Sleepless in London! Anesthesia Department Problems.

One of the worst nightmares of any university department head is to have his department lose its accreditation. After all, the whole justification for the existence of clinical departments is to teach the expertise of which the members are supposed to be the ultimate arbiters and teachers. The humiliation of having a group of carefully selected experts decide that your department doesn't cut the mustard is extreme and the prospect of the department members (and everyone else) working through and addressing the identified shortcomings is painful. I know, I was there once. Although it is rare for provisional accreditation to lead to total withdrawal of accreditation it can do and the re-assessment in two years time had better show that most if not all of the recommendations addressed have been carried out. Otherwise you may be out of business!
So I was more than a little surprised to read in my local newspaper that the accreditation team found that the anesthesia program at the esteemed (they told me so themselves) College of Medicine of the university of Western University not worthy of full registration.
There are numerous reasons why a department may fall short of meeting some of the requirements, many of them not related to the standard of medicine practiced though that of course is a prime concern.
The prestige of the teaching program as well as the performance of its students in national qualifying examinations is another. The excellence of the program as perceived by the participants is crucial. No resident wants to be in a program struggling to maintain its accreditation.
The contribution that the department makes to new scientific knowledge is reflected in numerous ways. Clinical research resulting in publications in prestigious medical and scientific journals, particularly those with an international reputation is the most desirable, but there are other acceptable if less envied ways of enhancing the departments stature. For instance the development of new teaching or evaluation methods, or advancement of practice techniques may make significant contributions and be recognized as such.
Administrative issues can play a major role in determining the success of a department. A well run department optimizes recruitment of quality faculty and residents which further enhances the department and makes it desirable to subsequent excellent candidates.
It will probably be a few weeks before the accreditation report is published. It will make an interesting read to an old has-been department head!

Not the Canada I emigrated to!!

Canada has changed greatly since I emigrated to this country in 1963. I had the good fortune to move here at a time when the pioneer spirit was still alive and well in many Canadians. I moved to Regina, Saskatchewan and my family and I received a warm welcome in that cold climate. The people were tough but very friendly and helpful and there weren't many wimps around. Folks worked hard and a -40F (which is where Fahrenheit and Celsius meet) day was lightly referred to as 'a brisk day'!  People were caring and efficient.
Things have changed greatly!  
A few days ago I went to the Post Office to buy a few stamps. The man behind the counter said, "Sorry, we're out of stamps."
I gazed at him blankly, wondering if I had somehow misheard him or he had misunderstood what I wanted.
"Er, just ordinary local Canadian stamps!" I said.
"Yes, we are out of them!" he smiled blandly.
"I'm not looking for Collectors sets or anything," I reaffirmed," just ordinary stamps".
He smiled some more. "Yes, we are out of them," he repeated. 
"When will you have some in ?" I asked.
"I don't know," he said, shrugging his shoulders. 
I had a letter in my hand I wanted to mail. "How about one local stamp, I have an important letter I'd like to mail now?"
"I can let you have an international stamp," he said, "but it will cost more."
"No thanks," I said, and walked out.
No wonder the country is going down the drain!!

The very same day I needed to get my multiple medication prescriptions refilled.
I phoned the drug store. It was Saturday. One of my prescriptions, a rather vital blood thinner that I have been on for years had run out of repeats. Somehow it had gotten out of sync with my other meds.  
"Sorry, we can't refill this until we get a repeat prescription from the doctor."
"I have run right out of them. I have been getting them from you for years, can you give me a few until I get the doc to phone in a renewal?"
"Sorry, we can't do that, we'll fax the renewal over to the doctor and you can get them as soon as we hear from her."
"Yes, but it is only Saturday, by the time that will be ready it will be Tuesday. I can't wait that long." said I.
"We can get an Emergency Pharmacist Prescription in circumstances like this, but it will cost you $15."
I objected to that on a principle that I don't want to go into here.
"I'll phone the doctor," I said.
I phone the Western University Family Medicine Unit, the teaching clinic where my doctor practices.
"Hello, I urgently need a prescription to be refilled. Can i speak to the Resident on call ?" I know there is a resident on call - I used to run a Department of Family Medicine.
"I'll put you through to the Nurse on call."
"Are you a Nurse?" I ask.
"No, we are a call centre," she answers.
"And where are you located ?" I ask out of morbid curiosity.
"In Northern Ontario." she answers.
"So you can't put my call through to the resident on call ?"
"No, I can only have the nurse on call phone you back."
Okay, I say and give her my phone number.

