Friday, June 16, 2017

A Referral for a Referral for a Referral

I'm curious: what must have happened to provoke the powers that be to make the health care system so inanely bureaucratic that wait times for life-saving surgeries are dramatically increased because of all the referrals for referrals required? Who could it possibly benefit?

I've written before about the system. After seeing an oncologist, to get a second visit to arrange to get a referral to a surgeon requires another referral to the oncologist from a family doctor. The same is true of many specialists.

It makes sense to have the family doctor as a first step to point people in the right direction. Some people might call an oncologist direct because they have a headache and think it's a brain tumour. I get that level of primary intervention. But how many mistakenly call their oncologist for a follow-up appointment?? That just doesn't make sense.

Imagine the savings to the health care costs if, on the first visit to the oncologist, you were given your options WITH the names and numbers of various doctors to see depending on the decision you make, and then you were allowed to actually call them all by yourself! So once you decide to go with the hysterectomy before the mastectomy, then you DIRECTLY call the gynecologist!!  That would be amazing!!  But instead, it's a bizarre, circuitous route from the family doctor to the oncologist to the family doctor to the oncologist (who says this should have been done months ago) and finally to whatever surgeon you need to save your own life.

AND the support staff of the family doctor and the necessary specialist set up an appointment time without having a clue about your schedule, so sometimes you end up having to change it, which pushes it all back even further. My daughter has a weird skin thing going on, nothing life threatening, but it's a similar set-up. Months ago, the family doctor said she should see a dermatologist. Just last week we got a call out of the blue from the dermatologist with a reminder for an appointment time for this week. I don't know who slipped up and didn't call me about the appointment in the first place, but it's not the first time that's happened. These receptionists are crazy busy! This week is way too late in the term for me to take a day off, so I asked for another appointment time. Next November is the best they can do.

Here's the thing. Sure it's a problem that some doctors can't see patients for six months. It will cost a fortune to get more doctors in the system, so I see why that could take some time and political wrangling to change. But it could actually SAVE money if patients could be allowed to make some of these appointments directly instead of having a separate appointment that prompts support staff to make arrangements on their behalf that end up not working for them anyway.

I recognize that if patients can call specialists directly, the problem would become how to differentiate the patients that are allowed to call directly from the ones that still need to be assessed by the family doctor. That will be tricky. But the question is, then, would the increase in the number of patients who slip through and directly call a specialist unnecessarily cost more than is saved by the decrease in the number of doctor visits set up just to be allowed to get permission to see the specialist that's actually needed? How many people would actually call a surgeon directly because they have a headache? And how many people have two or three extra doctor visits that are solely to get permission to see the doctor they need to see?

There should never be an appointment with a family doctor that's just to get them to sign off on a referral without the patient actually needing an examination or assessment to figure out which specialist is needed. In other words, if the doctor's specific skills aren't being used, then that appointment is a waste of the taxpayers' money. When an oncologist tells me to come back with a decision so we can get started with surgery, then it's a sham to force patients to make three different appointments with three different doctors before getting to the actual surgeon.
    

Sunday, June 11, 2017

On Bertrand Russell's The Conquest of Happiness

Some  Russell quotations have been floating around lately, so I read The Conquest of Happiness, first published in 1930, and, boy, did I need this right now! The main ideas and some bits I liked are below by chapter. The book is really just a mix of Stoicism and Epicureanism, so you could just read that instead, but they're not nearly as palatable. This summary is really long, but not nearly as long as the book!


Part I: Causes of Unhappiness

1: What Makes People Unhappy? 

This chapter has some racist bit, but I imagine he was still more progressive than most at the time. We won't throw the baby out with the bathwater at any rate. He raises his thesis here: we can only be happy by being prudent with desires and by focusing outward. 

Lymphedema: A Research Study Overview

I'm cancer free, but very anxious about lymphedema. It's become a bit of an obsession, so, for anyone googling it, here are all the studies that I really should have researched before consenting to the Axilliary Lymph Node Dissection (ALND) surgery that half my doctors told me I didn't need, and the other half convinced me I should have had done months ago. In all that back-and-forth discussion, nobody gave me the harsh facts about lymphedema. They were all too focused on the cancer, so much so, that I really wasn't able to give informed consent based on their cheery consolations: "We don't see that so much; I wouldn't worry about it." The risk is small, but it's about as small as having cancer in my lymph nodes to begin with (somewhere between 15-30%). And the potential effect on my life is enormous. As far as I can tell, I basically agreed to risk being permanently disabled in order to have peace of mind that my cancer won't spread. Writing about it at least will briefly keep me from insanely measuring the circumference of my arms over and over.

My surgeon has taken a very Epicurean approach. He's quite convinced that there's no rhyme or reason as to why some people get it, so I should just live my life, without a compression garment, and not worry about it unless it becomes a problem. I asked about booking a kayaking trip eight-weeks post surgery, and he gave me his blessing. However, while it's true that there are risk factors beyond my control, there are also some things I can do to prevent this condition - things that patients should be told to do to decrease the risk. I believe he's negligent in not sharing the latest research. All of these doctors were. It shouldn't be up to patients to seek out studies to determine how to proceed. That's why they get the big bucks!!

Monday, May 22, 2017

Nader Interview with Chomsky on the Requiem for the American Dream

Ralph Nader interviewed Noam Chomsky last Saturday about Chomsky's new book Requiem for the American Dream and film of the same title currently on Netflix. He's trying every type of media to spread this understanding of history, to "throw fact against myth."

I saw the film back in December and outlined his ten-point plan then. The interview followed that format as well, so I'll just summarize the key points here as succinctly as possible. The following is all made of direct or close to direct quotations from Chomsky with bits of Nader included. Check out the transcript if you want the whole thing verbatim to mine for quotes. This is just the idea.


After the uprisings of the 60s, both the political elites of the left and right were affected by the notorious Powell Memorandum of 1971, Supreme Court Justice Lewis Powell's memo to the Chamber of Commerce. Powell leaned to the right and saw an attack beginning from left-wing extremists like Herbert Marcuse and Ralph Nader who were out to undermine the free-enterprise system. His conclusion was that businessmen really own the country and should fight back. But the liberals at the same time, affected by Samuel Huntington's Crisis of Democracy, came to a similar conclusion, albeit more muted: There's too much democracy, and passive parts of the public are starting to enter the political arena. It's creating too much pressure on the state; the pressure from the corporate sector is never mentioned, though. That's comparing national interests to special interests: the young, old, farmers, workers, women, etc. Those special interest groups need to be made to go back to being passive. Huntington called on schools and churches to better indoctrinate the young.

Coming from both sides, it couldn't avoid having an effect, and neo-liberal policies were formed starting late in the Carter administration but peaking during Reagan's time. In an effort to reduce the role of the public, they reduced the role of government and transferred it all to the market where the public doesn't have any power. The de-regulated industries and banks grew dramatically and, instead of just loaning money as needed, they started to get into predatory activities, like speculating with other people's money. The worldwide effect was a sharp increase in the concentration of wealth in the hands of the few, which led to more power, which led to more concentration until we have a fraction of the 1% in charge of almost everything. This marked a sharp decline in democracy as 70% of the population is disenfranchised since their own representatives will pay no attention to their opinions. Now, under Trump, the people appointed to head the departments of state are the very people whose record has been to stifle those very agencies they've been appointed to run. These cabinet appointments would be comical if their effects weren't so awful.

We see all this is the trend towards populism: a framework of the people set against the elite. There's tremendous anger and contempt for institutions now, and some are collapsing. We could see it in the last election with Sanders rising up despite no support from the wealthy or media, and Trump becoming unstoppable. And in France we just saw an election in which the two major parties were wiped out, and two from the edges, a neo-fascist and a neo-liberal, were the popular choices. Worldwide there's disillusionment reflecting the fact that policies are in place with the explicit objective of undermining democratic participation.

The more savage fringe of the Republican Party, Paul Ryan, is undermining workers' rights, safety rights, and health programs, and increasing big tax cuts for the rich at the expense of the most vulnerable parts of the population. Industry is subsidized by the public at $80 billion per year, which is nothing compare to the subsidies to energy and agribusiness. All talk of a free market is a joke. Tax payers are forced to subsidize their own oppression. 

The focus on the people's problems is a ruse to atomize society - to pit factions against one another so they'll all be more easily controlled. It's divide and rule: people turn against one another rather than focus on the government: they argue about reproductive rights, gun control, and same-sex marriage, instead of cracking down on corporate crime. This is how it worked with Senator Inhofe who believes climate change is a hoax. He was asked how to win elections: "God, gays, and guns." Divide and rule distracts people from the most frightening issues.

