Thursday, August 27, 2015

Gratitude Thursday Journal

Yes, I'm grateful.  I slept well.  It's a bit like being an underwater diver when I'm using the CPAP machine.  The air is bad though.  Forest fires smoke still blowing into the valley.  I've got a summer cold on top of that.  Without "Advil Cold and Sinus" and CPAP I'd not sleep through the night.  So I'm really grateful for sleep and breath.
When I put on the CPAP my first breath starts the machine. There's a pause though. I'm momentarily without air.  It causes me to feel the suffering that asthmatics and others with lung disease know. It's also the greatest fear in dying.  I've bagged dozens back to life and know the terror in their eyes up close.  Scuba diving first hand I've felt the panic of not being able to get air, the faulty system, struggling with panic, fixing the problem or once buddy breathing to the surface.
I'm really thankful for breath.  The breath of life and mostly we take it for granted. Smokers even shit on God with their tobacco and marijuana, blaspheming the Holy Spirit in the most ignorant suicidal way.  Like eating poop.  The psychotic stupidity of smoking isn't beyond me. When I was as schizophrenic as any average cigarette and marijuana smoker I didn't care for God or spirit or breath or life.  I actually took pride in 'learning to inhale' the smoke.  Like a little girl priding herself on cutting her wrists and making the blood flow.  I smoked.  Just thankful it wasn't longer.
Last night I dreamed of sailing. I love those dreams.  Like the dreams of my parents or the dreams of old lovers or the dreams of my former dogs.  I miss the flying dreams.  Haven't had those for a while. Remember Freud called flying dreams, dreams of sex.  A female psychiatrist countered him saying that sex was dreams of flying. Can't remember what her name was.  Maybe Karen Horney, when Freud said women had penis envy, she responded by saying men have womb envy.
I'm certainly thankful for my little dog.  Yesterday was National Dog Day.  I posted a picture of Gilbert the cockapoo.  There's a huge extended network of us who only know each other by the name of our pets.  It was the same with sailboats cruising.  We didn't remember each other's names, just the name of the sailboat.
China's market crash flattened out yesterday. I'm thankful for that.  There was a rebound too. Don't know how much money I made or lost. My accountant says I should keep track of these things.  I look back and realize that studying psychiatry was silly. Maybe reading the books to get the exams and have a job but all that other study. It's never made me any money.  I made more money as a general practitioners.  4 years of study and countless evenings and weekends reading the literature. Yesterday I "looked up" a dozen things and read a couple of articles. It's almost daily.
Smart people, don't read science and literature but follow stocks and bonds.  I wish I could do both.
But these days I'm not doing much.  9 am to 930 pm Monday at the office, no lunch, no breaks, coffee maker in my office. A half dozen emergencies.  Not suicide.  Bureaucrats, insurance agents and police 'needing' a letter from me or my patient would be denied work, income, or freedom.
It wasn't like this.  I treated individual illness when I began.  Today I'm always treating systemic failures with the patients more and more just evidence of the deconstruction of society.  I'm still ashamed at all the gouging of students for their education.  It must have been a half dozen or so last year I helped through their bankruptcies.  I don't know how anyone survives in Vancouver.  The young women admit to prostitution. There's a host of names for it but it's just prostitution.  Having roommates makes it's difficult.  Everyone is juggling housing space.  It's a national election issue.
Smart people made 'medicine' a government issue and contractors gouged and became billionaires doing incredibly shoddy work with their leaky condo scandals, all the while benefitting from 'free' physicians.  In another world I'd 'nationalized' housing like "they" nationalized medicine.  Then everyone would have a house or condo.  I'd write ads saying "People shouldn't go bankrupt to have a roof over their heads".  A third of my patients are living in 'shelters' .  And everyone knows if you want to get rich you get into construction, real estate or estates.  Donald Trump wasn't stupid enough to become a doctor.  I feel like I should stand in solidarity with my Ontario doctor brethren. They're facing 'claw backs'.  What an interesting term for government 'theft'!  Steal a little and they put you in jail, steal a lot and they make you king.
It's all too far about my pay grade. I'm thankful for this trailer. I'm thankful for the new tools I've learned about from research, a new medication, and some new ideas of how to address my patients addictions.  I really have to focus my energies though.  I was taught early that when you're doing more work than the patient you should back off yet that's when the patients complain. I live in constant daily fear of patient complaints. Medicine is totally a 'popularity' contest with everyone struggling to be mediocre because any originality and any enthusiasm is destroyed by complaints - judges, bureaucrats, human rights commissions, advocates.  Some patients come with a huge gang.  The room fills with their 'allies' and dozens of unemployed 'critics' desperate for a cause.  I'm bent over double in abeyance praying I do as I"m told.  The patients tell me what they've read on social media, the arched eyebrow and threatening tone let me know what they think of my opinion about whatever it is is this weeks fashion.  I'm supposed to do what Gabor Mate does or the Kardashian twins.  Only with celebrity medicine am I going to please some.  They've got the complaints line on speed dial.
Now I'v missed the physician assisted suicide discussion. The majority were concerned about it.  I loved that most were concerned about the real practicalities.  I just wanted to know how the College was going to prepare for the complaint from the patient who I refused to shoot between the eyes until they paid for the bullet. Naturally people wanting physician assisted suicide will want it 'for free' and then how will I get the body out of the office. If I had two offices it would be a bit more practical but with only one office what will the patients in the waiting room feel as the last patient is wheeled out. The supreme court is always so high and mighty in Canada that they never dirty themselves with cost or details that the real world has to deal with. Certainly killing people will transfer a whole lot of health care resources to the death column.  Same happened when the incredibly lucrative industry of abortion caused cut backs in obstetrical care and delivery resources.  It's always a choice. I choose life but the system more and more chooses death. Death is cheaper.  I wonder when we're finally have a referendum of Article 21 and Death Care versus Health Care. But just the same as with abortion the spin doctors will call Death 'health care'.  Personally I'd rather the killing came out of the city sanitation budget. My patients don't have enough money for their medications as it is and can't afford housing so maybe a crypt is an advancement.
I'm thankful I don't have to lead this country. It's election time and Harper, Mulcair and Trudow are all vying for leadership again.  Given the Canadian superior know it all media those three men must be masochists.  I think they're all brilliant and incredible individuals but the policies they're offering though all fairly centrist or left of centre may or may not help us old people in the coming decade of aging baby boomer decline.
I've got to get dressed for work. I'm grateful I have a job to go to. I'm certainly grateful for my teachers, and all the learning that helps me be helpful.  I'm really grateful for the experience, 30 years and tens of thousands of patients.  Everything that used to scare me and seemed so difficult today rarely concerns me.  I remember when I worried about a patient with one disease.  Hilarious. Today my patients have a dozen diseases and I'm working with a half dozen other doctors who are amazing and we're somehow helping these aging jalopies get another lap.  So many though tell me that they're so thankful for their time because they can be longer with their grandchildren.
Time to shower. Thank you God for running water and heat and the car that will get me to the new office and staff and books and computers and the whole vast organization called civilization.  Thank you God.

