David Berner - story telling

One of my all time favourite songs is Lyle Lovett’s “If I had a boat”.  It goes ‘If I had a boat I’d go out on the ocean and if I had a pony I’d ride him on my boat.”  I found myself thinking of that song listening to the incredible David Berner tell stories of as many incongruous moments in his fascinating long life.

He told of his helping set up  X-Kalay, recovery house for addicts leaving jail in Winnipeg. That’s the story of his book. “All the Way Home”.   He talked about living in London England doing the most boring job, putting items in a ledger for the Queen. He told of his time with Bob Hunter, later of Greenpeace Fame, in the “Company of Young Canadians”.  Then his work as a famous actor and comedian. He’s so very funny.  

The audience laughed and there were enough in the theatre business there to appreciate his description of his life a ‘between gigs!”  

He wrote for the Province and the Tyee and is known for the David Berner Monologues and the David Berner Show which continus to appears on Shaw Television 

 He worked at CBC having various jobs including interviewing folk from all over the world but mostly in the entertainment industry.  He’d later work as a radio and television interviewer for a variety of stations, including CJOR and CKNW  He reminisced about old leaders in the radio and television journalism world.  

He told wonderful anecdotes of Oscar Award Winnners he knew.  We especially loved hearing  about Shelly Winters,  Ginger Rogers, Carol Channing, and Ray Malan.  But his stories about his Jewish grandmother took the cake. 

He continues to teach and work as a therapist with addicts. I personally knew him from the Drug Prevention Network where he was the Executive Director. He has also been  working at Orchard Alcohol and Drug Treatment Centre doing group therapy. He told moving tales of recovery bringing tears to our eyes with the stories of hope. 

He  talked of his writing and concluded with reading a delightful work of detective fiction. It was a couple of hours of sheer entertainment. My partner Laura loved it all.  

I found myself thinking of Billy Bishop Goes to War, Canada’s most famous one man show.

Addiction Dialogues, Hillcrest Community Centre

The Hillcrest Community Centre host for the evening was very helpful and organized.  We had a large room upstairs  away from the busy but healthy pool and gym activities below.  We began as people were still coming in till it was finally a full house.
David Berner, radio host, actor, founder of X-Kalay Foundation for addiction, author of the recent book, All the Way home and group therapist at Orchard Treatment Centre on Bowen Island, was the moderator extraordinaire for the event.
Opening the panel was Counsellor Candace Plattor, author of Loving an Addict, Loving Yourself.  She spoke mostly to the effect of addiction on family and community. She described solutions for treatment incorporating choice and choices individual and family needed to make to avoid enabling.
Brenda Plante, Executive Director of Turning Point Recovery Society , spoke to the incredible success of their recovery home programs over that last 30 years. Brenda Plante is a household name in the recovery community of Vancouver for her big hearted, thoughtful but well managed programs. She has support from communities, neighbours, clients, governments, RCMP and all the doctors and counsellors working in addiction.   Already with houses in Richmond she's  just opened their newest house for women in North Vancouver.  She spoke of the program and the need for addicts to be reintegrated into life. Addiction is so isolating. It takes everything away. She encourages  people to become involved in groups,  clubs and various activities as part of their process of abstinence and recovery.
(I already have half a table of  tickets to the Turning Point's annual Gala. This year  Mathew Perry of the show "Friends"  is the keynote speaker.)
I, a physician, psychiatrist and addiction medicine specialist,  sat next to Brenda,  proud to be among such greats of the recovery community. I spoke mostly to the medical and psychiatric aspects of addiction, talking about genetics, liver, damage, lung damage, cancers caused, HIV and Hep C spread,  neurochemistry, harm reduction and medications, only being valid as they lead to abstinence and recovery. The 'cure' for addiction is abstinence.  (I did express my concern that there is a ‘customer’ model developing in the ‘harm reduction’ arena, with  conflict of interest, lack of faith and cynicism with increasingly two tiers of treatment, abstinence for the rich and educated and  harm reduction for the poor and less informed.  I spoke to the tremendous success of smoking cessation and how only 20 years ago this room might well have been filled with smokers and their accompanying clouds.  No better example could attest to the success of recovery. What is possible for cigarettes is equally possible for other drug addiction and alcoholism.  I mentioned Sabet's definitive book, Reefer Saniety, on the myths associated with marijuana.
AnnMarie McCullough began the first Recovery Day in Vancouver Canada. Now it’s spread throughout the provinces  so that it’s likely to be a national day perhaps as soon as  this year or next.  She also began Faces and Voices of Recovery while working at Orchard Treatment Centre. She spoke to the millions who are in recovery and the significance of their vote and political power. She was glad that the Health Minister, Terry Lake, provincially and Health Minister, Tony Clement, federally were so supportive of recovery. She encouraged everyone to speak to MP's and MLA’s and get involved like they were this evening, increasing  community awareness of the disease and need for treatment.  She spoke to the success of 12 step programs, other group therapies, treatment centres and recovery houses.
David shared a letter he’d received recently from a man, 35 years, clean and sober from drugs and alcohol, thanking him for believing in him in the days of  X-Kalay.
The audience participation began their with questions and answers.  Members from the Portland Society used this time to speak of  their controversial  provision of  alcohol for alcoholic and crack pipes for crack addicts. This lead to some interesting discussion.
A school teacher expressed his concern for the need for adolescent services.  Brenda Plante and Ann Marie spoke of the acute shortage of beds and other resources for adolescents.   Last Door Treatment Centre had however just opened some more  The need for adolescent services was a major concern to the audience.  I shared how Dr. Shimi Kang, an adolescent addiction psychiatrist was doing truly amazing work in the field.  (Our host  later told me he knew her and her husband personally and what a wonderful caring people they were.)
A tall man shared sadly how many friends of his had been killed by addiction. He spoke of Canadian solders who’d survived tours in Afghanistan only to come home to die in the clutches of drug addiction. He was very angry with  criminals invading every aspect of Canadian society with their "drug terrorism".
I couldn’t help remember  Sturges North motorcycle rally hearing  the great Canadian rock and roll band, Steppenwolf, singing their classic song, Goddam the Pusherman! I say, Goddam the Pusherman!
David thanked everyone for coming then individually we answered questions  speaking with people who told such tragic  stories of family members and friends  devastated by the disease of addiction.  A lovely woman was caring for the small children of her brother and wanted to know how to speak to the absences of addicted parents.
We were thanked all round.  Further Addiction Dialogues are planned.