Manufactured consent has a media system that deceives the people. People undermined by political decisions are voting in favour of candidates undermining them, like was explained in Strangers in Their Own Land. They have been turned against their own interests through an offer of narrow choices. Courts have persuaded the majority that there are too many frivolous lawsuits clogging up the system, but less than 2% of wrongful injuries get into the courts in the first place.

The image that comes up is of people standing in a line. Behind us are our parents and grandparents who worked hard to get the American dream. They got ahead, so they moved along in the line, but now the line has stalled or declined. Ahead of us, people are flying into the stratosphere. That doesn't bother us, though, because that's the American dream. What worries them is the people behind them. This is where scapegoating occurs. Reagan talked about welfare mothers driving in limos to the welfare office. That story. People behind us are worthless and lazy. The federal government role is to help the worthless behind us to get ahead of us with food stamps, affirmative actions, etc. So we end up hating the government for helping the poor instead of hating corporate interests. It's a very effective way to control people. Trump's promises, to bring jobs back, etc., won't be realized. The working class, many who voted for Obama before but were disillusioned, then voted for the enemy. What happens when they realize the promises' delusion again? The ruling powers will be forced to turn to more extreme scapegoating. Who's the someone else? The most vulnerable parts: foreigners, etc. It could turn out to be pretty ugly. 

This is the moment to act constructively. Sanders was remarkable. Thanks to Fox News, the most popular political figure in the country right now is Sanders. This indicates available opportunities to turn the tide.

Historically, labour unions provided the means where people could get together, act in concert, and carry forward progressive steps towards freedom and democracy. The strikes of the 1930s ushered in the New Deal, which had a beneficial effect into the 1950s. So unions are being attacked for their ability to build solidarity. People are the enemy of concentrated power, so we have to marginalize them somehow, and break up any institution that joins them together. Common beliefs are essential. Raising taxes on the rich has been a popular demand for forty year. At the polls, there's general support for having national health care. It's horrible, a pay or die situation. Drugs are more expensive in the U.S. than anywhere in the world. That goes back to the end of Reagan when 70% of people thought the right to health care should be in the constitution. The government is forbidden by law to negotiate drug prices. A poll found 85% are opposed to that, but it doesn't enter debate in congress.

Many Trump and Sanders voters have similar concerns. There's a real possibility of putting together a progressive coalition around jobs, health care, and taxing the rich, but there's an enormous struggle to prevent it from happening. By fostering extreme consumerism to drive into their heads the only thing that matters is the number of commodities they have - it takes a huge effort to create this imagery. But there are huge areas of support for civil liberties, changing the war on drugs, the corporate tax system, wars of aggression, climate change. Everyone wants their own children to have access to a good school, water, air, food - that's what we need a cutting age movement for. If it hits 75% of people, it will be politically unstoppable.

The effectiveness of a protest, like a hunger strike, is measured by the moral and cultural level of the outside population. If it's ignored (because the culture and morals are low), then it's ineffective. If it's high, and people can appreciate the reasons for the action, then it can have a huge effect. It's effective if the population appreciates the reasons and comes to support and perceive it. But, for example, there's very little reported on the current Palestinian hunger strike. The U.S. has a large share of responsibility of deprivation and suffering: We provide aid and ideological support for the pursuit of Israeli policies in occupied areas, which are brutal. The hunger strike is directed at us. The question is, do we perceive it and do we react. This is the fourth week, and it's still not in the mass media. There's a black out.

So far, Trump has been a kind of a charade at two levels. Trump makes one outrageous claim after another, then the media go after him, after the latest crazy thing. Meanwhile he uses that to strengthen his base by saying the liberals are attacking him. Support for him increases as the people see themselves attacked by the liberal elites. Meanwhile, at another level, Paul Ryan is pushing through legislation of the most extreme. But attention is focused on other things, and the Democrats are to blame for that. Maybe that outrageousness will implode on him, but so far it's working very well.

I just takes 1% in each district to be connected in order to take back congress. "We the people" is what begins the constitution. If we can band together to turn the situation around, an emerging left-right alliance would be unstoppable.


Hedges on Impeaching Trump

"If the deep state replaces Trump, whose ineptitude and imbecility are embarrassing to the empire, that action will not restore our democracy any more than replacing Commodus restored democracy in Rome. Our republic is dead. . . . Corporations, cannibalizing the federal budget, legally empower themselves to exploit and pillage. It is impossible to vote against the interests of Goldman Sachs or ExxonMobil. . . . The executive branch of government has empowered itself to assassinate U.S. citizens. . . . The outward forms of democratic participation—voting, competing political parties, judicial oversight and legislation—are meaningless theater. . . . The relationship between the state and the citizen who is watched constantly is one of master and slave. And the shackles will not be removed if Trump disappears."

Read it here.


Sunday, May 21, 2017

Taking Comfort in Stoicism

When thing take a turn for the worst, no philosophy helps me like re-reading the writings of Epictetus, Seneca, and Marcus Aurelius.

I had a dream last night that I was at a bike show (about bicycles, not motorcycles), talking to a distance rider, when, after a long conversation, I noticed that his one arm ended just this side of the elbow. He had a prosthetic, but nothing fancy, just something to help him grip the handlebars. And I felt so sheepish for whining about my trivial issues.
What, then, is to be done? To make the best of what is in our power, and take the rest as it naturally happens. (Epictetus Discourses B I, Ch I)
We have to figure out what's in our power to control, then stop griping or trying to fix what's not in our power to change. It is what it is. So, right now, I can't change the fact that I had this surgery and that things went wrong. That's in the past where I exercise no control. But then we have to learn to affect what we can control with courage. I can control my behaviours: how well I do my painful stretches and care for my wonky arm, and I can certainly control my attitude, but most importantly, I can control my perception of things (which will, in turn, affect my attitude and behaviours).

Before I get to controlling perceptions, be aware the tricky part isn't actually changing how we see things, but that earlier bit: knowing what's in our power to control. Does it makes sense to rally against powerful interests in order to shift energy consumption in order to save the planet? Is saving our habitat actually within our control? Likewise, in this situation, does contacting my MPP about the problems with the current health care system, which I've done, actually do a hill of beans to change anything? It's harder than it looks to have the wisdom to know the when to accept our lot and when to have the courage to fight for change. We have to take a chance and fight for what's right, yet not hang on to the outcome, not have any expectations that our actions will see results in our lifetime.

A recent interview with contemporary Stoic author, Massimo Pigliucci, sums it up well:
We should very much try to change things for the better, that’s the whole point of the Stoic discipline of action, and that discipline is connected to the virtue of justice. But we should also be rational about it, and understand that sometimes things go our way, and at other times they don’t. We have varying degrees of influence over external events, but the only things truly under our control are our judgments and actions, for which we are morally responsible.
My disposition leans towards fighting anyway, so I'm more likely to need to be reminded to accept those things so obviously outside my limits. It is what it is.... It is what it is....

To change our perception of things, we just need to be grateful for what we have and remind ourselves of those worse off than us. Regularly imagine the worst thing possible happening, and consider how you could cope with it, and then we'll be ready for anything.
No prospect of hardship comes to me new or unexpected I anticipated it all and have rehearsed it in the privacy of my mind....And so a wise person gets used to future misfortunes, and what other people make bearable by long suffering he makes bearable by prolonged thinking. (Seneca Letters from a Stoic 76)
I'm very good at preparing for the worst when it comes to big things. I had a new will drawn up last September and showed my kids where to find all the important documents, just in case. But it's the minor annoyances of life that we sometimes overlook and allow to build up until we're in a tizzy.

When stretching is painful, and I note an ounce of self-pity because I haven't prepared myself for the unexpected pain, then a quick mental image of Franco playing Ralston in 127 Hours can do the trick to help me get over myself and recognize how minuscule my troubles really are - and how much much worse they could be.

We're also advised to remind ourselves that if this were happening to an acquaintance, we wouldn't be so affected by it, so it's silly to be affected by it when it happens to us.
For example, when our neighbor's boy breaks a cup, or the like, we are presently ready to say, "These things will happen." Be assured, then, that when your own cup likewise is broken, you ought to be affected just as when another's cup was broken. Apply this in like manner to greater things. Is the child or wife of another dead? There is no one who would not say, "This is a human accident." but if anyone's own child happens to die, it is presently, "Alas I how wretched am I!" But it should be remembered how we are affected in hearing the same thing concerning others. (Epictetus The Enchiridion 26)
I know if it happened to another, I'd think, "It's unfortunate and frustrating, but it's not the end of the world, for heaven's sake!" This too shall pass. Just thinking like this, a little each day, affects our attitude towards things, makes us less upset at minor annoyances. And that in turn affects our behaviours, making us far more patient and understanding with one another.

