Conversations with Jillian - Interview with Dr. Marie Faughnan and Dr. Robert Stewart [S201]

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Rob and Marie, it is so lovely
to be here with both of you today.

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It's great to be here with you, Jillian.

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Thank you. Great to be here as well.

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I'm so excited and looking
forward to this conversation.

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I'm going to start –

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before we get into why it's
the two of you here together –

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I want to start by asking each of you a
little bit about your journey to medicine.

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How it is that each of you
came to be doing

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what you were doing
before the part of the story

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that we're going to
talk about in a little bit.

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And Rob, maybe I'll start with you.

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Sure.

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I mean, I didn't start out in
university to pursue medicine at all.

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I started in biology
and then got a little bit

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turned off by courses in insect biology.

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And so, I switched to psychology
and finished up in psychology.

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And then I got this idea that
maybe I would pursue psychiatry.

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And I liked it very much, and right up
until my fourth year of medical school,

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psychiatry was going to
be my avenue to pursue.

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And then I did my surgery
rotation, and I knew I would like it,

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but I didn't know I
would absolutely love it.

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So when I applied to
post-graduate training,

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it was just straight surgery in those days

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And so, I had to do a
little bit of tap dancing

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because I'd done all my
elective time in psychiatry

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and had to convince them that
I truly wanted to be a surgeon.

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And it worked out.

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And I just love what I do.

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And then urology seemed like it
was the happiness business in surgery.

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And I've enjoyed every day of
my career from that day to this.

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Marie, how about you?

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Respirology. How did you
end up doing what you do?

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Yeah, good question.

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So, I studied biochemistry in undergrad

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but with a vision of going
to medicine or research.

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I was always thinking of both.

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So, it was a very happy
day when I got into medicine.

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I studied medicine in Montreal in
French at Université de Montréal,

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and then I went on to
do my internal medicine,

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not knowing really what I wanted to do.

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In fact, I thought I wanted
to do endocrinology,

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and I had done several research projects

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and had really gone and kind
of invested a lot in endocrinology.

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And then, once I started doing my rotation
and I landed on my respirology rotation,

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I was really taken with
the people in respirology.

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Like the respirologist, and also
the patients, it just felt like home,

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and I could see myself doing that.

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So, it was a maybe a smaller
switch than psychiatry to urology,

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but it was a pretty clear
switch for me to respirology.

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I sort of found my people,

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and then I came here to Toronto
to do the respirology training.

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So, I want to move now
to talk about the snake bite:

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the snake bite that set
everything in motion.

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And Rob, I'm going to
ask you to begin there.

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Okay. Well, I went to visit
my daughter in Singapore.

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She was doing a term away, which
was very much part of the culture

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at McGill University
where she was studying

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to go away for a term in third year.

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And so, I wanted to make sure
that she was getting settled well.

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And about six weeks into it,

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I said, "Sarah, I'm coming
for a week to visit you."

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And she said, "Dad, we're not staying
in Singapore. We're going to Bangkok."

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And I said, "Oh, okay, well,
I'll make all the arrangements,

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and your only job is to get
me a ride on an elephant."

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And she said, "Dad, you can't
do that. That's animal abuse."

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And I thought, "Well, yeah,
I probably can't do that."

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And she said, "I'll take you
to an elephant sanctuary,

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and you can pet them, and you can
feed them, and I think you'll like it."

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And I thought, "Okay, let's do it.
You know, I'll humour you. We'll do that."

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And so, we had to hire a car to
drive us well outside of Bangkok.

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It was several hours.

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And when we got almost
there, the driver stopped

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at this beside-the-road fruit market,

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and he said, "We're stopping
here to get elephant food."

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And I said, "Well, what's elephant food?"

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He said, "Corn and bananas."
Well, that was simple.

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I said, "Sarah, you get the
corn. I'll get the bananas.

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We'll rendezvous back here in five
minutes, and we'll get on with our day."

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So she goes off to get corn, and I
found this pallet of bananas piled high.

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I thought, "This is simple.
This is elephant food."

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And I stuck my hand into the banana
pile, and I felt this chomp on my hand,

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and I had my hand spread
and it was right on the web space

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between my thumb and first finger.

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I felt it - chomp -
and I pulled my hand out,

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and I looked at it, and I could see
the puncture marks in my hand,

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and I immediately googled
it, as one would I suppose,

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and realized that a viper
snake would have two fangs,

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like a poisonous snake might have two fang
with two puncture marks, but I had five.

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And so, I thought this is probably
not a poisonous animal that bit me.

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And then, I saw this silvery snake slither
out from the back of this banana pile

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and into what seemed to be the jungle

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because we were out in
the middle of nowhere really.

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And so, I quickly decided,
maybe not so well informed,

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but I decided at the moment
that this wasn't a poisonous snake

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and that I was going back to
Toronto the next day anyway,

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and I would just deal with
whatever eventuality happened.

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And so that's what happened.

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We went on our little elephant tour,
and we had a great time and I was

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going home the next day, but it's
a 21-hour flight to get back to Toronto,

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and by the time I landed in
Toronto, I had a temperature of 40

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and wasn't feeling well getting off
the plane and went to work the next day

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and spoke to one of my plastic surgery
colleagues who looked at it and said,

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"You know, you've got cellulitis from the
tip of your fingers up to your shoulder.

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And I think your tendons
are infected as well.

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And we're going to put
you on some antibiotics,

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and I'm going to put
you in a plaster cast."

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So, that happened, and
I thought we had a plan.

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Three days later,
things weren't getting better.

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And so, like a great patient,
I took the cast off myself

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and realized that the cellulitis
wasn't really getting better.

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And I thought, "Well, maybe I could get an
opinion

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from one of the tropical disease experts."

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And so I called him up, and he said,

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"I don't know what lives in the
mouth of a snake in Thailand.

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But," he said, "I think you
should ramp up the antibiotics,

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you know, broader spectrum."

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And so he put me on
amoxicillin/clavulanic acid,

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and lo and behold, within five days,
the cellulitis seemed to be regressing,

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but I continued to have
fevers and chills every night.

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And then I got all of the symptoms that we
associate with Stevens-Johnson syndrome.

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That took a couple of weeks,
but a rash that covered my trunk,

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sort of a target-style rash that then
coalesced into something very confluent.

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I had small joint arthritis.

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All sorts of arthralgias
in my hands and wrists.

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And then the skin on my lips and
the inside of my mouth sloughed off,

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and everything I ate tasted so spicy.

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Anything I ate, no matter how bland it was

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it just tasted spicy because
the inside of my mouth was raw.

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But that all healed up
within a couple of weeks.

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But the thing that seemed to
persist were these nightly fevers

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and profound fatigue.

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And I was told that, "We
could plasmapherese you,

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we could put you on
high-dose steroids,

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but they don't necessarily
work all that well,

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and maybe the best thing
to do is just tough it out,

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and probably within six months
it should get better."

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And so, for all those months,
I sort of had my fingers crossed,

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hoping against hope that this would
just naturally resolve into the background

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But it didn't.

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And at six months, it was
maybe even a bit worse.

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And eight months, worse yet.

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And then about 10 or 11 months,

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I felt that I didn't
really have a diagnosis.

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It wasn't just Stevens-Johnson Syndrome;

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it was something worse
because I was getting worse.

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And I couldn't function
very well at work at that time.

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And so, I spoke to my
Surgeon-in-Chief and said,

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"I believe I need some time
to get to the bottom of this.

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I need to take some time
off and just get this sorted."

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And so, I went to a hospital and saw a
general internal medicine person one day

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and went through a whole bevy of tests,

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imaging up and down and a
whole bunch of blood work.

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And at the end of the day,
she came back, and she said,

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"This has affected your liver
as it can affect end organs."

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Stevens-Johnson syndrome,
we've seen it in kidneys,

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and in my business,
I've seen it occasionally.

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And I knew it could affect livers,
but it was so off my radar screen

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to think that this could be
happening in the background.

