Cognitive Behavioural Therapy, CBT, is not new. It was developed by Aaron Beck. I did 6 months of formal weekly training in this psychotherapy approach in my psychiatry residency in the mid 1980's. At that time it was not a standard part of the psychiatry residency. Psychoanalytic psychotherapy was the dominant form of therapy in my training program. CBT training was an 'elective' then whereas today it's fairly mainstream.
The principal behind CBT is that 'mood disorders' and other psychiatric dysfunctional states are a product of 'cognitive' internal process. Simplified it says 'we feel what we think and behave what we feel.' Therefore if you change your 'thinking' then feeling and behaviour will change accordingly. Though the actual techniques that Beck developped were fairly original the idea of the effect of thinking on mood and behaviour was in fact ancient. It's part of the standard teaching of Christianity and Buddhist so heralds back thousands of years. Beck himself acknowledged the origins of his work in the Stoic philosophers of the ancient world. In psychology 'positive thinking' therapy had turn of the century application in the early hypnotists proponents. Mesner's 'Everyday in everyway I'm getting better and better" self affirmation may as well have been early CBT.
Beck's real genius was in the development of a particular strategy of positive thinking and teaching of this that could be replicated and reproduced to allow for scientific study of the basic premise. His methodology was such that with CBT alone there was an approximate 75% cure in the treatment of depression in a roughly a few months.. Without treatment depressions commonly lasted a year. CBT was equal then to the response rates of patients treated with antidepressant medications. When the two forms of treatment were combined the response was enhanced even more.
In contrast to psychoanalytic psychotherapy which on a weekly basis similiarly administered resulted in relatively equivalent response rates, practitioners in CBT could be trained in shorter periods of time with great effectiveness. My own training in psychoanalytic psychotherapy as a psychiatrist took place over 4 years and was quite intensive whereas I learned CBT in a matter of months. Further CBT could be given to groups whereas psychoanalytic therapy was much more labour intensive and effective one on one. Even better CBT could be self administered. Burns, a student of Aaron Beck, wrote the best seller 'Feeling Good' which today still stands as a terrific text for patients to be given suffering from mood disorders.
Being relatively cheap and easy to learn, it has also leant itself to being used as part of research, it's value shown to be beneficial far beyond just 'depression' and having benefit in anxiety disorders, thought disorders, and addictive processes.
In contrast to psychoanalytic therapy that worked to 'weed' out misinformation acquired in childhood, CBT focussed on the 'present' and didn't really consider it that important how a person had become 'misinformed' about how to think effectively.
For example 'catastrophizing', is seen as a 'cognitive distortion' in CBT. It is recognised that people who tend to catastrophise in crisis are being 'irrational' and less 'effective'. Individually, with a therapist or in a group one learns to 'identify' this trait, see it , in fact, as an 'error' and bypass it or work around it. The techniques that Dr. Beck developped for this included 'talking back' to the 'misinformation'. As an example, "I don't get paid today because the mail doesn't arrive, I think, I'm not going to be able to pay the rent and am going to be homeless." Instead I should think, 'it's not the end of the world', I will contact the people who expect me to pay them that day and advise them that the mail has been delayed and I will pay them tomorrow. " This is 'normal reality' unless one is dealing with the mafia or government beaurocrats. Government beaurocrats actually respond humanly if you give them the same information in triplicate with a witness of a lawyer or doctor or prime minister as notary. The world doesn't need to end.
Interestingly these 'irrational tendencies' were common and formed the basis of the development of the 'fallacies' in the study of 'logic'. Beck's contribution was to simplify these 'fallacies' for the lay person, counselloers,r psychologists and others by putting a memorable spin on them. An example from Dr. Burn's list of Cognitive Distoritions in Feeling Good was 'disqualifying the positive". In this situation the person says it doesn't matter if I have the money in the bank to cover the rent, I didn't get the cheque in the mail so I'm going to be homeless. The nature of the focus here is to 'disqualify' the assets one has.
My mother used to say 'count your blessings' because frankly depressed and angry people commonly focus on the negatives and as long as they do commonly create a 'self fulfilling' prophecy. "CBT has been used in sports training athletes not to 'psych themselves out' but rather to 'psych themselves up'
Ironically, the business psychology world had been using many variations on CBT in their 'inspirational' talks and 'motivational' sales training. If anything the academic world in this case was commonly playing catch up to the business world and refining what worked. Scientific study has proven what often common sense already knew.
Maslow, developped the term 'self actualization' in his study of highly successful people. He wasn't a CBT therapist but rather his approach was to study 'well people' and then suggest that the very strategies that made them well be applied to helping the sick. Freud had originally in the early years of the study of mental illness only treated 'sick' people and learned their differences. Today therapists have learned many 'effective' ways of thinking from those leaders in society and are taking these strategies into psychiatry. Not surprisingly Thessalonians of the New Testatment of the Bible had CBT recommendations telling people to 'think on positive things'.
In addiction work Hal Morley, now deceased, always encouraged an 'attitude of gratitude'. He said with an 'attitude of gratitude' one simply could not remain depressed and negative.
