Friday, May 31, 2019
The head of surgery was a vascular surgeon. I’d do a rotation in predominantly vascular surgery under his direct tutelage. An honor really. I was considered a good assistant so it might well have been self serving. I think all the time helping my father and brother under cars taught me anticipation.
We did lots of aortic aneurysms but the surgery I remember most was the 12 gauge buckshot abdominal shooting. There were other shootings but this was the one I fell asleep pulling back on a liver retractor.
“Gunshot surgery not exciting enough for you, Doctor?’ Hearing my name I startled awake.
“No sir. It’s not that.” We’d been at it for 8 or 9 hours. He’d been carefully removing every lead pellet from the intestinesand then carefully closing up the intestine. We’d already taken out the spleen and stopped what seemed like a hundred bleeders. Now he was delicately moving along the small intestine and integument feeling with his fingers to get all the lead out. It was 5 or 6 in the morning and we’d started the night before. I had already peed in my scrubs. With all the smell of piss and shit I’m sure no one noticed. Falling asleep was noticed. I’d been on the retractor for hours.
“I just wouldn’t want you to fall over backwards and hit your head causing the nurse to feel she had to take care of you, leaving me alone with the patient.” The nurse smiled over the mask at the twinkling eyes of the master surgeon.
A couple of more hours later we closed up. Sponges were counted carefully. All the tools were counted and doubled checked. Then he used a staple gun to close the abdomen, a long incision from chest to pelvis, to have the best view in an emergency operation.
The man lived to go to jail. The other criminal had died. I came away thinking that anyone who shoots another human being should be required to clean up the mess and assist in the surgical repairs. Let him hold the retractor.
I come from a ranching, hunting family so grew up surrounded by guns and had begun competition shooting in early teens. I shot rifles and shot guns. I shot birds and ducks. In my family we also had a rule if you shoot something you had to eat it. So that was a good reason for me not shooting bad men. Te must taste rancid.
But really bullets make a mess and the laws against criminals who use guns are so terribly weak in Canada. When I lived in England the criminals were afraid to use guns because the laws against them were terrific but in Canada the law was easy on gun wielding criminals. I didn’t like it. Any of us who worked trauma had little respect for the bleeding heart judges who’d go easy on gun wielding criminals.
I never saw any gun accidents. Even when I worked in the country I didn’t see gun ‘accidents’. I continued to see criminals shooting each other and doctors like me cleaning up the mess and judges going easy on them. Fact is judges should be required to stand in OR’s holding retractors 12 hours so maybe they wake up and stop playing politics and do their jobs.
I did a month in the Emergency where I”d see knife wounds. My favourite memory is this poor old guy who came in with a long bread knife stuck his abdomen. The police had found him on the side of the street and called the ambulance. The ambulance had correctly not touched the knife that looked like Excalibur standing out of the guys abdomen just begging to be pulled out. The head of emergency told us not to and called the trauma surgeon. All the nurses and staff were so solicitious with this poor guy moaning with this knife sticking out of his abdomen.
Well , next thing the police have found another guy and he’s brought in on a gurney with half a bag of groceries with him. He was found unconscious and had been bashed about the head with a baseball bat. His face was all swollen. The police and ambulance had picked him up nearly delirious collapsed but insisting he wasn’t going to let anyone steal his groceries hence the bag of groceries on the gurney.
Now this guy looks up and sees the other guy with the knife and is almost on him pulling out the knife.
“You bugger that’s my knife’ he’s screaming.
The guy with the knife in his belly is holding onto it and swinging his free arm to keep the other guy away from it. Thankfully the police hadn’t left. So they come back in and hand cuff both guys to their gurneys till trauma, called to hurry, comes and takes the first guy away, The second guy goose necking as he sees the other gurney leaving, keeps screaming “that’s my knife”.
Well, the story unfolds. The first old bloke with the knife in his belly had attacked the second old guy with a baseball bat attempting to steal his bag of groceries. He almost did and would have if the second old guy hadn’t bought a bread knife that day. So when the first guy is winding up to whack him again with his baseball bat the second guy pulls out the bread knife and plunges it into the guy abdomen above him. The first guy falls in the road. The second guy picks up his groceries forgetting his knife and staggered off home not making it because he’s now got a head injury that causes his collapse. Neurology finally arrived to find him and take him from the emergency. They had to bring the bag of groceries or he wasn’t going to go with them despite being still handcuffed to the gurney.
Apparently the two old guys knew each other from the Legion too. The nice first guy was the actual bad guy with while the second guy really was an victim who was lucky to be a live .He had a small hematoma and both guys had surgery later that day with the different services. They were in their 80’s and did their recovery on different wards. No further battles were reported, the nurses taking special care to keep the two old raging bulls apart.
I delivered a lot more babies in my internship. I’d chosen a rotation in OBGyn in the summer time. This was when the staff men and staff women were mostly on holidays. If you wanted to deliver babies, which I did, you, picked a summer rotation. So I was teaching nurses disco dancing and catching babies like they were coming off an automatic ball toss machine. It sounds crude but all our delivery rooms were full. The nurses with nurse wisdom attributed it all to power failure 9 months before.
I had this complicated case where the baby heart disappeared and the staff OBGyn on call was called in for an Emergency C Section. She was that amazing East Indian lady. I was wheeling the gurney with the nurse into the OR washing hands looking over my shoulder at the patient in labour having contractions. The East Indian goddess had arrived and had thrown a gown over her gown. Sparkling 24 k gold earrings. Hair up, booties over high heels she was magnificent. I had been terrified at the thought of doing the C Section on my own. The baby had to come out and this glorious doctor may as well have ridden out of the skies on a white charger.
“We’ve washed enough, “ she said. “Hurry up. Hurry up.’
A surgical tray was being wheeled in as we entered.
No issue of pressure here. She just sliced that belly open like gutting a pig. With finesse. The uterus just popped out like a dive balloon surfacing on the ocean. The anaethestist was still trying to catch up with the gas. The mother was still alert. Another cut and the uterus was open and the baby was coming out. Just a little blue. Cord around the neck. If the vaginal delivery had continued the baby would have been dead.
“It’s a girl.” She smiled. She reached in for the placenta and scooped it up. She handed the baby to the nurse letting her snip the umbilical cord having pointed where she wanted the scissor cut to be. The mother was whoozy. The anesthetist was backing off having hardly turned the gas on..
I was suturing up the uterus. “Big stitches. Big stitches”. She was coming from the other side . Her hands like an automatic sewing machine to my 2 or 3 sutures.
“Now close her up”. She again started from one side like a human sewing machine while I plodded in from my side getting two or three sutures in before we were finished.”
The anesthetist had taken the face mask off and the mother was coming around. She’d hardly been under. She was awake. Her eyes were fluttering. She was reaching up for her baby. Sleepy tired smile.
The amazing OBGyn had picked up the baby and handed it to her having the nurse put her hand on the back of the baby to hold her close to the mother. The mother was not just smiling but glowing. . The mother and child together. No one else in the room. The duo staring at each other. The great waltz continued.
“Doctor, “ a head poked in through the door. “We’ve another delivery.’
“Can you handle it, Doctor.” I was quite overwhelmed but the word doctor was affecting me. I was growing into it. It still sounded like somebody else was being called. “I’ll see.”
“Call me if you need me. I’ll be a few minutes before I leave.” Sometime when I asked how she became so quick and so good, she told me that in India she’d delivered ten thousand babies and done hundreds of C/Sections.
I went on to deliver the next baby with that staff lady ‘hanging around’. The baby was crowning when I’d scrubbed and got in the room . With grace and apparent practice the baby came out perfectly smoothly navigating the turn and twist like a seal. A perfect exit by an Olympic baby. I was only their to witness. Mother and baby were so happy with the performance.
I looked at the window in the door, the OBGyn hair up , dangling gold earrings giving me a thumbs up and a wave. The masked female Zorro disappeared into the night. We all went back to waiting the next delivery.
There was the chiropractor trying to reduce his wife’s pain with last minute manipulations. There was the acupuncturist needling his wife.
There was the guy who barged onto the ward shouting
“Where is she?”
“Where is she.”
He was pulling aside the drapes and looking into the room until his bruised wife I was admitting stood up and he saw her.
He literally charged at her and was lifting his foot to kick her in the swollen belly when I got in between. The nurse was beside me telling him to leave. His wife cowered behind us and I said “You have to leave” . We could see security coming. He was just staring at me with hate. Venomous hate. Then he turned and stomped off the ward evading the security.
I never got the back story. I just remembered the effect of rage and fear on perception. The police interviewed us and asked me how tall he was. I said I was 6 feet so he must have been 6’2 or 6’4”.
“Everyone else said he was only 5’6 inches or there about. »
I could have sworn he was taller and bigger than me,
It was night after night excitement and deliveries. . Every night I was on call we had a half dozen deliveries and I’d get one or two because I was there. Thankfully I didn’t have to do a C/Section on my own. There were more c/sections but these were usually scheduled during the day and I’d assist. No more emergency c/sections. When I wasn’t doing Obs that I was asssisting with cancer surgery in Gyne.
Today most of the cancers that I was doing surgery on back then have cures. Mostly we were end stage and doing what we could to relieve pain. The breakthroughs in research are amazing to any of us who have been around and have memories. Cervical cancer is all but prevented and cured in early stages. Uterine cancers are also detected early and surgically curable. The ovarian cancers are caught early now on ultrasound. cTScan has revolutionized abdominal diagnosis but especially so with gyne.
