The Bloody Hand.
I have an impressive semi-lunar scar on my right hand. It curves from the base of my right thumb toward the middle of my palm. I can feel it with my right middle finger. It has been quite a helpful scar because by running my right middle finger over it, it has always enabled me to distinguish my right from my left hand. I can do this in less than a second and in my profession this is sometimes very important. So let me tell you how I got it.
After the 'Sinking of the Titanic' as someone in the family used to refer to the Trike in the Canal incident, the site of interaction between my cousin and I seemed to shift for a time to my neighbourhood. In retrospect this was probably because there was no canal nearby for us to drown in. On the day on which the event in question occurred, for some unusual reason CB and I were left alone for a couple of hours while my mother attended something which I cannot recollect. My grandparents and their adult and as yet unmarried offspring lived five doors away, at number seven, My father, their youngest son lived in number two. He dropped in to see his parents at least a couple of times a week, usually at about eleven pm when most people were thinking of going to bed. It had been well drummed into me that number seven was as much our home as number two.
My mother had barely gone out when CB suggested we go into the back yard to play ‘Cowboys and Indians’. Since there was no TV to babysit kids in those days we often had use our bodies and minds to amuse ourselves, with the resultant development of physical and mental faculties and a lot of other things besides, including occasional injuries.
“Okay,” CB said, “Lets play cowboys and Indians. The backyard can be the Fort and I’ll be the cowboy defending it against a tribe of wild Indians. You’ll be the Indian chief trying to climb the wall and break into the fort.”
“Why can’t I be the cowboy defending the fort and you the Indian chief?” I demanded.
“Because I’m three years older.” He said aggressively and then relented. “After I defend the fort and kill you, then I’ll let you be the cowboy and defend the fort. Okay?”
We went out into the back yard into one of those rare Irish days when the warm sun was shining in a clear cloudless sky. The yard was rectangular with a tall limestone wall at the end of it. The wall had a solid brown wooden gate that egressed to a lane that was wide enough to accommodate our dust bins which the city collected on a daily basis. Although that may sound a little far-fetched, bear in mind that were three mail deliveries daily and that a letter mailed in London England usually arrived in Dublin the next day. (We didn't need email! If you were seven years old and standing in that lane scaling a wall that was about three times your height was a pretty formidable task. Furthermore, the arcane activities that went on in that lane after dark was more that enough to keep any seven year old away.
“Okay” said CB
,, escorting me out the backyard door into the lane, “Now you have to climb the wall and try to invade the fort.” He slammed the gate shut.
I stood there, looking up at the huge fort wall I had to climb. Could I ever scale that wall and capture the fort? I could see a few scallops in the wall that might serve as footholds, so I gripped one with my hand and found a foothold for my foot, and before I knew it I was on my way! As I approached the top of the wall, I loosened my bow and arrow for immediate action. I approached the top of the wall for my coup de grace. It looked as though I was going to take the fort after all. Suddenly, out of the blue a six-gun appeared from nowhere. “Bang!!” it said, “bang, bang!!” it repeated, The poor Indian was so taken aback that in his attempt to defend himself he relinquished his precarious grasp and fell to the ground. The thenar area at the base of the right thumb managed to land on a broken shard of glass that was the remains of a small whisky bottle that some young would-be lover probably threw against the wall when he found it wasn’t enough to make his girl friend drunk enough to fornicate with him. It was, unfortunately sufficient to carve a deep semi-lunar cut in my right hand.
“I’m cut,” I yelled. “I’m bleeding, there’s blood everywhere.”
CB, to give him credit, immediately relinquished his role as heroic fort defender, and opened the yard door to see what I was screaming about. I held my bleeding hand up for his inspection. He remained cool, calm and collected in the face of the spurting blood from my hand. He cupped my right hand in both of his and coolly separated the wound edges and looked in.
“This looks serious,” he said, “I can see cut arteries. I think that means you are going to bleed to death.”
