IDAA 2017 Snowbird UTAH - CME - Crucial Conversations with your patient: pain and cannabis - Dr. Mark Weiner

I really enjoyed Dr. Mark Weiner’s  presentation because it clearly delineated “cannabinoid research and treatment’ from the whole area of “medical marijuana”.  Marijuana is a 100 compounds in one with a wide diversity of response and much marketing these days of the ‘anecdotal evidence’ without consideration of the overall  science.   I’ve been prescribing for some years ‘medical marijuana’ and pharmaceutical “nabilone”  and the excellent ‘SATIVEX ”(Bayer)  buccal spray with considerable discrimination and concern.  It’s never a first line choice.  I have seen a lot more negative results than positives. Admittedly the occasional positive result is, like any success, a joy.
There is however a religious devotion especially among  the heavily addicted devotees to the ‘herbal’ treatments with a whole lot of religious claims of “panacea”.  There is  little consideration of cannabinoids as just another ‘medication’ to doctors like myself.
I’ve seen people respond to marijuana like I have to other treatments but it’s not a panacea.  There are also serious side effects.   It certainly was widely available and passed over in favour of the most successful modern treatments that have been associated with cures of epidemics, increased longevity and amazing cures of once deadly diseases.
I was commonly recommending marijuana for my patients with HIV and Aids when they developed anorexia. It was an excellent ‘adjunctive treatment’ but it wasn’t curative. Today being diagnosed with HIV is similar to being diagnosed with Diabetes. The life expectancy is shortened by perhaps 10 years.  When I first worked with HIV it was a deadly disease with few survivals and large death toll despite the ubiquity of marijuana.  Today the pharmaceutical companies and medical researchers have produced retrovirus medications in combinations that have caused the extraordinary successes in treatment of new cases. The latest of these treatments, Truvada, is truly a god send but I know some of the nutbars in the ‘medical marijuana cult’ would tell people not to take it because it is produced by their ‘devil god’ "Big Pharma”.  I can honestly say as a simple clinician it’s increasingly difficult to do my job with all the argumentative stoners with their overnight Google MD’s.  Now that Big Tobacco is backing Big Marijuana with Big Smoke Money at the public health level we know whatever tax benefits we see for politicians will be off loaded in increased suffering for patients and health care costs.
I have a head injury patient whose response to marijuana was truly remarkable. I had tried a wide variety of medications for his various symptoms before the trial of marijuana which had a profoundly beneficial response. Unfortunately clinically the majority of my head injured patients have been made worse by marijuana as it disrupts mood stability and motivation and interferes with memory and learning in these other cases.  I read the heavily funded marketing literature on marijuana and it reminds me of when Cocaine was said to be a ‘cure-all’ without addiction. Then Belushi died.
As a clinician, typical of my colleagues. I don’t care what works. I just want to see my patients get better and we welcome treatments. The paranoia associated with the ‘us and them’ crowds of ‘health food’ ‘pusher’s’ is difficult to tolerate.  Today’s marijauania is 30% THC compared to the 3 % THC of the highest grade marijuana of my college days. The dangers to developing brains of this high dosage compound and the longevity issue of using a potentially toxic substance over long periods is worth consideration.
I enjoyed Dr. Mark Weiner’s discussion  of  the effects of cannabinoids on the heart especially in elderly patients causing me to be better equipped to discuss the pros and cons of medical marijuana in the increasing numbers of retired patients who ask me about it’s use in various chronic diseases.
Some patients commonly in clinical practice try to pidgeon hole the doctor into an “either you are for or against marijuana’ categorizatio.  As a psychiatrist I’m well aware of this   ‘black and white thinking” and profiling  so common in paranoid disorders and drug abuse.”  I enjoyed how Dr. Mark Weiner side stepped this issue simply by presenting the clinical evidence. This is what we know. This is what we can say about the cost/benefit of this treatment for individuals.. It’s really no different than what we say when a person wants cosmetic surgery or some other medical treatment which isn’t ‘first line’ and might even be classified as ‘experimental’.  He was clear in presenting the ‘evidence’ and maintaining his comments in this realm. It was refreshing. I learned from his example.
