Yes, I’m Judging You

I wasn’t shocked by the news that a 5-year-old Kentucky boy accidentally shot his 2-year-old sister to death last week. I’m not even shocked that it happened because the mother had walked away just for a moment.  I was mortified, however, that the handgun he shot her with was his birthday present the year before. Whaaaaattt?  I had to Google the story just to be sure I heard that right.

How is it possible that while some parents agonize over whether the food they’re feeding their kids may be genetically modified or tainted with E. coli, others don’t even think twice about gifting a .22-calibre rifle to a preschooler? The prevailing gun culture in the U.S. highlights just how foreign our neighbouring country is to me.  As Canadians, we see the U.S. as our closest ally, a country we feel most akin to.  Some would say “we’re just like Americans”.  Then a story like this breaks and it flies in the face of Canadian convention.

In Toronto, Canada, meanwhile, an all-points bulletin went out earlier this week to the public to watch out for a young man roaming the city because witnesses saw him carrying and loading a gun at various points throughout town.  The whole city was on high alert because of this one gunman.  Canadians are frightened of guns.

And that seems about right to me.

This notion in many parts of the U.S. that guns are a badge of honour that need to be handed down from generation to generation… well, that’s just crazy talk to me.  If guns and learning to use guns is the legacy we as parents are proud to pass on, I would suggest we have not made progress.  What is it about the right to bear arms that is so sacrosanct to some?  If none of us owned guns, we would not have to worry about being attacked by anyone else, right?  Right?  What am I missing here?  I feel like I read a book that was missing a chapter.

To the parents of the Kentucky boy: how do you feel now?  Are you ok with this?  I don’t mean to make you feel bad (ok, maybe I do, a little), but you have to believe that if you got your son a Lego set instead of a gun, you would still be able to wake up to a smiling 2-year-old girl today.  It’s not one of those decisions where you can look back and think, “If I had just known that a gun could kill someone, I wouldn’t have bought it.”  I really make a concerted effort not to judge other parents, but I feel I have the right to judge you.

Some days, I am so perplexed by the decisions made by some parents.

What If You Felt Yourself Slowly Sinking Into Madness?

Tags

anti-NMDA-receptor autoimmune encephalitis, Brain On Fire, mental illness, Susannah Cahalan

I just burned through an incredibly captivating book called “Brain On Fire” by Susannah Cahalan, an autobiographical story of a young woman who – once vibrant, outgoing, effervescent and talkative – found herself spiralling into a world of paranoia, hallucinations, inability to string more than 5 words together, memory loss, psychosis, seizures and catatonia.  The hardest part to read was about her own self-awareness that something was dangerously going wrong with her and she couldn’t control it.  How horrifying it must be to watch yourself going mad.

While most psychiatrists would have quickly diagnosed her as mentally ill with schizophrenia or schizoaffective disorder (and in fact, one neurologist diagnosed her as an alcoholic who should just stop partying so hard), she was lucky enough to have a team of doctors at New York University (NYU) Hospital who were mystified enough to want to get to the heart of what was going on with her.  She could have been drugged up and left to die a slow death in a psychiatric ward.  Instead, she has pretty much fully recovered to her “normal” self, but left feeling incredibly vulnerable.

Through a combination of luck, medical perseverance, and parents and a boyfriend who refused to believe she was mentally ill, she was found to have anti-NMDA-receptor autoimmune encephalitis, and only the 217th person in the world to have been diagnosed with this in spring 2009. Essentially, antibodies were maliciously attacking a part of her brain and inflaming it, causing it to change the way she behaved – she had a sick brain. Despite the increased rate of diagnosis since Cahalan’s own experience, it is still a mysterious syndrome, where some patients may recover partially, some fully, and some may die… all for inexplicable reasons.

Cahalan has no recollection of her period of hospitalization when she was at her lowest point, and in fact, near death. She managed to piece together that time through interviews with family and friends, hospital records and videos and entries in journals that were kept by her father and mother.  Understandably, she found it incredibly difficult to watch the videotapes of herself in hospital: it was like watching scenes from One Flew Over the Cuckoo’s Nest or The Exorcist.  This person was not someone she recognized or knew, and yet, it was her… at least physically.  How odd it must have been to feel so… separated from oneself.

