Saturday, February 7, 2015

Journal Feb 7, 2015

I’ve slept on the boat enjoying the return of the mild weather. My electric heater has been sufficient to maintain cozy. I’m walking about in sarong and t shirt missing the Sea of Cortez. Gilbert has been bringing me the ball to throw every minute or two.  Outside there is steady cool rainfall.  I offered to let Gilbert out on the dock to pee but he returned inside the boat instead.
Rachel, his north shore Pet Smart groomer took all his fur. He was so matted and it was pulling at his skin making him very sensitive. He yelped when touched the last day. Thankfully the girl who runs the coffee shop in our office building recognized the problem.  I was just about to take him to the vet and took him to Rachel instead.  Problem solved. Gilbert has been happy and energetic as never before.  His only concern was having to share his friend Laura and me with her new cat, George.
My anxiety today is this three day weekend.  It’s clearly a cadillac problem. Yet if I get any time off I want to use it well.  I’ve become a workaholic with increasing demands and a fear of aging without a pension, no house and concerns about public care of the elderly. If I didn’t have that to think about this week I’d be back to thinking about zombie wars or alien invasion.
The fact is, I feel I’m thinking about ‘security’ in a way I don’t know if I’ve ever thought of before.  My friends say I’m ‘growing up’.  It’s not that I don’t love my work, the idea of it, the service and the people, (I really love the people), it’s just that for the first time in my life I’ve been asking ‘would I go to work” if I was a millionaire.  I can honestly say that I would have answered that in the affirmative for most of my life.  I loved being a physician, doing psychiatry and then addiction medicine. Yet today I am feeling overwhelmed and exhausted by the hostility in the workplace and the direction of our health care system.
I spent two years ‘getting people off benzodiazepines”.  The College of Physicians and Surgeons announced that people on methadone couldn’t be on benzodiazepines because research showed the combination was potentially deadly.  They gave a deadline.  Doctors began referring patients to me. I began benzo tapers.  The problems arose when the patients wanted me to keep them at the same dose or give them more. Repeatedly my life was threatened. Twice people brought guns to the office and showed me ‘they were serious’.  That wasn’t the first time so I just ignored it and continued with the ‘program’.  Eventually dozens of people were tapered off benzos.  I’ve only got one or two of the group left and they buy there’s on the street and their urines are occasionally positive.  The process exhausted me. I was terrified to go to work some days knowing no one cares.
In my other practice I encountered hysterics and threats when I tried to reduce benzos since the research goes for all benzo and narcotic combinations, as well the new research shows that benzos are dangerous for the aging populations as they reduce the possibility of recovery from stroke.  Each week I have one or another patient really angry with me (they’re frightened) and I’m tired by these wrenching sessions because in the past repeatedly when I’ve refused people what they wanted and followed the oath ‘do no harm’ the patients have escalated by complaining to the College of Physicians and Surgeons or lawyers or Ministers of Health.  Repeatedly I’ve been bullied for ‘doing the right thing’, ‘doing what my teachers taught me ‘ , doing what is ‘good medicine’  doing what is ‘pure and right’ and ‘good’ only to have a gang come down on me and punish me claiming that somehow it was the ‘way” i said ‘no’ .  I’m terrified of saying ‘no’ yet in my personal life I’m struggling with working through my own illness which has me in fear wanting to be a ‘people pleaser’.
Now I’m dealing with all the angry entitled pot heads whose marijuana use makes their care impossible for families and care givers. These are the patients with head injury or addiction and the ‘harm reduction’ models are highly supportive of ‘marijuana use’ but don’t seem to recognize how difficult it is to deal with people who are so stoned they may as well have consumed a 26 of vodka before the doctors appointment.
Just yesterday I was condemned by a family member angrily because I wouldn’t see their relative immediately and in addition to that agree to see them twice a week. I’m struggling to see people monthly, or every three or six months and constantly for years working without any resources of time or medications.  Increasingly the patients aren’t ‘funded’ for medications and every day I’m adding a phone call and begging session with a bureaucrat to get my patient the medication they need.  Not only that weekly I’m writing ‘begging’ letters to get my patient services their politicians promised.  Then daily or weekly I’m ‘answering’ to some other beaurocratic authority why I ordered a test or gave a medication. These individuals I talk to are utterly ignorant of clinical care and responding to a ‘flag’ on a computer program about one ‘detail’ while I’m dealing with the multitude of face to face issues that are in real life with real patients.
