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Nel, it's so wonderful to be here
with you today.
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Thank you so much for making the time
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to talk to me.
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Well, thanks for having me.
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It's great to be here.
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So, I want to start this morning by
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going back in time.
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And I want to go back
to the first time that
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you and I met, which was around,
I think, 1998
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or 1999.
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I was a medical student at
McMaster, and
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you were the chief resident in
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psychiatry, Chief Nel Wieman.
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And I want to start there with
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who you were at that point,
the weight
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that you carried and what
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the expectations for your career were
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back then.
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Thanks.
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Yeah, that seems like
such a long time ago.
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I think at that point
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there was another
Indigenous psychiatrist who
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came before me.
His name was Dr. Clare Brant,
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and I always acknowledge him because
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he was the first, but he
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died unfortunately when I was in
27
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the second year of my residency.
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And so then I became the only
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Indigenous psychiatrist
in the country and
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the first female to
train as a psychiatrist.
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And so at that time,
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I almost
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in a way had two careers, right?
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I was working
35
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in the medical system, working
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as a chief resident and
37
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all the duties and
responsibilities that came
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with that.
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And then at the same time,
I was starting to
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build this career as someone
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who could speak up on behalf of
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First Nations people and
advocate for
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00:01:53,713 --> 00:01:56,950
improved mental health and
health overall.
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So, I do remember that time.
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I felt a lot of responsibility.
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I think one of the things
that I just as a
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bystander remember too.
48
00:02:04,257 --> 00:02:06,459
I mean, there was
media coverage about you.
49
00:02:06,493 --> 00:02:08,294
There was a big article
in the newspaper about
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00:02:08,294 --> 00:02:11,197
you, sort of carrying this mantle
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and this weight.
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And I wonder even then, looking back,
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what do you think was the impact of that
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weight at that time?
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I think for myself,
I do remember one article
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that came out around that time, and I
57
00:02:24,277 --> 00:02:26,880
remember somebody wrote,
I think it was in
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the Canadian Journal of Psychiatry.
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And then the next month,
there was a letter
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to the editor, something about,
"Well, she
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seems like a really nice person,
but she's
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never going to accomplish that.
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It's just there's too many problems.
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The problems are too big."
And I remember
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reading that, and then
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I thought, my whole career
has been based
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on people telling me that I can't do
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something or that I'm
not good enough to do
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something. And so
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why would I remember
that particular letter
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30 years later?
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So, I guess I just used it
more as motivation.
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But for sure,
there was a huge challenge.
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I think probably the biggest tension
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for me was still being early in my
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training, early in my experience,
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and yet being called upon to be the
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expert in Indigenous mental
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health.
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We're going to talk
in a minute about a
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sequence of really
difficult events that
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occurred in your life.
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But between you finishing your
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residency and that
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period of your life,
could you just
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fill in some of the
blanks professionally in
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terms of what kind of work
you ended up
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doing and where you
professionally found
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your home?
90
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When I first graduated from
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my specialty training, I had the
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opportunity, even during
my residency, to
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be part of a group that was creating
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a mental health service on
Six Nations of the
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Grand River territory,
which is just outside
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of Hamilton.
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And, now
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when I look back on it,
we were doing
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culturally safe things before it was
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00:04:05,745 --> 00:04:06,879
even called that.
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00:04:06,879 --> 00:04:09,182
I think the term cultural safety
was coined in
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1998 or something in New Zealand,
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but of course, we didn't know
about it at the
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time. So the first eight years of my
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career, I worked mostly
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at this community-based
mental health clinic
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on reserve, working exclusively
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with First Nations people.
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And then, I did a
little bit of time,
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some shifts in the regional emergency
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psychiatry department
because I really loved
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emergency psychiatry.
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And then after that, it
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was really difficult
working on reserve, I
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have to say.
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There was one psychiatrist
that I managed to
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cajole to come and work a day a month
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or something and see the
young children and
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the young adolescents.
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But primarily, I was
the only psychiatrist
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working in the community at the time.
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And so over those eight
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years, I had
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become the keeper of people's
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secrets and the holder of
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all of those stories.
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And there were different traumatic
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events that happened
in the community: a
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really tragic death of a toddler
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and all sorts of other things.
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And so after eight years, I found
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myself feeling pretty,
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I wouldn't say burnt out,
but probably pretty
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close to burnt out.
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And so I accepted an opportunity
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to move to downtown Toronto,
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and I switched and started
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working in the what is now the Dalla
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Lana School of Public Health in sort
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of a research-teaching capacity.
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And I co-directed a research program
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that was intended to build
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capacity for Indigenous students to
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get engaged in health research.
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And I did a little bit of
clinical work at the
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time, mainly with
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Indigenous.
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I worked with an Indigenous HIV/AIDS
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organisation and a
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program for the homeless.
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So, I've always been drawn to working
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with populations who are in situations
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of vulnerability.
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And I did that, I think, for about seven
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years, and then I
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took a job working as...
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It wasn't called an assertive community
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treatment team, but that's
how we functioned.
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I worked for YWCA Toronto
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on our mental health team, providing
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support to 100 women living with
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serious mental health and addictions
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issues.
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And then lastly, I decided
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that I need a little more structure than
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the situation I was working in
at the Elm centre,
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and I accepted
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a position working at the Centre for
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Addictions and Mental Health in downtown
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Toronto.
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So Nel, in 2005,
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a few really difficult things
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happened in your life, and they
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had a series of impacts
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that you experienced afterwards.
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And I wondered if you could talk
for a moment
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about what went on starting
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in 2005 and the aftermath.
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Even for us as physicians,
life happens,
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and things got really
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challenging for me, I think, because so
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many things happened all at once.
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As I mentioned, I accepted a position
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in downtown Toronto,
so that involved leaving
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my home and
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moving to downtown Toronto,
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which is very different setting.
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My marriage ended, and
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around the same time, my mother,
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who was elderly; she was 85
191
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at the time. She essentially
192
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went into hospital for the
last time and was
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hospitalised for about a year
of her life.
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And I was the primary caregiver for
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the family because my father had already
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passed away.
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And then at the very same time, my best
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friend, who had been my
best friend since we
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were four years old,
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00:08:01,347 --> 00:08:03,783
was diagnosed with cancer while she was
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12 weeks pregnant with twins.
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00:08:06,085 --> 00:08:08,521
And so she made the very
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00:08:08,521 --> 00:08:11,157
difficult decision to
delay her own treatment
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so that she really wanted to
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00:08:13,493 --> 00:08:15,728
deliver two babies that were healthy.
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And so she essentially sacrificed
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herself.
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It turned out that
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she was at Mount Sinai Hospital,
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which is right around the corner from my
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office. So, that whole year
212
00:08:29,275 --> 00:08:31,611
was spent adjusting to a new
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place to live, a new job,
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00:08:34,881 --> 00:08:37,083
trying to look after
my mother from a distance
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00:08:37,083 --> 00:08:39,085
because she was living
in Thunder Bay, flying
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00:08:39,085 --> 00:08:42,188
back and forth at times, and then
217
00:08:42,188 --> 00:08:44,624
basically spending almost
every day or as many
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00:08:44,624 --> 00:08:46,592
days as I could with
my best friend in the
219
00:08:46,592 --> 00:08:49,295
hospital. So, it was pretty
220
00:08:49,295 --> 00:08:50,296
ragged; it ran me ragged, and
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looking back on it,
I don't really think I
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00:08:55,668 --> 00:08:58,905
took any time for myself
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00:08:58,905 --> 00:09:00,907
to process any of it.
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00:09:00,907 --> 00:09:02,041
And in
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00:09:03,776 --> 00:09:06,546
early January of 2006, my mother died.
226
00:09:06,546 --> 00:09:09,282
And then five months after that, exactly,
227
00:09:09,282 --> 00:09:10,516
my best friend died.
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00:09:10,516 --> 00:09:13,119
So, I lost the two most important
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00:09:13,119 --> 00:09:15,621
women in my life in the span of five
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00:09:15,621 --> 00:09:16,856
months.
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00:09:16,856 --> 00:09:18,991
And then what began to happen
in your personal
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00:09:18,991 --> 00:09:20,793
life after that?
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00:09:20,793 --> 00:09:23,796
Yeah. So, things very slowly
234
00:09:23,796 --> 00:09:25,798
started to unravel.
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00:09:25,798 --> 00:09:28,634
I think being a physician
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and trying to, and
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not just being a physician, being an
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Indigenous physician and
having leadership
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00:09:34,640 --> 00:09:37,009
roles and things like that,
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my major response to that
241
00:09:40,446 --> 00:09:42,682
whole year that I had been through
and all the
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00:09:42,682 --> 00:09:45,117
grieving and the loss was
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00:09:45,117 --> 00:09:47,753
just to work harder,
to just throw myself
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00:09:47,753 --> 00:09:50,156
into my work, and numb my
245
00:09:50,156 --> 00:09:52,792
feelings and just pretend
246
00:09:52,792 --> 00:09:55,294
as if it was all okay.
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00:09:55,294 --> 00:09:57,630
And of course, then as a
248
00:09:57,630 --> 00:09:59,932
psychiatrist, you also think,
"Well, I'm
249
00:09:59,932 --> 00:10:01,867
really going through something
right now, and
250
00:10:01,867 --> 00:10:04,170
I'll be able to figure it out
myself."
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00:10:04,170 --> 00:10:06,606
That sort of notion
252
00:10:06,606 --> 00:10:08,975
that when we as
253
00:10:08,975 --> 00:10:11,510
physicians but also as human beings
254
00:10:11,510 --> 00:10:13,980
feel capable of reaching
255
00:10:13,980 --> 00:10:16,315
out for help, that culture didn't
256
00:10:16,315 --> 00:10:18,017
really exist back then.
257
00:10:18,017 --> 00:10:19,719
That was quite a while ago.
258
00:10:20,853 --> 00:10:23,456
And so I suffered along
259
00:10:23,456 --> 00:10:25,791
for a long period of time.
260
00:10:25,791 --> 00:10:28,728
And I think I developed a
261
00:10:28,728 --> 00:10:31,197
pretty severe depression looking back on
262
00:10:31,197 --> 00:10:32,365
it. And
263
00:10:33,666 --> 00:10:36,235
my major way of coping with that was to
264
00:10:36,235 --> 00:10:38,170
start drinking more.
265
00:10:39,605 --> 00:10:41,641
I would say I was always a social drinker
266
00:10:42,708 --> 00:10:45,478
throughout my life,
but it wasn't problematic
267
00:10:45,478 --> 00:10:47,246
in the sense that it
didn't interfere with my
268
00:10:47,246 --> 00:10:49,382
life in any way or impair me.
269
00:10:51,717 --> 00:10:54,053
But because I started working harder...
270
00:10:55,254 --> 00:10:57,590
It's interesting because a lot of my work
271
00:10:57,623 --> 00:10:59,925
involves travel, and I think
272
00:10:59,925 --> 00:11:01,827
for a lot of physicians,
this is the case.
273
00:11:01,827 --> 00:11:04,563
We travel a lot,
274
00:11:04,563 --> 00:11:07,333
and it's really easy
275
00:11:07,333 --> 00:11:09,802
to drink when you travel because
276
00:11:09,802 --> 00:11:11,771
you can have a glass of wine
when you get to
277
00:11:11,771 --> 00:11:13,472
the airport and you have
a glass of wine on
278
00:11:13,472 --> 00:11:15,875
the plane, and then you get
to your hotel
279
00:11:15,875 --> 00:11:17,777
room, and oftentimes
people would leave me
280
00:11:17,777 --> 00:11:20,179
these gift baskets that had cookies and
281
00:11:20,179 --> 00:11:21,614
chocolate and a bottle of wine.
282
00:11:21,614 --> 00:11:24,050
Well, I'd help myself to that.
283
00:11:24,050 --> 00:11:26,952
And my major
284
00:11:26,952 --> 00:11:29,021
thinking at the time was
285
00:11:30,523 --> 00:11:32,491
I had terrible insomnia.
286
00:11:32,491 --> 00:11:34,894
That's actually the symptom that bothered
287
00:11:34,894 --> 00:11:37,363
me the most. And so the drinking
288
00:11:37,363 --> 00:11:39,765
at the time, even though I would
289
00:11:39,765 --> 00:11:42,501
advise patients not to do this,
290
00:11:42,501 --> 00:11:44,904
but for some reason
ourselves as physicians,
291
00:11:44,904 --> 00:11:46,172
we don't see that.
292
00:11:46,172 --> 00:11:48,207
We don't take that advice.
293
00:11:48,207 --> 00:11:50,509
So I started using wine to be able
294
00:11:50,509 --> 00:11:51,544
to sleep.
295
00:11:51,544 --> 00:11:54,313
And then before I knew it, it just
296
00:11:54,313 --> 00:11:55,881
got worse and worse and worse.
297
00:11:55,881 --> 00:11:58,184
And I was waking up,
hung over every morning
298
00:11:58,184 --> 00:11:59,385
and still going to work
299
00:12:00,553 --> 00:12:02,855
but definitely not feeling at my
300
00:12:02,855 --> 00:12:05,458
best and probably not being
301
00:12:05,458 --> 00:12:07,993
my best and just looking
302
00:12:07,993 --> 00:12:09,829
forward to getting home
from work so that I
303
00:12:09,829 --> 00:12:12,131
could crack open a bottle of wine
304
00:12:12,131 --> 00:12:13,833
and start drinking.
305
00:12:15,801 --> 00:12:18,370
And Nel for you, what was
306
00:12:18,370 --> 00:12:20,873
the tipping point that prompted
307
00:12:20,873 --> 00:12:23,509
you to seek support or
308
00:12:23,509 --> 00:12:25,878
disclose how difficult things
309
00:12:25,878 --> 00:12:26,979
had become in your life?
310
00:12:28,314 --> 00:12:30,649
I think one of the reasons why
311
00:12:30,649 --> 00:12:32,952
I speak so openly about this is
312
00:12:32,952 --> 00:12:35,421
because I really want other
313
00:12:35,421 --> 00:12:38,891
physicians in this case to be aware
314
00:12:38,891 --> 00:12:39,892
that this is one
315
00:12:43,496 --> 00:12:45,998
trap that we can fall into.