(I reflected that a patient had told me that my dog who had his eye removed recently for glaucoma could have been saved with the cannabinoid oil this patient promotes.  Its been shown to be of some benefit in human glaucoma.  So feeling guilty that my dog had lost his sight in one eye I was willing to consider anything to help him keep his sight in the other eye.  His veterinarian ophthalmologist, Dr. King, hadn’t recommended cannabinoid but another medication which has been working very well in keeping the pressure down in his remaining eye.  I reviewed the veterinary research literature that evening and found that in fact marijuana had been researched and was contraindicated in dogs. Veterinary medicine is fascinating because a drug that can save a cat’s life can kill a dog.  They’ve been researching cannabinoids just as we have.  My patient is a religious nut about marijuana.   I definitely have prayed for my dog’s eyesight.  I have trusted  Dr. King whose treatment is working just fine.  I had a delightful dinner with Dr. Larry Cooper a San Diego Opthalmologist who was kind enough to share some stories of his successful surgical and medical cures of eye disease, being especially thankful for the gifts of modern medicine which have resulted in him being able to save a person’s sight or life.  I really don’t think he as a compassionate clinician would withhold any treatment but I expect that if I smoked a joint I could even imagine this wonderful mensch of a doctor could indeed be an evil operative of Big Pharma and Big Surgery. )
I enjoyed the lecture because it dealt with the science of today. Dr. Mark Weiner is simply one of the leading authorities and yet also broad minded. He does emphasize what the research says about cannabinoids and questions what is in a marijuana plant in general.  He’s a scientist and not a snake oil proponent. It was an interesting lecture from this perspective.  What we know. What we don’t know. What research says. What research doesn’t say.  I enjoyed that.  Great ideas.  I will make a point to follow him in future and consider adjusting my practice to take account of the insights that he provided.
 This is not a reflection of the overall lecture which was much more extensive. I’ve just selected certain slides and some ideas that were of interest to me. I wouldn’t want anyone to see this writing in any other light than this. I certainly will be attending more of his lectures if I can and would strongly recommend him as a presenter, communicator and scholar.

IDAA 2017 Snow Bird, UTAH - CME - Science of Recovery - Dr. Ray Baker

Dr. Ray Baker provided insights into the latest research into Recovery.  A lot of research had gone into addiction but this is the beginning of the study of the health after addiction. The research documents the success of recovery. Epidemiological research showed the percent of population serious problems and its significance. The research into what had worked for individuals to achieve recovery showed a variety of tools had been used. The importance of the treatment centres was highlighted as was the value of the 12 step programs.  Dr. Baker went on to discuss the importance of Recovery Capital especially as this related to response to treatment and prevention of relapse.
Even though I’m an addiction psychiatrist working in the field I am amazed at the cutting edge work that Dr. Baker highlights in his presentations. He’s known as a great clinician but his academic credentials, presentation skills and research are often not as well known. This is possibly because if you talk to him personally he’ll be more likely to talk about his family, or his increasing love of running.  I thoroughly enjoyed the presentation and have only poorly given a taste of it with a very few of the slides he used. I trust this will encourage others to catch a future presentation of Dr. Baker’s, watch for his coming book, and follow up on the references he has provided in the area of the Science of Recovery.
I’d personally been interested enough in the commonly misquoted Cochrane study which suggested 12 step programs weren’t beneficial to seek out the chief addiction medicine researchers for those Cochrane Studies at the ISAM presentation in Malaysia.
“We said it couldn’t be studied as a addiction ’treatment ‘ because it wasn’t simply a " treatment." It’s always misquoted.  We ourselves  recommend 12 step programs clinically.”  I remembered that conversation because the chief Cochrane researcher lamented that there wasn’t research to date to support the obvious evidence of the success of 12 step programs especially with regard to long term recovery.  I enjoyed that Dr. Baker had shown that studying Recovery as opposed to  Addiction Treatment supported what we all saw clinically.  Further by looking at the idea of Recovery Capital conceptually there was increasing opportunity to standardize and research aspects which we all know clinically are most relevant to treatment success.  I often have to point out that the Cochrane Studies were originally developed solely for the purpose of comparing one medication treatment to another  and as a tool are best when  limited to this narrow focus. Unfortunately, it’s easiest to show with a short weekly to months  pharmacological trial the benefit of one limited treatment compared with another.  Recovery by contrast is a concept of life change that shows increasingly over years. The cost of research selects in favour of an acute intervention but not so much for chronic conditions as addiction is.  Dr. Baker raised these issues and proposed solutions some of which included paradigmatic shifts in thinking about treatment.  I loved his use of lay persons as recovery coaches and recovery monitors to help get patients to meetings or to doctors appointments and follow up.