Tuesday, August 25, 2015

Drug Induced Paranoia

He had just walked into the room. Big guy.  Lots of chains and tattoos. Unwashed hair.  Poor eye contact.  Slouched down in the chair across from me.

Lifted his head.  Stared at me.  Real hard.

I waited.

"I don't want you writing anything down." he said.  Low voice, Controlled. Ordering.

"I take notes. It's what a doctor does.  It's the law." I replied, softly.

When you have worked here long enough, you've heard it all.   You feel the insaniety  though.  Maybe it's in the tone.   It feels  palpable.

"I don't want you to write anything down. I know you doctors give your records to them.  That's how they know everything. I don't want you writing anything down."

"What do you want from me, then?"  I didn't ask about them.  Them is them.  If you have to ask you probably don't know.  He walks out and you don't see him again.  So much for caring.  That kind of stupidity is 'selecting'.

"I want my drugs."

"Your methadone?"

"Yea."

"Are you doing any street drugs."

"I'm not going to answer any of your questions.  You're just going to tell them."

"Who are you worried I'm going to tell?" Now it's right to ask about them.  Things are moving along now.

"Everybody.  The only way people know I do drugs is someone tells them. I don't want you telling anyone else.  I know it's in my record but that's because doctors won't shut up and just give me the drugs I need."

I'm old. I'm afraid.  I didn't want to tip him over the edge. I was just seeing him in passing.  I've never seen him before, might not see him again.  I'm just covering for a colleague.  I peruse the chart, peripheral vision keeping track of his torso.  The chart shows  hes been doing crack and crystal meth. He'd actually been doing well.   Not using heroin like before. My colleagues a good doctor.  Maybe the guy was just pissed to see me.

