Sunday, May 29, 2011
Saturday, May 28, 2011
Then Laura Gilbert and I headed off to Envision for liability insurance. This would allow me to ride logging roads. Everyone apparently gets liability insurance. As it was my first ATV and I had to consider that I might actually drive it, I got all the insurance. . Alien abduction is covered as it the rapture. If my ATV goes before me I can collect on the insurance.
We then drove on to Canyon Alpine RV Park where Brent had been watching over my Rockport Mini Lite Motor home. I thought it a good idea for the Polaris Sportsman 500 to get a good night sleep before I actually considered drivig it out of the back of the truck. Laura wasn't sure I should actually ever take it out of the back of the truck. Gilbert was just delighted to be in the outdoors sniffing everything a dog could sniff.
In the morning I positioned the truck in front of a two foot ledge, laid out my ramp. After extensive prayers and burnt offerings, I backed the new Polaris Sportsman 500 H.O.ATV down the ramp and sang Hallelujah. It really wasn't at all difficult.
Gilbert was very excited. The Sportsman was as much for him as me. The last couple of years I've hunted with a Honda 230 enduro motorcycle. Gilbert has ridden in a carrier on the back but his excitement when I get off the bike nearly tipped it. Then with the recent increased truck size from the Ford Ranger to Ford F350 I found it difficult alone to get the motorcycle onto the back. Gilbert will continue to ride on Harley Electra Glide in city and cruising but now offroad he will learn to ride on the ATV with a quick release harness. I liked there was lots of storage at the front and in the seat of the ATV. Further I liked that everything could be locked down.
This first time out I drove off alone. It was a bit like one of those black and white cowboy movies with the lone fellow riding off to his potential end. I headed up into the Alpine with a rifle only too ready to shoot a black bear if one actually tried to maul me. I was really ever so careful at first with the ATV. However, remembering what Ryan had done I got the courage to increase the speed over 5 mph. It wasn't long then before I was up to 25 mph and still feeling safe. The Polaris Sportsman 500 is simply unbelievable as a hunting machine. I drove all over the side roads going through culverts, down and up ravines. The roads I took were decomissioned. The ATV had no problems. Compared to a motorcycle I could actually look around on the ATV really scanning the hills and forest. I was on gravel, mud and grass going through ditches and motoring up and down without any difficulty. The Low gear was perfect for coming down the mountainside. It rained alot while I was riding but the sun poked it's head out from time to time just to admire my new Sportsman and my increasingly competent driving. With luck I will keep ahead of Kingston for a few months though I doubt I'll ever catch up to Paris given her head start. Ryan was planning on a Ranger 850 with turbo charge and Harrier fighter plane hovering capability.
I love the Polaris Sportsman 500 H.O. ATV. Thank you Ryan. Thank you Kingston for breaking it in and thank you 5 Star Motorsport.
Thursday, May 26, 2011
Surgical residencies are hard work. They are physically demanding. I'd done the first year in a surgical residency and knew this. A familial tremor raised concern and as at the time it wasn't known if the tremor would worsen. I chose to respond to a friends request to I join him in country family practice to keep the hospital there open. I did the credentialling for membership in the College of Family Physicians and began work as a country gp.
Subsequently I was approached by Dr. Jack Hildes who heard of my desire to work as a missionary doctor. "Why go overseas when there is as much need for doctors to serve in the Canadian north, " he asked me. He'd been unable to get a doctor to work with the Northern Medical Unit from Canada and had to recruit an Irish and English doctor. They'd come on board after me and despite the three of us the north was woefully undermanned. The nurse practitioner program had started fine but because of government administration problems the original nurse practitioners had all left, all but one. They'd been replaced with regular RN's who needed medical back up and consultation. I agreed to do this as part of a Community Medicine Residency. I did 2 years of Community Medicine and Public Health. a year into which I started my psychiatry residency. I continued to fly north as physician and psychiatry resident till near the end of my program. .
Most of the problems I was seeing were psychosomatic. Anxiety and depression and family problems had dominated the country pracdtice. There was also violence and job stress. Then in the north it was isolation, problems with government and major addiction issues. I worked Churchill, and Island lake but I also doctored in Shamatawa, a name some might still remember for the lead poisoning from gas sniffing addiciton that so hurt this community. I 'd seen that physical illness was as often as not a product of psychosocial problems which were the originating cause. Psychiatry at the time was the speciality that dealt specifically in biological psychological and sociological systemic perspectives. It wouldn't stay that way. As a result I've not been able to use roughly half my training. Psychiatry was once the study of the mind till over night it became all about the brain and a weak sister to the robust field of Neurology. Overnight, it seemed, science was out and pseudoscience was in. That's another story.
Psychiatry residency wasn't physically exhausting. I was even able to maintain a part time clinical practice as well as doing psychotherapy out of my home, continuing as an an occasional flyin doctor in the north as well as doing occasional locum work instead of having holidays or weekends. I felt I needed to get extra money for my marriage. There were so many demands on me at the time. Today there are too but today I can say 'no' more easily. I moonlighted for the doctor in charge of the Winnipeg Detox in those days, too. I never knew at the time that that experience would be a precurser to my later subspecialization in Addiction Medicine.
I recount all this here now because I toured my old medical school this last trip to Winnipeg. I'd not been back in the medical school for decades despite many visits to Winnipeg to see my parents. The fact was I carried alot of shame about my last year there, the divorce, abortion, the abuse, andthe betrayal, all the seeds that would 10 years later fuel a diagnosis of alcohol abuse, binge pattern At the height of my success I felt a failure.
