Harm Reduction Good; Harm Reduction Bad

Harm Reduction Treatment is a term which is used commonly in Addiction Medicine. It followed “abstinence based’ treatment.  In other areas of medicine the term ‘palliative care’ is an equivalent expression.

The positive aspect of “Harm Reduction’ was that it provided care specifically for those who were not ready to embrace ‘abstinence based’ treatment or for those who had failed, even repeatedly failed, conventional abstinence based therapies.  

Historically ‘abstinence based’ therapy for alcoholism was exemplified by the Gold Standard , Navy Pilot program. Navy pilots cost millions to train and flew jets worth even more millions.  When they developed addiction as they did, grounding them caused  a major loss, often involving suicide, while letting them fly, was obviously dangerous. The treatment which followed included a 30 day inpatient treatment, followed by 3 meetings a week of AA (Alcoholics Anonymous), weekly drug and alcohol counselling and monthly visits to see a psychiatrist. At 5 years 80% of pilots were abstinent and flying.  A major success.  

This treatment with some variations is the treatment principally used for judges, doctors, other professionals, union members and all those ‘contributing citizens’ who individually or by insurance can afford the ‘best’.  It is well known by the advocacy of such distinquished treatment programs as Betty Ford, Talbot, Homewood, Edgewood, Orchard etc.  Often patients begin with a period of detox and follow up today can include SMART, a cognitive behavioural group therapy.  Group therapy is the cornerstone of abstinence based therapy.  A fundamental principle of addiction treatment in this model is that substance abuse compensates for relationship deficits.  Accountability and support come through fellowship and community.  Isolation begets addiction, participation treats addiction.

By contrast Harm Reduction Treatment has tended towards maintaining the substance use with a view to control. Originally the World Health Organization validated the Harm Reduction Programs only as they ‘lead to abstinence’. Abstinence is the ‘cure’ per se for addiction.  To this end methadone, suboxone, Kadian and now Heroin are used as Opiate Replacement Therapy.  Eventually patients were weaned off opiates however where in the abstinence models this occurred in weeks, in the Harm Reduction Model this might well take years.  

Alcohol is provided in a controlled fashion on the hour for chronic alcoholics, maintaining the steady state alcohol level and avoiding withdrawal as well as the revolving door detox, hospital and jail scenarios.

There is no doubt that harm reduction is good Community Medicine. 30 years ago when I was doing a Community Medicine Residency I studied the Swiss Methadone Maintenance programs of the day, showing then as they do today, that providing methadone, reduces the spread of diseases associated with needles, like infections, most importantly hepatitis and HIV.  They also dramatically reduce the cost of revolving door hospital, detox and jail scenarios. The legal cost alone for the theft associated with heroin use is horrendous and methadone simply dramatically reduces this.  

Harm Reduction Treatment is very good for the community when it is approached responsibly and it’s fiscal benefits are understood.

 Locally the Portland Hotel Society was a scandal with all manner of corruption and devastating failure as their Harm Reduction Model became dominated by crime and a ‘better living through chemistry’ attitude which indeed promoted drug abuse as opposed to treating it. The Portland Hotel Society has since modified it’s approach. 

For individuals as opposed to the community, harm reduction can be very good.  Methadone and suboxone specifically impressively reduce the use of needles and help individuals get free from the life of servitude supporting the criminal drug dealer factions and associated crime.  Eventually patients who might otherwise have died often have the time to move on to abstinence based therapies.  When the patients come for methadone or suboxone their other physical and mental health needs can be addressed.  Otherwise they might well avoid health care.  Housing, food, health care are all available as part of the a good methadone program.  Certainly we encourage participation and provided biopsychosocial interventions to the patients on methadone. The College of Physicians and Surgeons of BC like other College programs across Canada and similarly in other civilized first world countries,  historically managed the methadone programs and encouraged they take a wholistic approach to the patient.  Opiate programs required a federal government waiver given that the laws against drugs like heroin were nation wide. Locally the addiction treatment has been transferred mostly to Province or State and University care. 

Harm Reduction Therapy could well be seen as bad if all the doctor was doing was being a ‘drug pusher for the multinationals’ rather than using motivation therapy,   12 step facilitation therapy and cognitive behaviour therapy to move patients along the spectrum of motivation to change as laid out by Prochaska.  The preventative medicine aim was through relationship therapy with the physician , psychiatrist, pharmacist and overall treatment team aiming to ensure the patient’s self esteem and health indices  improved.  These indeed do and for many individuals the methadone and suboxone treatment have been life saving.  Heroin and other ‘needle maintenance programs’ are early ‘add ons’ whose value is not nearly as evident given that the key feature of methadone was that it moved patients off needles with the community risk inherent to methadone or suboxone, oral medications.

The alcohol therapy has been an end stage treatment model for chronic alcoholics who have failed all other programs and whose lives are more manageable without the drunk then withdrawal roller coaster broken by relationship with health care and managed hourly alcohol intake.

Champix  and bupropion, nicotine replacement gums and patches, and vapes are all Harm Reduction Therapies which have had proven success in helping people become abstinent for nicotine and smoking.