I wasn't well.  Feeling fairly irritable myself.  The air was bad here.  Smoke and pollution blowing up from the forest fires in the south.  The lighting was already bad in this building.  Hazy. Eerie.  Besides a garbage truck had spilled out back.  The bad air now stank.  Couldn't get worse.

He was probably having a bad day.  Something must have happened before he came in.  He wouldn't leave a urine.

"It's going to be positive for crack".  he said.

I thought that was progress.  I didn't want to push him.   I could have followed the rules strictly, goose stepped, clicked my heals, shouted Heil Hitler.  There's real advancement in that approach. On the other hand, people who do that,  usually have 'burn out' and 'compassion fatigue".  Sometimes they're just new and afraid.   The system doesn't want anyone to know about the Jews and Auschwitz. You're supposed to crayon inside the lines.   I took an Oath "Do no harm".  Days like this I think it's a curse.      It wouldn't  help him, my being hard.  I wanted to keep an open mind.  But not so open the marbles fell out.   Only people far from the front survive being pollyanna.  They're the critics.

I gave him the medication.  He'll be back in a few days to see his own doctor.  After he left I wrote a brief note. No harm done. Gave my colleague a heads up.  Somedays, we bend a bit. Sometimes we don't.  Maybe it's was just the air. Maybe it was them.

Sunday, August 23, 2015

Cognitive Behavioural Therapy

B.F. Skinner developed the 'behavioural therapy', essentially programming animals with reward mechanisms.  It wasn't original but he systematized it and popularized it and made this ancient 'training' and 'educating' mechanism scientific so that it could be 'programmed'.  Rats and maizes and all that sort of stuff was shown to be made up of little building blocks.  Many clinical applications followed.
Pavlov's dogs, 'conditioned' by being giving meat on the sound of a bell, salivated thereafter when they heard the bell.  
Cognitive Behavioural Therapy followed showing that 'cognitions' programed behaviour.  No surprise. If I think I'm going to fail at a task and say to myself, "you're a failure, you're a failure", I'm more likely to fail.  Like the 'little engine who can'  subjects in experiments were told to change their 'self talk' and surprise surprise the outcome was scientifically significantly altered.
Insight therapy for example, psychoanalysis, delved into the past to see what was causing present day limitations, whereas Cognitive Behavioural Therapy focussed principally on the present.
It is in fact an "educational" form of therapy and lends itself to group instruction, reproduction and work book materials.
Feeling Good was the 1980 classic in the new "Mood Therapy" written by Burns who was a student of the greatest Cognitive Behaviour Therapist of the day, Dr. Beck. His "Beck Depression Scale" remains today as a standard Cognitive Behavioural Therapy tool.
Patients, or clients, like students, are encouraged to record their 'thinking', what are they 'actively thinking about a problem .
eg.  "No one likes me."
Then the person is encouraged to write the 'cognitive error'  ie this is a Generalization.  Whenever a person thinks "no one likes me" they are indeed encouraged to respond to their inner Cognitive errors 'that is a 'Generalization", some people don't like me, some people do."
Psychology , a relative new kid on the block, tends to forever 'rename' things and claim them.  It's a very 'plagiaristic pseudoscience' at this level.
The original "cognitive errors' or 'cognitive disonance'  or 'negative programming' was best described years ago in philosophy under the heading, "Fallacies".
Most of the cognitive errors which are popularly called with 'neat memorable psychology labels' were rigorously defined and given the proper labels of 'illogical' thinking.  Indeed Cognitive Behavoural Therapy in it's own way attempts to encourage 'logical thinking'.
Much of the understanding and communications used in teaching Cognitive Behavioural Therapy were originally developped in Theology and Philosophy and now are renamed and over taken by psychology.

Michael LaBoisiere, (42 Fallacies)  a French philosopher has, to my mind, made the Fallacies most understandable.  Listening to patients for decades I've noted the 'illogical' thinking and the 'emotionally reasoning' and simply ticked off the 'fallacies' the patients use much as Laboissiere describes.  Burns has in his classic popularizing book Feeling Good listed a few of these cognitive errors like 'catastrophising' , "the world is going to end".
The fallacie of catastrophising is taking a single event and assuming that one event represents the whole and because it's a negative event assuming that the future will be negative.
Affirmations are 'thought blocking' techniques that go back thousands of years in pastoral care and theological literature.
Patients are advised to say "All shall be well" rather than "I"m going to die, I'm going to die."  Since the panic thought leads the body to accelerated heart rate hyperventialiation and blacking out it's fairly maladaptive.  So by 'blocking' the negative thought with the affirmation 'all shall be well' one breaks up the negative behavioural program by changing cognition. 