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And she said, "Tomorrow, I'm
sending you to the transplant clinic."

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And it was literally like that.

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It was just an anvil between my eyes.

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I had no reason to
suspect this was going on.

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And there I was in the
transplant clinic the very next day.

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Wow. So a span of
eight, ten months, totally,

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between that first bite, that random event

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and finding yourself as a
patient in the transplant clinic.

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That's right. That's right.

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Marie, when did you first get wind
of what was happening with Rob?

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So, I think it was kind
of March or something

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when I heard that Rob
needed an organ donor.

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And we heard about it – I heard
about it at our division meeting.

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So, we were around the table having
one of our usual division conversations,

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talking about everything that's going on,

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and then that morning,
we had all gotten an email

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from the chief of medicine;

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it was a letter from
Marg, from Rob's wife,

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saying that Rob was sick

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and that he needed a liver transplant and
that they were looking for an organ donor.

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An additional detail that was in that
letter was that Rob was O negative, right?

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And that they needed an O-negative donor.

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So, we're sitting around the table
in our division, and everyone's like,

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"Marg is one of our colleagues, right.

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And Rob is one of our colleagues.

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And we have connections with both of them.

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And everyone, I think, at that table
was like, "What are we going to do?

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What can we do? How do
we help Rob find a donor?"

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But I think maybe I felt it even
more that day because I'm O negative.

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And I was just like,
"Right, like I could do this."

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And so, that was kind of when
my thinking started about it.

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So you started thinking at that point,

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and what happened as you moved
from that period between contemplation

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and taking the first step of a very
long process?

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Take us through that.

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I think that making the decision
was the hardest part, actually.

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I think at first
I just asked random people

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questions without revealing anything.

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Because maybe it was a crazy idea
to even be thinking about it.

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But I remember at that
division meeting saying,

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"Well, what's it like
to be a liver donor?"

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And several people
at the table said things,

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but probably with not
all that much information.

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Maybe it takes a few months to recover,

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or there was sort of some
very vague information.

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And then I kind of thought, "Okay."

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I wasn't consciously
thinking about it yet,

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but then it seemed like every day
when I got on my bike ride home,

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which is always when I
do my clearest thinking,

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it just kept coming back
to me.

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I was thinking,

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"Well, Rob needs a
donor. And why isn't it me?"

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And so, I would go through all these
reasons why.

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Well, I have patients to look after.

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I've got my kids and I've
got et cetera, et cetera.

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And then I realized after
a couple of weeks of this

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that I didn't have enough information.

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But I really needed to know, to ask
someone who could really

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give me detailed
information so I could decide.

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So, lucky me, one of my cycling
friends is a liver transplant surgeon.

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So, I just messaged him one
day, sort of randomly, and said,

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"You know, hey, what's
it like to be a liver donor?"

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And he said, "Why don't we
meet for coffee tomorrow?"

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So, we met for coffee.
So, this is an amazing thing,

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right, to be able to message
a liver transplant surgeon,

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"Hey, can you tell me what it's like?"

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without telling anybody else
that I'm asking this crazy question

226
00:13:06,583 --> 00:13:09,000
because I was wondering
if it was a crazy idea.

227
00:13:09,208 --> 00:13:14,416
So, I met with Gonzalo, and
he told me about it, basically.

228
00:13:14,458 --> 00:13:16,750
And I told him why I was asking,

229
00:13:16,750 --> 00:13:19,416
but I said I have no idea if
this is the right thing or not,

230
00:13:19,458 --> 00:13:20,958
but tell me what it's about.

231
00:13:20,958 --> 00:13:23,833
And he wasn't trying to convince me.

232
00:13:23,833 --> 00:13:28,791
He just kind of said it like it was, "This
is what the surgery is,

233
00:13:28,833 --> 00:13:32,833
this is our experience
in the UHN program."

234
00:13:32,875 --> 00:13:35,333
And by the end of the
conversation, I was like,

235
00:13:35,375 --> 00:13:39,083
"Well, you know, that seems pretty
doable. Like, what do I do next?"

236
00:13:39,416 --> 00:13:43,083
And so, from there, I signed up.

237
00:13:43,125 --> 00:13:47,916
I went online and filled out a form to
say yes, I'd be interested in doing this.

238
00:13:47,958 --> 00:13:51,666
And then you kind of wait to hear, right?

239
00:13:51,708 --> 00:13:55,041
He did tell me that they only
assess one person at a time.

240
00:13:55,083 --> 00:13:57,291
So, you might sign up
and hear nothing for a while.

241
00:13:57,291 --> 00:13:59,750
So, it was a couple of
weeks that I didn't hear anything,

242
00:13:59,750 --> 00:14:01,416
but I thought, "Okay, this is good.

243
00:14:01,458 --> 00:14:04,000
I made at least the step to get checked."

244
00:14:05,416 --> 00:14:08,583
So that was a very
important first part of it.

245
00:14:08,625 --> 00:14:11,875
And it meant a lot to
be able to ask a friend

246
00:14:11,875 --> 00:14:13,541
who was so knowledgeable about it.

247
00:14:13,541 --> 00:14:15,791
Like, it's a special thing
as a doctor, right,

248
00:14:16,000 --> 00:14:19,500
that we have these friends
who can really tell us like it is.

249
00:14:19,500 --> 00:14:23,208
And also, that it didn't
seem that scary to me.

250
00:14:23,208 --> 00:14:26,125
I was still worried about, that
was the medical part, right?

251
00:14:26,166 --> 00:14:29,791
I was still worried about
work, patients, family, you know

252
00:14:29,791 --> 00:14:31,791
all the other things on my list.

253
00:14:31,791 --> 00:14:35,416
But at least the medical, surgical
part didn't seem that scary to me

254
00:14:35,416 --> 00:14:38,041
because I had all the information
and I knew what it meant.

255
00:14:38,291 --> 00:14:41,333
So that was a very important first step.

256
00:14:41,333 --> 00:14:47,166
That demystification of the process
in a language that we already speak.

257
00:14:47,666 --> 00:14:50,875
Exactly. So that was
kind of like the first step.

258
00:14:50,916 --> 00:14:53,416
And then I didn't tell
anyone when I did that,

259
00:14:53,458 --> 00:14:56,750
but my husband was away when I signed
up online, and when he came back,

260
00:14:56,791 --> 00:14:59,250
I was having dinner with him.

261
00:14:59,291 --> 00:15:02,000
That was kind of the next
step because I thought,

262
00:15:02,041 --> 00:15:04,791
"Well, I need to tell him
before it's too far along,

263
00:15:04,791 --> 00:15:06,833
need to see what he thinks."

264
00:15:06,958 --> 00:15:08,666
So, I was having dinner with him,

265
00:15:08,666 --> 00:15:10,666
and we were just having
a nice dinner talking.

266
00:15:10,708 --> 00:15:12,666
And I said, "You know, there's
something I want to tell you about.

267
00:15:12,666 --> 00:15:14,291
I've been thinking about this thing."

268
00:15:14,333 --> 00:15:18,833
And I told him, and it was
like the end of the conversation.

269
00:15:18,833 --> 00:15:22,833
He was like crickets
for the rest of dinner.

270
00:15:22,833 --> 00:15:30,291
So I just sort of floated it out there,
but he was clearly blindsided by it.

271
00:15:30,291 --> 00:15:33,833
So, I needed to give him
a bit of time to process it.

272
00:15:34,458 --> 00:15:38,458
And he did. Eventually, like
a week later, I said,

273
00:15:38,458 --> 00:15:43,458
"You know, I wanted to ask you
again about that thing about the liver.”

274
00:15:43,500 --> 00:15:47,458
And, basically, he said,

275
00:15:47,500 --> 00:15:50,625
"You know, is there any chance
you're going to die doing this?"

276
00:15:50,666 --> 00:15:53,708
And I said, "No, you know,
here's the data from Gonzalo.