In CBT work the relationship with the 'client' or 'patient' is much more like a 'teacher' student relationship than the traditional psychoanalytic psychotherapy relationship where transference and counter transference, the 'process' and the 'relationship' itself were the focus of therapy. In CBT patients are given 'home work.' They are encouraged to 'journal' and it's accepted that 'success' in therapy is no different than one would expect for 'success' in geometry'. The more one does, the better one gets at 'changing' one's negative thinking to 'positive thinking' and 'purposeful and effective' living.
I commonly ask patients with depression to avoid daily news since it's commonly negative and fear mongering. In this way I'm not acting at all like a traditional psychoanalytic psychotherapist but am being very directive and drawing from my experience as a family physician addressing allergies in children. In that world I'd remove those things that caused sneezing and today in the process of CBT I help the patient remove daily news for instance from their daily repetoire and not uncommonly see patient's moods improve immediately. I also tell the depressed to stop listening Sylvia Plath. An analytically oriented session in constrast would encourage a patient to reflect on the meaning of their listening to, say Kurt Cobain, when they were insisting they wanted to live not die. I might simply tell a person to listen to Bach or Sarah McLaughlan or Bare Naked Ladies.
Going over a particular stress we would look at what the person was thinking and how they could think more effectively. The questions asked are 'what could you have done differently? What would you have liked to have said." What were you thinking?. What would be a better way of thinking given those events?."
Indeed in the Christian community there seems to be a bit of CBT going on when people ask 'What Would Jesus Think/Say/or Do?"
CBT has been called physiotherapy for the mind because it's done in much a way as a person with a physical injury goes to a physical therapist to learn how to walk or move an arm in recovery. In CBT people are trained to think differently about situations, people and relationships. Often pen and paper examples are used much as teachers do in the class room. In group therapy, examples of difficulty are shared and other members are asked how one could think better about such an experience.
It's not 'rocket science'. It's common sense, mostly. However in day to day reality people rarely are exposed to what others are thinking. They just see that a person is 'acting' poorly and rarely know how 'odd' and 'different' their thinking may be.
As CBT therapists can themselves 'think' their 'thinking' is 'superior' and come across unknowingly as terribly arrogant, I encourage everyone who has studied CBT to read Job in the Old Testament. Job is a character who is blameless, thinks well indeed, and accurately but his friends faced with his difficulties do their own version of CBT without any benefit and far too much judgement and arrogance.
That said, CBT is a tremendous asset for anyone and worth the learning. There are superior therapies and ones which are better for specific conditions and individualized therapy is usually better than any of the 'off the rack' therapies. I'm an 'eclectic psychotherapist' so I've been formally trained in several of the major modalities of psychotherapy so am least at risk of the criticism of 'give a boy a hammer and everything is a nail." That said I'm very thankful for my training CBT a quarter century ago and the advances I've acquired in this modality over the intervening years. I doubt a day goes by I don't get to use some aspect of this therapy.
For anyone interested in CBT I strongly recommend Feeling Good, by Dr. Burns. I still remains a classic and can often be bought cheaply at a second hand store. The first copy written circa 1980 was probably better than later editions anyway. It's bright yellow, like sunshine. Go Figure!
Thursday, December 29, 2011
Tuesday, December 27, 2011
Chrysler 200
I like renting vehicles when I'm travelling, not just for the convenience of transportation, but because it allows me to truly test drive a vehicle I might one day wish to own. That was the case with my Harley Davidson , Electra Glyde. I rented it first in Boston then later in Texas. A year later I bought one at Trev Deely, Vancouver. I
was fortunate on this trip to visit my father in Ottawa to get a Chrysler 200 from Alamo car rental. All I specified was a small or mid sizer car easy to park with trunk room sufficient for a wheel chair and walker. They gave me the sleek Chrysler 200. 4 door, automatic, with roomy trunk, it was aerodynamically designed for gas mileage efficiency. A really pretty car. What struck me at first though was the visibility. Something about the shape and fit of the front windshield made for increased visibility. The console was elegant. At night there was just enough light up front and not too much. Everything was accessible and visible. Classy really. I liked the key fob for it's feature that the car could be started from inside. A must in winter weather with snow on the ground and flurries of snow in the air. It came with heated seats too. Easy to operate radio too. So just sitting in the car with my luggage in the trunk which would hold Dad's walker well, was a pleasure.
Driving was even better. I was seated low to the road and felt like I did in my old mustang. It was sporty. Great pick up and go. And most important superb breaking in slush and ice. I drove it for 5 days and loved it. So did my father and brother who rode with me. My brother, used to a Toyota or Volvo, liked it well enough driving it on an icy slushy sleet and snow morning when I thought his experience of Ottawa road conditions would be superior to mine. Dad appeciated my older brother driving knowing too well of my preference for speed and maneuverability. The Chrysler certainly was maneuverable. It parked superbly too.
So it was indeed with regret that I left it at Alamo in Ottawa to return to Vancouver. I'd certainly be glad to own one.
was fortunate on this trip to visit my father in Ottawa to get a Chrysler 200 from Alamo car rental. All I specified was a small or mid sizer car easy to park with trunk room sufficient for a wheel chair and walker. They gave me the sleek Chrysler 200. 4 door, automatic, with roomy trunk, it was aerodynamically designed for gas mileage efficiency. A really pretty car. What struck me at first though was the visibility. Something about the shape and fit of the front windshield made for increased visibility. The console was elegant. At night there was just enough light up front and not too much. Everything was accessible and visible. Classy really. I liked the key fob for it's feature that the car could be started from inside. A must in winter weather with snow on the ground and flurries of snow in the air. It came with heated seats too. Easy to operate radio too. So just sitting in the car with my luggage in the trunk which would hold Dad's walker well, was a pleasure.