The term 'emotional reasoning' can be understood by considering the statement 'It feels good so it is good."  Translate this to "it looks good so it is good" and you have a person who would pick up a 'red' coloured insect without realizing that 'red' is often the symbol for deadly.


Ad hominen means 'against the man'.  The cognitive distortion would be to say, "I can't believe what John told me about physics because John isn't married".  Commonly people have this kind of bizarre thinking.

Generalizations are fallacious and cognitive distortions can occur.  Eg.  My mother told me I could  trust her brother but he sexually abused me, therefore everything my mother says is false."  This isn't true and therefore based on this one 'event' patient generalizes that what their mother told them about the existence of gravity is also false.  Not true.

Alot of the problems with distorted thinking can be found in the media presentation of stories, marketting and advertising.  Clinton was not a poor president because he had sex with Monica.  However, since he had a contractual relationship with his wife called marriage and a duty to his children as father and as a president he had a responsibility to follow contracts and a duty to the country. When questioned by Star as to whether or not he had sexual relations with Monica he could reasonably have answered "I didn't commit adultery".  Biblically, technically, oral sex is not mentioned and adultery laws most clearly are related to knowing who the father is in patriarchal societies.  However when he answered he 'did not have sexual relationships with Monica", he either 'lied under oath' thereby forfeiting his responsibility to the american people or he didn't know that what he was doing was deemed 'sexual' whereby he'd be a complete idiot and not worthy or safe to be President.  The media coverage of this pivotal moment in history was however mostly at the level of a lot of rather stupid media coverage, crass and sexual.  We can't have good media with so many perverted mental midgets being allowed to speak on tv. However the vast majority who watch mainstream media aren't themselves that swift. Most media is marketed to the majority who are under the college level.  Hence the stupidity of mainstream media and the continuation of the insaniety for which CBT is needed to address.

Eg.  I loved him so I killed myself.

Love does not beget suicide, only narcissism begets this kind of adolescent suicidal behaviour.  Yet Hollywood continues to celebrate it's suicides and continues to support the cognitive disorder that love is destructive when theoretically at least love is considered love because it's life enhancing.

Schizophrenia per se is often associated with flipping the pronowns which we call 'projection'.  In cognitive behaviour therapy we encourage people to use "I " statement.  "I don't like you" rather than "You don't like me".

