Wednesday, August 24, 2011

Jack Layton

I seem to get all my bad news in coffee shops lately. I was having breakfast at a coffee shop last Monday when my wife texted me to tell me that Jack Layton had died.

I have supported the NDP all my life. In my income bracket, the Conservatives would be far better for me; I am a corporation, lowering taxes is what they are all about. ( I might even create some jobs with the extra money, that's what corporations do with their money from tax cuts ;Q.) I periodically get involved, mostly I just donate and show up to futilely cast a vote (my Cons member routinely gets 60%)

The past 20 year have not been good to the NDP. They were reduced to a small rump in the House of Commons, and have lost some of the provincial governments that they had. Most of Canada's is now governed by governments more right wing than we would have ever thought possible 20 years ago. Federal and provincial governments in the past 20 years have rolled back many progressive changes that took most of the 20th century to accomplish.

The NDP has always picked polite, well meaning, non-charismatic intellectuals as their leaders. They have run nice polite campaigns while the other two parties kicked sand in their face. They have won lots of moral but very few actual victories.

Jack Layton was different. He was a politician. Yes, a politician. Someone who fought back, who played by the same rules as the other parties. Some people didn't like that. After all the NDP is supposed to been polite and principled. (These were usually the same people who said in the past that they couldn't vote NDP because they didn't have a strong leader). And sure he made claims we knew weren't possible. Like for example he talked about hiring new family doctors. Like, where was he expecting to find them (in the medicentres and cosmetic clinics?). But he brought back a new respect for politicians and what they could accomplish. Many people support all or a large part of the progressive agenda. It's just that the salesmen and women have not been very good at it. Until Jack Layton.

But he made politics interesting and the last five years have been an exciting time for progressives. I remember the coalition a few years ago, when it looked like for the first time Canada was actually going to overthrow a government. Too bad Iggy screwed that one up. But Jack got him back when he skewered him about his attendence in the House of Commons in the debate. And in that debate it was fascinating watching Harper looking at Jack with a mixture of hatred and fear. And of the excitement of the Orange Wave this year and the possibility on the last weekend with the Liberal vote collapsing that Jack and the NDP just might win. And on election night the sight of him on stage waving his cane in the air.

But what I like about Jack was that he always seemed to be having fun. Like the picture, how many times have you seen a politician hoisting a beer (too bad about the Habs sweater). Other politicians go through their photo ops but they don't look like they are having any fun.

But one thing that nobody ever points out is that Jack with his popularity as a municipal politician and his pedigree (which unfortunately seems to be important in Canadian politics) could have run for the Liberals in the 1990s, been given a safe seat, a Cabinet position and we just might now be having a state funeral for a sitting Prime Minister, not the Leader of the Opposition. Who would have blamed him, so many other progressive politicians have sold out (run for the Liberal party). Instead he threw his lot in with a party that had been reduced to 11 members and took three tries just to win a seat. That is committment to principle.

I did meet Jack once at barbecue put on by the party. My wife told me I should go and talk to him so I did but overwhelmed by his aura I was tongue tied and didn't get much beyond introducing myself and saying how nice it was to finally meet him. He was polite and smiled. I wish we (I) could have talked more.

From the grave Jack sent this letter to Canadians which he composed two days before his death. What impressed my wife and I was his advice to Canadians on how we can all try to be better. What an inspiration.

My wife and I attended a candle-light service for him last night. A few thousand people came out and we had speaches from politicians. As we left a choir sang the Canadian version of "This Land is Your Land" . We used to sing this song in elementary school. It is too bad many of my generation never thought about what it means.

Jack said:

"Hope is better than fear. Optimism is better than despair. So let us be loving, hopeful and optimistic. And we’ll change the world."

Joe Hill said, "Don't mourn, organize". Maybe I should get off my ass.

The Genocide Museum

My wife and I visited the Genocide Museum in Kigali which I blogged about in my alternate blogoverse. Here is my posting below and I will comment further underneath it.