We had this golden age of female medical and surgical care after the dark ages of women being ashamed to complain of ‘female problems’. Thanks to good public health and prevention women were getting pelvics and examinations and early detections meant people weren’t having what I faced back in those surgical intern days. We’d open abdomens and cancer was every where.
The sad part is that today the Administration and Doctor Police are bowing to feminist and sharia pressure are discouraging doctors from ‘touching’ women. All doctors male and female in the cultural communism gambit are being portrayed as perverts and enemies. “Don’t even ask women about anything sexual unless they raise the issue,” Government is telling doctors. “Women are too sensitive to be asked about sexual matters.” Meanwhile swaggering feminists are crying ‘sexual harrassment’ if any male or female doctor so much as looks at them.
“I don’t examine any woman now.” He told me. Just one of many gp’s saying the way it was. He hadn’t even been falsely accused or had a complaint just didn’t want to take any risks.
“I’d be ashamed if someone else found disease I’d misssed” said a College registrar to a doctor on examination. The women beside me said, “she obviously doesn’t have to pay the rent.” She was an administrator so far removed from reality as to be deemed psychotic. Doctors weren’t worried about ‘looking good’. Clinicians were good and smart but they didn’t want to take any risks with their licenses.
In practice I’d ask women routinely when they had their last PAP or pelvic examination and most would say years. These were women with drug and alcohol problems, high risk, some prostitutes, their principle resource walk in clinics. No doctor ‘dared’ to do a ‘physical’ or a ‘pelvic’ or ask about their ‘sexual’ health or even ‘periods’. As a psychiatrist I made dozens of Gynecological diagnosis a year confirming my history with referral to the incredible OBGyn Crossroads service atttached to women’s and UBC. The gynaecologists were the best but the administration were back in the medieval age with their political correctness and not wanting to offend. GP’s and walk in clinics were responding to the message they were giving loudly, ‘let the women die. Better a million women die than one woman complain. » So the light went out on women’s medicine. I was there to watch it fade
I was so thankful I was there when the days were lightand the profession wasn’t dominated by increasing darkness.
One of my favourite deliveries was with this great blond beautiful family physician. She arrived in to deliver this Portuguese lady who was screaming her head off. The family physician was bigger than the patient in labour. 9 months herself.
“I don’t know why she’s screaming. She seems perfectly okay. Every thing is normal. The anesthetist and nurse can’t see anything unusual either.” I told the very pregnant staff lady.
“That explains the young man and his father I passed in the hallway.” She said.
“What?” I asked
“Two men are wringing their hands and consoling each other outside the door. It’s cultural. The louder and longer the Portuguese women scream the longer their husbands and fathers care for them in the first year. This girls going to have a year or two of loving care the way she’s going. She might even get her meals in bed! » she laughed as another loud keening wail erupted.
We went ahead with a normal delivery. The men’s guilty fearful faces looking through the window at the great mystery of creation.
The healthy baby boy was delivered . A new gurney with ecstatic mother was pushed out in the hall by the nurse.
The beautiful family physician asked the anesthetist for help getting up on the bed.
“I’m afraid I’m going to have to deliver, John” she said to the anesthetist. “My waters broke during the last delivery. I think I’m crowning. It feels that way. » She said puffing Lamaze breathing.
« Would you mind taking over. I’d rather you do the delivery than put the intern out. I suspect it woud be more difficult for him. Could you call the staff lady, Doctor” she said to me as the anesthetist moved to end of the bed.
Thankfully the East Indian staff lady was on the ward. I called her.
‘She’s delivering, isn’t she? I told her, she would . But she wouldn’t listen. Her other three babies didn’t like to wait either.”
I was thankful as she carried on, passing me as she entered the holy of holy sanctuaries.. The adults were gathering and caring for one of their own. The head nurse passed me. The saints were gathering. I sat at the desk waiting, to making notes..
There were no screams. A handsome harried professional man arrived anon. I pointed him to the delivery room. He rushed in. Moments later the happy cry of another new born baby rang through the ward like cathedral bells.
I completed medical school. I remember I did a final examination after being up all night delivering babies. There was no longer any preparation time. Examinations were things that occurred and you had to be prepared for them but your clinical schedule pre empted everything else. Babies needed to be delivered. Ski the studies. Mother’s couldn’t wait. The whole idea of warm bodies and extra hands became critically important in clinical years. Pragmatism rules in the real world of life and death. We all did our best with what we had.
I once did a survey of nurses because they didn’t know. They didn’t know that when we were up at night we were not going to be off the next day. We worked straight through 36 hours then slept and then began another 36 hours. We were one in 2 nights on call when I got involved in student politics. I objected to that and was one of many involved in limited the ‘call’ schedule to one in 3. The survey showed that even the nurses who worked ‘shift’ work 12 hours on 12 hours off didn’t understand. Increasingly because of the dominance of wasteful endless unnecessary administration demands we as clerks and internet and residents were being woken in the night to sign things buses were being told to do so some administrator could ‘cover his ass’. Increasingly we found that what we were being asked to do wasn’t ‘essential’ and never an ‘emergency’ but a whole lot of ‘paper work’.
It was in my internship I shouted for the first time “I don’t care if the goddam chart dies, my first responsibility is keeping the patient alive.” I would be roundly penalized by the new swaggering elite. There competing motto may as well have been, “Who cares if the patient dies, as long as the chart looks pretty!” As clinicians we loved British humor in an episode of “up the Doctor. Ajournalist is interviewing the hospital admistrator in a bran new hospital. “I see you have a lovely new Hospital’a”
“Yes its very lovely
How long has it been opened.
“But you don’t have any paints, Doctors or nurse, just office staff,
Shouldn’t there be patients doctors and nurse in a hospital.
Oh no. That’s who causes all the poblems in the hospital. !”
I completed medicine. I got my diploma. I attended the ceremony. I also felt alone. My wife Maureen didn’t seem to be there for me. I felt that first then. We’d studied together. I was graduating a year ahead. It was a glorious occasion but she wasn’t happy. She was sad because she wasn’t graduating. Suddenly my day, my occasion I wasn’t centre stage. Her unhappiness was competing. She was on the stage not as the triumphant but rather irritated. It was a minor thing but it would grow. Mrs and more I d see the stages with the people doing all the work being pushed aside by this other group.
By contrast my mom and Dad were incredible. They were there and they were so proud of me and I felt their joy and their love. I was centre stage in their world this day. Other days no. But this day they were so proud of me. The picture of Maureen and her Sister graduating in their robes would be ever front and centre but mine ended up in a bottom drawer or lost. My mother and father would display the graduations of my brother and I on their mantel They’d add Maureen’s and my sister in laws too. But in my home I was moved aside. I felt that.
Maureen would arrange the follow up and it was a non event. I would throw a lavish party for her and her friends on her graduation a year later, doing for her what I wished she’d done for me. I’d remember this too as the time I began to ‘do unto others as I would have them do unto me’ with a sort of twist. If I felt somehow that I had been short changed on uncared for I’d do a return in double and greater. I found that I began doing this in my marriage. The sense of giving and taking was shifting. When we began I felt there was equality. I felt through medical school we were contributing to our marriage and life equally but the sexual life was falling. I became dissatisfied. As she moved along in her career she was moving further away from me and more back towards her family. She seemed to only want to have sex every week or two but I hadn’t changed wanting it a couple of times a week. She seemed to treat it as work. I became more and more an accessory. I was fine as long as I accessorize well.
She also wanted to eat out in fine restaurants all the time. I’d know we needed to eat and be satisfied with quick food or a pizza but she increasingly wanted to be wined and dined in style. I was still the one making extra money and the extra money increasingly was going to her desire for fine dining. I’d have these irritating thoughts begin with internship when the actual work load increased but I began to get paid. We were paid $10,000 a year back then. Together we were still barely managing. My friends were saving but she didn’t like to save and she didn’t like to work more but increasingly wanted more and wanted me to work more so she could have more.
I had had to give up giving blood because I’d collapsed and been told I was depleting my own body dangerously. I kept trying to find ways to make money to pay for this woman who was increasingly self absorbed, my princess.
Of course this was marriage and in marriage individuals move to and fro, together and away, in love and forgiving, to alienated and judgemental.
I was looking forward to her completing her medical school so we could get on to having a family. I was doing a surgical residency, 4 years but she was going to complete an internship and have a baby. Carly Simon was singing ‘that’s the way I thought it would be.”
I loved how songs paralleled the inner world. When I’d gone to England with Baiba, Carley Simon had sung ‘you’re so vain’ and I ‘d love playing that on the jukebox in the men’s only bar where I was working as the bar tender, James Taylor singing, I’m just the bar tender” I was dancing behind the bar to the jukebox songs serving shots to old Scots who called me the ‘colonial’.
Now I was listening to Carly Simon still years later. We had our record turntable, the amplifiers and component parts. We had our albums. When we were home alone , the rare occasions, we’d put on mood music. We danced in the living room. Slow dancing. Rumba. Fox trot. Or Jiving to the Beachboys. Joni Mitchell was our easy listening favourite. I loved James Taylor. It was all yuppie fare. I’d later get the Yehudi Menuhin and Ravi Shankar album and play it all the time. I also began by internship to take an interest in classical music. It was simply a progression. I’d love the Scottish ensemble’s Bach Brandenburg concertos. We’d listen more to Cleo Lane. We loved Cleo Lane. Clowns. We’d go to her outdoor concerts when she came from London to Winnipeg. Jazz was so important in those internship days. A flavour more than a mood. It went well with the red wine we were drinking more of.