Sunday Journal, Aug. 23, 2015

There’s still smoke in the air.  Fires are burning in the interior.  Campfire restrictions.  Concerns this summer about tourism. Firefighters from all over.  Many out of their houses. Whole communities destroyed.  In addition to the smoke, I can smell  Fall  in the air.  The nights are cool.
Wednesday my throat became raw.  Poor sleep that night.  Thursday my voice going by noon. Afternoon work cancelled.  I didn’t feel particularly infectious.  More like environment.  My patient has TB. I was in the radiology department getting X-ray.  Everyone snivelling. Laura said she’d had three days of headache and sore ear. Her waiting room was sore throats galore. Maybe it was viral.  I’m just seeing all the asthmatics having difficulty breathing. I’m tired too. Fatigued.  Run down.  Getting older. Don’t seem to rebound.  Whine a lot.
Seeing my chiropracterDr. Richard Cho these last two weeks the neck and back pain eased with more strength in right arm.  I was having difficulty lifting a cup.  Trying to ignore it.  Denial my first go to defence.  Using my right hand to drink coffee in public to conceal the tremor.  Thanks to my doctor friends in Virginia got the message of self care again. Phoned Richard.  Sure enough all the tension has taken it’s toll.  Running helps.  Getting to the hot tub.  Wading through the immense increase in work that follows and precedes a week off.
Dr. Smokey Bear. Stamping out forest fires.  All the beaurocratic demands for paper from doctors, exponentially increased a thousand fold.  Everyone now thinks the physician can be used as an extension of their organization. I was glad to hear the Ontario doctors refused. I wish the BC doctors would set minimum standards and stop demanding patients pay.  Despite the signs up to discuss with staff they bring work into the office and feign not seeing the signs. I learn they are trying to get a better deal than the gp offered.  Horrendous waste of health care resources.  Waitlists and double doctoring.
I spent 2 hours with a patient last week, it was a 20 minute paid visit, but I was concerned.  Concluded they needed an emergency Neurology and MRI visit and was beginning to pull favours when the patient told me the MRI they had last month was norma. They then complained the previous doctor hadn’t been any good. Pulled out some disability forms.   He wanted disability.  I’d asked him every which way about seeing other doctors about his problem.  He’d insisted no one had done anything and that no one took him seriously.  Even told me he had tried to sue one of his doctors but the lawyers wouldn’t take the case.  In the end he was just "Double doctoring".  Wanted disability.  Patients daily complain about waitlists but no one holds people like this accountable.  Yet the doctor police are multiplying exponentially as well. More and more doctors are afraid to see patients because of the threats to their licenses so become doctor police instead.  Of course no one polices the doctor police.  The last bastion of professional security.
I am tired today.  Another difficult night sleep. But great run yesterday.  5 k or more.  Along the river.  Furthest I’ve run without walking.  Walked a lot on the way back with Gilbert. He enjoys this all though fears that when running,  the territory isn’t being marked as often as canine standards demand.
Laura and I began watching Sons of Anarchy season finale.  I bought it at London Drugs when I was getting a set of AudioEngine 2+ speakers for the computer.  These plug in the wall and are awesome. Laura and I  watched an iTunes rented Rob the Mob movie which was terrific too. Loved the theatre quality surround sound. Then we got out the Sons of Anarchy DVD.  Of course we had heard he killed his mother.  It wasn’t something that the world could keep from getting out.  It wasn’t a ’spoiler’. In fact I wanted to watch the season to see how Sutter the writer killed off his wife Katey Sagal.  We’d heard Katey Sagal talk at the Turning Point gala so loved her.  “What’s going on between her and Sutter?” everyone was asking.  Okay, I bought the series to be in the loop. It really is  good.  Laura and I watched the first three seasons when we were up north at the first Sturges North Motorcycle Rally in Salmon Arm.  I’d driven up in the truck pulling the RV with my Honda 250 CRF strapped down  in the truck bed.  The whole weekend was so memorable with Steppenwolf and the Animals.  Laura and I rode in from the campground at night on the 250.  Then I joined the Veterans Ride with the smallest bike there and somehow kept up going Full Open Throttle without burning out the engine.  In those next months we watched all three seasons.
Then synchronistically, after I’d just told Laura I had to ride my bike this morning, Dave shows up to tell me the East Vancouver Show and Shine was going on Saturday at the Waldorf.  It couldn’t be better.
Dave usually rides with Emory his little dog.  I ride with Gilbert.   Today we left the dogs at home.  Gilbert would rather hang out with Laura. She spoils him.  Body rubs massages, treats.
