Friday, August 18, 2017

On the Absurdist Victory: All is Well

A while back I wrote about a video comparing Stoicism and Existentialism. The video also touched on different psychology principles developed from each philosophy. Stoicism is easily seen in CBT and REBT, which start with the premise that when we're upset it's because of our perception of things, not the things in themselves, and we often have an irrational view. Through reality testing and viewing the situation in a detached way we can be less emotionally affected by anxiety around events. It's been very effective in reducing anxiety levels in patients.

Existential psychoanalysis took a different path:
"The basic thrust of existential psychoanalysis, if it aspires to be at all existential, must in turn be rooted in the sensibilities of existential philosophy. That sensibility may be characterized by two principal themes: a) all human knowledge is rooted in personal experience; b) the weight of experience is so exasperating that we seek to escape it through self-deception....Every one of us employs deceptions for the same reason. Whenever we're thwarted in our endeavors we feel disappointment and frustration. We may fear that we won't get our way by being honest and resort to guile and manipulation - the principal source of neurotic guilt....On a deeper level it entails the patient's willingness to plumb the depths of experience while accepting responsibility for whatever comes to light, for better or worse."
Instead of our view of externals provoking upset, it's in the struggle for people to accept the truth about themselves and recognize their various attempts to escape it. Instead of looking at individual daily triggers, they look at that big one: We search for meaning and purpose in life, but the reality has to be faced - that there simply isn't any. We've been thrown here randomly, and it's up to each of us to make the best of things. The "curative power lay in the patient's capacity for honesty." Upsetting experiences are useful for taking us outside ourselves and possibly provoking a transformation of consciousness that leads to maturation. No pain, no gain. Suppression of experiences is the problem. We need to give voice to them, no matter how ugly. From an early age, we devise pleasant fantasies to override potential traumas as slight as disappointment, and then we become anxious that there's something deep within that we don't really want to know. Self-deception and deception by others, both forms are part of every issue. We're all inherently devious and deceive one another as a matter of course. The solution is acknowledging our radical freedom, digging past the deceptions to find our authentic selves, and recognizing the absurdity of it all.

On Fascist Movements and Free Speech

Some people are upset because Ryerson cancelled a panel discussion featuring Faith Goldy, of Rebel Media, who openly expresses the belief that Muslims are a problem in our country. A Ryerson spokesperson said,
"After a thorough security review, the University has concluded that Ryerson is not equipped to provide the necessary level of public safety for the event to go forward. In light of recent events, Ryerson University is prioritizing campus safety."
I don't blame them. I wouldn't give her the platform to speak in the first place. I think free speech is important, but it's particularly important because we need the right to criticize people in positions of power and to question legislation. It's not important that everyone can say everything they think to as many people as possible. Her right to free speech isn't eroded since she's still free to talk on the internet and in her own media venues. [ETA - Even Rebel Media doesn't want her anymore.] She just wasn't given the right to speak at that one location.

I'm a fan of our anti-hate speech here in Canada. I don't believe in free speech at any cost when we see how many people can be influenced by a charismatic speaker with a warped agenda. Intelligent debate is the ideal, of course, but the reality is that some of these speakers can make the worst atrocities sound necessary. Get enough people worried about the economy, and it's too easy to pick a group of people to blame and then run them out of town - or worse. (I say way more about free speech here.)

Wednesday, August 16, 2017

Inconceivable! His Dinner with Chomsky

Wallace Shawn sat down for a chat with Noam Chomsky (video link here), and here's what they talked about - slightly abridged and loosely quoted (for clarification purposes) with links. It's a great recharge for activists!

Shawn - Many people are shocked to see the president is now a cruel, brutal, greedy type of a man, and this is now the face of America, but I'm not shocked because this has been the face of the United States for decades. What do you think is not new, and what do you think actually IS new?  [For more on this, check out Cenk Uygur's interview with John Cusack. It's pre-election, and the president he's criticizing at the beginning is Obama.]