What’s probably most disturbing about this story - and Cahalan writes about this as well - is how many people since the evolution of time, may have had this but were never diagnosed?  How many people were left to die in a poorly managed mental health system because they were deemed “crazy”?  Or in the case of children who exhibited symptoms, were classified into the generic “autistic” category and left mistreated?  To me, this story amplified the notion that illnesses of a mental nature are neurochemical diseases and can be treated.  Our brains are wildly sophisticated organs but one poorly wired neurotransmitter can completely change how we behave – that’s pretty miraculous.  Cahalan is hopeful that neurologists, immunology specialists and psychiatrists are now working more closely together to look at the brain and human behaviour as a collective force.

Most inspiring was the undiminished faith her parents and boyfriend had in her.  They refused to let her go.  They could see that a part of her was “still there” and that’s why they prodded the doctors as much as they did.  How easy would it have been to just give up, to be overcome by fright after watching one too many incidences of psychosis or one too many seizures? It’s proof again of how important it is to get second and third opinions, and why you are your own best advocate for your health (or in Cahalan’s case, because she could not be her own advocate, she had a devoted family who fought for her).

It was a remarkable story, and a stark reminder of how important it is to have people in your life who know you, who really know you, and won’t give up on you.

Less Incentives, More Humanity – The Problem With Healthcare

Tags

doctor, escape fire, healthcare, incentives, medicare, primary care

Watching “Escape Fire” on CNN this past weekend gave me pause for thought about the state of healthcare.  While the documentary was about the broken healthcare system in the U.S., it was clear that our own medicare system in Canada has very similar problems, particularly in the area of primary care.

Coincidentally, finding myself immobile while on the mend from a muscle strain in my leg, I pulled out a book from the archives to read while icing down: “Freakonomics” by Steven D. Leavitt and Stephen J. Dubner.  In the book, the authors propose that incentives are the cornerstone of human behaviour, and that for every great incentive scheme ever created, there is at least one person coming up with a better scheme to cheat the system.

Our medicare system’s fee-for-service structure is a classic incentive scheme.  For primary care doctors (or general practitioners – GPs – as they’re more often called in Canada), the more patients they see, the more money they can bill the government (and just a reminder: that’s your money and mine!).  So what could possibly be their interest in actually caring for and about the patient?

We’ve all experienced it. Before you even get a ‘hello’ from the physician’s receptionist, she’s asking you for your health card. You can barely get ten words out during your appointment before your doctor starts to walk towards the door to get his next patient. There’s no recollection of your previous conditions or treatments unless you have been diagnosed to die.  I’ve always said that you are your own best advocate for your health, and I think that holds more true today than ever before.  Your doctor ain’t looking out for you, my friend.

The American primary care physician who is profiled in Escape Fire says she feels the same pressure.  With the threat of her clinic closing, she has to choose between pushing through more patients and spending less time with them on preventive education, or risk losing her job because she couldn’t get her billings up.  Insurance companies in the U.S. (and the government in Canada) don’t typically reimburse physicians for education – important preventive measures such as nutrition counselling, for example.

Meanwhile, you can more easily get a stent placed in your heart before you can even get access to a family doctor.  And heart surgeons get reimbursed quite nicely, thank you very much, leaving little money for front-line doctors who are (I would think) supposed to stop the flow of patients to specialists so that healthcare spending doesn’t continue downstream.  Why do you think medical students would rather be a specialist than a GP?  They’re no dummies!

There is a quote in the movie that our “healthcare system should have more ‘care’… low tech, high touch”.  In Ontario, as our government tackles its deficit issues and looks at healthcare spending cuts, there is an argument for putting Ontario doctors on salary (and therefore becoming government employees) instead of fighting over how much fees should be charged for what service.  Salaried doctors won’t worry about the number of procedures and focus more on the quality of patient care.

Incentives can be useful to improve productivity, but it’s this current obsession with productivity that has taken away the humanity from healthcare.

What do you think is wrong with healthcare today?

Random Bursts

Since I haven’t been able to keep my mind focused on a single, visionary idea for a post, you’re stuck with this: random bursts of thoughts.

If you’ve read my occasional political rants, you would understand that I was mortified when I read that Prime Minister Stephen Harper is an introvert by nature.  Gasp!  Could it be that he and I have something in common?!  The horror!

