Is There a (Happy and Rested) Doctor in the House?

Do you ever worry about your doctor's health? If indeed you have a doctor? I have to confess that I only occasionally remember to wonder if my doctor is doing okay. I am much more likely to be thinking in terms of whether she is available to me, competent, perceptive, on top of things concerning my health, friendly and considerate and compassionate when I need her to be. As someone who spends a lot of her time thinking about how my friends are doing, and offering support when I am able, it is disappointing to realize how one-sided my thoughts are concerning someone who I have known and liked for quite a few years. We do express affection for each other, and when she was brutally assaulted a number of years ago I was sensitive to her distress for months afterward. But then I fell back into being the baby in the relationship.

Now that it is stirred up in my mind, though, I can't help stringing together all the moments I have stopped and wondered how a doctor friend of mine manages his or her enormous and taxing workload, or been horrified to hear the hours that ER doctors work, heard about increasing restrictions on the amount of time allowed per consultation, and so on. It adds up to a lot of moments over a bunch of years. Doctors in this country are suffering, and I have been mostly oblivious to it.

What stirred these thoughts up was an episode that aired this week on White Coat, Black Art, on CBC: Doctor Burnout. It begins with a recording of a doctor freaking out at a patient who has made a demand on him that he is in no shape to respond to. It was a wakeup call for me.

At one time in Canada we felt pretty smug about our health care system, especially when (imagine us fluffing our feathers here) we compared ours to the system available in the United States. We meanwhile streamed in and out of our doctors' offices and hospitals concerned only with how well we were treated and how good the food was, and, of course, whether we got better. I speak only of those I knew. Doubtless there were holes in the system even in the good old days, but those holes got bigger and bigger over the decades, and in time there was a constant flow of talk about the myriad problems we now face, from increasing costs (both to society and to the individual), loooong waitlists, a rising two-tiered health care system, and suddenly (or perhaps not so suddenly), the near-impossibility of getting a GP (family doctor). Our cries of "Unfair!" resounded, and I was not alone in looking with fear at the disintegration of that once envied system, hoping it would not crash at last into a mimic of the US system, sure that this was the direction certain forces were trying to make it go.

In the midst of all of that, I for one felt disappointed and at times angry with my continually disappearing GPs, leaving me in sometimes a very difficult position, with a grouchiness that arose not only in some physicians but in the nurses, receptionists, and other practitioners that people the health care sytem, with overlooked health conditions (even when I pleaded with them to take care of them--I am thinking particularly but not only about the cancer that went undiagnosed for nearly a year despite my repeated requests to have the lump removed)... But only occasionally did the fog of my (reasonable) self-interest clear enough for me to see how the people in that system were suffering.

I particularly remember being helpless in a hospital bed when a certain nurse was cutting and abrupt with both myself and another patient. It was only later that she said to me--I suppose I must have called her on it in a gentle way--that she cared a lot and was in a fractious state because she couldn't do what needed to be done for patients and was exhausted. So her distress that arose from compassion resulted in her acting uncompassionately. A lightbulb went on, then fizzled out again when I got back to normal life.

There are a million reasons why we need to shore up our ailing health care system. The suffering of the people whose job it is to deliver it is one huge reason. Even if that suffering didn't result in mistakes and bad bedside manner, it would be reason enough to put things right. We wouldn't want to live stretched past the limit ourselves. Why would we expect it of them?

Below are links to the radio program I listened to and to an excellent article on the topic I was pointed to by a doctor friend of mine. The article, from a US newspaper, points out that 300-400 doctors (presumably in the States) kill themselves every year, and that doctors are at double the risk of other professionals to take that terrible step. Women physicians are especially vulnerable.

So, I am glad that I start every appointment with my doctor with the question, "How have you been?" and that I get to actually hear from her how she is. Now I hope I will be more forgiving when she is impatient with me (as she has been perhaps twice in the decade or so I've known her), and that I will remember that she is doing the best she can in an imperfect system. And, by and large, doing it very well.

Doctor Burnout, CBC Radio One, White Coat, Black Art, with Doctor Brian Goldman. 11 November 2017.
Taking Care of the Physician, by Perri Klass MD. The New York Times, 13 November 2017.