Revia (naltrexone) is a medication which reduces craving for alcohol and empirically reduces alcohol intake in those who abuse.  Acamprosate is another such medication. 

Narcan kits which reverse overdose are definitely a harm reduction strategy especially when put into the hands of first responders.  They are a simple preventative medicine strategy for those of my patients who I encourage to have on hand when they are using with family or friends trained to know how to use them. 

The safe injection site is obviously another  harm reduction strategy.

Needle Exchange programs are proven harm reduction therapy where the patient exchanges a dirty needle for a clean needle. Unfortunately locally the needle exchange program devolved into a ‘free needle’ program with needles being tossed out of a basket in the local park. 

A variety of medications have been used along with diets to treat obesity and overeating, sometimes call food addiction. At the extreme, when behavioural change fails, surgical interventions such as stomach stapling have been long acknowledged as life saving.

So why is Harm Reduction Bad?  Obviously it isn’t of itself.  Reducing harm is good and the use of this marketing term is very seductive indeed. Unfortunately it can be ‘enabling’ and can cause the disease to persist given the huge element of denial involved in addiction.  Further the Harm Reduction Therapies tend to be pharmaceutical or medicalized  and costly compared to the low cost equivalence of the more labour intensive approaches of treatment centres and frankly almost cost free community support programs.  Often all the high cost and front end approaches are used and use up the patients resources while in the end the recommendation is to continue in AA/NA or SMART as this is a chronic disease process and unfortunately the real issue is prevention of relapse.

When patients have work and family and community relationships still in tact they are most likely to benefit and succeed with the conventional abstinence based programs, detox, treatment centre, and group therapy. In traditional medicine this is considered the ‘primary’ care model and harm reduction therapy is considered ‘secondary’ or ‘tertiary care’.

Harm Reduction becomes ‘bad’ when judges and doctors and the wealthy are given the abstinence based approach while the poor are ‘maintained’ on their drugs without giving them the opportunity of ‘cure’ which comes with abstinence based models.

Further, the harm reduction models can contain an inherent negation of the patient’s capacity to change.  Seminal studies have shown that a patients capacity to change and get well depends strongly on the therapists belief in their capacity to do so.   If the therapist doesn’t believe the patient can overcome their addiction to heroin the therapist will indeed prove to be the rate limiting step. The success of AA and NA is that the rooms are simply full of individuals who have indeed climbed the Mount Everest of Recovery and encourage others to believe they too can succeed.  

Both models have their naysayers and both models have their glorious success stories. The social justice warriors often argue that the addict and alcoholic should have ‘free’ stuff , in this case ‘free drugs’.  Unfortunately the disease of addiction is one of ‘more’ and there simply isn’t enough of whatever to suit the active alcoholic or addict who will die or commit crimes to persist in his or her narcissistic hedonistic pursuits.  

Should society pay to increase the risk to itself.  Part of the difficulty today is that there are increasing numbers of those who feel society should allow them to ‘spread their disease’ , a group of HIV positive individuals having parties with ‘non infected’ but those seeking “solidarity”.  

In the best of possible worlds when physicians, psychiatrists and other care givers are seeking what is best for the patients ,understanding the severity of the disease, the limits of resources and looking at each case individually there is rarely any conflict between the models .as in the individual’s life and care both models are at different times and sometimes together  being used.  

Politically, Harm Reduction Therapy has, I believe, a great deal more potential for harm than traditional abstinence based therapies.  Naturally there is a concern that the rise in addiction and death has been parallel to the increase in Harm Reduction Programs. Is this an association or is some of this cause and effect.  Changing the ‘drug dealer’ from the street criminal to the State has sent a different message. Legitimizing drug and alcohol abuse can be problematic.  Promoting marijuana use for profit just like promoting alcohol for profit may cost individuals and communities while a few profit.  

What is best for the individual, what is best for the community and what is best for the State and treating services are great when they all work together. Historically, the individual has been lost in the demands of community and State and those that ‘profit’ from individuals with disabilities such as addiction.  

We have always done ‘Harm Reduction’ as doctors. My concern has principally been individuals get the best care. The group “Like Minded Doctors” developed in part to discuss these concerns. 

Reno Nevada after IDAA

I loved Cheryl’s Sunday Morning Spirituality talk. Hope and redemption.  Then it was farewells, hugs all round.  Maybe another whole year before seeing people that uplift and sustain me.  We talked of attending other meetings, so many had, a similar one in Melbourne next year, the annual one of the British Doctors, New England doctors and Western conference.  I must make room for this in my schedule if only to keep perspective. Judy smiled knowingly at me when we talked of detaching from the politics of the profession.  So much has been about recognizing our fears.  Aging and the proximity to dying has touched me in ways I’d not noticed before.
My missionary doctor friend organized a workshop on trauma. I didn’t know where to begin.  An ER doctor was unable to get the image of one gunshot wound in LA out of his head. He’d seen so many stabbings and gunshots but this one touched him. I keep seeing thelittle girl who overdosed with her boyfriend last year, taking a year off from college.  He lived. She died. The face on the disease

I’m sitting here in the Reno Outdoor Cafe Campo. It’s on the Riverwalk and gives are really special face to the city.  The main street is casinos while here is this witness to elegance and fine living. The promenade.  Truckee River. A lovely stream with rapids and boulders, yet here and there some depth.  No doubt a happy place for some species of fish.  Hanging potted plants are all  along the way.  A Latin busker sang a sweet song while a young man jogged past the well dressed young lady pushing her baby buggy.

