Saturday, February 6, 2016

TGIF - Thank God It's Friday

I love seeing patients.  I love helping and healing. I love listening and teaching and working one on one.  I loved working with groups as much too. 
Yet I've grown old.  I've been working the equivalent of three full time jobs for more than 35 years as a physician.  I began working part time at 16 and full time at 18.  I paid my own way through school working and  with scholarships.  I was denied a bursary because of my parents hard earned assets. I had to take some loans but not like the students today. I remember my parents both working from morning to night. My grandparents seemed to work even harder.  So I've worked.  Along time.  At very difficult jobs. 
Einstein said Genius was 99% perspiration 1% inspiration.
I am today tired at the end of the day.  Really tired. My body aches and my mind doesn't seem to want to concentrate on anything.  It wasn't but a few years ago I did two evenings a week of night school for years to eventually obtain an M.Div or Master of Arts in Theology, whichever way you want to call it.  In addition I have always done hours a week of medical and psychiatric reading directly related to my clinical work.  Lots of journals and searches. Lots of books specific to cases. Lots of neurochemistry, neurology , psychopharmacology and psychotherapy training. Years of applied formal study, writing and course attendance beyond my already advanced subspecialty training (12 years of post high school education and several more medical certifications).
This evening and weekend work boggles my mind today. I don't know where I found the energy.  I am exhausted by the end of my day.  I am up at 7 am and have a commute from Burnaby to Vancouver that fluctuates between 1/2 hour to 1 1/2 hour depending on city administration. 
At work my patients are collectively angry at me for  'running late'.  I am on call 24 hours seven days a week and have been most of the 30 years of work as a physician. Many years I was called into hospitals or clinics. For years I did home visits and answered emergency calls night and day. Now and for some years I rarely have to leave my home. I can answer most questions over the phone.  There's advantages to being in a big city but the generalist -specialist system in the province broke many years ago.  Every patient was supposed to have that Rockwell Painting Family Physician.  Now the patients I see so often are without a physician. They go to walk in clinics where the relationships they have with their doctors is less than they have with their shoe salesman. More often than not as a subspecialist, I'm doing specialist and generalist work.  More often than not I know my patients more than any other doctor.  That's supposed to be the job of the high paid generalists. Meanwhile they're just trying to manage the declining value of their education and their increasing costs of being any physician.
I have had 3 marriages.  Two of the those marriages I was the caregivers of sick wives with sick parents for half of the two ten year stretches with professionals.  I never escaped from work.  All day with depressives and all night and weekend with depressives grieving.  They were over worked and over tired  physicians too and suffered caregiver burden. I was going from work to home work to work.  I suffered 2 divorces in which I was blamed and condemned and punished and humiliated and ostracized and brutalized by society, women and the courts despite the fact that I'd actually entered Canadian marriages, one of the least attractive arrangements for men in all the world comparatively, three times.  Three times I made a commitment and did my utmost best to keep it and failed like 50 % of society who do marry as increasingly most don't.  I could have done better.   The majority of Canadians don't. I lasted 10 years at a time. Most marriages these days only make it to 5 years.  The blessed 30% of society that have long term marriages are rarely 'dual income no kids'.  The women mostly have children and the men are mostly better off financially. They're commonly associated with a strong faith and community support and have parents who stay together and are supportive. My parents stayed together, a loving hard working couple. I married women who came broken marriages with angry mothers or fathers who drank too much. My wives and I drank too much. A lot of Canadians drink too much.  Those who do have a much higher incidence of divorc.
Today men eschew marriage and sharing of their assets since the  great pillage of the 80's and 90's when Canadian women were called the 'best housekeepers in the world' because 'they always got the house.  They also got the children mostly and men collectively were called 'rapists' and 'dead beat dads'.  When men weren't being ridiculed and shamed as a 'class' and as a 'group' they were being told about their 'entitlement' going back generations.
