A Good life

Death conquers all.
There is so much arrogance in audience.
The dying take center stage.

 All but  the newborn's cry are upstaged.
The baby's wail alone is more commanding,
Than groan or keening lamentation.

Somewhere a fat lady sings.
The soldier says the bullet
Has the name on it.

Practicing the presence:
The infinite mystery, inexplicable.
There is no rushing ultimate reality,
In the margins of existence,
We wait.

"Patience!"

The good death is refined.
Messy with elegance,
Dying, an art beyond all art.
The tea brewed to perfection.
Is savoured to the last drop.

Love  is in the outlying.
Departures and meetings, meaningful.
The melody goes beyond the lyrics;
The silence  outlasts the storm.

Thank you for your gifts, dear brother.
Thank you for making this home.

My God, my God, why have you forsaken me?

“My God, my God, why have you forsaken me?:
Why are you so far from saving me, so far from the words of my groaning?
Oh my God, I cry out by day, but you do not answer, by night and am not silent.
I opened my Bible to this page. Today I thought I should use my new big print edition Bible for this exercise. I just open the Bible somewhere and reflect on the words that first appear to my eyes.  This is what I saw today.  The fact is my Bible is worn from use. It is likely that I’ve come to this page over and over again. The Bible falls open here. It’s the opening of Psalm 22, the first words of which were said to be the last words of Jesus on the cross.
I have to be cautious though because this is a verse of self pity. In my narcissism and isolation I am prone to self pity.  I work as a healer, I’m a physician. My humility is that I insist the medication and charms and incantations cure but somehow I believe still that it is in the relationship.  I love the St. Francis prayer “Make me a channel”.
I feel this as I’m healing. At the end of a day of work I feel like I’ve had all the strength and energy drawn out of me. I can work differently. I can be removed and have the beurocratic boundaries up around me like the barriers lawyers and businessmen erect. But I don’t. I took an oath and I do the best I can to heal.
In psychotherapy it is as if we share spinal columns.  There’s a merger that is borderline in the pathological but yet is akin to walking a mile in another’s shoes.  In shared stories and vulnerabilities I meet the defeated in their wound.. I find the pain and shadow and go there. I am one with the nightmare. I find the nightmare within myself.  Then I reassure.  I rally. I cheer lead. I exhort.  I see disease as an enemy and I’m the Sergeant, Lieutenant, Captain, Commander encouraging men and women to go another day.  I have magic potions. I have special ‘tests’ and ‘rituals’.  I have ‘names’.  I am Adam in the garden. I have a wealth of experience and secrets.
But now government has lost faith.  They are dishonourable.  They admit to defeat for the country. Like Nazis we find they have put their money overseas and are running to Argentina. That have plunged the country into inexorable debt and given themselves wages. They are spending recklessly overseas and buying future homes to flee to.
First they brought abortion and killed the children of our forefathers rather than paying mothers a living wage.  They lied and cheated and defiled.  They gave their Order of Canada to the greatest Nazi killer of our time Morgentaller, a survivor of Auschwitz who identified with his aggressor and hating catholics encouraged their abortions.
Today abortionists make more than those who deliver babies.  I am punished for keeping people alive. I am a fool. I am ridiculed in high places. They have stopped seeing patients and gone to committees. Everywhere committees gather to discuss the other. But no one wants to see the other. They take the money for the other and give themselves awards and celebrate each other in an amazing circle jerk but all the other has are waitlists.
Bombs are where the money is and dreams.  It’s Matrix all over.
Now we have physician assisted  suicide.  In Holland euthanasia began in compassion and then it developed into a profit centre like our jails.  Corruption is everywhere.  Especially in Quebec. The Liberal government of Ontario has the greatest world debt for a sub nation. I am sent letters upon letters for finding brain tumours with MRI challenged to justify my spending on the war against disease.  My patients can’t afford the medication.  The sick are impoverished while the leaders of democracy strut about like Czars and emperors.  The new Napoleon with his Sophie are a Hollywood favourite with million dollar jaunts and flaunting their wealthy living like Rothschilds in the 30’s .
And the UN has given us Agenda 21 wanting to kill off billions of people rather than celebrate the life we have.  People are the enemy.
Or so it seems.
I cry to God because my brother has cancer. My patients have cancer. And we’re all aging and death is nearer in years than ever before. I didn’t think of death like this since I worked with Aids patients.  Now in the epidemic of luxury I work with the drug addicted and they die.  I know them personally intimately and I am up against a wall.
My spiritual teaching is ‘surrender’.  I am to ‘accept’.  I pray the serenity prayer. I acknowledge my lack of omnipotence. But Jesus resurrected and resurrected Lazarus. He healed the unsealable.  I believe in miracles.  I have known so many. I have seen so many patients live who others said would die. I have truly known and walked in the sacred.
All around me the atheists are loud and they reduce everything to the limits of their own imagination. I am a scientist but their pseudoscience and their science business frauds are rampant. I am gifted in my theism by the science I have learned. I walk in Heisenberg and Planck and enjoy the multiverse and immortality. Yet as I withdraw and observe I recall Arjuna talking to Krishna about the war.  It’s not about the war but it’s about ones own participation.
I pray for my brother.
My dogs back was hurt and he was near the point of needing to be put down. But today he is well enough. I fear for his future. His hind legs lack the strength they once did but he is older as I am and my back legs lack the strength.
My life is harried. I am always trying to do so much. I’ve overwhelmed. I’m daily encountering emergencies. I’ve worked for decades in the areas of greatest need with the most vulnerable alone, without so little support.
