Hanoi Pho, HomeStyle Vietnamese Restaurant, DTES

I had a great lunch at Hanoi Pho, 406 E Hastings St. 2 blocks from Main Street.  The interior was clean and pleasant, uplifting. The service was superb. The food was the best. We had springs rolls to begin.  My friend had Wonton which he loved. I had the Beef Stew and rice. It was perfect.  I loved the meal and restaurant.

Part of it was it’s location.  It’s like the Heatley a couple of blocks further up. Bits of light on the fringe of the darkness of the DTES.  Forest trying to grow in the desert of humanity. Businesses showing that there’s still people who care.  

Just blocks away slum landlords, street people, drug dealers, filth, tragedy and sadness. Yet here I felt like I’d found an oasis. 

Good food, good vibes.  A truly lovely restaurant. A really great lunch. 

It’s so easy to look at the ugly and miss  the goodness, humanity and real quality. 

“I’m going to kill you and your dog”

I’m sitting here physically exhausted. Just drained. I was sitting with Gilbert in the car pulled to the curb crying.  I feel so alone, afraid, old, vulnerable and unprotected.

This afternoon I was walking Gilbert , my old blind cockapoo with damaged back, in the DTES.  The sun was out. I’d just had lunch.  Children were playing in the park. I was returning to the clinic where patients would be waiting. Sometimes people wait months to see someone like me. The health care system is broken, mismanagement and poor leadership.  Like all the fewer and fewer front line clinicians I feel like the proverbial little Dutch boy with his thumb in the hole in the damn.  Any day the flood is going to happen.  Maybe it has and people are just being distracted by climate change projections about a dubious future anywhere from decades to hundreds of years away.. Right now the threat is here. The threat is now. The threat is real.  People are dying daily in the DTES. 

Today there were three ambulances on my way to work on Hastings. The half hour commute has become an hour to two hours each way. This day a fire truck blockaded half the main thoroughfare, at another traffic jam it was just one ambulance, lights flashing, and at the next several police cars and an ambulance. There ‘d been shooting the night before here. Three incidents, some one killed and others targeted.  I confess I was a bit anxious about going to work.  

I’m pretty tough. I’ve been shot at, knived, faced down countless guns, fought my way out of several street flights younger. I’ve been falsely accused by psychopaths too, a couple of times. Last year I refused to see an addict who threatened to kill me and my dog. He threatened to kill the lawyer’s dog, his boss’s dog and eventually after a year of texts still threatening to kill me , despite the police being involved it only stopped when he threatened to kill Justin Trudeau. The College of Physicians and Surgeons implied I provoked him by refusing to see him.  It was the old politically  correct arrogance.  An administrator with comparatively  no clinical experience think grandiosely if they’d ‘handled’ the situation, the guy wouldn’t be upset. The politically correct position is  ISIS murderers, pedophiles, rapists just need a little counselling and they’re be good neighbours. I’ve worked with psychopaths and sociopaths and lost that illusion with experience.  I’ve surged 40 years of the toughest assignments. 

The pit bull ran at us the full length of the block , no leash, no master, just a full out charge.  It came straight at me.  Ears back.  Like a land shark. I positioned myself with Gilbert directly behind me.  He knew there was danger. The dog lunged in the air at me and I took his charge right on my thigh I’d positioned to take the charge. He bounced off. He circled real quick trying to go between my legs at Gilbert.  A pit bull or bull terrier can kill a small dog with one bite and shake. I knew a biker with a pit bull who bragged about his dog killing little dogs with one bite and one shake.

I have a woman in my practice. She was passing some street people going into the store. They man and woman were sitting with the pit bull. The pit bull lunged at her grabbing her arm.  She’s in her late 60’s. The crushing bite has permanently disabled her. She has a ‘claw hand’, constant pain and can’t pronate or supinate the forearm.  It’s quite disturbing visually.  The street people and their dog disappeared. No consequences. There was no victim’s compensation. I saw her for the night terrors and despair. She’s been so depressed and tired. It’s a year now and she’s living on a pension, permanently disabled, can hardly pay rent and can’t afford much beyond bare essentials. Vancouver is an expensive city. Canada doesn’t treat its old well. 

The dog was circling trying to get past me . I was blocking him with my legs. What I presumed was his master came charging down the street screaming at me. I’m partially deaf. I didn’t hear what he was saying.I was shouting ‘Get your dog on a leash. It’s against the law to not have your dog on a leash.”

Suddenly I’ve now got this young bully right in my face standing full in front of me , the dog still circling behind me, watching for a change to get at Gilbert,  two bully assailants.

 He’s screaming, “Did you kick my dog? If you kicked my dog I’m kill you.”

“Your dog attacked me and now you’re threatening me.”  I said with shock and disdain.

“My dog didn’t attack you.”

“Yes it did”. It was still there off leash looking for an opening to get at my dog

“I”m going to kill you and your dog.” He said. 

He was standing arms up, odd position. I was not moving, staring him straight in the eyes, defensive mode, I hate to think how many times I’ve been in this position.  So many bullies attacking us as kids. The biker knifing me when I was 16.  The gang with the chains and knives threatening us northern Ontario.  The guys swinging billy clubs at me. Getting shot at. Guys with knifes, guys with guns.  I escaped the muggers in Athens only a couple of years back. I could run fast then. First lesson of self defence. Run!  But my knee hurts today.

 I ‘m wary. The kids’ a punk. I’m steady ,ready. He has his arms up chest high away from his body. I just watched his eyes but figured later that this stance was supposed to attract my eyes. He had one arm out and the other cocked for a punch. I saw it with my peripheral vision. Didn’t fall for it. He seemed a little perplexed. The look that goes with guys who figured they had an easy target. Probably attacked other old guys before. Predator, only picks easy prey, normally hides in a gang.  

He also seemed to not mean to say “I’m going to kill you and your dog.”  He seemed to register that he’d ‘technically threatened me’, whereas his first statement ,”if you kicked my dog I’m going to kill you “ that was said with confidence. That was okay. He might have been a jail house lawyer but he did say “I’m going to kill you and your dog”.  I reacted to that, getting even more ready. I take the first punch always and luckily don’t have a glass jaw and mostly get the last punch. Still my mind is screaming I’m too old for this shot.

Then the thought flashed through my mind.  He’s gong to hit me and I’m going to hurt him bad and his dog’s going to attack me and Gilbert who can’t even see the assailant just smell him. I might just kill his dog to protect Gilbert. Then I’m going to go to jail. I’m going to go to jail for defending myself.  I had no doubt I’d ‘win’. Men can size each other up.  Even as an old guy the punk wasn’t dangerous alone. But he could come back with his ‘gang’ . I can’t fight gangs any more. I’d fought against several guys late teens taking down three out of 10 with kicks to the face and knees to the head causing the other half dozen guys to let me leave. I walked through Harlan in my 20’s.  I’d been an athlete then. Now I’m old and fat and I’d probably beat him unconscious with my fists or do a hip toss , throwing my back out, and breaking my fingers so I couldn’t do surgery, play guitar or write reports. That’s what flashed through my mind. 

“I’m going to kill your dog,” he sneered.  He backed down. Turned began to walk away. His dog had headed back to what was a girl and their bike.  He turned to follow and looked back at me “I’m going to kill your dog”.  He said. So many people competing for Darwin Awards these days. 

He owned the city.  The police and citizens they’re the prisoners. The City Council doesn’t live here. They’re out in Elite World, somewhere in West Vancouver or maybe on the  Moon. Too many politicians stoned. They’ve got body guards and guns , criminal money laundering and drug dealing connections and lawyers on speed dial. The province is only less corrupt than Quebec whose owned by Mafia and Biker gangs.  

I”m nobody.  I’m not safe.  He put his dog on leash and then walked back saying he again was going to kill my dog. I phoned the police then.  I didn’t trust him not to turn around and come for me.  But It was over. The altercation was winding down. As the call was going through he was getting further away. He was going.  I was shaking. That’s what happens after adrenaline with me. I’ve saved lives and then been shaking in hospital corridors after the resuscitation of some adult or child.  

I remember stopping this guy slapping his pregnant wife on the maternity ward , threatening to kick her in belly, her crying. I strode in and pushed him out of the room and he pushed back and then left. The police arrived, asked me for a description. I thought he was 6 foot tall. It was in threat mode.  We make ourselves look big. The English wore tall black fur hats on their heads for that purpose. The guy was something like 5’5”.  I shook after that, embarrassed.

The police call was awful. I felt liked I was being interrogated , told them the street corner, that he was going away from Hastings by the park but then the guy wants to know north or west or towards Richmond and I can’t see the mountains and I don’t know what his girlfriends’ wearing. I’m in self defence mode watching his eyes for movement ready to defend against kick or strike. I’m not an outside observer.  The questions upset me.I felt sick to my stomach. I’m feeling faint and nauseous.  Then the guy asked if I wanted to talk to a police officer.  I thought he was. But then he told me he was the ‘call taker’.  I was too fed up, him asking me questions I didn’t have the answer to and didn’t want to discuss. 

