Tuesday, March 31, 2009

"Old Electric" Office


I am excited. The move to my new office in the Old Electric Building in China Town is progressing well. Two Small Men with Big Hearts are packing and boxing furniture. Tracy and Mark are well organized. Arnold, the personable new building manager, just gave me the keys. I looked at the new office again.
I love the space. The wood paneling is so rich. I’d not noticed before but I have a view of the snow capped mountains and Carrall Street. It’s been a whirlwind of stop and start activity and struggle to get this far. So much stress and uncertainty in the last months.
The “Old Electric” is a Heritage Building. The electric trollie tracks stop outside the 23 West Pender entrance. The China Town Gate is there as well. The UBC downtown School of Architecture is on the main floor and some 30 or 40 lawyers have offices there. A number of the more respected talent scouts and agents have there auditions somewhere in the building . Elevator and coffeeshop and lounge at lunch time had a creative downtown business buzz,almost as if the old electricity still pulsed in the buiding’s heart.
Outside down town Vancouver was bustling as well A sunny spring day had everyone who could be outside. The cheery warm air held promise of coming cherry and plum blossoms. I love the prospect of exploring new environs. Such a variety of shops, parks and cafes. I am looking forward to spring rolls and wonton soup for lunch.
My favourite downtown coffee stop is Waves at Pender and Main. It’s always busy with a mix of Cantonese and English voices filling the air as people gather and chat. Wall outlets make us laptop folk feel warm and welcome.
When I came out of the building earlier my little 50cc Honda Ruckus was happily talking up to a big Honda Goldwing. They looked so cute together I almost took a photograph.

Sunday, March 29, 2009

Colin Waring


It's been a complex weekend.
I've just returned from my sail boat where I fixed the diesel stove finally. I'd replaced the pump but the problem was also in the fuel line so I replaced that today. It sounds easy but the new hose was larger outer diameter than the old hose so I had to enlarge all the holes it fed through. Flame and heat finally sallied forth like magic after I did the work. That made it worth it.
I'd put the charged battery back in the Harley after leaving the light on last week. It was good to be riding a bike on a sunny day I stopped by Trev Deely just to look at their huge spring selection of new models.
Colin Waring is in Lion's Gate Hospital on the North Shore. He had a hospital acquired pneumonia after some mild congestive heart failure. His loving sister Jennifer Waring, who'd been a nurse, had flown in from Lawrencetown, Nova Scotia. I'd spoken with his son who'd flown in earlier this week. Colin is a greeter at Christ Church Cathedral. We've known each other a number of years. He's 75 and was born in India, tells stories of a much different childhood than my Canadian one. His much younger sister was also born in India . They joked about lions and such today. Colin rallying with a bit of the stiff upper lip. Jennifer and I were gloved in yellow gowns. Colin had helped me at the office, rescuing me when I was all alone with too many phones ringing.
Ruth took a year cake at the Dug Out so happy to have J. back with her after the events of a year ago. It was always good to see Lyle and share with Ed. Dianne was in great form as well. "God gives you lemons and you make a lemon cake, " she said as I realized I was indeed eating lemon cake.
Al told me a couple of jokes: "If love is blind, how come so much is spent on lingerie." and "If work is so good, how come people have to be paid to do it."
I just watched Screamers II on tv. A sci fi movie about a weapons systems gone very wrong. Kind of cowboys and Indians with robots and machine guns. The cat and I shared barbecued chicken from IGA.
This week I'm moving the office to China Town . I told Colin to come by when he gets out and we'll go for wonton.

Saturday, March 28, 2009

Dr. Bernie Klassen


Our friend Lorne called me yesterday to say that our friend Bernie had died in Costa Rica from a heart attack. A Costa Rican woman had called him. The funeral would be next week in Chilliwack.

I remembered later how I met Bernie. Doug , whose dead now too, called him and told him to take me to my first AA meeting. Bernie would be my first AA sponsor.

I was living in Tom's Slesse Park trailer having left my former life not knowing if I wanted to be a doctor again because I was tired of protecting patients from negligence and greed only to have the authorities whose job it was to do just that devote their lives to protecting the wrong dooers and killing the messengers. I wasn't drinking. I'd gone back to reading the Bible and asking myself where my life had gone awry. I was going to Father Fred's church and asking God what was I going to do now when Bernie showed up.

He was such an incredible character, full of life, smiling, laughing and driving a new truck. It didn't bother him that I was sitting there with Shinto, my dog, a Bible and shotgun , nothing much else, and looking fairly wild. Bernie was a man of great courage.

"When I stopped, an ambulance came to my office and took me away in a straight jacket. I didn't think they'd know what pills I needed in detox so I was grabbing handfuls as they took me away, my pockets spilling pills onto the street in the middle of town in broad daylight. That was 10 or more years ago. I got back to work and love my life today." he said as we drove to Cultus Lake.

Cultus Lake would be my first AA meeting. I'd been telling my story of leaving medicine, going to Mexico and drinking when we got out of the truck and headed down the side stairs to the basement of the church. "In AA you're what we call a high bottom," he said behind me as I was about to step through the doors. I thought, oh my God I'm enterring a cult of aliens and I'm going to be anally probed. But the sound of laughter in the room kept me going forward. The welcome was wonderful. No one talked about bottoms and all everyone did was shake my hand. At the end of the meeting they'd all say, "Keep coming back."

The only criteria for membership in AA was a 'desire not to drink'. I had that. I figured I needed all my wits about me to figure out where I needed to go now. My wife was too far gone to go back to.

From that day Bernie was beside me. I didn't want to be a psychiatrist again

I thought the 99% gave the 1% a bad name but it turned out that I'd been running with the Turkeys. Bernie, Willie, Doug and Ray would all help me get to Homewood Treatment Centre in Quelph where Graeme Cunningham told me that first night, "The cheetahs run with the cheetahs and the turkeys run with the turkeys, and you sound to me like you've been running with the turkeys." Sure enough I had.

Ray would introduce me to International Doctors in AA and soon I'd know so many more doctors and psychiatrists who cared. NASA doctors,doctors to presidents and royalty would be sharing their stories with me. I'd find other psychiatrists all who were good men and women, ethically sound and morally upstanding. Dr. Lam from EMAS and Willie with the Christian Medical and Dental Society would show by their examples that morality and medicine were not mutually exclusive whatever the government might want to sell.

They were all like the good folk I'd first met at the University of Manitoba Faculty of Medicine where Arnie, Clark and Nady so inspired me to be the best doctor I could be. Somehow with booze, sexual abuse and bad marriages I'd got away from all that later.

Hank, the flight surgeon and psychiatrst from Louisiana would remind me how important psychiatry was. Art would set an example that a man could be really good at heart and still be a psychiatrist. I'd talk to wives like Carole and Anita and feel the admiration of good living and know they'd stood strong together. I'd never known how I'd made such wrong choices but knew that booze never helped.

I'd share all this with Bernie, as he took me through the 4th step of AA and I shared my 'moral inventory' looking at the expectations and resentments in my life, where I'd gone wrong, what people I'd hurt and how I'd been responsible in the end for so much of what went wrong. Bernie never judged me. I never felt ashamed in his presence. Instead I felt human again.

It had been so long since I'd known people who cared for others as all these people did. I'd grown so sick of hearing patients referred to as customers and listening to doctors and beaurocrats talking about people as profit. I was sick and tired of all the lies.