If we can affect our perception of things, then we're well on our way to want what we have and not want what we don't, and actually be content for a moment - that is, when we can remember all this!
He who fails to obtain the object of his desire is disappointed, and he who incurs the object of his aversion wretched. If, then, you confine your aversion to those objects only which are contrary to the natural use of your faculties, which you have in your own control, you will never incur anything to which you are averse. But if you are averse to sickness, or death, or poverty, you will be wretched. Remove aversion, then, from all things that are not in our control, and transfer it to things contrary to the nature of what is in our control. (Epictetus The Enchiridion 2)
The sooner we can accept that some pain and suffering is part of life, and that death is coming for all of us, the sooner we can get on with things and enjoy each day.

And then we can use these seemingly unfortunate events to a greater purpose by using them for self-improvement, like bombarding parliament with letters of concern about the state of our ER departments, or, more to the point, by acclimatizing ourselves to greater troubles. Look how much I can tolerate!
With every accident, ask yourself what abilities you have for making a proper use of it. ....If you are in pain, you will find fortitude. If you hear unpleasant language, you will find patience. And thus habituated, the appearances of things will not hurry you away along with them.  (Epictetus The Enchiridion 10)
Aurelius predated Nietzsche's, "What doesn't kill you, makes you stronger" somewhat with this bit:
Everything which happens either happens in such wise as thou art formed by nature to bear it, or as thou art not formed by nature to bear it. If, then, it happens to thee in such way as thou art formed by nature to bear it, do not complain, but bear it as thou art formed by nature to bear it. But if it happens in such wise as thou art not formed by nature to bear it, do not complain, for it will perish after it has consumed thee. (Meditations 10)
This won't consume me. I was formed by nature to bear it!

So, that one day when my daughter changed my dressings and the blood shot out from my side a little like this:


I was a little traumatized that we had to catch it all in the sink - not just woozy, but made quite afraid to take the bandages off again. But I'm still healthy and active, living and breathing and using my arm a little more every day. And, like my dream reminded me, some people don't even have two hands to work with. I'm very much one of the lucky ones!


Then again, I lieu of reading the Stoics, it helps just to keep this song in mind:




Saturday, May 20, 2017

On Mistakes

Okay, so maybe just one more post about doctors...  I know it's awfully boring. The last one was in play format to make it more palatable. But it's tedious because I feel so middle class to just now awaken to the fact that the health care system is in crisis. My ignorance is embarrassing. (So is my need to vent.)

The problem I'm going to ramble on about today is that it seems some health care professionals sometimes act out of fear of litigation, or fear of stepping on toes, or something, and it's having a damaging effect on patient care. Erin Anderson wrote about this problem in ERs years ago:
An Ontario study published [in 2011], which looked at 22 million patients visits from 2003 to 2007, found that the longer patients waited in a crowded emergency room – only to be discharged and sent home – the more likely they were to die or be admitted to hospital within seven days. That's disconcerting when we know that more Canadians, unable to find family doctors, are using the ER as an alternative. The problem may get only worse.
I was so taken aback with how crowded the hospitals were. A five hour wait seems to be normal now. And my experience was to just be sent home only to be sent back by my family doctor five days later.

Then Anderson wrote about Toronto doctor Brian Goldman's excellent TEDTalk about doctors refusing to admit to mistakes:
“The culture of medicine has an almost immunological response to error: The first instinct is to send out the antibodies and try to contain the contagion and get rid of it,” Dr. Goldman says, citing a survey of 1,800 American physicians released this month that found 20 per cent had kept mum about a mistake. Clearly they fear lawsuits, but that's not all. “Underneath is this terrible insecurity that many physicians feel, that they'll be caught out on a mistake and people will find out that they are not perfect, and somehow admitting you make mistakes is the first step in being asked to leave the profession. … We're ashamed to talk about it.”
That the second ER doctor I saw actually insisted on a chaperon, a random nurse, to come in while he examined my armpit, illustrates dramatically the fear of lawsuits. We need to get back to trusting one another. It's hard, though, because doctors do make mistakes. What do we do about that?

The video is so good, I'll embed the 20 minute talk here. It's all about the problems that happen because of a fear of admitting our mistakes:




Goldman says we need a "redefined medical culture" where physicians know they're human, point out others' mistakes in a supporting way so everyone can benefit, and recognize that since there will always be human error, we need a system of backups to detect the mistakes. Absolutely.

I was in ER a week ago Friday, then again the following Wednesday. Both times they told me I was temporarily fine regardless the pain and swelling, and "it's better if your surgeon decides the course of action." WHY is it better? On my first ER visit last Friday, I specifically asked if there was a way to drain the hematoma - a couple of huge, swollen lumps of fluid and clotted blood in my armpit, big enough to make it necessary for me to hold my arm out from my body, with my hand constantly on my hip, throwing my body on an angle resulting in an ongoing tension headache. The report description: "a large complex fluid collection... measures 7.7 x 5.0 x 7.6 cm." Yes, that says centimetres. But the ER doctor wanted the surgeon to make the call. Just in case. Yesterday, finally able to meet with my surgeon again, he suggested we drain the hematoma, and I'm scheduled in for next Thursday. Yay!

But had the ER doctor felt comfortable making a decision in lieu of the surgeon, then I might be drained and recovering by now. I might have been able to ride my bike this weekend! Instead I'm in a state of coping and tolerating and waiting. And I'm disgusting, constantly dribbling out of an open wound in my side, which is a good thing, but a gross thing.

But I get it. As a teacher, if a student came to me about an essay for another teacher, I would be very hesitant to comment. I won't really know what the teacher's assessing with the assignment, so my advice might put the student down the wrong road. And I wouldn't want to comment in opposition to the teacher for fear of the student perceiving it as a collective undermining of the teacher's evaluation (as they sometimes hope to create). I totally get that. But if the student were struggling, and the teacher unavailable for a time, and they just need advice on something relatively clear and unequivocal, like grammar and mechanics, then I'd be up for the task. And if my decision bought them an extra week of time, then I'd be remiss if I refused to make the call on those semi-colons. I know this is not entirely analogous because it means making the call to have someone stick a long needle in me, but the decision-making analysis - to make a call on a colleague's ward - is the same.

And I really wished I had been more persuasive: complained about the pain more, suggested the surgeon probably wouldn't mind and might love that the ER doc was so competent, that kinda thing.

That ER doc also sent me for an ultrasound to check for blood clots in my bloodstream, which could cause problems. He reported that they didn't find any, and sent me home. But then my family doctor gave me a copy of the report, and the ultrasound technician indicated that that "veins are poorly seen" because of that mass of fluid. So, yes, they didn't find any clots, but apparently they couldn't really see my veins, either. When I mentioned the "poorly seen" part of my test to my medical oncologist the next day, she had them add on a doppler while they're at it next week to check blood flow. But that whole thing gives one pause. It hurts when I breathe deeply or laugh, so, of course I think I've got a pulmonary embolism! My family doctor assured me that it's just the pain from my hematoma radiating, but if I keel over between now and Thursday, avenge my death! No, actually, don't. That's the whole point here. I've seen seven medical professionals in the last seven days, so I'm bound to be fine. Right? 

As a teacher, I'm ever relieved that my mistakes don't cost lives. If I give a wrong date for a philosopher, I just correct it the next day. I rarely give out a test without a missing number or a typo somewhere. I check and check, but there's usually one little error in there somewhere. We just all fix it and go on. But the fact that doctors are as fallible as I am is a little panic-inducing.

But imagine if we could be less litigious. I never call Telehealth anymore because they always always tell me to go to emerg. If they tell me I'm probably fine, then they run the risk of me dropping dead, and then getting sued. But it's a useless service if it can't actually perform the function as an alternative to the hospital triage. They need to have the medical know-how, but be as protected as moms are. Moms never get in trouble for giving medical advice. My mom wouldn't let me see a doctor unless my arm was pretty much off. She had a quick remedy for everything. It was mainly bed, a cold washcloth, and some hot lemon that she made from scratch (secret recipe: lemon juice, orange juice, and hot water) that seemed to cure everything. I think my mom could stand at the doors of the ER and convince 70% of the people there to go back to bed. We need a system that can operate like that without fear of reprisal. After some hearty mom advice: clean it off and put a bandaid on it, take a couple aspirin and go to sleep, and, the ever popular, try to go to the bathroom, they can just end every call with, "I think you should go back to bed, but it's ultimately up to you," to shake off some responsibility.

Or maybe I just need my mom right now. Over twenty years gone, and I'm still at a loss to figure out what to do without her. Anyway...