Chomsky - My wife is from Brazil, and she predicted the Trump win before the primaries. From the outside, there's much that is not new. Recently the U.S. demanded that Cambodia pay back a debt incurred when the U.S. was destroying their country. There was secret bombing. It seems probably hundreds of thousands were killed. The Khmer Rouge was a small group, but ended up become a mass army of peasants starving and driven off the land by American bombing. The U.S. offered aid to get them to purchase American agricultural produce, and now they want payback. The American ambassador to Cambodia couldn't understand why Cambodians often make anti-American comments, but that's the America plenty of people see all over the world.

What is new, and dramatically new, is the U.S. withdrawal from the rest of the world on the issue of greatest significance for the prospect of human survival: climate change. The Washington Post had images of receding glaciers that will raise sea levels by many feet and pretty much drive tens of millions off land. A good part of organized life in coastal cities will be devastated. Every country in the world with the exception of the United States is committed to at least some actions on this issue. The US alone is not only refusing to participate, but is actually moving in a dedicated fashion in the opposite direction: trying to maximize the damage.

Sunday, August 13, 2017

On Slippery Arguments and Equity at Google

You can read most of the infamous Google memo here, and for the record, I don't think opening up this discussion should be a fireable offence, but I'm just concerned with this one piece of the puzzle right now:
"the distribution of preferences and abilities of men and women differ in part due to biological causes and these differences may explain why we don't see equal representation of women in tech and leadership."
David Brooks calls this "championing scientific research."

But consider this analogy. Walk into an art gallery full of art by Picasso, Monet, Dali, Van Gogh...  It is the case that men and women have some inherent differences on average; that claim has some validity. There are certainly more differences among the groups that between them, but there's still a difference however slight. BUT it doesn't follow that that's why we don't see equal representation in an art gallery. It's clearly not the case that women inherently, evolutionarily, don't prefer the arts and don't have any artistic talent. We can see that so clearly and easily because we are well aware that over the past centuries few women were allowed near a book much less a paintbrush.

We're far enough away from that museum scenario to really shake our head at the blatant injustices that produced such disparate results. However, as a society, we're apparently not quite able to step back and recognize the profound level of inequity that has created current gender distribution in the world of high tech.

Saturday, August 12, 2017

On Community, Again

I just read local author Paul Born’s Deepening Community. In places, it’s very close to what I’ve written about in terms of ensuring that we’re kind to one another at the very end. He doesn’t skirt around the issue that we’re in dire straights and that we can choose how to behave when push comes to shove. (But I think he should have called the book, The Born Community.)

I've written about community before, and I'm going to say much of the same thing here but in many, many more words!  There are pictures and video clips to break it up. (I included headings for clarity and page numbers throughout - where I remembered.)   I aim to critique Born's book while trying to get to the bottom of what can be done to foster a cohesive sense of belonging and caring spanning the globe.  I'm using Born's book as as starting point, but I don't have all the solutions.  I'm ever in the process of seeking.

Friday, August 11, 2017

Prevention as an Ounce of Cure

Here's an update on what I've learned about lymphedema after an ALND. It's way less scary now that I know how to manage it, but it's still a drag. It takes about an hour away from me every day. I'm just in the earliest stages, and it possible to stay here forever, but not without a bit of effort - something breast cancer surgeons should make sure patients understand. It's all about retraining the lymph flow to take a different path through the body. The body's divided into 'watersheds' which all move to the closest lymph nodes, but, with some missing, some areas have to be redirected. Here's what's working for me right now, and what I wished I had known straight out of the hospital - just ten things!:

Thursday, August 10, 2017

On Having the Lowest Graduation Rates

This recent article in my local paper tells us that our region is lowest in the province for graduation rates.


