Sir William Osler

 
Willy Osler, as he was known to all his friends, was the most gifted of Canadian physicians, the Father of Canadian Medicine, born in rural Ontario in the mid 19th century and died in 1919. After the University of Toronto he graduated from McGill and practiced in Montreal, Baltimore at Johns Hopkins where he was a founding member and at Oxford. He founded and refined the method of bedside teaching; taught that history and physical examination, listening to and examining patients, was the hallmark of teaching diagnosis and treatment. Osler was a compound; composite particles ground together by life's mortar and pestle, where reason, body and soul were blended in. One could say about Osler, that it is one thing to practice an exemplary form of medicine; it is another thing entirely, to teach a thousand medical students to practice an exemplary form of medicine.  

At the time of Osler's dying, he kept, at his bedside, a single one  of his favorite books. Sir William Osler had a deep understanding of both the body and spirit of medicine. It is no accident that the compound nature of Osler embraced the book, Religio Medici, (The Religion of the Doctor), written by Sir Thomas Browne shortly after his medical graduation in 1643. I believe the quotation I draw from it now, in turn, embraces Osler. “--thus there are two books from which I collect my divinity: besides that written one of God, another of his servant Nature, that universal and publick manuscript that lies expansed unto the eyes of all: those that never saw him in the one, have discovered him in the other." It was my privilege to give the Annual Osler Lecture to the Vancouver Medical Society this year. 

Bag of Skin

Me, Myself, and I are contained in a bag of skin called Jim. We talk to one another regularly about the direction the bag is going, and generally, what it's all about and what's best for it. We know the bag hears us because it often mouths our dialogue and we hear ourselves being repeated, though not always accurately. We are democratic in this bag and this Trinity of ours never tries to dominate or take over from one another and simply laugh off the escaped little foibles that we see from time to time that drive the bag go off in somewhat hapless directions. Jim, who is easily mystified says, "Who are these entities that claim to be me, or that claim to direct me in my life?  Are they Angels or Demons or just Gods or Muses? Do they arise from an undigested bit of beef, a blot of mustard, a crumb of cheese, a fragment of an underdone potato, as Scrooge apparently said to the ghost of Jacob Marley?"---- We reflected that the three of us are becoming more obvious as Jim gets older and the bag has to listen more closely to the inner life, since in addition, Me, Myself and I are probably stirring up the bag more often?.--- Jim finally asked, "Who are you guys anyway? "-- We, as the Trinity answered in unison. We have rehearsed this answer many times as we have always been there in the bag of skin called Jim and have waited for the question which has finally come.--- "Jim, We are much older than you and have been here many years before you. You, for your information, are a new bag and always will be, since the  cellular replacement of all your current cells arrives from earth's supplies every few weeks as you reconstruct your old skin and renew its cellular contents with new materials. For that reason, though your template remains old and getting older, you become a new cellular entity each week or so, as earth recycles its materials to and fro. Every cell your bag contains undergoes complete renewal;  even your wet bones rise again, renewed, though much more slowly, but the paradox of new cells in an old bag template remains.  We just are. You however, are of earth. Relax! You are no more mad than everyone else;  not more, not less. You're just listening to us more carefully and somewhat more urgently now!"

Heritage Symbols

Of course the Bishops of the Catholic Church in Quebec do not want the Crucifix to remain in the National Assembly. Who in God's green earth would want to be part of the scent of a mandated religion, including bishops? Who would want to be part of a heritage structure in an assembly, when one is part of a living religion, not a historical society? This is Canada and if a particular government within the country chooses to fossilize Christianity we are not going to be mandated as a thing of the past, so remove the crucifix for God's sake now and the one on the mountain too.  We'll join the abundant religions that seek peace and goodwill to all mankind. It's not the end of secularism, that's for sure, but hopefully it's moving toward the end of sectarianism. At least I hope God gets my drift because he has a big stake in the matter. I'm hoping that Sophocles once again will remind us all, as he did, that, "Without numbers are the world's wonders, but none more wonderful than man." Let's not write anyone off.

Cock of the Walk?

   When I was in 4th year medicine in 1956 and working as a Clinical Clerk in the Winnipeg General Hospital I recognized the retired Head of the Department of Medicine sitting on a bench. He was dressed in a carefully fitted blue suit with worn elbows  and a button off his fly and he looked tired and was staring into space. He had been the Professor and Clinical Head of Medicine for many years and a notable scientist and teacher. Possibly he had been retired four or five years. He was sitting alone and as the Emergency Department doctors and nurses flowed around him he remained unrecognized, an old man on a bench with himself for company. The Urology department was adjacent to the Emergency entrance and it was clear that he had an old man's problem and was waiting his turn patiently as an Outpatient. Having practiced and taught medicine in the Winnipeg General for forty years you would have thought that someone else besides me would have recognized him or stopped to talk to him. I'm sorry to say I didn't stop either, but I was a lowly clerk and I reasoned that it might have intruded on his dignity for such as me to approach him. What a mistake we make! The former Dr. So and So! The present Dr. Has Been. Walking down the corridor he must have walked ten thousand days for forty years past a Urology Outpatients he may never have thought he might use, caring as he did for those in that era who were without funds or insurance. In those days the teaching faculty looked after the indigent, the old and the desperately sick rather than the carriage trade. Teaching was more important than earning to those committed teachers.  It's one thing to practice exemplary medicine. It's another thing entirely to teach a hundred persons how to practice exemplary medicine. A student nurse and an intern walked by and the nurse said, "That old man has been waiting on that bench for over an hour. I saw him then, when I went for coffee."--- Somebody said to me recently this year, and somewhat aggressively too, when we were talking about waiting lists,"You doctors are part of the corruption in medicare because you take advantage of the rest of us by getting looked after first and jumping the queue. It's not fair! You people don't deserve to get any advantages over real people."--- It brought back my memory of the former Dr. So and So and the Clinical Clerk. I always thought we were real people.