Beyond risking actually making a decision, how the doctor reacts makes a significant impact. We are all human, and we pick up on cues. If they seem annoyed at such a petty case, like the ER doctor did, then it affects how much the patient might complain. If they openly express shock at what they're seeing, like the CCAC nurse and my family doctor did, then they can make a patient absolutely terrified that they're about to drop dead. Many doctors have offered me options stone-faced, making it all my responsibility. I hate that! But if they don't, then they get blamed for a bad call.

The patient makes a difference too. There are all sorts in the ER. As suggesting in the TEDTalk, a hint of alcohol changes everything. But also being a trooper and hiding pain stoically is a bad idea. Being loud and abusive takes up everyone's time and patience, but being completely silent and complacent doesn't work either. You have to be just the right amount of a pain in the ass to get treated instead of just being sent home with some Advil.

When I saw the surgeon after my dramatic week, he seemed a little bit wary of me at first, like he thought I'd be angry with him. He kept thanking me for my patience in all this, and apologizing for how it all went. Apparently all it took to open a little blood vessel was too much arm movement in the first day or two after surgery. I wish I had known why it was important to not move the arm. It would have made a difference for sure. I was careful not to lift anything, but I made myself a salad on day two, and cutting vegetables involves a lot of little motions even though I didn't bear any weight. I was disappointed he couldn't just lance this mass and get it over with, but one more week and one more procedure, and I should be on the mend.

My medical oncologist is so warm that her flip-flops on my case can easily be forgiven. She sounds just like Demi Moore, and she always touches my knee just so. She originally told me not to do the surgery at all because the chances of the cancer having spread were about 1%. Then, a couple months later at a random check-up, she was adamant that I have surgery immediately because she recalculated and found the chances were actually closer to 25% or so. And she was just so sure. And yesterday she told me they were all clear. No sign of cancer anywhere. Yay.


Stage 3 Lymphedema
It's all so bittersweet. Maybe it's just that I love to complain, and hurray I don't have cancer and all, but... I was very close to never having this surgery in the first place. Most of the doctors I saw told me there was no point. Then she convinced me. And then the surgeon shook his head at the naysayers. And then I did it. Now that I have, and found out I didn't need to (except for peace of mind), I will have to worry about lymphedema and infections and any minor thing happening to my left arm for the rest of my life. Apparently, getting lymphedema after this surgery is a total crap shoot. There's no rhyme or reason to it, so my surgeon told me to just enjoy myself. Go backwoods camping and hiking, but be just a little more vigilant about cleaning bug bites or minor scrapes or cat scratches. And keep moisturized to avoid skin peeling around the cuticles. And always use sun lotion. And I am so bad at doing all that!! It means finally breaking my revolting habit of biting my hangnails off! And I still have to take the estrogen blockers, which give me impressive hot flashes. The alternative to the surgery was knowing that the cancer might spread and having to check for recurrences in what's left of my chest.

Holy buyer's remorse, Batman. At least it was all free.  

Ack, it's always something! If it's not one thing, it's another. Either you risk having cancer, or you risk having lymphedema. Either way, we're all just bags of bones trying to extend our stay here as long as possible. I'm just grumpy because I couldn't ride my bike on this glorious day!



ETA: Apparently overcapacity at my local hospital and others is becoming an election issue. I wrote this in response:
I'm glad someone's tracking this. It's a mess in there! We need way more money in health care to make sure it rivals the best in the world. But we also desperately need better organization in the system so there's less duplication of services and way less of a run-around trying to get the right treatment. I need to see a specialized physiotherapist that I can only get with referral from my medical oncologist, but I need a referral from my family doctor to see HER, so I'm looking about 4-6 months of waiting before I might actual get into physio so I can deal with an issue that needs immediate attention. I'm actually using Google for all my medical needs! It worked great to help me figure out how to build a studio in my backyard, so this should be fine! This is ridiculous.  

Thursday, May 18, 2017

Another Trip to ER

Me: So, I have a letter from my doctor. I was hoping that would make things go faster. It still took two full hours to get to this point, though.

Triage Nurse: I wish family doctors would come to the hospital once in a while. They have no idea how things work here. A letter doesn't do anything to move you faster. That all depends on the volume of people and the number of doctors available.

Me: It'd be nice if there were some way to be called on, with an automated phone call or something, so we could leave and come back. Last time I waited nine hours without food or water because the volunteers told me I'd lose my turn if I left.

TN: (annoyed) Your health care is your own responsibility. If you're hungry, then you should have left. Someone would keep your place for you.

Me: They were very clear with me that I wasn't to leave or else someone would call me and, if I wasn't there to answer, then I'd be dropped from the roster.

TN: You just come to one of us. We would have held your place for you.

I gave up this line of discussion because it was futile to indicate that any attempt to walk directly to the triage nurse area would always be circumvented by a string of people. It's not possible to just poke in your head to get them to watch our for you personally. That's such a ridiculous suggestion! Or it wasn't possible for me last Friday, at any rate. Not at all.

TN: How's your pain level?

Me: It's not too bad. It's tolerable. It's a lot of pressure, like elastic bands around my arm and armpit and chest. I'm really just here because the doctor told me to get checked out if the hematoma doubled in size, and it has. So I saw my family doctor, and there's still a lot of bleeding, and she was like, "Woah! You should go straight to the ER!" I have to change my dressing leaning over the sink, it bleeds so much. So here I am.

TN: So low pain level, but your irritation level's at a ten!

And then, so uncharacteristic of me, I started crying. Once one tear escaped my hold, then it snowballed. I acted like it wasn't happening and just kept answering questions, surreptitiously wiping my eyes as if maybe I had an eyelash curing inward or something innocuous needing some tending to. Last time I was reeling in pain, and it was 90 minutes to the triage nurse, followed by five hours before I actually set eyes on a doctor, and then two and a half hours of tests and waiting for test results before I could go home. I was just hoping for a script for more Tylenol 3s to help me sleep through a night, but they only gave me Advil anyway, and then told me the name of my condition. My time there was completely fruitless. This time it took even longer to get to triage, which had me worried. And I wasn't in enough pain to want to be trapped there all night again.

TN: It shouldn't be long now. There are just a few ahead of you.

Me: Last time they said the same thing. Less than an hour, they said. And I'm not even sure I need to be here. I think I should just go.

TN: But it's better to wait. Then you'll know for sure if everything's alright.

I sat in the other waiting area, the one further from triage and closer to the droning of the TV. There are captions running along the bottom of the screen; do we really need the volume cranked as well? Only one baby crying today. Last time there was a few. The man next to me came in at the same time with a severed finger - like, completely severed. He didn't get in any quicker. They didn't even offer him ice. I felt like I was wasting everyone's time and taking up a spot that someone else should have. And then they called me to a bed to wait.

Instead of sitting alone on a bed for hours, it was just minutes. I can't help wondering if my sudden emotional outburst had any effect.

Doc: I'm going to check the hematoma, and... just wait! Wait!

He motioned with his hand for me to stop unbuttoning my shirt and called for a nurse.

Doc: (his back to me, leaning just his head out of the curtained doorway) I just need you for a minute. No, he can wait. Just come here right now for a minute!

I felt bad dragging someone away from another patient, and it also made me nervous that I was suddenly such a high priority.

Nurse: Do I need gloves?

Doc: No, I just need a chaperone.

Me: What the f...  Are you serious?! I don't even have any boobs anymore!! What do they think's going to happen behind a curtain? Do you really have to take up the time of another person for this?

Doc: it's just in case.

In case of what?! It was weirdly flattering, though. Like I still vaguely resembled a woman. Or maybe I just looked voracious, and he was concerned for the harassment to go the other way. I mean, it's been a while. He checked out the bulges of blood clots collecting under my skin, the skin so taut it looked about to burst. Of course he was concerned about something happening between us.

Doc: You're scheduled to see your surgeon tomorrow. You could wait to see the surgeon here, but it's probably best to get advice from the surgeon who operated on you.

Me: My doctor told me I should be seen today.

Doc: It's up to you, ultimately, but it could be some time to see the surgeon here, and I think you'll be fine for the night.

And I left. Just one more sleep before I can see the surgeon about this bloody mess! But isn't it curious how all these decisions, to wait in triage, to see the surgeon tonight, they're all so adamantly MY decisions to make. It's been the case from the first moment it was suggested I might get surgery. It takes all the responsibility off the health care staff, but it often leaves the patient at odds as to what's best. I was pleased at least that this doctor made it clear which way he'd go, even though it's still completely up to me (aka not his fault if I happened to get worse overnight). But it's really too bad my family doctor couldn't have make that call.