Bernie was an old fashioned country doctor whose patients were his friends and neighbours

Living in Chilliwack I'd know his patients and all of them accepted and admired him warts and all. So many people in AA meetings were sober because of him. "We'd stop going to other doctors," they told me, "but Bernie didn't judge us." These were sick people. Alcoholics and addicts without good medical care cost a hell of a lot more than they do when they get regular care and begin to accept an ounce of prevention. They just don't tolerate attitude and we're all too thin skinned for our own good. I couldn't guess how many hundreds or thousands of lives Bernie saved by being himself and doing the best despite it all. He was a survivor. Addiction is a deadly disease. It's ubiquitous and so many people hide it well until it's lethal for themselves or others. "We're as sick as our secrets, " Bernie would say and lived his life in a fish bowl.

Dr. Rabbi Twerski would say, 'at least in AA you know who the drunks and addicts are."

I always knew Bernie sober except the night he'd relapsed and called me for help. Naturally, a crazy woman, a physical injury and a combination of pain and frustration and he'd picked up. But Bernie wasn't a liar. He had the honesty to be a member of AA and reached out for help getting back on the wagon before damage would be done. In a world so steeped with deceit and lies I so admired Bernie's honesty. It was a light in the darkness for me always.

And he loved women. Lorne and I and he would joke in Chinese restaurants about what great deeds, acts of heroism and what saints we'd all have been were it not for our "love of the ladies". They seemed to cloud our reason and we'd talk for hours over coffee laughing fondly about days of wine and women. Mostly it was lamentations.

Bernie made us laugh. When all else seemed bleak he'd be laughing and telling a story of a new day dawning. He believed in the Holy Spirit. Told me he prayed for guidance and trusted in God to be there. Once when I was struggling with the lies and violence praying for the strength to not return an 'eye for an eye' and strike back 'evil with evil', 'hate with hate' trying desperately to pray for the creatures I'd taken to calling the Borg, Bernie was there for me. I was almost catatonic with rage and despair when I phoned him. He told me to come right over. Something in the tone of my voice, the long silences between sentences, the shallow breathing got his attention. I don't ask for help easily.

That day, I went right to his home climbing over the scuba gear and sitting down in his living room. As I sat down, he just picked up his banjo and played and sang "How Great Thou Art". After that we sat awhile in silence before I was ready to go on. We never did talk about whatever it was that was bothering me. We didn't need to. He knew I just had to remember that there was another side to all the insaniety and evil in the world. He was intuitive that way. Another time he just talked to me about his love for his family, his children, how important they were, how family were the best antidote to suicide, how good his brother was, how important friends were, and his love for his community. He spoke about himself getting my mind off myself. He'd pick me up and we'd drive out in the country, park somewhere and he'd just talk. Sometimes tears would be running down my cheeks listening. Somehow if he carried on, I'd have the strength to go on too. One day at a time. I didn't want a drink. I just didn't want to have to face the ignorance, hypocricy ,conceit and arrogance of beaurocrats and bullies. Days would go by and I'd alternate between wanting to just walk away or stay. Always Bernie would be there saying it gets better. His happiness and downright hilarity gave me hope. If he could stick it out then maybe I could too, I'd think. One day, thanks to Bernie, I thought maybe I can help others too.

I'd visit him at his office and there he'd be, stethescope around his neck full of wisdom and life. We'd go for lunch and he'd always laugh and see the humor where I'd be looking for the gloom and nursing the despair. He'd sit beside me at AA meetings and share something inspirational, tell a little anecdote from his day or the way things had been and how they were now. He'd be working the steps of AA and looking to God and his fellow man for the solutions to life rather than to booze. Always he gave me hope. When I didn't believe in myself, he did.

After I left Chilliwack, returning to Vancouver, my practice, my sailboat, later Saipan and back to Vancouver again, we'd keep in touch by phone and with cards. We'd see each other occasionally and the lights would come on somewhere in the sky. A handshake and hug from Bernie was joy itself. Then we'd tell stories of where we were and where we'd been and Bernie would laugh. His laughter was infectious. He gave so many people life and laughter. I'm crying now missing him, wishing I could see him one more time again. But I know he's laughing in that great old meeting in the sky waiting for me. Thank you, Bernie.

Friday, March 27, 2009

She's the Man




"She's the Man", 2006 American romantic comedy directed by Andy Fickman and written by Ewan Leslie and Karen McCullah Lutz was truly a lark. Viola, played by Amanda Byrnes covers for her twin brother, attending school for him while he skips to play music in London. While at school, her passion's soccer and soon she's playing on the school team with her roommate, and now heartthrob Duke played by Channing Tatum. It's the soccer version of Shakespeare Midsummer's Night Dream with as much confusion about who's who until the final score. What a wonderful romp!

The Rapture Let Me Down

video

The Rapture Let Me Down

by william hay

Another Easter's Come Around/I guess the Rapture let me down

I'm still stuck here on the ground/I guess the Rapture let me down

Jesus, take me first, I prayed/but he left me here another day

You've got to live your life My Way/if you ever hope to get away

You've got to love and forgive/You've got to be unafraid

That's just what Jesus did/and He lived His life that way

But the Rapture let me down/Another Easter's come around

I'm still here upon the ground/the Rapture let me down

NATIVITY


Nativity
By William Hay


There was unrest in Israel. The Palestinians and the Jews were fighting in the streets. Shots had been fired. In the last months 180 Palestinians had been killed and thousands had been injured.

The Canadian Consulate had a travel warning out and the medical conference I was to attend here was cancelled. I came anyway.

I was first attracted to the practice of medicine as a “calling”. I was studying the Bible at University of Winnipeg under the professorship of Dr. Carl Ridd. He encouraged us to read about this man, Jesus. He was a healer, a teacher, a prophet, a carpenter, a son and perhaps a God. I didn’t know much about God at the time. When it comes to what Christians call “sin” or “missing the mark” that is being outside the influence of the divine, well, I’m admittedly more knowledgeable. One might even say that at times in my life I followed an errant path with great passion and precision.

At this time I was studying diligiantly and praying and searching for God and meaning in my life after the excesses of the late 60’s had left me empty and needing to be filled. Dr.Carl Ridd was a man I could admire. A world class athlete, a manly man whose wife and children loved him and one who was forever taking up unfavourable causes, like the plight of the poor or the needs of children, in a world where money and progress meant so much more. I listened to him and enjoyed his deep sense of compassion.

I was born a Christian. I went to Sunday School. I lived the faith as best as my parents could do with a wild thing. I was more comfortable with my dog than people and up to mischief with as much alacrity as he sought out the prizes in garbage. We were a pair.
While I fell away from the church for sex and drugs and rock and roll I returned to attend once more and talk to the minister and then later Dr. Ridd. I’d sit in the chapel at University of Winnipeg and pray alone between classes. My marriage was on the rocks. I didn’t seem to be of use to anyone and so many people laughed at me because I seemed to always have strange ideas of justice and equality.

The war in Vietnam was raging and I didn’t want to fight. I prided myself on saying that I was a lover not a fighter even though I too was an athlete and spent years studying the martial arts and getting in to far too many scraps to be wholly innocent of provocation.

Jesus was a man of Peace and Jesus was a healer. It was in that chapel at University of Winnipeg I decided to be a doctor and follow in his footsteps. I was campaigning against war in general and marching for peace not against the soldiers but against the arms manufacturers and the war profiteers who so often became our politicians or the ones behind our politicians.

I’d become a doctor and I’d be a member of physician groups for peace. One day I’d be here in Jerusalem nearly 30 years later reflecting on my life and praying again fervently to God to guide me in my life. I was all dried up as I’d once been then. Divorced again and feeling out of sorts with the endlessness of work. Asking why too often.

And remembering Jesus. He was the greatest healer. Other physicians have written books about his miraculous powers at curing blindness, infectious diseases, orthopedic deformities and all manner of illness. Before his time he preached immunology. The infectious agent he called “demons” and “right living” was his recommendation. The whole history of Jewish law before had been oriented to “life”. Chaim. The rabbis and teachers all the way to Maimonides and on would give themselves to sorting out the laws of God in nature and find that which benefited health. Jesus taught the same.