I did two months of intensive care. I followed this girl who had the highest IQ in our class. I loved her because I followed her on two rotations .ICu was one of them. She had absolutely zero common sense. She’d go onto be a great researcher in a lab somewhere without humans. Because I followed her everyone loved me after a month of this clutz female high functioning aspergers. The stories about her were rife. Given the call beeper and shown her call room she took the bus home. With the first emergency she answered from her home. She thought the call room was for napping. She’d not thought she’d have to sleep there. The buses had stopped running too so she’d only be able to get there the next day.
ICU was incredibly easy for me. Lots of procedures. I did procedures well. The old ‘see one, do one, teach one’ was in play. The staff man showed me a ‘cut down’ and I did the next one by myself then was teaching the other interns. I did countless cut downs, intubation s and lumbar punctures after that. I learned thanks to the great nurses how to assess the comatose and what needed to be done in Myocardial Infarctions and Respiratory failures. We would run all over the hospital with the crash cart and save lives. It was really exciting. I was being a real doctor for the first time, calling the shots, making all the decisions myself and trying not to wake my staff man who was at home sleeping with his wife and kids. Yet if I did call I got these incredible doctors who would either tell me what to do and go back to sleep or tell me what to do and show up at my side within a half hour. Sometimes I’d have another resident from another service, like surgery or cardiology, tasked to help me. I never felt unsupported and the doctors in ICU were all amazing. Everyone had a job and everyone knew it and everyone did it well.
By the second month of ICU I found I knew it all. That sounds ‘arrogant’ but I’ll try to explain. In one month of ICU 99% of what is done daily is repeated. The same limited set of procedures and routines is followed. By the end of one month of learning I was really the ‘senior intern’ or ‘resident’ in ICU. If you watch tv you don’t know this. Everyone is doing the same thing over and over again. It’s not liked Dr. House and internal medicine. It’s not like surgery. In other fields there’s a wide variety of activities and cases but in ICU it’s relatively straight forward. The whole thing is routine but 1% of the time it’s completely unusual and that’s when the genius ICU head stepped in. He saved the day. But the rest of the time it was basic. Airway, Heart, Consciousness. Managing ICU flows and oxygen mixtures was something I took to like a duck to water.
I had one guy who was dead but the family were flying in from Africa and South America so I was tasked with keeping him alive for 3 days. No sweat. I managed his meds and flows and he looked pink for the relatives and then I pulled the plug. I pulled plugs. Pulling plugs isn’t easy. None of this is easy. Lots of folk are critical about the language or the short hand or the way we talk in the front lines. That’s because they are so protected and removed from reality. People are doing lots of near death and death like things in ICU. We lost people. Very few people survive to get to the ICU and mostly when we were called to the ward the person was dead. We saw a lot of horror, ICU nurses get ptsd just like soldiers. Death and more death with the rare life saved.
In one case the woman we were called to on the ward had rigor mortis. Not a good sign. That meant she was dead hours before someone had checked. On the general medical wards the administration had begun to short staff nurses . So I was called with the 99 cart and a nurse to find this patient frozen solid.
Observe is the first rule of medicine.
Palpate is the second.
I’d looked at her and thought she was off. She obviously wasn’t breathing. I felt no pulse
Auscultation is the third.
I listened with my stethesecope and no heart sound. So I thought we were done. If a person’s death is ‘unwitinessed’ and there’s no pulse or breathing when we arrived the chance of resuscitation, even in the hospital was next to nil. If that occured in the community, for a person to leave the hospital required a miracle. We could resuscitate them. We could get them on the machine. I could keep dead people pink.
But they weren’t walking out the hospital on their own steam. That was when I began to learn about the manipulation of statitistics. I learned how politics was used to falsify data, not really,but really. So there was this set of data about who came to and got out of the ICU which made the ICU look good. This was important because the ICU was the most expensive part of the hospital and when I worked there I never was asked to think about the cost of anything. I could use whatever I needed to get a person back to life. I did. I was really good at resuscitation after only one month.
This lady though was stiff. She wasn’t coming back . When I lifted her head to see if I could incubatedher , her neck was frozen forward by the rigor mortis. We weren’t going to get a tube down her throat. We couldn’t even open her mouth. The nurse and I were going through the motions and knew it was a lost case.
“She’s in rigor mortis” I said. He nurse shook her head.
“There’s a new resident.” I said.
“Thinks she’s a hot shot.” The nurse said.
“We should call her.” I said with a wicked grin.
“Yes,” the ICU nurse laughed.
The new resident had already pissed off the nurses talking down to them. The nurses liked me because I knew they were essential and always they helped me. I didn’t have this Me Tarzan You Jane, I’m the officer , you’re the enlisted men attitude. This worked great for me in clinical work because we formed teams really well and the work got done immediately. I never had problems with good teams either, fitting right in. Later I’d have problem with the really bad member of a bad team the bad one keeping the rest of the group down. This is the Union nemesis. But that was years to come. The new resident had dished the ICU staff and me acting like she ‘knew’ everything, planning on being a cardiologist and having done a month of cardiology before coming to ICU.
“Let’s calll her.” I said. “We can hide and watch. This dead person is the best teaching case we’ll ever get.”
The nurse was all for it. Decades of experience in ICU. I was the bad apple. Pranks were still the William Osler thing to do. I was still doing pranks.
We called the 99 again.
She came running, out of breath. and didn’t stop to look. She didn’t observe. She Didn’t stop to palpate. She just put her stethescope on , didn’t hear a breath, pulled out the incubator and tried to get the neck back. We were watching from behind and she was man handling the little dead lady like an Intubation Sally but the neck wasn’t going back and the claw hand was flung up and still she didn’t stop. She was on the verge of breaking the woman’s jaw and neck to get the neck back so she could incubate when I stepped out and said
“Did you notice the tell tale hand” I’d notice the claw sign first thing but couldnt believe it. It was more pronounced.
“Did you happen to notice she was dead and rigor mortise had set in?”
She stopped. Almost cried. Stood up , furious. Screamed at the nurse and I for doing that. I said.”Observation.” Palpitation. Auscultation. If you did the BASICS we’d not be having this discussion. I’m not the one who made the mistakes. You did. So own it and don’t make the mistake again.”
“I’ll get you if it’s the last thing I ever do. “ she screamed “ No one sets me up and makes me look bad. You bastard. You fucking bastard.” She stormed out of the room. She complained to everyone about me but she was digging her own grave. Everyone asked if she’d looked at the body. The nurse backed me and said we’d thought it good training. We really had thought it was a good teaching exercise. We hadn’t thought she’d miss it so completely she almost broke the patients neck and jaw. She totally failed to do all the basics.
“That didn’t go so well” I said to the nurse.
“No it didn’t. We hate doctors like her. They’re really rare but they seem not to have the smarts and these huge egos and don’t take correction well.” The nurse shared.
When she couldn’t kill the messenger she shut up. This was good because the administration didn’t want it out they were mismanaging nurses and people were lying dead with rigor mortis on the acute care hospital wards. The nurse who had called me felt really badly. The resident, after using up all her bullying tactics, actually began to learn. The staff came in to spend time teaching her because she obviously couldn’t be trusted without the basics. I liked that. The head of ICU just cared about patietns and his staff and seeing what a nutbar she was came and taught her himself so he could go to sleep at night sure that she’d not be killing someone or manhandling dead people. Everyone just left me to myself.
“You know when to call for help. You can’t imagine how hard that lesson is for some to learn.” I had no trouble calling for help. I didn’t like to but if I needed help I always got it. I’d spend my career doing that. It would eventually have me pounding on the doors of health ministers and others trying to get my patients help.
The story went through the hospital and the next month or so everyone asked her ‘have you resuscitated any dead people to day.’ She began to laughed when other interns and residents waved at her with a claw hand. She became accepted when she laughed. Everyone made mistakes. The thing was to learn from them.
I just loved ICU. Even the macabre memory of teaching the ICU disco dancing Staying Alive between rows of huffing respirators
Thursday, May 30, 2019
I remember in my final year of medicine taking a surgical elective at Victoria Hospital. Victoria was principally a privately funded hospital the brain child of the surgeon administrator. Even today the studies show doctors make the best hospital administrators so why we have these other people telling what doctors and other health care folk should be doing doesn’t make any sense. It also explains why the Canadian health care system has become a growing nightmare, of waste, ineffificiency, corruption and mismanagement.
The Victoria Hospital ‘big brain’ surgeon at the time figured out what would make a hospital most attractive to surgeons thereby attracting the best surgeons there. It wasn’t part of the teaching hospital system though surgeons would bring residents with them for certain procedures. I was attachéd to the amazing orthopaedic surgeon who loved doing hip replacements there. I was also attached to the Plastic Surgeon who would do his noses and breasts there. It was mainly ‘elective’ surgery. Both these amazing surgeons were glad for an ‘extra pair of hands’. I’d take care of their patients with the nurses who were compassionate and caring.
To make the whole operation run smoothly the surgeon administrator had installed a proto computer system in the wall of each OR which was a checklist of what needed to be done before the surgery could occur, lab, consent, etc. The surgeon efficiently put in the minimum requirements and then dictated a minimum set of notes post surgery. It was almost a paper free environment decades before such an idea would occur.