But then the guy cut in front of me with the dog and a friend a block ahead of me turning on to Hastings. Talking on the phone I’d been slowly waking back to the office. Now he’s between me and the clinic. I say I want to talk to the police.  I’m afraid. I’m afraid for Gilbert. I’m afraid he’s now  going to be waiting outside my work with other low life. I’m reminded of the bully in high school who waited for me caught me with a brass knuckle under the eye,  before I took him down. The police arrived. I’ve still got the scar. The fear seems cumulative. I didn’t used to be so disturbed. I think I took things better younger. I’m not feeling good now. 

I got back to the clinic. I told administration what had happened and that I was going home. I’ve stiff upper lipped my life and I just can’t do it any more. I ‘m too old for this shit. I was still shaking. My voice was quivering. I couldn’t help anyone and no one could help me. I say, I can’’t work here any more I don’t feel safe.  I’ve been unhappy with the dangerous drivers on the commute, the hostile neighborhood, everyone so easily offend and now an outright threat. I figure it’s some kind of warning.

I haven’t felt safe in Vancouver for a few years.  It’s the atmosphere.  I can’t get it out of my head the greatest police woman I know  saying “I left when the city wouldn’t let the police fight crime but wanted us to record crime.” She also said “we’d catch criminals and the judges just let them back on the street.”  I see all these guys who have had gun crimes and they’ve done a very little time. Then  they all tell me they have guns. Meanwhile I’m treated like a criminal as a law abiding citizen with a hunting rifle who done more exams and tests and been vetted more than medical school. I’m just a hunter and I’m treated worse that criminals with guns. There’s no deterrence. It’s Bizarro World Canada.  I’m afraid. I never got over a Canadian paying a terrorist who murdered an American soldier $10 million dollars. Crime pays in Canada.

My colleague talked to me as I headed out for my car. “I’ve phoned the police too and it’s the same things.  Always this whole list of questions about me like I’ve done something wrong and nothing happened .” He’s supportive, worried I’m okay. I’m not okay but I appreciate his concern. 

I couldn’t drive home. I pulled over to the curb and cried. I’m old and afraid. I’m afraid I’m old and vulnerable and I can hardly protect my dog. Im grieving more these days. I’m afraid I can’t shake it off. I’m afraid I don’t feel safe in Canada. I feel so vulnerable. Just driving a few blocks in the DTES a half dozens people walked across the road in front of me. If I hit them I’d be held accountable.  The tent city is just there. There’s cops and drugs on crime going on right there on the street, Insite is near by and the cops can’t even go there because it could threaten the addicts so my patients tell me that’s where all the big drug deals go down.  “The cops can’t go there.It’s the criminals own place. No surveillance.”.  

The guy swaggered.  The dog swaggered.  The girl, well, they like ‘bad boys’. Makes them feel safe, even if they kick them around. Eva Brawn world .  Good girls are so passé. The new world order. He swaggered. He could have hit me. It was in his eyes. I truly felt that if I looked a little weaker and hadn’t kept saying “get your dog on the leash”, he’d have lifted his leg and pissed on me. He’s top dog in this area. I’m little dog.  He’s got the City, the Politicians, the Media and he’s beat on others  before. He’s probably spit on his share of cops too.

I was glad when the cop phoned me. He game me confidence. Felt reassuring. 

“I’ve been working down here for the last 25 years and it’s probably the worst it’s been.”

“Three guys murdered yesterday scared me,” I’d said.

“Only one guy shot and two other incidents. It was bad but not as bad as that. We’ve got the guys description and we’ve got some guys who will keep an eye out for him.  If we find him we’ll call. He sounds like he’s got away with bullying other people. If you charge him we can deal with it as a criminal thing. You’d have to pick him out of a line up. He did threaten you and that’s criminal. “

“I felt if I defended myself I’d go to prison.” 

“Only if you use unreasonable force.”  

“What’s reasonable when you’re defending yourself”.  

“Yea there’s that.”

It don’t trust the government.  They’d asked me if the guy with the dog was white and I’d said no. Maybe aboriginal, not black.  But there it was ‘white priviledge’ and ‘social justice’. It was in the tone. Old white guys are in season. The judges aren’t reasonable. If anything they’re afraid too.  Afraid to offend one of the social justice groups.  I felt alone. I was thankful the cop sounded sane.  

“It’s not as bad as it seems. I can tell you.  There’s enough of us on the police force who know what to do but we’re not allowed.”

I immediately think of New York . The city is amazing. Overnight they had good city administration and the city became great again. Safe, clean. A tourist attraction.   I trust this policeman..  He’s not a politician. He’s down to earth and reassuring. He’s not blowing smoke up my ass.

“Thanks. Okay. You’re a good man.” I say.  

I got out of the car again. I’d taken the call on the Mini speaker phone. I felt light headed. I sat down on a staircase with Gilbert. It was a busy loud street and I saw the little guy was afraid. All the noise. Old blind dog. No doubt he worried about me. I cried again. I’m exhausted. I’m just exhausted. I felt weak and clammy. I had to slow and settle my breathing. Reassure Gilbert. Sit for a bit. I still didn’t feel right. 

I got the text asking if I was coming to work tomorrow. I figured I would. I don’t think I can take Gilbert downtown anymore.  I don’t know how parents with children can live in Vancouver.  I know my friends with toddlers are terrified of the criminals ,the needles everywhere, the gangs. 

 I ‘m afraid for my dog. Seeing that pit bull charging full speed right at me and Gilbert,  then this guy threatening me.  All he had to do was put his dog on a leash. 

I’m home now and tired and afraid and men don’t cry. Tough men like me ‘buck up’ .  

I just can’t seem to get it together. I keep crying. IF it’s not the bullies in government with their ‘lick above, kick below’ mentality, it’s little shits on the streets picking on the old guys. I’ve got to pull myself together..

This too will pass. 