I did spend 6 months talking to Dr. John White intermittently about my journey in life. As a Christian psychiatrist he was kind enough to invite me into his office and listen and talk with me about my own feelings about my practice and study in pscyhiatry. He always said my problem was spiritual rather than psychiatric. It was a decade at least before I understood what he meant. I saw Dr. Zloty as part of my training in psychoanalytic psychotherapy. He said I was normal except for a bit more anxiety than others might have. Indeed, I was a golden boy. In the last 6 months of my psychiatry residency my life as I knew it collapsed. I found myself looking into an abyss. At the time I was very fortunate to be working under Dr. Falconer. Dr. Bebchuck, Dr. El Guebaly and so many more were there when I needed them. I completed my residency, passed my exams. I was even offered a position on faculty and began to work as associate professor and staff psychiatrist. But I wasn't there. My heart was broken. I later wrote in an article for the Journal of Health and Religion, "a broken heart for a pscychiatrist is like broken hands for a surgeon." Physician heal thyself.
Psychiatry isn't hard on residents physically. It does challenge one psychologically though. It's brutal socially. I'd hardly thought of suicide yet daily I was with patients who may as well have been trying to sell nihilism. While I was trying to sell life they were giving me every excuse for ending it. Everything I held dear and near seemed to be questioned in the crazy world of psychiatry. Naturally patients are psychotic and question reality. Worse psychopaths, almost like the snake in the garden of eden whispered always, that their 'way' was the best way. Why not 'cheat' ,'steal', do harm, destroy? . It would also take me years of maturity to appreciate the men and women whose teaching wasn't as appealling at the time but turned out to become the cornerstone of what made my own clinical practice successful. The frank narcissism of others wore on me and wore off on me. Part of the problem of idealism is that altruism can be a castle built on sand. I questioned God, morality and ethics. I found myself all torn up inside.
Psychiatry residency isn't physically exhausting but it can be emotionally, psychologically, socially, morally and ethically devastating. Residents commonly had divorces and breakdowns and many over the years dropped out. Some suicided. Others ended up in hospital beds. I made it through barely.
I left the University of Manitoba. I left my faculty position. I left my broken marriage. I left my family and friends. I barely escaped with my saniety. Maybe I didn't escape with my saniety. Maybe it took the next 10 years for me to find the lost bits of myself. Those bits I'd not held dearly or those bits others had chosen to steal. The next ten years were a roller coaster. I drove a beat up Baha Bug I'd named Pendergast to California. I did my American medical examinations. I had to relearn all the basic sciences and physical clinical medicine after years of focus on psychiatry. Subsequently I was offered staff positions at Stanford and Berkeley but instead returned to Canada. I was actually planning on taking a position offered to me in Carolina. I liked the magnolia blossoms. I'd intended to drive across Canada. But my car broke down while I was visitting Expo. Friends took me skiing. Next thing I knew I was a clinical lecturer at UBC..
My parents lived in Winnipeg. I don't know if I'd ever have returned to Winnipeg were it not for them. When I did return, I rarely visitted anyone, but them. My visits were brief almost clandestine affairs until recently. There was a rumor I died. I did take pleasure in making an appearance. .I returned to lodge a formal complaint one winter through blizzards in a recovery car without heating. I did that because I was told it was the right thing. It wasn't. It helped me with prayer though. In the end I was visitting my mother in Deer Lodge Hospital, thankful for the wonderful care she received. Her internist was one of my early teachers, a godsend. The nurses were saints.
I never regretted my medical school training. What I learned at University of Manitoba allowed me the priviledge of serving countless lives in family practice. Delivering a hundred babies, setting Rodeo fractures, and dislocations, being the only doctor in a meningitis epidemic on a reserve, doing a myriad of things all hours of day and night, thankful to my teachers for the skills I'd received. I am forever thankful to theUniversity of Manitoba Department of Medicine and Surgery. To my mind they are unsurpassed. My work with the Northern Medical Unit under the mentorship of Dr. J. Hildes was unforgettable. I am simply so very very grateful. I am thankful too for the patients who allowed me to join them on their healing journeys. Much of the medical school training was functional and technical. Medicine is very much an applied science. Most of my real learning was on the wards with small groups or individually with leading staff men. I had the thorough priviledge to learn from the giants of medicine late nights in corridors or at the bedside of patients. My greatest teachers were the humblest of men who always thanked the patients for their many clinical lessons. Many spoke of God.
The same is true of the department of psychiatry, headed by Dr. Harry Prosen. There are regrets though. Much of this revolves around the abuse and stigmatization of the mentally ill. The remarkable men and women who were my teachers struggled at those edges of reality beyond the safety of the physical. The very best touched my heart and soul..
I mention this solely because it all contributed to my returning to my alma mater, University of Manitoba, this year.
I'd not been to any University of Manitoba Alumni events, reunions or even walked through the halls I once lived in till then.
Every visit home I'd pass by the University of Manitoba, Faculty of Medicine door at the Health Science centre. . I'd sit in the rental car outside the old entrance and remember. Often I'd just cry.
This last time I was in Winnipeg attending the Christian Medical and Dental Society Meeting, more than a quarter century after I'd graduated. This time I actually entered the university and walked through the halls, curious. I walked around those halls for hours. feeling good, so very good about being a student there, once so long ago. I'm a grey haired man today. Yes, the students looked like children.It reminded me of my clerkship and internship when some old fart like me said, "Go find me an adult, sonny, I'm too old for children playing doctor."
On the second floor outside the lecture hall entrances I found the picture of my class on the wall. Everyone I remembered was there and then some.