316
00:12:45,998 --> 00:12:48,701
And I want people to know that
317
00:12:48,701 --> 00:12:51,370
if you're struggling or
if you're suffering,
318
00:12:51,370 --> 00:12:53,806
that there is help and that things
319
00:12:53,806 --> 00:12:55,207
do get better.
320
00:12:55,207 --> 00:12:57,810
But at that time, I think for myself,
321
00:12:57,810 --> 00:13:00,179
there came a time when I just wasn't able
322
00:13:00,179 --> 00:13:02,047
to work anymore.
323
00:13:02,047 --> 00:13:05,017
I went off on a medical leave,
324
00:13:05,017 --> 00:13:07,052
which actually only
made things worse, because
325
00:13:07,052 --> 00:13:08,921
then I didn't have to keep myself sorted
326
00:13:08,921 --> 00:13:10,990
during the day.
I could just do whatever I
327
00:13:10,990 --> 00:13:11,991
wanted.
328
00:13:14,026 --> 00:13:16,762
And I can't describe,
329
00:13:16,762 --> 00:13:18,831
because I will describe later
what it feels
330
00:13:18,831 --> 00:13:21,433
like to be in recovery,
but to be that sick
331
00:13:21,433 --> 00:13:23,803
and depressed and drinking heavily
332
00:13:23,803 --> 00:13:24,804
and
333
00:13:26,305 --> 00:13:28,140
then as an Indigenous person,
as a First Nations
334
00:13:28,140 --> 00:13:30,576
woman, I just became
335
00:13:30,576 --> 00:13:31,577
embedded,
336
00:13:34,413 --> 00:13:37,316
I think, in a web of shame
337
00:13:37,316 --> 00:13:40,386
and guilt and despair
338
00:13:40,386 --> 00:13:41,921
and hopelessness.
339
00:13:41,921 --> 00:13:44,323
And I wouldn't
340
00:13:44,323 --> 00:13:46,759
say I was suicidal, but I realised
341
00:13:46,759 --> 00:13:49,562
because I have some medical knowledge that
342
00:13:49,562 --> 00:13:52,298
this was very harmful to me.
343
00:13:52,298 --> 00:13:54,366
And I thought,
"Well, I guess this is just how
344
00:13:54,366 --> 00:13:56,235
it's all going to play out.
345
00:13:56,235 --> 00:13:58,137
I'm just going to drink myself,
and eventually
346
00:13:58,137 --> 00:14:00,873
I'll get some terrible
complication, and
347
00:14:00,873 --> 00:14:04,210
that'll be it." And I didn't have
348
00:14:04,210 --> 00:14:06,579
the cognitive ability at that time
349
00:14:06,579 --> 00:14:08,948
while I was sick to realise
350
00:14:08,948 --> 00:14:10,115
that there was a way out.
351
00:14:11,217 --> 00:14:14,153
I was just stuck in my
352
00:14:14,153 --> 00:14:15,821
illness and in my shame.
353
00:14:15,821 --> 00:14:17,790
And I think that's an
important point that
354
00:14:17,790 --> 00:14:20,125
people don't really remember;
355
00:14:20,125 --> 00:14:21,760
that sort of, "Well,
why don't they go out and
356
00:14:21,760 --> 00:14:24,330
seek help?" Well, I didn't go out and seek
357
00:14:24,330 --> 00:14:27,900
help because first of all,
I was too ashamed
358
00:14:27,900 --> 00:14:30,669
to come forward. But I literally
359
00:14:30,669 --> 00:14:33,205
couldn't imagine things
360
00:14:33,205 --> 00:14:35,641
being better. I just was living
361
00:14:35,641 --> 00:14:37,443
with the status quo.
362
00:14:37,443 --> 00:14:39,845
And because my despair
363
00:14:39,845 --> 00:14:42,481
was so severe, I was pretty
364
00:14:42,481 --> 00:14:44,350
complacent. I just thought,
"I'm just going to
365
00:14:44,350 --> 00:14:47,419
let happen to me what's going to happen."
366
00:14:47,419 --> 00:14:49,755
So, I think that's important
for people to
367
00:14:49,755 --> 00:14:51,891
know or family members or
friends of people
368
00:14:51,891 --> 00:14:54,660
who are sick and using substances that
369
00:14:54,660 --> 00:14:56,962
they can't just snap out of it
because their
370
00:14:56,962 --> 00:14:59,531
brain, my brain, literally was sick.
371
00:15:01,400 --> 00:15:03,702
Well, you remind me of something
372
00:15:03,702 --> 00:15:06,038
that I think also applies
in a more general
373
00:15:06,038 --> 00:15:08,374
sense any time a physician or
374
00:15:08,374 --> 00:15:10,709
a health care worker is suffering
375
00:15:10,743 --> 00:15:13,312
with a significant illness, and
376
00:15:13,312 --> 00:15:15,714
we have this feeling that we should
377
00:15:15,714 --> 00:15:16,749
we know what to do.
378
00:15:16,749 --> 00:15:18,317
As you were saying earlier,
we know how to
379
00:15:18,317 --> 00:15:21,120
tell a patient to manage things,
but that's
380
00:15:21,153 --> 00:15:22,922
in the setting of our healthy brain.
381
00:15:22,922 --> 00:15:25,090
So that's at a moment when
our brain is not
382
00:15:25,090 --> 00:15:27,893
bathed in, whatever inflammatory
383
00:15:27,893 --> 00:15:30,596
process is going on or the neurochemical
384
00:15:30,596 --> 00:15:33,499
alterations that
are part of experiencing
385
00:15:33,499 --> 00:15:34,867
addiction. And I think
it's one of the
386
00:15:34,867 --> 00:15:37,770
cognitive traps that perhaps
387
00:15:37,770 --> 00:15:39,972
physicians often fall into seeking help.
388
00:15:39,972 --> 00:15:42,308
You make the
389
00:15:42,308 --> 00:15:44,143
assumption, and people around
you maybe make
390
00:15:44,143 --> 00:15:45,744
the assumption, that
you're making decisions
391
00:15:45,744 --> 00:15:47,913
with your normal,
your usual brain, your
392
00:15:47,913 --> 00:15:50,849
day-to-day pre-illness brain,
and that is
393
00:15:50,849 --> 00:15:53,419
really not correct at all,
as you say.
394
00:15:53,419 --> 00:15:56,055
I think the other thing that happens
395
00:15:56,055 --> 00:15:58,657
to physicians who are in difficulty
396
00:15:58,657 --> 00:16:00,993
with substance use is that point you
397
00:16:00,993 --> 00:16:03,362
made about we think
398
00:16:03,362 --> 00:16:06,732
that we'll be able to fix ourselves
399
00:16:06,732 --> 00:16:09,034
because it's not that
I didn't have medical
400
00:16:09,034 --> 00:16:10,235
support.
401
00:16:10,235 --> 00:16:13,372
I had a psychiatrist that I was seeing who
402
00:16:13,372 --> 00:16:15,541
was trying so hard to be helpful for me.
403
00:16:15,541 --> 00:16:18,310
And I really feel badly because
404
00:16:18,310 --> 00:16:20,379
I was not an easy patient.
405
00:16:20,379 --> 00:16:21,947
I know they say doctors make terrible
406
00:16:21,947 --> 00:16:23,882
patients, but I literally was not an easy
407
00:16:23,882 --> 00:16:26,218
patient. So I think of her
408
00:16:26,218 --> 00:16:28,620
with gratitude all the time,
409
00:16:28,620 --> 00:16:30,823
but I really thought that
I could manage this
410
00:16:30,823 --> 00:16:31,824
all on my own,
411
00:16:33,692 --> 00:16:36,261
and so when you asked about what brought
412
00:16:36,261 --> 00:16:38,731
you to the point of seeking help, I have
413
00:16:38,731 --> 00:16:40,532
to honestly say that
it really wasn't me, it
414
00:16:41,867 --> 00:16:43,569
was the people around me.
415
00:16:43,569 --> 00:16:45,437
It was my partner.
416
00:16:45,437 --> 00:16:46,739
It was some friends of mine.
417
00:16:46,739 --> 00:16:47,740
And
418
00:16:49,208 --> 00:16:51,710
I should mention actually that I had been
419
00:16:51,710 --> 00:16:53,645
in and out of recovery.
420
00:16:53,645 --> 00:16:56,015
I first started trying to go
421
00:16:56,015 --> 00:16:58,717
to self mutual
422
00:16:58,717 --> 00:17:01,387
aid groups back in
423
00:17:01,387 --> 00:17:03,889
probably around 2007.
424
00:17:05,324 --> 00:17:08,027
And I didn't actually go to residential
425
00:17:08,027 --> 00:17:10,062
treatment till 2015.
426
00:17:10,062 --> 00:17:12,364
So for eight years, I
427
00:17:12,364 --> 00:17:14,967
was trying to seek help
at different times.
428
00:17:14,967 --> 00:17:16,802
And I had long periods of sobriety.
429
00:17:16,802 --> 00:17:19,171
I had two years at one point, a
430
00:17:19,171 --> 00:17:21,573
year at another point; I probably was
431
00:17:21,573 --> 00:17:23,942
sober more than I was drinking
432
00:17:23,942 --> 00:17:25,811
in eight years,
but when I was drinking,
433
00:17:25,811 --> 00:17:28,781
especially toward the end,
it was really bad.
434
00:17:28,781 --> 00:17:30,749
So, it wasn't really me.
435
00:17:30,749 --> 00:17:33,085
It was the people around me,
people from
436
00:17:33,085 --> 00:17:35,454
my recovery community who...
437
00:17:35,454 --> 00:17:37,589
we see this all the time in recovery.
438
00:17:37,589 --> 00:17:39,725
People relapse,
and they go in and out.
439
00:17:39,725 --> 00:17:40,726
And
440
00:17:42,294 --> 00:17:44,596
so finally, it is
441
00:17:44,596 --> 00:17:46,198
a little bit funny because
I do have a very
442
00:17:46,198 --> 00:17:47,199
black sense of humour.
443
00:17:48,434 --> 00:17:50,736
My partner had been in contact
444
00:17:50,736 --> 00:17:53,772
with the Ontario Physician Health Program,
445
00:17:53,772 --> 00:17:55,741
and they said, "Sure, sure, we can get her
446
00:17:55,741 --> 00:17:57,276
into residential treatment."
I think it was
447
00:17:57,276 --> 00:18:00,546
Wednesday. "We can get her in
on Friday."
448
00:18:00,546 --> 00:18:02,981
And he was so relieved, and he told
449
00:18:02,981 --> 00:18:04,650
me, "They're going to take you
into treatment on
450
00:18:04,683 --> 00:18:07,119
Friday." And I'm like, "I think
451
00:18:07,119 --> 00:18:09,588
I need until Monday." I was just
452
00:18:09,588 --> 00:18:11,824
like, "I'm not quite there yet.
453
00:18:11,824 --> 00:18:13,826
I just need a few more days."
454
00:18:15,060 --> 00:18:17,463
So Nel, you talked about some of
455
00:18:17,463 --> 00:18:19,364
the very reality-based
456
00:18:20,666 --> 00:18:23,502
difficulties that physicians
can experience
457
00:18:23,502 --> 00:18:25,804
when they are seeking support for
458
00:18:25,804 --> 00:18:27,072
addictions.
459
00:18:27,072 --> 00:18:29,041
But I want to ask you about the structural
460
00:18:29,041 --> 00:18:31,176
barriers that exist
as well because sometimes
461
00:18:31,176 --> 00:18:33,512
I think we downplay them, we glorify
462
00:18:33,512 --> 00:18:35,881
seek help, call this number, etc.,
463
00:18:35,881 --> 00:18:38,350
but we don't always talk candidly
464
00:18:38,350 --> 00:18:40,652
about what we need to be doing
465
00:18:40,652 --> 00:18:43,021
better from a structural perspective
when it
466
00:18:43,021 --> 00:18:45,991
comes to physicians accessing
those supports.
467
00:18:45,991 --> 00:18:47,493
And I wondered if you could talk
a little bit
468
00:18:47,493 --> 00:18:50,329
about your experience in that role.
469
00:18:50,329 --> 00:18:52,764
So, I think to start
470
00:18:52,764 --> 00:18:54,533
out I really want to
raise my hands to the
471
00:18:54,533 --> 00:18:56,702
Ontario Physician Health Program
because I
472
00:18:56,702 --> 00:18:59,338
think they have one of the best programs
473
00:18:59,338 --> 00:19:01,707
across the country in any province
474
00:19:01,707 --> 00:19:04,676
or territory.
They really seem to understand
475
00:19:05,978 --> 00:19:08,480
the situations of physicians
476
00:19:08,480 --> 00:19:11,517
who are experiencing
477
00:19:11,517 --> 00:19:13,919
substance use challenges
but also are
478
00:19:13,952 --> 00:19:15,220
so incredibly supportive once
479
00:19:16,855 --> 00:19:19,224
you've made that decision to be in
480
00:19:19,224 --> 00:19:21,860
recovery and be on that healing
481
00:19:21,860 --> 00:19:22,861
journey. So
482
00:19:26,331 --> 00:19:27,799
that part was great.
483
00:19:27,799 --> 00:19:29,501
I had a lot of support.
484
00:19:29,501 --> 00:19:31,770
I had a clinical case coordinator
who I still
485
00:19:31,770 --> 00:19:33,405
keep in touch with.
486
00:19:33,405 --> 00:19:35,841
And Dr. Joy Albuquerque was
487
00:19:35,841 --> 00:19:39,077
the medical director at that time,
and she was
488
00:19:39,077 --> 00:19:41,380
a fierce advocate of
489
00:19:41,380 --> 00:19:43,916
trying to dispel the stigma
490
00:19:43,916 --> 00:19:46,351
around substance use and, frankly,
491
00:19:46,351 --> 00:19:49,588
the discriminatory treatment that people,
492
00:19:49,588 --> 00:19:52,024
including myself, experienced
493
00:19:52,024 --> 00:19:53,592
in trying to return to work.