Image: "Daydreams of a Doctor" by Columbus Barlow (1898) (14778458162). By Internet Archive Book Images [No restrictions], via Wikimedia Commons

Sound and (Car) Fury: A Note to CBC 180

Cap Haitien, 2006

It's happened again. I've been driven (er...) to write a letter to the CBC. This time to Jim Brown and co. at the Radio One program The 180. I often have the impulse to answer back to radio, and in the privacy of my own head, usually do. But only now and then do I write a letter. You'll find a couple more in the archives of this blog.

Here, I am responding to two stories: responses from a past episode on noise, and

What keeps walkers safe? A West Vancouver crosswalk gets mocked online

Hello, Jim Brown et al.

I meant to write about whose responsibility it is to keep pedestrians safe, but I can't suppress (haven't tried) the first thought I had when I heard you ask what noise we would eliminate from our world if possible. Here's a 180: music.

Not all music, but unwanted music. We are bombarded with music today, and long gone is any thought of making it of a calming sort. (I was surprised to hear on CBC some time ago that when tested, people actually do find Muzak the most calming music, even though we profess to hate it.*)

I love music. I sing. Often. Many times a day, in fact. But I don't sing while shopping, while concentrating on writing, while having a conversation, and I don't like being forced to listen to music—even music I would like if I was in the mood to pay attention to it—when I am trying to do these things. I'm also out of sync with the tastes of the baristas and DJs of the world, apparently, so most of the music I hear, I really don't care for. I'm a person with jangling nerves. Not always, but certainly when trying to do three things at once, quickly so the person behind me can stop tapping their feet, trying to filter out noise really doesn't help. I'm also a person with enough hearing impairment that trying to distinguish what a friend across the table from me is saying is difficult even without the drone.

What a grump. (But golly, don't we love a soapbox?)

As for crossing the street. As a pedestrian, I regularly get annoyed or frightened by the antics of drivers who are either not paying attention or think their mission is more important than those of us on shanks' mare. On the other hand, as a human being I am well aware of the imperfections of my own attention, skill, vision, and of my complete ability to make a mistake. Being of a fragile organic nature I know that although I really love to be right, I would rather survive than go down under someone's wheels.

A few years ago I lived in Haiti, which was a real education in many, many ways, particularly around the assumptions I made because of the world as it appeared to be organized, growing up in Canada. One of the best things about Haiti was its approach to this topic.

At first it seemed to me that there were no rules, and I was petrified. People drove quickly willy nilly down the road, slamming on horns more often than brakes. On the main streets merchants lined the sidewalks and pedestrians picked their way through traffic in vaguely similar ways to unregulated roads here. But on narrow streets, crowded with small merchants sitting on the ground or on small hand-cut chairs with their wares on tables or in baskets around them, the situation was very different. I nearly had an embolism the first time I went as a passenger down one of those lanes. The driver did not slow down, and swayed back and forth around potholes in just the way he did on the larger roads. Chaos (to my eyes) ensued. Pedestrians fled, chickens scrambled, merchants grabbed their tables and got out of the way, and we bounced wildly down the road.

No one was hit.

I soon learned that in Haiti pedestrians are entirely responsible for their own safety, and so they have their eyes peeled. They don't arrogantly (or unawarely) assume they are safe or that the other guy needs to stand down. They get the hell out of the way and survive. People do get hit by cars in Haiti, of course. At that point the driver will do the fleeing if at all possible, as they stand a good chance of being beaten badly by the crowd. So it's in a driver's interest not to hit people.

It seemed to me at the time, once my hair settled down, that their system had real advantages (apart from the beatings), and I have been (in general) a much more pro-active pedestrian ever since. Which, in this era of deteriorating rode etiquette, is for the best.

Cheers.

Casey

* Wish I could track that story down, but I can't. At least, not easily.

Bottles on a Vast Sea: Letters to the Radio (1) CBC Rewind

Bottles on a Vast Sea:

Letters to the Radio

I listen to thoughtful radio. Sometimes, unavoidably, I listen to thoughtless radio, too, and sometimes that’s even fun.  But mostly if I am going to fill my head with sound I like it to be thought-provoking, informative, hopeful perhaps—I want it to feed me, heart, mind, and soul, in some way.

Of course, this leads to responsive thoughts in my own private cranium, and the odd time I want to express them to the speaker. The obvious way to do that is to write a note to the radio program, an email or a comment on their website or even a tweet. Seldom do I get a reply, though occasionally a producer will say something brief and encouraging. My thoughts go bobbing off on the vast internet sea, to be read or ignored, but there is something useful in doing it even without the response, so I carry on, a little sheepishly, my one-way correspondence with the mute unknown.

