Sunday, 17 June 2018

O Cannabis, our own our native plant..............

   As the LWLs of the Liberal establishment demean the once-great nation of Canada and turn a population descended from hardy, hard-working pioneers who worked a harsh frigid  rocky land into, if not a paradise, at least an honorable, prosperous nation where almost everyone who was prepared to work made a decent, comfortable living.   Those who through fate or misfortune couldn't or wouldn't work had a safety-net, which although modest would allow them to live and eat and have some form of shelter.  Not enough, perhaps, but more than many of their parents and grandparents could have hoped for.
The pioneers were tough but they made sure that the next generation of Canadians would be better off.
   The plan for the future somehow went astray.  After only a generations or two, the recipients of the benefits that their forebears bestowed upon them began to feel entitled to receive benefits that they had done little to deserve.   In addition, some began to think of the achievements of their parents and grandparents as somehow dishonorable, although that never prevented them from enjoying the benefits.  They began to believe that the extraordinary efforts of their parents and grandparents really meant nothing because it was at the expense of 'others'.   Meanwhile, they did not feel that the personal benefits that they themselves enjoyed were actually criminal, because they 'cared'; they apologized; they did everything they could without sacrificing any of the comforts they enjoyed.  They were working for the cause.  They were 'noble', virtuous, ready to apologize for the sacrifices that their forbears made to ensure their security and comfort.  They ameliorate their guilt for benefits they enjoy every day by sticking it to the hardworking taxpayer, who are dumb enough to pay for them.  These crybabies need 'safe-spaces' to cower in and recover from the micro-aggressions inflicted upon them.  An innocent comment can send them into a paroxysm of rage and hatred towards those who disagree with them. 
     And what do these LWLs have in store for Canada. Now they revel in the prospect that Canada is about to compete with the worlds major marijuana drug and perhaps other drug pushersCanada is already being labelled as the 'world's number one Cannabis exporter.    
     It is not the Canada I emigrated to!! 
     Apart from the financial rewards to the Treasury which will surely be generous, it is appalling that a government can be so indifferent to the safety of its citizens, that it can allow the legislation to proceed before there are methods available to safeguard the roads, the construction sites, the school zones, the workplace for its citizens. 
     The technology exists to monitor impairment and is  gaining momentum.  Unfortunately, the dollar signs take precedence over public safety in a political setting where irresponsible profligacy has been the rule.

Tuesday, 12 June 2018

The Angiogram.



    Its fourteen years now since I had my coronary artery bypass surgery.   Just a few days ago, a friend of mine who is booked for an angiogram and may be having a similar procedure asked me about it and I responded as accurately as I could.  I mentioned to him I had taken notes at the time and that I had later published an article in a medical newspaper, The Medical Post describing the procedure.  Although I have yet to locate the article, I still have my post surgical notes that I offered to share with him.
   Here they are starting with the angiogram




Bypass.  Pt 1.   The Angiogram.

I stared straight upward at the overhead camera, a chagrined that I had asked what it was, when I should have known perfectly well what it was.  But I wasn't thinking clearly right then, I was rationalizing the risk statistics of the procedure and knew I took a bigger risk every time I took the freeway.   Cardiac arrest, well that was easy enough to deal with, a couple of good electrical shocks and it either started up again or it didn't.   And if it didn't, nothing too serious, you didn't even know about it.    No, I wasn't worried about that, or about a hemorrhage from the thigh artery; they can always fix that.   The only thing I was really worried about, was stroking out, ending up like a close friend, a helpless prisoner in his own body.   Death was a lot easier to handle.   Not that I wanted to die; I still had plans and ambitions.  Far more pressing than any of the above thoughts, was the itching and burning in my groins, despite the copious shaving cream and the fresh new razor I had used when following the instructions.   My sympathy for the poor metrosexuals, who shaved this area on a regular basis as a part of their daily ablutions had increased.   