494
00:19:53,592 --> 00:19:55,928
I think the one thing that employers...
495
00:19:55,928 --> 00:19:58,430
I get that from a College
496
00:19:58,430 --> 00:20:01,266
perspective, we have to be safe, and
497
00:20:01,266 --> 00:20:03,435
patient safety is paramount.
498
00:20:03,435 --> 00:20:05,938
But when you're really doing your best
499
00:20:05,938 --> 00:20:08,340
and you're continuing in
500
00:20:08,340 --> 00:20:11,176
your recovery and you're stable,
501
00:20:11,176 --> 00:20:13,612
being made to feel as if
502
00:20:13,612 --> 00:20:15,914
you're in imminent danger
503
00:20:15,914 --> 00:20:18,217
of creating some situation
that is terrible
504
00:20:20,152 --> 00:20:22,754
is not the best feeling for someone
505
00:20:22,754 --> 00:20:25,123
whose self-esteem is already
506
00:20:25,123 --> 00:20:26,458
so low.
507
00:20:26,458 --> 00:20:27,459
And
508
00:20:29,161 --> 00:20:31,196
so I think one of the things
that we could do
509
00:20:31,196 --> 00:20:33,298
about that is just recognise that
510
00:20:34,399 --> 00:20:36,902
people who are in recovery
511
00:20:36,902 --> 00:20:38,303
and are trying to recover...
512
00:20:38,303 --> 00:20:41,173
My intention
513
00:20:41,173 --> 00:20:42,774
was never to harm anybody else.
514
00:20:42,774 --> 00:20:43,875
I mean, I know I did,
515
00:20:45,277 --> 00:20:47,813
not patients, thankfully, but I hurt
516
00:20:47,813 --> 00:20:49,615
the people around me who love me,
517
00:20:51,283 --> 00:20:53,752
but we never intend to harm anybody
518
00:20:53,752 --> 00:20:54,753
else. Substance
519
00:20:56,088 --> 00:20:58,357
use is such a self-centred illness.
520
00:20:59,591 --> 00:21:01,893
And at any rate, so I think there were
521
00:21:01,893 --> 00:21:04,429
some barriers in me returning to work.
522
00:21:04,429 --> 00:21:06,832
I think people had some
523
00:21:06,832 --> 00:21:09,501
very preconceived
524
00:21:09,501 --> 00:21:11,870
notions, stereotypical notions, of
525
00:21:11,870 --> 00:21:13,572
someone who use substances.
526
00:21:14,573 --> 00:21:17,509
I think workplaces where physicians
527
00:21:17,509 --> 00:21:19,845
work in some ways are still
528
00:21:19,845 --> 00:21:22,481
pretty mired
529
00:21:22,481 --> 00:21:25,684
in stigma and stereotyping
530
00:21:25,684 --> 00:21:27,986
around people who use substances,
531
00:21:27,986 --> 00:21:29,921
and that includes the
health professionals who
532
00:21:29,921 --> 00:21:31,023
work there.
533
00:21:31,023 --> 00:21:33,725
Since I've been in recovery, and I can
534
00:21:33,725 --> 00:21:36,061
proudly say I've been sober
for over eight
535
00:21:36,061 --> 00:21:38,630
years, I've been in
536
00:21:39,798 --> 00:21:42,134
support accountability
537
00:21:42,134 --> 00:21:44,603
groups with other
physicians, nurses,
538
00:21:46,271 --> 00:21:48,006
pharmacists, for example.
539
00:21:48,006 --> 00:21:50,409
And people really are trying their
540
00:21:50,409 --> 00:21:51,443
best.
541
00:21:51,443 --> 00:21:54,179
And so when you return to
your workplace
542
00:21:54,179 --> 00:21:56,648
and people are making assumptions
543
00:21:56,648 --> 00:21:59,184
that at any minute you could
544
00:21:59,184 --> 00:22:01,219
pick up a big jug of vodka and start
545
00:22:01,253 --> 00:22:02,387
chugging...
546
00:22:02,387 --> 00:22:04,756
That wasn't my intention, but
547
00:22:04,756 --> 00:22:07,025
that's how I was made to feel.
548
00:22:07,025 --> 00:22:10,028
And so that
549
00:22:10,028 --> 00:22:12,197
was really hurtful to someone...
550
00:22:12,197 --> 00:22:14,566
When you're in
551
00:22:14,566 --> 00:22:17,169
recovery, you start
552
00:22:17,169 --> 00:22:19,838
climbing back from a pretty low place.
553
00:22:19,838 --> 00:22:22,641
When I first got to residential
554
00:22:22,641 --> 00:22:25,143
treatment, I remember the first few days
555
00:22:27,145 --> 00:22:29,181
I was wandering around with everyone else
556
00:22:29,181 --> 00:22:30,649
going to the groups I was
supposed to be going
557
00:22:30,649 --> 00:22:32,884
to, and this doctor stopped me in the
558
00:22:32,884 --> 00:22:35,287
hallway... he was actually,
I think, the chief
559
00:22:35,287 --> 00:22:36,722
of staff there.
560
00:22:36,722 --> 00:22:37,756
And he said, "You know Nel,
561
00:22:39,891 --> 00:22:41,993
I've seen you since you
got here the last
562
00:22:41,993 --> 00:22:45,230
three days," he said,
"and all you do is
563
00:22:45,230 --> 00:22:46,231
stare at your shoes." And
564
00:22:47,933 --> 00:22:50,302
he said, "Someday you won't
565
00:22:50,302 --> 00:22:51,636
feel like that." And
566
00:22:53,205 --> 00:22:55,640
I still get a little emotional talking
567
00:22:55,640 --> 00:22:56,641
about that because it
568
00:22:58,643 --> 00:23:00,746
was like he had that faith in me
that I didn't
569
00:23:00,746 --> 00:23:02,013
have yet.
570
00:23:02,013 --> 00:23:04,282
And so that's the kind of treatment
571
00:23:06,752 --> 00:23:09,421
I think that people deserve;
572
00:23:09,421 --> 00:23:11,490
they deserve to be treated
with dignity and
573
00:23:11,523 --> 00:23:12,491
with respect
574
00:23:14,159 --> 00:23:16,595
and a hopefulness
575
00:23:16,595 --> 00:23:18,163
instead of "You're
576
00:23:19,598 --> 00:23:22,467
a misbehaving physician; you're
577
00:23:22,467 --> 00:23:24,002
a disruptive physician." Instead
578
00:23:25,003 --> 00:23:27,305
of that approach, being "We're here
579
00:23:27,305 --> 00:23:29,741
walking alongside you." And I think
580
00:23:29,741 --> 00:23:32,377
that would go a long way toward having
581
00:23:32,377 --> 00:23:35,013
physicians feel comfortable
coming forward to
582
00:23:35,013 --> 00:23:36,014
seek help
583
00:23:37,749 --> 00:23:39,684
if they didn't feel as if...
584
00:23:41,353 --> 00:23:43,755
I think physicians, a lot of us build
585
00:23:43,755 --> 00:23:46,158
our whole lives around to a certain
586
00:23:46,158 --> 00:23:48,827
extent, not completely,
but on what we do
587
00:23:48,827 --> 00:23:51,663
and who we are. It's a big part of how
588
00:23:51,663 --> 00:23:52,831
we see ourselves.
589
00:23:52,831 --> 00:23:55,467
So, when that all comes crashing down,
590
00:23:55,467 --> 00:23:58,203
there's not a lot left in some ways.
591
00:23:58,203 --> 00:24:00,672
And of course, then there's that extra
592
00:24:00,672 --> 00:24:01,673
layer of have
593
00:24:03,141 --> 00:24:04,443
I ruined my career?
594
00:24:04,443 --> 00:24:07,112
Am I ever going to be able to get back?
595
00:24:07,112 --> 00:24:09,881
Am I ever going to feel good about myself
596
00:24:09,881 --> 00:24:12,484
again? One of the reasons
597
00:24:12,484 --> 00:24:14,519
I'm agreeing to do this interview
is because
598
00:24:14,553 --> 00:24:16,922
I'm here to tell those physicians
599
00:24:16,922 --> 00:24:19,925
that all of that is possible.
600
00:24:19,925 --> 00:24:22,461
And all you have to do is really take
601
00:24:22,461 --> 00:24:24,596
life a day at a time.
602
00:24:24,596 --> 00:24:27,165
And you'll amaze
603
00:24:27,165 --> 00:24:29,568
yourself by how much better
604
00:24:29,568 --> 00:24:30,602
things get.
605
00:24:30,602 --> 00:24:33,071
I'm at a point in my life where I don't
606
00:24:33,071 --> 00:24:34,840
think I've ever been happier.
607
00:24:34,840 --> 00:24:37,742
I've never functioned more fully
608
00:24:37,742 --> 00:24:39,978
and better in my entire life.
609
00:24:41,079 --> 00:24:43,615
And a great
610
00:24:43,615 --> 00:24:46,551
point to make with a bit of humour
is sober
611
00:24:46,551 --> 00:24:48,820
colleagues are the best colleagues
because we
612
00:24:48,820 --> 00:24:49,888
work hard.
613
00:24:49,888 --> 00:24:51,423
We can always be on call, we're never
614
00:24:52,491 --> 00:24:54,893
hung over, we're always
615
00:24:54,893 --> 00:24:55,861
there.
616
00:24:55,861 --> 00:24:58,830
We become very dependable, reliable
617
00:24:58,830 --> 00:24:59,865
colleagues.
618
00:24:59,865 --> 00:25:01,967
And I think that's a completely
different way
619
00:25:01,967 --> 00:25:04,469
of looking at physicians
620
00:25:04,503 --> 00:25:05,470
in recovery.
621
00:25:06,738 --> 00:25:08,740
That story that you just told about your
622
00:25:08,740 --> 00:25:11,076
colleague gave me a chill, and
623
00:25:11,076 --> 00:25:12,077
it makes me think of this
624
00:25:13,778 --> 00:25:16,181
paradox about us that we can
625
00:25:16,181 --> 00:25:19,317
be so compassionate towards our patients.
626
00:25:19,317 --> 00:25:21,419
And again, as we've talked about,
we're not
627
00:25:21,419 --> 00:25:23,788
always compassionate towards ourselves,
628
00:25:23,788 --> 00:25:26,258
but there is sometimes this phenomenon
629
00:25:26,258 --> 00:25:29,027
where we can just be absolutely horrible
630
00:25:29,027 --> 00:25:31,429
to each other,
particularly horrible to other
631
00:25:31,429 --> 00:25:33,732
physicians who are experiencing illness
632
00:25:33,732 --> 00:25:36,368
and manifesting some form of,
633
00:25:36,368 --> 00:25:38,703
what we perceive or would
634
00:25:38,703 --> 00:25:40,872
superficially call, weakness.
635
00:25:40,872 --> 00:25:43,341
And I wonder, as a psychiatrist,
what do you
636
00:25:43,341 --> 00:25:45,076
make of that? What do you think is behind
637
00:25:45,076 --> 00:25:46,044
that?
638
00:25:46,044 --> 00:25:47,879
So, I think what it
really comes down to when
639
00:25:47,879 --> 00:25:51,116
physicians are unkind
640
00:25:51,116 --> 00:25:53,418
to other physicians who are
in difficulty, I
641
00:25:53,418 --> 00:25:55,820
think really what it comes down to
642
00:25:55,820 --> 00:25:58,356
is there probably
643
00:25:58,356 --> 00:26:00,625
is something in that physician
who's having
644
00:26:00,625 --> 00:26:02,093
trouble that
645
00:26:04,362 --> 00:26:06,031
triggers something within that person.
646
00:26:07,365 --> 00:26:09,668
Because the reality is, and I've
647
00:26:09,668 --> 00:26:11,670
become so comfortable
speaking about being in
648
00:26:11,703 --> 00:26:14,072
recovery now and recovery
649
00:26:14,072 --> 00:26:17,275
makes me be scrupulously
650
00:26:17,275 --> 00:26:19,678
honest about things, is that we
651
00:26:19,678 --> 00:26:20,679
all struggle. All
652
00:26:23,148 --> 00:26:24,783
the way back to the beginning
when I started
653
00:26:24,783 --> 00:26:26,751
this interview, I said,
"Life happened to me,"
654
00:26:26,751 --> 00:26:29,020
and life continues to happen.
655
00:26:29,020 --> 00:26:31,356
Things get turned upside down.
656
00:26:31,356 --> 00:26:33,658
And there have been other losses
since then
657
00:26:33,658 --> 00:26:35,560
and other challenges.
658
00:26:35,560 --> 00:26:37,862
But I think it
659
00:26:37,862 --> 00:26:40,298
makes some physicians
660
00:26:40,298 --> 00:26:42,801
feel afraid that the same thing might
661
00:26:42,801 --> 00:26:44,369
happen to them.
And that might be a very
662
00:26:44,402 --> 00:26:45,370
unconscious thought.
663
00:26:46,538 --> 00:26:49,307
Or just that the whole culture
664
00:26:49,307 --> 00:26:51,710
of medicine is that
we must be strong, we
665
00:26:51,710 --> 00:26:54,112
must be seen to be perfect,
we must
666
00:26:54,112 --> 00:26:56,414
be competent. And seeing the
667
00:26:56,414 --> 00:26:58,750
humanity, actually, in
668
00:26:58,750 --> 00:27:01,820
another person, or even frailty
669
00:27:01,820 --> 00:27:04,489
for a moment, is
670
00:27:04,489 --> 00:27:05,690
unacceptable.
671
00:27:05,690 --> 00:27:08,426
So, we all have this persona
672
00:27:08,426 --> 00:27:10,462
that we have to maintain,
"Oh, I know exactly
673
00:27:10,462 --> 00:27:11,596
what's going on with that patient.
674
00:27:11,596 --> 00:27:12,931
I have the perfect treatment plan.
675
00:27:12,931 --> 00:27:14,899
I'm always competent.
676
00:27:14,899 --> 00:27:17,469
I never make mistakes."