On Petty, Self-Serving Teachers Taking Sick Days

A timely local article (timely for what I'm going through) in the Record, discusses the horrors of teachers who are allowed to have paid sick days - or that's how it's being read by a vocal group of commenters. The facebook rants following it are so routine that the insults are having less effect, which is dangerous. Sure it sounds good on the surface - just let the dirt roll off your back. Yup, we're all lazy sods who barely work six hours a day with tons of breaks and holidays - because prepping and marking and helping kids outside the classroom don't count as work. Sure. Whatever. But without any retaliation, the loudest haters in the public will allow the sick pay created by unions to erode completely.

We've all seen the shift away from the glory days of unions; the singsong "look for the union label" days are far behind us due to the neo-liberal double-barrel of deregulation and privatization. But, in the U.S. at least, there's a clear correlation between union membership and a strong economy. When the economy was at its best, a third of the country belonged to a union. When strong, supported unions dissolve, the economy tanks. Taking care of people actually has a positive effect on businesses. Isn't that just obvious?

I will never understand this race to the bottom born from people who insist nobody should have paid sick days or benefits or regulations around breaks or a limit to hours worked or job protection after a maternity leave or safety regulations or just generally reasonable standards. Decades ago, groups of people gathered together to fight for better working conditions. Their resolute unity worked brilliantly to pressure employers to ensure people have the basics covered. People solidified to demand a healthier, safer, more secure life for all citizens. And people are upset about that now because...???

The Record article is actually about the fact that, since reducing sick days to 11 days per year, teachers are calling in sick more often. Some people think teachers are following the use 'em or lose 'em mentality. The Record takes a surprising pro-teacher stance with the words of WRDSB trustee, John Hendry, who thinks that it's possible teachers are taking more sick days due to increased stress.

In contrast, back in March, CBC reported the same data with a different slant: Sandals says "teachers are taking more sick days because they lost the right to bank them" and the article later refers to sick days as "an expensive luxury." Similarly, in an article about this also last March in the Globe & Mail (apparently the Record was really behind on this one), "Labour lawyer Howard Levitt said...'this plan obviously dramatically exceeds what employees in any private sector employer that I have ever heard of receives, I never cease to be amazed at the exorbitant giveaways at all levels of the public service.'"

I don't know Levitt's scope, but when I worked in insurance, my benefits were at least as good. But that was long ago. They might have eroded significantly by now.

Then Luisa D'Amato weighed in on this to counter Hendry's position. According to D'Amato, it's unlikely teacher stress has changed: "there aren't signs it has become more challenging lately." She jumped on the "use it or lose it" bandwagon and shamed the "petty, self-serving" teachers for doing something so harmful to their dear students as to take time away from the classroom.


ABOUT THOSE STATS

First of all, let's look at the numbers. Well, let's try at least. It's really hard to find any. The data were compiled "by the School Boards' Co-operative, a nonprofit agency created by school boards for actuarial analysis." I couldn't get access to any useful information on their site, but I did find an interesting comment on the company from a disgruntled employee:
"Elitist organization, ultra conservative, introverted work force who were very self-serving, immature and impersonal. Surface deep organization composed of purists aimed at hiring for Caucasians only. Pompous top management who run this not for profit organization as an unspoken dictatorship but who were none-the-less easily manipulated by underlings who knowingly steered the CEO & COO. Some staff members betrayed confidences by passing on confidential materials and reports to management - totally unethical behaviour encouraged, condoned and accepted by upper management."
I found that as I was scouring for stats showing absenteeism rates prior to 2011, in order to see a longer view of the changes in absenteeism, but none were to be found. Apparently Ontario doesn't keep those kinds of records. So we don't really see how the rates have fluctuated within a longer context. Be aware we're drawing a lot of conclusions on a very short timeframe.


ABOUT THAT STRESS

If it is the case that absenteeism has dramatically increased, and D'Amato's pretty sure nothing's changed that could account for increased stress, then apparently she hasn't heard of AER. After the new rules were implemented, so many colleagues had problems that I made a FAQs page that I wasn't allowed to distribute at school, so I put it here. It's the most positive view of AER I could possibly take. These policies have changed the classroom dramatically. There is no question in my mind that they have added to teacher stress levels. No. Question.

Five years ago, if students didn't have work in on time, we'd take off 10% a day for a week, then give the assignment a zero. No questions asked, no badgering, and no phone calls home for senior grades. The only time I ever called home for a grade 12 student was the very rare occasion when someone failed one of my courses. Students handed things in or accepted the consequences.

Now zeros and late marks are verboten. And students are pushing the boundaries like crazy. Just this semester I've had to deal with students who refused to write a test after reading the questions because they hadn't yet gotten notes for a day they missed two weeks ago - because they know I can't give them a zero for refusing to write it. And I've had several cases of people going out of town for the weekend, not having wifi, so not finishing work assigned a week earlier - and knowing I can't give them a zero if they don't hand in anything. These are grade 12 students about to go to university. It's considered my responsibility to call home every time a student doesn't hand something in, which could be 20 kids in a class for a minor assignment. And it's my responsibility to beg them to please, please get the work in - please, maybe tomorrow?!?

I have my own system that's pretty firm, and it has saved my sanity, but I've found myself slipping this year from sheer exhaustion. Others are scrambling after the kids in a downward spiral. The new policy places unreasonable pressure on teachers, and the lack of pressure on students to get work in on time isn't doing them any favours.

We're told to work smarter, not harder, and it makes me want to impale someone with my metre stick every time I hear that. Marking isn't an issue; it's the same as ever. Chasing is the new issue. It takes up far too much of my time that could be spent marking in a timely fashion or creating innovative lesson plans or helping the students who actually want to do the work. So, yes, there ARE signs it has become more challenging lately, thank-you very much!


ON THE 'USE IT OR LOSE IT' PERCEPTION

When I worked in insurance, we got two sick days a month, and many of us used them liberally. We called them "mental health days" and spent time relaxing and rewinding whenever we felt like we needed it. We definitely subscribed to the use it or lose it mentality. At the time, I was young and healthy, and we worked in little teams so everyone's workload was covered by everyone else.

But I find it hard to believe so many teachers are doing that because it's a whole other ball game calling in sick as a teacher. It involves writing a script of your entire day, word for word lessons, explanations of all the students' quirks, clarification of how to use the equipment in the room, etc. It's far more work than just going in. The day I smashed my head on the sidewalk and was taken to the hospital where a doctor told me I had a concussion and should sit in a dark room for the next week, I went to work rather than prep classes for a supply teacher. It's that much effort. Admin told me to go home, and they called in a supply, but I went to class and taught the lesson with a supply teacher reading a paper in the back of the room.

Furthermore, I wonder how many times teachers are calling in sick but actually going to work. The policy is that we can take off a minimum of half a day at a time. That means if I book a ten minute appointment in my lunch, and it's possible it'll run into my prep period, then I have to take off half a day. But then I don't want to spend the effort getting a supply, so I tell admin I plan to show up for the class, and the supply is used elsewhere, or banked, or something. I'm not even sure. And, from one cancer surgery to the next, I've had a ton of brief appointments just a few minutes' walk from work, that I've always scheduled so as not to miss any classes, but I've had to take half a day off work every time even though I didn't miss teaching any classes. I wonder how much money it would save to allow teachers to book appointments during their lunch hour and cover them for a few minutes if it runs into their prep period. Or maybe, God forbid, let teachers use their prep period as they deem most useful to them, like professionals, rather than mandate they sit in their rooms just in case there's an on-call for them.

Finally, it should be made clear that supply teachers aren't mandated to prep lessons or evaluate anything. They're the puppets of the absent teachers. If I'm away, I'm still in charge, creating word-for-word lesson plans and marking everything from home when doctors have told me I need complete bedrest. Taking a day off work never means a day of rest and relaxation. It means being up late at night prepping, then putting out fires on e-mail all day, then cleaning it all up the next day back. This perception that teachers are petty and self-serving, and taking sick days just because they'll lose them otherwise, is just lunacy.

Saturday, May 13, 2017

More Doctors and Nurses, Less Waiting

I went to the CCAC yesterday after my surgery on Tuesday - the Community Care Access Centre - an agency I only heard about when they had a local whistleblowing scandal a couple years ago questioning the decision to reduce case managers instead of front line therapists, and then more recently, when they spent money to send employees to a conference, which turned out to be largely funded by donors. It's a very necessary agency that cares for people after surgery among many other things, and it's a concern if funding is mismanaged.

It's also a concern if funding is reduced.

It's a complicated system to an outsider. After my surgery, I felt fine and declined homecare, but changed my mind once the drugs wore off, and it took many phone calls to relay that decision because homecare is under a different umbrella than the regular CCAC on-site work staff. This article says the system in Ontario is, "plagued by inconsistent standards of care, byzantine processes and a troubling lack of transparency for both patients and family caregivers." And apparently they're all going to be shut down soon anyway to be replaced by LHINs: Local Health Integration Networks.