 I had kissed my wife goodbye and walked toward the Cath Lab, double gowned.   Modern sensibilities and sensitivities ensured that patients no longer wandered hospital corridors with 'back to front gowns', their tails hanging out for general condemnation or admiration.   I'd been issued with two gowns, one opening at the front and one at the back, providing total coverage.  I held my clothes in a white plastic bag, in my right hand.
The Nurse introduced herself. 
"I'm sorry we're running a bit late," she said.   "What do you want us to call you?   Dr. Smith or Stan?"
"Stan will do," I said. "And that's okay, I haven't anything else to do today," I said, and I meant it.
All of a sudden, a masked pirate, swung into the cath lab.  
He wore a red floral bandana, with the collar of a bright red shirt peeping above the drab green of operating room attire.   Was this really the balding middle-aged doctor, with a rather peculiar sense of humour, that I had spent a half an hour with last week?   I guessed it was.   Whatever it was, I sensed a deep respect from the surrounding staff.
"He's got a rather peculiar sense of humour" warned the nurse whispering into my ear.
I smiled back weakly and nodded.
'Don't worry," the pirate said to me, "this won't be too bad."
"Very few things in this life are as bad - or as good as they are reputed to be", I replied, the homespun philosopher as usual.
The pirate pondered for a moment, and then said, "I think that sums up life pretty accurately."    A slight note of appreciation in his voice.
  
He had told me last week that the rare complications of the procedure included hemorrhage, stroke and cardiac arrest, just to name the most severe.   "If you hemorrhage we'll just have to do open surgery to stop it, if you stroke out, there's not much we can do, but if you arrest we can just defibrillate you on the table," he said benignly, making it clear that the latter was by far the most desirable of the choices.   Obviously, the one he would have chosen for himself, if he had to.  

Then, he went on to tell me that I would feel a strange warm feeling, when the dye was injected into the intravenous which had been set up right at the beginning of the procedure.
"You'll feel hot and wet all over, and might even feel as though you had lost control of your bladder, but don't worry, you won't and I'll be standing right there," he said with a strange sensitivity, as though that would help.
He injected the local anesthetic into my groin, and after a few moments I felt nothing, but the miraculous relief of the itching and burning of the razor burn.
Dr. Pirate brandished the sleek cardiac catheter like a rapier.
"Now I just take a run at you with this!" He laughed.
The nurse bent over and she whispered reassuringly into my ear, "he's just kidding", and even though I knew it was just joking, I wondered how many times I myself had caused a frisson of anxiety in a patient, with a light word, meant to be humorous and to reassure.
It surprised me that I felt nothing at all, as the catheter ran up through my femoral artery, up my aorta and into my heart.
"You can see it all there on the monitor," the male nurse said, "if you don't mind seeing that sort of thing."
I looked at the x ray of my heart beating.   I saw the thin line of the catheter thread its way into my coronary artery, like a wire coat hanger being threaded into a key hole.  I hoped it would leave enough room for the blood to get through.
"Take a deep breath and hold it," commanded the Pirate.  
I did as I was told, until it started to hurt, I waited a few moments. 
"It's starting to hurt," I said, knowing that was because he was depriving my poor myocardium of much needed blood.
"That's okay, it's supposed to.   You can let it out now."
The pain resolved quickly.  
Okay, now I'm learning how to play this game, I thought.
As soon as I started to feel some discomfort as the next coronary artery was being threaded, I didn't wait.   "It's starting to hurt".   Save my myocardium.
"Okay, you can breathe out."
Ah, now I've got it mastered, I thought, there's a solution to every problem.
The procedure was repeated a few more times, with little discomfort and the monitor show continued.
After a few more thrusts, peppered with light commentary, the show was coming to an end.   
"We are just about coming to the end of this, and I'm going to be thrusting my fist into your groin, to make sure there is no bleeding."  he said. "You just lie perfectly still and we will get these three big strong nurses to lift you over to the stretcher.
Two of the nurses were fairly slight young women and the other was a slight young man.   They picked up the stretcher sheet corners and whooshed me over on to the stretcher. 
No wonder they all have back pain, I thought, knowing that many of the patients they lifted were twice or three times my weight.
A fist was thrust into my groin, applying firm pressure.   The impatient Pirate took control of the gurney with his other hand and wheeled it quickly out into the corridor. 
A couple of words in my ear, "your right coronary is a hundred percent blocked, your left anterior descending about fifty percent blocked, and the obtuse marginal and posterolateral branch of the circumflex eighty to ninety percent.  I think you are a bypass candidate."   This guy didn't waste any time.
No time to wait for orderlies or porter, we headed straight down to the ICU.    Irene was waiting outside the Cath Lab. 
"Are you alright?" she asked me, the pirate pushed on.   "Are you……?" she directed her question to the pirate.
"I'm the orderly," interrupted the man with the strange sense of humour.
"He’s the doctor" said Stan, "this is Irene, my wife."
"Hello," said the Pirate, pushing right on for the ICU, where Irene wasn't allowed to follow.
"I'll see you as soon as they move you," she called out.
And there he stood with his fist pushing into my groin for the next ten minutes.
"Drink lots and wash out all that dye," he said, "and keep lying absolutely flat for the next hour or so.  I don't even want you to raise your head, then we'll move you to the observation ward."
Every few minutes the nurse solicitously bent over me, with a glass of water and a flexible straw.
I gulped greedily at first, but then started to think of the consequences of pushing the fluids too enthusiastically.    I didn't want to have to empty my bladder while I was lying flat on my back, and that was going to be at least the next hour.   Better to wash the dye out a little more slowly, and a little later when I could at least sit up, it might be easier.

