Journal, Sept. 1, 2015

I would like to wake up like my dog.  Gilbert is always bright eyed and bushy tailed. He wakes happy and excited. Licks my face.  Walks all over my chest, squirms and cuddles me. Then eventually brings me a yellow tennis ball because he knows that will be the first thing I want to do when I wake up.  Sometimes he just drops it into my face in case I want to chew on it before I throw it for him to fetch.
I wake up more grudgingly.  I had great dreams last night.  There's a world I often find myself in, in my dreams, this alternate reality. I return to it often. It's not the toilet where there's shit everywhere and no where to shit or stand. That's a bad dream. I didn't have that dream. No this other place is water, boats, people, dogs.  I'm often rounding a peninsula in a sailboat, anchoring in a sheltered cove.  It's sunny and blue sky and the sea is calm.  I'm walking with a dog near the shore. Lots of meetings with friends and family.  Sometimes there's old people and coffee tables. It's what I imagine heaven as.  I didn't really want to leave those dreams this morning.
If I showed up in someone else's office and described my feelings, they'd say I was 'dysthymic'.  Probably a little seasonal affective disorder, the technical explanation.  End of summer, beginning of fall.  I find my mood fluctuated with the sunshine. Then there's that Canadian thing of fall and winter where the summer is leaving and it's like losing a loved friend you don't see enough of.  This summer seemed to rush by.  I feel like I've hardly had a summer. So much work and stress and anxiety and burdens. They're not even mine but I've carried them.
Just yesterday, on the last day of August I said to a colleague, 'Freud took his holidays in August.  August used to be the slowest month.  Everyone cancelled. Peoples problems were less. There seemed to be more optimism.  What happened?"  He agreed. This August was different.  Troubling.  Less carefree.  The pace was steady at his office too.  No change in the density and traffic and flow.  None of the lulls.  That's what it was for me.  The emotional sound of nails scraping on a chalk board or frozen pane of glass just seemed continuous all year round.  My patients circumstances, often financially burdened, didn't change.  Even as they learned new ways of coping the stresses they were under increased.
We're aging too. Not only are the celebrities of our youth and adult hood dying but friends and mentors.  Grieving is a reason for feeling blue.
Taxes were a trial this year.  The office move was costly and unsettling.  An expanding company growing wealthy with increasing staff and marketting success displaces the lawyers and doctors working in their little office. The big guy has more clout. Our leases come up. They're not renewed.  One can't blame a big corporation wanting to collect from just one tenant rather than a dozen.  But moves are unsettling.  I'm aging and fear I'm seeing change as loss more than as opportunity.
Aging is all about loss and handling loss gracefully.
I didn't ride my motorcycle or take out my boat as much as other years.  The challenge and work of it all seemed unattractive. I chose to run on weekends instead, thankful for the repair of injuries and the returning athletic capability. It's hard though. Everything hurts.  I hurt when I walk to the washroom each morning. All the traumatic arthritis of distant crashes and near death remind me with the first stiff and painful steps of the morning.
When I talk with friends I feel more and more like I'm reviewing the conversations I loathed when my father and mother shared. I tell her I've got back pain tying my shoes. She says her vagina itches.
Only older people 'share' such intimacies freely.  Harry tells me about his hemorrhoids. We discuss infirmities.  All the medical words I learned as a young doctor my friends are now using to describe their own symptons.  I try to remain in denial.  Denial is my first and favourite go to place.
Aging and the thought of dying are contemporary discussions.  I am morally against physician assisted suicide but I know that suicide is never far from my mind.  Homicide isn't that far away either.  Thankfully the Darwin Awards allow me to laugh about all the stupid people. The older I get the more people seem stupid. And truthfully they are. Their inexperience and ignorance coupled with their arrogance is flagrantly thrust in your face. The worst are those with some power.
Daily someone tells me about grandstanding clerk or low level government worker cutting off the heads of others to make themselves look taller.
I find myself back biting, back stabbing.  I speak negatively about individuals and institutions and immediately regret it.  My long deceased aunt who was the executive assistant to the Canadian ambassador in Washington during WWII never said a negative thing against others. At her funeral it was what we all talked about. No one could remember this lovely Christian woman saying anything negative about anyone.  She used to say "if you don't have anything good to say about someone it's best you say nothing."  She was silent at times. We remember that.  But I love that she was so positive and refined.  I would be like her.