Magical Thinking

During a particularly low period in my life some 40 years ago I found myself, in  desperation, seated in a pew in the small right-hand chapel of the cathedral in Lotus City. I was by myself. I had been, for a number of months, wrestling fruitlessly with the perceived and the unperceived causes of my despair. The blackness of a mood alters reason and logic, that under ordinary circumstance allows clear-sighted appraisal of one's state of being and a way forward. Such, had not been available to me during the time of my struggle. The ennui of the melancholic magnifies the perceived, hides resolutely the unperceived and renders invisible the knob to the door that allows one to move forward. Since magical thinking as a symptom, as decreed by our psychiatric colleagues, all of us in the medical profession, or at least most of us, are fearful of the inner madness that magical thinking will imply if we seek that solution or confess that pathway. In classical Greece, the Stoics, of which Plato was the preeminent member, believed that continuing illness was due to lack of virtue, and the quasi healing temples of Asklepios required the assuaging of the ill-will of the gods before healing could occur. As I sat in the pew in my disassociated state, trying to focus on the space I had come to, I tried to pray but nothing would come. I looked up from prayer and the large crucifix over the small alter contained the bleeding and dying figure of Christ. As I studied this image it occured  to me that when you don't know how to pray, as He had said to his disciples, pray what is now called, The Lord's Prayer. As I mumbled the words to the Lord's prayer I came to the sentence that says, "Forgive us our trespasses as we forgive those who have trespassed against us." I stumbled forward and found the knob on the door. My urgent need was to forgive my mother and dad and I drove to their home and hugged and cried with them as we healed one another. I equated forgiveness and redemption that day. We must know what message is given by whom and where and when magical thinking can be judged by its fruits.

The Sexton

As I lie on my preserved plot in the Anglican cemetery on Lotus Island, getting the feel of it, the blue sky and cumulus clouds and bright sun that I love along with the pastoral surroundings of verdant nature will be there, as before, when I am underground. For my sins I guess, I am the cemetary manager for the four Anglican cemetaries on Lotus island where there seems to be more dead Anglicans than live Anglicans these days. That makes me the sexton and the description of that job says one is the custodian of the sacred objects. Can I think of a more sacred set of objects than the remains of the families' and friends' loved ones? I cannot! To assist with those who choose the plot they wish, to organize and be with those who dig, to stand back as the circle of family and the priest inter the remains, and connect with the grief at the outer edge of the circle,  becomes an enclosing act of worship, not just for the person, but for the event of commital. To enter the earth and become the earth is the final act and the final goodbye. I had no idea my first year as a sexton would teach me so much. I guess it may be true that most, or maybe all of life is just a rehearsal!

Budget Terrorism

Some years ago, before Governments and their agents, hospital boards and CEOs and CFOs were given an extra allocation for some surgical procedures that had been underbudgeted, those of us doing major joint replacements were struggling. Patients were waiting in Lotus City two and three years to get a surgical booking and in addition to pain and disability, actual hip pathology often altered, that compromised the end results. Since hospital budgets were usually predicated on the previous year and negotiated by the governing body of the hospital with the provincial government, there was inertia in the system despite the rapid advance of technology in replacement surgery. Rationing therefore flourished, and allocation of budgets both stalled and were applied to the most publicly attractive care packages that would seem to provide hospital boards and provincial governments, to its public, in a good light. Eventually a confrontation was engendered by the orthopedic surgeons and the hospital, occasioned by threatening the competency of these nonmedical decision- makers to, and through public channels!  It was ugly but provoked two things! One, our offer that an independant evaluator of the hospital's choice would review the entire procedures to determine the adequacy of the budget and the irrationality of the rationing. The orthopedic surgeons as a result of this review, won the round in spades, but the hospital, of course, never provided the details of the written report for our review. Typical! As a result however , at that time, and this is the kicker, the budget never changed!
However again, since they were beaten up by their own reviewer, they made an offer. We could increase the numbers of replacements by using a substantially cheaper prosthesis, manufactured by a different procedure, and that way, stay within the same budget. Can you imagine me saying to you that we can get on with your hip replacement with an inferior prosthesis? Of course the carrot they thought for the orthopedic surgeons was that they could do more hip replacements with the same hospital budget and therefore make more money for the surgeons themselves through the separate medical insurance plan. Their administation saw this as win, win! We both could pick the pockets of a different funder, the medical services plan! Budget terrorism!  It wasn't a win for us since, it isn't ethical to put an inferior prosthesis in a patient's hip or knee; our onus is to minimize post operative short and long term complications for our own survival and resist clever solutions derived on the backs of patients. Boards, CEOs and CFOs never have to see patients: never have to see surgical failures year after year in the office; groan! Fortunately adverse pressure worked to some degree and budgets much later were expanded for replacements; unfortunately after I retired. They never really understood why we didn't jump to their initial offer of B level prosthesis.

