'll ever forget. Everything from the condition of this prominent non-mobile elder who we were treating, to the condition in which he and his family lived was not something you could make up. It was a confusing feeling too. They were not a conventional obvious lack of food, clothing or basic needs like you see in those World Vision ads. This household seemed to have these necessities; but its upkeep was non-existent. Clutter was scattered everywhere from old discarded electronics to food crumbs. There was food out, which had clearly been out for weeks given that it was covered in mold. Our patient only seemed to have his home-care nurse looking after him judging by the dry urine and flaking skin around him. Earlier that week, apparently a dog had to be removed from the property due to being severe malnourished. I spent that morning on a two-hour ride on a 17-foot boat in choppy waters after eating a gigantic egg and cheese sandwich, and it was after that home visit that I felt the most ill that day.

It's not a feeling of pity I took away from the home visits. While I did feel sorrow and sadness for these families, it was more than that. I felt embarrassed that these living situations occur regularly on these First Nations reserves within our country on which we pride ourselves on our strong social infrastructure, and that while we call ourselves a "first world nation", these pockets all over the country are clearly no better than developing nations.

I can't attach blame to these feelings though, or offer insight into what I've seen. My time here is also shedding even more light to me on the layers of complexity of the relationships between the government, First Nations people and other citizens of this country. Many fractures exist. In many ways I have seen the friendliness, openness and beauty of these First Nations villages and its people, but I have also learned more about the politics, tensions, dynamics and bureaucracy that exist at many levels. Some people dedicate their lives to these aforementioned areas.

There's still so much to learn.

Remote BC

Just finishing up my first week in a super rural remote First Nations village, Bella Bella, along the pacific coast of British Columbia. It's on a small island that actually faces east towards the mainland of BC but between the two land masses is a pristine ocean channel through which fishing boats, whales, kayaks and the occasional ship traverse.

The town's most prominent guests are its ravens, crows and bald eagles. On any given day, I can count a handful of any of the above either soaring high in the air, perched on a tall post or tall tree branch or flying low above the rooftops. I've never seen this many bald eagles in my life. On Sunday, when I think some fishing boats came in, I saw at least four bald eagles circling above. They're basically the pigeons of this town. Haha.

A pleasant custom I learned on arrival is you wave or greet anyone with whom you cross on the road. It doesn't matter if you're driving a vehicle or going a walk, a friendly wave is the norm, regardless of familiarity. It adds an extra element of openness and courtesy. Anonymity is not likely around here.

The band store is where people get any sort of groceries. It's not cheap to import anything so while I was looking to maybe have a half pint of blueberries today, I'm also not keen on paying $6 for it. It hurts paying $6 for a 1 L bottle of milk too. Unfortunately, the cheapest things in the store are canned or preserved meals, candies, sodas and junk food. Good luck making an affordable salad or snacking on fresh fruits for very long. Trying to bake an apple crisp would probably set somebody back at least $20 on the apples alone.

The people here are pleasant and actively interested in who you are, which makes the transition easier. They want to know your name and where you're from. It's been a week and I've stuffed myself full from two gracious dinner invitations.

I've spent an afternoon kayaking on the calm waters, watching the soaring birds of prey look like circling specs over certain areas of forests. You gotta wonder what kind of prey they're stalking. I'd love to catch one of them in the act of swooping down to catch a mouse or fish.

On a run, looking west of the town are rolling hills of coniferous trees as far as I could see. Of course, the rolling hills meant my pace was getting destroyed on that run, haha.

I hope to check out some hiking trails this week if the weather clears up, and of course more kayaking. What I would give to see a whale while I'm on the water...

Costa Rica thoughts

On vacation in Costa Rica, and it is a rather intriguing country to visit. Its natural beauty is obvious and the Costa Ricans have done an excellent job (from what I've seen) in preserving much of it, especially given the immense tourism industry it possesses.