How’s this for a remarkable statistic?  In a 2006 study, it cost $356 on average in physician-related costs alone to treat an obese child. Conversely, it was estimated to cost $23 per child to implement a school-board wide health promotion and obesity prevention program.  Why are we not focused on prevention when we know exactly what is causing obesity? This isn’t cancer; there’s no mystery here!  Obesity is sucking health care taxes that would be better spent elsewhere.  Prevention has to start in our homes and in our schools.

After being hit by another snowstorm last week here in Toronto, I continue to be surprised by how a little bit of snow has become a news event. Seriously.  It’s February in Canada; what did you think was going to happen?  Whining about snow has become a favourite sport, it seems.  I think there is some truth to this opinion column from The Globe and Mail: we are hating on winter to our detriment.  The less of winter we have, the more global warming holds us hostage.  Is that what we really want?

Warning: full-on rant coming up…

I want DQ to enjoy our four seasons and she really does see the benefits of each one.  Except when at school.  Her play yard is full of snow that never got plowed.  “Great!”, you say. “Lots of snow for the kids to play in!”  You would be wrong.  On this cold morning, I overheard a parent saying to a teacher, “You’re going to supervise them carefully outside, right?  This snow is really icy.”  [Insert first eye roll here]  The teacher replied, “Yes, we’re going to speak to the office today about keeping the kids indooors today.  It’s too icy.” [Insert second, larger eye roll here]  This, after getting memo after memo from the school with their finger-wagging, condescending tone, reminding parents to dress their kids appropriately for the weather because “we go outside every day except when the temperatures go below -20″.  Give me a large break.  I’ve lost track of how many days DQ has spent recess and lunch hour indoors this winter, and believe me, it has never gone below -20.

Let’s wrap it up on a brighter note then, shall we?

Didn’t think you’d ever meet a cool scientist?  Meet Jennifer Gardy.  She’s an epidemiologist and her passion is to trace and track disease outbreaks by following how genomes mutate in pathogens as they travel from patient to patient.  As she says, “It is literally CSI, but it’s ‘cootie scene investigation’ instead of Crime Scene Investigation.”  If all scientists could get this excited about their work and post science-minded tweets that are actually intriguing, we’d have so many more science graduates doing great things in the world.  A nice role model for young girls with the slightest interest in science.

 

Is the Future Really Hopeless for Today’s Students?

It has been disconcerting to read so many news stories about student stress and anxiety in the past year.  Recently, a student survey conducted by the Toronto District School Board (TDSB) - Canada’s largest – revealed that most teenage students are worried about their future all the time or sometimes.  Many say they are constantly tired and they have trouble concentrating.  In this survey, and in qualitative feedback coming out of McGill University’s Mental Health Services in December 2012 - just before final exams – students cited that they felt like “crying all the time.”  This is remarkable. I don’t recall ever feeling that way as a student.  So what’s different?

Certainly on the surface, the future doesn’t look rosy.  Students today – empowered by social media – are much more aware of the state of the economy. All we hear about is growing unemployment, housing bubbles, and ever rising commodity costs leading to a higher consumer cost of living. But are they looking at the future with the wrong lens?  If you’re a student today, there are baby boomers who have started the transition to retirement - 9.6 million of them will be retiring over the next 20 years.  That’s a lot of job vacancies!  Granted, many employers will take advantage of this and choose not to replace many of those jobs, but not all 9.6 million of them!  Isn’t that hopeful?  It’s certainly not hopeless.

But let’s look at how quickly this full glass gets empty.

I would suggest that parenting has a lot to do with the mental health of today’s students.  I would be curious to see a more detailed cross correlation data of the TDSB survey. Students from lower income families understandably would bear a lot of stress.  There are so many other external factors that affect them.  But what about the role of ethnicity?  Tiger Moms – who are usually of a certain ethnicity (ahem – I can say that; I’m Chinese) – put so much undue pressure on their children to excel, not just to ”do your best”.  More like “you better damn well be perfect or you will put your family to shame!”  No pressure there.

So on one side, we have these students of certain ethnic backgrounds who are pressured to be perfect and have a reputation for being so, and on the other side, we have the “average” non-ethnic students who are now competing on a much different playing field.  The bar has been raised so high, and now everyone’s stressed!

