The Good, The Narcotics and The Truly Ugly

Being a doctor here is mainly a good thing. This seems like a short and simple statement but the intricacies of modern medicine make it difficult to say whether it is enjoyable, or frustrating or well and truly disheartening. With the central pressures on the NHS in the UK - governmental targets which are impossible to meet with lack of funding and doctors - and the postcode lottery of treatment, medicine ceased to be 'fun' even at a basic level. 

A family doctor in a small town can expect a whole different set of pressures - a long workday which does not necessarily end, even when not 'on duty'. A large investment in the emotional as well as the physical well-being of patients and even families. A very different kind of doctor-patient relationship than I have been used to up until now, will less formality and no clear-cut boundaries. And the proverbial buck stops with you, as you are the end of the lifeline.

I like this most of the time - my patients call me Bella, and if they are feeling more formal, Doc Bella. They feel comfortable to share their lives and vulnerabilities. They are complimentary when they feel as if they have been taken care of and listened to, even if no obvious solution is forthcoming. I look after them through pregnancies, family crises, severe pathologies and even death (or I hope to, as I have not been here long enough yet to achieve all these things). This was how I wanted to run my practice in the UK, but was hampered by time limits (no sign on my wall here that says 'YOU HAVE 10 MINUTES ONLY', and there would not have been one in England if I had not been found to have removed mine surreptitiously), ridiculous targets and a high patient turnover in the area. 

More difficult are the times you are buying a bunch of incredibly unhealthy food at the store (usually an assortment of chips and baba ganoush, which is more like garlic mayo here), when you are flagged down by a patient who asks for test results. To be honest, unless I see them regularly then I usually will have trouble recalling their name, never mind the intricacies of their head CT. I have to wave this off currently 'not sure if I have seen them yet, why don't you give the girls a call on Monday and see if they have arrived....' , which I always hope will elicit a nod and an appreciative smile. At least they can pass me off as the eccentric English doctor who calls everyone 'sweetie' - a euphemism for 'I have no idea what your name is' more often than I care to say.

Another problem crossing the pond is the narcotic use here. Although I am sure that Canada is not on a par with the US, where it seems narcotic scripts are a part of life (see Woody Allen and Diane Keaton's great conversation in Play It Again Sam, a 1970's film where they are discussing the relative merits of various narcotics and anxiolytics with certain soft drink combinations or in more modern times the addictions of House MD), it is still far beyond the UK where such potions are tightly regulated. The only patients I had on anything stronger than codeine were palliative care patients who were dying of cancer or other disorders. Here hydromorphone (have never used this before) is given out like smarties and oxycodone is massive on the black market (physician's triplicate script pads are worth around $3000 dollars).  Patients who are addicted and even selling the tablets will 'doctor-hop' to get more tablets than they will or should use. I have generally been unwilling to give out these and the patients who I have inherited who are on them, I am trying to wean off or transform their pain by other means. 

And lest I had forgotten I am English, as we have been so welcomed here and feel almost part of the community already, I ran into a little 'racism' the other day. I was working hard in the ER and a man came up to me while I was note-writing and asked me if I was going to see his child. I replied that yes, she was next in line and I apologised for the wait - I had been seeing a stroke patient, a heart attack and an elderly gentleman who had fallen (such is the importance of triage). His face changed from passive to aggressive in the space of a heartbeat - the hospital and all the doctors were accused of unbelievable behaviour and he obviously felt that he had been ignored at other times. Incidentally, his daughter was suffering from a minor problem much better suited to the GP's office. I attempted to apologise for myself and my brethren and again reiterated that I would see her very shortly. He refused and dragged the uncomfortable-looking child out behind him. As he went, he uttered 'and piss off back to England'. My immediate reaction was to utter something equally outrageous to his departing back, but luckily he did not hear me as this was marginally unprofessional. 

This has stuck with me - if only to remind me that there is only one race still - mankind.

From perogies to poutine - the gastronomy of Canada

Having generalised (probably a little grossly) about Canada so far in my blog, this is definitely the time to separate the country, when discussing food. As most will know, this is a subject dear to my seemingly ever-expanding stomach, so I would not want to attribute BC vittels to those in other provinces. Canada is made up of British Columbia, Ontario, Quebec, Nova Scotia, New Brunswick, Manitoba, Prince Edward Island, Newfoundland and Labrador, Saskatchewan and Alberta (for those who did not know and yes, that included me comprehensively). 