Some thoughts on things I've noticed while visiting:

• On first impression in the airport, when arriving, it is absolutely flooded with tourists. I haven't been to Mexico or Hawaii so I can't speak in relative terms but I felt like I was in an American airport like in Florida or something. The crowd consisted mostly of tweens and young families with a few interspersed retirees.
• Poverty exists  and is apparent in some areas, but it doesn't quite have the feel of typical developing nations, nor does it give off the vibe of it putting up a massive luxurious front to hide the rest of the population (more than other places, at least). There does appear to be some money floating around in its economy from the thriving tourism industry. 
• I don't sense a strong resentment nor a will to exploit the tourism industry from the people here. More often than not, it more seems that the locals are proud to show off what their country has to offer, but are also fiercely defensive on preserving it... I appreciate both of those qualities.
• We asked one of our tour guides what has made Costa Rica safe for so long, and he quickly replied that their country has no army! A google search verified that it has been abolished since 1948 after the end of their most recent civil war. Since then, unlike any of its neighbors, there have been no further conflicts in over 50 years. 
• Again on tourism - I think it's astounding that given the foreign money that comes in, the locals still don't expect tips. They are gladly appreciated of course, but unlike many other places I've visited with strong tourism, they haven't taken tips for granted to this point.

And I haven't even talked about what we've explored yet. Until next time!

Quebec City

Quick post. Finally got a small break for six days. Got it on the tail end of an unpleasant flu.
In QC with some good friends. Nothing too groundbreaking here, but it's been nice. Walking tour showed me this city used to be a bustling port city full of commerce and trade which essentially evaporated with the emergence of the steam engine. In a city of only 500K, their restaurant market is massive. If anyone comes by here, making a reservation at Chez Boulay is a must. I didn't know cod could be pan seared in such a way that the fillet just flakes away and disintegrates in your mouth. Ridiculous...

As always, a song for you at the end of the post. Didn't like Ports of Morrow that much but I'd have to say I'm still a Shins fan. The song is called "No Way Down"--

The end of the TO chapter

It was actually pretty sad leaving Toronto in that last week. Mostly because living with Q and Court had gone so well. Not that I was expecting any problems, but it was almost being back in med school where we could casually hang out together, shoot the breeze, walk home together, and so forth. Near the end of the week I realized there was a variety of things I wanted to do when in town but never had the chance. I also struggled to understand where the time went. Sadface emoji.

The ICU elective itself was great. I felt I really hit my stride in the last couple weeks and got a decent amount of exposure (and success!) to procedures I was looking to get practice on while I was there, put myself out there a few times in management plans and juggling multiple issues in some of the more sick patients. In reality, it was an introductory exposure to critical care since I'm only a PGY-1 so I hope it sets me up for more comfort and preparedness for it next year.

Anyways, here are a couple highlights:

If it looks like we're sitting around, looking at that empty chair,
it's because we are. We Skype'd in James in Newfoundland who
has been banished there. He seems to be enjoying it though. 

Being artsy on the drive back from a brief weekend stay in Kingston.
It's too bad I don't have instagram anymore. 

Wandering around Kensington Market I came across a gem of a
seafood market, Hooked. Other similar shops in the area were cheaper, but
just smelled awful so I decided to take a gamble here. I think it
paid off. I just had a brief conversation with one of the ladies behind
the counter but I could tell she knew her stuff. I think it's incredibly
responsible that they knew exactly where they get their fish,  and the
environment where they reside. I look forward to reading more about
this industry and where I can find a similarly responsible seafood
market in Ottawa.

London wrap-up, !UPDATED - with photos

Boy that was a nice vacation. I didn't get to do all that I wanted, but London is a marvelous city. At times it can feel overwhelming, but it's also one of those places where if you just wandered about for a day, chances are you'd come across stuff by accident and have a good time. I didn't get to see Tate Modern. Somehow I forgot all about it until it was the evening before I had to leave. Oh well, till next time.

Highlights, all of which I would recommend for anyone going to London whether it's their first or fifth time:
- running in Hyde Park
- walking down Portobello Road in Notting Hill and checking out its shops, but also going a few blocks off the path to really take a good look at some very affluent property... not to mention that Bentleys, Aston Martins and Jaguars are relatively commonplace.
- The sticky toffee pudding at Holly Street Pub. Worth every calorie, goodness. And a wonderful pub atmosphere
- Daytrip to Bath. DO pay the museum admission fee, and DO utilize the free audio tour. Walking up Alexandra Park provides a great view of the city on the rolling hills.
- the Wildlife Photographer of the Year exhibit at the Natural History Museum was breathtaking. It's amazing the dedication many photographers put in their work, and it shows nature at its finest, but of course also some heartbreak with mankind's influence as plain as day. If you're ever in London when it's on display, it's a must-see in my opinion.

