Wednesday, December 31, 2014

Climate Change Hysteria and a New Year

I fear the dawning of a New Year will be a severe disappointment to the United Nations Climate Change Committee.  I fear I am alone as I listen to their incessant cry:
“Do as I say or die!"
“Give me money or the world will end!”
Meanwhile everyone is being reasonable. But nothing is ‘enough’.  Nothing less than perfection is ‘good enough’.
I’ve heard this message, this critical, whining, complaining, message all my life.  The ‘position’ has been different but always it’s the ‘new religion’.  This Cult of Death cries over and over again.
“Do as I say or die!”   “Listen!, Listen!”. "Listen to me alone!"
Today they claim ‘science’ but science is debate. This isn't science.  It's histeria.  It's fanaticism.  It's politics. It's hustling.
 I am a scientist, The science they slogan is pseudoscience. It's not real science.  The money they want is real money.   It’s always about money.  Give me money and I’ll save the world.  Give me your money.  Do as I say.  You can’t trust anyone but me.  I’ve heard this all my life.
I’m getting old now. It's getting old.
Yet another New Year has come.  Love has won, again.  I’m thankful.  I’m really thankful for all the real scientists, all the real problem solvers,  solution based folks building and making and winning despite the complainers and whiners.
The United Nations is an industry of third world dictators.  The Security Council is the headquarters central for the arms trade.  I’m not being cynical. I simply know casinos don’t want to stop gambling just limit the gambling to those who don’t lose control and sell their children. I know the bars don’t want to stop selling booze just not sell it to those who have already had one liver transplant. The tobacco industry was fine with selling cigarettes as long as you had both lungs.  Really after you’ve lost one lung to cancer you really should move along.  The images of the victims of these industries are bad for their business. The same is true for the UN. It’s industry is war.  The ‘security council’ doesn’t want to stop war. It's in the business of selling weapons and ammunition.  It just doesn’t want the war to get out of control. It’s same old game.  It's the Great Game.
Now the climate change hysterics are on about saving the world with their latest set of regulations. They want another set of United Nations climate change police.  We've got police for the police and committees upon committees.  It’s all hysteria.
“Trust me! Trust me! Trust me!”  "Give me your money!"  "Give me your life!"
You’re wrong.  Your predictions have all been false.  The world hasn’t ended.  The sky isn’t falling.  The war to end all wars didn’t end all wars.    Just get on with it. You do your thing. I’ll do mine. But stop your incessant childish bullying.  Stop your name calling and your false advertisements and your claim to represent ‘science’.
You’re the United Nations and you're not even United.   The number of mistakes you’ve made , the terrorists you’ve backed, the dictators you’ve supported and the money you’ve wasted is irreverent.
Now you claim that by having another meeting, another committee in your unending rounds of government committees with your resolutions , your exorbitant salaries, and your dictates, that you will save us all from ourselves. You talk. You talk.  You talk and you talk and you talk. And you talk to each other.  And you agree to agree and you want us to pay for your party.  While the rest of us are digging holes and planting trees.  We’re building while you tear down.
You criticize the whole history of human kind. You condemn all that has brought us thus far. You deny life on this planet. You deny the very life that has blossomed and risen.  You are insane.
It’s a New Year.
Despite your incessant hysteria. Despite your promise of death, we have lived.  I'm here to tell you we are in a "Life Change" equation  but today We are alive.
I know you will rain on this parade. You rain on any parade.  You're soul suckers. Meanwhile, I’m going to laugh and sing and celebrate another New Year.  BecauseI believe.  I believethe future is safe even from your soul sucking.  I believe and I have faith. I believe in the present and I believe in the future and I believe in the past.  I believe good men and good women will prevail. I believe we will survive.  We will survive and we will thrive.   I am in love with life. I am just damned tired of your constant whining, complaining,  criticizing and negativity.
It’s a New Year.
We’ve survived despite your claims otherwise.
It’s a New Year and the planet is still here.
Wake up.  Arise.  Celebrate.
Get over yourself. Get out of yourself.  Hear the fear that is you.  Change yourself.  The planet is fine.  We’re fine.  There’s lots to do.  There’s all manner of work to be done.  We don’t need another committee. We don’t need any more ‘threats’.  Stop selling your mealy mouth wares, hawking your worn out slogans with that same old hysteria.  Become the solution.  Be the solution.  Show me, don’t tell me.
It’s a New Year.
I’m frankly thankful. With your mass hysteria,collective stupidity. brain washing the young, and the corruption of the media,  I admit I’ve had my worries.  I know climate. I know science.  But the truth be told nothing is more dangerous than my fellow man except maybe my fellow woman.  And the folk who make up the United Nations are the power brokers of the greatest killers of all times.  You don't get to sit in the United Nations unless you've pleased the man whose selling the big guns in your nation.  Sure they'll outlaw guns for common folk but all the leaders in the United Nation they have guns.  They have the biggest guns of all times.  They can change the climate or the planet anytime they want.  They can kill us dozens of times over but they don't want to.  That would be bad for business.  And they're in the business of war.  That's why it's called the Security Council.  And they don't want things to get out of control.  Not out of their control, anyway. The leadership of this world is based on survival.  They may not be the fittest by any sense of the word but they are survivors.  And they want to survive and they want their kids to survive.   While no one wants to talk about that elephant in the room, that elephant is saying ‘trust me to fix the climate’ . Frankly I don’t trust them to fix squat!  They’re wanting to meddle for profit and nothing else.  Their science is pseudoscience.  And they lie.  Some say that the biggest brain was made for the biggest lie.
But it’s a New Year.
And I’m glad for it.
It’s a New Year. I’m going to dance and sing.  I’m going to tell everyone to dance and sing and celebrate whether it rains or it shines.
Ding dong the witches dead!  Beware of her negativity and incessant complaining and whining and threatening and bullying and demanding.  Just because it kills her doesn't mean it has to kill you.  Mostly beware of anyone saying they're doing it for someone else good  but not their own.  Beware of give me money to help a snail. Or I'm going to kill him for his sake.  I”m saving the planet for the children and the grand children.  Hell, that’s prophecy and religion.  Predictions and projections are just fancy words for “I can see the future”. Give me your money.
Well I can see the future.
t’s a New Year.
Despite all their doom and Death Cult chants we’re alive.
We survived.  Dance, sing, celebrate!
I thank God for that!

Thursday, December 25, 2014

Gilbert, Therapy Cockapoo

Gilbert has been a therapy dog since he was a puppy. I’ve had him at work with me in both my psychiatry and my addiction medicine clinics.  He’s been a ‘greeter’ and ‘play therapist’. He’s also had a great intuitive depth as to who needed his love and care.  Several of my most disturbed patients isolated in their psychosis and misery have been helped out of their morbid depression by Gilbert’s paw and wet nose or gentle tongue.  

I think he’s my therapy dog as well since I’m happiest with him around.  It’s hard to be angry when I watch his enthusiasm with life and little critic antics.  So finally with the help of friends and authorities Gilbert received his formel Therapy Dog vest.  He’s now credentialled and official, his years of selfless work acknowledged.  

Normally he doesn’t like wearing jackets and such though that doesn’t stop me and my staff from dressing him, he actually doesn’t mind this lose fitting  ‘vest’ .  He really does look professional now.

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Christmas Day 2014

The Christmas Eve service and the Christmas Day service at St. James Anglican Church was blessed. Father Mark Greenaway-Robbins in his sermon this morning asked us “What would Jesus think this Christmas Day?”  He spoke to all the amazing acts of generosity which were occurring around the world and not really being covered as such by the media.  The first ‘giving’ he described was to the millions of refugees around the world who are being taken in by strangers and organizations.  There’ the Red Cross and the Red Crescent and many more.  He celebrated all the Christians doing missionary work and caring for the poor and sick around the world. He spoke to the local work in the Downtown Eastside by the Salvation Army, Union Gospel Mission, the United Church, and of course the many volunteers from St. James Anglican.  He thought Jesus would see all this charity and love pouring out from individuals far away and near by and be thankful.  

Father Mark Greenaway-Robbins and Ruth Greenaway-Robbins will be in Wales in the New Year. In person, at the end of the service, he asked that I pray for them.  Naturally I was grieving his imminent departure and thinking all about my loss, fearful about who the new minister would be.  And of course Father Mark said just the right thing and took me out of myself yet again. Leaving I saw Father Mathew whose street clinic is to the old men in the DTES.  I always feel better just seeing him.  My friend Helen is preparing to leave on missionary work in Africa.  The Muslims have been killing the Christians but it’s not really the Muslims, just bad men, claiming God on their side.  It won’t be the first time, that has occurred. But even now Muslims of 4 countries are joined with the US to contain the plague of ISIS.  These fanatics dinosaurs have arrogantly claimed their vision as jihad when indeed they’re nothing more than barbarians and pillagers.  The sad part about religion in war is that it’s always the ‘comic book’ brand that gets the followers.  

I’ve enjoyed Father Mark these last years at St. James Anglican because his message in sermons and in the Thurible he writes each week speaks to the highest and deepest in Christianity.  

Personally I admire Helen because she goes with love to help the children in Africa. I’d personally rather go with the French Foreign Legion or a British Expeditionary Force.  I’m like the ‘machine gun preacher’.  I should feel complete with my Bible but frankly I am never comfortable without a knife handy and really would gladly have a Glock 9 mm pistol at hand always.  I don’t have a pistol.  I let my licenses for these expire and sold the two I had some decades back.  I’d had fun for a while shooting at targets and would gladly return to that but the bureaucracy and propaganda irritate me.  

And Jesus, son of God, was born to Mary in Bethlehem.  God the creator entered His Creation and changed the fabric and nature of the universe from that day forward. The Cosmic Christ was created.  The world had been in black and white before that, a kind of Darwinian place of Kings and Queens, Emperors and empires, with their richest followers and most powerful adherents.  Jesus by contrast was the ‘servant king’.  As an adult he’d wash the feet of his disciples and welcome children to him and celebrated women.  The secular authorities in the name of Herod would seek his death shortly after his birth. His family would escape to Egypt before returning in later years. There is mystery to that time in the east.  Jesus was learned always beyond his years.  Christmas Day though he was a baby in swaddling cloth in a manger.   His birth was the promise, “he so loved the world, he gave his only begotten son’.  The birth of Jesus was the essence of hope. This world is just a passage. The real world is much more.  