That's the culture
677
00:27:17,469 --> 00:27:19,137
that we created.
678
00:27:19,137 --> 00:27:21,673
And so when someone is struggling,
679
00:27:21,673 --> 00:27:24,142
I think that disrupts that
680
00:27:24,142 --> 00:27:26,444
balance. And it can be distressing,
I think,
681
00:27:26,444 --> 00:27:27,445
for people.
682
00:27:28,246 --> 00:27:29,881
Now, the last thing I want to ask you
has to
683
00:27:29,881 --> 00:27:31,082
do with vulnerability.
684
00:27:31,082 --> 00:27:33,718
And you talked a little bit about putting
685
00:27:33,718 --> 00:27:36,221
an authentic story out there, the power
686
00:27:36,221 --> 00:27:38,757
of that, how that works in service
687
00:27:38,757 --> 00:27:41,259
for our colleagues to help us make
688
00:27:41,259 --> 00:27:43,061
changes to our culture.
689
00:27:43,061 --> 00:27:45,430
But I want to ask you, as a clinical tool,
690
00:27:45,430 --> 00:27:48,266
as something that is
of service to patients
691
00:27:48,266 --> 00:27:50,468
because so often
we have these high boundaries
692
00:27:50,468 --> 00:27:52,871
where people don't know
anything about us
693
00:27:52,871 --> 00:27:55,340
and learners and early career folks think
694
00:27:55,340 --> 00:27:58,243
they can never divulge that humanity, the
695
00:27:58,243 --> 00:28:00,011
fact that we struggle too.
696
00:28:00,011 --> 00:28:02,047
And I just want to end by
talking to you about
697
00:28:02,047 --> 00:28:04,482
what it's been like to have patients
698
00:28:04,482 --> 00:28:07,719
and people in your professional community,
699
00:28:07,752 --> 00:28:10,055
who you may have
clinical relationships with,
700
00:28:10,055 --> 00:28:11,589
know what you've been through.
701
00:28:11,623 --> 00:28:14,192
How does that become something that you
702
00:28:14,192 --> 00:28:17,696
are using for the greater good?
703
00:28:17,696 --> 00:28:19,264
I'm not sure I would say,
"Oh, I'm so glad
704
00:28:19,264 --> 00:28:21,466
that I went through all that." But it
705
00:28:21,466 --> 00:28:24,235
definitely has made a difference
706
00:28:24,235 --> 00:28:26,771
for me in the work that I do, both when
707
00:28:26,771 --> 00:28:28,840
I was working as a clinician
and now as a
708
00:28:28,840 --> 00:28:31,142
physician working in public health.
709
00:28:33,078 --> 00:28:35,714
I have yet to encounter
710
00:28:35,714 --> 00:28:38,917
a negative experience with a patient
711
00:28:38,917 --> 00:28:42,654
if I have even divulged
712
00:28:42,654 --> 00:28:44,989
any information that I'm in recovery.
713
00:28:44,989 --> 00:28:47,425
I know I did it a couple of times
714
00:28:47,425 --> 00:28:50,095
when I worked in the emergency department.
715
00:28:50,095 --> 00:28:52,564
And again, I have to say, as
716
00:28:52,564 --> 00:28:55,066
a First Nations woman, I don't see
717
00:28:55,066 --> 00:28:57,469
divulging some things about ourselves
718
00:28:57,469 --> 00:29:00,672
as a lapse in boundaries if
719
00:29:00,672 --> 00:29:03,074
it's going to serve
720
00:29:03,074 --> 00:29:05,477
the patient and make it a safer
721
00:29:05,477 --> 00:29:07,212
experience for them.
722
00:29:07,212 --> 00:29:09,581
And I'm so fortunate now
in my role at First
723
00:29:09,581 --> 00:29:11,649
Nations Health Authority
where I get to be
724
00:29:11,683 --> 00:29:14,085
open and honest and be
725
00:29:14,085 --> 00:29:15,920
my authentic self.
726
00:29:15,920 --> 00:29:18,957
I do a lot of public health messaging.
727
00:29:18,957 --> 00:29:21,593
I do a lot of public speaking
728
00:29:21,593 --> 00:29:24,129
across BC with our
729
00:29:24,129 --> 00:29:26,564
different regions and our Chiefs and our
730
00:29:26,564 --> 00:29:27,599
health leaders.
731
00:29:27,599 --> 00:29:31,202
I almost always mention that
I'm in recovery
732
00:29:31,202 --> 00:29:33,638
because I think what it shows people
733
00:29:33,638 --> 00:29:35,740
is that...
734
00:29:35,740 --> 00:29:38,109
It's just a way to destigmatize.
735
00:29:38,143 --> 00:29:40,512
And to
736
00:29:40,512 --> 00:29:43,348
have people say, well,
this is no different
737
00:29:43,348 --> 00:29:46,017
than someone who experiences
738
00:29:46,017 --> 00:29:48,720
a different kind of chronic illness.
739
00:29:48,720 --> 00:29:51,055
We do
740
00:29:51,055 --> 00:29:53,158
a lot of public health campaigns
where I work,
741
00:29:53,158 --> 00:29:55,527
and we have the Sober
742
00:29:55,527 --> 00:29:57,962
for October campaign where we ask people
743
00:29:57,962 --> 00:30:00,398
to either think about, reduce, or
744
00:30:00,398 --> 00:30:02,267
limit their drinking of alcohol during the
745
00:30:02,267 --> 00:30:04,869
month of October.
And it's the only challenge
746
00:30:04,903 --> 00:30:07,305
I ace, and
747
00:30:07,305 --> 00:30:09,774
I get to do a lot of messaging that
748
00:30:09,774 --> 00:30:12,310
month and make it seem
749
00:30:12,310 --> 00:30:14,612
to people that actually being in
750
00:30:14,612 --> 00:30:17,315
recovery is a good thing.
751
00:30:17,315 --> 00:30:19,651
And with the recent release
752
00:30:19,651 --> 00:30:21,953
of the Canadian safe drinking guidelines,
753
00:30:21,953 --> 00:30:23,521
I think anybody
754
00:30:24,756 --> 00:30:27,125
can do a rethink of where
they're at in terms
755
00:30:27,125 --> 00:30:29,561
of their alcohol use and do
756
00:30:29,561 --> 00:30:32,263
some re-evaluating and just try to
757
00:30:32,263 --> 00:30:34,732
be as safe as possible.
758
00:30:34,732 --> 00:30:37,302
And honestly, I can't
759
00:30:37,302 --> 00:30:40,171
describe to you how good it feels to be
760
00:30:40,171 --> 00:30:41,172
who I am now. I
761
00:30:43,141 --> 00:30:45,910
don't define myself by my alcoholism; it's
762
00:30:45,910 --> 00:30:46,945
a part of who I am.
763
00:30:46,945 --> 00:30:49,314
It's not the whole part.
764
00:30:49,314 --> 00:30:51,850
But the best
765
00:30:51,850 --> 00:30:54,152
thing is every single morning I wake up,
766
00:30:54,152 --> 00:30:56,654
and I feel clear and
767
00:30:56,654 --> 00:30:58,990
I feel able to take on the day,
768
00:30:58,990 --> 00:31:01,359
and I have the tools that
769
00:31:01,359 --> 00:31:03,761
I need to take
770
00:31:03,761 --> 00:31:06,564
on both the work, my demanding job,
771
00:31:06,564 --> 00:31:09,400
and the demands of my life.
772
00:31:09,400 --> 00:31:11,936
And I would wish that for everybody, and
773
00:31:11,936 --> 00:31:14,839
for physicians especially, who might
774
00:31:14,839 --> 00:31:17,075
have the chance of seeing this.
775
00:31:17,075 --> 00:31:19,410
If you're in any doubt at all, if you're
776
00:31:19,410 --> 00:31:22,046
struggling, I would really encourage
777
00:31:22,046 --> 00:31:24,249
you to seek help with the physician health
778
00:31:24,249 --> 00:31:27,652
program in your province or territory and
779
00:31:27,652 --> 00:31:28,720
start that journey.
780
00:31:28,720 --> 00:31:31,055
And whether it stops and starts like I did
781
00:31:31,055 --> 00:31:34,025
for eight years, whether it continues
782
00:31:34,025 --> 00:31:36,427
solidly like I have for the last eight
783
00:31:36,427 --> 00:31:37,428
years, it's
784
00:31:39,364 --> 00:31:41,699
not going to be something that
you'll regret.
785
00:31:43,601 --> 00:31:46,471
Well Nel, it is just
786
00:31:46,471 --> 00:31:48,606
a privilege to have this conversation
with you
787
00:31:48,606 --> 00:31:50,942
this morning. I feel both in
788
00:31:50,942 --> 00:31:53,244
awe of the work that you're
doing but also
789
00:31:53,244 --> 00:31:55,847
just so grateful for it and
790
00:31:55,847 --> 00:31:58,416
so proud to be a fellow
McMaster graduate with
791
00:31:58,416 --> 00:31:59,350
you as well.
792
00:31:59,350 --> 00:32:01,019
Thank you.
793
00:32:01,019 --> 00:32:02,453
It was a pleasure to be here.
794
00:32:02,453 --> 00:32:03,421
Thank you.
00:00:14,881 --> 00:00:16,850
Nel, it's so wonderful to be here
with you today.
2
00:00:16,883 --> 00:00:18,651
Thank you so much for making the time
3
00:00:18,651 --> 00:00:19,352
to talk to me.
4
00:00:19,352 --> 00:00:20,487
Well, thanks for having me.
5
00:00:20,487 --> 00:00:21,921
It's great to be here.
6
00:00:21,921 --> 00:00:24,290
So, I want to start this morning by
7
00:00:24,290 --> 00:00:25,525
going back in time.
8
00:00:25,525 --> 00:00:27,660
And I want to go back
to the first time that
9
00:00:27,660 --> 00:00:30,730
you and I met, which was around,
I think, 1998
10
00:00:30,730 --> 00:00:32,665
or 1999.
11
00:00:32,665 --> 00:00:35,101
I was a medical student at
McMaster, and
12
00:00:35,101 --> 00:00:37,504
you were the chief resident in
13
00:00:37,504 --> 00:00:39,372
psychiatry, Chief Nel Wieman.
14
00:00:40,373 --> 00:00:43,143
And I want to start there with
15
00:00:43,143 --> 00:00:45,578
who you were at that point,
the weight
16
00:00:45,578 --> 00:00:48,048
that you carried and what
17
00:00:48,048 --> 00:00:50,550
the expectations for your career were
18
00:00:50,550 --> 00:00:51,484
back then.
19
00:00:51,484 --> 00:00:52,952
Thanks.
20
00:00:52,952 --> 00:00:54,754
Yeah, that seems like
such a long time ago.
21
00:00:56,489 --> 00:00:58,158
I think at that point
22
00:01:00,493 --> 00:01:02,662
there was another
Indigenous psychiatrist who
23
00:01:02,662 --> 00:01:05,365
came before me.
His name was Dr. Clare Brant,
24
00:01:05,365 --> 00:01:07,867
and I always acknowledge him because
25
00:01:07,867 --> 00:01:10,336
he was the first, but he
26
00:01:10,336 --> 00:01:12,705
died unfortunately when I was in
27
00:01:12,705 --> 00:01:14,808
the second year of my residency.
28
00:01:14,808 --> 00:01:17,811
And so then I became the only
29
00:01:17,811 --> 00:01:20,146
Indigenous psychiatrist
in the country and
30
00:01:20,146 --> 00:01:23,550
the first female to
train as a psychiatrist.
31
00:01:23,550 --> 00:01:26,119
And so at that time,
32
00:01:26,119 --> 00:01:29,322
I almost
33
00:01:29,322 --> 00:01:30,690
in a way had two careers, right?
34
00:01:30,690 --> 00:01:33,226
I was working
35
00:01:33,226 --> 00:01:35,728
in the medical system, working
36
00:01:35,728 --> 00:01:38,031
as a chief resident and
37
00:01:38,031 --> 00:01:40,800
all the duties and
responsibilities that came
38
00:01:40,800 --> 00:01:41,935
with that.
39
00:01:41,935 --> 00:01:44,270
And then at the same time,
I was starting to
40
00:01:44,270 --> 00:01:45,538
build this career as someone
41
00:01:48,608 --> 00:01:51,177
who could speak up on behalf of
42
00:01:51,177 --> 00:01:53,713
First Nations people and
advocate for
43
00:01:53,713 --> 00:01:56,950
improved mental health and
health overall.
44
00:01:56,950 --> 00:01:58,751
So, I do remember that time.
45
00:01:58,751 --> 00:02:01,254
I felt a lot of responsibility.
46
00:02:01,254 --> 00:02:02,989
I think one of the things
that I just as a
47
00:02:02,989 --> 00:02:04,257
bystander remember too.
48
00:02:04,257 --> 00:02:06,459
I mean, there was
media coverage about you.
49
00:02:06,493 --> 00:02:08,294
There was a big article
in the newspaper about
50
00:02:08,294 --> 00:02:11,197
you, sort of carrying this mantle
51
00:02:11,197 --> 00:02:12,265
and this weight.
52
00:02:12,265 --> 00:02:15,368
And I wonder even then, looking back,
53
00:02:15,368 --> 00:02:17,137
what do you think was the impact of that
54
00:02:17,137 --> 00:02:18,138
weight at that time?
55
00:02:19,239 --> 00:02:21,908
I think for myself,
I do remember one article
56
00:02:21,908 --> 00:02:24,277
that came out around that time, and I
57
00:02:24,277 --> 00:02:26,880
remember somebody wrote,
I think it was in
58
00:02:26,880 --> 00:02:29,382
the Canadian Journal of Psychiatry.
59
00:02:29,382 --> 00:02:31,918
And then the next month,
there was a letter
60
00:02:31,918 --> 00:02:34,120
to the editor, something about,
"Well, she
61
00:02:34,120 --> 00:02:36,222
seems like a really nice person,
but she's
62
00:02:36,222 --> 00:02:37,690
never going to accomplish that.