Dave’s Harley is a red Heritage Softail. I’ve got a black Electraglide.  “They’re supposed to have a bikini contest,”  he told me on the way. “Even better”, I said.
Great sunny hot day.  Not too much traffic.  Good to ride in tandem.  Dave rides in shorts and t shirt.  I’ve got to have jeans and jacket armour.  At least my jacket is webbing. Too hot for leather.  When we got to the Waldorf there was a hundred or more bikes around.  It’s not like Gastown though where the bikes are congregated.  Here they were ranged around the block and in parking lots nearby.  Only weakness of the show. Half the fun is looking at everyone’s bikes.  In the actual venue there were only a few dozen, albeit some really fine choppers. Hot rods were in the venue.  Beer gardens.  Leather sale booths.  T shirts. Entrance by donation.  Dave gave them $5 for each of us.  I certainly didn’t complain.  All around fabulous young women showing a lot of skin.  Something about leather bras that speak to the inner animal too.  Lots of tattoos.  Great bikes.  One especially had silver skulls everywhere.  A couple of the cars and one of the bikes could have been right off the set of Mad Max.  Dave and I just walked about talking engines.  There was a souped up mustang.  Both Dave and I reminisced about our Mustang days. He’d had his in the 70’s and I”d had mine in the 80’s   One of the chevy “classics’ was a car my friends father owned when we were 12.  The ford truck on display looked a close proximity to my uncles truck from the Manitoba farm.  Dave told me his grand daughter was 20. He’s younger than I am.  “She says her friends like to tell the old guys they don’t have ‘daddy issues’.”  We’re laughing about that sad as it might seem.
We ride back to Burnaby taking Knight to Marine Drive.  There’s not much traffic this time of day on a Saturday.  I realize I’m normally only driving during the Vancouver rush hour so my view is skewed.
“I’ve been catching my limit up by Squamish,” Dave says. "The salmon are pooling in the ocean because the rivers are too dry to go up yet.”  It’s the salmon run time of the year.   After we get back he comes by bringing a lovely salmon.  Laura and I and Dave chat awhile while Emory and Gilbert play ‘he who pisses on something last wins”.  They’re dehydrating fast.  Dave’s got fish on his barbecue so can’t stay.  I use salmon rub on this and pack the centre with garlic butter before wrapping it in aluminum foil.  15 minutes on the barbecue and it’s perfect.  Incredibly tasty and melt in your mouth moist. So fresh.  Unbelievable good salmon.  Thank you Dave!
Laura and I had it with potatoes we boiled up and served with sour cream and salads.  We watched more episodes of Sons of Anarchy.  So many people getting shot in the show I’m sure it’s what affected Whalley Surrey this year. Gangland shootings galore.  Monkey see, monkey do.  So many young people smoking dope they lose connection between what is real and what is fantasy.
This morning Laura tells me she’s had dreams of being chased by motorcycles on her little bike.  My sinuses have been stuffy.  I had the couldn’t find a clean toilet dreams. Shit everywhere.  Sons of Anarchy doesn’t wake up the best part of the brain.   I remember the second last season when I found myself almost nihilistic after watching an episode but then counteracted it with watching an episode of Blue Blood.  Gives new meaning to the “Feed your Brain”.  Katey Sagal playing Gemma is an incredible actress. After years of fake feminist unidimensional ‘victim’ women with the ‘activist feminist’ saving the little girl, Gemna is playing a multidimensional sociopath with Oscar award winning complexity.  Unfortunately no Hollywood would award this Eva Braun performance. Lies that kill a nation.  And as usual no one is ‘pure’ in sons of anarchy. Everyone in Charming is corrupted somehow.  But that’s this slice of reality.  Even the ministers they know are into the sex trade.  In the methadone clinic I meet people who were raised in gangster families and this is their reality.  Not the sanitized CBC yuppie think.  Real ugly.  Maybe it’s why I dream of being unable to find a toilet which isn’t covered in shit with nowhere to stand and nowhere to sit.
Thankfully the Show and Shine Bikers are the norm. Good guys who like to ride. More and more people going two wheeled to enjoy the wind and freedom and save on gas.  When I was in europe and asia there were 10 times the scooters and motorbikes so there’s a long way to go here before the field is saturated.  Cars will always have a place like trucks but the motorcycle has a special place of it’s own. The ultimate commuter.  And there’s nothing that beats it for two people getting away with a tent.  Laura and I have had some wonderful times with the two of us on my bike and the tent and sleeping bags and cooking gear in the saddlebags.  Modern cowboys.  We stopped this since Gilbert and I got Laura a bike so the three of us could continue this only she’s anxious on her own.  That leaves the Miata which is almost as good but seems to suit staying in motels more than tenting.  The truck and RV are certainly the way to go. I can put the Harley in my toy hauler garage but I don’t want to do this for a weekend.  It’s perfect for a month or more vacation though. I’m the same with the big boat. I don’t want to take these out for a weekend anymore. Too much trouble whereas the motorcycle is perfect for the simple quick getaway and overnight camping.  We loved our rides down to the US too.  Maybe I need to get Gilbert his own trailer.  I just don’t like towing.  Defeats the purpose.
