Monday, December 31, 2012

Fishing Story

Some years ago, when we as a family fished often and successfully as well, the pianist's aunt and uncle and married children, a farm family, came from South Dakota for the Christmas season to Lotus City. On a beautiful winter's day several of the party, including the pianist's uncle, went fishing with me to Fiddle Reef. Now Fiddle Reef is aptly named because the reef is the shape of a violin and is marked by a navigational bouy at the wide end where though traffic is heavy, and at the stem end by a bouy as well! The rock is low enough in the water, that at maximum low tide it doesn't dry. We all planned to have supper at the marina after the fishing excursion, so the others gathered at the appropriate time in the evening. I was absolutely intent on my guests all catching a fish and trolled for the entire afternoon around the margins of Fiddle Reef, delicately avoiding grounding our lures on the reef! They all took turns with the lines but despite my best effort; nothing! The pianist's uncle was one of these special gentle human beings and it was his turn on the lines. The rest of the family had gathered at the marina restaurant and they could see us at Fiddle Reef, still fishing in the gloom, lights on now, and it was cold, so we trailed clouds of steam as we went back and forth in terminal desperation to catch a fish. The season was such that these were almost entirely winter spring salmon of 5 to 15 pounds, developing size at that time of the year. Suddenly, as we were about to give up, a line screeched into action and a fair sized fish started breaking water at a tremendous speed, shaking and writhing with each jump. Fortunately it was a Penn reel rather than a knuckle duster so our uncle could play the fish more easily. The violent action at the end of the line did not abate for some time.  I ventured to everyone on the boat that it was a large cohoe because a spring salmon, as I said, rarely if ever leaves the water in its struggle to free itself. Was I ever wrong! One thing the spring salmon does to a bait fish ball is to enter the school with its tail lashing, crippling some of the small bait fish, and then turning and eating the crippled fish at leisure. Sure enough, the 10 pound salmon we hooked, was hooked in the tail. It behaved like a cohoe only because of that. I had never seen a tail hooked fish before or since, but that seems strange in retrospect because of the manner by which the salmon generally, within a bait fish school, cripples them before it returns to eat. That's why almost all salmon lures are created to simulate crippled bait fish. Salmon, like all of us, like getting things the easy way and having a leisurely meal. We got back to the marina to join the crowd who forgave us for the wait.Our uncle had lots of fun fishing, but when he went home to South Dakota he said he had quite a tale to tell. Pardon me!

Saturday, December 29, 2012

Death of the Autopsy

In the decades of the 50s, 60s and 70s the autopsy rate gradually diminished until the present time when the indication for post mortem examination is now largely confined to forensic reasons leading often to inquests, or sudden unexplained death within 24 hours of hospital admission: almost always ordered by the coroner or court. Why this particularly useful examination has been discarded as a frequent assessment in the past of the utility of treatment ; an overview of disease and disorders commonly missed in diagnosis and treatment; and as a teaching tool in clinical-pathological conferences to enlarge the diagnostic acuity of the clinicians and students; can be surmised in the light of the litigation sensitive time we live. As a result we have trouble claiming a unbroken willingness to pursue all avenues of evidence based science in the interest of developing continuing patient care. I am sure that my practicing colleagues would say, "It's OK for you to espouse this now because you are no longer in practice!" Fair enough! Still, there are a lot of other reasons routine autopsies are not more frequently done. The deceased's family is unwilling to have their loved one's body subjected to autopsy for reasons of pure science. The hospitals on tight budgets are unwilling to add further expense that would compromise immediate needs. There is an acute shortage of pathologists and a complete autopsy is very time consuming. The provincal governments are unwilling to increase the allocation for non-treatment expenses. Physicians erroneously believe the sophisticated imaging of today is a satisfactory replacement for a comprehensive autopsy, or at least good enough as a routine. Physician insurance and hospital insurance companies would be reluctant parties to expanded autopsies that might increase the number of litigants based on hitherto uncovered live data. Let sleeping dogs lie is in order. Maybe that is so. Good medical care still exists in this country where informed consented risk taking by physicians is practiced, rather than cherrypicking only easy cases and offloading the more  risky. All these factors come into play and evidence based science is the loser as a result. And so, in fact is the patient in the end when the doctors are often having to look over their shoulder. Whoever might win are the lawyers and the chronically disgruntled! Oh well, easy for me to say. I still remember with fondness the cut and thrust of the clinical path conference with the clinician pitted against the pathologist: the clinician attempting a rational assessment of a patient, unknown to him, but with all the clinical records available, in the bright glare of his colleagues and students, thereby exposing his diagnostic acumen or lack thereof, before the autopsy findings were finally revealed. What a way to learn to think systematically and still remain humble!

Saturday, December 22, 2012

Shake Your Head!

The last permissible opportunity for us to be publicly uncouth was the Freshman Parade in downtown Winnipeg in September 1953. My friend Larry, Mel and I were appointed by the class as the parade committee for the Medicine Float in the  Freshie Parade of that year. The theme of each float was to reflect, in some way, the ethos of each faculty to which we were ostensibly to become devoted. Let the gestating Engineers hang Volkswagons from bridges, the Aggies sit on their straw bales and milk a plastic cow, ours was the Sex Machine in full production. To allocate the portrayal of the dignity and image of Medicine to a callow group of youths, not yet baptized in the rigor of the course, must have shaken the heads of the faculty. Having interviewed, in the last few years, applicants for Medicine at UBC, I saw the quality of goodness and mercy, at least presented to us by them, bore no resemblance to the unihibited attitude we unfortunately displayed. It seems scary to me now. Christine Jorgensen, once George Jorgensen, was the first person known to have a sex change operation. The procedure, an amputation and vaginoplasty, was done in February 1953, and she was an instant celebrity from then on. Taking advantage of a topical, and somewhat, then permissibly mentionable topic, was an idea we thought was timely, edgey, and colourful enough to win the first prize for the best float in the parade. Our advantage was that two members of our class were identical twins. One would enter the Sex Machine dressed as a man and the other twin would immediately walk through the exit on the other side, dressed as a woman. The committee had a great time building the sex machine out of plywood on a flat bed truck and embellished it with levers and wheels with all sorts of dirty labels describing the surgical activity within the box, augmented by fireworks and smoke issuing forth from the machine thoughout the duration of the parade. Rather than winning the prize for the float, we were castigated by the Winnipeg Free Press for unbecoming behavior  and  immorality. Curiously, we were never sanctioned by the Medical Faculty, though we did receive a significant series of lectures on ethics, dignity and grace necessary to the practice of Medicine. Thank goodness for me, in 1953 the entrance criterion was entirely based  on marks. There was no interview process for putative medical students at that time. I suppose the possibility of taking raw material; intelligent, but still in the stage of a lump of clay; demonstrably human and unrestrained;  callow but honest; posed a interesting challenge for faculty. Better the students that would have been too dumb to lie, than those who are often facile during the interview. Still, I do have to shake my head.