Driving was even better. I was seated low to the road and felt like I did in my old mustang. It was sporty. Great pick up and go. And most important superb breaking in slush and ice. I drove it for 5 days and loved it. So did my father and brother who rode with me. My brother, used to a Toyota or Volvo, liked it well enough driving it on an icy slushy sleet and snow morning when I thought his experience of Ottawa road conditions would be superior to mine. Dad appeciated my older brother driving knowing too well of my preference for speed and maneuverability. The Chrysler certainly was maneuverable. It parked superbly too.
So it was indeed with regret that I left it at Alamo in Ottawa to return to Vancouver. I'd certainly be glad to own one.
Dad, 93, Christmas 2011
Dad developed a severe lung infection that required hospitalization and chest tubes late fall. He was even quarantined for a bit when they worried he might have TB. With the excellent medical and nursing care at the Queensway Carleton Hospital he revived and was able return to his assisted living home, Stonehaven Manor.
My brother and I were in close contact during this time. I even phoned his doctors and was reassured they were indeed the best, doing all I could hope for. When he was discharged he wasn't fully recovered by any means, improved from before, and stable, but suffering from inactivity of illness, stress and the loneliness of modern hospitals. Talking to him I was concerned.
Normally I'd fly out to visit after Christmas because with nephews, their friends and Adell's family he has a lot of stimulation already then. This year though, talking to him ,I was concerned he might well not rally and this might well be our last Christmas together. My brother and I decided a family Christmas everyone together would perhaps be best than our usual staggering of the winter visit.
Unfortunately we were told that Westjet wasn't allowing pets to travel, so Gilbert, my cockapoo, who Dad so loves, wouldn't be allowed to come. I was told all the the airlines had a Christmas policy excluding pets. As it turned out Westjet told me later they would have allowed me to take the little guy as carryon but they weren't allowing animals to travel down below.
Gilbert rallies Dad. His enthusiasm for life is infectious. Last year Gilbert jumped on his lap, licked his face and ears and the two of them wrestled. Dad always had dogs. We grew up with dogs. Now Gilbert would have to remain in Vancouver while I went off to Ottawa. Since I often depend on Gilbert to rally me I was disheartened.
Asked I would have Dad was 92 but he corrected me this trip telling me he was 93. "No wonder you fell old, " I told him. "I thought you were only 92." Ron told me he'd begun to get better in the week before I arrived. He'd lost 40 lbs recently but was beginning to eat again. He'd had such difficulty getting out of bed, walking with breathing difficulties, arthritis and problems remembering where he was going, all one could do was admire him.
One of the fellows who he eats breakfast with daily, told me, "Your dad is a tough one, after all he's gone through this fall." I could only agree. The man telling me this had just got out of hospital that week after a heart attack himself. I told him Prince Phillip just had a heart attack too so maybe he was now "related' to the Royals. He was French Canadian and replied, "I don't care for the Royals." Late 80's he was the youngest at Dad's breakfast table.
When I got to Stonehaven Manor, I was just glad to see Dad sitting up in the festively decorated lounge. He has macular degeneration and didn't recognise me. He usually calls me by my brother's name but even with cues this time he had difficulty identifying me as his son. Then he knew me. Then he beamed that I'd come to visit. I've friends who dutifully visit their parents who have long forgotten them in their disease and dying. I felt how they must feel and thanked God that Dad's mind was still intact. I felt so good to be recognised by my father.
My brother Ron is with him every week taking him on outings every day or so. Stonehaven Manor is an excellent place with lovely facilities, white table cloth dining, great food, variety, entertainment in the evenings, bus outings, near by restaurants and parks. Dad's loved being there these last 4 years making many friends some of who have passed away. He always hushes his voice when he mentions the deceased.
Ron and I've enjoyed the staff. Administrations have changed but mostly the wholesome family oriented flavour that first attracted Adell to this place has remained. When Mom died in Winnipeg Ron and Adell accepted it would be best for Dad to move to Ottawa. Ron was retired while I was still working more than full time and living on a sailboat. The nephews could visit Dad in Ottawa as well, and Adell whose done so much for him. I feel guilty at a distance and love the care my brother and sister in law extend to my Dad, our Dad. I make a point of calling every week or more, and flying out to visit each season. I should do more.
Ron and I got Dad out for lunch the next day. We got him out to a mall figuring the hustle and bustle of frenzied last minute Christmas consumer shopping world would do him good. He insisted we get Adell a present and he just happened to need a rest beside a jeweller. The lady said she thought Adell would enjoy the emerald necklace. Dad was so pleased. "She does so much for me and everybody else," he said.