All of these are ‘cadillac problems’ and nothing that needs solving for today.  I’m still trying to figure how to mount the speakers in the RV but keep them portable so I could take them elsewhere.
I’ve been having fun with FITBIT - I do more exercise than I thought. My diet is still excessive, really good food but too much night snacking. That second portion of ice cream is the waist full  event.   I sleep better with 9 restless night events versus 30 when I use my CPAP machine.  I have to get the fittings fixed. Laura says I snore and shallow breath when I’m not using it.  It’s a bother but I see the benefit. When I first got it I really noticed the difference in my energy and alertness.
I finished Wilbur Smith’s Dessert God, a great historical fiction novel about Egypt during the time when the Hyksos took over northern Egypt, Nimrod was king in Sumeria and Crete was ascendent on the waters. I really enjoyed reading it.  This summer, partly because of the plane flights, I’ve been reading a lot and enjoying it.  Mostly fiction, though I was reading the Nady el Guebaly and Gallanter Textbook of International Addiction Medicine and the Teenage Brain, by the neuroscientist mother.   I read inspirational literature every day but haven’t been reading as many textbooks as I have other years.  I would love to get back into the study of Biblical Hebrew. I was astounded at how dynamic the language was compared to English translations.
It’s hard to believe it’s the end of August.  Hunting season opens for bow in 2 days on Vancouver Island. I’ve taken a couple of days off for a long weekend when rifle season opens here on the mainland.  Next weekend I might get the ATV out for the long weekend since it’s bow season.  I’ve got the bow but for bow hunting you really ought to sit along a trail where theres fresh spore since you need to be close for a kill.  Dave’s fish got me thinking of hunting. I don’t have the patience for BC fishing but I am so looking forward to having venison for the pot this fall.  I love venison stew.
All the reports I have to do are burdensome but somehow I find the time. Unfortunately they’ve interfered with summer and are likely to mess up the fall. I don’t mind extra work in winter and spring but I’d like less work in summer and fall.  My colleagues all share that this summer there’s been no slack.  The shortages of services are backing up with aging population meaning more patients and increasingly the ‘workhorses’ like me retiring and no one replacing us.
There’s an election year with each party claiming to be better able to spend our tax money and me increasingly disappointed by government giveaways.  30 years and more of working and taxes and more and more I see people not working and being paid by government and under the table.  But my mind is such it can always come up with the negatives. I have to actively focus on the positives, give my head a shake, show the right gratitude. I’m blessed with today. Outside the weather is lovely. I walked Gilbert this morning and it’s truly beautiful.  The luscious green of Burnaby is something I still remember finding so attractive when Baiba and I came here 1971 and stayed with her family friend. Coming from Winnipeg I couldn’t believe how luscious and green the trees and shrubs were.  Now I’m looking out of my RV at the green forrest. It’s truly a blessing.
I’ve this lovely mobile home with a great dog and girlfriend and full fridge. I’ve had spectacular coffee and porridge. I’ll not make it to church today.  I’m taking it easy.  A winter christian.  Hope to make a meeting later.  But the weekend like so many is a recuperation time for getting ready for work.  I think of work as the ‘front’.  So many angry people.  I was only verbally abused a few times last week.  But I’m tired of it.  It wears on me.  I find myself thinking death is better.  Then I listen to the media and it’s all skewed and merry with no grasp of the reality of drug addiction.  I’m the only lucid moment is some peoples days.  Meanwhile the authorities are into Chamberlain appeasement without the realization that’s there’s never enough and everyone demands more until they turn to violence.  I know. I’m on the front lines. The ‘authorities’ are so far removed they may as well live on the space station.
But its Sunday.  Day of rest.  Sabbath.  Time for prayer and thanksgiving.
Thank you God for all your blessings. Thank you for the sunshine and greenery. Thank you for the wealth and wellness, family,  friends and pets. Thank you for this day of rest.
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Wednesday, August 19, 2015

