Monticchiello + Montepulciano, Tuscany

From Cortona we drove to an agriturismo near Montepulciano, a working farm where four generations of women worked together in the kitchen making our meals. 

We walked ten miles, inadvertently, one day. We were told that there was a walking trail to the small village of Monticchiello, and to watch for the red and white stripes marking the path. Sometimes it was clear, but more often that not the markings were on a fence post toppled into the ditch.

We walked with Tuscany spread out in patchwork squares in every direction. Twenty olive trees planted in a diamond shape; a rectangle of yellow vineyard; squares of field in green, lime, grey, purple. Forested mountains, cliffs, villages, castles. Tiny, deserted Monticchiello was my favourite. Where was everybody? Laundry hung from windows, cats had ramps up the sides of buildings, plants burst out of window boxes behind curved bars. A textiles shop was open and I bought some striped dish towels.

After lunch,we headed straight for Montepulciano. This proved a mistake, as it was much further than we anticipated. We could see our agriturismo across the hills at one point, with the cypresses lining the driveway, but the road kept leading us away from it. Finally at Montepulciano, drinking lemon soda at a cafe, I said to Pete - Actually, what I really want right now is to lie on the bed and read the Internet. So we took a taxi home and did exactly that. 

And that's it. The next day we looped back to Rome for our flight home. Back to the baby with her silky blonde shock of hair and perfectly fat cheeks, and our house coated in wet cedar leaves, and patients who accuse me of taking a brief vacation every year or so.

It was good to be there, and it's good to be here. 

Cortona, Tuscany

From Perugia we drove to Cortona, another medieval town. It was full of persimmon trees, sometimes with the leaves blown off and just a crop of glossy orange fruit studding the bare branches. 

There were cats everywhere, and planters overflowing with succulents and geraniums, and hardly a person in sight. 

 Harvesting olives:

We drove on to Il Convento Frati Cappuccini, a monastery just outside of Cortona founded by St. Francis of Assisi in 1211. Stone buildings, terraced, rise up Monte Sant Egidio with waterfalls cascading in front and a massive dome of forest behind.


We visited St. Francis' cell, which had a short board for a bed, a half log for a pillow, and, previously, a Madonna replica on the wall that was stolen in 1972. (Who does that?) We walked a little ways into the woods. The bell tolled, the rope disappearing between the buildings; how many times has that bell rung over 800 years? We saw one other visitor - the beauty of traveling in November.

We came across a young, very pleasant, very attractive man who told us he was in the process of becoming a friar. It's no secret that I am fascinated by anything related to the Catholic priesthood. I so badly wanted to quiz him on his motivations, his influences and fears, his childhood, what his parents thought. I guess I could have asked him if he had a blog.

Remaining: Montecchelio + Montepulciano

Perugia, Umbria

After three days in Rome, we rented a car and drove to Perugia, where we stayed in the Castello di Monterone, a castle dating from the 13th century. View from the tower:

We walked the three kilometres to the medieval town centre of Perugia. We wandered for hours, turning down whatever narrow walkway we wanted, in and out of churches, several breaks for coffee. Not a word about the Amanda Knox trial, anywhere.

History was always one of my least favourite school subjects, even in university. I loved the concepts underlying math and science, and the creativity of English and art, but history felt like a tedious memorization of facts. It bored me; I had no patience for it. But it's an entirely different thing when you're presented with the brick and mortar evidence of times past. This trip made me acutely conscious of my place as one lone individual in a very long continuum of historical events. That might sound forbidding, but I find it strangely comforting to recognize I'm a tiny cog in something huge. 

Next up: Tuscany


Turns out you can blog from planes now, 30,000 feet over the Atlantic. To my right, the sun, having risen a spill of gold along the curve of the horizon, is climbing, but slowly, as we speed ahead of it. To my left, on an unoccupied seat, coffee and my notebook and a black Sharpie. And left of that, Pete, reading Miriam Toews' A complicated kindness.

