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KITCHEN CHRONICLES: Will Anne be able to forgive Fiona’s betrayal? PLUS rave reviews for this Caribbean shrimp appetizer.


By Barbara Sibbald



Fiona’s stomach turns. Do I need to go to the bathroom again? she wonders. Was it was a mistake inviting Anne over to the house? Maybe we should have met at a café. Neutral space. She sighs. But Anne agreed to come. Via email. We haven’t talked in nearly a month, Fiona realizes.

Her stomach flips again. What if Anne’s still angry? What if she thinks Luc was insincere, if he apologized to her just because I was so upset.

Her thoughts are interrupted by a tap at the screen.

—   Anne, with a tan! Fiona says with a big smile. She opens the door, beckoning her long-time friend to come in.

—   You look fabulous!

And she does. Her golden skin shows off her blonde curls and her green eyes sparkle.

—   Hi Fee, Anne says, stepping into the kitchen. Tuscany was spectacular!

—   That’s great. Have a seat. Red? It’s a Masi.

—   Thanks. Another taste of Italy.

—   So it was a good holiday?

—   It was a great holiday! We took it easy instead of our usual binge-tourism. Hung out in outdoor cafes, watching people, chatting. Walked for hours. Sat in parks and gardens. We did go to galleries and museums, but we limited ourselves to just a floor or a couple of rooms each day. You actually appreciate and remember what you see. It really worked well.

—   Where did you stay?

—   We were south of Siena, in a small old hotel plopped in the middle of a vineyard. We’d walk through it and on the other side there were these dusty olive trees. We had rented a car so we took in a lot of the sights: San Gimignano, olive groves, an old spa.

—   It sounds divine. Try some of the shrimp. Candace’s recipe.

—   Oh, I love that. And how are things with you, Fee?


Fiona hesitates but opts to plunge into dangerous territory.

—   I won’t pretend I haven’t missed you, Anne. And I’ve been horribly upset by how I behaved. Luc talked to you?

—   Yeah, he did, but it took me a while to process it all. Going away was a good idea in so many ways. I talked to Georges about it as well. He agrees he put Luc in a really awkward situation, and that telling him was a mistake.

—   Really, he said that?

—   Yeah. You know Georges is really making an effort. He was so kind and attentive to me on the holiday. He even bought me a guilt ring.


She flashes an emerald and diamond beauty.

—   It’s gorgeous, says Fiona, catching Anne’s hand. The green is stunning — matches your eyes.

—   Thanks, Fee, she says. More important, it wasn’t just a meaningless gesture. Now that we’re home — well, we just seem to be on a different footing. Early days yet, and we’re still in couples therapy and he’s in individual therapy, which is good, but things seem to be sorting themselves out.

—   Oh Anne, I am so glad things are on the mend. But I still feel horrible about what I did. I feel like I really betrayed you.

—   You did, says Anne simply. Fiona flushes with shame.

—   And I was furious with you at first, then mostly sad and disappointed. But gradually, I realized why you did it. Even if I still think it was wrongheaded, paternalistic….

—   I wanted to protect you, says Fee.

—   I know. I realize that now. And it’s because you care about me.

—   You’re my best friend. But, well, I made a big mistake. A big ethical error. And so did Luc. The right thing to do would have been to tell you the minute we knew. As you said, if the shoe were on the other foot, that’s what I would have wanted.

—   I nearly lost the two people who mean the most to me in the world, says Anne. If I can forgive Georges, I can certainly forgive you and try to move on. I mean, I may have a bit of trouble with trust and it may take a while to get fully back on track, but I think we’re up to the challenge.

—   So do I, Anne. There’s nothing I’d like more.

—   Here’s to a renewed friendship then, says Anne raising her wine glass.

—   And my atonement, says Fiona, clinking. Thank you for giving me another chance, Anne.


*Caribbean Shrimp

- Makes 10 appetizer-type servings

1 tablespoon vegetable oil

2 tablespoon fresh ginger, peeled and minced

2 limes, juiced

2 garlic cloves, peeled and minced

1 tablespoon low-sodium soy sauce

½ teaspoon sugar

½ teaspoon hot red paper flakes

¼ cup fresh coriander, washed and minced

2 pounds large tail-on cooked shrimp (thaw, if frozen)

  1. Stir together vegetable oil, ginger, juice of both limes, garlic cloves, soy, sugar and pepper flakes.
  2. Stir in finely chopped coriander and cooked shrimp.
  1. Cover and refrigerate at least 1 hour and up to 1 day. Stir occasionally.
  2. Place in a shallow plate with toothpicks. Garnish with coriander sprigs.

Thank you to Candace Brookbank for this recipe.

 Kitchen Chronicles is a weekly series by Barbara Sibbald — novelist, award-winning journalist, and long-time contributor to Ottawa Magazine. Visit Kitchen Chronicles every Sunday for a new installment — and a tested recipe.



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REASON TO LOVE OTTAWA: Because two guys on Parliament Hill have been listening to our secrets for a century

By Cindy Olberg

Sydney Mutendi of Harare, Zimbabwe sits by the Whispering Wall monument on Parliament Hill, May 3rd, 2014.

Sydney Mutendi of Harare, Zimbabwe sits by the Whispering Wall on Parliament Hill, May 3rd, 2014. Photo by Jackson Couse


Perhaps you’ve heard whispers about an unusual monument hidden in plain sight on Parliament Hill. On the east side of the Centre Block, past the statues of the Famous Five and Queen Elizabeth II, there’s a statue referred to as the “whispering wall.”

The Robert Baldwin and Sir Louis-Hippolyte LaFontaine memorial, designed by Walter Seymour Allward and built in 1914, is a tribute to two statesmen who worked together to give legislative power to elected assemblies and prove that French and English Canadians could collaborate on political issues.
Often praised for its original curved design, another quality tends to get overlooked: it carries sound. When two people sit at opposite ends of the monument and whisper, they can hear each other — perfectly, as if they were sitting side by side.

According to Craig Merrett, a professor of mechanical and aerospace engineering at Carleton University, it’s caused by a phenomenon known as evanescent waves. “Sound waves almost move in a ripple along the surface of the wall, and the person at the other end can hear — with little distortion. With the sound waves moving along the surface of the wall, it actually doesn’t lose its intensity as much as when you normally just talk into open air.”

Students from Sir Guy-Carleton High-school at the Whispering Wall monument commemorating Robert Baldwin and Louis-Hyppolyte Lafontaine, the collaborative Premiers of Upper and Lower Canada. The students, from grades nine through twelve, are on a leadership training scavenger-hunt to Parliament Hill, May 4th, 2014. Photo by Jackson Couse.

Students from Sir Guy-Carleton High-school at the Whispering Wall monument commemorating Robert Baldwin and Louis-Hyppolyte Lafontaine, the collaborative Premiers of Upper and Lower Canada. The students, from grades nine through twelve, were on a leadership training scavenger-hunt to Parliament Hill, May 4th, 2014. Photo by Jackson Couse.

The effect is fun for passersby, but it’s not an intentional design element. Other famous examples include the dome in St. Paul’s Cathedral in London and a dam in Williamstown, Australia – both of which attract tourists with their sound-channeling properties.