Over the next few days we had him over to Ron's place for Christmas turkey dinner and Christmas present openings. After a delicious Christmas turkey dinner at Stonehaven and another at Ron and Adell's, Ron figured we had stopped his weight loss and maybe given back a couple of pounds of all he'd lost. I'd shot a deer this fall and had brought a venison roast figuring that would perk his appetite. Adell did the roast to perfection in the oven and sure enough Dad was delighted to have venison again. "I used to shoot a deer for food every year," he reminisced, telling me hunting stories I'd first heard in childhood. Dad then reminisced about Mom and trips they'd taken. Dad shared how he missed going to church this fall, his illness and the cold weather stopping him from attending the Anglican church down the way.
"I feel useless," he said. "I can't see anything, I can't do anything. I don't think I'm going to make it. " he told us. It was apparent that Dad's negativity with his brush with death this fall was wearing on my optimisitic brother. Ron's always been energetic, outgoing, a natural leader, and one who rallies people. Dad wasn't having any of it when we took him to the park for a walk. "I can't walk, " he said, "My legs are useless and I can't get my breath." We'd just walked him to Macdonalds and he'd done just fine, complaining all the way mind you.
"You don't think about all the bullets you've fire but concentrate on the ones you've still got in your gun," I said,
"You can still eat and sleep and be with your family." Encouraging Dad to look at the positive I remembered them doing the same for me after I'd lost games in sports. What goes around comes around.
"Yes, that's true," he responded. He seemed to like the answer. "Count your blessings," I said wondering how many times I'd heard my Baptist mother say that to me.
When we were younger Dad had been the heart of enthusiasm. He was forever planning adventures, taking us on cross country car trips, camping and boating, always excited about people and things. Now we had to be there for him. He started out farming and logging with his father before joining the RCAF for WWII. After the war he worked as a millwright before completing his engineering. Working for Mathews Conveyours he was in charge of projects supervising a hundred and fifty men at a time. Those men he worked with I knew, told me, my father was a good man. It was years later I learned that 'good men' weren't that easy to come by, especially in those you had to work for. In his spare time, which he didn't have much of, he loved working on boats, cars, trucks and machines, He had the best of friends. An avid fisherman and hunter, he loved the outdoors. Most of all he loved mom and he loved his family.
Now ,h
e's afraid of falling down. Sat down on the floor when I was with him mistaking the space between the table and couch as a chair. I tried to catch him but all I could do was help him get up. Ill health can be depressing. He's lost weight and had lost his appetite but that's to be suspected with elderly people after major hospitalizations. Ron, with the years of training as a parent of three boys , him a hamburger at Macdonald's even when he said he wasn't hungry. He ate it all and said, "that was pretty good." I can see it's hard on Ron, parenting his parent.
Adell's cooking also got through to him and he even had the hot cherry pie with ice cream he'd insisted he couldn't eat. I loved my brother and his family seeing how much love they give Dad. He wouldn't be alive today were it not for Ron and their love.
When it came time to leave I told Dad that I'd be back in the spring with Gilbert. "I miss that little rascal," he said. I know, I thought, and wished I'd had him with me to spark Dad even more. But with his nephews and Adell fawning over him over the holidays and Ron and me prodding him to participate he really had rallied, nonetheless.
He had pedal edema and shortness of breath in the evening with some delirium as well. Watching him carefully I know the staff probably put that down to dementia. It's hard to sort these things out but I was glad to talk with the nurse and ask her to mention this to the doctor. I told her how I was really impressed but thought he might benefit from some medicine " tweaking" so he'd be less confused and disoriented in the evening. She'll mention it to the visitting doctor. He'll do what is right with the observations I've made. Being a physician I certainly didn't want to tell him what to do. But blood work is usually done in the morning and potassium abnormalities might show up in the night. He's on some potent meds that certainly can cause electrolyte imbalance and the geriatric patients are like babies when it comes to mental process and electrolyte balance. Even a fever can thrown them into another dimension. Really pleasant caring staff make all the difference..
But like all staff in medicine these days, over worked ,over stretched and caring for a lot more fragile or complicated and older population than days gone by. I never see the 'harried' looks I see in health care in general beurocratic offices so just feel that in addition to the constant proximity to diseasea and death the staff are working with restrictions and shortages that others can't imagine.
"I"ll be back in the spring with Gilbert," I told Dad hugging his frail body. It was the best Christmas I've known since Mom passed over.
. 
My brother and I were in close contact during this time. I even phoned his doctors and was reassured they were indeed the best, doing all I could hope for. When he was discharged he wasn't fully recovered by any means, improved from before, and stable, but suffering from inactivity of illness, stress and the loneliness of modern hospitals. Talking to him I was concerned.
Normally I'd fly out to visit after Christmas because with nephews, their friends and Adell's family he has a lot of stimulation already then. This year though, talking to him ,I was concerned he might well not rally and this might well be our last Christmas together. My brother and I decided a family Christmas everyone together would perhaps be best than our usual staggering of the winter visit.
Unfortunately we were told that Westjet wasn't allowing pets to travel, so Gilbert, my cockapoo, who Dad so loves, wouldn't be allowed to come. I was told all the the airlines had a Christmas policy excluding pets. As it turned out Westjet told me later they would have allowed me to take the little guy as carryon but they weren't allowing animals to travel down below.
Gilbert rallies Dad. His enthusiasm for life is infectious. Last year Gilbert jumped on his lap, licked his face and ears and the two of them wrestled. Dad always had dogs. We grew up with dogs. Now Gilbert would have to remain in Vancouver while I went off to Ottawa. Since I often depend on Gilbert to rally me I was disheartened.