They worry that "Students who did graduate also took longer to do so than almost anywhere else." The graphic shows 68% finish after 4 years, and 81% after a fifth year (so, 13% stay for a victory lap). I share their concern that almost 20% aren't graduating, but not their concern about taking a fifth year. I commented there that I don't support that particular focus:
"I encouraged all my kids to do a fifth year of school - it's the last chance for a free education, and it gives them more time to take electives. I've always seen the drive to have kids finish in four years as just a cost-savings method at the expense of a well-rounded education. What's the educational benefit of pushing kids to finish faster?"
They claim,
"The board is reluctant to more strongly dissuade Grade 9 students from choosing academic studies over applied studies, even as students who start high school with unrealistic expectations fail to keep up and must later switch streams." 
They say that like it's a bad thing. Sure, it can be a challenge to work with students on material far outside their capabilities, but a public education is there for everyone to find, not just their talents, but also their limitations. Every student should have a right to try to stretch themselves to do work that's difficult because some actually make it after a few attempts at the higher levels. Nothing should dissuade them from trying all their options at this point in life.

The Plight of the Millennials

Further explanation here. 
First, a bit about statistical norms and the normal distribution. In social sciences, for something to be considered a statistically significant characteristic of a group, it just needs to be present in about 68% of the population, or one standard deviation from the norm. There's tons of variation in the other 32%, so all the generalizations below might not apply to the people in your life. But, according to researchers, they apply to most people in each group, so we can still look at trends. I remember studies in my day showing a clear correlation between violent movie viewing and violent teens, yet I loved slasher flicks and still lean towards more gruesome films despite the stats. And, more to the point, nobody stopped making those movies. This recent article is unlikely to change a thing, but we're still wise to consider it.

The article in question is The Atlantic article, "Have Smartphones Destroyed a Generation?" which adds to a running list of problems with kids today caused by technology. It hits home from some of the trends I've noticed anecdotally in my classroom over the past 26 years: that phones are distracting, lead to unrealistic idealization and familial alienation, and affect sleep habits. But the writer misses any discussion that phones also drive constant change, consumerism, and cognizance of tragedies, and the significance of other factors affecting trends in this demographic. Here's a chart I sometimes use in class for an overview of demographics by year of birth. We've moved way beyond the boom, bust, and echo labels.

Friday, August 4, 2017

On Comparing Existentialism and Stoicism

This summer, I went on one camping trip with a book on Stoicism, then another camping trip with a book on Existentialism, and I was intrigued by the many similarities. Then I came across this video that has some overlap with what I had noticed. As they say in the video, Massimo Pigliucci (MP) on Stoicism and Skye Cleary (SC) on Existentialism, both are philosophies that offer a way to live instead of just a way to think about the world. I'm putting it all together here with quotes (names linked to sources) to sort it out for myself. I'm just thinking out loud here. This is too long for any normal person to want to read.

These are both philosophies that allow surveyors to pick and choose from variations on a theme as neither has one authoritative dude overriding all others, and, it would appear, few of the big guns cared to adopt either label anyway. For the Stoics, defining yourself as one is avoided because it's pretentious. In The Role Ethics of Epictetus, it's clarified that we are simultaneously different things, and how we play each role is more important than what our roles are. The roles are often not our choice, but how we do them are, i.e. whether or not we're a virtuous son, mother, teacher, or waiter (MP). For Existentialists, we can't be defined by the roles we take on because we're more than the mere facts about ourselves (SC), so labels become meaningless.

Saturday, July 29, 2017

Arendt on Revolution and the Necessity of Eradicating Poverty

Hannah Arendt's essay, "Thoughts on Poverty, Misery, and the Great Revolutions of History," written in the 1960s, was apparently just recently published for the first time. It continues to be relevant in our increasingly weird times with a tyrant who would rather dominate than excel in case after case:
"For the will to power as such, regardless of any passion for distinction (in which power is not a means but an end), is characteristic of the tyrant and is no longer even a political vice. It is rather the quality that tends to destroy all political life, its vices no less than its virtues. It is precisely because the tyrant has no desire to excel and lacks all passion for distinction that he finds it so pleasant to dominate, thereby excluding himself from the company of others; conversely, it is the desire to excel which makes men love the company of their peers and spurs them on into the public realm." 
She explains that the goal of revolution from a tyrant isn't just that people are treated well, which any benevolent dictator would do, but that people have access to the decision-making process that determines how they will be treated:

Chest Tattoo with a Side of Lymphedema

As a means of healing and prettying up my mastectomy scars, I looked forward to a chest tattoo. I envisioned never wearing a bathing suit top again! After my mastectomy, I asked my surgeon about it. His only concern was that it wouldn't look good when I finally gave in and got reconstruction. But, if I'm absolutely sure I don't want recon work done, then I could get the tattoo as early as six weeks after surgery. That would have been done in December, but we were just about to go to Costa Rica, so I postponed it for after the trip. And then I found out I needed more surgery, so I postponed again. I asked the second surgeon if he had any concerns about a chest tattoo, and he said the same thing, just to wait six weeks post-op. He didn't even have concerns about me tattooing my arm if I were so inclined. He said women regularly get nipple tattoos after surgery, which are perfectly safe.

So I had an artist friend draw up this amazing sketch for me based on a pile of random ideas I threw at her:

Friday, July 28, 2017

On Regret

I've taken many questionable risks in my life. I lean toward leading a life that's lived fully over a safe and secure existence. Most I bounced back from easily from typical childhood falling from trees when I've climbed too high to dropping out of high school and somehow ending up with a Masters. Sometimes it's gone extraordinarily well for me. When an elderly woman next door to me died, I went deep into debt to buy and flip her crumbling house only to find it packed with cash. People thought I was crazy for my efforts to save my school from the chopping block until it all worked, and I'm still there. People were adamant that I can't possibly hold my head high as a teacher and unwed mother back a few decades when premarital sex was shameful, but I ignored them all with the most delightful results. And when my third pregnancy was fraught with complications, and doctors strongly advised me to terminate because of a high risk of Edwards syndrome, I, still single, took a chance and have another healthy daughter to show for it. I've been very very lucky over the years.

But then there are the times that didn't go as well. That time I was convinced I was overinsured and cancelled the insurance on a property, then it promptly went up in flames. That time I got scared of my debt load and hastily sold the slightly charred land - 24 acres with 2000' of waterfront, then soon realized there's nothing else like it out there in my price range. And that time I was convinced by a couple doctors, in opposition to others doctors, equally educated, to get an auxiliary lymph node dissection (ALND), and only afterwards found out about, and succumbed to, the risks of lymphedema.

Like most people, I imagine, I have an easy time ignoring my luck and a really hard time coping when my decisions don't pan out as well. Regret is a bugger.

So I wrote to Stoic advice columnist, Massimo Pigliucci, explaining my surgery situation in very general terms so it could be applied to and/or understood by more people, and I made it sound worse than it is to get a response to the worst case scenario. In general I asked "How were the Stoics so able to get on top of these types of thoughts so well?"

On Wasting Time

I had a brief Facebook conversation with Massimo Pigliucci about my decision to fritter away a morning watching the rain and petting my cat. He said, "It's up to you to determine whether your morning was wasted or not. But from a Stoic perspective the good use of time comes when one is doing something virtuous." And I started wondering further about what specifically counts as wasted time. So I turned to a thorough re-reading of Seneca's On the Shortness of Life. Here are the bits that stood out to me with chapters noted after each quotation:

Seneca points out that people complain about the cruelty of nature because life is short, even Aristotle did, but it's not short, it's just that we waste much of it (1). Then he lists many examples of what a waste of time looks like:
"soft and careless worthwhile pursuit....held in the grip of voracious avarice....diligence that busies itself with pointless enterprises....sodden with wine....slack with idleness....tired out by political ambition, which always hangs on the judgment of others....desire for hope of profit....passion for soldiering....striving after other people's a fickleness that is shifting" (2).