Now I’m on my sailboat, enjoying the peace and calm in the harbour. The sunshine today has been splendid.  I’ve some time off from work and a trip to Turkey planned.  As usual I move any valuables to storage and have arranged for friends to manage my ‘stuff’ while I’m away.  Gilbert stays with his surrogate mother.  He’s sleeping now beside me.  He enjoyed our time in church today.  He has so many friends there. Then we played ball. Now he’s eaten a “little cesar”  and is sleeping.  The ceramic heater is sufficient for the boat.  I’m cozy and have found the electric blanket so will check that out as I’ll be sleeping here this week.  I have hoped to take the boat out but had second thoughts because the forecast has been for rain but now I see that that’s only on Saturday so once I get the RV repair arranged I just may get out.  I have this lethargy which is only made worse by giving into it.  That desire to hide in bed under the blankets and never come out comes over me this time of the year. I really must resist it. There are so many things to do and see.

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Wednesday, December 24, 2014

Christmas Eve

I'm working Christmas Eve. Here in the Downtown Eastside Vancouver.  I'm seeing addicts who have chosen a different direction in life.  Leaving injection adulterated heroin and the darkside they've begun their journey of recovery taking oral prescription methadone.

"Methadone is a godsend,"  my patient just told me.  He's looking to return to work.  No longer fearing the deadly diseases associated with IV drugs, he's looking to return to work in the New Year.  "I couldn't work."  Heroin had taken over his whole life. Now he has a girlfriend whose also on methadone and they're celebrating Christmas together with turkey dinner.

So many of my patients have had the last dime of their money taken by the drug pushers.  Drug pushers are sad.  At the top of that dung heap is the guy addicted to money. At the bottom is the guy whose psychopathic devolution is such that he'll enslave his fellow man for his own comfort.  Most of my patients are just victims.  They used their welfare checks, turned tricks, gave blow jobs to bullies, did petty crime. When they'd had enough self abuse they walk through the doors of Doc Side Medical Clinic on Main Street.

There are other such places.  Clinics where methadone doctors are licensed to help this marginalized population of ill.Some start their journey going to NA and AA.  Others start here , stay on methadone maintenance like any other medication but become abstinent in all other regards, return to work and families, pay taxes, and return to law abiding citizens remembering their days of addiction as a bad nightmare.

Right now my friends are helping the homeless with coats and food.  Many of those helping once had addictions themselves. Not all homeless have addiction. Too many of the homeless here are those sad and tragic people who because of mental illness were well cared for in state mental institutions. Now those have closed and too many of the mentally ill are the prey of the drug dealing predators, those parasites on society.  Too often I see the families of the mentally ill who can't wrest their loved ones from the representatives of organized crime.  The police do all they can.

We do what we can.

(Patients come and go. It's steady.)

Christmas eve is the lowest time of the year.

In the morning we will celebrate the Birth of Christ.  Hope for a new age. The promise that another year will come and life will move forward.  In pre Christian days the winter festival celebrated the hope of the new year.

The crocuses come out in February here, at latest March.  Patients seem so low then at some nadir they rebound and come back as if from the dead.  Dark night of the soul.  The 'bottom'.

The New Year comes that way.  This year waning.  The light dwindling.  Then the return of the sun.  My generation's Beatle song "Here Comes the Sun!" celebrates the spring as none other can.

The renewal.  The new beginnings.  And a baby cried in a cradle.  A new age began.

There is hope.

Tuesday, December 23, 2014

Sperm and Darwin

When one thinks of Darwin, German SS Nazi Storm Troopers come to mind.  Survival of the fittest and all that  social relativism started with this fellow whose ideas literally infected our notions of sperm.  Billions of little tadpoles eject from the penis of a man and according to Darwin they are in a 'race' to impregnate a female egg.  Only one sperm will unite with one egg and Darwin claimed this sperm was the 'winner'.

Frankly, I don't think Darwin knew sperm.  Imagine a billion little men trapped inside suddenly let lose.  They're not going anywhere but away.  They're escaping.  They running en mass away from the prison or asylum.  The Latins are forming congo lines. The Irish are doing jigs. The French are pontificating and gesticulating while they run.  The Americans are trying to take charge while bringing up the rear. The Canadians are being polite but running no less fast.
It's a mad dash for the first stretch, given the propulsive release.  After that it's like any other billion group of men going no place. They're spread out.  Some are out in front, not competitively, but just to get away from the other guys and see what's around the corner.  There's some guys bringing up the rear because that's where they can keep an eye on things.  The meanderers are muddling along in the middle.

The Vagina has always been a confusing place for men.  Imagine the poor little guys without GPS (or a woman to ask directions for them) trapped in cul de sacs.  If they were hell bent on reproduction like Darwin claims they'd find a way forward.  Yet once they come up against a wall they head the other way happy to be helped along by Gravity.  Turned around,   they joyfully escape to the great outside where there are bright lights and terrific musky scents.   There's also  that spectacular Whistler Blackcomb ski ride along a satin smooth inner thigh.  Maybe these sperm are the winners, the great escapees who end their short exciting lives puddling the sheets.  It's not like sheets and sperm are unknown to each other.  That alone shoots hole  in Darwin's mere intellectualism.

Darwin selected  the tunnellers to prop up his less than perfect theory.   His little 19th century brain gave all his attention to the sperm that entered the Cervix and headed up the Uterus.  Now what a long trek that will become for these little guys, their little tadpole tails wagging slower and slower,  no doubt. You just have to know a whole lot of them faced with the wonder of that great ocean probably turned back thankful for Gravity and the Great ski resort below.

The remaining sperm randomly headed off.  Those straight arrows that raced  right up the centre only banged their teeny heads against the Great Wall.  What sort of devious arrangement is this that those who angle off to the side, shiftilly, actually find a way out. It goes against the very ideals of Darwinian 'fittest'.  There's no efficiency in this arrangement. The  muddlers and amblers are as likely in the Uterus to find their way to the Fallopian Tubes as any Neitzian Superhero hell bent on the 'race'.

Besides anywhere along here an Egg might be stalking, already having slid down the Fallopian tube ready to pounce on an unsuspecting sperm simply minding it's own business, looking for a way out of a gooey maze. It's the Egg that's selective and probably seeking some poor schmuck trying to escape.

Mostly the sperm get waylaid in the Fallopian Tube.  Here their way of escape is blocked by something like a black gartered Dominatrix Egg.  . Most of the sperm might very  happily sneak around the sides of this engulfing Gaia mother just  to  get out the back door.  Maybe they draw lots. "Okay, Ernie, you're the slow one, we're going to leave you here to face that Egg alone. The rest of us guys will go get help".  Next thing poor Ernie is trapped for life in an Egg sucking the very DNA out him.  The Egg meanwhile is already pissed that she was just expelled from her home so isn't too pleased with Ernie.  The two of them start housekeeping  under threat of an abortion guillotine as well.  Meanwhile the 'gang' are partying their way up the Fallopian Tubes ready escape to into the great Abdominal Mall. Without responsibility they live out the wild full life of a happy unattached little sperm man.

There's a billion of these guys. They end up all over  the place.  Some in the wrong hole. Some in kleenex.  There's no reason whatsoever to think that the one sperm that gets tackled by an Egg is the fittest.  Darwin was simply wrong. Darwin was a  19th century English chauvinist.  The Egg could as easily captured Ernie because he was slowest or stupidest.   No one is saying he's not a nice guy.  He just might not be the fittest.

Sunday, December 21, 2014

Early Music Vancouver - J.S. Bach's Christmas Oratorio

Early Music Vancouver Baroque Orchestra performed J.S. Bach’s Christmas Oratorio, Cantatas 1,3, 6 at the Chan Centre at UBC this afternoon.  Stephen Stubs, music director, Teresa Wakim Soprano, Krisztina Szabo, mezzo soprano, Zachary Finkelstein, tenor, and Summer Thompson, Baritone. The Early Music Vancouver Baroque Orchestra was in truly fine form. This Northwest Baroque Masterworks Project was completing 5 sold out performances.  It was simply the most uplifting music. I loved the voices, the music and the Christmas story Bach told in word and music. I loved the 17th century instruments, especially the bassoon,  and that sense one could back in time. Bach loved God and poured out his heart and soul in his music and song.  No music so moves me like Bach does, a perennial favourite.   While Brandenberg’s Concerts have always been my favourite but after tonight’s experience of a life time I’ll be forever in love with his Christmas Oratorio. Thank you Early Music Vancouver! My friend Laura  was equally delighted as was the whole audience judging by the resounding applause. Early Music Vancouver’ Baroque Orchestra’s next performance is Handel on Valentine’s Day.  
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Saturday, December 20, 2014


In the beginning there was God and God created the  heavens and the earth, (the universe, the multiverse all matter, energy, things and people in it and of it)
Was there God and building blocks?
Was there God and nothingness?
Or was there just God.
And God Created all from himself (Thyself).
The One became many.  The journey outward.
We are created in  the “image of God’.  That’s the “imagination of God”.
I remember Dr. Carl Ridd telling us that when he taught Literature of the Bible, at University of Winnipeg in the early 70’s.  I was struck by the ‘face’ of it.  Later I’d appreciate 'appearances'  as described by  the theologian, Owen Barfield.   The psychiatrist,  Dr. Carl Jung,  called the outer layer of our individuality  “persona’ ,  that face we showed to the world, the mask we wore.   Indian mystics meanwhile sung “I am the bubble, make me the sea.”
Asking the Burning Bush who he was, the answer came to Moses, “YHVEH”  That name of God, that could never be spoken, for to know God fully was to loose oneself, YHVH was later translated “I am that is who I am.”  Part of the great mystery is that only an approximation of reality in analog.
The depth of each of us, that very ‘beingness’ of each of us, the soul, that individual dream of God was, in deed, our very connection to the One Dreamer, or Creator.  The greeting "Namaste", means simply  'the God in me salutes the God in you." Jesus Christ translated means 'God Within", "God will come again". The meaning of the word Gospel, was simply the  "good news".
I am a child of God.  I am made of the same 'god stuff', the 'soul stuff' of creation.   I can think of God and know God because I’m actually "God thought"  or to use a term from  science fiction writer, Robert Heinlein,  "God grok".
The prime being, or prime number is 1.  There is an alternative beginning in zero.    The life myth in the east was more circularity while in the west linearity prevailed suggesting a possible gendered yin or feminine and yang or masculine masculine understanding of  matter or energy. Of course, the physicist, Albert Einstein joined them in his famous equation E=MC2  which connected the matter of energy and mass such that later we could think of matter as 'slow energy', or energy as 'fast matter'. It was really relative.
Because of the nanoseconds involved in human thought and the individual experiencing of experience, if God is "Number 1" then  I am "Number 2" ,despite how desperately I might wish to be  “Number 1’.  Hence the notion of  Humility as a spiritual concept like grace that follows the study of history where an endless stream of Nietzean supermen claimed they ware ’number #1” only to pass away like leaves of grass while the idea of God remained.  Even the atheists build on the platform of anti theism.
Martin Buber called the experience of God,  “I and Thou” in contrast to the essentially paranoid position psychiatrists  call  "I and It."  In one there is a sense of awe and wonder whereas in the other there is that primitive sense of fear and alienness.     In the  sense of not being alone, even in the depth of my aloneness, in that place that Kierkegaard called ‘existential angst’, I can retreat or stand and embrace.  At the essence of embracing there is the ultimate surrender,  some  call 'love'.
In prayer, especially that personal relational prayer James Houston describes, I build the path to that awareness. In calling out to the other, even in the Dark Night of the Soul,  in love, in seeking the light ,in turning outward from my own ‘morbid depression’, I ascend to that that place of  eternal lightness of being.  I am lifted then ‘as on eagles wings’.
And the journey home begins.