And yet as a healer he could not heal himself. As a savior he could not save himself. God he taught loves us and is in relationship to us wanting to be loved by Him, to turn from the darkness of evil ways to the light of health and purity. Evil really, to the Jew, was so often just an expression of “unhealthy”. So much scorn has been made of the language of the ancients by the arrogant and modern that it behooves one to reflect on what was said at the time in the context of the day. We are all prone to misinterpretation and the teachings of Jesus on health are probably the most misunderstood.

And yet the men I most regarded who made the greatest contributions to science were themselves believers in God. Einstein, so easily comes to mind. Then all the great medical doctors of the Victorian era who laid the groundwork for all our learning in medicine today were themselves Christians. Jesus has always inspired healers.

To the Jews he was a rabbi or teacher, to the Moslems, a prophet or seer and to the Hindu an incarnation of God, while to the Christian he is all and more. But mostly he is a healer for as Kierkegard wrote in this condition of life we as humans suffer “sickness unto death”. This has been called the existential angst. What modern and postmodern psychiatrists call anxiety and mood disorder and what physicians so often see as a precurser of somatic illnesses especially the chronic slow killers of today is this sense of alienation from our selves and our God. It’s so readily captured by the terms that so often bring patients to physicians “being out of sorts”, “not feeling myself”, not feeling “right”, something “not good”, something “off”.

I am in the Holy Land today remembering to take off my hat in the churches, my shoes in the mosques and to put on my hat in synagogue while in the streets people are being killed for not much more. I am asking God to heal my broken life and studying the teachings of the world’s greatest healer because while I’m facing a postgraduate subspeciality examination next month I really don’t think I’ll fail because I haven’t yet learned Anion Gaps.

But there is this other “gap” this other place where balance is necessary. There is this time when I sit in whatever place of worship and reflect that for thousands of years men and women have sat where I have and prayed, and worshiped and reflected and contemplated and taken time just to ask why and beg for guidance from some unseen perhaps nonexistent really place.

As Buddhists might say I’m seeking the stillness to balance the business in my life. I am reflecting on the man whose life called my own to follow in the path of healing and who I hope will guide me on to the grave because quite frankly I’ve never regretted a day of service in the art and science and spirituality of medicine.

On the other hand left to my own devices in my own personal life I’ve sure been prone to make a muck up of things at times.

“You know as a physician I only deal in probabilities. My prognosis is an educated guess and highly significant but even with all the greatest advances in medicine and the miracles and downright wonders of modern science I cannot with any certainty say that I or anyone else for that matter is going to be here and alive next week.”

“Or tomorrow if you keep going to Bethlehem when our governments have clearly told us not to.”

Together we laughed. And we laughed even more when someone said, “Could you pass the bread.” Maybe I just came to the Holy Land to learn to laugh again. It sure is something you see a lot of here when in honesty I still expect religion to be solemn and boring. But no the priests and monks and rabbis are as human as Jesus and everywhere in the tunnels and streets of Jerusalem there are children playing. I know that Jesus would have liked that. Because he did say that we must become like children again and as a healer I know that that surrender and releasing and letting go and giving in and relaxing is the first stage in recovery. It comes after the shock of realization and the trauma of illness and the utter come-uppance of a path not taken or an unimagined horror. My first comfort as a physician is to share with patients and let them know that they are still human and apart of when their illness whatever it be makes them feel apart from.

Whenever I sat with a person dying I knew so many friends and family turned away. It was as if death to them were an infectious disease, something that was best avoided even if it meant unforgivably and deeply shamefully turning away from a loved one dying when this world doesn’t even give us enough time for living. It is in those moments when as a doctor I see the nurse and the closest family and so often a man of the cloth there. Bosses and business associates, politicians, tax collectors, plumbers and all others who had once benefited from this life have long ago turned aside.

We’re all in this thing together and together we can help each other through. Jesus today still helps me through. I can give him that much. He has given me so much for so little that I can indeed here among the ruins, shrines and museums find it in my heart to thank Him.

Today I’ll ask the Lord to cleanse my heart while I try to find somewhere to do my laundry. Maybe tomorrow I’ll go onto Gallilee if that isn’t too dangerous.

Tuesday, March 24, 2009

Children of the Silk Road











What a thoroughly uplifting film! Sensitive and powerful directing by Roger Scottiswoode. Jonathan Rhys Meyers plays George Hogg full out. The movie opens with this Oxford graduate adventurer at the 1937 Rape of Nanking, during the Sino Japanese War . George Hogg went on to help rescue 60 war orphans walking them over mountains on a 3 month 700 mile journey. George Hogg's character is as moving as the true life story of this incredible man.




Australian Radha Mitchell is utterly beautiful and believable as a heroic American doctor nurse patterned on Kathleen Hall a true life New Zealand nurse who George Hogg helped.




Unfortunately the New Zealand communist, Rewi Alley, who founded the Shandon Baillie School in Shaanxithe, accompanied George and hatched the idea for 'long march in miniature was written entirely out of the script. Historical revisionism though does not detract from the actual joy of the movie itself. Jane Hawksley and James McManus have written a remarkably moving script. Chow Yun Fat is superb as the partisan leader and the wise Chinese who saves George. Michelle Yeoh's eyes express worlds.




From Shanghai to the winter mountain passes, with strafing war planes and a hard working burro the movie has all the sweeping vision of epic while telling an intricate tale of romance and sentiment amidst of war and hardship. The boys are unforgettable! The cast and crew deserve special applause. A great and inspirational movie of a pivottal time in the life of the great people.

Monday, March 23, 2009

Alcoholism and Coffee Enemas


Alcoholism and Coffee Enemas
By William Hay

“Why aren’t you working in Boston anymore?” I asked him one night at the end of my trauma rotation in internship. He was one of my finest mentors with incredible clinical skills and a personable way with the staff. He had been stand offish when I first met him, the aloof white coat giving us interns orders and doing rounds. But one weekend had been particularly hairy and we’d pulled through. All of us working around the clock to deal with the onslaught of emergency cases.

Normally the hospital is pretty maxed out but then a big city event comes into town and then it’s overtime and overwork, too few nurses, too few doctors and too few beds. I can’t remember the event, a rock concert or a sporting event. It didn’t matter. Just a place where they served a lot of booze to make a lot of money and didn’t consider that half the trauma seen in hospital emergencies are booze related.

The violence, knifing, battery, gunshots is even higher. It had been one of those weekends that we got to know each other. He’d told me about his wife and home, the things that come up in the middle of the night when we wait for xrays to come so that we can decide whether Mr. Smith’s baseball bat injury is just a contusion or a fracture.

Mr. Smith was the last of a long list which included head injuries, stabbings, heart attacks and way too many drunks brought in by the police from the streets where if the police hadn’t stopped to pick them up they would have frozen in the night. It got to 40 below thereabouts and the cars didn’t start without a plugged in all night electric heater to keep the oil pan warm.


“Alcoholism”, he answered. I certainly didn’t expect to hear that. He didn’t seem like any of the folk we were treating. Here he was this senior medical staff man esteemed and reknowned and as I heard him he was telling me he’d had to leave Harvard for boozing.

“See this cavitation in the upper quadrant of this xray. That’s Klebsiella pneumonia, almost pathognomic for alcoholism. The drunks fall down and lying on their side aspirate vomit into their upper lobes and bugs grow. We don’t see as much as we used to. More and more it’s just general pneumococcus or strep pneumonia but sometimes you’ll see this. And there it is.” I looked at the xray with him thankful to have a classic textbook finding show up and have it pointed out.

