Student Wellness - Faculty of Medicine

ISSUE: 22
Student Wellness
Memorial University of Newfoundland, Faculty of Medicine
Rural & Distributed Medical Education
Alexandra Maher is a third
year medical student and an
active member of the Student Wellness Committee. She leads a balanced and
healthy lifestyle and loves to
run. Alexandra is presently in
Saint John, New Brunswick. THIS ISSUE
R.U.R.A.L.
Kelly Monaghan
Dr. Jong — Enjoying
work and living to
the fullest
Rajiv Thavanathan &
Justin Oake
Winter 2012
Welcome from Dr. Ravalia, guest editor
I am delighted to be your guest editor this month.
Attaining the balance between a busy practice
and my personal life has proved to be a challenge, but living and working in the beautiful
community of Twillingate has certainly afforded
me the opportunity to attain this balance.
We have been very fortunate to have a long
and rich relationship with Memorial’s Faculty
of Medicine. The community is very receptive
to having trainees live and work here, and our
citizens extend a warm and hospitable welcome
to them.
We have endeavoured to develop a team based
approach to care and our students and residents
are a crucial part of the team.
My philosophy is based on an egalitarian model
where adult learners are afforded an environment
that is conducive to teaching and learning.
Respect, empathy, kindness and malleability are
my guiding principles for creating a harmonious
“home away from home.” Adequate housing and
community engagement are an important part of
this equation.
The articles in this edition are a testimony to the
high caliber of good human beings who make
this Faculty a platinum institution.
Being a rural teacher has been singularly the
most enjoyable and memorable part of my
medical experience.
Mohamed Ravalia is a family physician in Twillingate.
An important part of my wellness ...
The unexpected
perks of distributed
sites
Alexandra Maher
Wellness and Rural
Medicine
Dr. Erin Smallwood
I felt like I was home
Dr. Neil Cheeseman
Dianne and Mikhail Ravalia
Adam and Mikhail Ravalia
}
1
R.U.R.A.L.
Kelly Monaghan
In fall of 2011 it was my privilege to begin clerkship with a family medicine rotation in lovely
Twillingate. Initially riddled with angst as to the
logistics and my audacity at leaving my partner
and children for eight weeks, it ultimately proved
a formative and rewarding clinical experience that
has nourished my interest in family medicine and
rural practice possibilities alike. Indeed, through
the grace of a family-friendly community, loggings
and mentor, Dr Mohamed Ravalia, inconceivably
I saw more of my family while in beautiful Twillingate than in my St. John’s based surgery rotation
that followed. What’s more I exercised regularly,
ate sensibly, studied judiciously, and had meaningful clinical and social engagements coupled with
the attendant psychological space to adequately
reflect on them. Is this not the essence of balance
and wellness? Accordingly, sweet Twillingate has
allowed me to re-imagine that a residency within
a rural oriented family medicine program — with
the requisite dash of family-centred policy — is
indeed reconcilable with my obligations at home.
Here is my interpretation (oh how we love acronyms!) of what rural practice has to offer:
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R – Richness of Scope
This much-touted benefit of rural-based family
practice is due to its expansive scope encompassing acute, chronic, and preventative medical
care provision, particularly in communities with
hospital-based practices and ancillary public
health, laboratory and x-ray services. Duties
may include emergency dept coverage, obstetrics, small surgical procedures including lumps
and bumps clinics, joint injections, vasectomies
and endometrial biopsies, as well as in-patient
management approaching the scope of internal
medicine.
U – Uncomplicated
Rural based practice struck me as less complicated than urban medicine, both personally and
professionally. Where shall I pick up the lettuce
today, Safeway or Foodland? The school options
are one, the patient catchment predetermined,
commute times non-existent. How tangibly one
can appreciate the social contexts of the patient’s
health and illness experience, from poverty to
violence, when manifest within one’s backyard. In
Twillingate academic preoccupation with boundary issues seems an urban construct, if you will, a
first world problem.