The government would take over the hospital. My father would almost die there. I’d be driving by on my way home from the university wondering if my father had checked in for his prostate biopsy. As I was working a week on and two weeks off on call in Morris Hospital as a family physician at the time I thought his admission was the next day. A wee small voice told me to turn off and check. It was actually a much stronger premonition, those fay experiences Celts take for granted but don’t discuss in public circles with those who are blind or insane. I just knew I had to check. Christians call it a ‘nudge’. I walked onto the ward. My mom was at the foot of the bed crying. Dad had had his ‘surgery’ and now was in coma. It was actually anaphylactic shock
I opened his lines, called for help and took over resuscitating him. He perked up and began breathing again. He’d been kind of gurgling with little respiration. Not technically dead as he had a heart beat. The nurse called the house officer. The house officer had been my intern the year before so accepted me giving orders . Together we got the meds into Dad , cardiology was called, and the surgeon, well past his shelf life, came by, embarrassed and apologetic.
He’d tried a ‘new medication’ on my dad. He was at that age where doctors try to ‘look with it » by trying the ‘latest and greatest’ without really understanding this. My dad was allergic to the medication. Dad also had a heart condition so that had complicated things too. It was a mistake, not an honest mistake per se, but a clinical error that could occur. If I hadn’t arrived he’d have died though so it was a mystical moment.
I did nothing more as Dad recovered well. His urologist was indeed one of the greats in his and Dad’s day but was falling off. We all worry older about this, going out gracefully. My father and mother were more upset later that I’d made a ‘kerfuffel’ and raised my voice at the staff. They wanted to remind me of how many awards their doctor had received in his day. Dad had no idea what had happened when he was absent. Mom was just upset that I’d hurried everyone.
They had real difficulty with the idea that if I hadn’t arrived and intervened Dad would be dead. I was forever a bad 15 year old to my parents and never ever got beyond that. Except in their conversations with others. Between us I was a teen ager but when they spoke of me to others I was a great man, a genius, a saint. Parents are weird. I was just thankful to God that I’d been called and heard and responded. I would have lots of uncanny experiences like that in the trenches of medicine.
They can all be explained away by those who lack the ‘sense’, the blind have always been able to tell the sighted what they don’t know. I was just thankful for the gift and wondered why it didn’t stay but only appeared on occasion. Like the night I gave 100 mg of morphine to a patient in the ICU and woke from sleep an hour later to realize I’d made a mistake. I had seen in my sleep forgetting to put in the decimal to make the 100 , 10. I dashed back to the ward and asked the nurse.
« Did you give the patients the morphine. »
« Yes I gave them 10 mg as you ordered.’
« I forgot the decimal point.’
« I didn’t see that. I just gave the 10 mg because that’s normal and what they needed. I’d never give a 100 without double checking. »
I loved and still love the interconnected feed back loops and checks within the system. My ‘unconscious’ or ‘my guardian angel’ or the ‘patients guardian angel’ and the nurse all prevented the patients death that day.
I wasn’t at Victoria Hospital when they began to use it for the old people. The government administration were just seeing beds as beds and filling them without further consideration. Victoria Hospital the greatest surgical hospital started to be used as a homeless people place and geriatric ward. The staff and whole hospital weren’t purposed for that. Thanks to the ‘new’ administration Mom almost died because she is a slow eater. To make the government factory run smoothly her tray would be removed before she ate. If her tray was left she’d eventually get around to eating it. But she nearly starved and didn’t get better without fluids or sustenance because no one in an acute surgical hospital was trained to treat 80 year olds. Then an orderly yanked her arm trying to hurry because the factory had a schedule and mom’s arm was broken. Everyone was angry with Victoria and I knew. It wasn’t Victoria Hospital it was happening everywhere. Gross mismanagement.
I’d do two years of residency in Community Medicine and study policy and public health. I could see the gross stupidity and watch all the idiots self congratulating themselves because they’d give themselves these goals without concern for the overall gestalt. Mom became a ‘bed blocker’ because there was a housing crisis and the housing minister was tougher than the health minister who caved and gave hospital beds up to housing. It was a classic mess. Insane really with politicians cock crowing and everyone so far removed from wards but always congratulating themselves and holding parties and ceremonies.
Mom was finally moved to the geriatric hospital, where the nurses and staff were used to old people. She thrived with excellent care but the writing was on the wall and a year later she died. The broken arm had meant she couldn’t get out of bed. A minor injury but in the elderly major. Of course the geriatric nurses would never risk such a thing because they knew so much about mobility but an acute surgical hospital which normally catered to the young and healthy didn’t deal in osteoporosis. The administration didn’t have a clue what an acute surgical hospital and what a geriatric hospital were. They had their pretty graphs and numbers with beds and kept them filled with all the wrong people in the wrong way and congratulated themselves. They kept giving themselves raises and perks. Soon the administration was the highest paid and most pampered positions in the health care system. They would never discuss it with real doctors but would find a yes doctor who wanted easy money and he’d agree with whatever they said to get the check. Often these administrative doctors were the real bottom feeders, lowest of the low, hiding some past and just glad to not have to actually see patients any more. They worked together as ‘nests’ self congratulating and awarding each other for anything but morbidity and mortality, the ‘m & m’ of real medicine and surgery.
I have on several times occasions across the ‘accident prone patient’ . The first time was very unsettling. Everyone of the best staff had made a mistake with this patient. People who never made mistakes. One after another. Things just went wrong with them. Realizing that there was something uncanny with them I doubled checks and double checked everything and was so glad to see them leave. I saw my first ‘accident prone patient’ at Victoria and watched the older staff all register the phenomena while the younger staff didn’t understand why everything was going wrong.
I loved Victoria Hospital when I was there because everyone was happy, nurses, doctors and patients and the whole place ran smoothly and efficiently. There were none of the beds in the hallways and the years of delay to get a scan. It was all ‘sane’. I loved the hospital in my day. But it would change. This was the golden age of medicine and surgery. This was still when the Canadian health care system was world reknowned, when Canadian doctors were admired the world over. We had the best of the British system and the best of the American system.
I’ve had a few « accident prone patients’. They are rare in good settings but their potential for doom increases in messy settings. They really are uncanny and while the chronically negative by the law of attraction can be the worst it doesn’t seem to be solely this but rather a phenomena that can happen to anyone. Once I identified an ‘accident prone patient’ I’d off set their negative spirit or predestination simply by increasing vigilance talking with older nurses who know about the ‘accident prone patient’ and getting everyone on board to make sure the ‘halo’ effect counteracted whatever weirdness they were bringing to the hospital. Smart old clinicians consult psychiatry on these. They’re identified by good staff missing things they never would. They seem ‘jinxed’. Administrators don’t know about them because they’re living in lulu board room world and don’t actually work in the real world. Experienced clinicians would reflect, ‘that’s odd, no blood work wasn’t taken’, ‘that’s odd the BP wasn’t taken’. Just a lot of ‘missed things’. Of course the lawyers loved these people and made a fortune off of their blame and shame and gain game but it had no scientific validity. No one but the clinicians would say. ‘That’s odd, harry , frank and Susan never do that....why would they miss that...etc ». I was ‘interested’ and when I got a whiff of sulphur I’d act on it and up the vigilance. I’d later learn from Freud about thanatos and Eros. Our society doesn’t speak about ‘death wish’ today because the legal game is so unscientific and not interested in anything but ‘blame’. As a scientist I wasn’t interested in blame but rather in keeping my patient alive and getting them better so I was interested in why this ‘phenomena’ occured. It was obvious to the experienced. But try to discuss the ‘accident prone patient’ for their sake and someone will scream’ don’t blame the victim’. And blaming the victim was another problem which would occur along side this so it was even more interesting. My colleagues and I would be ‘interested’ in addressing the phenomena but eventually administrators and lawyers would move in with the accountants and politicians and the gag orders and the lie lie lie deny deny deny and what’s the cheapest solution. So one day we’d have euthanasia as medicine. Odd really especially as these folk would insist that they were ‘loving and caring’ as if everyone else wasn’t.
Once you’re in a clinical setting all sorts of new things that never appear in the books show up. It’s real. The older staff pass on tips to the new apprentics. Secrets are shared. Things that journalists never know are discussed. The things judges never hear are discussed. Late night with coffee and peanut butter the truth is told.
The hospital is a whole little world, like a ship at sea. It’s all tribes and societies. The text books are important but they’re just the tip of the ice berg. When you begin to live in the hospitals you see a whole other world. That’s where the gestalt becomes critical.
At Victoria I had this incredible experience of assisting operations every morning for 3 hours then having the afternoon to read and do surgical medicine. I talked with the patients and changed dressing and mobilized patients. In the afternoon I was doing after care. Sometimes I’d do pre care too. I’d accompany the orthopaedic surgeon to the Winnipeg General for his clinic there as well as to attend surgical rounds. I’d also spend a lot of time attending pathological rounds where the pathologist would tell us what had really been going on with the patient. They commonly found several conditions shutting down and we only knew of one. Wear and tear happened systemically. I loved surgical pathology rounds. The pathologist invariably shared things he’d learn that were like a classic ‘who dunnit’. We’d be thinking the butler and the pathologist would show us it was the chambermaid. Really fun rounds. Lots of surprise and laughter and learning for all. Pathologists are a quirky lot and well reflected on television shows which have capitalized on their personalities.
Victoria Hospital was a wonderful time in my life. It confirmed my desire to be a surgeon. 2 months with the most wonderful surgeons and staff. The Plastic Surgeon was a Harley Street Surgeon, Britains best who fell in love with Winnipeg girl who was vacationing in London. In a fabulous love story this genius followed her back from the capital of the world to the outer reaches and lived happily ever after. He was in charge of the Burn Unit at the hospital and his amazing skill saved countless lives. He’d be called into American hospitals for special cases because his expertise in certain areas was world reknowned. He developed techniques for particularly rare burn unit problems like rotating good tissue around a vessel to place it where the burn had removed all flesh. Things he did then were totally original but today are common and taken for granted. He rapidly became the head of plastics and revolutionized the department.