Take a friend and experience it for yourself -  tell each other a secret or something nonsensical. But bear in mind: you’ll be doing it under the watchful gaze of two politicians who continue to remind us that communication is the glue that bonds English and French Canadians, whispers and all.

The Novak family of Vancouver - Milan, Marek, and Gabi Novak and their mother, Paula Da Rosa - talk to each other across the Whispering Wall on Parliament Hill, May 4th, 2014.

The Novak family of Vancouver – Milan, Marek, and Gabi Novak and their mother, Paula Da Rosa – talk to each other across the Whispering Wall on Parliament Hill, May 4th, 2014. Photo By Jackson Couse.

This REASON TO LOVE OTTAWA is found on Page 17 in the 2014 Summer Issue of Ottawa Magazine, available now at independent local news outlets or at

KITCHEN CHRONICLES: Cowboy cuisine from Trish’s Russian pal. PLUS Roast chicken on a vodka bottle


Russian hijinxs

—   Trish! It’s so great to see you. Now I can stop cleaning the damn house!

—   Sorry to just pop by unannounced, Fee, but I was at the market and I just thought I’d see if you were at home.

—   Is something wrong?

—   I’m succumbing to guilt overload. I’ve asked Iryna to leave by Sunday and I’m dodging her!

—   But I thought things were going well.

—   The first few days were great. Last Saturday, we took a long walk along the river and in the evening we sat around talking and drinking shots of vodka. Well, they drank vodka, I had tea.

—   What did you talk about? The political situation? The corruption? That’s what I’d be interested in.

—   Craig too, but she didn’t seem to be interested in politics at all. I think half the reason Craig didn’t make a fuss about her staying was he thought she might give him some insight into what’s going on there. I think she knows a lot, but she skirts his questions, pretends she doesn’t understand. Did you read that article in the Globe a couple of weeks ago about Russia’s nouveau riche and its corrupt bankers? I asked her last week about the banking system, and she pretended she didn’t understand the meaning of “corrupt.”

—   That’s so bizarre.

—   I know! On the one hand, she’ll talk about the hardships now, and how it was better before — under Communism — for the average person; then there was work and food for everyone, all the basics. On the other hand she’s totally loyal to the new system, to the national goals. She’s strident about it, talking about how well they are doing, how rich in resources they are.Russian dolls

—   So nothing about the cowboy capitalism?

—   The Wild West seems to be settling, from what I read. She was a lot more forthcoming on the train. Since she’s been with us, the closest she’s gotten to being critical was on the night of the vodka shooters. Vodka with dill pickle chasers no less. (“Is the Russian way,” she says.) So after about five shots, she admits that the people feel “humiliated.” But then she seemed to immediately regret saying it, but refuses to elaborate. Craig and I talked about it afterward. Our guess is that people feel humiliated because of the failure of communism. Because it didn’t work: with the corruption, the inequity, the brutality under Stalin, people’s innate greed. Yet it seems that, in some ways, people were better off. Free apartments and education, inexpensive cultural events, strong family values and nationalism.

Read the rest of this entry »

KITCHEN CHRONICLES: Trish entertains a surprise visitor from Russia. Plus hearty Ukranian Borscht.

An Actuary from Russia

By Barbara Sibbald


—   So, what’s happening with Anne? asks Trish.

Fiona’s two friends have met a few times, but failed to connect. Anne’s too serious for Trish, not artsy enough. As for Anne, Trish reminds her of her most needy patients. Still, they have a lively interest in each other’s lives, via Fiona.

—   She and Georges have gone away for a couple of weeks, says Fiona. To Paris and then Tuscany. To try to sort things out.

—   Must be nice!

—   Yeah, well, I wish them the best. And I’m really glad Luc had a chance to talk to Anne before they left.

—   What about?

—   He actually apologized for not telling her what he knew, and for putting me in such an awkward situation.

—   Luc apologized, Wow!

Uke Russian Roll

Fiona laughs, but feels a bit miffed by Trish’s insinuation that Luc is incapable of apologizing.


—   He does sometimes, you know. So, what’s up with you?

—   I have a Russian woman coming to stay with us.

—   What? Who? asks Fiona.

—   It just sort of happened, I didn’t plan it, says Trish. I guess I’m too soft-hearted.

—   Or soft-headed, says Fee, grinning.

—   On Sunday, I was coming home on the train from visiting Joanne and I saw an empty seat beside this huge woman. She looked interesting, and it’s a long trip. She’s a giant really, well over six feet, with these huge hands: old Ukrainian stock, it turns out. And she was dressed like she was a hundred and eight: drab grey suit and sturdy scuffed black shoes. Soviet issue I suppose. But it turns out that Iryna’s very well educated — PhD in law — and she’s been sent to Canada by the Russian government to look into types of insurance systems. Think of it, under the Soviet system, there was no insurance. None.

—   Of course. How strange.

—   Yeah, but now people have private property, so suddenly there’s this need. And that’s just one small thing, one thing that we totally take for granted.

—   I don’t think I’ve ever met anyone from Russia.

—   Me neither. It seems so exotic to me. Chatting with her was like visiting another country: she told me all about things — things you wouldn’t find out even if you visited. She told me about their life, about how, in the old system, personal success was unimportant and personal development meant everything. And how people were so well educated — with two, three degrees. Now illiteracy is a problem. On the plus side, they don’t have to line up for food anymore and can buy anything they want. If they have the money. But of course, most people don’t have the money. Unemployment — another thing that didn’t exist before — is high. And so is crime. And there are people playing instruments in the subway — they might as well be beggars, she said, all disapproving like. But some of them are members of their national orchestra who have to busk because their salaries are so low.

—   That’s just shameful, says Fiona.

—   Especially for Russia, because she says they love art: theatre, ballet, everything. Their metro is filled with sculptures, chandeliers, marble floors. It’s all about the aesthetic, but it’s for everyone, not just the intellectual or social elite, like it is here.

—   What do you mean? We have public galleries?

—   Yeah, but you have to pay to get in. And you and I both know it’s only certain people who go. But in Russia, Moscow anyway, where Iryna lives, the art is everywhere. Banners with poetry on them lining the streets. A sculpture of Pushkin. I mean where’s our sculpture of Birney? Even their chocolate bars wrappers feature iconic paintings. Imagine if Mars bars were wrapped in a Tom Thompson painting!

—   So what did you tell her about Canada?

—   I talked about what it means to be a young country, a country of immigrants. So after all this chat, when we arrive in Ottawa, naturally I offer to give her a lift to her billet. And she asks for my phone number, says she’d like to meet up with me again because I explain things so well. I was flattered, so I gave her my phone number, said we should get together for lunch.

—   And she calls.

—   Of course. She asks me to meet her at her office on the seventh floor of this building on Laurier. So after work, I go to the seventh floor and when I get there, I realize I don’t even know the name of the outfit she’s with. I wander around asking people and, of course, no one’s ever heard of her.

—   Sounds like a scene in a Kafka novel!