277
00:15:53,708 --> 00:15:55,666
I've read the paper and, you know,

278
00:15:55,666 --> 00:15:58,291
these are the things you've got
that could happen but not that.”

279
00:15:58,291 --> 00:16:00,416
He said, "Well, then, I think it's good.

280
00:16:00,416 --> 00:16:02,958
I think if you want to
do it, you should do it."

281
00:16:03,000 --> 00:16:07,833
So that was a second really
important part of the process for me.

282
00:16:08,041 --> 00:16:09,291
Yeah, big milestone.

283
00:16:09,333 --> 00:16:12,291
What I really hear in what
you were just saying is that gulf

284
00:16:12,291 --> 00:16:17,125
between the uncertainty of
what something will really be like

285
00:16:17,125 --> 00:16:22,916
and then the necessity of filling in
those gaps with actual information.

286
00:16:22,916 --> 00:16:25,500
And it just makes me think, Rob,

287
00:16:25,500 --> 00:16:31,750
of your experience as a transplant
surgeon, albeit a different organ.

288
00:16:31,791 --> 00:16:34,375
What were some of the gaps that you faced

289
00:16:34,375 --> 00:16:38,250
when you were now in this
situation in the transplant clinic?

290
00:16:38,250 --> 00:16:41,541
What you might have
thought that you would know

291
00:16:41,541 --> 00:16:44,041
that you actually had no
knowledge of whatsoever?

292
00:16:44,541 --> 00:16:49,041
Yeah. Exactly. I mean, they said
to me on that first appointment,

293
00:16:49,083 --> 00:16:52,916
"Rob, you need a transplant, and
you should start looking for a donor."

294
00:16:52,958 --> 00:16:57,125
And frankly, I had no idea where to begin.

295
00:16:57,125 --> 00:17:00,666
There's no clear algorithm
here. There just isn't.

296
00:17:00,666 --> 00:17:05,000
And it was pointed out to me by
a senior surgeon in the program

297
00:17:05,041 --> 00:17:08,333
that I couldn't be an advocate for myself.

298
00:17:08,333 --> 00:17:09,083
It doesn't work.

299
00:17:09,083 --> 00:17:14,625
It's too awkward for the potential
donor being approached like that, you know

300
00:17:14,666 --> 00:17:16,125
"I need a liver."

301
00:17:16,458 --> 00:17:20,583
That's difficult.
And it's awkward for me to ask.

302
00:17:20,625 --> 00:17:23,458
And so he said – and it
was very good advice:

303
00:17:23,458 --> 00:17:25,625
"Get somebody to be your advocate."

304
00:17:25,625 --> 00:17:29,791
And Margaret did. I mean, she
just really stepped up and did it,

305
00:17:29,833 --> 00:17:33,333
and she took it on like a huge project.

306
00:17:33,375 --> 00:17:36,791
And she was on her
laptop at 4 a.m. every day,

307
00:17:36,833 --> 00:17:42,833
contacting colleagues and
friends in Europe and elsewhere.

308
00:17:42,875 --> 00:17:46,083
And that seemed to be very helpful,

309
00:17:46,083 --> 00:17:49,875
and other folks have social
groups that they can reach out to.

310
00:17:49,875 --> 00:17:54,250
I mean, the first people who came
forward were all of my family members.

311
00:17:54,291 --> 00:17:56,416
But for various reasons,
it didn't work out.

312
00:17:56,416 --> 00:18:00,541
You know, I'm six foot two and
there's a size matching element

313
00:18:00,583 --> 00:18:02,208
that has to be considered, et cetera.

314
00:18:02,250 --> 00:18:04,375
And so, my family members didn't work.

315
00:18:04,416 --> 00:18:08,000
And so, then the next
sort of concentric circle

316
00:18:08,041 --> 00:18:11,500
were friends, colleagues,
things like that.

317
00:18:11,541 --> 00:18:13,750
And as a kidney transplant surgeon,

318
00:18:13,791 --> 00:18:17,875
we don't get involved in
the search for a donor kidney.

319
00:18:17,916 --> 00:18:22,250
We meet the recipient at the very
end, you know close to
the time of their surgery.

320
00:18:22,291 --> 00:18:24,750
And so, all of this has already transpired

321
00:18:24,791 --> 00:18:28,458
And so, I didn't really...
I mean I knew it went on, of course,

322
00:18:28,458 --> 00:18:32,666
but I didn't have any firsthand experience
with people searching for a donor.

323
00:18:32,708 --> 00:18:34,708
So that part was really new to me.

324
00:18:35,000 --> 00:18:38,875
It's interesting you know
when you talk about

325
00:18:38,875 --> 00:18:41,666
through the process
needing to appoint an advocate

326
00:18:41,666 --> 00:18:46,916
and that being a very clear
requirement for it to be someone else.

327
00:18:46,916 --> 00:18:50,208
I think there are a lot of people
outside of the medical community

328
00:18:50,250 --> 00:18:54,750
who would assume that being a
physician going through these things –

329
00:18:54,791 --> 00:18:56,791
and as we talked about,
there are definite advantages.

330
00:18:56,833 --> 00:18:59,708
There are ways that our
socioeconomic status helps us.

331
00:18:59,750 --> 00:19:02,750
There are ways in which being
part of the medical community,

332
00:19:02,750 --> 00:19:04,208
we speak the language already.

333
00:19:04,250 --> 00:19:06,250
There are lots of things that we do know,

334
00:19:06,250 --> 00:19:09,166
but there are some paradoxes there, right,

335
00:19:09,208 --> 00:19:14,916
in terms of being able to advocate for
ourselves and being in the role of patient

336
00:19:14,958 --> 00:19:17,541
And I wonder if you could
talk about your experience

337
00:19:17,583 --> 00:19:19,250
navigating some of those things, Rob.

338
00:19:19,500 --> 00:19:23,000
Well, being a patient was an
entirely new experience for me.

339
00:19:23,041 --> 00:19:28,875
I really didn't have much
background experience.

340
00:19:28,875 --> 00:19:31,375
I didn't have a way forward.

341
00:19:31,375 --> 00:19:34,250
I didn't know how to conduct myself

342
00:19:34,250 --> 00:19:37,833
as I was learning slowly
to become a patient.

343
00:19:37,875 --> 00:19:41,083
It's a gradual process. It
doesn't happen overnight.

344
00:19:41,125 --> 00:19:46,750
And I initially remember vividly
sitting in these waiting rooms,

345
00:19:46,750 --> 00:19:50,708
the transplant clinics, they're big
waiting rooms with lots of people.

346
00:19:50,708 --> 00:19:54,125
And I would just sit there
and look around the room.

347
00:19:54,125 --> 00:19:56,666
And, of course, you
invent a story for everybody

348
00:19:56,666 --> 00:19:59,625
that you see on a regular
basis at these appointments

349
00:19:59,625 --> 00:20:04,458
and try to understand what their situation
might be like as you bide the time.

350
00:20:04,916 --> 00:20:11,958
And as a physician, all of us can resonate
with this idea of having a busy clinic,

351
00:20:11,958 --> 00:20:16,041
taking one patient's chart, going out
to a waiting room, calling that patient,

352
00:20:16,083 --> 00:20:18,583
ushering them into an examining room,

353
00:20:18,625 --> 00:20:23,708
and you are sort of laser-focused
on that individual in that moment.

354
00:20:23,750 --> 00:20:27,250
But in the waiting room, as I
was learning to become a patient,

355
00:20:27,291 --> 00:20:32,708
what I started to realize was an
appreciation of the collective suffering.

356
00:20:32,708 --> 00:20:35,583
You look around the room,
and everybody is suffering.

357
00:20:35,583 --> 00:20:37,125
Everybody has a story.

358
00:20:37,125 --> 00:20:40,458
And in many cases, it was a
story that was so much more

359
00:20:40,458 --> 00:20:42,916
harrowing and frightening than my own.