Then there’s the issue of  the thinning of the ozone layer and all the environmental concerns that come with it.  And what about all this talk of the depletion of our natural resources?  Let’s face it: how would you feel if you were told the earth is being scorched and might not exist by the time you’re 50? I’d be pretty darned pissed off at my parents for being so greedy!

Oh, and by the way, how would you feel if you found out that your parents’ pension plan doesn’t exist anymore and they’re going to become dependent on your income to get through their much longer-than-anticipated lifespan?

Hmmm… we just sucked that glass dry. Yup, kids, you have every right to be stressed.  The future looks pretty bleak for you, so you better study and work harder so that you can fix all the problems we created for you.

And by the way, sorry.

I’m An Introvert; I Don’t Need to be Fixed

After my post about my introverted self, one of the follow-up posts I’ve had on my “to write” list was how employers/managers should manage introverts.  In my own experience, I always felt throughout my career that my employers tried to transform me into an extrovert.  Performance review after performance review was consistently peppered with “needs to speak up more”, “needs to participate more vocally in meetings”, “needs to voice her opinions more”, despite the fact that at the end of the day, I outperformed on deliverables.

I often felt frustrated by this, because while I probably didn’t recognize it at the time, I really wanted to say, “But that’s just not the kind of person I am; you don’t understand how I work.”

Coincidentally, I’ve suddenly been seeing a lot more noise about this topic in social media and in the press in the past week.  I watched this TED Talk from Susan Cain, author of “Quiet: The Power of Introverts in a World That Can’t Stop Talking”.  It was another enlightening moment for me, as she pointed out how our education systems and our workplaces are built to encourage extroverted behaviour, and if you don’t play by those rules, you are labelled as anti-social.  More often that not, introverts get passed up for promotions even though they are the stronger performers. 

What a great point: if one out of every two to three people are introverted, we need to find a way to work with them!

Today’s Globe & Mail also tackled the issue of kids who are identified as introverts and how the school system – and even parents – treat this as a condition that has to be corrected.  But why do they assume there’s something “wrong” with introversion?  The flaw with this article is that the writer seemed to equate introversion with shyness.  Shyness is a condition where one can be crippled with social anxieties.  Introverts don’t have a problem interacting socially, they just don’t like to do it in large groups.

As Cain points out, schools and workplaces need to adapt with different ways to optimize introverted students’ and workers’ productivity.  We actually have a lot to offer, but you’ll never get it fully out of us in an extroverted environment.

The Demise of The Cooking Show

Tags

cooking show, Food Network, foodie, foodie-ism, Jamie Oliver, Lidia Bastianich, reality cooking show

I enjoy cooking. When I was little, I always loved watching what few cooking shows there were on TV (you remember “Wok With Yan”, don’t you?  Yeah, that was about it.).  So when The Food Network came along, I felt like I’d gone to heaven.

Out of The Food Network grew a culture of foodie-ism.  And that’s a trend I hope will die soon.  Because foodie-ism gave birth to reality cooking shows, which I do not enjoy. How did Mark Burnett come to take over The Food Network?!

I long for the days of interesting and inspiring cooking shows where one could learn to – imagine this – cook!  Chefs would teach you about ingredients and techniques instead of hoping to win $10,000 or have their name published in the Insiders’ Report.  And then the washed up celebrities had to get a piece of the action, too, with this “Rachel vs Guy Celebrity Cook-Off” show, as if “Celebrity Apprentice” and “Dancing With The Stars” weren’t enough.

With the flexibility I have now with work, I am sometimes able to catch a mid-day show on The Food Network while I’m having lunch. This is where I score.  All the true “cooking” shows are on during the morning and mid-day (is this because the “housewives” are home and the station figures they need to learn to cook?!).  Thank goodness for Jamie Oliver’s “15-Minute Meals”.  All Jamie wants to do is show you how to cook specific dishes, in a practical and more healthful way – brilliant!  It doesn’t hurt that he has no pretensions like many other celebrity chefs do. It’s clear that he loves food, he loves cooking and most importantly, he doesn’t like to fuss.