Maybe next time I will invest in an Arsenal match. I should also remember to make sure my next trip includes a weekend while in London. A lot of galleries and museums offer after hours admission with DJs and somew interesting looking events on Thursdays, Fridays and Saturdays.

Bath

This is why the walk up the steep hill to Alexandra Park was worth it.

London calling

Last night, I felt a bit unnerved as I tried to fall asleep, knowing I was going to London the next day. I was trying to think of how to make the most of my trip, but also wanted it to be a unique experience. I was also kind of struggling with where to start. I'd been to London before and knocked down most of the big hotspots (Tower Bridge, Big Ben, the Palace, etc etc) so I wanted something … different. 

Sometimes I struggle in giant cities because the vast majority of things to do encompass eating, watching or shopping. All of these activities are of course unique to each city someone visits but seeking these activities ad nauseum can get a bit mundane. And expensive. 

Fortunately, London has a plethora of unique activities I could pursue. And really, the opportunities are limitless because as the saying goes, "Tired of London, tired of life". Of course, as I said above, a lack of limit in choices can be paralyzing in itself so I've thought hard to have a few goals over the next few days:

- find different ways to learn about parts of London's history (walking tour? London fire? one or both world wars?)

- see Tate Modern (I missed it last time)

- find an interesting place to read

- do a "day trip" exploring one area/borough/neighbourhood in particular

On deck today - I have been craving sushi for a long time. Let's find an affordable place to see. And I'll check out one of the National History Museum (there is an exhibit of the best wildlife photos of the year) or the National Portrait Gallery, which is something slightly different and should be a good learning opportunity. 

London ho! 

Leeds wrap-up

Just spent the last two days visiting Leila while she's on exchange in Leeds. First impression when walking through town was that it was purely a college/university city. Students wandered the streets, many were lined up in lines for bars, while others were chatting with their casually lit cigarettes in hand loitering outside of them. 

I pretty much fell asleep within a couple hours of arriving and was knocked out cold until the next morning, fortunately letting my body recover from that deep fatigue that I'm familiar with after a long night on call. 

We went to the Leeds v. Tottenham FA Cup Round 4 match the next day. Now I get the hype behind experiencing an English football game. The atmosphere is nothing like a regular season hockey game in Canada. In Edmonton, we would ride the LRT to the arena, opposing fans would sit next to each other, there would be some polite teasing, but nothing over-the-top, and in essence have a mostly family-friendly night of entertainment. 

In contrast, in the shuttle bus to the match, there would be boisterous chanting about Leeds, repetitive Tottenham bashing including a well-known chant about how one of the players is fond of consanguinity. At the stadium, the visiting team's fans are in their own section, and I understood why. While the overall atmosphere was loud and cheerful, there was definitely an underlying tone of pure hostility against the opposing team and its fans. This climaxed at the end of the match where there was a police escort surrounding the visiting teams' fans as they tried to quietly exit the stadium. The tension was palpable as they were surrounded by this crowd of Leeds fans, both sides heckling each other.. and not just in the "ha-ha, match well played mate" type of way. 

The match itself was awesome. It was a crowd of 28,000 which is on the smaller end when it comes to English football, but while it's also bigger than any hockey game it was orders of magnitude more intense than what I've experienced. Chants would erupt spontaneously, and would not have to be cued by a jumbotron and there were at least four or five that everyone at the stadium knew by heart. Every time Leeds scored, it felt like a giant party, and I wanted them to score more just to experience that mood of pure elation that went rampant through the crowd. It lacked the necessary "bigh-five a perfect stranger" I enjoyed in hockey games, but seeing an entire stadium jumping up and down like that made up for it. Fortunately, Leeds won 2-1 which is nice because being an Arsenal fan I also despise Totttenham so it was a jolly trip home. 

We walked around campus briefly on the way back to my sister's dorm and stopped at a student pub for a small dinner before just hanging out the rest of the evening. 

Now on the train, and London awaits...

The maps (continued) and the next vacation...