I am a keen student of history. I wish more of our world leaders studied history. On the other hand I like to live in the now and try to move forward while learning from what has gone on in the past.

We had a free day in Kigali today so we decided to visit the Kigali Genocide Museum. Many people had suggested that this would be a must see in Kigali so we went. I really didn't know what to expect.

We found the museum on the map. Because safe taxis don't come to our neighbourhood we decided to walk to central Kigali where we could get into a decent taxi and get there that way. We stopped at the Cafe Bourbon for a latte and chocolate croissant by which time we actually felt energetic and decided to walk the rest of the way. Like most things in Kigali there is no straight line between two points and while it looked like we were half way there already, what the map didn't show was that we were at the top of one large hill and to get to the museum we would have to descend to the bottom of the hill and then walk up half way up the next hill. This is complicated by the lousy map we have and the lack of street signs in Kigali. The guide did say that we could see it across the valley.

Eventually we arrived at the museum. What impressed me the most was the number of Rwandans in their best clothes heading up or coming down the hill from the Museum/Memorial to pay their respects to their dead relatives.

The Museum itself is surrounded by a number of themed gardens related to life before, during and after the genocide. After passing through these gardens you then visit the mass graves. The remains of 300,000 people mostly from Kigali are entombed there. The graves are covered with flowers left by relatives. At the end of the garden is the Wall of Remembrance which is about 50 metres long. They are trying to put of the names of all the dead, however they have only managed to fill two panels and there is a lot of wall to be filled.

After this we went into the Museum. This contains a history of Rwanda before during and after the colonial period. It then explains in great detail the events of the Genocide. This is underscored by filmed interviews of survivors and historic news footage. There is a room of pictures of the dead, and a room full of some of the skulls and bones. Many of the skulls have bullet holes or machete marks. There is another room devoted to the children who were murdered.

The second part of the Museum is devoted to other genocides including the Armenians, the Herraro of Namibia by the Germans (which I never knew of), the Holocaust, Cambodia and the Balkans.

The goal of the museum is to maintain awareness of genocide in the hope that this will never happen in the future. I always thought that by now we would have found a way of resolving disputes that doesn't involve killing people. I continue to be disappointed.

We walked the long climb home somewhat somberly. The streets we walked through were humming with activity and it seems that the Rwandans are at least trying to live in the now.

This article in the Globe last weekend rekindled my memory.

As you can read, there is a dispute threatening this new Museum over whose rights were the most abused or who got genocided the hardest.

Now having your friends, relatives or ancestors shot, macheteed, gassed or starved is not pleasant at all, no matter how many or how long ago. I suspect if we go far enough back in our family tree we will come across an ancestor whose rights were egregiously abused (in my case you might have to go back to the Norman Conquest!). More likely you are going to find an ancestor who participated enthusiastically in taking away someone else's human rights. The fact is as a student of history and unfortunately an observer of current events, I can't believe how badly we treat and treated our fellow human beings.

The Rwandan genocide occurred 17 years ago. Some of the participants are in jail. To distinguish them from other prisoners they wear pink pajamas, Some of them worked in the hospital doing chores. They looked somewhat old and not at all evil or dangerous. From all accounts I have read a lot of people participated in it either actively or passively. Not all of these people are in jail or exile, which means if you have a group of Rwandans over 30 there is a good chance that you are in the presence of someone who may have hacked someone up with a machete or been the crowd egging them on. It would be hard to imagine a group of people being whipped up into such a state of irrational rage, except that it has happened quite a few times in other so called civilized societies in recent memory. I try to put things in perspective by imagining how I might respond if something similar happened in Canada (and don't think it couldn't). Would I shelter those people being persecuted at risk to myself or my family; would I, if asked to participate, join in knowing that failure to participate might endanger me; would I even enthusiastically participate? I hope it would be the first but I don't know.