—   Yeah! Except this is the twentieth century in Canada. So finally, it dawns on me that I can just call Iryna’s cell. It turns out she’s on the seventeenth floor. She’s holed up with the Canadian Insurer’s Association Anyway, she tells me how much she’s learning and how great it is, and that she’s decided to stay another two weeks. But she has a problem: She can’t stay where she is because it costs too much, and she wants to know if I know of any inexpensive place she might stay, because she doesn’t have very much money.

—   Oooh, tough one!

—   I know! And I’m thinking I’ve become a sort of ambassador of good will for Canada, so before I even think about it — without even asking Craig — I ask if she’d like to stay with us, I have a spare room. Well, it’s supposed to be my office, but I usually take my laptop to the living room anyway. And there is the futon couch in there. Until the crib arrives. So, Irnya accepts; I mean why wouldn’t she?

—   Yikes, what did Craig say when you told him?

—   He was incredulous at first, said I had no right, should have asked him first, et cetera et cetera. Everything I expected him to say, all of which is true. But then when I told him what she’s doing and that she’s respectable and all, well he’s still pissed that I didn’t ask first, but what’s done is done. He came home with a Russian phrase book yesterday, so I think he’s okay with it.

—   When’s she coming?

—   Tomorrow.

—   Maybe she’ll teach you how to make borscht*.

Russian dolls


*Ukranian borscht

Four servings


1 ½ cups potato, peeled and chopped into 1/3″ chunks

1 cup sweet potato, peeled and chopped into 1/3″ chunks

1 cup beets, peeled and chopped into 1/3″ chunks

2 tablespoons butter

1 ½ cups chopped onion

1 teaspoon caraway seeds

Vegetable stock (from cube) to top up beet/potato water to make 4 cups

1 large carrot, peeled and sliced

1 stalk celery, washed and sliced

3 cups cabbage, chopped

black pepper

1 bay leaf

¼ teaspoon dill weed

1 tablespoon + 1 teaspoon cider vinegar

1 tablespoon + 1 teaspoon honey

1 cup tomato puree

sour cream

1 tomato, chopped


  1. Place potatoes and beets into a saucepan, cover with water and boil until tender. Strain, saving the water in a large measuring cup.
  2. Melt butter in large pot over medium heat. Add onion, caraway seeds and salt. Cook, stirring, until the onion is translucent.
  3. Top up water from beets and potatoes with vegetable stock, to total 4 cups.
  4. Add stock, celery, carrots and cabbage to pot and cook until vegetables are tender.
  5. Add potatoes, beets, pepper, bay leaf, dill weed, vinegar, honey and puree.
  6. Cover and simmer 30-plus minutes.

To each bowl add a dollop of sour cream, a sprinkle of dill weed and a couple of tablespoons of chopped tomato.

 Kitchen Chronicles is a weekly series by Barbara Sibbald — novelist, award-winning journalist, and long-time contributor to Ottawa MagazineVisit Kitchen Chronicles every Sunday for a new installment — and a tested recipe.

FROM THE PRINT EDITION: Diversity — and commitment — drives Ottawa’s theatre scene


Laura Hall and Cindy Beaton in Ottawa Little Theatre’s production of Mauritius. Photo by Maria Vartanova

Laura Hall and Cindy Beaton in Ottawa Little Theatre’s production of Mauritius. Photo by Maria Vartanova

Earlier this year, CBC Radio hosted a phone-in program asking listeners to respond to the question: “Is live theatre dead?” Some callers agreed, saying, more or less, “It’s been replaced, and good riddance.” Others insisted that nothing rivals the sheer human power of live performance.

In fact, not only is theatre alive, it is growing. Market research done using Statistics Canada data reports that between 2001 and 2008, total consumer spending on live performance increased by 49%. Canadians spend twice as much on performing arts as on live sports, and — according to a 2010 survey — theatre attracts 12.4 million Canadians annually, compared with only 11.1 million for live popular music. That means that almost half of all Canadians over the age of 15 attend live theatre at least once every year.

Still, the economics of theatre — where production costs typically exceed revenues — are brutal, and the average performance-related annual income of actors hovers around $12,000, as reported in The Toronto Star in 2009. “Many actors and comedians leave the occupation because of high job insecurity,” says Service Canada in a report called “Job Futures.” “Like many other occupations in the arts, multiple employment is common.”

There is a lot of competition in Ottawa. With most of the oxygen being taken up by the National Arts Centre and the Great Canadian Theatre Company, there may actually be more companies producing good work here than there is audience. But John Muggleton, an actor who worked in television in Toronto before returning to Ottawa as director of marketing at the Ottawa Little Theatre, says that the competition is not waged with other theatres. “It’s Future Shop and Best Buy that hurt us, all selling products designed to keep people at home.”


Ottawa Little Theatre, founded as the Ottawa Drama League in 1913

If theatre has survived, it is an economic miracle, largely because of the commitment of driven artists. As David Whiteley of Plosive Productions says: “Nothing else is so comprehensive, so expressive. Nowhere else do you work so closely, so creatively with others. Nothing else brings together so many of the arts — visual arts, music, story-telling, writing. Theatre is complete.”

The Gladstone Theatre shines as an example of theatrical passion. The venue — on Gladstone Avenue west of Preston — was a tired old commercial space until 1982, when the Great Canadian Theatre Company (GCTC) converted it into a rough-and-ready theatre space. There, the company presented Canadian works for over 25 years. In 2007, it was strong enough, financially and artistically, to move into a new purpose-built home. The old bare-bones garage-cum-theatre on Gladstone was left empty. Enter Steve Martin.

In one of Ottawa’s most gallant theatre adventures, Martin purchased The Gladstone and renovated it into a little jewel of a theatre. He had a vision of a small, classy theatre, managed as a business and producing a year-long list of good plays, well publicized and featuring the city’s best artists. The results were disappointing. Martin now leases The Gladstone to Plosive Productions, which manages it as a rental facility and uses it for its own productions. One of those was a recent production of the Canadian classic Billy Bishop Goes to War, a one-man tour de force with actor Chris Ralph playing 18 roles; the play has been nominated for a Rideau Prize for Outstanding Production and Performance.

John P. Kelly of Gladstone Theatre - Photo by Lois Siegel

Director John P. Kelly of SevenThirty Productions, a company that presents regularly at The Gladstone Theatre – Photo by Lois Siegel


One of the regular tenants at The Gladstone is John P. Kelly’s SevenThirty Productions, which mounted November last fall — a play that won Best Professional Production and Best Actor awards for Todd Duckworth from the Capital Critics Circle. Kelly came to Ottawa in 2004, expecting to find work here. Instead, he was forced to found his own company, though the last thing he ever wanted was to produce. The results have been artistically acclaimed, but it is a hard living. What keeps Kelly going? “It’s what I do,” he says. “It’s who I am.”

Companies like Plosive and SevenThirty are keeping The Gladstone alive, and Martin remains convinced that his vision is tenable. He believes, however, that theatre-goers are looking for a “blue jean” experience, something that rivals film for ease of access and affordability. He will test that theory with a new show this summer, the Pulitzer Prize-winning Glengarry Glen Ross by David Mamet. Ticket prices will be low, and Martin intends to marry theatre with live dance music on weekends to appeal to a younger, music-oriented crowd.

