What it’s like living as a doctor under the (Toronto) poverty line

“Hey, would you like to come catch some lunch with us? There’s this new Mexican place around the corner.”

“No thank you, I have a lot of work to do, I’m going to stay here and catch up on some documentation, next time though!”

“Alright, have a good lunch.”

I quietly closed my office door and flushed pink with embarrassment. I hope that was convincing. I reached for my battered book-bag, and pulled out the two slices of toast and the bag of almonds I had laying around the apartment that morning. My chopped up frozen peas and corn were still frozen.

It tasted a little like cardboard, but it was OK. As I sat eating, I couldn’t help but think about other social events I had to come up with some elaborate excuse to avoid, because I was broke. Beyond broke. I recalled the Tim Horton’s server earlier that week, who stood by annoyed as she counted out my forty nickles – or I thought it was forty. I was five cents short; luckily the annoyed customer behind me overheard and threw a dime down on the table, a little in kindness, but also to help get the line moving, I thought.

That was three days ago. I haven’t been able to afford a coffee all week.

It gets more difficult some days, particularly when tempted with succulent chicken polo frito I know I can’t have. I looked down at my jeans, which I had worn every day this week. They looked shabby and I saw a small yellow dot of something – mustard? – on one pocket. I tried to brush the spot off but it only smeared the yellow-goo deeper into the fabric. I felt the seam of the jeans, gently rubbing the pale, white thread I could tell was going to give out, at some point. Hopefully they last until my birthday… I only owned two pairs of pants that fit me you see, and one was in the wash.

And the drier was broke.

kid s blue shirt hanging on the clothesline — Photo by Lisa Fotios on Pexels.com

This scene may seem vivid, I hope it is. These events don’t begin to touch on the poverty many residents of the world, country, and Toronto face on a daily basis. I have a relatively safe apartment in a decent neighbourhood, and most months I can afford to get a transit pass.

This story is also about me, and it’s not where I expected to end up as a doctor. So what gives?

For those of you who have read this blog for some time, you will know that I am something called a resident physician. Residents are kind of primordial doctors, having finished medical school, and now completing a program in the specialized area of medicine they will eventually work in for the rest of their life.

Becoming a resident, and a doctor, takes many things. It takes academic rigour, professionalism, dedication, and mental toughness. It also takes a tremendous amount of money.

To enter medical school, you need an undergraduate degree. For most people in Canada, those degrees, four years in duration, can cost anywhere from $10 000 to $50 000, depending on the school you attend. Most young people in Canada don’t have this kind of money just sitting around, and ultimately the vast majority of university students depend on one of two sources of funding – student loans, or help from their parents. Leaving conversations about how the education system is designed to discriminate against the poor aside, I’ll mention here that I was one of the more fortunate undergraduate students at Memorial University, and only graduated with about $15 000 in student loan debt.

In the fourth year of my BSc (Hons) in Cell and Molecular Biology, I began applying to medical schools – at about $700/$800 per application. Those of you who know anything about medical school admissions knows that you don’t want to “hang your hat” on one school, it’s not unlike the lottery. Keeping this in mind, I ultimately opted to apply to seven medical schools, which stung my pockets, but felt necessary at the time.

I was ultimately offered two interviews, one of them here in Ontario, and after some reflection and my acceptance, I found out I was going to medical school! In Windsor, Ontario.

Most Canadians mistakenly associate things like $25 000 a year education to places like the United States. Not so, for medical school. I was dismayed to realize my tuition would be that, and more per year, considering the various $1000 “enrollment fees” and the “one time $800 course fees,” for the odd mandatory skill seminar put off by the school. I did the math, and yes, this was going to cost me $100 000. And I was going to pay interest on that money, as well as my $15 000 student loan, every single day, until the time I graduate. (As an additional fuck-you from my medical school, they went on to increase the cost of tuition every single year I was in medical school; my fourth year, initially supposed to be $21 000, the cheapest year since it was essentially six-months in duration, costed $26 000 by the time for me to pay).

Now of course, as anyone with student loans will attest to, the cost of education is hell of a lot more than tuition. There are textbook costs, transit passes, rent, groceries. All of these things costed money, and since I was going to school 3000 km away from my nearest relative, I had nobody to lean on.