Thursday, July 27, 2017

Paradigm Shift in Climate Change Policy

In the news, Caroline Lucas, in The Guardian says one good policy isn't enough; we need a paradigm shift:
"Rather than simply looking for one headline-grabbing policy, the government should be embarking on a paradigm shift when it comes to how we get about in this country. ...Ultimately we need a green transport revolution, not another tinker with a transport system that’s creaking. Let’s aim for towns and cities that are easily navigable by foot and bike, a fully electric and publicly owned train system that covers the country, and local public transport that’s a joy to use – rather than the overpriced, unreliable service that’s currently on offer in so many places."
And Brad Plumer, in the NYTimes, says California is making that shift:
"The state plans to rethink every corner of its economy, from urban planning to dairy farms....If California prevails, it could provide a model for other policy makers, even as President Trump scales back the federal government’s efforts on climate change. The state may also develop new technologies that the rest of the world can use to cut emissions....The state’s emissions are nearly back to 1990 levels... and it has installed as many solar panels as the rest of the country combined....The board envisioned the number of electric cars and other zero-emissions vehicles on California’s roads rising to 4.2 million by 2030 from 250,000 today. Freight trucks would have to become more efficient or electrified, while cities would need to adopt far-reaching strategies to promote mass transit, biking and walking."
I love that they both mention cycling. I'm not convinced cap and trade will save us, as Plumer suggests, but it's all a start. We're not at that paradigm moment yet, but at least our heads are turned in the right direction:
"There may well be an art whose aim would be to effect this very thing, the conversion of the soul, in the readiest way; not to put the power of sight into the soul's eye, which already has it, but to ensure that, instead of looking in the wrong direction, it is turned the way it ought to be." - Plato's Republic, book 7

Monday, July 17, 2017

Climate Comedies

I caught Al Franken and David Letterman's Funny or Die series on climate change: Boiling the Frog. It's vaguely informative and not particularly funny, but fans of either guy might be willing to check it out. They focus on what their children and grandchildren will have to live with, and how they'll answer when asked what they did about it all, which I think is a fairly relatable tactic. And at about three minutes each, it's easy to watch an episode while you're waiting for the kids to get their shoes on. It's great for a populous with short attention spans, but it's hard to find a funny angle to talk about the dangers we're facing.

One episode referred to the show Years of Living Dangerously, which I hadn't heard about despite being three years old. It's a star-studded series (including Letterman in one episode) exploring climate change with lots of dramatic shots and music, but, based on the premiere only, it's not walking the walk. The very first scene has Harrison Ford excited to be flying a jet to visit with climate scientists. In one of the Boiling the Frog episodes, Franken asked Letterman, couldn't he just read about India's coal problem without travelling there? It's an important question. We have lots and lots of movies about climate change already. I'd put DiCaprio's film at the top of the list for clarity and persuasiveness. So it's been done. We need to stop flying film crews all over the world so Ford can say, ominously, "I'm going there to find out more!". I'm all about this stuff, and it got excellent reviews, but I won't be watching past the dramatic premiere.

The information is all out there in multiple genres and media already. Maybe it's got to move out of the documentary arena and into the HBO dramas for people to start paying attention. We need a risk-taking coming-out show like Ellen had when her character admitted to being gay. It's a similar risk to start talking about environmental destruction on a popular show in that sponsors might pull their ads, but, if it's done well, it could raise ratings enough that sponsors will come back. Then all other shows will scramble for a token environmentalist on their show! Right?

Somehow, of course, even despite religious protests at the time, two women kissing has a bigger draw than people choosing bikes over cars or overtly recycling or refusing to fly anywhere for ethical reasons. And it has a way bigger draw than famous people flying place to place to look at desolate and destroyed areas of the world.

Friday, July 14, 2017

On Hedges' Veganism Claims

Chris Hedges' recent article, "Eating Our Way to Disease," largely just advertises the new doc What the Health:
"Kip Andersen and Keegan Kuhn—whose documentary Cowspiracy, about the environmental impact of the animal agriculture industry, led me to become a vegan—recently released a new film, What the Health, which looks at how highly processed animal products are largely responsible for the increase of chronic and lethal diseases such as diabetes, heart disease and cancer in the United States and many other countries."
Eating vegan is more ethical from an animal rights point of view. I believe it's healthier for the body to eat way more vegetables than meat and that it's much more efficient for people to eat grains than to feed grains to cattle and then eat the cows. From a moral, nutritional, and environmental perspective, I support the shift to veganism or at least vegetarianism, or, at the very least, reducetarianism. Absolutely.