There are pictures of every graduating class of doctors going back more than a century. I was so very proud standing there after my own life time in the practice of medicine. I let myself swell with the pride of belonging. I've earned my place so many times over. Somewhere I stopped acting a doctor and became one. The abuse of younger years holds little sway these days. I'm still as confused as ever some days but my faith is stronger. I'm heavy with experience. So many thousands of patients, lives, illness and deaths. As a doctor and clinician I know today I have nothing to be ashamed of. Others may. But I'm not alone anymore. I've paid my dues and I've paid my respects.
Walking through those hallowed halls of higher learning, I was touched by grace. University of Manitoba Medical School, Community Medicine, the Northern Medical Unit and Department of Psychiatry are all sacred to me again.
It's been a long journey with too many sleepless nights. It was good to return to the beginning. Looking at the picture of my class I remembered the comaraderie, and especially the humor. In the midst of all the seriousness we still found time to laugh. I heard Dr. Ronald say, "I'm just an internist. All I have is pills and love. " Standing alone in the halls of the University of Manitoba, Faculty of Medicine I felt the love from all those years ago. Thank you to all my teachers, classmates and patients.
Wednesday, May 25, 2011
Transmission of information occurred across nerves which by connected by synapses. Synapses were spaces where chemicals were released which in turn excited another nerve in the relay system of communication. Further synapses from other nerves could alter the communication speed or even over ride the actual communication. Neurochemical transmitters were identifed and named such as adrenaline, serotonin, gaba etc. Some 50 plus neurotransmitters have been discovered. Different synapses have been identified as well. Further the brain geographically is not so neatly demarcated as once understood. The complexity of different broca areas is competing daily with the increasing discoveries of specific roles for different regions. It's not that there isn't a sensory 'homongus' or little man shaped outline in the brain which is like the whole of the skin surface of our body ,but rather that the sensory communication associated with the homungus can be modified by many other areas of the brain. This is in actual fibers of communication within the brain called 'tracts' . These are rather like 'freeways' while in additon there are back roads and trails of communication between all the different parts of the brain.
The amygdalla is important in emotional modification of messages as the hippocampus is important to memory. These 'solid' structures are however at best 'relay stations' and 'command posts' for the specific functions. The information about the importance of these 'regions' was first noted with exquisite contribution of surgical genius's like the Canadian neurosurgeon Penfold. In his surgical attempts to stop epilepsy he noted the relative importance of different parts of the brain. Further knowledge came from the study of the pathology of brains where a known deficit was identified while the person lived. Today research is more often delineated with the use of imaging devices such as EEG, CTScan and MRI. Actual function can be observed with the functional MRI or fMRI. Further SPECT and PET scan add to the overall picture which to date is vastly limitted by the small numbers in the samples. Specific questions therefore are easier to answer than any generalized or overall question per se.
This leaves areas of central importance to function connected by multiple hard tracks fueled by chemical communication. In addition to this the 'hard' brain surrounds a 'lake system' , fluid filled caverns called 'ventricles'. The Cerebral Spinal Fluid is a veritable soup of nutrients and communication altering chemicals. Brain cells specifically utilize 'glucose' or 'sugar' which allows alot of the understanding derived from imaging techniques. By tagging 'sugar' so it can be 'seen' in the functional imaging techniques areas of brain which are working (ie using up sugar) will light up on the camera lens of say the fMRI. By this technique it was noted that cocaine affected the frontal lobe of the brain and that after cocaine was stopped the frontal lobes of the brain did not return to normal functioning for at least three months. The frontal lobes of the brain are the youngest developmental regions of the brain and most associated with what is considered to be truly 'human' characteristics such as 'compassion'. Psychopaths are noted to have the most abnormalities in their frontal lobes compared to normals.
That said, the 'hard' brain rests in this 'soup' of neurotransmitters and chemicals which can modify communications "up and down regulating' it in the jargon of this field of research. The 'blood brain' barrier can further alter what enters the Cerebral Spinal Fluid. The blood brain barrier in this sense acts like the 'placenta' for a mother and baby separating what body and brain experience from, say, digestive nutrients. Hence, the 'vitamins' or 'health food' which is ingested and must then be absorbed from the digestive tract into the body per se must then be further selected for transmission across the blood brain barrier. This transmission is an active membraine whose transmission portals are affected by the homeland security muscled by ATP, a chemical that alters the shape of gateways.
The understanding of neurotransmission with it's balkanization of geographical regions, connected in regular warrens by trails and freeways coupled to reservoir lakes feeding the soup of psychoactive chemicals that bathe it, depending on the fickleness of the blood brain barrier, tends to defy the reductionism that the stupid and lazy firing on even fewer cylinders demand.
Pseudoscience however is always available to give warm and fuzzy answers that ignore the trillions of synapses that make neurotransmission within each brain a microcosm for communication amidst the millions of participants of the earth,who are situated around several lakes and bathed by the atmosphere in chemically active compounds, the least of which is oxygen.
Scientifically then we are like the greatest computer of the Hitchhiker's Guide to the Galaxy which when asked the 'meaning of life' after years spewed out a list of numbers. The understanding of the numbers then begat the building of an even greater computer to decipher the meaning of that code.
Neurotransmission is the way the brain produces a digital series. Mario de Beauregaard , the brilliant neuroscientist and researcher and author, explains in Spiritual Brain how this 'digital communication' is not as some simplistic souls would have us believe, either mind or soul. Neurotransmission is a function of the brain. Mind and soul are more akin to the person who sits at this magnificent organic wonder of nature and either programs or deciphers the programs that are possible within the limits of these seemingly limitless matrix.
