Justin Lorentz, genetic counsellor at the Odette Cancer Centre, and Male Oncology Research & Education Program lead has a mission to identify, educate and support women and men who are at an increased risk for cancer.
WHEN KNOWLEDGE IS POWER
Justin Lorentz is a genetic counsellor at the Odette Cancer Centre, the Male Oncology Research & Education Program lead and an avid blogger. His mission is to identify, educate and support women and men who are at an increased risk for cancer.
KN: Do you believe in fortune tellers?
Lorentz: (Laughs) I do. I believe in psychics, fortune tellers and mediums. I've never been wooed by one, but, in theory, I believe.
How do you predict who is at an increased risk for cancer?
Rather than looking to the future, I look to the past – to a family history. We offer genetic testing to patients or families we suspect have hereditary cancer, looking mostly for the BRCA1 and BRCA2 genes. We all have two working copies of these genes, but if someone is born with a mutation in one copy, they'll be at higher risk of developing certain cancers.
Last year, Angelina Jolie went public about undergoing a mastectomy after finding out she carried the BRCA1 gene mutation. BRCA1/2 are known as breast cancer genes.
That's true. For women born with this gene mutation, the lifetime risk for breast and ovarian cancer jumps significantly. But many people aren't aware that men can also be affected by these gene mutations. Men can be carriers that pass on the mutation from one generation to the next, and they can be at an increased risk for breast and prostate cancer.
Is the lack of public awareness about how BRCA affects men your motivation behind the Male Oncology Research & Education (MORE) program?
Men with prostate cancer tend to die with prostate cancer, but men who have the gene mutation are more likely to die of their prostate cancer. It's significantly more aggressive; yet, we do the exact same screening for guys who have the mutation as we do for the general population.
The MORE program is about answering big questions: Should men with the mutation be screened differently? Are there other genes that can help us predict risk? Why is prostate cancer so prevalent in guys of Caribbean ancestry? We want to figure out how men at an increased risk for prostate cancer can be better managed, so that they can get the best care possible. If we can predict cancer, we may be able to prevent it.
You're giving people a glimpse into whether or not they are likely going to get cancer. Is ignorance bliss?
Information is power: It's a tool people use to make the best decision for themselves. Men and women with these gene mutations have options – whether it's having breasts or ovaries removed or doing regular screening to nip cancer in the bud. If someone chooses to know whether they have a BRCA gene mutation, they can adapt treatment or sometimes their life plans. With hereditary cancer, it's never just about one patient; it's about a whole family.
– Interview by Katherine Nazimek
YOU CAN CALL HER "DOCTOR"
Dr. Tiffany Florindo is a new Family Medicine Resident graduate and winner of the Steve Kandell Award for clinical excellence in family medicine at Sunnybrook.
MM: Becoming a physician takes a long time, 10 years or more, depending on your area of specialty. How do you go the distance?
Dr. Florindo: It definitely takes a lot of persistence and a good line of credit! You also need a huge support system and a "person" – the one who is going to kick your butt when you feel like throwing in the towel.
So who is that "person" for you?
I'm lucky because I have two: my mom and my sister.
The field of medicine is not for the lighthearted. Does anything make you queasy?
I really don't like when joints and bones are not where they are supposed to be. Oh, and bodily fluids. Depending on the night, those can end up on your scrubs. White is not an optimal colour to invest in when purchasing work attire.
How do people react to you as a young doctor?
That depends on the patient. Some think it's refreshing to have someone "younger" in charge of their care. That being said, I've also been called student, kid, girl … anything but doctor. I find it best to smile through it. Eventually they realize that I'm not just there to ask silly questions and I actually know what I am talking about. It keeps me humble.
You were recently elected by your peers to be chief medical resident. That's a great honour!
Yes, it definitely is. I'm confident in my abilities, but realize that I still have so much to learn.
Confidence must have been just what the doctor ordered when you did a placement in Moose Factory, Ont., a small island in James Bay.
When I first stepped off the plane and realized there was no cell phone service, I thought, "What have I gotten myself into?" But the group up there is completely amazing. I spent a few days further north in a community of only 200. When you're the only one around, without much support, you learn a lot about yourself and your medical training kicks into high gear. It makes me realize I'm doing exactly what I was meant to do.
– Interview by Monica Matys
THERE IN TIMES OF TRAUMA
Furmas Rahman is living proof that hard work and determination will help you succeed. While working as a patient service partner in Sunnybrook's Emergency Department, he completed his full-time degree in nursing in April and aims to pursue trauma nursing.