“Bring me to number seven, (my grandparents home a few doors away)”
I cried, “Auntie Doris knows First Aid, She’ll know how to save me,”
We raced the five houses up to my grandparents’ home, me holding my upturned wounded right hand with my left one, while my life’s blood drained away. CB banged loudly at the door, he himself getting a little anxious at the amount of blood that by now seemed to be everywhere.
My elderly (to me!) grandmother answered the door and quickly grasped what was going on.
“Doris, come quickly, Stanley’s cut his hand.” She sounded concerned but not panicked. After a quick assessment of the bloody mess, Doris blanched slightly and then remembered her First Aid.
“CB said I’m going to bleed to death because the artery is cut,” I wailed.
“Don’t be silly, we’ll just have to bring you down to Dr. Fitzpatrick around the corner and he’ll stitch you up and you’ll be fine.”
I don’t know which horrified me more, the thought being stitched up or the thought of it being done by someone other than Dr. Alec McKaye, who, even at the tender age of seven, I knew to be a miracle-worker. My mother and my grandmother had told me that.
Auntie Doris had learnt her First Aid well. She applied a laundry clean handkerchief to the wound and bandaged it tightly into place forming an effective pressure dressing, as we would call it today.
“Okay, let’s go,” she said so authoritatively that I could see resistance would be futile.
Mrs Fitzpatrick opened the door and quickly appraised the situation.
“ Ah you poor little fellah,” she said, “Let’s take off the bandage and have a look.”
“No, no,” I yelled, but the bandage was off before I knew it.
“Oh yes, that’ll need a few stitches alright, I’ll call the Dr.”
“No, no,” I yelled, but she called him anyway.
“Ah don’t worry, laddie,” he said, swiftly grasping my hand while I buried my head in my Auntie Doris’ bosom. “You’ll hardly feel a thing and it will be over in a minute.”
“Aren’t you going to freeze it, doctor?” asked Auntie Doris in a tremulous voice, feeling my agonized gyrations against her.
“Sure, aren’t I finished already,” he smiled, “and it barely hurt you at all young man, did it?”
He didn’t wait for an answer and just proceeded to give me an anti-tetanus shot while I was trying to think of answer.
Auntie Doris tenderly wafted me out of the door, past the waiting CB who’s usual insouciance was ebbing under the pressure of anticipating having to explain a cousin killed in action.
When we got into number seven Auntie Doris said “I think after this we both need a little drink, and poured herself a couple of ounces of Scotch, and about a teaspoonful for me. Even though I am sure it was no single malt, I wonder if that was the beginning of my appreciation for the taste of, as well as the medicinal powers of Scotch .
As my father used to say: Whisky when you're sick makes you well:
Whisky makes you sick when you're well! How true!!
Monday, 15 February 2021
Death (almost) and the bloody hand!
The Bloody Hand.
Saturday, 13 February 2021
Corrections Canada - The Regional Psychiatric Centre.
a year later I was offered the Headship of the Department of Family Medicine at
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
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 just gave up.
we had moved to
He sat in my office,
“So how are you enjoying being the big boss at the Regional Psychiatric Centre?”I asked.
“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.
“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 teaching 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 did a month rotation in my office. 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 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 would go to the department that quickly removed any doubt in my mind as head of a department with a healthy deficit.
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. Departmental colleagues and I would each come 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
On January the second nineteen ninety-eight, I showed up at the RPC Saskatoon, federal maximum security institution of Corrections Canada and walked up to t he perimeter fence.. 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. As I walked across the courtyard I noticed a pretty cozy-looking tiny house to my right that spiked my curiosity. I made a mental note to find out its purpose. 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 clank sounded as someone who had been following my progress on the multiple video cameras, sprung the release. As I looked around then and subsequently from within the tightly controlled security nerve centre, to which I was only admitted once by a particularly friendly guard, I realized that there was no area inside or outside the building which could not be video monitored. Once inside the building, the guard behind the desk said, “Hold on a minute doc, I’ll get the clinic nurse and then we’ll take you on a guided tour of the institution and wind up in the clinic”
The sinking of the Titanic or the Cowboy in the Canal.
Cowboy in the Canal or The Sinking of the Titanic.
