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Dear colleagues,

Summer has arrived. Somehow, a June letter passed me by as I recovered from the travel of a busy spring. There is so much to write about. I鈥檓 going to try to weave it together into something coherent.

I鈥檓 seeing spots. Black and white. Everywhere. I went to see Angine de Poitrine with over 100,000 other people on Saturday night at the Montreal Jazz Festival. I鈥檇 been looking forward to this show for a couple months and it didn鈥檛 disappoint. Except for the panicked looks of exiting souls wondering what in the world they鈥檇 got themselves into, it was pure joy. I wouldn鈥檛 say that this duo from Saguenay plays the kind of music that I would typically spend a lot of time listening to, but I can鈥檛 take my eyes off of them, the Internet that they swallowed, the memes that followed, and the excitement that everybody has about something so utterly foreign that feels so essentially human. As many have said, Angine de Poitrine is like the antidote to the algorithmic slop that seems to be slowly taking over our attention. And, ironically (and happily) it鈥檚 taken over all my algorithms.

The other spots I鈥檓 seeing are soccer balls. I鈥檝e watched more soccer in the last few weeks than in the past year. While we won鈥檛 have a game in Montreal, there is something thrilling about hosting a World Cup. That is especially true in a year when Canada is already exceeding expectations by making it out of the round of 32. I feel so excited about this team. As the coach Jesse Marsch said in an interview, this is a team of first- and second-generation immigrants, each with their own family cultures, fighting together to make their parents adopted country proud. Over and over, people (including the prime minister) have commented on this team's character, and it鈥檚 reflection of a national character that values and believes in strength through diversity.

And I think that brings me to the subtext of this letter, which is a reflection on immigration. It鈥檚 something I鈥檝e been thinking about a lot lately. In September, we will have been here 5 years. It seems to have passed awfully quickly. Having benefited enormously in comparison to my own home country, especially since 2024, I have appreciated so much about this city, this province, and this country. In the last months in particular, I鈥檝e come to feel a sense of pride in this place.听

I met an older woman in the hospital today who鈥檇 been in Canada for nearly 5 years. Having traveled from Eastern Europe through the Middle East to join family here in Montreal, her journey here looked very different from my family鈥檚. While I felt a kinship with her born of a shared experience of immigration and time, she carries, in Susan Sontag鈥檚 estimation, an additional passport: from the land of the sick. This is rough country in which no one wants to find themselves. And yet this is where we meet all of our patients.听

For most, this is an inescapable place. But it is one of dramatic landscapes and unexpected beauty. I consider it part of my job as a palliative care clinician to help people find that beauty. The other day, I reflected with a patient and his daughter about the fact that people spend trying so much time and energy trying not to die that they cannot appreciate the foresight of our own death and what that affords: the chance to plan, to make bucket lists and work through them, the chance to celebrate being with people you love and to not take it for granted. The chance to have agency.听听鈥淚 hadn鈥檛 thought about it that way,鈥� the man said; 鈥淚t鈥檚 a good point.鈥� People often say that they want to die in their sleep, but what about the power of choosing to die with your eyes open?

I don鈥檛 mean to romanticize mortality (though our mortality is likely what makes romance meaningful). While I hope to embrace it when the time comes, I don鈥檛 know how I鈥檒l feel. I just mean to point out that if dying is seen only as a series of losses, of 鈥渢here鈥檚 nothing more we can do鈥漵, then it can only be demoralizing and sad. What we project when we come into people鈥檚 rooms with bright faces and confidence and a desire to know them is that there is opportunity ahead. That we鈥檙e there to help them find it. Especially when the opportunity for cure has gone.

What does this have to do with Angine de Poitrine and World Cup soccer?听听Well, the world feels troubled, overheated in conflict and climate. Our healthcare and political systems feel broken, sometimes cruelly so. I don鈥檛 think the world is on life support, but it seems seriously ill. And yet, there are moments of such beauty. Of 100,000 people connecting at Place des arts with their tens of thousands of hands held up in the shape of a triangle (if you don鈥檛 know what I鈥檓 talking about, see the internet). Of tens of millions connecting to watch a beautiful game. Of people finding themselves unexpectedly in foreign lands and finding a sense of place.

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Hopefully, you鈥檝e seen the emails about registration for the 50^th听Anniversary Montreal International Palliative Care Congress. There are heavily discounted rates for those of you who receive this letter/newsletter. Please take advantage of it. I have heard from many that the meeting feels expensive. I hope you also feel that it is an investment in yourself and in this meeting to attend. Attending this conference will be an extraordinary opportunity to celebrate 50 years of innovation that originated with our predecessors. And, if you can come, don鈥檛 wait until August 3^rd听(the final date of the early bird rate) to register. And

I can鈥檛 wait to see so many of you there.