I saw a couple of men yesterday and introduced them.  They had both suffered catastrophic brain injuries and were never thought to be well in anyway again.They really belonged in institutions but somehow struggled on the outside. I saw them.  I read literature night after night, studied journals attended seminars, asked colleagues, and did my best. It’s beyond anything I ever learned in school and there is no clear answer. Each is unique.  I was thankful for the wisdom of colleagues. Only a few of us work here and it’s not my thing though everyone says it is. It’s just so hard and no one else wants to do it.  Over and over gps tell me the called dozens of my colleagues and they’ve been turned down. There is no wealth in seeing sick. Everyone is cherry picking the well. But a decade later I watched these two interact and so enjoyed their laughter. A couple of soldiers who shared a common battlefield. I love their families. I love the community. I love health care. They epitomize all that is good.  I was so glad to be apart of it.  But there’s been so many tears.  I cry myself to sleep at night unable to help.
The rich and well get the first tier of care. There is Betty Ford for them and now they’re just opening places for the other to inject their existence away.
I am thankful. The sun has come out again today. I was so sun sufficient. For weeks now coughing all day and all night, exhausted, chest hurting from the work of coughing.  Pain in the intercostals.  Feeling in the morning like an elephant has sat on my chest.  Thinking I’m dying. Every night at 3 in the morning thinking I’m dying.  One night dragging myself to the couch and finding the phone and preparing to phone an ambulance but then I could breathe.  Breath, like everything I take for granted. Going to work embarrassed by the cough. Wondering if it’s a cold or just allergies.  Suffering and feeling the suffering of those I try to help with so few resources.
Always there are critics. The parasites abound. They are so far from the front lines but in their space station air head wisdom they can criticize but they are utterly incompetent in face of danger and lack the humility to admit to the depth of their cowardice. They are dying to. Their fear is ever obvious in their attempt at control.  I watch them cross their legs , the wrinkles at the edges of their eyes. They are in shock. I ‘d like to talk to them, reassure them. but they have gone to hide in their positions.  They have lost their humanity and take solace in the machines they worship. It’s the money. I can not but envy them. They are driven by the rankest of forces. Money buys them.  And I am little different.
I say I would be sailing if I were rich. But I am able to flee to the sea and still I linger asking myself how come God doesn’t heal me. I only ask for a miracle. A cure for cancer. I will die but let them live longer and suffer less.
I am suffering for not. I am on a cross and friends are calling, get down we need the wood. I am here another day.
There is another complaint.  I never had a complaint when I worked as a general practitioner. I never had a complaint when I worked as a general psychiatrist. I was so admired when I was in surgery and community medicine.  But now I’ve worked for years with the addicted and alcoholic and criminals, sociopaths and psychopaths.  I am alone so much in the community, one to one in a little office.  I have been attacked. Guns have been pointed at me. I’ve been held hostage. I’m afraid more easily.  A young man told me that some doctors get more complaints. I spoke with the forensic psychiatrists about ‘rate your doctor’ and how their patients loathed them.  I spoke with the head of addiction and physician care and he had two complaints against him and one to the human rights.  So I thought it was the field. I’ve had a complaint each year this last five years and each has been because the patients drug addiction has caused them to be denied work.
The last two have insisted that because I ‘named’ them ‘substance abuse’ and that because I did the urine test that showed positive then that was why they were given a DUI and that was why they were not allowed to work.  I’ve known dozens of doctors who covered for patients, colluding with their addiction and causing them to be a risk to others. There are no complaints of ‘sins of omission’.  I’ve done exactly what I was required to do and this young doctor , incredibly inexperienced, working in a beurocratic job suggests that I could somehow know better how not to get a complaint.
So it’s ‘blame the doctor’ and I really don’t want to be one any more.  It’s the soldiers fault who gets wounded in war. There’s someone in Ottawa or Washington who is avoiding the frontline themselves but studying grafts and showing how certain soldiers are the ones that get wounded.
I know this is a resentment.  The young man is a grandiose arrogant idiot but then I am the one who is suicidal. I’m the one who wants to go back to working in a hospital with all the dozens of people for every patient and the resources and the gang approach to medicine and the immense waste of resources. I miss the intensive care where no one was expected to live and they didn’t so no one could complain. I miss the years I did psychotherapy like the psychologists and wonder what is it that wants me to work where there is the greatest difficulty.
Why couldn’t I just sail a little boat in English Bay but instead sailed solo across the pacific at Christmas facing the greatest fears. What made me face 40 foot seas.  Why do I push myself to the limits. Why not get on a committee and work well within the ‘wire’.  If only I avoid the ‘other’ stay safe, play it safe, don’t rock the boat.
I really want to .  I wonder at a life with complaining hurting dying diseased people. I wonder at a life of despair.  The money isn’t good enough for the abuse I get. Accountants make a whole lot more and don’t have people pulling guns and knives on them.  I am threatened routinely. If you don’t write what I say to write I’m going to lose my job and you’re going to be sorry. I refuse to collude.  I am increasingly being the fall guy for insurance companies that didn’t want to pay in the first place but now blame the doctor and the patients complain that the doctor won’t say they’re in a wheel chair when they’re not. Increasingly there’s this lie that is being perpetrated. We’re been consumed by the bureaucracy which takes the fat and leaves nothing for anyone else.