Addiction Dialogues, West Vancouver

I was honored to be asked by David Berner to be apart of Addiction Dialogues.   A panel discussion would allow the community to discuss and answer the concerns of homeowners, citizens, parents, employers and others interested in what addiction is and what can be done about it at an individual, family, work and community level.
David Berner, Executive Director of the Drug Prevention Network of Canada, had founded the first residential treatment centre which began in Vancouver British Columbia as the X -Kalay foundation and continued in Manitoba with Jean Doucha and the Behavioural Health Foundation.   His recently published book, All the Way Home, tells of those early years. Today as well as being an endless crusader for truth and proponent of living life to its fullest, as a weekly talk show host  and addiction counsellor, he helped co found the first Recovery Day in Vancouver.
AnnMarie McCullough started the Faces and Voices of Recovery and began the first Recovery Day in Vancouver which now occurs nationwide.  She also leads work at Orchard Treatment Center.  She was radiant sitting beside me, her inherent beauty even more so, since her recent engagement announcement.
Lorinda Strang, Executive Director the the Orchard Treatment Centre sat next to me. Her experience and work in the field is especially well known to the community of West Vancouver where she raised her family.  Wealthy communities such as West Vancouver are preyed on by drug dealers, their children at greatest risk.  
Candace Plattor, Registered Clinical Counsellor, and author of Loving an Addict, Loving Yourself, completed our panel.
As moderator, David Berner opened by asking us all what we thought addiction was.
Candace spoke mostly to it’s impact on family and relationships as well as stealing the life from the individual.  In her work she as often cares for family members who find themselves pulled into the desperate chaos of those addicted to a variety of chemicals as well as the process addictions, like sex, internet, eating disorders, gambling.
Lorinda Strang spoke to the total destruction of the person’s life purpose and the loss of all their interests and relationships and their failures in their relationships and the workplace.  She described how positive it was that businesses and families were recognizing addiction earlier and getting these members to treatment centres such as Orchard earlier when successes were most assured. She described the denial process and the abhorrent thinking, the rationalizations that ‘explained away’ all manner of loss and failure but never addressed the addiction itself. She talked of the wasted lives she saw daily in their work, people arriving like zombies and becoming human again in their relationships with other, lives restored with hope and joy and purpose.  She spoke of detox as only a first phase but the next months made easier in a treatment centre but then the life long need for awareness. The disease of addiction is a waxing and waning  condition from which one may recover, as evidenced by the millions that have,  but still they carry the risk for relapse.
I spoke to the neurochemical evidence of disease, the  genetic evidence, the twin studies, fMRI data, the hijacked dissociative thinking likened to a computer virus or cancer so that a person begins to ‘worship’ and ‘serve ultimately as a slave’ their God of addiction despite ‘negative consequences’ such as health problems,  failure in school, athletics, loss of important relationships and inability to maintain or manage work at previous level.  Whereas I tended to quote studies and research and stats, boringly, impressed myself by the science, the others tended more to tell personal stories, speak of clients, their families, friends and lovers and the communities they knew.
AnnaMarie McCullough spoke to the negative effects on the individual and the community. She spoke to the stigma associated with the disease and the isolation the individual experiences and the road back to community which comes in the recovery.  She expressed concern about the ‘enabling’ individual and community services which were in as much denial as the individual with the disease of addiction. She spoke of Recovery Day’s function in increasing awareness and helping individuals and their communities see just how successful recovery is and how beneficial it was for the community.  She especially emphasized the joy that recovery restored and the love that people felt after often years of being desperately hiding and lying about their disease.
David Berner spoke to the grief and tragedy of the individuals who turned to addictions as their only solace and how this immediate relief then turned around and hurt them more and more as time went on.  He spoke to these individuals not wanting to be addicts, their mothers and fathers and brothers and sisters. He spoke to their being sick and the horrible lives they so often endured before  they became addicts. He spoke to the child who was physically and sexually abused and developed an addiction as a teen. More and more he said his concern was for the children who were turning to addictions and becoming horribly addicted because of the high risk teen agers have for addiction to marijuana, alcohol, cocaine, and all the process addiction. He said more and more the people he was seeing had not known any normal life having so often left homes and schools to follow their addictions.  He spoke eloquently for the tragedy of the addicted, their families, the loss to individuals and families. There is so much grief, he said.  He was sad that so many young addicts had lost the capacity to work and how much work had meant in his life, how addiction took away purpose from individuals he saw and yet how much joy he'd had himself having purpose in life and working to complete what he set out to do.