Yet men had shared their work and wages with women and their children collectively.  When women became principal earners collectively they cared for their children but rarely cared for the man as well. A large proportion of the Yuppie women took their high earnings and lived the life they had disparaged in the 'playboy' man, themselves now the 'play woman' enjoying owning their own homes, travel alone or with groups, and some even hiring male prostitutes ('companions') or flaunting their younger (boytoys).   Hugh Hefner is scandalized while the Kardasians and Mila Cyrus are eulogized.  Penthouse letters were scandal whereas Harlequin romance became racy and '50 shades of grey" was the new female Story of O, a Babarella for the girls who celebrated the 'independence' of Hanoi Jane. 
I just went to work. As physicians, male and female, we talk about missing out on whole decades of cultural phenomena.  50% of my class were female doctors.  As male and female doctors collectively had the equivalent of 2 or 3 jobs. Among ourselves we noted that fewer women went into the tough heavy lifting of surgery with it's increased income and more went into psychiatry with it's light lifting flexibility.  None of us except perhaps the government doctors worked an actual one job equivalent.  All of us did the equivalent work in hours alone of 2 full time jobs and some of three full time jobs.  A full time union job is 30 to 40 hours a week.  They have weeks of vacation leave, maternity leave, and sick time.  We have consistently been recorded as working 60 to 80 hours and some of us  100 to 120.  In private practice this is direct patient contact.  We don't have paid leave. We don't have time off. We don't have maternity leave. We don't have sick leave. In public practice the 40 hours may well be half committee and administration.  I saw the least number of patients ever when I worked in government.
By contrast in private practice I'm running a business with increasing demands and costs and frankly given the hours I put into the work I've never made 'minimum' wage. Recently an MD MBA doctor in Ontario published his 2 year experience as a physician in private practice and closed his office and concluded that at most he made $25 an hour and couldn't foresee paying off his education debt working as a clinician.   I've made a half million gross one year but at the end of day I'd lived my work. I'd done the higher risk and most horrendous work a doctor could do.  I'd made myself ill with the stress of trying to meet the demand of patient ever ducking from the bullets shot at our backs by the administration and ministries.  They all 'lead' from behind like the Russian did in WWII shooting in the back anyone who faltered.  Medicine doesn't collectively have an advanced administrative model.  There are platitudes and laws  upon laws and pretty graphs and lying paper work but at the end of the day it's a very 'toxic workplace'.  Hospitals are apparently worse given the high turn over of staff.  All the surveys of medical 'well being' and 'job satisfaction' suck for front line workers.  The government and administration doctors and the high paid doctors who do some kind of lucrative 'procedural' medicine fair better.
More hours for me aren't like union jobs  with time and a half or double time , the work I did was lost to staff and overhead and increasing costs of work till at the end of the year I took home what a worker my age makes for a 40 hours job.  I'd worked over a 120 hours a week in high stress work. though.  My life has been threatened repeated. I've been attacked.  I've had psychopaths make false allegations and lying complaints that have cost me unmeasurably. I've caught deadly diseases and done things and seen things that wake me in the night screaming with horrible nightmares. I did not ever 'cherry pick' my practice.  I just did the work, serving where I saw the greatest need.
Like most people,men and women, who work, I've benefitted from my work. I've had houses and travel and vehicles and outward signs of success in some ways.  But I'm unable to own a house in Vancouver. I've bought houses and been an indentured servant to the mortgage, having no money but paying a mortgage instead of a rent and at the end of the day having 'no rights' with regard to my property, as opposed to houses in other parts of the world. Then there was property tax and a general sense that the whole home ownership 'scam' wasn't what it was like when my dad bought a home which profited him to own and he could do what he wanted on his property without police invasion or being accountable for people hurting themselves on his property.
I ve watched the corruption in society move from gambling and sex trades into construction with the Charbonneau Enquiry confirming what we all thought, that the Bikers and Mafia controlled the city and the construction industry was more corrupt than the sex trade.
I have sat year after year as I saw one person after another ruined by the corrupt system. Everyone pays exorbitantly to protect ourselvesfrom such horrors but the protection units and insurance agencies seems mainly there to collect money.  Taxes have skyrocketed as services have declined.