Asked I would have Dad was 92 but he corrected me this trip telling me he was 93. "No wonder you fell old, " I told him. "I thought you were only 92." Ron told me he'd begun to get better in the week before I arrived. He'd lost 40 lbs recently but was beginning to eat again. He'd had such difficulty getting out of bed, walking with breathing difficulties, arthritis and problems remembering where he was going, all one could do was admire him.
One of the fellows who he eats breakfast with daily, told me, "Your dad is a tough one, after all he's gone through this fall." I could only agree. The man telling me this had just got out of hospital that week after a heart attack himself. I told him Prince Phillip just had a heart attack too so maybe he was now "related' to the Royals. He was French Canadian and replied, "I don't care for the Royals." Late 80's he was the youngest at Dad's breakfast table.
When I got to Stonehaven Manor, I was just glad to see Dad sitting up in the festively decorated lounge. He has macular degeneration and didn't recognise me. He usually calls me by my brother's name but even with cues this time he had difficulty identifying me as his son. Then he knew me. Then he beamed that I'd come to visit. I've friends who dutifully visit their parents who have long forgotten them in their disease and dying. I felt how they must feel and thanked God that Dad's mind was still intact. I felt so good to be recognised by my father.
My brother Ron is with him every week taking him on outings every day or so. Stonehaven Manor is an excellent place with lovely facilities, white table cloth dining, great food, variety, entertainment in the evenings, bus outings, near by restaurants and parks. Dad's loved being there these last 4 years making many friends some of who have passed away. He always hushes his voice when he mentions the deceased.
Ron and I've enjoyed the staff. Administrations have changed but mostly the wholesome family oriented flavour that first attracted Adell to this place has remained. When Mom died in Winnipeg Ron and Adell accepted it would be best for Dad to move to Ottawa. Ron was retired while I was still working more than full time and living on a sailboat. The nephews could visit Dad in Ottawa as well, and Adell whose done so much for him. I feel guilty at a distance and love the care my brother and sister in law extend to my Dad, our Dad. I make a point of calling every week or more, and flying out to visit each season. I should do more.
Ron and I got Dad out for lunch the next day. We got him out to a mall figuring the hustle and bustle of frenzied last minute Christmas consumer shopping world would do him good. He insisted we get Adell a present and he just happened to need a rest beside a jeweller. The lady said she thought Adell would enjoy the emerald necklace. Dad was so pleased. "She does so much for me and everybody else," he said.
Over the next few days we had him over to Ron's place for Christmas turkey dinner and Christmas present openings. After a delicious Christmas turkey dinner at Stonehaven and another at Ron and Adell's, Ron figured we had stopped his weight loss and maybe given back a couple of pounds of all he'd lost. I'd shot a deer this fall and had brought a venison roast figuring that would perk his appetite. Adell did the roast to perfection in the oven and sure enough Dad was delighted to have venison again. "I used to shoot a deer for food every year," he reminisced, telling me hunting stories I'd first heard in childhood. Dad then reminisced about Mom and trips they'd taken. Dad shared how he missed going to church this fall, his illness and the cold weather stopping him from attending the Anglican church down the way.
"I feel useless," he said. "I can't see anything, I can't do anything. I don't think I'm going to make it. " he told us. It was apparent that Dad's negativity with his brush with death this fall was wearing on my optimisitic brother. Ron's always been energetic, outgoing, a natural leader, and one who rallies people. Dad wasn't having any of it when we took him to the park for a walk. "I can't walk, " he said, "My legs are useless and I can't get my breath." We'd just walked him to Macdonalds and he'd done just fine, complaining all the way mind you.
"You don't think about all the bullets you've fire but concentrate on the ones you've still got in your gun," I said,
"You can still eat and sleep and be with your family." Encouraging Dad to look at the positive I remembered them doing the same for me after I'd lost games in sports. What goes around comes around.
"Yes, that's true," he responded. He seemed to like the answer. "Count your blessings," I said wondering how many times I'd heard my Baptist mother say that to me.
When we were younger Dad had been the heart of enthusiasm. He was forever planning adventures, taking us on cross country car trips, camping and boating, always excited about people and things. Now we had to be there for him. He started out farming and logging with his father before joining the RCAF for WWII. After the war he worked as a millwright before completing his engineering. Working for Mathews Conveyours he was in charge of projects supervising a hundred and fifty men at a time. Those men he worked with I knew, told me, my father was a good man. It was years later I learned that 'good men' weren't that easy to come by, especially in those you had to work for. In his spare time, which he didn't have much of, he loved working on boats, cars, trucks and machines, He had the best of friends. An avid fisherman and hunter, he loved the outdoors. Most of all he loved mom and he loved his family.
Now ,h
e's afraid of falling down. Sat down on the floor when I was with him mistaking the space between the table and couch as a chair. I tried to catch him but all I could do was help him get up. Ill health can be depressing. He's lost weight and had lost his appetite but that's to be suspected with elderly people after major hospitalizations. Ron, with the years of training as a parent of three boys , him a hamburger at Macdonald's even when he said he wasn't hungry. He ate it all and said, "that was pretty good." I can see it's hard on Ron, parenting his parent.
