Wednesday, September 10, 2014

Work and Positive Attitude

Work has been quite overwhelming the last few weeks.  I've been at the office till midnight and working on the weekend.  It's mostly been going through files and finding things undone, lots of errors, minor frustrations.
The trouble is that this has added to my own heavy daily work committment. I'm a physician and the work never ends, just more and more lining up at the door as resources are depleted or diverted.  It''s the administrative demands that irritate.  More and more time and energy spent trying to collect the money for the work done, more and more requirements to record.
A judge said to the doctors, "If it is not written down, it didn't happen".  Our insurance lawyers responded by saying "for every 5 minutes with patients you must now record 5 minutes of notes".  The 'legal medicine' or 'defensive medicine' position just cost Canada half the work force of doctors. Meanwhile we as physicians are told that our rates for insurances will skyrocket.
I'm tired as I go to work this morning.  Each day this week I've woken at 4 am.  Early morning wakening is a sign of  depression. But it's also an indication of weather change and a full bladder. I drink too many ginger ale late at night and pay by the early morning pee run. This sometimes follows the dog deciding my face needs to be licked not at our normal 7 am but rather at 5 or 6 am. Then he gets a pee break or water.
The change from summer to fall, the change of season, the loss of summer, the recurrence of all the previous years of trauma going back to school or work, burdened shoulders, head down, nose to the grindstone......I find more and more people are not working....I find more and more people are on the street.  I feel alone labouring. Long hours and long days and years in years out.
Of course everyone sees my adventure. I sail and hunt and travel but the cost is still 60 and sometimes 80 hour work weeks.  As a 'business owner' in Canada I really hope one day to actually get paid 'minimum wage'.  Half my earnings to hidden taxes, half my earnings to overt taxes, 40% of income to overhead, and the highest cost of living in the world, or North America.  I don't own a house.  Of course I could have a 'downpayment' and be a slave to a mortgage. Did that when I first graduated medicine.  Feel for everyone who struggles to pay the mortgage in Vancouver.  The cost of the cheapest shack for sale is $600,000.  Condos are sold here but there's all the attendant nightmares of rising fees and aging populations with more and more fixed pensions.  Renting is still possible but bedbugs abound and theft and breakins are ubiquitous.  Vancouver is a city of crime and drugs and bikelanes obstructing main thoroughfares, and absentee landlords.
All day I hear the horror stories.  Of course I have a skewed view of life. No one comes to a psychiatrist to celebrate. They're hear telling me daily how hard it is to meet a guy in vancouver that's not bisexual or just wanting porn sex. They tell me all the girls want is money. They tell me they're being evicted. They tell me their neighbour is a witch or an addict and they can't get the police to do anything about their threats they make when they're high on crack. And that's the uptown complaints. The down town complaints are bedbugs, rats and and homelessness.
I work at balancing the 12 hour days of misery.  I avoid people who are negative in my personal life. I consider my time alone in the woods with my dog the 'shower'. I release the demons that have jumped from my angry patients who have been raped and bullied.  I shake them off when I'm alone with nature.  Sailing the wind takes the worries out of my hair. I have all these worries for my suicidal patients wondering if I've been listening and encouraging enough.
My patient who used to use the Vancouver Safer Injection Site, that wonderful Political Monstrosity, just died. I can't get his face out of my memory. He haunts me. He was telling me last how heroin could be injected safely and how he liked the safe injection site.  I encouraged him' to consider abstinence, encouraged him to participate, to belong, to come out of the cold. I could spend all day singing Desperado to so many of my male patients.  Come in from the cold. They're so tragic and sad. The women are hiding in their apartments while the guys are sleeping under bridges.  So many tragedies.
So I go to meetings where we celebrate life. I've not got to as many as I should. I need to see 'normal' people happy and building and working and getting ahead in life. I love when I get to church and see the celebration their and listen to the idea that there is more to life than just money.
Everything costs so much here.  A doctor can't afford to live in Vancouver.  I just learned that I lost thousands of dollars by failing to 'bill' properly. The insider track tells us about these deals. I was a year or two late in learning about a tax free savings account.  I spend all my time looking up the latest treatment and trying to keep abreast of the latest research only to find that I could have saved hundreds of dollars by buying a different phone plan or parking in a cheaper place.  I'm at a loss as to how I can do the best for my patients and manage a business and manage the personal affairs when there are so many 'sharp' dealers and 'tax men focussed solely on takeing as much as the market can bear' and 'sharp businessmen'.  Everyone now charges hundreds of dollars for services and they don't have more than a couple of years of training. I'm being 15 years in education, all the money lost to learning while today I feel sorry for all the kids who enter the workplace in debt. How can they be 'generous' when they're raped financially in their first years.  I'm saddened at the end of life.  I look back and realize that everyone who focussed on money rather than patients in medicine are now in charge. The world is ruled by the money men.  Who cares how many died or stayed sick. The hospitals didn't care. Oh we all pay lip service, but it's where do we put our priorities.