« I’d the cosmetics here to balance the work on burns. This pays me for a month of work there. Hollywood keeps offering me ultra rich positions to come down and work with the movie stars but there’s nothing like helping a child or anyone really whose face has been lost and I get the priviledge to restore it. In England I’d do that. My speciality was restoring a smile. I had a niche. England was great cosmetic surgery and a burn patient got the best care but here I not only get to operate but I get to develop a department to ensure the burn patients get the best outcomes. Winnipeg has been very good to me. «
He’d then mention the doctors like the Victoria surgeon who were visionary attracted the best of the best to Winniepeg. Winnipeg had this heart in medicine and surgery that would be crushed in time. Peopl who really cared would be bypassed for others. I liked the Osler type greats, humans with big hearts and big brains. Lots of my teachers were like that.
These marvelous surgeons would chat with me like friends telling me stories and sharing the history of surgery, talking about Richardson’s and other families in Winnipeg who had funded the hospital and expansions.
« Winnipeg is a generous city. I’ve know other places where the people are rich but they’ve not cared for hospital or arts. They’re into their own gluttony or hedonism or places around the world but here there are these incredible people that really care about community. I worked in a few hospitals in my training and lived in a couple of different cities but stayed here because of the Winnipeg community. People care here. ’
The Neurosurgeon who was called in to consult on the Teddy Kennedy case was from Winnipeg. His personality was as close to Spock as any man I’ve ever met. To watch him operate though was to watch hands perform ballet. He was a yogi in his calmness too and connected to some ancient source of wisdom. Very few of words. All across the world people would apply to assist him. HE was that good and that famous. One or two would be chosen and they’d be his ‘disciples’ truly blessed and privileged. I was invited by him to be on his team for a month. I ‘d just asked and been accepted.
« You’re the fellow who taught my wife dancing. She told me about you. You can start Monday. I don’t know you’ll see much but I’ll make sure you learn. My colleagues speak well of you. That will be all. » He was militaristic, abrupt. Years later I’d learn that someone like him I worked with would defend me, put in a good word for me, or suggest that others pay attention.
So for a month or two I looked over shoulders and waited. There were 5 to 8 of us in the room. Theoretically if a plague struck everyone before me down I’d take up the scalpel and scissors and finish the extraordinarily impossible surgery at the base of the brain. What was the joy of that experience was the chief resident a brilliant man who loved to teach and said. « He likes you, he doesnt really show much emotion but we know he likes you. He likes us all really. We wouldn’t be here if he didn’t like us. He respects competence, conscientious and care. You are conscientious and care so he likes you but he hopes I’ll make you competent. Few become neurosurgeons but those who go through a neurosurgery rotation become a whole lot better doctors. »
The great man’s wife was gorgeous and brilliant and hilarious. I loved teaching her dancing. She learned everything so well and was naturally flamboyant. She could have been a movie star. A regular Marilyn Monroe. Now to see them together was a delight. HE was so serious and quiet and reserved while she was the life of the party. Compliments. They loved each other deeply each in their own way. The tenderness and mutual respect was so apparent..
I ‘d love to be a student of Dr. Ross, another great surgeon. He was a general surgeon who specialized in GI. My favourite all round surgeon and just a wonderful guy. It helped that my friend to be Frank was his surgical assistant. Frank, a Checkoslovakian whose father ,a doctor, had escaped from the Communists. Frank completed school in Canada and had done his family medicine. He’d continue to do family medicine but several days a week he worked as a surgical assistant. He became Dr. Ross’s principal surgical assistant. I became number 3. That went on for months. I’d even come back and assist Dr. Ross when I was a family doctor, referring cases to him and being invited to assist, sometimes with Frank or without by then.
« It’s the way you handle tissue, » Dr. Ross said. « If you are gentle with the tissue, the healing will go well. » he told us. He’d teach as he was operating. Pointing out things. Always talking about what we were seeing.
When we asked him why he’d become a GI surgeon rather than cardiologist or Neurosurgeon, the more lofty surgeries, he replied.
« I saw how relieved my patients were when they were unable to defecate. Young people know about diarrhea but the older you get the more you know of constipation. Their whole bodies would rebel. Then I’d relieve the obstruction and give them the opportunity to relieve themselves again. It’s quite miraculous really. They were also the most grateful. I done heart surgery, respiratory surgery, all the rotations, but it was the GI patients who were simply the most relieved. They were the ones that sent me cards of thanks sometimes for years and decades later. I thought about that and decided that being an ‘asshole’ surgeon was what I needed to do. It gave the patient and me the most relief and satisfaction. It’s been a good choice. »
We laughed. Surgeons were known for profanity but always well chosen and timed. He’d rarely swear. There wasn’t any hysterics in the operating room either. It was always meditative. I felt like I was in a physical symphony environment. The surgeons would tell jokes or whatever they needed to do to relieve the tension but their hands were always a dance. I loved watching the impossibly fine movements
Dr. Ross was a deeply spiritual and humble man. He took me round each week to talk kindly with his ‘fistula’ patient. « He’s my fistula patient. Everyone whose done enough surgery has one. He deosn’t heal like other or like he ‘should’. Fistulas form just looking at him. All I can do is do my best. I study fistulas always in the literature. I keep up. It’s beyond the present limits of our craft. We’re trying everything we can. I figure fistulas are there to teach me humility. He’s been in the hospital a year. Every doctor has their one case, some more, that they just can’t help. We need to keep working on that one but never forget all those others whose lives we share. This fellow is my nemesis. He’s what keeps me grounded. I would do anything to heal his fistulas and may one day. That’s why I liked Crohn’s and Ulcerative Colitis. When. I was young like you I liked the appendicitis and gun shot wounds. We could do surgery and cure them and congratulate ourselves. If things went well great, if not the patient died. It was always neat. But Crohn’s and ulcerative colitis they just carry on. A lot of what we do as doctors isn’t cure. We provide relief. We comfort. This guys fistula happened after I removed the Bowel that Crohn’s and destroyed but the crohn’s affected the new tissue just as soon as we took out the old. And a fistula occurred.
A smart doctor would avoid the colitis patients. He’d cherry pick the best cases. I’ve just never been so smart. It’s the tough cases that are the most challenging though. If we left it to lawyers and insurance folk or gambling men all these people would be left to die. None of them are a good bet. »
Dr. Ross would talk to Frank and I eye to eye in the surgery before cases while we drank coffee. I heard more wisdom in the surgical lounge often than I heard in church.
I loved the ear nose and throat and opthalmologic surgeons. They showed me what they were operating on through these incredibly huge magnifying lenses they wore on their heads like Navy Seal night vision glasses. They had such control of their fine motor functions that they could literatlly split hair sized tissue structures. My tremor alone would have destroyed that whole surgical space. What would be a ‘familial tremor’ would become more apparent in the coming year.I’d have it investigated and be cleared but it would get under my skin. I certainly never thought of microscopic surgery. The tremor went away when I was doing activities but it was there and I worried it would grow. No one could say for sure.
When I began my surgical internship thanks to my experience at Victoria Hospital and the surgeons I’d assisted I was going to be a general surgeon like Dr. Ross. I thought there was a need in Africa for an all round surgeon. I imagined cutting off gangrenous appendages and saving lives by removing the bad bits of appendicitis’s. I liked he very idea of cutting out ‘bad bits’. I was already in 4th year assisting at surgeries I knew I could do. I was being given the knife and taught where and how to cut. I was closing up the wounds with the assistant.
I will never forget the first time I was offered the scalpel.
« I think you’re ready to make the first cut Dr. Hay’. And there I was pressing down with the scalpel against the resistance of flesh and fearing I’d put the knife right through the abdomen and into the aorta. I hardly made scratch.
The surgeon laughed. « You’ll have to eat more Wheatie’s if you expect to be a surgeon one day.
Despite everyone wearing surgical masks we knew everyone was smiling and chuckling.
« Don’t be bothered. I don’t think you could see my first cut either. Better to be gentle than brash. Harry there hardly broke the skin when I asked him first to cut. »
It’s an apprenticeship. We’d all been there. It was an apprenticeship. Soon I’d learn just the right pressure. The gentle pressure. The amount of pressure that would send a scalpel an millimeter through the skin. It was easier once the empidermis had been passed. The outer layer is like a hide. I’d always be good at minor surgery. I was in awe when the tissue parted and inside cavities appeared.
I began learning these « gifts of the guild » at Victoria Hospital. It was in the doing things. Feeling the needle moving through flesh sensing it entering the vein by the slightest of touches. I’d learn to put in butterfly needles in babies’ skulls and a few years later save a dozen or so with just those needles when I was faced with a meningitis epidemic on an Aboriginal reservation. A minor skill that I did over and over again for a week and all the kids lived with only one having minor mental impairment that would resolve.
I’d follow these surgeons who were teaching my hands to feel to ST. Bonfice Hospital and Winnipeg General. That’s where the emergencies occured. That’s where the chaos reigned. That’s where there were residents and interns before me. That’s where as many as a dozen would be in the room. Sometimes we’d even sit looking at the surgery from arena seating. The more I knew about the surgery the more I admired the surgeons and what was being done. They really were the greatest athletes I would ever know. Their bodies were their instruments. Their hands and eyes Olympic standard.