Fentanyl Epidemic

“I’m a doctor just like you,” he said.  I knew him in passing.  A good fellow.  Well intentioned. Most of his life a drug addict.  Now he and a friend like two teen agers going fishing patrolled the Downtown Eastside with Narcan kits they got free from the pharmacy.  Instead of trout he caught life slipping away in the gutters. Occasionally, he brought it back with drama and flourish.
“I’ve saved a dozen lives,” he said.
It was good entertainment. He used himself. The suboxone helped him and only a few times a week did he ‘party’.
 “We like the fentanyl because it’s strong enough we can push through the suboxone.” he said.  The patients liked the oral methadone and suboxone because it stopped the withdrawal sickness.  They could have a life separate from the daily grind of finding the money and getting high.
Their faces linger in my memory.  Only weeks ago I saw them.  A couple of young Caucasian women, in their 20’s with boyfriends.  They came as couples to get their opiate replacement medication.
I talk up a storm about AA/NA/SMART, the non pharmacological treatment groups, Detox and Treatment Centres and Recovery Homes..  We really only get paid for the prescriptions. The doctors break into two groups. The rich ones who write a lot of prescriptions and the poorer ones like me who do counselling and try each time to push the patients closer to recovery.
Recovery isn’t Harm Reduction.  Recovery is a proactive program of wellness leading to abstinence from mood altering substances.  Harm reduction is supposed to be a step on the way. But now our Prime Minister is so vocal about smoking pot and all the tobacco company wealth is back in the business of smoke everyone in the DTES is either smoking marijuana or cigarettes or both.  The trouble with drug addiction is that it really dulls the senses and their addiction to smoke is seen as nothing compared to the heroin and crystal meth and crack cocaine.  Then there’s the sex addiction, gambling and pornography and crime.  It’s a smorgasbord of free choice in the DTES.
But mostly they tell me they don’t want God or any of that spiritual or religious stuff.  They want drugs.  Addicts are materialist hedonists.  They are sometimes even like the monkeys we studied back in school with the electrodes in their amygdala pleasure centre who would live to pull the lever of pleasure.
More and more they tell me they don't want any of the recovery options. "I just want that free heroin. Can you direct me to where I can get my injections for free.  I don't want to stop using. I just want to get the stuff free."
Each of the women was demure with whimsical smiles and street smart eyes. College drop out. They’d been into opiates only for a year or two at most. They’d started with pills they got at parties and then became hooked. With their boyfriends they now needed fentanyl pills every day, at least one or two, sometimes more. They ground up the pills and snorted them.  They smoked marijuana too.  A lot of the marijuana had been sprinkled with fentanyl so the herb was hurting folk bad.  Even the organic shops marijuana had been tested and come back positive for fentanyl. I imagined with the fentanyl so cheap dealers were going about sprinkling powder here and there to increase their clientele.
Drug dealers are lizards who want to be your friend.
The Fentanyl was coming from China.  It was sold on line and brought in over the border en mass.  My hypochondriac patients complain that it and crystal meth are in the air in the DTES.  The paranoids are afraid of the food outside in the markets. They’re crazy but no more so than the neighbourhood.
It’s just that their faces linger. The two women from last month. I've mostly forgotten the patients that died before them.
Sometimes I remember Gordon Lightfoots song, “Only a go go girl in love with someone who doesn’t care.”  I think of their mothers.
They’re dead now.
Their boyfriends each on different weeks came in and told me the same story.
“We got high together and overdosed.  I woke up but she didn’t”.
They were sad but it hadn’t changed their own drug habit.  If anything they did more.  Running from the demons. Burying the pain.
“Sometimes you see the shadows out of the corner of your eye,’ the older guys tell me.
I talk about higher power and participation.  I repeat till the cows come home that it’s a disease of relationship and that they have to find a way to associate with people that don’t use.  I hand out pamphlets and point them to all the different groups and services that we have.  The government pays for drug and alcohol counsellors but it’s like getting adolescent boys out of gangs, one on one care doesn’t work. They need a new group, a new club, a new association.  Their religion is addiction. They see their drug as god and their dealer as their priest.  It’s high ritual.  The language doesn't tell you that but it's there as bold as the body bags.
I ask him if he’s stopped using.
“Not yet. “ he says telling me about the great feeling saving a life gives him with his free narcan kits.  I think of it as band aids.  It’s like a lone medic in Afghanistan. Every life counts.  Don Quixote charges another wind mill.  There has to be a Dulcinea.
I expect the feminists would call me chauvinist because I remember those two women more than the half dozen more young men I’ve known who are just as dead in these last few months.  It’s wrong to even speak of gender. Freedom of speech is dying as quickly as youth.  It's only okay to speak of what we're told to speak.  Designated truth or fake news.  More illusion of choice. There are so many divisions today.  I worry I’ll offend someone even by asking them to live. The Prime Minister is proud of his new physician assisted suicide programs.  They’re opening more and more needle injection sites with dilaudid and some are even giving free heroin.
They once assisted the Tong, Euro Gangs and Hell’s Angels who brought in the Heroin profiting by the government taking care of providing drug clubs, keeping their business alive with safe injection sites  and carrying all the costs of bad drugs.  Now they’re actually going toe to toe with pharmaceutical grade product versus the ‘shit they call down’, the gangs provide.
“It’s not heroin anymore.  It’s not been for a long time. Synthetic shit. That’s why the fentanyl is attractive. Cheaper and it does the trick better.” he said.
The uppers go with the downers.  Jib, or crystal meth is everywhere as well. Not as much crack smoking as doing jib these days.  There’s a lot of doing jib then heroin to get to sleep and then getting onto straight heroin and maybe cigarettes or pot. After the drugs get happening big time the alcohol which may or may not have been there in the beginning becomes less important.  Some say drugs account for 80 or 90% of the material theft.  The insurance companies are not suffering.
Legalization which is what our Prime Minister was pushing means that a drug could be sold in a school candy machine. If it’s legal, it’s legal. Like mother’s milk.
Decriminalization is accepting the disease model and treating the whole matter not as a moral issue but rather as an epidemic.  Harm Reduction, really palliative care, a term with a marketing twist came out of the cancer treatment and then the Aids Epidemic.
Harm reduction may not be that good for the individual. Individuals do best if they get into AA or NA , treatment, recovery houses or join a church.  When they look at people 20 years abstinent individually they mostly work,  belong to spiritual organizations and have replaced their previous habit with community participation and love.  Love of God, love of family, love of fellow man and woman.  Drug addiction is at best mental masturbation.
The Harm Reduction is good public health and ultimately may be preventative as the profit in drug sales moves into the public purse. It’s hard to say if there’s any less gambling today but the government gets the money rather than the Mafia.  Now one then wonders what’s the difference between public sector crime and private sector crime.
But I’m a medic in D Day and the enemy in this case, the drug dealers, they don’t provide medics for their ‘side’.  I still think I'm on the good side. I just don't know some days if I'm doing righteous work or enabling.  There’s a whole lot of other types of medicine I could do.  But I’m down here in the DTES with more and more young people. When I began in the 80's working in a detox the clientele was mostly in their 50's.  Not a lot of really old people in this work.  Living past 60 not so common here as in the suburbs.
My patient is going off with his buddy to look for more bodies in back alleys in hope he can revive them.
I’m just doing what doctors do, pushing life, where the profit always seems to be more in pushing death.