I also am a huge fan of Lidia Bastianich, whom I now watch on some weeknights on Tele-Latino (TLN).  I love how she loves food!  Her passion shines through when she’s preparing and eating her food.  You don’t see this kind of love in the eyes of the chefs competing on “Chopped”, “Top Chef” or “Sweet Genius”; all you see there is stress, and that’s not what I want to associate with food and cooking.  Another great time to watch true cooking shows is on Saturday mid-morning thru to early afternoon on PBS.  I’m not usually home then, but it’s a guilty pleasure when I actually get an hour to catch something here.  Lidia’s shows can also be seen then, as well as Julia Child, America’s Test Kitchen and Martha Stewart – true originals.

Pretension has taken the fun away from food.  Food bloggers, food porn, spout-to-tail dining, molecular gastronomy, reality cooking shows, the insistence that you are not a foodie if you haven’t eaten kale or quinoa… in my opinion, these are all things that have bred pretension in the food business and have taken the attention away from what should be at the heart of food: it should be fun, fulfilling, convivial and full of love.  Maybe I’m just old and not keeping up with the times, but I’m ready for today’s foodie-ism to end.

The Middle Class Student

That was my longest hiatus ever from blogging, so far! While my head has been percolating with ideas for posts, my hands just could not keep up.  But it’s good to be back in the swing of things, despite the treacherous cold.  Breaking news: it’s winter!  So here we go…

Have you ever had a teacher who changed your life?  I haven’t.

I am always in awe of stories about teachers who made such an impact on a student’s life that the teacher would be given credit for the student’s future success.  When I think back to my teachers throughout my school years, not a single one stands out as one who was extraordinary, never mind someone who changed my life.  Some were good, some were unorthodox, many were terrible and never should have been awarded a teaching degree.

The closest I ever came to a teacher who seemed to care about me was a university stats professor.  At the time, I thought he was about 80 years old, but he was probably closer to 60.  He phoned me at home, excited to tell me that I had a perfect score on my final exam.  It was all I could do to not giggle when he suggested I consider pursuing a future in statistics.  It’s not his fault. The education system at any level doesn’t provide real-world, practical advice to inspire career goals – how was I going to apply an expertise in statistics in any job, I thought.  But had I been told that a degree in economics could have made me rich as an investment banker, for example, I would have considered it more seriously!  Every student should be given mandatory career counselling so that they can understand the thousands of possibilities that lie ahead of them, based on where they seem to excel.

I hope DQ will one day have a teacher whom she will admire and look to for guidance.  It’s important for children to have mentors outside the home.  I respect the teaching profession, and I’d like to believe that all teachers choose to pursue the profession out of altruism and a burning desire to help people learn and grow. I unfortunately did not witness a whole lot of that passion in my own experience.  Most of them really tried, I could tell.  But as with finding the perfect partner in life, it’s tough to get a teacher who is the “whole package”: interesting and passionate, really cares that you learn, and most importantly, knows how to teach.  Remember the teachers who read straight out of the text book and that was the lesson?  Kill me now.

I suppose where there is the greatest opportunity for teacher impact is with a disadvantaged student: someone who comes from a broken home, living in borderline conditions, having to care for a sick parent… the scenarios are unfortunately endless and real.  These are the situations out of which great teacher stories are born, because teachers embrace these moments.  As with politics however, the “middle class” layer of students seems to get lost in the shuffle.  Unless you are seen as doomed or brilliant, you become a cog in the school machinery, just another part of the bell curve.  Maybe that’s where I fell.

Did you have a teacher who changed your life? 

It’s a Wrap: Final Thoughts on Newtown

A few rambling thoughts here as I wind down my busy, introverted brain for Christmas.

