Author: doctorisout(side)

blog, ideas

Why I Didn’t Watch the Royal Wedding


No Comments

Because I fundamentally disagree with a system which supports and reinforces a hierarchy of human existence. I reject the idea that some lives are more valuable, important, or noble because of their last name, where they were born, or the type of clothes they wear.

Because I can’t help but estimate how many of my patients could have been fed, housed, or treated with the cost of the outfit-changes alone.

Because I wonder how and why we, as a society, are uncomfortable with meeting the gaze of our homeless neighbours but will pine for a glimpse of far-away strangers with forced, flashy smiles. Why is humanity made palatable by designer dresses, artificial designations, and shiny cars?

Because I resent the expectation that women should give up their interests and career pursuits to maintain an image deemed appropriate by others.

Because I’m waiting for the day when the love of all people is acknowledged and celebrated with the same zeal and enthusiasm. A day when all people feel safe and welcome to step outside and express their truest identities.

Because I believe that there are other events in our society worthy of our discussion which are discounted, dismissed, or diminished because they make society uncomfortable and do not generate such handsome pay checks.

Because I wish that other successful, ambitious women received the same amount of attention as the blushing bride so that little girls could dream beyond their wedding day where the tenacity of their resolve and creativity supersedes the price tag on their gowns.

 

Advertisements
blog, health, ideas, medicine

What I Learned From My First Year As A Resident Doctor


No Comments

1. You’re only one…Google search away from coming up with a differential so long that even your staff is rolling their eyes.

2. Getting two pillows in your call-room is the universe throwing you a HUGE bone.

3. You’ll constantly be surprised by your ability to run on less and less sleep and more and more coffee.

4. You’ll start to understand why the enthusiasm of medical learners brightens up any ward.

5. Being part of a professional group is nice and so is having benefits – begin chanting – I have rights! I have rights!

6. Nothing cures the post-call blues like the comedic genius of Kevin Hart, John Mulaney, Amy Schumer, and Amy Poehler. Nothing.

7. One of the coolest moments will be being when you get called to a code and are able to manage it (#iknowstuff).

8. Be kinds to nurses.

9. Be kind to the person who hands out call room keys.

11. Drink lots of water and lots of coffee. But more water than coffee.

12. People can’t help you if you don’t let them know you’re struggling.

13. Rounds scheduled on days that end in ‘y’ typically have coffee at them.

14. Sometimes the quality of a rotation depends on the frequency of free coffees.

15. It goes faster than you think.

16. Patients love when you ask about their pets.

17. Ask how often the hospital keyboards get cleaned. I dare you.

18. Be kind to everyone…but especially the Timbit guy at Tim Horton’s.

 

health

Diverting Distraction


No Comments

Hello everyone and welcome back! This next post is long overdue and for that I apologize. I’m trying to take a step back, re-calibrate my schedule, and refresh my goals. Moving forward, I’ve challenged myself to sit down and write once per week so you can look forward to more consistent content in the near future!

Lately I have been thinking about distraction…mostly because I’ve been feeling so distracted. With changing rotations, endless amounts of charting, research deadlines, financial stress, social engagements, and the Olympics (much love to you Team Canada), I have been finding it increasingly difficult to tune into the task at hand and tune out all the noise in the background. I’ve always prided myself on being a multi-tasker extraordinaire; however, lately juggling 5-10 different tasks hasn’t been working for me or for what I’m trying to get done. So what to do? I’ve been trialling out a few different strategies. Here’s a little bit of what I’ve learned:

  • Recognize when it’s time for a break – This point should be bolded, underlined, circled in red, and covered in glitter. I somehow got the idea that feeling distracted meant I was being lazy and that there’s no way it could possibly represent anything else. I couldn’t be more wrong. I took a day off (gasp) and did absolutely nothing on my to-do list. Instead I listened to some of my favourite albums, read some new (non-medicine) books, napped and went to Crossfit. Initially, I felt SO guilty; however, in the following days/weeks, I had a renewed sense of focus. It was not only easier to concentrate but I had more fun doing the projects I had set out for myself. Huh.
  • One thing at a time – There’s more and more research coming out to suggest that multi-tasking isn’t cognitively efficient. It puts our brain in overdrive. We’re pouring out valuable energy with multiple background thoughts that burns our tank dry sooner rather than later. Undoubtedly, there’s times where balancing tasks may be unavoidable; however, trying to start and finish one task at a time is actually more efficient in the long run.
  • Make a timeline and be reasonable – Rome wasn’t built in a day and my 16 page research abstract certainly won’t be either. Break down tasks into smaller steps and figure out an appropriate plan of action. Then, stick to the plan. If distractions start coming in, refer back to your plan, incorporate changes as necessary and return to the task at hand.
  • Know your strengths and capitalize on them – I’ve always admired people who can plug away on papers and studying well into the wee hours of the morning. I have never been one of them. The times I’ve tried I’ve woken up with impressions of my textbooks on my face – cute. What I do know is that I do some of my best work in the mornings. Just like a hockey player shoots with their preferred hand to increase their chance of scoring a goal, I’ve tried to play to my cognitive strengths and schedule some of my more demanding tasks when I’m at my sharpest.

What helps you stay on task? How do you block out distractions? Comment below!

 

health

AWESOME Moments as a Doctor


No Comments

Has anyone read ‘The Book of Awesome’ by Neil Pasricha? It is one of my absolute favourites for days that feel less than awesome. The concept of the book is brilliant and yet so simple – recognizing and celebrating life’s sweet little moments. After a tough shift, I challenged myself to come up with 16 ‘Awesome’ moments in Medicine. What a fun exercise this was! Some are a little sassy, some are sweet. But all helped me to come back to a more grounded, grateful head space. Here are my 16 ‘Awesome’ residency moments:

  1. When your last page comes at midnight and no other issues come up before handover.
  2. When whatever gentle soul was making up the call rooms left TWO pillows and TWO blankets instead of one – hello comfort!
  3. When you go to grab a coffee and there’s NO line.
  4. When you get the scrubs that tie up in front rather than the silly, sultry pair which show some scandalous side skin.
  5. When some generous soul buys a box of 80 Timbits for the department and there’s a healthy number of sour cream glazed remaining.
  6. When you walk outside into the crisp autumn air and feeling the sun on your skin after finishing a 26 hour call shift.
  7. When you thought you left your stethoscope on the 8th floor and you look into your call bag and it’s. right. there.
  8. When one of your staff kindly offers to buy dinner for the team.
  9. When you need to look up some blood work and there are several computers ready and waiting.
  10. When said computers load in a reasonable amount of time without any crashes, glitches, implosions, explosions…
  11. When your last patient ‘No Shows’ after a double-booked, ten hour clinic day and you have a quick moment to catch your breath (and document).
  12. When(ever) the therapy dogs come around to visit (!!!)
  13. When some grant money comes in that you weren’t expecting.
  14. When the surgeon has a bumping playlist going in the OR (and also when you no longer have to be in the OR #psychiatry).
  15. When you run into some of your friends in other services and are able to exchange quick hugs, smiles, eye rolls while desperately trying to keep up with your staff.
  16. When your call room has an en suite washroom and you get a taste of true luxury.

…Awesome, right?

health

Procrastination Nation: How to Boost Your Productivity Without Burning Out


No Comments

Happy December everyone!

It has been a little (LONG) while since I’ve been back. I apologize for the radio silence – there’s no easy explanation; however, I would be lying if I pretended that I haven’t been dominated by my “to-do” list. You don’t have to be in medicine to have experienced the pure chaos of running from task to task to task. Between work, appointments, research, house work, and studying it can feel like a small miracle to have eaten lunch some days! When life gets busy, it can be hard to maintain a sustainable level of productivity and it becomes all too easy to put off tasks. Although procrastination may feel like a welcome break in the immediate period, usually that feeling doesn’t last long. This past weekend, I had a day where it felt so good to put off all responsibilities – gym? Maybe tomorrow. Emails? Not today’s problem. Grocery shopping? Peanut butter for dinner it is. The next day, I was kicking myself. So I started reflecting on ways I can (and sometimes have) boosted my productivity. Here’s some of my strategies:

Eat and eat well.

I feel like I talk about the importance of proper nutrition every blog and for good reason! You can’t expect to pour yourself into other tasks with any empty cup. In fact, when we’re undernourished, it’s harder to regulate our emotions, concentrate, and practice good decision-making. My go to snack? Right now I’m really loving mixing up some cottage cheese, blueberries, and cashews. Perfect mix to propel me through my to-do list!