I kept thinking of the episode on Fawlty Towers where a group of Germans comes to Basil's hotel and he keeps on telling everyone "Don't mention the war!". On Monday after our visit, a Rwandan asked me what I had done on the weekend and I mentioned that I had gone to the Genocide Memorial. I then felt that I had put my foot in my mouth but he didn't react and I went on to talk about what I did for the rest of the weekend. The first time we really discussed it was with Jean our driver, who it turns out lost both his parents in the genocide. He went to a refugee camp in Burundi where his sister and he were adopted by a Burundian couple. He is currently suing to try to get back his parents' house in Kigali. Another time at dinner with one of the anaesthesiologists we asked him about the genocide. He put his head down, started to cry and told us that he was a genocide survivor and that 500 members of his extended family had been killed. I still don't know whether it was something we should bring up or whether is best left to brought up by a Rwandan.

Aside from the Kigali Museum, there are smaller genocide memorials all over the country. Every year, the genocide is commemorated with no just one day but 100 days of commemoration, equalling the 100 days of genocide. It is almost like the country itself has become a monument to the memory of the genocide. Rwanda however is so much more than its ugly past and I keep on wondering whether it is time to live in the present.

As an aside while swimming at the Serena Hotel my wife and I met Linda Melvern who has written extensively on the genocide and I am reading one of her books right now, trying to just make sense of what happened.

I read somewhere that the buildings at Auchwicz are now falling apart and there is a debate as to whether to restore them or not. I like history but sometime it is better to let evil just crumble into the ground.

Sunday, August 21, 2011

Why Internists Should Never Be Intensivists.

I had a really interesting phone conversation with one of our internist/intensivists this morning.

My morning on call started out with an abdominal washout from ICU. This unfortunate lady had her anastomosis break down a few days ago.

Much to me surprise unlike most abdominal wash-outs from ICU she arrived extubated and "breathing" O2 through nasal prongs.....with a SaO2 of 81%, She frankly looked like shzt. Rapid sequence induction with ketamine and her sats perked up with the endotracheal tube back where it belonged. The plan had been to try to hook her back up and close everything however even our most cowboy surgeon looked a things and said no way. Anyway 2 hours or so of digging around the abdomen, creating a colostomy and closing the wound ensued. As he got into her abdomen, I noticed I needed 100% O2 and some PEEP to keep her sats up. So my plan was to send her back ICU ventilated. That actually was my plan from the start of the case.

As we were in the home stretch one of the nurses called me over to the phone.

"Why aren't you going to send her back to the ward?" a voice asked.
"Who am I talking to?", I asked.
"Dr. Yankovic (not his real name, but the resemblance is striking)," came the reply.

Dr. Y is our head of critical care, a pulmonologist who was practising ICU when I showed up in town.

"Let me see, " I said, "She came down with a sat of 81%"
"So she needs some oxygen" snapped Yanko.
"She was on oxygen", I said,
"Which you would have known if you actually made rounds before 0900, " I thought. "Further," I said,"the surgeon wasn't able to hook her back up, he is closing the abdomen but it is quite tight, and I don't think she will tolerate early extubation."

"Fine," said Dr. Y, "I guess I will have to finish your job for you" Click.

Now I might expect this from some young whipper-snapper intensivist who hasn't seen a surgical patient since medical school but this is someone older than me who is head of his department. I might even expect something like this if ICU was full and this lady didn't have a bed. More and more ICU has come to expect us to run our recovery room as a step-down where patients can be ventilated for a few hours which usually runs into a few days. One of my colleagues who never complains had a similar conversation with one of Yanko's colleagues, also an internist, which ended with the exclamation, "well, if you can't look after her, I guess we will have to take her!"

ICUs historically were run by anaesthesiologists who understood surgery and actually knew something about medicine. That was until internists realized there was good money to be made in ICU, as opposed to internal medicine. Now a significant number of intensivists have an internal medicine background.