When the subject turned to treatment each individual spoke to the hope and the scientifically proven successes of a variety of treatments, the high success of 12 step programs and abstinence, the benefits of treatment centres and recovery houses, the amazing successes of the drug courts, the usefulness of urine testing and variety of medications and services that were of proven benefit.
Candace spoke of the benefits of the therapy to family members and how even when an addict didn’t respond family could learned to protect themselves from the consequences of the addictions and be prepared to help when they could.  She described her work of recovery with loved ones and how as they learned to take care of themselves the addicted one often came round.
Lorinda Strang talked  of the countless successes that she had seen in her 20 plus years working in Addictions and the work of the Orchard Treatment Center on Bowen Island. She described her anxieties raising her children in West Vancouver, the difficulties that wealthy communities faced when it came to addiction and what could be done for the community and the children.  Living in this community she had seen the success of recovery and still continued in contact with people who once were thought to be untreatable but had recovered and gone on to be shakers and makers of society.
I spoke of the need to treat addiction and mental illness, as a dual diagnosis.  Yes it was common for those who abused alcohol to be anxious and depressed (alcohol is a depressant - 2 drinks on occasion, beneficial, 3 or more drinks toxic)  No treatment of only the anxiety and depression was  going to improve the addiction. Freud said addicts and alcoholics were untreatable and Dr. Carl Jung said only a miracle would work.  Because addiction is a brain disease the thinking of the addict is diseased so one had to treat the addiction first then it was possible to address whatever mental illness was underlying. All the attempts at treating the ‘underlying’ conditions first were proven repeatedly to lead to failure in the majority of people, but especially children and teen agers.  It was like trying to stop the bleeding being made by slashing without taking the knife out of the persons hand.  Hence the dual diagnosis and concurrent treatment programs that focussed first on the addiction then as safety and stabilization was achieved more and more secondary treatment of the mental illness was incorporated into the overall treatment plan.
I said that the success of all addiction treatment was evident in the amazing society success of the anti smoking campaigns.  Being of an age when all such community meetings were in a 'cloud of tobacco' smoke one didn't even have to think of the actual incredible reduction in cigarette smoking in society.  The loss of adult sales had caused the evil tobacco empire to directly target children in their marketing campagns so to my mind, we'd stopped short not arresting the CEO”s of Tobacco Companies.
These were the people who were now looking to make even more money selling misery to the young  by offering their ‘marijuana smoke’ or maybe even a ‘lighter cigarette, one half tobacco and half marijuana’ . As Amsterdam and Holland have moved their BC Bud products into the most restricted drug category, the same as Heroin and Cocaine, these big business forces were pushing for legalization of marijuana so they could get greater access to the teen and children ‘customers’ .  All the abuse of drugs including heroin and cocaine, except marijuana, had been falling as a result of education and recovery but now big business was targeting the young with marijuana.
No smoke is ‘safe’ and all evidence points to the the extensive health costs of all smoke (tobacco, marijuana, cocaine) yet these same corporate individuals who profited from tobacco smoke are now funding the marketing behind the ‘legalization’ of another ‘smoke’.
(I think I got a little upset at this point and told of the three young men I’d seen last year who’d developed schizophrenia after smoking BC Bud, and spoke of my scotty dog being murdered by the drug dealers who objected to my refusal to lie about their positive urine tests when they wanted to get “safety sensitive’ jobs where the other workers there didn’t want cheech and chong ‘pot smokers’ in their midst because they caused so many workplace deaths and accidents’)
David Berner kept the topic on track and opened the floor to comments from the audience. One amazing young man spoke eloquently of his experience with addiction and recovery and seeing so many of his friend damaged by drugs and then those like himself who got clean and sober getting back to school like he did, getting work and having great lives compared to their previous lives.