Make a list.

It can be really easy to get lost in the chaos of every day life and forget what you actually need to do. Making a list can make your to-do tasks seem much more manageable and concrete. It can also help you subdivide different tasks into smaller steps which might make them appear less daunting. I also find that there’s significant satisfaction which comes with crossing off an item. Check! On to the next one please!

One thing at a time.

Science tells us that multi-tasking may not be as much of a gift as it was originally thought to be. It turns out, we’re more likely to complete tasks efficiently and effectively if we focus on one thing at a time. Furthermore, taking on tasks one by one seems so much more manageable that trying to balance five all at the same time.

Add in some fitness!

Feels like I’m adding another thing to your list right? Wrong! Yes engaging in physical activity is a time commitment, but it doesn’t have to be an hour on the elliptical at the gym. Many of us are aware that engaging in regular physical activity translates into improved mood and energy levels. There’s tons of “sneaky” ways to incorporate physical activity into your day without ever stepping foot into a gym. I like riding my bicycle to work and taking the stairs in the hospital. Youtube is also an awesome resource for a number of different workout videos. Free, accessible, and different lengths – what more could you want?

Practice mindfulness.

To-do lists can seem so tedious. Sometimes I find myself dreaming about the couch waiting for me at the end of it. I found myself thinking one day – how can I reframe my thinking so I’m not just trying to get through X activity and wishing away hours and/or days of my life? Can I take charge and be present in every moment? Living moment by moment makes it easier to find comfort, ease and peace in the present task. It’s not always easy and doesn’t always work. But with practice it becomes less effortful and more consistent.

Try to add some fun wherever you can.

Can you do the activity with a friend? Blast some music in the background? Bring a book while you’re waiting for that doctor who takes forever? Making our tasks a little more enjoyable will make them more tolerable and less likely that they’ll get pushed off until the day after tomorrow (after tomorrow, after tomorrow…).

 

What are your tips for keeping procrastination at bay? I’d love to hear them and share ideas! Comment below.

health

Re-fueling the Tank: Tips for Preventing Burnout and Taking Self-Care to the Next Level


No Comments

Good evening everyone! Keeping with my recent post Physician Burnout: More Than Just an Old Battery (Part 1), I thought I would discuss some strategies for preventing burnout and promoting wellness. We last spoke about what burnout is and how to recognize it. In the coming days we will explore why burnout happens; but for now, I thought it would be important to identify a few strategies anyone can use to prevent burnout. During a yoga class not too long ago, one of my instructor’s said: “You need to fill your own cup before you can fill anyone else”. This really resonated with me. The next day at a resident training event, we were encouraged by a presenter to find one self-care activity before, during and after work and to watch, without expectation or judgment, the effects on our perceived sense of well-being. I remember thinking, “Who has time for that?”, but I decided to give it a shot anyway. Here are some of the ways I have been practicing self-care during my day to day. Not only have some of these strategies been useful to prevent burnout, I believe that they have made me a happier, more engaged, and effective resident.

Pre-Work

Let’s face it – mornings can be a little bit of a mad dash on the best of days. As someone who’s had a long-time love affair with the snooze button, I knew changing my routine was going to be challenging; however here are some changes which have worked for me:

  • Setting my alarm 15 minutes early (the mad rush becomes a little less mad)
  • Packing my lunch the night before
  • Listening to a playlist while getting ready (Despacito anyone??)
  • Taking five minutes to cuddle with my cat
  • Setting a 15 minute limit on how long I check emails
  • Getting rid of Instagram – starting my day as the primary focus rather than that of other people
  • Double checking where/when I am supposed to be the night before (rather than when I’m leaving the home)
  • Riding my bike to work

During Work

When the presenter first suggested that we practice self-care while at work, my eyes almost disappeared rolling into the back of my head. Again, with what time?! I went home and thought long and hard about how I could incorporate self-care into my work routine. I imagined telling my staff that I would be back in 30 minutes – just popping out for a pedi! Fortunately, I came up with some other ideas before sacrificing my professional identity:

  • Drink water
  • Eat the snacks you bring
  • Stop, take five deep breaths, feel the chair underneath you and the floor beneath your feet
  • Wash your face
  • Drink water
  • Stand outside for five minutes
  • Name one positive thing that has happened during your day and one person you are grateful for

Post-Work

This category felt pretty straight forward – good food, good wine, good friends – problem solved! But sometimes, our go-to feel good measures aren’t always available. I tried to think of mini self-care exercises which were time efficient but wouldn’t break the bank either!

