I am under attack right now by deceitful psychopathic individuals who may simply be ignorant rabid dogs biting the hand that feeds. I do object that those who killed God in our society also destroyed the ten commandments for their personal benefit. "Thou shalt not bear false witness,' went out the window in exchange for Marketting and PC.
I have been in similiar situations on other occasions. I have asked for guidance as a Christian from the elder men and women I turn to when I feel persecuted. Sometimes they tell me "Get down off the cross, we can use the wood." Other times they tell me, you are right. Now they tell me I am right. These people are hurtful, nasty people who are in fact shooting at you with 'false accusation's and slandering your name. I'm not psychotic. I'm not mad. I'm not even bad. But they are.
Christians are supposed to love and forgive. I 'm not a particularly loving or forgiving Christian and have a memory for resentments that is prodigious. I go to church and read the gospel because I 'need to' as much as I 'want to'. Often the experience is more like an enema than anything else. My God was 'forgiving'. So my friend says 'What Would Jesus Do?" I say, he'd kick ass and throw the lying theives out of the temple.
My minister told me that it was very Christian to 'duck' when people were shot at you. When Hitler said that "Germans were ready to die for the fatherland," Patton, replied, "that's just what we want you to do."
C.S. Lewis gave the WWII talks later published as "Mere Christianity'. He supported the British soldiers fighting against the Neopagan Nazi hoards. The Nazis had conquered Europe and were exterminating Poles, Jews, Gays and just about any one else who wasn't in favour of National Socialism lead by Adolf Hitler and his girlfriend, Eva Braun.
My psychiatrist minister friend said that yes, Jesus might well cleanse the temple of bad men, drain the swamp so to speak, but if you plan to go to war, he told me, "you should put on the armor of God."
Ephesians 6
11. Put on the whole armor of God, that ye may be able to stand against the wiles of the devil.
12. For we wrestle not against flesh and blood, but against principalities, against powers, against the rulers of darkness of this world, against spiritual wickedness in high places.
13. Wherefore take unto you the whole armour of God, that ye may be able to withstand in the evil day, and having done all, to sad.
14. Stand therefore, having your loins girt about with truth, and having on the breastplate of righteousness;
15. And your feet shod with the preparation of the gospel of peace;
16 Above all, taking the shield of faith, wherewith ye shall be able to quench all the fiery darts of the wicked.
17. And take the helmet of salvation, and the sword of the Spirit, which is the word of God:
18. Praying always with all prayer and supplication in the Spirit, and watching thereunto with all perseverance and supplication for all saints;
Truth, righteousness, gospel, faith, salvation, Holy Spirit and prayer, supplication and perseverance.
I kneel before God and ask his guidance.
However if I am being attacked right now, I duck. I also return fire if this can't be avoided.. Jesus taught , Love God and Love Your Neighbour AS Yourself. The idea that Jesus and his followers were wholly hippy pacifists does not hold with the biblical evidence of the apostles armed with swords. It is true that Christians 'turn the other cheek' so are not 'easily offended', not like the evil kneejerk offence activists today.
In psychiatry we learned that we must protect ourselves from the dangerously insane because they 'knew not what they did' . If we let an insane person hit us then we would be doing them harm as well because when the mentally ill were 'allowed' to hurt others their restrictions and drugs were increased.
We were taught to avoid violence where possible. If violence occured we 'controlled' the violence with the least restriction. This was unlike the encouragement for neglect and cowardice so often heard today. In the asylum we did not retaliate. We did not take revenge. Indeed our patients might well think we were invading white coated aliens. Truly we ourselves might behave similiarly with such beliefs.
So how can I protect myself especially knowing that the Cold War depended, as much of the history of the world has depended, on the fundamental laws of the jungle. Dangerous predators rarely attack each other but prefer the docile herds. The oldest law of the world is the Chinese Law of the Fish, "there are big fish and little fish and the little fish have to be fast and numerous. " Big fish counter each other with equal threat and given the potential of dangerous counteraction negate the 'value' of attack.
Hitler invaded his neighbours because they were weak. Chamberlain caused WWII as much as Hitler. It takes two to tango.
The members of alcoholics anonymous which began with Christians before becoming a universal self help organization based on non religious 'spirituality' cautions those in recovery against even "righteous anger'. The reason is that people who have been alcoholic or drug addicts are at risk of relapsing with extreme emotions and tend towards over reaction and catastrophisation especially in early recovery. However, the members of AA joined the American Armed Forces and fought offensively and defensively with bravery and reknown in the terrible WWII Italian campaign. Abstinent men in recovery, members of AA, Christians successfully fought the elite Nazi troops killing them en mass. They did not relapse either.
So how can I be forgiving in war.
My minister said, forgiveness comes 'later'. It's the antidote to resentment. Resentments are described as taking poison and hoping the other guy dies. They are toxic and go contrary to the teaching of 'love thy neighbour as thyself' or 'do unto others not as they do unto you' but rather 'do unto others as they would do unto you.'
For now I'm putting on the armour of God.
Showing posts with label diagnosis. Show all posts
Showing posts with label diagnosis. Show all posts
Wednesday, October 26, 2016
Friday, March 11, 2016
Panic Attack
I know anxiety. I know panic attacks. Yet I realize as I ask people in detail about a panic 'attack' or an anxiety 'attack' they have a different idea of what medicine means. Life is an anxiety attack is poetic justice but not clinically relevant.
The DSMV lists Panic Attack Specifiers. Panic attack is not a mental disorder itself They can occur in the context of other mental disorders, (e.g. depression, ptsd, substance abuse) and some medical disorders (cardiac, respiratory, vestibular, gastrointestinal).
Panic attack is distinguished by an abrupt surge of intense fear or discomfort and reach a peak within minutes, during which time four or more of the following symptoms are experienced:
1. Palpitations, pounding heart, or accelerated heart rate
2. Sweating
3. Trembling or shaking
4. Sensations of shortness of breath or smothering
5. Feelings of choking
6. Chest pain or discomfort
7. Nausea or abdominal distress
8. Feeling dizzy, instead, light-headed or faint
9. Chills or heat sensations
10 Paresthesia (numbness or tingling sensational)
11. Derealization (feeling of unreality) or depersonalization (being detailed from oneself)
12 Fear of losing control or 'going crazy'
13. Fear or dying.
If you are having you, first stop should be the emergency to make sure there's nothing physical especially if your name is Sigourney Weaver in the Aliens.
The DSMV lists Panic Attack Specifiers. Panic attack is not a mental disorder itself They can occur in the context of other mental disorders, (e.g. depression, ptsd, substance abuse) and some medical disorders (cardiac, respiratory, vestibular, gastrointestinal).
Panic attack is distinguished by an abrupt surge of intense fear or discomfort and reach a peak within minutes, during which time four or more of the following symptoms are experienced:
1. Palpitations, pounding heart, or accelerated heart rate
2. Sweating
3. Trembling or shaking
4. Sensations of shortness of breath or smothering
5. Feelings of choking
6. Chest pain or discomfort
7. Nausea or abdominal distress
8. Feeling dizzy, instead, light-headed or faint
9. Chills or heat sensations
10 Paresthesia (numbness or tingling sensational)
11. Derealization (feeling of unreality) or depersonalization (being detailed from oneself)
12 Fear of losing control or 'going crazy'
13. Fear or dying.
If you are having you, first stop should be the emergency to make sure there's nothing physical especially if your name is Sigourney Weaver in the Aliens.