British Columbia has benefitted from the whole Pacific Northwest cuisine movements, which emphasises fresh, seasonal and local foods and is lucky enough to have the bounty of the Pacific to draw on. BC is famed for salmon - there are 5 types - chinook, coho, pink, chum and sockeye and they are all edible. The smoking process here is somewhat different to the delicate cold-smoking that you find in Scotland (this is not the same as 'smoking in the cold' which happens frequently in Scottish pub car parks since the ban and is not so delicate). Even cold-smoked salmon has brine or sugar added for a heavier taste. The First Nations make salmon candy - which is smoked salmon marinated in maple syrup, smoked again and black pepper is added - this results in a sweet/fishy treat (two words I had not thought to use in the same sentence) that only Fraser seems to like in our family. Salmon jerky is smoked, dried and smoked again and is often to be found in the backpacks of hikers for a 'protein treat' on the run. A local technique which we discovered in the summer is to BBQ salmon on a cedar plank which gives it a unique piquancy that is duplicated in the nostrils on a wander through the red cedars of the local forests.

Other ocean bounty that is employed on the menus of BC chefs and in homes - ling cod, steelhead (which my husband has been promising to go off and fish for in the local creek recently), sea urchins (most of which are exported to Japan), gooseneck barnacles, crab and shrimp of various varieties. 

Vancouver appears to have a diverse food scene that tends to concentrate on the local and fresh with heavy leanings towards the Pacific Rim. Sushi, sashimi and noodle houses seem to be on every corner, although I have been reliably informed that quality can not be guaranteed and to hunt down specific places. Secretly I am longing to go to the Legendary Noodle House where you can watch the chef making noodles by hand behind a glass partition - sounds somewhat like a hibachi and just as much exhibitionist fun. 

There is a hearty Slow Food Movement here and lots of 'artisan' farmers, although this word is bandied around a little too abundantly and I have even seen a sign for 'artisan' smoothies. However, there are some interesting small producers - at the Tapastree (geddit, ed?) they serve a huge variety of small plates that utilise a number of different cuisines and they include a mozzarella that is being made on Vancouver Island by a farmer who has imported the buffalo. We have had several locally made cheeses and smoked meats in the Salt Tasting Room in Gastown (in a street called Blood Alley, which makes it sound somewhat less appealing and like a Jack the Ripper hunting ground). Venison, elk and buffalo meat are all available and a lean substitute for steak or traditional hamburger. At the Sechelt Farmer's market in the summer there are a number of smallholders who sell sea asparagus, wild garlic, chanterelle mushrooms and heirloom tomatoes, and these markets are replicated in small towns throughout BC.

Just in case you are beginning to think all I do is eat, we must not neglect the wine of British Columbia which is well-kept secret outside the region. Pinot Gris and Pinot Noirs abound from the Island and the more famous Okanagan Valley and some of them are outstanding (I am no Jilly Goolden, but they are worth a try if you can find them outside BC) - we also appreciate the names of the vineyards - Church and State, Dirty Laundry, Therapy, Zero Balance, Burrowing Owl and even See Ya Later. Better known for Ice Wine - an exhorbitant but delicious dessert wine, the Okanagan seems to be hiding its lights under a bushel and is content to do so.

As far as the rest of Canada goes, we shall just have to see. The Ukranians brought pierogies, which are dumplings with a cheese and potato paste in the centre, and these seem to be ubiquitous (and like lead on the plate and in the stomach for several hours). Poutine originated in Quebec and spread across the nation - 'french' fries with fresh cheese curds and beef gravy - but we have yet to sample this 'delicacy'. 

So, as I sip my Tim Horton's coffee and eat my maple syrup laden pancakes, I will be back to more medical stories - and not the one where I go for an angiogram hopefully......

Poutine - doesn't it look appetising?

Canada is not the USA

When we first came to Western Canada to see Sechelt and meet our long, lost relatives, we quickly realised, that despite the proximity, Canada was most certainly not the USA. Both countries make up North America, have the longest shared border in the world and are intimately related by trade and job provision, but they maintain a difference that is tangible. There is definitely a need for a separate cultural identity as it would be easy to be overwhelmed by a richer, more influential and more populated neighbour. Trudeau once said relations with the US were like sleeping with an elephant - no matter how friendly and even-tempered is the beast, one is affected by every twitch and grunt.

There are more obvious factors that separate the countries - Canada still has the Queen as the head of state and the French culture permeates all of society, not just Quebec. The amount of space versus population, which always amazes me as you can drive through so many places in the US without seeing a car (although obviously a lot of it is not frozen wasteland, unless you have been to Nebraska in the winter). Canada is truly enormous and recently the government announced they were going to protect a large area of Boreal Forest in the north of Ontario - the area concerned is twice the size of England alone (although, let's face it, England is slightly smaller than Oregon). Even more shocking is that the population of England (not the UK) is over 49 million and the whole of Canada has a population not far over 33 million people.