We're en route to Vancouver after eight days in Italy. It was our first trip away together, without kids, in over ten years. Pete's parents flew in from Ontario to stay with the kids. 

We started in Rome. Taking a taxi from the airport to the centre of the historic district, the driver continuously pointed out ruins, monuments, glorious buildings that we felt we should recognize but didn't. After a brief stretch of highway we were on tiny cobblestone roads, curling around old buildings, pedestrians moving aside against restaurant tables and planters - and suddenly we were in a square, with the Pantheon looming above us, and our hotel beside it. Our room was eye level with and literally a stone's throw from the Pantheon roof. We could look down the giant pillars at figures walking in and out, footsteps echoing, and across at birds in cubbies in the rocks of the roof. 

We visited the Colosseum in the rain. The history of that place is truly fascinating. Almost two thousand years ago, spectators were given admission tickets in the form of pottery shards with the section, row and seat written on it.  A day's events typically included  animal hunts, followed by the execution of criminals, and then the gladiator fights. Part of the area beneath the arena is exposed, where men and animals were held until they made their entrance in the arena via a system of pulleys, lifts and ramps. Apparently one spectacle involved fifty bears being released onto the stage simultaneously.  A few years ago restorers unearthed the arena's drainage system, and found ancient apricot and prune pits, bone hairpins and game pieces. Games (similar to today's board games) were only allowed in December, but spectators played anyway, surreptitiously, between shows. 

We visited St. Peter's Basilica, waiting in line for security scans, white figures of the collonade above us, set against blue sky. All nationalities, languages, religions were represented in the lineup. Soaring spaces inside. Dead popes, stairs down to St. Peter's remains roped off, opportunities for offerings everywhere. Paintings and sculptures and marble wherever you looked. We went up to the dome, and looking down had a new perspective on the vastness of the place and the likely terror of working at this height. Inscribed in a complete ring around the base of the dome, in Latin: Tu es Petrus et super hanc petram aedificabo ecclesiam mean et tibi dabo claves regni caelorum (You are Peter/'Rock' and on this rock I will build my Church, and to you I will give the keys of the kingdom of heaven.)

Then flight after flight of stairs, not for the claustrophobic, in narrow slanting stairwells, to the cupola. Windy and packed. Down to the rooftop at dome level, where there was an espresso bar, and a store run by nuns with exquisite nativity scenes. 

We went on to the Vatican museums, where we started with the Sistine chapel. A surprisingly simple, oblong, dimly lit room. I'd no idea the Creation of Adam was one of that many paintings. Full of visitors, but plenty of room to move. Necks craned, looking and looking, identifying the different biblical scenes. 

I did not take this photo. Credit unknown. Available through Creative Commons.

We visited the Vatican museums when they were empty, the sun setting. Showcases (wunderkammers) of lamps, spoons, door knockers. Old maps, globes, where the west coast of the New World was a smudge or a shrugging line or simply a blank. The Raphael rooms were gorgeous; we were alone in them. 

And finally, we visited the Galleria Borghese. The park was beautiful; flat with evenly spaced trees. We wandered through the museum with audioguides pressed to our ears, separated. There was Bernini's Rape of Persephone, her hands flung upwards, twisting away from him, thigh yielding to his huge hand, tear on her face. His Apollo and Daphne, she turning into a tree, skin to bark, hair to branches, toenails to roots, bushes between them. During restoration they discovered that when struck, the uppermost twigs ring like crystal. David, with furrowed brow, biting his lip, left shoulder twisted over right foot. Bernini's work introduced the Baroque period, with a focus on physicality and movement, and this collection is stunning.

And just as exquisite as the sights was having Pete all to myself, uninterrupted conversations, no need to be aware of the time. To be done dinner, with no counters to clear, no kids to put to bed, no lunches to make - instead to lie on the bed with our laptops, researching early Roman history side by side, was bliss.