The Road

I bought a print the other day of the Camino, the road from France to the Spanish town of Santiago de Compostela. It was in an exhibition series of paintings in our library exploring the nature of roads. Standing on the road; a trail really; was a solitary lengthened shadow of a figure with a stick: the low sun, the sense of impending twilight; and the antiqued paper giving the print of the road a quality of roughness and endless distance. A road always suggests a journey: leaving somewhere, or something, or someone, and going to something, or somewhere. But the gist of the journey is the process, not the beginning or the end. The shadow on the road is fully in contact with it, not just the soles of one's feet, and the shadow looks forward and backward throughout the journey, leading and following, and watches the traveler from one side or the other as well, through much of the day. Though the traveler passes through the country, the road, hard and rough, the traveler footsore,  he is confined by the direction of the roadway if he is to progress to the intended target. If it's the road to Zanzibar Dorothy Lamour makes with her friends, or the Yellow Brick Road or the Camino road, the place to be is the place between. This is where we walk a step at a time. In my print, the solitary figure expressed by shadow gives a feeling to the viewer of the loneliness of the roadway. There is no Bing Crosby or Bob Hope to accompany Dorothy! There is no Toto to accompany the other Dorothy! But of course, these are only fantasies of reality on the roadway.There is no bicycle, no automobile, just a narrow road in my print for which each step is the only present and the only reality. My print could have been anywhere because road is a metaphor for life. I have never taken the road to Santiago de Compostela and I am too old now to do it, but a road is a road is a road and we all are on a roadway to somewhere and leaving somewhere.  It's the process that we live with from that road we decided to take, rather than the goal that will take us somewhere else. How many times did you start with a goal and find during the journey that the real purpose was somewhere else?

Phantom Limb

When a leg has been removed, for any reason, the image of the leg remains as a phantom and you may alight from your bed after a sound sleep and attempt to stand on something that is not there. The cortical imprint of your leg in the brain remains for some period of time despite the sensory input that no longer exists. This is called the phantom image. The larger map of neural areas in the brain for the lower limb are the joints, knee, ankle and the great toe. These are the phantom images identified most commonly by the patient, but as the brain adapts to the loss of limb, recognition occurs that there is a forshortening of the phantom towards the stump end, rather than just fading away. Before it fades the foot is felt on the end of the stump. If a history of severe chronic pain has been present for some time in the affected limb before amputation, then rather than just a phantom image alone, phantom pain will sometimes ensue.  The brain we now know has a self adjusting ability to add or delete mapped areas that serve the body as needed and it is is increasingly understood, but change is slower and less deliberate than we might wish, nevertheless the brain has infinite potential to adapt in time. Where chronic pain has been present it is probable that the cortical representation is larger and adapts more slowly. Given this mystery of pain, or image, where the limb source no longer exists, it should follow that pain in other parts of the human vessel we call our own could still be  remembered despite all manner of conditions that now no longer show any discernible problem of pathology. Phantom pain in the back, gallbladder, shoulder disorders or a legion of other painful conditions that defy explaination are not entirely dissimilar to phantom pain following limb amputation that is clinically unquestioned even if still ill understood. When they said in that scheme of things, that it's all in your head, it would have a different meaning if the analogy to phantom limb is a viable theory. Then it might mean, it's still on your cerebral cortex for a while and wait till the three pounds of grey matter remaps itself. It may be a simpleton's theory for a high powered neurophysiologist, but I am long in the tooth and too short of time to shut up.

The Doctor's Dilemma

I was speaking with a friend about Downton Abbey and Lady Mary Crawley's dilemma with the Turkish gentleman who, given his age, must have had a fatal arrhythmia during intercourse. It reminded me of a similar, little known , but celebrated circumstance in Lotus City in the mid 20th century when I began practice there. The city was very small at that time and medical practices were both tight and longitudinal so families were often attended by the same physicians from cradle to grave. As a result of this, patient and doctor loyalties were high. The doctor of whom I speak, attended, for years, two carriage trade families who lived in the same neighborhood as him. One night he received a midnight call from the wife of a prominent business man, in a panic, that a friend of hers had died in her bed. The man who died, a lawyer, was also the doctor's patient, a widower who had enjoyed a meal, and later, congress with the lady since her husband was away on business. Unfortunately good living had rendered the older lawyer somewhat unfit for such action. Faced with such a situation and the eruption of scandal involving two of his patient's families and also their issue, the doctor's dilemma arose. The man had clearly had a heart attack at the time. As a result the doctor and the lady, fueled no doubt by adenaline, carried the man to the doctor's car and transported him to his house and put him in his own bed with new pajamas and tucked him in. He then made a house call in the morning and called the coroner. The question of course is, what was the moral imperative that contended with the legal requirement of the doctor? A physician has a duty to the country, his colleagues and to his regulatory body to obey the law. He also owes a duty to the welfare of his patients at some cost, if necessary. He risked his medical practice by illegal transport of a human body from the place of sudden death in order to cover up the truth. However, dead is dead and a bed is a bed! What was the harm? It would have been easier for the doctor to avoid criticism by a self- righteous tack.  He took a chance! In a small city where everyone knew everyone's business, they thought,  the secret was kept for years. Succor for the innocent of the families I suppose, and avoiding the trials and near disasters that befell Lady Mary.

