21
Oct 17

It's a quintessential late October in southern Alberta; the nights are reliably frosty, an early snowstorm has come and gone, and this week the remaining yellowed leaves that had been gamely hanging on to their faded beauty were mostly stripped away by a howling windstorm.

Another frigid prairie winter beckons, in blithe defiance of the warm and insistent assurances of most climate scientists (97 percent!).  I'm almost certain they're just toying with us.

And, as if in abject obedience to the season of freezin', little children are crowding the local emergency department, busily swapping streamers of snot and coughing trillions of viral particles in every direction.  Cold and flu season, eternally joined at the hip to the onset of winter, is here in its full infectious glory.

The scene at the children's hospital yesterday generated a flashback to my youth, as I used an alcohol swab to wipe cooties off the bell of my stethoscope in between patients for the umpteenth time.

I'm not sure who initiated the ancient practice of mashing up the livers of cod fish to extract the oil contained therein, so that it could be stuffed down the gullets of protesting children.

For hundreds of years this unsavoury process fed the ritual practice of parents in northern climates such as Norway, Canada and Scotland.  As winter threatened and the weather turned bleak, dusty bottles of cod liver oil were retrieved from the dark recesses of medicine cabinets where they had been patiently and malignantly waiting; rancid liquid was liberated onto teaspoons and crammed into children's mouths in the interests of fending off colds and flu.

It was a ritual attended to with puritanical religiosity at my house. The stuff was abhorrent, revolting, nauseating - but it was "good for us", so there was nothing for it but to choke it down.

Other parents, in those days, came up with all kinds of additives to convince stubborn and resisting children to swallow the noxious stuff - they added peanut butter, masked it with chocolate, mixed it in juice, chased it with honey, offered all manner of bribes. In my household,  inducement more commonly took the form of a gruff and heavily accented "swallow it, or else", which had a remarkable and salutary effect on our compliance, sans sweeteners. Post-traumatic stress disorder has one of its long and tangled roots in the cod liver oil era, assuredly.

But as it turns out, and though I hate to admit it, centuries of collected wisdom surrounding the benefits of cod liver oil proved to have some scientific basis.  Old-fashioned smelly cod liver oil contained reams of vitamin D, along with vitamin A and omega 3 fatty acids; undeniably healthy stuff, and probably effective at least to some degree in fighting off marauding viruses. And the epic struggles to shift oil from spoon to stomach laid the foundation for all sorts of effective strategies to get people to "take their medicine", many of which we use today.

Needless to say, the exhortation to just "take your medicine" has wide applicability, far beyond the dutiful ingestion of doctor-prescribed pharmacopeia.  The messy unspooling of human affairs spawns many a circumstance which demands simple acceptance of unpleasantness without carping and complaining.

With all of that as preamble, let me turn briefly to the ongoing great Canadian tax furor as a present-day exemplar of this sort of thing. Justin Trudeau and  Bill Morneau, ministers prime and finance, having jointly applied their political stethoscopes to the aging and ailing beast that is the Canadian tax code, quickly generated as a diagnosis, "The Rich Are Not Paying Their Fair Share."  Not an unusual diagnosis, this one, rather on par with "The Common Cold", as evidenced by the frequency with which it seems to infect political jurisdictions everywhere.

Nevertheless, a remedy was deemed both necessary and urgent, and so the two men swiftly concocted what they felt certain would be an effective cure, an antidote loosely described and energetically advertised as "Leveling the Playing Field".  

To their dismay, however, long-suffering Canadian taxpayers simply refused to  "take their medicine". Farmers, doctors, small business owners, and entrepreneurs took umbrage at being labeled tax cheats and scoff-laws.  They rose up in anger and in unison, stubbornly resistant to the new tax treatment.   And multitudes of seasoned tax experts quickly offered robust "second opinions", warning of the harm that would ensue if the proposed "remedy" was employed.

But despite the growing mountain of evidence that they had got their diagnosis completely wrong, Mssrs. Trudeau and Morneau did not withdraw their medicine. Not at all.  In homage to cod-liver-oil-administering mothers of yore, Mr. Morneau spent the past week adding sweeteners and adulterants to his original brew, in the vain hope that by "tweaking" the mixture taxpayers would open up and just swallow it, already.

It's been an extraordinary spectacle.

After all, in my own profession, incorrect diagnoses are not rare.  Medicine remains a stubborn mix of art and science;  signs and symptoms of disease don't always arrange themselves neatly around a clear verdict.  And, in this predawn era before robotic doctors assume control, physicians remain human and fallible. So incorrect conclusions are drawn, despite careful and thoughtful deliberation.  And wrong diagnoses lead on to wrong treatments, and bad things happen.

Of course, in the light of new evidence that destroys original clinical hypotheses, competent physicians immediately cease prescribed medications, revise their clinical opinion and plan, and set about trying to mitigate any harm that has been done. What they don't do is double down on their original diagnosis, and continue on with treatment, simply tweaking it to make it a bit more "palatable."