}
Quote of the
Month
The secret of
success is to be
in harmony with
existence, to be
always calm to
let each wave
of life wash us a
little farther up
the shore.
—Cyril Connolly
2
R – Relationships
The richness of relationships is something that
nourished my soul in Twillingate, including
patient-physician and inter-professional relationships. A bucket of berries, catch of mackerel,
DVD copy of a locally produced documentary,
and a spontaneous poem recitation are just some
of the gifts I received or witnessed bestowed in
gratitude for patient care. Mutual respect permeated interprofessional interactions as well, and
hierarchy was notable if only for its absence. It
was heartening for me that busy hospital staff
— physicians, lab workers, nurses, and secretaries alike — regularly took time to congregate in
the cafeteria for morning coffee and chat where
on Fridays they specifically toast the virtues of
Marie‘s fresh-from-the-oven-made-from-scratch
cinnamon buns.
A – Autonomy
One of the principle reasons I am attracted to
family medicine is the practice autonomy it affords.
I can work in any community, urban or rural, for
the need is ubiquitous. Since NL family physicians
are predominantly self-employed the possibilities as to the extent to which one wants to, or is
able to, give of oneself at a particular stage of
life are unbounded. In rural practice, specifically,
family physicians often have a salaried option if
that suits better. A recent anecdote of a specialist
who left the province when her request to work
80% so she could spend more time with her children was denied by the regional health authority
has emphasized this for me. To accompany my
daughter on a Thursday field trip
I simply won’t book patients. If loss of income
is an issue I’ll add a weekend clinic. Should
childcare be a challenge I’ll work part-time. And
unique to hospital-based rural family practice in
particular, is that if a speciality service become
difficult to access (like vasectomies) such might
be offered within the scope of family practice
with the requisite training of course. Scope like
schedule is entirely negotiable.
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L - Lifestyle
Last, but not least, something that resonated
during my rural family medicine experience was
the lifestyle quality it affords, the opportunity
to breathe. Each day I was able to dash home
to lunch, fix myself an omelette, catch the news
highlights, check my email or do an errand and
return to clinic for 1:00. The air was clean, the
traffic nonexistent, the beauty inexpressible, the
outdoor activities exciting, the sense of community palpable. And of course as future physicians
we will all be blessed with more income than
necessary, regardless of specialty, and therein
the means to explore the world, and get a fix of
urban life as necessary.
In 1925 Dr. Francis Peabody delivered his famous
Harvard address in which he emphasized, “the
secret of the care of the patient is in caring for
the patient”. I would argue that physician balance and wellness is the necessary corollary to
that old adage. In gentle Twillingate last fall I felt
I somehow approximated that state and saw in
it the possibilities for an extraordinary practice:
physician as healer, detective, mentor, teacher,
academic, community leader, activist, neighbour
parent and friend. Undoubtedly my musings are
fueled by a romanticized, minds’s eye view of
charming Twillingate, and maybe too by my once
in a lifetime hiatus from my otherwise plentiful
domestic responsibilites. I am certain,
however as my ensuing years and career
choices unfold I will
always be humbled
and grateful for that
wonderful interlude.
}
Kelly Monaghan is
a third year medical
student. She also has
a PhD in community
health and is a mother
of four.
3
AN INTERVIEW WITH DR. JONG:
Enjoying work and living to the fullest
Rajiv Thavanathan & Justin Oake
Tell us a bit about how a rural practice has
influenced your life Dr. Jong?
I am certainly very grateful for the opportunity to
live and work in a rural area. Work for me is both
challenging and rewarding. I have said to my
family that if I die, I die a happy man — grateful
for opportunities provided to me — by my patients
who have shared the lives and their families and
the communities they live in — and through my
patients I have lived many lives. The breadth of
my work offers me the opportunity to be more
effective as a physician. I enjoy my work — it is
interesting because it is challenging.
