Friday 27 September 2019

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."
"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.

Tuesday 24 September 2019

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!  


Saturday 7 September 2019

Slick Lab V Slack Lab.

   I find myself increasingly quoting Ronald Reagan: "I'm from the government and I'm here to help!" are the most terrifying nine words in the English language.  Anyone familiar with waiting around hospitals for X Rays or lab work cannot fail to be impressed by the efficiency of the private sector when compared with the civil service mentality of the public sector.  Viz my visit to one of the private labs for some blood work this week.
   I pulled into the parking lot and parked my car in a designated complementary spot clearly labelled as such.  At the hospital even a short parking stop would be $3-$4.  I made my way to the lab and since it was 10am I was not surprised to find it crowded.  A large monitor mounted on the wall listed the twenty or more patients ahead of me by first name and the anticipated time of their wait.  I checked in anticipating a fair wait and since there was a coffee shop not more than a few feet away,  I slipped in and bought myself a large coffee.
   I am a rather impatient individual so I always bring some tasks with me to keep myself amused.  With my coffee in one hand and my National Post in the other I settled myself down in one of the rather comfortable chairs to enjoy my coffee and catch up on the news.  No sooner had I settled down than I heard my name being called out.  Impossible, must be a mistake, I thought.  I looked up at the screen and saw "Stan.......waiting time ........0!  I was directed to the torture chair, where a pleasant lab tech took my coffee and placed it safely for me while she took my blood.
   I had gone into the lab at 10 am and was back in my car sipping my coffee at 10.29.
  That never happened at a hospital!!
  I suspect the whole health care system might benefit from a healthy dose of competition.

Monday 2 September 2019

Turn on, Tune in, Drop out!

Turn on,
Tune in,
Drop Out!
Blame the Doc, blame Big Pharma, blame the Nurse, blame the health care workers, blame the porters, blame the cleaning staff. Blame everyone, that is except those most to blame, Those who most manipulate the health care system for their own ends. Those who purport to be health care experts while knowing little about health care other than how to manipulate it for political or financial gain. Maybe we should blame the society that nurtures addiction by failing to accept responsibility for the role it plays in perpetuating it and in minimizing it and enabling it for so long, Recently there has even been a move to change the terminology of addiction because those words are not acceptable anymore: they attribute responsibility to the addict, their enablers and to societal attitudes in general and that is not politically correct. How can we resolve a problem that we don't want to accept responsibility for let a!one our role in its generation through ignorance or apathy or both? Addiction and drug abuse problems have existed since long before medical records were kept. Humans realized early on that ingestion of certain substances brought about immediate resolution of all the pains and problems of the world. No, more than that. Instant gratification, instant ecstasy. Some decided that they would not settle for anything less, regardless of the cost. After all, surely a few years of ecstasy tops a long life of hard work, suffering, responsibility for oneself and others and the gradual loss of all the strength and independence one works so hard to maintain. Life is not easy and growing old is a long and painful experience for most. Unfortunately the dawn of the permissive age resulted in the decline of that ability good parents have tried to give to their children to accept responsibility and self discipline. Actions have consequences. and we have replaced that irrefutable truth with the concept of instant gratification trumping all. That was easiest avenue for the parents to take, particularly in the sixties and seventies, but there was also the misconception that it was good for their children too. It wasn't.
Nevertheless, it was the idyllic objective of most physicians to prevent or cure disease and when that end is not possible to relieve pain and suffering to make life as tolerable as possible.  At least, it was in those days. Medical students spent their youth in gaining understanding of and insight into illness, physical and mental and most of us did succeed in doing just that.
At least, that is the way it used to be until the politicians and their administridiots took over!
And make no mistake about it, they have taken over.  
So what has this to do with the current addiction catastrophe? We have to go back a number of years to grasp how we got here.
When I was a young man studying medicine in the 1950s the prescription of narcotics was not lightly undertaken. Physicians were very much aware of the risks entailed and most of them prescribed carefully and judiciously. Sometimes perhaps a little too stringently but always with the intention of providing as effective relief was possible. Physician prescribing patterns were monitored by a variety of methods of varying efficiency. At some point the Heath care administridiots aided by many of the professional associations decided that they knew better. Physicians were not treating many patients aggressively enough and were instructed to be more 'generous' in their prescribing of narcotics, failure to do so was negligence. Most patients who are being treated with narcotics for pain want to get off them as quickly as possible. Precisely those patients who were at greatest risk of becoming addicted, many of whom could be adequately treated without narcotics, were demanding narcotics and cautious physicians were often admonished for withholding them, by groups who had no special skills or knowledge in this area of patient care. Patients referred to pain specialists for help in treating their addiction often returned to their family doctor on more potent medication, than they were originally on. Dosages patterns grew larger and in my senior years of practice I frequently saw narcotics prescriptions for doses that would have resulted in loss of license in my younger years. The growing permissiveness of society towards street drugs in general and opioids played no small part in the increasing flood of drugs pouring into our country. Then we act surprised at the death and destruction that ensues. And how do our politicians and administridiots react. By legalizing marijuana! Some recommend much more than just pot..

No wonder they want to blame J&J, and Big Pharma, and anyone but themselves.
Look around, "Turn on, tune in and drop out," didn't work out too well. Timothy Leary did a lot of damage!