Not if they want to continue on as doctors, that is.

The ire of Canadian taxpayers continues to build, fueled by the realization that the immense fortunes of the Prime Minister and the Finance Minister will survive utterly untouched by the proposed tax hikes.  The outrage reached fever pitch this week with revelations that Mr. Morneau has knowingly made governmental decisions that will add to his massive wealth, already of such magnitude that he misplaced an entire French villa.

Mr. Trudeau has managed to turn Canadians against Canadians, doctors against nurses, business owners against their employees; perhaps that sad outcome was part of his grand plan - I don't know, and I sincerely hope not.  But I do know that he has turned great numbers of Canadians  squarely against his young government, disgusted by the ethically dubious bumbling of his party and the growing stench enveloping Parliament Hill.

The situation for the Liberal Party and for Mr. Trudeau could scarcely be more dire. And the toothpaste is not going back in the tube.

But all is not lost. Yet. There is a way forward, a narrow path out of this self-inflicted mess.

As physicians know, by far the best way to address medical error is to confront it, head on.  A patient or family harmed by a medical blunder is usually and understandably very upset, but that wrath truly boils over when a physician refuses to acknowledge error.

A sincere and simple "I'm sorry", along with a thorough explanation of what transpired, is a tremendous thing, a veritable balm of reconciliation, a sturdy bridge to restored trust and renewed respect.

And so to Mr. Trudeau I offer this healing elixir, freely:

Address the nation, sir.

Tell us that you are sorry.

Tell us that you misread the situation, that you made the wrong diagnosis, that you offered the wrong prescription.

Tell us that you had the best of intentions, but that you now realize your errors.

Tell us that you will immediately repeal all proposed tax changes.  Go even further, cancel that top-bracket rate hike - it didn't work, and you know it.

Tell us you will go back to the drawing board, that this time you will consult deeply and widely with experts, to plan the surgical, wholesale revision the tax code so desperately needs.

It really is the only way to proceed, sir.  And it would be unprecedented, a bona fide master stroke.

Canadians are a gentle and merciful people, incapable of resisting an honest and humble display of contrition.  They would count your motives as pure, and gauge that you genuinely desire what is best for our country.

They would forgive you. 

The twin and ominous thunderheads of scandal and ineptitude that threaten your administration would retreat, clearing the way for sunny days and sunny ways; your popularity would scale new heights.

As for Mr. Morneau, alas, it is too late:  his Canadian goose is thoroughly cooked, I'm afraid, another decent man laid low by pitiless political combat.

But you can survive, Mr. Trudeau, and even thrive.

Just choke down the cod liver oil of repentance and apologize.

13
Oct 17

 

"Time and tide wait for no man", declared Geoffrey Chaucer, back in the day.

And boy am I feelin' it.

I turned 50 this year, and as much as I'd like to subscribe to the pithy "50 is the new 40" maxim, I'm afraid it's simply a bromide framed to help us ignore the incontrovertible realities and indignities of aging.

If you, faithful reader, are of similar vintage, you know precisely what it's like to wander the house, befuddled, searching endlessly for those newly acquired reading glasses, only to find them perched precariously atop your receding hairline.  And then to discover that you can't find the book for which you needed the darn glasses in the first place.

I could go on and on - lost keys, misplaced children, that time I found myself half-way to Banff after I simply went out to buy a gallon of milk - but I'll spare you the weary details.

At least I'm getting wiser, I tell myself.

Which brings me to the news this morning that Finance Minister Bill Morneau failed to disclose, for two years, property that he owns in Europe via one of his private corporations.

I must confess to a twinge of annoyance, at first, when I read through the story.  I mean, it's almost too easy to get a hate-on for a man who can so casually own a villa in the south of France that he actually completely forgets that he has it.

But then, upon some further reflection, a bit of my age-acquired wisdom surfaced.

The finance minister is, after all, 54 years old.  And the fact that he is stratospherically richer than me shields him not one iota from the absent-mindedness that creeps up on all of us.  "Time and tide wait for no man."

So he misplaced a villa.  Big deal.  Could happen to any of us.  "Let him who is without sin among you be the first to throw a stone," we are rightly advised in the Gospel according to John.

The Mayans lost entire civilizations as they got older, for crying out loud.

So back off, I say.  Leave the man in peace.

5
Oct 17

 

It was a glorious early morning today in Calgary, crisp and clear, with an enormous harvest moon glowing orange just above the western horizon, crowned by millions of stars just beginning to wink out in obeisance of dawn.

Despite the grandeur, I found myself imbued with a touch of melancholy as I drove my eldest daughter to her 7 am volleyball practice.

The vestiges of my most recent emergency department shift, completed only eight hours earlier, were still clinging to me, I suppose.  The ancient notion that full moons are attended by evil spirits seemed almost a verifiable truth, as my caseload was heavily peppered with troubled children caught in the crossfire of family strife, suicidal youth, and capped by a five-year-old boy whose skull was fractured by his very own father.