Doc-Side Medical Clinic

Dr. G. Horvath has had  low key Downtown East Side medical clinic for many years. A family physician with advanced training in physical injury and addiction medicine, he manages this 'walk in clinic' as well as maintaining a methadone/suboxone clinic.
As an addiction psychiatrist I met him when I was licensing to provide methadone treatment. One of the most respected clinicians in the field he commonly trains new physicians in the addiction medicine practicums.
Licensed now in methadone treatment and well credentialled in psychiatry and addiction medicine,  I was actually happy to continue to work  at Doc-Side clinic if only because Dr. Horvath is an excellent colleague who is glad to share his knowledge on complex cases.  He's a doctor's doctor, a consumate clinician, caring and extremely conscientious.
I've worked here five years now.
In addition to managing methadone patients a couple of afternoons a week I provide psychiatric consultation to addiction medicine patients one morning a week.  This is possible because if patients don't show for an appointment the clinic has a 'stand by' arrangement so I'm able to work and not lose income.
Private psychiatrists who make up over 75% of psychiatrists tend to be cautious about seeing patients with drug or alcohol problems because this group is notorious for missing appointments. When a patient misses the appointment the doctor doesn't get paid. Since we're all running businesses with overheads of roughly forty per cent, drug addicts and alcoholics, often the most in need of psychiatric services, fall between the cracks.  Further the DTES patients are no able to pay the 'missed appointment' fees that the better heeled carriage trade can.
The other 25% of doctors work  in salaried positions with all the benefits. The public mental health programs have physicians as 'consultants' but mostly the patients see counsellors.  The 'team' approach is ideal to care but patients complain commonly about a variety of factors, some of which might well have validity.
At Doc-Side medical there is an Administrative Assistant and two or three administration personnel maintaining records, ensuring clinic payment and managing medication timing and urine testing.  The clinic costs at a methadone clinic are substantially more than a regular clinic because of the urine testing, random urine testing and required provincially mandated rules for clinic maintenance.
In British Columbia there are three forms of methadone license.  A physician or psychiatrist may have a license to prescribe methadone for pain. Methadone is a potent long acting narcotic that has specific benefits and use in oncology and palliative care as well as other areas of medicine.  I have this license but while I prescribe narcotics occasionally for pain haven't had a major pain practice in which I'd be using that license for this purpose.  Other narcotics not requiring special license are usually sufficient for most doctors who don't 'specialize' in pain areas specifically.
The second methadone license is that for prescribing methadone in a Methadone Treatment Clinic.  All the doctors working in methadone maintenance programs must have this special license and must in addition to academic training, have a day at least of apprenticeship experience with a senior methadone doctor.  Dr. Horvath, as an acknowledged leader in the field of heroin addiction and methadone maintenance is such an individual
The third methadone license is a clinic license.  Dr. Horvath, having a license for methadone maintenance also has a license to run a methadone clinic.  Methadone maintenance programs in the province are run out of clinics.  I and a half dozen more doctors who have a methadone prescribing license rotate through Doc Side Medical Clinic.  The requirement for a methadone doctor to have a methadone clinic license includes extensive experience and standards of excellence in their history of medical practice.  Others, such as pharmacists may obtain a 'methadone clinic' license, I believe, but the process is rigorous.
Because addiction is often associated with a higher risk lifestyle, from a public health perspective there is increased concern for communicable diseases and trauma associated illness.  There is further a very high overlap between addiction and alcoholism and co morbid psychiatric disorders.
Since working in the clinic I've treated all manner of psychiatric disorder, from gross psychosis, schizophrenia, neurotics, psychopaths, sociopaths, personality disorder, Bipolar disorders, Traumatic Brain Injury, Paranoid Disorders, Disocciative Disorders, Anxiety disorders  and alot of PTSD.
I was a supervisor in the Vancouver General Hospital Psychiatric Emergency so the psychiatric conditions are well within the range of my subspecialist training and experience. What is difficult about the work is the overall lack of resources.
Two of my suicidal depressed patients went to the hospital last year only to be turned away. They hung themselves. I don't fault the ER because the threat of suicide is high with alcoholism and addiction.  I only wish that I was there and  grandiosely hope that I might have stopped my patients from premature death.  Working with addicts and alcoholics I've seen more death than when I worked with HIV patients.  Suicide is difficult to deal with an I know many psychiatrists who have avoided the high risk areas choosing more boutique practices where patients are less suicidal and have more resources available to reduce the risks.
What I find interesting though here is the burden of physical illness I encounter.  The other doctors I work with, like Dr. Tsung and Dr. Kljajic are excellent family physicians like Dr. Horvath.  They have excellent cutting edge diagnostic and therapeutic knowledge .  I was a country family physician and treated the physical illness of many patients in my psychiatric practices but it's been often years for me in terms of therapeutics. I daily look up the latest treatments and often have luxury of asking one of my esteemed colleagues their opinions.
 Diagnostically I believe I'm far better than I was as a young doctor, simply because of experience.  I did appreciate asking my colleague when I saw a classic case of erysipalis.  Thankfully he knew what it was and what the treatment was.  I just recognised the pathology  but couldn't remember the name and treatment.  I am blessed with having seen so many patients I know 'normal' and am very alert when I see 'abnormal'.   The forms of cellulitis here are very variable. Last month I diagnosed a new TB case. Hep C is prevalent. I have several HIV patients.  Among ourselves invite each other to listen to heart murmurs and observe unusual patholgy. It's a joy working with other clinicians.
Only last month Dr. Horvath diagnosed a pulmonary embolism we all auscultated.  Last year I sent a patient to cardiology with myocarditis because the heart sounds were abnormal. We've felt our share of abnormal livers so don't bother each other with those.
 Every patient entering the Methadone Program gets a complete physical and standard screening laboratory and hematology testing. So we pick up our fair share of anemia and hypothryroidism.  I diagnosed a cancer last month sending the patient for confirmatory xrays and onto the appropriate sub speciality clinic at the hospital. I appreciate asking the other doctors who work on the same days I do their opinions and they seem very happy to have my psychiatric input on some of their more unusual patients.  Psychopharmacology is second nature to me as is physical pharmacology to them.  We do see a lot of trauma and order a number of ultrasounds and xrays. Dr. Horvath's orthopedic training has been as helpful as my rodeo doctor experience in diagnosing dislocations. Addiction obscure symptons and often patients aren't that good historians because of mental illness. So it all helps.
Methadone clinics reduce crime and disease spread by stopping the theft and sex trade that so often goes with addiction. But it's especially good for it reduces and stops illicit needle use. Doc Side Medical Clinic is a major unsung public health resource in the Downtown East Side,
In addition to the medical and administrative staff with patient follow up and administrative close contact with pharmacies we maintain a close collegial relationship with the various housing assistance programs, the major local detox programs such as Harbour Light  and the long term facilities such as Union Gospel. We're also fortunate to have a very good relationship with Vancouver's outstanding "drug court".   We encourage attendance in peer support programs such as NA and AA and the new SMART group programs routinely.
Presently there is a counsellor associated with Doc side who is here half the week. He's highly informed about various resources and has been most helpfull getting patients a variety of services. He's assisted people on the methadone program finding housing, getting rape crisis assistance, advocacy and as well provides both Cognitive Behavioural Therapy and Mindfulness Meditation Therapy for patients.
All we're lacking from my perspective is an outreach community nurse.  When a patient misses their methadone for three days the dosage must be lowered to the starting dose because of fears over overdose.  The pharmacists keep a record with computers of 'reversal' of methadone dosage. If a person were to miss 2 dosages an out reach nurse could find out what the problem is and hopefully arrange for the person to get their methadone rather than being lost to follow up. It's the one major disruption in care that often results in the patients ongoing relapse.  Relapse is common with addiction but the key is ensuring that the person gets back into the program as soon as possible. Further we have patients with major medical and mental health issues who just fall below the radar. A community nurse could follow up with a home visit to see what the concern is.  It's sad to say but patients have been found dead in tenements after days. This could be preventable.  I think of my patient who had a heart valve issue and simply with the winter cold didn't have the energy to get out to the pharmacy.  With a community nurse we would have found out early rather than late.  Just like my schizophrenic patient who became psychotic and afraid to leave his room when he stopped his anti psychotic medications.  The drug dealers sell door to door and do deliveries so we're commonly 'competing' with 'saving souls' from the lowest forms of drug dealers. It would be nice to have the resources.
Increasingly addiction is being conceptualized as very like an infectious disease. It 'spreads' through neighbourhoods.  This is especially true with young people.  A drug dealer will show up at a school or workplace or construction site also and slowly 'push' to a widening circle of addicts. It starts as 'recreational' but the aim of the dealer is to find the vulnerable because addicts are major cash cows.
The good news is that Recovery is even more 'infectious'.  For most of my patients , I am the only person they really get to know who is 'clean and sober'. They get to know the staff and counsellor then the pharmacists and slowly a widening circle of people who are normal surround them.  It's further recognised that physicians have a great deal of importance in initiating behaviour change.  It's no surprise that the Big Book of Alcoholics Anonymous 50 years since it's inception continues to start with the Doctors Opinion. A day doesn't go by that my colleagues aren't promoting smoking cessation and working here I see every once and a while their gargantuan efforts pay off.
Drug dealers are death salesman and they pile lies upon lies. Commonly patients are grossly misinformed about addiction and alcoholism. The methadone clinic is commonly their first contact with the recovery movement.
Thanks to the leadership of Dr. Horvath , all the doctors who choose to work at Doc Side maintain a recovery focus.  We encourage people to change their life style and get better health care and move onto abstinence based programs such as Narcotics Anonymous. We encourage patients to get into 'safe' housing.  We discourage crime. It's a great atmosphere to work in.
Research has shown that patients who are in well run methadone programs will tend to progress out of the sickness and criminal life and back to work and health and better social relationships by 2 to 3 years in methadone treatment programs. By contrast patients who continue to use heroin IV on the streets may be dead in that time or have acquired more chronic lifestyle related diseases. We also detox mostly younger patients over months from shorter addictions to heroin and other narcotics. Increasingly Suboxone has helped in this regard.
By contrast there have been reasonable criticism of some methadone clinics where the doctors and pharmacists were running a 'drug pushing' factory.  The patients were seen as 'customers' and the pharmacists especially didn't seem to want to lose the high priced drug sales that are associated with methadone maintenance programs.
The College of Physician and Surgeons of BC and the College of Pharmacists of BC are both involved in tight regulation of the programs overseeing training and maintenance. Personally critical of some of the highly expensive and destructive aspects of political correctness in government bodies I've only seen the finest work done by the College in this field.  The Colleges even have 'sting' operations and work closely with the Vancouver Police and RCMP to manage the programs. Just this summer 46 pharmacists and pharmacies lost their licenses to dispense.  Every once  in a while too a doctor is reprimanded for mostly negligent work. Dr. Horvath is asked, for instance, to review the work of colleagues and other clinics to ensure their records and management are at the standard set by the Colleges for this program.  The Colleges much to their credit run a very tight ship.  The area of addiction is rife with potential for abuse and corruption so I've grown to admire those in the College that ensure these programs run with excellence.
So Doc Side Medical Clinic is this rather low key clinic doing a rather large amount of work in an area of greatest need. There are other methadone clinics nearby where friends work  too.  I know they're 'run' with the same concern and consideration that Dr. Horvath shows. We often run into each other in the regular continuing medical education events for addiction medicine we attend each year. Most of us are certified with the Canadian Society of Addiction Medicine which maintains the highest standards of care.
Methadone clinics, especially the well managed ones, are often under appreciated and not that well understood. There are no Doc Hollywood  working here, that's for sure.  I daily see the work and it's paying off with time. I see the benefit.   Because we cover for each other I see my colleagues work and talk with their patients.  I especially appreciate the work of Dr. Horvath and the other doctors he's attracted to working in one of the most difficult areas of medicine, in one of the most notoriously difficult areas of Canada.  Doc Side Medical Clinic serves the the Down Town East Side of Vancouver (DTES).  