However, I was now confused if his answer “alcoholism” was to my question or to the patients xray.

“Make sure this guy gets 100 mg of Thiamine,” he said. I’d already written the order. Wernicke’s, the reversible brain disease caused by Vitamin B deficiency with classic triad of ataxia, confusion and ocular palsy so often was a product of us starting IV glucose in these folk who’d leached out their vitamins and for the body to handle the sugar load it used up the last of the Vit. B leaving none for the brain. Instantaneous delirium and dementia if not reversed. Permanent brain damage if not caught. Too often missed so that now any one who is even suspected of having an alcohol abuse history gets Thiamine. Which of course means that the druggies, junkies and street folk get their thiamine and the business executive doesn’t. The latter goes crazy and ends up in a home while the “stereotypical” drunk gets better and remembers where to buy his booze for another week.

“Alcoholism, sir? I asked.

“Yes, I was working as the head of emergency in the big city ER. Lots of trauma. Lots of gunshot wounds. You’ve seen it on tv. We didn’t have the resources or staff there that they have on television. But we had fun. The nurses have a lot of heart down there and we didn’t take ourselves as seriously as you do up here in Canada. Maybe we just had to be so good we could afford to laugh.”

“Nurse could you see Mr. Brown’s magnesium level is checked. If it’s normal leave it but let me know if it’s low so we can top it up.”

“What happened?” I asked.

“Coffee enema’s. I was giving the drunks coffee enema’s to wake them up. They’d come in obtunded and I just figured the safest thing to do was to give them coffee enema’s. It worked. We didn’t have beds to admit them and we couldn’t send them out of the emergency room till they were more awake. You see all those guys we’ve got waiting out there drinking coffee. The police bring them in. We check them and admit them or sit them down and hold them till they’re better. Well, the guys I was seeing were so gone I couldn’t get a history of what else they were taking. Lots of barb and benzo abuse then. So I got the idea that coffee enemas would work. The nurses weren’t impressed with me but it worked and I kind of figured it would be a deterrent in a way.”

“Nurse, Mr. Jones in three can go now. His blood alcohol is 100. When he came in it was 250 so it’s falling.“ Down south I’d get these guys, take a blood alcohol but we’d not know if it was rising or falling. They’d be in the coma range 400 to 500 and I’d give them the enema and they’d wake up enough to tell me when they had their last drink. "

"But it was the coffee and sugar. "

“The coffee and sugar?” I asked.

“If the guy was awake I asked him if he wanted sugar in his coffee If he said yes, I’d put it in.”

“They fired me, what can I say”.

Sunday, March 22, 2009

Sunday in Vancouver











Another perfect spring day in Vancouver. Dean Peter Elliott's 4th day in Lent sermon at Christ Church Cathedral included a delightful story with great resonance. He preached that a Rabbi had told his disciple to put the Torah "on his heart". When the disciple asked why put it 'on' the heart and not 'in' the heart, the Rabbi replied, "it's because humans are so hard hearted. Putting the Torah on the heart it's there for when their hearts break and the Torah can fall in. "




Later at the DUG OUT in Gastown, a First Nations woman shared that "A man had fallen off a cliff at night catching hold of a branch. Hanging there he'd called to God to rescue him. He heard a voice say 'let go'. But he wouldn't let go and hung there all night long. In the morning he looked down and saw that he was only 2 inches from the ground."




The theme of the day seemed to be faith, letting go of fears and trust in God. Despite the long winter the spring had finally arrived as promised.




"My whole body aches. My legs hurt and even my bum hurts, " she said at the Mr. Pickwick's. We'd stopped for Queen Charlotte Island Halibut and chips after bicycling again around the seawall from Gastown. Our friend Marie, kick scootering home from a rehearsal for the Joni Mitchell song, Both Sides Now, joined us.




Together we watched the most competent Vancouver Police with their well disciplined horses ride through the busy traffic of Denman while all the little purse dogs barked bravely and ferociously from behind the legs and feet of their owners.




In Stanley Park, I quickly dismounted my bike and unholstered my camera when a family of racoons crossed the bike trail. At Lost Lagoon the geese, mallards and wood ducks enjoyed the ice free waters.
Dragging our sorry asses around English Bay we barely made it back . There's alot to be said for my 1200 cc Harley Davidson compared to winter flabberized 'shanks mare' power.


However tonight I'm going to enjoy the couch and ice cream guilt free and with just that added touch of smugness.





video

Saturday, March 21, 2009

WAR,INC.

Written by Mark Leyner, Jeremy Pikster, and John Cussack, War Inc. is an hillarious political satire set in Turaquistan. John Cussack plays the love lost James Bond for the private corporation Tamerlane occupying the country lead by Viceroy Ben Kingley who says "America is just our focus group". The gist of corporate war is to destroy countries to make lucrative markets for corporate products. Tanks sporting sponsor advertisements destroy the countryside while journalists are given daily sanitized virtual reality briefings. Cussack falls for the pure journalist Mellisa Tomei who joins him to save rock star, Hillary Duff. Dan Ankroyd plays the former American Vice President now a corporate CEO. Joan Cussack is gut wrenchingly funny in her role as the corporate assistant trying to keep John on course when Mellisa is kidnapped and Hillary gets cold feet. Truly Saturday Night Live meets Rambo in this unfortunately probably true rendition of world affairs, at least on the emotional level. The slap stick is in malfunctioning missile guidance systems with the black humor of a chorus line of survivors with prosthesis advertising corporate compassion. It's all there. John Cussack is way over the top and outside the box which is why this is a movie well worth seeing.

Bicycling the Sea Wall







It's a gloriously sunny day, first full day of spring. The promise of summer sun after a rainy weary winter. Everyone was out on the sea wall that runs for miles through downtown Vancouver.



Today Laura and I rode our Navigator bicycles from the West End where I live to my new office at the gateway to China Town. Enroute there were dogs galore of all shapes and sizes. Roller bladers, bicyclists and joggers abounded. The tennis courts in Yaletown were full. I watched a 2 on 1, Chinese girls against the guys basketball skirmish before Plaza of Nations.



False Creek with it's marinas and sailboats was pretty in the sunlight. Such a joy to bicycle.



I took the long way round to the new office and found the shorter route back looking forward to incorporating exercise into the work schedule. Despite the new trend in male pregnancy I haven't taken kindly to being asked when I was due. The new Zero One "flex" jeans on sale from the Bay last week have only provided temporary relief.



Laura meanwhile kept telling me how she wanted to scoop up the little dogs and carry them home in her basket, they were so cute. I only had to apologise to a few yorkshire terrier owners when I returned their purse dogs from the passing blond haired cycling dog snatcher.



Other than that excitement it was an uneventful ride. Summer's coming. Hooray! Hooray!

Sexual Frequency


SEXUAL FREQUENCY
By William Hay
Sitting in my office I’ve often been asked questions about what is normal even in marriage. The most common question seems to have been about frequency.
I did have an elderly patient who was happily married. He complained after a car accident which had caused a mild TBI that he and his wife no longer had sex as frequently as before. He said, “I did it every day, sometimes seven times a day but now at most once a day and sometimes hardly ever.”
He’d been married over 40 years. After my report went out his wife came in with him to see me. English was their second language. He was more fluent and she made a point of saying, “tell him!” Somewhat sheepishly the little man admitted he’d mixed up his English, he’d meant to say week when he said day.
As it was his wife corroborated that they’d normally had sex daily and now it was never more than once a week and sometimes not for several weeks. They were both in their 70’s and very much in love holding hands in the office and being almost inseparable as they left.

Several couples I saw in practice had sex daily for 30 or more years.
Other married couples had stopped having sex for an equal number of years.