Whatever they're called or do, I haven't really followed it all, but they are ABSOLUTELY NECESSARY.

Or something is necessary.  I don't really care how they operate so long as they exist - so long as something's in place when you leave the hospital. It would be kinda nice if it was your own surgeon who could answer questions, but their costs are too high and their time too valuable. Or something like that.

I got my drainage tubes out this morning. When we got there, the cab driver questioned my intentions: "Carpenters?! Is this a union office? Are you part of a union??" No, silly, Care Partners. Well, yes, actually, but that's a longer story, and what's it to you, bub!?

Anyway.

The CCAC nurse warned me that I might faint because the drain was "right up in there." I didn't, but it was significantly worse than with my mastectomy. The armpit has a bevy of nerve endings. My surgeon was right: boobs are just blobs of fat - easy peasy. Lymph nodes are much more integrated and involved in things. The nurse had concerns. I was reporting more pain that I should have at this stage, but maybe I'm just sensitive. But the blood in the drain was more thick and dark than is typical, so she expected a clot, but couldn't find one, and I had way too much bruising way too far from the site, and it shouldn't be swollen right down to my wrist! She removed the tube anyway (thank God), but told me to see my doctor immediately.

Before I left, I asked her about aftercare. Shouldn't I be doing exercises of some sort? I had a booklet to take home after my mastectomy. She thought the surgeon should have given me something, but the day surgery staff was pretty sure CCAC should have something for me. There are too many cooks stirring this soup!! Thank god for Google (and here too). We're on our own, here, kids.

I called my surgeon, but he, as with most of the doctors I try to see, lives behind a protective wall of receptionists or assistants or a "care team" of some sort. They told me I don't see him for that kind of thing, and that I couldn't see him anyway because he's not in on Fridays. It's my family doctor from here on in. So I called her, but she also doesn't see patients on Fridays. Okey dokey. I know her well enough to know that she wouldn't know what to do with my engorged black and blue arm anyway. So, her receptionist suggested emerg was my best option. Middle of the afternoon, how bad could it be, right??

I went to work in the afternoon because I'm out of fully paid sick days from my surgery in the fall - yes, I've got a strong union, but the public perception of being allowed to carry over sick days was deadly to that clause of our contract. God forbid we piss off the public. That fear also ensures every PD day is spent in useless meetings rather than being allowed time to prep classes and mark work in a timely fashion. That part of our job is to be done on weekends and evenings. But I digress.

Okay, one more thing. When I had surgery last semester, I went part time for a week. I had all my classes in the morning and my prep in the afternoon. So I taught A, B, C, 3/3 of my courses, then went home to fall into a mild coma. That counted as half time because I was only in the building for half the day. This time, new semester, I have two classes in the morning, and one in the afternoon. I decided I'd come for the afternoons and teach that one class and stay for my prep. But that doesn't count as a half day. This time it counts as 1/3 day because I'm only teaching one out of three classes. Hmmm.  Doesn't that seem a little fishy to count by day portion or number of class, whichever is less? . . .  Whatevs.

So I went to the hospital right after my class instead of staying for my prep period, because I'm going to do all my marking at home anyway. I half expect to be docked 1/6th pay for publicly acknowledging leaving early - that's fair, teach one of three classes for 1/6 of your pay. And I'll be spending my weekend prepping for the supply teacher and marking even though I'm on sick leave because supply teachers aren't mandated to mark or prep anything. IF I PUNCHED A CLOCK.... Blarg!!

So I got to the hospital at 1:40. It was packed. I finally met with the triage nurse at 3:00. He said I should be seen within an hour because the section I needed to go to was moving pretty quickly. I asked about my meds, which I was scheduled to take at 3:30. A different nurse insisted that the hospital needed to dispense all that rather than my kids coming to deliver them. After an hour of figuring that out, and being given only an Advil because they can't actually dispense Tylenol 3s or any of the other nerve repair drugs and aromatase inhibitors I'm on despite insisting they must be the only dispensing physicians while I'm in their care, I called my daughter to bring me my plethora of pills.

At 6:00, I won the lottery and got called on to move TO A BED, which was very exciting. I thought it meant I'd be seeing a doctor!! But hold yer horses. All in good time. I hadn't had anything to eat or drink since 11 in the morning  - I was terrified to leave the waiting room in case I missed my turn, and the water from the sinks in the hospital tasted horrible. I work right next door and drink the tap water there all the time. I'm not sure what makes the difference, but I tried to force down a few sips out of the tap while I waited. At 7:30 the doctor came to check me out. He said I have a hematoma, blood collecting under the skin, which was causing the extra special pain this time round. This called for an ultrasound to check for clots in the veins which could cause all sorts of problems. His turn was over for now, and he left.

At 8:40, I saw the ultrasound technician in a dark and creepy part of the hospital. We were the only ones there. After tracing all my veins with her gooey magic wand, she told me someone would come to take me back up, and I was left all alone in a hospital gown, open at the back, and my jeans. A thin coating of goo remained down my left side despite attempts at cleaning it all off. It's tenacious stuff. While I waited, I tried to wipe a bit more with a kleenex, and it was quickly saturated with thick, dark red globs. The sticky dampness I felt was pretty much all blood. My escort arrived and told me a nurse would redress that wound. Back in my curtained room, I scrubbed the blood from my jeans with the paper towel eroding as I rubbed, leaving traces behind in a bigger mess.

A nurse came and cleaned me up. She tried valiantly to find a pamphlet of exercises for me, but had no luck. The day surgery staff was long gone. She told me to call my surgeon on Monday, even though that first week after surgery is most important for aftercare, and I already know the surgeon doesn't take my calls. But don't worry - Google's got my back.

While I waited for the results of the ultrasound, I read every word of every poster in the room. One in particular warned people that they might get a call asking them about their experiences. They want to know what would make the emerge experience better. I'll tell you. It's one thing. There is one answer to that question: We need more doctors and nurses available. Just MORE. That's it. It's not complicated and doesn't require a survey. We need more money to pay for more staff so we have shorter wait times. No matter how it's organized and where little bits of money are misspent or where there's an overlap of services or cracks between them, those are all important issues and all, but nothing will get better until we have more staff to be able to take on more patients. But not just in emerge. We need more staff everywhere. It took me months to get in to each surgeon to find out I should have had surgery months ago. Take money from education if you need to. Cut my salary in half if that's the only place we can find a buck. I mean God forbid we raise the marginal tax rate or anything. I don't even care right now. I just want the Ontario health care system to be swimming in cash, at least enough for some quality water fountains so we're not so monopolized by Timmys to quench our thirst. This level of care is ridiculous. I feel like I live in the states!

Anyway, at 9:50, the doctor came back with the results. No clots in the veins! Hurray! I just have that hematoma that needs regular surveillance. Come back if it doubles in size or the swelling gets significantly worse (what does significantly look like??), or if it gets hot or I get a fever. All that jazz.

My incredible, beautiful, precious children had dinner ready for me when I walked in the door, eleven hours after leaving for a half day at work - ahem, a one third day at work. It's questionable for me to be back at work at all. I was advised to take two weeks off; I should be spending my days resting. I decided I could manage one class that's presenting seminars to me. But I should have been resting those other nine hours today instead of sitting upright in a hard chair lacking arm supports, in a crowded, noisy room full of contagious germs, with no access to food or water or necessary meds, and no accurate timeline of events - not even a reasonable guess - on offer.

My kids took pics of the hematoma so we could document any changes. You don't want to see that. [ETA - it's here, for the morbidly curious.]

Okay, it's amazing that I had access to an ultrasound tech immediately (relatively immediately). And of course there were a few patients screaming and growling in the triage area and an old guy too drunk to understand why his police escort wouldn't let him have a cigarette. We need more money in mental health services and addiction treatment. Absolutely. And whenever I felt impatient, I watched the number of people there with little ones. Sitting for hours in pain is nothing compared to sitting for hours with a child in pain. They should always get bumped to to the front of the line.

No. Scratch that. There shouldn't BE a flippin' line!

Wednesday, May 10, 2017

Another Surgery Down

I feel like a pro at getting surgery now. That's probably not a good thing. It occurred to me it's kind of like travelling. The first time in an airport is a bit terrifying. It's confusing and chaotic and nothing seems to make sense. Then after a few times, you learn the drill and get used to the types of weird requests made: when to take off your shoes, how to make the bag check tag machines work, and whether or not you can make it to the bathroom once they announce "now boarding."

Getting surgery means explaining who you are and what's about to happen to you over and over to each new person. I assume there have been some serious mishaps in the past to necessitate that level of triple and quadruple-checking. It's really scary walking in there the first time, but it's so much easier once you know the kinds of things that are likely to happen: what the O.R. looks like, how many people will be milling about in there, how it feels to be put under, what it looks like when you wake up in recovery, and then again on the ward with family around.