Still to come, possibly, if the mood strikes me: Umbria and Tuscany.

Neptune blue

Elizabeth Zimmermann seamless saddle shoulder pullover in colourblock

Leif asked me to make him a sweater, and he was very specific with his request: "Blue like the planet Neptune, lined with rabbit fur, and with Ninjagos on it." One out of three would have to do.


Elizabeth Zimmermann has revolutionized my knitting. In Knitting Without Tears she provides a sweater template, giving the ratios of sleeve to body to collar. You measure your subject (newborn to grown man), select your yarn (fine to bulky), determine your gauge, and knit the sweater. You can do the band, cuffs and collar however you prefer: ribbed, hemmed, rolled. You can stripe it, or work it in monochrome, or, as I did here, use colourblocking. It's very freeing. 

This is the seamless saddle shoulder pullover, with a hemmed band and collar in contrasting yarn, and ribbed cuffs:


The yarn is Brooklyn Tweed's Shelter, worsted weight wool grown in the USA. I used hayloft, almanac and sweatshirt. The colours are rich, it's perfectly textured - highly recommend.

Leif could never disguise his pleasure when he'd find me working on this; he'd do a little hum and come over to put his arm in a sleeve and to remind me about the rabbit fur. He wears it very enthusiastically. Testing-the-seams enthusiastically. He pulls it over his head in such an inefficient way that I'm always reminded of a fetal face presentation.


And I finished it just in time. The weather's turned; our front walk is covered in wet cedar leaves, the winds are blowing down Indian Arm and we've just turned on the furnace. 

Project details on my Ravelry page


Bedtime for Ilia

  1. We have two of these gorgeous MacAusland blankets. They're made on PEI by MacAusland Woolen Mills, "from sheep pastured in the cool mists of Canada," as one reseller put it. I see these blankets for sale all over Vancouver for triple what you pay buying direct from the website. 
  2. Maileg Bambi. In 2006 every nursery decorating book I had (pre-Pinterest, remember?) featured these bizarrely skinny rabbits. It took me years to identify them as Danish-made Maileg products, and they've grown on me. They're not cuddly, but they do have removable bloomers and other charms.
  3. I gave Ilia her first hot water bottle tonight. She lay stiffly on her back with her feet centred squarely on the warm rubber, mind blown.
  4. Echo toddler bed. Ilia's still in her crib, and I probably shouldn't admit that Ariana (seven) is still in a toddler bed. With rails. Everyone's got to advance one bed and it just feels too complicated at the moment. 
  5. I've never paid $40 for baby slippers, and since the Wooly Baby Thumper slippers are sold out, I wasn't put to the test.

The element

In his NYT bestseller 'The Element', Ken Robinson argues that we are in our element - doing what we should be doing - when we do the thing we love, and in doing it feel like our most authentic self. 

This got my attention. I've often felt that the place I am most me is in the clinic, and I find that somewhat disturbing: how can that be, if my children and closest friends never experience me in that context? I feel I'm less the real me at home - or maybe that's wishful thinking. At any rate, I like myself best at work, and the following description by Robinson of people in their element holds true: 

". . . time passes differently and they are more alive, more centred, and more vibrant than t any other times." p21

He suggests that we find ourselves in our element when four things align: aptitude, passion, attitude and opportunity. Because his description of the attitude necessary to find one's element (perseverence, ambition,  wanting something strongly and being willing to exert oneself for it) is, I think, almost universal among physicians, I've 've taken the liberty of replacing "attitude" with "need" for the purposes of applying this to medicine. 

And so, the four pieces that fit together when in one's element: 

  1. aptitude (what you're good at)
  2. passion (what you love)
  3. a̶t̶t̶i̶t̶u̶d̶e̶  need (in the world, that your work fills)
  4. opportunity (a position where you can do the work)

I'm a good physician, I love medicine, I provide primary care to refugees, and I work in the only such clinic in the province. Perfect score. 