  • Changing out of my work clothes
  • Washing my face
  • Drinking water
  • Checking in – what do I really need to feel well right now? There are a number of things we feel we ought to do, but do have need to do them?
  • Lighting a candle
  • Go for a short walk or even just sit outside
  • Water a plant

Will all of these techniques work for everyone? Probably not. Is it possible to perform each of them every day? I find it challenging for me. The bottom line is – try to schedule in time to recognize your physical, emotional, and spiritual needs and nurture them in the ways you know how and maybe even try some new ways. What keeps you well? Do you think any of these strategies work for you? Any that you would like to try?

health, ideas, medicine

Physician Burnout: More Than Just an Old Battery (Part 1)


1 Comment

Good evening everyone. I hope that you are all well. I’m sorry that it has been a little while since my last post. I have been having quite a time trying to balance my clinical duties with long, long hours at the hospital with my research interests with my interpersonal relationships with physical activity with the needs of my new (recently ill) kitten. Needless to say, there has been a lot on my plate. So much so, that I have been feeling like there’s not too much room left. I thought I would right about a topic which has felt a little closer to home than usual – burnout.

We use the term ‘burnout’ pretty regularly in everyday life when speaking about a variety of household objects – batteries, candles, light bulbs, etc. Typically, the word is used to describe the amount of an energy source or, rather, lack thereof. When used in the context of physician health, burnout also denotes a depletion of energy but this energy takes on a number of different forms including physical, mental, emotional, and spiritual. Different physicians may vary in how much each of the aforementioned domains is impacted; however, the outcome or end picture is fairly consistent. Physicians who are burnout are significantly less engaged and/or effective in their clinical duties. In some of the more extreme cases of burnout, physicians may feel totally disconnected from their personal and professional identities coupled with a sense of purposelessness. Now many people are at risk of experiencing burnout – it is not an affliction unique to physicians; however, I have chosen to speak from the physician perspective because of my personal experiences.

What does burnout look like? There are a few common symptoms which have been described in the literature; however, like many other illness states, burnout’looks different on different people. The rates of burnout vary between different specialties, genders, locations…you name it. The following are some commonalities which have been highlighted, although not all symptoms need to be present for one’s burnout to be clinically significant or, in non-medical jargon, “real”,

  • Exhaustion – Mentally, emotionally, physically, individuals feel that their current pace of life is not sustainable and that a “crash” is inevitable, however that crash may look.
  • Lack of purpose – You begin to question the usefulness of your work – “Why do I do this every day if people don’t listen to me?” Devoid of meaning, your work becomes something to get done, rather than something you enjoy doing. You go through the motions of your day-to-day without ever feeling like you are making a difference.
  • Depersonalization – You become mentally and emotionally disconnected from your work. You find it increasingly difficult to relate to others and the “real world” seems a lot less “real”. Deadlines – do they even matter? A complaint? It will probably just go away or maybe it won’t – it would not matter to you either way.

 

Have you ever experienced burnout? What was your experience like? What symptoms did you notice in yourself? How did you become aware of these symptoms? In future segments, I will be exploring the importance of identifying and addressing burnout as well as strategies individuals and organizations can employ to prevent its occurrence. Any other thoughts or questions? I would love to hear from you!

ideas

A Cat’s Purpose: Self Care and Self Love?


No Comments

Happy Sunday everyone! I hope you all had a safe and happy weekend and are ready to tackle the week ahead. I had a busy, but productive, weekend doing some off-service call. It was really challenging but also a great learning opportunity which I will speak more to another day. I’m promised myself that there would be no more medicine talk for the rest of the weekend (boundaries are healthy, right?).