The newcomers may be struggling, but Ottawa veterans have arguably survived by identifying a clear niche, venue, and audience.


DSC_0114 copy

Odyssey Theatre ensemble photo by John Forster

Odyssey Theatre, for example, is Ottawa’s pioneer “theatre in the park.” Since 1986, it has been producing its annual flagship play in Strathcona Park, where it specializes in commedia dell’arte (the classic masked street theatre of Italy). Ottawa people like to stay outdoors in summer. The Odyssey has captured their attention and used its seasonal success to build, grow, and diversify. It has taken time.

The GCTC also found its way. It started in 1975 with an identifiable constituency — cultural nationalists who wanted to see Canadian works on the stage. It has worked for over three decades to develop that audience and to build a strong business. It has taken patience.

Avalon Studio - photo by John Muggleton

Avalon Studio – photo by John Muggleton


A close and disciplined focus may have worked for established companies, but diversity is the emerging trend. Ottawa’s newest theatre business, for example — the Avalon Studio — has several strings to its bow. Last fall, Muggleton and actor/teacher Chris Ralph discovered a long-abandoned vaudeville theatre on Bank Street that had been repurposed for office space. They have reopened it now as a modestly sized and wonderfully atmospheric old theatre, but the Avalon is also making its living as a recreational drama school and event venue.

Ralph, whose acting career includes a diploma from the National Theatre School and work in Montreal and Toronto, is optimistic about the industry. “Theatre isn’t dead,” he says, “but it is evolving. To survive, we have to be flexible and inventive.”

Plays have to change as well, says Muggleton, and to have smaller casts. “As we work out of smaller venues, we need a different kind of play — two- or three-handers that we can afford to mount. Plays also have to be shorter, faster, and more dynamic.” And those plays have to be strong enough to please audiences trained by the consumer market to expect consummate polish and high-paced delivery. There is no room, ever, to compromise quality.

Quality is not the issue for Third Wall Theatre. The company has been presenting classic plays to Ottawa audiences for the past 13 years. It is a critical favourite, recently nominated for five Rideau Prize awards. It is worth noting that although the critically acclaimed God of Carnage drew the second largest audience of any show in Third Wall’s history, it was not a financial success. Welcome to the world of theatre.

Third Wall Theatre - God of Carnage - 2013 - Mary Ellis, Todd Duckworth, John Koensgen & Kristina Watt

Third Wall Theatre – God of Carnage – 2013 – Mary Ellis, Todd Duckworth, John Koensgen & Kristina Watt


Third Wall is remarkable in that it has a resident company, a body of actors on which it draws for all productions. This is an unusual model for a small company, but it has allowed Third Wall to build a winning theatrical team. Not only is the company able to count on some of the city’s best actors, but the model helps actors develop onstage relationships. Third Wall has also invested in the nationally recognized director Ross Manson.

Quality is expensive, and Third Wall has felt the sharp end of the financial stick. It too has diversified to survive, notably with the Empty Space Series, where actors gather in the splendid hall of Glebe St. James United Church to read from short stories, letters, or poetry. The company has also created the Third Wall Academy, a training program for young actors. And it is currently hammering out a new business model, including partnerships to develop new theatre works based on classic works of fiction.

At least Third Wall has found a home. Earlier this year, it staged Harold Pinter’s classic one-act play The Dumb Waiter in the friendly, rough-hewn Avalon Studio. In doing so, it benefited from the affordability of an intimate space, the marketing expertise of Muggleton and Ralph, and access to the emerging Avalon community. Third Wall also experimented with an innovative ticket system for that show, with gradually increasing prices for ticket-buyers. This gave the company access to upfront revenues and helped build buzz around the production.

So is live theatre dead in Ottawa? In this brave new world, where newspapers, books, and cursive writing are all threatened with extinction, will theatre be among the casualties? Let us look for an answer to Mark Twain, who once famously observed, “Rumours of my death have been greatly exaggerated.”


“Passion Play” originally appeared on Page 27 in the MAY 2014 Issue of Ottawa Magazine.

KITCHEN CHRONICLES: What happens when loyalties are split. PLUS easy baked risotto

By Barbara Sibbald



—   I know I accepted your conditions, Luc, says Fiona angrily. I agreed not to tell Anne, but what choice did I have? I mean really?

—   Fee, do we have to talk about this now? I just want to relax and read the paper while the risotto* bakes.

—   Luc, I’m steaming. You put me off last night.

—   I didn’t get home until eleven!

—   Well, we need to talk about this.

He shrugs, wearily.IMG_4300

—   The way I see it, you left me with no choice, continues Fiona. If I hadn’t accepted your conditions, if I had told Anne that Georges was screwing around…. Well, you said it yourself, you’d feel I was being disloyal to you.

—   Well, you would have been.

—   So basically, my choice was being loyal to you and not telling Anne, or vice versa. Either way I’m the big loser.

—   It’s not quite so black and white, Fee, he says. You know you didn’t want to tell Anne, not really. You wanted to save her the pain of knowing, and if Georges had just quietly broke it off, well so much the better.

—   What? No harm done? Are you kidding me? Of course there was harm. There was harm from the moment Georges decided to have it off with Giselle. Before he even did it. And, yes, I am a bit of a coward when it comes to breaking bad news.

—   More of a Pollyanna, he says, grinning.

—   Whatever, she retorts tersely. The fact is, I avoid it at all costs. But this time, I should have done the tough thing, because that was the right thing. Anne had a right to know, and to make her own decisions about this. The secrecy has just made it so much worse. Now Anne’s not only been betrayed by her husband, but also by her best friend.

—   And you blame me?

—   No, not entirely, of course not. But Luc, you did put me in a terrible position.

—   By telling you about the affair in the first place?

—   Yes.

—   So it would have been better if I kept it a secret? To keep secrets from you? My partner?

—   Yes. No. Well, no, but you should have thought it through more thoroughly. About what it meant to tell me, and whether telling Anne was the right thing to do, no matter what the repercussions were for your friendship with Georges. Look what’s happened now! You and Georges are still fine friends and Anne and I have had a total blow-out over this. So basically, my friendship was sacrificed to save yours.

—   How was I to know that would happen, Fee? It’s certainly not what I wanted.

—   What did you want?

—   I wanted to save both friendships, and maybe their marriage as well.

—   Aren’t you the noble one! Don’t you think that was just a tad controlling, Luc?

—   Not that again! he says. It always comes down to that for you, doesn’t it Fee? Any argument we have, over sex, or Gavin, or the house, it always comes down to me wanting to wrest control. Don’t you think there might be more to it than that?

—   Of course there’s more, but that is the root of a lot of this. And besides, you’re changing the topic.

—   Which is…?

—   Why can’t you admit that we made a mistake in November when we decided not to tell Anne? I can admit that now.

—   Hindsight’s always twenty-twenty. Fee, we’ve just gone through this, the whole circle. You didn’t want to tell Anne any more than I did. You accepted my solution gratefully, you know you did.