It’s here my trajectory deflected from my colleagues. You see, not everyone enters medical school as equals. The vast majority of my colleagues received significant financial help during medical school from their families. Most people in medicine you see, have doctors for parents, many have a trust fund. A quick Google search can shed light on the tremendous problems of socieoeconomic skewing in medical school classes – it seems like hiring and accepting people from penthouse suites doesn’t increase physician availability in the projects (no s*** guys I could have told you that)!

This is also the case in all education programs, where some students have it better than others, but when you’re surrounded by people without student loans, travelling across the world on the odd weekend, you feel it a bit more. Everything I paid for in medical school was on my back, and it still is.

And I’ll be the first to admit it. I had housing costs, groceries, living expenses. I also enjoyed myself during medical school, not excessively, but in an effort to feel like a part of my class. It was difficult, living in Ontario, and being the only person not travelling to Europe over the summer. It hurt wearing shabby mall-bought clothes among my peers when most of them shopped at expensive outlets.

I eventually finished medical school, and it was finally time for a pay day.

I also fell in love.

I ended up being accepted into a residency program at the University of Toronto, and I moved to the city to be with my partner. She had just finished a different academic program herself, and we had very little money. We accepted the cheapest apartment we could find that had access to the subway. You see, with both my partner and myself working in health care, we worked 12 hour days, if not longer, and a two-hour-each-direction transit ride was not an option. We found something that was a 45 minute transit ride away from our work, 700sqft, at $1800 a month. Yes, that’s obscene. It’s also the reality in Toronto.

The Canada Mortgage and Housing Corporation estimates that housing becomes “unaffordable” when it takes up more than 30% of your income. Many people in Toronto are in an unaffordable housing situation, myself included. This rent costs about 52% of my income per month.

Now I know what you’re saying. “That’s not a lot of money for a doctor.” It is for a resident. My resident salary in Ontario is $58 000, before taxes.

And before my $1200 of student loan INTEREST payments a month (barf).

And before groceries.

And before cell phone.

And before my transit pass.

At the end of the day, it’s really not a whole lot of money. There’s often a month where I have no transit pass for the first few weeks, and I count dimes I have left around the house in hopes of getting on. A few times, I’ve had to sneak onto the bus. Often the bills go unpaid. Don’t ask me about my VISA.

All of that to say, I’m hurting, and a lot of young professionals in this country and city are as well. It’s atrocious that medical schools, or any school, can gouge you for money they know is going to sit on your student loans – I’ve paid enough interest to my bank at this point I could have almost paid off a quarter of my debt. It’s disgusting that the government of Ontario does not account for the school of residency when determining salary – you make the same in Thunder Bay, with a significantly lower cost of living, than you do in Toronto, the most expensive city in the country.

So what’s it like living like a doctor near the poverty line? Just ask me.

selective focus photo of pink tablets — Photo by Dear W on Pexels.com

It was happening again. These damn asthma attacks. My shortness of breath was getting worse, and I was bent over breathing to try and get a sufficient breath.

“I think I need to go to the hospital.”

An ambulance costed $75… I checked my Uber app – declined. “Please update payment method.” Fuck.

I got in the subway, wickedly coughing, and then transferred to a bus, which I took to the hospital. I was somewhat blue by the time I got there, and they admitted me right away. They prescribed some puffers, and told me to take my allergy pills.

The following day, I went to the pharmacy with my two puffer prescriptions. I left the allergy pills in the aisle – $15 for ten pills? Not happening.

“Alright, that will be $15.”

“I thought my insurance plan covered the drug costs?”

“It does, but for this medication, there’s a co-pay.”

“I’ll only take the one then.”

Dr. Travis Barron is a resident physician in Toronto, Canada.

Keeping your faith when you’re a doctor

Often times, late at night, I find myself reflecting. Reflecting on life, myself, all I have become, and all I have lost. Growing up, I didn’t have the most friends, but I could always count on my brain. Looking at where I am now in life, is a tremendous source of pride. I was the first in my family to attend post-secondary education, and the first physician as well. In many ways, to my family, I’m seen as a stepping stone for the Barron clan to exit from rural poverty.

brown wooden cross pendant on closeup photography — Photo by Thijs van der Weide on Pexels.com

That doesn’t mean there aren’t some regrets.