A nurse I hadn't seen before breezed into the room.  
"I'm taking you down to the recovery unit," she said, wheeling the gurney out of the cubicle it had been occupying for the last hour.   She got almost out of the unit, when the Pirate swung in.
"Where are you taking him?" he barked.
I wondered if I had just been saved from a hijacking.
The unfortunate nurse flushed and said, "just to the recovery room."
"No one leaves here until they have been checked by me," he commanded gruffly.   "I have to make sure they are not bleeding."
He rolled the gurney back behind the curtain, pulled back the gown and looked into my groin, was satisfied and said quietly, "okay, you can go."
She rolled me to the West Wing, where I was deposited in a two bed ward, the other bed was empty.   Irene awaited anxiously.
“Are you okay?”
“Yes, everything feels numb right now,” I said.
The ward nurse was cheerful and pleasant.  
“You’ve got to drink lots of water," she said cheerily, "wash all that poison out of you.   And I bet you're starving.   What would you like to eat?"
"What's on the menu?" I hadn’t eaten since the day before.
"Sandwiches, cookies, whatever you'd like.   But you have to drink lots, juices, ginger ale, cranberry juice, whatever you fancy.   If you do real well, I'll let you stand out of the bed to pee." She smiled.
This was the best offer I'd had all day.   I gulped down a glass of cranberry juice through the flexible straw and ate a tuna sandwich.   It was a little easier to drink now that I had been promoted to sitting up a few degrees.   What was it that they'd said a few degrees every hour?   I was starting to want to pee. The nice nurse whisked by with the water.  
"Have a nice big drink now and I'll let you stand out at the side of the bed," she said.  
I thought that one over and decided it was a deal.   I sucked down a big gulp of water and looked over at the side of the bed to the bedside table, where amidst the debris of sandwiches and small juice containers, I saw the new, pristine, disposable urinal.   A far cry from the old stainless steel ones, which were handed out when I was a student.   I flipped off the lid and tried it on for size.   It seemed fine.   I swung my legs over the side of the bed, barely sitting on the edge of the bed.   I was lucky my weight was propped on the bed for as soon as I put some weight on the right leg, it collapsed under me.   I tried to feel it; it was completely numb.   Totally anesthetized!   I carefully propped himself against the edge of the bed, put the urinal in place, and was all ready to pee, when the commotion behind the drape that surrounded my bed distracted and inhibited me.   The nurse stuck her head through the drapes,
"You've got a new neighbor," she said,
Irene, who had stepped outside for a moment popped back in.
"Everything okay?" she asked.
"Yes," I sighed, giving up on the bottle, and swinging back into the bed.
Irene sat on a chair near the end of the bed.   The New Man's wife sat on a chair at the end of his bed.  They were nice friendly people; I had seen the New Man come into the intensive unit soon after me.   They started talking to Irene immediately.   I felt overwhelmed with a desire to sleep, so I kept eyes closed and didn't pull back the drape.
I heard them talking and Irene replying, and then I drifted to another place where I was lying on a chaise, on a beautiful sunny day dozing, before diving into David's pool to swim another twenty laps, just to show myself I could do it without any chest pain.
I woke up about half an hour later, and thought I ought to be more sociable.    Just as long as the New Man or Mrs. New Man didn't discover my occupation!  
"Hi," I said to Mr. and Mrs. New Man.
"Hi," said Mr. New Man, "have a nice sleep?"
"Yes, thanks," I answered.   Now I really wanted to go to the bathroom.
"What do you do, Stan?" asked Mr. New Man.
No, I thought, I'm the patient, today, I can’t tell him I’m a physician.
"I work in Mount Brydges," I answered, leaving it there.
Mr. New Man left it at that.
"Is your leg numb?" I asked.
"No, never was."
"Been to the bathroom yet?"
"Yes, the nurse let me go just before you woke up."
 I had a bit of feeling in my right leg now.   How come Mr. New Man had already been allowed the luxury of actually navigating to the lavatory on his own two feet?      Well, I was going to make my own way there.   I slid out of the bed, could feel my right leg ready to buckle when I tested it for weight, found I could stabilize it with my hand, and hobbled the few paces to the bathroom.    There was a convenient bar to hold on to, which made it easy.   Ahhhhh, heaven!
It was easy after that.   I joined in the conversation, checking for sensation in my leg at frequent intervals.  After all, I didn’t want to be in here a moment longer than necessary and the nurse said I would be able to go as soon as my leg would support me sufficiently to independently walk down the corridor and back.
And Sure enough another hour made all the difference and I could indeed walk down the corridor under the watchful eye of the nurse.    She whisked me into a wheelchair and out to the waiting car
"Good luck for your surgery " she called after me as I got into the car.  
Part 2, the Bypass Surgery- next week.