—   So I’m solely responsible?

—   Architect of your own actions. If you’d stood up for telling her, if you’d insisted, even if you’d followed-up on Georges and Giselle and the fact that it kept going on for two months….

—   Hey, don’t stick me with that too, says Fiona, pointing her finger at his chest. That was your piece of the ultimatum. You said you’d talk to him. You should have followed up on that.

—   Well, the fact is that neither one of us did. So, yes, I take some of the blame for that.

—   And what about telling me in the first place. Don’t you think you should have given that a bit more thought, for the situation you dumped me in? persists Fiona.

—   You aren’t going to let this go until you have blood, are you?

She stares at him, her dark eyes flashing angrily. Luc sighs.

—   Yes, I probably should have thought it through. But Fiona, one of the best things about our relationship is that we do tell each other everything. We believe in that.

—   Yes, we do, she says, and that’s a good thing. But sometimes we have to think before we speak, appreciate what the information will mean to the other person. In this case, what the moral implications were. And that there may be a price to pay, on both sides, for being honest.

—   I did pay a price, I lost Georges’ friendship for a while.

—   And now I’ve lost Anne’s, and I’m not sure she’ll come back.

—   She will. You guys are tight.

—   Maybe. You don’t know that. And I’ve really hurt her. Deeply.

—   I am sorry about that, says Luc.

scrambled-eggsFiona can hear the sincerity in his voice.

—   Do you think it would help if I talked to her? he asks. If I told her it was my idea not to tell her.

—   You’d have to apologize too, you know, for being paternalistic about it, for putting your friendship with Georges ahead of their marriage and my friendship with Anne.

—   Phew, that’s a lot of weight.

—   I’ve taken my hit for the team, says Fee.

—   Yeah, yeah. And Fee, I am sorry I put you in that position. You’re right, I didn’t think it through.

—   Well, Georges shouldn’t have told you either, says Fiona. It’s not all your responsibility. Just because he was lying to his wife, doesn’t mean he should have assumed you’d lie to yours.

—   I don’t think he thought of it in those terms, he just wanted an alibi.

—   Purely selfish then.

—   Yeah.

—   So you’ll talk to Anne?

—   Yes. I’m really sorry about what’s happened, Fiona. Really sorry.

He takes her hand across the table and she looks up at him.

—   One thing’s for sure, she says, Georges’ selfishness isn’t going to make us fall out.

—   No, he says, giving her hand a squeeze.


*Easy bake risotto

Serves 2

1 tablespoon olive oil

3 types of vegetables, washed and chopped, about 2 cups in all (choose from red pepper, leek, garlic, onions, mushrooms)

1 cup Arborio risotto

3 cups vegetable stock (from cube is fine)

Fish (haddock, salmon or trout, no skin) or vegetable (broccoli, asparagus or cauliflower)

2 tablespoons grated parmesan

  1. Preheat oven to 350 °F.
  2. Heat oil in medium, oven-proof pot. Add 3 types of vegetable and rice. Sauté until vegetables are fairly tender.
  3. Add vegetable stock and bring to a boil.
  4. Cover and put in the oven for about 15 minutes.
  5. Put fish or veggie on top, sprinkle with parmesan. Cook another 5 minutes. Serve with green salad.

Thank you to Josefine Lami for this recipe.

KITCHEN CHRONICLES: Is keeping quiet the same as lying? PLUS spice it up with cauliflower curry


By Barbara Sibbald

There’s a tap at the back screen. Fee turns from chopping up cauliflower for a curry* to see Anne standing outside, pale and frowning.

—   Anne, she says, rushing over to open the door, what’s up? You look upset.

—   I am upset, she says tersely. May I come in?

—   Of course, of course, says Fee, stepping aside. Please sit down.

Her radar is tingling. Why’s Anne being so formal? What’s going on? Omigosh, has she found out that we knew? Please, no!


—   Glass of wine? Fee offers.

Anne shakes her head.

—   I need to know the truth, Fiona. Georges let it slip in therapy that he’d talked to Luc about the affair. I guess in my heart I sort of suspected as much. I asked him if you knew too, and he just shrugged. Did you know Fee? Did you?

Fiona’s heart pounds. She’s been dreading this conversation, rehearsing it in the middle of the night, oscillating between telling and not telling, unable to decide but knowing she’d have to sooner or later. Anne’s too smart not to figure it out. Now the hour has come, and Fee knows she has no choice.

—   Yes. Yes, I did know. I didn’t want to know. When Luc told me, I said he’d put me in an untenable situation, but we talked about it and he said he’d give Georges an ultimatum: either break up with Giselle or we would tell you.

—   When was that? Anne asks cooly.

—   Near the end of November, I guess. I told Luc that I wouldn’t lie, that if you asked me, I’d tell you everything I knew.

—   But otherwise, you wouldn’t say a word.

—   I didn’t see what would be gained, Anne. If he was breaking it off any way.

—   How can you make a call like that for me, Fiona? It’s so paternalistic. Don’t you think I had the right to know? You of all people. I mean if Luc were having an affair and I knew, wouldn’t you expect me to tell you so you could make your own decisions?

—   Yeah, I guess so. Yes, I would.

—   Why didn’t you think of that when you were discussing this with Luc?

—   I did. I told him you were my best friend and my loyalty was to you. And he said if I told you it would mean the end of his relationship with Georges, his best friend, and that I should be loyal to him…to Luc that is. He can be pretty persuasive, so I agreed, but only on condition Georges broke it off.

—   But that was in November….

—   Well, then Christmas came and Mom and Neil’s visit and well, yeah I did lose track for a bit. And….

—   So November to February? You cut him that much slack?

—   Luc thought Georges had broken it off. That’s what he told me in January — the day after that crazy night of cards. Still, that was well over a month after Luc gave the ultimatum. We should have set a deadline, and I should have followed up.

—   There’s lots you should have done, says Anne. The least of which is to tell me what the hell was going on. What I don’t get is how you could have pretended nothing was wrong. Remember when I found out and I came here? I cried at this table and you sat there and you lied to me. You said Luc didn’t know.

—   I never actually said it.

—   Well you implied it. You didn’t fess up. I feel so betrayed, Fiona. How could you? I thought we were friends.

—   We are. Oh, Anne, I’m so sorry. I thought I was doing the right thing, balancing my loyalties to you and to Luc.


She pauses, gazes out the kitchen window, then back at Anne.

—    I knew it was wrong, she says quietly. I’ve had nightmares about you finding out. But Luc…well I shouldn’t blame him, but he did give me a sort of ultimatum too: him or you. It was hard to see what was right with him pushing his view. I knew it was wrong of him, and in retrospect I was wrong to accept it. And we were both wrong to let Georges linger so long. We should have given him a week, end of discussion.

—   I’ve been a good friend to you, Fee. I’ve helped you with Gavin, with finding this house, with Neil…. I just don’t understand how you could be so disloyal. It hurts. It hurts a lot. I’ve been such a fool.

—   No, no, I’ve been the fool, Anne, says Fiona, the tears welling in her eyes. I’m so so sorry, please, please forgive me.