Not easy to shake that stuff, despite the magnificence of the heavens.

I'm also perhaps still a bit wounded by a comment made a few days ago by someone close to me, who ventured this nugget:  "I remember when you used to care about underprivileged people."  

This in response to my recent and frequent posts in support of the thousands of Canadian doctors upset about tax changes being foisted upon them by Prime Minister Justin Trudeau's government.  Apparently, since I've had the audacity to stand up for our profession, to protest that we are not tax dodgers and tax cheats, to decry the daily demonizing of physicians in our venerable House of Commons, that makes me a grubby, petty capitalist concerned primarily with lining my deep pockets with the hard-earned dollars of taxpayers.

And this week brings the dispiriting news that the divisive and dishonest class warfare techniques employed by our current government have been successful in deceiving our fellow citizens: 49% of Canadians evidently are in agreement that "fat-cat doctors" and small business owners are not paying their "fair share" of taxes.

So I can be forgiven a bit of melancholy, I think.

With all that good cheer as a backdrop, I turned my attention today to a revision of my high school "Career Days" speech.

In the halcyon days of yore, before our trust-fund-endowed leaders exposed us for what we are, doctors were esteemed as leaders; as people of achievement and integrity; as holder of positions to which young people might actually aspire. 

My invitation to "Career Days" has not yet been rescinded, however, and so an adaptation of my usual remarks is in order.  Needed inspiration comes from an excellent piece penned by Elliot Levine entitled "Mr. Morneau, your analysis is incomplete..."

The eloquence angle needs some work - I've never been accused of being overly polished, after all - but here's the thrust of the matter:

"Thank you once again for inviting me to speak to you.  

My message to you today is simple:  

Don't "reach for the top."

Don't strive to excel.

Don't "try, and try again, if at first you don't succeed."

Don't become entrepreneurs.

Don't dare to think that you can build a successful small business.

And certainly don't dream of becoming a doctor.

Don't sacrifice years of your life in unnecessary toil or sacrifice or study.

Imagination, innovation, perseverance, ingenuity... all those things are overrated.

Instead, become a civil servant.  

All of your needs will be met.  You will want for nothing.  

Secure income, paid vacations, fully financed and elongated maternity leave, reasonable and regular working hours, excellent health and dental benefits, complementary self-improvement courses, and, in the end, a platinum pension, fully indexed to the rate of inflation,  to nourish your golden sunset years:  all these things can be yours.

You'll be able to rest, blissfully and securely, in the everlasting arms of our government.

Just one tiny note of caution:  don't get sick.   Because we will no longer be training doctors, after all.

Don't worry overly much about that last bit.  I have it on good authority that "wikiHow" is set to publish a new piece, entitled "How to remove your own appendix."  It's called the Morneau technique.  Good luck with that.

For everything else, we have the peerless Dr. Google, under whose expert guidance all symptom pathways lead assuredly to death.  There is, after all, nothing more certain in life than death, and, under this government: Much. Higher. Taxes.

Thank you for your attention."

3
Oct 17

This morning, in off-the-cuff remarks to the media, President Donald Trump pronounced what happened in Las Vegas on Sunday night to be “in many ways a miracle”.

Fifty-eight dead.  More than 500 injured.  Immeasurable horror and grief and misery, untold pain to come, as families try to come to terms with the naked evil that ripped apart their lives and stripped away their loved ones.

A “miracle”?

Kudos, of course, to the intrepid police officers and SWAT teams that scrambled, in the teeth of great danger, to locate the madman and put an end to the carnage.  They are owed an enormous debt of gratitude for their valor.  Absolutely.

But a miracle?

This uttered by an American president both ardently supportive of and staunchly supported by the National Rifle Association, an organization doggedly determined to protect the rights of Americans to carry assault weapons.

A host of different descriptors come to mind:  reprehensible; disgusting; deplorable; disgraceful; blameworthy; shameful; repugnant; unforgivable. 

Pick one.  Pick them all, actually - they all apply.

I suppose it is a “miracle” of sorts that the American president, US congressional leaders, and a great swath of the American citizenry continue to defend their Second Amendment right to “keep and bear arms”, while depraved countrymen use said weapons to execute thousands of Americans in massacre after massacre after massacre, from schools to army bases to nightclubs to churches to music festivals.

It’s a miracle that this continues in a civilized, developed society - if by that one means “unbelievable” or “unfathomable”.

Defenders of the “right to carry” should be mandated to spend serious time in the trauma bay of any large American hospital, to bear intimate witness to the unrelenting waves of critically wounded gunshot victims as they crash through the doors, bleeding and broken and dying. 

They should be forced to trudge alongside the families of those who are murdered, as they “walk through the valley of the shadow of death”, as they descend into a black hole of grief and despair, never again to see their sons, their daughters, their mothers, their fathers…

Perhaps then, at long last, the enormity of this malignant stain on the fabric of American society would gain some purchase on their souls.

Now that would be a miracle.