Mainly events that occur in and around the medical world. Some you need to know about and some you don't. All to either inform or amuse you.
The Toilet Paper Revenge.
A visit to the psych centre.
Our visits soon became routine. we had regular clinics 3 times a week and responded to calls twenty-four hours a day. One or more students or residents attended the clinics to learn how to deal with these difficult and often manipulative patients. The variety of patients were extreme ranging from the xxy ( the bad guys in old monster movies ) who you wouldn't want to meet in the back alley on a dark night, all the way to clean-cut, well-groomed even in prison garb, inmates. All the usual complaints that occur in any practice presented, as well as a large number of manipulators who came to the clinic with some ulterior motive that could range from the desire to get hold of some illicit medications to getting hold of some item of clothing that had become popular (and 'fashionable') among most of the prison population. For instance Nike runners were a high prestige item and inmates often demanded them for painful feet or low back pain. They were often aggressively specific in their demands and they were loyal to brand names so that a cheap trainer would be quite unacceptable to them. Their response, when they were not given what they want could sometimes be violent. Such demands could run right through the institution and if an inmate managed to manipulate such a prescription there would be an avalanche of people with foot pain and lower back pain all needing Nike shoes. Eventually, when I was presented with such requests I had a cover story that they could only be prescribed by a specialist in Orthopedics and I would be glad to arrange an appointment for them but that the waiting time would be about a year. That worked very effectively and usually stopped the request.
One of the common situations was an attempt to obtain narcotic drugs by feigning symptoms. They thought that would result in a prescription for what they wanted. They had other schemes to obtain drugs that they could not get prescribed for them. Visitors entering the institution were screened very carefully because they sometimes smuggled in illicit medications. Indeed the inmates were so successful at getting medications illicitly that the staff carried out searches from time to time. The inmates were cleared out of their cells and a spontaneous search would sweep through the institution looking for narcotics and other drugs. Many drugs were discovered on these searches and on one occasion a search revealed a partially completed homemade still to distill alcohol. Although it never actually succeeded in producing any alcohol, its manufacturer's had made significant progress in its construction before being discovered.
Some of our students were attractive young women and in an all-male institution of this sort, this naturally aroused considerable interest and necessitated careful security precautions
Some of the inmates were only temporarily remanded while a psychiatric assessment was carried out. Those individuals were sometimes released into the community. When they did not get what they wanted, some of these inmates would level threats at the psychiatrists, physicians and or nurses. I recalled one such individual who issued a threat that when he got out he would ‘get’ me. As he was only being held on remand and it was likely that he would be out soon, it left me feeling a little uncomfortable. Shortly thereafter he was discharged. Not long afterwards, I came home one night to find that the trees and bushes in my front yard were draped with toilet paper and my front room windows were smeared with toothpaste spelling out some obscene words. After cleaning up and considering who was responsible, It occurred to me that it might be the individual who had previously threatened me. I went along to our local police station to report damage and danger. I explained the background and that I worked in a maximum-security prison. The police sergeant said, " They didn't do much damage, you were lucky they only used toothpaste and not paint.”
I pointed out that it was not the property damage I was concerned about but the potential danger to my family and myself.
“ Oh well, we'll have a patrol car cruise around your cul-de-sac once in a while and keep an eye out for anything strange.” He didn't seem worried at all. The end result was that my neighbour who had a trailer parked outside his house on the street in our cul-de-sac found a fifty dollar ticket on it a few days later.
"Strange "he said to me.`` It's been parked there for ages and I never got a ticket before. "
I didn't tell him it was because I'd asked the police to keep an eye on our house. I guess they thought they might as well ticket his trailer and have something to show for their trouble. Fortunately nothing ever happened and I never did find out who the perpetrator was, but when my colleague suggested that he lend me his shotgun for a while in case any murderers or rapists break into my house I gave it serious consideration.
The Break-out. (Almost).
As I entered the RPC one morning, there seemed to be a lot of commotion at the entry gate with a line up of individuals with various business to complete waiting to get in. By this time I was well enough known to the guards to push my way ahead to gain entry. There were a lot of officers there.
"What's up," I asked. "What's the big hold-up?"
"One of the guys tried to break out and he managed to get into the area between the inner and the outer fence. He was just starting to climb the outer fence when Gil showed up with a shot-gun, lined him up in the sights and told him he better get down or he'd be shot."
"I'll bet he did as he was told" said I.
"He did," said the guard.
I walked across the courtyard and entered the building. As I approached the clinic I saw Gil, sitting at a desk, typing earnestly with two fingers.
"What are you doing there? " I asked.
"You heard about what went on this morning ? I'm just writing up my report."