Cheating

Avoiding pitfalls in university exams includes sidestepping opportunities to cheat. The temptation to do so in a competitive environment, when we were trying to get the marks necessary to get into and to stay in Medicine, presented themselves occasionally. I escaped the pitfall twice in my student years, largely through cowardice I must confess rather than any surge of ethics. In my premed year my marks were good since I needed them to transfer to the medicine faculty and a colleague, not a friend, but a playboy and bon vivant in my premed year and also an occasional drinking companion, knowing that I was heading to good marks in invertebrate zoology, asked me to write his exam for him. He offered me fifty dollars to do it: a big sum in 1953. I told him no, mostly because of cowardice, but also self-righteousness since he never bothered to spend any time at the subject. I don't really think at that time I had any strong ethical sense. I just was cautious about being found out and risking the destruction of my budding career. The second time was in second year medicine when my friend, in first year medicine, gave me a prepared copy of the final second year bacteriology exam two days before the examination. Once in my hand it was difficult not to look at it. There was no question on it that I couldn't have answered easily. However, paranoid though I may be, I think in retrospect I was being set up for disaster. I was a good student in bacteriology, but I wasn't a great student in bacteriology. A laboratory technician, whose wife had been trying to seduce me, had left a copy of the examination questions "inadvertently"  near my friend's library table in the evening. My friend couldn't help but notice it and was impelled to show me. What to do? I had no way out. I solved the problem by writing the exam badly enough that I could get by without detection while kicking myself at the same time. Cowardice however has a place in all of this. Had I taken great umbrage, and asked for a separate exam since I had seen a copy, the shit would have hit the fan for every one but me. Thanks to my cowardice no one lost their job, no one was exposed for cheating, no one was expelled for passing information about exams, and I was never seduced, probably again about cowardice and naivety rather than ethics. There is no doubt that growing up in the prairie boondocks you had to look where you were going to avoid stepping in fresh cow pies.

Short Pants

I was the last kid in my age group to graduate to long pants, the coming of age event for boys in Kindersley, the prairie town where I grew up. That was the secular coming of age that was delayed by my mother's insistence that short pants were less slovenly than long pants, notwithstanding the dirty knees. Maybe it was easier to wash the knees than wash and iron multiple pants. I was also the only boy in my age group that had to attend Sunday School and when I finally prevailed with her to absent myself after my confirmation, since at that time my father didn't go to church and therefore could argue my case. Besides that I was the only boy in Sunday School except my young brother and he didn't count. It was my religious coming of age! The delay in my coming of age from a secular delay and spiritual absence, determined my fate that I could never reach cool, or so I grieved then. Down deep now, I would have grieved if my children became cool too soon in life, so in retrospect, I thank God for my mother! Moreover I had bow-legs, a genetic disorder since the paternal family tree records these parenthesis' in photographs with swimming costumes from long ago, otherwise in the forbears they are masked always by pictures taken  deceitfully in long pants. It wasn't fair. Despite the bow-legs, none of our family, to my knowledge, developed osteoarthritis of the knees since the bow-legs arose from bilateral Tibia Vara. and therefore the knee joints were preserved. I think that was lucky. Uncool and bow-legs but lucky in the end. It has taken me a long time to realize it isn't me, it's us and it's good!

Just Who do You Think You Are?

As I lay in bed asleep last night I woke up with a start and a small inner voice said, "Just who do you think you are?  What right have you to keep saying "you" in your writing, or your diatribes in fact, as if you are lecturing to some invisible novitiate who is hanging onto your every pathetic idea. Take your last blog, Happenstance, all I can say is what a pedantic piece of nonsense masquerading as something deep. Drivel! Why don't you stick to the strange little episodes of your life events, some of which are exaggerated, but at least less pretentious than your meagre ideas of life. And your putative book cover, that's another matter. You haven't even left enough rope to hang yourself."  Well, you can see I am having a crisis of confidence! I admit that from time to time I have over-rated my puny ideas of life.  "It isn't so bad that you write these ideas of life, but that you think you are on the high road when in fact you are a poseur, because you keep preening yourself as you write that it is all newness," said the small voice. I suppose that I am grateful for the small voice even though down deep I admit it is not all that comforting. Still, if I believe that what comes along is always for the good, whatever comes, I accept that Jobian idea, at least for the moment till the next bad thing comes along, as it will and then I'll chuck Job. Pontificating is unfortunately a fault of mine, but magnified as a fault if one has no business doing it! Maybe as the pianist says I should stop saying "you", as if I was a teaching somebuddy and use "one" or better still "I" when it really is me, not you. Anyway, I have to ask the small inner voice, "Just who do you think you are? I'm not going to take everything you say as gospel." I may be kidding myself, but even if some of it is stupid it is at least my attempt to be  honest. There is a lot of crap out there in the writing world so I am entitled to contribute mine as well, including Happenstance.