One thing I reflect on often, is faith. Growing up, the church was a huge part of my life. I ached to attend Sunday mass, and volunteered as an altar boy at the first chance I had. At my parish, Confirmation was typically reserved for 12 and 13 year old children. With special permission from the priest, I was allowed to be confirmed at age 8. And I came in top of my class. One of the highlights of this part of my life was when the priest at my church – Holy Trinity Parish, sharing a name with my elementary and high schools, Holy Trinity Elementary and High School – asked my mother and I to be the parish’s representatives at a special visit by the Archbishop of Canada, to the largest Catholic church in St. John’s, the Basilica (as a side note, on that day, I tripped on my way into the pew, and muttered, ‘Jesus, Mary, and Joseph!’ under my breath; my mother made sure I heard it later!).

As these things go, you get older, and you try your best, in many ways, to differentiate yourself from your family. Religion took a smaller role in my teenage life, although it remained important to me. Friends and school and manhood became my primary concerns.

Eventually, I attended post-secondary university at the Memorial University of Newfoundland, majoring in Biochemistry and then switching to Cell and Molecular Biology. That was followed by medical school, in Windsor, Ontario, and eventually residency in Toronto, where I am today.

When I moved to Windsor, a sense of community was lacking. What was this foreign place, so very different from my home? People avoided eye contact in the street, there were no friendly greetings or short conversations with the server at Tim Horton’s. And I missed that. So, I went to the nearest place I could think of, to help bring back that sense of community. I went to church.

A church service is a church service and in many ways the mass at Our Lady of Assumption in Windsor (the oldest church in Canada west of Montreal, now tragically shuttered and closed down), and I felt at home. Though the parishoners and the priest were different, the prayers remained the same, and in some ways I was at peace.

After my second service at Assumption Parish, I began to worry. Something wasn’t feeling right, and it took me a while to realize what it was. I stopped going to the church and looked elsewhere for community. If anyone out there has gone to medical school, you’ll know that my only option was the medical community, a sort of cult, comprised of medical students, residents, and doctors, and where the conversation invariably turns to the latest asthma medication or multiple sclerosis study.

Eventually, it came to me. I had lost faith.

Putting in to words what this meant to me is difficult. If any of you have faith, you know what I mean. God and Jesus were in many ways part of my own being, and the Catholic faith was for me the compass by which I navigated the world. Religion, to my perennially teased and tortured by my classmates in grade school soul, was for many years my anchor. And here I was, drifting off to sea.

I struggled with this for some time and eventually religion moved from my mind. I immersed myself deeper in medicine, and intentionally avoided any religious themed discussions, out of fear it would rip my being in two. To add some context, I’ve been in post-secondary education for eleven years at this point. Eleven years of fanatic education, of evolution, world religions, the big bang, science, and medicine. Eleven years of learning men (and women) are the masters of this world and that it is ours to discover. God, in fact, was only ever mentioned in discussions surrounding the unreasonableness of a Jehovah’s Witness refusing a blood donation. The problems caused by belief in Allah during Ramadan for kids with nutritional disorders. Never did that lens turn inwards, never was the question asked about our relationship with God.

That’s not to say I’m the only religious person that attended medical school, I know I wasn’t. I have friends and colleagues that were and continue to be active in the church. Me, I was Captain Scott, frozen in the Antarctic ice lost and without hope of rescue.

But like Captain Scott, there was hope. Although he died, Captain Scott is famous for the journals he comprised while he and his crew used pick axes to try and cut their boat free of his frozen water coffin. Of course this was a failed venture, and not until a subsequent Antarctic expedition during which his remains were discovered were his journal entries found and disseminated. And what was found was remarkable. These men, faced with their inevitable death, had been singing. They were in good spirits and they sat and played cards and ate breakfast. They joined together in prayer. They had faith, and the spirit lived on.