  A while later the nurse calls me back. Pleasant, polite and helpful, but she has to go through the whole history algorithm which takes a considerable period of time. Although I had been on this medication a very long time, from this same pharmacy and was just requesting pills to tide me over for a few days, their failure to exercise a modicum of commonsense resulted in five people wasting time. To cut to the chase, the nurse informed me she would get through to the resident on call and ask her to call the pharmacy. She would call me back to let me know I could pick up the prescription right away or if there was any obstacle. This she did and I got my prescription.

This is Monday and I stopped by at the local Canada Post Office to pick up the stamps they were out of on Saturday. They were still out of local stamps, but were expecting them in any minute!!   I went to a local chain drug store. They had all the stamps I could use and would give me discount on seniors day, to boot.

I guess free enterprise really does work better.

A Geriatric Night in the Emergency Room.

There was hardly anyone in the emergency room that night. We sat in the sparsely occupied emergency department that looked like a bus station at 3 a.m. waiting for the triage nurse to assess my wife. It was six o'clock an I guess everyone was having their supper, including the staff. My wife had fallen down the basement steps and for all they knew could have been hemorrhaging to death. Still, after only half an hour or so sitting dazed in the wheelchair, someone came out to triage her. The girl looked about sixteen and I asked her if she was the triage nurse. No, she said. She was the student triage nurse. She did a good job. She asked the routine questions that I won't bore you with right now and then politely vanished into the night without further comment.
Ah, good, I thought. My wife will soon be seen by the Doctor. We sat and sat. An occasional patient drifted in, otherwise nothing seemed to be happening apart from an occasional patient drifting out. Not like any emergency department I had worked in, and I had worked in quite a few. We hadn't had any supper so I bought an exorbitantly priced bag of potato chips from a vending machine. After that my wife needed a drink (I needed one too, but not of water!). I found a water-vending machine. A small bottle of water cost only $2.95. (A similar sized bottle in Costco is 25c! ) Outrageous - in a hospital yet!!
After only an hour we were called out of the waiting area to have the whole history taken again by the triage nurse as well as a cursory medical examination. This was the real one, not the student! We were ushered back into the waiting room as the triage nurse had identified that my wife was still alive!! The same few patients were still sitting there - none looking as though they needed an emergency room. It was approaching nine pm, my wife and I were getting restless and irritated.   "I'm leaving here and going home if I'm not seen by nine pm." said my poor battered bruised wife who was now exhausted by being in a sitting position for three hours. She had once several years earlier been in the same ER following a severe accident resulting in facial fractures and had insisted on leaving after waiting many hours before being seen, regardless of the consequences. At least on that occasion the ER had been very busy. On this night there was nothing happening apart from an occasional patient drifting in and out.
At about one minute to nine we were again called into the assessment area. This time the young man who assessed her was the medical student. The history and medical examination protocol was again followed. After only a further hour my wife was seen and examined again, this time by the medical resident. After this she (the resident) assured us we would be seen shortly by the Emergency Room Physician. By now my wife was lying on a gurney in a cubicle in the ER, three of the four walls of which were a thin curtain, so that every word of the discussions taking place in the bubble on either side of us seeped through the drapes. So much for the alleged respect for privacy that we hear so much about!
Less than an hour later, the ER Physician appeared in person. He was a pleasant man in his middle forties. The history and physical examination were, of course, repeated once again but this time concise and to the point.
"Looks like she is alright, but we better do a CT scan and a few X rays. Accidents like this kill old people," he said, not unkindly.
So, after shuffling around at home for a day and sitting in a wheelchair in emergency for several hours the patient was placed on a rigid fracture board and neck collar, so as not to transect her spinal cord, while the X rays were performed. In terms of subjective suffering that's when the acute phase began. The scan and x rays took about an hour but she had to remain immobilized until the results were available and interpreted, which involved another hour. Those two hours were by far the worst part of the whole experience, both because of the acute discomfort of the hard board and immobilization and some temporary but very frightening visual disorientation and vertigo. Eventually the ER physician came back with the good news the CT scan and x rays showed no brain damage or fractures.  
At twelve thirty am, six and a half hours after our arrival, we were on our way home. We knew the game had changed, permanently.