Adell's cooking also got through to him and he even had the hot cherry pie with ice cream he'd insisted he couldn't eat. I loved my brother and his family seeing how much love they give Dad. He wouldn't be alive today were it not for Ron and their love.When it came time to leave I told Dad that I'd be back in the spring with Gilbert. "I miss that little rascal," he said. I know, I thought, and wished I'd had him with me to spark Dad even more. But with his nephews and Adell fawning over him over the holidays and Ron and me prodding him to participate he really had rallied, nonetheless.
He had pedal edema and shortness of breath in the evening with some delirium as well. Watching him carefully I know the staff probably put that down to dementia. It's hard to sort these things out but I was glad to talk with the nurse and ask her to mention this to the doctor. I told her how I was really impressed but thought he might benefit from some medicine " tweaking" so he'd be less confused and disoriented in the evening. She'll mention it to the visitting doctor. He'll do what is right with the observations I've made. Being a physician I certainly didn't want to tell him what to do. But blood work is usually done in the morning and potassium abnormalities might show up in the night. He's on some potent meds that certainly can cause electrolyte imbalance and the geriatric patients are like babies when it comes to mental process and electrolyte balance. Even a fever can thrown them into another dimension. Really pleasant caring staff make all the difference..
But like all staff in medicine these days, over worked ,over stretched and caring for a lot more fragile or complicated and older population than days gone by. I never see the 'harried' looks I see in health care in general beurocratic offices so just feel that in addition to the constant proximity to diseasea and death the staff are working with restrictions and shortages that others can't imagine.
"I"ll be back in the spring with Gilbert," I told Dad hugging his frail body. It was the best Christmas I've known since Mom passed over.
.
Thursday, December 22, 2011
Nuba Restaurant, Vancouver
Aim, who works part time as my assistant when she's not teaching university or writing international columns on world affairs, picked Nuba for our Christmas office party.
8 people were there. Great company. Beautiful intelligent women and handsome non belligerent men.
Nuba on Hastings at Cambie was packed. It was Wednesday night and everyone seemed in that 25 to 45 affluent with it set. A few older guys like me were dotted about here and there but definitely not a grey carpet shiny dome place by any means. Alot of conversation but none of that 'loud' crowd. Very New York, Parisian eatery atmosphere. Surprisingly fluid.
The hostess was helpful and the waitress was a delight. Lots of suggestions. Interesting and novel drinks and food. By group consensus we went with the group platter with individual items. A wide range of exotically prepared Lebanese delights, mostly vegan, were to be shared , with wedges of bread for convenient nibble and bite or toff amounts. In addition everyone got to choose a personal kabob or something similar. I had a delicious lamb kabob while I noticed others had chicken and shrimp.. The Lebanese are known for their sea food but lamb is what I like best. If I say so myself, a very good choice.
But the communal platter with hummus spreads, and greens and just a whole boodle of tasty bits, more than enough for everyone, was the most fun. Everyone was sampling and comparing. Aim commented on the cultural aspects of food at one point with her and Joanne discussing how in Asian culture the discussion of food in general while eating food in particular was so much part of the process. Mark who had travelled the world over shared insights into food by comparison and actually had pictures in his iphone of recent dishes he'd enjoyed on his latest international flights.
Everyone was sharing stories as well. The laughter was infectious. After something Chris or Phil said we were all laughing and I wondered if we were being 'loud'. Laura or Elizabeth was telling a story when I realized every other table was bursting out with intermittent laughter too.. Some of it was the Christmas Season for sure but I really did think something about the decor, the staff, the way the tables were dispersed and the food just brought out the best in people.
Eventually we all seemed to slow down then stopped eating Even the occasional picking came to an end as we all sat happily sated.. The waitress appeared, asked if we wanted more, we were fine, the bill appeared and was extremely reasonable, not at all a burden by any means, given the luxury of the repast.
Then we were collectively mobilizing and saying fair wells and holiday well wishes outside across from the Victory Memorial Park on Hastings.
I really can't remember a group dining experience I more enjoyed in recent years. I've never had such an enjoyable work and staff outing, by any means.
Nuba seemed just perfect for a group function though I imagine all those couples who were interspersed among the larger tables might well go away ad say it was just right for them as well.
8 people were there. Great company. Beautiful intelligent women and handsome non belligerent men.
Nuba on Hastings at Cambie was packed. It was Wednesday night and everyone seemed in that 25 to 45 affluent with it set. A few older guys like me were dotted about here and there but definitely not a grey carpet shiny dome place by any means. Alot of conversation but none of that 'loud' crowd. Very New York, Parisian eatery atmosphere. Surprisingly fluid.
The hostess was helpful and the waitress was a delight. Lots of suggestions. Interesting and novel drinks and food. By group consensus we went with the group platter with individual items. A wide range of exotically prepared Lebanese delights, mostly vegan, were to be shared , with wedges of bread for convenient nibble and bite or toff amounts. In addition everyone got to choose a personal kabob or something similar. I had a delicious lamb kabob while I noticed others had chicken and shrimp.. The Lebanese are known for their sea food but lamb is what I like best. If I say so myself, a very good choice.