LB: How did you become interested in nursing?
Rahman: I started working at Sunnybrook in the Critical Care Unit as a patient service partner (PSP) in 2002. At that time, I just needed a job, but as I worked alongside the team I became very interested in all the different professions that support critically ill patients. Ultimately, I found that nursing was my true calling.
What exactly does a PSP do in the Emergency Department (ED)?
I support and assist the nurses with whatever they need. This could be walking or positioning a patient, stocking medical supplies, even supporting the team in the trauma room, if necessary. It really is a team effort in the ED, so anything I can do to fill in the gaps and make things run smoothly is what I'm there for.
How did you manage your PSP job and go to school full time?
It really was about finding a balance. I love Sunnybrook and the patients here, so the job was like a bonus. The work here also really reinforced what I was learning at school during the day. The ED has been a "real world" classroom. It also helped that my colleagues were very supportive of me.
What is it about trauma nursing that interests you?
Trauma patients have always affected me. I see a young person who has numerous injuries from a car crash, and I think, "That could be me or my family member." It is very humbling to work with these patients, and it takes a lot for them to get back on their feet again. I want to help those people get back to doing the things they enjoy.
Is it true what they say about full moons and the ED?
Well, sometimes when I'm driving in for my night shift and I see a full moon I think, "Hmm … this could be interesting." But I really have to be prepared for the fact that any day could be a day without time to catch my breath. The ED is very unpredictable, so I have to go in assuming my shift will be non-stop.
After all that hard work, how does it feel to have earned your degree?
It's such an incredible feeling to know that I accomplished this goal. I didn't think I would be able to do this, but I did and I really have everyone at Sunnybrook to thank for that. My colleagues encouraged me to keep at it. They would say, "You can do it, Furmas!" They made it that much easier because they had my back through it all.
– Interview by Laura Bristow
FEELING HER PATIENTS' PAIN
Yvonne Ramlall is a registered practical nurse (RPN) and nursing researcher at the Holland Orthopaedic & Arthritic Centre. She was recently awarded the 2014 Dr. Robert B. Salter Award from the Canadian Orthopaedic Nurses Association (CONA).
SF: When did you know that you wanted to be a nurse? Can you describe when and what it was that led you into this profession?
Ramlall: Sadly, my dad passed away when I was eight years old. He was a porter at the general hospital in British Guyana, and I recall my mother telling me that my dad wanted me to be a nurse. He had planned to send me to London to live with his niece and attend nursing school.
When I came to Canada, I went to school and was employed for 25 years in a private medical laboratory, the last 15 years working as a hematology technologist. The owner and president of the lab was diagnosed with a terminal illness, and there was no guarantee of my future there. My own mother had died six weeks earlier after suffering a stroke.
Distraught, I took some time off and completed a fl oral design course. It was then that I decided to honour my mother and father's memory and go down a new path and become a nurse.
As a member of the interprofessional care team on the acute surgical floor at the Holland Centre, what do you find most rewarding about your role as an RPN?
Being able to continue my commitment to practise. I also love innovative research and sharing the knowledge gained to improve patient care and education for patients having major orthopaedic surgery. Being a leader and a mentor to students and new staff, as well as advancing the practice of nursing, is also rewarding.
How did you initially get involved in nursing research?
I have always been passionate about improving the pain experience of patients, following total joint replacement. In 2006, I applied for a fellowship through the Registered Practical Nurses Association of Ontario (RPNAO). My first study was based on the knowledge that was learned through the Joint Pain Management Collaborative, an initiative that spans across Sunnybrook. I wanted to find out if patients were meeting their goals after surgery.
Were they getting enough pain medication? With early discharges, how were they managing at home? For me, these were relevant and very important questions.
You have travelled throughout the world to present your research. Can you share a little of this?
In 2012, I presented my second research study on the pain experience of patients whose primary language is not English, following primary total hip or knee replacement surgery. More than 200 people from close to 20 countries were represented at the conference in Qawra, Malta. I have also presented my research in Dublin; Bristol, England; and Melbourne, Australia. It is a wonderful experience to exchange ideas and overcome challenges with orthopaedic nurses from around the world!
Recently, you were awarded the Dr. Robert B. Salter Award from CONA. What happens next?
To be honoured with this award and know that I have contributed to research, and to knowledge translation, has inspired me tremendously. Once you start doing research, it's hard to stop!