I started reading over his shoulder.
"the prisoner had managed to get over the inner steel chain fence and had made his way to the outer fence and had begun climbing it to make his way to freedom. I pointed the shotgun at him and said 'please step down immediately or I will have to shoot you.'
I laughed because I knew that Gil didn't talk like that. "Okay, what did you really say?"
Gil laughed right back and said, " I said 'drop, fucker, or I'm going to waste you! He dropped!'"
I attended the RPC for seventeen years and that was the closest we ever got to a jail break!
The Regional Psychiatric Centre. Corrections Canada.Pt.2.
Walking the Walk.
After passing through the metal detector, the metallic clunk of the lock being released on the inner door, allowed the visitor to begin the long walk across the courtyard to the main building. As I walked across the courtyard I noticed a pretty cozy-looking tiny house to my right that spiked my curiosity. I had to find out its purpose. It seemed all pink and fluffy.
"What's that little fairy tale cottage over there all ?" I asked.
The guard, whose name was Gil grinned. "We call that the 'Fuck Hut', er I mean the 'Love Hut'" he said. "That's where the poor deprived prisoners, er, I mean inmates - they don’t like the erm prisoners here,spend the night for a cosy little interlude when the wife or as they say nowadays ‘significant others’, comes to visit. They can't be denied their conjugal rights, you know."
He laughed again. "One guy's wife phoned a couple of weeks ago to know why he was being allowed to bring in a hooker who swore she was his wife. It's not a bad life here once they get used to it."
As I approached the second set of security doors, I wondered if I was going to have to go through the same routine again but they were expecting me and a loud clunk sounded as someone in security who had been following our progress on multiple video cameras, sprung the release. The tightly controlled security nerve centre, to which I was only admitted once by a friendly guard, was very high tech and any part of the institution could be monitored in detail or locked off, if deemed necessary. Once inside the building, the guard behind the desk said, “Hold on a minute doc, and we’ll take you on a guided tour of the institution and wind up in the clinic where you'll be working. I’ll show you around and introduce you to the clinic nurse who'll be working with you.”
The circular corridor was divided into sections so that any area uprising could be instantly isolated to prevent spread. The large steel gates unlocked noisily as we approached each section and locked equally noisily after we had passed through.
" Very smooth," I said. Canadians were efficient in those days and did what had to be done.
Inside the circle of the building was a large central area where the prisoners were allowed to exercise and in the centre of that area was a beautifully landscaped cultivated area. I noticed one or two men picking daintily at the edge of the turf.
"The prisoners do a really nice job of maintaining these gardens," I said to Gil.
Gil laughed at me again. "This place is maintained by the biggest and best landscaping company in town, Doc. I wish I could afford them. The only prisoners who work in the garden are those who request to do so, provided they are not considered too dangerous. Prisoners can't be coerced into working and those who volunteer have to be paid."
We stopped at a point in the corridor where a locked door on the left had a sign that read 'General Medical Clinic'.Gil pressed a button and spoke into a speaker. "Okay, we're here at the clinic. Let us in."
Again the loud clunk of unlocking. We walked in. I looked around the clinic area. This clinic looked better than my family medicine clinic at University Hospital! The clinic itself was well laid out, no intrusive security precautions apparent and better equipped than my office at University hospital. Corrections Canada is federally funded never seemed short of money, whereas health care provincially funded was always in need.
"This is your Nurse, Doctor Smith,” said the guard, introducing me to Heather, a pleasant young woman who looked about fifteen years old and who wouldn't have weighed a hundred pounds soaking wet. I have a daughter who is a nurse and I couldn't help thinking I wouldn't want her working here. It was a hazardous job but Heather turned out to be a fearless young woman who seemed to manage two hundred and fifty pound six foot two giants comfortably. Thought I, she’s a better man than I am!
"I hope That you always have adequate security when you're working in this Clinic.
“ Oh yes, I have my belt alarm,'' she said, indicating the gadget attached to her belt. “All I have to do is press this button and there's someone here right away. Most of the time there is a guard right in the room with me."
"I think that we'll have to change that a little and tighten up the security. When we are seeing patients there will be a guard in the room at all times and if it is a patient with a violent history there will be two guards in the room and another just outside the door in case we need it.”
"Well there is patient confidentiality to consider, some of the guys don't want anyone hearing about their personal problems," Heather said.
You bet they didn’t!
"In this situation I think our safety is more important than patient confidentiality so the guys will just have to suck it up. If there's any problem with that then we need a meeting with management. Further,if there are investigations or treatments that can't be done here at this institution and patients need transfer to university hospital, facilities will have to be developed to move them promptly, observing all the appropriate precautionary measures necessary. Because these guys will have to be handcuffed and ankle cuffed when they're being taken over to University Hospital and two guards and a driver will be necessary to undertake the journey safely.”