Tuesday, December 16, 2014

Addiction Intervention

Intervention refers to the active process of direct participation in the life of an addict. There are actual addiction intervention services and people with extensive training specifically in this process.  A television series of the same name was highly educational, not the only 'interventionist' approach, but certainly a well scripted example of a  acknowledged professional interventionist approach.

Before AA began Bill Wilson was being an interventionist in what would later be called '12 step calls'.  He himself was approached by Ebby who as an 'evangelical' Christian reached out to help his friend.

Personally, as a psychiatrist I have no difficulty with the notion of 'intervention'.  It can be a concern when abused as was the case in police states like Communist Russia.  When I was a member of the Psychiatrists against Political Abuse of Psychiatry we were advocating commonly for scientists incarcerated in asylums for disagreement with the political regimen of the day.

In traditional medicine a patient comes to a doctor with a complaint and the doctor prescribes a medicine which the patient takes or doesn't take.  Only in 'public health' is the intervention approach taken or in life threatening emergencies.  I remember a women walking in for a routine obstetric visit and me wheeling her up to the delivery room with the help of the nurse after my examination revealed she was nearly fully dilated.  She delivered a healthy baby in the delivery room within the hour. If I hadn't 'intervened' she'd have delivered in my office.

In psychiatry it is normal for me to sign a committal paper for a dangerously in sane person. Once I've done this the police will escort the patient to an asylum for their and the community's safety.

Generally speaking everything in medicine and psychiatry  is voluntary and driven by the patient. This is the same in addiction medicine. Patient's 'seek' help. They commonly admit that they've been told by their boss or family that they should see a doctor but their decision to see me is their own.

Many addicts and alcoholics simply curse everyone and leave.  This is called the 'geographical cure'.  Having burnt all their bridges they move on to a new set of potential victims taking their disease with them.  Geographical cures are notoriously inadequate treatment for serious addictions.

The disease of addiction and alcoholism is associated with minimization and denial.  Denial refers to the refusal to see that alcohol or drugs aren't the solution but rather the source the problem.  Denial is most apparent to a physician treating the myriad physical consequences of alcoholism and addiction, such as pancreatitis, cancers, ulcers etc.  I heard the statement "I don't have a problem with alcohol, I can quit anytime I want to" on liver failure ward from a yellow skinned 'flapper'. In end stage liver disease you ask a person to put their hands face up and over their heads and because of the associated neurological disease the patients hands 'flap'.  Commonly alcoholics in denial come into emergency vomitting blood whereas addicts will be picking bugs out of their skin and seeing CIA agents hiding in trees. Addicts in psychiatry wards  insist that all they need is to be released from the psychiatric ward to get a little more cocaine and that will stop the aliens attacking the world.  

In the days of Freud alcoholism was considered worse than schizophrenia because the alcoholic could have periods of lucidity that would fool them and those around them for a time into believing the person was cured.  In contrast schizophrenia was a steady deteriorating disease at the time without the episodes of apparent recovery.  The first reproducible 'cure' for alcoholism came in 1935 when the first 50 men in Akron Ohio remained sober following the steps that later would become the program of Alcoholics Anonymous.

Now we know that if a person developing addiction or alcoholism can stop their substance abuse in  the early stages (while they still have a job and some vestige of family left) then the success rate of treatment is roughly 80%.  End stage addiction and alcoholism associated with isolation and deteriorating physical disease have as poorer  prognosis.  This is to other  'end stage diseases' whether they be in mental illness like schizophrenia or physical illnesses like cancer.  In the last decades there has been considerable success in 'staging' alcoholism.  The well known John Hopkins University "Are You an Alcoholic?"  20 questions survey is less frequently used as a diagnostic tool today but it remains an excellent staging tool.

Some would say making the diagnosis of 'alcoholism' or 'addiction' is the first 'intervention' .  While I've never been attacked for diagnosing cancer which I've done frequently I've been physically attacked, repeatedly threatened, had my home windows broken and my car windows broken, and had multiple complaints to the College of Physicians and Surgeons for diagnosing addiction.

Because of the denial associated with the disease of addiction and alcoholism, Prochaska developed 'staging' for the 'readiness to change'  noting 'pre contemplation', "contemplation', "determination' , and "action' phases.  Making the diagnosis to someone in 'pre contemplation phase' is a potentially threatening scenario but thanks to a lot of trial and era and experience 'motivation therapy' 'interviewing techniques' offer some excellent tools for practitioners.

The complaints are never 'supposedly about' the diagnosis.  Alcoholics and addicts are not so direct.  All too often inexperienced, inadequately trained, or simply negligent 'complaints officials' have been royally duped.  The idea that  'one can make a diagnosis of addiction or alcoholism' without some patient getting angry is the greatest fallacy of the inexperienced and negligent.   My favourite forensic psychiatrist working in the jails after a life threatening attack said, "I'd always been told if I worked long enough in forensic pscyhiatry with the most dangerously insane people, there would come a time when I'd feel my life was in danger.  That was it."  The patient had been strangling the man with his own tie when his secretary intervened.

The joy for me working with front line workers in general is that they lack the ignorance and arrogance that is stinky and pervasive among the effete  Monday Morning Quarter Backs.   If you make enough diagnosis of alcoholism or addiction you will get a complaint.  Indeed the complaints department is increasingly one of the principal reasons for the collective failure of the medical system to address what has been called the 'public health crisis of the century'.

Diagnosing alcoholism and addiction, because of the stigma and the history associated with the disease, is commonly taken less favourably than diagnosis of cancer. When I diagnose cancer the patient may question the diagnosis,  express sadness and may well want a second opinion but they won't be  'angry at me'. If they are angry it's because I didn't make the diagnosis sooner.

In contrast with the disease of addiction and alcoholism the first reaction is commonly 'defensiveness' and the second is 'kill the messenger'.  Patients are commonly 'angry' at the diagnostician if only because they've been able to see a long list of 'enablers', negligent physicians.  Commonly the alcoholic or addict due to the psychopathic tendencies associated with progressive disease have been actively lying to clinicians and experience the 'diagnosis' as being 'caught'. A trained diagnostician will ask how many are "two beer" since 'two beer' is the knee jerk answer of the alcoholic confronted by the question of 'how many beer do you drink'.  "Two".  I suspect there are those who do drink 'two beer' and I feel genuine sorrow for them because they probably don't know that 'two beer' is alcoholic code for 2 'cases of beer".

It was common among 'enabling' doctors for them to be the least competent clinicians missing the diagnosis sometimes because they themselves suffered addictions.  It was even joked that you only had a drinking problem if you drank more than your doctor, especially if your doctor worked in government services.  I intuited early a colleagues later diagnosed severe addiction because he never diagnosed addiction in patients I'd subsequently see with advanced disease of alcoholism and addiction but rather diagnosed them as Bipolar or Adult Attention Deficit Disorder.

If you see a psychiatrist  he may even miss the diagnosis of alcoholism or addiction because of the overall poor teaching of addiction medicine and addiction psychiatry in the general programs.  The psychiatrist commonly  diagnosis 'depression' instead. In the workplace a person  with a diagnosis will be expected to take a medication and see a counsellor at most. However if you receive a diagnsis of alcoholism you can be denied work in safety sensitive areas, be required by union contract to attend a 1 to 2 month inpatient treatment centre, have 3 meetings a week of follow up and get random urine testing for any number of years following the diagnosis. Given the denial involved in addiction, the diagnosis of 'depression' by the negligent or incompetent or addicted physician won't have any effect on the alcoholism or addiction.  However if you receive a diagnosis of alcoholism or addiction from a caring and conscientious well trained clinician then the treatment will most definitely cut into your drinking and drugging.  So naturally the simplest thing to do is get a lawyer or make a complaint to the College of Physicians and Surgeons about the character of the doctor.

My favourite complaint of this nature was from a pot smoking pilot who swore at me and threatened me when I said that they would need to have a urine test for drugs.  They insisted they had a 'right to smoke pot' and I countered they might but that if they were smoking pot they couldn't continue by law to be a commercial pilot.  The proceeded to complain to the College of Physicians and Surgeons in an attempt to have my license rescinded.  The severity of their cannibis addiction was that they would rather destroy a physician and risk the lives of thousands rather than stop smoking marijuana. In their complaint which never mentioned their occupation or their chemical dependency on marijuana, they objected to being sent by Transport Canada to a psychiatrist and addiction medicine specialist who had a Bible in his office. I had a Bible on my bookshelf beside the Koran, Bhagad Vita, Plato and countless other philosophical, theological and psychiatric texts.  The College of Physicians and Surgeons investigated me for a year about my religious affiliation.  Not long after a similiarly 'impaired' pilot caused an accident which took countless lives. Transport Canada said to me after the whole ordeal that they routinely had difficulties of this nature.

I was called 'too confrontational' whenever I made the diagnosis of alcoholism because "making a diagnosis of alcoholism" was synonymous with 'confrontational".   I was also called 'insensitive' and one woman alcoholic said I didn't 'listen" to them when they were insisting that their boss expecting them to come to work every day.  She wanted to talk about anything but her DUI and her addiction and thought that if she could just distract me to focusing on her boss "rigid' behaviour.  I listened and eventually it became clear that her 'solution' to her problems was for me as a physician to write her a carte blanche letter which she could use whenever she wanted because  she just "sometimes" (weekly or more ) needed to have a day off  from work after a heavy drinking session. It's discouraging to know how many colleagues would have provided just such a letter out of fear more than anything.