Besides your clinical practice, tell us a bit about
your research interests?
There is so much we need to discover in rural
health — most of the research is urban based and
the solutions are often not realistic from the rural
context. I try to research what can influence local
decisions and help improve what we can do in
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our rural/northern regions. I strive to work with
the communities to help with their research — to
understand the problem and to find solutions.
For example, with crab asthma, which was alarmingly high in some communities, we work with
the fish plants manager and workers to discover
the prevalence of the condition, the proteins that
trigger the allergic reaction, the factors in the fish
plants that contribute to increase in aero-allergens,
a practical method to arrive at the diagnosis,
the impact of the crab asthma for the worker
and the community, and solutions for mitigating
the impact of crab asthma. Furthermore, I have
researched physician recruitment and telemedicine. I also supervise a PhD student, and am Vice
President of Medical Services for our region.
That must keep you incredibly busy! Do you
have time for any interests of your own?
Despite all the work I do — often including
evenings, I still find time for other pursuits. I am
}
4
lucky for my family — my wife Cathy and my two
kids. They are most important to me — even
more than myself. When they were younger and
at home I would look forward to fooling around
with them — quality time which I enjoyed when I
was not working. This included skiing or building
a snow hut. As a family we have been on many
hikes and overseas travel. For us, Labrador still
has the most pristine wilderness and for us still
the best place to hike, snowmobile and explore
— better than the fiords in Norway and more
immense than Gros Morne.
Do these outdoor activities necessarily require
a lot of travelling?
No! More recently, we discovered the Mealy’s
mountain which is just in our backyard, visible
from our home in Happy Valley. The snow shoe
hike or skidoo ride up along the Kenamish River
is a great adventure. Next year we plan to canoe
the Churchill River again, hopefully without flipping the canoe this time! For the past two years
we participated in the Labrador canoe race
and we are still holding on to first place for the
masters mixed category. We even take students,
residents and my physician/faculty colleagues on
these trips.
It sounds like you take more from these trips
than just the sheer physical exercise.
Up on top of Mealy’s mountain the country is
vast, serene and spectacular. The air is clean and
the place is peaceful. This is where I learnt how
important land/nature is. I am fortunate to be
friends with the elders who have taught me a lot
and with whom I have learnt to see what Nitissan
(land/country) is — it is life. We camped together
and they showed me how to use traditional medicine and how to live off the land — including how
to cook porcupine.
So what would you say is your favourite
pastime?
Fly fishing for salmon is my favourite pastime and
I religiously set aside five days every year to go to
the best fishing spot on the Eagle River. I probably
fish harder than I work — up at 5am and stop at
10pm because it is too dark. Both my kids have
been to this spot — accessible only by helicopter.
My wife wonderful as usual, always lets me go to
fish. I always bring back fish. I also started running marathons four years ago when the Trapline
marathon got started. I participated because as
a local physician I felt it was important for me to
practice what I preach about a healthy lifestyle.
Now I run regularly and I have more energy than
before, and just what I need as I grow older.
It seems like a great opportunity to promote
wellness in your community!
The Trapline running is a great success story with
ever growing numbers of participants and visibly
more runners in the community. Now we have
a healthy lifestyle club for high-risk patients run
by a multidisciplinary team. Patients who did not
think they could walk or run are now doing it, and
have requested for this to continue throughout
the winter.
That’s great to hear that patients are taking
advantage of what’s available to take a more
active role in their own health.
It is as much a social club as a physical exercise group — a place where myself and other
health providers learn from patients and become
friends.
Do you feel like your patients have a greater
role in your life in more than the traditional
doctor-patient relationship?
Personally I do not believe that friends cannot
be patients — this is probably more true in small
communities — I care about them as much as
they care about me.
Thanks so much for taking the time to talk with
us, any final thoughts?
Work and life is not a chore. It is about enjoying
work and living life to the fullest.