If I had to say what was normal frequency based on what I’ve learned in practice over 25 years as a family physician and psychiatrist, and taking thousands of sexual histories from couples and individuals , I’d say that married couples frequently changed the frequency of their sexual encounters because of children and work obligations and health , varying from daily to at least every month or two.
It did seem that when I asked couples and individuals who were married about their sexual frequency that problems of some sort or another seemed to be associated with sex less frequently than once every month or two.

On average most couples most years had sex once or twice a week and that they continued to have sex once every week or two well into their 60 years after 30, 40 or more years of marriage. Young couples could have sex many times in a day early in marriage in their 20’s but later most averaged out while some actually maintained the stamina of the early years with perhaps less vigor. Physical illness was the most disrupting of factors in sexual frequency along with marital conflict.
That was in the older generation. Pre Viagra, pre cialis, mostly pre or during sexual revolution and most with religious affiliation. That’s still a whole lot of sex. On average anywhere from a thousand to 10,000 times in a long term marriage.
Some of these people might see me for marriage therapy and would say, believing themselves, “I never loved him “ or “I never loved her.” I really would have liked to have been a Jerry Seinfeld or Monty Python bug on their bed room wall.
However, I know that anger and depression cause “ retrospective falsification.” It’s a form of “emotional reasoning”. If I couldn’t stand to make love with him/her today then I could’t have made love to them before. The mind ‘selectively’ forgets what doesn’t serve their present day ‘war’.
Dr. Jay Lifton demonstrated this process as necessary for war wherein the English focused on the most unsavoury aspects of the Germans and vice versa forgetting all their mutual history of friendship when they became enemies. Counsellors commonly lacking training and experience in marriage therapy are a principal cause for breaking up marriages as are the courts where the lawyers and judges accept ‘subjective’ truth and the fallacies of memories over the ‘objective truth’ evidenced in the actual lives of married couples. One might well ask the clever ones what ever happened to the ‘wisdom’ of Solomon.
Anecdotally when I reviewed the sexual experiences of patients having marital problems it was common that the first indication of marital difficulties was often when the sexual frequency reduced to less than once a month or at least seasonally. Routinely asking about sexual frequency it was overwhelmingly evident that those who had regular sex in marriage were happier and healthier individually and as a couple than those who did not. Of course there are horrendous biases in the reporting and in the selection in my practices but that was the overall impression based on asking the questions and hearing the responses. All the the sexual literature I reviewed was itself rife with it’s own set of biases and experimental flaws. Despite this we appeared to be in the same ball park even those out in left field.


It’s simply not an exact science. Given the inexactness of science in the area of sexual communication and the confounding variables of honesty, dishonesty, social acceptability values and memory, I really don’t think there’s anything out there much more authoritative on the whole regarding the normalcy of sexual frequency even in marriages than I’ve commented on here.
It’s fair to say that mostly I encountered men wanting greater frequency and women wanting less but the differences weren’t that dramatic if the couple had no other major problems. Women more commonly wanted it once a week and men in these situations twice a week. There wasn’t a whole lot of dissatisfaction about this either and commonly the desires switched with married men in their 40’s and 50’s wanting sex less than the older women. Physical health was most commonly the determining factor for those in their 70’s.
Interestingly, over the years these self reports changed with more commonly younger women complaining that their male partners were not willing to have sex more frequently. This indicates that the ‘research’ data is in ‘flux’ and again no one truly knows what is ‘normal’ even in marriage and what is common is a fairly broad range. Epidemiological data 10 years old for one region might not have any validity today or be skewed by region, age, race, religion, cultural bias or the times.
The only thing in the end that seemed more fixed than fact was predjudice and bias. This commonly was reflected in the notion of any individual that their ‘desire’ reflected the ‘norm’ and that whatever they wanted whether it was lots or none was somehow the ‘norm’. And of course, nothing could ever have been further from the norm.
And if that’s the ‘norm’ for marriage, the ‘norm’ for singles today is even more abnormal.

Friday, March 20, 2009

A Time to Dance


Libby Skala's tribute to her great aunt Elizabeth 'Lisl" Polk played tonight at Pacific Theatre http://www.pacifictheatre.org/ starring LibbySkalla. http://www.libbyskala.com/
Her dance was as varied as her vocalizations and the story rich and captivating from beginning to end. Touchingly telling the tale of this remarkable pioneer of 1930's modern dance and innovator of dance therapy, Libby followed Lisl life from Vienna across Europe escaping Nazis to poverty then fame in New York City. Libby was beautiful throughout bringing the heart, sadness and promise of an era to the little theatre with her remarkable art. I was thankful I'd brought friends and rewarded by their praise as heartfelt as my own. What an uplifting and joyful evening! Thank you again, Ron Reed, for bringing us another great production of this brilliant and talented young woman.

Developmental Sexuality


Developmental Sexuality
-by William Hay

In psychology 101, students are taught that the first relational bond is mother child. The child developing in the womb does not have a sense of separateness from mother until after birth. No one knows for sure. It’s not something that can be ‘proven’. Indeed there is even hypnosis work with memories that suggests separateness is experienced in the womb. Yet the prevailing wisdom is that child is born in a state of ‘merger’.
Self and not self. This is the first key aspect of immunology. There is a need to recognise that which is friendly, helpful, and like from that which is not. The child’s awareness of self and environment is growing all the while in the early years. The child is perceived as beginning believing that mother and child are one.
.
The ‘terrible two’s’ when the child is in ‘rebellion’ is psychologically a time of “separation and individuation”. This time is characterized by the word ‘my’. By now the child has had to accept father and other siblings into their world. The magical thinking of the child has been narcissistic and omnipotent. There’s a large scale drama occurring in the world of the child where all revolves around them and then they are utterly alone. Emotions range like rivulets and great oceans.
Anger is associated with fear and during the ‘terrible two’s’ the child rapidly experiences rage and stubbornness and through the process, loved, comes to know a sense of interdependence.
A healthy child seen in public at a certain age will not ‘cling’ to the mother. A clinging child suggests to examiners that the child is afraid of losing the ‘uncertain’ mother. The child lacks ‘security’ for whatever reason. An emotionally healthy child will be able to move away from the mother in public while keeping her in eye sight. This will allow the child to explore the environment in safety. Where once in the first months of life the child was nearly attached physically still to the mother, and certainly dependent on the family the child is increasingly making forays away from the safety of the mother and family into the immediate environment.
The next phase of separation and individuation is seen in early adolescence. Adolescence has been characterized by the likes of Bok in three stages. The first is the moving away from the family and identification increasingly with a same sex same age adolescent group. The next phase is the becoming a part of the mixed sex same age group where sex and love relationships are played out with those outside the primary family. The final stage of adolescence is the establishment of a new ‘creative’ unit which will allow the child to separate physically from the family psychologically and establish a new family.
At this time the new family unit identifies with other family units of roughly the same age and begins to ‘nest’ and begin the cycle again for introducing new members to society.

This separation individuation is core but has many variations, not the least of which is homosexual development or celibacy in priest hood. These latter developments are seen as potentially self imploding while serving the group nonetheless.
The key feature though is that there is a ‘developmental’ time when this development can be viewed in the mainstream. The age of the individual in each phase varies greatly.
At one time the families cycled with separation from family and recreation of new family and individuals every 20 years. This continued in the lower classes into the 50’s and then as with the upper classes there was what was termed a ‘delay in adolescence’. Where once women reproduced children at age 16 to 18, increasingly child bearing moved into the 20’s, then the 30’s and now for many it does not occur though the external forms of the behaviour are symbolically preserved.