All round for me a highlight of the CME presentations this year. I see myself taking some of these ideas back to my clinical practice and changing the questions and recording I do in my continuing care of patients.

IDAA 2017 Snow Bird UTAH - CME - Trauma of the Monitoring Program, Dr. Penny Ziegler

I love Dr. Penny’s lectures. I think of her as the Joni Mitchell of the lecture circuit. Her insights are as deep as  Sarah McLaughlin lyrics. Her experience is as broad as Carole King. I always hear that huge heart of hers as she speaks , her compassion for patients so readily apparent.  She is the therapist who speaks the language of the heart.   I really want to be like her whenever I leave I a lecture of hers. It’s like watching a scene beside some guy named Monet only to find that when you’re asked to draw that scene later , you’ve got stick figures in black and white and that Monet guy  has this wondrous picture of colour and form.
This lecture was no different.  It was also cat lady funny, not in a "laughing at" but a "laughing with” way.   We all deal with difficult people. We survive them. We love them. We want so much to make things work for them. We see them doing things that must have worked at some time in their lives but have long worn out their usefulness.  Dr. Penny helps professionals having difficulties in the workplace.  She described “all the usual suspects”.
The licensing board is a legal entity established to protect the patients and at the same time manage the business and law of health care professions.  Dr. Penny worked with the professional assistance program providing therapy and monitoring and helping the individuals over the hurdles and trying if possible to restore them to their workplace.
She presented a number of case studies which she’d clearly made confidential but maintained the conflicts and dynamics. Some of us recognized ourselves in the scenarios. I identified with them all.  There’s a quality in coping strategies that they are valuable but it’s the subtle or not so subtle differences like assertiveness and aggressiveness. Not only could we as professionals see ourselves in the cases but we could see our colleagues and some of our patients.  What was clear in Penny’s presentation was that she never lost sight of the humanity and struggling child and the fear that occasioned the behaviours.
It was a marvellous lecture. I love cats. I know how they behave when they’re afraid. It’s a worthwhile lesson to remember for my own practice and to remember with my own behaviour.   For the academic and therapist in me it was like getting to hear another performance of Stevie Nicks. I’m forever thankful that there are psychiatrists like Penny who remind me to the core of the compassion that drew me to this field.  There was  spirituality and  mystery.  There was also the  reminder to us all that individually when we think of ourselves as one T.S. Elliots’ CATS, we may well be coming across as one of Dr. Penny Ziegler's Cats. Callico Cats! Callico Cats!
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IDAA 2017, Snow Bird Utah, 5 K Fun Run/Walk

I completed the IDAA 2017 Snow Bird Utah, 5 K Fun Run/Walk in 45 minutes.
I live at the sea level. The altitude is 8100 feet here.  I didn’t sleep well the first night here. I had dreams of an embarrassing death on the Sun Run, an obituary that read, “Bill had long been known to suffer from sloth and gluttony.” When I shared that I’d had a restless night, others said it was the altitude. They obviously aren’t haunted by the ghost of Sigmund Freud.
A whole lot of enthusiastic volunteers  make it all possible.  I expect the emergency doctors, cardiologists and respirologists doubled up along the route hearing that I was participating. At least I hoped so.  
I took a picture of my friends John and Ray before the race.  John had completed an Iron Man and Ray who was competing this year in Kamloops for the Canadian championship team.  They were discussing weekly running routines of 15 to 20 hours, obviously threatened by my pear shaped, flabby muscled  presence.   I do Netflix marathons on the couch with hagen daz ice cream longer than that.