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}
Justin Oake is a second
year Master’s student
and an active member
of the Student Wellness
Committee
Rajiv Thavanathan is
a 2nd year medical
student. His interests
include sandwiches,
dinosaurs and playing in
bands — but not all at
the same time.
5
The unexpected perks of distributed sites
Alexandra Maher
I decided to take
advantage of the
chance to go back to
New Brunswick for
my clerkship as I had
heard positive reviews
about the rotations
that students were
exposed to. It was
also an opportunity
to get closer to my family in Fredericton and my
fiancé (with whom I had been in a flight-requiring
long distance relationship for 6 years) who was
in Halifax. Unfortunately in early July my fiancé
learned that he was going to southern Florida for
work for 7 months starting right away which was
going to leave me alone in Moncton, New Brunswick for Internal Medicine, not knowing anyone
and not being able to go to Halifax for visits on
the weekend, the prospect seemed daunting.
I arrived, somewhat unwillingly, in Moncton, having
left my close friends in St. Johns and my fiancé in
Florida. In my first week, however, I met a number
of new people at all different levels of medical
training and from many different schools. We
enjoyed each other’s company and explored a
number of Moncton’s restaurants as we got to
know one another. I also had a chance to explore a
new city and I really enjoyed it. During those
months in Moncton I also attended my first Thanksgiving at home in 6 years and was able to have a
number of weekends at home with my whole family
which was really enjoyable and an unexpected
bonus. The education style in Moncton was
different from Internal Medicine in St. John’s, which
offered the bonus of working one on one with the
Attendings. After a good couple of months in
Moncton I then travelled to Saint John, New
Brunswick where I will spend the next 7 months. It
is a great opportunity to explore another new city
and meet students from different schools, learn
from them and share my experiences.
Overall I believe that there are numerous benefits to attending a distributed site which include
meeting new people, learning different systems
and being comfortable with new situations and
unfamiliar places. There are also challenges of
being at a distributed site which I haven’t reviewed in depth here because they will be different for different people, but if you have an open
mind and a sense of adventure I think that trying
a distributed site is an excellent opportunity.
Alexandra Maher is
a third year medical
student and an active
member of the Student
Wellness Committee. Wellness and rural medicine
Dr. Erin Smallwood
As family physicians in Corner Brook, Dr. Erin
Smallwood and Dr. Mark Smallwood feel that
they have achieved a state of wellness within their
chosen medical profession. The two family physicians practice in a fee for service group practice
in the city of Corner Brook on the West Coast of
Newfoundland. While Corner Brook is considered
a city, it undoubtedly has a small-town feel. Family
physicians within the community function with
more of a rural style practice. The majority of GPs
have admitting privileges whereby they care for
their own inpatients and liase with their specialist
colleagues on more of a consultant basis. While
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on-call requirements, morning ward rounds, house
calls etc. can make for a busier work life, both Erin
and Mark feel that they have maintained a state of
wellness by establishing a sound work-life balance. In their opinion this is the key to wellness,
regardless of your chosen career. Dr.’s Smallwood
are both involved in numerous community activities ranging from Yoga, Down Hill Skiing, Cross
Country Skiing, Snow shoeing, Camping, Cycling
to name a few. They are both actively involved
with the Arts Community and can often be spotted
performing on stage at the local Arts and Culture
Center in various theater and dance productions.
}
6
Where do they find the time you may ask? They
make time. Both Erin and Mark feel that making
time for personal interests, their family and
friends is crucial to maintaining a state of well
being. They make special efforts to keep their
personal lives a priority. This is not without effort
however. It can be harder to maintain privacy and
be anonymous in a smaller community. Patients
often feel a sense of entitlement to your time
whether it be in the clinic or in the line at the
grocery store. While living and working in rural
communities can help facilitate doctor-patient
relationships and allow for a more satisfying
practice, it can also present challenges. The
inability to be anonymous can result in physicians
feeling as though they are never “off duty.” To
offset this challenge and help maintain the
aforementioned work-life balance, both Erin and
Mark have strived to establish personal and
professional boundaries. They acknowledge
these limitations and whenever appropriate or
necessary communicate them with their patients.