I wrote about some concerns with Hedges' praise of Cowpiracy before:
"The documentary Cowspiracy claims that 51% of GHG emissions are from agriculture (scrutinized here). Every other report on emissions has much lower numbers, including the IPCC, which puts it at 24%.... It's still up there, and it's definitely something we should act on by eating way less meat, but that 51% number seems to be seriously questionable. Documentaries need fact-checking too....But then Chris Hedges started praising the documentary and citing that number as fact. Yes, even the great Chris Hedges doesn't have time to fact-check everything he sees, and his bullshit meter must have been subdued from all the footage of suffering animals. When facts are reported inaccurately, but they help the cause, it's harder to be motivated to correct them. But it doesn't make them any less inaccurate."
Those last two lines linger.

First of all, we need to acknowledge the three-dimensional nature of all of us, neither demonizing nor glorifying anyone. I tend to think of Hedges as a bit of a hero, and he's clearly intelligent, but it appears that that doesn't stop him from being a little sloppy around some facts. Others have raised concerns around plagiarism, and his response there is perplexing. Well, it's only perplexing if we think of him as better than the rest of us fallible souls.

But secondly, if these shocking claims encourage people to eat less meat, which will have a positive effect on the environment (not quite as much as claimed, though), then should we just let it go? A Lund University study shows that eating a plant-based diet is one of the four most important activities individuals should do to affect climate change. The amount of meat we eat is definitely a problem. Should we let people think meat-eating is as bad as these films suggest? I think not. I fear it runs the risk of a Reefer Madness backlash. Once teens realize that their health teacher's tales of people jumping off a building after one toke from a marijuana cigarette are total bullshit, then they stop believing anything else from them. They need to know the real problems with smoking pot, and there are some, in order to make an informed choice. If Hedges supports claims that are a little bullshitty, then people might stop listening to any of it and continue to eat meat several times a day despite some real problems with that.

And then he boasts that the companion book to the new movie was written by his wife.

Her book's reviews on Amazon are mostly glowing, some reviewers suggesting they're using the book in their high-school classrooms (which feels more like a pitch than a review), but the criticisms there addresses specific concerns, many with solid backing:
"This is nothing but fear mongering at its best. You simply cannot say that processed meats cause as many deaths as tobacco, it's factually impossible! There are 34,000 deaths per year on average (W.H.O estimates) from processed AND red meats. There are over 8,000,000 deaths from tobacco every year. This is no way, shape, or form comparable to processed meats."
Here and elsewhere people are taking to task another claim from the book and film that beef is toxic because pollution gets in the cows when they eat grass, since it's obvious that the same pollution would get into vegetables and grains that we eat. Denise Minger does a thorough take-down of claims from Dr. Garth Davis, one of the experts from the film. And the Skeptical Cardiologist questions some claims from another expert, Dr. Caldwell Esselstyn, as does Minger.

I don't have any interest in seeing the film or reading the book, but I skimmed the Amazon "look inside" pages, and this bit caught my attention (page 75):
"People who ate 68 grams (about a cup) of broccoli sprouts significantly inhibited the bloodstream levels of an enzyme linked to cancerous tumor development (24), only three hours after eating the sprouts. The broccoli sprout snack was just as effective, or even more so, than the chemotherapy agent specifically concocted to lower that enzyme (25). Broccoli sprouts or chemo? Hard decision." 
Hold the phone - so broccoli can replace chemo?? I linked the studies cited to show the problem with this claim. The second study (25) found that the spouts briefly inhibited the epigenetic markers for cancer. But it makes it very clear that the study was  an attempt to prevent one specific provocation, not a therapy for cancer that exists. The three (three!) participants tested were all perfectly healthy at the time. And, as Wong says elsewhere, genetic markers cause only a small percentages of cancerous tumours anyway. The first study cited (24) explains the idea, but doesn't actually discuss the broccoli sprout study specifically as one would expect given the location of the citation in the passage. If it were a student's essay, I'd call that padding. Regardless, the original study's finding is in its initial stages and, more importantly, doesn't remotely suggest broccoli sprouts could replace chemotherapy in the least. Wong conflated concepts in a very misleading way.