Wednesday, 30 May 2018

The Decline of Canadian Health Care.

   That mainstay of medical diagnosis and of the doctor patient relationship, the annual physical history and examination is  under  attack.   The mandarins of medicine have decided that vital part of medical practice, the complete history and physical examination are non productive and too expensive to be universally applied.    Very sad, because for generations that consultation was the base of the pyramid of medical care.  There, the patient had an opportunity to voice his or her concerns to the physician, whether logical or not, have a hearing and an opportunity to determine whether the concerns were grave or not.  The doctor got to know the patient and the patent got to know the doctor.  The patient and doctor get an opportunity to decide if they are a good fit for each other and if their relationship is productive.   Every patient is an individual and requires some difference in approach and possibly differences in therapeutic approach.  The bureaucracy wants to make everyone the same, except of course, themselves and the elite that they serve.   Most of them have a background in  finance and business and knew nothing about medicine until they entered the political arena, after which they pooled their mutual ignorance to become self designated 'experts'.   They also decided that this was not only a good money making career, but possibly an entry into politics and a very rewarding way to garner votes.  They were prepared to make unrealistic promises that they thought they could bully a humanistic profession to make and they were right.   Early on, many physicians seemed quite happy to go along with promises the administridiots were making because it made them look like heroes too.  Unfortunately, it was not long before it became apparent that the bureaucracy wanted the kudos of providing health care at no costs to themselves.   In other words, they wanted the jobs, the pensions and the votes that a world class medical service would enable without doing the work or providing the services.  They wanted to gain their fame and fortune on the backs of physicians and nurses.  Shamefully, the bodies who should have been looking after the interests of both physicians and patients were timid and ingratiating and served neither the best interests of physicians or patients.   The game is still being played and choosing wisely, a program that could be valuable in helping to define what consultations, tests and investigations are being used unwisely is discouraging that inexpensive baseline of medical practice, the complete history and physical examination.
   No wonder Canadian medicine ranks eleventh out of twelve in the developed countries.
   Tragically, the Canadian public bury their head in the sand instead of demanding change.   Things can only get worse!