“God help us, we can’t keep up this pulling, that is certain. Amongst ourselves we are unendingly cheerful, but what each man feels in his heart I can only guess.”
― Robert Falcon Scott, Scott’s Last Expedition: The Journals

I am not an Antarctic expeditionist, but like Captain Scott, my spirit lived on. The Holy Spirit? Maybe. I’m not going to call myself divine. Like an ember on the floor of a seemingly dead fire, I would soon realize my faith could again burn bright.

I was at a low point of my life in the third year of medical school, and I was wondering whether the choices I had made were truly the right ones. I felt like most of my friendships in Ontario were superficial, and that most of my friendships in Newfoundland were decaying. In many ways, I felt caught between two worlds and two provinces, not dissimilar to how I felt being caught between religion and medicine.

So naturally, I went to church.

And I went again.

And again.

And eventually the happiness I once had from sermon returned, and I found myself at peace. What had changed, I asked myself. I was still a physician-to-be, I still felt trapped in mainland Canada. Simply put, I had faith.

To this day I continue to struggle. Struggle with thinking about the impacts of evolution on the development of our planet and climate, and reconciling that with the Catholic calendar. Struggle with thinking about life saving blood transfusion and a deeply held belief having ones blood other than your own is a sin. Struggle with my obligations as a doctor to discuss treatments that in many ways go against the very fabric of Catholicism. Sometimes, it isn’t easy.

But I have faith. I have faith that both my lives and both sets of beliefs can co-exist peacefully. Faith that it will all work out. Faith that as a doctor who has tried to do nothing more than elevate his family and extended family out of poverty, and to help the sick and diseased and unwell and disadvantaged, there is a place for me in Heaven.

Some days are easier than others; today is a good day. I’ll continue to toe the line and think and reflect and consider what it means to be a Catholic in 2019. And in the end, I’ll always know, both things can be true. They have to be.

Editor’s note: There are many faiths in the world and I don’t think asking which faith is, “correct,” is a helpful question. What matters to me is that people feel at peace with themselves and their choices. Maybe that means Catholicism, Islam, Hinduism, or Environmentalism. However you identify, there are bound to be conflicts between your faith and what the modern world asks of you. The purpose of this post is to describe my own struggles in reconciling these two ideas.

Dr. Travis Barron is a resident physician in Toronto, Canada.

A (brief) slow down

Hello internet world,

My greetings will eventually sound less lame! I hope you have been enjoying mindMD and I truly hope it’s provided some help or hope for even just one of you out there.

Man, am I busy!

As you can read here, I’ve recently jumped into a new residency program and it can take some time to get your bearings. I’m sure you’ve all been in similar situations.

What does that mean for mindMD? Lots of awesome, cool topics, as they relate to medicine as a whole, with a special eye for the psychiatric and psychological interplay with physical health.

It also meas a brief slow down, for now.

Don’t worry, I’ll still be posting! For the next month or so, you can anticipate three or four posts a week.

In the meantime, you could help me, by sharing this blog with your friends if you like it! I stay as far away from social media as humanly possible in this day and age, so any Facebook or instagram exposure you can offer is greatly appreciated,

Until next time!

DTB

“That thing around my neck is called a stetho-something” – me

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Blogging for mental health

Of all of the human accomplishments through the ages, none capture the beauty of our soul to the same degree as art. Art is an activity unique to humans, and is perhaps the most significant way we differ from our animal relatives. Art transcends the individual, the collective, time, and space. Art in many ways is eternal. The impact of one person’s art, if forever forgotten in it’s truest form, is reproduced again and again through the impressions of those that first drank it in.

Which brings me to the topic of today’s blog post – blogging for mental health.

multicolored abstract painting — Photo by Steve Johnson on Pexels.com

I started this blog just over three weeks ago, on what would become the tail end of my time in the Department of Psychiatry. During the spring months, I held many conflicted feelings on the field. I was not happy professionally and yet mental health remained, and remains, something very important to me. My self reflection led to a conclusion – that I needed an outlet. So I started the blog.

And it’s helped. I went into medicine for a reason, to be a support for those in need. I hope I’ve lent myself to you. But I cannot understate the support you’ve given me by helping my spirit be at peace!