So, in more exciting news, I’ve adopted my first pet! I’ve been dreaming about this moment for a long long time and have been a pet lover all my life. I was fortunate enough growing up to have the sweetest dog. He was sassy, affectionate, energetic, and incredibly loving. His name was Tucker (I come from a long line of Leaf’s fans – don’t hold it against me!) and he was a Portuguese Water Dog. Here’s a picture of my sweet buddy:

Tucker

Unfortunately, in January 2017, my family had to make the difficult decision to say goodbye to my lovely boy. He was just shy of his thirteenth birthday and had recently been diagnosed with a metastatic hepatic malignancy. At the time, I was across the country in British Columbia preparing for my first residency interviews. I was devastated and continue to miss Tucker each and every day. I’ve had some time to process this shared loss and have learned a little bit about myself and the role animals have in keeping me well. Tucker helped keep me physically active – we would swim, walk, run, and play. He provided emotional comfort – his over-zealous greetings and our hours of cuddling on the sofa still bring a smile to my face. When Tucker passed away, so many rituals, routines, and comforts passed with him. My family home felt eerily quiet and I felt lost.

Some months down the road, although my heart is still heavy, I have begun to heal. I know that Tucker couldn’t have possibly been around for ever and, most days, I’m able to accept that. This experience has also helped to reveal an added layer of empathy in my professional practice. A self-proclaimed “dog person”, I had difficulty understanding of different people would become so attached to different animals…until I had to respond to dismissive comments about losing my special pet: “I bet that’s hard, but he’s just a dog right?”. These comments were challenging but also illuminating to what seems like an obvious truth – people are different. We all have varying relationship preferences, emotional needs, life goals, temperaments…the list goes on and on; however, just because I might not identify as an “iguana enthusiast” or “fish fanatic” does not mean that I can’t appreciate and relate to the underlying emotion. Moreover, if others struggle to relate to my sense of loss, I can place myself in their shoes and understand that I might also be emotionally ambivalent we were discussing the loss of a gerbil. Irregardless of which side I am on, my hope is to recognize these natural variations in human emotion and perception and acknowledge them with respect and an inquisitive mind.

On a happier note, as I mentioned earlier, I have adopted my own pet. For those of you who I haven’t connected with on Twitter, this is Gatsby, a 3-month old, 900g rescue from a local shelter. I already adore this energetic little dude and am looking forward to building new rituals and routines.

Do you have any pets? How do your furry friends keep you well? I’d love to hear about them or even see photos! Have a great week ahead!

Uncategorized

Team Work Makes the Dream Work: Communicating Effectively with Your Doctor


No Comments

You arrive at your scheduled appointment with a list of things you’d like to talk about. You spot your doctor dashing from room to room as you study the clock wondering how long you will be waiting this time. You glance at a sign pasted next to the administrative assignment: ‘Only one issue will be discussed per visit. Thank you in advanced.’ You sit down and begin to fiddle with your phone. 5 minutes goes by. 15 minutes. Where is this person? 20 minutes goes by. When your name finally gets called you feel frustrated, tired, and irritated. And the appointment hasn’t even started yet. Sound familiar? How will you get all your concerns addressed? How can you explain them while maintaining your sanity? Straight from the horse’s mouth, here’s some thoughts on how to make the most out of your time with your doctor:

Come prepared with an up-to-date list of medications.

I’m not a betting woman, but if I were I would place money on your doctor asking for a list or clarifying the medications they already have documented in your chart. Write them down in advanced or take a picture of them with your phone. This simple act will save you both from having to guess the names of the little blue or white pills you’re taking. Don’t forget to include any vitamins, herbal remedies, or over-the-counter medications!

Have a game plan.

Typically people don’t show up to their doctor’s purely for social enjoyment. What is it that’s been bothering you? Do you have multiple complaints? Which are the most pressing? If your doctor isn’t able to get to them all in one visit, are there any which can be followed up in the next week or month? You don’t need a medical degree to know what’s been troubling you the most. Let your gut be your guide and we’ll help you take care of the rest.

Think like a doctor.

I’ll let you in on a little secret. In medical school, we are taught a basic approach to characterizing complaints. You can improve the efficiency of your appointment by reflecting on some of these points even before seeing your physician. Let’s take knee pain for example. Things you can expect to get asked are: Onset (When did the knee pain begin?), Palliating and provoking factors (Is there anything that makes the knee pain better? Anything that makes it worse?) Quality (What type of pain is it? Throbbing? Stabbing? Burning?) Radiation (Does it spread anywhere?) Severity (How bad is the pain?) Time (When is the pain the worst? At night? When you wake up? Has the pain changed over time?). Put it altogether and here is how I might respond to my doctor when asked what brings me into the clinic today: “Well, I seem to be having this pain in my right knee which started yesterday after a bike ride. Walking on the knee makes it a lot worse, while staying off it makes it a little better. I feel like the back of my knee is throbbing and it’s only gotten worse. The pain doesn’t spread anywhere“. This format doesn’t give your doctor all the answers, but it does give them a great foundation to figure out what’s going on.