Is it any wonder that I feel daily as a child of 2 given a space craft before I can read and write and not even knowing if any instruction manual can appreciate the miracle of the sensory apparatus, let alone the world wonderland that I'm allowed to play in, despite all the bullies and dangers that abound. Neurotransmission then is the internal brain communication, or script that I write a poem with.. It is the words and sentences, maybe even paragraphs and stories but not Shakespeare. And I am not Shakespeare. The wonder also is in the uniqueness that abounds, to the eternal frustration of those who would simplistically bar code humans, because of some as yet not understood flaw in the connection between their frontal lobes and heart which makes them blind to what their occipital lobes would tell them about what their eyes can so obviously see.
Monday, May 23, 2011
After that we filled up with diesel at our favourite Huskey where they cater to the big trucks, have everything imaginable for the road, and have gobs of room for newbie RV haulers. Then we were actually on the road. Both Laura and I were paying attention to every sound the engine made as I kept to 80 km. "We're breaking in new parts, " I said. "It doesn't matter how slow we go, "She said. "We're hauling a trailer and everyone else can get around us. " She had her seatbelt on and whenever I looked over I noticed she was praying.
It was on the hill before Hope the engine had overheated before. This time no problema! "We're going to make it. I love Chilliwack Ford!" I shouted.
In Hope we stopped to phone Canyon Alpine RV Park to confirm a site. The woman who answered was delightful. So joyful and full of enthusiasm for her RV Park. Lots of pull through sites. Perfect for the newbie. Pet Friendly. "Look forward to seeing you shortly!" she said.
We headed up the #1 Canyon road. Tom had said big rigs had been travelling on that since time immemorial so he thought it would be fine when we'd told him we were going to go on that or the Coquahalla. The weather for Boston Bar area was better than Merritt where we would have gone if we'd taken the Coquahalla. I trusted Tom's judgement and we headed up the Canyon. In the places where the passenger could look down the ravine I saw that Laura had her feet up bracing herself. I remembered Mark Twain's comment that he'd died many times already but so far only in his mind. Laura was bracing herself and praying while I was chatting. I get chatty when I'm concerned about those around me being concerned. I realized I was tense too. This hauling an RV was serious stuff. Canyons, ravines and tunnels. All the while I was listening to the engine and thanking God and Chilliwack Ford for the sweet sounds it made. I was also watching the temperature guages delighted that they were not changing despite the steep incline..
I love Sailor's Bar Tunnel simply because I'm a sailor too. Laura and I reminisced about the time we came home on the Harley Roadster motorcycle where we hit the bad patch of road enterring the tunnel finding ourself air born at 90 km/hr going into the tunnel darkness suddenly blind. We were very thankful when the tires hit and we stayed upright. Another trip with Bill Mewhort we'd come home with his trailer on the back of the truck hauling a little trailer full of the moose I'd shot and him speeding to catch the last ferry back to Vancouver Island. That was a memorable ride. Of course there's been dozens of other times I've travelled this route and only those two stick out. This one might as well because it was my first time hauling an RV into the mountains. As a prairie boy, I do remember the first time I drove through the Rockies to the coast and this had some of the flavour of that adventure.
Canyon Alpine RV Park is just beyond Boston Bar. I'd often hunted and fished the Nahatlach River across the bridge from Boston Bar past the North Bend. I'd also spent time around Lytton which is just a ways further north. . Consequently I'd been in this area and noted the Canyon Alpine RV Park in passing. I'd thought I'd like to stay there someday.
Pulling in with our RV behind us I had one of those God moments realizing that this was a kind of miracle. Tracing back the seeds that had lead to just this day had it's own synchronistic personal value. Laura said, "We're doing it. This is what you said we'd do when you got the motorhome last year and here we are doing it." There's joy in the fulfillment of modern day prophecies. God's grace is bountiful to say the least. Here we were living the adventure.
Brent and his wife are RV Park owner operators. Being motorhomers themselves they'd decided last year to buy this RV park and were loving it. Really friendly and helpful they gave us an easy pull through and ensured that we were happy before leaving us to get the electricity and water hooked up, tv cable, and sewage hose inserted. Gilbert loved the gated area for dogs where he ran big circles before rolling in the fresh cut lawn. Laura tidied up the interior of the motorhome, what had been displaced in the move. I then set up the lawn chairs. Ah.....sitting together in the sun with Gilbert on a leash beside us. This is heaven. Hummingbirds flitted about the trees above us.
I always have great ideas about what I'm going to do, like hunting, fishing, hiking and bicycling and building things but with no guilt whatsoever I languished in my oh so comfortable reclining lawn chair, having pulled the trailer here and set it up. Now I really was just enjoying reading in the sun. The book I was reading was about a space cowboy, nothing deep by any means. Great RV or beach read though. I read a little and dosed a little. Laura was reading an Oprah magazine and occasionaly brought out gingerale or chips. Gilbert chewed on a bone. When the sun was going down we had hotdogs and cheese in fresh buns we'd picked up in Hope. There was a sprinkle of rain so we went inside and watched tv before getting into the heated bed. Gilbert naturally joined us. This is really roughing it. I think Laura slept well because earlier she'd been convinced I was going to kill us all by driving over the canyon edge.
In the morning Gilbert got me up licking my face. He has no conception of 'sleeping in'. So I got up, pulled on sweats and took him for a walk. The mountains and trees were beautiful with sunshine waking the valley. Gilbert had an idea that I'd play ball all day with him but instead I walked back to the trailer where I made coffee and fried scrambled eggs and microwaved bacon. The toaster made the toast. Laura was very pleased at breakfast in bed. Gilbert was only too happy to scour the frying pan and clean the dishes.