Come back here for further episodes of 'geriatric adventures' in the near future .

"Doctors, get your affairs in order!"

   "Doctors, get your affairs in order!"
       Screamed the op ed piece in the my favourite newspaper, The National Post.   Because I have spent much of my professional life training physicians, I read the article with considerable interest.
   The article was written by an unfortunate journalist whose wife died of a very aggressive malignant melanoma.  Treatment options were very limited and the tumour metastasized relentlessly to her brain.  The author was particularly outraged by the Radiation Specialist who they had never met before.  He came in to share the MRI results with him and his wife.  He gave it to them straight -a little too straight.  Unlike Drs in the past who often avoided the discomfort giving bad news always causes, by just not giving it, physicians understand nowadays that patients want and are entitled to the truth.  There is no way to make bad news sound like good news, but there is such a thing as beating the patient over the head with the truth.  Even the most unpleasant truth can be conveyed with compassion.  "Get your affairs in order is not such a message."  Such a statement is not necessarily arrogance, nor deliberate callousness.  It is often lack of communication skills in a technician who happens to be a health care specialist..   The specialist's opinion was that she had about four to six weeks to live without treatment, maybe three months with radiation to her brain.  After almost sixty years of medical practice, I know there is no way to make bad news sound like good news, but prognosticating in such a definitive fashion is often very inaccurate and decimates the sliver of hope a patient may be hanging on to.  A tiny bit of hope is better than none - and there is always a tiny bit of hope!        

   Patients recognize compassion when it is present and equally recognize its absence.  After delivering the catastrophic news, the physician added, "Get your affairs in order!"  The husband was enraged and insulted.  "Who are doctors to assume such arrogance to themselves?" was his retort.   He went on to say that the only affairs of his wife that were out of order were her medical affairs. 
   He was suffering greatly from a horrible, cruel, acutely painful and unreasonable situation.  Coming to grips with that sort of tragedy is inconceivable. But human beings in suffering, often feel that there must be someone or something responsible for their suffering.  We do look for somewhere to place the blame and often the doctor or nurse is handy. When the health care worker is less than skilled at communicating it compounds the problem.  It often makes them seem indifferent or even callous.  Not all people enjoy the gift of caring communication which in a health care worker is a particularly egregious problem.      The bereaved, in such circumstances cannot conceive of the physician or other health  care worker as being uncomfortable or even grieved and just not knowing how to convey the bad news to the unfortunate victim and/or their family.  Physicians used to be experts at communication with patients.  They spent hours listening, interpreting and explaining to patients the nature of their disorders, their significance, their management and the likely outcome in so far as they anticipated.  In other words Physicians and patients were at one with each other. They were on the same side. The relationship was not adversarial.  I never feared a legal suit because I knew most of my patients were on my side, just as I was on theirs.  There was no 'one complaint per patient', no ten minutes per visit, no 'appointment in six weeks', whether you needed it or not.  An annual 'complete physical examination', was a medium for the physician to become familiar with the patient as an individual and his individual complaints.  It was also an opportunity for the patient to get to know the physician and his/her approach and for them both to get the right match.  It was an indispensable component of thorough medical care, cost a pittance and we have allowed the administridiots to legislate it away. 
   All those things don't seem to matter any longer and we wonder why there is 'no service' anymore.  
   Perhaps it's time for the whole health care system to put its affairs in order!

   Comments welcome.

Poor Parenting!

Incompetent parents and Rapacious Lawyers.

The parents of two children in Canada filed a legal notice against Epic Games that likens the hugely popular game to major narcotics.  They claim that the game ‘Fortnite’ is as addictive as cocaine, morphine, fentanyl etc. They are being encouraged by money hungry lawyers to launch a class action lawsuit. 

   "Epic Games, when they created Fortnite, for years and years, hired psychologists - they really dug into the human brain and they really made the effort to make it as addictive as possible," Alessandra Chartrand, a lawyer with Calex Legal, told the Canadian Broadcasting Corporation.  She went on to claim that the merchandisers of the game did all they could to make the game as desirable as possible (isn’t that what every manufacturer does with their product?) and that the poor parents who came forward said that if they knew it was so addictive they would never have let them start playing the game or at least they would have monitored it a lot more closely!  They went on as though they had no role or responsibility for any of this, when they were clearly the enablers. 