Sunday, December 2, 2012
Subthreshold states in Psychiatry, Athens Psychiatric Conference, Dec. 2, 2012
These are my rough notes from Dr. Kuey's very thought provoking discussion of diagnosis in which he considered categorization and dimentionality with great intellectual vigour and heart felt empathy. A truly great speaker and tremendous mind.
Lectures Sunday, Dec. 2, 2012 First Interdisciplinary Congress “Psychiatry and Related Sciences” Chairs; W. Gaebel (Germany) M. Mavreas (Greece)
Subthreshold states in psychiatry” a major challenge for clinical practice and classification system L. Kuey (Turkey) MD Associate Professor of Psychiatry, Instanbul Bilgi University (WPA Secretary General)
DSMIV - there is no assumption that each category of mental disorder is ‘discrete’ and goes on to discuss ‘boundary cases’ where there will be ‘probablistic’ DSMIV says itself it should n’t be used as a ‘cook book’. In practice though there is a tendency that these are ‘categories’ - the ‘scale of apparent mobordity (and scale of subthrehold) not consistent with the idea of ‘discrete nosological entities’.
Disorder refers to the patients experience Diagnosis refers to the examiner’s experienc Psychiatry has no ‘golden standard’ theerefore ‘quality of diagnosis” is important. This is important because our diagnosis are often ‘stigmatising”.
Both reliability ad validity problems exist High rates of ‘subthreshold’ and “NOS” categories. Problems of categorical classification systems never ending categories ignorance of humanistic perspective most of treatments are not specific to diagnosis yet diagnosis is the definer of treatment in other areas of medicine We may be at limits of what ‘Categorical” .
Therefore we are now at Categorical and Dimensional Approach Which one is more used in daily clinical praxis? Most clinicians use a ‘prototype’ approach whereas researchers are limitted definitely by category
Eg. Ling Xing Gate - only dead king could pass - definition of life and death for patient a diagnosis may not be life and death but may feel like this
Subthreshold states in psychiatry ‘are not uncommon’, significant How do we define threshold sympton frequency sympton duration etc eg depression - if we raise threshold - underdiagnosis or misdiagnosis if we lower - over diagnosis eg depressive symptons and depressive disorder
Is there a risk of pathologising common/normal behavior as subthreshold? Yes - but the clinical state or dysfunction could differentiate may need to thresholds one to decide ‘disease’ one for ‘health’
A threshold for each and clinical states between Longitudinal perspective -prodomal, illness, residual - need attention esp in bipolar and sz spectrum and addiction “Our understanding of health and illness is ill”
“We are both healthy and ill from different perspectives”.
Lectures Sunday, Dec. 2, 2012 First Interdisciplinary Congress “Psychiatry and Related Sciences” Chairs; W. Gaebel (Germany) M. Mavreas (Greece)
Subthreshold states in psychiatry” a major challenge for clinical practice and classification system L. Kuey (Turkey) MD Associate Professor of Psychiatry, Instanbul Bilgi University (WPA Secretary General)
DSMIV - there is no assumption that each category of mental disorder is ‘discrete’ and goes on to discuss ‘boundary cases’ where there will be ‘probablistic’ DSMIV says itself it should n’t be used as a ‘cook book’. In practice though there is a tendency that these are ‘categories’ - the ‘scale of apparent mobordity (and scale of subthrehold) not consistent with the idea of ‘discrete nosological entities’.
Disorder refers to the patients experience Diagnosis refers to the examiner’s experienc Psychiatry has no ‘golden standard’ theerefore ‘quality of diagnosis” is important. This is important because our diagnosis are often ‘stigmatising”.
Both reliability ad validity problems exist High rates of ‘subthreshold’ and “NOS” categories. Problems of categorical classification systems never ending categories ignorance of humanistic perspective most of treatments are not specific to diagnosis yet diagnosis is the definer of treatment in other areas of medicine We may be at limits of what ‘Categorical” .
Therefore we are now at Categorical and Dimensional Approach Which one is more used in daily clinical praxis? Most clinicians use a ‘prototype’ approach whereas researchers are limitted definitely by category
Eg. Ling Xing Gate - only dead king could pass - definition of life and death for patient a diagnosis may not be life and death but may feel like this
Subthreshold states in psychiatry ‘are not uncommon’, significant How do we define threshold sympton frequency sympton duration etc eg depression - if we raise threshold - underdiagnosis or misdiagnosis if we lower - over diagnosis eg depressive symptons and depressive disorder
Is there a risk of pathologising common/normal behavior as subthreshold? Yes - but the clinical state or dysfunction could differentiate may need to thresholds one to decide ‘disease’ one for ‘health’
A threshold for each and clinical states between Longitudinal perspective -prodomal, illness, residual - need attention esp in bipolar and sz spectrum and addiction “Our understanding of health and illness is ill”
“We are both healthy and ill from different perspectives”.
Thursday, July 5, 2012
Basal Cell Carcinoma - cured
I'm rather happy today. I saw Dr. Alastair McLeod again. He's a really fine gentleman. He looked at my face. I'd stopped the Aldara 5% cream at his request 2 weeks ago. The inflammation settled on the polysporin cream. 2 weeks of waiting. Then thanks to Dr. Chalmers original reassurance and seeing Dr. McLeod I wasn't picking at my face or psychotic with anxiety.
No slabs of flesh and ripped muscle hung from my facial bones. I was being good and had gone to the high stress work without any major flareups. I'd not peed in corners or physically attacked strangers. None of the normal stress indicators had flared up, thanks to the excellent medical care I received from these grand men of medicine. Even doctors have trouble acting as if everything is normal in these abnormally unusual times.
"Well, let's see it," he said. He put his holy light in my face and looked at my skin like only a dermatologist can. "I think it's okay," he finally said.
I did my whooping, happy dance. Football players and basketball players have nothing on aging intellectuals prepared for death, being told they're going to live. It's brings out that "Elaine dance" thing from Jerry Seinfeld. Soon I was waltzing him round and round the waiting room, doing tango across the floor, back flipping chimpanzee style. That's when he brought in a little reality show to the Sermon on the Mount. He said he was just saying that "In my opinion, it's not cancer".
"Watch it till September and if it's continues to resolve, you're okay, otherwise you can come back and see me." It's really hardly a speck compared to the growing lump it was.
"Don't let anyone tell you that Psychiatrists and Dermatologists don't cure things." he said in parting.
I was really happy. Relieved indeed
.
Whatever it was, "it" had appeared to go away. Just like a bad house guest or one of those people who start to talk to you somewhere you were looking for peace a quiet.
Personally all of the following could have happened:
1) It was an hallucination of mine and I convinced several other doctors to join in the group hallucination, a folie e deux thing. My deep seated guilt about teen age masturbation had resulted in the psychoneurotic phenomena that caused projective identification in the doctors I consulted. It healed because I 'faced' my neurosis and brought my 'shame' to be shared.