This year I did put some thought into strategy. I hadn't factored in the hills when I signed up last year for the run.  I'm more of a flat walker than anything else.  In previous years my strategy had only been to run  when a young volunteer could see me.  I walked the rest of the way.  This  required a lot of tiring hyper vigilance on my part.
My strategy this year was simpler.   I attribute it to my survival. Even now I'm waiting for CNN Sports interviewers to call me up to discuss it.
"Run down hill."  Walk up hill.!"  "Run downhill. Walk up hill!"  As I was doing just that,  I was saying it like a  mantra to avoid any craziness.
Ray and John and others finished the race a half hour or so before me but I don’t think any others considered making out a will before the race.  When I crossed that finish line I saw heavenly paparazzi snapping my picture.
 I really am thankful for the Sun Run organizers and volunteers.   I'm also thankful to Bobbie, Carole  and Cheryl who got me to come along on my first IDAA Fun Run all those years ago.  

Five Fundamentals of Civility for Physicians, Dr. Michael Kaufman, IDAA 2017 Snow Bird Utah

Dr. Michael Kaufman is a fine,  kind, caring, learned, gentleman and physician.  His presentation on the Five Fundamentals of Civility for Physicians was especially superb.  He began it with a clip from Dr. House which though hilarious had at least half of us physicians cringing.  It was a priceless performance by Dr. House who indeed presented at times the best and worst of medicine.  I have selected some slides that appealed especially to me. They in no way represent the overall presentation but give some idea of the breadth and depth of the CME.
 Dr. Kaufman is a leading expert and communicator in this field as well as humorous in his presentation.  I found myself thinking nostalgically of suburbs and childhood and safety, a world far away because frankly, myself and others have become to uncivil.  Yet it’s so very important as Dr. Kaufman and the research clearly show.  By discussing incivility and it’s impact, Dr. Kaufman showed how civility could counter that.
I confess as a Canadian, given our public image for politeness and  civility, I thought it fitting that Dr. Kaufman a truly admirable Canadian should be presenting on this.  Personally I think of him as the ambassador to own  more a warrior like self.  I would and have  "argued" the need for both. Dr. Kaufman would 'discuss' the matter more respectful and likely have a deeper and more lasting impact.
His presentation showed the need for more civility, especially for doctors,  and not less, something I would not argue with at all.  He definitely makes a strong case for civility as a learned behaviour.  He showed that it  can be taught and learned.  There’s a skills set. I’d say it was part of what we once called the art , of the art and science of medicine, now with the support of more science.

IDAA 2017 Snowbird, Utah

What a lovely location. Like Whistler and Blackhomb.  A ski resort in winter, hiking and study resort summer.
I had a great ride up the canyon discussing religion and spirituality with Larry from San Diego.
"Can you point out the archives?" he asked the driver.
Sure enough there on the side of the mountain was entrance to the great Mormon archives stored deep inside the mountain.  The books and prophecies all kept safe these last 60 plus years. It took years to construct.
At the lodge, checking in I began seeing familiar faces. We smiled. We laughed. We hugged. It was old home week. I've known these doctors 20 of the best years of my life. This meeting is the best experience ever.
My psychiatrist friend Hugh and his beaufiful wife, now retired, enjoying life.  Then the writer Nathan and his wife. What a joy to see Bobbie before seeing her flighty husband Tom. Of course Carole. She pointed to Art and he stood up to give me the hug of all hugs.  Art naturally commented on how beautiful the wives are.  Dave from Manitoba was actually checking in just after me.  Dave from Cyberdocs was getting a coffee when I got down to the meeting.
I"m into the second day. Traci introduced me to the best New Orleans shrimp last year. She's living in a house in the woods with deer that come to visit.  She showed me pictures. Then Judy showed me pictures of her dog.   I  showed off pictures of Gilbert.
Cheryl looks better every year with her lanky runner's body, so spiritual.  Mary is adorable as usual remembering me and everyone else.  She's like the gr. 1 school teacher who knows all the kids.  We a wide range of adults. Doctors, Dentists, Veterinarians, Health Care professionals, spouses, kids. The teens are crazy.  Young doctors in their 30's to the white haired crew I now belong with.
I loved the view of the mountains out of my room.