My favourite and most ludicrous of these calls was the one from the young hospital tech telling me my patient had walked out and refused their ‘blood thinner’ after their emboli.  “Did you know my patient is an IV heroin user?”
“Do you really think she should be on blood thinners?"
“Well, yes if she isn’t she’ll throw another clot?"
“And what’s going to happen when she takes the IV out of her arm?"
“She shouldn’t be on heroin when you’re giving her methadone."
“Yes, but if she does do heroin and is on blood thinners she’d bleed out wouldn’t she."
“Well that’s a possibility”
“And I’d say that possibility outweighs the possibility of her having another emboli?"
“Is there any research on that?"
“I doubt it. But if you can find it I’d be very interested. I happen to like any research that deals with the real life considerations of multifactorial probabilities coupled with non compliance and suicidal tendencies and limits of public funding and mixed messages to the addicted populations. In the mean time I’m not going to force my patient to take something she doesn’t want to take when it might well kill her."

That’s a daily conversation or in a good week, weekly.  And it’s always against the back drop of the gross ignorance in the community about addiction and public policy and the conflicting ‘messages’ of experts.  Businessmen all the while are wanting to encourage people that the problem is ‘society’ despite the fact that deadly addictions exist in every society in the world just like schizophrenia which is 1% of all societies but still there are those who say schizophrenia is caused by environment.  The ignorance about genetics and environment is increased by the rich shifty salesmen with a hustle.
I realize too that if I was rich today, I’d sail away.  That’s what’s got me in conflict.  I really would like to hoist the sails and head out alone on the Pacific to taste the downwind sailing experience in the trade winds again.  I’d like to sit back and let the autopilot and wind veins do their work while I drank coffee and read novels in the sun.  I”m forgetting all the negatives about ocean crossings and focusing on the escapes.  I’m also thinking I have a limited life and do I really want to argue with bureaucrats and lawyers all day long week in an week out begging for the services the government promised.
I’ve had a flu for two weeks and that’s really limited my patience with the never changing only worsening bureaucracy.  I’m on the front lines but there’s now dozens so far removed from reality that they’re on space stations and they’re calling me up on the phone, emailing me and faxing me their ‘opinions’. There are so many chiefs today and not a single person wanting to be an indian.  And all these chiefs don’t have any experience and their training is minuscule and usually by academics who are so far removed from reality as to simply not be able to remember the last actual human contact.
And I feel superior.  yea. A day doesn’t go by now when I feel I don’t know what the hell I’m doing since the government, thanks to the Supreme Court, that appointed odd body of seniors opinion, says that ‘physician assisted suicide’ is all the rage now.  Meanwhile they’re giving heroin down the street from me and everyone wants me to write up their ‘medical marijuana’ and I’m missing out on the big bucks that are going around with all this hustle.  It’s the same as the abortion industry, what a racket,  Abortion doctors get a half million a year but they have the least amount of work and are one trick ponies, suck and scrape.  Just walk in the door and you get the dead baby.
Meanwhile I’m plagued with all manner of ethical concerns.  I’m constantly asking if this is ‘do no harm’. Am I ‘helping’ the patient. The drug dealer just asks if he’s charging enough money and how many customers has he. I’m looking back at my life and comparing it against the business model and realizing I’ve been a fool.
I was in the bank yesterday looking for a misplaced amount of money. They recorded a ‘withdrawal’ for $30,000 which I didn’t make that I know of.  And the girl said that ‘withdrawal’ didn’t mean that it was ‘withdrawn’ but it may have been moved to another account. Well, it was frightening and confusing and she would sort it out for me.  Just a minor matter but she was so judgemental in her tone when I said I ‘didn’t know’ whether the $30,000 was a GSP or MST or some other bank acronym. “I know I didn’t ‘withdraw’ $30,000 from my bank at that time. I don’t know what form the $30,000 was in.