CB was my older cousin by 3 years and it often fell to him to schlep me around and take care of me, a task he didn’t relish. CB must have been about ten or eleven at the time and was as tough as nails. He lived in a rougher area than I and had learned to look after himself. I was about seven and a bit wimpy before CB knocked it out of me. His father was tough too and enforced a sometimes harsh discipline.
Near where CB lived was the Dublin Canal, a waterway, where horse-drawn barges conveyed cargo of various kinds to their destination. We loved to play along the banks of the canal and were constantly cautioned of the danger of getting too near the water’s edge and falling in.
One beautiful day in June, CB and I were playing cowboys on the banks of the Canal. My tricycle was the designated horse.
“I saw John Wayne chased by a bunch of baddies trying to kill him at the pictures (as we called the movies) yesterday,” CB said. “He galloped away on his horse and escaped by grabbing the branch of a tree and letting the horse race on with the bad guys following it.” (A frequent scenario in cowboy movies in the old days - when they weren't singing and strumming their guitars).
I was suitably impressed as I was by most of my big cousin's ideas especially when he cursed, because I wasn’t allowed to do that like the tough kids did and lots of CB's friends were tough kids.
“I think I could do that,” CB said after a short period of deliberation. He looked around and I saw that gleam in his eyes that usually meant trouble for someone.
“See that tree over there with the branch sticking out? Well, if you could get up some speed on your trike I'll stand on the back axle and you ride under that tree. I'll grab the branch and let the horse - I mean the bike - gallop on, You can be the horse."
“Why have I always got to be the horse or the Indian or the bad guy?” I complained. “Anyway it’s too near the water, you might fall in.”
“Ah, don’t be such a sissy,” he jeered, “And after we do that I’ll let you be John Wayne and I’ll be the bad guy.”
“Okay, but be careful” said I.
“Pretend someone is chasing me from back there, I’ll yell when you’re to start.”
With that, he mounted his trusty steed – the back axle of my much loved red tricycle, for which he was too big anyway, and after yelling ‘charge’ to me, (I had to pedal mightily to get up to the right speed) galloped away toward the targeted branch.
We did seem to gather great momentum as he approached the tree. I watched as he deftly grasped the protruding branch and swung himself into the foliage of the tree. My admiration quickly turned to horror as I saw the ‘horse’ –my treasured tricycle surge on into the canal. I managed to jump off in time to avoid going in with it!
“My bike, my bike – it’s gone into the canal,” I wailed.
After sharing a moment of horror CB quickly rose to the occasion.
“Ah shut up, I’ll get it out for you,” he said confidently.
The tricycle protruded from the edge of the water and CB advanced to the water’s edge and tried to grab the handlebar.
“Damn,” he said, “I just can’t reach it. Here, give me your hand and I’ll stretch out and be able to grab the handlebar and pull it out of the water.”
“Okay, but be careful, you’re right near the edge.”
I gingerly advanced along the canal bank towards the water until I was close enough to grasp CB’s hand. Using my weight to balance himself he stretched out over the water.
“I almost have it, I just need another inch.”
As he stretched out to grasp the bike, I felt the grip of our hands starting to slip. He leaned away a little more and our grip continued to slip.
“Ahhhhhhhhhh,”yelled CB as he slid down the muddy bank into the water.
I started crying and ran the half block to CB’s house.
“Help, help, CB fell into the canal and is drowning and my bike is in the canal.”
His father assumed a terrifying demeanor, “I warned him a hundred times to stay away from the canal. This is not the first time he’s fallen into that bloody canal.”
With that he raced up to the canal with me in hot pursuit. We arrived in time to see a muddy sodden monster that had just emerged from the canal that on closer inspection turned out to be CB. My uncle got my precious bike out of the river and I think that CB got some harsh justice as well as a bath!
Sunday, 7 February 2021
A great actor.