I’m not alone in this. The catharsis of art is undeniable and the positive impacts of art on our mental health have been documented for decades. Our human languages are beautiful, and often fail to describe the emotions many of us are feeling. Art provides a medium for expression, unquestionable expression, because you know at the end of the day that you’ve done this for you.

On a clinical level, I often recommend art to patients when they are suffering. And even when they are not. I’m often met with a comments like, “I don’t know how to paint,” to which I usually respond, “neither do I!” Art can be as simple as rearranging your bookshelf. Taking in a movie. Or writing a blog.

Dr. Travis Barron is a resident physician in Toronto, Canada.

The small things

“Thirty five!”

My heart begins to pound. Could it be? That’s three out of six numbers so far, I had never done this well.

“Seventeen!”

I’m out of the seat. I grasp the lottery ticket in my right hand tightly and stare at the TV. Images of yachts, parties, European vacations flash before me. The woman on the TV bends over and pulls the last number from the bin.

“Eleven!”

I’m screaming. Everyone’s screaming. We’re hugging, jumping crying in joy, when –

cup of coffee near croissant bread — Photo by julie aagaard on Pexels.com

BEEEEEEEEEEEEEEEEEEEEEEEEP

I role over as I bring myself from a foggy haze back to the planet Earth. I look to my side, expecting to see the brightness of the TV and the infinitely smiling lottery woman. Instead I’m met with a dark bedroom and the slightest hint of sunlight beginning to break through the bedroom window.

It was all a dream.

For a moment, I’m sad. I mourn my yacht. I mourn the Greek islands. I prepare to mourn for my would-have-been pet Tiger, when the hope begins to trickle into my mind.

It’s Saturday.

Oh, Saturday. The king of days, the glory of glory. We meet again. What have you brought me today? Is it a hike? An interesting play? The sweet nectar of shameless hedonism and laziness so that I may bathe myself in relaxation? Perhaps.

But first, there’s coffee.

Ah, coffee. I smell the sweet fumes, the pungency of the beans as they’re cracked over blade. I’m intoxicated with the idea. I climb out of bed and realize my mouth is watering. I sneak by my loved one and enter the kitchen, the regular opening scene to my Saturday-plays.

I grind the beans, turn on the machine, and wait patiently through the glug-glug. Soon, it’s ready. I sit on the step and drink from my chalice. I find myself wondering just how much of my blood is this very drink. For those moments, the world is still. As long as there’s blackness that sits in my cup, time is frozen, and it remains in good form until I take the final sip.

I find myself mourning the lottery once more. I look to my cup and smile to myself. What I really appreciate, are the small things.

Dr. Travis Barron is a resident physician in Toronto, Canada.

Three weeks in!

Hello internet! Travis here, on day nineteen of the blog! Blogging is something new to me, so thanks for bearing with me as we go through growing pains together. I now know what a widget is!

Why did I start blogging? Well, I find education empowering. As different as every single patient who takes a step into my office is, it amazes me how many similarities there are between their questions and misconceptions on the field of mental health. Hopefully by sharing my understanding, I can help someone out there find some clarity.

To that effect, do any of you have a topic you’re wondering about? Have any questions? Send them my way and I’ll do my best to answer them next week!

Stay tuned for Mental illness exists for a reason (part 3) this weekend! You can read part 1 here and part 2 here!

When soul meets body

“Come on babe, we need to get closer! It looks like there’s a gap ahead.”

We pushed through the crowd and finally got within ear-bleeding distance of the stage. We arrived at the gap we had seen from some ways away, and were met with a small pond in the center of the concert ground. I guess we hadn’t added two and two when we went to this concert on a beach, and heard, almost incessantly along the way that, “the lake was up.”

We had become one with the lake.

65197096_159513941754770_6094586745271158401_n The evening was a Thursday in June and my partner and I had just seen one of my favourite bands, Death Cab for Cutie. Death Cab found their fame in the mid-2000’s, a time which I was unsurprisingly in high school. Why unsurprising?

