Tuesday 17 October 2017

From the Land of Milk and Honey to the land of pot and drugs!

Canada and cannabals.

Oh cannabis! Oh Cannabals!
From a land of milk and honey to the the Land of Pot and Drugs.
At last Canada is  beginning to get the recognition she deserves.  At last the LWLs are managing to shake our reputation as a dull, staid, hardworking, law abiding, fair, polite population descended from rugged pioneers who braved the harsh Canadian elements to make a future for themselves and their families.  They expected and got no hand-outs but family and friends and other pioneers were always there.  No snowflakes there, no whiners for 'safe space' in case someone might hurt their feelings.  No political correctness.  They did what they had to do and built this great country into what it is today,  or rather what it was until recently.  Then along came a rich boy, with great inherited wealth, posing as a crusader for the middle classes, who never had a proper job. He and his wealthy right hand man introduced tax measures that they made sure to shelter themselves from, while recklessly spending our tax dollars.  Even the health care system matters little to them as long as it doesn't cost them too many votes.  We are at the bottom of the list as far as health care is concerned.  Do they care?  Not a bit as long as it doesn't cost them votes.  I don't want to be repetitious, read my blogs if you want to know more about that.
   One area  in which they are successful is in making Canada, a nation which already has a critical drug addiction problem and alarming statistics regarding narcotics morbidity and mortality, into a drug haven.  Our Trans-National drug smuggling operations are gaining fame and just recently four young Canadians were arrested in Australia and pleaded guilty to smuggling commercial quantities of cocaine.  These crooks crossed all social barriers, one of them being a graduate of the renowned Ivy Business College here in London, Ontario. 
   ‎ Meanwhile, our liberal government is wasting no time in preparing their drug peddling future and making sure they have the monopoly in pot dealing for recreational drug abuse.  They will take in millions and so will a small group of unscrupulous doctors who are  doing that already.  Action from the College of Physicians and Surgeons? Not a word. Shameful!
   ‎ It is no surprise then that the government is getting into the  drug business.  Apart from the millions they will make, it helps them to win votes from a certain type of individual. In addition a stoned population is likely to be much less aware, let alone critical of what's going on.  It embarrasses me that my profession stands by, like a group of lobotomized fopdoodles.
   ‎So let's just carry on and become a land of pot and opioids.  

Monday 9 October 2017

Commonsense and the decline of the Medical Profession!

   For much of my life I was convinced that most of my colleagues exhibited a fairly high level of commonsense.  I still think that was true for at least the first half of my career.   I began to notice occasional nonsensical patterns years ago, but nothing like the present day behaviour.   Almost daily, I read about health care decisions that make no sense other than that it secures and extends the power and position of the government and their obsequious non medical administrators.  I can understand their actions, after all, they don't have to work very hard and they are rewarded generously and look forward to a relatively young pensioned retirement.  It is more difficult to understand the physicians who had sacrificed much of their youth learning the Art and how to apply it, accepting a role that is subservient to a group whose background is largely business/financial and who know and care little about the Art and how it should be practiced.  Populism, does not encourage good medicine, but even the very bodies who were originally devised to maintain the standards and professionalism of medicine have thrown in their lot with the politically correct social warriors.  I speak of such organizations as the Provincial licensing bodies, The Colleges of Physicians and Surgeons and of organizations like the Canadian Medical Association.  
   Examples abound.  In Saskatchewan, a doctor was disciplined for sending threatening emails to a colleague.  The doctor repeatedly called his colleague "an idiot" and threatened to beat him to death!
  His tone rapidly deteriorated and I will give you just a couple of his choice statements.
   "Fucking idiot, Swica.  Don't call me "MUZIMU, (sic) Evel spirit".
   "Idiot, I can stand feces better than you.  You are worse than feces. I just can't stand you, idiot."
   So, what do you think the College did?
   They didn't even have the courage to suspend this disgusting physician for such unprofessional behaviour.  Could it be that they are afraid of the consequences of doing the right thing? They ordered him to take an ethics Course!  The College is grossly derelict in its duties and in commonsense.  They board of the college in question requires basic education in ethics. 

Item #2.  
   The Wonderful Wizard of Oz, otherwise known as Dr. Mehmet Oz, a surgeon who has prostituted his profession to become a snake oil salesman, continues to hold a medical license in the great United States.  This has convinced me of the disinterest of the licensing bodies in protecting the public, a privilege granted them for that purpose.  Instead, they seem much more interested in protecting their turf, their jobs and their power.  (We are no better here in Canada.)
   Dr. Oz (it sticks in my craw to even call him Dr., but I'm from another century!),is recommending cannabis as an 'exit drug' for the opioid crisis.  Because he is a 'celebrity' and one with a medical degree to boot, the public will be raptly convinced that the way out of opioid addiction is pot. It is difficult to believe that the decent, conscientious members of my profession, do not rise up and demand that this snake oil salesman be required to provide proof of such a claim.  The potential for damage of such statements is enormous.  Who speaks out to challenge it?  Very few.  The opinions of the real experts are barely acknowledged.  After all, who would not rather hear that pot cures everything, than that it is just a harmful drug that keeps the masses a little more manageable?