This time it was an axillary node dissection to see if the cancer's spread to my lymph nodes. Weirdly, my kids and I were re-watching a bit of Archer the night before, and we landed on the one where Archer gets cancer. It was an uncomfortable coincidence. I didn't register the event in the series, just the jokes, so it took me by surprise.  It's not funny when it's so close to home.

I had zero nausea after surgery, which was awesome, and I felt great while I was in the hospital. But then the heavy drugs wore off, and it was a rough night. The pain was out of this world. Yes, it was worse than labour. I took the maximum pain killers allowed, but they seemed to do nothing. It was as if my whole armpit and shoulder area was filled with molten lead, hard and fiery. I imagine it's pretty much how Wolverine felt. I moaned and rocked pathetically for hours instead of roaring like this:



Then, suddenly, it got better. Today, just 36 hours later, I feel great again. Well... human at least. I still have to get my kids to open my many pill bottles. I won't be able to expect much of my left arm for a while. Luckily, after years of toting a rotation of toddlers on my left hip, I learned to do everything one-handed. But why all meds come in child-proof containers is beyond me.

The doctors and nurses were all lovely, but many of them seem to come from a different era. Or something. Before the surgery, I was sitting with my two oldest kids in the waiting area when the nurse called me in. She told me only one of my kids could come in. I exclaimed, "Oh no! It's just like Sophie's Choice!" and people in the waiting room laughed. My daughter stepped up because my son had sat with me for the last one. But then the nurse gave my kids a little lecture about taking care of me. She thought they were hoping to stay behind, but they both wanted to come with. We've gotten that throughout: people surprised or confused at my kids taking care of me so well. After a few minutes in an empty ward, my daughter texted my son to sneak in. We're rebels like that.

Then after the surgery, the nurses told my daughter I wouldn't be able to do any housework so she'd have to do all the vacuuming. We don't even own a vacuum. But, once again with the lectures. And why all directed at my daughter? I hate to think it's a necessary part of their job because most families don't help each other without being told. And it also sucks that it appears so female oriented. It's still seen as women's work to do all the caretaking and cleaning. That's dumb.

I might be able to get my drainage tube out tomorrow, which is more exciting that you can know! It's disturbing having a bulb of soupy blood clipped to the bottom of your shirt while you're out and about, trying to be a normal person.

And then we just wait and see.

Sunday, April 23, 2017

Another Perspective on the Rise in Anxiety

Anxiety is...
"not a coherent fear of a particular thing, and it tends not to focus on the problems you already have. Anxiety is the ambient apprehension that terrible things might happen. . . A mainstay of 20th-century age-of-​anxiety complaints was that our world was becoming too complex for anyone to keep track of or feel like a relevant participant in, full of strange and byzantine distances between individuals and the grand global forces affecting us. . . . You can argue with a store owner; you can’t argue with the call-center representative of the company contracted to maintain the point-of-sale machine owned by the other company contracted by the multinational conglomerate that owns the store. . . . Feelings of anxiety are closely connected to an inability to handle uncertainty. What might make human beings less anxious, it seems, is having a firmer sense of what in the world is happening and what’s likely to happen next. We seem temporarily short on both."

Monday, April 17, 2017

Living in Glass Houses

Über environmentalist Bill McKibben tells us, in The Guardian today, to "stop swooning over Justin Trudeau":
Look all you want, in fact – he sure is cute, the planet’s only sovereign leader who appears to have recently quit a boy band. And he’s mastered so beautifully the politics of inclusion: compassionate to immigrants, insistent on including women at every level of government. Give him great credit where it’s deserved: in lots of ways he’s the anti-Trump, and it’s no wonder Canadians swooned when he took over. But when it comes to the defining issue of our day, climate change, he’s a brother to the old orange guy in DC.
It was Canadian diplomats, and the country’s environment minister Catharine McKenna, who pushed at the Paris climate talks for a tougher-than-expected goal: holding the planet’s rise in temperature to 1.5 degrees Celsius. But those words are meaningless if you keep digging up more carbon and selling it to people to burn. . . . he got a standing ovation from the oilmen for saying “No country would find 173 billion barrels of oil in the ground and just leave them there.". . . Environment minister McKenna, confronted by Canada’s veteran environmentalist David Suzuki, said tartly “we have an incredible climate change plan that includes putting a price on carbon pollution, also investing in clean innovation. But we also know we need to get our natural resources to market and we’re doing both.” Right. But doing the second negates the first – in fact, it completely overwhelms it.
Things are worse to the south but at least we all know it.
Trump, of course, is working just as eagerly to please the fossil fuel industry – he’s instructed the Bureau of Land Management to make permitting even easier for new oil and gas projects, for instance. And frackers won’t even have to keep track of how much methane they’re spewing under his new guidelines. And why should they? If you believe, as Trump apparently does, that global warming is a delusion, a hoax, a mirage, you might as well get out of the way. Trump’s insulting the planet, in other words. But at least he’s not pretending otherwise.
It's easy to find fault with out neighbours, but, even with Harper gone, we still have a mess on our hands.

Friday, April 14, 2017

Just Another Oil War


An article Robert F. Kennedy Jr. wrote more than a year ago shows how oil interests created ISIS.

"The reverberations from decades of CIA shenanigans continue to echo across the Mid-East today in national capitals and from mosques to madras schools over the wrecked landscape of democracy and moderate Islam that the CIA helped obliterate....This is the bloody history that modern interventionists like George W. Bush, Ted Cruz and Marco Rubio miss when they recite their narcissistic trope that Mid-East nationalists 'hate us for our freedoms.'
As we focus on the rise of ISIS and search for the source of the savagery that took so many innocent lives in Paris and San Bernardino, we might want to look beyond the convenient explanations of religion and ideology and focus on the more complex rationales of history and oil, which mostly point the finger of blame for terrorism back at the champions of militarism, imperialism and petroleum here on our own shores."

1949 - Syria "declared war on the Nazis, expelled their Vichy French colonial rulers and crafted a fragile secularist democracy based on the American model. But in March of 1949, Syria's democratically elected president hesitated to approve the Trans Arabian Pipeline" so the CIA engineered a coup and put in their own dictator who approved the pipeline. This move effectively destabilized the country.

1953 - Roosevelt and Stone orchestrated a coup in Iran because their democratically elected president, Mosaddegh, who "idealized the U.S. as a role model, . . . tried to renegotiate the terms of Iran's lopsided contracts with the old giant, BP." He uncovered the coup attempt and expelled all British diplomats but didn't expel the CIA, who were complicit. Eisenhower ousted Mosaddegh and installed Shah Reza Pahlavi, who favored U.S. oil companies, but whose two decades of CIA sponsored savagery toward his own people from the Peacock throne would finally ignite the 1979 Islamic revolution that has bedeviled our foreign policy for 35 years."

1956 - JFK infuriated many with a speech "endorsing the right of self-governance in the Arab world and an end to Americans's imperialists meddling in Arab countries."

1957 - Stone went to Damascus with money to arm Islamic militants, the Muslim Brotherhood, to overthrow al-Kuwaiti's democracy and "engineer national conspiracies and various strong arm provocations in Iraq, Lebanon and Jordan that could be blamed on the Syrian Ba'athists. . . . In response, the Syrian army invaded the American Embassy...ejected Stone...purged all politicians sympathetic to the U.S." The CIA continued to try to topple Syria's government by arming the Muslim Brotherhood "to assassinate three Syrian government officials" which pushed Syria away from U.S. and into alliance with Russia and Egypt. Eisenhower mounted a war against Arab Nationalism "when Arab self-rule threatened oil concessions." He advised, "We should do everything possible to stress the 'holy war' aspect."

1958 - Anti-American Army officers led a coup to overthrow Iraq's pro-American monarch, Nuri al-Said...exposing [him] as a highly paid CIA puppet. . . . In response to American treachery, the new Iraqi governement invited Soviet diplomats and economic advisers to Iraq and turned its back on the West."

1963 - The CIA succeeded in installing Ba'ath Party to power in Iraq led, in part, by Saddam Hussein (see Klein's Shock Doctrine for a lot more on that). "The CIA supplied Saddam and his cronies a 'murder list' of people who 'had to be eliminated immediately in order to ensure success.'" Reagan supplied him with billions in training, knowing he was using poisonous gas and biological weapons in his war against Iran. He was seen "as a potential friend to the U.S. oil industry."

1983 - Donald Rumsfeld, in Iraq, presented Hussein with "a pair of pearl-handled revolvers and a menu of chemical/biological and conventional weapons" while the CIA supplied Iran "with anti-tank and anti-aircraft missiles to fight Iraq."