2) Threatened by the 'knife' and emergency immuno response occured saving my face from mutilation.
2) The Aldara Cream 5%, (Imiquimod) known to be effective in the treatment of early basal cell carcinoma did the trick of stimulating my own self healing response to reject the cancer. We all have cancer cells that are being killed off routinely. This explains the common 30% spontanious healing response seen in all kinds of medicine.
3) My friends and myself praying for me contributed to the spiritual healing response. Some face 'demon' was exorcised.
4) I took time off from my very very very high stress job and read novels and bounced around on a boat at anchor far from the work 'front' , away from the battle noise of screaming and tears, away from sickness, misery, insaniety. Especially away from the 'anger' and entitlement. Especially far away from the Monday morning quaterbacks and all the countless regulators and judges and those who don't want to get their hands dirty but sure want to make their ridiculous marks by 'criticizing' those who do. I hung out with the dog and girl and rested. Rest is amazing for healing too.
5) Dr. Chalmers and Dr. McLeod are both true healers and their 'tools' of healing are just means whereby these great medicine men conceal their 'healing touch'. Both of them touched my face. Both of them spoke soothing hypnotic words to me. It was like treating Dr. Hoffer's patients. His vitamins were never 'proven' to work but I saw first hand that the man was a great healer and the patients he passed along to me and those I inheritted when he retired were living proof of his amazing healing abilities. I think often healers are just that and the meds and potions and blades and things aren't what is really doing the work. Healing is deeper in the relationship, at the level of empathy and experience.
6) It may come back. I might be hit by a bus before then. My friend Tom wants me to go up in his rebuilt antigue plane with him. Pay back from me getting him to sail back from Hawaii with me. Maybe I will have surgical solution hopefully bilaterally so the turkey neck can be tucked a bit. I could end up looking as good as Nick Nolte the way I'm going and I don't have his wisdom to go with the appearance of such. For now I'm utterly relieved.
7) I'm older and I'm feeling my age. Those of us still working feel the weight as it seems more and more are carried by fewer and fewer. But that's the tax burden and the failed economic systems. My anxiety about the future affected my health in the present and was a message to me to focus on the present where I can live with God. God has always taken care of me so I really needn't worry about tomorrow. Castastrophising and awfulizing don't help.
Thanks to all those who prayed, the well wishers and the friends and family. What a silly I am! Vanity, all is vanity.
No slabs of flesh and ripped muscle hung from my facial bones. I was being good and had gone to the high stress work without any major flareups. I'd not peed in corners or physically attacked strangers. None of the normal stress indicators had flared up, thanks to the excellent medical care I received from these grand men of medicine. Even doctors have trouble acting as if everything is normal in these abnormally unusual times.
"Well, let's see it," he said. He put his holy light in my face and looked at my skin like only a dermatologist can. "I think it's okay," he finally said.
I did my whooping, happy dance. Football players and basketball players have nothing on aging intellectuals prepared for death, being told they're going to live. It's brings out that "Elaine dance" thing from Jerry Seinfeld. Soon I was waltzing him round and round the waiting room, doing tango across the floor, back flipping chimpanzee style. That's when he brought in a little reality show to the Sermon on the Mount. He said he was just saying that "In my opinion, it's not cancer".
"Watch it till September and if it's continues to resolve, you're okay, otherwise you can come back and see me." It's really hardly a speck compared to the growing lump it was.
"Don't let anyone tell you that Psychiatrists and Dermatologists don't cure things." he said in parting.
I was really happy. Relieved indeed
.
Whatever it was, "it" had appeared to go away. Just like a bad house guest or one of those people who start to talk to you somewhere you were looking for peace a quiet.
Personally all of the following could have happened:
1) It was an hallucination of mine and I convinced several other doctors to join in the group hallucination, a folie e deux thing. My deep seated guilt about teen age masturbation had resulted in the psychoneurotic phenomena that caused projective identification in the doctors I consulted. It healed because I 'faced' my neurosis and brought my 'shame' to be shared.
2) Threatened by the 'knife' and emergency immuno response occured saving my face from mutilation.
2) The Aldara Cream 5%, (Imiquimod) known to be effective in the treatment of early basal cell carcinoma did the trick of stimulating my own self healing response to reject the cancer. We all have cancer cells that are being killed off routinely. This explains the common 30% spontanious healing response seen in all kinds of medicine.
3) My friends and myself praying for me contributed to the spiritual healing response. Some face 'demon' was exorcised.
4) I took time off from my very very very high stress job and read novels and bounced around on a boat at anchor far from the work 'front' , away from the battle noise of screaming and tears, away from sickness, misery, insaniety. Especially away from the 'anger' and entitlement. Especially far away from the Monday morning quaterbacks and all the countless regulators and judges and those who don't want to get their hands dirty but sure want to make their ridiculous marks by 'criticizing' those who do. I hung out with the dog and girl and rested. Rest is amazing for healing too.
5) Dr. Chalmers and Dr. McLeod are both true healers and their 'tools' of healing are just means whereby these great medicine men conceal their 'healing touch'. Both of them touched my face. Both of them spoke soothing hypnotic words to me. It was like treating Dr. Hoffer's patients. His vitamins were never 'proven' to work but I saw first hand that the man was a great healer and the patients he passed along to me and those I inheritted when he retired were living proof of his amazing healing abilities. I think often healers are just that and the meds and potions and blades and things aren't what is really doing the work. Healing is deeper in the relationship, at the level of empathy and experience.
6) It may come back. I might be hit by a bus before then. My friend Tom wants me to go up in his rebuilt antigue plane with him. Pay back from me getting him to sail back from Hawaii with me. Maybe I will have surgical solution hopefully bilaterally so the turkey neck can be tucked a bit. I could end up looking as good as Nick Nolte the way I'm going and I don't have his wisdom to go with the appearance of such. For now I'm utterly relieved.
7) I'm older and I'm feeling my age. Those of us still working feel the weight as it seems more and more are carried by fewer and fewer. But that's the tax burden and the failed economic systems. My anxiety about the future affected my health in the present and was a message to me to focus on the present where I can live with God. God has always taken care of me so I really needn't worry about tomorrow. Castastrophising and awfulizing don't help.
Thanks to all those who prayed, the well wishers and the friends and family. What a silly I am! Vanity, all is vanity.
Saturday, March 31, 2012
Writing Medical Legal Reports
Manjot Hallen, of Klein Lyons was introduced with a long list of accolades. He had a topic which was principally directed towards doctors and junior counsel. I liked that. It's always best that the best teach the basics. Later I'd have a chance to speak with him in the break.
The fellow was a normal amiable pleasant sort until I put my specific legal question to him. I was asking him about a complex decision in which a judge utterly ignorant of science went off on a tangent of law of such utter irrelevance to the case "as I presented it". In answering it , Manjot's head tilted and his eyes looked to the upper left quadrant. For a moment then, was like this big brain, had rotated in and he began his response. . It was an amazingly balanced response, considering all sides, succinctly shared and suggesting possibilities of thought previously not considered. Next he was smiling and chatting pleasantly like a normal person. I went away not at all surprised at his success, to date.