Happenstance

 If you believe that some of the seemingly trivial events in your life leading to consequences have happened without your control you may have some concern about life and your prospects. If you believe that life in the final analysis occurs without much control, like Brownian Movement, and flecks of dust particles just collide or don't and control ultimately is of limited value anyway, then que sera, "it ain't my fault!"  If however you consider happenstance, and that is, there is direction, as yet unknown, to the seemingly unrelated and trivial events leading to whatever consequence you may  arrive at, one will have a somewhat fatalistic point of view. I have no doubt  all of these conditions are in operation, but I can't help but think that there were coincidences in my life that were directed, but not by me. Things beyond my control, things that were not randomized, but linkage that led to a chain of events that were arranged from beyond. Does it not feel good that there is some guidance in this life?  That there is some outside force that will connect whatever dots there are to connect! That the direction is not all up to me and I cannot hold the whole world in my hand and direct it to do the right thing or know the right thing for that matter. That I am not powerful enough to avoid all the pitfalls in life or alternately the pitfalls in my life may for my own good. If Brownian Movement is in an epic battle with Control and Happenstance for our lives, and it's winner take all, then we had best be on our knees. I'm cheering for Control or Happenstance: hanging loose or anal! I think a dose of both! Not either/or!

Fishing with Children

I have a photograph of my eldest daughter when she was 9, standing on the dock in Cowichan Bay, holding, with both hands, a 22 pound spring salmon that is two thirds of her height,  that she caught while trolling in the bay. In the late fall, if rain was still slight, the rivers were low and the big fish could not go up them to spawn till the rains came. As a result the big fish accumulated in the bay and fishing was spectacular. River mouth fishing is no longer allowed there for very good reasons. I have a photograph of my youngest daughter when she was 9,  taken near the end of day, at the end of the fishing season in Lake of the Woods, when we were due to go back to the coast. She rowed out to the pickerel hole by her self for the last time. She came rowing back to the cottage near dark, in jubilation, having jigged with minnows for 2 hours, carrying a 6 pound pickerel, the largest of that season. I have a photograph of my son when he was 11, whose line we thought hit bottom around Fiddle Reef off Lotus City waters, and I scolded him for not watching the line carefully enough to avoid snagging. As we dragged and hauled and backed up the boat to pull at different angles to relieve the snag, we pulled in a dead weight, 44 pound halibut. The halibut suddenly became alive on the bottom of the boat once gaffed and landed and it took a time and effort to subdue since we didn't carry a 22. When I went fishing with my 10 year old grandson by the Can Buoy at Batt Rock, a submerged mount in Ganges harbour, we illegally tied up to the Can Buoy to still fish, and he caught an 18 pound silver green ling cod. Unfortuately the ling cod were out of season and he had to throw it back. He wrote of his sorrow. They are now 52, 49, 54 and 24, but those are fish to remember and there is an imprint on a software gyrus of each, labelled Desire, that portends danger for some fish, some time!

Operating Room Nurse

The nursing bureaucracy at the Lotus City hospital where I toiled in Orthopedic surgery decided in their wisdom to apply the Peter Principal to the operating room charge nurses. Said to be in he interest of  broadening the focus and utility of senior nurses for more Service flexible usage they concluded charge nurses should move from time to time, to different Services within the operating room. Senior nurses have a short learning curve so they get up to speed quickly, but the decision never really took any of the surgeon's opinions into account. By that time of course in the corporate structure it was none of our business despite the long established relationships we had developed with the charge nurses and the sort of seamlessness we had in the provision of patient care. The generals and colonels often hatch new ideas that break a few eggs on the corporal's plates. It is getting harder and harder to decide what rank is the more expendable, as our hands on people think about it. The curious thing is, as far as I know, I was the only one to raise an objection to this lateral move. Maybe it was because we had a treasure in our Orthopedic Service, but it was also fear for myself since I was getting older and as I was distracted when conversing from time to time, she would remind me what I should be doing. It was apparent that the bureaucracy would ignore any plea from me on this basis, particularly since all the other Service Chiefs lusted after my treasure. Like Priam allowing Paris to steal and harbour Helen away from Menalaus, I had no wind left to resist. Since I was old and feeble I had to resort to shock and awe and good humor to succeed. I therefore wrote to the nurse bureaucrats a simple phrase on my letter of protest to say that I would kill myself if they moved Ms SL. They possibly had never  received such a letter before, so were non plussed and relented in my case for a decent period of time. Perhaps they thought me mad and therefore needed a steady hand at the tiller. However, as the ship of state sailed on, she went eventually to the General Surgeons and I had to become a big boy again despite that delayed pillage.

Evil

In our weekly book club we are working through Edmund Spenser's, The Faerie Queene. In Book One, the evil arch magician, Archimago, features large in the narrative. As we discussed the Canto in question at the time, I mentioned as an aside the inherent evil of Ariel Castro, a topical current event I thought mildly relevent to our discussion. I was immediately challenged by my friend Dennis, who said, "You think you are superior to Castro!" I was taken aback, but in defense I said quickly, " Well, I don't think I would secrete away three little girls and abuse them for ten years with ropes and chains." "Maybe not, he said, "But you are talking about the law, not nature, because none of us is different. We are all of the same substance and have a dark and universal side! It's just that some of us don't recognize it!" I don't want to put words in Dennis' mouth, but it was a week ago and the words of his are roughly as I have related. I have since thought about it and he is right about me. I was too glib and in the right circumstances I believe, I, and many others I venture and hope to say, are capable of almost anything that would seem evil in retrospect. My defense to Dennis was that there needs to be accountability for one's action. He agreed with that, but clearly separated justice and morality. I guess the question is, is there a moral man? Is there an honest man? Do we have the courage to face our dark side? Do we fall back on the idea that the devil made me do it? I have to assent, we are all made of the same clay. I remember the moment of realization that Lawrence of Arabia broke up in, when he said he had shot a man with his gun, and the horror he suddenly realized, when he admitted, not that he killed a man, but that he enjoyed the killing. The insights we gain in the book club, spun from the magic of Spenser, are far more than the narrative itself. It comes also from the clean and honest exchanges that arise from the seed. It must however, as my friend John says, be read as a group to harvest this fruit!