My first year was a Surgical Internship. I was accepted into Surgery. I’ve written elsewhere how unusual the interview was. All questions about what I’d done with my hands, like my hands were being interviewed, my fixing bicycles and cars and working on macrame all more important to the surgeons than my academic straight A’s.
I’d also get accepted into OBGyne and Pediatrics. I was approached by Surgery, OBGyne, and Pediatrics but not by Internatl medicine. I might have been able to get a position in the latter but everyone knew I wanted to ‘cut’. I also continued to not have enough respect for the detail needed for internal medicine. I’d learn this respect later in residency. Psychiatry and Community Medicine were medical specialities. Psychopharmacology was all about detail. Neurology was detail. Everything was detail but I only grasped the importance of the decimal and zeros when I was a year or two older. I wanted to cut and I loved fixing dislocations and putting on casts and doing sticking needles everywhere. I loved the ‘doing’. And I’d have that other unusual capacity of thinking in an emergency. I excelled there and in ICU. I could function under stress. It was something that was necessary for surgery and I had that. It would be a while before I’d get that skill which came with reflection, the essence of internal medicine considerations. . Then I was really interested in the practical and pragmatics..
The women really liked my care of women. I had great female teachers. They celebrated my egalitarianism and were impressed that I championed them individually. I was loved by the children . I’d organize students to do visits to the pediatric surgical wards. We’d do our various entertainments. A number of us had funny song and dances. Thèse things were noticed. Like my spending Friday night in the Emergency when I learned I could assist and gain valuable time learning there. I thought everyone would be jumping at this but less than 10 of us in the class took advantage of it. I loved helping with the children. Little people. Big problems. The trouble with that was that I feared I’d kill parents. I couldn’t stand seeing parents who harmed children. I knew it would not be a good fit. Despite being asked repeatedly to join Pediatrics I stuck with my surgical plan and thought maybe I’d do pediatric surgery one day. The gynaecologists liked me too. I’d met them delivering babies. I’d delivery a dozen or more in my fourth year.
I remember St. Boniface Hospital and the deliveries. They just came. No holding up those trains. I’d be delivering a baby with a nurse simply because the OBGyn was doing a C section and the resident was doing a difficult delivery’s and the nurse and I were left with the easy one. Often the family physician didn’t get in in time. The nurse would call me to gown up and we’d be off to the races. I loved obstetrics. I loved the OBGyn’s too especially this beautiful EAst Indian doctor who told me she’d delivered thousands in her home country before she came here. I liked people who shared numbers not as a brag but as a means of sharing experience. I’d delivery a hundred babies before I stopped doing that and one day George my family physician my best friend would say he’d delivered a thousand or two. Without the ‘numbers’ you didn’t know.
My brother ran a marathon. I never ran a marathon. I know what it’s like to run a half marathon. There’s a whole lot more beyond that. Only people who’ve only run a mile know it all. Experience is humbling. .
I wanted to cut and the cutting crowd wanted me. I was happy about that.
For the next year I’d focus solely on the physical. It was a great year. I loved the learning. I always loved the learning and still love the learning. I especially loved hands on learning. Surgery was the very best hands on. All the surgeons I knew could have been great musicians but only the greatest musicians, like Ravi Shankar, Yehudi Menuhin could have been great surgeons. I was happy to have played in the band.
Wednesday, May 29, 2019
It’s a dream thinking back to those years. All I did was study yet I don’t remember the lectures and studies so well. I believe I could if I focussed .They’re just beyond the veil. The first two years of academic medicine 23 to 25 are mostly a blur.
I believe I was married then. The wedding doesn’t even sit still in my mind. Just glimpses beyond the veil. Maureen was so slender. She had this magnificent white gown that so became her. The perfect bride. The bridesmaid, her identical twin Susan, and Debbie were beautiful. Jon and Fern were great. The song and their singing and guitar amazing. I remember I had tails to my tuxedo. We danced Viennese Waltz after. Straus. I remember a photograph of us dancing and we really are spectacular. Viennese Waltz is. It was all so elegant. My parents were happy. They liked Maureen. There was dancing. Somewhere there’s an album of photos. Photos and mementos stir the memory but I don’t really want the stirred memory .I’m just curious today what surfaces.
I remember the summer we drove out to Banff with Glen and his wife. I don’t know when that was. A year later I’d be an intern I believe. Hiking in the Rockies was a glorious week of comarderie and charm. We had wine skins and climbed all day to the top of mountains, day hikes, then we’d descend at night, faster going down. We had tents and made big fires and barecued hot dogs and steaks. There were barbecued marshmallows too. We drank red wine. I had my pipe. We sat about at night in the glow of the fire. Happy with the exercise. Our friendship, camping, the day hiking. Then we drove home.
Maureen taught me to drive when I was 25. We got an old Pontiac or Buick from a family member of hers, some aunt, a very cheap old car but in good condition. My father had been unable to teach me to drive .That’s a whole story in itself but Maureeen was encouraging. Gentle, intelligent, encouraging. She was a natural teacher. A truly inspiring loving person. I am forever thankful for the formula her father taught her for backing into a parking place. Pull along side the forward vehicle. Turning the wheel of the car backing up watching the driver mirror, stop when you see the inside light of the vehicle behind then go 1 or 2 feet further then spin the wheel the opposite direction. It’s snug. An amazing gift. Her father taught her brother and the sisters. My father was a great driver, especially long distance. He didn’t know how he parked perfectly, never unpacked it. Maureen did. I’ve used that little ‘trick’ ever since. I can park a car anywhere. Not a trailer or something else, that was my father’s forte. I don’t have it. My brother was a safe driver. I wasn’t. I survived my driving. I drove a lot. Everything. Fearlessly.
I remember making love to Baiba one night coming home from the theatre, at Portage and Main. I was in a parka and she was in a long fur coat. We leaned against a building. The wind was blowing. This is the coldest place in the world. 60 degrees below zero windchill. Leaned back against the wall and pulled me towards her opening her coat and lifting her skirt. We made love standing with her moaning into my ear. The great policeman in his beaver coat came around the corner walking his beat.
‘Everything okay there? » I just froze
« Yes sir, Baiba called back her voice silken and smooth and so sensuously aroused
Alright then. » he answered embarrassment tinging his voice as he hurried along.
We completed the act , tidied ourselves up, bundled against the cold, carried on
It’s memories like that which remain and come to mind when I’m with a different wife or girl. It’s like I’m visitting Texas and I think of France. I can’t share these thoughts. ‘What are you thinking? » Well I was having a good time and another moment came to mind.’
I’ve been so punished for my thoughts. I’ve been told over and over again how wrong I am. I’ve been told countless times what not to say. I’m still being told to be quiet and shut up by the young now. I admit I thought there’d come a time when we’d be ‘okay’. But I sometimes long for death to get beyond the constant criticism, usually in the tones, the haughty judgemental expressions, the rolling eyes, the turning away. Never okay. Never good enough. Always a social blunder. Meanwhile the judgemental have rarely the experience or training but ‘just know you’re wrong’. Now it’s more and more junior doctors or people in generally speaking authoritatively about things they know diddly squat about. I usually ask them now how many cases of whatever they’re going about they’ve done or seen. The ignorant are always the most certain. Meanwhile I’m always self questioning and double checking and even when I get it right wonder if I’ll be able to do it again. I thank God a lot.
I know I’m not alone. I know these ‘perfect’ people might not even know how ‘loud’ they are when they are critical of everyone around them. I’m sensitive that way. It took me years to ignore it and just carry on. I see a lot of ‘sensitive’ people who are wielding their sensitivity like a weapon but rather just trying to squeeze by.
Women, like my second wife, and many of those since, have been secretly ‘hostile’. My last wife was outrightly covertly aggressive. A drug addict crazy lady who actually tried to kill me and would have if I hadn’t had a sixth sense for imminent danger. I usually have to assume that I ‘had it coming’. Though often I really don’t know and a lot of people like to « save up revenge, it’s best served cold. » I’m usually operating in the here and now.
I remember the sex after my second wedding suddenly over night mostly going stale. It wasn’t me. We joke among men and say what is the greatest sexual turn off for a woman? Wedding cake. That would be the case then. Not my first marriage. But the second marriage this ‘respectability’ suddenly took hold. She began to act like her mother. Of course when I pointed this out it was the worst thing to do. But I just couldn’t understand where the carefree teenager had disappeared too. Work took it’s toll no doubt but I’d learn from Dr. Talbot years later how common it is for professional women to take their husbands for granted. Female doctors were the worst for putting their husbands as least important. Not just women but a lot of people have this tick box thing going, okay married, tick, next house, tick, next cruise tick etc. My father said I didn’t do the maintenance on my cars and I believe he meant relationships. I’m not alone. We’re a throw a way society. We consume and use people and things up.
On vacations, camping in tents, or in hotel or motel rooms there’d be a rewakening of the passion but it ‘s absence was literally palpable to me . A switch had turned. Sometimes it would turn on again. But it was never the same. I also remember she was totally against oral sex and yet I was hours and days and years between her legs while she tried to orgasm. Before marriage every night. She always orgasmed then. After marriage suddenly I was slave to her desire. Marriage and for the first time I had to beg. « You know I think I’m better looking than you,’ she’d say. « I think more men would want me than women would want you. ‘ she’d say. I’d agree but it was a odd way of thinking to me.