Intervention is the act of 'confronting' an alcoholic or an addict with their disease, how it's hurting their health, how it's affecting their work, how it's affecting their family and friends. The common intervention pattern (as seen on television) is a 'group' or 'family meeting' with or without professionals in which the person is invited to come and "listen'.  At this meeting each person expresses what they see, to the loved one, and then what the disease is doing.  With that the group or family asks for actual committment that the person will go to a treatment centre or rehab center or detox.  The cornerstone of the 'solution' is an actual 'action' taken by the alcoholic or addict, not just 'talk'. Addicts and alcoholics love to 'talk' about detox, rehab or treatment but usually a 'written contract' or threat of consequence is necessary before they will take action.  Some consequences that have been highly effective in the family have been "if you want to see your kids, you must attend treatment and have random pee tests.'

In the work place, treatment and 'accountability' go hand in hand. "If you want to keep your job, you must follow the treatment program and under go urine testing for a minimum of three years."   The best accountability measures are attendance at support meetings such as AA/NA/Smart, and active urine testing.  Sometimes it is set up that a person go direct to rehab on the same day as the family intervention.  When people generally speak of 'intervention' this is what they are thinking of.  I tend to use the word 'intervention therapy' more broadly. In any 'intervention' the person is being 'told' what is expected rather than it being only a 'suggestion'.   Intervention therapy is sometimes called 'accountability therapy'. Interventions are commonly associated with expectations of action and consequences or accountability.

Treatment centres and rehab centers are one in the same. They are an 'active intervention' in a person's life. Their first and major effect is to remove the alcoholic and or addict from their 'environment' of addiction.  Alcoholism and addiction are a 'culture' of addiction. There's 'ritual' involved. There's the 'friendly ' bar tender, the 'dealer' on speed dial, the using friends and the drinking buddies.  The initial intervention involved in going to a treatment centre was for 28 days, with treatment centers providing counselling, group therapy and recreation and even work without the added drug or drink.  This 'inpatient' process with drug testing and 'rules' and 'conventions' 'normalizes' the routines of addicts and alcoholics.  They are socialized into a 'healthy lifestyle' beginning in rehab.  This can go on for 1 to 6 months.

An intervention which ultimately involves a recovery house where a person lives with other addicts or alcoholics in a clean and sober environment with expectations to attend groups and even have urine testing not uncommonly can go on for a month to 2 years sometimes more.

Interventionist therapy was used for children kidnapped and 'brain washed' with crazy Jones type religionists or jihadist radicalization. Removing the individual from the source of the 'insane thinking' was recognised as a first step to the person 'resocialization'.  The effectiveness of the 'interventionist approach' has been by those who see drug and alcohol abuse as a 'disease' and that it is indeed 'highly contagious'. Those who are most successful at staying abstinent for five years or more are commonly associated with a group of non using or non drinking individuals who support their recovery and abstinence.  In contrast to highly effective interventionists there ware the minority of politically correct wishy washy laissez fare drug and alcohol counsellors who consider drugs and alcohol a 'life style choice'.  The key to good intervention is knowing clearly the outcome planned and desired and having everyone on board to this clearly stated goal.

In motivation therapy the initial contact, best by a clinician, is an expression of concern and a question such as 'do you think you might drink too much.'  "Do you feel marijuana might be the reason you can't hold spit in your mouth today but used to be a straight a student?"  Family members and friends can ask but if denial is strong the person will wave off the question but only become angry if one persists.  Intervention is usually saved for a person careening out of control or with multiple relapses or one whose going through money rapidly, risking their health, beginning to be on the verge of losing their job or any number of signposts.  In intervention it's obviously beyond the 'question' stage and the individuals, family and work all know there's a problem with alcohol and drugs whether the individual knows or not.

Intervention has been lifesaving for many.

Sexuality and Love

Sexuality is the term related to the physical expression of sex in relationship.  It's not 'love' perse but definitely an aspect of the umbrella term love.

CS Lewis talked of 4 loves , sibling love, friend love, love of parents and eros or sexual love.
The truly single distinguishing feature of marital relationship is sexuality.  I have relationships with many in life but only have one or a few of the totality as 'lovers'.

Sexual Medicine is a division of psychiatry and medicine which addresses sexual difficulties. The DSMV has an extensive list of sexual dysfunctions such as 'hypo arousal' and 'premature ejaculation. In this world sexuality is considered in the context of the pillars of science: determinism, materialisms and empiricism.

Love is more often scene as a matter for the 'arts' , something more 'poetic' when indeed there's long been a 'science of love' in the relationship studies of psychiatry and psychology.  There the term 'love' is exchanged for such things as 'bonding behavior', 'mating behaviour', 'object relations'.  There's all matter of scientific study of 'love' but it's not called 'love'.  Sex in contrast is definitely a matter of study with scientific journals being devoted to the top of sexuality and sexual behaviour.

Sex is about both procreation and recreation.  The 'pleasure' of sex is considered by scientists of a particular school to be the 'reward mechanism" for reproduction.  The two are definitely not linked solely in this matter so sex is not solely for procreation.  Homosexual sex seen in many species of nature is clearly not related to procreation in the traditional way of thinking.  Neither is masturbation which is so pleasurable that actual 'taboos' are found against it in many religions and cross culturally.


Sunday, December 14, 2014

Thank you God for Christmas Season

Thank you God for Christmas Season. Thank you for the old hymns I’ve heard since childhood. Thank you for the memories of my mother’s sister visiting us at Christmas, the turkey, the gifts under the tree, the tobogganing, hockey, skating on the frozen river. Thank you for all these childhood family memories that come back at this time of the year. Thank you for nostalgia.  Thank you for church today. Thank you for advent and Gilbert. Thank your for candles and love. Thank you for the choir and the ritual and the celebration. Thank you for the faces I know and the people I know.  Thank you for Kevin and AJ and the god children and lunch with them.  Thank you for family and fun times.  Thank you for chocolate. Thank you for books Thank you for work .  Thank you for vehicles. Thank you for the sunshine today.  Thank you for my boat and the dogs and the dock. Thank you for the ocean. Thank you for movies. Thank you for all the blessings you bring.  Thank you for sunshine and the dawn and dusk.  Thank you for light and air and breath and scents. Thank you for this world, this creation. Thank you.

Saturday, December 13, 2014

Commercial Drive with Gilbert

We’re sitting at the JJBean. Busy shopping Saturday. Very few parking places on Commercial Drive.  Decided to stop way down this end because Gilbert likes to walk on the Drive. Lots of other dogs and great pee pole possibilities.  I’ve just been coming here for years.  Always think I’d like to rent in this area for the atmosphere.  Funky ethnic, students, the buzz on the drive, a favourite street of lesbians, apparently. Some well dressed women whatever the reason.
When my friend lived here though, she didn’t like the drugs.  Described needles and paraphernalia in her car park each morning. I wouldn’t like that. Whereever there’s drugs there’s theft.  And stupidity.  And arrogance.
Commercial Drive is diverse.  I’ve always liked that.  Once so Italian with the international soccer game bars.  I’ve always liked the coffee shops.  People watching is the best here. Gilbert likes the eau de dog butt.
I’m sitting across from the Royal Canadian Legion. New blue paint job and golden writing beside painted red poppies. Lest We Forget.  I tell people that it’s not just about fallen soldiers. It’s the fact that the elephant in the room is every nation is an arms producer or consumer. The fact is that the west is just better at making weapons.  That’s what raised us to such prominence.  The irony in anger management is that we don’t want citizens en mass to embrace passivity but rather that they only use their anger in answer to the call of the nation.  I was in the Peace Movement and worked with Veterans Affairs.  I think a lot of very silly and stupid people would like to forget history and live in a haze.  I love real politick.  I love the saying, "if you want peace, prepare for war."  I probably have been working on the street too long knowing too many sociopaths in high and low areas.  I believe in Peace.  This is the season for Peace.  Peace on Earth. Good Will to All. But the lesson of Meteora and Cappodoecia is the same lesson that Tibetans learned when faced with the machine guns of the Chinese.
People stop to talk to me on the street here, mostly visitting Gilbert.  It’s cloudy but not raining. I was at the boat earlier checking on it after the storms. I'd been down one evening to check the mooring too.  All’s well. The neighbours said they’d been there for last nights blow and one of the docks had been lifted out of it’s mooring.
I stopped at MEC (Mountain Equipment Coop).  My hiking boots I’d had with the othotics are losing their sole. I was pleased to replace them with a set of KEEN’s that seem right enough I won’t need to wear the othotics. My injury has healed sufficiently that hiking is less and less painful.
A new overcoat shell is light weight enough that I think it will be the trick for traveling where flying is involved.
My friend is coming into town to visit family in the hospital so I’m planning on meeting up if only to provide support. I'd been planning on hunting but Gilbert’s being sick all Thursday night and lethargic yesterday made me wait a day.  He’s recovered fully now so I could have gone hunting but caution is best.  He certainly gets me to work each day.
Aim and Marc are off to Australia. Aim has a position as professor at University of Sydney in political science.  It’s hard to believe but we’ve all been friends for 5 years now.  Laura and I interviewed her to work as my assistant that long ago.  She was doing her phD at UBC and welcomed a day of work.  Thanks to her Joanne and Hannah followed and now she’s trained Angel.  I’m so very thankful for her contributions.  She's such a brilliant good spirited young woman of such high character.  Laura accompanied me to the dinner and we all laughed recalling Aim's life with Gilbert.  “I’ve never had a dog’, she said.  Gilbert only a handful of love when they met was glad to teach her all there was to know.    He lead her all over the neighbourhood pulling her behind him on 'their' walks.  We’ll all miss her.  Marc’s friends were there as well. It was  their last night in Vancouver with everyone wanting to see them one last time before they left.
The big news this week wasn’t on CBC.  Apparently Obama was supported by Warren Buffet who has billions invested in the railways that move the oil now in the US.  So Obama’s not favouring the Keystone Pipeline isn’t about the environment but more about political patronage.  The cost of transporting oil by train is $30 a barrel versus $10 a barrel by pipeline and the pipelines are a whole lot safer environmentally. Meanwhile Russia continues to insist it’s in the Crimean Ukraine to protect ethnic Russians.  Well no one would not think that maybe Russia is motivated financially by the hugely important Crimean Port system, here in the west people really  think ‘idealism’ is only what the ‘environment movement ’ is about.  I just ask everyone to 'follow the money trails'. I don’t care that environmentalists are extorting millions or billions on behalf of the spotted owl, or some other cuddly creature, it’s just the hypocrisy and dishonesty that offend me.  I work and I do pro bono work.  I give to charity and church.  It’s just the way the adult world works.  The real work goes on despite the drama.  Naturally if I want to sell windmills I'll knock the  oil generators. It's not rocket science and life goes on. Meanwhile the propaganda folk play the masses like the sports casters promote their teams and play with the passions of the masses.  Team sports prepare the kids for war and finally now that women are playing hockey they're not so gullible politically. One day they'll wake up and understand how 'sexual harassment' concerns lost the citizenry all the gains since Magna Carta. It's not about race or gender or any such distraction. It's about power and money and the smart investors invest in both teams.
It’s Advent though and I’m really happy to see a painting of a mother and child being sold by a street vendor on Commercial.  Hallelujah!  I say that it’s better to celebrate those things one most appreciates than to denigrate those that one doesn’t. I’m thankful for Aim’s present of the biography of Prime Minister Harper. I really did like him when I met him.  I liked Prime Minister Turner too.  We've been very fortunate to have the high caliber of leadership we have in Canada.   I’m  now looking forward to reading the life of our country’s leader.  He's a regular Goreski, Hadfield with a little bit of Lenard Cohen and Russel Peters and Celine Dion added to the mess.  Canada rocks.
A car with a Christmas Tree on top just went past.  There is a certain festivity on the street. I loved the Santa Claus going by on the motorcycle.  A couple of stylish girls have adorned their heads with antlers.  I’ve not put much money in the parking meter so will have to leave soon.  My MEC jacket is certainly as comfortable as the new shoes.  There’s not much colour in the coats and hats that people wear but their running shoes are dayglo psychedelic.  Oh well time to move on.  IMG 7235IMG 7227IMG 7239IMG 7241IMG 7236