Church - Sunday

It’s 10:30 am. That’s the time church starts.  I’m sitting on the couch in my housecoat.  Gilbert is lying on the couch at my feet.  I’m not going to make it to church. It’s been raining heavily.  Gilbert and I ran in the rain this morning. I’m aching.  My church, St.James Anglican, is in Vancouver’s  Downtown Eastside. l just moved my office out of that area after 5 years of being there.  Driving down there has been a true nightmare.  Zombie like drug addicts staggering about the streets, sirens and police angry at their impotence desperate to ticket a tax paying citizen because the local criminal and drug addicted population is a revolving door group that knows the law so well they invariably set up police for internal affairs and human rights commission investigations. I personally got tired of the screamers. The noise pollution is horrid.  Couples drunk or on crystal meth would walk down opposite sides of the street screaming full volume at each other about who spent the money on the last fix.  Needles littered the street. And politicians promised to make it easier for the locals to use and provide more ’stuff’ for them under the auspices of ‘harm reduction’.
I became cynical.  I was disheartened not by the victims of the drug dealers and the agencies, but rather with the horrendous waste of tax payer dollars and the corruption. It was also sad.  A tragic war zone.
I’m feeling I did my time. It was like a tour of duty.  A kind of non combatant military Afghanistan placement in the centre of Vancouver, one of Canada’s most beautiful cities.  I still work a day downtown but my lease came up and I was forced to move. So now my office is further along Hastings in the suburban zone, out of the downtown eastside.  My first day there I was shocked by the quiet.  There was no one screaming outside my window. There were no demonstrations. No honking horns. No sirens every hour. There was quiet. I’d forgotten what it was like.  I know it from weekends. To survive I’d gone out to nature, either the woods or the sea every weekend possible to cleanse myself of the work.  But now I’m not at all exhausted in that way after a week of work. The work is as demanding even more it seems at times but I took a walk in my neighbourhood. It was so different. No one was bullying me.  I didn’t have to wonder whether some scruffy guy selling cigarettes was going to move for me to pass through. I used to be fearful crossing Carrall at Hastings because a whole bunch of people close together on drugs and alcohol and their dealers congregated there disrupting the flow of walkers.  I felt sorry for businesses because all the tourists who’d love to walk to China town turned around before this army of  near do wells.
Inside the Supervised Injection Site has created a police no go zone so dealers up the street work in the open. No surveillance of the clinic or surroundings is allowed. So all manner of criminal activity and gang meetings go on around that there.  Millions and millions of  criminal dollars pass through this 8 block radius.  Nothing stays. It’s just drug city and deals are made here.  Heroin and BC Bud.  Now that the marijuana is legalized there’s more marijuana dispensaries than Starbucks in the city. Most of them are around here.  There’s prostitutes as well.  And guns.  Not the guns the government tries to outlaw but criminal guns with serial numbers filed clean.  Hand guns, not long guns.  Bodies show up in the dumpsters in the alleys.
I’m more relaxed now.  My vehicles were broken into annually.  Once I was walking down the street a block from my truck and saw my dirty laundry.  “Hey, that’s my underwear, “ I said.  Sure enough, in a snatch and grab someone had grabbed my laundry and rifled through it as they continued down the street.  I picked my stuff up for a block but hated cancelling patients to get the truck into the repair and having to cancel more to pick it up.  When my computer was stolen it took months to restore the applications and files and get it back to where it was previously. Thankfully today iCloud gets past that kind of abuse.
Now I love my church.  I came when a man made a dramatic scene kicking my dog and girlfriend out of church where we’d gone for over a decade and even had the dog blessed by the bishop. He’s a therapy dog.  A great little cockapoo but my girlfriend was humiliated and I just think that anywhere that doesn’t want my dog really doesn’t want me. We’re pretty much a like.  At the same time I understand that some dogs and some owners aren’t socialized.  There’s a need for ‘rules’ and there’s a need for ‘exceptions’.  I remember when children were excluded from a lot of places. Then there was a time when Jews weren’t allowed. Then there was a time it was blacks and then Chinese. Then it was gays and now it’s still transexuals.  But really it’s dogs.  People have a way of creating ‘legalities’ and living in ‘legalism’.  It’s evidence of an inherent desire to exclude and to dominate and control.  I could even accept that dog owners need special insurance to take their dogs in ‘special places’.  I don’t buy the blanket statement by health departments against animals given how uncouth so many people are.  I’ve also been in civilized advanced countries where dogs are welcome in restaurants and churches.
So I was thankful when the former minister told me that “your dog is more than welcome, but I’m not sure about you.” he said jokingly.  There’s a general consensus that my dog is better behaved that me.  And I loved Father Mark and his wife.  I loved their children and dogs.  I began to love individuals in the church, especially Alice.  I loved that my friends Elizabeth and Karen introduced me to the church. I loved that Anna was there with her kids.  I loved several people I met there. I especially loved the jams at tea sales and the lunches and the coffee. The music was great. Father Mathew was an inspiration .  My hearing is not as keen as it was so the sound system bothered me. I had to move around to get my better ear in a better location.  I don’t know if it was the rock and roll or the hunting that’s caused the right ear to be increasingly selective but mostly I noted after Father Mark left that those giving the sermons were angry with the mikes rather than loving technology. So when Father Mark left I was a little less keen.
Now I’m not a summer Christian at the best of times either. I’m usually sailing or camping on weekends. I’ve never had so many weekends home in years.  The trip to Istanbul in the spring and Ireland a few weeks back has had me really enjoying sleeping and hanging out at home.  I would say I’m ‘isolating’ but I have no depression or lack of joy in my fellows. I just feel a little bushed. I’m off to see my brother next week and to Virginia after that so I’m travelling a lot and enjoying any down time.
I don’t like going into the DTES now. I don’t like driving there.  I’m a bit off driving perhaps after the intense Ireland driving on the wrong side.  It’s just I don’t want to deal with people walking on the road and Vancouver drivers lack of skills training.  There’s forever someone who hasn’t been toilet trained to use his signals.  Then there’s this weird macho competitiveness that holds up traffic all over the city because people don’t let people flow in but want to keep everyone else out of their lane.  The traffic jams occur as a result.  I think this is a product of multi culturalism, my bias, too many people trying to be number one and working out their issues on the road rather than cooperating together and moving with the flow. it’s also the drug addicts. and the cell phones. A lot of drivers are disconnected from reality and in their own stinky petty worlds.  The chaos in the DTES might make it worse.  I just don’t have any desire to get in a vehicle and go into town on the weekend for any reason.  Commuting has caught up on me.  I’m a half hour to an hour every day each way going to work and the commutes are getting more and more ludicrous with police blocking two lanes to stop someone rather than taking them off the highway so traffic continues to flow. There’s so much insanity out there that yes I like the safety and certainty of my suburban home on the weekends right now.
So no I didn’t get to church.  I’m better at getting to church in Winter and spring.  I love church but wonder if it’s time to find a new church.  I went to the nearest one here but the preacher was kind of teleevangical happy happy and the people were mostly old women.  The other church didn’t like dogs.  I may have to phone about.  It’s not on my list of priorities. I feel spiritually uplifted by my time with Archie and George.  I really should get out to be with those guys more often.  I’ve been enjoying walking and running with Gilbert.
I will sort everything out after Kingston and Norfolk.  Each year when I get together with the psychiatrists and we say the serenity prayer en mass I seem to find my direction. Right now I’m just crawling into the home plate.  Marking time.  I’ve got too much work and not enough money and want to work less but can’t see how I’ll manage because of the increasing costs and the inflation.  The projects I have are already delayed by lack of funds so I have to find more acceptance.  This city is so expensive too that I fear stepping out the door costs money.  I’ve paid for this ‘parking place’ for my body and Gilbert’s so it’s a ‘safe zone’.  I don’t feel I can afford to leave in a way.  I haven’t taken my boat out this summer because I don’t want to risk costs. The moorage I’m at has shrunk so I haven’t room to dock solo.  The fear of hitting another boat returning has me simply not wanting to take my boat out.
I love riding my motorcycle because its so cheap yet at the same time I’ve had this fear of injury as I still intermittently deal with the ankle injury I got when I dumped my bike in the intersection. A true nutter Vancouver driver slammed on his breaks crossing as a kind of epileptic seizure without any reason causing me to slam on mine. I had too much front brake and not enough back brake in the turn so my ankle twisted holding the bike up.  I realized the guy had this idea he’d cross two lanes and get into a shop but realized it was impossible and had done this bizarre stop as traffic was coming at us and me looking at the oncoming traffic not expecting him to stop with a clear lane ahead and no reason not to complete his turn. The ankle swelled up something fierce and I was thankful that George, who’d corralled me in church,  didn’t think it was broken and the X-ray he insisted on confirmed it.  The fact was that soft tissue tears aren’t nothing and it was a year of healing and still occasionally I’m bothered by it.  Indeed all the old injuries are flaring up with weather, all the sites of traumatic arthritis.  So on lilly livered days I’m find the idea of curling up in fetal position in bed attractive.  Not from depression but just a bit of anxiety about whats out there. I’m a little agoraphobic at times despite all the years of adventure.  Shell shock.
Now I have to trust in God. I’m praying and I need to meditate more .  But I need to floss and do sit ups too.  Maybe I’ll go over to the pool and swim. I don’t like all the kids in summer.  It’s best to get to the pool early morning or late at night.  I like the winter months better.  We’ve had some good guy meetings in the hot tubs. Talking about nothing.  Not now with screaming teens.
I’m enjoying movies.  I watched Sword of Vengeance last night and really enjoyed it.  Gilbert and I missed Laura.  She’s baby sitting a bird this weekend.  We’re just comfortable around her.  She makes Gilbert happier. Tom visited last week and it was a great evening meal. Gilbert was ecstatic with all his friends. I’m alone and that’s good at times but I like the company too. All a matter of balance. I’ve got a couple of friends here Dave and Mac and we were both talking about how much we enjoy being alone with the dogs. Guys and their dogs. But it’s good when the girls are over. Aging is a kind of return to late adolescence.  Hanging out, dating.   I have difficulty generating activities occasionally. I’ve got this full schedule. I collected laundry yesterday, did some cleaning on the boat, bailed the dinghy, dropped off stuff at the storage locker and that was Saturday.  I got a computer repaired on Friday yet I feel like I’m not doing anything. I work a full week. I’ve written chapters in a book. I’ve dealt with a half dozen emergencies in the evening. I ‘ve cooked my own meals and cleaned. I’m self sufficient.  I ‘ve walked the dog and managed him. I’ve showered and prayed, read , completed another book, watched some movies.  It’s not like I’m a slouch but I feel like I’m not getting the important things done.
This time on earth is to come closer to God. God acts through people. There are Godly things. I’ve done a lot in life. In Ireland and Turkey I was uplifted by visiting the shrines.  I’m talking with god. I read inspirational books, Richard Rohr, Emmett Fox, right now.  I’ve been reading so much theology over the year. I got the master of divinity and am working slowly on a book on spirituality. I’ve one trip left to complete the travels I’ve done specifically to form the basis of a Christian book on the dispersal of the message.  I would go on perpetual pilgrimage.
Then I’d be happy to be an emperor in a brothel with a maiden feeding me grapes. I would even at times have a valhalla heaven where I fought with swords all day to feast and fuck all night to start all over again.  I like lust and gluttony and sloth and all the character defects and don’t have a whole lot of discipline these days against ice cream. I remember when younger I flogged my body till I was a provincial champion athlete and then flogged my body a whole lot more to bicycle across europe and sail across oceans.  I am content right now on this couch with the dog beside me and the toilet nearby. I think I’ll move to relieve myself then make another cup of coffee and face the challenge of whether to watch a movie or read a book.
I’m thankful for this. Sometime today I’ll move further than the fridge. It seems to happen. I’m active for several hours on my days off doing applied activities when I was really doing nothing like the chores of yesterday, maybe 4 to 6 hours in total.  When I was sailing it was common for me to do at least 3 to 4 hours a day on some applied thing, maintenance, chores whatever. I expect if I was retired that would be the pattern.  Working now I’m doing 10 hour days. Wouldn’t it be great if I could be paid the same as I am for 10 hours for half the time. This would be human.  I’m a workaholic, wage nigger as it is.  It’s not the money that drives me as much as history. It’s just the way it’s been but now I’m older I’m having to rethink things because I ‘m tired more.  While a change is as good as a rest, I’m more into resting on weekends these days than I am in getting out and doing something.
The things I could do
1) Go through the storage locker and get rid of anything that is no longer being used. Get the  boat stuff on the boat. I’m not living on the boat so I might as well get all the boat stuff I moved off for space back on it. I could even get my scuba gear on it.
2) Get out in the woods on the 4x4 and set up targets and do some target practice. I have joined hunting clubs but the rifle ranges are full when I’ve gone so rather than pout get out in the gravel pits with pieces of plywood and get the rifles precision firing. The rifles are sort of entered but you really could use the practice and it’s a gas to ride about on the 4x4
3) you should be fishing. You’ve got the equipment and licenses but you’ve not gone this last year.
4) You haven’t used your golf clubs in years. Just because they don’t accept Gilbert on the courses doesn’t mean you couldn’t leave him at home and get out to a driving range. You love driving ranges.
5) Dancing. Now that you’re running and walking with less pain you could get out dancing.  You’re still a bit fragile but a night of dancing would do you good.  The guys are always encouraging you.
6) You have to learn Biblical hebrew and you should keep up with your spanish. Your spanish speaking friend wants you to visit and you’ve been meaning to get down there again. Your’ spanish speaking teacher has online courses. You should keep this up. Maybe read ST. Theresa and ST. John in their spanish language.
7) You really have to get on with writing the books you’re working on. I know it seems to be enough to get 2 or 3 pages written and that exhausts you but you could do more.
8) You have to visit some friends. You don’t see John enough.
9) You’ve not been playing guitar either. And you certainly could use lessons.
10) Theres the job of getting the files digitalized. You have to get started on that.  You have so much to do and you’re just not moving very fast on anything.