But the communal platter with hummus spreads, and greens and just a whole boodle of tasty bits, more than enough for everyone, was the most fun. Everyone was sampling and comparing. Aim commented on the cultural aspects of food at one point with her and Joanne discussing how in Asian culture the discussion of food in general while eating food in particular was so much part of the process. Mark who had travelled the world over shared insights into food by comparison and actually had pictures in his iphone of recent dishes he'd enjoyed on his latest international flights.
Everyone was sharing stories as well. The laughter was infectious. After something Chris or Phil said we were all laughing and I wondered if we were being 'loud'. Laura or Elizabeth was telling a story when I realized every other table was bursting out with intermittent laughter too.. Some of it was the Christmas Season for sure but I really did think something about the decor, the staff, the way the tables were dispersed and the food just brought out the best in people.
Eventually we all seemed to slow down then stopped eating Even the occasional picking came to an end as we all sat happily sated.. The waitress appeared, asked if we wanted more, we were fine, the bill appeared and was extremely reasonable, not at all a burden by any means, given the luxury of the repast.
Then we were collectively mobilizing and saying fair wells and holiday well wishes outside across from the Victory Memorial Park on Hastings.
I really can't remember a group dining experience I more enjoyed in recent years. I've never had such an enjoyable work and staff outing, by any means.
Nuba seemed just perfect for a group function though I imagine all those couples who were interspersed among the larger tables might well go away ad say it was just right for them as well.
Sunday, December 18, 2011
Waldorf Hotel, Vancouver - Brunch
It was only a week or two back when I posted pictures of Laura and I enjoying brunch on facebook. We bemoaned that the place we'd gone after church was closing. Laura's friend , Tracy, came back, 'the best Mexican breakfast is at the Waldorf' . We rememberd the Waldorf as a bar. "She and her husband have been all over the world. I'm pretty sure they would know a good breakfast place when they found one."
So it was the Tikki Room at the Waldorf for Laura and I today after church. Gilbert protected the car. Sure enough the atmosphere was fantastic. The waitresses were delightful. Great energy. And the Rancho Huervos were out of this world. Best I've had in Canada. I even ordered them in Spanish thanks to my Simon Frazer spanish class. We loved it. The coffee was perfect too.
They won't have brunch again until the first week of January. Feliz Navidad.
It was fun. Thank you, Tracy!
So it was the Tikki Room at the Waldorf for Laura and I today after church. Gilbert protected the car. Sure enough the atmosphere was fantastic. The waitresses were delightful. Great energy. And the Rancho Huervos were out of this world. Best I've had in Canada. I even ordered them in Spanish thanks to my Simon Frazer spanish class. We loved it. The coffee was perfect too.
They won't have brunch again until the first week of January. Feliz Navidad.
It was fun. Thank you, Tracy!
Christmas Presence - Pacific Theatre-Dec182011
http://www.pacifictheatre.com
It was good to be at Christmas Presence again. I've gone annually many years and never been disappointed. The musicians volunteer. There are actors and actresses, skits, readings and poems. It's about Advent and the Coming of the King. Christmas. Mary and the Manger. Jesus the Baby. Wisemen. All the Christmas Story told in emotions more than words. Songs of love and celebration. Witty tales of homespun lore. Stories told of contrasts between Christmas and consumerism. Tonight there was even the hilarity of Santa seen through the eyes of Mulder and Skully. If you visit the site you can see all who were there, keyboards, double drums, banjo, stand up bass, guitars. Sheree Plett, Peter La Grand, Jeremy Eisenhower, Nelson Boschnan Trio. Colin Stewart. Dwayne Harder. I bought those CD's on the table after the show so suspect these were among those playing. I don't know if they all were there. Everyone who came to play, to act, to perform arrived this evening and the consumate professionalism was amazing. Touched by grace no doubt. Thanks to all who played and came. Each year's a celebration of the mystery. A full house
It was good to be at Christmas Presence again. I've gone annually many years and never been disappointed. The musicians volunteer. There are actors and actresses, skits, readings and poems. It's about Advent and the Coming of the King. Christmas. Mary and the Manger. Jesus the Baby. Wisemen. All the Christmas Story told in emotions more than words. Songs of love and celebration. Witty tales of homespun lore. Stories told of contrasts between Christmas and consumerism. Tonight there was even the hilarity of Santa seen through the eyes of Mulder and Skully. If you visit the site you can see all who were there, keyboards, double drums, banjo, stand up bass, guitars. Sheree Plett, Peter La Grand, Jeremy Eisenhower, Nelson Boschnan Trio. Colin Stewart. Dwayne Harder. I bought those CD's on the table after the show so suspect these were among those playing. I don't know if they all were there. Everyone who came to play, to act, to perform arrived this evening and the consumate professionalism was amazing. Touched by grace no doubt. Thanks to all who played and came. Each year's a celebration of the mystery. A full house
St. James Anglican Church, Vancouver, Dec. 18, 2011 - 4th Advent Sunday
"You know we'd be able to make it to church on time if we skipped our morning baths and showers," I told her.
"I'm not going to do that. I feel awful when I'm not clean." she replied.
"But we're already washed," I reminded her. Referring to our baptisms, of course. That which differentiated us from the 'unwashed".
"I'm still not going to church dirty," she answered
"What's the use of confession then" I said. She's the kind of girl who cleans up before the cleaning lady comes whereas I'm more likely to throw a bachelor party the night before the cleaners are due.