Our Hero

Our Hero has crawled out of bed.  He is wearing a camel coloured tshirt with an IDAA Palm Springs logo. The bed was king sized with an electric blanket.  He will think about crawling back into the bed many times that morning.  Keeping his options open, he didn’t turn off the electric blanket.
It had been a long time since he carried poison on the off chance he changed his mind about living.
There were exotic women in his life in those days.  Impossibly sexy women whose lithe bodies captured rays of moonlight them hostage for eternity. Fifty such women, some more beautiful than the others and some definitely far wiser.  He remembered them all fondly, like family, like goddesses.  If he could crawl back into his past it would be to those warm places where such angels made nights bearable. That was before he knew the joy of the electric blanket.  He suspected though he might well have sacrificed too much for security.
Our hero hadn’t made it far. Only as far as the toilet. He emptied his bladder reflecting on privilege and the average size of his satisfactory penis.  They’d been discussing racism in the cafe the night before. A mixed group of post grads and other intellectuals. They were dissecting the recent police shooting of a black man with little to go on but the comic book media stories and other farcical renditions of reality.  Our hero had begun to expect that in the not too distant future the news would be given as musicals because it was simply that time  they came back around, especially in the fashion of entertainment.  Then the robbed business man could express his angst and joy at rescue by the junior policeman who might just do his part on point in tutu while the black man  died white faced singing a  monty python song or whatever else the ratings would suggest.
Our hero had wanted to counter the discussion about ‘privilege’ with his own idea that white men and oriental men especially, and even the brown men, simply envied the black man for his outrageously huge cock. Our hero had known cocks. Not necessarily the way the scandalized reader might think but rather from working in an inner city morgue. Even after death there was little doubt that the black man was more often superior.  And that is where the word 'privileged' had come to mind.   How the cafe crowd had pattered on about privilege in terms of wealth and materialism when he’d been thinking about averages.  Everyday our hero reflects on his personal inadequacy. If there had been no globalization, or for that matter, porn, he’d have grown up happy in his hobbit like existence thinking average was okay in a vanilla sort of way.
Now especially after the photographs of Colonel Hadfield he felt small and insignificant, and vulnerable.  What if an even more superior race lurked just outside the galaxy waiting to invade.  He'd not even lost his perfect ex wives to black men.  The truth be known, he'd lost them like others lose their keys or drunks lose their cars. Sometimes he our hero in his cups  couldn't remember who he'd come to the party with.  Still he thought with envy, what if  a superior race of golden men with a better set of jet pods and mansion cribs in worlds with three moons were just waiting for him to let his guard down.  What privilege was it to forever be ready to protect any one of the impossibly beautiful  women that didn't even know he existed today from invading aliens with huge slongs and love potions.  But that was what he lived for.
When he finished pissing in the centre of his own private indoor tiny pool, the product of thousands of years of civil engineering experimental hit or miss, he felt  thankful at least for the steady stream. His was a thoroughly robust waste disposal unit.  All systems go.  He didn't even need Saw Palmetto, yet.
 Our Hero next sat down to meditate, still wearing the camel coloured t shirt but now noticing the red and black plaid flannel pyjamas bottoms.    Cross legged, on the divan (translation:couch) ,  he focused his mind on the centre of the universe, the creator, god of gods, all or nothingness, nada, the supreme, number one, zero, all being, love, peace, Jesus Christ  and countless other matters divine and transcendental.  He always hoped for a lift off, some sort of transcendental fireworks, burning bushes or angelic choirs, speaking in sophisticated foreign tongues, or even nirvana.  He wasn't greedy. He just wanted a tiny bit of paradise, like that flavoured candy that burst in back of one's  mouth after you bit into it  or those fireworks that kept fire working blossoms of light after the first big bang.  Admittedly he wanted multiple orgasms like a girl but he wasn't really sure about big black cocks.
Besides he couldn’t get the jar of Kirkland roasted  cashews out of his mind. He'd seen them on the table just before  he closed to eyes to leave the physical and contemplate the spiritual.  The cashews even displaced thoughts of young girls and black cocks and childhood candies till that was all he was thinking about and opened his eyes.  He truly savoured the first after meditation cashew, chewing slowly and swishing the fragments of ecstasy about his mouth before swallowing.  
Then he lay down on the couch. The bed seemed too far away, despite the promise of the electric blanket. This was  perfectly fine inviting  black leather couch (translation: divan) Pulling the white Hudson's Bay blanket over his head our hero thought maybe lying down was as good a way to meditate as sitting up.
Lying on his side facing away from the light and door,  he thought about old battles, schoolyard bullies by the dozen,  the same ruffians morfed into  judges in courts with sheriffs and Glock sidearms, loud mouthed university cretins became journalists with poisoned pens,  military units and swat teams surrounded him, muggers in foreign cities accosted him. .  He tried to still his mind with holy names but instead thought of the Count of Monte Christo and Bruce Coburn with a rocket launcher.
What would Arnold Schwartzenagger, Bruce Willis or Mel Gibson do, even if they were white guys with only average penis size, given the galactic dimensions of the universe.  He'd just watched Brad Pitt in Troy and didn't want to think about Brad Pitt.  Only yesterday he'd heard physicists postulating a parallel and opposite universe to account for the Einstenian unidimensiality of time.  By that formulation there were still two Brad Pitts and two Angelina Jolies.  In no equation was our hero, the writer going to get the leading lady even if he was Seinfeld or Woody Allen.  Humanism itself had that dirty kleenex scent of masturbation that made the Mystery that much more palatable if only in a Monty Python dead parrot kind of way.
Our hero's  dog found him in a fetal position and licked his cheek.
He got up and let the dog out watching him pee for an eternity on the same long suffering bush that clearly hadn’t considered the dog in it’s seedling choice. of real estate.
Our hero is something of a European hero.   Not at all the Robert Redford hero of America. There was no clear vision.  He’s was a man who was going anywhere.  There was no manifest destiny.  He was Canadian.  He was caught in an Existential angst of history and rewrites with lamentation.  If he'd been truly European his mothers might be the impossibly desirable Angelina Jolie which would  explaining in some weird Frankfurt School way  Alexander the Greats conquest of history. How different things would have been for the young man if Ellen Degenes had been his mother. Or he'd been born in Quebec and his mother had been Celine Dion.  In any of a vast array of possibilities,  he might well have ended up sipping lattes in a Roman suburb with a fat mink of a lover not at all interested in charging elephants on Arabian horses.  Meanwhile Ghengis Khan and his brothers obviously never heard of sex addicts anonymous.
Our hero has made himself a cup of coffee on the gas burner stove and  reflected, in a European style, not quite  Russian Doystoyevski but almost,  on the subject of  Ethical Beans. Even as the black aromatic substance boils he  wonders if Unethical Beans wouldn’t faste more savoury. If he were a business man he'd definitely start an Unfair Trade Unethical Bean company knowing with certainty he'd become rich in this world of cosmic losers
It’s the Christmas season.  Our hero told a friend in the Downtown Eastside drop it shelter that it was That Season again.  The celebration of drunks and bad driving.  He'd commented on how people react to yawns by yawning.  Now daily he found himself thinking of picking up a drink of yuletide misery.  He’d never wanted to drink like a gentleman.  A single glass of spirits had no real appeal.  Our hero had always had  hard drinking Humphrey Bogart  as his hero.  He truly loved his saltry long legged lover and  hard drinking companion Lauren Bacall.  The black and white era of television never captured the Kodac truth of the vomit technicolor on the urine stained porcelain altars hard drinking men and women worshipped.
 In the Yuletide season our hero never  remembered the time the  flying saucer beds and rooms,  guts aching with dry heaves. Instead he thought of white table clothes and black bow tied waiters and  the song “Tiny Bubbles’.
Now our hero is now looking down at his fat white belly thinking of the old time images of success envisioned in  Hugh Heffner mansions, Los Vegas casinos, Metallica stadiums and Willie Nelson smoke filled rooms are today replaced by men and women of wealth, power and significance are taking selfies at the top of Everest or jumping out of planes dressed in elephant suits.  There are no more after hour parties at the lounges.   Winners wake early and flock to the gym. The fall of Wallstreet sounded the death rung on Cocaine.  Sweat lathered bodies make now love like porn stars with the stamina of stallions.  The whole generation of our hero is wasted in old folks homes re encountering their youth in IV’s and better living through chemistry.
No one cares if he the Troudeaus smoke dope or Colorado sold it's Rocky Mountain High to new corporations of pot smoke.  Doctors encouraging mothers in posters to smoke to make smaller babies are lost on the new generation of stoned 'medical marijuana' users   It’s not like anyone in Canada, Jamaica or Colorado or Washington for that matter is  going to be climbing moutnains or jumping out of planes. The baby boomers have long gone to seed and listen unthinkingly to the ranting paranoia of David Suzuki delusional about climate change denial as if anyone ever doubted the rain.  Why not lie on the couch all day?
Finding our hero curled up on the couch again in a fetal position the dog has brought him a squeaky toy in hope of cheering his master up.
The new Pope, Pope Francis,  has declared animals go to heaven.  Our hero is now at a loss.  All his life he’d thought that animals weren’t welcome there.  He didn’t want to go anywhere that didn’t welcome his dog. But now that heaven was a place for more than saints he reflected on changing his ways.  He'd always known he was welcome in hell, especially given the authority with which his ex wives spoke of the institution.  He'd even known many who’d gone there before him.  Having taken to reading the mortuaries in hope of seeing the names of old enemies he'd seen instead the names of long forgotten friends.  But now that animals were welcome in heaven maybe he might have to re consider his life. It was the season for that.  A child was born, they said.  Maybe there was more to life than shit and bones.  He couldn’t go on sniffing asses forever.  What was this place called Heaven anyway.
With that our Hero tossed the squeaky toy for the dog to fetch and reached for the jar of Kirkland cashews.