63
00:02:37,690 --> 00:02:39,792
It's just there's too many problems.
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00:02:39,792 --> 00:02:41,861
The problems are too big."
And I remember
65
00:02:41,861 --> 00:02:44,330
reading that, and then
66
00:02:44,330 --> 00:02:46,833
I thought, my whole career
has been based
67
00:02:46,833 --> 00:02:49,169
on people telling me that I can't do
68
00:02:49,169 --> 00:02:51,070
something or that I'm
not good enough to do
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00:02:51,070 --> 00:02:52,272
something. And so
70
00:02:54,340 --> 00:02:56,910
why would I remember
that particular letter
71
00:02:56,910 --> 00:02:58,278
30 years later?
72
00:02:59,345 --> 00:03:02,849
So, I guess I just used it
more as motivation.
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00:03:02,849 --> 00:03:04,751
But for sure,
there was a huge challenge.
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00:03:04,751 --> 00:03:07,220
I think probably the biggest tension
75
00:03:07,220 --> 00:03:09,589
for me was still being early in my
76
00:03:09,589 --> 00:03:12,292
training, early in my experience,
77
00:03:12,292 --> 00:03:14,594
and yet being called upon to be the
78
00:03:14,594 --> 00:03:16,930
expert in Indigenous mental
79
00:03:16,963 --> 00:03:18,231
health.
80
00:03:18,231 --> 00:03:20,700
We're going to talk
in a minute about a
81
00:03:20,700 --> 00:03:23,102
sequence of really
difficult events that
82
00:03:23,102 --> 00:03:24,837
occurred in your life.
83
00:03:24,837 --> 00:03:27,907
But between you finishing your
84
00:03:27,907 --> 00:03:30,510
residency and that
85
00:03:30,510 --> 00:03:32,812
period of your life,
could you just
86
00:03:32,812 --> 00:03:34,714
fill in some of the
blanks professionally in
87
00:03:34,714 --> 00:03:37,083
terms of what kind of work
you ended up
88
00:03:37,083 --> 00:03:39,953
doing and where you
professionally found
89
00:03:39,953 --> 00:03:41,054
your home?
90
00:03:42,121 --> 00:03:44,624
When I first graduated from
91
00:03:44,624 --> 00:03:47,060
my specialty training, I had the
92
00:03:47,060 --> 00:03:50,163
opportunity, even during
my residency, to
93
00:03:50,163 --> 00:03:52,832
be part of a group that was creating
94
00:03:52,832 --> 00:03:55,168
a mental health service on
Six Nations of the
95
00:03:55,168 --> 00:03:57,237
Grand River territory,
which is just outside
96
00:03:57,237 --> 00:03:58,504
of Hamilton.
97
00:03:58,504 --> 00:04:00,873
And, now
98
00:04:00,873 --> 00:04:03,409
when I look back on it,
we were doing
99
00:04:03,409 --> 00:04:05,745
culturally safe things before it was
100
00:04:05,745 --> 00:04:06,879
even called that.
101
00:04:06,879 --> 00:04:09,182
I think the term cultural safety
was coined in
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00:04:09,182 --> 00:04:11,551
1998 or something in New Zealand,
103
00:04:11,551 --> 00:04:13,620
but of course, we didn't know
about it at the
104
00:04:13,653 --> 00:04:16,089
time. So the first eight years of my
105
00:04:16,089 --> 00:04:18,791
career, I worked mostly
106
00:04:18,791 --> 00:04:21,661
at this community-based
mental health clinic
107
00:04:21,661 --> 00:04:23,997
on reserve, working exclusively
108
00:04:23,997 --> 00:04:25,632
with First Nations people.
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00:04:25,632 --> 00:04:28,501
And then, I did a
little bit of time,
110
00:04:28,501 --> 00:04:31,271
some shifts in the regional emergency
111
00:04:31,271 --> 00:04:33,539
psychiatry department
because I really loved
112
00:04:33,539 --> 00:04:35,308
emergency psychiatry.
113
00:04:35,341 --> 00:04:37,443
And then after that, it
114
00:04:38,511 --> 00:04:40,413
was really difficult
working on reserve, I
115
00:04:40,413 --> 00:04:41,414
have to say.
116
00:04:42,782 --> 00:04:44,851
There was one psychiatrist
that I managed to
117
00:04:44,851 --> 00:04:47,387
cajole to come and work a day a month
118
00:04:47,387 --> 00:04:49,756
or something and see the
young children and
119
00:04:49,756 --> 00:04:51,324
the young adolescents.
120
00:04:51,324 --> 00:04:53,559
But primarily, I was
the only psychiatrist
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00:04:53,559 --> 00:04:55,328
working in the community at the time.
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00:04:55,328 --> 00:04:57,897
And so over those eight
123
00:04:57,897 --> 00:05:00,199
years, I had
124
00:05:00,199 --> 00:05:02,502
become the keeper of people's
125
00:05:02,502 --> 00:05:04,837
secrets and the holder of
126
00:05:04,837 --> 00:05:06,205
all of those stories.
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00:05:06,205 --> 00:05:08,574
And there were different traumatic
128
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events that happened
in the community: a
129
00:05:11,077 --> 00:05:13,379
really tragic death of a toddler
130
00:05:14,514 --> 00:05:15,982
and all sorts of other things.
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00:05:15,982 --> 00:05:18,484
And so after eight years, I found
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myself feeling pretty,
133
00:05:20,953 --> 00:05:22,989
I wouldn't say burnt out,
but probably pretty
134
00:05:22,989 --> 00:05:24,057
close to burnt out.
135
00:05:24,057 --> 00:05:26,893
And so I accepted an opportunity
136
00:05:26,893 --> 00:05:29,429
to move to downtown Toronto,
137
00:05:29,429 --> 00:05:31,998
and I switched and started
138
00:05:31,998 --> 00:05:34,500
working in the what is now the Dalla
139
00:05:34,500 --> 00:05:36,803
Lana School of Public Health in sort
140
00:05:36,803 --> 00:05:39,205
of a research-teaching capacity.
141
00:05:39,205 --> 00:05:41,841
And I co-directed a research program
142
00:05:41,841 --> 00:05:44,510
that was intended to build
143
00:05:44,510 --> 00:05:47,013
capacity for Indigenous students to
144
00:05:47,013 --> 00:05:49,349
get engaged in health research.
145
00:05:49,349 --> 00:05:51,417
And I did a little bit of
clinical work at the
146
00:05:51,417 --> 00:05:53,386
time, mainly with
147
00:05:54,754 --> 00:05:55,988
Indigenous.
148
00:05:55,988 --> 00:05:58,057
I worked with an Indigenous HIV/AIDS
149
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organisation and a
150
00:06:00,460 --> 00:06:01,594
program for the homeless.
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00:06:01,594 --> 00:06:04,197
So, I've always been drawn to working
152
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with populations who are in situations
153
00:06:06,666 --> 00:06:08,501
of vulnerability.
154
00:06:08,501 --> 00:06:10,470
And I did that, I think, for about seven
155
00:06:10,470 --> 00:06:12,972
years, and then I
156
00:06:12,972 --> 00:06:15,241
took a job working as...
157
00:06:16,309 --> 00:06:18,077
It wasn't called an assertive community
158
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treatment team, but that's
how we functioned.
159
00:06:20,747 --> 00:06:23,683
I worked for YWCA Toronto
160
00:06:23,683 --> 00:06:26,285
on our mental health team, providing
161
00:06:26,285 --> 00:06:28,821
support to 100 women living with
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00:06:28,821 --> 00:06:31,224
serious mental health and addictions
163
00:06:31,224 --> 00:06:32,525
issues.
164
00:06:32,525 --> 00:06:35,161
And then lastly, I decided
165
00:06:35,161 --> 00:06:36,763
that I need a little more structure than
166
00:06:38,030 --> 00:06:40,633
the situation I was working in
at the Elm centre,
167
00:06:40,633 --> 00:06:43,069
and I accepted
168
00:06:43,069 --> 00:06:45,371
a position working at the Centre for
169
00:06:45,371 --> 00:06:47,340
Addictions and Mental Health in downtown
170
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Toronto.
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00:06:48,741 --> 00:06:51,577
So Nel, in 2005,
172
00:06:51,577 --> 00:06:53,980
a few really difficult things
173
00:06:53,980 --> 00:06:56,449
happened in your life, and they
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had a series of impacts
175
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that you experienced afterwards.
176
00:07:01,587 --> 00:07:03,823
And I wondered if you could talk
for a moment
177
00:07:03,823 --> 00:07:06,225
about what went on starting
178
00:07:06,225 --> 00:07:08,694
in 2005 and the aftermath.
179
00:07:09,829 --> 00:07:12,865
Even for us as physicians,
life happens,
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00:07:12,865 --> 00:07:15,301
and things got really
181
00:07:15,301 --> 00:07:17,670
challenging for me, I think, because so
182
00:07:17,670 --> 00:07:19,972
many things happened all at once.
183
00:07:19,972 --> 00:07:22,942
As I mentioned, I accepted a position
184
00:07:22,942 --> 00:07:25,244
in downtown Toronto,
so that involved leaving
185
00:07:25,244 --> 00:07:26,245
my home and
186
00:07:27,980 --> 00:07:30,650
moving to downtown Toronto,
187
00:07:30,650 --> 00:07:32,685
which is very different setting.
188
00:07:32,685 --> 00:07:35,721
My marriage ended, and
189
00:07:35,721 --> 00:07:38,257
around the same time, my mother,
190
00:07:38,257 --> 00:07:40,893
who was elderly; she was 85
191
00:07:40,893 --> 00:07:43,329
at the time. She essentially
192
00:07:43,329 --> 00:07:45,298
went into hospital for the
last time and was
193
00:07:45,298 --> 00:07:47,700
hospitalised for about a year
of her life.
194
00:07:47,700 --> 00:07:50,036
And I was the primary caregiver for
195
00:07:50,036 --> 00:07:52,371
the family because my father had already
196
00:07:52,371 --> 00:07:54,140
passed away.
197
00:07:54,140 --> 00:07:56,742
And then at the very same time, my best
198
00:07:56,742 --> 00:07:58,678
friend, who had been my
best friend since we
199
00:07:58,678 --> 00:07:59,979
were four years old,
200
00:08:01,347 --> 00:08:03,783
was diagnosed with cancer while she was
201
00:08:03,783 --> 00:08:06,085
12 weeks pregnant with twins.
202
00:08:06,085 --> 00:08:08,521
And so she made the very
203
00:08:08,521 --> 00:08:11,157
difficult decision to
delay her own treatment
204
00:08:11,157 --> 00:08:13,493
so that she really wanted to
205
00:08:13,493 --> 00:08:15,728
deliver two babies that were healthy.
206
00:08:16,762 --> 00:08:19,065
And so she essentially sacrificed
207
00:08:19,065 --> 00:08:20,366
herself.
208
00:08:20,366 --> 00:08:22,835
It turned out that
209
00:08:22,835 --> 00:08:25,438
she was at Mount Sinai Hospital,
210
00:08:25,438 --> 00:08:26,873
which is right around the corner from my
211
00:08:26,873 --> 00:08:29,275
office. So, that whole year
212
00:08:29,275 --> 00:08:31,611
was spent adjusting to a new
213
00:08:31,611 --> 00:08:34,881
place to live, a new job,
214
00:08:34,881 --> 00:08:37,083
trying to look after
my mother from a distance
215
00:08:37,083 --> 00:08:39,085
because she was living
in Thunder Bay, flying
216
00:08:39,085 --> 00:08:42,188
back and forth at times, and then
217
00:08:42,188 --> 00:08:44,624
basically spending almost
every day or as many
218
00:08:44,624 --> 00:08:46,592
days as I could with
my best friend in the
219
00:08:46,592 --> 00:08:49,295
hospital. So, it was pretty
220
00:08:49,295 --> 00:08:50,296
ragged; it ran me ragged, and
221
00:08:53,900 --> 00:08:55,668
looking back on it,
I don't really think I
222
00:08:55,668 --> 00:08:58,905
took any time for myself
223
00:08:58,905 --> 00:09:00,907
to process any of it.
224
00:09:00,907 --> 00:09:02,041
And in
225
00:09:03,776 --> 00:09:06,546
early January of 2006, my mother died.
226
00:09:06,546 --> 00:09:09,282
And then five months after that, exactly,
227
00:09:09,282 --> 00:09:10,516
my best friend died.
228
00:09:10,516 --> 00:09:13,119
So, I lost the two most important
229
00:09:13,119 --> 00:09:15,621
women in my life in the span of five
230
00:09:15,621 --> 00:09:16,856
months.
231
00:09:16,856 --> 00:09:18,991
And then what began to happen
in your personal
232
00:09:18,991 --> 00:09:20,793
life after that?
233
00:09:20,793 --> 00:09:23,796
Yeah. So, things very slowly
234
00:09:23,796 --> 00:09:25,798
started to unravel.
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00:09:25,798 --> 00:09:28,634
I think being a physician
236
00:09:28,634 --> 00:09:30,970
and trying to, and
237
00:09:30,970 --> 00:09:32,371
not just being a physician, being an
238
00:09:32,371 --> 00:09:34,640
Indigenous physician and
having leadership
239
00:09:34,640 --> 00:09:37,009
roles and things like that,
240
00:09:37,043 --> 00:09:39,078
my major response to that
241
00:09:40,446 --> 00:09:42,682
whole year that I had been through
and all the
242
00:09:42,682 --> 00:09:45,117
grieving and the loss was
243
00:09:45,117 --> 00:09:47,753
just to work harder,
to just throw myself
244
00:09:47,753 --> 00:09:50,156
into my work, and numb my
245
00:09:50,156 --> 00:09:52,792
feelings and just pretend
246
00:09:52,792 --> 00:09:55,294
as if it was all okay.
247
00:09:55,294 --> 00:09:57,630
And of course, then as a
248
00:09:57,630 --> 00:09:59,932
psychiatrist, you also think,
"Well, I'm
249
00:09:59,932 --> 00:10:01,867
really going through something
right now, and
250
00:10:01,867 --> 00:10:04,170
I'll be able to figure it out
myself."