   A word about these parents.   After fifty-five years of general practice I know a thing or two about this topic.  I would have been able to identify the syndrome when the family brought the kids in for their pre-school check up or for their immunizations.  When some families came in to the office, it quickly became apparent that the kids were the boss, not the parents. I remember one mother giving her three year old her cell phone to shut him up so that she could talk to me.  I remember the kid throwing the phone (a considerable upgrade from the one I was using) across the room. I remember saying “he’ll wreck the phone” and the response,”it’ll keep him quiet for a while!!” I remember I used to keep my kids civilized by giving them a slap on the bum when necessary!  Not often, but when it was necessary to prevent them from running into the ongoing traffic, both literally and metaphorically.  

    Ah yes, I am proud to have been ‘politically incorrect’ for much of my life.

    So, I would say to the ‘Fortnite Suers’: “look at yourself, you bought them their the games, or at least sanctioned them and failed to control their use.  If you didn’t recognize that they were spending hours gaming everyday you are either incompetent or indifferent or both. Or maybe just glad to get them off your back. If you did recognize it and failed to stop it you were worse than incompetent.  Perhaps it took the smell of litigious wealth generated by some rapacious lawyers combined with the relief of shifting the blame for your negligent parenting to the gaming company."

The parents case:

"They knowingly put on the market a very, very addictive game which was also geared toward youth. In our case, the two parents that came forward [said], 'if we knew it was so addictive it would ruin our child's life, we would never have let them start playing Fortnite or we would have monitored it a lot more closely."

Ms Chartrand likens the case to a 2015 class-action lawsuit against big tobacco companies that accused the firms of not doing enough to warn consumers of the addictive nature of smoking. No comparison!

   Let's see if our legal system will continue to reward inappropriate behaviour.  I'm afraid I already know the answer!

Parking in Toronto - a cautionary tale!!

Parking in Toronto - A cautionary tale!

  

    A few weekends ago we went to Toronto to spend a couple of days with some family who were visiting from the other London.  We know them well and looked forward to catching up on all the sort of family news that we ex-patriots often miss.  We booked into a hotel that we know and that is fairly central.  As  Irene and I were only staying overnight, the plan was to chat away for a couple of hours in a large foyer area behind the hotel and then go out to dinner.  My daughter and son-in-law live in Toronto and since there were four visitors and four of us we were taking two guests in each car and heading out for the restaurant. 

    Parking in Toronto as in most big cities is a nightmare. The underground parking lot for the eighteen story uptown hotel we stay in is huge being shared as it is by the hotel, the public library, several businesses, banks and a myriad of other establishments.  It burrows underground for four stories, in extremely tight corkscrew turns and every time we have stayed there part of it is under construction.   The exits are hard to locate and open into several different buildings and several different streets.  I always have great difficulty in locating my car no matter how carefully I document the letters and numbers that are supposed to lead me to it. 

   Bill, on the other hand leaves his car on a side street across from the hotel.  He has always parked there and seemed to find a place relatively easily.  So much so that I have contemplated parking my car there to avoid the inconveniences of negotiating the parking lot.  Fortunately, I have never done so.

    After innumerable coffees and chats we decided it was time to head out to the restaurant where we were dining.

    "I better come down to the parking lot and help you find your car," said Bill considerately.

    "Thanks," I said, happy that the big city guy was going to help this country bumpkin to find the car.  Or so I thought.

    We burrow four levels underground sand emerge in a metal concrete cemetery the size of two football fields.  All the directions I had so carefully recorded are totally meaningless.  We walk around and around to no avail. There is not another human being in sight.  Just as we are beginning to despair a young woman pulls into one of the few parking spots available in that huge jungle.  We walked towards her careful not to appear threatening.  (After all two old fogies advancing on a young woman in a deserted lot.).   Fortunately she was unperturbed.

   "We've lost our car," said I. "I thought I had this lot mapped out.  We have no idea how to find it. Can you help us?”