Thursday, December 11, 2014

Thank you God

Thursday morning. I ‘m over the hump in the week of work. I’ve survived seeing more people with body lice, the coughs and the sores of general practice.  I resisted scratching for a while but finally did.  The crawling starts at the back of the scalp.  It was only for a moment.   A brief moment of insanity.  A dissociative experience of the scores of scabies infested children I treated years ago.
When people yawn we tend to yawn with them.
 Now that’s over.  I loved the shower and the soap and was thankful again.  Thank you God for the simple blessings of hot water and soap.  Thank you for the warmth of my bed last night too.  The storm with rain and chill went on late but I was cuddled deep in down.  It was a good night Lord.  I’m truly blessed.  I dreamed fond dreams of friends.  My ‘stout’ friend and I felt obliged to do sit ups on waking in my dream. Now here I am and truly I should be doing sit ups to address the Christmas girth but no I’m sitting at another desk.  Desk jobs. Executive functions.
I miss the sea and wonder about trade wind sailing and the healthy daily exercise of moving with the boat and waves.  It’s enough that I’ve been hiking mountains on weekends in search of the elusive buck deer.  All week though I sit in my office. At night mentally exhausted I come home and watch tv and eat, good food, but more food than I really need.
I hear of people hibernating and complaining about that as I complain about egg nog.  The luxuries of affluence and mental illness.  Isolation is not an option elsewhere as it is in the decadent west. One learns loneliness in crowds not in empty rooms.
 Cooperation is  matter of global concern but here in my  locality it’s not a thing we speak of.  I’ll drive to work in a bit and run the gauntlet of men and women walking in the middle of the street playing suicide by commuter or just not caring.
I’m thankful for my car. My little Miata. I’m thankful for the ITunes University and the ability to listen to lectures coming to and from work. This week it's been history, philosophy and theology.  Over the years, I’ve listened to hundreds of hours of medical lectures.  For decades I  religiously ordered weekly audiotapes that I played wherever I drove, thereby staying abreast of family medicine and internal medicine while practicing my own speciality.  Then it was pod casts.  I miss the mini cassettes I got from the Medical Library on loan.  The CD’s I used were mostly for talks on  addiction. Thank you God for my new book, Psychiatry and Addiction.  It was a few years coming.
  The years pass. The retooling of an old mind for the new tasks.  I’m a constant learning machine.  I enjoyed reading physics yesterday, hearing the words of Max Planck once again. Reading the scientist Madame Curie was fun too.  Maybe one day I'll have the time to read Louis Pasteur again.  I read these greats first a quarter century ago.  They were dead by then. The "new" sciences were called new long after those who’d created them had passed. It makes me wonder what the "new" science is today. It will only become clear after we’re dead.  Life is movement. Creation is creating.  Im in the thick of it today.  Living in the present.
Richard Rohr has been good to read. My morning meditation often with Emmett Fox. I'm looking forward to hearing the Bach Cantatas again.
 I’m looking forward too to Turkey.  More churches, more art and mosques this time.  I’ll see architecture and people and have a taste of history and the world will be a little closer.  I’d set out to bicycle through Istanbul in the 70’s but the mountain passes were closed early by snow so we’d headed south to Morrocco.  Now I’m doing a leg of an ancient journey.
There’s porridge and coffee and yoghurt to eat.  Then I’ll shower and dress. I don’t have to shave.  I’ve a regular Santa Claus beard for the season.  Gilbert has his little bear coat too.  Thank you Lord for family and friends. Thank you for all your blessings. Help me do the next right thing. Help me help others. Thy will be done, not my will.  

Sunday, November 30, 2014

Gilbert's New Sweater

We were walking down Commercial, across from the park.  Gilbert pulled me into the pet store there. We’ve been before. He likes the treats.  Today he even accepted getting a sweater. He’s a nudist and doesn’t like wearing clothing. It’s so cold though that I think he appreciated the sweater. He’s appreciated wearing his jacket when he’s been riding on the ATV.  I’ve had to stop a couple of times because he’s wet and shivering behind me. I get out his jacket or sweater and put it on his little body.  The same has happened when it’s been raining on the motorcycle and though he’s in his box behind me he’s got shaky cold. I get out the jacket he got from his family or a sweater and put it on him. I think this has all got through his natural resistance to human clothing on dog.  He also likes the treats.  But he really looks good in his new sweater.