I have resentments. I have fears.  I find myself often with one foot in the past and one foot in the future, resenting something in the past or worrying about something in the future, shitting and pissing on my day because I can't get my head in the same room as my ass is.  I'm constantly bringing my mind back to the present.  The present is all I truly have and it's called a present because that's where God is.  Yet I'm a sinner. To sin means 'to miss the mark'.  It comes from the days of archery when the intention of the archer was to hit the bullseye but for a variety of reasons including his attitude he missed.  I'm trying to focus on God and the present and practice the presence of God but all too often I'm distracted by news I listen to with the misinformation and disinformation of the media.
I find myself wanting to enlighten everyone to the lies that I hear. The talk of the economy is put at a propaganda level of communication. There's 'techniques' of misinformation and disinformation that Hitler and later Stalin first ingeniously developped. Then the marketting companies advanced them so that every add campaign now incorporates these fallacies and cognitive distortions.  I listen to the source and hear the 'hustle' or the 'ad campaign' then later in the day hear otherwise intelligent folk parrotting the fashion of the month.  I'm momentarily crazed.  I feel like the human in the alien attack 'Invasion of the Body Snatchers."
But what does it matter?  Stupidity is being nurtured.  Collectively we're being herded.  Someone is pulling the strings. Or is it just as it is.
I struggle to avoid thinking or discussing matters that are 'above my pay grade'.  It would be so easy to be paranoid, knowing one is right, relishing the warm cuddly feeling of victimship and being paranoid.  Even Freud said 'sometimes the paranoids are write'.
But I'm a psychiatrist. I'm trained to 'tolerate the tension of opposites'.  Like the chess player I am I play either side with equal skill. I see the Glass Bead Game for what it is.  Just light and shade. I remember Leonard Cohen's song, There's a war between the rich and the poor, a war between the man and a woman.....there's a war between the odd and the even."
It's the dualism.  It's Martin Buber's I and Thou.  My questions and concerns are always a dialogue with God. We're forever playing hide and seek.  I'm facing death and life is just another state of discussion with death.  Everything is relationship.  I'm just trying to find the laughter and the love.  The "L" words.  Sex is a metaphor for our relationship with life.  Everythign is bipolar, waves and particles, everything in motion.  Finitude is an illusion but infinity and finite are just faces of a coin.
Unfortunately the more intelligent one is the more risk there is for depression. As a great older Christian psychiatrist told me , bitter people are a dime a dozen. "You don't want to be a bitter old man. That's common.'
My friend talks about the obese ladies, first gaining weight then wearing runners and expandable pants.  "They've let themselves go," she says.
Addictions are a way of living with one central fear of death and invalidity.  The existential questions are now poignant for me.  I read Kierkegaard, Camus, and Doystoyevski as a kid, appreciating the art and enjoying the story. Today I wonder if the hundred babies I delivered were good.  Or were half terrorists.  My friends children are drug addicts and drug dealers. I look back on a life of healing but wonder how many of those I healed went on to be criminals and murderers.  I took comfort in my indiscriminate love yet today I question the daily work of rescue and seeing every single person as a child of god and treating them as if they were a family member.  I prided myself in believing I was being a good person treating the devil and the saint equally.  I took an oath 'do no harm' and now with 'physician assisted suicide' being promoted by the Supreme Court of Canada, I'm looking back wondering if all those suicidal people I spent hours, days, weeks and years convincing that life was worth holding on to, well maybe I was wrong.  I could have worked less, made more money, had an easier life, just killing people.  I know the abortionists have a hell of a good life killing babies.  I still have nightmares about the dead baby I delivered. I still have nightmares about the boy who suicided on my watch. If I was a killer at worst I'd have to think about the ones who lived.
The abortionists haven't always got away with their killing. I heard the deformed courageous woman who didn't die when she was aborted.  She lived and told her story. "J'acuse" comes back to mind. The great French story of justice.