The two countries were once at war - in 1812 the US and British forces in Canada brushed up against one another and gained a little piece of land each which was restored as quickly as it was hard won. There is a war of sorts being fought now over the Northwest Passage which the US maintains is 'international waters' and Canada is claiming for its own (and with threats to militarise.....). Barack Obama chose Canada for his first international visit and met with the premier - unpopular and head of a minority government, Stephen Harper. The Canadians greeted him with a fanfare reserved for royalty and the Pope and seem pleased that he is ideologically closer to the Canadian ideal than his predecessor (Canadians are fighting in Afghanistan, but not Iraq). 

We live a short drive to the border and enjoy being able to go to the US relatively easily, but there is no doubt once the lengthy border process is over things do change. There are plenty of residents in our town who have never been to the US, but often fly over it to the winter sun of Mexico. As you leave the Peace Arch, food portions get bigger, public places get noisier and gas gets cheaper (or should I say even cheaper having come from the UK where it costs about $100 to fill up). Although much of the television in Canada is from the US, they do make a few of their own programmes (the ever-amusing Corner Gas and the cult Degrassi Junior High anyone?). When we first came to BC, my lovely relative pointedly interjected 'they're Canadian you know' into conversations about famous movie stars and indeed it is true - Jim Carrey, Mike Myers and John Candy, as well as more contemporary stars like Seth Rogen and Ryan Reynolds, came from the largest country in North America (and in fact the world now Russia has been split). There is definitely a large dose of national pride and Canada Day is celebrated with parades, Molson and perogies (more later). This is actually refreshing to us - in a national survey only 20% of English people knew the date of St. George's Day and we are relegated to national pride only when our football team and fans are embarrassing themselves on the fields of Europe where their forebears fought and died.

Canadians should be proud to wear their Maple Leaf on their backpacks across the world, although one bit of history to end with - the US and Canada were once just colonies of the Empire - how things have changed.

Canadian Myths Debunking........

1. That it is snowy in Canada for 11 months out of 12 in a year.....

This is our first winter here and Sechelt had its

 worst snow in over 20 years. Apparently we normally have one week and it's gone. This was the view from the cove down at the bottom of our back garden and we enjoyed watching the coasters compare number of inches in their driveways in a manly fashion.....

2. That there are bears wandering around everywhere, even in your back garden....

This charming cuddly cub (ahem) was trotting around our backyard during most of the summer, eating plums and pears from the tree and once scaring Craig out of his wits. As he walked through from the garden next door where he had been collecting some wood, the bear

 was around a metre away from him, staring at him quizically, all 8 furry foot of him. He gradually backed away from the bear, growling loudly as he went - the poor animal pretty much shrugged (who is this crazy guy with not enough fat on him to make a good hibernation feast) and ambled off.

3. That all Canadians are wandering around dressed like mounties.....

Well, this was July 1st, Canada Day, when all the RCMP (Royal Canadian Mounted Police) do get dressed up in their ceremonial togs to parade. Unfortunately it was about 30 degrees so the sweat factor in all that red worsted wool must have been somewhat high. Most of the time

 they seem to copy their US counterparts and are to be found in blue costume and cap in Starbucks or shooting their speed guns at you on particularly tricky corners of the highway. I frequently get to see them in the ER escorting handcuffed assorted felons or mental health patients to be 'pinked' by me (the colour of the mental health forms that summarily detain people who are a danger to others or themselves).

4. That Canadians are obsessed by the Maple Leaf flag and all things maple........

The flowers are by the Peace Arch where British Columbia meets Washington State on the coast and where the three of us have spent some fun times in summer heat waiting to cross. Not only do we have the car wait, but then the foot wait inside the wonderful customs building which makes it very clear that there are no toilets despite the two hour queue and the lack of

 chairs. Luckily Fraser is quite accommodating about being changed on a narrow wall heater. Welcome to the US......

Fraser is enjoying both a dead bear and the general Maple Leaf theme here - although actually both belong to a transplanted American friend in West Sechelt. However, he did kill the bear and skin it himself, so he is pretty much a Canadian.

5. All Canadians have big four wheel drive trucks......

Our beloved Jeep Patriot - the first car I have ever owned and which proudly displays my novice driver sign (although I am positively amazing compared to a large number of the coasters). And this one is definitely true - even in the city.

6. Canada is a big country with some of the most stunning scenery in the world, not a myth.