Monday Morning Journal

I’m pleased that I’m awake. I slept well. Gilbert joined me in the wee hours. Reassuring to feel his little body pressed up against my back.

It was chilly.  My first thought. Pulling the blanket over my shoulder

A touch of autumn chill in the summer time air.  This August uncertain weather. Rain yesterday.  Premonitions.  PTSD.

I meditated. Nothing special. Going through the motion. Quaker, contemplation.  Silence. Calling on the Holy Spirit. Breathing. Reminding oneself that breath is where it’s at. The often forgotten breathing that is the motor of life.  

Coffee, granola, yoghurt

Facebook.

Gospel Riders put up a Larry Norman song.  Never heard the guy. Listen to his song.  Why not ask Jesus.  See that Janis Joplin sang it to. But didn’t listen to herself.  We’re all like that. Advice we give others we don’t take ourself.  What about Jesus?  

I picked up the bible yesterday and put it down. I have the Big Book by my couch and haven’t read it this week. I mean to do so many good things. Write a book about the Christian diaspora.  Write another addiction book. 

 I cleaned my desk a bit so I could begin writing travels with Gilbert.  I’ve been thinking of all the little ‘repairs’ that need doing.  I let them expand in my mind, minor tasks, nothing critical but they become the focus and I flog myself. Steal the joy of the day with focus on what ‘needs’ to be done.  

I was in a spiritual whirl wind in Tennessee. I read cyberdocs and others share their joy.  I’m grieving a bit. Another year before we meet. Then Phillip is meeting in Serbia in October, Hope Alive’s annual meeting. I’d like to be there.  But I’m in India in the fall. . This week another round up at Salt Spring.  Camping. Spiritual speakers. Sharing.  Learning more about the disease of addiction.  

I’m not joyous and free.  I’m laboured. I’m a little lethargic.  I read about the enthusiasm of childhood and wonder at all the trauma and mixed days that have me again fearing leaving the house. No good reason today. But I really could hide under the blankets till next I’d have to pee.  I’m going through the motions. I’d rather be skipping school. 

Jesus loved children and saw that we’d have to be childlike to get into heaven. Innocence and naivety no , but open hearted, trusting. I trust God. Not the world.  I mostly fear being falsely accused and hammered by the government. I fear reporting killers and rapists and experiencing the retaliation of truth telling. I fear that I’ll not walk by and say nothing when cruelty occurs.  I fear getting pulled into helping others again only to be punished like them.  I’ve been an ally of the sick, disenfranchised, marginal, stigmatized, old and very young.  I’ve been bullied like them..

Now it’s pretty good.  I’m not alone.  But old. I’m not too marginalized now..  I’m condemned for experience age and knowledge.  I hurt. Physically.  That’s the weather change.  The coming of the cold. 

I’m here to celebrate. There’s dancing on Salt Spring. Hopefully I’ll see Kirk.  I tried seeing Tom on the weekend. It’s as good to see others. I like the encounters.  History.  Our personal relationships.  Old friends.  Even old enemies are not so bad. 

I’m blessed really.  I have so much to be thankful for but instead of looking at all the blessings I’m condemning myself for the dirty dishes.  I’ve a scratch on the truck that needs a white pen to repair it. I used a clear pen already to stop rust but I need to stop at the dealer and get  another white touch up pen.  

My mind has always been like that. Constantly focused on repairs and not enough on thankfulness. I just looked up and saw the fridge magnets where the glorious travel spots and memories are displayed. I rarely look at the surroundings.  There in the corner is the picture I took so many years ago in Oxford when I thought first to be a doctor.  Now I want to be a writer again.  I feel I’ve done my bit.  I’ve served. I’m amused that in my mind my ‘life of service’ ended with 65.” The arbitrariness. Now I’m on borrowed time.  

I still get asked if I want to be a doctor. I certainly say yes. I love healing and helping people who are ill. But medicine is co opted by the government that has no boundaries and micromanages everyone as if we are their employee. Few of us are. Most of us are contractors but they’re ruling us now like we were military conscripts. They are boorish bullies without boundaries and no grace. They are self serving ignorant thugs. Doctors who have sold their soul to the company store. Collaborators for cash. 