But my friend says there's no 'justice in the courts'. The courts are there solely to protect the rich and maintain the status quo. The reformer is the enemy of anyone who benefits from the status quo.  So the whole the beaurocratic system and all the outward appearances of the government system especially the courts are there to maintain the position of the rich and powerful.  They now have a term 'social justice' and it's even more disengenuous. Deconstructionism and constructionism.  Right is wrong. Black is white. I read between the lines and educated beyond my intelligence see what's really being said.  The government and courts are as 'fixed' as soccer and Vegas.
But of course it's all above my paygrade.
If I knew what I know today, would I do what I've done with my life.  Well, I wouldn't have married. I told my wife that her idea that marriage was for a couple and that marriage didn't need kids meant that marriages might as well be gay. I'd married for the sake of family and the women overnight said 'my body my own.'  My baby was killed aborted. I married and raised some women who were only little girls and we played at love and kept each other close covering each others back for a decade at a time. But the children were killed and I couldn't even save the life of my own child. The Supreme Court killed my baby as much as anyone.  The Prime Minister and Queen killed my baby.  And now as I age I'm growing more and more alone. Like millions of other men who daily must struggle to avoid being bitter.
Another man says his son stole all his money and left him to die. Her daughter is using the grand children to maintain her drug habit. Her children get her the money from social services she uses to maintain her addiction.  Obviously if one wants to be bitter, one can chose having children or not having children as the excuse for having a bad mood.
My bad mood is explained as much by anything but I wonder if life wouldn't have been better if I had devoted myself to learning killing instead of healing, Hundreds of my patients begged me let them die.  I struggled through depression after depression.  I helped women get through morning sickness and waddling days, and aches and pains then labour and delivery only to find that the courts and the beaurocrats are going to judge me in my senility on my 'popularity'.  I took over from a doctor who the patients still sing the praises of down here in the Down Town Eastside. He's famous today and I see that he maximized the methadone and opiates he could give, maximized the benzodiazepines he gave and didn't ever really address their addictions, didn't recommend abstinence but just gave them more and more drugs until they died or he left and said he was sorry he couldn't give them more illusion and pain relief.
I expect families will thank me for killing their relatives.  So many of my patients over the years have suffered caregiver burden. I have defended my patients over and over again from relatives who were wanting them dead or committed. I have fought to protect my patients assets and over and over again begged and cajoled to get them housing and treatment and hospitalization.  I now think if I'd just become a lawyer I could have written a law and told the physicians to kill the patients. I'm still struggling with a judge who condemned me for advocating for my patient and the doctors who supported him.  It doesn't matter that years latter my lawyers 'won' and the doctor's role as 'advocate' was upheld. I know this judge as a lawyer had a conflict of interest. All over the lawyers are looking to be in every aspect of our affairs insisting only they can represent everyone. So now we each of us daily need a lawyer who is a beurocratic body guard.  My rich colleagues have them on retainers and some go into the hospitals with their lawyer at their side.
I think of physician assisted suicide as I consider these profound changes in society and the devolution of Canada as I know it. I've read the horror stories of Holland's experience with legalized marijuana, their banning BC Bud, their 180 degree turn around after 20 years of that failed experiment. I've also read how their 'physician assisted suicide' started out kindly then became a variation on Hitler's gas chambers with widespread killing of the aging mentally ill because killing is always cheaper.  The addicts are given places to shoot up because their doctors don't believe in them as humans. They've given up hope. It's palliative care because we'd rather spend money on court rooms and elections and massive government waste and corruption than on authentic health care.
But what do I know. My opinion about what is right and wrong is just one man's views.  The whole of the democratic process suggests that each individual's opinion is equal to another.  So today more and more individuals on the planes I fly on think their opinion is as good as the pilots. M ore and more people comes into my office after a cursery look at internet and tell me what I'm supposed to do as a doctor. Everyone is an overnight expert with a google and it doesn't matter that the research says that all the computer health care programs have a 50 to 80% error range.  It's sexy.
A few of us old doctors at the back of the lecture hall listened to a couple of cute your female academic doctors give a presentation on 'Physician burn out".  They called their talk 'compassion fatigue'.  We joked, "when was the first time you diagnosed yourself as burnt out."
My first year after residency. When I left the university and was on my own in real medical practice.", one answer.
"I stopped counting after my 19th nervous breakdown", the other grey haired world reknowned clinician said.
I said, I've not had a drink or drug in 16 years so I don't know if I'm just being a 'dry drunk - "rest irritable and discontent' or I'm experiencing "burn out".