The sun is hot here.  The city has let artists paint the outside of buildings. Across the way a pretty wall of clouds and sky. More eye candy. A many faceted whale is sculpted  in a deep dive a long way from home in Nevada.  
The city is known for it’s restaurants and cuisine. Staying at the Peppermill Resort I loved all the meals they prepared. The smorgasboard brunch with John was a treat with Mexican and Chinese offerings beside the roast beef and all day breakfast items..  Obviously gamblers like to eat too.

The gambling machines in the airport when I arrived were a surprise but then later I told a friend that I expect every home in Reno has it’s own gambling machine shrine. The city is to gambling what Napa is to wine.  

My work with addiction skews my view. Mostly 80 to 90% of people can enjoy pleasurable activities without stealing from their grandmothers or selling their bodies for cash in the pursuit of pleasure to fuel some activity.  Dr. Nady el Guebaly, founder of the International Society of Addiction Medicine spent his life time studying gambling seeking to prevent those small few who simply couldn’t stop. It’s a deep field for research with advances occurring all the time in the study of genetics, Neuro chemistry, social and psychological factors. 

It’s nice sitting here reflecting on all the other activities that occur in a major city regardless of the primary industry. Here tourism is increasingly important but once the town was a centre for ranching and hub of migrations and transportation. The bridge a ways down had a sign recording the history of the development of Reno in the Gold Rush days as a resting point and transit point on the way to the California mines.

I”m just thankful to have been here.  The IDAA conference has taken me to so many American cities I might otherwise not have known. I love these settings of IDAA and the resorts.  Lake Tahoe is close and many chose to take a dinner cruise on Friday evening.  I tried to arrange a horseback ride with Heavenly Hooves but they were booked a week a head.  Sierra Adventures also was booked full, the popularity of the outdoor adventure that apparent.  

I’d only stopped in the past passing through Reno driving from Western Canada down to California.  I was travelling with a wife and Mustang car then but would love to come through here on my Harley. There’s that Wild West flavour here and Hollywood made it’s share of western movies in Nevada at one time.

The airport is calling now.  It’s been a great conference and I’m thankful to Reno for being here to host such events so well.  Till next I come, hopefully with more time and a motorbike or kayak.  