It is imperative for each individual physician to
determine what he or she needs to be happy
and healthy. This will depend on your community,
your style of practice and personal needs. As
physicians we work in a demanding and at times
stressful profession whereby physician burn out
is not uncommon. While we are skilled at giving
advice to our patients about the importance of
maintaining a healthy, balanced lifestyle, we are
not the best taking this advice and applying it
to our own lives. Though there is always room
for growth and improvement, both Dr. Erin and
Mark Smallwood feel that they do a reasonable
job in heeding this advice and thus feel they have
established a strong sense of wellness with life.
Dr. Erin and Mark
Smallwood are both
graduates of MUN
Medical School and the
MUN Family Medicine
Program. They currently
live and practice as family physicians in Corner
Brook Newfoundland
and are both involved
in medical student and
resident teaching.
I felt like I was home
Dr. Neil Cheeseman
Student and resident wellness is a much discussed
topic these days. The issue is particularly relevant
to students who are finding themselves doing
rotations in smaller towns and sites across Newfoundland, as they are separated from the larger
hospital infrastructure as well as from their peers.
I elected to spend ten of my twelve blocks in my
second year of family medicine in the small,
somewhat isolated town of Twillingate in Notre
Dame Bay. Such a stretch had not been executed
in this town before, but I felt the support would
be there. I had been to Twillingate before, and
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the community had quickly drawn me in. But I
was concerned about how I would fare away from
the bulk of my classes, friends, family, and my
own home.
What made this rotation so fantastic was the
focus that was generated on wellness.
The staff at the hospital was friendly, patient,
and accommodating. They were eager to interact
with me, recommend hiking and biking trails, and
to fill me in on the latest happenings in the town.
The physician back up was ideal. Solid support
}
7
while on call in the emergency department. An
open door policy for asking questions during routine clinics. Meals frequently provided when times
at the hospital were busy and stressful. And other
small contingencies that were built in: mandatory
morning coffee break with the staff, cinnamon
bun Fridays, spaghetti lunches (It really was the
best sauce!). These small things showed that the
staff had my own well being in mind on a daily
basis, aside from just the larger scale.
However, large scale wellness was also a consideration. I was provided with a private residence with
all the appropriate conveniences: laundry, internet,
cable TV. My lifestyle of independent living back in
St. John’s was a key consideration in providing me
with the equivalent level of comfort and privacy.
As well, I was granted near-full control of my
clinics schedule. I was allowed to book the
number of patients I was comfortable seeing, and
could take the occasional half day off here and
there for research time, an early exit back to town
for a weekend to beat the bad weather, or on a
forecasted sunny afternoon so I could get some
mountain biking in before the sunshine vanished
into the early evenings. This not only granted
me the luxury of functioning as an adult learner
who could address, design, and achieve my own
educational goals, but also gave me a realistic
sampling of what life would be like when I was
functioning as an independent practitioner.
Lastly, the community itself was very welcoming. I
was constantly kept up-to-date on social events,
concerts, festivals, and group dinners/parties. The
invite was always there. neighbours would invite
me over for tea and bread and stories. Occasionally, baked goods appeared in front of smiling,
friendly faces on my doorstep. The school
provided me access to the gym for work outs and
cardio. Local fishermen took me out for boat
rides and days of hauling lobster pots. I felt that I
belonged. I felt like I was home.
In summary, student and resident wellness needs
to be addressed via three levels. The administration, the hospital staff, and the learner all need
to play their own roles in ensuring that social,
physical, and mental well-being needs are met.
The learner in particular must be willing to ask for
things, state their concerns, and be allowed to
come up with their own solutions, where possible. The administration and medical staff need
to help facilitate this, while ensuring the learner’s
educational goals are met.