Dr. Kaufman from Canada, a really admirable nice guy gave a talk on Civility. The guys a walking testament to civility.  A Canadian civil servant.  A reincarnation of Confuscious. He'll reincarnate into the diplomatic corp in his next life. A regular ambassador.
CME- the top addiction doctors and psychiatrists and they're here talking about PET Scans and research. I liked chatting with William, the Neurosurgeon about selection bias, data skewing and the limits of science. St. Louis post grad, top neurosurgical research.  "We developed the PET scan." he said.
Some very funny shares.  Lots of understatement.  Special research programs different people admitted to doing with their own funding.  High cost outcomes. Dubious affiliations.
I love the laughter. I don't think I cry laughing except here. It's safe.  I helped George who had to sit because the air is thin.  I bound up stairs and huff. He was doing the Indie 500 with his walker when he slowed down and took a seat after bounding up the same stairs.  A dozen doctors stop to see if everyone is okay.  Breathe.  Breathe.  Everyone is okay.
We hold hands and say prayers. Hundreds together.  It's so comforting. So serene. So healing.
I'm already feeling better. Less stressed. No longer alone.  Talk of spirituality, relationships and self care.
My first meeting was in Toronto. The banner said, "We are not alone".  I cried seeing that.  I feel so alien as a man standing in the middle surrounded by extremists all believing they're in the middle and attacking me as an extremist.  Humanity.
It's good to be a live.  Eating a great hamburger outside I watched a gopher running across the grass. Later I saw one running down the hall and out the next door.
"They sometimes go inside and take a while to find their way outside." The staff told me.  I like being out of the city. It's so peaceful here.  The resort is a bit of a maze but everyone is so friendly.  Sunny, hot, blue sky.
And every where I go I see people I know and care for and they care for me.

Healing Anger, Whores and Saints

Laura is looking after Gilbert.  Friends are watching my home. Anything worth anything is in my storage locker or here on me. I dazzle with tech.  Apple bling.  I am off work.  I’m off the clock.  20 years ago I chose life.  The woman in my life then had tried to kill us and me.  The woman before her had killed my baby. Drinking and smoking I had fallen in with a desperate lot. When a friend suggested I quit drinking and smoking I thought I’d prove to him I didn’t have a problem.  “I’d show him.” I had returned to the church because it had been there I remembered the good days. It had been there where I’d heard the calling to go into medicine. It was good to be on my knees praying. I’d meditated for so many years. Praying was good. Crying and remembering and knowing that it was highly unlikely anyone was going to get drunk,  smoke dope, shoot guns, or have an orgy. The church was a safe place. I was invited to go with a new friend to a 12 step meeting.  I didn’t want to work then. I felt responsible for the deaths of my wives. I felt that the abortion had been beyond my power but I was blamed for it. I thought that my professor who’d used me for sexual gratification and taken advantage of me. I felt a whole lot of self pity. I felt a lot of anger and resentment too.
Now they asked me to talk on anger at this conference.  I’ve talked here before.  I always hope they’ll forget. I don’t think I talk well.  I once did.  But not anymore.  Mostly I doubt myself.  But then I see how little others know and it seems I’m still okay.  I’m useful. Increasingly an old elephant in a country where the government hires poachers. I keep seeing my colleagues being taken out by the demonic.  Some strongman with the young around him, puppets, with strings attached. I don’t know what happened to my strings. I’m just glad I made it another year. I’m crawling into home plate, tears running down my cheeks.
It’s been tragic year. My brother died. My best friend in so many ways died.  My best doctor friend, my best Christian friend, my best recovery friend.  My other best friend of the same ilk grows yearly more ill.  Then my other young friend dies.  The Landlady was a real greedy ugly clever business woman.  I meet more of them. Women who didn’t play team sports. Feral.  Insectoid.  They use men. On Facebook the silly sorts talk about narcissists and psychopaths and sociopaths and they don’t know. I’m there are day. I loved Snakes in Suits.  Looking back at my career I fought them over and over again.  Hitlers and Stalins in clown masks.  Always I knew the problem was me.  My fear is the world I see.