I have learned

I have learned again that I have a great group of colleagues and friends from around the world and that I can call them at any time and know that they will listen and help me with any problems I might be encountering.  In retrospect I’d be wiser to reach out sooner rather than stew and worry and jury rig solutions on my own.  I know I have friends close to home but these friends I’ve known and shared with for 20 years have insights into similar problems and concerns. In one case what I thought was a local insane administrative problem reflects some ideological move which is happening far and wide and causing untold suffering for patients and doctors. Yet it’s an idea that has infiltrated the wee pee sized brains of the stupid and taken root like the holy words of Marx.  Some as yet unidentified health administration ‘prophet’ has infected these folk causing sickness in middle management, a kind of arrogant brain fever.  I am not alone. I felt so alone.  Yet British doctors and Australian doctors and doctors all across America and Canada are seeing the same insanity and the victims of the mental aberration don’t even perceive themselves as having this idiocy.  They collectively lack insight and react aggressively to anyone who tries to point out their derangement. They are definitely not willing to change and in the precontemplation phase regarding any willingness or motivation to change. So we do best to detach with love. Most of us can’t leave or don’t want to.  All of us seem most to love helping patients and serving our fellows so its a bit of a muddle right now for a wide variety of reasons, mostly the lack of education of management, their faulty models, aging populations, chronic disease and unfunded political promises. The tendency to ‘blame’ the individual doctor for systemic flaws simply reflects their own fear and aggressiveness.  It is best to stay safe.
I have learned that there are new medications that are indeed curative despite their side effect profiles and well worth a trial where all else has not been working. The costs of the new research are high but the cures are indeed amazing. There is hope for much with modern medicine. In the field of addiction where the reward site of the nucleus accumbens and dopamine tone are identified genetic studies and new medications are coming along. Some 10% of the population, maybe as high as 20% are affected severely by isolation and shaming. The existing legal approaches to the disease are wholly counter productive and politically there is a need to educate politicians, judges, and various others to appreciate the effects of shaming and isolation.  Primitive administrative models which rely on shaming and isolation, focusing on making individuals feel less than, are indeed the social mechanism that fuels addiction.  The monkey models of the effects of isolation and making one feel less than are amazing. The animals have no desire for cocaine before the mistreatment but after exposure to such regressive management become rapidly addicted.  The cost of addiction is simply widespread and misrepresented because of the tendency to see different organ or illnesses as separate when they have the same underlying abnormality of the reward mechanism.
I have learned that there is much benefit in exercise and that mobility should be more the focus than being free of pain.  Mobility is central to the human condition and once mobility is loss a wide range of illness follow.  Addiction is tied to loss of mobility so work with pain must emphasize mobility foremost.
I have learned that street fentanyl is a misnomer compared to the pure fentanyl used by anesthetists. The nature of the ‘fentanyl’ or ‘down’ used by patients is more akin to animal tranquillizer than opiate. I feel remiss in not being on top of the chemistry of these agents and will when I am home research this more as there may be insights to be had regarding addiction and substance.
I have learned more about the models of health care delivery and that there is a political buzz word ‘universal health coverage’ which doesn’t mean anything like people think it means. I have learned that Americans in general have no idea what the Canadian health care system functions like. It is apparent that the various health care systems around the world including the American handle emergencies and acute illness well but the problems arise in chronic care and rarer diseases.  It was truly fascinating talking with front line workers like myself about what would actually be done for individual cases and how similar the deficits were for the homeless and that access to medical care varied dramatically especially for the rural folk,  It was a wholly different discussion than the political disinformation and misinformation ideologically driven by media.
I have learned that I really like having discussions with colleagues about religion, politics and health care, and all manner of matters because not one of them belittled or abused me for an opinion different from theirs.  It was interesting that there were so many differing political opinions regarding the present President, those who clearly hated him and those who loved him but no one became violent or offensive but instead stated simply how the regime change was affecting them personally.  I was fascinated by how down to earth the people were and how gracious, more than me by a lot, those were who had been exposed to the 12 step. I found the parents and grandparents even more gracious and just a true joy to be around.
I have learned that the vast majority had benefitted from 3 to 5 year monitoring and that a restrained approach consistent with other socially affected models which didn’t demonize patients was truly effective.  Given that many diseases affect performance it was enlightening to see alcoholism and addiction compared with other illness and the kinds of monitoring which were appropriate for these.
I have learned once again that I learn more talking to colleagues with similar experience and training in a hallway than I do in a lecture theatre at my level of experience and age.  I am so thankful for the many conversations I had with senior colleagues, most now retired, two of my favourite psychiatrists sharing about their retirement this year, what they are missing, why they left, what their plans are.  I also learned that several enjoyed cutting back their practices and continue to work. I noted that most had moved away from the soul sucking models of management and were less driven by monetary concerns as by respect. I laughed at a colleague describing reducing his day because he realized he was too old to live long after treating more than one ‘death star’ patient a day whereas in his previous model of care he was treating a half dozen of these unmotivated chronically angry and demanding patients which he aptly named ‘death stars’.  I liked that together we could talk honestly and that political correctness was eschewed because we all were in the front lines and our compassion wasn’t just the matter of fancy word, virtue signalling and sound bites but reflected years of compassionate care and service.  Among ourselves no one derailed the conversation with the stuff that duels dealt with in the past but rather we discussed better what to do with ‘death starts’ and how best to survive and manage the experiences.  Interesting to me they were not limited to psychiatry but a common concern of specialists, if not more so than generalists.
I have learned that my colleagues are accepting care from their colleagues and many have had really good medical care, knee surgeries and heart surgeries and investigations and are alive today because of the success of medicine today.  That gives me hope as I age and fear the politics of health care and am afraid of dependency.
I have learned that I have been short and inconsiderate at times, allowed myself to be over extended and been insensitive to others. I have learned that I must review my own behaviour and responses daily and that I must apologize for my omissions and errors more quickly. I am aware that the deaths of my brother, my best friend and another close friend plus the severe illness and insanity of two close friends, the surgical removal of my dogs eyes has all caused me to be less attentive to those around me but that while I feel I'm running on 6 cylinders rather than 8 I'm not alone. Those others around me are normally equally stressed though differently. I have examples around me and an idea of the person I would most like to be and while the demands have escalated exponentially, and the number of angry and threatening and entitled people is disproportionate there is much I can do about my response. Daily review is something I have let slip and I need to be more proactive about this self reflection. My greatest mentors have died or are sick themselves so I must do more about shoring up my defences. Meditating more and praying more are showing benefit but I must exercise and surround myself with more positive relief from work given the death and disease where I am.  I must if I am to continue say no to the outrageous demands of the needy and co dependent and accept the adage physician heal thyself and be proactive and say no more not less. I have to put a premium on my spiritual well being and on my life because the truth is there are too many today who have not been socialized and they exist in low and high places.
I have gained so much hope and appreciated most the examples of my superiors and the laughter.  I loved learning all the personal challenges friends had and that they carried on. I am left wanting to emulate these men and women who have so often as indivduals and doctors set the example that has helped me carry on when I’ve been overworked, stressed, lonely and afraid.  I have learned that if they can carry on, so can I so I’m near the end of this conference looking forward to return.

God Seeking and God Sought

“I just have trouble with a notion of a God.” He said, seriously.