Item#3.  The Good Psychiatrist.
   The opioid crisis and The Good Psychiatrist.
   I read an article this week in a medical newspaper entitled, "How to address the opioid crisis."  It was written by a psychiatrist, who commented that this was the first article she had read that made sense to her in how to curtail the 'opioid crisis'.  Its essence was, 'invest in social capital'.  
the psychiatrist suggests that the best way to address abuse and dependence on opioids is to help communities strengthen the ties between people.  This is 'social warrior' talk, that sounds good until you begin to analyze what it actually means.  It means that drug dependencies are due to factors that communities should seek to address.   She suggested that unemployment and economy difficulties cause a rise in the opioid emergency room visits and deaths.  She suggests society can change to accommodate and make life more tolerable for the unfortunate addicts.  It implies that society is responsible for the opioide crisis.
   Nowhere does she state definitively that no matter what society does, no matter how many injection centres or Narcan kits are available, the final call is with the addict. Unfortunately, my observation has been that despite such measures the problems continue grow. 

Sunday 1 October 2017

An Emergency Happy New Year!

                                          Happy New Year!

        It was my first night on call in the Emergency Room, all by myself, away from the legions of senior supervising residents and  experienced physicians and specialists of the teaching hospital, in a smallish city in Kent.    Me, the brand new intern, alone for the first time and terrified.   

        At half past eleven I had finally seen all the patients and the waiting areas were empty.  It wasn't that it had been so busy, but there had been a constant stream of patients all evening.  New years eve and  I was going to get to the midnight ‘Ring in the New Year' party on West One after all. 

        "Ready for a nice cuppa yet, doctor?" asked Mary Hand, the nurse.

        "No thank you.  Have to leave room for a tiny drop of whisky at midnight."  I grinned.

         "Yes, I'll go down with you for a few minutes and we'll leave Jane to mind the shop.  Then, I'll come back and she'll go down for a while."

          Another patient trickled in with a bad backache that she had had for four years, but seemed a bit worse tonight.  As she was on her way home after the late shift and passing by, she thought she'd drop in and have it looked at. I had no sooner packed her off than the dedicated line to the ambulance service began to ring. Jane came running down to the Cubicle where I was still completing my notes.

          "I just had a call from the Ambulance driver.  They are bringing in a man who has just been hit by a train.  Real bad they say he is.  They’ll be arriving in five minutes."

           I felt a wave of panic pass over me.  Until now, I’d always been in a large teaching hospital, with its hierarchy of students and physicians of increasing experience, capabilities and specialization.  This meant that there was fierce competition when the 'big stuff' came in.  The sharks from the specialty services were constantly cruising the water to see that their trainees were getting exposure to enough clinical material.  Consequently, junior interns were pushed aside, and although present, often didn't get the hands-on experience that is so important. 

         The sirens screamed as the ambulance pulled up to emergency bay.  The nurses had prepared the acute trauma room and directed the ambulance men pushing their gurney into it.  I rushed in, suppressing the overwhelming desire I felt to run away.  The sight that greeted my eyes justified my fears.  On the gurney lay a man of about forty-five, motionless and intact, until my eyes came up to his head.  The scalp and underlying skull were avulsed from just above eyebrows carrying with it a fair chunk of brain all hanging on a hinge formed  by a delicate flap of skin.  It was an injury that no-one could possibly have survived.  That much was immediately obvious to me as I attempted to suppress the gasp of horror that came to my lips.  The two nurses, who had rushed to the bedside with IV fluids and other emergency equipment, also gazed at the corpse in horror.  I didn't know what to do.  Medical care for the patient ends at the moment of death.  But wait a minute; everyone knows that the first thing a physician has to do is certify the patient as dead.  There are three clinical signs of death, dilation of the pupils, absence of heart beat and absence of breath sounds.  As I learned so well in later years, when you don't know what to do, you do what you know how to do.  

         "I called the Senior Surgery Resident.  He'll be right down." Mary said.

         'Don't just stand there, doctor, do something.'  The prevailing philosophy might often better have been 'don't do something, doctor, just stand there'.  But it wasn't, and I felt compelled to take action.  I took my pen flashlight out of my white coat pocket, retracted the blood-encrusted eyelid of the unfortunate dead man and shone the light into the dilated pupil, knowing full-well that he was dead. 

         Just then, a tall well built, blond man, in a white coat, strolled into the room, with an easy stride.

         "I'm Rhys-Jones, the surgical resident," he introduced himself, smilingly, with an Oxbridge drawl.  The he laughed.  "What the hell are you doing?"  He laughed again and then went on. "The man's brain is lying beside him on the bed and you're looking for pupillary reflexes.  You're not going to find any, he's dead!"

         I felt stupid, not for the first time and certainly not for the last.  I knew it doesn't last long.

         "You must be the new intern from Ireland, Lord save us," he said, with a mock Irish accent.  

         "Bejaysus, that I am," I answered, in my mock Irish accent, to disguise my embarrassment because I had very little accent at all.

         "We better give the coroner a call, this will require an autopsy.  Only, of course," he chuckled with a wicked grin, "if you didn't get a pupillary reflex.  And since you have cleared the waiting room, you might just want to stop in at the residents lounge on your way home for a quick glass of Kentish cider."
           I was only too eager to oblige!