Thursday, 24 May 2018

The Intern/Pathologist!



   He had missed the beginning of the Academic year, when all the internships and residency positions were matched, so he knew it wouldn't be easy.  He had arranged an internship abroad, but illness had forced cancellation.   Their meager savings weren't going to last very long.

    In those days in Dublin, teaching hospitals were smaller institutions, totally unlike the huge, impersonal institutions of today.   They inspired a fierce sense of loyalty and pride, and a feeling of competitive collegiality, that doesn't seem to exist today. That sense of loyalty extended as much to recent graduates as it did to professional forebears who had found fame and fortune in the medical texts, as well as consultants and teachers over the past couple of centuries.   So, it only stood to reason that he should start at the Meath Hospital, the breeding ground of such immortals as Stokes and Colles and Graves, many of whom had diseases or syndromes or clinical signs named after them.   This was the hospital he had done his undergraduate studies in so even though he  was out of sync with the clinical year he  was hopeful  that they would find a job for him.
            
     "We were on our way to Manchester, Connecticut, when my wife became ill and we had to turn back," he said to Dr. Pickles, the administrator.  "I know I've long missed the deadline for an internship, but I really need a job.  I can't afford to wait until the next selection date, which is more than four months away."
    "I'll do whatever I can," Pickles said sympathetically.  "All the regular internship positions are filled, but I'll try to find something for you.  Why do you look more familiar to me than most of your class?"

     Stan smiled uneasily, there had been one or two pranks in his student days that might have brought him to Dr. Pickles attention! "I guess you just saw me around."

     "Just give me a day or two.   Why not drop in on Wednesday, I'll probably have an answer for you by then.
 
     Stan  knew why he had looked familiar to him.   It was all about Dr Graves of international fame as the discoverer of thyrotoxicosis, also known as Graves Disease.  A bust of the Great Man decorated the main atrium of the Hospital, which was atop a broad flight of concrete steps.  Dean Eleftry, was an older medical student from Vancouver, BC, who had come to Dublin to study medicine.  He was a nice guy, who everyone liked to poke a little fun at because he was considerably older than the rest of students and also because he spent a lot of time polishing his little old Ford convertible.
      That night, a motley crew of students were heading back to the hospital after a good night at the local pub.  All three sheets to the wind, the older ones handling their booze a little better than the younger.

        "Let's do something with old Eleftry's car," Tom Snowdon said, in a loud self-assured English accent.  "I'm so fed up watching him polishing and nursing it, I think it's time we taught him a lesson."

        "Yes, maybe let the air out of his tyres," Pete Sangster responded.

         "For God's sake, don't be childish Sangster, can't you think of anything more original than that," Snowdon responded scornfully."

        The rest of the noisy group suddenly quietened down, wondering where this was going next.

        "Why don't we carry his stupid little car up the steps and deposit it in the main lobby of the hospital.  That would certainly create a little pandemonium in the morning." Snowdon said.

       Hoots of drunken approval emanated from the group.

       "We'll get into terrible trouble if we're caught," Stan said.

      "Don’t be such a funk," Sangster said contemptuously.

       The herd mentality was kindled and there was no stopping them now.                                          
     "Do you think we can lift it?" Sangster asked.

      "Let's give it a try," an anonymous voice suggested.

            As many pairs of hands that could squeeze around the little car tried to get a good grip on some lifting point and heaved.

            "It's as light as a feather," another responded.

            Twenty or so, able -bodied students lifted the car and slowly carried it up the twenty - eight concrete steps that opened onto the main lobby of the building.   Others held the large twin doors open, while the car was quietly placed in the centre of the lobby.

            "It looks wonderful there," drawled Ronny Snowden, "but it would look much better if we put that bust of Robert Graves behind the steering wheel."

            "Christ,"said Stan, "all hell will break loose."

            A contemptuous glance from Snowden, while  a couple of his followers struggled to get the bust into the front seat behind the steering wheel.