‘But the Big Bang is a kind of God,isn’t it. The latest name for ‘creator’ or ‘creation’. 

“I guess you could say but I don’t believe in this being of God interested in our affairs so to speak.” His hair was combed and he was well dressed, casually so but groomed. Soft spoken

“I get that but this experience I’m in might well be a God dream.” I said, “I know I’m not God but this may be God and like a program their may or may not be an administrator. That’s a whole other question.”

“Intellectually, I can’t disagree with that. I don’t know either way.” He said.

“ The issue of ‘faith’ is that you can’t experience something perhaps if you don’t believe in it. The scientific mind shows that. All that electron wave particle business.  I find the aetheist ‘closed minded’.  There’s simply no convincing her of anything not in her sensuality. The sensualism is sexy. There needs to be a crack in the comfort before you even question it. I don’t have any need per se to challenge them. But I feel a need to answer their arrogant assumption that there is no God. In this incredible universe of billions of stars you’re going to say there’s not even the possibility of a candy stripped polka dotted God of Gods, God almighty, It’s highly irrational to maintain such a position. But they do.”

“But religious people speak as if they know what God wants and says,” he rightly noted.

“Oh they do. Some are as big a wanker and aetheists are.  Arrogant.  Literalists.  Even the Bible must be interpreted. Collectively humans have been ‘told’ by God to ‘breathe’ and they do so at birth but beyond that there’s no absolute really.  Even understanding the meaning of love or lust is a matter of experience age and understanding.”

“But a baby could just ‘breathe’ without a command from God or programming from God,” he said. 

“  Mysticism is something different. The question I was asked is which is more likely, that I’m a material being living in a spiritual plane or a spiritual being having a material sojourn.  I’m rather fond of the latter idea. There is this God man thought.  I can imagine and dream infinity but live in this finitude. That’s not the reall bugbear bit.”

“What is?’ He asked, still curious.

“The bit that really caught me though was the whole notion that as I was seeking God, God was seeking me. That Hound of Heaven poem. The divine dance. God as lover.  God’s not lost. I’m lost. I hold with in me the sense of a home, of coming home and love is like that. It’s an intuition or feeling, not really intellectual. But you have to be willing. If you turn your back on this thing it’s not going away but there is a door and the door handle is on the inside. I know that much.  Do you see what I mean.”

“I guess, in a way,” he said.

“ I’m not making it very easy or clear. I’m sorry about that. But the experience doens’t lend itself to words any more than human love does. Better told with art or music. Or equations.  Cathedrals are my favourite expression. These days it’s sometimes more likely to experience something God like coming out of mathematics or physics. Scientists are  more religious in their string theories and quantum understanding. I fear the social function of the church, as important as it is, has over ridden the contemplative.  The community is good.  

Are you sure it’s God you have difficulty with more than people or yourself. I doubt God is that difficult or even complicated. Loving God ironically makes loving myself and others easier.” I said.  We left off there. Maybe we’ll speak again, sometime.   

IDAA2018 Reno Gratitude

Thank you God for the idea of a higher power and even still a loving God. Thank you for this new day. Thank you for this conference.  Thank you for Peppermill Resort. Thank you for the friends and colleagues I know here. Thank you for Gordy, Dick, Cheryl, Art, Carole, Tom, Robbi, Jan, Julie, John, actually thank you for all the Johns, Irv, Nathan, Traci, Mary, and while we at it Martha, who isn’t here but may as well be, and for Graeme, and Alistair, and Randy  and Mary Beth, and Ginge and Mike, Tommy, Dorothy, Alex,Elizabeth, Val,  and John again, especially Dave and his son,  I keep thinking of John’s, and Karen and Adam and Corinne, and Brett, and all these names who mean so much to me, who I know today like classmates and love as friends who I admire too, but thank you for the relationships.  Thank you that I remember the names. Thank you for the warm feelings the names ignite within me as I remember so many fond encounters. Thank you for the individuals and the group. I learned here that you work through people and these people have been instruments of love and care and knowledge.  I like that there is this mother ship and we all fly out from it and return with our stories and I experience. Thank you for all the people I’ve been blessed to know, the lives I’ve touched and been touched by. Thank you for the sharing. Thank you for the meaning. Thank you for the sense that I can join a table and know I’ll be welcome. Thank you for the civilization. Thank you for the good manners. Thank you for the high mindedness. Thank you for the Like Minded Doctors. Thank you for the Cyber docs. Thank you for the psychiatrists. Thank you for the humor and the laughter. Thank you for the sense of community. Thank you for the organizers. Thank you for the wives and husbands. Thank you for Jerry Moe and the children. The children and teens are wild. Thank you for the books and t shirts. Thank you for the meals and runs and activities. Thank you for the CME. Thank you for those who are gone but we remember. Thank you for the weather, the swimming pool, bikinis. Thank you especially for bikini’s Lord Jesus.  Thank you for laughter. Did I say how much I like the laughter. Thank you for the freedom. Thank you for this oasis away from the cares and concerns and petty mountains of daily existence. Thank you for the reminders of reality and that so much is mere attitude.Thank you for the challenge to trust and have faith.  Thank you for the positives. Thank you for the moments of sharing of loss and the stories of building and beginnings. Thank you for the book and all the other books. Thank you for reading and history. Thank you for beauty and good cheer. Thank you for all the good things I’m reminded of here. Thank you for the research. Thank you for the early morning meetings. Thank you for surgeons and internists and especially anesthesiologists.  Thank you for the dentists and pharmacists and psychologists and vets. Thank you for the colour. Thank you for the sunny sky. Thank you for peace and order. Thank you for safety. Thank you for healing. Thank you for medicine. Thank you for recovery. Thank you for all Lord. Thank you for showers and coffee too.