They’re fighting for crumbs under the table.
And I’m grateful.  I can breath. My chest is only a little sore. I bought a lot less. I’m here in the sun. I”ve walked. I’m not dying myself. But I have no miracles. I pray and I can’t seem to convince God that my patient and my friends and family need to win the lottery.  I am insignificant.  A speck of irrelevance.
My God, My God.

I am thankful for the view. My little dog is looking out on the street. A young woman just walked by with perky breasts, tight summer clothes and barefoot.  I’ve been enjoying taking pictures of flowers. There is so much joy and pleasure to be had right here. I am thankful for this day. This is a Saturdayl Most days I’m just recouping for the onslaught of sickness and disease.  The horrors of addictions.  Livers coming out of the bodies like Sigourney Weaver’s aliens.  Rashes and unknown diseases. And contagion.
I know a famous specialist who told me she avoids people with disease as she is afraid of their germs.  She was glad to get through medical school and residency so she could avoid seeing patients. She writes books and others do her touching for her.  The trick in medicine is to spend the least amount of time in direct contact with illness.  And yet contagion hides for days before it declares itself.
My brother is told to avoid crowds.  The Chinese were wearing masks on planes .  The new handshake is touching knuckles. In church when they say the peace they no longer touch.
Insanity is infectious.  Like addiction.
I love the sun. I am so thankful for this reprieve.  I am so very thankful that I am able to sit here and have this table, this chair, this bible this light and this place to journal.
Journalling is like squishing the puss out of my brain. I bleed out of my ears. And then with it gone from my thoughts inside I can carry one. I can rally.
I cleaned my home.  I made my bed .  I shook out the rugs. I washed down the bathroom. I changed the sheets.  I cleaned the toilet.  I have oils burning and fans running the scents through the home.  The windows are open. I am thinking now of lying in the sun and hoping to rejuvenate some.
Let the self pity go. Let the resentment and fear go.  Pray for enemies.  Find peace of mind.  Welcome the coming of death.  It’s only years or days or hours that I have .  I liked that we walked today for hours and I remembered that last year I had such injuries and pain I couldn’t have done that. There are always blessings. It’s always perception.
Thank you God. Thank you Jesus.  Forgive me for my lack of faith. Forgive me for my whining and complaining. Forgive me for my inadequacy. Teach me yours ways. Help guide me in what it is I am to do. Show me the way.  Help me to be more helpful.  Help me be less afraid.  Let me sing praises and pray and and celebrate the wonders of the sacred. Let me see the dance of love in all creation.  Thank you God.