He slipped out then and joined the half dozen other dogs and little kids who were walking their big dogs. Soon Gilbert was being chased by three leash dragging german shepherds and labs with children running and screaming and dogs all having a marvellous break in their morning routine. Soon parents were there and Gilbert sheepishly 'heard' me calling him finally. Little girl screams settled down and I apologised for Gilbert's escape from the trailer. The one dad was more concerned with his daughter's screaming like a bear attack and encouraging her to save that particular scream for something more than dog's at play.
I liked the RV park. Little kids voices in play were all we heard. No heavy metal music or reggae. Nobody smoking ganja and no heavy drinking. There were fires around the camp that night but by 10 or 11 it seemed everyone had settled inside.
I'd gone for a drive in the truck around the logging roads seeing lots of mule deer does. I even saw a great marmot. I took my rifle and target practiced for a bit, hitting a bullseye first shot so figuring the rifle was still sighted in from the fall. Still I think I"ll talk to Reliable Guns on Frazer about getting the rifle taken down and cleaned. Carrying them on my back on the motorcycle in the fall, I could see caused a lot of grime to get in and on the rifle . I probably should break it down myself. I'd done that before but these days was happy to have an expert check it out. It's like so many things in my life. I have learned how to do them and done them myself but just can't make the time to do everything. Master of one thing, jack of all others. You really can't be a master at everything or you do very little.
Another time Laura came for a ride with me in F350 over the mountains on the logging roads. Ostensibly I was bear hunting. It was black bear season, I had a tag. The rifle was in the back seat and I do love bear ham but mostly we were exploring. I'm planning on getting a quad this year, maybe trading in the off road motorcycle. Gilbert is the occasion. He'd ride better on a quad and I'd be able to carry game out of the woods easier. We saw some nice trails where quads had gone. A couple of the fellows in the RV park had theirs along and used a road just beyond the park to get to the backwoods. Brent the owner told me about the hiking trail. You can hike right up to a big cross on the top of the mountain. "Lots of trails lead out from there as well." Brent said.
Gilbert and I climbed half way up the mountain on the logging road,with me taking along a rifle just in case but that's as far as I got being somewhat out of shape after a winter of flu and sickness and undue stress.
I did enough exercise to enjoy getting back into the lounge chair though. This time I was sitting by a wood fire I'd made while Laura barbecued steaks which we all, including Gilbert of course. Nothing like homecooked meals eaten out doors. It's hard to believe this is the May long weekend only and we've a summer of RV fun ahead of us.
Today I might even get air in the bicycle tires and take a spin round the park. We've holidays this summer for RV camping and then we'll take the canoe along. There's fishing near by here in the Frazer River. "The Spring Salmon will be running soon," Brent told me. There's all manner of River Rafting around here too. There's fishing on the Nahatlach and that's only 20 minutes drive. There's just too much to do especially when my favourite RV camping event is lying on lounge chairs in the sun. An artist studio is within walking distance down the road. Features 15 local artist. That's a must see. After this last wet Vancouver winter sunbathing is the best however, especially when you are beside your own self contained mobile home on a quiet little piece of God's country. We love Canyon Alpine RV Park and can't wait to come back another week since we do have to go back to Vancouver for work tomorrow.
I think I first attended Pacific Theatre a quarter of a century ago. As long as I've been in Vancouver I've enjoyed productions by this truly gifted company. The plays are sometimes Christian and always high minded and thought provoking, though sometimes very very witty. It's theatre as it should be today. I always get season's tickets and never am disappointed. I often take friends who are always appreciative and thankful that I thought to bring them along. If I can't make a play I'm always able to gift tickets and am well rewarded with gratitude for such a fine gift. Pacific Theatre is simply unsurpassed. Consistently fine directing, acting and production. The plays in the coming year include A Christmas Carol; Doubt ,a parable; Danny and the Deep Blue Sea; 100 Saints You Should Know; Tuesdays with Morrie; The Meal; The Last Days of Judas Iscariot; Christmas Presence, and Sideshow. There's alot of theatre and performance happening at Pacific Theatre, Hemlock and 12th. I look forward to another year of great production. Thank you Pacific Theatre!
I loved reading C.S. Lewis' Great Divorce but I think I enjoyed Pacific Theatre's (www.pacifictheatre.org) presentation even better. Everything about this play was simply perfect. George Drance and the Magi Theatre had adapted the novel making it a very fine play. Kyle Rideout directed the play and the timing and acting showed evidence of such fine professionalism. The cast was large for Pacific Theatre. Actors included Brandon Bate, Matt Beairsto, Julie Casselman, Masae Day, Stephanie Elgersma, Kyla Ferrier, Evan Frayne, Lyndon Johnson, Jeff McMahon, Phil Miguel, Holly Pillsbury, Kirsty Provan Sarah Ruth. Each of these characters played a person or spirt at the gate of heaven. Foibles and outright vanities kept the very human from progressing on to the mountain of God. Laura McLean, Ana Lelena Garza, Frank Nickel, Jessica Howell, Chris McLaren, Florence Barret, Lauchlin Johnston, and Crystal Dodding all made the production truly memorable. The cast was young. It was a young crowd and yet the story and it's themes were old and timeless. Laura and I left thankful we'd come and talking all the way home about this truly wonderful Christian production.