After inspecting the clinic, the team, which had now grown to include a couple of administrative bodies, continued on to inspect the living quarters of the inmates. Each prisoner had what we in the competitive outside world would call a studio apartment. Some of my patients who worked hard trying to make a decent living did not live as well as these inmates.
Next, the nurse shepherded us into the dining room which was more like a middle range restaurant than a jail.
"The staff can eat here too, so if the clinic runs on a little late you could save a little time and then go on to your office, " said Heather, and then added, "You should try to make it on a Thursday," she smiled, "because on Thursday we get steak! That’s a rule. Steak once a week”.
Who said 'crime doesn’t pay?'.
Corrections Canada.
Following a modestly successful career in training young physicians in family Medicine in an era when superspecialization was the solution to all the world's problems, I was offered the Headship of the Department of Family Medicine at University Hospital in Saskatoon, the site of the College of Medicine at the University of Saskatchewan. Generalists In a territory the size of Texas, with a population of 1000000 were desperately needed. The opportunity was too good to turn down and eventually led to becoming the Chair of the Department of Family Medicine and a full Professorship. When I was forty I had taken an academic position as Assistant Professor of Family Medicine which involved teaching undergraduate and postgraduate students and developing a residency training program in the newly built teaching hospital, The Plains Health Centre. It was with mixed feelings that I left the community based partnership that I had enjoyed for fourteen years. My partners were of a caliber I don’t seem to encounter very often nowadays. Hardworking, caring and rugged individualists. We all took our own night calls, did our own deliveries and made house calls. All without whining about how hard we were working and what facilities we could access for burnout!! (What was that, anyway?) We kept our post-partum patients in hospital for five days, because we knew that new mothers needed the rest and weren’t likely to get it at home. When a patient pressed for early release we would reluctantly let her go home on the fourth day and feel we were exposing her to stress.
In those days our heart attack patients stayed in hospital for several weeks and weren’t even allowed to get up to go to the bathroom for the first week. We would look after the elderly at home, making house calls as necessary to monitor their progress. Those were the days before the ‘Health Care Industry’, when being a physician was naively thought to be a noble profession.
I had only been in my new position a few days when my nurse knocked on my office door,.
“Dr. Smith, there are two Mounties here to see you, they say it’s personal,” she said apologetically.
“Oh, they’ve finally caught up with me,” I said laughingly, “show them in.”
Two young RCMP officers came into my office, looking a little uncomfortable.
“We’ve come to pick up your RCMP special constable pass, doctor,” the shorter of the two said, awkwardly.
“Oh, you mean you’re firing me?” I asked gravely.
“Oh, nothing like that, sir. It’s just that our headquarters are in Regina. I’m sure that if we have any medical needs in Saskatoon you’d be the first person we’d be contacting.”
I reluctantly handed over my RCMP Special Constable pass thinking of all the story-telling mileage I’d gotten out of it over the years. Little was I to know, however, that before long I was to be offered another position with the Justice System that would be more interesting, more lucrative and more dangerous than the one I had just given up.
Soon after we had moved to Saskatoon where the Medical School was, I was approached by an old friend of mine from my Regina days. Dr David Williams was a graduate of Cambridge University, who had come to Canada, possibly to escape two ex wives and two sets of kids who’s maintenance kept him permanently impoverished, to the extent that he found it difficult to maintain the lifestyle he preferred. That included wining, dining, skiing and travel. Fortunately his current lady was also a physician, who was well able to support herself. He was a very competent and busy family physician whose itinerant lifestyle was prompted more by personal preference than by any professional shortcomings. In any event, he ended up in Saskatoon as the Medical Director of a maximum security Corrections Canada Psychiatric Institution. (Prison!)
He sat in my office, “So how are you enjoying being the big boss at the Regional Psychiatric Centre?” I asked him.
“The job is actually quite interesting and pays well too!” he responded.
I interrupted, “How the heck did you get did you get a high level administrative job like that, you hadn’t had much administrative experience, had you?
“No, not formally, at any rate. As you know, I did a term as President of the Provincial Medical Association and did interact quite a bit with Health Care Politicians and bureaucrats, regarding various issues. Being fluent in French didn’t hurt either.”