All in good time. God is good.  I’m so thankful for all I’ve done and all that is in progress.  I’ve not made it to church but I’m thinking about God.  I imagine God with me and imagine all is God.  I would be his eyes and nose and fingers too.  Right now Gilbert is licking my feet.  Jesus washed his disciples feet.  Gilbert is God like in many ways.  I don’t know what the ball fixation is. Is this an earth metaphor?  Now he’s stretching and hoping I’ll take him out where he can sniff butts.  He’s giving me that look. One paw on my arm.  He thinks a lot of what I do at the computer, the iPhone and various screens is not nearly as good as walking him.  I could do that more.  There’s a sedentary compulsion that takes over. I think I’ll get up.  Enough of this.
Praise the Lord.  yes.

Office Move

Management said that my lease was up and they were not willing to renew it. I'd noticed that the other small law offices had disappeared. A single business on our floor had multiplied from 20 employees to 120.  They were willing to lease the floor for longer term.  I couldn't blame management.
It's just that change is difficult.  I had 'other plans'.  Suddenly my work, livelihood and routines were upended.
Thankfully my assistant, Angel, was on the ball. We both looked for accomodation. I contacted the government agency funded to promote business in the DTES. Despite several emails and calls they didn't get back to me.  I thought of how slow government is compared to the private sector.  Just another example. I couldn't wait.
Angel and I began looking and independently came across this particular office.
Single offices with a single reception area were actually less common than years gone by. The norm today is a reception area with receptionist serving anywhere from 3 to 10 offices.
My patients complain about the high cost of parking in the downtown. Where I was had been far better than the medical Broadway corridor where I'd been. Still,  in the last year parking was becoming difficult.
Personally I didn't want to go even more downtown because of the commute and the increasing insaniety of bike lanes in downtown.  I was also thinking it would be good for me to avoid driving through  Main and Hasting if I could because I was getting really terrorized by the people wandering like zombies through the streets. I was especially afraid of the stoned individuals who had tried to hug my Harley when it was in motion.
So, faced with the move I'd not planned, I thought the bright side might be somehow not having to face the last 4 block drive to my office which had become increasingly harrowing. I think I was developing PTSD from repeated near accidents with people running screaming in front of my car.  After bumper to bumper Vancouver commute with all the nonsense on the freeway I was a jumble of nerves for this last gauntlet run through the suicidal thrill seekers whose minds were not present.  What upsets me is that the city sees the commuters and tax paying citizens as the problem.  Their 'harm reduction' policies versus 'abstinence based recovery' support addiction.  They  put 30 km/hr signs on the road rather than fences along the roadside.  I am increasingly irritated by a city government that wants to turn the DTES into a ghetto recreation drug zone. Everywhere there's a marijuana dispensing location claiming to cure everything.
When Angel and I found the same office independently I sent her out to see it.  She thought it was great. Management was great. So I drove over.   I immediately saw that the new office was next door to the Serenity Recovery Store. As I treat so many people in Recovery I thought this touch a little god sign.
Most importantly the management was dog friendly as they'd been at the Old Electric.  They also accepted fish tanks.  It's amazing how many places don't accept dogs and  fish tanks. I'd looked for several days at the offerings.  I was so pleased at the welcome Gilbert and I  received at this new place.
A priest had an office below me and a lawyer next door. A professional building in a suburban neighbourhood with lots of street parking and a lovely dog walk for Gilbert.
The only downside was that there was no elevator. I am still working one and half day a week in the Doc Side clinic which is also moving up Hastings. They have a ramp at their new office so I have told the couple of patients that I'm seeing who have mobility issues that I will see them at that clinic.  I remember when I was on Broadway.  The elevator broke down for three months. I saw several patients at the coffeeshop. This solution would be  at least better than that.
All round it's a nice place. When I told a patient about the 'god moment', it being located next to the Serenity Recovery Store, he laughed.  He told me that he knew the site well and while he'd not known about the Recovery Store he knew it was next to Italian Sporting Goods.  My devious unconscious had not recorded anything else but the Serenity Store.   Yet when I drove by again,  sure enough there was the family owned Italian Sporting Goods store I've loved in years past.  There's also a tattoo parlour and coffee shop.
If I've a cancellation occurs I can walk down stairs, browse the inspirational literature, buy a coffee, get a tattoo and buy a gun. Then I can return and talk to the priest or lawyer. All round, my kind of place.
Having a place was a tremendous relief. My personal life has been rocked around the clock.  The amount of work I had seemed overwhelming without adding a move in tax time to the mix.  It all  seemed nearly impossible. But daily prayer, to do lists, a very helpful assistant in Angel, Gilbert's good humor and taking 'one day at a time' got me through this storm.
A few weeks before the move Angel and I began boxing the books, and pictures and separating what needed to go  to storage and what was going to be taken to the new office.
Bill Gyles who has helped me with previous moves had a friend of Bill's who organized with Angel to do the actual move.
I worked in chaos and mess for a couple of weeks. The office was hell because of the sunshine and heat. It was almost unbearable. The building air conditioning was down. Then Angel found out on our last day that I actually had the heat on in the office.  Unbelievable!
Patients were incredibly tolerant, sitting amidst boxes and walls with pictures and diplomas removed, and the horrible heat. (Stupid doctor).
Gilbert was great through out, greeting everyone and giving them the opportunity to feel better throwing ball. The fish ignored all the crisis.
Then we were moved.
I hardly made it through the last day at the Old Electric Building.  5 years I'd been in the DTES full time. I will still be there a day and a half but the rest of the week I'm now in suburbia.
The new office was a chaos of boxes and hot.  My first activity was to run to London Drugs Monday Morning and get a portable air conditioner. We're waiting for curtains. But the sun sure heated the office up quickly.  I do love the sun though.
No bedlam on the roads. Nobody trying to sell me drugs on the street.  Lovely houses like any suburbia picture around me.  And quiet. I couldn't believe the quiet.  I'd become used to all day sirens and the people screaming randomly on the street below my office. Here was quiet.  Glorious quiet.
Angel really began to like the waiting room as she organized her office area to her likes.  A whole lot of accumulation had to be put in boxes for storage because it was no longer pertinent.
I saw patients, who were again tolerant. There wasn't much difference in the chaos and boxes of a move, accept that this was clearly the 'beginning' of something new and better.
I really had wondered how I'd get through the office closure and the opening of the next office while maintain continuity of care with so many complicated patients really in crisis. I've reports that need to be done with deadlines attached but somehow it all looks possible again.
Angel had the internet and phones connected.  My computer and printer were working. I had my prescription pads and pens. I actually got through a day of work with everything we needed found.
It was a long day in a long month but we was moving forward. I'm even moving forward on all the other beaurocratic paper work I need to do now.
In the midst of the move my terrific accountant Anil came by and we completed the paperwork for Revenue Agency Canada. Much to my surprise I had money to cover the move and the taxes.
So many things.  So many moving parts.  So much that could have gone wrong but didn't.
Before getting the notice of the lease being up,  I'd booked a conference in Ireland and Laura and I had planned a week travel vacation there around the date.  I'd certainly not have done that if I'd known but we'd made arrangements and booked flights, conference and accomodation so continued to do this.
And yes, it's all coming together. I'm really looking forward to learning more about adult autism as well as seeing some of those addressing the problem of  alcoholism in Dublin. I'm really looking forward to  visitting the church of great grandparents. Laura's grandparents were actually married in a church where we are going too.  It's a further continuation of my theological studies in Christianity, Celtic Christianity being one of the main branches of the church. So it's been a light at the end of a dark and busy tunnel to keep that plan. And now the office move is done. Angel will have the time I'm at the conference to turn the chaos into an attractive tidy efficient functional space. I'm so glad to have her at this time with her capacity to rising to occasions.  She was the Badminton Champion in the Yukon and is really a good sport.
Now I'm waiting for DocSide to move. They've had problems with tiles and other features in their new building delaying the move for a month now.  When I come back I expect to be in two new offices.
And frankly I'd really wondered how I'd be able to make the move.  The College requires we notify patients 3 months ahead of practice closure so when I learned of the lease being up 2 and 1/2 months ahead, my first thought, I confess,  had been to run away to sea.  But I couldn't even do that because I didn't have enough time to notify patients. That fleeting escapist delusion didn't last the hour before I thought of joining a circus. That seemed like a good alternative when I considered all that was involved in moving an office especially at this time.  Thanks to saner thoughts, lots of help and prayer, it now has been done. I may even have a friend taking up the day I'm not there which would help with the overhead costs.
I'm really thankful everyone was understanding.  Thank you all.  