Anne stands up.

—   I can’t talk about this anymore. I need to think, she says.

She walks out the door without saying goodbye.

Fiona sits at the table, staring at the Formica, tears slowly trickling down her face, knowing she shouldn’t blame Luc, but unable to bear the full brunt of the responsibility herself. Will Anne ever forgive me? she wonders.

*Cauliflower curry

Serves 3-4

1 ½ pounds cauliflower (2 medium heads)

3 potatoes, peeled and diced

3 tablespoons butter

½ teaspoon ground ginger

½ teaspoon salt

½ teaspoon turmeric

½ teaspoon cayenne

½ teaspoon cinnamon

½ teaspoon coriander

½ teaspoon mustard seeds

½ teaspoon cumin seeds

1 clove of garlic, peeled and put through a press

½ cup water

1 ½ cups peas (fresh or frozen)

2 tablespoons torn cilantro leaves

2 tomatoes diced (fresh or canned)


  1. Wash the cauliflower and break into small (bite-sized) flowerets.
  2. Heat butter in a large pot over medium-high heat and add all the spices. Stir.
  3. When the spices are warm, add the cauliflower, potatoes and water. Stir and cover tightly.
  4. Steam until the cauliflower is almost tender.
  5. Add peas, cilantro and tomato. Cook another 5 to 7 minutes, stirring gently from time to time with a wooden spoon.
  6. Serve with yoghurt and mango chutney.


Kitchen Chronicles is a weekly series by Barbara Sibbald — novelist, award-winning journalist, and long-time contributor to Ottawa MagazineVisit Kitchen Chronicles every Sunday for a new installment — and a tested recipe.

KITCHEN CHRONICLES: A legacy of bitterness. PLUS barbecued tandoori chicken

Kitchen Chronicles is a weekly series by Barbara Sibbald — novelist, award-winning journalist, and long-time contributor to Ottawa MagazineVisit Kitchen Chronicles every Sunday for a new installment — and a tested recipe.


Will He?



Fiona slams through the back door. He’s such an asshole, she thinks.

—   Luc, she calls out, mustering her inner sweetness so she doesn’t sound as bitchy as she feels.

—   I’m home. Luc?

—   Be right down, babe, he calls from upstairs.


She plunks her heavy courier bag on the table and rummages through it, pulling out a letter. She takes it out to re-read.

—   Asshole, she mutters.

—   Hope you’re not talking about me, says Luc, coming in and giving her a kiss on the cheek. What’s up?

—   I got this letter from Dad. At work no less, because after nearly a year he still doesn’t have our home address straight. Shows you how much I mean to him.

—   Whoa, Fee. What’s up? What does he want?

—   It’s a note really, and a copy of his will. Basically, Neil and I get nada. Nothing. It’s all going to wifey two.

—   Nothing?

—   A few family trinkets. Neil’s getting grandpa’s piano for chrissakes. How’s he supposed to move that from Vancouver to Halifax? And Neil doesn’t even play anymore. It was Dad who was keen on that. As soon as he left, Neil quit. Basically, Dad knows nothing about us.

—   What’s he leaving you?

—   The family silver, which I suppose is worth something, but I’ll never use it. I hate it. After polishing it every Saturday morning for years and years. Never quite to his standards, mind you. I’d have to line it up on a cloth on the kitchen table for inspection and he always make a big joke out of rejecting a few pieces. But it was no joke to me.

—   So some silverware with bad vibes, and that’s it?

—   Yeah, that’s it. He says his first obligation is to Lorelei. We’re young and can look out for ourselves, but she’s got rheumatoid arthritis now so he wants to make sure she’s okay.

—   Well, he does have to look after her. Especially if she’s sick. But his track record for truthfulness is kind of shaky.

—   So what happens when she goes? I guess her kids will get everything. It’s so friggin’ unfair.

—   A legacy of bitterness, says Luc.

—   You’re so right. I’m furious. I mean what about Neil? He’s sick too. Doesn’t he even consider his own son? And there’s Mom, too. She’s not exactly rolling in it. He might leave her something. She is the mother of his children.

—   How old’s your dad? Eighty-five?

—   Eighty-four. But he’s healthy, as far as I know. He’s probably just getting things in order. I don’t know why he decided to tell us about the will now.

—   Maybe it’s a trial balloon, to see how you’ll react. Wills can be changed.

—   Or maybe he just wants to be mean, to bug us. That’s possible too, with Dad.

—   I think you should go to a lawyer, or maybe a mediator. Get some professional advice on how to handle this.

—   You mean figure out how to negotiate with him?

—   Yeah. Let’s assume it is a trial balloon, that it’s not set in stone. I’m sure he doesn’t fully appreciate Neil’s situation. I mean it’s not like you’ve been calling with weekly updates.

—   That’s true, says Fee slowly. Neil hasn’t talked to him since Christmas. I haven’t either.

—   And does he know about our finances? How much we owe on this house? How much we’ve saved — or rather haven’t saved — for Gavin’s university? He might change his mind if you talked to him, if you opened up to him a bit.

—   I don’t know, says Fee, shaking her head, he’s friggin’ stubborn. And cheap.

—   But he does love you.

—   I guess he does. Yeah, he does.




She looks up at Luc, grinning.


—   How did you get to be such a smarty pants? Okay, I’ll go and talk to someone, work out a way to broach this with him so he doesn’t go ballistic.

—   Stick to the facts. He’s a lawyer, he understands facts.

—   Thanks, Luc, says Fee, giving him a full hug. My voice of reason.

—   Chief cook and bottlewasher too. Shall I fire up the barbecue for the tandoori*?




*Grilled Tandoori Chicken

Six servings

Note: Needs to marinate at least 8 hours.

1 ½ teaspoon Dijon mustard

2 tablespoons vegetable oil

¼ cup low-fat plain yoghurt

1 ½ teaspoon fresh ginger root, minced

¼ teaspoon cumin seeds

¼ teaspoon ground turmeric

2 tablespoons lemon juice

1 jalapeno, seeded and finely chopped

2 ½ pounds chicken breasts, bone in

Juice of half a lemon


  1. Place mustard in bowl, add oil, drop by drop, whisking until well blended. Stir in yoghurt.

  2. Using a mortar and pestle or spice grinder, grind the ginger root, cumin, coriander seeds and turmeric to form a paste. Add lemon juice and mix well. Stir into yoghurt mixture with chopped chili.

  3. Remove skin from chicken. Make very small cuts in the meat. Arrange in a shallow dish and pour the yoghurt mixture over. Flip to coat all pieces. Cover and refrigerate at least 8 hours (up to 24 hours).

  4. Barbecue chicken 15 to 20 minutes on each side (15 if the top is down on the barbecue), or until juices run clear when chicken is pierced with a fork. Watch carefully and turn to prevent burning.    

LOST IN TRANSITION: Transitioning from the pediatric to adult health care system

This feature appears in Ottawa Magazine’s May 2014 issue. 