360
00:20:42,958 --> 00:20:46,458
You make me think of the
concept of inattention blindness.

361
00:20:46,500 --> 00:20:51,708
That really we are trained to focus on
the one thing in front of us,

362
00:20:51,750 --> 00:20:54,458
to tune out everything
else, to look at the lesion

363
00:20:54,500 --> 00:20:57,041
as opposed to everything
surrounding the lesion.

364
00:20:57,041 --> 00:21:00,916
And it is an unlearning process when
we sort of learn to see things again

365
00:21:00,958 --> 00:21:06,708
with different eyes that doesn't
necessarily go with that conditioning.

366
00:21:07,000 --> 00:21:07,708
Yeah, very much so.

367
00:21:07,750 --> 00:21:10,916
Yeah. So, Marie, you were also a
patient. What was that like for you?

368
00:21:11,666 --> 00:21:14,666
You know, it was a really
good experience for me, actually.

369
00:21:14,708 --> 00:21:18,625
It's a pretty different thing
to decide to be a patient,

370
00:21:18,666 --> 00:21:22,208
which doesn't happen very often, I think.

371
00:21:22,250 --> 00:21:26,916
So, it's a very different experience
than I think being sick and having to

372
00:21:26,958 --> 00:21:33,333
deal with illness and deal with
this unwanted, unexpected situation.

373
00:21:33,333 --> 00:21:35,791
To me, it was something I
very clearly decided to do.

374
00:21:35,791 --> 00:21:41,250
And, in fact, once I found out that
I was a good match, so to speak,

375
00:21:41,250 --> 00:21:43,666
I was really excited to move forward.

376
00:21:43,708 --> 00:21:46,500
So, I honestly felt a lot
of excitement about it.

377
00:21:46,541 --> 00:21:51,125
A lot of nervousness about planning, but
a lot of excitement about moving forward.

378
00:21:51,125 --> 00:21:56,208
And I think the other thing is that the
team at UHN, I mean, they were amazing.

379
00:21:56,250 --> 00:22:02,250
So, everything was super organized
and everything went according to plan.

380
00:22:02,291 --> 00:22:06,916
So, it was really a
remarkable experience for me.

381
00:22:07,500 --> 00:22:13,375
The one thing I remember that I
found a little bit difficult is

382
00:22:13,375 --> 00:22:15,833
when we were in the hospital afterwards.

383
00:22:15,875 --> 00:22:18,541
I say we because we were
on the same ward, okay, right?

384
00:22:18,541 --> 00:22:21,875
But I remember being really self-conscious

385
00:22:21,916 --> 00:22:25,166
about hearing whether people
were sanitizing their hands or not

386
00:22:25,208 --> 00:22:26,875
when they were coming in to see me.

387
00:22:26,916 --> 00:22:29,583
So it was one of those
kind-of-painful things of being a doctor,

388
00:22:29,583 --> 00:22:32,750
and you know too much because
you know the sound of them sanitizing

389
00:22:32,750 --> 00:22:35,875
and whether they were
rubbing their hands long enough.

390
00:22:35,875 --> 00:22:37,416
And the sound of them not sanitizing.

391
00:22:37,416 --> 00:22:40,875
Right. And so, it'd be
like, "Oh, hi, you know."

392
00:22:40,916 --> 00:22:44,916
So, I found that I was in a bit of
a heightened awareness state

393
00:22:44,958 --> 00:22:46,250
because I didn't want to get sick,

394
00:22:46,250 --> 00:22:49,041
and I was going in there healthy
and wanted to come out healthy.

395
00:22:49,250 --> 00:22:52,041
But really, they were stellar.

396
00:22:52,083 --> 00:22:54,666
So I had a very good experience.

397
00:22:55,166 --> 00:22:58,166
There's a moment that Rob
told me about a little bit earlier

398
00:22:58,166 --> 00:23:00,708
that I wonder if you could expand on.

399
00:23:00,708 --> 00:23:05,041
And it was sort of a moment in
conversation between the two of you

400
00:23:05,083 --> 00:23:10,583
when your liver really became, in
conversation between the two of you,

401
00:23:10,583 --> 00:23:14,666
Rob's liver, and we were talking about whe
does that happen? When is that transition?

402
00:23:14,708 --> 00:23:17,166
So, what was that
moment for the two of you?

403
00:23:17,583 --> 00:23:18,708
That's a good question.

404
00:23:18,708 --> 00:23:21,208
I mean, I remember pretty soon after

405
00:23:21,250 --> 00:23:27,166
that we were talking about it, and Rob
and Marg were always so grateful.

406
00:23:27,166 --> 00:23:29,083
And I remember saying at a certain point,

407
00:23:29,083 --> 00:23:31,375
and I think this might have been
what you were talking about, I was like,

408
00:23:31,375 --> 00:23:33,375
"You know what, it's fully yours now;

409
00:23:33,416 --> 00:23:36,291
you don't need to keep
thanking me for it, you know."

410
00:23:36,291 --> 00:23:37,583
And Margaret would be like,

411
00:23:37,583 --> 00:23:39,416
"Rob's going to take
good care of that liver."

412
00:23:39,458 --> 00:23:43,458
And I was like, "It's fine. It's fully
yours, you know. No takebacks."

413
00:23:43,500 --> 00:23:47,041
With respect, Marie, it
was even more than that

414
00:23:47,041 --> 00:23:51,708
because we'd had coffee that day
and I had brought up this idea of you know

415
00:23:51,750 --> 00:23:54,291
I'm trying to take good care of your liver

416
00:23:54,333 --> 00:23:56,083
And you didn't say anything at the time,

417
00:23:56,125 --> 00:24:00,625
but when we got out of the coffee shop,
you squared off with me and you said,

418
00:24:00,625 --> 00:24:02,833
"Rob," and you hugged me, and you said,

419
00:24:02,833 --> 00:24:06,833
"Rob, this is your liver now.
Don't talk about it in any other way."

420
00:24:07,041 --> 00:24:08,041
I'm glad you heard me.

421
00:24:08,041 --> 00:24:10,083
I heard you. I did.

422
00:24:10,083 --> 00:24:12,416
But it was a very meaningful moment for me

423
00:24:12,416 --> 00:24:17,625
Because it's a gradual process
to then believe that this is…

424
00:24:17,625 --> 00:24:20,583
…something that's real.

425
00:24:20,625 --> 00:24:26,375
Because, you know, becoming an organ
donor is the purest of elective surgery.

426
00:24:26,416 --> 00:24:32,375
And that altruistic gift is an
extreme expression of empathy.

427
00:24:33,125 --> 00:24:40,250
Marie was such the hero in this exchange
because she had a big decision to make.

428
00:24:40,250 --> 00:24:42,500
I didn't have a decision to make.

429
00:24:42,500 --> 00:24:46,708
You know, there was nothing I could do
about my situation. I couldn't help myself

430
00:24:46,750 --> 00:24:49,125
And that was probably the
most frustrating thing of all.

431
00:24:49,125 --> 00:24:52,958
We're used to being in the
driver's seat, turning the dials;

432
00:24:53,000 --> 00:24:56,041
you know, we're all sort
of type A personalities.

433
00:24:56,083 --> 00:24:59,791
And this was very
difficult to be a passenger

434
00:24:59,833 --> 00:25:03,083
and be out of control and feeling helpless

435
00:25:03,583 --> 00:25:04,875
Yeah. So, that just takes me back

436
00:25:04,916 --> 00:25:06,833
to something Marie was
saying a few minutes ago

437
00:25:06,875 --> 00:25:08,708
about the locus of control,

438
00:25:08,750 --> 00:25:12,291
sort of making the choice to do this.

439
00:25:12,291 --> 00:25:16,916
And we have some very
positive framing in terms

440
00:25:16,958 --> 00:25:20,958
of what it feels like
to make that decision,

441
00:25:21,000 --> 00:25:24,750
make that step. How
it is actually reclaiming

442
00:25:24,791 --> 00:25:27,875
sort of that same
being-in-the-driver's seat

443
00:25:27,916 --> 00:25:30,250
feeling that you talked about, Rob.

