The last time I visited Las Vegas, my good friend Melissa and I took an ambitious detour towards the city on our route from Edmonton to San Francisco. We arrived at 11am, her car way overheated and packed to the brim with everything I owned. We stopped at a mall somewhere and the city looked burnt up, like it wasn't built for daylight. People looked sad and wandering lost. We left after a few hours.
We both preferred the desert terrain and glorious, whipped crimson sunsets.
He sat back, exhausted. “I am so worried about where we go from here. I am so worried for how my wife will do without me. We get 70 or 80 years here,” he said, looking at me, “But I know I’ve got an eternity left in Heaven.” He went on to share that he is worried about money, his children and his home. Norfolk General is a bucolic terra firma for faith, fellowship and farming. The idea of an eternity in Heaven crosses cultural divides between the Mexican and Jamaican migrant farmers, the farming families of European descent, the Mennonites and the First Nations. Of course we face the same economic and social challenges as the rest of rural Ontario but it seems these challenges are weathered with stirring self-reliance and closeness.
I am technically an outsider. I am not a woman of faith. I am from the country too, but a different kind, farther north. My Low German is about as good as my Mohawk and my Spanish, which is to say non-existent. I don’t know anything about farming. But despite all of that, each of these communities has made space for me through my role as a provider of care. When I drive to work every morning, I drive through the Norfolk County hamlets, villages and fields, past the side roads, around the tractors and other slow, wide loads, to a new kind of home. Each one of my patients asks me if I think I could stay.
I am prone to Facebook tirades and lengthy arguments with people who think about things differently than I do, and with people that are just trying to get my goat.
These arguments are typically about issues of justice or equity, as I see it. In that sense, the issues are of great import. But in another, the tiresome back-and-forth with Internet acquaintances is not important because it doesn't accomplish anything. I also leave them feeling angry and incomplete.
I am a social media crusader and I don't particularly like it. I like the thrill of the argument, but no one ever wins and a lot of time gets wasted. So there's that kind of social media user.
Then there are these kinds of social media users who produce a whipped cream version of their lives for the Internet. They have pretty faces and wear pretty things and go to pretty places. And it makes me smile.
In northeastern Afghanistan, there is a province called Badakhshan. In Badakhshan, there is a capital city called Fayzabad. In Fayzabad, there is a provincial hospital. In that hospital, there are dozens of women who came from far away to have their babies. They are Pamiri women and women from the Wakhan corridor. They are women from everywhere in between.
In 2011, I took my very best shot at helping out. I was 27 years old and I moved from Ottawa, Canada to Kabul, Afghanistan for a job with a well-known and well-respected global non-profit. I thought I would do some good. I thought I would learn a lot.
As someone training in family medicine, I covet the opportunity to teach young women, and men, about their nether bits and how they work. Young women and men sort of know how the bits work and high school health classes do a decent job covering the very basics.
But when it comes to caring for the vulva and vagina, a little advice can go a long way.
I am so fortunate to be working with a great OB\GYN generalist. I watched him discuss genital hygiene with a patient this week and was really quite pleased to know that a lot of the advice he gives is stuff I've figured out on my own. But that same advice is rarely discussed in routine primary care visits with family doctors. Let's talk about it now!
A few years ago, I got the America's Test Kitchen Cooking School Cookbook for my wedding shower. It has all of these great image-based tutorials for classic meals like roasts, turkey, gratin and other important cultural 'meal'stones (ha!).
So then I started looking around to see if they had a podcast because my podcast game has been a little blah lately.
Two women led us through the oldest residential school in Canada this afternoon. One was a survivor. People who spent part of their childhood in a residential school are known as survivors. The other had a grandfather who lived in this residential school in and around 1899. They both generously took us - seven Canadian family medicine residents - through one of this country's darkest legacies....
I listened to the audio version and have tried a couple of recipes. My thoughts? I love it. It's really reasonable in its presentation of the evidence. And the recipes are not aspirational. They make sense.
I think about the years and years of play I sacrificed for my education and my career. And finding space for play - to enjoy my life - is now a spiritual imperative. If I was to die of a rare cancer next year, like Dr. Kalanithi or my friend Jen Young, it would all feel so profoundly unfinished. And it would feel like that because I have a lot of banked play time that remains unused in my esoteric life account.
Over the last several years, I've had a voyeur's view into the lives of people confronting terminal illness. The hoops of medical training dropped me squarely into the existential sorrows of perfect strangers as they realize that these days or months are their last. It feels great to help where you can, and utterly, outrageously sad when there is nothing to do.
But just before Christmas, I found out a truly adored member of my family has two large tumours, likely representing an aggressive cancer.
Yesterday, was talking to a woman who has experienced a great deal in her life. She said to me,
I want to taste peace.
I want to taste joy.
I need to taste my food.
I need to taste my kids.
The past needs a great hug.