The bottom line Dr. Yankovich: I'm not asking you to finish my job, I'm asking you to do yours and I shouldn't have to ask. And by the way, get a haircut.

Friday, August 19, 2011

Rwanda, A Stranger in a Strange Land

I returned from Africa at the beginning of June, having spent 4 weeks in Rwanda and a week safari in Kenya. I have already posted on my experience with the teaching aspect which was not that positive although I am getting over that and also re-posted some pieces from my travel blog. I have not really posted on my total experience over there which to say the least interesting and eye opening. People who I continue to meet for the first time since coming back always ask me in passing how was my trip? It is really hard to express what I did and felt in a short conversation.

I volunteered 2 years in advance of the mission. I thought that would give me lots of time to get my life in order. In the interim there were a few changes like becoming site leader and I never did (or ever will?)get my life in order. As the trip approached I began to experience near panic attacks; Africa is a huge mystery to me. Rwanda with its still recent violent past was another issue and even though people assured me it was (and is) the safest country in Africa I was a little scared. And then of course there is the packing and trying to make sure you don't forget anything because you know you will not be able to buy it there (again not true, you can buy just about anything at the Nakumat in Kigali).

Inevitably the time came. My wife drove me to the airport with a huge duffel bag of everything I thought I would need for 5 weeks in Africa. I first went to Halifax for a Global Horizons course. Halifax was of course where I interned and where I met my wife, it still remains a city I enjoy visiting and with a lot of pleasant (and less pleasant) memories. After 4 days in Halifax, it was off to Toronto where my wife rejoined me, to fly to Brussels. We spent 2 days in Brussels, one of which we mostly slept but did so some sightseeing, drank some beer and had some good and bad meals. It was also a last chance to buy some of the stuff we realized we had forgotten.

Our European mini-vacation had to come to an end however and early in the morning we went by taxi to the airport to fly to Kigali. After taking a very long time to get through security we got to our gate where we met "my" resident who had flown overnight from Canada.

When I am flying somewhere I have never been before I often look around at the passengers and wonder what their story's are, why are they on this flight etc. The flight was a mixture of people who were obvious Africans although whether they were returning or visiting was hard to tell and quite a few whities. It was a comfortable flight in a large not fully booked plane which gave my wife and I lots of room to stretch out and even try to nap. We alternately napped, and read with interruptions for airline food and drinks. The map on the screen in front of us showed our steady progress, over Europe across the Mediterranean, skirting Libya and down over Egypt and the Sudan. The eight hour flight passed almost too quickly and we were soon descending into Kigali. It was pitch black by the that time but we could see lights below. The Kigali airport lies on a ridge and the landing was so smooth that seeing the lights still below us, I thought for a moment we were still descending. We exited the plane into the African darkness, which seemed darker than I had ever experienced. There was a strong smell of wood-smoke in the air. We walked along the tarmac to the terminal which was newer and nicer than I expected. To our surprise we sailed through immigration and were soon waiting for our bags. Outside the baggage area we could see people waiting for us and we knew someone would be meeting us but weren't sure who.

Exiting baggage we with some relief saw a sign with our names on it and met the resident Damascene, who had come to pick us up with a hospital driver. I had been advised to change money at the airport. $100 US gave me a huge wad of Rwandan francs.

One of the first things I remember once we left the airport was the large number of people out walking along both sides of the sidewalks in the darkness of the mid-evening. Traffic was light and moved quickly. We drove along the sides of hills looking down at lights below until we passed onto what we would come to be familiar with, the Nyamirambo Road which lead to our apartment. The apartment was a three story building on a dirt road, a block off the main drag. It was walled off with spikes on the top of the wall. Our driver honked, and the gate opened and we entered a courtyard. Our apartment was one floor up and we hauled up our bags. We were relieved to see that while sparsely furnished, our apartment was at least clean and comfortable.