“I wanted to talk to you about a couple of things, Stan. As you know, I’m the medical director of the Regional Psychiatric Centre. I’m quite enjoying the job but I have a couple of concerns. The first is that I don’t want to get so far out of medical practice that I can’t get back into it. I don’t want be an administrator for the rest of my life. I know that you have some community based physicians come in to the clinic and do some teaching, as well as farming out residents and students to community based practice. So, I’d like to offer my services to your department one day a week, doing anything that you feel would be useful in the department as long as it involves patient care. I have done some teaching in the past and had students do a month rotation in my office when i was in private practice. Actually, I got some pretty good evaluations from the students. So do you think there may be something I can contribute that will allow me to continue to have some exposure to patients on a weekly basis. Of course I don’t want any remuneration and any fees that I generate can go into the departmental slush fund or whatever.”
“I have no doubt that you would be a valuable asset to the department. If you can firmly commit to coming on a Monday, which is our problem day to get teachers to come into the unit, I can definitely facilitate you. You say you had a couple of issues you wanted to discuss, what else do you want to talk about?”
“We have a whole phalanx of psychiatrists at the Psych Centre, but we have as yet, no clear-cut mechanism for providing general medical care for the inmates. We wondered if the department of Family Medicine would provide that care.”
“That’s going to provide a considerable time commitment, Dave. There’s no way we could do it on a fee for service basis.” I said.
“We don’t expect you to do it on a fee for service basis.” He mentioned a figure that quickly removed any doubt in my mind as head of a university department with an unhealthy deficit. The Department needed the funds.
I looked impassively at Dave for a moment and wondered what all the wives and mistresses saw in him.
“I’ll have to discuss this with members of the department, but we’ll certainly give it serious consideration. I could see that it could have some very valuable advantages from a teaching point of view,” I said. I didn’t add that it would also have some very valuable advantages from a financial view for a teaching department that was having difficulty maintaining its mission while functioning in the black. Let me talk to the department and think about it for a day or two and I’ll get back to you.”
Experience had taught me never to say yes or no to any idea, no matter how good or bad it seemed at first blush, until one had a chance to think through all its implications.
My decision to follow such a policy had served me well over the years and avoided embarrassment on a number of occasions.
It didn’t take me long to convince Staff and Residents that providing the general medical care for the Regional Psychiatric Centre would be a valuable teaching service as well as providing the financial means to provide some much needed improvements within the Department.
And so it came to pass that Dave became a regular Monday afternoon teacher in the Department of Family Medicine and the Department of Family Medicine became the official care providers of the Regional Psychiatric Centre. We negotiated a start date a couple of months down the road and it took all of that time to get the necessary security clearance and complete the contract. Two of my departmental colleagues and I would alternate coming out to the centre on a weekly basis accompanied by a family medicine resident to hold a clinic and the physician or resident on call for the department would manage out of hours calls.
On January the second nineteen eighty-eight, I showed up at the RPC Saskatoon, federal maximum security institution of Corrections Canada and walked up to the perimeter fence.. This place was for males only - the really dangerous guys. The entire complex was protected by a double ten foot high fence broken only by a single entry point that served as a check point for anyone or anything entering or exiting the centre. Sensors secured the area between the two fences which were sufficiently sensitive to be triggered on occasion by birds or small animals.
The entrance was protected by a checkpoint that was an office with an outer and inner door between which was a security desk and a scanner of the variety which we have all become familiar with at every airport. The security doors were glass in their upper part so that any prospective entrant who rang the bell to gain entry could be observed and questioned as to the nature of their business. Once admission was considered appropriate the visitor was questioned regarding the nature of his business and prior to gaining admission to the institution proper was required to turn out his pockets and empty any briefcase or other baggage to avoid the possibility of anything being smuggled in or out or of being stolen by the inmates. After passing through the metal detector the metallic clunk of the lock being released on the inner door, allowed the visitor to begin the long walk across the courtyard to the building.
Monday 29th Jan.
Met with Dr. Ben-Basud, head of the clinical decision making group at BG . A very interesting man who moved here from Jerusalem to head up the decision making group. We talked about changes in medical education, (he is about my age) and the change from traditional histo - pathologic based diagnosis and treatment, to 'evidence based medicine', which attempts to encourage professionals and decision-makers to pay more attention to statistic -based evidence to inform their decision making and to eliminate traditional or outdated practices. unless to some of the recent Russian emigrants who had been accepted into the FMR program. The Residency here is a four year program, the last of which is, more or less a social service year in which the resident practices independently for the most part, with some general supervision. This usually occurs in the various outlying clinics in the Negev. These immigrant physicians are faced with the task of trying to learn Hebrew and English at the same time- no easy job. Incidentally, they are among the best dressed people I have seen in Israel, where most of the physician are in jeans or cords and shirts. Afterwards I was driven back to the hospital by one of these residents, who was driving one of the nicest cars I've seen in Israel.