It is a difficult balance, and can often seem intimidating to all parties involved. However, with open
communication, support, a sense of ownership,
and genuine hard work, the goal of wellness can
be obtained for all parties involved.
Dr. Neil Cheeseman
applied for the best job
he ever had via lunchbox.
He is hoping that his
future career as a family/
emergency medicine
doctor will be half as cool.
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8
The Rural Medicine Interest Group (RMIG)
Heidi Wells
The shortage of rural
family physicians is
a critical issue across
Canada and particularly in Newfoundland and Labrador (NL). Studies
have shown that medical students from rural backgrounds are more likely to pursue family medicine
and practice in a rural area.1,2,3 Despite this fact,
rural students are less likely to apply to medical
school compared to those from urban centers.4
Memorial University’s medical students have
established a new avenue to address this problem. The Rural Medicine Interest Group (RMIG)
has been set in place as an attempt to increase
the percentage of applicants that come from rural
areas to study at Memorial’s Faculty of Medicine.
The focus of this group is to mentor undergraduate students, particularly from rural areas and to
stimulate an interest in medicine among rural high
school students providing motivation to attend
university and ultimately medical school.
RMIG is composed of 8 executive members from
both the first and second year medical classes. We
have also elected 2 undergraduate students interested in pursuing a career in medicine to sit on our
executive. The election of these individuals serves
as a connection to the undergraduate community
and hopefully if they are accepted in to future
medical classes at Memorial, as experienced members to continue the efforts of the RMIG group.
To target the undergraduate population we
have to date hosted two rural medicine interest
nights with guest speakers including our Dean
of Medicine Dr. James Rourke, Dr. Karaivanov a
family physician from Labrador and several family
medicine residents. The focus of these interest
nights is to invite undergraduate students to
join current medical students to gain knowledge
about rural medicine. These interest nights also
provide undergraduate students the opportunity
to meet with medical students in small groups
to answer questions about application to medical school or about life as a medical student. We
hope that through these efforts we will increase
the morale between medical students and premedical students and stimulate an interest in rural
medicine at an early stage.
One weakness rural medical students have identified looking back on their high school years is in
the information that they received about careers
in medicine and the path to take to become a
RMIG Executive Back, left to right: Melissa George, Julie Warren, Emily Osmond, Emilia Bartellas, Alysha Sears,
Carolyn Arbanas, Keon Hughes Front, left to right: Cecily Stockley, Heidi Wells, Nikita Hickey
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9
successful applicant. To address this we have
designed an ad-campaign that has been delivered to high schools across the province to
address several concerns rural students may have
when thinking of a career in medicine. In addition
to this we plan to begin a series of rural visits in
the winter to these high schools to encourage
university attendance and stimulate interest in
medicine through educational activities. We hope
to alleviate the barriers that rural students may
face in attending university through education
of financial assistance opportunities, ways to get
involved upon attending university and help ease
the transition from high school to university.
RMIG has received funding to carry out the above
initiatives from the Canadian Medical association,
Memorial University’s Faculty of Medicine and
Memorial University’s Office of the President.
To track the progress of both sectors of RMIG, we
are conducting a prospective study to determine
how effective this approach will be and hope to
publish the results in the coming years. We also
hope that similar efforts can be replicated in
other medical schools across the country dealing
with similar issues.
(3) Mathews M, Rourke JT, Park A. National and
provincial retention of medical graduates of Memorial University of Newfoundland. CMAJ 2006 Aug
15;175(4):357-360.
References
(1) Easterbrook M, Godwin M, Wilson R, Hodgetts G,
Brown G, Pong R, et al. Rural background and clinical
rural rotations during medical training: effect on practice location. CMAJ 1999 Apr 20;160(8):1159-1163.
(2) Hutten-Czapski P, Pitblado R, Rourke J. Who gets
into medical school? Comparison of students from
rural and urban backgrounds. Can Fam Physician 2005
Sep;51:1240-1241.