The Palimpsest

When my career was young and I knew what I knew, I found myself suddenly surrounded by a exceedingly dense fog. I could not find my way and I was directionless. I reached with all my strength into the dense fog, well up to my shoulder and suddenly something touched my hand. I couldn't feel it move away, but I grasped it in desperation so it wouldn't escape and pulled it out of the mist. It was a parchment. It appeared old; brown,wrinkled, lined with age and on its surface there was a script, written line by line, filling the parchment face, full of strange cryptic characters. When the fog lifted I sat at my desk and tried to imagine what I had been given. I did not understand the script and so I concluded that those writings therefore must be irrelevant. As a result I took my eraser and erased the printed characters. Having done so there were still the indents on the parchment face where the writer had pressed on the stylus. On that blank page, now available to me, I wrote a treatise on the nature of modern medicine. I had seemed to have found my way; I wasn't directionless, and I knew what I knew. Still, I was haunted by the strange characters I had erased and became aware that I knew what I  didn't know. Later, I had a dream in which the written description of those exquisite simulacra from the past, appeared to me in translation. I realized that I had erased and overwritten that former script because of the hubris I felt about the present and the failure to know the relevance of what I never knew. I erased my treatise on modern medicine and burnished the indented parchment to bring back, into life,  the indentations. A palimpsest through the fog and mist of time was a gift to teach me what I need to know.

Time Anxiety

My mother and her twin sister would meet my grandfather at 5 pm at Portage and Main and they would get a ride home to Little Britain each night. My mother was at Normal School on the Pembina campus and my aunt in Medical School on the Bannatyne campus. If they were late to arrive at the downtown location my grand father would leave them behind and go home on his own. In the winter, Portage and Main resembled Greenland. If they were late they would then have to take the street car, north to the end of the line and transfer to the infrequent bus for the 20 odd kilometers all told, and arrive home at 7 or 8 pm. Growing up with my mother I knew she had time anxiety and her constant refrain for any or all appointments where I was hauled along was, " Hurry. Hurry. Hurry." It is not within the nature of little boys to hurry, hurry, hurry, but over time these emminations were assimilated. After all, your mother is your mother! And so, inevitably, I also have time anxiety. It drives the pianist crazy. To lighten the mood I will play act by pawing the floor like a bull. It may have been funny the first time but not the endless agitation. Since she understands the irrationality and is always ready to go in an organized fashion she never plays a taunting hand. The curious thing about time anxiety I note is that those who have it, often walk close to the edge of their cliff of fear, a self imposed dawdle, that enhances the truth of their reaction, instead of leaving a little earlier to reduce the fear. Dawdling followed by anxiety was characteristic of both my mother and me. We rarely if ever missed the appointments, as I recall, but I now know it was all my grandfather's fault and not my mother's.

Memory and Acuity

My brother Ken, four years younger than me, has a more accurate long term memory of the events of our youth than I do. Whereas I recall the effect of the events on me in fairly vivid detail he had the more acuity for the event itself. I knew enough to know never to argue with him because he was almost always right. I had remembered, I thought, of an event I heard of in 1946. My uncle Edgie had been a prisoner of war in Stalag 8B for 3 and a half years after Dieppe. I was telling Ken's son that in prison Edgie had wagered a fellow prisoner that he could swallow a dead mouse for a dollar. I was telling Ken about this and he said, "No, you are wrong, the bet was that he could bite the mouse in half for a dollar." He did! Now neither Ken nor I have talked about this probably for 60 years but his acuity in the matter does not in any way take account of the horror I felt learning of that event and whether it was biting or swallowing is completely beside the point in my memory of my interior revulsion at the time. So far this little story has nothing elevating or useful to teach, but I have been reading Roger Lundin's book, Emily Dickinson and the Art of Belief. He says," for her, (Emily) memory meant the recollection of intense experiences or encounters rather than the rituals of general commemoration. It usually involved the revival of a sensory impress." In addition, he says, "She was intrigued only by the memory of what went on within the dwelling of her conscious life." I think that may be the difference between Ken and me. He saw and remembered the details of what went on in life vividly but accurately. My recollection of the same facts that I would have heard so long ago, is completely colored by the recall of the feelings. The acuity is swept up by the memory of the feelings which are the more powerful in me. In a world of law, testimony, false memory syndrome, accusation, redemption, recall, feelings, emotion, acuity,  and recompense---Justice demands, stick with the reporter rather than the poet.