251
00:10:04,170 --> 00:10:06,606
That sort of notion
252
00:10:06,606 --> 00:10:08,975
that when we as
253
00:10:08,975 --> 00:10:11,510
physicians but also as human beings
254
00:10:11,510 --> 00:10:13,980
feel capable of reaching
255
00:10:13,980 --> 00:10:16,315
out for help, that culture didn't
256
00:10:16,315 --> 00:10:18,017
really exist back then.
257
00:10:18,017 --> 00:10:19,719
That was quite a while ago.
258
00:10:20,853 --> 00:10:23,456
And so I suffered along
259
00:10:23,456 --> 00:10:25,791
for a long period of time.
260
00:10:25,791 --> 00:10:28,728
And I think I developed a
261
00:10:28,728 --> 00:10:31,197
pretty severe depression looking back on
262
00:10:31,197 --> 00:10:32,365
it. And
263
00:10:33,666 --> 00:10:36,235
my major way of coping with that was to
264
00:10:36,235 --> 00:10:38,170
start drinking more.
265
00:10:39,605 --> 00:10:41,641
I would say I was always a social drinker
266
00:10:42,708 --> 00:10:45,478
throughout my life,
but it wasn't problematic
267
00:10:45,478 --> 00:10:47,246
in the sense that it
didn't interfere with my
268
00:10:47,246 --> 00:10:49,382
life in any way or impair me.
269
00:10:51,717 --> 00:10:54,053
But because I started working harder...
270
00:10:55,254 --> 00:10:57,590
It's interesting because a lot of my work
271
00:10:57,623 --> 00:10:59,925
involves travel, and I think
272
00:10:59,925 --> 00:11:01,827
for a lot of physicians,
this is the case.
273
00:11:01,827 --> 00:11:04,563
We travel a lot,
274
00:11:04,563 --> 00:11:07,333
and it's really easy
275
00:11:07,333 --> 00:11:09,802
to drink when you travel because
276
00:11:09,802 --> 00:11:11,771
you can have a glass of wine
when you get to
277
00:11:11,771 --> 00:11:13,472
the airport and you have
a glass of wine on
278
00:11:13,472 --> 00:11:15,875
the plane, and then you get
to your hotel
279
00:11:15,875 --> 00:11:17,777
room, and oftentimes
people would leave me
280
00:11:17,777 --> 00:11:20,179
these gift baskets that had cookies and
281
00:11:20,179 --> 00:11:21,614
chocolate and a bottle of wine.
282
00:11:21,614 --> 00:11:24,050
Well, I'd help myself to that.
283
00:11:24,050 --> 00:11:26,952
And my major
284
00:11:26,952 --> 00:11:29,021
thinking at the time was
285
00:11:30,523 --> 00:11:32,491
I had terrible insomnia.
286
00:11:32,491 --> 00:11:34,894
That's actually the symptom that bothered
287
00:11:34,894 --> 00:11:37,363
me the most. And so the drinking
288
00:11:37,363 --> 00:11:39,765
at the time, even though I would
289
00:11:39,765 --> 00:11:42,501
advise patients not to do this,
290
00:11:42,501 --> 00:11:44,904
but for some reason
ourselves as physicians,
291
00:11:44,904 --> 00:11:46,172
we don't see that.
292
00:11:46,172 --> 00:11:48,207
We don't take that advice.
293
00:11:48,207 --> 00:11:50,509
So I started using wine to be able
294
00:11:50,509 --> 00:11:51,544
to sleep.
295
00:11:51,544 --> 00:11:54,313
And then before I knew it, it just
296
00:11:54,313 --> 00:11:55,881
got worse and worse and worse.
297
00:11:55,881 --> 00:11:58,184
And I was waking up,
hung over every morning
298
00:11:58,184 --> 00:11:59,385
and still going to work
299
00:12:00,553 --> 00:12:02,855
but definitely not feeling at my
300
00:12:02,855 --> 00:12:05,458
best and probably not being
301
00:12:05,458 --> 00:12:07,993
my best and just looking
302
00:12:07,993 --> 00:12:09,829
forward to getting home
from work so that I
303
00:12:09,829 --> 00:12:12,131
could crack open a bottle of wine
304
00:12:12,131 --> 00:12:13,833
and start drinking.
305
00:12:15,801 --> 00:12:18,370
And Nel for you, what was
306
00:12:18,370 --> 00:12:20,873
the tipping point that prompted
307
00:12:20,873 --> 00:12:23,509
you to seek support or
308
00:12:23,509 --> 00:12:25,878
disclose how difficult things
309
00:12:25,878 --> 00:12:26,979
had become in your life?
310
00:12:28,314 --> 00:12:30,649
I think one of the reasons why
311
00:12:30,649 --> 00:12:32,952
I speak so openly about this is
312
00:12:32,952 --> 00:12:35,421
because I really want other
313
00:12:35,421 --> 00:12:38,891
physicians in this case to be aware
314
00:12:38,891 --> 00:12:39,892
that this is one
315
00:12:43,496 --> 00:12:45,998
trap that we can fall into.
316
00:12:45,998 --> 00:12:48,701
And I want people to know that
317
00:12:48,701 --> 00:12:51,370
if you're struggling or
if you're suffering,
318
00:12:51,370 --> 00:12:53,806
that there is help and that things
319
00:12:53,806 --> 00:12:55,207
do get better.
320
00:12:55,207 --> 00:12:57,810
But at that time, I think for myself,
321
00:12:57,810 --> 00:13:00,179
there came a time when I just wasn't able
322
00:13:00,179 --> 00:13:02,047
to work anymore.
323
00:13:02,047 --> 00:13:05,017
I went off on a medical leave,
324
00:13:05,017 --> 00:13:07,052
which actually only
made things worse, because
325
00:13:07,052 --> 00:13:08,921
then I didn't have to keep myself sorted
326
00:13:08,921 --> 00:13:10,990
during the day.
I could just do whatever I
327
00:13:10,990 --> 00:13:11,991
wanted.
328
00:13:14,026 --> 00:13:16,762
And I can't describe,
329
00:13:16,762 --> 00:13:18,831
because I will describe later
what it feels
330
00:13:18,831 --> 00:13:21,433
like to be in recovery,
but to be that sick
331
00:13:21,433 --> 00:13:23,803
and depressed and drinking heavily
332
00:13:23,803 --> 00:13:24,804
and
333
00:13:26,305 --> 00:13:28,140
then as an Indigenous person,
as a First Nations
334
00:13:28,140 --> 00:13:30,576
woman, I just became
335
00:13:30,576 --> 00:13:31,577
embedded,
336
00:13:34,413 --> 00:13:37,316
I think, in a web of shame
337
00:13:37,316 --> 00:13:40,386
and guilt and despair
338
00:13:40,386 --> 00:13:41,921
and hopelessness.
339
00:13:41,921 --> 00:13:44,323
And I wouldn't
340
00:13:44,323 --> 00:13:46,759
say I was suicidal, but I realised
341
00:13:46,759 --> 00:13:49,562
because I have some medical knowledge that
342
00:13:49,562 --> 00:13:52,298
this was very harmful to me.
343
00:13:52,298 --> 00:13:54,366
And I thought,
"Well, I guess this is just how
344
00:13:54,366 --> 00:13:56,235
it's all going to play out.
345
00:13:56,235 --> 00:13:58,137
I'm just going to drink myself,
and eventually
346
00:13:58,137 --> 00:14:00,873
I'll get some terrible
complication, and
347
00:14:00,873 --> 00:14:04,210
that'll be it." And I didn't have
348
00:14:04,210 --> 00:14:06,579
the cognitive ability at that time
349
00:14:06,579 --> 00:14:08,948
while I was sick to realise
350
00:14:08,948 --> 00:14:10,115
that there was a way out.
351
00:14:11,217 --> 00:14:14,153
I was just stuck in my
352
00:14:14,153 --> 00:14:15,821
illness and in my shame.
353
00:14:15,821 --> 00:14:17,790
And I think that's an
important point that
354
00:14:17,790 --> 00:14:20,125
people don't really remember;
355
00:14:20,125 --> 00:14:21,760
that sort of, "Well,
why don't they go out and
356
00:14:21,760 --> 00:14:24,330
seek help?" Well, I didn't go out and seek
357
00:14:24,330 --> 00:14:27,900
help because first of all,
I was too ashamed
358
00:14:27,900 --> 00:14:30,669
to come forward. But I literally
359
00:14:30,669 --> 00:14:33,205
couldn't imagine things
360
00:14:33,205 --> 00:14:35,641
being better. I just was living
361
00:14:35,641 --> 00:14:37,443
with the status quo.
362
00:14:37,443 --> 00:14:39,845
And because my despair
363
00:14:39,845 --> 00:14:42,481
was so severe, I was pretty
364
00:14:42,481 --> 00:14:44,350
complacent. I just thought,
"I'm just going to
365
00:14:44,350 --> 00:14:47,419
let happen to me what's going to happen."
366
00:14:47,419 --> 00:14:49,755
So, I think that's important
for people to
367
00:14:49,755 --> 00:14:51,891
know or family members or
friends of people
368
00:14:51,891 --> 00:14:54,660
who are sick and using substances that
369
00:14:54,660 --> 00:14:56,962
they can't just snap out of it
because their
370
00:14:56,962 --> 00:14:59,531
brain, my brain, literally was sick.
371
00:15:01,400 --> 00:15:03,702
Well, you remind me of something
372
00:15:03,702 --> 00:15:06,038
that I think also applies
in a more general
373
00:15:06,038 --> 00:15:08,374
sense any time a physician or
374
00:15:08,374 --> 00:15:10,709
a health care worker is suffering
375
00:15:10,743 --> 00:15:13,312
with a significant illness, and
376
00:15:13,312 --> 00:15:15,714
we have this feeling that we should
377
00:15:15,714 --> 00:15:16,749
we know what to do.
378
00:15:16,749 --> 00:15:18,317
As you were saying earlier,
we know how to
379
00:15:18,317 --> 00:15:21,120
tell a patient to manage things,
but that's
380
00:15:21,153 --> 00:15:22,922
in the setting of our healthy brain.
381
00:15:22,922 --> 00:15:25,090
So that's at a moment when
our brain is not
382
00:15:25,090 --> 00:15:27,893
bathed in, whatever inflammatory
383
00:15:27,893 --> 00:15:30,596
process is going on or the neurochemical
384
00:15:30,596 --> 00:15:33,499
alterations that
are part of experiencing
385
00:15:33,499 --> 00:15:34,867
addiction. And I think
it's one of the
386
00:15:34,867 --> 00:15:37,770
cognitive traps that perhaps
387
00:15:37,770 --> 00:15:39,972
physicians often fall into seeking help.
388
00:15:39,972 --> 00:15:42,308
You make the
389
00:15:42,308 --> 00:15:44,143
assumption, and people around
you maybe make
390
00:15:44,143 --> 00:15:45,744
the assumption, that
you're making decisions
391
00:15:45,744 --> 00:15:47,913
with your normal,
your usual brain, your
392
00:15:47,913 --> 00:15:50,849
day-to-day pre-illness brain,
and that is
393
00:15:50,849 --> 00:15:53,419
really not correct at all,
as you say.
394
00:15:53,419 --> 00:15:56,055
I think the other thing that happens
395
00:15:56,055 --> 00:15:58,657
to physicians who are in difficulty
396
00:15:58,657 --> 00:16:00,993
with substance use is that point you
397
00:16:00,993 --> 00:16:03,362
made about we think
398
00:16:03,362 --> 00:16:06,732
that we'll be able to fix ourselves
399
00:16:06,732 --> 00:16:09,034
because it's not that
I didn't have medical
400
00:16:09,034 --> 00:16:10,235
support.
401
00:16:10,235 --> 00:16:13,372
I had a psychiatrist that I was seeing who
402
00:16:13,372 --> 00:16:15,541
was trying so hard to be helpful for me.
403
00:16:15,541 --> 00:16:18,310
And I really feel badly because
404
00:16:18,310 --> 00:16:20,379
I was not an easy patient.
405
00:16:20,379 --> 00:16:21,947
I know they say doctors make terrible
406
00:16:21,947 --> 00:16:23,882
patients, but I literally was not an easy
407
00:16:23,882 --> 00:16:26,218
patient. So I think of her
408
00:16:26,218 --> 00:16:28,620
with gratitude all the time,
409
00:16:28,620 --> 00:16:30,823
but I really thought that
I could manage this
410
00:16:30,823 --> 00:16:31,824
all on my own,
411
00:16:33,692 --> 00:16:36,261
and so when you asked about what brought
412
00:16:36,261 --> 00:16:38,731
you to the point of seeking help, I have
413
00:16:38,731 --> 00:16:40,532
to honestly say that
it really wasn't me, it
414
00:16:41,867 --> 00:16:43,569
was the people around me.
415
00:16:43,569 --> 00:16:45,437
It was my partner.
416
00:16:45,437 --> 00:16:46,739
It was some friends of mine.
417
00:16:46,739 --> 00:16:47,740
And
418
00:16:49,208 --> 00:16:51,710
I should mention actually that I had been
419
00:16:51,710 --> 00:16:53,645
in and out of recovery.
420
00:16:53,645 --> 00:16:56,015
I first started trying to go
421
00:16:56,015 --> 00:16:58,717
to self mutual
422
00:16:58,717 --> 00:17:01,387
aid groups back in
423
00:17:01,387 --> 00:17:03,889
probably around 2007.
424
00:17:05,324 --> 00:17:08,027
And I didn't actually go to residential
425
00:17:08,027 --> 00:17:10,062
treatment till 2015.
426
00:17:10,062 --> 00:17:12,364
So for eight years, I
427
00:17:12,364 --> 00:17:14,967
was trying to seek help
at different times.
428
00:17:14,967 --> 00:17:16,802
And I had long periods of sobriety.