The audience asked great questions.  Someone talked of Gabor Mate’s book, Hungry Ghosts and how it helped them understand the trauma of addiction. Asked about the use of hallucinogens to treat addiction, I pointed to the possibility of a ‘sexy’ treatment helping one individual in a thousand but that we’d seen such ‘sexy’ cancer cures come out of Mexico with false promise only to have people spend their life savings on these 1 in 1000 remedies and then die when they could have taken a safe and proven treatment.  
I commented on the local work and research of Dr. Ray Baker, who started the first Canadian addiction education program for medical students . Working in Occupational Medicine he speaks to the high success of addiction treatments, in the 80% range, when the disease is caught early enough that the person still has a job or is  in school and has supportive family.   Dr. Baker still shows that in those who are at the end stages of the disease, physical illness, unable to work, isolated, that the success that present day addiction treatments with modern approaches, 12 step programs, treatment centres and recovery centres is still greater than the rest of our medical colleagues treating end stage diseases like tuberculosis or diabetes.
There were excellent questions about the lack of government funding, specifically for adolesenct treatment facilities.  AnnMarie McCullough and Lorinda Strang spoke of the poor histories of past governments in their waking up to the epidemic of addiction but that increasingly the government has been on board with helping but still had to come to a better understanding. David Berner spoke of his meeting this week with the British Columbia Minister of Health, Terry Lake.  “Terry Lake was very concerned about addiction in the community, especially it’s affect on adolescents”.  The BC Liberals were invested in addressing the need for increased treatment.  An example was the support the new Turning Point Recovery House in West Vancouver had received from local and provincial government.
I answered the questions about changes in methadone ‘delivery’ policies stating that the primary concern of the College of Physicians and Surgeons of British Columbia was the safety of the citizens of BC.  The greatest concern of the College of Physician and Surgeons is the ‘diversion’ of methadone and the risk diverted methadone would pose for an adolescent or child.  The concern for that ‘risk’ was the basis of the review of the present day ‘delivery’ policies because some pharmacists had not been able to ensure the level of safety that the College of Physicians and Surgeons and their sister organization the College of Pharmacists require for the Methadone Program to run.
Regarding the question of Harm Reduction versus Abstinence I pointed out that the World Health Organization position was that all harm reduction program were only valid so far as they worked towards abstinence.  Controlled drinking had been a failure and as David Berner pointed out Mothers Against Drunk Drivers had done amazing work to ensure that judges, especially  remembered the danger that addicted persons posed to the community and didn’t just listen to the major alcohol  producer and sales lobby.
There was question too about some of the  more controversial local Harm Reduction programs. I quoted the Welsh study that showed that the lack of faith and hope of some counsellors for the recovery of their members was often far far less that the scientific evidence of success of the individuals themselves. In the Welsh study the ‘harm reduction’ counsellors had commonly given their ‘clients’ an under 10% or  30% likelihood of success when the follow up studies showed that 60% of these individuals a gained and maintained abstinence.  Dr. Marc Gallanter of Harvard showed that 80% of doctors maintained long term recovery in Alcolics Anonymous and Narcotics Anonymous many being 30, 40 and 50 years abstinent in his research.  I expressed the concern locally that no judge or doctor with addiction would be advised to accept a “harm reduction’ program whereas often that’s all my poor patients were being advised to take.  This white collar and blue collar approach to treatment was simply wrong.  Further when I talked to some of the harm reduction proponents they were really saying there was no 'hope' for their 'customers' and that they should be just given 'palliative care' (i.e. comfort, since no cure was available).  I found myself thinking of some of the people I'd met who had promoted 'euthanasia' for all mentally ill patients. I was so thankful that the Welsh study showed how wrong these individuals usually were.
Everyone loved Candace' concern for family and friends of addicts;  Lorinda’s experience and expertise helping individuals and family, the world renowned fine work of the Orchard Treatment Centre, AnnMarie McCullough’s passion for community and recovery and David Berners great sense of humour and skill as a public speaker and moderator.
I was just thankful to be apart of something very good  and be there for those special moments when David, AnnMarie, Lorinda and Candace’s words touched my very soul. The people who were present wanted the very best for their community as their presence, attention and questions showed.  I really admired them most