            "Let's put a scarf around his neck and a cap on his head, just to complete the picture," Snowden added.

            One of the more fashionable members of the group volunteered his scarf and rather racy hat which he carefully arranged to give the centuries deceased Graves a decidedly sporty appearance.   Even Stan had to admit that the effect was dramatic.  They stealthily withdrew to the students residence before releasing their whoops of apprehensive delight at their daring act.

            Stan awoke in the morning slightly hung-over and reflected on the previous nights action.  He got up as quickly as he could, anxious to see the damage.  He walked out into the courtyard.  About twenty maintenance workers were laying wooden planks in parallel tracks down the concrete steps.  The car, with Dean Eleftry sitting behind the wheel was purring gently, having just been driven through the twin doors and was now being secured by ropes attached to the front axle, so that it could be lowered slowly down the parallel planks to street level.  A large crowd stood in small groups at various vantage points around the courtyard.  Some laughing, some talking in hushed tones.  Dean was now anxiously supervising the maneuver to make sure his beloved car wasn't damaged.

     The next morning Stan was in the line-up that the students and interns were ordered to attend, when the perpetrators were exhorted to turn themselves in, so that the entire class wouldn't suffer the consequences for the desecration of the venerable and internationally respected [except by us!] Robert Graves.  Of course knowing that there's safety in numbers, no-one claimed responsibility and no-one remembered there ever being any consequences.  Steve hoped that was not why he was remembered by Dr Pickles.




   When he showed up at Dr Pickles office on monday morning he was greeted by a pleasant smile .

"I have good news for you, Smith," he said to Stan.  "Although all the regular internship positions have been filled, there's a vacancy in pathology, that normally would have be filled by a second year pathology resident, that we have been unable to fill, so we can offer that to you for four months and that will bring you into sync with the regular rotations. It will be quite a valuable experience as well as allowing you to earn some money "

            Stan was relieved to have a job, but a little apprehensive about his ability to do justice to a position normally occupied by a person with one or two years more experience than he had.

            "Thank you, sir, but do you think I'll be able to manage it satisfactorily?"

            "Oh don't worry about that.  You'll be working directly under the supervision of Dr. McMurray, and she'll give you all the supervision you'll need.  It will be a wonderful educational experience because there are no more senior residents between  you and your consultant.  You'll get the opportunity to do things that a junior rarely gets near."

            Monday at eight-thirty Stan arrived at Dr. McMurray's office, ready to start work.

            "Good morning," the pleasant -faced middle-aged secretary smiled at him.  Then, in a slightly remonstrative way, added, "Dr. McMurray is down in the morgue doing an autopsy.  She said that you're to go down there right away.  She starts at eight sharp, you know.  Don't worry  though, I'm sure she will take into consideration that it's just your first day."

            "Gee, I'm sorry, I thought we started at nine." Stan answered apologetically.

            "Just take the elevator at the end of the corridor down to the basement and turn left.  You'll see a big gray double door in front of you.  Walk right in."

            Stan followed the directions  and found himself facing the doors.  He turned the handle and walked in.   The smell of formaldehyde was overwhelming.  Standing at the operating table was a woman clad in operating room attire, a scalpel in her hand and so pregnant that she could barely reach the corpse.

            "I glad you could make it," she said irritably. "now get yourself gowned and gloved.  I need a hand."

            "I'm sorry, Doctor, I thought we started at nine.  I should have checked with you.  It won't happen again."

            As he slipped off his jacket and tie and secured the rubber apron that protected him from neck to ankle he felt like a butcher about to butcher a carcass.  He pulled on a green gown, tied it up at the back and stepped up to the mortuary slab.

            "Okay," said Dr. McMurray, "step up here and get another suture around the esophagus, above the one I've already secured, I can barely stretch that far, with this in front of me," she said pointing to her swollen belly.

            Stan leaned forward, still a little shaken from what, in those days was the rather bizarre picture of a very pregnant woman doing an autopsy.