IDAA Reno 2018 Fun Run

This is my annual cardio exam.  The Fun Run is guaranteed to have emergency doctors and perhaps a cardiologist or cardiac surgeon. I feel safe.  It’s been decades ,really, since Bobby and Carole convinced me to come along and walk with them on that first Fun Run when Cheryl, our sky pilot, flew by at Mach II. Her example inspired me to actually try to run in following years.
Skip sets a mean pace once the run starts.  Cheryl did sort of pull me forward   to give  me some momentum  at the beginning.  I  ran along beside her for a bit quite amazed that she and her running companion could actually talk and run.
She said, “I just started going for a walk around the block whenever I wasn’t feeling right. Then sometimes two blocks. It helped especially when I was feeling angry. Eventually I began running.” She’d done 8 or more marathons by this time.  I didn’t hear any more.   There was a slight incline, maybe 1 %  so I had to reverted to walking. I’m specializing in ‘flat’ running’ and only walk on the incline.  
On the second lap around the lake another couple picked me up.  A plastic surgeon and a dentist.  They inspired me to run for a bit too.  But soon I was walking again.  I begun walking and talking with an emergency doctor who had not got to the level of running and walking at the same time either.  We  walked and talked just fine. .  Interesting guy.  Miles and days passed as we conversed.
Still I ended last.  John then ran around the Virginia in a couple of minutes to check for bodies in the bushes. They gave us red t shirts to assist with this.
Alex and Dorothy guided me back to the hotel.  Dorothy said she’d started an exercise program only months before. She glowed.  I dripped and slouched on.    My body was barely working and my mind was intoxicated with blood and oxygen.  I felt immense gratitude. I was still alive.  I’d  passed another annual cardio exam.
I took 2 naproxen when I got back to the hotel room,  even though a dozen dilaudid and a fentanyl chaser with scotch might have been better. I drank another bottle of water and headed for the hotel hot tub by  the pool.  I expect Neil Armstrong felt a bit like I did then when he said.  ‘one small step for man….".
Since I’m still walking after this year’s IDAA Reno 2018 Fun Run I've  signed up for next year's IDAA 2019 Fun Run in Knoxville Tennessee. Maybe this year I’ll practice. I don't think Sloth and Gluttony are my friends.

Spiritual Awakening or Not (Holy Spirit Come, please, thank you)

The 12th step of AA says, “Having had a spiritual awakening as a result of these steps. we tried to carry this message to alcoholics, and to practice principles in all our affairs.” In the 4th step it says “Made a decision to turn our will and our lives over to the care of God as we understood Him.”  In step 11 it says “Sought through prayer and meditation to improve our conscious contact with God as  we understood Him, praying only for knowledge of His will for us and power to carry that out."

Well, I pray every day. St. Paul said ‘pray unceasingly’ and when I’m not applying my mind to some task then I’m quite commonly praying.  My prayers are the “our father’, ‘All shall be well’, ‘Be still and know that I am God’, the 3rd prayer, “God I offer myself to thee’, “Holy Spirit Come”, the Dessert Father Prayer “Lord Jesus Christ, Son of God have mercy on me.”  Sometimes I recite the rosary, “Hail May, Full of Grace.”  Other times I just talk to God.  I cry out to Jesus, “What do you want me to do?”  

I consider prayer to be ‘talking to God’ and ‘meditation, listening to God’.  So I also ‘meditate’, that is ‘still my mind’, focus on my breathing, sometimes repeat a prayer or name, like Holy Spirit Come.  

I believe God is all.  Intellectually I’m a subset of the greater program. I’m a part of the whole. God is the whole.  That’s intellectually. Emotionally I feel God is ‘daddy’ , or father/mother. Jesus called God Abba, like papa.  There is this potential then for a ‘feeling’ of ‘security’.  That sense of comfort I felt as a child in the presence of my family and home.  I’ve had a lot of injuries, psychologically and some physically, and I’m not so trusting anymore. I prefer my own space. I’m a bit paranoid after the betrayals and abuse.  I loved the Travelling Wilbury’s song, “I’ve beat up and battered round, I’ve been stood up and I’ve been shot down, Baby you’re the best thing I’ve found, Handle me with care.”  