444
00:25:30,291 --> 00:25:32,125
I wonder if you have any other
thoughts about that, Marie?

445
00:25:32,125 --> 00:25:38,833
Yeah, it felt great to make the decision.

446
00:25:38,833 --> 00:25:41,125
And in retrospect now,

447
00:25:41,125 --> 00:25:44,833
I think that it was an amazing experience.

448
00:25:44,833 --> 00:25:46,541
I'm so glad I did it.

449
00:25:46,583 --> 00:25:49,541
You know, it's like the
best decision I ever made.

450
00:25:49,583 --> 00:25:54,208
And so I feel really good about that.

451
00:25:54,208 --> 00:25:56,000
And I kind of think, "Wow,
I could have missed it"

452
00:25:56,041 --> 00:26:00,000
if I had just sort of kept thinking
why it wasn't a good idea.

453
00:26:00,000 --> 00:26:05,000
So, you're right, a big part of it was
figuring out whether it was a good idea.

454
00:26:05,000 --> 00:26:08,625
And also, part of making the decision

455
00:26:08,666 --> 00:26:13,083
and having the decision be a good
one was also all the people around me.

456
00:26:13,125 --> 00:26:16,416
So, once I went through
the medical part, and then,

457
00:26:16,416 --> 00:26:19,250
it was like, okay, is this
going to be okay at work?

458
00:26:19,291 --> 00:26:21,291
And is this going to be okay at home?

459
00:26:21,333 --> 00:26:26,416
And both home and work
people were just like a huge yes.

460
00:26:26,458 --> 00:26:32,166
So, that was really neat, and that
gave me kind of the extra courage

461
00:26:32,208 --> 00:26:36,875
to make that final step and really
decide to do it. And I'm so glad I did.

462
00:26:37,375 --> 00:26:38,708
And I love that framing.

463
00:26:38,750 --> 00:26:43,458
I think you really enrich our
understanding of the fact that

464
00:26:43,500 --> 00:26:46,666
it was clearly the person at the centre

465
00:26:46,708 --> 00:26:50,541
of the effort was you
in terms of the donation,

466
00:26:50,583 --> 00:26:54,333
but there was just this real, practical,
tangible,

467
00:26:54,375 --> 00:26:57,125
necessary support from your colleagues…

468
00:26:57,125 --> 00:26:59,333
…and your medical community
and your friends and your family.

469
00:26:59,375 --> 00:27:00,958
A hundred percent.

470
00:27:00,958 --> 00:27:05,125
At work, it really kind of blew me away.

471
00:27:05,166 --> 00:27:07,500
You know, like the minute
I told people at work,

472
00:27:07,541 --> 00:27:11,291
because I'm going to have
to figure out some coverage

473
00:27:11,333 --> 00:27:14,125
and make some arrangements
and ask for some favours.

474
00:27:14,125 --> 00:27:16,166
And the minute I told people
at work, everyone was like,

475
00:27:16,208 --> 00:27:18,916
"What can we do? How
can we be part of this?”

476
00:27:19,375 --> 00:27:25,250
It was really touching, actually.

477
00:27:25,291 --> 00:27:26,791
Surprise is not the right word,

478
00:27:26,833 --> 00:27:30,125
but I wasn't ready for that because
I'd been so worried about the details

479
00:27:30,125 --> 00:27:33,958
that I had forgotten that when
you want to do something special

480
00:27:34,000 --> 00:27:39,208
and you decide to do something
generous or to help somebody,

481
00:27:39,208 --> 00:27:43,208
other people want to be part
of it. So, that was amazing.

482
00:27:43,250 --> 00:27:45,083
So, it was actually really easy,

483
00:27:45,083 --> 00:27:51,375
like all of the arrangements at work
and making all all those coverage plans

484
00:27:51,416 --> 00:27:53,208
and everyone wanted to help out.

485
00:27:53,250 --> 00:27:54,916
Yeah. You can just sort
of hear it in your story,

486
00:27:54,916 --> 00:27:56,458
just taking on a life of its own, you know

487
00:27:56,458 --> 00:27:57,791
and enlivening…

488
00:27:57,791 --> 00:28:02,041
…giving everyone a positive focus
of something at a time of, again,

489
00:28:02,083 --> 00:28:04,291
when that control is taken away.

490
00:28:04,625 --> 00:28:09,291
And even when they came back after,
coming back,

491
00:28:09,333 --> 00:28:11,916
it was hilarious to me because
everywhere I would go in the hospital,

492
00:28:11,958 --> 00:28:13,333
people would be giving me thumbs up,

493
00:28:13,375 --> 00:28:20,541
people I didn't know.

494
00:28:20,583 --> 00:28:21,958
That was really special.

495
00:28:22,000 --> 00:28:23,750
Or I'd see a patient, and they'd say,

496
00:28:23,791 --> 00:28:26,250
"You know, I'm also a
patient of Dr. Stewart's."

497
00:28:26,250 --> 00:28:28,916
I don't know if I ever told you that.
People would say, and I'd be like, "Oh!"

498
00:28:28,958 --> 00:28:32,375
And they'd say, "We really
appreciate what you did for him."

499
00:28:32,375 --> 00:28:34,125
And it would really surprise me.

500
00:28:34,166 --> 00:28:35,041
So, it would come out...

501
00:28:35,041 --> 00:28:38,541
it came at me all these
different ways at work afterwards,

502
00:28:38,583 --> 00:28:44,125
and it just gave me a real
sense of, how just like you said,

503
00:28:44,166 --> 00:28:47,875
it means a lot to people to
be part of something positive,

504
00:28:47,916 --> 00:28:52,666
and it meant a lot to me to have this
community that kind of joined me in this,

505
00:28:52,708 --> 00:28:57,083
and it made me feel more
confident about the whole plan.

506
00:28:57,083 --> 00:29:02,458
Well, you just make me think of too...
we're so overwhelmed with horrible things,

507
00:29:02,458 --> 00:29:03,458
negative cases,

508
00:29:03,458 --> 00:29:05,666
difficult outcomes, suffering.

509
00:29:05,666 --> 00:29:09,708
But when there's something
that people can believe in,

510
00:29:09,750 --> 00:29:13,875
something where a person
can see a different trajectory,

511
00:29:13,875 --> 00:29:17,041
a different path, the whole
other ending to the story.

512
00:29:17,041 --> 00:29:22,125
It's so powerful. And especially
for a community. That's amazing.

513
00:29:22,416 --> 00:29:28,041
Rob, I want to go back and talk a
little bit more about physician as patient

514
00:29:28,041 --> 00:29:30,958
because certainly one
of the things in our series,

515
00:29:31,000 --> 00:29:33,333
we've had the opportunity to talk

516
00:29:33,333 --> 00:29:37,833
and will continue to talk to physicians
who have faced life-altering diagnoses.

517
00:29:37,875 --> 00:29:41,416
And I know one of the things
that I think it's really helpful

518
00:29:41,416 --> 00:29:45,125
for us to explore together
in these conversations

519
00:29:45,166 --> 00:29:49,041
are the barriers, the things
that are conditioned into us.

520
00:29:49,083 --> 00:29:52,041
We talked about the type A personalities

521
00:29:52,083 --> 00:29:56,833
but also the medical exceptionalism,
the things that we are marinated in,

522
00:29:56,875 --> 00:30:01,250
in terms of medical culture, that
can influence our behaviours, again,

523
00:30:01,250 --> 00:30:04,875
in ways that the general
public might not understand,

524
00:30:04,875 --> 00:30:09,791
or might think are completely
illogical for us as physicians.

525
00:30:09,791 --> 00:30:15,541
And I wonder, as you move to this
other part and phase of your life now,

526
00:30:15,583 --> 00:30:18,166
and certainly one where everybody
knows that you have been

527
00:30:18,166 --> 00:30:21,708
and continue to be
a physician-patient,

528
00:30:21,708 --> 00:30:25,083
what other things
have really been illuminated for you?