So I ask myself , why am I working for a corrupt organization that is so often causing the deaths I’m trying to prevent.  More and more people are denied what they were promised or have as their due and I’m being an ‘advocate’ rather than doing therapy.

 I’m writing letters for them to government agencies and insurance agencies because these bullies have coopted the medical system and turned us into ‘police’.  We are “ policing “ for the government and insurance. 

 “You must have a doctor ‘co sign’ your illness’. Everyone is now a criminal in Canada and reduced to bad child by these agencies of evil.  Overnight the bank might as well tell adult Canadians you need a doctor to ‘co-sign’ your having a bank cheque.

I’m less impressed with my organizations that take millions of dollars and pay them selves richly but haven’t stood up to these bullies that demand doctors write bullshit. I just referred a patient to a university department and my colleague’s beurocratic entity demanded several pages of hand written data as a barrier to my getting service for my patient. 

 “Hi John, would you see my patient?”  

“Sure Bill, send them over.”  

That was what we did. I’m a highly trained specialist. He’s a highly trained specialist. I wouldn’t ask his help if I didn’t need it. He trusts my judgement. I trust his.  We make the call. Now there’s a dozen layers of costly beurocracy.

Now the patient demands a full body scan for the common cold and if we don’t give it the government beats up the doctor with committee tribunals.  

I”m afraid to go to work.  I’m afraid of the bully bureaucracy.  The College of Physicians and Surgeons of BC is utterly insensitive and the University, the Canadian Medical Association and The Canadian Psychiatric Association, all these administrative sorts, are paid for paper pushing. They serve themselves. They don’t serve the doctor or the patient. 

I have to gird myself to go into that hell of idiocy. Monday morning brings this out. Health care beurocracy phobia.

My favourite recent example is the 5th multi million dollar ‘investigation into the missing women’ of the northern BC all the while the bus line that stopped the girls from hitchhiking in he north was closed for lack of funding.  It was the same idiocy that had a million dollars of lighting put in campuses to protect the privileged university girls from rape where rape was as rare as intelligence when a mile away the rape stats where highest in the impoverished areas where municipalities couldn’t afford lights.

That’s what I see.

So I don’t want to be a doctor and deal with low IQ burearocrats chosen for their never having studied Nuremberg or read ‘totalitarian societies’. On their interviews they are asked have your read Kafka’s “the Castle” or 1984. If they answer yes they don’t get the job. Cowards are promoted. 

Meanwhile I seem to have a psychological issue with authority. I’m carrying a whole lot of character flaws. I ‘m impatient. I’m critical. I’m judgemental. I’ve got a whole lot of work to do on my own self so why point a finger at the ‘face of government’.  I’ve got to be more grateful.

The fact is the Canadian bureaucrat is quite possibly more intelligent that his fellow species of dung beatle the world over. I’m comparing him to perfection rather than remembering that everyone in the world wants to come to Canada for health care because I as the doctor have been subjected to ‘rent control’ for 30 years, underpaid, over worked and without corruption.  Canada is the best of a bad lot.

I’m here. It’s my choice to be here. I’m doing this work. I say to pay for my truck but I don’t even need to have any of these ‘things’. I was touched by my friends living overseas for cheap.  I don’t want to join Doctors Without Borders and face another bureaucracy.  I just want to go to work here today and be more child like. I want to appreciate the sick bureaurcrats killing Canadians on behalf of the corrupt government which is less corrupt than other political structures.  

I want to count my blessings. I want to think more of Jesus. I want to be good at heart. I ‘d better shower.  

The problem is me.

I miss Milton. He used to say he had a sticker on his mirror that said, ‘you’re looking at the problem.’  

God grant me the serenity to accept the things I cannot change

The courage to change the things I can

And the wisdom to know the difference.

Okay thanks for the pep talk Jesus.  I ‘love shower shave and go out the door and face the ‘complaints department of life’.  

Bio

Psycho

Social

Spiritual

That’s the work I’m trained to do, hear a concern and work together to see it as 4 dimensional and develop a strategy of working together with the patient to achieve a resolution.