God Revisited on Commercial Street

I am sitting on the terrace of the East Van Comedy Club looking at the sun setting in the distance.  Perhaps thats a fitting place to consider God in today's often godless society.
I’ve stopped here because it’s a good place for dogs. They set out dog water dishes at either end of the terrace.  Gilbert is tied to a bicycle post next to me. He loves Commercial Drive.  It’s a dog friendly community with lots of folk walking their dogs.  Now he’s lying in wait to meet and greet passers by.
I’ve been to St. James Anglican this morning. Good to see Father Mark and Father Mathew.  Karen and Matisse were there.  Kevin, AJ, the boys and Kendra were there. I loved that the Women’s Auxilliary had it’s sale after church. I’m stocked up with Christmas Bread, home made marmalade. I got the boys and Kendra hand knitted togues which Kevin sized for me.
(The waitress just brought me a Cafe’ Latte. Now she has brought gumbo.  Looks delicious.  Looking at it I think I’ll take to calling the stews I make ‘gumbo’.  Seems more descriptively true.  I know I started out to Revisit “God” but I’m going to take a break and eat this gumbo while it’s hot. There’s snow on the ground and it’s been quite cold indeed.  My beard helps but this gumbo should really hit the spot, Mmm, the food here is hot and Godly.  In Winter I'll go to a 'hot heaven' before a 'cool' heaven")
Now that I am ‘sated’ with very delicious gumbo and fresh baked bread with herbal butter, I might consider the subject of God differently than one might starving and under siege.  There's always 911 prayers and lot of the preachers speak from fear rather than love.
God is one, i.e. God is all.  Or God is none.  That’s the one and zero conception with the line going through the centre to create the symbol of infinity. I can conceptualize the finite and perhaps even consider infinity though mostly the latter I consider in cartesian mathematical terms.  I don’t know that man can truly conceptualize the infinite certainly not as he does the finite.  I’m ever changing as well with a sense of some kind of unchanginess.  This is even more apparent as I grow older and myself hardly recognize myself as the once young man.  The waitress is very young and no doubt looks at me like I looked at old ladies at her age.  I look at the young as young but not as I do the very old which for me are the 90 year olds.  It’s relative. But not all things are relative and 'it is what it is' is only as true as 'it isn't what it isn't'.
All such concepts weren’t readily available to the ancients.  The world was once pagan or ‘polytheistic’ and our ‘secular’ society is increasingly appearing little different from any ‘polytheistic society’.  In the Roman sense the Gods were named and personalized whereas in the secular society they may well be addictions.  Bachus rules the alcoholic.  In Medieval times the polytheism was limited to ‘demons’.  Today we have Ford and Fararri.  We call our Gods nationalities and corporations but it’s only when we limited the definition of ‘religion’ to a ‘god based faith’ do we exclude the comparative ‘religion’ of ‘communism’.  It claimed to be ‘godless’ but it was nonetheless a cult of personality with Lenin and Che little different than Kennedy and Reagan.  Nationalities are God like to those who are 'secular'.
I appreciate the interconnectedness of everything materially.  I understand as a scientist the significance of fractals, the universality of atoms and DNA.  The ‘atomic’ theory of universal interconnectedness goes back to the Greeks in Pre Christian times. Yet I learned in a theological lecture at a seminary that St. John’s ‘In the beginning was the word”  referred to the notion that we are all made of the ‘god stuff’.  Created in “God’s Image’ is essentially being the dream stuff of God.  Today Holograms give us capacity to understand this universality.  Certainly the movie “Matrix’ taking off from the findings of Hummarabi texts helps one appreciate that ‘to dream is the rub”.  Dr. Carl Jung expressed the idea that we were joined by the “universal unconscious”. This was in essence an idea from the Vedantas and expressed by Buddha.  We are the sound made by the celestial spheres.  Waves and particles.
(there is a young man who has sat down with two young women who have accents and would appear to be travellers. His voice has become louder and more raucous despite the fact that he’s drinking coffee. He’s irritating, nonetheless as he struts his intellect in hope that the girls will want his cock.  It’s not what he is saying that irritates but rather the loudness and the tone as he talks authoritatively about generalities but mostly wants he wants someone to unzipp his fly. I celebrate his youth.  He is with two beautiful women and I am  alone with a computer and a dog. My irritation is likely envy. )
Talking and thinking about God is what one does when lust is not more readily available.  Football players and warriors aren’t known for their intellectualism however Marcus Aurelius’s memoir is as sensitive a writing as one might find. He speaks of the stoics and today we’d call this a treatise on minimalism.
Under every idea - right now it’s the hegemony of Climate Change and politics of the Middle East and China and America - under all these is an issue of God.
I liked that the desire for uniformity went with the idea that those who were ‘contrarian’ somehow lessened the benefits that collective thanks and praise could bring to a community.  So the Christians, the contrarians, for their first 300 years offended the secular or polygamous Roman empire.  Now Christians are offending the secular society again.  Meanwhile my Christian friend demands and gets overtly angry with anyone who doesn't share his 'narrowest' certainty about Christianity.  I have several Christian friends and they're all more 'certain' than each other about Christianity.  The devil is in the details.  Agreement is like herding cats.  It's so hard to agree with these disagreeable certainties.   The tower of babble is such a  very human story.
God, the father, God the son, and God the holy spirit, the 3 in 1 God offended the Jews who believed in the One God, the God of the jews and mostly considered him God the Father.
Now I’ve been encountering more and more Moslems who are in the news because a significant percentage of them are radical and fundamentalist.  When Christian fundamentalists limited themselves to televangelism they were of no concern to the majority. The same was true for the Muslims but when they began beheading everyone who didn’t convert they became like Religious Communists.  The communists, mostly the Russian and Chinese variants of ‘atheism’ have a combined killing of a hundred million in the last hundred years, about a million a year. They make the Nazi’s look like amateurs.  No Christian group, even the witch hunting spanish inquisition, did anything like the Communists when it came to killing. The French Revolution numbers were infinitesimal.  Muslim radicals haven’t killed nearly so many but they’re the Rock Stars of death right now though the communists are still killing in Ukraine and China.
Meanwhile we're aborting babies with a frenzy of killing and the Canadian government is literally orgasming over the idea of Euthansia. The courts cream at the idea of legitimizing suicide.  No wonder the Pope called this a Culture of Death.
But what is life. Is it finite or infinite. Do I end with my death. I don’t know with any certainty. Even Houdini couldn’t get a message back with any certainty. I really don't believe in the infinity of my finitude but figure i'll muddle along waking no doubt in some variation of this life dream.  I suspect I'll be accountable to 'retribution' and 'karma' and that I may come back as a frog or burn in a fiery bath or play harp badly on a cloud.  All outcomes are possible.  Death is significant no matter how the government would reduce all individuals to numbers and accounting as subtraction.
So the Council of Nicea was an attempt to get equal agreement among Christians on the nature of God. Was God the Father equal to God the Son and where did the Holy Spirit fit in.  We have many denominations of protestantism in addition to the Roman Catholic, Greek Orthodox and Russian Orthodx.  The Muslims have Sunni and Shiites like the Jews have their Ashkenazi and the other one, the one that’s more eastern.  Buddhist war , actually kill each other, all vegetarians though, over who owns a Buddhist temple.  Hindus have long fought the Siks. Divisiveness is at nature human.
It’s really a bit like soccer fans or hockey fans at the grass roots.
I know God.  I know God is loving.  I have lived this and reasoned this.  I’ve long left atheism behind given the overwhelming scientific evidence that they’re collectively less healthy and well. Yet there are the gays who are less healthy and well in some groups solely because of their marginalization. The rich and mainstream , the ‘winners’, are normally healthiest.
I pray.  I was raised Christian.  I meditate. I have a direct consciousness of something one might call a ‘higher power’.  I don’t ‘feel’ this as polygamous or even as ‘trinitarian’.  I accept the trinitarian nature of God as easily as I accept the make up of DNA.  Does it matter to my ‘faith’ or my function.
But the question arises because the Aetheists , what my friend calls ‘anti-theist’, the Communists, and Radical Muslims, like the Radical Feminists, and the Radical Climate Change Cult, all seem to be looking for a fight.  Mostly people want a bigger slice of the pie and today the pie is money.
I’ve vowed ‘to live and let live’.  I believe in God. I”m a Christian.  I am probably also an evangelist because I ‘advertise’ my Christianity not that differently than I do my Canadianism.  I’m called a Patriot which is like being an Evangelist. I’m not going to knock on your door or consider it a ‘win’ if you convert to my religion. I’m certainly not going to behead you if you don’t agree, put you in a gas chamber or rant at you ad infinitum about the victimship of women or the terrible plight of black people or how the chinese are much maligned or even how Americans are difficult to live beside. I’m not that way inclined.
I rather like my company and the company of my dog and I like to sit alone with my ‘imaginary friend, called God”.   I really don't think God is imaginary though.  Everything but God seems more the imaginary.  Actually I don’t talk to God as ‘God’ but rather call him Lord. I don’t think of God as feminine anymore than I think of the earth as Feminine.  I haven’t this whole issue with ‘gender’ or ‘race’ or football teams. I didn’t know today was the Grey Cup.  I’m personally wondering which hotel I’m going to stay in in Turkey in a few weeks.
Now I’m going to walk the dog.
I think God is more ‘yes’ than ‘no’ too.  I love St. John of the Cross and “nada’.  God is not anything of this world.  God is transcendent and more. God is more ‘mystery’ too, so I’m a big fan of the medieval ‘Cloud of Unknowing’.  I think a lot of Evangelicals spout their ignorance with their certainty over uncertainties.    I am a scientist so I worry when people speak without the basic understanding of ‘thesis’ , antithesis, synthesis, Hegel, Black Boxes and  ideas that beget ideas.  ‘Evolution’ may not be darwinian per-se but it is a process of learning and learning on learning.
(The guy in the next table is saying he’s an ‘artist’.  Actually he’s saying he ’s a contractor. An illustrator.  )
I like that he’s ‘thinking out loud’.  The group is having fun. I remember being in such groups, sharing ideas. Good CAFE SOCIETY.  I forgive him his raucous laugh and loud voice.  I hope they come together too. Really.
Time to walk more with GilbertIMG 7196IMG 7198