I haven't had very good priorities.  I've put myself second in relationships and work and now I am thinkng of death. Old age is coming and all the promises have been broken.
I remember thinking that when I got older my wisdom and learning would be appreciated. The young turks are more arrogant today and the government hires 'boss men' who do as they're told , they get titles and whips and don't know how to find their ass with both hands. They need the hierarchy and they loathe me.  I'm an old fart. I know more than they do and that threatens them. They're critical of details that are irrelevant.
Just yesterday I heard rispiridone may lower the methadone dose so it's questioned. I've never seen this. It's hypothetical. Some use of the same enzyme for metabolism. I check out EPocrates and there's no 'contradindicatation' for rispiridone and methadone there. No mention of 'dosage' and no consideration of 'clinical' matters. A pharmacist drunk on textbooks has told a patient this and the patient always believing in needing more methadone has compalined that I gave him rispiridone and lowered his methadone level but it's the crack and crystal methaddone that he's using. But to say that is to make a stupid statement, no matter how true, that if young women wouldn't drink to intoxication when out socially they'd reduce the incidence of 'date rape' by half or 90% or more.  No body wants to consider that alcohol and drug abuse are the real problem. Blame the doctor, blame the medicine, blame the men, but never consider stopping the crack or wearing a cloak at the end of the night and arranging safe chaperoned exits.
Society is to blame.
I rather like society on good days. When I've not been too long on the front lines or ducking friendly fire like I've been doing this week I know Canada as a great country. We have the most wonderful outdoors and wilderness.  The people are generally great.
I'm one of those cosmopolitan Vancouverites who loves that he has aboriginal friends, black friends, asian friends, middle eastern friends, rainbow friends, and friends from a half dozen major religions. I am often sorry that people don't know what they're talking about because they've been misinformed by a propagandistic media, often by journalists who themselves are wholly ignorant of what or who they are writing about.
The world is going to end.
Everyone is concerned about the rise in CO2.  Most people don't know this is what plants breathe.  So yes, build cities underground and the problem is solved.
Plant trees.
All kinds of possibilities abound scientifically. The 'climate change' folk admit to a 'pause' , like a 'ceasefire' in Israel and Palestine.
But white man guilt never lets up. "Make the Rich Pay".  Bernie Sanders and the Koch Brothers never debate face to face.  The masses won't allow any 'honest discussion'.  The lines are drawn and people shoot at each other from bunkers of stupidity.  News has become sports and sports is big business.
I don't know.
I muddle through.
When I spend days and nights reading positive literature and seeking uplifting material and go to meetings and church its like I'm showering and then I'm in the midst of those who don't believe in bathing.  I don't like the smell. It's rank.
I am trying to micromanage my own negativity. I was coming to work and people stoned and drunk at 8 am were staggering and dancing in the street backing up traffic for blocks. It's bad enough they don't work but they don't let others get to work. And our Mayor, increasingly suspect, celebrates people living in parks and living on the streets because he let the Portland Hotel Society leadership take the millions for housing for the homeless buy themselves million dollar homes. So let the homeless build tent cities and block traffic for blocks staggering about on the main thoroughfares to the city.  Meanwhile drug lord Mark Emory is running for parliament.
And I feel like my life has been a waste trying to heal people , trying to get people off drugs, trying to keep people alive when the richest doctors now are the ones promoting euthanasia and the richest health care folk are the ones getting everyone stoned.  In southern California they're giving dope for free to those not working and nobody seems to consider dope makes people dopey.
But I can't afford righteous anger. It pollutes my brain. I have to see the positive. Focus on the good. Look for the light. Find the silver lining to the cloud.
I'm just down a weekend short and a church service low in spiritual fuel.
I'm a cheer leader.  The home town team hasn't had the best coaching.  I haven't seen that many wins. We're aging. Too many deaths.  Too much disease that's not getting better, and not going to get better, All my pain patients suffering with little solace.
But there's no benefit in anything but a positive attitude. Work is good.  God is good.  God is good all the time. An attitude of gratitude is the best way to banish fear.
Thank you Lord for life.  Help me to see more clearly. Help me to get beyond self centered ness , rise above ego and self pity.  Celebrate.  Salvation.  Health and love and light and life. Focus.  Focus.  

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