These were the notes I took of the presentation. The Trial Lawyers Association of British Columbia had a cd of the conference with relevant notes and references. Manjot's slides were excellent. My notes don't do the subject justice because I only recorded the bits particularly of interest to myself. The fact is doctors are required to write reports and Manjot Hallen has made it clear what is necessary.
The fellow was a normal amiable pleasant sort until I put my specific legal question to him. I was asking him about a complex decision in which a judge utterly ignorant of science went off on a tangent of law of such utter irrelevance to the case "as I presented it". In answering it , Manjot's head tilted and his eyes looked to the upper left quadrant. For a moment then, was like this big brain, had rotated in and he began his response. . It was an amazingly balanced response, considering all sides, succinctly shared and suggesting possibilities of thought previously not considered. Next he was smiling and chatting pleasantly like a normal person. I went away not at all surprised at his success, to date.
These were the notes I took of the presentation. The Trial Lawyers Association of British Columbia had a cd of the conference with relevant notes and references. Manjot's slides were excellent. My notes don't do the subject justice because I only recorded the bits particularly of interest to myself. The fact is doctors are required to write reports and Manjot Hallen has made it clear what is necessary.
Ten Commandments (of Medical Legal Reports)
Manjot S. Hallen
Rule 11.6 - governs experts, expert must sign off on their report with your name and address
11.6b - must provide regulations
11.6 i - facts information is based
Supreme court also says
1. Thou shalt write your own report
- Did you prepare the report?
- Jones v M and Dhaliwal v Bassi
- (Problem more often in engineering because they work in packs and senior engineer signs off)
- Dhaliwal v Bassi - psychiatrist signed off as if it was own, but psychiatrist signed off on a registered psychologist in his office, should have been psychologist who signed off and the psychologist who was there.
- what about when I have locums working for me - eg my locum saw pateint 25% of the time, generally rule of thumb is if you’ve seen your patient more than locum it’s okay,
- Thou shalt provide a CV - must provide an updated CV
Must provide more information than your designation and speciality area
Include your training and experience as well as lectures articles, classes you teach
Information needed to qualify you as an Expert
Can only provide an opinion in your area of expertise
3. Thou shalt clearly state the facts
- Medical legal consultants vs General Practitioner
- - Consultant easy - here are the facts, these are my assumptions and these are my opinions
- for gp its okay to list clinical entries - these become the facts -
- mixture of fact, hearsay (verbal complaints) and reference to documents (x-rays and MRI’s)
- Thou shalt provide a clear diagnosis
- Have a clear diagnosis section or have the diagnosis clearly noted in your summary
- Thos should be the easiest commandment for you to follow - this is what you are trained to do
- Thou shalt comment on causation
- Did the MVA or Accident cause the injury?
- Balance of probabilities
- Using the standard you should be able to say if it is ‘more likely than not’
- Not scientific certainty - is it 51% or 49%
- Counsel relies on this opinion
- Thou shalt provide a prognosis
- clear prognosis is great but not necessary
- good, guarded and even ‘too soon to provide a clear prognosis’ is better than ‘prognosis is not possible’
- Examples at end of Appendix A
- Thou shalt provide your report in a timely manner
Rule 116(3) - must be served 84 days prior to trial - no longer than 60 days
- I have a letter I rarely use - I can report you to college of physicians and surgeons - i’ve used it only 3 times
- adverse inference if report not provide by treating doctor (can devastate the patient)
- Thou shalt assist the court
Rule 11 -2 - duty to assist the court and not be an advocate
- I recognise in giving an opinion to the court, I have a duty to assist the court and not be an advocate for any party. this report is prepared in conformity with that duty, and if called upon to give oral or written testimony in the trial of this matter, I will give that testimony in conformity with that duty
- Carr v. Simpson (2010) BCJ 2083
- it takes alot to be considered biased
- Thou shalt charge the appropriate fee
-The BC Medical association Guide for Medical Reports
GP -A00072 - $935.00
Medical legal consultant (specialist) $2500 to $3500.00
- Thou shalt not speak at length of irrelevant matters
- need to have a general knowledge of what is relevant
- dispense quickly with irrelevant visits - no need to elaborate at length
- mention other relevant events/injuries that may efect your opinion on causation or your Diagnosis and/or Prognosis
talk given at the Trial Lawyers Association of British Columbia, Essential Soft Tissue Injury Conference, Vancouver, BC March 30 , 2012
Wednesday, March 21, 2012
Bioethics and Psychiatry, British Columbia
A young physician joined a research facility. A number of physicians worked there. The head physician had been 'star' in his day. His research was mostly on new medications. He was well financed by one drug company in particular. The trouble was getting patients enough for his drug studies.
He and some of his colleagues addressed this problem by 'broadening the "diagnosis". Though the disease category wasn't 'cancer' it could well have been. To recruit more people for his research he included people who would not traditionally have been said to have 'cancer' These "healthy' recruits would further 'dilute' the side effects of the medication and allow for better outcomes. It did subject a whole lot of people to unnecessary toxicity though and in addition could cause some people without other disorders to be given simply the wrong treatment thereby missing the right treatment for their 'correct' diagnosis.
The young researcher was suspicious of this and raised his concerns early. The head researcher explained this away and used a lot of 'attitude' and 'dominance' behaviour to make his point. This of course concerned the young physician even more because people who depend on the gun don't usually have any better argument.
Using the 'local' research criteria the young researcher diagnosed a man with the condition. The man was indeed sick with this particular condition that could affect his judgement. He was offered a position in the research trial. When he balked the head physician came and essentially sold the man on the research.
In selection for research people can be recruited for pay, or be offered a position, or have the pros and cons explained and an advocate or family member included to help in the decision. The young physician having had some research experience before joining this community had been exposed to a much different and more 'patient centered' approach to selection.
In this community however there seemed to be a real 'drive' to get patients enrolled in programs. At the time the young physician never thought that there might be incentives associated with this. He'd worked in sales to pay his way through undergraduate studies and he actually saw patients being 'sold' on being part of research that really wasn't likely to benefit them and might well not provide any benefit for the world as a whole. The interactions were distinctive to those trained in process.
Of course this is also all hypothetical and fictitious. In medicine it's said that hindsight is a proctoscope that's 100% perfect only because it's in the hands of assholes.
That the man would be treated with the research drug and die as a result of the wrong diagnosis and wrong treatment could well have happened to anyone. Medicine isn't an exact science. Mistakes occur and only after death does one recognise the errors.
Usually after death, though, especially suspicious deaths, there isr a post mortem. This can be a physicai post mortem done by a pathologist and it can also be a psychological post mortem done by the staff. The head physician ensured that neither was done confirming the young man's concerns.
The young man followed the old man's directions because he was senior and more experienced. The young man never even speculated that there was conflict of interest.
The experimental drug didn't work. The research failed. The man died. Usually, having an experimental drug is sufficient cause for more intensive investigation of the factors leading up to death.