I long to get off this plane at the destination and see a familiar face. My same time next year colleagues.  I find such comfort and solace with dozens of other psychiatrists who share the language of the heart.  I am so tired of being around people who chop off the heads of others to make themselves taller. I’m tired of the competition and the rat race. I turned 65 and stayed. I bought a truck to anchor me in a debt. I’m buying a new home. I’ve the money in the bank but if I spent it the government would take 70% but everyone is glad to bet on my future. I have insurance.  These are things. I just want to move onto the next dimension in time but all my talk with God remains the same with the message to stay, to work, to carry on. I want to be in my sailboat in the Atlantic fighting waves I can see not being stabbed in the back by lying psychopaths who I’ve tried to help and treated as warm blooded creatures hoping and praying they would revive but they’d bit the hand that feeds. The whole loser coward money grubbing arrogant monday morning quarter back set are there to judge. They no longer can do. They’re gloriously incompetent and need to give themselves pats on the back and lots of raises and hang together while they make insane and impossible demands that are the height of silliness.  Insectoid. I pray for them. I pray at their backs.  Their platitudes and superiority and grandiosity are shallow.
The National Post wrote the article what is the difference between the Government of Canada and the the Hell’s Angels.  I like the Jesus stories. It’s the government that errs.
I was asked to talk about anger. Not anger management. The bastards, my friends, I suspect, know something.  I live in a sandwich of slices of homicide and murder with the littlest bit of lettuce between. My mind is a ping pong ball.  I slide into this meeting, slouch into the meeting and somehow rally. Every year for 20 years it’s the same.  I want to give up on my fellow man. I want to go out and killing like Arlo Guthrie kill. I’m a sniper. I’m a chemist. I have countless poisons readily available to me. I have skills and knowledge.  I don’t scare myself. But then the violently insane are more afraid of me than I of them.  I thought Hannibal Lechter was the only psychiatrist portrayal of any validity. The new Sopranos girl is a counsellor. A ego massage therapist. I got in trouble ,the umpteenth time calling my colleague a mental whore, insisting I’d not care if he was an escort but his street slut behaviour was no good for the profession. I was wrong. He’s in leadership today.  Lust surpasses love in the world today. Truth is relative.  The silliest don’t know they’re in the experiment. I’m in God’s brain like Malkovitch.
Today’s music sucks. I’m listening to the music of my teens and twenties again and understanding where my influences came from. Doystoevsky, Allan Watts, Kierkegard, Camus, Kaffka, Paradigm shifts, Story of One, National Geographic, the Bible, Francis Bacon, Science of Fear, Future Shock, HG Wells, Churchill, EE Cummings, Franny and Zooey.  I grew up reading these and now talk to people who quote people magazine.  Or did. They’re now reading O Henry and I’m reading Star Trek. I’ve devolved.  Facebook is an entertainment.  The serious are paid and propagandize.
I like Jordan Peterson. I like freedom of speech. I fear we’ll facing the destruction of the free world by the tyrannies of dead communist doctrine wedded to the other great tyranny dead Islam.
Here in the air port there are some pretty girls.  There are fat old men, like me.  Children and back packs.  Jet set.  There’ no glamor.  It’s work to go through security. I ‘ve come down from the adrenaline rush. They’ve ojected to my guns and taken so many knives and nail scissors off me.  Half dressed and dis oriented I have left my passport or my ticket at the security cheque.  I’m back in school being caned and strapped and screamed at.  I can’t get a lather up when a princess says she was traumatized by a man looking at her.  I see the torture victims in my work and challenge anyone to say these people weren’t emotionally abused and physically and mentally abused.  There’s a oneupmanship in the self pity challenge test.  My emotional abuse needs all the public health care and I can’t be concerned about your cigarette burns and broken bones and missing limbs. I’m emotionally abused.
And the richer the person is the more they can get.  I love the picture that showed a trailer park and said that if the the guy in 50 Shades lived in a trailer on welfare it wouldn’t be a book but an episode of criminal minds.