(4) Kwong JC, Dhalla IA, Streiner DL, Baddour RE,
Waddell AE, Johnson IL. A comparison of Canadian
medical students from rural and non-rural backgrounds.
Can J Rural Med 2005 Winter;10(1):36-42.
Heidi Wells is a second
year medical student
from Grand Falls-Windsor and the president
of the Rural Medicine
Interest Group.
Financial Wellness Tip
Medical school and residency should be about preparing for a life
of opportunity, not about accumulating an unhealthy debt load.
That’s why MD advisors spend so much time working with medical
students and residents, helping them understand their banking
and borrowing options and make decisions that are truly beneficial—both during school and beyond.
As you advance through school, your MD advisor can expand the
range of financial options available to you. We’ll show you ways to
start building up your investment portfolio and strategies to pay
down your debt faster, and we’ll give you access to more financing solutions for the next major goals in your life—such as starting
your own medical practice or purchasing your first home. For more
information contact your MD advisor at [email protected]
Tamara Stocks, CFP, Financial Consultant, MD Management
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11
Lunch and Learn Sessions
RELATIONSHIPS
February 29, 2012
MENTORSHIP & CARING CONNECTIONS
March 22, 2012
PERSONALITY TYPING
April 24, 2012
CaRMS
May 22, 2012
NIGHT WITH CLERKS
February 28, 2012
Wellness Notes
Dr. Gina Higgins
I just got a package in the mail. It was a new
winter coat, and as an added bonus, it fit. (Never
a given when ordering clothes online, but when
circumstances make a necessity of shipping and
handling, one does what one can). When the
mailman delivered it to the door, he greeted my
oldest son (5) by name and gave him “his” mail the grocery store flyer. Daniel gravely considered
it, as befits a young man moving up in the world,
and then laid it right where it belonged - on the
woodstove tinder pile. We had already started
the fire that morning, with kindling cut by my
husband. This bit was from a large dead tree
that had been threatening to fall over onto the
vegetable garden late last summer. Instead, it
now keeps us warm on those nights with wind and
snow hissing at the window, and the last of the
hot peppers and rhubarb are still in the freezer.
Rural life and rural medicine are interesting
entities. In some ways slower than their urban
counterparts, they present the opportunity to
engage all the senses as we nurture connections.
These connections are broad - from the mailman
and grocery store workers to nurses and hospital
workers, to friends as we take the opportunity to
sit in the sun (or the wind and snow, depending;
this is Newfoundland after all) with family and
friends and enjoy being. Of course, urban
dwellers can do this as well. I remember living
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Dr. Alfred Goodfellow, family doctor, Botwood
in town and sitting on the porch chatting with
friends as cars drive by, heat waves rising from
the pavement in the summer, or exhaust-crudded
snow lining the sidewalks in the spring, winter
and fall. Subtle though the differences are, they
do exist, and I treasure being on the side of the
difference I inhabit.
When I go to work, my patients sometimes ask
}
12
how my children are (they had seen them with
me at the grocery store), or how my run was (I
huffed past them while they were out walking last
night). I also see them with their families, or in
their workplaces, on a regular basis. I get to know
them in deeper ways than doctor/patient. I have
the opportunity to see them as people interacting
in a vibrant community, and it adds layers upon
layers to my understanding of them.
Of course, if you treasure your anonymity, the
haven of rural practice may not be for you. Believe
me, the observing of interactions definitely goes
both ways. My patients sometimes present for the
first time saying something like “I heard about you
from my sister and my cousin. We were all talking
the other day. My aunt says you delivered my
niece’s baby. They’re doing fine.”
Another part of this whole set up I love is my
ability to mold my medical practice to fit my
dream of what I wanted out of Family Medicine.
