Story #1
His favourite was the native lady who told me,
“I want to see my lover again but I don’t want any more surgery.”
This seemed a strange thing to say so I asked more questions. I tended to do that and often wondered why others didn’t. I suspect a lot of people don’t want to hear what will follow.
“He likes to drink. I like to drink. My old man here doesn’t know. We’ve been getting together for years at least once maybe twice a year. . I just tell the doctors my stomach hurts and they send me down to Winnipeg. There they do surgery and take out something else with their knives .Then I can spend three months drinking and being sweet with him before I have to come back north. I miss him so bad but I don’t want any more surgery.”
“What surgery have you had?
“My appendix was the first time. Then my gall bladder. They did a hysterectomy. Then they took out some scars and some other stuff. They even took some of my stomach. Last time they operated on my lung. My sweetie said there’s nothing more they can take out. But my man here would beat me if he knew. There’s no other way I can go. Can you help me doctor.”
I reviewed the file. Sure enough 10 years of surgery. Every scan known to man. Every blood test. All she did was say “my stomach hurts’. No further history recorded. Eventually some surgery and then she’d be let go to the community. She’d drink for three months and stay with her “auntie“.
I discussed it with Jack who laughed at all the unnecessary investigation and surgery.
“I don’t know how many people here are doing just this. They don’t seem to care at the university. You’ll have to send her out but I’d just express some concern about further surgery and possibility of surgical scarring. That might save her from the knife. I’d love you to publish that story after the doctors who did this were gone. Maybe a new set of doctors could learn. ‘
Story #2
I was interested in the children with ear infections and hearing loss and the elegant papers written about the different Eustachian tubes in natives and the particular resistance to antibiotics related to the native genetics.
Really, whole journals and thousands of academic papers. Not a word on compliance at the time. We’d have internists and infectious disease specialists fly in to hold a clinic. The mothers would bring the children. They’d get the latest and greatest antibiotics. Hundreds of thousands of dollars.
Eventually the children would get sent off the reserve and get tubes in their ears. This was a problem because the kids were not supposed to swim with tubes but swimming was the principle summer recreation on the Rez. More infections, more antibiotics, more tubes.
I’d sit down and talk to the mothers. They didn’t like talking to white men. I had the local native healer with me and together we got the story. They’d just answer ‘yes’ to what the white man doctor said.
“They get angry when you disagree with them.” She told me.
Angry?
“Not mad angry, but silent angry. They’re not happy.”
“So you answer ‘yes’. I said.
“Yes makes them happy.”
They’re very sensitive to the mood of the interviewer. The content of the questions aren’t as important. They’re very agreeable and want to please because they don’t want to get hit. All the women on the ‘wet reserves’ had been hit and the white man hadn’t helped. He sold the booze to their men. The chiefs had a huge drinking problem. So bad they wouldn’t talk to me about it.
So when the ENT doctors came and they saw their kids they answered what they thought the doctors wanted them to say..
Now the children don’t like the ear drops. Most of the infections, the externa media cultured pseudomonas eventually. If they were treated early with amoxil the acute otitis cleared. The chronic was a different matter. The kids didn’t like drops and they spit out their pills. The native mother’s didn’t believe in ‘forcing’ kids to take medicine. They also were afraid of putting things in the kids ears when they were squirming.
I must have been the only doctor in years who did home visits. I’d get a boat to take me from the island nursing station to the shore. Then I’d walk from house to house with a nurse and ask if I could come in. The natives were happy. I got served great bannock. I’d ask to use the washroom and find years of the most expensive and latest medications for ear infections all piled neatly unused in the cabinets.
The kids simply weren’t getting any of the pills. They were all there in bottles stored in cabinets. All the drops and all the pills. In all the homes I visitted there was a stock pile of medications that could have treated a village.
“He won’t take the pills. They taste awful.”
“He spits them out?” I asked.
“Yes, I’ve tasted them. They’re bitter. If they want children to take the pills they must make them taste better. It’s not his fault. I tried hiding them in honey and he still spit them out.”
I’ve got a dog. It’s not rocket science. Kids are at least as smart as dogs. My dog spits out his pills. Sometimes he won’t even take fresh roast because he tastes the pills. Kids aren’t stupid.
“He won’t let me hold his head. He runs away into the woods. Sometimes half the village is looking for children after the white men doctors come and leave their stupid medicine ear drops.”
My interest in ‘non compliance with medical regimen’ and ‘non adherence to medical regimen’ and ‘resistance’ as it’s called in psychiatry and later ‘motivation to change’ research we used in addiction medicine was triggered in general practice then strengthened in Community Medicine. Placebo response in chronic diseases is as much as 30% so treatment should be better than placebo but with non compliance running at 50% in some populations what ever benefit the Cadillac latest medicine offered was a mute point in my clinical work. In the psychiatric population ‘non complaince’ rises to 80%.