Walking

Somehow, I have probably driven the six blocks to town a thousand times, while passing the features along the way. They are as familiar to me as the details of the interior of my house, but a blur. I could walk the distance in my sleep without foundering.  Or, so I thought! I have been grounded for a while, so have been unable to drive. I have been unwell and am beginning to rehabilitate by walking. Ambling is closer to the description of my ambulant adventure. It is closer to the adventurous walking that a child in no hurry would do. What struck me with such intensity is the myriad things that I missed in driving one thousand times past them. My trail was a zigzag beside the roadway and into the grassy byways. The trail was punctuated by stop and go, periods and dashes. I saw disuse and decay, new hope and splendor. I saw trial and error, failure and success. I encountered friends and strangers, talked to some and nodded to others. It's hard not to acknowledge passers by in a small town. A fish store closed out of season, a stone sculptors studio empty from his death, a towering new apartment climbing a rock face, a rotting house buried on a waterfront slope at the end of the harbor, a band shell ready to make music, unused wharfage and rotting steps to the harbour, blocked off, and all the wild shrubs and trees and byways between them. A marina with a few winter boats and signs forbidding parking other than guests and staff, and a church inviting all to come and park. That of course is the macro, but each feature in fact, was a picture that invited one to stand there and see the micro in it all. I think I saw what a painter might see. I finally came to the town and all is familiar there because after a drive, I have always, perforce, walked around in the town.

Random Harvest

The top banana of the Greek Gods, Zeus, swallowed his wife Metis at the time that she was pregnant. Eventually,  Metis gave birth,  and Athena, who because she was part of the meal, had to emerge through the top of Zeus' head. This isn't a book of stories about food or obstetrics or neurosurgery or even a cranky husband though it may include some or all of these topics. It's about control, or rather the lack of it. Zeus had to deal with Athena's arrival on her time table rather one of his choosing. She ended up being useful to him, rather than stronger than him as he had originally feared! If I am a fermentation vat, from time to time a bubble arises from below, breaks my surface with a "boing", and produces a spreading ring that lasts a while. The vat doesn't know when the bubble is going to break out and can't stifle it. Like Athena, the bubble rises up in its own time, ruffles the surface, and thereby is part of the fermentation. The random harvest of thoughts, that arise de novo; grasped at and scribbled about, without questioning the birth process, and without stifling yourself, is therapy of a sort; like taking a stroll through your head. It's clear that there is a lot to see there, but it only shows itself to you when it will. Like Zeus, I must have eaten a lot of stuff in my life that is still sitting around waiting to be born, or wanting to be born, but perhaps I am too thick-skulled yet to let it all out. Possibly I am still stuffed with stuff and long to empty myself, but I must wait for Athena, Goddess of Wisdom amongst other jobs and useful to me as well. It's at least intriguing to me what the muse will say next, and when the bubble will arise. Constipated or not, I am content to sit on the stoop and wait for it.

Mountain Climber

Today is the feast of the Transfiguration. Those who climb the mountain to the top will be changed if not transformed. To reach the top is not to stay there. The hardest part is to go back into whatever valley your have to deal with where you wanted to be cool,  not giving up and giving in to the new view. The priest today said that some of us may have been at the mountain top and were transformed. I was, I was, my hand is up! I didn't ever really diserve to get there, but I was placed there by a Holy Helicopter. I felt like a bird with wings for three months and moved with the wind but was probably considered mildly mad by my colleagues and friends. I may have been dreadfully eager to reach all those I saw in need who treated me with compassion, but it all gradually faded since living on a mountain top too long addles the brain. Transformed, no, transfigured, no, but changed and slowly adapted, yes. The valley is where we are to be, not the mountain, not Olympus, not Mount of Olives, not the Acropolis not even the mount of the Transfiguration. I actually prayed a prayer that the feeling of religous euphoria would leave me because it was interfering with my ability to do my work. Not to worry, some of it all sticks. You may be lucky enough to have your string jerked as well, but gradualism is the thoughtful and longitudinal way to go. That's just the work part that is demanded of those of us in the valley. Partly blind, partly poor, partly weak, control recused, hardly cool, that's us.

Testing the Waters

You never know what you are capable of until you are tested in the waters. Once one has come through a testing we can say, "I know that I can cope with that and get through it, so I can push through that much storm thus far, which opens my possibilities." When the family of the pianist and I managed a wooden cabin cruiser for over twenty years it was scary at first running the inland Salish Sea. I had at first made tentative forays on calm days till I mustered up courage and took three of my friends for a weekend of fishing several kilometers out in the briny deep. I had taken the Power Squadron course and read a book on seamanship as well. I guessed that I was ready. The weather was calm for two days and we had a great time putting into moorages along the way and celebrating our feats of seamanship on land and sea . On the way back to the homeport the weather changed and the boat, already an older boat at that time, with a wooden dingy that would accomodate one, blew off the transom and broke up. We secured our life jackets and stayed whitefaced at the large following high seas, that swung our backside from side to side like a dog in heat until we entered the first safe harbour along the way, still far from home. We anchored out and called to the waterfront houses till some one rowed out and rescued us. The pianist picked us up and drove us home. She said to all of us, "You guys stink." That of course compounded the chagrin. Sailors indeed. Stinky nonsailors indeed. That foolhardy experience, notwithstanding however ill prepared I was, taught me what our boat could cope with; tested by the waters. Yet, whatever foolhardy lack of preparation was present, I learned in spades. It's hard to learn everything from a course, when passion will teach you from experience.  As one prepares for, and expands what you thought were your limitations, as in the limitations of your craft, one pushes the boundary further and further incrementally, always aware of the endpoint of pushing the boundaries to foolhardiness. There has never been a shortage of life without risk in the young, but calculated risk unfortunately only comes with experience. Mistakes if you survive can frequently teach more than success.