Happy to see there appears to be some conversation about mental illness going on (see my earlier post asking about why this was not an immediate burning topic in the aftermath of the Newtown shooting).  However, I am astounded at the disrespect shown by people who judge parents of children with mental illness, with calls to send their kids to prison, remarks about how mental illness is just an excuse, and accusing the parents of being selfish and not protecting their other children.  Wow.  Live a day in their shoes and you’d be singing a very different tune.  It is further proof of how poorly educated we are about it.  These critics are skeptical that the mentally ill cannot control their brains, but that is the crux of mental illness.  I’m curious if research will ever take us back down the path of brain surgery as a remedy, rather than medication, and certainly rather than confinement. Just as heart surgery has become almost standard procedure for many heart diseases, will there be a better alternative to lobotomies as a surgical remedy for some severe forms of mental illness that can lead patients back as full-functioning members of society?  “If they can send a man to the moon…”

The Newtown tragedy certainly gave us perspective on our priorities.  We have realized that we can spend billions to send troops to Afghanistan faster than we can get gun control measures in place.  A dangerous bridge that might have killed 20 people can be fixed in less time than it takes to get military rifles off America’s streets.  More money will be spent on foreign aid than on the support of our own mentally ill and disadvantaged citizens.  Through all this, one thing is clear: politics is power.  But politics are usually pretty screwed up.

President Obama, always the eloquent orator, said it best at the prayer vigil for Newtown’s shooting victims:

This is our first task, caring for our children. It’s our first job. If we don’t get that right, we don’t get anything right. That’s how, as a society, we will be judged.

All the talk of the fiscal cliff, of Obamacare, of Iraq and Afghanistan… None of that matters if we can’t even protect our own children.

I am a fan and supporter of President Obama’s, but in my mind, this will be the true test and defining moment of his second term presidency.  I find myself so tired of the rhetoric about gun control.  I am thrilled that there is a new sense of urgency and that there has been more action taken now than after events like Virginia Tech and Aurora.  But, like New York City Mayor Michael Bloomberg, I am really holding Obama to task on this one.  For the love of our children – our future – put your money where your mouth is.  I love your speeches; they can bring me to tears.  But I feel like I’ve heard these same words spoken over and over again in the last five years.  I would love you more for your actions and your true leadership now.

Wishing you all a blessedly safe and happy holiday season.

Newtown: Gun Control Is The Easy Answer… Too Easy

Tags

gun control, mental health, Newton, schizophrenia

In the wake of the tragic events that took place in Newtown, CT, I wanted to chime in on the emotions and opinions that have been expressed in the media (broadcast, digital, print and otherwise).

The anger has been unequivocally and hastily directed at the lack of gun control legislation.  And while I wholeheartedly agree that this needs to be urgently addressed, I am curious as to why there is not the same level of anger being directed toward the lack of social infrastructure to address mental health issues.  Clearly, this killer had some issues.  If his mother was a teacher at Sandy Hook, I can’t believe this was an indiscriminate act of violence.

I’m not surprised, of course.  Nobody wants to talk about *whisper* mental health.  We prefer to brush it off, instinctively calling these killers “crazy” and crying to have them thrown into jail or onto death row.

But what if somebody had caught on to some early signs of trouble and knew where to go to see how this individual might be assessed and, dare I say it, even helped?  That’s the trouble.  As bystanders, we don’t know where to go for “this sort of thing”.  Slowly, society is coming out on mental health stigmas like depression or bipolar disorders, but what of more fright-inducing conditions such as schizophrenia?

Here in Canada, I keep hearing sound bites from politicians about needing a “mental health strategy”.  Organizations like the Heart and Stroke Foundation have been able to develop and communicate clear strategies for what to do if someone is having a heart attack or stroke.  We know to act within minutes to help save a life. And while I don’t know any statistics, I would hazard to guess that these have had an impact on lowering the severity of the events, and hopefully even slightly helped lower fatality rates.  A condition like schizophrenia is obviously going to be a lot more difficult to diagnose, but we have to start somewhere.  If I don’t even know what to be on the lookout for, how can I possibly help?

Isn’t it interesting how every time we come across dramatic stories like the Newtown shootings, the profiles about the killers invariably make mention of how they “kept to themselves, didn’t talk much, were loners”?  I am undoubtedly being very simplistic in saying this, but instead of deeming them eccentric or odd, and ignoring them, are we better off trying to draw them in to see if they need help?  And yet, again, how can I do this if the category of “needs help” hasn’t even been defined for me?  It’s just so much easier to call for gun control.

While we have only scratched the surface of the facts behind this case, I really don’t think the Newtown tragedy is a one-dimensional event.  Get some gun controls in place and quickly, yes, but let’s also ask ourselves this: if we’d been able to spot someone with a mental health disorder, given him the help and/or medication he needed, would this have happened?