We both were happty to arrive in time for the sermon by Father Mark Greenaway-Robbins. With my Baptist background, church is all about the sermon. That and the gospel singing and bible readings, of course. Father Mark though doesn't beat us up with descriptions of hellfire and damnation so I'm never really sure I've heard a sermon. Growing up in an evangelical Baptist congregation I remember well the minister frothing at the mouth and painting glorious pictures of hell in such detail my father wondered if he knew more of that place than the destination where we were supposed to be heading.
Father Mark's sermons are mostly inspiring, informative and transcendent. He's even amusing at times. My friend, Laura likes his sermons immensely but given her Catholic background, she's only there for the wafer, if the truth be told. Just give a Catholic the body of Christ and they'd be happy. If ever the Catholics and Jehovah Witnesses got together they'd have drive through wafer's for sure to serve the need of busy Christians belonging to the 'wealth and health' evangelical factions.
St. James is afar more traditional Anglo Catholic. Father Mark's sermon touched on trust in God wisdom and love. Father Mark actually talked about the 'communion of saints' from the creed and prayer to Mary. Quite revolutionary thoughts for protestants but well in the mainstream of the mystical meditation revival in today's church. Televangelists can go on and on about prayer such that Christians decades back had to go to India to learn about meditation. Today the 'relationship with God' is central to the spiritual journney of Christians. We gather together in church to share peace. Yet our real spiritual journeys are in the work weeks between these oasis of gathering in the desert of modern materialist consumer society.
Christmas is a time of celebration. Advent tells us that Jesus is coming. Hallelujah.
After the service we joined dozens of other parishioners for coffee, tea and cake, the after church fellowship tradition. Laura borrowed a St. Thomas a Kempis book from the library and I kept Gilbert in chec. He was so excited to meet Bear and Dido, a couple of other church going dogs, that I was terrifed he'd want to express himself in piss elation. While Laura conversed with Elizabeth, Phil and I waxed poetic about world affairs and spiritual matters. Out of nowhere Karen appeared with Mathias and there were hugs all round. Mathias is walking now but Laura and I remember his baptism when he wasn't much bigger than a flesh formed idea.
Father Mark had in church today welcomed a 9 day old baby bringing the family to the front where we applauded them all for being there together so soon after such a monumentous occasion. The choir sang Emmanuel with especially fine voices.
And later Laura and I walked back to the car with Gilbert , all of us feeling just a little bit
closer.
"I'm not going to do that. I feel awful when I'm not clean." she replied.
"But we're already washed," I reminded her. Referring to our baptisms, of course. That which differentiated us from the 'unwashed".
"I'm still not going to church dirty," she answered
"What's the use of confession then" I said. She's the kind of girl who cleans up before the cleaning lady comes whereas I'm more likely to throw a bachelor party the night before the cleaners are due.
We both were happty to arrive in time for the sermon by Father Mark Greenaway-Robbins. With my Baptist background, church is all about the sermon. That and the gospel singing and bible readings, of course. Father Mark though doesn't beat us up with descriptions of hellfire and damnation so I'm never really sure I've heard a sermon. Growing up in an evangelical Baptist congregation I remember well the minister frothing at the mouth and painting glorious pictures of hell in such detail my father wondered if he knew more of that place than the destination where we were supposed to be heading.
Father Mark's sermons are mostly inspiring, informative and transcendent. He's even amusing at times. My friend, Laura likes his sermons immensely but given her Catholic background, she's only there for the wafer, if the truth be told. Just give a Catholic the body of Christ and they'd be happy. If ever the Catholics and Jehovah Witnesses got together they'd have drive through wafer's for sure to serve the need of busy Christians belonging to the 'wealth and health' evangelical factions.
St. James is afar more traditional Anglo Catholic. Father Mark's sermon touched on trust in God wisdom and love. Father Mark actually talked about the 'communion of saints' from the creed and prayer to Mary. Quite revolutionary thoughts for protestants but well in the mainstream of the mystical meditation revival in today's church. Televangelists can go on and on about prayer such that Christians decades back had to go to India to learn about meditation. Today the 'relationship with God' is central to the spiritual journney of Christians. We gather together in church to share peace. Yet our real spiritual journeys are in the work weeks between these oasis of gathering in the desert of modern materialist consumer society.
Christmas is a time of celebration. Advent tells us that Jesus is coming. Hallelujah.
After the service we joined dozens of other parishioners for coffee, tea and cake, the after church fellowship tradition. Laura borrowed a St. Thomas a Kempis book from the library and I kept Gilbert in chec. He was so excited to meet Bear and Dido, a couple of other church going dogs, that I was terrifed he'd want to express himself in piss elation. While Laura conversed with Elizabeth, Phil and I waxed poetic about world affairs and spiritual matters. Out of nowhere Karen appeared with Mathias and there were hugs all round. Mathias is walking now but Laura and I remember his baptism when he wasn't much bigger than a flesh formed idea.
Father Mark had in church today welcomed a 9 day old baby bringing the family to the front where we applauded them all for being there together so soon after such a monumentous occasion. The choir sang Emmanuel with especially fine voices.
And later Laura and I walked back to the car with Gilbert , all of us feeling just a little bit
closer.
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