It is the elephant in the living room.
Story # 3
Nutritionists came to the reserve to do a survey. They proceeded to invite dozens of the mothers to the nursing station or saw them after I ran a clinic. They were a trapped pupulation waiting for a boat ride back to their houses. I looked at the questionnaire. I knew the native ladies were going to just be answering ‘yes’. I asked them about this. There was no provision for that. They noted the natives seemed agreeable.
I pointed to one question asking them the ‘colour and consistency of the stool’. Really this is the ‘norm’ for so much of what we see in reality. The university is full of psychotic people. Even this young nutritionist hadn’t figured out what was wrong with the question.
“Have you ever used an outhouse?” I asked her. Very Miss Chatelaine as K.D. Laing so aptly observed.
“No,why?”
“The reserves have outhouses. No one can see anything in the outhouse. No one can sort out the colour and consistency of their own poop in the pool beneath them.” I said.
“Martha,” I said to one of the native ladies I’d just seen. “ Is your poop purple with candy strip rainbow colours?”
“Yes, doctor.” She replied.
The medical research was bad enough but the allied professional research was based on thoroughly outdated models. Real 1950’s stuff. Meanwhile I’m interested in ‘truth’. The nutritionist got really angry at me.
“You’ve ruined all my research. How could you!”
Now that’s the normal response I get. “Kill the messenger”. It’s standard. Today I don’t even bother. Idiots reproduce. There’s a whole lot of money in pseudoscience and lies. The truth is never popular.
Back then I’d like to find out the truth because it always amused Jack. When I’d tell he’d shake his head .
Jack had been the doctor who gained fame in the polio epidemic in Winnipeg. He mortgaged his own house to get another respirator. He had teams of volunteers bagging people and then switching them on and off the respirators to open their lungs more.
“If we’d waited for the politicians to get around to doing anything we would have had thousands more dead. Governments are good but they’re too slow.”
He’d established the Circumpolar Health alliance and develop the the Northern Medical Unit. I’d fly back and forth with him to the north. We’d meet with Elijah Harper. His “coup” with me was I was the first “trilateral contract. He insisted the government to include the natives in the contract with the University.
Story #3
I wrote a letter to the head of medicine, “She murdered my patient.” I said.
The College of Physicians and Surgeons advised me that I was going to lose my license for condemning a nurse. It was unprofessional to do this. I’d studied professionalism and knew they liked to make up their own meanings to old words to suit their ends. I respect language. I’ve had an Oxford Dictionary since teen years. Governments don’t respect words or ideas. The more left leaning the more they say even truth is subjective. Language is relative to government interested in power, control and money.
Dr Johnson paraphrased by Bob Dylan, Nobel Lauriate, said “steal a little and they put you in jail, steal lot and they make you king”.
It’s important to know that no whistle blower has gone without punishment in Canada. I’ve been a good ‘in house’ critic and avoided ‘out house’ criticism , taking the matter directly to the public or some outside agency. I’ve just wanted the problem solved so my patients don’t suffer.
The patient was a lovely young man who’d been drinking the night before and come in with epigastric pain. I did all the examination I could that day before the plane came to take me back to Winnipeg. It was a Friday. He’d been drinking on the Thursday night. I made the diagnosis of ‘gastritis.’ I did a complete physical, and drew a picture of the abdomen. Recorded all the history and then recorded the provisional diagnosis and the differential.
I concluded
1. Patient must not have any pain killers
2. If pain persists he must be medi evacuated for abdominal X-ray and surgical consult.
It was boldly charted and remained as evidence.
The nurse on the reserve was a brilliant native woman who loving her people had left, gone to university, got her nursing degree and come back. She was abused royally. It was so hard to get native people to come to the reserve and when it’s your own, there’s even more ammunition to apply. We loved her because she was so bright and so knowledbeable about the community. She should have been head nurse but the ministry sent in a new ‘black ‘ nurse with no skills or experience. It was the beginning of cultural communism and the trend to let racism override competence and training.
My friend said, “she hates Indians. You’d think being black she’d understand but instead she hates us worse than any white man’.
My friend quit the reserve because of her. Came to the city. Dr. Hildes was so disappointed. He wanted local people to return to their communities. I was involved helping him with the native doctor training program.
The black nurse ignored what I’d written. She didn’t everything wrong.