529
00:30:25,333 --> 00:30:26,875
Well, a number of
things. I mean, I think that

530
00:30:26,875 --> 00:30:30,500
we can talk about the
physician as a patient.

531
00:30:30,541 --> 00:30:35,500
We can also talk about the physician who i
looking after a physician who is a patient

532
00:30:35,541 --> 00:30:38,250
And so, it's all sort of part of the same,

533
00:30:38,250 --> 00:30:42,250
but it comes from a different
angle, a different lens.

534
00:30:42,291 --> 00:30:46,875
And the two are very much
intertwined at times, and I think that

535
00:30:46,875 --> 00:30:51,041
when a physician becomes
a physician of another patient,

536
00:30:51,083 --> 00:30:54,291
it can sort of challenge
our equanimity a little bit.

537
00:30:54,291 --> 00:30:58,916
Boundaries become blurred, and
assumptions are made, as we all know.

538
00:30:58,916 --> 00:31:02,041
You know, people tend to
talk over your head quite a bit.

539
00:31:02,041 --> 00:31:04,791
And I was really frightened
that people would assume

540
00:31:04,833 --> 00:31:07,000
that I had knowledge that I may not have

541
00:31:07,041 --> 00:31:09,083
and that they would talk over
my head, and there would be gaps

542
00:31:09,125 --> 00:31:12,166
in my understanding of exactly
what was going to happen.

543
00:31:12,166 --> 00:31:13,916
And so, I made it clear
with all of my doctors,

544
00:31:13,916 --> 00:31:18,541
"Please talk to me like you
talk to all of your other patients.

545
00:31:18,541 --> 00:31:23,000
Don't let all of these years of
training and rigour go out the window

546
00:31:23,041 --> 00:31:27,041
because you think you're going to do
me a favour by cutting a few corners

547
00:31:27,083 --> 00:31:30,708
and just getting right
to the final statement."

548
00:31:30,708 --> 00:31:34,250
I really needed to hear it,
like all patients needed to.

549
00:31:34,250 --> 00:31:39,041
In part because it was overwhelming
for me emotionally, and I wasn't well;

550
00:31:39,083 --> 00:31:41,500
I wasn't thinking as
clearly as I normally would.

551
00:31:41,500 --> 00:31:44,916
And so, for a number of reasons,
it was really important for me

552
00:31:44,958 --> 00:31:47,833
to be treated just like a patient

553
00:31:47,875 --> 00:31:52,125
and not to feel that someone was
trying to go the extra mile for me

554
00:31:52,125 --> 00:31:55,375
by talking to me at a very
high level or something like that.

555
00:31:55,416 --> 00:31:57,708
I didn't need that at that time.

556
00:31:57,708 --> 00:31:59,166
The doctors and the nurses

557
00:31:59,208 --> 00:32:02,083
and the allied health
professionals were fantastic at that.

558
00:32:02,083 --> 00:32:04,000
They were so skilled,

559
00:32:04,041 --> 00:32:08,000
and they immediately allayed
any fears that I might have had

560
00:32:08,041 --> 00:32:09,875
that that would be the case that
would sort of turn out that way.

561
00:32:09,875 --> 00:32:11,291
It didn't.

562
00:32:11,333 --> 00:32:14,916
They were really, really
excellent at what they did.

563
00:32:14,916 --> 00:32:20,250
But somewhere in our training,
I guess, we get armoured up

564
00:32:20,291 --> 00:32:25,333
to believe that we can't experience
disease because we cure disease

565
00:32:25,375 --> 00:32:29,041
and that we are somehow
different from others when, in fact,

566
00:32:29,041 --> 00:32:32,416
we are as vulnerable as
all of the patients we treat.

567
00:32:33,250 --> 00:32:36,625
And one of the other things
that I started thinking about

568
00:32:36,625 --> 00:32:38,375
as I was going through it

569
00:32:38,416 --> 00:32:42,583
was that we have this compassion
and empathy for our patients.

570
00:32:42,583 --> 00:32:43,708
And it's very real.

571
00:32:43,708 --> 00:32:48,291
It comes from a very real,
genuine place, I believe.

572
00:32:48,291 --> 00:32:52,041
And yet, when we get sick
ourselves, we judge ourselves.

573
00:32:52,083 --> 00:32:55,416
We see illness in ourselves as weakness.

574
00:32:55,458 --> 00:32:57,791
And I couldn't get over
that for the longest time.

575
00:32:57,833 --> 00:33:02,291
I carried a big stick and
flagellated myself for getting sick.

576
00:33:02,333 --> 00:33:07,916
And we need allow ourselves
to have or to permit
ourselves, I guess,

577
00:33:07,958 --> 00:33:12,833
to experience illness the same
way as the people we care for.

578
00:33:12,875 --> 00:33:16,541
And I think that it can extend
even within our community

579
00:33:16,583 --> 00:33:19,416
to something that is
also to be unwished for,

580
00:33:19,458 --> 00:33:22,541
and that is when we judge
our colleagues who get sick.

581
00:33:22,541 --> 00:33:24,958
You know, I mean, we need
to be more caring.

582
00:33:25,000 --> 00:33:28,208
We need to be more
accepting within ourselves.

583
00:33:28,208 --> 00:33:32,666
And I think that pushing for better
wellness within our medical community

584
00:33:32,708 --> 00:33:34,833
is something that's
always worth striving for.

585
00:33:35,416 --> 00:33:39,416
You know, there's so
much to take apart in what you just said.

586
00:33:39,458 --> 00:33:42,291
But one thing I really think
is this idea of compassion,

587
00:33:42,333 --> 00:33:44,083
that compassion for other people.

588
00:33:44,125 --> 00:33:49,291
We know that in many cases, people
in general struggle with self-compassion,

589
00:33:49,291 --> 00:33:53,833
but in medicine, of course, there is this
perception that exists in certain quarters

590
00:33:53,833 --> 00:33:57,958
that self-compassion is a kind of
weakness, a kind of self-indulgence.

591
00:33:58,000 --> 00:34:02,708
We are averse to it
despite literature that tells us

592
00:34:02,708 --> 00:34:04,291
that actually it does
make us better doctors

593
00:34:04,333 --> 00:34:07,875
and does help with personal
resilience, et cetera, et cetera.

594
00:34:07,875 --> 00:34:11,166
But there's also something
curious in there that I think

595
00:34:11,166 --> 00:34:15,000
ties right back into those roots
around medical exceptionalism.

596
00:34:15,041 --> 00:34:16,833
You know because on the
one hand, it's like,

597
00:34:16,875 --> 00:34:21,625
I don't deserve this, what other
people have, but there is a kind of, again

598
00:34:21,666 --> 00:34:23,791
grandiosity in that conditioning.

599
00:34:23,833 --> 00:34:26,791
I don't think we come to
medicine embedded with this idea.

600
00:34:26,833 --> 00:34:29,041
I think it's implanted and sort of evolves

601
00:34:29,083 --> 00:34:32,083
as we live in this professional
culture for a long time.

602
00:34:32,083 --> 00:34:36,250
But, gee, I must be terribly
special if I'm not worthy

603
00:34:36,250 --> 00:34:38,541
of the same compassion
that everyone else is.

604
00:34:38,583 --> 00:34:44,208
So, there's even this flip side to it
that it's not just I don't deserve it.

605
00:34:44,208 --> 00:34:47,791
It's like I'm special,
so I don't deserve it.

606
00:34:47,791 --> 00:34:48,625
Or don't need it.

607
00:34:48,625 --> 00:34:51,333
Like it's a complex...
or need it or require it as well.

608
00:34:51,333 --> 00:34:52,666
Yeah

609
00:34:52,666 --> 00:34:54,916
And this piece that
you talked about, again,

610
00:34:54,958 --> 00:34:59,500
I think is so interesting of
berating yourself for getting sick,

611
00:34:59,500 --> 00:35:03,875
but when we think about it, we think
about what else are we conditioned to do?