Facing the Challenges of Aging and Dying, An International, Interdisciplinary Conference, Queen's University, Kingston, Ontario, Canada

Catherine Dhavernas (French Literature, Theory, Queen’s University) and Janet Dunbrack (Board Chair, Hospice Care, Ottawa) organized a conference on Aging and Dying.   I attended this conference noting that increasing numbers of my patients are considered aging. Indeed I’m considered Aging.
It’s been many years since I studied with Elizabeth Kubla Ross and increasingly I have patients dealing with dying parents. Personally I am feeling my age as loss.  Once extremely fit and athletic a series of injuries in the last few years have taken far too long to recover from. The aches and pains remain and on top of that some fat old man seems to have invaded my body.  Where once I’d love to run today I walk and actually prefer to ride. I’ve had the loss of some smell after a particularly severe sinusitis and added to that is thinning hair and some mild hearing loss.  It has given new meaning for me personally to the classic Canadianism, “eh?"
My older brother, the rock of the family, the one who lead the way through childhood, the one who protected me in cubs and scouts, had a near death experience with a pulmonary embolism and subsequent discovery of pancreatic cancer.  Queen’s University oncology department doctors have been the best.  He’s responding to chemotherapy now.  We only just buried the ashes of my father and mother who died separately these last few years.  It was my brother who dealt with the bureaucracy of the funeral parlour and graveyard who tried to insist that only my mothers ashes, not a mix of my mother  and father’s ashes were ‘reserved’ a space in their prestigious graveyard.  It was my brother’s wisdom and patience that solved the problem waiting till the right time to stroke the outstretched palm, knowing that this was all it was ever about.  Baksheesh,  The trade in the dead.  My suggestion, typical through life, that I’d add some more corpses to their precious graveyard had been tempered by my brothers understanding and acceptance.  He’s been a voice of reason always.
As a psychiatrist who has helped stop literally hundreds from killing themselves I’ve been depressed with the Supreme Court’s new ‘physician assisted suicide’ stance.  I took an oath to ‘do no harm’ and the weasel words of their decision seem less logic and more convenience.  The UN Agenda 21 has invaded courts and bureaucrats like cancer offering death in the name of life wherever it goes.  I was excited by this conference because it promised to address this topic.  One of the leading lawyers involved in Quebec’s euthanasia program was to be a speaker as was the University of Toronto's leading medical authority on palliative care.
Nearly 25 years ago I’d been condemned for recommending ‘palliative care’ for a patient only to find that the doctor and nurse who were claiming to be more caring and more concerned than me and clinically wiser, were doing pharmaceutical company experiments on the elderly and demented for kickbacks without consent.  As so many were making such big money I was lucky at the time to keep my license, finding no friends in the very places where people were on high government pay to protect the lives and dignity of patients.  The practice stopped, I was ‘set free’,  I was hated by those who had lost a prime source of income and considered stupid for not accepting the lucrative olive branch offered to me to turn away.  I was thereafter designated a ‘non team player’ and suspect as ‘disloyal’.  Palliative care meanwhile was what was appropriate for my patient and supported by her family.  So in the end Palliative Care won out.  It’s today a cornerstone of end of life care and thinking. Yet I know this wasn’t always the case from my personal horrendous experience.  
 
The conference was held at the beautiful Isabel Bader Conference Centre at Queen’s University.  A truly lovely location with wonderful views of Lake Ontario and state of the art facilities.  Not surprisingly the symphony performs there which explains to some extent the elegance and sense of refinement that permeated the facility.


The originators of the conference , Catherine Dhavernas (French Literature, Queens) and Janet Dunbrock (Board Chair, Hospice Care, Ottawa)
opened the morning sessions.

 “Aging and dying are a reality central to the human condition”.  The greater significance of this now is that ‘with growing aging population…raising the awareness (with) sense of priority and care they deserve…and belief in multidisciplinary exchange with an awareness of barriers."
She saw that the arts and humanities could work with the health professionals ,noting that her own interest and awareness had resulted from her volunteering to assist in the palliative care unit.
She introduced the topic of “Narrative Medicine”, and described how ‘literary studies help develop awareness."
She quoted Rita Charon, Narrative Medicine, Honouring the Stories of Illnesss, 2005

Rita Charon, Narrative Medicine, Honoring the Stories of Illness 2006

-“We clinicians act as ventriloquists to give voice to that which the patient emits.  I put it that way because the patient cannot always tel, in logical or organized language that which must be told. We let the other talk through us, finding the words in which to say that which cannot be said.”

“No story is possible, if by story one means: to tell a story of events which makes sense>”

Sarah Kofman, Smothered Words

She showed pictures by  Rembrandt and Goya (“Anatomy Lesson” Rembrandt1632 and ‘Witches Sabatth” Goya 1821-23 to illustrated the change from painting as a pursuit of knowledge and the dead as an object of knowledge to a different perspectives, a dead man as object of knowledge to superstition replacing knowledge.
 “Does medicine have to overlook the unknown? was the question raised.
Drawing from works of Marguera Yourcenar the Abyss, the movement from ‘self to other’ was discussed with the origins of the essence of ‘palliative care’ underlined. “the patient in the throes of death….acknowledges the unknown and unknowable….nonverbal only viable way to care for patient - invisible inarticulable care."
“our society, aging, denies unknown….promotes youth in denial."
It was a deeply moving presentation that raised all manner of considerations for me a physician.
They stated ‘Our hope is to open discussion across various disciplines to recognise aging and death."
The conference certainly did this for me.