Be your own health advocate but maybe leave Dr. Google at home.

It is incredible the wealth of information online for us to learn more about different health problems and treatments available. You can plug a symptom in on Google and within seconds have a differential diagnosis of 100+ medical conditions. I think the internet can be an empowering education tool for patients and physicians alike; however, it can also be overwhelming and create trust and communication barriers between both parties. Patients can feel frustrated that physicians aren’t taking their concerns that they have X disease seriously; physicians feel irritated that patients are self-diagnosing. How can we work through this? Here’s what I think – If you want to do some of your own research – go for it. Try to avoid websites based on other individuals’ personal testimonials and instead search for resources that are based on more reports. Your doctor should be able to recommend some resources if you are having difficulty finding some. If you choose to do your own research, try to avoid using diagnoses when asking for assistance with symptoms. That being said, it is perfectly reasonable to discuss what your particular concerns are after your symptoms have been appropriately characterized. For example: Instead of telling your doctor that you have Guillain-Barre Syndrome, maybe say that you are concerned that the increasing numbness and weakness in both of your feet could be related to Guillain-Barre.

Know your learning style.

Some people can remember ever detail of a conversation just by listening to it. Some people are more visual and need things written down. Try to reflect on how you absorb information best and advocate on your behalf. If your doctor is rattling on and on about atherosclerosis and you know you are a visual person, ask if they can draw you a picture or direct you to some print resources. Depending on your physician’s learning style, they might not have considered that you might benefit from a different teaching aid.

Keep an open mind.

I can be an inpatient person. When I show up to an appointment, typically my expectation is that I will be seen around that time (or why bother scheduling appointments at all?!). I used to become really edgy and crusty while waiting for physicians – can anyone else relate? However, since starting to practice medicine, I have developed a little more empathy. Undoubtedly, there are some physicians who are better than others at managing their time. They are a conversation for another day. For the majority of physicians who are usually endeavour to keep to their schedule – the universal fact is that things happen. People are unexpectedly unwell/in crisis and as a physician you are obligated to respond. When these unexpected “bumps” happen (and boy do they happen), they typically take up a fair bit of time. Am I suggesting that you should be all “sunshine and roses” with your physician who is consistently four hours late? No. But for your own sanity, and that of your doctor, maybe pause to consider what events might have lead up to the delay. When I feel frustrated by the wait (frustrated is the politest descriptor I could think of), I try to have a gratitude moment – I am not the person in trouble.

Final thoughts: Communication is a two way street. Some doctors are better communicators than others. Following these steps doesn’t guarantee that you will have a productive and fulfilling appointment; however, they are guides to help you, as the patient, use your time as efficiently and effectively as possible. I hope they are helpful! Any other tips or strategies you have learned? I would love to hear them!

 

blog.pass

health

Media-trician Moment: ‘Thirteen Reasons Why’


No Comments

On March 31 2017, Netflix released a drama web television series based on Jay Asher’s 2007 novel ‘Thirteen Reasons Why’. The web series, starring Katherine Langford and Dylan Minnette, explores the final, tumultuous weeks of a high school student, Hannah Baker, through a series of tapes she leaves behind after she has suicided. Hannah leaves detailed instructions for select individuals on where and when they should listen to the tapes. The individuals Hannah has selected are people she feels have been implicated in her psychological downturn including several peers and one teacher.

‘Thirteen Reasons Why’ became a hot and controversial series seemingly overnight. Some audiences praised the show for its coverage of sensitive subject matter such as sexual assault, bullying, suicide, and the use of social media in transmitting intimate photographs. Some health organizations condemned the show’s graphic portrayal of sexual assault and suicide and expressed concerned that these images would  be triggering for struggling adolescents and young adults.