The young physician had pleaded with the older more experienced physician but had been silenced repeatedly. The young physician questioned the diagnosis and questioned keeping the man in the double blind research trial because he was clearly deteriorating and death was imminent. In those days the young physician was known for being very diplomatic and respectful of authority as the young and highest trained from the finest institutes are.
He'd never encountered such a problem before and didn't know what further he could do. There was no one, he believed, more senior he could take his concerns to. Further the young man had already been told that that he wasn't considered a good ' team player". Being a 'team player' was indeed the highest praise one received in this hospital research institute and perhaps this community at large. .
He sadly learned later from other researchers that there were many discrepancies and other deaths had occurred . No one spoke up because that was considered unprofessional. The doctors in this community appeared to put the greatest emphasis on professionalism and a lesser emphasis on such matters as patient life and death, , truthfulness, transparency, patient advocacy, patient's rights or any number of considerations that might well have contributed to saving the man's life.
Further, there was no place in the university for anyone who bucked the system. The hierarchy in research was sacrosanct and the grand man was politically well connected. This hierarchal problem is central to 'systems research' and the study of why corruption is so wide spread in some communities. For example, the success of the Japanese car industry at one point was the result of a letter box which was solely read by the CEO of the company and open to be used by all employees. Prior to that innovation in the 'system' was blocked by middle management and yukuza who simply removed any one who suggested change in the existing system.
The reformer is the enemy of anyone who benefits from the status quo. Only the CEO and Board were specifically interested in the quality of Japanese cars because of world wide competitiveness whereas the lower level managers were only interested in their jobs remaining unchanged with all the privileges and perks in tact.
The young man wanted to do something but exhausted all avenues except whistleblowing. Whistleblowing is not taken lightly by professionals. It's essentially committing suicide to bring attention to someone being murdered. It's like Tibetan monks who pour gasoline on themselves and ignite it. Whistleblowying in Canada is routeinely punished. In British Columbia whistleblowing is crucified. So it was not something to be done lightly.
The young man in the end had refused to make the unsavoury decisions alone and insisted that the old man attend the patient and give the orders publicly rather than the young man doing what he no longer believed in alone and in silence. The old man was furious with the young man for this refusal to cooperate but saw the patient and publicly gave the order which caused the patients death.
The patient died.
The young man not trusting the older , came into the hospital and copied the file. The next day he learned that the old man was saying that the patient had died through an error of the young man's. Further, the chart was suddenly missing and the orders of the old man were expunged from existence. The research assistant later said that the research data was all re written too. It had been done before when people had died she told him. Crying she said I can't say anything because he'd ruin my career if I objected. He learned that several of his colleagues had been directly involved in this sort of thing unbeknowst to him.
Everyone has heard the adage, you can't make an omelette without breaking a few eggs. No one higher in the food chain was ever concerned about such matters because they had their own skeletons in their closets to worry about.
The young man simply left the hospital. He didn't want to have anything more to do with the old man or with the colleagues whose behaviour, specifically sins of omission, contributed to the deaths of patients. As he put it, "I just wanted to play hockey. I didn't know that I'd joined a bush league run by the mafia. " He never lost his love of hockey though.
He later learned that the research funding had further caused the senior man to have a conflict of interest because there was serious support for a particular outcome measure in the research. Alot of money apparently was involved not in finding if the drug was good or not but solely in proving this drug was good and extending it's distribution potential. The particular drug company involved did not itself have a good reputation.
The young man did not know any of the history of the trend of the very government appointed beaurocrats to choosing sketchy low cost suppliers rather than reputable institutions. Deaths of patients could therefore be likened to the crashes of airplanes that occured increasingly because maintenance was being done by low cost knock offs rather than the specified parts the manufacturer required for wings and engines. A patient's death could always go by quietly but airplane crashes attracted attention.
The difficulty for young doctors in primitive barbaric systems is that they are so dependent on the context of their situation and lizards have long been known to eat their young whereas mammalian species usually care for theirs.
The young researcher left the hospital and returned to general practice.
He was subsequently approached by a former senior colleague to come forward and speak out against the head and tell the truth about the death of the patient,he was was less than keen. He felt he was out of that system and had nothing further to contribute. . The colleagues who approached him and begged him for his assistance said that they could not do it as their careers and positions with the university would be jeopardized if they did. They said that the old man was crazy and killing people and it was his duty to stop the carnage because he had the evidence and could make the complaint.
He discussed this request with a colleague. The colleague said simply, "I've known that man who wants you to do this for many years. He's a psychopath. He is playing on your goodness and doesn't care for anyone but himself. He lacks empathy. He hasn't the capacity for love. He's a chameleon but he's still a lizard. "
Women doctors who he'd formerly worked with also approached him and begged him to help them, his female colleagues.
So he wrote the letter.
The letter caused the head doctor to lose his position. He was deposed by a jury of his peers who felt his behaviour was wholly 'unprofessional'. .
The young physician was never forgiven. The other senior colleagues who'd 'used' him went on to high position. The woman colleagues never looked him in the eye again. ..
At the time the young physician thought there was still nobility in his colleagues and that he was duty bound to stop the unnecessary death which was continuing. At the time he never suspected that the persons who were asking him to make the supreme sacrifice were indeed only hoping to get the old man's position. He personally knew of no conflict of interest that he had. Thanks to his teachers and his family and their values he was quite simply most interested in doing what he thought was right, helping out and helping ensure better health care for patients specifically and in general. Otherwise he happy to be hunting and fishing and working in his private practice. He figured he'd do research elsewhere if the opportunity arose but he wasn't going to do research locally given the lack of regulation and the tendency of governing bodies to either be themsevles corrupted or simply wholly negligent.
The longer he was in the community the more of a political Sodom and Gomorrah it appeared.
It was at this time that national and international regulatory bodies were refusing to certify the provincial institutions in general. The greatest calamity of the decade was that the Vancouver Stock Exchange lost it's license to practice due to gross corruption. The business community en mass was considered so criminal it lost the right to self government. For years thereafter it only ran with supervision of the Toronto Stock Exchange. The government in general was notorious for questionable practices which explained why everyone called this the 'wild west'. A day didn't go by in his office where some patient wasn't being harmed by some group of shysters and their government affliliates like those in the infamous 'leaky condo fiasco'.
Even when MLA Moe Sihota caught the Attorney General and Premier doing dirty deals over their cell phones, the Premier and Attorney General tried to have Moe Sihota arrested for 'eavesdropping'. They subsequently brought in a law that would severely punish anyone who exposed graft in government. I was shocked that those caught red handed seemed quite content to accuse the accuser. It was with great admiration I watched Moe Sihota avoid imprisonment. What seemed significant was that no particular 'party' was alone in dirty tricks.
Everyone was complicit at the time in no end of lawlessness that was occuring partly because of the great growth in the city and province and because of the wealth that was flowing through the great port. The principal agricultarl trade of the community was marijuana and all manner of individuals in all levels of government were somehow involved in the multi billion dollar industry. The city was further one of the principal avenues of heroin into the US with millions of dollars of profits dispersed through the community.
The logging companies were clear cutting and lying about replanting but at least paying taxes whereas non tax paying fat cat marijuana criminals were planting acre large plantation in the clear cuts left by the logging companies .