In earlier times children were valued for their own sake. Later they moved from being ‘tools’ in society and part of the essential development of the society, to being ‘toys’ and entertainment with value not independent from the parents. The introduction of ‘labour saving’ devices, the fear of the future, the unwillingness to expand outward, society trapped at the void of space as Europe was in pre Columbus times at the void of the great ocean. Where once children were necessary to man the farm and war machines and build the factories today they are not so necessary.
In the past children were celebrated because more children meant for most more income. The adage was simply that more hands make the workload easier and the thought of more mouths to feed was not intrinsic to cultures that celebrated life.

Later in the ethnocentricity of the present age would the rewriting of history occur and suddenly children, womanhood and family would be viewed through the lens of what has sometimes been seen as a dying or devolving culture. Indeed today many of the leading theorists are at the ‘end’ of their world of DNA. The grandscale of abortion in our society is testimony to the extraordinary transformation of culture that collectively celebrated life, childbearing, womanhood and family to one that now denies the child existence, promotes the individual over the family and society and generally dead ends.
Now that does not necessarily mean that devolution is inferior to evolution. Indeed some theorists believe the cycles are as necessary as any other ‘cycle’ in nature. It’s just a question of where a society or even individual is along this line.
In the end , it really comes down to the matter of drawing a line even if one only believes in circles. Believing in circles one must ask how tightly wound or loose the circle will then be in the metaphor of an individual or cultural life. So much debate and certainty depends upon the fundamental understanding an individual or culture or age has over this process. There are those who do not believe in development itself and may themselves not develop as a consequence. Snapshots,slideshows and movies all can give a different perspective on process. The point remains in drawing the line. Perhaps also one might ask who has done such drawing as end points are commonly in science beginning points as well.

Wednesday, March 18, 2009

Vancouver Seawall Song

video

Vancouver Sea Wall Song

by william hay

Walking on the seawall/in the afternoon/I was meant to meet you

Satin, lace and perfume, tuxedos and cologne, let me take you home

London, Toronto, Bombay and New York, Hong Kong and Tokyo

Paris and Rome

Ballet and opera/dancing beneath the moon

Incense and candelight/dinner for two

Tel Aviv and Cairo, Mexico City and Vera Cruz, Moscow and Barcelona,

Let me take you home

Our love was heavenbound, Our love was heavenbound

Let me take you home.

Tuesday, March 17, 2009

Cloud of Unknowing

Cloud of Unknowing
by william hay

I thought there was a time to know you/As you no doubt know me
I hoped this time of life for living/And death would set us free

I'd walk with you and talk with you/And you would be with me
But still there is a Cloud of Unknowing/And Yes I would know Thee
As you no doubt know me.
video

Pills and Booze

video

Pills and Booze

by william hay

You promised that you'd love me/In sickness and in health

You promised that you'd love me/And you'd love nobody else

I know you loved your mother/And I know you loved your shoes

And I know you loved your automobiles/I know you loved your booze

How you loved your pills and booze

I know you loved your lies/I know you loved disguise

I know you loved your country club/But you really loved your highs

Marriage of white in a church with white steeples

Marriage of white in a church with high steeples

Monday, March 16, 2009

Glorious Night!


It's a glorious night to be alive.

Five fingers and five toes moving.

Eyes present.

Lips and mouth and ears all fairly functional.

City lights. Fresh air.

Rains have cleaned the streets

And washed away the blood of despair.

Hope sings anew.

Thank God this day is done.

It's a glorious night to be alive!

Sunday, March 15, 2009

CCC, St. Patrick's Day Parade and Cheapskate







The day began with me in my black kilt, white knee high socks and Irish turtle neck sweater. I was mentally designing fur underwear for kilt wearers who foolishly ride scooters in freezing rain and sleet to church. On the scooter though, I got around the barriers set out for the 6th Annual St. Patrick's Day parade. In Christ Church Cathedral I arrived for mass and the sacred Irish hymn, Be Thou My Vision. The choir and congregation lifted their voices most high. A celtic harpist sang and played marvellously at the close.
Outside the Celticfest parade was coming steadily onward. The Irish kids were the most amazing wee people. In the freezing rain that turned to snow they just kept on dancing and playing their instruments. The crowds lined the streets and cheered. The bagpipe and drum police bands were at their finest. It was a truly great tribute to the spirit of the glorious land of poetry and song.
I'd bought tickets for Cheapskate ,the West End charity fund raiser weeks before. It was being held at the West End Community Centre Skating Rink. So next I found myself in kilt on rental skates on the ice for the first time in nearly 20 years. It was a terrific turn out with fabulous chilli and hot chocolate. A couple of the group were spectacular skaters and one in particular was flying high in the air doing magnificent leaps and turns. If I'd not worn my kilt I might have tried to emulate their pirouetting performances but modesty prevailed.
An hilarious auction followed. Priceless items from the "L word" show coupled with a Joe Average piece were mixed in with other donated ketch. One man or woman's junk became another's prize. I got caught up in the spirit of the thing and left with a bowling ball.
Carrying the bowling ball home on the scooter was a challenge but the sun had come out and the roads were no longer slippery.
Now my body cries out for a warm bath. Maybe there I'll remember why I bid on a bowling ball. No one else did.

video

Wet Reserves and Dry Reserves


Wet and Dry Reserves
By William Hay, MD

There are still those who believe that the disease of alcoholism is a sympton and not a cause. It is an idea that remains prevalent in some psychiatric circles which believe that alcohol is a “self medication” of mood disorder.

That it is an immediate acute temporary central nervous system depressant is not questioned by those who believe instead that chronic use, that is alcohol abuse and dependence are primary illnesses.

In the 80’s I had the great fortune to go to work with Dr. Jack Hildes. He was the head of Community Medicine at the University of Medicine but more reknowned for beginning the Northern Medical Unit http://www.umanitoba.ca/faculties/medicine/units/northern_medical_unit/which provided medical services to northern Canada. The Circumpolar Health Conferences which brought together the global care givers in the Arctic and Sub arctic areas was just one of the projects that Dr. Hildes was involved in initiating. He received the Order of Canada, the country’s highest award for his work in medicine.

Part of my work involved flying into northern Manitoba Indian Reserves, predominantly Cree or Ojibway nations, isolated from cities and towns by vast forests impermeable to roads except in winter when ice roads were built and supplied year round by planes.

The people of these reserves, some of my finest teachers and the warmest deepest humans a young man could care to encounter also had tremendous senses of humor and reserves of patience. They had long dealings with the white man and were never sure with good reason to wonder if any of his gifts weren’t yet another attempt to finally complete the genocide begun with the Indian Wars and following reserve movements.

“You’ll see the difference between the wet reserves and dry reserves when you fly into them, “ Dr. Hildes said. “You’ll also see the lead encephalopathies that come with gas sniffing by the children. “

I would fly north out of Winnipeg for most of the day in an old DC3 which I could have sworn had seen time in the war. I began going into the reserves I want to focus on when the snow was thick on the ground, up to one’s waist if you stepped off beaten paths. I wore a heavy blue nylon parka with a fur lined hood, down filled boots, and wore long johns under jeans and sweaters. I always had thick mitts and a wool toque and red scarf. I think the Northern Medical Unit paid for that parka which I bought at the Hudson Bay Store. My medical bag was a part of the packsack I carried with a light weight down sleeping bag I’d been taught in survivor training provided by the Northern Medical Unit was the best defense against a plane going down.

The DC3 was loud and usually I was the only passenger, though I once shared my window with a highly irritated infrequent flyer half german shepherd half wolf returning from a Veterinary visit to the city. He sort of joined me on take off and growled when I shifted under his weight. I don’t think he liked the view. The rest of the plane was filled with supplies. We were the sole passengers. He stayed on my lap till the co pilot came back to see if I wanted an instant coffee in a Styrofoam cup. He was able to convince the dog that I was perhaps not the sole reason for his predicament. The co pilot gingerly encouraged him to return to the floor. I had long ago completed my exam of the canine teeth and curled lip reflex so was most grateful for assistance.

