Saturday, January 31, 2009

Vancouver China Town

China Town. The lease on my office near Vancouver General Hospital is up in a couple of months. They’re tripling the rent. The last time I had to move my office from Broadway and Granville, a friend called to ask if I would come to Northern Marianas Islands. Next thing I had solo sailed Giri with my cat and dog across the eastern Pacific to Hawaii in the winter of 2004. From there we flew across the western Pacific to Tokyo then on to Saipan. For the next year and a half I’d be a psychiatrist in the islands having the privilege to work at the Commonwealth Hospital of the Northern Marianas Islands with the incredible staff and people. Scuba diving, making music, dancing, playing golf, attending churches, meetings on palm beaches, good friends and awesome food, it was a dream come true.
This office was devastated early by tragic staff problems that we barely survived thanks to the honesty and hard work of others. As a business though it was a loss due as much to the contempt of government for medical doctors and the truth as the spiraling overhead costs. Even the parking lots around the hospital gouge the sick and prey on those that care for them. The most stigmatized are the mentally ill and the emotionally disturbed, loosers in the eyes of prevailing Social Darwinism.
As arrogant governments steal to pay for their mismanagement and sickeningly gross corruption tax collectors rape the middle classes to pay for the services the criminals en mass participate in for free. More and more are above or below the laws police no longer uphold. A famous study showed that the mentally ill of asylums voted identically to the general population explaining finally community insaniety.
My work, once devoted to simple and gracious neurotics, has been increasingly involved with angry hurt addicts, the complex brain injured and the disheartening defensive traumatized who find themselves victims in a society that celebrates victimizers. Where once my patients had one disease and maybe one medication today so many are aging and chronically medically ill with multiple medications for multiple illnesses. The pay and time allotted for patients remains the same but all the ‘cream’ of business has gone to the highly lucrative alternative health care and wellness clinics. The severely sick and disabled can’t afford to be ill. Increasingly my patents need a lawyer just to get their life saving medications paid for by public institutions that pride themselves now on being “for profit”.
It’s a cold city that celebrates a 2010 winter Olympics none of us can afford to participate in. Already many of my patients are facing homelessness as everyone fears the congestion that will make traffic unmanageable. Gunfire of road rage has already erupted.
I wonder if I should move to Nunuvut. I loved the north and the cost of living makes work there attractive. Maybe a Harley engine in a snowmobile would go with ice sailing. I have been in contact with eastern jobs where the pay is three times what is offered here and costs manageable. When the BCMA polled doctors locally nearly a half said they wished they’d chosen another career.
Given the government disdain for psychiatry and utter ignorance coupled with arrogance I sometimes think of returning to family medicine with it’s 7 minute visits and quick fix answers. Nothing I do is apparent except lives change for the better. When I do my work really well they all believe I wasn’t even necessary. It’s all in the pill isn’t it? I was amused to see that the pharmacists figured they could prescribe as well as doctors but now see even they aren’t willing to accept the responsibility for prescribing psychiatric medication.
Some days I miss the knight in shining armour role I gave up for the court jester. Yet Shakespeares kings listened to no one else and only the fool told the truth. "The truth shall set you free."
But I like my life here. I enjoy my patients. I’ve always enjoyed my patients. There’s no money or time for the complexity but the challenge is certainly there. I read at night to keep up with advances and enjoy that. I’ve never been paid for any of my education beyond general practice. There’s no reward in Canada for higher education and certainly little support for specialization or subspecialization unless it involves a procedure you can grandstand with. I offered to take over the defective police tazers and provide a cosmetic service for the S&M crowd but my insurance wouldn’t go for it.
Still I love the multiculturalism of my referral base. My friends are here though my family is back east. My sailboat needing repairs always calls to me and I really wouldn’t want to leave without the rising debt. There is sophistication in the east and more honesty in the north. Occasionally now that Obama is president I even think of journeying south.
Other days I miss the country. Most free weekends I’m hunting, fishing, hiking or motorcycling back roads. I used to be sailing but my boat needs an xray and I can't even get my boat an xray.
A night at the Ballet makes all the city ugliness worth it. Yet this year this extraordinarily exceptional company couldn’t meet it’s costs. In contrast a little town like Rossland supports an Opera Company while Qualicum supports a theatre company. Vancouver prefers free heroin.
So here I am in China Town. I like the feel and vibrance of Main street. Costs are reasonable but I can imagine daily fresh produce.
My life is so busy that laundry and shopping are the greatest enemies of leisure. I work 5 days a week and usually Saturday and Sunday I'm doing support activities. I’m aging and must somehow incorporate exercise into the 10 hour work days. I imagine more walking during the week with so much to see.
There’s a real diversity here with community and people living and working as such. Asked where I’d like to live and work in Vancouver I really had to admit that my first choice after the west end was this area.
My friend wants me to come to the north shore. Right now my boat is there. I’ve applied to work in Abbotsford and Chilliwack but they don’t want doctors. A lot of the public face is ‘shortage’ but when it comes right down to having a doctor in the eyes of government that would raise health care costs. Waitlists and doctor shortages are lucrative to politicians who don’t have any reason to keep their promises. It’s been easier to get work in foreign countries than to meet the demands of beaurocracy locally. All my Canadian training and experience is for naught.
My foreign friend says they like him better because they know he won’t question the authorities because they won’t let his family join him if he does. Canadian born I still believe in civil liberties, human rights and freedom of speech all no longer available to doctors whose livelihood hangs by a thread the minute they question.
As many days I want to go back to the country or the north I’d like to stay here but that brings up getting another less expensive office and where. On the other hand, I ran away to sea last time my office life was disrupted. Maybe this time I’ll wait till a circus is passing through town.

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