A very sad weekend. Christopher Plummer, one of my heroes died. Stratford, Ontario, which is less than an hour's drive from London, Ontario, is one of the world's finest theatre centres and has four excellent theatres in that charming town. The Stratford Shakespeare Festival brought Irene and me great pleasure over the years. It was a 'home from home' for Plummer since the fifties when he first played Henry V. We saw him in the Tempest when we were visiting our son who was doing his residency at Western University. He brought us to the Stratford Festival to see Plummer playing Prospero. He was superb of course.In recent years we saw him play Caesar in Caesar and Cleopatra and also his outstanding one man show 'A Word or Two.' It was outstanding. I am sure it must be extant though a cursory search failed to show a site where it could viewed. I will continue to search for a recording.
During his performance of 'Hamlet' in Stratford he fell ill with kidney stones. His understudy had to play the role. His name was William Shatner.
He did okay too!!
An amusing little addendum.
When family and friends from afar visited Stratford was always on our visit list. We would drive by and occasionally have a drink in the Westover Inn , a classic hotel set in an 1867 manor home where Christopher Plummer kept a suite for whatever part of the season he spent in Stratford, just a short drive away. It was appropriately labelled " Mr. Plummer's Suite".
On one particular occasion when some of our friend's originally from what North Americans still call the 'Old Country', were visiting we took them to the Festival Theatre, Stratford's largest theatre. As we stood in line, my friend leaned over and whispered into my ear,"I think that's Christopher Plummer about three or four people ahead of us.".
I looked, indeed it was, standing in line, just like everyone else. No fuss, no one bothering him as he chatted quietly to his companion. No special treatment. I guess that's just the measure of the man.
I'm sure he had no need to do that.
Wednesday, 3 February 2021
Sex Conversion in Minors.
.Conclusion All medical, psychological, and counseling professionals are to follow a code of ethics. Psychiatrists are to be “dedicated to providing competent medical care, with compassion and respect for human dignity and rights.”172 Social workers’ primary responsibility is to promote the well-being of clients.173 Psychologists are to do no harm. 174 Marriage and family therapists are to advance the welfare of families and individuals.175 However, the treatment and results of conversion therapy to change sexual orientation do not seem to follow these ethical guidelines.176 Conversion therapy has been denounced by all major medical organizations because it claims to “cure” something that is not a disease or illness.177 The serious risks posed by the so-called treatments outweigh any positives that might possibly be considered.178 As such, California is taking the proper steps toward protecting today’s youth from harm.179 Even if an appeal to the United States Supreme Court is 171. See S.B. 1172, 2012 Leg., Reg. Sess. (Cal. 2012) (codified at Cal. Bus. & Prof. Code § 865.1 (2012)); see also Am. Psychological Ass’n, supra note 37. 172. The Principles of Med. Ethics 2 (Am. Psychiatric Ass’n 2013), www.psychiatry.org/ File%20Library/Practice/Ethics%20Documents/principles2013--final.pdf 173. Code of Ethics of the Nat’l Ass’n of Soc. Workers (Nat’l Ass’n of Soc. Workers 2008), http://www.socialworkers.org/pubs/code/code.asp. 174. Ethical Principles of Psychologists and Code of Conduct 3 (Am. Psychological Ass’n 2010), http://www.apa.org/ethics/code/principles.pdf. 175. See, e.g., Mary Jo Zygmond & Harriet Boorhem, Ethical Decision Making in Family Therapy, 28 Fam. Process 269 (1989), http://www.mftcourses.net/var/www/mftcourses/documents/zygmond%20borhem%2089.pdf. 176. See supra notes 9–11 and accompanying text. 177. See supra text accompanying notes 27, 30–33. 178. See supra text accompanying notes 36–37. 179. See S.B. 1172, 2012 Leg., Reg. Sess. (Cal. 2012) (codified at Cal. Bus. & Prof. Code § 865.1 (2012)). 