   I showed her the map I had drawn on a piece of paper.  She looked at it and laughed. “I’ve been parking here for five years, your map isn’t too good but with the letters and numbers I have an idea where you might be.  The easiest thing will be for me to take you there.”

   She did.  Thank’s Ma’am, or we might be still there!

   “Okay,” I said to Bill. “I’ll meet you up front where your car is parked and we can load up the two cars.”

   With considerable difficulty I wended my way up four very tight spirals and eventually merged into the street.  I pulled up outside the hotel where my three passengers were waiting, loaded them into the car and waited for Bill and his three passengers to draw up in his car.  We wait and wait -no car, no Bill. Eventually he appears leading the other three.

   “Stan, I left my car just over here, didn’t I ?  Or was it around the other side of the hotel? I can’t find it.”

   “You left it just over there.” I pointed.

   “Well, then it has been stolen.” he said.

   I got out of my car and we crossed the street to a row of parked cars where we thought he had parked his car.

   “Unless it has been towed ?” he said anxiously, “but there isn’t any no parking sign, is there?”

   “No”, I said, looking around carefully.   Then I saw it!! A very tall light pole extending almost to heaven.  Right near the top was a postage-stamp sized sign that read: No parking 3pm -5pm.  It was barely legible to these old eyes, but there was a sign so no basis for appeal.  Instead of just ticketing the car, the miserable SOBs towed and ticketed the car leaving no notification of where it might be towed to.  It was getting late so we called a cab to take the carless group to the restaurant, and poor Bill spent the dinner time on his cell phone trying to track down his car, which he eventually did.

   Cost of car retrieval: the towing company charged $300 to release the car, the City of Toronto added a parking fine of $150.  

Bastards!!

Parking in Toronto - A cautionary tale!

Butterflies and Computers.

The Butterfly and the computer.

       He had been my closest friend for years, through all our school days and beyond. We had lived right across the road from each other and were inseparable. Although our paths diverged dramatically after that, and we no longer had anything in common, whenever I came to Ireland or he came to Canada or the States, we went out of our way to get together. I guess we still had enough left between us from the old days to feel close.  Now that I was established and comparativelt I stayed at the Gresham, a fine Hotel I couldn’t have imagined in my younger days. Later he told me his only previous evening at the Gresham, was a visit t o a rich grand uncle who reputedly died of malnutrition, because he was too mean to eat.  

"It's nice to see you," I said, trying to remember the last time I had seen him.   I think it was the bar at the Lincoln years earlier, or maybe Davy Byrnes. Both were a safe bet..   I had phoned him a few days earlier, asking if he’d like to get together with me for a drink. He arrived alone.

 "and how is Anne?" I asked, surprised that she wasn’t present.

  "Oh, she's fine, asks to be remembered to you." 

"Good,” I said, though I wondered if something might not be quite right between them.  He seemed a little uncomfortable and when you are a psychiatrist specializing in marital issues you anticipate problems everywhere.

“Oh no, Things are going well between Anne and me, but I’d like to talk to you about my brother, Matt."  

   I remembered Matt well. He was the younger brother who was always hanging around and getting in the way when the big boys were having fun.    He had gone into the small upholstery business their father had built. 

"Yes, I seem to remember him re-upholstering some furniture for me when I was a resident.   What's he up to these days?

"Things are not good, he's getting a divorce."

"No!”

"Yes."

"Oh dear!" I understated, surprised "And they had three or four kids? What happened?"

"Four kids, I don't really know what went wrong but I know Matt would really like to talk to you. He always thought the world of you.   He always said that if he had the chance, he would have become a psychiatrist himself.

   "Ah yes" I said ironically, "lots of people say that. So what happened?" 

   "None of us really know.   They always seemed like the perfect married couple.    Even their names had a rhythm, Matt and Mady. None of us in the family had ever heard them raise their voice to each other.  In fact everyone in the family, and I think, outside it too, thought they had the perfect marriage. 

   But one day, Mady came  home and apparently said, out of the blue, "I want a divorce." When I asked Matt what went wrong, he said he said that Mady had fallen out of love with him some time earlier and that  he didn't want to talk about it. Then, when I heard that you were going to be in town and I mentioned it to him and suggested half jokingly that it mightn't be a bad idea for him to talk to you, and to my surprise he said he thought that it would be a good idea, So I wondered  if maybe for old times sake you might see him. He's in pretty poor shape."   