“The Indians vote themselves whether the reserve is going to be dry. No one can bring in liquor after that. They don’t much bother the doctors and nurses and pilots since mostly they’re on the Hudson Bay lands where the store is. “ Dr. Hildes told me.

This reserve I flew into was a dry reserve. It could have been Little House on the Prairie. The streets were clean. All the children were well dressed. I attended the clinic and other than those illnesses peculiar to the region, like frostbite, and diabetes, the overall picture of health was no different really than that in the rural town I’d previously done family practice.

If anything the people were happier and there was a simple friendship network. Most folk went to church. The schools ran and after school hockey and other team games were important. There were volley ball games by the adults in the gymnasium in the evening and lots of good music with guitar and violin. Country and western songs were favoured by the Indians there. Johnny Cash was king.

I enjoyed my work there, doing home visits, getting my hot percolated coffee fresh from off the top of the big stoves used to heat the cabins. I’d see cuts and scrapes and listen to the chests of the old folk with my stethoscope. The nurses who did nurse practitioner work in the clinics served as doctor often. I as the doctor traveled to several different reserves by bush plane or ski doo and in summer by open boat with the evinrude outboards. The reserves were always on lakes or rivers having developed when the canoe was the main transportation. Trapping, hunting and fishing were still the main activities of the men though construction and some forestry was going on.

What was remarkable was the sister reserve. When the main reserve voted to go dry a few hundred folk decided they weren’t ready to give up alcohol.

“I remember being frightened around the men. When they were drinking with my aunt my grandfather told us to hide. There were 3 of us girls, all friends. We must have been maybe 5 to nine years old. The men would come stumbling after us. It was sexual. My aunt was raped. I heard her screaming. They were all drinking. Sometimes we hid under the bed but mostly we had to hide in the bushes.” She was a lot older when she was able to talk about those days.

“Henry was just hanging there. I found him out by the river. He’d been drinking. We’d all been drinking. I had my knife and cut him down before I went to get the others.” The young man told me that story back in the city in the psychiatry ward. He’d been diagnosed schizophrenic before there were cross cultural psychiatrists who recognized that PTSD was pretty well endemic in the wet reserves. Those whose lives were compounded with the Residential Schools experiences were worse.

I would walk across a bridge about a mile or so from the main reserve. The families who opted to stay wet had just moved a mile or so away. They just didn’t go over to the main reserve when they were drinking because that was the rules. The Indians in general were pretty good at following their own rules but not too particular about white man rules.

When I had clinics the folk would come from both reserves but when I began doing house calls with the nurses I really got to see the way it was. The nurses did all the public health. They were a dedicated rare breed of women, often from as diverse locales as Britain or Australia. Some Americans but mostly Canadians who faced all manner of hardship but lived to care for the people. They taught me a lot.

“Annie would have come to the clinic but she’s been feeling so poorly that she would have been ashamed not to be seen hardly able to walk. It’s her heart that’s bothering her and I’d certainly appreciate your seeing her, though, I’m sorry she’s in the worst part of the reserve and sometimes there’s trouble.” This was as much as I’d heard this nurse say in one go. She was a doer and native herself. Hardly five feet and a real ball of energy with a heart especially for the children.

In the wet reserve, the incidence and prevalence of all the alcohol related diseases was incredibly high. The contrast was extraordinary since the main reserve shared the same genetics and the only difference that could be seen was alcohol. Heart diseases, diabetes, pneumonias, liver diseases, skin infections, sexually transmitted diseases. All of them were over represented. The greatest tragedy was the children with Fetal Alcohol Syndrome.

When I came across the bridge and walked along the snow packed trail between the scrub spruce and fir I got to the first of the shacks. All around the outside of the shack was garbage. This was typical of all the houses here. The dogs who were everywhere go into the garbage bags and spread the waste. Nobody bothered to carry it the extra steps to the containers. They just threw it out the back door.. Pea cans, milk cartons, plastic plates, all strewn across the white snow.

Further on there was a shack which had half the wall missing. It had been abandoned though the rest of the building and the roof at least looked relatively new.

“What happened, “ I asked.

“Some men were there. They ran out of wood for the fire. They were drinking. They just took the wood from the walls.” She said as we walked and her breath formed white mist with the cold.

“How come you’re outside, Elvis.” She asked the little boy we found coming around the corner to the main street. He was kicking at the snow and shivering.

“They’re having a party at my place.” He said, looking down. Behind him the music from the house was loud and it was only 10 am. Hard to tell when the party on the wet reserves began. Often they went on for a day or two, binge drinking being the normal pattern.

“Come along with us, we’re going down to Annies. She’d like to see you.” She said to him, putting her hand on his hooded head and bringing him along with us.

Annie’s was at the end of the houses and just to the back of f the main road. She wasn’t able to get up and the public health nurse just opened the door telling her in her own language that she’d brought the doctor.

Annie was in her seventies lying in bed breathing poorly but smiling to see us. She was covered in blankets and when I went to examine her I found she was wearing four dresses. Her pulse were weak and her blood pressure abnormal. There were a lot of rales and crackles in her chest. Her heart sounds were tachycardic and hyperdynamic. I got under all the blankets to press her feet and watch the slow filling of the imprints of my fingers tell tale signs of edema.

She was in classic congestive heart failure and luckily I had some lasix along. I started her on this and went on to discuss the rest of the treatment with the nurse who would continue it after I left for the next reserve. I sometimes wonder today if I’d just treat confidently on clinical findings and not get ekgs and chest xrays which of course weren’t available within hundreds of miles. Even if I’d wanted them, mostly the old folk weren’t keen to leave and go to the city. Annie never did learn to speak English though you could tell she understood more than she let on.

When I stepped out of the cabin I felt good. The little boy had stayed with Annie and the two of them were happy drinking the tea the nurse had made while I was doing my examination. We’d had ours before leaving and shared cookies with the boy who asked so politely and shyly if he could have two. The nurse didn’t refuse him and Annie smiled sitting up in her bed.

I’ve always loved medicine and healing but these cases were the ones where you saw the results immediately. There was the community intervention with the boy and then the medical miracle of Annie. She was already perking up by the time we left and she’d be up and about doing her house work when the nurse visited the next day. I felt like the doctor hero for a moment because quite frankly often the work is drudgery with the results only apparent over time.

That’s when the 3 young drunk bucks appeared round the corner. They were stumbling drunk.

“Hey, look it’s a white guy” one said

“Kill the whitey, “ said the next.

“You’d better run, “ the nurse said beside me and next thing I’d gone from hero doctor to fleeing doctor running alongside this nurse who despite her short legs was going full tilt.

“Get to the chief’s house, the last one on this side, Go.“ she said. I continued to run while she turned and ran straight into the belly of the biggest guy in the middle bowling him over, the two of them sprawling in the snow.

The other two slowed up for only a second and then I heard, “Kill the whitey again” I heard a bottle break against a cabin wall and they were coming after me again. I ran faster to the chief’s banging on the door until this drunk little guy came out. The two guys had stopped short of his veranda.

“Who are you, “ he said. “I’m the doctor.”

“Go away boys, he’s the doctor.” He slurred. The guys didn’t move so the chief pulled me in. “You stay awhile here, They’ll go away soon.”

All around the cabin there were bodies in various states of inebriation and a couple of the women were lying on the bed half undressed.

“Want a drink,” he asked.

“No, thanks, “ He stood staring at me after that and sort of wavered forward and backwards

The public health nurse came in at that point and said it was okay to come out.