I tend to wallow in self pity.  The more intelligent one is the more prone to depression. Gratitude is the attitude and I’m often daily writing out gratitude lists and journalling gratitude. Thank you God for this day. Thank you for for this life. Thank you God for the sleep. Thank you for the money to afford this conference and this lovely elegant Peppermill Casino and Spa room. Thank you for the friends I will meet here. Thank you for the meetings. Thank you for sobriety.  Thank you for freedom from addiction. Thank you for choice. Thank you for all the people here who smile at me and laugh with me and hug me and welcome me back. Thank you for belonging. Thank you for my men’s meeting wednesday night in Burnaby.  Thank you for my family. Thank you for my friends. Thank you for my pets. Thank you for my vehicles. Thank you for my home. Thank you for my colleagues in the clinics I work in. Thank you for my patients. Thank you for my work. Thank you for my knowledge and learning.

But God I want to improve my conscious contact with you. Paramahansa Yogananda described seeing Jesus at the foot of his bed.  I have had many spiritual experiences. I’ve been blessed or cursed with the white light experiences.  I’ve felt your presence and I’ve seen your action in my life, up real and close. I’ve experienced your saving my life. I fear talking crazy like this in my work where there is  this terrible sterility and hostility.  I want to know you more, love you more. I know you work through others and that this life is a dance.  I know that anxiety is a measure of my distance from God. Too often I’m anxious about change, fear of financial insecurity, fear of loss of work and then the projected fears of moving, changing location and friends and searching work where there is less cost and less hostility and corruption and criminality in the city. I long for the sense of ‘home town’ , ‘laid back’, less sense of political criminality, less the big city, gangland, illegality and lawyer protected injustice. I fear the thieves and the gangs and the government attacking the little guy and protecting the corporate and gang and bureaucratic theft and negligence. I fear my aging and my inability to work and being dependent, and nursing homes, and being tortured in institutions. I’ve seen too many horrors and made too many enemies fighting for my patients and fearing that I will experience the nightmares that I’ve rescued them from. I fear that no one will help me. I fear I’ll be alone with a callous satanic, uncaring hospital administrator, only concerned for his own hedonism and profit while I’ll be suffering, going without an answer to my ‘call button’.  I fear I’ll be invalided. I fear I’ll be lying in my shit and piss and no one will come. I’ve found patients in hospital dying alone. I’ve found staff walking out of operating rooms in the middle of operations because they had a date.  I’ve seen things I wish I didn’t see. These are in the health care profession. The goodness of the people there is incredible. I remember my first hospital though with the corrupt administrator and how it took me years to confront his greed , theft and deceit.  He was removed and I learned that he’d been transferred from another hospital where he’d done the exact same thing, stealing, manipulating, mismanaging funds, playing one staff against another, having sex with the staff, favouring one over the other, and not caring when my patients were not getting what they needed. I saw that and changed that but fear that no one will protect me from these monsters. Yet the board at that hospital had overall been good old boys and women, duped by this slick sociopaths.  They were well meaning. The staff , well there were 30 nurses and 28 were a god send and a half dozen were truly saints, especially that sweet older nurse who like a sergeant guided me in surgery with her breathing and tension.  She handed me tools before I asked for them, assuring me by her behaviour I was on or off course.  I loved her and the administrator hated her, called her dementing and she was so sweet and wise and loved the patients as only a mother could. And that administrator with his mistress were bullying her. And I couldn’t protect everyone and now I don’t think I can protect myself.  I pray to you God protect me.

 

I don’t fear death. I long to be on the other side. I have dreams of family and friends and meetings in the air. I know the good die young and I’ve not been that good. Mostly it’s the sexual indiscretion, the monogamous contracts in which the woman acts out her aggression with negligence, withholding and covert and passive aggression. The promise of the food in the cupboard is inevitably faced with a bare cupboard.  Then I’m the adulterer in the adulterous marriage, paying back and war of the roses. And as the man I’m always at fault.  The abortion in which I had no say. The condoms with the tips cut off. The lies upon lies upon lies.  the threats and her cocaine. God I hated her cocaine and all night long rages and me trying to go to work each day after she’d tried to kill herself or me and all the lies….I’m afraid of relationships in Canada. Women have all the money and power and the courts have jailed thousands of falsely accused men and every man I know has faced extortion. Now it’s the sexual harassment lies and it was only yesterday women were claiming every man was a rapist and the courts were taking the children from men because the women said all ex husbands were pedophiles’. And now all white men are rapists.  And I afraid to fight back because the bullies say that resistance is attack. The courts support the criminals, their customers and every day I learn of some new patient who has experienced a break down in the system. Waitlists and perception.

Because it’s perception. It’s all perception. I walk down this road with roses on one side and shit on the other and forever am watching the shit.  I read a Stephen King novel rather than an uplifting spiritual book.  I am like St. Paul who says “I do that which I don’t want to do and don’t do that which I want to do.”  These days I’m just getting over a binge of overeating and sloth. My girth is no longer expanding and I feel so much better with exercise and activity. Yet there I was in winter hardly able to go to work given the bullying administration and their deceit and the support of lies and corruption and malingering psychopaths.  I lived in fear for a year with my dogs life threatened in constant emails, I’d block one and another would appear. And my last dog was killed and I failed him. I feel I ‘ve failed too many times.