  Matt came to see me and sat across the table from me in the bar at the Gresham.  It was the perfect therapeutic milieu and after the usual niceties, we got down to business. 

   “You know, Rory, she was seventeen and I hadn't quite turned sixteen when we started going out together. Everyone said we were too young to get seriously involved. But you know what it's like when you are that age.  You just know that you're madly in love and the raging hormones do the rest. I had planned to go to University but by the time I was 18 I couldn't see us waiting another five years to get married. In those days, you didn't get married until you could support a wife.   So I went into my father's business which was doing quite well in those days. We got married right after I turned 21 and thought we were going to live happily ever after. Unfortunately, it didn't work out that way. I don't understand it. We were so madly in love.   

  Mady desperately wanted to go to University and wanted to get a degree. I'm not sure exactly sure why, but it seemed to me like a little more than being simply a quest for knowledge.  Perhaps it was something to do with self esteem. She always seemed to feel that life owed her something."

   I interrupted, "were you doing badly financially then?”

   "Things were not going as well as well as we expected, so we were having a bit of a struggle," Matt answered.

   "And what sort of home had Mady grown up in?"

   "Her da was a small businessman the same as mine, although considerably better off.  He was a nice little man and I always quite liked him. Her Ma was another kettle of fish altogether.   She was a real basket case and thought she was a fancy lady who had married beneath her.  

   Meanwhile, the kids kept coming along and by the time  we had three, Mady still wanted to complete her BA degree.  What she intended to do with it was anyone's guess. 

   "I don't get it, what did Mady want?"

   Matt was silent.  He seemed deep in thought. 

   "I'm not sure," he said, somewhat pathetically.

   "So what happened when she finally did get her degree?" I asked.

   "I asked the same question myself," Matt said. "I thought she might want to go out and get a job and help us to pay our bills.  When I suggested that she seemed shocked that I could have such expectations.

  ' I need to get a Master's before I can do anything like that, she said indignantly.'

   So what could I do? " 

  "How did she relate to kids?" I asked, changing the subject. 

   "She was great with them," Matt said.  "She had a certain child- like quality herself, a sort of naïveté that could be very endearing.   But along with that went certain peculiarities."

   "Such as?" I asked my curiosity piqued.

   "We were never allowed to discuss age in our home, it was an unmentionable.  Then, she developed some very peculiar friends at university. Don't forget she was older than many of the kids she was friendly with..  So she had a quite a few followers who were in our house more than in their own. To be honest, I sometimes found it quite irritating, I think it  flattered her that they loved to hang around her and thought everything she said was so profound. I found our friends growing reluctant to visit and I was tending to spend more time with the boys at our local pub. ”

   “You told me a few minutes ago about how madly you were in love with each other.   There must have been some point at which you both realized that things were changing.   When was that?” I asked.

  Matt thought for a while.   “I don't really know, I can't think of any one thing.   We both always wanted kids, and enjoyed the same sort of things.    Somehow we seemed to go two different ways, despite that. Sometimes, I thought it was because I didn't make enough money, and life was turning out to be tougher than we had anticipated.    I had always planned to go to University too, and even when I went to work in the business I had some really unrealistic ideas about making enough money to save for me to go to university and by that time Mady would have got her degree and would help me just like I helped her.   Sometimes we'd talk about that, at least I would bring it up, and I could see she didn't like it. Sometimes, it would end in a bit of a row, and she would say I resent it because she is going to university and I'm not. When I got to thinking about that I could see that maybe she was right, and that made me even more resentful.   So I thought maybe if I could make a bit more money I could put some away and then I'd be able to afford to do what I want. I started working a bit later in the evenings and sometimes going back to work after supper. After a while I began to get annoyed that some of those evenings when I made it home, there was no one there, or worse, a bunch of kids sitting around that I had to get rid of.  .Later when our kids started coming along there was often a babysitter and a note for me to say my supper was in the oven or the fridge, and to help myself. So I started going for supper with a couple of the lads who scooted down to the local pub for a pint or two and some fish and chips or some bangers and mash. Eventually we were both spending more time apart than together, and often, even when we were in she had some student friends over, or I had a couple of lads over for a game of poker.   Much of the time when we were together we were fighting anyway, and the rest we were doing duty things, family and kids, you know what I mean.    