The business of the administration and promotions were made for those who would 'turn a blind eye'.
Conflict of interest was the norm. Further, greed was the community pathos. With rising costs of living and declining pension potential everyone seemed to be scrambling and no one was interfering in how their neighbour went about survival. Mad men and mad women dominated the landscape.
What was interesting was that they didn't tend to go to church as much after their deeds of dubious treachery and barbarianism, they as often as not showed their hypocricy by seeking social support for their age old villainy in psychological and philosophical theories that would justify their venomous behaviour. Social darwinism was all the rage along with pursuit of happiness at all costs. In this age of narcissism there were all manner of drugs illicit and medicinal which could be guaranteed to remove any insomnia or depression that might have once made guilt and shame more unbearable. Sympton management was all the rage.
The young man thought that his colleagues decisions to remain mum, and protect their careers, appeared to him to suggest they were like thieves in a den, not willing to question a thief among them, All manner of shady things had been going on at the time which he'd found offensive but none had caused the unnecessary death of a patient. So he wrote the letter which was used by the hospital and university authorities to depose of the great man.
What the young man didn't know about office politics was that he was just a tool in a greater conflictt, carelessly and stupidly used to remove an opponent. The puppet master, another drunk and thug, didn't win the gambit but someone else became head. That person was not necessarily any better or any more caring of patients.
The old man was in retrospect just declining and scared, anxious about money and aging, clinically out dated and irresponsible. In the grand scheme of things using the retrospectoscope of highsight, he was really the best of a very bad lot. The young man regretted seeing him brought down even if it was the right thing because this old stag was really just surrounded by wolves. The wolves took over then and things went even worse. It wasn't for another several years before a head was chosen who actually took their Hippocratic Oath seriously and research and the hospital began to function once again somewhat as a 'patient centred' facility.
In a way the old man was like a King Lear. In other ways he was a MacBeth. Seeing him go was like watching a Zorba the Greek episode with all the clawing old ladies and lesser rat like people grabbing the remains of what he had left. Years later the young man was sorry he'd hurt the older man simply because he was so much better than what immediately had followed. Further as he grew to know those who'd pressured him to come forward he realized he had indeed fallen in with worse than theives.
He' d learned however that he could depose a metaphorical Hitler. He was like David in the Bible who could relatively easily depose a Goliath but it was much more complicated when he had to deal with Saul. The problem wasn't just single men in his mind but rather all the alliances. He described his predicament as not being able to deal with the NEST. To explain this he'd say, if the allies or even the Germans themselves had assassinated Hitler, it was just possible that Goebbells or Eichman would have taken his place. Quite possibly they'd have been worse.
The idea that removal of a leader meant better things was only a communist idea from the failed machinations of Marxism. Revolution didn't improve things but rather as likely made things worse. Like the Beatles he'd all along sung, "We don't want a revolution" but somehow through his inability to see the Saul in a person he'd thought a friend he'd betrayed his own personal principles alligning with a project which was intrinsically ungodly from the start.
Years later one of the gang would suggest he needed to study ethics and professionalism. By then he knew that God had a great sense of irony.
Professionalism was loyality to the group and the group's good cause. The difficulty with professionalism was specifically that it was so similiar to tribalism. The German Army was the most professional soldiers of history yet the cause they served changed from what was called higher " kultura" or culture to low culture. The lower unit of any society after family is tribe. It's a gang. It's a self serving entity that defines all outsiders as the enemy. Historically a profession was a subsection of society that served its membership and the greater needes of the society as a whole. Tribes care not for society as a whole and like gangs serve only themselves.
The young man only stayed with the team because he thought it better than the alternative gang. Professional soldiers were said to be superior to the mob because of the discipline and allegiance. But it was a Prime Minister of England who said " I don't need you to agree with me when I'm right, I need you to agree with me when I 'm wrong." That's the nature of the party system of the government. It's especially dangerous when it devolves from professionalism into tribalism.
A National Post editorial put forward the question "What is the difference today between a Canadian Political Party and the Hell's Angels?" This was a question that didn't need to be asked 20 years ago but was clearly one being asked today.
In medicine the doctor owed allegiance first to his Oath and his profession. His oath was first 'Do no harm' and that the "patient should come FIRST:'. The Beurocrats were very good at platitudes and 'saying the right thing'. Georgia Strait newspaper annually made a joke of banning the words over used by beaurocracy as 'buzz words' and 'politically correct' hypocrisy. There was a serious disconnect between the words and behaviours of some individuals and especially the institutions which promoted them.
By use of the corporate and beurocratic term, 'terms of reference' all investigation into any malfeance limited their 'apparent' culpability, accountability and responsibility. Hence even a massacre commission might insist that it was only called to judge the death of one person in a massacre when that sole person alone had in fact, as the subsequent report showed, died of natural causes. By limitting 'terms of reference' the commission didn't have to account for the countless machine gunned bodies.
The young physician had seen too much unnecessary death and in the end was labelled a whistle blower. He'd stopped many individual deaths. by speaking up. His 'sacrifice' individually had been in countless lost nights of sleep, personal threats to himself, endless hours of research and consultation with others, and immense loss of income all to conclude that the 'NEST' seemed the same as when Kafka described it as the "Castle". He had played the Glass Bead Game and become Magister Ludi but to no avail. The best he could do was indeed simply the 'next right thing'.
Talking with the deacon of the Queen's church in Buckingham he was told by this old white haired poet, "I finally learned that there's all the money in the world to help the sheep that survive the fall from the top of the cliff as long as you don't do anything about the hole in the fence up there. And God forbid you don't say anything about the people pushing the sheep off the cliff."
Today he was looking for a bioethicist who had sacrificed his career to save the life of one man. From what he'd read so far philosophers learned far more from the death of Socrates than Christians learned from the death of Jesus. He wasn't sure though they had anything to offer in tying action to word because everyone was so very good at paying lip service and no one seemed willing to pay the blood price.
He and some of his colleagues addressed this problem by 'broadening the "diagnosis". Though the disease category wasn't 'cancer' it could well have been. To recruit more people for his research he included people who would not traditionally have been said to have 'cancer' These "healthy' recruits would further 'dilute' the side effects of the medication and allow for better outcomes. It did subject a whole lot of people to unnecessary toxicity though and in addition could cause some people without other disorders to be given simply the wrong treatment thereby missing the right treatment for their 'correct' diagnosis.
The young researcher was suspicious of this and raised his concerns early. The head researcher explained this away and used a lot of 'attitude' and 'dominance' behaviour to make his point. This of course concerned the young physician even more because people who depend on the gun don't usually have any better argument.
Using the 'local' research criteria the young researcher diagnosed a man with the condition. The man was indeed sick with this particular condition that could affect his judgement. He was offered a position in the research trial. When he balked the head physician came and essentially sold the man on the research.
In selection for research people can be recruited for pay, or be offered a position, or have the pros and cons explained and an advocate or family member included to help in the decision. The young physician having had some research experience before joining this community had been exposed to a much different and more 'patient centered' approach to selection.