The spiritual relationship between a person and music is difficult to put into words. Music, for most of us, represents something transcendent, the simultaneous embodiment and understanding of our soul by vocalist and band. Music makes us feel connected and understood, not only by the artists standing before us, but by each other. Some of the closest friendships and bonds have formed through collective belting of the latest punk song on the fringes of a bloody mosh pit. Somehow, you arrive at the conclusion that, this person gets me, based purely on the fact that they also didn’t mess up the end of, “Northern Lights.”

The point is, music, for many of us, represents identity, on an existential level, and our sense of identity begins to solidify as a teenager. Not a coincidence I love crappy mid-2000’s punk and emo, my father loves Deep Purple, and his father some old guy on a scratchy microphone.

The role of music in expression cannot be understated. Whether it’s singing, “What’s My Age Again?” in your 2001 Corolla with your friends, or tearfully singing, “Always,” to yourself in the shower, music allows us to understand, express, and manage our own emotions to a higher degree.

62021206_213464446295848_7931776062685125866_n On a primitive level, we were built for this. The part of the brain that understands music is actually completely separate from the part of the brain that controls language. There are types of strokes where people who cannot communicate through speech find success in communicating through music. Late stage Alzheimer’s can often preserve the music centre, long after language has been coldly taken away.

This part of the brain also develops earlier in human development than the language centre. Instead of a chicken/egg phenomenon, the answer here is clear. Music came first! This may be why babies coos in musical tunes, long before they tell you, “give me that food!” The point being music, in humans, gets at something primal, ancient, and fundamental to our existence.

Do you have a favourite band or song that seems to bee your go to during times of happiness or sadness? Leave it in the comments!

Dr. Travis Barron is a resident physician in Toronto, Canada.

Goodbye Psychiatry, I’ll miss you!

Getting off of the 501 streetcar, I realized this may be the last time I make this trip for a while. I soaked in the Ossington Avenue intersection, after almost being ran-over by a passing car (ah, the familiar feeling), and walked towards the doors of the Centre for Addiction and Mental Health (CAMH). As I peered at the campus, my sense of loss was accented with fondness and the strange intervention of excitement at what is to come.

I had officially departed the Department of Psychiatry, and joined the Department of Family Medicine.

19623600_1882847292039496_9104144131264872448_n I know what you’re thinking. This guy with the mental health blog, leaving psychiatry? That doesn’t make any sense!

All I can say is, we all have our own journey.

During my time in psychiatry, I worked in a variety of hospitals across the city of Toronto, CAMH being among the most memorable. I had the privilege of working with some of the world’s – that’s rights, world’s – leading experts in mental health. It was truly an honour. Psychiatry has given me more than I can possibly express through the lens of a blog post. I know that because of the Department, I am a better person, and a better physician.

So what gives? I just wasn’t happy.

The supervisors and colleagues I have worked with in psychiatry have done, and will continue to do, amazing work and help heal some of society’s most marginalized. For myself, the opportunity to see a broader variety of people, and be more of a utilitarian with my skills, as opposed to a specialist, has come to reveal itself as important to my happiness. I remain passionate about mental health. Every single one of us is touched by mental illness, in some way. There isn’t a patient that presents to a physician anywhere in this country who hasn’t been influenced by their own psychology.

_DSC3796 The absence of a mental health system in Ontario has played a role in this difficult decision. The number of times I have recommended CBT to someone, knowing their options are 1-2 year waitlist or out-of-pocket, is heartbreaking. Discharging severely unwell people, with attenuated psychotic symptoms, or severe drug addiction, to the street, because the waitlists for supported mental health housing can be almost a decade, is gut wrenching.

This is no fault of my amazing colleagues, who at this very moment continue to fight and advocate for the patients for which they care. Malignant neglect by the government’s of this province – and frankly, the country – have resulted in a patchy system with too many holes.

It’s not all bad – change is coming. The programs CAMH continues to create and advocate for are world-class and industry-leading. But as I am sure many of you know, there remains a way to go.

Which for me, means it’s time to move on. And I’m excited. For new beginnings. For a change of pace. For brighter days. And for my General Surgery rotation (just kidding, terrified about that one!)

Goodbye Psychiatry, I’ll miss you.

Dr. Travis Barron is a resident physician in Toronto, Canada.