Portland Hotel Society Scandal

Portland Hotel Society Scandal reminds me of the phoney doctor who worked in a community. He gave all the criminals letters of recommendation. He flew anyone anywhere on tax payer money. He doled out narcotics and benzodiazepines.  He was everyone's friend.
No one got well.  The truly sick people were highly suspicious. Within months there was a realization that what he was doing was extremely, extremely expensive and odd.  He was caught.
Crack pipe dispensers and 3 million dollar a year drug club to shoot up street bought heroin.
Mark Townsend and Liz Evans have made a lot of friends by 'buying them stuff'.   He's given heroin addicts a place to shoot up. He's not interfered with the DTES gangs who haven't had to worry about  losing customers by their getting off heroin.  With all the 'high life' going on while the old heroin users are dying, off the young are stepping up to lead this 'life' or death. The drug dealers have always supported Mark Townsend. They're his biggest fan. All of his programs  promoted a 'culture of addiction'. 
He's even ?'bought'? politicians, though I don't know if that's politically correct to say.  Bought is such a telling word .  However the Canadian media wouldn't think twice about using such language for this sort of thing outside Canada.  In a similar Asian or US scandal , every Canadian reporter would be "asking questions' about  'extortion' and 'kickbacks' because the 'people need to know." .  This would be especially true if "mismanagement" occurred  in the evil 'energy industry'.  But aren't this self proclaimed 'do gooders' even more wrong when they're caught doing serious wrong.
The NDP Jenny Kwan appears before the camera paying back what she says her 'husband', she's 'separated' from 'misinformed' her about. "I never knew" she said.  And all the reporters go, "oh, she never knew. See she's crying. " Yet, only last year for weeks CBC hounded the Prime Minister's office claiming shrilly in every manner that PM Harper must have known what was going on with the Duffy expense 'scandal'.   Did Mulcair know Jenny Kwan was using tax payer money to go to Disneyland?  Now Jenny Kwan is going home to be with her children. Ahhhhh, ooooo.  I'm surprised there wasn't a stuffed animal or a bunny rabbit.
Was the attack on Harper 'racist' or 'gender biased' or the lack of attack on Jenny Kwann, racist or gender biased.?I never can tell anymore with the media so obviously partisan.
It struck me as the most two faced deceitful presentation for a feminist. If Duffy had 'cried' would he have got off more easily? This isn't the age of chivalry, yet there we still accept 'tearful'  presentations by women blaming their husbands  and everyone 'coos'.  Does that mean a man can blame his wife now?
Thank God, Christy Clark doesn't do that silly shit.  Already sick by what this bozo group was  doing  the Kwan pathos nearly made me spew.  I actually could have accepted 'mismanagement' and 'misappropriation' but when this drama queen act came on it really screamed 'cover up'.  With all the conspiracy theories out there, I never take notice until there is an actual cover up. You can't see the conspiracy theories but the cover ups seems to stick out like a sore thumb.
Am I the only one that asks, were any of  these persons connected to the gangs and drug pushers downtown?
Am I watching too many episodes of  Criminal Minds?
The CBC skewered Duffy and the Senate for their 'mismanagement of funds ( ?theft" - I love white collar language. If the rest of us do mismanagement or misappropriation it's called theft)   Martha Stewart and Conrad Black went to jail for that sort of thing but I sure didn't see the media getting all soft and sweet with either of them.  The comedians have however done as good a job with Mark Townsend and Liz Evans as they did with Mayor Ford.
Maybe I listen to CBC going on and on about Ottawa too much.  Then watching Law and Order and CSI and NCSI  I couldn't help but ask, if Jenny Kwann got  $35,000 from one business, were there any other business 'shook down' for money. Oh, sorry, was it possible 'her husband' was 'shaking down' others or, damn, there goes the language problem again.  "Inviting donations', is that the term?   Naturally, the NDP should be with the RCMP looking into the overall finances of Jenny Kwan as a public 'servant' like they did with the senate. Shouldn't they? Will the tax department be looking into Mark Townsend and Liz Evans like they certainly would look into me or you?
But obviously I watch too much tv.  They seem so willing to do 'financial audits' of 'individuals' when those individuals are involved in 'extortion' or "theft" or "kickbacks" or sorry, there's that language problem again.  I can't help but think of thieves thieving.  Mismanagement Mark Townsend.
I just can't figure how you can spend $800 on a hotel room running a supposed 'charity' and 'non profit' business. I asked a few of my profit based "dirty capitalist" friends and none of them had ever spent more than $150 on a hotel room. $800. Wow. That boggles the mind.
So how come we have so much 'mismanagement' in government. This 'unprofessionalism" and lack of 'morality' or even better lack of 'basic ethics' is not tolerated among doctors, accountants or believe it or not, lawyers.  So why should these 'managers' for government funded businesses get a pass on their 'books' when my lawyer and accountant must 'pass' mine.  Is the accountant for the Portland Hotel Society going to be speaking to his professional body about his 'oversight' or 'lack of oversight'.  Is the lawyer for the Portland Hotel Society going to be speaking to the Law Society about his or her 'oversight' or lack of oversight.
Mark Townsend, Liz Evens, Small and Kwan are just a small part of the 'nest' that makes up a 28 million dollar business.
There were doctors involved in the Safeless Injection Site. As a physician I couldn't help but wonder if those physicians will be at very least asked to confirm their 'innoscence' in this thoroughly repugnant scandal. 
Terry Lake, our Health Minister is to be admired for the extraordinary political risk he has taken making sure the provincial audit saw the light of day .  My question is when the RCMP will be tasked to address what really is missing.  Hundreds of thousands or  millions.  We  only got a peak at what the public purse was paying for.
I just can't help but think that the Canadian Tax Department would be all over me if I didn't even keep records as the audit shows over and over again these folks failed to do.
The darkness of the Portland Hotel Society and how far down the management chain the corruption and taint goes is appalling.
 Now that said, the front line workers are awesome. This is what is so sad about the DTES. The workers down here are truly amazing.  The homeless and addicts are also trying very hard to get help in a tough economic climate in a very expensive fast changing city.
And I know with regard to 'all the usual suspects', the Mark Townsends, Jenny Kwans, and Liz Evans, I'm supposed to think, "live and let live". That's why I'm thankful for the Terry Lake.
Thanks to Terry Lake there's more likelihood today the money will get to those who need it most.