The phobia for the unknown stranger exists because for years I’ve been assailed with constant impossible demands. Only a fraction of humans are reasonable. Unreasonable people sick are even more unreasonable.Reasonable people are unreasonable people when they’re sick it doesn’t help that the boss is even sicker.

“I have this problem doctor. I want a pill like cocaine that’s medically approved.  “

I want you to tell my employer I’m sick

I want you to make my insurance pay me to go to India

I want you to lie for me.

I want you to tell my husband I can’t have sex

 I want you to give me money

I want you to do as I tell you.

If you don’t do as I tell you, see this gun, I’m going to kill you.

If you dont’ so as I tell you, I’m going to complain to the College of Physicians and Surgeons of BC and they’re going to believe me. (who is lying ) over you because they always do. I’ve already complainedd to a dozen agencies and they’ve all hurt everyone I don’t like because I’m bigger and tougher than them all.

If you don’t do as I tell you I’ve going to get my lawyer to ruin you.

If you upset me I’m going to stalk you and the police aren’t going to do anything 

If you don’t do as I tell you I’m going to kill your dog. I already killed your last dog. I’ll kill this dog. 

If you don’t do as I tell you I’m going to threaten your wife. I threatened that second one didn’t I.

If you don’t do as I tell you I’m going to scream and have a scene.

If you don’t do as I tell you I’m going to destroy the walls of the building and your landlord is going to evict you , remember when I did that?

If you don’t do as I tell you I’m going to punch you in the face, remember all the times I did that? 

Now hurry up and get me -housing, hospital beds, money, drugs, lawyers, sex, services.

You’re just here to do stuff for me. That’s what the others do. You are here to do as I tell you.

Google says you’re supposed to do this.

My pharmacist told me that you’re supposed to do this.

My herbalist told me you were no good and you should do this.

My mother told me she read your blog and you’re sicker than I am

You called my brother a pedophile and put him in jail and I’m going to pay you back for that.

You can’t write that down.

I don’t want my boss to be able to hear what we said. You’re supposed to be confidential. The insurance company gets this.

I’ve had sex with my doctors and I don’t trust doctors.

I’m having sex with my lawyer and he’s willing to sue anyone I want as long I keep giving him blow jobs.

My friend is the Premier

Do you know I have more money than you’ll ever see and I could buy this hospital.

My brothers are hell’s angels so you’d better do as I tell you.

All of that’s true.

Knives gunshots punches.

And the worst is the College bureaurcrats acting like they are superior and blaming you for being shot at. Virtue signalling syncophants, 

Well it’s the way you communicate. People who have never been on the real frontlines, have never certified a dangerously insane person in the community, have never had a pedophil arrested, have never treated escorts with ptsd or lying lawyers or multi millionaire power brokers or mafia, silly suburban doctors picked for promotion because of their ignorance and inexperience, have the arrogance and grandiosity to act and talk like they “know”. 

I miss Dr. Brown. I miss the old guys who had similiar experiences, had rolled up their shirt sleeves and could talk with authority. These people today  are wannabes, wankers,  and get arrogant and superior when you call them on their inexperience and safe protected lives in institutions and good neighbourhoods.

It was years after the plane crash I couldn’t fly but I got back up in the air and now I’ll go out the door again. Life is an adventure.  I used to do counterphobic stuff. I used to think if I drove my Harley and sailed through storms and did white water canoeing I could be less troubled by the social stupidity.  Now I don’t know.

Now I think the answer really is Jesus. 

Who do you defer to, Doctor?