Wednesday, May 18, 2011
Tegretol or Carbamezapine was the next medication found to be a mood stabilizer. This was used as the second line of choice in Bipolar I, manic depressive disorder. It's also an antiseizure medication and specific therapy for temporal lobe epilepsy. Clinically I have seen it's benefit with anger management as well. Bipolar II is a tenuated form of Bipolar I and was previously called 'cyclothymic' or 'dysthymic' disorders. It can benefit from the use of carbamezapine especially if the 'irritability' component is outright anger. That said it's use in Asian populations has to be considered in terms of cost/benefit because of the risk for a subset with HLA-B-1502 Allele developing fatal dematitis. If use is considered in asian population then test for HLA-B-1502 is indicated first. Aplastic anemia and agranulocytosis blood disorders are a risk so cbc with special attention to wbc is indicated. The CBC should be taken before starting mediation. There are alot of serious reactions possible including hepatitis, pancreatitis, suicidality, water intoxication and arrythmias. Therefore CBC, wbc, liver enzymes and EKG are to be considered before starting and when the patient is on the medication especially with increasing dosage.
Valproic Acid was the mood stabilizer most promoted for Bipolar II and so called 'rapid cycling' disorders. The difficulty with these variants of bipolar is there is a lack of specificity and interrater reliability. Clinically it is also common for mood swings and complaints of them to occur in patients with addiction. When the clinician commonly fails to take an intensive alcohol and drug history or the patient is not forthcoming, the patient is at risk for having liver disease missed. There are been cases of sudden death with valproic in patients with liver disease. Liver screening is indicated. Adverse reactions noted in Eppocrates include coma, encephalopathy, aplastic anemia in addition to the concerns that can occur with Carbamezapine. My tendency is to not use valproic acid in the drug and alcohol populations which I treat where liver disease must be considered as most likely. That said I have seen other patients whose lives have been much benefitted from the use of valproic acid.
It should further be considered that the dosages used in psychiatric treatment are often far less than these medications have been used at for seizure disorders for which carbamezapine and valproic acid were first used for.
Gabapentin and Topamax (topiramate) are other mood stabilizers which have benefit in psychiatric disorders. Topamax must be considered carefully as it can be associated with kidney disease and it can cause reversible with stopping the med unusual localized anaesthesias. Topamax is often appreciated as it is also associated with weight loss.
Lamotrigine is the latest of the mood stabilizer medications and has been shown to be very beneficial in some cases. It tends not to be a first choice but has been very robust in its efficacy further it has benefit in augmenting other therapies. It has a side effect profile similiar to valproic acid with sudden death and aseptic meningitis. I can't say I've heard of any of these complications and my patients have benefitted as greatly from this medication as from the apparently safer carbamezapine, gabapentin and topiramate.
Oddly Dilantin, another anti seizure medication doesn't appear to have any benefit in treating mood disorders.
Clonazepam, the long acting diazepam (valium) and lorazepam the short acting anxiety medication are interestingly 'anti seizure medications. Given this it's not surprising that other anti seizure medications have benefit in anxiety disorder, irritability disorders and the bipolar disorders.
Increasingly atypical antipsychotic medications such as olanzepine, rispiridol, seroquel (quitiapine) and the newer abilify and zeldox have become mainstays of use for 'mood stabilization.'
There is always ongoing conflict with pharmaceutical companies and the regulating bodies around this issue of 'off label' and 'on label' usage. These latter drugs were developed at 'anti schizophrenia' drugs but as schizophrenia commonly has a major anxiety component with some schizophrenias overlapping with mood disorders clinicians naturally use these medications with complex cases and find them beneficial. Medicine is art and science and psychiatry is very much so. The pharmaceutical companies develop medications that are profoundly beneficial for patients and the government regulatory bodies do their best to regulate their usage to reduce the risk to the population. The politics of this are often difficult for patients who don't understand that very often a safe and very helpful medication for them specifically is politically and legally suddenly in question because of the means whereby it came to market. Ironically if a pharmaceutical medication of proven benefit says that its good for anxiety and depression where it's only got 'on label' promotion for depression the company can be sued for millions. I say ironically because the so called 'health food" "alternative medicines" can make no end of unproven and mostly false claims without any legal consequences. Further much of the information that is being given to patients by pharmacists is not relevant to them as the doctor chooses a medication and dosage which is specific and considered in the light of their clinical experience. Because of problems of the courts and the FDA more often than not the side effects given for medications are 'medical disclaimers'. One case is a million risk is shown beside a one in 100 risk side effect without any explanation given to patients.
I was very thankful that men like Pierre Gilbert, Author of Demons, Lies and Shadows, A Plea for a Return to Text and Reason, had done the research to enlighten us more on one of today's most misunderstood and perhaps meaningless 'buzzwords'. These are extracts from the notes. I'm sorry if I've not got the spelling right. Perhaps blogging is a 'post modern' endeavour as it does not pretend to be a finished work but always represents a 'work in progress' like the 'hypothesis' of science which has so much more humility than the arrogance of intellect.
- rejection of notion of objectivity (classical foundationalism)
- rejection of the notion of absolute truth
- rejection of meta narrative
- Rejection of Judeo Christian moral God
- Exultation of the self and moral autonomy
- And they lived happily everafter????
- There is no absolute truth ? (A contradiction in terms)
- No evil in the world?
- No absolute moral code? (There is plenty of moralism in our media)
- Postmodern where it doesn’t matter - okay in spheres that don’t seem critical to us in religion and sexuality
- Modern where it matters - ‘who needs a post modern engineer? (who wants a post modern doctor? who wants a postmodern bank account)
- No metanarative? - What about materialism? Evolution, secularism, pluralism, new age spiritualism.