In this community however there seemed to be a real 'drive' to get patients enrolled in programs. At the time the young physician never thought that there might be incentives associated with this. He'd worked in sales to pay his way through undergraduate studies and he actually saw patients being 'sold' on being part of research that really wasn't likely to benefit them and might well not provide any benefit for the world as a whole. The interactions were distinctive to those trained in process.
Of course this is also all hypothetical and fictitious. In medicine it's said that hindsight is a proctoscope that's 100% perfect only because it's in the hands of assholes.
That the man would be treated with the research drug and die as a result of the wrong diagnosis and wrong treatment could well have happened to anyone. Medicine isn't an exact science. Mistakes occur and only after death does one recognise the errors.
Usually after death, though, especially suspicious deaths, there isr a post mortem. This can be a physicai post mortem done by a pathologist and it can also be a psychological post mortem done by the staff. The head physician ensured that neither was done confirming the young man's concerns.
The young man followed the old man's directions because he was senior and more experienced. The young man never even speculated that there was conflict of interest.
The experimental drug didn't work. The research failed. The man died. Usually, having an experimental drug is sufficient cause for more intensive investigation of the factors leading up to death.
The young physician had pleaded with the older more experienced physician but had been silenced repeatedly. The young physician questioned the diagnosis and questioned keeping the man in the double blind research trial because he was clearly deteriorating and death was imminent. In those days the young physician was known for being very diplomatic and respectful of authority as the young and highest trained from the finest institutes are.
He'd never encountered such a problem before and didn't know what further he could do. There was no one, he believed, more senior he could take his concerns to. Further the young man had already been told that that he wasn't considered a good ' team player". Being a 'team player' was indeed the highest praise one received in this hospital research institute and perhaps this community at large. .
He sadly learned later from other researchers that there were many discrepancies and other deaths had occurred . No one spoke up because that was considered unprofessional. The doctors in this community appeared to put the greatest emphasis on professionalism and a lesser emphasis on such matters as patient life and death, , truthfulness, transparency, patient advocacy, patient's rights or any number of considerations that might well have contributed to saving the man's life.
Further, there was no place in the university for anyone who bucked the system. The hierarchy in research was sacrosanct and the grand man was politically well connected. This hierarchal problem is central to 'systems research' and the study of why corruption is so wide spread in some communities. For example, the success of the Japanese car industry at one point was the result of a letter box which was solely read by the CEO of the company and open to be used by all employees. Prior to that innovation in the 'system' was blocked by middle management and yukuza who simply removed any one who suggested change in the existing system.
The reformer is the enemy of anyone who benefits from the status quo. Only the CEO and Board were specifically interested in the quality of Japanese cars because of world wide competitiveness whereas the lower level managers were only interested in their jobs remaining unchanged with all the privileges and perks in tact.
The young man wanted to do something but exhausted all avenues except whistleblowing. Whistleblowing is not taken lightly by professionals. It's essentially committing suicide to bring attention to someone being murdered. It's like Tibetan monks who pour gasoline on themselves and ignite it. Whistleblowying in Canada is routeinely punished. In British Columbia whistleblowing is crucified. So it was not something to be done lightly.
The young man in the end had refused to make the unsavoury decisions alone and insisted that the old man attend the patient and give the orders publicly rather than the young man doing what he no longer believed in alone and in silence. The old man was furious with the young man for this refusal to cooperate but saw the patient and publicly gave the order which caused the patients death.
The patient died.
The young man not trusting the older , came into the hospital and copied the file. The next day he learned that the old man was saying that the patient had died through an error of the young man's. Further, the chart was suddenly missing and the orders of the old man were expunged from existence. The research assistant later said that the research data was all re written too. It had been done before when people had died she told him. Crying she said I can't say anything because he'd ruin my career if I objected. He learned that several of his colleagues had been directly involved in this sort of thing unbeknowst to him.
Everyone has heard the adage, you can't make an omelette without breaking a few eggs. No one higher in the food chain was ever concerned about such matters because they had their own skeletons in their closets to worry about.
The young man simply left the hospital. He didn't want to have anything more to do with the old man or with the colleagues whose behaviour, specifically sins of omission, contributed to the deaths of patients. As he put it, "I just wanted to play hockey. I didn't know that I'd joined a bush league run by the mafia. " He never lost his love of hockey though.
He later learned that the research funding had further caused the senior man to have a conflict of interest because there was serious support for a particular outcome measure in the research. Alot of money apparently was involved not in finding if the drug was good or not but solely in proving this drug was good and extending it's distribution potential. The particular drug company involved did not itself have a good reputation.
The young man did not know any of the history of the trend of the very government appointed beaurocrats to choosing sketchy low cost suppliers rather than reputable institutions. Deaths of patients could therefore be likened to the crashes of airplanes that occured increasingly because maintenance was being done by low cost knock offs rather than the specified parts the manufacturer required for wings and engines. A patient's death could always go by quietly but airplane crashes attracted attention.
The difficulty for young doctors in primitive barbaric systems is that they are so dependent on the context of their situation and lizards have long been known to eat their young whereas mammalian species usually care for theirs.
The young researcher left the hospital and returned to general practice.
He was subsequently approached by a former senior colleague to come forward and speak out against the head and tell the truth about the death of the patient,he was was less than keen. He felt he was out of that system and had nothing further to contribute. . The colleagues who approached him and begged him for his assistance said that they could not do it as their careers and positions with the university would be jeopardized if they did. They said that the old man was crazy and killing people and it was his duty to stop the carnage because he had the evidence and could make the complaint.
He discussed this request with a colleague. The colleague said simply, "I've known that man who wants you to do this for many years. He's a psychopath. He is playing on your goodness and doesn't care for anyone but himself. He lacks empathy. He hasn't the capacity for love. He's a chameleon but he's still a lizard. "
Women doctors who he'd formerly worked with also approached him and begged him to help them, his female colleagues.
So he wrote the letter.
The letter caused the head doctor to lose his position. He was deposed by a jury of his peers who felt his behaviour was wholly 'unprofessional'. .
The young physician was never forgiven. The other senior colleagues who'd 'used' him went on to high position. The woman colleagues never looked him in the eye again. ..
At the time the young physician thought there was still nobility in his colleagues and that he was duty bound to stop the unnecessary death which was continuing. At the time he never suspected that the persons who were asking him to make the supreme sacrifice were indeed only hoping to get the old man's position. He personally knew of no conflict of interest that he had. Thanks to his teachers and his family and their values he was quite simply most interested in doing what he thought was right, helping out and helping ensure better health care for patients specifically and in general. Otherwise he happy to be hunting and fishing and working in his private practice. He figured he'd do research elsewhere if the opportunity arose but he wasn't going to do research locally given the lack of regulation and the tendency of governing bodies to either be themsevles corrupted or simply wholly negligent.
The longer he was in the community the more of a political Sodom and Gomorrah it appeared.
It was at this time that national and international regulatory bodies were refusing to certify the provincial institutions in general. The greatest calamity of the decade was that the Vancouver Stock Exchange lost it's license to practice due to gross corruption. The business community en mass was considered so criminal it lost the right to self government. For years thereafter it only ran with supervision of the Toronto Stock Exchange. The government in general was notorious for questionable practices which explained why everyone called this the 'wild west'. A day didn't go by in his office where some patient wasn't being harmed by some group of shysters and their government affliliates like those in the infamous 'leaky condo fiasco'.