I just spent four weeks in a training program for visual literacy at a local art gallery, a program designed to help residents with the art of noticing in the clinical setting. If I pick and chose charitably from the program, the things I loved were the things that helped me see forms of human life more vividly.
It’s just about time to leave the office for the day and you’ve got a choice to make before you step outside the door. Are you going to put your running shoes on and head straight to the gym? Or are you going to open your to-do list and be persuaded to skip the self-care because you’ve got homework to supervise, groceries to buy and a house to clean? Or maybe you’re tempted to nap? On certain days, one of these choices is going to make more sense than the others. But going to the gym, or wherever you like to move your body, requires the greatest investment of self-regulation.
How we understand willpower is shifting. Willpower is the conscious self-control we use to resist impulses. The prevailing idea in studies of willpower is that our supplies are limited and reduced by fatigue, hunger and stress. Research from the past five years has introduced some new features to this core idea.
I began my recovery from anorexia nervosa in July of 2008. I had just returned home from Vienna, where I was a UN intern for 6 months. I was sitting with my parents in their backyard. I had a jar on my lap of green sludge. It was a concoction of spinach and water and a few berries which, with the correct blender and a healthy mindset, would be a perfectly fine snack. In that setting, however, it was a bitter metaphor for deprivation and rammed home an awareness that my life was shrinking.
That jar of spinach water was the only thing I had eaten all day. I ate the stringy, leafy mess with a spoon because the blender was a dud. It was not even close to the grossest thing I had ever eaten in the name of calorie restriction.
I told my parents that afternoon that I thought I needed some help. I needed some help because I was passing out all the time. I was growing hair all over my body and losing it on my head. I was freezing cold all of the time, even in the hot summer sun. I was also struggling to control my bladder. I could feel my body falling away.
But the scariest thing was the thought tumor.
This is the name I use to describe the cloudy, racing, repetitive thoughts that characterize the most treatment-resistant part of an eating disorder. The thought tumor - the compulsion to restrict, in my case - is a most dangerous invisible ailment.
I owe my life to the books. This is not an exaggeration.
We went to the internet. Was there anything available for a 24 year-old with a first time eating disorder presentation, with no co-morbid mental illness? Nothing free, that's for sure. There was a private place in BC - where I was supposed to be going back to graduate school in the fall to finish up my Master's degree - but it was so expensive. It would require a re-mortgaging of my childhood home. The psychiatrist I spoke with during the telephone assessment was pretty insistent that I agree to inpatient therapy. I could tell I was getting close to needing medical attention.
Everything I have ever learned about nutrition, healthy living or lifestyle changes has come from self-directed learning outside of medicine. Everything I've ever learned about why obesity can be - but not in every case - so toxic to the body, I learned in medical school.
I learned about the solution in one place and the biophysiology of the problem in a completely different place.
This doesn't make any sense. But this is how it is.
When I was a student at the Institute for Integrative Nutrition, we mostly learned about coaching practices and self-care. When I was a medical student, and now also as a resident, my learning sits squarely in the disease model. I felt like the basic premise of my training was: Obesity is a disease and we treat the consequences with pills. Exercise and eating well are awesome but we don't really know how to get people to do that. We realize the problem is much bigger than any one person, but that's how medicine works.
My supervisor and I were working with a patient last week and he said "hey, have you heard about this new weight loss drug that just got approved?" The patient said no. I also said no, because I had no idea what he was talking about.
I went home to look it up - Liraglutide - and I realized that I did actually know about the drug. It's a diabetes medication that tries to squeeze as much insulin as possible out of the pancreas, keep the pancreatic cells alive and reduces hunger at lower doses.
At higher doses, and for the same reasons, it is helping people lose weight and it is being marketed as Saxenda for these purposes.
I belong to two internet body-related Facebook groups. My membership reflects my ongoing need for inspiration around healthy change and my interest in the saga of how women relate to their bodies, and how society relates to women and their bodies.
A new member recently introduced herself with a paragraph like this, "My name is Sally. I weighed 120lbs in 1995, then 145lb in 1998 after my baby, then 195 in 2003 after my second baby, then 140lb when I did Atkins and then now I am feeling gross at 175lb. And that's my story! Thanks for adding me!" Hold your roll, Sally. That's NOT your story. Why do you think that's your story? Sally, there's more, so much more.
But if we only share, and we only live by, our dieting CVs, then are we actually living?
I call this Concrete Diet Thinking where the attention is purely on the physical world, the material understanding of losing weight. It is embodied by "Calories In, Calories Out."
I have a pretty decent strategy for planning my lunches on regular weekdays and I would like to share.
This is not a post about recipes. It is a post about assembly.
There are enough posts about recipes on the internet. I'm good. You're good. Let's move on.
I have three criteria:
FAST: You know how some hard core food blogs are like "Prep Time 30 minutes!" but it really takes six hours, a trip to Siam Reap and an epic Google rabbit hole to actually make the recipe? Ya, I don't do that. I assemble things into a container. Anything more is just showing off.