1997 - The U.S. Department of Defense found "a strong correlation between US. involvement abroad and an increase in terrorist attacks against the U.S."

2000 - Then Qatar, who shares the world's richest natural gas repository with Iran, proposed constructing a pipeline through Saudi Arabia, Jordan, Syria and Turkey, linking the pipeline directly to European energy markets. The U.S. and EU were on board, but Bashar al-Assad didn't support the pipeline. It would have given Saudi Arabia's Sunni Monarchy a foothold in Shia dominated Syria. And Russia, who sell gas to Europe, saw the pipeline as a threat. Assad endorsed a "Russian approved 'Islamic pipeline' running from Iran's side of the gas field through Syria and to the ports of Lebanon." to make Iran the principal supplier. Israel was "determined to derail the Islamic pipeline" because it would strengthen Iran and Syria.

2001 - After 9/11, Assad "gave thousands of invaluable files to the CIA on Jihadist radicals, who he considered a mutual enemy. Assad's regime was deliberately secular and Syria was impressively diverse."

2009 - "Soon after Bashar Assad rejected the Qatar pipeline, the CIA began funding opposition groups in Syria."

2011 - U.S., France, Qatar, Saudi Arabia, Turkey, and England formed the "Friends of Syria Coalition" to remove Assad.

The idea of fomenting a Sunni-Shia civil war to weaken the Syrian and Iranian regimes so as to maintain control of the region's petro-chemical supplies was not a novel notion in the Pentagon's lexicon....“U.S. leaders could also choose to capitalize on the sustained Shia-Sunni conflict trajectory by taking the side of the conservative Sunni regimes against Shiite empowerment movements in the Muslim world ... possibly supporting authoritative Sunni governments against a continuingly hostile Iran." and "sell Americans the idea that the pipeline struggle was a humanitarian war."

2012 - A study by the U.S. Defense Intelligence Agancy warned that the U.S. support of radical Sunny Jihadists was making ISIS the major force driving the insurgency in Syria. "Not coincidentally, the regions of Syria occupied by ISIS exactly encompass the proposed route of the Qatari pipeline."

2014 - But then ISIS horrified people. "Strategies based upon the idea that the enemy of my enemy is my friend can be kind of blinding.... We made the same mistake when we trained the Mujahedeen in Afghanistan. The moment the Russians left, our supposed friends started smashing antiquities, enslaving women, severing body parts and shooting at us." The U.S. blamed Turkey, Saudi Arabia and the UAE, and Obama claimed ISIS was an outgrowth of al-Qaeda in Iraq. To many Arabs, however, "the evidence of U.S. involvement is so abundant that they conclude that our role in fostering ISIS must have been deliberate."

Prior to the American invasion, there was no Al-Qaeda in Saddam Hussein's Iraq. Bush destroyed Saddam's secularist government and his viceroy, Paul Bremer, in a monumental act of mismanagement, effectively created the Sunni Army, now named ISIS. Bremer elevated the Shiites to power and banned Saddam's ruling Ba'ath Party laying off some 700,000, mostly Sunni, government and party officials from ministers to school teachers. He then disbanded the 380,000 man army, which was 80 percent Sunni. Bremer's actions stripped a million of Iraq's Sunnis of rank, property, wealth and power; leaving a desperate underclass of angry, educated, capable, trained and heavily armed Sunnis with little left to lose. General Petraeus' decision to import dirty war tactics, including torture and death squads, from the CIA's El Salvador conflict in order to shock and awe the Sunni resistance, instead ignited a shockingly bloody spiral of sectarian violence that devolved quickly into escalating atrocities topped finally by the Sunni Army signature head cutting. The Sunni insurgency named itself Al-Qaeda Iraq [AQI - later ISIS].

Military-aged men are fleeing the area because it's not their war: "The super powers have left no options for an idealistic future that moderate Syrians might consider fighting for. And no one wants to die for a pipeline."

Kennedy's Proposed Solutions:
"If we are to have an effective foreign policy, we must recognize the Syrian conflict is a war over control of resources indistinguishable from the myriad clandestine and undeclared oil wars we have been fighting in the Mid-East for 65 years. And only when we see this conflict as a proxy war over a pipeline do events become comprehensible. . .  
Once we strip this conflict of its humanitarian patina and recognize the Syrian conflict as an oil war, our foreign policy strategy becomes clear. Instead, our first priority should be the one no one ever mentions—we need to kick our Mid-East oil jones, an increasingly feasible objective, as the U.S. becomes more energy independent. Next, we need to dramatically reduce our military profile in the Middle East and let the Arabs run Arabia. Other than humanitarian assistance and guaranteeing the security of Israel's borders, the U.S. has no legitimate role in this conflict. While the facts prove that we played a role in creating the crisis, history shows that we have little power to resolve it. . . . 
We need to begin this process, not by invading Syria, but by ending our ruinous addiction to oil."


Wednesday, April 12, 2017

A Bigger Problem with Air Travel


It was almost four years ago that Nature, a highly reputable peer-reviewed science journal, published a paper that suggests that climate change is going to affect us sooner rather than later. We will stop our more destructive habits like air travel, mass consumerism, factory farming..., but by choice or necessity is yet to be seen.

According to the research paper, globally, if we do nothing, we'll be in "a state continuously outside the bounds of historical variability" by 2047. "These results are sobering indicators of the pace of climate change if one considers that the timing of climate departure will occur sooner if 'pristine' climate conditions are used to set historical climate bounds," indicating change in the year 2033 or 2051 depending on the models used. It will hit the tropics first, and over a billion people currently live in areas that climate change could render inhabitable in 35 years at the latest.  "This suggests that any progress to decrease the rate of ongoing climate change will require a bigger commitment from developed countries to decrease their emissions but will also require more extensive funding of social and conservation programmes in developing countries to minimize the impacts of climate change."

Then there's this bit from Climate Central:
It's possible that warming already in the pipeline has ensured parts of the West Antarctic ice sheet face unstoppable melt. That would raise sea levels up to 13 feet and threaten coastal communities around the world.

More recent news suggest that "Australia now faces a closing window to save the reef by taking decisive action on climate change." Bleaching events are happening too rapidly to allow for recovery time. And then this line,

"Some reef scientists are now becoming despondent. . . . We've given up. . . . we've failed."

The reef is in a "terminal stage" and measures to improve the situation were failing. But some are more forcefully optimistic: "Every moment we waste, and every dollar we waste, isn't helping the issue. We've been denying it for so long, and now we're starting to accept it. But we're spending insufficient amounts addressing the problem."



Sunday, March 19, 2017

On Beauty and the Beast

I saw the newest version of this classic, which was close to being very good. There were a few long boring bits, and the CGI of the beast was hard to watch, but I liked that they added a little subplot about LeFou. I'm not talking about how inclusive it was, how in 2017 the Disney Corporation finally allowed an explicitly gay character (as opposed to the slightly less overt previously slipped in). I'm more interested in one particular line LeFou speaks: "Meh, I've decided to switch sides," which wasn't a double entendre. He just suddenly, flippantly, realizes that he's wasted years spending all his time and energy supporting a cad, and he changes teams in the middle of the final battle. There's not a moment of guilt or shame becoming a turncoat. He flipped from 100% for him to 100% against in the bat of an eye. He made it look so easy.

And I think of Trump's closest minions, and what a delightful plot twist it would be if one of them would turn on him. The problem is that many of them are far worse. But maybe Spicer could suddenly start speaking truth to power as he stands at his podium. Maybe some kind of realization would hit Conway enough to lift her off her knees from that couch and suddenly help her see the bigger picture, brush off her allegiances, and take to the streets with the protesters. What a fairy tale that would be!

Maureen Dowd has written a beautifully caustic piece about the sycophants on the hill:
Maybe if these elites-pretending-not-to-be-elites deigned to talk to some knowledgeable elites in government once in a while, they might emerge from the distorted, belligerent, dystopian, Darwinian, cracked-mirror world that is alarming Americans and our allies. They might even stop ripping off the working-class people they claim to be helping.
Of course Belle is Angela Merkel being courted by Trump (We were both wire tapped!) who is outrageously sexist and has no respect for her education or intelligence. He has no respect for anyone's education or intelligence. But who is the Beast? Who is the good guy that has tolerated a spell making it look hideous, making it behave cowardly, but with some bit of goodness beneath, and with the strength enough to destroy Trump if it can only regain its former glory?

The fourth estate.

If Trump's henchmen don't have the wisdom to turn on him and his lies have people carrying pitchforks to ignite crosses on lawns and fight their neighbours, then the only beast that can stop him is knowledge. Once the fog lifts and the angry mob starts to see their neighbours as people again, then maybe, just maybe, Trump's reign will crumble.