It took a long time for me to decide what to put up on my bare walls. I figured there would be a number of days when I'd just be staring into space and it should be something I enjoy looking at, but complex enough that I don't get bored seeing it every day, AND something that can get my mind going. You could say... something to promote momentum. Figurative, literal or otherwise. I chose maps.

Exhibit A: Star map
If you know me, you know I love space - its immensity, mystery and the way it will unconditionally humble anyone. It's tangible but is incomprehensible. I think this strange balance (or imbalance?) of the known and the unknown of the cosmos have always intrigued me... hence the reason for this star map.

Exhibit B: "interactive" world map

This one plays a number of roles. It's in my bedroom, and is the first thing I see each time I wake up in the morning. The pins on it indicate places outside of Canada I've visited. I'll probably add the ones in Canada eventually when I get those small pins designed for use on maps, but for now the thumb tacks will do. I also intend to add photos of my friends in different places of Canada, and eventually the world. It'd be interesting to track changes to it over the next few months and years and see how it evolves. I hope to get it a lot more busy, and be forced to buy many more pins...

... which leads me to my next point, the next vacation has been decided. Plane ticket purchased via the recent seat sale on Porter. There's a bit of adventure, food, city and outdoors all mixed together -- New England. Hopefully I'm there just before the mad rush for the autumn but in time still to see some evidence of the season change. Should be awesome. I'm pumped.

the tour

I remember listening to this song the day I got into medical school. Really, it doesn't make any sense in terms of the lyrics or anything... it just sounded triumphant, and that's how I felt at the time.

Three and three-quarters years later I'm sitting in the airport waiting to begin my tour as I (and the schools) decide which residency program I'm going to be joining in July. It hit me as I left my house that somehow these (almost) four years have just whizzed by and I'm at a point I couldn't even fathom when I first got accepted.

How do I feel? It's a mixed bag, as usual. Anxiety, excitement, ... and gratefulness.

It's strange, I try to imagine how me from 2008 would have reacted if he sat down beside me and had a chat about what's transpired over the past four years. He'd probably say I look a bit more tired, and probably with a different style. I'm sure he'd have no idea what was in store for him.

But it's not over yet.

Belated: New pack leader and living out of a suitcase

#1. Family Medicine

Now the outright leader of the pack, and by quite a large margin. This transition happened over the span of the last couple months as I got exposed to these specialties and realized how much I would not be ok with (a) losing knowledge, and likely interest, in many aspects of medicine, and (b) to essentially devote my life to one particular section of a specialty. Even seeing the R3s/R4s in things like Internal Medicine and Orthopaedic Surgery already forget some basic principles that I think make you a good doctor is not something I want to end up being (of course, they are incredibly smart in what they do).

Secondly, the flexibility of Family Medicine is unparalleled. I will in all likelihood chase extra training in Emergency Medicine to work at the very least part-time for a while. And maybe hospitalist and sports medicine training are down the line too. Just the fact that all these options are possibilities that I could chase whenever I'd like makes me excited. Funny enough, the actual concept of basic Family practice is not something I'm excited about, but I do enjoy talking to people, being involved in their lives and am an advocate on more than just prescriptions and routine advice. I think it' something I could be good at.

I wouldn't even know what to rank second at this point. Maybe Internal Medicine if I really enjoy it in Toronto. Funny enough, I'd probably shoot myself if I matched to the FRCPC Emergency specialty so I might not even rank that. My main question at this point is how I'm going to rank - primarily by location or by specialty? Given recent events, location is now more important to me than before, but we'll see what happens in the next few months.

 

Nomad life

See my map HERE

Sydney and Cape Breton have been great to me. It really has felt more like a vacation than another elective. It's astounding how some parts of the island look like they came straight out of those postcards or ads for the Maritimes, and then you realize you're standing there. Those giant rocks. Those waves that crash against the shore. I've wanted to step out on those rocks and have the waves just crash on the same rock I sit on, but it's probably not the safest idea in the world. The smell has really gotten to me though. Now, I'm normally a guy with a pretty awful sense of smell but every time I step outside and I can smell the salty ocean air, it's just something else.

Crab has been the best thing I've eaten here, probably because it's in season. The lobster was unfortunately a bit disappointing but it was still tasty.

I'll leave you with some photos. Halifax is next, and then my southern US trip with some of the guys.

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