Sarah Mercer, Injuries, surgeries, and medication will always be part of her life, but that doesn't faze her as much as the transition to the adult health care system. Photo: Justin Van Leeuwen

Sarah Mercer — injuries, surgeries, and medication will always be part of her life, but that doesn’t faze her as much as the transition to the adult health care system.
Photo: Justin Van Leeuwen

By ROGER COLLIER For young people with chronic health conditions, turning 18 signals an important milestone. That’s when they transfer from nurturing, family-centred pediatric hospitals to the overcrowded, fragmented adult health care system. Not all make it to the other side “The scariest thing ever”

At the age of nine, while lounging on the floor of a friend’s home, playing Monopoly, Sarah Mercer attempted a feat that put her in hospital for three days: she tried to get up. Unfortunately, her left knee had other plans, opting to fracture rather than co-operate.

“That’s when I began using my wheelchair,” says Mercer. “I started walking again later, but I kept falling and breaking my bones.”

Mercer has spina bifida, scoliosis, osteoporosis, and a blood-clotting disorder called factor 5 Leiden. She was born with club feet, two hernias, and a partially split spinal cord. There have been about 40 surgeries over the years, the first when she was 12 days old. Her feet have been reconstructed, her spine has been fused, and several of her tendons are no longer in their original locations.

In short, Mercer’s health problems are chronic and complicated. Injuries, surgeries, pain, medication — these have always been parts of her life and always will be. At the Children’s Hospital of Eastern Ontario — or CHEO, as it’s known to everybody in Ottawa — Mercer is on a first-name basis with people in many departments.

Though the thought of yet another surgery doesn’t faze Mercer, there was always one thing that did worry her: a date. January 24, 2013. That was the day she turned 18, which meant her time at CHEO was coming to an end.

“It’s the scariest thing ever,” says Mercer. “The doctors there are like family. They’ve seen me grow up. They’ve been through really tough times with me. Leaving them is like graduating from high school or moving out of your family’s home. It’s very nerve-wracking.”

Mercer is hardly the only young person with a chronic disease to bid farewell to a children’s hospital with some trepidation. When patients “age out” of the pediatric system, typically at 18, they encounter an entirely different culture of care. They leave a nurturing, family-centred facility where all their health needs — physical and mental — are addressed under one roof. In pediatric hospitals, patients receive care from multidisciplinary teams, which could include nurses, physiotherapists, social workers, surgeons, psychologists, pain specialists, and other health professionals.

On the other hand, the adult health care system they enter is fragmented and difficult to navigate, particularly for those who require the services of many medical providers. Someone like Mercer, for instance, will have to visit multiple locations across the city. As well, the adult system is bloated with elderly patients, who outnumber young adults by an ocean-wide margin. Welcome to waiting lists, shorter appointments, and impersonality.

“I’m used to it being very personal and one-on-one,” says Mercer. “Now I go to an appointment, and it’s like, ‘What’s your name?’ ”

Adult health care providers expect patients to be independent. There is no handholding, no deferring to parents, no reminders to keep appointments. You are expected to be an expert on your condition and the primary advocate for your health. Gone are the days when you could lean on others to fill in the details about your medications, therapies, and equipment needs.

In other words, after you blow out those 18 candles, you move out of a cozy, full-service medical home and into a confusing, overcrowded medical maze.

“People become very comfortable at CHEO because everything is here,” says Diane Gregoire, who became familiar with Mercer during her years as coordinator of spina bifida care at the hospital. “They don’t always realize they will be leaving at 18. You can get so overwhelmed and busy, and all of a sudden, you’re a teenager and have to start thinking about life after CHEO.”

Like other children’s hospitals across Canada, CHEO is striving to ensure that transfer to adult care is not merely an administrative event but, rather, a carefully planned transition. The goal of transition programs, which are growing in number and scope every year, is to facilitate continuous and coordinated care between the pediatric and adult health care systems.

A good transition can help young adults with complex medical conditions enjoy a greater quality of life and function better socially, academically, and professionally. A poor transition, however, can lead to anxiety, complications, deteriorating health and, in some cases, disappearance from the health care system altogether.

Lost to follow-up

If you talk to experts in the field of transitioning to adult health care, you’ll hear one phrase time and again: lost to follow-up. What that refers to, in layman’s terms, is when someone leaves a pediatric setting and doesn’t see a doctor for a year or more. Once removed from the familiar and reliable structure of their childhood medical homes, some young people simply disengage.

“Sometimes they never make it to the other side and re-engage with the health care system only at a time of crisis,” says Dr. Khush Amaria, team lead for the Good 2 Go transition program at The Hospital for Sick Children (SickKids) in Toronto. “They show up in an emergency room, and nobody knows their health history.”

One study often cited as an example of this phenomenon followed 360 former SickKids’ patients between the ages of 19 and 21 with complex congenital heart defects. Slightly fewer than half of these young adults made their recommended annual follow-up visits to a specialized adult clinic, despite being at risk of complications such as arrhythmias and premature death. The study, published in 2004, found that more than a quarter of the patients hadn’t attended a single cardiac appointment since turning 18.

It is also common for newly independent young adults to get sloppy with their medication. Perhaps the drugs cause weight gain or acne, and the desire to make a good first impression at college or a new job sways sound judgment. Or it could be forgetfulness or indifference. Whatever the reason, the consequences of poor adherence to medication can be severe, depending on a person’s condition.

The health of young people with HIV, for example, can go south quickly if they interrupt antiretroviral therapy. Recipients of donated organs put themselves at risk if they skip their anti-rejection drugs. There isn’t an abundance of robust research in this area, but one 2000 British study of young people with transplanted kidneys did have troubling results. For eight of the 20 patients in the study, the donated organs failed within three years of transfer to an adult transplant unit.

Why would someone with a serious medical condition walk away from the health care system or stop taking their medication? Their health — their very lives — could be at stake. Well, it just so happens that the age when people transfer between health systems coincides with the peak period of risk-taking and experimentation in their lives.

Compared with adolescents, young adults are more likely to binge on alcohol, abuse drugs, or participate in risky sexual behaviour. It is a time of seeking new sensations, of pushing limits, of challenging rules. So perhaps it shouldn’t be a complete surprise that — after a lifetime of appointments, procedures, and pills — some young adults balk at the strict regime they had little choice but to follow when their parents were in charge.

“You have this period when people are already at higher risk of harm. Then you have young people with chronic illnesses, some who may have been sheltered all their lives. Now they have this blast of freedom, so they may stop taking their medication or take it erratically,” says Dr. Lorraine Bell, director of pediatric transition to adult health care at Montreal Children’s Hospital. “It could be because no one is watching, or it could be overt rebellion.”

Other factors can contribute to a less than stellar transition to the adult system. Young adults are a mobile bunch, and finding doctors in a new town can be challenging. People in their late teens and early 20s often struggle financially, making it difficult to pay for medication not covered under insurance or other costs related to their care. Furthermore, a busy or inflexible schedule at university or work limits their freedom to book and attend medical appointments.

However, the greatest challenge to planning and executing better transitions just might be getting all four parties that should be involved to work together.