Sailing Vessel "GIRI" Dimensions



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13 tons
39.9 feet deck bow to stern length
31 feet length from forepart of stem to foreside of head of rudder stock
11 foot beam (width)
8 feet 5 inches depth from top of deck at midships to bottom of keel
Windshield is 5 feet height from deck
Boom holder is 69 inches from deck
Mast 40 feet
Radar and Wind Generator Post 6 feet from deck
Engine - New Volvo Penta D2-40 Marine Diesel installed June 2014
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Tuesday, August 18, 2015

Tuesday Journal

I had pleasant dreams.  I awoke with the iphone alarm. I took Gilbert for his morning walk and constitutional.  It really was a lovely morning.  Sunny day, blue sky, sweet breeze.  I even had breakfast, coffee, oatmeal and yogurt. I had a multi vitamin.  I did some dishes and took out the garbage.

I was actually in a pretty good mood for going to work.  I've had some cumulative anxiety about getting in the car and going to work.  Too many negative experiences seem to come over me as I'm making my way out the door. Memories of patients hitting me, pulling out guns, threatening me, lying, bullying.  Ironically, I've not had much of that for a while and yet it's been recently that I'm having this anxiety.  A variation on social anxiety.
Then too today I had to drive to the DTES and I'm really finding myself anxious about driving through that area with all the people walking on the streets, the chaos, the gauntlet of insaniety and the flagrant evidence of financial mismanagement by all levels of government.  It's right in your face there.  I'm reacting to the time I was there always and became immune for a while to the shouting and crime and sirens.

I had thought to ride the motorcycle.  I took my sportscar instead.  I love the Miata.  Gilbert loves his seat.  It was a mistake to not take the motorcycle.  Traffic was backed up on the freeway. Instead of the 30 to 40 minute drive it was an hour and a half before I got to work.  My mood was changing.  I was already allowing the environment to affect my equanamity.

I got a coffee.  It tasted of grease and soap.  Disappointing.  I had to address paperwork which was onerous.  I saw a few patients.  One went missing. I liked seeing them. They're progressing and growing forward.

The staff here are great. I really like my colleagues.  In the background there's a vague negativity. That John Mayer feeling, "I want to run through the halls of the school" kind of feeling.  I realize that there's already a touch of fall in the air.  I feel that summer is going and I've been travelling and working and not taking advantage of the good weather. I work all winter hoping and praying for summer to go sailing and camping and then it's come and gone this year.  I'm already planning hunting but there's a background of disease.  I'm weighted down with concern.  I pray each day for the health of my loved one.  There seems to be a ceiling on my own happiness.  I do what I can to go forward.  I've the feeling of moving in molasses.

I look forward to watching tv.  I've download Extant and Dark Matter and Rookie Blue. I reading Wilbur Smith's latest book. I want to cocoon. It's summer and I really should be out in the woods or out on the water and instead all I've been doing is weekending in the RV. I'm regenerating. I'm cozy. I 'm recouperating.

The weekend was good.  Laura and I cleaned the freezer on the boat.  The fear of old food rotting is now gone. I took out the liveaboard clothing and left a cupboard with just the boating wear that needs to be there. I'm making slow progress each trip to returning the boat to a travelling vehicle from a water side apartment. I ve not been sailing since April.  The boats packed together on the dock made my solo departing and returning seem just too risky. I'd like to go out and come back evenings and weekends but don't want to face the return with so little room and fear of damaging neighbours.  It seems to much at this time.  I love being out in the boat especially expeditioning and especially being at anchor but I'm just not doing it. Instead I'm more interested in clean up.  I'm planning on putting up on the hard for fall in preparation for another passage. It's offshore ready except for the cockpit drain. I did run the new engine for an hour.

Now I've got to return to work.

Thursday, August 13, 2015

Gratitude, Thursday

Thank you Lord for the sunshine this morning. Thank you for last nights CAA social. Thank you for friends and books and writers and readers. Thank you for Leonard Cohen and the speech of his I just heard. Thank you for the years of life and memory. Thank you for that very first poem and all the poems that have followed. Thank you for the songs and prose.  Thank you most for the laughter and love.  Thank you for the work and all the stories. Thank you for the truth and experience. Please Lord bring health and wellness to my family. Watch over those in need and guide them.  Help me to be the best I can be. Thank you for the pinnacles and peaks but also the valleys Lord. Thank you for the streams and oceans.  Thank you for the grass and all the walks and journeys. Thank you for nudity and naked bodies entwined. Thank you for dance.  Thank you for studies and libraries and coffee shops. Thank you for paper and pens and keyboards. Thank you for pets and friends. Thank you for medicine and surgery.  Thank you for talking cures and relationships.  Thank you for neuroplasticity. Thank you for biofeedback, meditation and prayer. Thank you for church and synagogue and temple. Thank you for Jesus, all the saints and all the artists and all the great works of celebration of spirit. Thank you the engineers. Thank you for the bridges. Thank you for the priests. Thank you for Bach. Thank you for lavender. Thank you for the rain. Thank you for pear trees and heather. Thank you for sails.  Thank you for boats and canoes.  Thank you for Gilbert. Thank you for Eva.  Thank you for friends once again. Thank you for our relationships and please please let me know you more and be with you more and walk with you forever growing closer and closer. God blessings on all.