            "Okay, cut right here, between the two sutures, then dissect away from the posterior thoracic and abdominal wall right down to the duodenum, and then cut between the lower two ligatures that I had secured earlier.  That way we can get the whole segment of bowel out, without spilling gastric content all over the peritoneal cavity.  Unless, of course, you puncture the bowel wall.  And, by the way, don't get a fright when Jim starts the saw going.  Jim, this is Dr. Smith," she added by way of introduction.

            Jim was the operating room orderly.  He nodded his head at Stan and smiled.

            "Ah, you'll get used to all this stuff quickly enough, doctor.  Just don't mind the noise."  He added this as he continued a transverse scalp incision and then pulled the apron of scalp forward to cover the face.

            Meanwhile, Stan continued his dissection carefully, anxious to avoid the humiliation of perforating the bowel, let alone the miasmic odors that would follow.  The loud vibrations of the saw cutting through bone provided the background for the next half-hour, while Dr. McMurray carried on dissecting and supervising Stan at the same time.  Following the gross dissection, Dr. McMurray showed Stan how to section the removed organs and place the specimens in formalin for later histological microscopic examination.  They were all finished before noon.

            "Do we have another to do this afternoon ?" Stan asked.

            Dr. McMurray laughed.

            "We don't kill all our patents, you know.  I've assigned you to Tom Morgan, the chief laboratory technician.  A good pathologist has to be able to do and to supervise everything a technician can do."

            Stan thought it would be imprudent to mention that he had no interest in being a pathologist.
            Between autopsies, learning to do routine lab tests, clinicopathological conferences and the general house staff call he had not escaped, Stan kept busy.  He slept in the hospital only when he was on emergency call.   
            For some reason he could never figure out there was an extra small stipend for doing an autopsy and this make a big difference to a penniless intern in those days when an intern got nothing like a living wage.
             So when Dr. McCarthy went into labour a week later, he was more than willing to do the autopsies despite his lack of experience!  

Tuesday, 15 May 2018

O Cannabis - our new national Anthem.

   Canada's claim to fame in the 21st century may well be being the first pot producer on the New York Stock exchange.  Indeed, drug pushing may be one of the very few things we are exceptional  at, as Canada earned a "C" rating in global ranking as investment levels  slump, ranking 12th of 16 developed countries for innovation.    "Indeed" is a job placement agency headquartered in Austin, Texas. Looks  like Cannucks are employing them to recruit for our drug pushing industry,though you'd think that would be something we could do adequately ourselves!!   Read on!  RN/RPN 
O Cannabis Clinic - Scarborough, ON
Full-time, Part-time.Find similar jobs: RN Rpn jobs - O Cannabis Clinic jobs

HERE WE GROW AGAIN!

O Cannabis Clinic is a Nurse Practitioner led medical cannabis clinic. We are growing rapidly and require more RNs & RPNs to join our team!
The successful candidate will:
  • ‪‪Be excited to work in an emerging and evolving healthcare field
  • Be willing to work from home
  • Have a good quality computer (or be willing to get one)
  • Have strong internet connection and webcam
  • Accountable for own actions and decisions, comfortable making decisions within the scope of the position
  • ‪Be passionate about providing exceptional patient care
  • Excellent written documentation skills that are clear, thorough, concise accurate and timely
  • Be in good standing with the College of Nurses of Ontario
  • Have liability insurance
The successful candidates will receive training on company assessment policies, medical cannabis, and the current Health Canada Access to Cannabis for Medical Purposes Regulations (ACMPR), though prior knowledge is an asset.
Responsibilities include:
  • Screening patient charts to determine if patients have met the requirements to be eligible for a medical cannabis consultation
  • ‪Maintaining detailed EMR notes and records
  • Providing counseling and educational cannabinoid information to patients about medical cannabis
  • Performing consistent follow-up with patients
  • Helping with current research studies
Hours & Availability:
  • We have both FULL & PART time positions available now.
  • We have schedules available 7 days per week.
  • Daytime & Evening.
  • Our clinic is open 9am-9pm M-F; 12-5 Sat & Sun.
Job Types: Full-time, Part-time.

Ah well, perhaps some of the taxes that will be generated may be used to prop up our failing health care system as well as generating a whole new layer of bureaucrats!