429
00:17:16,802 --> 00:17:19,171
I had two years at one point, a
430
00:17:19,171 --> 00:17:21,573
year at another point; I probably was
431
00:17:21,573 --> 00:17:23,942
sober more than I was drinking
432
00:17:23,942 --> 00:17:25,811
in eight years,
but when I was drinking,
433
00:17:25,811 --> 00:17:28,781
especially toward the end,
it was really bad.
434
00:17:28,781 --> 00:17:30,749
So, it wasn't really me.
435
00:17:30,749 --> 00:17:33,085
It was the people around me,
people from
436
00:17:33,085 --> 00:17:35,454
my recovery community who...
437
00:17:35,454 --> 00:17:37,589
we see this all the time in recovery.
438
00:17:37,589 --> 00:17:39,725
People relapse,
and they go in and out.
439
00:17:39,725 --> 00:17:40,726
And
440
00:17:42,294 --> 00:17:44,596
so finally, it is
441
00:17:44,596 --> 00:17:46,198
a little bit funny because
I do have a very
442
00:17:46,198 --> 00:17:47,199
black sense of humour.
443
00:17:48,434 --> 00:17:50,736
My partner had been in contact
444
00:17:50,736 --> 00:17:53,772
with the Ontario Physician Health Program,
445
00:17:53,772 --> 00:17:55,741
and they said, "Sure, sure, we can get her
446
00:17:55,741 --> 00:17:57,276
into residential treatment."
I think it was
447
00:17:57,276 --> 00:18:00,546
Wednesday. "We can get her in
on Friday."
448
00:18:00,546 --> 00:18:02,981
And he was so relieved, and he told
449
00:18:02,981 --> 00:18:04,650
me, "They're going to take you
into treatment on
450
00:18:04,683 --> 00:18:07,119
Friday." And I'm like, "I think
451
00:18:07,119 --> 00:18:09,588
I need until Monday." I was just
452
00:18:09,588 --> 00:18:11,824
like, "I'm not quite there yet.
453
00:18:11,824 --> 00:18:13,826
I just need a few more days."
454
00:18:15,060 --> 00:18:17,463
So Nel, you talked about some of
455
00:18:17,463 --> 00:18:19,364
the very reality-based
456
00:18:20,666 --> 00:18:23,502
difficulties that physicians
can experience
457
00:18:23,502 --> 00:18:25,804
when they are seeking support for
458
00:18:25,804 --> 00:18:27,072
addictions.
459
00:18:27,072 --> 00:18:29,041
But I want to ask you about the structural
460
00:18:29,041 --> 00:18:31,176
barriers that exist
as well because sometimes
461
00:18:31,176 --> 00:18:33,512
I think we downplay them, we glorify
462
00:18:33,512 --> 00:18:35,881
seek help, call this number, etc.,
463
00:18:35,881 --> 00:18:38,350
but we don't always talk candidly
464
00:18:38,350 --> 00:18:40,652
about what we need to be doing
465
00:18:40,652 --> 00:18:43,021
better from a structural perspective
when it
466
00:18:43,021 --> 00:18:45,991
comes to physicians accessing
those supports.
467
00:18:45,991 --> 00:18:47,493
And I wondered if you could talk
a little bit
468
00:18:47,493 --> 00:18:50,329
about your experience in that role.
469
00:18:50,329 --> 00:18:52,764
So, I think to start
470
00:18:52,764 --> 00:18:54,533
out I really want to
raise my hands to the
471
00:18:54,533 --> 00:18:56,702
Ontario Physician Health Program
because I
472
00:18:56,702 --> 00:18:59,338
think they have one of the best programs
473
00:18:59,338 --> 00:19:01,707
across the country in any province
474
00:19:01,707 --> 00:19:04,676
or territory.
They really seem to understand
475
00:19:05,978 --> 00:19:08,480
the situations of physicians
476
00:19:08,480 --> 00:19:11,517
who are experiencing
477
00:19:11,517 --> 00:19:13,919
substance use challenges
but also are
478
00:19:13,952 --> 00:19:15,220
so incredibly supportive once
479
00:19:16,855 --> 00:19:19,224
you've made that decision to be in
480
00:19:19,224 --> 00:19:21,860
recovery and be on that healing
481
00:19:21,860 --> 00:19:22,861
journey. So
482
00:19:26,331 --> 00:19:27,799
that part was great.
483
00:19:27,799 --> 00:19:29,501
I had a lot of support.
484
00:19:29,501 --> 00:19:31,770
I had a clinical case coordinator
who I still
485
00:19:31,770 --> 00:19:33,405
keep in touch with.
486
00:19:33,405 --> 00:19:35,841
And Dr. Joy Albuquerque was
487
00:19:35,841 --> 00:19:39,077
the medical director at that time,
and she was
488
00:19:39,077 --> 00:19:41,380
a fierce advocate of
489
00:19:41,380 --> 00:19:43,916
trying to dispel the stigma
490
00:19:43,916 --> 00:19:46,351
around substance use and, frankly,
491
00:19:46,351 --> 00:19:49,588
the discriminatory treatment that people,
492
00:19:49,588 --> 00:19:52,024
including myself, experienced
493
00:19:52,024 --> 00:19:53,592
in trying to return to work.
494
00:19:53,592 --> 00:19:55,928
I think the one thing that employers...
495
00:19:55,928 --> 00:19:58,430
I get that from a College
496
00:19:58,430 --> 00:20:01,266
perspective, we have to be safe, and
497
00:20:01,266 --> 00:20:03,435
patient safety is paramount.
498
00:20:03,435 --> 00:20:05,938
But when you're really doing your best
499
00:20:05,938 --> 00:20:08,340
and you're continuing in
500
00:20:08,340 --> 00:20:11,176
your recovery and you're stable,
501
00:20:11,176 --> 00:20:13,612
being made to feel as if
502
00:20:13,612 --> 00:20:15,914
you're in imminent danger
503
00:20:15,914 --> 00:20:18,217
of creating some situation
that is terrible
504
00:20:20,152 --> 00:20:22,754
is not the best feeling for someone
505
00:20:22,754 --> 00:20:25,123
whose self-esteem is already
506
00:20:25,123 --> 00:20:26,458
so low.
507
00:20:26,458 --> 00:20:27,459
And
508
00:20:29,161 --> 00:20:31,196
so I think one of the things
that we could do
509
00:20:31,196 --> 00:20:33,298
about that is just recognise that
510
00:20:34,399 --> 00:20:36,902
people who are in recovery
511
00:20:36,902 --> 00:20:38,303
and are trying to recover...
512
00:20:38,303 --> 00:20:41,173
My intention
513
00:20:41,173 --> 00:20:42,774
was never to harm anybody else.
514
00:20:42,774 --> 00:20:43,875
I mean, I know I did,
515
00:20:45,277 --> 00:20:47,813
not patients, thankfully, but I hurt
516
00:20:47,813 --> 00:20:49,615
the people around me who love me,
517
00:20:51,283 --> 00:20:53,752
but we never intend to harm anybody
518
00:20:53,752 --> 00:20:54,753
else. Substance
519
00:20:56,088 --> 00:20:58,357
use is such a self-centred illness.
520
00:20:59,591 --> 00:21:01,893
And at any rate, so I think there were
521
00:21:01,893 --> 00:21:04,429
some barriers in me returning to work.
522
00:21:04,429 --> 00:21:06,832
I think people had some
523
00:21:06,832 --> 00:21:09,501
very preconceived
524
00:21:09,501 --> 00:21:11,870
notions, stereotypical notions, of
525
00:21:11,870 --> 00:21:13,572
someone who use substances.
526
00:21:14,573 --> 00:21:17,509
I think workplaces where physicians
527
00:21:17,509 --> 00:21:19,845
work in some ways are still
528
00:21:19,845 --> 00:21:22,481
pretty mired
529
00:21:22,481 --> 00:21:25,684
in stigma and stereotyping
530
00:21:25,684 --> 00:21:27,986
around people who use substances,
531
00:21:27,986 --> 00:21:29,921
and that includes the
health professionals who
532
00:21:29,921 --> 00:21:31,023
work there.
533
00:21:31,023 --> 00:21:33,725
Since I've been in recovery, and I can
534
00:21:33,725 --> 00:21:36,061
proudly say I've been sober
for over eight
535
00:21:36,061 --> 00:21:38,630
years, I've been in
536
00:21:39,798 --> 00:21:42,134
support accountability
537
00:21:42,134 --> 00:21:44,603
groups with other
physicians, nurses,
538
00:21:46,271 --> 00:21:48,006
pharmacists, for example.
539
00:21:48,006 --> 00:21:50,409
And people really are trying their
540
00:21:50,409 --> 00:21:51,443
best.
541
00:21:51,443 --> 00:21:54,179
And so when you return to
your workplace
542
00:21:54,179 --> 00:21:56,648
and people are making assumptions
543
00:21:56,648 --> 00:21:59,184
that at any minute you could
544
00:21:59,184 --> 00:22:01,219
pick up a big jug of vodka and start
545
00:22:01,253 --> 00:22:02,387
chugging...
546
00:22:02,387 --> 00:22:04,756
That wasn't my intention, but
547
00:22:04,756 --> 00:22:07,025
that's how I was made to feel.
548
00:22:07,025 --> 00:22:10,028
And so that
549
00:22:10,028 --> 00:22:12,197
was really hurtful to someone...
550
00:22:12,197 --> 00:22:14,566
When you're in
551
00:22:14,566 --> 00:22:17,169
recovery, you start
552
00:22:17,169 --> 00:22:19,838
climbing back from a pretty low place.
553
00:22:19,838 --> 00:22:22,641
When I first got to residential
554
00:22:22,641 --> 00:22:25,143
treatment, I remember the first few days
555
00:22:27,145 --> 00:22:29,181
I was wandering around with everyone else
556
00:22:29,181 --> 00:22:30,649
going to the groups I was
supposed to be going
557
00:22:30,649 --> 00:22:32,884
to, and this doctor stopped me in the
558
00:22:32,884 --> 00:22:35,287
hallway... he was actually,
I think, the chief
559
00:22:35,287 --> 00:22:36,722
of staff there.
560
00:22:36,722 --> 00:22:37,756
And he said, "You know Nel,
561
00:22:39,891 --> 00:22:41,993
I've seen you since you
got here the last
562
00:22:41,993 --> 00:22:45,230
three days," he said,
"and all you do is
563
00:22:45,230 --> 00:22:46,231
stare at your shoes." And
564
00:22:47,933 --> 00:22:50,302
he said, "Someday you won't
565
00:22:50,302 --> 00:22:51,636
feel like that." And
566
00:22:53,205 --> 00:22:55,640
I still get a little emotional talking
567
00:22:55,640 --> 00:22:56,641
about that because it
568
00:22:58,643 --> 00:23:00,746
was like he had that faith in me
that I didn't
569
00:23:00,746 --> 00:23:02,013
have yet.
570
00:23:02,013 --> 00:23:04,282
And so that's the kind of treatment
571
00:23:06,752 --> 00:23:09,421
I think that people deserve;
572
00:23:09,421 --> 00:23:11,490
they deserve to be treated
with dignity and
573
00:23:11,523 --> 00:23:12,491
with respect
574
00:23:14,159 --> 00:23:16,595
and a hopefulness
575
00:23:16,595 --> 00:23:18,163
instead of "You're
576
00:23:19,598 --> 00:23:22,467
a misbehaving physician; you're
577
00:23:22,467 --> 00:23:24,002
a disruptive physician." Instead
578
00:23:25,003 --> 00:23:27,305
of that approach, being "We're here
579
00:23:27,305 --> 00:23:29,741
walking alongside you." And I think
580
00:23:29,741 --> 00:23:32,377
that would go a long way toward having
581
00:23:32,377 --> 00:23:35,013
physicians feel comfortable
coming forward to
582
00:23:35,013 --> 00:23:36,014
seek help
583
00:23:37,749 --> 00:23:39,684
if they didn't feel as if...
584
00:23:41,353 --> 00:23:43,755
I think physicians, a lot of us build
585
00:23:43,755 --> 00:23:46,158
our whole lives around to a certain
586
00:23:46,158 --> 00:23:48,827
extent, not completely,
but on what we do
587
00:23:48,827 --> 00:23:51,663
and who we are. It's a big part of how
588
00:23:51,663 --> 00:23:52,831
we see ourselves.
589
00:23:52,831 --> 00:23:55,467
So, when that all comes crashing down,
590
00:23:55,467 --> 00:23:58,203
there's not a lot left in some ways.
591
00:23:58,203 --> 00:24:00,672
And of course, then there's that extra
592
00:24:00,672 --> 00:24:01,673
layer of have
593
00:24:03,141 --> 00:24:04,443
I ruined my career?
594
00:24:04,443 --> 00:24:07,112
Am I ever going to be able to get back?
595
00:24:07,112 --> 00:24:09,881
Am I ever going to feel good about myself
596
00:24:09,881 --> 00:24:12,484
again? One of the reasons
597
00:24:12,484 --> 00:24:14,519
I'm agreeing to do this interview
is because
598
00:24:14,553 --> 00:24:16,922
I'm here to tell those physicians
599
00:24:16,922 --> 00:24:19,925
that all of that is possible.
600
00:24:19,925 --> 00:24:22,461
And all you have to do is really take
601
00:24:22,461 --> 00:24:24,596
life a day at a time.
602
00:24:24,596 --> 00:24:27,165
And you'll amaze
603
00:24:27,165 --> 00:24:29,568
yourself by how much better
604
00:24:29,568 --> 00:24:30,602
things get.
605
00:24:30,602 --> 00:24:33,071
I'm at a point in my life where I don't
606
00:24:33,071 --> 00:24:34,840
think I've ever been happier.
607
00:24:34,840 --> 00:24:37,742
I've never functioned more fully
608
00:24:37,742 --> 00:24:39,978
and better in my entire life.
609
00:24:41,079 --> 00:24:43,615
And a great
610
00:24:43,615 --> 00:24:46,551
point to make with a bit of humour
is sober
611
00:24:46,551 --> 00:24:48,820
colleagues are the best colleagues
because we
612
00:24:48,820 --> 00:24:49,888
work hard.