- Self confidence of post modern society is illusion and delusion
- it’s is an expression of man’s (C. L. Lewis ‘s) “bent” towards Pantheism
- Rejection of Christianity
- no kids - largest self genocide in history of the world
- no to personal responsibility
- No community
- No personal and no moral God
- Nihilism - like to feel good about their nihilism - hence a jargon and philosophy that is so confusing
- Doesn’t explain Love, doesn’t explain good
- you are allowed to be different as long as you serve the interests of the empire
- - therefore, your differences cannot be any that are important to the empire.
- “Everything is beautiful ....in it’s own way”
- Nihilism: from nihil (=”nothing”) This belief is quite consistent with tribal religions around the world. The world is interesting dangerous place and the point of your religion is to learn where the traps or taboos are. The aim is to live the most pleasant life you can, it’s a weird video game, y
- Consistent with tribal religions aimed at survival
- Consistent with secularlism /naturalism/ atheism; rarely embraced here so far
- Marx, Mao, Capitalims, Christianity - are all ‘meta narratives - these stories have been seen as stories to priviledge somebody else - has lead to disillusionment
- “I’m from the government, I’m here to help you.” “I’m a doctor, you can trust me.”
- characteristic of the disillusioned....
- and of the ‘diversity-aware’
- The more you know about others the more you ask is that true or is that what a white person ,or a middle class - what’s obvious to one group - is not what another group would perceive it - diversity aware - realize they don’t think quite the same way in China.
- but also of those who apprehend human limitations .....like us Christians...we shouldn’t have needed post modernism to tell us that we tend to see things from our interests. We tend to see the world the way I enjoy the world . I didn’t need marx or neitze to know that I just needed to read the bible. We don’t know it all and that’s why we need God’s revelation and others. We could be skeptics our selves of this kind if we know our limitations
- increased number and diversity of such frames in Cnaada espe. since 1960s
- general doubt of authority - in culture at large there’s this doubt now - described his stunning experience as basketball coach of small kids - “I want a 2nd or 13th opinion”
- skepticism from disillusionment of inflated medical expectations - last 100 years or so amazing strides - now lay people expect you to fix everything - do you have to run another test - now you know it fix it, ---don’t know where to position our confidence in authorities - 0-1. We have realized that amount of platinum research that is wrong is shocking. How do we have confidence in things we know - like top of line medical research - mass media has made this a real mess - everyone who has study with 12 people goes viral and then the top people declare it crap 2 weeks later and it shows up on page 36.
- dubiousness of much medial research
- Everything is beautiful in it’s own way. Everything is affirmative. We have dropped in Canada the adult world ‘tolerance’ and replaced it with “affirm’. Opposife of ‘affirm’ is ‘exclusion”. Tolerance is a much wider grouping. It’s impossible to practice medicine because you can’t ‘affirm’ everything and everybody. Somebody is going to be disappointed. You simply can’t tolerate this. “It’s impossible to practice medicine, or live in any other mode, this way
- Relativism 2 is wrong, and we must offer the hopeful Christian alternatives when, we encounter Relativism 2.
- Relativism 3 makes a lot of sense but it’s dangeroous. The idea that human beings are limitted in our knowlege. It makes sense to be skeptical of claims to truth. Having an appropriate filter , scripture teaches us how easy it is to be fooled, but if we are too skeptical we become paralyzes
- but too much skepticism paralyzes us and prevents our acting while
- too much confidence flatters u and prevents our learning
- real danger is that we trade faith for fanaticism
- so a stance of ‘critical realism’ seems to make sense - medically as well as in the rest of life ----I think that reality is more or less true, so that if we’re going to do will of God , makeing disciples in Christian mode, we should be quite confidence most of our interpretatiosn are quite right ....however the critical part is the ‘humble’ part is that I
- people come from different backgrounds - we need more education in other frames - I believe religion should be taught at secondary level to learn these other frames
- with development of ‘translation skills’ between frames
- with recognition and recommendation of trans-cultural truths.
- -The Creation Commandment: make Shalom. Take this good raw material and have dominion over it. God doesn’t oppress us and doesn’t exploit us. God creates us out of the earth and we are in symbiotic realtionship. This is a subsistence garden. We need the garden. We make shalom. We creatively improve the world. We have caught up in the church myth of heaven - you die, go up, shapeless white robe, assigned to a cloud, and you play, and the worse thing about this is you can’t die. Give up all your goodies so you can come to the worse church service ever. Others believe heaven will be a beach with cabana boy. The biblical image “you’re going to reign with Christ”. After the final judgement there are no non Christians. Jesus is the son of God, not just divine. We have resurrection of body. We’re going forward to the new Jerusalem that came down from heaven , the garden , We should make shalom.
- The world because of us, in Genesis 3, has great fall. This is a temporary situation of a fallen world. Being Christian is way we come back to being proper humans, be what we always should have been. The point of being a Christian is to be saved out of a deathly life and be properly related to God doing what we are supposed to do.
- The great commission is to be disciples, not just preaching the gospel. Preaching the gospel is easy - preach on street corner - until they take you - then preach in jail. Easy.
- In contrast called to “make disciple”. To make disciple means to change allegiance. No one could make me cheer for a team I don’t like. I choose to cheer for the home team, canucks. It is a trivial example. It’s hard work converting myself to a good disciple. Jesus says “make disciples’. By the same power I make you disciples is the same power to help make disciples. We need to cultivate humans. Everything we can do to help another human being to a better disciple
In contrast Dr. Stackhouse offers shalom. Dr. Gilbert asks that we don't throw the baby out with the bathwater. Shalom.