Casuistry

Casuistry may seem an obscure word, but it is a noun more employed in the world at the moment than any other I can think of, from all advertising, political rhetoric, advocacy groups and legal selectivity. It is not hyperbole, it is worse. It is more subtle, more damaging and employs both anabole and hyperbole as well as deceptive reasonableness. Anabole at what it wishes to ignore and hyperbole about what it wishes that you not ignore. It can be seen in newsprint and internet and in the clever constructions from the comment sections. It is convincing to those who hear or read things, the spectators of life, than those who do things. Unfortunately, there is such a limited breadth of things we can do, and such a wide breadth of things we can watch! The only object of the casuist is to convince. We must always ask what is the interest of the convincer? The reaction of the audience may be cynical and believe nothing, or gullible and believe everything, or somewhere in between. You may in fact have already become aware that this paragraph I have written is an example of casuistry. It may not rank as a clever construction but it smacks of too much generalization to be on the high road. Still, it probably contains a tuppance worth of truth that those who already share the premise will find it wholely satisfying. If the file folder in your cerebral cortex is only available for A and not for B, then A will be accepted and B rejected. We have been programmed as spectators. As always, evidence is in the eye of the beholder. How do we get to a folder AB? I wish I knew!

Vaillaume cello

I have no background knowledge of music or musical instruments since I am a surgical mug and tone deaf, but I am married to the pianist so I glean her occasional droppings. I go to the occasional soiree and nod at expressions of ecstasy expressed by friends so as to join in, but I know where I belong and it's in the other kind of  theatre, the operating theatre. I have tried! The pianist's mother was a concert cellist, and she played until she was eighty five, and practiced in our home rather than her apartment since she was driving her adjacent apartment dwellers crazy with her unending scales! I was working one day years ago in the operating room with a colleague doing a long case and he was going on at the time endlessly it seemed, about a side occupation that he did in addition to his general practice. He was a classical music lover and scholar and had an interest in brokering string instruments! He was enthusiastic about a Stadivarius that he had aquired the rights to, and had traveled to Olympic City, "Where the money is, "he said, to show it to a client. I idly listened to him as he rattled on gaily about his forays into the precious instrument trade, while keeping track at the same time to the surgical matter at hand. Then he said, "I have a bead on  a Vaillaume  cello as well and they are very rare but there is a client of mine who is in the market if I can find one. There is a beautiful one in Olympic city I can't access." "Oh yah," I said, half listening, "We have one of those in our closet at home." There was silence. He knew I  was a barbarian and couldn't tell the difference between a cello and a kettledrum. At least that's what he thought. "No,"he said. "Yes,"I said, "I think it's in a closet somewhere."  Well, there was no way that he wasn't going to see it that night. He said nothing more and assiduously paid attention to what we were doing to his patient for the balance of the case. He bounded up the stairs at our home at 10 pm and said in an air of profound disbelief to the pianist, "You don't have a Vaillaume cello in your closet, do you?" "Yes", she said,"my mother bought it in Paris in 1920." My friend examined it carefully and then looked at me as if I were a newly hatched giant of the music industry. I felt like a poseur, but after all that talk, I wasn't going to let him know that I was just a surgical mug who knew what was in the closet.

Busy Hands

In the olden days when my children were teenagers, from time to time, when lassitude struck and indolence lurked around the corner, I would observe the axiom that, "Busy hands are Happy hands!" It was and is a tenet of faith I carry, but of course they would respond immediately by gagging motions into a fake barf bag. I expected such a response of course, but we had communicated and they  knew it, though it became sort of a joke, (CBS) Corny but Satisfactory. I was astounded to get a communication from the Royal College of Physicians and Surgeons of Canada the other day with information that we had unemployed Orthopedic surgeons, Neurosurgeons and Cardiac surgeons, newly graduated, that couldn't find places  to work in Canada now. The cream of the crop that we can't seem to fit in after all that training and skill; not being utilized to the fullest. One of the most satisfying aspects of my career in Lotus City was part of the recruitment and utilization of young Orthopedic surgeons added to our roster every three to four years throughout most  of the past thirty years. They added greatly to the health of our Service with the contribution of current knowledge and new skills. Rather than competition, the addition of these surgeons added to the energy of all and confirmed the adage that busy hands are indeed happy hands. Rationing of health care in this country by governments may save money, but in the face of inordinate waiting lists, inadequate expansion of high tech facilities, and unwillingness to address the antiquated Canada Health Act for fear of political suicide, the slow erosion will continue. Where is a latter day Edmund Burke when we need him? He may have been turfed by the electors of Bristol after a term, but he lives on in our minds and literature, while the ever compliant politicians of his day were never heard of again. My long association with surgeons has taught me this: these brothers and sisters under the skin would work for nothing if the tool shop is excellent and the team is topnotch. Money is not the big issue; it is the side issue, even though the money is good. I too am cognizant of the over all major costs these surgeons secondarily generate for the health care budget. Let's face it!  Health care Delayed is Health care Denied! A stitch in time saves nine. The work is fascinating and truly, "Busy Hands are Happy hands!"