“What were you doing tackling the big guy,” I asked as we walked back over the bridge.

I know him from when we were children. He’s wouldn’t hurt me. He just doesn’t like white men. Drunk he’s violent. He just got out of the penitentiary for manslaughter.” She said as we trudged in the snow.

Violence, death from freezing in the snow, medical complications of alcohol, substance abuse with gasoline sniffing and a regular Peyton Place of STD’s made the wet reserve a kind of Dante’s Inferno compared to the Home Sweet Home Little House on the Praire main reserve.

I just always wished my colleagues who never diagnosed alcoholism could have seen this contrast. Maybe then some of the 40% of people who are in hospitals as a consequence of drinking and the 75% of people in the jails could get the kind of medical treatment which would address their primary problem and give them hope for a normal life.

Even when the reserves went dry the bootleggers would still fly planes full of booze and land them just outside the reserve limits. In spite of this and the Hudson’s Bay wanting to profit selling alcohol and the government always happy to benefit from the taxes made off liquor the dry reserve movement keeps happening. It’s the foundation of the empowering of the Indian movement that lead to the profound changes in the 80’s and 90’s in the Indians achieving self government.

As long as the Indians were drunk the government could manipulate them, Iguess.

Maybe if the country as a whole could take a lesson from the Indians we’d see some improvement in government, I thought. Certainly the denial about the profound medical and social costs of primary alcohol abuse and addiction would be addressed.

I’m just thankful that I had the opportunity to work with Dr. Jack Hildes Northern Medical Unit and see first hand what a people could do for themselves and how prevalent. extensive and ubiquitous alcohol problems and addictions are.

I recently heard one colleague call it the “great masquerader”. It presents as trauma, seizures or heart disease but it’s really just alcohol. Kind of like infections which spread through the body and give rises to rashes and fevers and many separate things that the good clinician recognizes for what it is. Alcohol does this in the body but its most profound effect for me is at the community level and in men’s thinking about alcohol and addiction. Pretty soon whole communities live in denial about drugging and drinking. Sometimes even the medical profession chooses to ignore the problem.

Maybe it will just go away. Maybe it won’t.




Saturday, March 14, 2009

Puppy Love


Puppy Love
By William Hay
I felt it was time to write of love. Not the love I know today that is jaded as a nation, sanquine with age and brittle. Even my soul today seems like an autumn leaf and the love I speak of is springtime fresh.
It was college of course. Something about higher education and meeting the dreams of parents and societies in that fantasy world of adult kindergarten. It’s called the ivory tower and the climbers still believe in rainbows and pots of gold. It’s also very intellectual and the hormones are begging to have a part in the great debates that change children and history.
Her hair was long and blond in the way wheat is. Her teeth were white as midsummer clouds. It was the fall semester and the world was changing colour. A north wind was blowing and leaves were chasing each other on the streets between the passing cars. I wore a navy double breasted pea jacket but had never been to sea. It was an age of costumes.
Her legs were infinitely long and she was slim and laughed so easily. Her pert breasts lifted as her back arched. Her face was radiant.
I don’t know if I fell in love with her when I first saw her because it seemed thereafter I never had not loved her. It was a sacred love. Eternal in it’s beginning and never ending in the end. Somewhere in between I was forever lost in the middle as so often happens when the intensity of the present precludes all thought of any other matter. Little mattered but to see her and to be with her.
It’s hard to believe in retrospect that I continued to attend my classes though as she shared several it was no great chore that my attendance was spectacular in those. I did however look less at the professors and chalkboards than I did at the nape of her neck . I always sat some seats behind her so the profs perceived my forward gaze as interest in equations or the arcane words they’d scribbled on their chalk boards.
When she sat in class I watched with fascination as her wool skirt rose exposing more of her strong athletic thigh. And if she spoke in class, asking a question after raising her exquisite hand and sculptured arm, my heart fairly sang. When ever I came near her I felt flushed and worried others might notice me blushing. If I had a tail it would have wagged uncontrollably at her approach.

I knew I was being silly. It was acute anquish to have the feelings of childish desire cascade and tumult inside a thoroughly adult body in a very meaningful and serious environment . I was studying to be a doctor and it was deeply disturbing to feel such oscillating emotions. At first my feelings soared just to see her but then I struggled for days to approach her because my nervousness around her quite overwhelmed my faith that in her presence I’d be able to speak.

With practiced casualness I sought her company after class one day and walked with her and then talked with her and tried to leave a memorable impression by joie de vivre, interest and humor. I was dressed in a blue suit and carried a brown brief case having to work after class unlike the other students dressed in studied dishevel.
Later she’d laugh and tell me that her friends called me, “super geek”. I had horn rimmed glasses and was studious and top in the class but never considered myself a ‘geek’. Feeling ever so ignorant , it came as a surprise that the latest costume of student was worn so convincingly.
But then I never thought that she was a ‘party girl’ and that ‘geek’ was her term for the title of ‘scholar’ I so aspired to. There were early clues. In the background the relationship might have heard the horror audience screaming, “don’t go in the shower!” But we weren't listening.
That name calling would be the root of the first argument we’d have lifetimes later older than Moses.
I was heavy. She was light as gossamer. I was the troll to her fairy angel. And the beauty of her lifted the soul within me but I could never rise so high and frivolously as she did with tinkling laughter and whimsical charm so reached desperately in the end. Running back and forth like a dog that has the mistress' scent but but cannot leap an insurmountable barrier. I had such short legs for my long body.
I remember her face like Lana in Doctor Zhivago. She is wearing a brown fur hat and long tan sheepskin coat with high suede boots. It’s outside the ancient brick of the university entrance where a great stone had been placed to commemorate history. At 6 feet I’m taller by only inches and she is looking up at me with fathomless eyes as snow falls around us. We may as well be little people in an upturned bowl of falling feather snow in a quaint forever tourist scene. It’s such a stationary moment of night and lighting. A brass street lantern had been installed not so long ago to replace a glaring neon light that kept away rapists but made the university look too much like a factory.
She is waiting as I am bending to kiss her. Our lips meet and I am never alone again and there is no more fear in the world and the feel of her in my arms beyond my parka and her coat is something purely wonderful. I have found a home. I hold her as cherished and precious while feeling strong beyond my years. This paradox of vulnerability and immortality would suddenly come alive to never leave me.
Later I would smell her perfume on my scarf and return to it over and over again as I wrote some long forgotten essay. There is really nothing I remember of those months of meeting but her. Every image of classrooms or halls is of her coming around a corner or her sitting there so poised. There must have been reels of tapes in memory banks of halls and classrooms and cafeteria moments when she was not there but they are all pushed aside by the details of the moments with her. All I ever recall is whatever she wore in those environments. Reality seemed an extension of her elegant attire.

Perhaps that came from reading Vogue. She loved that magazine and her clothing emulated the finest Paris haute coiffure in the little Canadian country town. It wasn’t really anything then but before I knew Paris, London, New York, Hong Kong, Tokyo and LA it was my only city.
Not long after that kiss everything became ours and I stopped to think of myself in any way but as ourselves. I don’t know that she ever did. I just assumed it like I assumed so much in that brief encounter with deity. A kiss can leave a trail of joy and tears.
In retrospect to her I must have seemed like a love struck puppy. I am quite sure I never humped her leg. I may well have drooled on her dress. I'm sure I messed her lipstick and mascara. We argued about such things. But when she showed me the pink leash and the lock for the cage I ran away to the northern timber and eventually went to sea. I might have noticed earlier had she not given me treats for doing tricks and carried me lovingly as she did, in her purse to the parties.
Sometimes when I’m alone howling at the moon I think of her. Scratching at the mange, I remember her forever young and beautiful . The scent of her remains indescribable.