The road to independence

When Sarah Mercer first entered preschool, her mother had to visit often to insert a catheter into her bladder. Lack of bladder control is a common complication of spina bifida. But for Mercer, depending on someone else to help her use the bathroom just didn’t cut it. “When I was four years old, I started catheterizing myself,” says Mercer, laughing at the memory. “I wanted to be in control.”

Mercer’s independent streak will serve her well in the adult health care system. Taking ownership of your health is vital to a successful transition. Unfortunately, not all 18-year-olds are prepared for that responsibility, says Deborah Thul, who runs the Well on Your Way adolescent transition program at Alberta Children’s Hospital in Calgary.

Thul says current research indicates that brain development continues for young adults into their 20s, so some may not have mastered the developmental skills needed to take on full responsibility for managing their own health care by their 18th birthday.

That is why plans for better transitions must include contributions from parents and medical providers from both the pediatric and adult systems. Of course, that is easier said than done.

One of the biggest challenges to getting parents fully onboard is their reluctance to let go. Many parents are overprotective of their children — even more so when those children have serious medical conditions. It is only natural that mothers and fathers accustomed to managing one crisis after another would struggle to pull back, think long-term, and see the sons and daughters they’ve accompanied to countless medical appointments as having the potential to live fulfilling, independent adult lives.

Mercer is fortunate that her mother, Laura Brown, has always stressed the importance of resilience and independence. That meant not using her condition as an excuse to fall behind in school and finding a part-time job when she turned 16, as well as going to the hospital only when absolutely necessary and returning home as quickly as possible. It meant not regarding life as a series of medical emergencies.

“The thing that was important for me was for Sarah not to see herself in the role of the sick person. She is more than her condition. Sarah has a chronic condition, and she needed to learn to live with it. That means living with pain, with a wheelchair, and with surgeries,” says Brown, who works in vocational rehabilitation to help people with disabilities find jobs. “I want Sarah to contribute to the world in some way. The world is not going to tailor itself for her. There will always be stairs, and it’s important for her to learn how to navigate them.”

The road to independence can be rough, though, when you encounter adult medical providers who don’t understand your struggles and have neither the time nor the skills to meet your needs. Sure, there are pockets within the adult health care system that have shown interest in improving transitions for younger patients, but in general, it isn’t seen as a priority. That’s because young people represent a very small proportion of the population, and most adult hospitals have their hands full with patients who are very old and very sick. With an aging population, that isn’t going to change anytime soon.

Furthermore, doctors on the adult side aren’t always familiar with treating some chronic conditions that start in childhood. There was a time not so long ago when many children with these diseases never saw their 18th birthday. But thanks to advances in technology, pharmaceuticals, and medical therapies, most youth with spina bifida, congenital heart disease, HIV, and other chronic conditions can now expect to live well into adulthood.

“There’s a new generation of patients that didn’t exist before,” says Dr. Sandra Whitehouse, medical lead of British Columbia’s Youth Transitions initiative. “There are more adults now with cystic fibrosis than children. It used be a children’s disease.”

In the pediatric system, however, transition is considered a hot topic. Pioneers in the field began to take interest about two decades ago. Now several of the larger children’s hospitals in Canada have transition programs and coordinators. Still, despite the advances, there is plenty of room for improvement.

“Closing the gap”

Here in Ottawa, CHEO began to focus on improving the transition to adult care in 2010, when it became part of the hospital’s strategic plan. Different approaches are being tested in various departments. In a pilot project, for example, doctors in the nephrology clinic partnered with colleagues in the adult system to improve transition for patients with kidney diseases and presented suggestions to youth and their families at a workshop.

The hospital has also created educational materials, including a readiness assessment tool to assist teenagers in figuring out if they’re prepared for transition. Do they know their new doctors’ names? Do they know all their medications? Do they know which pharmacy they’ll be dealing with?

“When people turn 18, there is so much happening. They are becoming independent, graduating from high school. They may be starting a relationship or a job,” says Shaundra Ridha, director of CHEO’s transition program. “There are so many changes in their lives, and if we can be a stabilizing influence, making the unknown less scary, that’s what we aim to do.”

As a member of the hospital’s youth forum, Mercer has provided input into how to better equip young people to transfer to adult care. “In time, the transferring is going to be smoother because they are going to start it earlier and all the departments will be on the same page,” she says.

Children’s hospitals in many Canadian cities — including Toronto, Vancouver, Montreal, and Calgary — are also making progress on improving transition. Many of the programs share similar principles, such as starting the process early, as young as the age of 10, and fostering independence in patients.

Transition coordinators also stress that the time of transfer should be flexible, factoring in the youth’s cognitive development and external support systems, as well as the availability of medical care. Other popular ideas include creating individualized transition and long-term care plans with input from both pediatric and adult providers, using electronic medical records to improve communication between youth and adult systems, and providing professional health care navigators for young adults.

Many transition experts point to the Good 2 Go program in Toronto and the ON TRAC (Taking Responsibility for Adolescent/Adult Care) model in British Columbia as leaders in the field. Good 2 Go offers a wide range of services and tools, including readiness checklists, transition timelines, discussion groups for parents and teens, and MyHealth Passport — a card for young adults that lists all their conditions, medications, allergies, and other medical information. ON TRAC provides separate toolkits for youth, parents, and health care providers, focusing on topics such as self-advocacy, sexual health, financial planning, and social connections.

The British Columbia Medical Association has also lent its support to the cause, releasing a policy paper on transition called “Closing the Gap.” The paper lists a number of recommendations, including having a family doctor from birth, individualizing transition plans, tracking young people with chronic conditions after they leave the pediatric system, and developing benchmarks to gauge transition success.

What is lacking, however, is consistency across the country. There are no national standards, no official guidelines, and no established best practices. To date, efforts to improve transition are mostly based on concepts rather than evidence. For good reason: though some data exist, much speculation remains. There is a need for more empirical research to quantify how transition services are actually affecting health outcomes. Do they reduce emergency room visits? Do they reduce in-patient admissions? Do they reduce deaths?

The good news is that interest is growing among researchers in obtaining that data, and this research guides the work being done by the Canadian Association of Paediatric Health Centres, which is presently developing national pediatric guidelines for transition from pediatric to adult care. So the future looks bright.

As for Mercer’s future, that’s looking pretty good too. She has moved into an apartment and, with the help of her mother, who stays over several days a week, has learned to cook, clean, and do laundry. She schedules her doctors’ appointments and gets herself there on public transit. And she still has the job she started when she was 16 at a movie theatre in Barrhaven.

In September, she enrolled in Introduction to Music Industry Arts at Algonquin College. A singer and musician (she plays guitar, piano, and ukulele), Mercer loves almost all forms of music, from acoustic folk to rock. The tattoo on her ribs — Come as You Are, a song by Nirvana — is evidence of that passion.

It is another of Mercer’s tattoos, though, that is particularly telling. The primary message her mother taught her — that her identity is not defined by her medical condition — has evidently sunk in. Mercer knows exactly who she is, and if she ever needs a reminder, she only has to look at the five words inked on her right forearm: To Thine Ownself Be True.

Photo: Justin Van Leeuwen

Five words inked on her right forearm: To Thine Ownself Be True.
Photo: Justin Van Leeuwen