I was asked the question, "Who do you defer to, Doctor?" by a lawyer in a court case.  It caused me to pause.  I was being asked about the care of my patient.  I was a generalist, a specialist and a sub specialist.  I knew that the lawyer seemed to consider some 'hierarchy' applied to doctors as it presumably does among lawyers and certainly is a matter in the military.
It probably pertained when I was an Assistant Professor at the University too.
But it wasn't relevant in that way to clinical medicine.
I said, "I don't defer to another doctor, unless he is willing to take responsibility for the patient and assume full accountability."
Indeed, that's what clinical practice is about. It's all in the relationship.
I thought about the question overnight.  Clearly I defer to God.  I defer to authority in a governmental sense but in regards to patient care, again it's different.
The lawyer asked specifically about someone who is high profile in the court system.  I found that interesting because again clinically the lawyer couldn't grasp that 'big guns' and 'little guns' weren't a matter of much substance in my clinical world.
I do have a constellation of characters who I admire and respect and would on specific questions seek their advice and probably accept this though in the end it would be a consultation. In a consultation I can disagree and go my own way with greater risk and responsibility once I'd asked for advise and chose not to follow it.
I have a host of doctors, though fewer as I've grown in years and experience, who I consider have more specific experience than I do in a particular area.
I am a psychiatrist in the general sense but am a subspecialist in the area of addiction with certification and extensive experience.  I routinely seek advise of colleagues who have more experience with a particular kind of patient. I have a half dozen doctors who are certified in addiction medicine, some of them psychiatrists even, but I don't think of them as 'superior' to me.  I think of their individual training as comparable in many instances as mine but think more about them in terms of numbers of cases diagnosed and treated.  I also think of their outcomes and most importantly the complexity of cases.
One fellow is particularly good with heroin addicts, but of two doctors I know one is more experienced with abstinence while another is more experienced with harm reduction therapies.  Another doctor has far more experience in sex addictions than me and there is one character locally and another in the next province who know more about gambling addiction than I can ever hope to know. Yet I don't think any of them know more about 'addiction' and the diagnosis and treatment of addiction than I do in my addiction psychiatry work.
In my psychotherapy practice I have subspecialised in trauma and especially with those in recovery, the 'dual diagnosis' group and don't really know another psychiatrist who shares my particular approach to this group, a mixture of 12 step facilitation, dynamic spiritual therapy focussing on the anxiety and isolation components.  I know others who work with a similiar population but their particular approaches to treatment are often different but I think they may get similiar results.
I have another niche where I am commonly sought for advise and that's where patients have major medical problems coupled with psychiatric disorders. The psychopharmacology of this subset of patients is particularly difficult.  Patients with head injury and an anxiety disorder or depression and a seizure disorder, kidney disease and psychosis.  These are a particular group of patients who I found that a colleague was also commonly seeing and I've benefitted from his specific insights.
I don't 'defer' to these colleagues in a 'deferential' sort of way except one lady doctor who has specialised in the treatment of pregnant patients with psychiatric disorder.  And come to think of it I would defer to her and do. It's an area of psychiatry that I really have limitted experience to hers.  There's definitely some areas in psychiatry in which I probably do 'defer' now that I think of it but they're areas like that.  Child psychiatry and Geriatric Psychiatry. The latter is a subspeciality area that requires more training certified geriatric psychiatrist would see far more patients over 75 years old than I do. Right now I only have a half dozen in my practice and may have seen less than a hundred in my lifetime.  In contrast my female colleague in geriatric psychiatry is not only a great clinician but she's my age and has being seeing old people as long as my other colleagues has been focussing solely on children.
So yes I do 'defer' in these cases and would surely and do surely defer to other specialists outside my own area of specialization. Hence I'm forever deferring to orthopods, surgeons, cardiologists, endocrinologists, rheumatologists, and urologists etc.  There are however some areas of overlap in neurology for instance. I do defer to neurologists commonly but there's some areas where my own experience and expertise cause me to feel that the area of overlap might be more in my peculiar bailiwick than that of a neurologist. This is true for pain specialists and occupational health specialists.  There are little overlapping territories where I acknowledge that the two of us might have equal expertise despite coming from wholly different backgrounds.
The matter of responsibility and accountability is always at play. There are commonly alot of 'adjunctive' players in the field but when the ball is dropped I'm very much aware of whether I'm going to be stuck holding the ball.  Alot of people who refuse to carry the ball really want to tell you how a ball should be carried. I'm more aware of these with age and experience.  Monday morning quarter backs and and arm chair philosophers.
The question was a good one. Lawyers are astute and I am thankful for the questions they raise and the opportunity their questions give me for self examination and further learning.  When personally I've need a lawyer I've been rather deferential to him or her though know that in the end I'm going to be the one who is ultimately accountable.