"Remember that survey a few years back where every doctor said they'd have more compassion if they got the annual $50,000 in back pay they thought they deserved but had been diverted to excessive administration whose role seemed sorely to interfere with medical and nursing care."
Yes I do.
I don't see anyone lining up to work with ex criminals, drug dealers, addicts and the dangerously insane but you notice how people who've never got their hands dirty are the quickest to be critics.
We began talking when the lecture was on, pulled our selves to gether and listened to the pollyanna stuff about getting exercise and getting enough sleep taking more time to keep up with the literature and all this 'sweet recommendations' we usually hear from the College, the day before or after they come up with some recommendation that multiplies every physicians workloads a hundred fold or the government refuses to pay for the increasing aging patient practice.  It's so easy to tell others to do the work.
"I've been hoping for war, " I said after that lecture ended and the three of us continued to talk.  "I ask God for forgiveness but it seems it's the only way that the 'dead weight' is winnowed out of the fat cat systems.  Germany has a better health care system and 1/20 the administration. "
The things breaks down into a poor me and shared expressions of self pity.
"I can 't afford to pay for me kids university and the alimony his mother demands."
And three old doctors all obviously suffering burn out have an ad hock  group therapy session and go off laughing in the end.
The rich and poor, the doers and the takers, the lovers and the haters have always been around.  12 step programs broke down the source of fear and resentment to 'financial insecurity, concerns about ambition, concerns about status, concerns about face and friends, and family."  Mental health is defined as the ability to love, work and play,.
There's infinite amount of work for doctors and never enough time in the day. Our love lives collectively suck and increasingly no one has the time or resources for play.  Doctors can't afford to buy a house in Vancouver on their income.  But then no one can, except those who inheritted or the criminals.
Bitch bitch bitch.
We have gratitude lists to change our attitudes.  I have to give my head a shake minute by minute. I thank God for the light and darkness, the happiness and sadness, sickness and health, the good and the bad. It's only in the contrast can I appreciate the good.  I am thankful for this life. It's had it's ups and downs. I know there are drugs to make everything bland.  The addicts I see are bubble boys and bubble girls. They are living their lives in illusions wrapped in the candy floss of their drug of choice, missing out on 99% of the spectrum of living. I remember when I drank wine, smoked a joint or smoked a cigarette.  Even these are their own valium type experiences.  Living life on life's terms is walking a high wire. It's 'raw".  It's the same with being intelligent. It would be so much easier to be stupid and believe in the 'group think' 1984 reality.
It's like the desire to take the other pills colour in the movie Matrix.  Just live in the Solyent Green world.
Time to get on with reality.  Ironically until they insist I kill people, they have made it law that I pimp for the abortionist, it's not enough that I say I don't do abortions, I required by law to make their killer richer. I expect the same will happen shortly when I say I'm too old to start killing patients for profit and they're say it's not enough for me to say I don't do it but that I must phone the killers and make appointments for my patients.  I wonder if I should go back through my lists of people I convinced not to kill themselves over the last three decades, speak to each of the hundred individually and encourage them to reconsider our decision.  I really think the lawyers in the supreme court should have taken lessons in boundaries and profession and stuck to 'lawyer assisted suicide' rather than telling physicians to kill their patients.  At least in Saudi Arabia they have a public executioner.  Given the way they've been botching up their killing in the court and jail side of the ugly business they probably want 'physician' assisted suicide because they know only physicians seem to know how to get things done. Which is why every restriction is place on us and the system hates and is terrified of us and other scientists.
I have to get back to making gratitude lists. This is always a me and God, I and it or I and thou thing.  The complexity reduces to me and the other.  I'm obviously not in a loving carefree mood. If I surrendered and accepted God is in charge and all loving then I'd feel better.
It's all above my pay grade. As my friend says we're all 'slaves'.  Best to be grateful to be an 'inhouse nigger'.  He laughs at me calling me a 'wage slaves'.  He bought parking lots and made a lot of money.  The parking lot prices outside the hospitals and clinics are always the best source of revenue.
I lack some gene that makes him think like that.  Still I love his humor.  God has a real sense of humor. When you can get your head around that then finally you stop taking yourself so seriously. I have to remember that.