I was on call 24 hours/ 7 days a week. She could have called me. She didn’t. My English colleague was 20 minutes away at Island Lake. She could have called him. She didn’t. She wouldn’t listen to the pleas of the native nurse. Ignoring what I’d written, on her her own she gave the guy with an acute abdomen and no clear diagnosis morphine, and kept giving this guy morphine. That’s cause for malpractice without my notes blatantly ignored.
His family brought him back, that night despite the morphine. The pain was that bad.
“Dr. Hay said he should be medivac’d if the pain persisted.” The native nurse and her family insisted. She ignored them. The native nurse tried to intervene. She got shouted down.
“She called me racist for questioning her!” She’d later tell me in the city where she’d got a nursing job and begun dating my colleague.
“I don’t take orders from a honky white doctor. The patients faking it. “ she told my friend who vouched for the character of the youth health worker with family. I’d hear my nurse friends frustration later when she told me the horrid tale.
The next day the morphine was increased. The chief came because the family went to him. She shouted down the chief calling him ‘racist’ for questioning her.
Then I got a call on Sunday from my English doctor friend.
“Do you know anything about this ‘acute abdomen. He was sent by medivac to here but there’s no records and I didn’t hear about it. The pilot was afraid he was going to die in the plane . Nothing was arranged. He’s in a bad way. Completely dehydrated and in horrible pain. Delirious. Febrile. I’ve called the jet. It should have been called to meet the bush plane. It’s going to take another couple of hours. This guys needs emergency. I’ve got lines in and am rehydrating him but his bellies rigid. . I should have been called.”
I filled him in, furious that I’d not been called.
The young man was operated on immediately on arrival. He died. Ruptured gallbladder.
“We probably could have saved him if he only got here hours earlier”, the surgeon told me.
I said, “she murdered my patient.” I wrote out all of what had transpired.
“You will lose your license unless you change your letter now to ‘there was a preventable death’. Apparently only a judge can say ‘murder’. But more importantly criticism of a colleague in an allied field is more offensive than actually killing patients according to the government doctor. .
She’d go on to kill a dozen more natives , most of them babies and children. There was a provincial enquiry. The chief and council had physically thrown her off one reserve and shed’ been sent to another where her killing spree continued. She was literally evicted from that reserve and the Chief was going to shoot her if she ever stepped foot on the reserve. I heard that it was simply unheard of to have a reserve take such strong measures but in this case two separate reserves had been inflicted with her malice or incompetence and both had retaliated.
The head of psychiatry took me aside and told me.
“They’d never tell you. I’ve just been all day in the hearing. Your name came up. You identified her with her first kill. I saw how they crucified you. If they weren’t so full of themselves they would have listened to you and a dozen natives, infants and children would be alive today.” He said.
‘What’s going to happen to her.?”
“She’s not going to be able to practice again in Manitoba. It’s easy to stop a doctor practicing but nurses have a much more powerful union. I heard that she was going to Northern Saskatchewan. Couldn’t believe it myself. But that’s what I heard. I just wanted you to know you made the right call. You’re a good doctor Bill. Don’t forget it. And don’t let the turkeys get you down.” He was one of my best mentors., a friend of Dr. Hildes.
In the back room I heard the black nurse was the lesbian lover of the most senior person in this government health care. I’ve have always said, “follow the money and when it’s not the money , find the sex.” Humans are rarely more complicated.
Maureen was crying in her sleep one night when I woke her. She told me she’d seen a nurse kill a baby.
“I can’t say anything. I want my job. I saw what happened to you. I can’t go through that. You don’t get ahead at the university doing stuff like that. Look what happened to you. They almost took your license. You’re persona non grata. I can’t go through all that condemnation and have people vilifying me. I just want to do my job.’ She said sobbing.
“But she killed the patient. There’s probably more. I don’t know. I cwertainly couldn’t recommend anyone go through what I did and my nurse might well have been a serial murderer and they just buried it and tried to ruin me.”
“ I just saw her kill one baby. Maybe I’m mistaken. I can’t be sure. But I’m not going to take the risk. Even if I’m right they’d punish me like they punished you. I might be wrong.” She knew she wasn’t, didn’t want to live with the guilt but didn’t want to be hurt so bad on one cas she’d not be able to help all the others.. she was a great doctor and would go on to be a great pediatrician with a great career helping countless children and families.
I held her. I’ve talked to dozens of doctors now who’ve told me how frightened they are of the College of Physicians and Surgeons.
The nurse Maureen saw would eventually be caught. She became a famous case in Canada. She killed dozens of babies. It wasn’t long after I held Maureen that some one blew the whistle. It got to the media. It became public. Eventually the nurse was prosecuted.
I miss Dr. Jack Hildes. I’d come to him and we’d laugh. Nothing fazed him. He was truly a mensch.
I
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