612
00:35:03,916 --> 00:35:07,583
Work without sleep, work without
food, work without expressing emotions.

613
00:35:07,625 --> 00:35:11,625
So, it really isn't a far
distance to go then to think,

614
00:35:11,625 --> 00:35:14,000
"Well, I should also be able
to work without getting sick."

615
00:35:14,041 --> 00:35:18,125
And this is one more, again,
interesting thing to tease apart.

616
00:35:18,166 --> 00:35:21,416
Yeah. It is. And we
have this medical mantra,

617
00:35:21,458 --> 00:35:24,708
and we're all very familiar with
it, and it goes something like this:

618
00:35:24,708 --> 00:35:28,458
Push. Push harder. Push even harder.

619
00:35:28,583 --> 00:35:32,750
And that, for sure, is not
conducive to healing oneself…

620
00:35:32,750 --> 00:35:34,125
…for sure.

621
00:35:34,125 --> 00:35:38,750
And so, that's something that
I think that, if as a community

622
00:35:38,791 --> 00:35:43,083
we explored more fully
and shared more honestly,

623
00:35:43,083 --> 00:35:46,416
it could make us all better at what we do.

624
00:35:46,458 --> 00:35:50,958
At least how we care for
ourselves is a big piece of that.

625
00:35:51,458 --> 00:35:56,208
I think in terms also of
this idea that you mentioned

626
00:35:56,250 --> 00:36:00,333
of treating colleagues
who are our patients.

627
00:36:00,375 --> 00:36:04,333
You make another point
that should be so apparent,

628
00:36:04,375 --> 00:36:07,458
and yet I think it so often is not.

629
00:36:07,500 --> 00:36:10,000
Whether it's when we
are patients or whether

630
00:36:10,041 --> 00:36:11,916
we're caring for colleagues as patients,

631
00:36:11,916 --> 00:36:16,250
and we forget that in the
moments when we're not well,

632
00:36:16,250 --> 00:36:20,083
our brains are not functioning
in the same way that they are

633
00:36:20,083 --> 00:36:24,375
when we are at work as the attending
physician or the physician in clinic.

634
00:36:24,416 --> 00:36:27,875
And it seems so obvious it shouldn't
even need to be said, and yet,

635
00:36:27,875 --> 00:36:31,333
I think time and time again, we make
some of those cognitive shortcuts,

636
00:36:31,333 --> 00:36:32,708
caring for each other.

637
00:36:32,708 --> 00:36:37,291
We think, "Well, I feel silly telling Rob
this, because, surely, he knows this."

638
00:36:37,291 --> 00:36:40,791
And then maybe Rob is going to
think, "I don't think he's very smart."

639
00:36:40,833 --> 00:36:44,166
And we get caught up
in all this kind of narration

640
00:36:44,166 --> 00:36:46,375
related to power dynamics and hierarchies

641
00:36:46,416 --> 00:36:49,875
and pre-existing relationships when really

642
00:36:49,916 --> 00:36:54,208
there's a need for kind of
returning back to the basics.

643
00:36:54,250 --> 00:36:58,875
And you said something else a
while ago, before our interview today,

644
00:36:58,875 --> 00:37:00,750
but you talked about this perception

645
00:37:00,791 --> 00:37:05,625
that we have that some of these shortcuts
and curbside consults are added value.

646
00:37:05,666 --> 00:37:07,583
Could you just reframe that a little bit?

647
00:37:07,583 --> 00:37:09,500
Because I thought that
was such great framing.

648
00:37:09,541 --> 00:37:14,083
Well, I think oftentimes that we are
trying to do our colleagues a favour.

649
00:37:14,125 --> 00:37:18,708
I'll see you in the hallway, and we'll
just quickly go over your symptoms.

650
00:37:18,750 --> 00:37:23,625
But in so doing, we throw
out the rigour of our training.

651
00:37:23,666 --> 00:37:28,958
We really try to distill it down
to something that's maybe

652
00:37:28,958 --> 00:37:34,541
not fully illustrative
of the larger problem.

653
00:37:34,583 --> 00:37:40,750
You know, we don't appreciate it with
the same rigour that we would normally.

654
00:37:40,750 --> 00:37:44,416
And in trying to do a
better job for our colleagues,

655
00:37:44,458 --> 00:37:49,416
I fear that it's possible at
times to do a less good job

656
00:37:49,458 --> 00:37:51,791
because of these shortcuts
that sometimes take place.

657
00:37:52,041 --> 00:37:54,541
It's not always the
case, but it can happen.

658
00:37:54,541 --> 00:37:58,458
And I think we can all see how
we could be vulnerable to doing so.

659
00:37:59,833 --> 00:38:01,750
Do you think, in your experience,

660
00:38:01,791 --> 00:38:07,958
that when we are seeing colleagues
or other health care workers as patients

661
00:38:08,000 --> 00:38:09,958
that we ask enough about
their emotional suffering,

662
00:38:10,000 --> 00:38:13,333
or is that something that we
maybe handle differently as well?

663
00:38:13,666 --> 00:38:17,958
I think we handle it differently.
I know I did; for sure, I did.

664
00:38:17,958 --> 00:38:23,625
I underplayed it because of that
sort of doctors-don't-get-sick-type thing.

665
00:38:24,250 --> 00:38:29,250
And now, as I have learned – or am
still learning – to be a patient myself.

666
00:38:29,250 --> 00:38:31,208
It's a very gradual process.

667
00:38:31,250 --> 00:38:36,291
Even though your traditional hierarchy,
in my case, got flipped upside down -

668
00:38:36,333 --> 00:38:40,541
and not gradually, but in
an instant in my experience -

669
00:38:40,583 --> 00:38:46,333
but still, it is a growing period of reall

670
00:38:46,333 --> 00:38:49,750
internalizing the fact
that you are a patient

671
00:38:49,750 --> 00:38:54,500
and in need and that you can't always
make the best decisions for yourself.

672
00:38:54,500 --> 00:38:58,750
You certainly can't heal yourself
in many of these situations,

673
00:38:58,791 --> 00:39:03,750
and you're so dependent in a way
that maybe we haven't been before.

674
00:39:03,791 --> 00:39:08,083
And that's a new role
for us to grapple with.

675
00:39:08,291 --> 00:39:14,291
Rob, you talked about a couple of things
that were really impactful and surprising

676
00:39:14,333 --> 00:39:17,666
about the whole experience, and I
wonder if you could share those now.

677
00:39:17,916 --> 00:39:19,125
Sure.

678
00:39:19,125 --> 00:39:22,500
You know, when I was told that
I would require a liver transplant,

679
00:39:22,541 --> 00:39:26,750
I had no idea what that involved.
And I alluded to that earlier.

680
00:39:27,166 --> 00:39:29,250
I didn't know how to begin.

681
00:39:29,291 --> 00:39:39,916
But as I began to search, I started to
realize the importance of how anonymous

682
00:39:39,958 --> 00:39:44,583
the donor recipient issues
have to stay by necessity.

683
00:39:44,625 --> 00:39:48,833
They have to be kept very separate
to be respectful of a potential donor

684
00:39:48,875 --> 00:39:52,125
who may have a change of heart at
the 11th hour or something like that.

685
00:39:52,208 --> 00:39:53,750
It has to be an anonymous,

686
00:39:53,750 --> 00:39:56,416
separate work-up

687
00:39:56,416 --> 00:40:01,458
so as to eliminate any
possibility of coercion, for instance.

688
00:40:02,291 --> 00:40:07,208
And while I understood
that, intellectually,

689
00:40:07,250 --> 00:40:15,250
to experience that frustrating
opacity was just challenging

690
00:40:15,291 --> 00:40:19,708
because I had all these doctors
who were cheering me on.