   "I was spending more and more of my spare time with guys I worked with or other business associates.  In particular, I was palling around with Frank Hodgkin’s, a guy I had employed three or four years earlier and made him manager of the business which was growing slowly but steadily .   Frank was always making suggestions about how to modernize the business, and for a long time I would give him a polite hearing and then forget about it. Now, I was paying more attention to what he had to say. Modernize, modernize, modernize were his three favorite words.  I wanted my business to thrive And now I was interested and paying attention to what he had to say.

   "We need to computerize, Matt," he would say.   "We have to get into the twenty-first century."

   "I don't know anything about computers, Frank.   I don't see how they can help an upholstery business."

   "There are lots of ways.   For instance, remember when we were held up three days completing an order last month because we had run out of spring units and it took that long to gel them.   Now if we had a computerized system, that could never happen because you would be automatically made aware of a low inventory."

   "Okay, So what else can your computer do?”

    "What do you want it to do?  That, Of course is the crucial question.   Some people want computers to play games, others want them to make their business more efficient.   For instance, even you must how noticed that almost every business now has a web site. Now, why do you think that is?"

   Matt thought for a minute as though there must be a catch in such a simple question. 

   "Advertising!" That's what we need to do -advertise!"

   "Yep! It's as simple as that. And we've got to get with it if we want to survive."

   So get with it we did. 

   And that’s when I really started working on how we could use computers as a tool to start making our business more profitable.   Up to this time I had nothing much to do with computers, or technology in general. In fact, my father had this antiquated idea, that if you built a better product, people would be beating a path to your door and success and fame would await you!   Instead, the business slowly but steadily declined and our competitors were getting into prefabricated units that cost half the price. Sure, they weren’t the same quality, but who cared if the product was cheap enough.   

   To cut a long story short, I began to immerse myself in computer technology and the technology of our business.   Now that I realized what Luddites my father and I really were, I determined to make up for lost time.

   First, I registered for a couple of courses in basic computer skills and it wasn't long before I was ready for elementary web design.  When I got our website up and running I soon started seeing some business coming in, in response to the advertising. So between work and web, Mady and I saw less and less of each other.   Sure, we had meals at the same table, but with the kids yelling and competing for attention, we seemed to have less and less time to talk about ourselves and even when we did, it mainly took the form of bragging to each other of our respective achievements in our chosen fields.  We both talked, but no-one listened. Occasionally, we made an effort, and with the best of intentions we went out to dinner together. I suspect both of us had a certain amount of anticipation that we would resolve some of our issues and go on to a better future together. Instead, after a little beating around the bush, and avoidance of unpleasantries, and a few glasses of wine, we both seemed to come to the conclusion that avoiding any of the delicate matters that might spoil the evening was the most important thing.   Nothing should prevent the prospect of the evening ending in blissful sexual union that might solve everything, forever. So we concentrated on the wine and sex and that solved everything, for a day or two! Our fascination with our interests, our careers and ourselves was all- consuming and by the time we had taken care of the kids, we had nothing left over for each other. I guess I would have been satisfied to drift on like that forever. I had an uneasy awareness that things were not ideal, but I managed to sublimate that without too much difficulty.    I was totally astounded when Mady announced that she wanted a divorce.   

‘A divorce?   Why would you want a divorce?’ I asked her.

‘Because there is nothing left in our marriage anymore’ she replied.   ‘We are like two strangers. Sure, we have not bad sex, once in a while, but there’s no real warmth there, no cuddling, no holding hands, no holding each other close, just because we want to be close.   You resent that I want to make a career for myself instead of just being a good little wife. You can’t help it, you don’t even know you resent it. But I can feel it. I just don’t want to live like this for the rest of my life.   I want someone I can share my life with." 

         I had been listening to him without comment for several minutes, now I asked,

         "Why were you totally astounded?”

          "I just didn’t think things were that bad.   We were both doing what we wanted. We shared the kids and I think I did my share of the day to day household chores.  So I thought we weren't doing too badly and that eventually things would settle down and that we would carry on as before.  I really had no idea that Mady was so desperately unhappy. When I realized that it was too late. I talked to her about it and even suggested that we go for counseling.   She said that our marriage lacked all warmth for a long time and that it couldn't be repaired."