And that is when I ‘lost it’.  “Do you know the names of the molecules that make up your DNA? Is your adenine in balance with your quinine? Has your GFR being tested recently? Do you know what your hematocrit is.  What is your LD or HD ratio. I didn’t even get into asking about dopamine, serotonin, and 50 other neurotransmitters or asking her if she was ‘real’ or the nature of the universe?  I just rattled off some acronyms we use daily with patients and pointed out they dealt with life and death and that no I don’t pay attention to what mutual fund acronyms my ’savings’ are in but I know I didn’t ‘withdraw’ $30,000.  The fact is i wouldn’t have noticed except it showed up on a bank statement as ‘withdrawn’ and I didn’t do it.
 She’s all smiling and treating me like an idiot because it’s clear that in her world ‘right and wrong’ and decided by ‘financial numbers’. I’m not a ‘valuable’ person because I only have ‘$30,000 whereas if I had $3,000,000,000 I’d be ‘more valuable’.  I don’t know why I even care about ‘making money and saving money’ because the banks can’t even keep track of it and they take it willy nilly and make gross errors just like the government but I’m not supposed to make an error. Like given warfarin to a heroin addict.  My mistakes show up in body bags.  At best lawyers and accountants and bankers will have a committee meeting where they’ll all be paid above my pay grade and maybe they’ll find my $30,000 which took years to save and came from working 12 hours a day 7 days a week.  But I lose faith in the system daily and go back to praying because there’s only certainty in God as this world is corrupted and dominated by theft and lawlessness.
I was thinking of sailing today.  I could clean up my boat and take it out.  I don’t know what to do. It’s raining so hard and I’m not happy with walking in the rain but I could since the dog probably would like to pee.
I look back on my life and realize that I never read financial magazines but read neurology and psychiatry journals. Instead of getting an accounting degree or law degree to improve my MD I went not to specialize in psychiatry and then addiction and then spirituality. Now I ‘answer’ to people who are less educated and less experienced so all my training in specialization has made me ‘ignorant’ because my ‘superiors’ instead got accounting and law degrees and laugh at how silly I was to think I should learn more how to deal with the patients illness.  We’re all just slaves to the money men and women and I’m just a better trained ‘indoor slave’.
I remember when my wife looked at me with disdain because I wouldn’t focus on making more money so she could have more things and more status. She thought it was ridiculous that I’d stay up all night trying to find an answer to the clinical question I’d encountered in the office looking back decades for descri[topms reading translations for journals from around the world, trying to ‘cure’ my patient.  It’s such a joke now. Even the government says kill them Give them pot or heroin. Give them cake.
The girl laughed at my not knowing what ‘kind’ of mutual fund I had my money in her in her bank. It was just ‘savings’ and yes I understood there were three risk levels and that they had pretty little names to sell their pretty little promotions but I know that the chassis on different cars and vans is the same chassis and I know how to fix a diesel and a gas motor and I can survive out in the wilderness and I can stop a baby screaming that has screamed for days and you think I’m just a ‘silly’ old man.  Ignornat of what is most important.
I didn’t notice the designer label on her clothes but it was there.
I’m a dinosaur and increasingly I find myself wanting to sail away.  I love Joni Mitchell’s song’ Skate Away.
But this is just the shaking off phase. This is just the feelings that everyone has at the end of a day of work.  They shake it off. They eat dinner, play wit their kids, do whatever hobby gets them through the night and they sleep.
I’m asking God does he really want me to be doing this.  Am I really meant to just fight daily with bureaucrats ‘begging’ for resources or just tell the patients ‘no’.  “The life saving measures are no longer available but we have assisted suicide should you desire.”
If I was a young man I’d go fight Is.  I’d be like Ernest Hemingway in the 30’s .  I realism demands simplicity.  I’ve concluded the enemy is me and my thinking and the external world a reflection of my own unresolved conflicts.  I think everything is about spirituality and materialism. I believe that whatever I have , a new car or a new boat is just a ‘fix’ that serves a short period of time to give me a sense of ‘wholeness’. I believe Pascal was right that we have a  hole inside ourselves and we keep trying to fill it with the wrong things.