Sunday, May 15, 2011
For Dad it was a matter of going where the work was. Granddad had built his farm and ranch where the water and pasture were. So Dad took the promotions and stayed in the West .A year later we moved to Fort Garry. Mom and Dad raised us there, staying on North Drive till their mid 80's. It was a good home. Mom loved the community club and Fort Garry Lance. Dad love his family, work and neighbourhood. He was a Manitoba boy from the north. Being in Winnipeg put him close to the duck hunting in Netley Marsh and the fishing in Blue Lake. It was a good place to raise his boys.
Winnipeg was for me as a child only a block or so of walking around the area of the Fort Rouge Apartment. Then in Fort Garry Winnipeg became so much bigger as I ranged out to know the block we lived on, the route to Viscount Alexander and even the trails along the Red River. There were a lot of kids in the neighbourhood. Soon we'd be ranging as kids all the way up to Pembina. Sometimes I even crossed the tracks. Before long all of Fort Garry, but mostly the south side, became "my' Winnipeg. As a teen ager we'd begin taking the bus on our own to the YMCA downtown. That would make the whole of Pembina ours and then the Bay and the Bay basement where we got those marvellous chocolate smoothies. As a kid I knew places like Lyon and Pembina because the old theater was there. We'd watch black and white movies there on Saturday morning. We'd walk down a street and know it because it was the route to somewhere but might never ever go to the next street over. I don't think I knew any street where there weren't dogs and kids. . There are still some streets in Fort Garry I have never been on and parts of Winnipeg that are strange to me. It's not like New York where New Yorkers can't possibly know very much of New York at all. The arrogance of New Yorkers rests in the confidence of the ignorance. . As a kid with a bicycle I explored everything and thought I knew everything. I especially loved riding south to the perimeter. That was forever. The wheat fields in summer , endless highways and skyways, to a boy on a bicycle were endless opportunities. Summer days would disappear in the endless turning of those bicycle wheels. No surprise I'd one day bicycle across Europe and be amazed at the density and detail of every mile of that cultivated civilization. .
As an adult I added bits of Winnipeg first by having girlfriends outside of Fort Garry. I joined the Manitoba Theater School and met Nina who was attending University of Winnipeg Collegiate so I was suddenly always in the Portage and Main area or down around the University of Winnipeg. Coffeehouse days would take me into Osbourne Village where I had my first apartment. A marriage to a girl from Grant Sreet area would open that region that had once just been along the route to the Airport. One day I'd live across from the army base. I even worked in Tuxedo for a while.. I don't thinik I know what's beyond Tuxedo and hardly spent any time in Charleswood. Work added more of downtown to my picture of Winnipeg. Looking back it was like watching the pieces of a puzzle take shape with intense details in some parts and others still a mystery. St. Vital was added because of the church and coffeeshop and later a bar and still later an AA meeting. A church friend in St. James added that bit to the overall picture. That and the park and zoo with the polar bears. University of Manitoba extended the Pembina Highway detail in the other direction. The Health Science Center and Medical School opened that area up but not more than a block around the campus and hospital. Other hospitals were added to the picture. Though I might seem to live in them doing 24 hour call and weekends I'd rarely venture more than a block outside of them. Always the Parliament Buildings were central. I can't remember how many times I walked past the Great West Life building. I later loved lunch at the Art Gallery. Those city places, the Bay and Eatons and the shops between were central to my picture of the city outside Fort Garry, Fort Rouge and Riverheights where I'd live. Later a decade or so after I moved to the west coas,t travelling home to visit Mom and Dad, I'd add the Forks. Dad liked to go there for lunch.
Each time I return to Winnipeg I don't find myself looking for new places though friends have added bits of the north end. I drive out to some place because they're there and next I know I 've got a few more landmarks. Mostly though I 'm retracing my steps looking at what has changed. I remember pushing my Toronto Aunt's wheelchair along Youge street when she was in her 80's and hadn't been able to walk there by herself. My visits and those walks filled in the way her world had changed while she'd been shut in. She was excited by what remained.
That's the way I am with Winnipeg. I'm nostalgic and excited by what remains, hardly seeing the new. Fascinated by the old. When I was a kid all I wanted to see was what was over the horizon. I remember when Basil's opened and we had this new coffeehouse to go to. New restaurants, Winnipeg is a place for fine and diverse dining, were so exciting. On my bicycle I ranged further and further away looking for more and more that was new and different. One day I'd drive away in a baha bug . It would be years before I'd drive through again. Mostly I'd come by plane with a safe return ticket. Winnipeg has a way of capturing people. It's known that the women steal men's hearts. Some men would even say the same. . Something changed the year I drove away. . Now there's not so much time any more in some ways. I used to have so much time for Winnipeg giving half my life to Fort Garry alone. Now my visits are so brief, too brief really.. I have so many committments and responsibilities. It's a pleasure to get a passing glimpse of a place that once meant so much. Driving by a cafe I remember a dinner party, the women so beautiful and the men young and vital with laugher and conversations that seem brilliant even today. I pass a park and see us as kids tobogganing. At another park I remember my brother and sister in law with their little ones tobogganning.
But there's so much of Winnipeg that's a mystery. I notice these great gaps now when I return. New places and old places I just never happened to visit. Endless urban spaces I never explored but somehow back then I thought I knew Winnipeg. It was my home. I knew my home and the trails I made around it to the important places I needed to go. That's where I return to. The old haunts and trails. Driving I snap pictures out a window. Glimpses in passing. Memories in motion. Snapshots from a Ford Focus rental.