The patients I saw as escorts told me ‘we’d be out of work if married women had sex with their husbands. ». My favourite joke was how ‘Church ladies are the worst. They eat and become obese.. Their men drink and the men come to us for sex. ».
I wonder if my mind is true in this regard. It’s true that when I’m on the peaks I can see all the valleys but when I ‘m in the valley I can see little of the peaks but feel the gloom and darkness all around me. I believe that we had great sex and a great marriage for years. It wouldn’t be till after medical school I became critical. That’s why I wonder about my memory. Because we divorced, like everyone who divorces. I suffer from ‘retrospective falsification »
I’ve had patients bring in their wedding albums and insist they never loved, they were the wrong person, they faked the smiles at the wedding. The fact is we marry the greatest and best love we know today. It’s like buying a car. We might see a Ferrari sport car or a diesel truck but end with a Honda Civic because it’s the right choice after all the considerations. She was right for me. We grew apart. We changed. Perhaps with proper maintenance or time I could have got ‘feeling back’ but I lost it. I’ve been the wife in two marriages to doctors. I’ve cooked, cleaned, and made twice the money and still begged in the bed room. I had resentments. Increasingly all I’d hear is how bad men were. It wears. I was doing as good a job as I could, being as good a man as I could but I was never good enough. I’d learn later a lot about alcoholics and alcoholic families. I began as the untreated al anon and later fit the other group better. The ‘family’ disease model was good. I liked women from alcoholic families, bad girls. My own family wasn’t like that. I was the black sheep there.
I understand now why Christians encourage the marriage of other Christians. I was continuing to pray and meditate and she was until the end of our marriage not interested in anything spiritual. « Girls just want to have fun’ was her anthem while at work she was amazing. A truly gifted doctor. Off work a fun seeking. And I was dull and serious and intellectual and full of myself a lot back then. Perhaps still am. It’s hard to see yourself but I realize I’m not a lot of fun because I’d often be in on these political battlefields.
Like Meditobans. Some Jewish aetheists with classic Marxist design had usurped the student paper and were publishing monthly diatribes against us all. Really bizarre. Their parents were wealthy and they were in medical school and totally into consumerism but doing that ‘dress like refugee’ gig and acting like they cared for the poor and actually published stuff like ‘stop the running dog capitalists’. It was all that was in the paper. I objected so I took it over. Got on the board. Took a vote, Did a survey and became the editor. Everyone hated these assholes but no one did anything about it. Mostly people tolerated a lot of shit and now years later I admire them for their tolerance and gastrointestinal fortitude. Everyone was thankful for my stopping the propaganda pillage and getting a variety of students to write about what was interesting to them. The paper became ‘democratic’. But these communist aetheist nutbars would be rich see no hypocrisy in themselves or their ardent causes. My friends and I would on about this and Maureen was just wanting to have fun and worried someone would be offended and why can’t you just get along, let things go.
There was dance some guys at the lake threw. Everyone was going on about how great these guys were putting together this dance for everyone. They were playing the victim. Getting laid by self sacrificing their time. But my soon to be brother in law was an accountant. I’d organized dances and coffeehouses so did the math. These ‘golden boys ‘ were making thousands off their friends .It was their ‘business’ and I would have not got involved but they want to play like they were a charity. Now I know this is the great scam.So many are doing it. Let’s pick a cause and make a fortune off it. My favourite enemy. I’m like a dog and a postman when I see this happening. So there it was. I checked out my calculations with my soon to be brother in law and he said yea they’re taking thousands for themselves.
So at the next meeting I asked what happened to the thousands made each year in thes ‘for profit’ endeavours. I thought it was great. I didn’t mind but if it was a ‘charity’ shouldn’t it go back into something not the organizers pockets and how was the distributions.
The next day a guy ran me off the road in his black pick up truck. I was bicycling to work 20 miles a day.
I was getting my bike out of the ditch, my knee scraped and bleeding, staggering up onto the road. This guy was swinging a black jack and began hitting his hand with it above me. I’m looking up at him. At a distinct disadvantage. I figured he would take me without the billy club but with it I was likely to lose.
He said to me, « We’ve got a good thing going here each summer. We throw this dance. We make thousands of dollars and split it among ourselves and because we’re such good guys we get fucked by the young ladies. Then you come along and think you’re going to fuck this up. What do you think is going to happen to you. You ride a bicycle to and from work each day along these empty stretches of road. You can have an accident really easy. »
He got back into his truck. Drove away.
I told my friends about the encounter. It wasn’t worth it. I’d encounter these scenarios routinely. Years later I’d see activist thinking they were challenging the system. I’d ask, « Has anyone threatened your life. Have you been shot at or knifed. ». No they’d say. I’d say ‘then you’re working for the man. ». They’d never understand . Useful idiots.
Wives don’t care. Girls just want to have fun. I was ‘heavy’ back when I was learning the way it was. Also getting in trouble with the ‘man’ still believing things could change not believing the lies. I don’t think I was easy to live with not that a female doctor is easy to live with on the best of days.
I’d find in later years I liked to get away from professionals . I liked being in countries where people didn’t speak English. I relaxed when I didn’t have to think. I was always questioning and being questioned married. There’s an expression, stop pulling the plant up to look at the roots. « Live and let live wasn’t an expression I understood back then.
These years of studying with her were overall such joy yet I lost that joy in the later bomb of divorce that took the good feelings in a large crater , like a nuclear explosion that goes out from the centre and kills with the blast and the radiation. I know I loved these years studying. I know we loved being together.
Now see, I tweaked a memory out of the darkness. Here it is.
We had this old apartment by the Red River. It was quaint and had terrific character. We loved it. We were so happy there. We bought furniture. We nested. Our friends came for dinner parties. Dinner parties are what I remember best with Maureen. We had these great friends and had great yuppie dinner parties. They began in that first apartment. Planning meals and shopping and following recipes and having the meal and then discussions and sometimes dancing after but more often sitting around listening to music, sipping wine. I remember with great fondness the importance of the stereos and the album collections and choosing the right selection of music. Ambience.
What was so memorable about our first apartment t was our gay neighbours had their bed above our dining room table. More than once they’d become amorous during a party and we’d laugh and have drinks in the living room. The funniest night was the first time this occurred when her family were visitting. Her mother was quite shocked.
« Oh, my! » she said when the chandelier began to bounce.. « I thought only two men lived upstairs. ».
« They do. ». Maureen said.
« Oh, my. » her mother replied. « They are very loud. »
They really were and the dinner table was silent till the moans and squeals came to an end.
As usual Maureen’s father ignored everything. He was a quiet alcoholic man whose wife spoke. When I’d see the Mrs. Boughet of English humor I ‘d think this did a great job of depicting him. He had a sly wit and my father and I enjoyed him when he was away from his wife. A thoroughly beaten down man. Apparently he’d been loud and violent when younger but now he was the other kind of drunk, after the wars. Self effacing.
The same thing occurred when my parents were over and Dad said nothing but mom kind of clicked her lips and teeth. She had this ‘click’ that rarely appeared. It required severe aggravation to bring it out. Not a’tsshss’ but rather a ‘clisstthsi’. She shook her head. I was glad the neighbours were having a quickie. It didn’t go on that long. Other times it really did go on and on.
We took coffee and tea into the living room.
Fred Penner the famoous Winnipeg children’s folk singer who’d go on to have his own tv show lived next door. I knew him from the folk music days and would always enjoy greeting each other ,coming and going, taking out garbage, brief chats.
As a medical student I had a certain cache. As two medical students we actually had social status. I’d not see this as a doctor and know that I was envied by some and others thought being a doctor came with high social approval. What they didn’t see is that as many took advantage of doctors and treated them abysmally. It was such a curse that most of us avoided sharing we were doctors in Canada. In the US being a doctor was out and out admired but in Canada it was treated like we’d ‘lucked out’ and not that we had worked and saved and got A’s.
There was this existing class system in Canada, the blue collar and the white collar. As middle class we were seen as getting everything on a silver spoon. In fact that simply wasn’t the case for half the class. It was also apparent that people liked to go to the bar and watch tv and do the least work and didn’t get into medical school because they lacked smarts, smarts certainly helped, but most were relatively lazy. We’d all seen this in sports when those who excelled simply put in the hours and time. They had to have the basic ingredients but so many did. What differentiated the top notch was the work. But in Canada the mediocre felt entitled to the rewards of the great and the ‘tall poppy syndrome prevailed’. This lot made themselves taller by cutting off the heads of others.
Yet in medical school there was an edge. People were competing to get in. I was one of a hundred applicants for my spot. I felt it. Maureen and I were ‘different’ in a good way. Being a medical students was socially approved. We were well thought of together.
The owner of the apartment complex was an ass. Later ‘rent evictions’ would become the norm of ‘clever businessmen’. They were uncommon back then. We were late a day getting back from vacation and didn’t get the lease renewal in by one day. He evicted us so he could raise the rent. Young married couple, in medical school, the best of tenants. And for a few shackles this ass evicts us and wouldn’t accept any explanation. We even offered to pay a higher price. But he was intransigent. He’d already rented the place. Moving in the middle of medical school was a huge issue.
Now this is a very fond memory. The place had the most picturesque hand carved bannister leading into the apartment. We were just leaving when the new tenants , a rock and roll band, drunk and stoned arrived. They had a piano. They couldn’t negotiate the turn on the stairs with the bannister. So one big bearded guy simply got an axe from their truck and chopped it down. He then chopped a bigger hole in their door. Now the piano got through. We loved that we got to see that. Loud loud music rocked the place as we drove by in the year to come, police cars flashing lights, it even got into the papers. A regular zoo. Whatever the landlord made evicting us he lost 10 times over.