I feel like Picard and the Borg. 

Islam and the communists have taken over the government and freedoms are being taken daily and hourly and I live never knowing what new law has been made to outlaw me.  I can’t keep up with the constant encroachment and everything costs more and more and everyone is angry and afraid and each day I spend it talking with drug addicts, trying to bring them back from the abyss.  I’m with so many people who have given up and I’m wondering why I keep screaming in the night.

I beg you God. Help me.  I really want to know you. I really want to be less afraid, less angry, less negative. I want to sing and dance and love and be the man I have been at times in my life. Must I give up being a doctor to get away from the stench of evil that permeates the field.  Can I spend more time with ‘like minded doctors’.  Can I believe in the vision of loving caring medicine. Can I focus on doing the best for my patient not constantly looking over my shoulder for some bureaucrat or media person to stab me in the back.  I feel completely vulnerable.  The administration constantly tells us to treat patients as the enemy.  I’m afraid because of the lies. I’m afraid of people pulling guns and knifes on me alone in the office. I’m most afraid of the women who lie. I’ve walked in and out of waiting rooms when women have been waiting seductive and naked stroking themselves saying they’re ready. I’ve literally run repeatedly for another woman to protect me from these sex attacks. I’m just trying to do my job. I don’t need this shit. I”m so tired of the arrogance and superiority of women who think all men ‘want’ them and that they can ‘seduce’ all men. I’ve said no a thousand times. I’ve run out of rooms. I’ve repeatedly thrown women out of my bed when  all I wanted to do was sleep. I thought it was funny and a compliment when I was young but then i learned that old adage about a woman scorned. They were lying angry women who denied their own assaults.  I’ve been hit by women and never hit women. I’m been repeatedly robbed by women and never robbed . And they have no ethics, supporting Eva Brawn and condemning Hitler. Yet the first time I was surrounded by a group of men with tire irons was when I refused to dance with a skank, just said, no. You don’t say ‘no’ to women in Canada.  They have the courts and police and military and parliament to back up their ‘lies’.  The stories they tell are fiction and I’ve lost faith in my society.

Why don’t you protect me God from lies and false allegations.  Why do you reward the bullies and the thugs that cower in the back ground and won’t work at the front where the anger is palpable.

 

I’m asking you God to still my soul.  I am helping patiences. I’m seeing them. I”m at the office every day. More and more of my colleagues are afraid to see a new patients. Fewer and fewer want to work for the little I work for. They have seen the shift and now are demanding higher pay positions and seeing fewer and fewer and becoming increasingly selective. I’ve spent years focusing on borderlines, addicts and sociopaths and psychopaths and now I’m without back up. “The customer is always right’ he told me with a smirk on his face.  

I am here facing my ‘resentments’, ‘addressing my fears’.  Invariably someone here makes me laugh. My concerns are ‘petty’. Really I’m blessed beyond comparison. God is so good. It’s my mind that’s prone to catastrophising and whining and focussing on the negatives.  Right now I’m here in paradise. There’s no bully. I’m not actually doctoring. I’m on vacation. My mind won’t ‘get in the same room as my ass is.’  It’s keeps flipping back to Canada and the terrifying communist governments and the destruction of Canadian values.  I have a kink in my psyche. I need a spiritual chiropractor to get me turned around. I am here to again be inspired because that’s what happens here. I’m with all these people who are doing really admirable things. They struggling with health and caring for sick and dying loved ones and going to work and not complaining. I’m a constant complainer.It’s so unbecoming. And I’m here with these others who are so much better at doing life. I’ve access to this ‘design for living’ and I want to be a ‘channel of peace’.  Yet at the same time I fear that my bellying up just encourages them. But it’s the BORG. What can I do.  

Time to go out and see who I meet. I’m afraid of this. I’m afraid to leave my room. I’m here among the best people and my shame and sense of defeat , the horror of false accusations and working under those who believe that doctors are contemptible as a lot, that all men are rapists and that all white men are racists. I’m missing my sailboat. I’m wanting to be alone at sea far from the maddening crowd. I don’t want to hear another story of Trudeau giving billions of our pension money to Muslim or Communist countries.  I don’t want to hear the news and I don’t have to listen. I’m here and I don’t have to play the old tapes. This is a new day.

Be hopeful. Be joyful. Think of the god kids. They’re growing. Think of Gilbert, blind but still alive and loving. George the cat is puking less. The world is a good place. I so enjoyed the riding my motorcycle for a day in the back trails not enncountering another. There’s the Salt Spring Round Up to look for ward to. More camping. More outdoors.

Get out of this hotel room and see people. These are your people and they care for you.  You care for them. They won’t care if you cry as you hug them. It’s like this each year.  I miss Bryce. Every year someone different appears in your life and is added as a friend.  There’s so many here you’ve come to know and love and now you just have to get out and face the day.  

Thank you God. Thank you Jesus. Thank you Bill and Bob. Thank you. Thank you . Thank you. Thank you.