After some time of doing this I suddenly thought, somebody might actually be interested in these thoughts of mine. So I am collecting a few together to toss off into the sea again, messages in bottles, on their own solitary journeys once again.

CBCRewind with Michael Enright

ON THE ROAD 1972 (3 July 2013)

I have written before to say how much I love this program.  I'll say it again. So rich.

It was strange to listen today to the boys interviewed so close in time to when I myself left home and hitch-hiked around the countryside. So familiar: the slang, the inquisitiveness, the delight. I wonder, if there had been any girls interviewed (I am using the words we used then, not the ones—Men and Women—I would apply now) if they would have been any more honest about life on the road. Which is not to say these fellows were lying, only that they were leaving out an awful lot, cleaning things up terribly for the interviewer. Or maybe they were a different class of traveller than I generally met.

That sounds like I have some sour grapes but I don’t, though I must say along with the wonders of the road that they describe, which I, too, experienced and still treasure, it was an often frightening and sometimes very painful time. I was younger than any of the interviewees. I climbed out my East Vancouver bedroom window one night three months before I turned fourteen and set out on an adventure that was nothing like what I expected and which I would not have had the nerve to embark on had I had an inkling of what I was about to do.

I wasn’t a successful student or cold weather employee bent on exploring Canada or a young philosopher out to discover life. I was a grade eight dropout and runaway who discovered a mass of young people who were almost adults compared to me, who alternately aided and exploited me, shared their wisdom and their flea-bitten puppies and a world I had hardly suspected. Of marijuana, hashish, belladonna koolaid, and self-appointed gurus who set my adolescent teeth on edge. Of young pregnant women abandoned by boyfriends and trying to use sex to attract a “father” for their unborn children. Of bikers whose sense of humour was frightening and degrading to me. Of guys my dad’s age who had wives and daughters at home but who thought it would be great to be given comfort by a castaway like me. Of gentle First Nations girls who tried to help me after I'd been hurt once more. Drop-in medical clinics, social workers and Christians with a mission to save me, old rubbies who taught me about logging camps and rolling cigarettes and what it was like to live on the street. Well-meaning doctors, disinterested cops, kindly farmers, prurient young men who I thought “liked” me but that wasn’t quite it.

Being on the road taught me about the intense beauty of the West, the towns and orchards and ditches and fields, the southern mountains and the northern taiga. They taught me about history, about European immigrants whose view of the world was so different from mine, about hippies and their ideologies. Jesus freaks, Kraft dinner, panhandling, throwing up, lice. I relaxed a little, started wearing a dog collar (not done in those days), discovered how hard it was for me to risk displeasing anyone, no matter who or what a wanker, realized how comfortable I was with wilderness, how unalike I felt with people, though I loved or though I loathed them.

It’s difficult to express in a few words how enriching those awe-filled times were, despite the hardships. I don’t know who I would have become without that unparalleled opportunity to see a thousand different perspectives all at once, a literal kaleidoscope of eyes, minds, histories, obstacles, and aspirations. I had emerged from the parental home with some creativity and little confidence intact. Crushed by a milieu that thought me weird and my ideas dangerous, being among idealists, however flawed, among people who at least thought it was okay to try new things, be wild, take risks, be unconventional (even though underneath they were as girdled by conformity as their parents were) gave me the first outside world confirmation of my mother’s strange philosophy. That we could be other than what the world tried to force us into. That we were good and alive and valuable. That somewhere in life we might find permission to be truly free.

If one of my nieces or nephews were to take to the road now, I would die of fear for them. I look back affectionately on streets that had no drug more dangerous than heroin, at a country that didn’t yet know mass murderers, where one thirteen year old, anyway, was never forced into prostitution. It was dangerous, gloomy, greedy, and often stupid then. It is a world far more terrifying and cynical now.

And yes, I do pick up hitch-hikers now and then, when I have a car and am travelling. They are younger than I ever learned to be, and every bit as eager to be alive. I wish them well.

On This Rare Occasion I Got a Response

Marieke Meyer (5 July 2013)

Hi Casey:

Thanks so much for your great letter and for telling us about your experience. Very thoughtful. You should write a book (or at least an article) about it!

Marieke

Note: Unfortunately, the episode I was responding to is no longer on the website. At least, I can't find it. You might try writing them a letter!