613
00:24:49,888 --> 00:24:51,423
We can always be on call, we're never
614
00:24:52,491 --> 00:24:54,893
hung over, we're always
615
00:24:54,893 --> 00:24:55,861
there.
616
00:24:55,861 --> 00:24:58,830
We become very dependable, reliable
617
00:24:58,830 --> 00:24:59,865
colleagues.
618
00:24:59,865 --> 00:25:01,967
And I think that's a completely
different way
619
00:25:01,967 --> 00:25:04,469
of looking at physicians
620
00:25:04,503 --> 00:25:05,470
in recovery.
621
00:25:06,738 --> 00:25:08,740
That story that you just told about your
622
00:25:08,740 --> 00:25:11,076
colleague gave me a chill, and
623
00:25:11,076 --> 00:25:12,077
it makes me think of this
624
00:25:13,778 --> 00:25:16,181
paradox about us that we can
625
00:25:16,181 --> 00:25:19,317
be so compassionate towards our patients.
626
00:25:19,317 --> 00:25:21,419
And again, as we've talked about,
we're not
627
00:25:21,419 --> 00:25:23,788
always compassionate towards ourselves,
628
00:25:23,788 --> 00:25:26,258
but there is sometimes this phenomenon
629
00:25:26,258 --> 00:25:29,027
where we can just be absolutely horrible
630
00:25:29,027 --> 00:25:31,429
to each other,
particularly horrible to other
631
00:25:31,429 --> 00:25:33,732
physicians who are experiencing illness
632
00:25:33,732 --> 00:25:36,368
and manifesting some form of,
633
00:25:36,368 --> 00:25:38,703
what we perceive or would
634
00:25:38,703 --> 00:25:40,872
superficially call, weakness.
635
00:25:40,872 --> 00:25:43,341
And I wonder, as a psychiatrist,
what do you
636
00:25:43,341 --> 00:25:45,076
make of that? What do you think is behind
637
00:25:45,076 --> 00:25:46,044
that?
638
00:25:46,044 --> 00:25:47,879
So, I think what it
really comes down to when
639
00:25:47,879 --> 00:25:51,116
physicians are unkind
640
00:25:51,116 --> 00:25:53,418
to other physicians who are
in difficulty, I
641
00:25:53,418 --> 00:25:55,820
think really what it comes down to
642
00:25:55,820 --> 00:25:58,356
is there probably
643
00:25:58,356 --> 00:26:00,625
is something in that physician
who's having
644
00:26:00,625 --> 00:26:02,093
trouble that
645
00:26:04,362 --> 00:26:06,031
triggers something within that person.
646
00:26:07,365 --> 00:26:09,668
Because the reality is, and I've
647
00:26:09,668 --> 00:26:11,670
become so comfortable
speaking about being in
648
00:26:11,703 --> 00:26:14,072
recovery now and recovery
649
00:26:14,072 --> 00:26:17,275
makes me be scrupulously
650
00:26:17,275 --> 00:26:19,678
honest about things, is that we
651
00:26:19,678 --> 00:26:20,679
all struggle. All
652
00:26:23,148 --> 00:26:24,783
the way back to the beginning
when I started
653
00:26:24,783 --> 00:26:26,751
this interview, I said,
"Life happened to me,"
654
00:26:26,751 --> 00:26:29,020
and life continues to happen.
655
00:26:29,020 --> 00:26:31,356
Things get turned upside down.
656
00:26:31,356 --> 00:26:33,658
And there have been other losses
since then
657
00:26:33,658 --> 00:26:35,560
and other challenges.
658
00:26:35,560 --> 00:26:37,862
But I think it
659
00:26:37,862 --> 00:26:40,298
makes some physicians
660
00:26:40,298 --> 00:26:42,801
feel afraid that the same thing might
661
00:26:42,801 --> 00:26:44,369
happen to them.
And that might be a very
662
00:26:44,402 --> 00:26:45,370
unconscious thought.
663
00:26:46,538 --> 00:26:49,307
Or just that the whole culture
664
00:26:49,307 --> 00:26:51,710
of medicine is that
we must be strong, we
665
00:26:51,710 --> 00:26:54,112
must be seen to be perfect,
we must
666
00:26:54,112 --> 00:26:56,414
be competent. And seeing the
667
00:26:56,414 --> 00:26:58,750
humanity, actually, in
668
00:26:58,750 --> 00:27:01,820
another person, or even frailty
669
00:27:01,820 --> 00:27:04,489
for a moment, is
670
00:27:04,489 --> 00:27:05,690
unacceptable.
671
00:27:05,690 --> 00:27:08,426
So, we all have this persona
672
00:27:08,426 --> 00:27:10,462
that we have to maintain,
"Oh, I know exactly
673
00:27:10,462 --> 00:27:11,596
what's going on with that patient.
674
00:27:11,596 --> 00:27:12,931
I have the perfect treatment plan.
675
00:27:12,931 --> 00:27:14,899
I'm always competent.
676
00:27:14,899 --> 00:27:17,469
I never make mistakes."
That's the culture
677
00:27:17,469 --> 00:27:19,137
that we created.
678
00:27:19,137 --> 00:27:21,673
And so when someone is struggling,
679
00:27:21,673 --> 00:27:24,142
I think that disrupts that
680
00:27:24,142 --> 00:27:26,444
balance. And it can be distressing,
I think,
681
00:27:26,444 --> 00:27:27,445
for people.
682
00:27:28,246 --> 00:27:29,881
Now, the last thing I want to ask you
has to
683
00:27:29,881 --> 00:27:31,082
do with vulnerability.
684
00:27:31,082 --> 00:27:33,718
And you talked a little bit about putting
685
00:27:33,718 --> 00:27:36,221
an authentic story out there, the power
686
00:27:36,221 --> 00:27:38,757
of that, how that works in service
687
00:27:38,757 --> 00:27:41,259
for our colleagues to help us make
688
00:27:41,259 --> 00:27:43,061
changes to our culture.
689
00:27:43,061 --> 00:27:45,430
But I want to ask you, as a clinical tool,
690
00:27:45,430 --> 00:27:48,266
as something that is
of service to patients
691
00:27:48,266 --> 00:27:50,468
because so often
we have these high boundaries
692
00:27:50,468 --> 00:27:52,871
where people don't know
anything about us
693
00:27:52,871 --> 00:27:55,340
and learners and early career folks think
694
00:27:55,340 --> 00:27:58,243
they can never divulge that humanity, the
695
00:27:58,243 --> 00:28:00,011
fact that we struggle too.
696
00:28:00,011 --> 00:28:02,047
And I just want to end by
talking to you about
697
00:28:02,047 --> 00:28:04,482
what it's been like to have patients
698
00:28:04,482 --> 00:28:07,719
and people in your professional community,
699
00:28:07,752 --> 00:28:10,055
who you may have
clinical relationships with,
700
00:28:10,055 --> 00:28:11,589
know what you've been through.
701
00:28:11,623 --> 00:28:14,192
How does that become something that you
702
00:28:14,192 --> 00:28:17,696
are using for the greater good?
703
00:28:17,696 --> 00:28:19,264
I'm not sure I would say,
"Oh, I'm so glad
704
00:28:19,264 --> 00:28:21,466
that I went through all that." But it
705
00:28:21,466 --> 00:28:24,235
definitely has made a difference
706
00:28:24,235 --> 00:28:26,771
for me in the work that I do, both when
707
00:28:26,771 --> 00:28:28,840
I was working as a clinician
and now as a
708
00:28:28,840 --> 00:28:31,142
physician working in public health.
709
00:28:33,078 --> 00:28:35,714
I have yet to encounter
710
00:28:35,714 --> 00:28:38,917
a negative experience with a patient
711
00:28:38,917 --> 00:28:42,654
if I have even divulged
712
00:28:42,654 --> 00:28:44,989
any information that I'm in recovery.
713
00:28:44,989 --> 00:28:47,425
I know I did it a couple of times
714
00:28:47,425 --> 00:28:50,095
when I worked in the emergency department.
715
00:28:50,095 --> 00:28:52,564
And again, I have to say, as
716
00:28:52,564 --> 00:28:55,066
a First Nations woman, I don't see
717
00:28:55,066 --> 00:28:57,469
divulging some things about ourselves
718
00:28:57,469 --> 00:29:00,672
as a lapse in boundaries if
719
00:29:00,672 --> 00:29:03,074
it's going to serve
720
00:29:03,074 --> 00:29:05,477
the patient and make it a safer
721
00:29:05,477 --> 00:29:07,212
experience for them.
722
00:29:07,212 --> 00:29:09,581
And I'm so fortunate now
in my role at First
723
00:29:09,581 --> 00:29:11,649
Nations Health Authority
where I get to be
724
00:29:11,683 --> 00:29:14,085
open and honest and be
725
00:29:14,085 --> 00:29:15,920
my authentic self.
726
00:29:15,920 --> 00:29:18,957
I do a lot of public health messaging.
727
00:29:18,957 --> 00:29:21,593
I do a lot of public speaking
728
00:29:21,593 --> 00:29:24,129
across BC with our
729
00:29:24,129 --> 00:29:26,564
different regions and our Chiefs and our
730
00:29:26,564 --> 00:29:27,599
health leaders.
731
00:29:27,599 --> 00:29:31,202
I almost always mention that
I'm in recovery
732
00:29:31,202 --> 00:29:33,638
because I think what it shows people
733
00:29:33,638 --> 00:29:35,740
is that...
734
00:29:35,740 --> 00:29:38,109
It's just a way to destigmatize.
735
00:29:38,143 --> 00:29:40,512
And to
736
00:29:40,512 --> 00:29:43,348
have people say, well,
this is no different
737
00:29:43,348 --> 00:29:46,017
than someone who experiences
738
00:29:46,017 --> 00:29:48,720
a different kind of chronic illness.
739
00:29:48,720 --> 00:29:51,055
We do
740
00:29:51,055 --> 00:29:53,158
a lot of public health campaigns
where I work,
741
00:29:53,158 --> 00:29:55,527
and we have the Sober
742
00:29:55,527 --> 00:29:57,962
for October campaign where we ask people
743
00:29:57,962 --> 00:30:00,398
to either think about, reduce, or
744
00:30:00,398 --> 00:30:02,267
limit their drinking of alcohol during the
745
00:30:02,267 --> 00:30:04,869
month of October.
And it's the only challenge
746
00:30:04,903 --> 00:30:07,305
I ace, and
747
00:30:07,305 --> 00:30:09,774
I get to do a lot of messaging that
748
00:30:09,774 --> 00:30:12,310
month and make it seem
749
00:30:12,310 --> 00:30:14,612
to people that actually being in
750
00:30:14,612 --> 00:30:17,315
recovery is a good thing.
751
00:30:17,315 --> 00:30:19,651
And with the recent release
752
00:30:19,651 --> 00:30:21,953
of the Canadian safe drinking guidelines,
753
00:30:21,953 --> 00:30:23,521
I think anybody
754
00:30:24,756 --> 00:30:27,125
can do a rethink of where
they're at in terms
755
00:30:27,125 --> 00:30:29,561
of their alcohol use and do
756
00:30:29,561 --> 00:30:32,263
some re-evaluating and just try to
757
00:30:32,263 --> 00:30:34,732
be as safe as possible.
758
00:30:34,732 --> 00:30:37,302
And honestly, I can't
759
00:30:37,302 --> 00:30:40,171
describe to you how good it feels to be
760
00:30:40,171 --> 00:30:41,172
who I am now. I
761
00:30:43,141 --> 00:30:45,910
don't define myself by my alcoholism; it's
762
00:30:45,910 --> 00:30:46,945
a part of who I am.
763
00:30:46,945 --> 00:30:49,314
It's not the whole part.
764
00:30:49,314 --> 00:30:51,850
But the best
765
00:30:51,850 --> 00:30:54,152
thing is every single morning I wake up,
766
00:30:54,152 --> 00:30:56,654
and I feel clear and
767
00:30:56,654 --> 00:30:58,990
I feel able to take on the day,
768
00:30:58,990 --> 00:31:01,359
and I have the tools that
769
00:31:01,359 --> 00:31:03,761
I need to take
770
00:31:03,761 --> 00:31:06,564
on both the work, my demanding job,
771
00:31:06,564 --> 00:31:09,400
and the demands of my life.
772
00:31:09,400 --> 00:31:11,936
And I would wish that for everybody, and
773
00:31:11,936 --> 00:31:14,839
for physicians especially, who might
774
00:31:14,839 --> 00:31:17,075
have the chance of seeing this.
775
00:31:17,075 --> 00:31:19,410
If you're in any doubt at all, if you're
776
00:31:19,410 --> 00:31:22,046
struggling, I would really encourage
777
00:31:22,046 --> 00:31:24,249
you to seek help with the physician health
778
00:31:24,249 --> 00:31:27,652
program in your province or territory and
779
00:31:27,652 --> 00:31:28,720
start that journey.
780
00:31:28,720 --> 00:31:31,055
And whether it stops and starts like I did
781
00:31:31,055 --> 00:31:34,025
for eight years, whether it continues
782
00:31:34,025 --> 00:31:36,427
solidly like I have for the last eight
783
00:31:36,427 --> 00:31:37,428
years, it's
784
00:31:39,364 --> 00:31:41,699
not going to be something that
you'll regret.
785
00:31:43,601 --> 00:31:46,471
Well Nel, it is just
786
00:31:46,471 --> 00:31:48,606
a privilege to have this conversation
with you
787
00:31:48,606 --> 00:31:50,942
this morning. I feel both in
788
00:31:50,942 --> 00:31:53,244
awe of the work that you're
doing but also
789
00:31:53,244 --> 00:31:55,847
just so grateful for it and
790
00:31:55,847 --> 00:31:58,416
so proud to be a fellow
McMaster graduate with
791
00:31:58,416 --> 00:31:59,350
you as well.
792
00:31:59,350 --> 00:32:01,019
Thank you.
793
00:32:01,019 --> 00:32:02,453
It was a pleasure to be here.
794
00:32:02,453 --> 00:32:03,421
Thank you.