691
00:40:19,708 --> 00:40:21,000
They were saying, "Rob, just keep running.

692
00:40:21,000 --> 00:40:23,833
We're looking for a donor. We're looking
for a donor. Just keep running the race."

693
00:40:23,875 --> 00:40:28,333
But you have no idea where
the finish line is. You just don't.

694
00:40:28,375 --> 00:40:36,125
And so again that loss of control was
really a challenging part of the process.

695
00:40:36,708 --> 00:40:42,000
So, I want to go back for a moment
to a bit of a bigger picture worldview,

696
00:40:42,041 --> 00:40:45,083
and I'm going to ask you first, Marie.

697
00:40:45,125 --> 00:40:50,250
How has this experience changed
your perspective on medicine and life?

698
00:40:50,708 --> 00:40:53,833
I think the way that it
changed me the most

699
00:40:53,875 --> 00:40:59,333
is it made me realize the
privilege of the position I have

700
00:40:59,375 --> 00:41:04,291
and to think about privilege.

701
00:41:04,333 --> 00:41:08,708
This is something over the last couple
of years that I've thought more about

702
00:41:08,708 --> 00:41:12,125
when I've tried to talk to
people about being a donor.

703
00:41:12,125 --> 00:41:14,791
Actually, I'll take a step
back. You know, Rob and I

704
00:41:14,791 --> 00:41:21,125
decided the day after the surgeries that
we were going to talk about this, right?

705
00:41:21,125 --> 00:41:25,000
And that we had decided
that we were, even before,

706
00:41:25,000 --> 00:41:27,791
that we weren't worried
about our confidentiality.

707
00:41:27,833 --> 00:41:31,833
We were going to talk openly about it
because everyone was going to know anyway,

708
00:41:31,833 --> 00:41:34,958
so maybe it was better
that they weren't whispering.

709
00:41:34,958 --> 00:41:39,500
But as the days unfolded
after the surgeries,

710
00:41:39,541 --> 00:41:43,333
we agreed that it was important
to talk to other people about it.

711
00:41:43,375 --> 00:41:46,250
And so, that got me
thinking about what is it

712
00:41:46,250 --> 00:41:48,041
that I want to say to
other people about it?

713
00:41:48,083 --> 00:41:53,583
And one of the first things was
that it was not that difficult to do this.

714
00:41:53,625 --> 00:41:56,750
And then that made me really
kind of think about the fact

715
00:41:56,750 --> 00:41:59,875
that one of the reasons it
was not that difficult for me

716
00:41:59,916 --> 00:42:03,958
is because of this
lucky position that I'm in.

717
00:42:04,500 --> 00:42:10,791
That as you mentioned before, we
have financial stability as doctors,

718
00:42:10,791 --> 00:42:13,833
and as I mentioned before,
we have a lot of knowledge

719
00:42:13,875 --> 00:42:16,916
about the process and the
surgeries and the recovery.

720
00:42:16,916 --> 00:42:22,166
So all those things kind of take down
a lot of the obstacles and scary things,
you know?

721
00:42:22,583 --> 00:42:28,958
So, it made me think about that
and be prepared to talk about it.

722
00:42:29,000 --> 00:42:31,833
Like I remember going to talk to
someone about the experience

723
00:42:31,875 --> 00:42:34,958
of being a donor and talking
to my daughter about it first.

724
00:42:35,000 --> 00:42:38,208
And my daughters are very
wise; they always teach me things.

725
00:42:38,250 --> 00:42:39,791
And so, I was saying to my daughter

726
00:42:39,791 --> 00:42:43,583
that I wanted to talk about
the fact that having this position,

727
00:42:43,625 --> 00:42:48,541
there were some things about the
privileged position that I'm living in

728
00:42:48,541 --> 00:42:50,833
that made it possible for me to be a donor

729
00:42:50,875 --> 00:42:53,500
but that that was uncomfortable
for me to talk about.

730
00:42:53,500 --> 00:42:56,291
And she said, "You know what, privilege,"

731
00:42:56,291 --> 00:42:58,375
she taught me such a simple thing.

732
00:42:58,416 --> 00:43:01,416
She said,
"You don't need to deny your privilege;

733
00:43:01,458 --> 00:43:04,666
you need to acknowledge it
and do good things with it."

734
00:43:04,958 --> 00:43:08,166
And so, that made me think,
maybe that's what this is.

735
00:43:08,208 --> 00:43:10,875
And maybe that's what I can share is that

736
00:43:10,916 --> 00:43:15,041
maybe as health care
professionals, as doctors,

737
00:43:15,083 --> 00:43:20,000
we're in a kind of a privileged position,
and maybe that makes us really good donors

738
00:43:20,041 --> 00:43:24,791
for a lot of the reasons I said already.

739
00:43:24,833 --> 00:43:28,291
And since doing the surgery,

740
00:43:28,333 --> 00:43:31,958
I've had two pretty close friends

741
00:43:32,000 --> 00:43:36,958
or part of my personal family
connections kind of thing

742
00:43:36,958 --> 00:43:39,791
who have donated livers.

743
00:43:39,833 --> 00:43:45,125
And so, that was really neat to
me to be able to use my experience

744
00:43:45,125 --> 00:43:48,458
and the fact that I was
game to talk about it

745
00:43:48,500 --> 00:43:50,791
meant that people came to
me and asked me questions

746
00:43:50,791 --> 00:43:54,125
and I was able to help them feel
comfortable in their decision process.

747
00:43:54,750 --> 00:43:59,500
So I think that those were the
most important things for me.

748
00:43:59,541 --> 00:44:03,750
Yeah. The way that we influence
the people around us with our choices

749
00:44:03,791 --> 00:44:05,583
in ways that we might never…

750
00:44:05,583 --> 00:44:08,166
…imagine is what I
really take away from that.

751
00:44:08,250 --> 00:44:10,708
Yeah, it was a hundred percent.

752
00:44:11,166 --> 00:44:15,416
Marie, I remember even before
the surgery, we talked a few times.

753
00:44:15,416 --> 00:44:19,458
And just sort of getting
a sense of each other

754
00:44:19,458 --> 00:44:22,500
and how we felt about
what we were about to do.

755
00:44:22,541 --> 00:44:26,791
And just before the surgery,
we talked, and we agreed, I think,

756
00:44:26,833 --> 00:44:30,041
that we both felt pensive, but not scared.

757
00:44:30,166 --> 00:44:32,750
The night before the surgery, right?

758
00:44:32,791 --> 00:44:34,750
The night before the surgery, yeah.

759
00:44:34,750 --> 00:44:37,708
But at that time, I think
we even agreed then

760
00:44:37,708 --> 00:44:40,500
that this was something that we
were going to talk about and share…

761
00:44:40,541 --> 00:44:43,416
…our experience,
whether it was good or bad.

762
00:44:43,833 --> 00:44:46,125
Ultimately, it was wonderful.

763
00:44:46,166 --> 00:44:47,708
And we were very lucky.

764
00:44:47,708 --> 00:44:54,416
But it's something that we would openly
share with others to the extent possible

765
00:44:54,458 --> 00:44:57,625
because it's such an
important thing to consider.

766
00:44:57,625 --> 00:45:03,166
I mean, the idea that we can be an organ
donor and save someone's life is profound.

767
00:45:03,750 --> 00:45:07,291
Yeah. It has just been a privilege to
have this conversation with you today.

768
00:45:07,333 --> 00:45:13,875
It's amazing to hear your story, to see yo
together and to hear both of you sharing

769
00:45:13,875 --> 00:45:18,458
this incredible experience
from different vantage points

770
00:45:18,458 --> 00:45:20,541
but ending up in the same place.

771
00:45:21,083 --> 00:45:22,166
Well, thank you for having us.

772
00:45:22,166 --> 00:45:22,958
Thank you.

773
00:45:23,000 --> 00:45:25,000
It was a real pleasure.

774
00:45:25,000 --> 00:45:26,666
Oh, pleasure was mine.