Insite - Safe Slavery

The Insite - Injection site license is up for renewal.  The location is a major concern for development in the area because this is where the drug addicts and dealers congregate.
The deterioration of the neighbourhood due to drug dealing and drug addiction resulted in Chinatown losing business to Richmond. The merchants in the downtown are plagued by the dangers in the streets and fears people have in that neighbourhood due to the  lawlessness associated with drug addiction. .
The elderly ‘cruise community’ tourists would gladly walk to China Town except for the stretch of No Man’s Land, a veritable gauntlet of drug dealers and cigarette pushers, hefty unemployed young men, who block the corridor between Gastown and China Town.  Insite is the “castle” of the drug abusing community and frankly, given the financial support of government and various other “enabling’ agencies, it's a feudal bastion to abuse.
By contrast, the world renowned, amazing fensui place of “natural" high, The Sun Yat Sun Gardens, is strangled by the proximity to Insite and the deterrant to development Insite creates.  All the restaurants, apartment complexes and all my poor patients who don't do drugs see no benefit from the presence of Insite in the DTES.  Yet no one asks them and Insite with its captive population of drug slaves promotes itself.  Everyone I talk to in the DTES  who doesn't do drugs and especially those who pay taxes considers Insite a major threat to the safety and development of the community. Who wants to raise children near a facility which support heroin addiction by promoting it's 'safety'.  What teen ager hears that Heroin is dangerous and IV drug use is the principal public health threat for HIV and Hepatitis when instead they see that major marketing ploy 'SAFE".  There is no safe injection site. As Dr Fay says it maybe 'safer but it sure isn't safe'.
The Hell’s Angels, Tong, UN gang and other allegedly criminal organizations associated with drug trade are the principal beneficiaries of Insite .  Their "customer base" is maintained and the message that injection drug use can be ’safe’ is promoted not only locally but nationally and world wide.  Labatt’s doesn’t demand tax payer money for the provision of pubs so drunks can consume in public.  People who use Insite get their drugs from dealers and use them at Insite or on the street in back alleys.  Insite's funding should not come from tax payers. If it is to be funded at all, it should be taken from the monies collected by the state when they raid heroin shipments or take the assets of dealers. Let 'harm reduction' be funded as a percentage of that 'take' but not from taxes.  Taxes should be used to prevent and treat addiction not to support crime.
There could well be a place for Insite in the overall scheme of things but instead Insite has taken the funding and falsely claims ‘credit’ for successes in treatment in the DTES which have been a direct consequence of religious organizations and the traditional methadone/buprenorphine substitution programs that are stepping stones to abstinence.   The success of the latter programs was that they restored individuals to work and relationships whereas a needle injection site marginalizes and maintains individuals dependent on drugs.  It's a slavery support system, not "therapy' and certainly 'not recovery'.
I love the advertisement that says it doesn't matter how you 'dress' up a place, if the message still stinks. Now we see Insite putting in detox and treatment facilities to 'perfume' the heroin injection facility'.
When the truth about the individual and community dangers of tobacco smoking came out people tried to ‘localize’ smokers but it was realized that even in cafe’s, second hand smoke remained a problem and the health costs of smokers to the community was overwhelming. This resulted in the widespread abstinence programs, everything being done, leading solely to that goal.   That has had the greatest success in the treatment of addiction.  People ‘cut down’  then went onto quit with the use of patches, nicotine gum and champix.  They weren’t ‘encouraged’ to use ‘safe smoking sites’.  Instead millions ‘quit’ with the traditional and successful scientifically proven approaches to stopping cigarette smoking.  Vancouver would do better to declare the city a heroin free city than promote injection sites.
The sad fact about the safe injection site is that it has kept too many people enslaved to drugs and this ‘group of addicts’ is an increasing political force. We all saw how the big tobacco companies co-opted the smokers to write letters on their behalf and misinformed them about the opposition to addiction.  Suddenly the tobacco company was seen as the ‘victim’.  The same has occurred with the wealthy and highly financed Insite. Questioning the existence of Insite, demonstrating it’s lack of validity, and Insite in sites it’s member to riot.  And riot they do with personal attacks on me for promoting the proven alternatives and questioning strongly why our government, provincially especially, and urban as well,  is providing so much money to ‘harm reduction’ and not providing equivalent funding to abstinence recovery.  There aren limitless numbers of people who will speak out about the horrors of heroin. The Anonymous People movie is just one of many examples which show what heroin does.  The 'safe' tobacco smoker folk were 'beatten' soundly by government ads that showed what tobacco smoke did to people. The Odd Squad made movies of the lives of heroin addicts in the DTES.  It's not pretty but it's not getting the funding or support from CBC and other media that as johnny come lately eventually got on board with the anti smoking campaigns that told the truth about nicotine addiction.  The same truth has to be told about heroin addiction.
What do we hear in the media, but Insite ‘drama’ whereas the quiet sincere effective successful messages of Alcoholics Anonymous, Narcotic Anonymous, the Harbour Light Treatment Centre, the Catholic Church;s most impressive initiatives, the first United Church, thework of Salvation Army and Union Gospel, the street mission of Father Mathew, the countless other street churches. These are discredited or ignored and all that is spoke of is Insite.  Believe me I would rather sing the praises of the amazing work of volunteers and spiritual people but their quiet message of strength and success is being blocked out by the cacophony of Insite loud speakers and fancy funding.
 Everyone working in the field knows the outstanding work of individuals, groups, churches and communities but the media and government seem blindsided by this very sexy expensive idea of curing drug addiction by supporting drug addiction. It has that kind of spend your way out of debt  attraction to the addict, brain damaged, temporarily or permanently by addiction.
We love ‘diversification’ in medicine. We love alternatives and multiple pathways to recovery. I simply object that the least effective most dangerous and truly frightening approach to recovery is demanding not only all the money but all the glory.  This is not scientific and it’s simply not true.  The ’so called’ research is anything but ‘unbiased’ . It’s threat to the community and threat to the youth is massive by contrast.
We heard about the famous Canadian actor dying after buying drugs outside Insite. Everyone in the community now knows where to get heroin, crack or methamphetamines. Just go down to Insite.  The dealers love the place.  It’s drug central.  A visiting friend walked by there last week and was offered drugs twice in the Insite block. But the police are discouraged from ‘policing’ the area because of the powerful politics of the entitled and the financial support they have.
Ironically, with the help of methadone and buprenorphine, NA and existing treatment services, the threat of IV Heroin was no longer the concern it was until Insite showed up at the time when crack and crystal meth were becoming the growing concern.
There is no ’safe injection’.  Even when I trained as a doctor to do injections I knew this.  There is no ‘elective’ reason for injecting people with a ‘recreational substance’. That’s disease and it’s enabling when anyone ’support’s’ and even ‘promotes’ it’s use.  The cost to the community of opiate use was so great that China banned it  more than hundred years ago, before the British invaded so they could ‘push’ it again in the Opium Wars.
It’s as nauseous historically as ’slavery’ ,  yet here we are promoting something akin to ’safe slavery’.  Let’s reinstitute slavery.  All we need is a  nurse to make visits to ‘plantations’ or today's equivalent,  ’child  sex slavery sites’  so we can promote  ’safe slavery sites’. Because the fact is, an addict is a slave. He doesn’t need a place to do needles but a place to get off drugs, Slaves don’t need nurses to watch them be slaves,  they need ‘freedom’.
Abstinence offers ‘freedom’.  Insite sells slavery.  At a very high price. I would be glad to see this place out of the DTES if only for the community and the people who live and work there.  We all want to have  safety for our homes and businesses.  I personally want freedom. Democracy depends on people being 'free' to vote.  Homes, businesses and communities grow in freedom.  Stop slavery.