I was moved by the pictures of the events of dying, the changes in perception over time and culture.  Each presenter was excellent.  I had come to hear mostly the University of Toronto physician discussing palliative care in light of the new physician assisted suicide changes in law.  There was a snag in the technology but I was delighted by how the planners rose above these post modern difficulties with almost medieval persistence.  The presentation was all I could have hoped for. I had also been most interested to learn from the lawyer who spoke on the Quebec legal experience of euthanasia. What was so satisfactory to learn was that  ‘Palliative Care’ was enshrined in the laws In Quebec.  Euthanasia was not something to be offered to the poor while the rich got Palliative Care.  The law demanded that the highest forms of Palliative Care be provided.
Now that said, I as a pragmatist and scientist was most impressed by the presentations by the ‘flaky’ arts faculty. Rather than ‘soft’ their presentations were hard and to the point.  I was truly challenged by the presentation on Caravaggio discussing the actual sense of timing and time as it changed. We have used ideas in science of brain death and such but here was a truly enriching consideration of the history of this idea of time and timing as related to art history.  Who would have thought!

(Instant of Never-Ending Death : Divergent Trajectories in Caravaggist Art

Itay Sapir

Art History

Universitye due Queebec a Montreal

Issues around death

-public versus private

-right to death

-technology)

I loved the whole idea of Ars Morendi and was thankful to learn of this. The discussion of the art of different periods and the ideas of what was important in the day and age most interesting.

(Ars moriendi - The Art of Dying in the Middle Ages

Thekla-Christine Hansen, M.A.

Art Historian , Mail: thekla.handsen@gmx.de

Christian-Albrecht-Universitat Kiel

Plan

preconditions - living conditions, medicine

 -ideas of afterlife in medieval times

Ars Moriendi- the art of dying well)

I loved the art and presentation and discussion of present day views of aging. Indeed, when the  somewhat fat old white guy torso was put on the screen I wondered for a paranoid instant who’d been taking pictures in my bathroom.  Yet, seeing this, I felt less ‘shame’ in my definitely changed look from the days when I too was young.  It struck home viscerally how much we are a youth culture and how ‘other’ I felt until hearing and seeing this.  I intellectually know this and yet the art and this presentation touched me in that experiential place where I went aha.  This was a great presentation. 

(The Art of Aging in the Photography of John Coplans, Suzy Lake and Cindy Sherman

-Meghan Bissonnette

Lecturer, Art History, Valdosta State University

Contemporary artist who —represent aging

1. aging as beautiful - 
2. coming of age - art and science - show - heartfelt/dignified/beautiful
3. rarely do we represent stigma - aging as sentimentalized
4. artist who take more critical stance
5. beyond stereotypical )

The presentation by a native woman brought home the importance of culture in any discussion of aging and death. AT UBC I’ve had the privilege of knowing and working with Dr. Soma Genesin, cross cultural psychiatrist who insights are always so profound.  This presentation raised the awareness of the cultural and aculturation aspects of aboriginal societies where a person’s belief systems could easily range from traditional to fully westernized so that ‘assumptions’ had to seriously be guarded against.  I was interested in the presenters tribal Mohawk nation ideas so different tribally from the Haida and Kwakiutl of BC and the Cree and Blackfoot plains tribes of mid west. Having worked extensively in the aboriginal cross cultural context with the benefit of First Nations Elder Anglican Minister Vivian Seegers medicine wheel insights I appreciated the difficulty the presenters had in general reducing so much material into an overview presentation.  The challenge would be akin to saying,  in 1 hour tell us about “European Culture”. The take home point was strongly made for the need to address this especially with the native elderly.

Finally , I loved Downar quoting Woody Allen,  “I don’t mind dying, I just don’t want to be there."

The conference was a day and a half. Unfortunately I had planned my flights originally flying out of Kingston but had changed to leaving Toronto so was unable to attend the morning conference.  I did enjoy the lunch and breakfast time which in ages gone by we called ‘mixers’.  There was a reception to and a celebration of the new courses and master program in Aging that had begun at Queen’s.  I do hope they continue this conference and would recommend it to all those who work with an aging population or have an special interest in aging and dying.  I’m very thankful to have attended