Interestingly, here lies a paradox (and I don’t just
mean myself and my husband - pair o’doc’s...
sorry, irresistable). The rat race and life in general
can be slower in a rural area, but the practice
has such potential to be complex, varied and
as texturally satisfying as double chocolate
cheesecake with those crunchy toffee bits. I get to
do deliveries, vasectomies, clinic, have inpatients,
and if I had the inclination I could add emergency
coverage as well. (Good thing I don’t or I’d never
sleep, but that I have the choice is key).
I’ll take the online shopping because the
selection in a rural area is limited. I’ll take a pass
on the fancy restaurants - I like cooking anyway. If
I feel the urge to travel an airport is close enough
for easy access. I don’t need to be able to go to a
mall or a bar. My children have access to all sorts
of extra curricular stuff, and watching them play
outdoors in relative safety with the flock of other
children in the same cul de sac is worth more
than whatever extra organized things might be
available in town. But that’s me, and everyone’s
different. Just as well, really.
I love this quote by Alice Roosevelt Longworth; I
think it says a lot about people and life and what’s
important. “I have a simple philosophy: Fill what’s
empty. Empty what’s full. Scratch where it itches.”
Gina Higgins is a
family doctor living and
working in Grandfalls,
with a full time group
obstetrical family
practice. A mother of
2 wonderful boys, she
also enjoys running,
winemaking and is
working part time on a
Masters Degree.
What’s Cooking
Roasted Root Veggies with Maple Balsamic
Dressing
For this dish, you can use whatever kinds of
veggies you would like including parsnips, red
onions and beets and red peppers!
Ingredients
2 lb sweet potatoes
2 lb carrots cut on a diagonal
1 lb squash cut into 2 inch wedges
2 sweet orange or red peppers
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Maple Balsamic Dressing Ingredients
2 tbsp balsamic vinegar
2 tbsp red wine vinegar
2 tbsp brown sugar
2 tbsp maple syrup (E.D Smith, no sugar added)
2 tbsp thyme freshly chopped
½ tsp salt
¼ tsp pepper
2 tbsp chopped fresh parsley
In a large bowl, combine veggies and toss with
olive oil. Spread veggies on one or two large
parchment paper linked baking sheets. Roast in
a preheated 375°F oven for 45 minutes or until
brown. To prepare dressing, combine vinegars,
brown sugar, maple syrup, thyme, salt and pepper in a small bowl. Toss hot roasted veggies with
dressing and bake again for 3 minutes. Finish
with a sprinkle of parsley. Serves 8
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Closing
As part of the New Brunswick contingent (circa
1983) I remember taking a taxi ‘over-the-road’ to
my first rural experience in the Placentia Cottage Hospital. The moon-like terrain enroute
to Placentia; the two large wards for patients;
wonderful meals in the hospital kitchen; and
flying over Merisheen and Red Island on our way
to the remote community of South East Bight are
wonderful vivid memories.
Early in the morning on the first night of the
experience, the ‘senior’ clinical clerk called me
to see a young child with who she thought had
appendicitis. The anxious mother watched as
the clerk missed the first, second, and third IV
attempt. Exasperated, the clerk exclaimed ‘this
child has no veins.’ The mother went pale, broke
out in a sweat and had to sit down saying “oh my
God. First my child has appendicitis and now I
find out she has no veins!” Wanting to put my 1st
year clinical skills into action, I clarified things with
the clerk in hushed tones and then reassured the
mother that the child did in fact have veins, it’s
just that it was difficult to insert an IV into them.
With the ambulance rushing off with the child and
her mother to St. John’s for probable surgery, I
watched the sun appear over Placentia Bay, reflecting on the clinical encounter and delighted in
the moment thinking ‘how lucky am I to be here.’
Scott Moffatt
Assistant Dean Student Affairs
Wellness links
www.ePhysicianHealth.com
(The world’s first comprehensive, online physician health and
wellness resource)
www.medstudentwellness.ca
(Inspiring, engaging and helpful information for medical
students and others concerned with wellness!)
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