         "You know, Matt," I said, ``There's a story about a butterfly and a rock.   The butterfly is flying around the rock looking for somewhere soft to land, but the rock doesn't have a soft spot to offer, so it may never be possible for them to live together in harmony.   Maybe that’s the way it is with you and Mady."

          “Maybe it is,” he responded. “But what should I do about it?” he asked naively.

   I gave him the standard psychiatric parry. “What do you want to do about it?”

           “I don’t really know,” he said.

    Right there and then I really did know, but for once, I remained silent, because I knew I could do nothing to help.

       It was about a year later when I heard they had gotten a divorce.

Just Plain Poor Health Care - the decline continues!

   I am reblogging this piece from two years ago, prompted by some of the horror stories that have been shared with me lately that would indicate that the decline continues, nay accelerates!
I will share some of these stories later, but it would not be appropriate to do so right now.  Meanwhile, just re-read and if you have any horror stories (or wonderful ones!) share them with me.

 Someone finally had the guts to come out and say it!  Brian Lee Crowley, of the Financial Post, on July 5th had the appalling honesty to say what many Canadians know but don't even like to mention, or hear mentioned by others, that we have one of the worst, if not the worst health care system in the developed world.  The heading of Crowley's article is :
     "This report just shredded every myth claiming Canadian medicare is superior - or fair"
  The report he refers to is the report of the Commonwealth Fund comparing health care systems in the rich industrialized world and it is regarded internationally as being highly reliable.
  The humiliation of having deteriorated so rapidly from  among the best to the present sad state is so damaging to the pride and hubris of those who boasted 'one of the best health care plans in the world' that they can't cope with it.   There are some who still think that, but it only testifies to their lack of knowledge or contact with the system.  I know that occasionally folks have good luck but the majority of people who have to depend on the health care system are poorly served.  I also know that there are those who know how to manipulate the health care system and that there are the 'elites' who push their way to the head of the queue.  No politician or bureaucrat or their army of administridiots stand in the line with the rest of the folks.  Oh yes, they will claim all are equal, but as George Orwell said, "some are more equal that others!"  The fairness that they boast of doesn't exist.
   How is it, you may ask, that we declined so rapidly from the best to the worst?  Regardless of the fact that we spend a fair amount of money we get poor value for it.  A very disproportionate amount goes to paying armies of civil-servants, many of whom are neither civil nor serve very well.  Most are not health care professionals of any kind and of those who are, few have real experience serving in the front lines.  They attend meetings where they like to hear the sound of their own voices and are frequently resentful of health care professionals who are wiser and more experienced.  Large amounts of money are sequestered to provide generous pensions and benefits. 
   Many of the administrative services that were intimately related to health care were for years provided by doctors and nurses on a pro bono basis - they did it without any personal reward other than that they cared.    They were committed individuals, usually with extensive experience in many aspects of health care.  Most of them knew what worked and what didn't.   Today many hospital administridiots have come up through the financial/business ranks and know nothing about health care but consider themselves experts anyway.  
   Because our government is not interested in individual health (unless it's a glamour story) but in votes, they have directed resources away from individuals and towards populations from whom they think they can win the most votes.  They play the 'statistics game' and the 'evidence based medicine game', they reward doctors for doing what they and their 'statistical experts' tell them will be cheap and effective and they penalize physicians for spending time on individual patients.  The fee schedule has been manipulated to make doctors do what the government want them to do and the Canadian Medical Association  and the licensing bodies has kow-towed to them. 
   The privilege that most free and prosperous societies  enjoy of allowing citizens to spend their own money on buying their own health care services is too threatening to the Canadian government, because they don't want the population to realize they are now getting second-rate care.  This would save money because some of those closed down operating rooms and wards would become productive, bring more money into the system and shorten waiting lists.  Think the government wants that?  It is that very lack of competition that allowed the disastrous deterioration to occur virtually without  public notice in the first place.  
   The decline will accelerate as the government brings in more and more unscreened refugees, hands out tax payer dollars by the millions and throws away opportunities that could make life better for all Canadians.
   They just want you to go on thinking we have the best health care system in the world!