I'm not going to fact check the many claims in the book, but one error of this type and magnitude is enough to throw into question other claims. And this passage is particularly dangerous if people take Wong, a classically trained actor, as a medical expert because the claim is published in a book about health and nutrition. I questioned the qualifications of the publisher and, lo and behold, it's a self-publishing company, Xlibris, so it's possible that nobody's fact-checked the material. Unfortunately, because it's in a paper form, it feels that much more legit. Caveat emptor and all, but this is troubling.

It's more important than ever that people understand how publishing works, what a peer-reviewed journal entails, and what is and is not peer-reviewed. But it's also important that we all understand some basics of the scientific method if we're expected to understand any of these studies. Or, at least, it would be nice if authors of nutritional books and films were able to use a basic scientific knowledge to understand their research more thoroughly. You don't have to have a medical degree to assimilate studies and form a conclusion, but you do have to read past the abstract.

Wednesday, July 12, 2017

Sooner Than You Think

Yesterday's NYTimes has a lengthy article, "The Uninhabitable Earth," subtitled, "What Climate Change Could Wreak - Sooner Than You Think."

In a nutshell:
"...the swelling seas — and the cities they will drown — have so dominated the picture of global warming ... that they have occluded our perception of other threats, many much closer at hand....Indeed, absent a significant adjustment to how billions of humans conduct their lives, parts of the Earth will likely become close to uninhabitable, and other parts horrifically inhospitable, as soon as the end of this century.... we have, trapped in Arctic permafrost, twice as much carbon as is currently wrecking the atmosphere of the planet, all of it scheduled to be released at a date that keeps getting moved up....the climate window that has allowed for human life is very narrow, even by the standards of planetary history." 

We'll have issues with death by heat, drought and flood induced food shortages, plagues of insects and bacteria that won't die off, suffocating air, constant war, economic collapse, and poisoned oceans.

Why are we so blind to all of this?
"The dilemmas and dramas of climate change are simply incompatible with the kinds of stories we tell ourselves about ourselves, especially in novels, which tend to emphasize the journey of an individual conscience rather than the poisonous miasma of social fate."
At least, at the very least, this is major mainstream news now. People are starting to listen. But will it make them more closed in with fear, even more flippant and careless, or actually more motivated to change??

Tuesday, July 11, 2017

On the Year that Kicked My Ass, and That Time My Ass Kicked Back

Well, it's starting to kick back, ever so slowly.

I went on another Wild Women adventure, this time to Georgian Bay to try my hand at kayaking for a change. I was with a whole new group of women, our ages spanning three decades and from a wide variety of professions and backgrounds (and photographic skills - all the pics here are from them). It's always a treat to be on the water surrounded by the giant slabs of rock and tall trees rooted in the tiniest crevices with people concerned for the health and well being of the water, air, and land. We wash on the ground well away from the lake, compost as we go, forgo campfires, and practice no-trace camping. Meetup groups aren't always as environmentally minded. The guides on the trips are exceptional, well practiced in both tripping and diplomacy, and the food is better than anything I typically eat at home.

Wearing the exact same clothes as last time!
On the last trip, I went in order to challenge myself to solo a canoe through the portages so I could travel alone. I've been on my own for almost a decade, and I'll need at least to be able to take the lead if I hope to ever get any of my not-so-canoe-y friends on board. In order to do the things I most enjoy, all by myself became a bit of a mantra.

And then this year of surgeries happened.

Total independence is no longer my goal - can no longer be my goal. I have to work towards working with others in order to get anywhere. This trip came just when I needed it as I teetered precariously on the brink of succumbing to self-pity. My dad, who also left me this year, always saw my quest for independence as a barrier and encouraged me to "let other people shine" by asking for help and sharing the load. I tried to asked for help, and for things forgotten, and for time for a break without feeling sheepish or ashamed of my blunders and inabilities. Interdependence is a hard one for me. And, through it all, I was still pushing myself, able to feel just enough muscle strain at the end of the day.
"Purely physical fatigue, provided it is not excessive, tends if anything to be a cause of happiness; it leads to sound sleep and a good appetite, and gives zest to the pleasures that are possible on holidays." ~ Bertrand Russell

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.