I have life today. Albeit I’ve had the flu and when Im under the weather especially when the outdoors weather is so putrid I feel hopeless and worthless and inadequate.  I could go to church , go to a meeting, visit a friend, help a sicker person or do any number of the things I know which would make me feel better.  What I probably will do is walk the dog. When I get back from that I may even clean up my boat.  I left it like this because friend said he’d be buy to install a new part so I’ve not tidied or cleaned because when work is done on the boat it’s always ugly and all my cleaning and tidying is for naught. Yet I know if I cleaned this boat up I’d feel good inside.
Right now there’s no reason for me to feel bad except that I’m taking incidents from the past and selecting them to bitch and complain about. IF I was truthful I’d now write a ten volume text on how good the week was.  For every negative altercation with a patient I have dozens of positive ones. Ive got so many patients who are no longer doing drugs. All the suicidals who were going to kill themselves in December and January are still alive and all but one is no longer suicidal.  That’s what I used to think of as ‘success’. I used to have these ‘morbidity and mortality’ statistics that showed me I was a great doctor. I loved that my patients with actual physical illnesses that should have them dead were living long past the projections of the physical doctors. I loved that patients were improving with work and relationships and using these multifactorial tools to demonstrate that I was actually involved in their upward mobility.  My c students gots a’s , my drop outs , returned to school., my never going to date again, dated again, my no reason to live, continued to live.  I held their hands for weeks months or years and felt I got them through some tough times. My model was that of medicine. I know the person has chronic obstructive lung disease but with this ‘focal’ therapy I’ll get them over this ‘crisis’ and they’re go on to manage their copd better and will seek help sooner and will know how to get the best mileage out of their beater.  I even overhauled a whole lot of farraris and got the drivers to see how best to get the most out of their life vehicle. I did this for years, an ‘unsung hero’.  We’re all doing this as doctors but now we’re being told that death and stupidity are what we’re supposed to be doing. The slippery slidy slope began with the killing abortion epidemic and now we’re going to off the sick, mentally ill and elderly. The Dutch experience is horrid.  They’ve just turned `180 on their drug policy and yet we in Canada are following them 20 years behind and jumping on their euthanasia band wagon which has shown equal corruption and problems.
So I can focus on these or focus on the positives.  I have a few joints that are in pain but the rest are good. I’m fat but I’m not starving. I can worry about the bank taking $30,000.  The ex wife took a million. The gf’s son in law stole $15,000.  The staff took $50,000.  My renter when I had a house did $50,000 destruction. I’m just rolling the ball up hill all day and having it roll back down on me. I can’t help but believe if I was anywhere but this horrible corrupt and gang dominated port city of Vancouver with all the problems things would be better. But whenever I travel I learn of even worse corruption in the cities I go to.
I’ve got everything insured but I pay $500 or $1000 for every claim and then I pay taxes for the police and courts which say I should be more insured.  It’s all so ‘crazy making’ that I understand why my patients prefer personal insanity to the collective insanity alternative the city offers.
Any external observer would say I have a fantastic life. They’d not want my work but they’d definitely want my ‘problems’ compared to the ‘problems’ they experience in their ‘after work’ lives. My principal problem is getting the work off when i get home at night or have a weekend. I can’t shake the work and get into the present. I’m living in the past and fearing returning to work.  I just read about Jeramiah and the drought.
We have abundance but the world is limited by the wastefulness of men and women.
Here I’ve got duplicates of things with the original lost in a storage locker and me buying a new one rather than spending the day sorting through the storage locker.
it really is time to knock off squeezing the pus out of my brain onto paper.  Journalling leaves the nonsense outside. I’ve cleared my brain. Today I’ll get into gratitude.  I’ll start now being thankful. All that shit is out and it’s just a product of the ‘way I look at life’.  My life is joy and amazing. All life is incredible. God is great. Life is a wonder. Why I don’t see this moment by moment is that I refuse to remain in samadhi and nirvana and won’t just focus on Salvation. Thy will be done, not my will. Live in love and forget about fear.  An attitude of gratitude. Thank you God. Thank you Mom and Dad. Thank you all my teachers. Thank you family and friends. Thank you forest and sea and sky. Thank you governments and bureaucrats and police and courts. Tahnk you pets and Facebook and clothing and heaters and raincoats.  Thank you for life and thank you for my eyes, ears and senses even my nose which is in rebellion. Thank you for breath.  Thank you
Do the next right thing. Get dressed and walk the dog.

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