We laughed at the ‘rent eviction’. But we didn’t find a nice place. We had no time. There was no room for breaks in the study year. This wrench had been thrown into a very tight schedule so we took the first place we could get and lasted there a matter of months. It was a 5th story walk up without character and just a box. I hated it and later would do everything to avoid being in such a cage again. There is so little one can do to make a box appealing. Apartments can be so great with an off side wall or some architectural consideration. But this was just a box.
I remember it because we moved with friends. It was always friends back then. We were always moving each other. We all had heavy brick bookshelves but it was the books. Boxes and boxes of books. All over the world there are professional men with back problems from those years when we moved each other’s textbooks and other books. The library was sacrosanct.
To get a work crew you offered food and wine. The move would last hours on a Saturday but the trouble was that last load after a bottle of wine. Well on this occasion, I just figured carpets and bedding could be thrown out the window on the lawn. It worked well. All the unbreakable stuff that was left for that last move went out the Fifth story window. My male friends and I who’d done hours of heavy lifting thought this was genius and fun. Maureen was not impressed , screaming about the neighbours and worried that some damage to sheets ‘might’ have occurred.
I’ve been condemned all my life for things that ‘might have occured’. The world is full of insane people who criticize others on the basis of their psychotic fears about what ‘could occur’. Nothing occured. Everything was fine. Nothing was broken.I talked nicely to the police who were called by some terrible biddy neighbour who hadn’t liked the noise we’d made moving, feet pounding up and down stairs carrying tons of books but the mattress towels and sheets and carpets and clothing flying out the window had done her in. The Police were satisfied with our explanation. As men we all held our backs and laughed .
I remember too that I took flexeril for the first time the next day and proceeded to drive through a red light completely unaware and would have remained so but for my passenger, who said, ‘you’ve gone through red light, and we’re going through another.’
I never drove on flexeril again, warned everyone about the effects of driving on benzos and flexeril. I get tunnel vision and lost interest in the bigger picture. I simply didn’t see the red lights. I was focused on the road and where I was going. Now that memory is there. But so many are not.
We rented a house after that horrid apartment building. The house was perfect. It would lead to us buying our first house. The rental house had been so enjoyable. We loved the back yard. We loved not having neighbours inches away on the other side of a wall.
This was all going on while we did medical school, studying together, after classes on weekdays and for a requisite number of hours on weekends. In third and fourth years we’d start not seeing each other as clinical rotations took us apart.
1977 was the year that Saturday Night Fever came out. My friend who went on to own the Arthur Murrays franchise called me up. He was always trying to get me to work. If I could get away from my medical clinics I’d swing by the studio and sell some dance lessons. It was a skill and I was highly successful at it. He’d also get us commercial work. We had done the Englebert Humperdinck record. He’d needed four dancers dancing Viennese waltz in the back ground and we each got $100 for an hour of work. I’d brought Maureen insisting she could dance well enough to do the role. It was her first television commercial. We’d love seeing it come on the tv at night and us hardly recognisable in the background of « Les Bicyclettes’. » She was beautiful.
Now Saturday Night Fever was just opening and he wanted me to come see the opening because he’d caught a glimpse of the dance in a preview.
»It’s the best dancing I’ve ever seen on film since Fred Astaire and Ginger Rodgers. It’s a new dance and it’s going to be big. ». I still love to see Travolta dance.
So there I was Saturday morning, not studying, but watching Saturday Night Live at the theatre with my dance friend. We watched it three times. We did the routine in the aisle. By the third time we had it down. In that moment I became ‘Disco Doc’. Arthur Murray’s got the jump on everyone selling ‘disco dance ‘ lessons way ahead of the curve.
It would be a sensation.
I taught Maureen and sure enough when we went out to the night club the next Friday it was like dancing years with Baiba all over again. Everyone cleared the floor and watched us dance. All our drinks were paid for. The actual disco moves were counter intuitive so not easy to get. Looked far easier than they were at the time. Truly original. Martha Graham dance. People then just couldn’t seem to pick it up unless they were already professional. But even then it was counterintuitive like hula dancing. The difficulty at first gave it it’s powerful appeal. Once you ‘got it’ in the ‘aha’ moment it was there forever.
I’d get asked to teach everyone to do the disco routine and after a night teaching a couples of our friends got the idea to run a class for medical students charging $10 a night. I needed the money. 10 couples and 5 to 10 classes in the next weeks with rent to the hall and Maureen helping. I think we paid off her stethesecope with the proceeds. Everyone was happy and years later the medical school classes would want me to teach them waltz so they could have a proper graduation ceremony. The result really was West Point military grade graduations thanks to my teaching the basics to everyone.
The medical students were all the first doing disco in town. It was great to be a part of the times.
Beer and Skits was a great competition between the Medical school years. The third and fourth years always won. So some of the guys approached me to help us win. I wrote a script called ‘Scar Wars. ».Star Wars came out in 77. Our rock musician got together a veritable orchestra and wrote a series of spectacular songs. Almost all of the class would be involved in some way in the production by the time it went ont.
The pornographer approached me with his camera and wanted to take pictures of the staff and plug them into pornographic films he’d made. The trouble was getting the staff standing, talking and bending in positions which he could splice into his films. He was a professional. It was felt that I could convince the staff to do things for my script. I didn’t mention the pornographic film. We just went around one day with my friend and his highly professional movie camera and I convinced the staff to do ‘things’.
Dr. Naimark was kind enough to jump off his desk and this became a scene where he was jumping into a bed of naked women. The best though was the emergency doctor, our favourite guy who was very New York with three gold chains around his neck. Now I knew nothing of how these shots would be used but my friend wanted him sitting and leaning forward, leaning back and leaning forward. The film ended with this number. He was spliced into a shot between a big breasted naked woman’s legs performing cunninglingus.
It was a great show. I played C-3PO my body painted in gold . Three of the blond beauties in our class, these guys who had gained overnight popularité as the Doc Hollywood characters wanted to do a disco dance half naked so I taught them the dance and they performed. They’d been doing these strip tease dances for the nurse parties and had their whole pop star following. They were really good and really hilarious. It was a great bar scene.
There had been ananatomy professor who did a very fun documentary type discussion of the history of ‘nudity’ in the beer and skits over the year, on stage with his pointer and pictures of previous beer and skits. He described the progression from the quarter moon to the half moon. It turned out the class before us had had a dozen students’ half moon’ on stage, pulling their pants down to show half their butts. I simply said if someone was willing to do a ‘full moon’ on stage we’d definitely ‘win’ that round. The top female student, very reminiscent of Sheldon’s girlfriend on The Big Bang Theory, very serious and not given to frivolity surprised us all and stepped up to take one for the team. With half nude disco dancing, a full moon, great costumes including mine, actual professional choreography, I did the stage movement and had all that training, and this amazing rock orchestra, well we simply blew the competition away and were an unforgettable sensation that raised the level of Beer and Skits for years to come.
I just loved all the humor my colleagues showed and seeing the amazing talents that no one knew about. Our quiet paediatrician to become was a serious violinist. The three blonds dancing stole the show but the ‘full moon’ was the show capper. I was pleased. I liked writing the Scar Wars script. I liked my little C-3PO part and I liked directing such smart talented people. I just had to say what I wanted and everyone did it. No explanation, no herding cats. People just performed the best and it was this organic success. The porn film was a piece de resistance , a great roast of the staff. It was so much fun.
It’s so sad that that was probably one of the last years laughter was allowed in a Canadian medical school. Overnight the front line staff, the doctors and nurses, were pushed aside along with the patients as a whole. The lawyers and bean counters moved in. It was all about administration. The politically correct took over. William Osler had been a great prankster and we’d do funny stuff in following years. I’d write humor for medical journals but the lights were going out. I always thought about McLean’s song, « The day the music died » and equated that with the ‘fun’.
I’d go on to write a national article about the administrators being the only one’s who liked the hospitals because the doctors, nurses and patients were taken down in the years to come. I saw the movie with the evil and the hobbit fighting the evil and the the colour and flowers being burnt out of the countryside. That’s what happened in the hospitals and medical school. The life was snuffed out and the music died. People who had no substance began to ‘act a part’ and put all the emphasis on appearances. Gag orders and white washing would follow.
But that was not then. Dr. Arnie Namark knew a good ship was a happy ship.
I was there when it was fun. I have told younger doctors about those days and they simply can’t believe it.
Being Disco Doc I was approached on my clinical rotation to teach the nurses ‘disco’ all the time. I’d show an individual occasionally but mostly we were too busy. Twice though I gave in. We were waiting around in the OR for deliveries to arrive on helicopter from the north . We had time. It was 3 am and the nurses insisted I teach them disco. To get room, we all gowned up and me with 6 nurses used the sterile theatre to do disco. It’s a memory I will carry happily to the grave. All of us in masks and booties and gowns dancing disco. Staying Alive. The attending arrived with the patients and was so impressed that we were all there and ‘waiting’. The delivery went off without a hitch.
The other most memorable time is in ICU. Again 3 am . The ICU had six resperiators and they were lined down each side. At least 4 had people comatose or semi comatose. The space between was all we needed for the 4 nurses and me to do disco line dancing . In the back ground is the humfing huffing of respirators and me calling out the steps. It’s another macabre happy memory I keep tucked away in my mind. Staying alive.
Medical school really was fun. Maureen was a beautiful companion and we felt like we were in the centre of the universe with only up to come.