“Loneliness is the poverty of self; solitude is the richness of self” – May Sarton
I love good writers, poets and story tellers so to be able to open with a quote by May Sarton (also an outspoken activists on gay rights years before its time) is a good omen. I can’t take anymore media coverage regarding #ChildrenInCages, I now need to tune out the world news and maybe just do some writing.
Here it is, 5:30AM, I’m wide awake, out of bed so it’s time to hit the keyboard. We just past the summer equinox and the sun should be out however it is stuck behind a thick blanket of clouds and the occasional downpour. There is a pleasant aroma to summer rains on the prairies but they are also harbinger of severe lightening and wind storms. We need the rain, we don’t need the lightening or accompanying winds. Right now there is a light rain with a gentle wind so I have my balcony door open to enjoy the aroma. As I write I also watch as the two black squirrels in the alleyway begin their daily back and forth along the power lines.
Last week I watched the season finale of “Into the Badlands” and felt a small tinge of loneliness. That loneliness comes from the realization that a void of time will now exist which will need to be filled with something. It may not sound like much to many of you but every four or five hours I have to get out of my wheelchair for awhile, hence my recliner. Rather than sit there and stare at nothingness I watch certain TV programs. I tend to favour shows like Into the Badlands because, like Game of Thrones, it uses fantasy to reflect some realities of life. So in keeping with the theme of my last post, “The Fiefdom of Bureaucracy“, I would like to continue by using the theme of the Badlands.
I completed my resettlement quest this week and, despite the shortage of master healers in the fiefdom of Calgary, I was able to find a good one I hope. Portent signs for that hope include her Irish heritage. I have an affection for many things Irish. It began with my fascination with druids and their impact on the Irish culture. That dates back to 750 AD (their history, not my affection). The Irish Druid played a major role in the development of medicine, laws and early democracy so Dr. Kelly has some favourable heritage qualities. For those interested I would suggest giving “Táin Bó Cúailnge” a read for an interesting background.
My love and fascination for the Irish druid aside a couple of other positive omens were, she is considerably younger than myself so it should be safe to assume she will be my doctor for what is left of my life. That’s important. She is also mature (and insightful) enough to understand the importance of being a prefecture for the new initiates of the medical profession. This was also the role of Doc Cloud, Ankara and Vitania, all healer/teachers in the Badlands. During my introductory meeting with Doctor Kelly she acknowledged the up-to-date influence of the symbiotic relationship a teaching environment creates. She is quite open to new ideas and procedures introduced by her initiates .
Her clinic is part of the Alberta Health care system’s adoption of the “Primary Health Care” team approach. She may be my primary health care provider but it is just as likely for me to see one of her “clerks”, “residents” or “interns”. All fit a role in the health care environment. Having grown up in the health care system and then working for fifteen years in the system I know enough about how it works to have some appreciation for this approach.
This same approach is used for the training of healers in the series I opened with “Into the Badlands” but a major component of that health care approach is the poppy fields, which is what helps keep the Baron’s wealthy but I will get back to that.
A word of advice to my peers, a large percentage of seniors have outlived their doctors and are searching for new ones. Most seniors don’t have the luxury or depth of understanding of the health care system my life experience has provided me. If you are searching and you go into a potentially new doctors waiting room, take a look around. We live in a time where you have to be your own advocate when it comes to your health so know the signs. Be the best advocate you can for yourself and learn how to recognize the signs. If the newest magazine in the waiting room is a 2012 copy of Peoples or you get into their cubicle and the doctor is clutching a prescription pad, I suggest you keep looking. These are signs that you may be dealing with a tool of the pharmaceutical industry and not a purveyor of positive healthcare.
Now back to the Primary Care process. No disrespect meant to any of the players in todays healthcare system so please don’t be offended. Life is to short to personalize everything and you are embarking on a profession where rudeness can be a reaction of fear or denial. With that said let me start with the bottom rung of the system, “Clerks”. These are medical students completing the level of education required to actually enter the hallowed halls of the medical facility. On a totem pole they would be akin to the bear at the base of the totem. They are there for the heavy lifting. They are the cornerstone of the daycare known as the medical faculty. They often suffer the abuse and indignity that many of the interns or residence were forced to endure during their own year as a medical clerk.
As a “professional patient” I could probably befuddle a clerk with a few esoteric terms associated with crystals or aroma therapy and they would spend the evening looking through their Merck Manual to figure out what I was talking about. The Merck Manual, for those unaware, is the reference bible of medical students no matter where they fit in on the totem pole.
Next we have the “intern”, the ones who have earned the right to put “doctor” in front of their names but haven’t progressed far enough into the system to be fully accepted by the professional registration body. This keeps them from billing the system directly but does allow their supervised work (enter the prefecture again) who can bill for their work. A good prefecture can also keep current by listening to what the intern is learning. This is the symbiosis I referred to earlier.
Part of a medical students learning process, regardless of their positioning on the totem, is to stay current so the pressure is on the intern to keep up. They would represent the second character of a totem pole, a salmon or perhaps a killer whale. They have some wisdom but are also still a bit player in the story the totem is telling. Their medicine bag of herbs and processes would be deeper than mine but they are still learning. As a polio survivor I would still have to do some educating of an intern because chances are very good they have never heard of polio and the polio has to be taken into account when working out treatment regimes.
And finally there is the “resident” (junior and senior, what a difference a year makes). These are the fledglings getting ready to leave the nest of academia. They are in the process of determining a specialty. Many know they want to do family medicine while others may want to pursue further training as a specialist. Be that plastic surgery, orthopaedics, oncology or psychiatry (the list is endless) but they spend their senior residency year making those decisions.
If anyone has ever watched (another favourite of mine) the TV series “Code Black” you will understand the concept of junior and senior residence. They would be the raven, beaver or whatever animal is represented second from the top of the totem. They have the finely shined, well used mortar and pestle. They are an examine away from being able to bill the system.
So, now I have a doctor (top of the totem) and a treatment team. My move back to Calgary is complete and I have all of the pieces on the board. Unlike Forrest Gump, to me life isn’t like a box of chocolates but more like a game of chess. You need the right pieces on the board to maximize you chances for success. They now seem to be there.
Now I have to work with my new doctor to deal with another crazy policy in the fiefdom of health. Back to the poppy field reference I made earlier. Sixty-five years of the wear and tear of polio does have an impact on how effective the body works. I do what I need to maximize comfort and when I find something that works I stick to it. For the past eight years I have been using Codeine Contin (100mg, slow release long lasting). Now, all of a sudden, I discover now that I am back in Alberta Blue Cross won’t pay for them. If I want to break the dosage up and go to T3’s (take four time as many and not long lasting) Blue Cross will pay or if I want to make the move to a stronger more addictive opioid Blue Cross will pay but they won’t pay for a slow release long acting med I take once a day. One would think that with the current opioid crisis this type of policy makes no sense. Again common sense trumped by a policy that makes absolutely no sense. So, again as my own advocate, I have an appointment next week with my new treatment team and this will be one of the items of discussion. A $90 a month prescription is crazy but it is even crazier to take a stronger, more addictive opioid, let the games begin.
Have a good one, I’m going to try and do a quick Safeway run between showers. I’m out of bagels and coffee cream. A big problem if I’m going to keep waking up so early…