I originally heard about the series from one of my colleagues who felt a strong, personal connection to Hannah’s narrative. Initially, I was extremely hesitant to watch the show. What I understood from my colleague’s description, was that the protagonist was utilizing the tapes as a form of retribution against those she felt victimized by. Throughout the series, each of the individuals identified by Hannah, slowly begins to realize their misdoings and expresses remorse for their actions. I was skeptical – how would this message be interpreted by different age groups, specifically those with developing insight? Initially, I felt that the message of the series was problematic and over-simplified the psychological and emotional impact of suicide; however, after hearing more and more media buzz, I decided to give the show a go. One post-call day, I suited up in my favourite track pants, grabbed some snacks, made a cup of tea, and settled onto my couch. The following are my thoughts on the series as a psychiatrist-in-training and person with lived experience with mental illness:

Suicide: I still feel that the series may romanticize suicide in the way that it portrays the reactions of characters implicated in Hannah’s psychological downfall. I’m cautious as to how the responses of these characters may be perceived and understood by individuals who are struggling with their own feelings of hopelessness, trauma, and self-harm. Suicide is not a conflict resolution tool and should never be conceptualized as such. Undoubtedly, a completed suicide is a high impact event. The person who has suicided has no further opportunities to engage in conflict resolution and/or to receive emotional and psychological support. Furthermore, the individuals who loved and cared for the person who has suicided are irrevocably changed by their passing; however, no one can truly anticipate or expect that their suicide will elicit a particular emotional response in their “wrongdoers”. The only people who can reasonably be expected to suffer from such an event are the individual who has suicided and their loved ones.

Normalization of Mental Illness: I commend the series for the amount of discussion it has generated around suicide, trauma, and mental illness. In Canada, we have made some progress in reducing stigma and recognizing mental illness as a legitimate health problem; however, there is still a long way to go. As a psychiatry resident, I get jibbed by other physicians on a fairly regular basis that I don’t want to practice “real medicine”. I think it is really important to recognize the platform the show has created to explore different facets of mental health, specifically within adolescents who may be less willing to discuss emotional struggles. Regardless of whether you agree with how the series has addressed suicide and/or trauma, ‘Thirteen Reasons Why’ has become so ubiquitous in popular culture that everyone (okay maybe not everyone, but a lot of us) are talking about it. Talking leads to exchanging ideas which leads to increased understanding which leads to change in societal perception leads to…I think you see where I’m going with this.

Support Systems: Hannah does make a few efforts to reach out for help; unfortunately, she does not find solace or support from any of the individuals she contacted. In fact, her feelings of abandonment and isolation are reinforced by these interactions. As the viewer, I felt hopeless and helpless watching Hannah’s missed opportunities for therapeutic intervention. I recognize that these “near misses” were juxtaposed with Clay’s identification of an isolated peer and his eventual decision to check in. That being said, I feel that this positive interpersonal interaction paled in comparison to Hannah’s missed interventions. I wonder if younger audiences were able to appreciate these subtle nuances. I feel that the ending may have felt different if a more resounding intervention was modelled to demonstrate that help is available and that it can be useful, especially in crisis situations.

Consent: I think the show is incredibly strong in its exploration of sexual assault and consent. Undoubtedly, the sexual trauma depicted in the show is difficult and disturbing; however, some really powerful modelling behaviours are demonstrated. The differences between Bryce’s and Clay’s verbal and physical behaviours towards Hannah and they ways in which they did (or didn’t) ask for consent are profoundly stark. I am glad that the show demonstrated positive consensual behaviours through Clay otherwise the sexual violence in other scenes would have felt gratuitous.

Final thoughts: Do I think ‘Thirteen Reasons Why’ is appropriate for all audiences? Absolutely not. It is undoubtedly chock full of mature themes. Regardless of their age and maturity level, young people would benefit from some guidance and support with some of the triggering themes presented. Do I think that the series should be banned from schools? Not necessarily.  ‘Thirteen Reasons Why’ has significant potential to be a powerful discussion and learning tool. I feel that the series can provide a platform for teachers, parents, healthcare professionals, and adolescents to engage in safe and therapeutics discussions around mental health, mental illness, and suicide. I look forward to exploring the upcoming season and hope that the show continues to address such sensitive topics in a mindful and compassionate fashion.

What did you think of ‘Thirteen Reasons Why’? Did you have any reservations about the show? Do you think any viewing restrictions should be placed on the show? Why or why not? Will you watch the upcoming season? I look forward to hearing your thoughts.