Suboxone and Dr. Patrick Fay

Even the offer of a splendid dinner in one of Vancouver's finest restaurants, the Market, in the Shangri la Hotel, isn't likely to get me out for an evening of learning after a normal grueling 10 hour work day so common to Canadian physicians.  As an addiction psychiatrist having family physician, specialist, subspecialist and more subspecialist certification, and an even unhealthier proclivity for extensive self learning,  I am usually finding in my own practice that the rate limitting steps in health care management are the stupidity and hostility of overpaid, under educated,  beaurocratic thugs with position authority and purse strings.  My rich patients can get the health care they need here or overseas but increasingly those most in need are targetted alongside their care givers for chronic abuse.
That said, Dr. Patrick Fay of Orchard Treatment Centre is not only a leading authority in addiction medicine but one of the most respected clinicians I personally know. Having had the honour of treating patients who have known him I've had the privilege to hear of his empathy and compassion as a human from those patients  as well as see the genius in his medical management with patients who frankly were most unlikely to make it. Dr. Gary Horvath another leader in the treatment of opiate dependent patients encouraged me to come out if only to have the pleasure of bantering with my addiction medicine specialist colleagues,  Dr. David Tsung and Dr. Leszek Kalinowski.  In addition to these two racanteurs I was delighted to finally meet  Dr. (George) Djordges Kljacic, a most highly regarded clinician and the author of The Art and Wisdom of Healthy Living. http://www.amazon.ca/Art-Wisdom-Healthy-Living/dp/1467033138. Across the table I saw Allison, Olive and Sean, the administrative and counselling staff of Doc Side Medical Clinic,  also present.
Sarah Hardy, the representative of Reckitt Benckiser Pharmaceuticals was a surprise.  I thought she was a Vogue model and shocked to have her speak to me till my mind overrode my eyes and accepted that this must truly be one of those unfortunate women of brains whose beauty confuses the average male, not that I was such a human.  She welcomed me and immediately began talking science, mu receptors, k receptors and partial agonists till my mind  was spinning. When the waitress offered me a glass of wine I gladly took a cup of coffee instead.