269 Indiana Journal of Law and Social Equality Volume 2, Issue 1 successful, adjustments can be made to make the legislation legal, as there is absolutely no reason why there should not be restraints on the availability of conversion therapy, especially for minors.180 First and foremost, the adolescent should have a say in the decision to receive any kind of treatment.181 “[A] child may provide effective consent if he or she is capable of appreciating the nature, extent, and probable consequences of the proposed treatments or procedures.”182 But, no child should unwillingly be forced into conversion therapy by his or her parents.183 Parents should utilize an authoritative model of parenting, where they listen to the child and take the child’s opinion into consideration before making a decision.184 This is the healthiest model of parental control and influence over children.185 Homosexuality is not a disease or illness; it cannot be cured. Thus, conversion therapy should be banned. As Ryan Kendall said in the summer of 2012: I never believed [I could be fixed]. I know I’m gay just like I know I’m short and I’m half Hispanic. I’ve never thought that those facts would change. It’s part of my core fundamental identity. So the parallel would be sending me to tall camp and saying, ‘If you try very hard, one day you can be 6-foot-1.’186 Ryan Kendall’s story is not the only tragedy of conversion therapy. There are numerous examples available, all of which claim the same thing: you cannot change who you are. 180. See supra Part III. 181. See Part III.D. 182. Weithorn & Campbell, supra note 50, at 1590 (referencing the Restatement (Second) of Torts (1979)). 183. See supra text accompanying note 157. 184. See Laurence Steinberg, Julie D. Elmen & Nina S. Mounts, Authoritative Parenting, Psychological Maturity, and Academic Success Among Adolescents, 60 Child Dev. 1424, 1433 (1989). 185. See id. at 1425 (comparing authoritative parenting to the authoritarian and permissive models). 186. Levs, supra note 98 (quotin
AMA supports state and federal bans on conversion therapy.
Ability to bring child to therapist for that purpose.
AMA voted in favour of pushing federal legislation banning psyis & p'ologists from informing children that they are the sex of their birth.
Virtual Medicine (or only when I larf!)Most People , including many physicians are overwhelmed at the innovation and efficiency of Virtual Health-Care. They see it as a New, Original and Economical way of delivering health care in many situations. They wonder at the efficiency of the high tech world and how much more convenient it is to discuss your problem on the phone or some video device than to wait to get an appointment or to sit in some crowded emergency room for some minor ailment that does not require hospital space or facilities in the first place.
You maybe surprised to hear that virtual health care was more universally available and more efficiently practiced when I first qualified (long, long ago) than it is now. In addition, it cost nothing! (to anyone other than the health care provider.)
And all you needed was a telephone.
The great difference is that my generation of general practitioners carried their responsibilities on their back.
My patients never got today's standard recorded message "if this is an emergency, hang up and call 911." Just prior to my retiring at the age of 78, the telephone service had become so effective at avoiding communication that I often found it difficult to get through to my own Nurse! Not her fault, the fault of the 'high tech idiots (Technodopes?) who devised systems so efficient to stop patients being able to get through to their Physician that doctors frequently could not even get through to their nurse!! They easily sold the software to the Docs. They, of course, assured the Docs, that it would improve medical care and the docs wanted to believe it.
I have always recognized the vital contribution that 'high tech' makes to medicine. I am well aware that I owe my own survival to it. I am not a Luddite, I don't want to escape to the past, because, having lived in the 'old days', I could tell you some stories to easily explain why neither I nor most people I know want to return there. Even though we may wax nostalgic about them at times. We live a lot better than previous generations due to high technology.
Let me complete the picture of just how much 'virtual care' there was. Most of the GPs I knew came home at night, connected briefly with their family and after dinner took the wad of phone calls from patients anxiously awaiting a call-back down to their office in the basement and spent anything from minutes to hours practicing 'Virtual Medicine' on their telephones caring for their patients. Most of the time when the phone rang throughout the day or the night, the doctor or his wife answered it.
Would you like to know what we got paid for that service?? Nothing. Let me repeat that. NOTHING! Did we resent that? Unbelievably, we didn't. We regarded that as part of duty , part of responsibility, part of what being a physician was.
Maybe doctors weren't so smart then. Or maybe it was just that medicine then was a vocation, not just a technical skill.
And they think Virtual Medicine is something new!!
Does it hurt? Only when I laugh!