These generalization seem the stuff of hell. My perception is the half filled glass versus the half empty glass but I'm looking around at those who were criminals and those who took the easy road and those who shirked and I'm still working and still paying for them.
I have this sense, wrongly no doubt, that I am carrying the world on my shoulders and the fear that after all these years of working and being taxed more than 50 % , there's not going to be a bed for me to die quietly in , hopefully with my boots on.  I think horses are better treated than the working Canadians since they can be put out to pasture while physicians all around me live without a pension. Our government colleagues and those who got out of patient care did the smart business moves and got into the big buck jobs and the big pensions.  But the rest of us who saw the patients and did the heavy lifting, since the 'frontlines' are where the horror is, in medicine and in war, we had to rely on RRSP's but the economy collapsed twice and around me 70 year old doctors are selling their houses and returning to work because they lost their shirts in the financial collapse. Those with pensions were protected by the government and their problems buffered.
Those government politicians with 'trustfunds' and questionable morals and ethics did best of course.
Comparison is what ails me.  I compare myself with those doctors who see a dozen patients a week or attend one or two clinics a week.  The Quebec doctors objected to having a mandatory number of patients of 15 or 20 a day. I saw 30 a day when I was a family physician, sometimes a hundred a day in crisis, and as a psychiatrist it's not uncommon for me to see 15 to 20 people a day though theoretically I'm booked  only 8 to 10 hours a day.
I don't leave the office till 6 or 7 most nights, sometimes 8, rarely have lunch, sometimes eating a sandwich talking with a patient, don't get the requisite 10 minutes between patients or the 15 minutes to write notes and never the 15 or 30 minute coffee breaks.
And other than the thanks from my patients I am subjected to constant criticism.  I am in every way 'guilty until proven innocent', vulnerable and tired.
I'm tired. I go home at night exhausted and often look forward to dying to get away from the constant criticism. No doctor in Canada is 'good enough'.  There is no security.  I am not perfect yet there is an industry of lawyers and bureaucrats who are suboptimal at all levels who demand that the front line workers have a standard higher than any of theirs.  They hypocrisy is stifling.
Then i talk to my colleague in the army.  For every soldier who is in frontline combat there are 100 people making a profit from his sacrifice.  He is the lowest paid.  He has the highest risk.  He is lucky if he is killed by the enemy.  One third of soldiers are killed by 'friendly fire'.  One third are killed by the grossest incompetence of their superiors.  "Charge of the Light Brigade." "A Bridge Too Far".  Hitler sending the Germans to Russia without overcoats.  The list goes on. I laugh. My friend who is a psychiatrist in the American military answer to a little Napoleon of a social worker who knows bugger all about anything.  She has me in tears with her stories of this puffed up cock of the walk.  I talk to a wise man, one of the mentors and guru priests/ministers I lean on.  He reminds me that I'm 'worrying about the future'.  Of course I know God is in the present.  If I'm angry and irritable it's probably a fear or a resentment. Resentments are in the past. Fears are in the future.  If I get myself clearly in the day then I'm in the NOW and being in the NOW means I've WON> It's called the PRESENT because it's a gift of god.
My lawyer mind makes a case for 'poor me' and the judge mind compares me with all those selectively who seem to be getting a free lunch.  I describe the middle class in Canada as those who are carrying 2 blue collar babies under each arm and have a couple of white collar babies sitting on their backs while they're the only ones trudging along. Keep on trekking, we say.
And my military friend makes me laugh.  And when I'm whining as I'm prone to do I know all I have to do is throw my shoes into the pile of humanities and most likely despite searching through them all I'll take back those that fit me.  Other's successes come with their failures.  I'm got to stop comparing my insides with other's outsides.
God is good all the time. I have to accept this and have faith and surrender to his will and what he wants for me.  I am a worker and I have worked.  I have pulled my weight and them some.  Those who haven't are the first to criticize.  I find that the more I talk with others who have been there the less cognitive dissonance I feel. The more gratitude I have the better I feel.  There is so much more I have to be thankful for. I really must cultivate more gratitude.
TGIF - Thank God It's Friday!!!!!

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