Tuesday, November 25, 2014

The Nightmares Come Like Seasons

The nightmares come like seasons. Waking in the night soaking in sweat, the terror and faces of the dead. The accusations, “you did not do enough”.  “You failed me like all those before you,” the suicides shout circling, disembodied faces and shrieking voices.  Life was not enough. Why didn’t you convince me. It was your job to save me. You failed me. You failed me.  The wraiths are there in black whispery gossamer chanting angry anxious spectres invading the depths of my sleep, tearing me from peace and making me a morning zombie.  I review the cases over and over and over again.  Ask what I could do different.  Know that the wise avoid such end stage lives.  The cherry pickers never go near those dying of a thousand pains and repeated rejections on rejections with bodies and brains not up to the task of survival.  And yet I tried.  Trying wasn’t enough. The thousands saved in forgotten wars don’t count for the dozen or more are there to accuse.  You did not do enough. I had no resources. I was alone I said.  The hospital discharged you. You hung yourself. I didn’t even know you were free. I was on holiday. I say to another. You didn’t wait for my return.  Borderlines on borderlines on borderlines. And now the angry say I should kill them and beg euthanasia and marijuana and opiates and say I don’t care. You don’t care. You have never known despair. You don’t know my pain. You don’t know my truth. You’re like everyone else. Your medications and your words don’t help. There is no reason for living. Life is a lie. The judges and politicians and bearocrats and institutions are all bought. There is no life without money. You don’t know poverty. You’re a rich doctor. You don’t care. You’re only in it for the money. You don’t care. You don’t listen. You don’t understand. You don’t help me. You don’t know your pain. Take the needle out of your arm, I say.  Take your lips from the bottle.  I need this, you say. It’s killing you.  If you knew my life you’d want to die too.  Let me die. The teen agers are begging me for euthanasia too and they were given marijuana and ritalin and opitates before.  But there’s no solution in running away. But what do I know. I get up and go in the ring and box each day with death and there’s no money in it. There’s no crowds. There are no sponsors, no contracts. Just me and someone saying I want to die and whatever audience there is says give them euthanasia. Who are you to judge life is better. Let them die.  Be kind and let the girl whose boyfriend left her kill herself on you tube.  Why do you interfere.  Let them die. Kill me she cries. Kill me he begs me. And the media is missing the point over and over and over again. Death by cop. Death by suicide. Drama and 20 minutes of Andy Warhol. I stood in the carnage of epidemic reservation suicides and stopped the teens from offing themselves in sensationalism.  Cutting down the hanging boy.  Looking at the face lifeless now in the morgue. Overdoses and overdoes and overdoes with an occasion jump from a bridge or stepping in front of the bus. In the nightmares the throats of those who hung are red and scarred while those that dove off high rise buildings have faces crushed like they did at impact.  And I was there in the front lines.  The aids patients who killed themselves in shame and misery. The children who failed their parents. The godless. The homeless. The sad and angry but mostly angry.  Occasionally there’s a gun and the exit wounds remain a memory like funerals that are subdued for a life so young.  Now more are suicidal and there are no beds. Their is no profit in the already marginalized.  My colleagues avoid them or reject them.  I’m there in the end but what is there to offer and what I offer they refuse. More and more they can’t afford the solutions that might change the course of history in this small important way but there’s rationing and so many people were unprepared for the party to end. Old age. Disease. Lovers leaving. No work because they thought there would always be jobs and the cost of housing rose and their pay didn’t and they waited too long to move back east. It’s lovely here in the summer. People kill themselves in the rain.  The faces accuse me.  I failed them.  I failed myself.  Even better I’m told I was wrong to care. I cared too much. I should have worked with healthier people, done more ‘prevention’, seen far fewer people, refused to see the very very very sick.  There’s only so much one doctor can do.  Each of us talks like this. I tried to share my nightmares but he was as frightened as I.  I saw that my horror triggered his horror and it wasn’t like soldiers. Ours is a dirty war. It’s like Vietnam. There’s no honour in stopping suicides and suicides want to distance themselves from you and their near escape with the abyss. Eventually death gets all of us. Why rush headlong. But the depression and the pain is like the rain. It’s sometimes 40 days and 40 nights. The long dark nights of the soul. The winter the men and women killed themselves with cabin fever. And my sleep is broken. My sleep is disturbed.  I have nothing more to offer her or him. There are no asylums any more. They closed the doors. The patients don’t even have homes.  There are no shelters.  The psychopaths and sociopaths steal the shelters and the homes and the money and the resources.  The corruption in the system is putrid but in the end they’re all so far away from the cries and accusations of the dying and the dead.  We’re going back to ECT and neurosurgery. All the pills and talk have been used and there are no further restraints.  Euthanasia is the only ‘medicine’ the single health care for profit government service will pay for says the truly cynical. I hold out hope. Offer yet another trial. I’m like an oncologist suggesting different treatments for the cancer of the soul.  Suicide.  Addiction. Depression. Schizophrenia.  I’m crying in the night again.  This too will pass. It always does. It lasted longer then but not now.  I know that tears are punished. There is no use in crying.  One shouldn’t care.  One shouldn’t advocate for the lonely and those in despair.  It’s all punishable. They punish those who feed the starving in America.  Do not feed the poor. Do not feed the animals. Do not stop the death. CO2 is the enemy. Stop the breathing. Save the planet. The rocks are more important than the life.  There’s billions for the spotted owl but not for the young man or woman not wanting to live in pain but worse not for the old.  The drug addicted psychotic with the false promises don’t even know which way to turn in their smoke filled haze.  They choose death like they would an ice cream bar or a toilet. Drugs and alcohol blur perception till death is like a bowel movement. Who cares.  Why are you stopping me.  Shut the fuck up. Don’t tell me death isn’t sublime. I’m going to kill myself and there’s nothing you or anyone can do about it. And there isn’t.  It used to be I could lock him up till the rage and insanity went away but there are no beds.  The hospital beds went to the jails.  The mentally ill are criminalized.  Marginalized. Stigmatised. And now I wake in the night with nightmares again. Dammit! Dammit! There’s nothing more we can do. There are no more resources.  There never were that many to begin with.  I’m old too.  I know more than I ever ever knew. I’m at the top of my game.  I’m a master and yet the challenges just get greater. I scaled the foothills as a kid but now each case is an everest of pain and disease and mental illness and lack of resources and addiction and suicide and crime and infectious disease and fear and anger.  I’m done in in the morning, worrying about details.  Did the shepherd count all the sheep. Did all the children come in from the playground .Are all the swimmers out of the lake.  Is there something new in medications I didn’t read about. Have I tried everything.  Should I have done a urine screen. How could I know the patient was smoking that much marijuana and drinking that much booze.  How come I didn’t do a home visit to check their medicine cabinet.  They were buying the benzos on the street. They got the opiates from several different sources. Why didn’t I see it coming. You did see it coming but you couldn’t stop it. They’re like bullets now but the speed of fire is machine gun.  You used to have only one person referred to you suicidal in a month but now it’s weekly. Everyone is suicidal and they’re all older and all the medications have been used by the gps and everyone has provided a consult but no one has time to sit with the patient and hundreds are clawing at your arms and legs and begging you for more time and I ask myself am I giving the time to those who need it most. It’s all triage now.  The ones that scream and scream and have seen everyone but won’t do anything for themselves may never get better but the one who needs just a little help might be missed but with just that hour or that day of care might get up and walk another year or more.  But this one can only have an offer of a detox but they’re refused the hospital and I know they might die. I’ve seen death. I’ve smelt death and I’ve known too much death.  But fresh out of school the boys and girls flock to the administration jobs. No one wants to work the front lines. No one wants to do more tours than the least possible with the chronics and the dying.  The rich are so much cleaner. The poor are so dirty. I scratch myself for days after some patients.  The scabies, lice and fleas and bed bugs get to me as much as the threats of suicides.  The threats of homicide are there as well. The bullying and the guns.  Sometimes they even point a syringe.  And it doesn’t bother me for weeks or months and then someone gets through the armour and I wake crying in the night remembering the judge condemning her for loving her child and her death in the morning papers.  And i couldn’t do anything about it so they condemned me as well.  And funny as it seems I’m sometimes visited by the old man that died because the hospital didn’t fill the oxygen tank and I was pumping dead air into dying lungs and he was looking at me forgivingly because well, ‘pneumonia is the old man’s friend’ .  So maybe the bureaucrats and for profit insurance folk in the space station offices are right euthanasia and give them a toke is all they need. The psychotic 20 year old Chinese genius smoking dope and never again to complete another brilliant year of university but convinced for ever that people are out to get him off in some schizophrenia ward when the drug dealer promised him nirvana.  MArijuana is good for you. It’s a herb.  I can’t forget the teen age boy hanging in his room, his clammy skin.  I didn’t even know him except to cut him down. Another doctors nightmare. Now a shared nightmare.  Silly now. I’ll go back to bed. It’s all so overwhelming but it’s just the rain.  And once again hearing ‘we have no beds’ .  Vancouver is not a place for old men, the mentally ill or the poor.  It’s a fast and tough city for the very best.  The old, and mentally ill and poor should move.  Die already.  Losers.  Here take some change. Move along.  And the money goes to the drug dealers and for booze.  There’s always money  for critics too.  And reports.  And special reports.  And committees.  I’m alone for an hour listening or talking or selling life and I’m the last one who will see the person.  “I phoned 37 psychiatrists and you’re the only one that would take them.” I’ve heard that dozens of times.  “I’ve no where else to go.”  And it’s not that I want to see them but I’m a people pleaser and I have trouble saying no. I have trouble collecting unpaid bills from patients or their rich lawyers or their rich families.  I have trouble saying no and trouble with accounting and thinking what’s in it for me and where’s the most money and how can I best use my time for my betterment not the betterment of others. I’m missing some special gene of self interest that would allow me to focus on the healthy and wealthy treating the worried well like health food stores and appearing compassionate with the broken fingernail. I’ve been bleeding out my butt for weeks he told me. His fistula smelt in the office but I didn’t say just taking out the aerosol after he’d left. The bandages must have slipped. The surgery went well. I’m so glad. He’s such a fastidious fellow. He was so ashamed of the smell.  I do hope the cancer doesn’t return. i’m praying ever day for my patients. I’m praying for them to be well.  I’m dying too. We’re all dying.  Life is finite. There’s not eternity here in this little compartment of infinite reality.  Why be so attached. Wear life like a loose robe.  Listen to the whining and the crying and the rage and leave it all at the office.  It’s easy. You do it most days. But then the nightmares come again.  I hate the nights of sleeplessness. I hate going to work bagged again knowing there will not be enough time and no more assistants and never any resources.  The boxes of kleenex and soap are an exorbitant cost.  The chairs have been worn out by sitting and waiting.  I’ve just ordered a new desk. The desks have come and gone as have the chairs and I’m still there.  It’s not all that much longer.  A decade, two at most.  It’s not like the beginning facing the 50 years before the gold watch, I’ve done 30 years.  Tens of thousands of strangers have become known and close and gone and they’re the sad, angry, sick and unhappy ones. So many are thankless. So many are just always ornery. Were born that way. Lifelong histories of difficulties, failures, crimes, divorces, lost jobs, illness.  So many people have let them down, used them, abused them and then there’s me and I’m just another one of them. The paranoids have given up differentiating friends and foes. Everyone is foe. It’s easier that way. Sometimes they take the medication. “It takes the edge off”. Other times they slash their wrists and bleed till they’re sutured in emergency.  She called me today and said she was suicidal and she’d told another helpless worker that she was suicidal and another hospital emergency had said they had no beds and I’m awake in the night wondering how I’ve failed, how I could have somehow stopped her jumping off the roof. They blur.  The boy with the gun.  All the ones on the suicide wards. The ones in the asylum. The soldiers here and overseas.  I’m depressed, doctor. I’m thinking suicide.  In the courts they get us to criticize each other dividing the doctors into the good and the bad so they can get ugly. The media loves the ugly. There’s sensationalism everywhere but in my office itsl just despair. It’s making love to same unloving woman or man day after day week after week. Everyone is good at the sprint. It’s the marathon that takes it’s toll.  I’m tired now.I’ll go back to bed.  The nightmares forgotten. The faces are gone.  I’ll go to graveyards. I ‘ll talk to trees. I’ll pray and meditate. I’ll sit alone in churches. I read and study some more . I’ll learn more and more about the latest drug and wait till some hotshot academic tells me I don’t know anything or some doctor police condemns me for not doing enough. There’s a shitload of critics and all manner of back benchers doing the light lifting but there’s way too few of us at the front lines.  There’s no resources.  It takes a village to raise a child.  They’re children. They’re humans.  They’re mentally ill.  I beg each day for my patients to get them food, shelters, medications, beds and it’s all unpaid. The begging the authorities and badgering the authorities. There’s no money in that. All I should be doing is writing a prescriptions and saying good day.  That’s where the money is. That’s what the smart doctors do. Those are the doctors who get ahead. They’re the ones that go on to police the doctors. They’re the smart ones who stay as far from the patients as possible.  8, 10, 12 hours of direct patient contact most days and for 30 years.  You should have stayed in that government job where everyone just met and talked about the patients in committees after committees but no one actually saw the patients. it was such a good job with all manner of perks and pension and health benefits.  you’re an asshole to have left the good things in life, the easy times. It’s your own fault you insist on seeing the really sick and accepting these end stage losers in your practice. you should be ‘selective’ like I am.  I ‘ve heard it all.  Dinner with the other old warrior doctor was good for the soul. We laughed when he told me he ‘d got scabies twice when I told him about getting TB .  Scars.  Silly silly scars. Memories.  I saw another TB today.  I didn’t know what that rash was and was so thankful that a colleague was there to look and recognize it.  Little mercies.  It’s so late. I’ve got to get some rest.  It’s a long day and the week has just begun.  They’re always dying around Christmas and then it’s a deluge till March or April. When the crocuses and tulips come, the suicidals lessen.  Until then it’s depression .  I’m just adjusting to the winter rains.  It rains tears in Vancouver this time of the year. I’m so thankful for all the other front line workers and doctors and colleagues.  My friend copes by riding his bicycle a hundred miles after work.  Now that’s one way of shedding demons. My other colleagues goes for day long drives. I’ve been out in the woods and really should be sailing.  But it’s just another day and another week.  it’s so much better than other years.  There’s the hope of death one day as release for sure.  Aging makes everyone seem less important in a different way.  It’s not so intense. And I can share it.  I don’t have to hide from those so superior they don’t ever cry and suck the life out of rooms when they swagger through the doors.  There’s so many working It’s worth it to remember that. So many things to be thankful for. So many nights of fitful sleep. So many good things and good friends. All the other patients weren’t suicidal this week. It’s just the one that’s triggered the deluge. The one that was phoning every night in the wee hours desperate has survived their storms this month and are smooth sailing, another job, a place to stay no longer crying in the phone and coming to the office desperate. The angry still hide behind the tears of self pity. The blamers and shakers still claim they’re innocent. There’s karma and retribution and no doubt you’ll come back as a butterfly. Someone has to be a caterpillar. These are the best of days.  So what if you wake in the night screaming soaked in sweat. It’s been an adventure. It’s a good year. Life is grand. God is good. Thank you for whole and everything and all. Thy will be done not mine.  God help me be the best I can be each day.  Be with me now as I go back to bed and help me through this night.  Thank you.