I relax here. We sit in small groups and talk. The guys and girls tell of their spouses and children with cancer.  The widowed and divorced and diseased share their experience strength and hope.  I feel so utterly self centre and useless. My life is blessed beyond belief but I’ve lived the year with a man threatening my life and the life of my dog and no matter how many ways I block his calls or his emails he finds a way to get in my face and laugh at me….he’s living proof that I have no security. The police did nothing. It wasn’t just me. He threatened lawyers and their dogs and the beurocrats and frankly I rather enjoyed that the beurocrats were threatened.  They likely took years off work and milked it for all it was worth.  So far from reality and yet sickness still get through all the barriers to their space station ivory towers. Even now there’s a new threat and they celebrate it and hate doctors all the while claiming they don’t but there Capos and get good coin to lead us to the gas chambers. Middle management.  But this week the police called concerned because he’s threatening the Prime Minister. I don’t know if the PM has a dog. Muslims don’t like dogs so I doubt it. Maybe his kids will be threatened but they are taking it seriously. The rest of us don’t count.  Yet if I or the lawyer or the eurocrats uttered threats we’d be out of work and in jail but this man and the PM are both above the law. I work with people who tell me of the murders and tortureds they’ve done selling drugs, pushing drugs, in prisons and in gangs.  It’s a slice of reality that doesn’t officially exist.
Some days I’m out in the suburbs.  Its different there.
I miss Hank. I miss Bernie. I miss Doug.  I miss Mom and Dad and my brother Ron, and George and Richard.  I remember my Dad lonely in the end saying, “all my friends have died.” He was old and missed my mother. I love when I dream of them. I love too when I dream of the dogs.
‘I think of sex changes. I think of Leonard Cohen. “I want a new Face.”
I think of turning states evidences, walking into Ottawa RCMP and telling them the good men I know. I know that the good are now the bad, the white is the new black, that 1984 doublespeak is the new Canadian, we live for Taqikya. I need a niqab.  “This face is covered up with age and shame.”  I sing hallelujah.
We stand together our heads bowed and say the Lord’s prayer.  More and more with say the Serenity Prayer of the great christian theologian Reinhold Niebuhr. The people who want to change the outside because they can’t face their own insides haven’t knee jerked objected to Niebuhr yet. They attack Jesus.  Christians are the most persecuted in the world.  You’d think they’d like it.
But we’re slow to anger. That’s the distinction I like about Christians. I turn my cheek 70 times 70 times. Then your life is mine.  I can and will wipe out your genetic signature.  It’s the genius of my scotty dog. The ultimate rodent killer.  I like the celtic blood.  Irish and Scottish.  A lawyer with the help of government stole millions from my grandfather.  He then escaped to a place where lawyers lives outside the law.
Maybe next year they’ll anger management.  When I trained with Elizabeth Kubla Ross I understood the anger. I’m angry at God. I’m still trying to do what I’m supposed to do, questioning meaning and purpose. The great psychiatric text was ‘Denial of Death’.  I loved when we discussed these books and shared them  Now the only question people ask is ‘how much did it cost’.  No one understands there is no price on my dog.
Asked if the woman would have sex for a million dollar, she said maybe, so the man asked ‘what about a dollar’.  What do you take me for she said. That’s been decided, now I’m just dickering for price.  I feel like I’m back in Morocco with camel traders.  I want to withhold my services and remove the gun that says we can’t say we say the price of your life or sanity or medication is what ever we say because your fees and your bills have exponentially escalated with no increase in quality or service while our education and expectations have skyrocketed and all these parasites have latched on like blood suckers ordering us to work for them as they siphon off the fat.
These two sisters , teens are so enthusiastic, travelling. Young. I’m jaded and look for spinning tires to back at. The modern windmill.  My dog and I charge the free way. He’s one eyed.  I’m biker trailer trash.
The bastards asked me speak on anger.
Not enlightenment. Not genius. Not sainthood.
Anger. The pricks.
Now all I want to do is get to a room and sleep and shower and watch tv and order meal service but instead I’ll sit and drink coffee with some old guy and learn or some old girl and learn. And I’ve been blessed to know Tony and Art and Beth and Judy and Dave and Julia and Steve and Carol and the list goes on.  I look forward to seeing a gay man whose missed his death several times and a man who was in a series of accidents but he survived. I met the man with a mechanical heart. Interesting eyes.
Now they’ll be calling .I must go.