Even when MLA Moe Sihota caught the Attorney General and Premier doing dirty deals over their cell phones, the Premier and Attorney General tried to have Moe Sihota arrested for 'eavesdropping'. They subsequently brought in a law that would severely punish anyone who exposed graft in government. I was shocked that those caught red handed seemed quite content to accuse the accuser. It was with great admiration I watched Moe Sihota avoid imprisonment. What seemed significant was that no particular 'party' was alone in dirty tricks.
Everyone was complicit at the time in no end of lawlessness that was occuring partly because of the great growth in the city and province and because of the wealth that was flowing through the great port. The principal agricultarl trade of the community was marijuana and all manner of individuals in all levels of government were somehow involved in the multi billion dollar industry. The city was further one of the principal avenues of heroin into the US with millions of dollars of profits dispersed through the community.
The logging companies were clear cutting and lying about replanting but at least paying taxes whereas non tax paying fat cat marijuana criminals were planting acre large plantation in the clear cuts left by the logging companies .
The business of the administration and promotions were made for those who would 'turn a blind eye'.
Conflict of interest was the norm. Further, greed was the community pathos. With rising costs of living and declining pension potential everyone seemed to be scrambling and no one was interfering in how their neighbour went about survival. Mad men and mad women dominated the landscape.
What was interesting was that they didn't tend to go to church as much after their deeds of dubious treachery and barbarianism, they as often as not showed their hypocricy by seeking social support for their age old villainy in psychological and philosophical theories that would justify their venomous behaviour. Social darwinism was all the rage along with pursuit of happiness at all costs. In this age of narcissism there were all manner of drugs illicit and medicinal which could be guaranteed to remove any insomnia or depression that might have once made guilt and shame more unbearable. Sympton management was all the rage.
The young man thought that his colleagues decisions to remain mum, and protect their careers, appeared to him to suggest they were like thieves in a den, not willing to question a thief among them, All manner of shady things had been going on at the time which he'd found offensive but none had caused the unnecessary death of a patient. So he wrote the letter which was used by the hospital and university authorities to depose of the great man.
What the young man didn't know about office politics was that he was just a tool in a greater conflictt, carelessly and stupidly used to remove an opponent. The puppet master, another drunk and thug, didn't win the gambit but someone else became head. That person was not necessarily any better or any more caring of patients.
The old man was in retrospect just declining and scared, anxious about money and aging, clinically out dated and irresponsible. In the grand scheme of things using the retrospectoscope of highsight, he was really the best of a very bad lot. The young man regretted seeing him brought down even if it was the right thing because this old stag was really just surrounded by wolves. The wolves took over then and things went even worse. It wasn't for another several years before a head was chosen who actually took their Hippocratic Oath seriously and research and the hospital began to function once again somewhat as a 'patient centred' facility.
In a way the old man was like a King Lear. In other ways he was a MacBeth. Seeing him go was like watching a Zorba the Greek episode with all the clawing old ladies and lesser rat like people grabbing the remains of what he had left. Years later the young man was sorry he'd hurt the older man simply because he was so much better than what immediately had followed. Further as he grew to know those who'd pressured him to come forward he realized he had indeed fallen in with worse than theives.
He' d learned however that he could depose a metaphorical Hitler. He was like David in the Bible who could relatively easily depose a Goliath but it was much more complicated when he had to deal with Saul. The problem wasn't just single men in his mind but rather all the alliances. He described his predicament as not being able to deal with the NEST. To explain this he'd say, if the allies or even the Germans themselves had assassinated Hitler, it was just possible that Goebbells or Eichman would have taken his place. Quite possibly they'd have been worse.
The idea that removal of a leader meant better things was only a communist idea from the failed machinations of Marxism. Revolution didn't improve things but rather as likely made things worse. Like the Beatles he'd all along sung, "We don't want a revolution" but somehow through his inability to see the Saul in a person he'd thought a friend he'd betrayed his own personal principles alligning with a project which was intrinsically ungodly from the start.
Years later one of the gang would suggest he needed to study ethics and professionalism. By then he knew that God had a great sense of irony.
Professionalism was loyality to the group and the group's good cause. The difficulty with professionalism was specifically that it was so similiar to tribalism. The German Army was the most professional soldiers of history yet the cause they served changed from what was called higher " kultura" or culture to low culture. The lower unit of any society after family is tribe. It's a gang. It's a self serving entity that defines all outsiders as the enemy. Historically a profession was a subsection of society that served its membership and the greater needes of the society as a whole. Tribes care not for society as a whole and like gangs serve only themselves.
The young man only stayed with the team because he thought it better than the alternative gang. Professional soldiers were said to be superior to the mob because of the discipline and allegiance. But it was a Prime Minister of England who said " I don't need you to agree with me when I'm right, I need you to agree with me when I 'm wrong." That's the nature of the party system of the government. It's especially dangerous when it devolves from professionalism into tribalism.
A National Post editorial put forward the question "What is the difference today between a Canadian Political Party and the Hell's Angels?" This was a question that didn't need to be asked 20 years ago but was clearly one being asked today.
In medicine the doctor owed allegiance first to his Oath and his profession. His oath was first 'Do no harm' and that the "patient should come FIRST:'. The Beurocrats were very good at platitudes and 'saying the right thing'. Georgia Strait newspaper annually made a joke of banning the words over used by beaurocracy as 'buzz words' and 'politically correct' hypocrisy. There was a serious disconnect between the words and behaviours of some individuals and especially the institutions which promoted them.
By use of the corporate and beurocratic term, 'terms of reference' all investigation into any malfeance limited their 'apparent' culpability, accountability and responsibility. Hence even a massacre commission might insist that it was only called to judge the death of one person in a massacre when that sole person alone had in fact, as the subsequent report showed, died of natural causes. By limitting 'terms of reference' the commission didn't have to account for the countless machine gunned bodies.
The young physician had seen too much unnecessary death and in the end was labelled a whistle blower. He'd stopped many individual deaths. by speaking up. His 'sacrifice' individually had been in countless lost nights of sleep, personal threats to himself, endless hours of research and consultation with others, and immense loss of income all to conclude that the 'NEST' seemed the same as when Kafka described it as the "Castle". He had played the Glass Bead Game and become Magister Ludi but to no avail. The best he could do was indeed simply the 'next right thing'.
Talking with the deacon of the Queen's church in Buckingham he was told by this old white haired poet, "I finally learned that there's all the money in the world to help the sheep that survive the fall from the top of the cliff as long as you don't do anything about the hole in the fence up there. And God forbid you don't say anything about the people pushing the sheep off the cliff."
Today he was looking for a bioethicist who had sacrificed his career to save the life of one man. From what he'd read so far philosophers learned far more from the death of Socrates than Christians learned from the death of Jesus. He wasn't sure though they had anything to offer in tying action to word because everyone was so very good at paying lip service and no one seemed willing to pay the blood price.
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