Dr. Patrick Fay's presentation on Suboxone was excellent, not just for the more academic overview of addiction and the place of buprenorphine in the treatment of opioid dependent patients but also for his extensive clinical experience.  Buprenorphone is the active opiate ingredient in Suboxone. Compared with the full agonist methadone which is also used for the treatment of opioid dependent patients, buprenophone is a partial agonist so has 'ceiling effect',  a decided limit to it's potential for abuse.  The genius of Suboxone is that it is coupled in a 4:1 ratio with Naloxone, the opioid antagonist.  Suboxone is taken sublingually which allows buprenorphine to be released without naloxone. However if it is injected the naloxone counteracts the effects, making the medication even safer from being abused IV.
Dr. Patrick Fay had excellent slides showing the 'disease' of addictiton. He distinguished addiction by the classic 3 'c's, loss of control, continuance despite negative consequence, and a compulsion to persist despite this. He briefly discussed the  MRI studies showing impairment in glucose utilization in the frontal lobes, associated with higher reasoning, and delaying gratification,  as well as discussing the impairment of the nuclear accumbens, the emotional reward centre of the brain. (http://en.wikipedia.org/wiki/Nucleus_accumbens).
Where he shone though was in detailing carefully for us clinicians how he himself began patients on suboxone.  He described the use of the COWS, Clinical Opiate Withdrawal Scale (www.naabt.org/documents/cows_induction_flow_sheet.pdf.,
Then he went on to say that though the guidelines suggest a number of 10 before starting he himself tended to prefer a number of 12. He began by giving the patient 2 mg then tended to give 8 or even more mg through that first day. He saw the patient usually three times  that first day and told the patients they needed to have that day off and a friend available to be with them.  He admitted that headache was a side effect that he'd seen but in the large numbers of patients he'd treated he'd only had one  stop because of persisting headache. He'd also had to stop one patient from going onto buprenorphine maintenance because they developed a variety of odd pains. Withdrawal syndrome was the principal concern because buprenorphine has such strong affinity to the mu opioid receptor that it displaces other opiates. When transfering a methadone maintenance patient to suboxone he reduces the methadone to roughly 30 mg a day before making the switch.
He had used suboxone extensively in young people 18 to 25 and preferred to include the parents in the care if the patients were living at home.  He found that this family approach to addiction therapy resulted in even better results. While some of his patients have been switched in the detox and treatment facilities he has at the Orchard Treatment Centre on Bowen Island the majority of his patients have been started on suboxone in the community. He himself has a clinic where he does just this on Commercial Avenue in Vancouver.  As well as young people he found those who appeared to most benefit from suboxone were those who were snorting opioids, those using opioids such as morphine or oxycontins as opposed to heroin, and those whose methadone usage was under 100 mg a day. He said that there was a belief in the community that it was easier to get off buprenorphine but that he himself had found that it was still difficult for patients to stop that last 2 mg a day.  Suboxone maintenance patients were commonly able to take their medications weekly and were seen monthly relieving them the need of daily visits to a pharmacy for witnessed injestion.  He used suboxone for detox and for maintenance of patients with very good patient report and success long term.
Overall he found that he had the best results with patients who recognised that  addiction was more than just the drug abuse but that it affected, sometimes prominently while other times subtly, their thinking and relationships as well. Addiction specialist, Rabbi Dr. Twerski has written an superb book, called "Addictive Thinking",  detailing this essentially neurological disease process.   Follow up in groups such as AA, NA, Smart Recovery,  and Cognitive Behavioural Therapy  were all associated with better long term protection from relapse. He quoted Dr. Marc Gallanter's (http://en.wikipedia.org/wiki/Marc_Galanter_(psychiatrist) research on the efficacy of 12 step programs in long term recovery.
Dr. Fay concluded his presentation with his own complex case studies of patients who really were truly extraordinary for their successful long term recovery from what was clearly a life threatening illness with near death experiences.
Dr. Fay was very optimistic about suboxone and it's benefits but certainly didn't see it as a replacement for methadone. He was clear in the need to combine the right patient with the right treatment in what has traditionally been the most successful approach to all medical treatements to date. He was insistent that addiction patients be treated fairly and with the dignity that anyone suffering a chronic disease deserves.
His presentation was excellent and well worth the time.  To prescribe suboxone now in British Columbia the physician must already have been certified as a methadone prescribing doctor and in addition complete  online educational modules at www.suboxonecme.ca.  I did this when I worked in the United States and remember the process as reasonable and relatively straight forward. Sarah told me that it usually takes about 6 hours total.  There is now also public funding for suboxone for selected patients for whom methadone is contraindicated.
sarah.hardy@reckittbenckiser.com is a great resource.  Dr. Patrick Fay's presentation was well worth the effort, even after a long day.