Thinking over other positions from which I've moved on, or avoided, or wished for, I can identify which of the above was missing. I lost my passion for work in Vancouver's downtown east side when I came to view the work as palliative. In private practice in an affluent neighbourhood of Vancouver's worried well, the preponderance of women complaining that their hair had lost its lustre left me feeling my work wasn't filling a genuine need. I've avoided high acuity settings (emergency room, deliveries) because I haven't kept up those skills. And I don't work in a medical practice where I'm given paid time to write because I haven't found the opportunity. 

I do think that health care workers have an advantage in finding our element in that the need is so obvious in our work. We care for sick people; what's more basic than that? It's less tangible for people like my husband, who works in business software. And I think it's more difficult still for artists to define and defend the need for their work.

The concept of opportunity trips me up a little.  My current job, and the one before that (HIV clinic) were both positions that I did not seek out. They were offered to me. Sometimes I second-guess myself: isn't accepting an opportunity a passive choice? Picking the low-hanging fruit? Shouldn't I be actively pursuing the perfect, hard-to-get position, chasing it down? (But what would that even be?)

Maybe we can increase our work satisfaction by changing what fills those four criteria. If I were to increase my skills (say, learning some basic surgical skills like appendectomies) and set up shop where there is greater need (rural Zambia) would I be even more satisfied? Perhaps that's why so many 50+ physicians do exactly that. 

I like the idea of applying this framework to job considerations in the future. I've been dipping my toes into administrative work. There's a need for (young) medical administrators, and plenty of opportunities. But I haven't had enough experience yet to determine whether I have a passion for it, and whether I have (or can develop) the necessary skills. Whether I would find myself in my element there remains to be seen. At least I know what to look for:

"One of the strongest signs of being in the zone is a sense of freedom and of authenticity. When we are doing something that we love and are naturally good at, we are much more likely to feel centred in our true sense of self - to be who we feel we truly are." p90

And you? Are you currently in your element? If not, which is missing: skill, passion, need or opportunity?

[cross-posted at]


I've been sorting my photos from 2011, Year of Ilia Tove. It's taken me this long to get some perspective so that I can go in and prune some of the hundreds of newborn pictures.

It does break my heart a little to see Ariana in these images, newly ejected from her long-held position as beloved baby girl. She took it graciously, and seriously; and yet on so many pictures she looks sidelined.

DSC_1570  2011Mar27_6535



There was this, though, and lots of it:


That sweet face. I hope I didn't do wrong by you.


One clinic day, three responses to my pregnancy

I dislike that pregnancy forces me to bring my personal life into the office. I don't have pictures of my kids on my desk, I am vague when curious patients ask where I live and on Monday mornings I never volunteer my weekend activities to the staff.

But this pregnant belly, no matter how discreetly swathed in muted professional clothes, begs comment from everybody.

* * *

A patient comes to see me for follow-up after a miscarriage. I am acutely aware of how difficult it might be for her to see her doctor pregnant . . . continued at Mothers in Medicine.

Ten guidelines for medicine-life balance

Right now, this month, seven years out of residency with a part-time position at the refugee clinic and three and three-quarters children, I have work-life balance. It's somewhat precarious, something that could be toppled by illness or an unbearable colleague or a newborn, but I would rate my current satisfaction with both career and home life as high. Here are some philosophical and practical guidelines that I follow:

1. Accept that you can't have it all - at least not at once - but you can have a life that is rich and full and satisfying. I watch resignedly as other (childless) physicians at my clinic leave to spend months working in Afghanistan and Peru. I'm the mother that arrives late to the preschool Christmas potluck and sets a box of mandarin oranges next to the homemade cheesy noodle casseroles. My son's school uniform pants are embarrassingly short and I couldn't make a recent cross-cultural mental health conference because I'm home with my daughter on Thursdays. But I have kind, secure children and what is arguably the most delightful, rewarding patient population in the city. It's enough.

Continue reading at Mothers in Medicine.