What is it about research that makes you want to do more?
By asking questions, we get answers. Sometimes those answers can tug at the heart. Not doing something about the negative outcomes will not improve the patient's experience. Then, by not challenging yourself to ask the difficult questions, one will not be able to influence the change that is needed.
– Interview by Sally Fur
ALWAYS ASKING "HOW CAN WE DO IT BETTER?"
Those who meet William Tran are immediately struck by his positive energy and passion for patient care. He is a clinical radiation therapist at Sunnybrook's Odette Cancer Centre and a research project manager for a clinical study, led by Dr. Gregory Czarnota, into chemotherapy treatment monitoring using ultrasound for patients with locally advanced breast cancer.
NC-S: What do you find most fulfilling about what you do?
Tran: I really enjoy supporting patients. Often they struggle with what the future holds, and it's nice to know that your efforts can potentially help them through that uncertainty. We hope that our research will reduce the "not knowing," and allow us to track treatment effectiveness earlier and to better tailor treatment for these patients.
What's also fulfilling is the interesting mix of research and clinical care with which I'm involved. I'm always asking questions: 'Why are things the way they are? How, or should, things be different? How can we do it better?' I guess you could say, uncertainty also allows us the opportunity to make changes. For example, to improve treatment approaches and perhaps do things differently – to explore new thinking.
What does "new thinking" look like?
The most recent thinking in cancer care is about treatment tailored specifically to the individual patient. We're also studying a newer frontier, using ultrasound imaging to monitor and characterize cancer cell death or the biochemical changes within cells, to better inform the course of treatment for each person.
You mentioned that you're always asking questions. Where does that sense of curiosity come from?
I guess it's about being open to different points of view. It's about not being complacent and to constantly explore ideas. Perhaps it's to challenge whether we should do things differently or to reaffirm that our approaches are effective the way they are.
Coming from a place rooted in new frontiers – having arrived to Canada as refugees, my family and I fled postwar Vietnam in 1980. Canada opened its arms. For that embrace, I am forever grateful and determined to always push for positive change – to give back and to make
a difference.
– Interview by Natalie Chung-Sayers
RULERS OF ENGAGEMENT
Brent Creelman, Senior Digital Media Strategist, and Sivan Keren Young, Manager, Digital Communications, have tweeted and Facebooked their way to making Sunnybrook the leading Canadian hospital in the social media stratosphere. Sunnybrook's use of social media to improve the patient experience is now recognized as a leading practice by Accreditation Canada.
MS: When did you first become interested in social media?
Creelman: I was in Grade 7 when I created a website to talk about my favourite TV shows. I learned about web development and also the importance of storytelling. That spurred me to study journalism at Carleton University.
Young: I developed my interest in the same grade. We've come a long way when you consider the high-reach impact of today's social media channels.
Speaking of high reach, aren't you responsible for captivating a whole country by live-tweeting heart surgery?
Creelman: It was incredible! In three days Sunnybrook gained 5,500 new Twitter followers. We had no idea the tweet would have such an impact. Teachers actually let their classes watch and ask questions, so it tied in really well with the hospital's focus on education.
How did you sum up a complicated surgery in 140 character tweets?
Creelman: You're definitely limited by space with Twitter. You need to grab attention quickly. We also added photos and videos to make it really compelling.
Sunnybrook's online voice is really conversational and friendly …
Young: We just started talking to people on Facebook and Twitter. One of our goals is to improve our patients' experience. It can be something as simple as answering a question about where to find a late-night coffee. This is really about engaging with our patients and families, and ensuring that we respond to their needs.
You must have some stories?
Creelman: We monitor all social media for references of the hospital. From time to time, Sunnybrook gets compared to Grey's Anatomy. Apparently we have a few Dr. McDreamys (laughs).
Young: There are also those simple day-to-day moments that are captured. On Halloween, we posted pictures on Facebook of a family's premature twins still in the hospital's Neonatal Intensive Care Unit, dressed up as a ladybug and a turtle. It elicited such an emotional reaction from our followers.
Have there been any bumps along the way?
Young: When Sunnybrook first started using social media, Facebook and Twitter were relatively new, and we were such early adopters. Sunnybrook took a leap of faith; we were willing to make mistakes and learn. And if we can make just one patient's day better, every day, then that's a good day.
– Interview by Marie Sanderson
This content was produced by The Globe and Mail's advertising department, in consultation with Sunnybrook. The Globe's editorial department was not involved in its creation.