Damascene suggested that we would need some food for the next day, so he drove us back to the "Simba" supermarket. I was still in a little shock, we had dropped into this strange country and now I have figure out what I am going to eat for the next few days and I have no idea what things are supposed to cost or what a sensitive Western stomach can handle. We ended up buying some milk, coffee, juice and pastries to eat for breakfast the next day. Oh yeah and of course beer. While we were in Simba's, people were watching the Champion's League final on a TV in the snack bar. I went in to watch feeling very conspicuous. One of the men watching pulled up a chair so that I could watch.

We came home unpacked a bit and watched the rest of the soccer game on our only TV channel, drinking the beer we had bought. We went to bed around 2200. It was very noisy outside our room and still quite hot. We slept under a mosquito net for the first time in our lives. While I waited for the Zopiclone to kick in so I could sleep, I remember almost trembling in fear of the unexpected over the next four weeks.

I awoke with the sun around 0530 went back to sleep and it was after 0800 when I finally got up. Our apartment had a balcony and I was able to go outside and see what we had not been able to see the night before. We were at the intersection of two dirt roads with the Nyamirambo road a block away. Surrounding us were a mixture of concrete one story buildings with corrugated tin roofs often with rocks on top to presumably keep them on, and some nice houses walled off from the street. It was Sunday and people were walking to church. To the west rose Mt. Kigali, the east the land dropped off into a valley and you could see large villas on the slopes across the valley. It was already getting hot.

After coffee and the pastries we had bought the night before we decided it was time to venture out. We had only the Bradt guide with its small maps but I figured we could probably find the hospital which we needed to find the next day and the tourist office. Armed with this we ventured out and turned right down the Nyamirambo road which I was lead to believe would lead us to the hospital and the central town.

Rwanda is known as the land of Mille Collines which means one thousand hills and Kigali is spread over many hills. This means that most of the roads tend to follow the contours of the landscape so a flat two dimensional map can be extremely misleading and two points which appear to be close together can be separated by a deep valley. In general it is not possible get between any two points in Kigali by travelling in a straight line. Because the roads curve it is very easy to lose your orientation. This is further exacerabated by the lack of street signs.

Public transport in Rwanda consists of Mutatus, garishly decorated minibuses crammed with passengers that travel predetermined routes and let people off wherever and motorcycle taxis which are cheap if you want to put your life at risk. There are car taxis which can be easily found in the tourist areas, less easily where we were living. These generally charge Westerners 5000 Rwf (about $9) no matter how short the trip.

We wanted to walk and so we set off down the Nyamirambo road. It was crowded with people walking in both directions. We stuck out like sore thumbs, our white skin and large hats shielding us from the sun. People were neither friendly or unfriendly. There was a large concrete drainage ditch along the side of the road that you had to be careful not to step into. Mutatus and motorcycle taxis raced along the road honking their horns. Alongside the road below road level were small shops and about every 50 metres was a small bar usually painted blue advertising Primus beer or another brand. The road sloped downwards at first until we reached the bottom of the hill where it proceeded upwards towards what we hoped would be the central town. We passed a large Mosque (Muslims in Rwanda, who knew?) and kept on going following the road which began to swing around the side of the hill which dropped off into a deep valley with houses all along the steep hillside. After some twists and turns we actually stumbled on the hospital but we were now hopelessly turned around and disoriented, our map had become more or less useless. More aimless wandering lead us to the Simba supermarket which we recognized from the night before. We stopped in the snack bar where we had watched soccer the night before and had a latte and a sausage roll on the terrace.

Pouring over our guidebook, we were now able to figure out where we were and found the Tourist Office and of course the Mille Collines Hotel, better known as the Hotel Rwanda from the movie. We also found the Union Trade Centre with the large Nakumat and the Bourbon Cafe which we patronized a lot. We also found the Serena Hotel where for $200 US you can use their pool and more importantly their showers for a month.

Mission accomplished we retraced our steps back the Nyamirambo road. It was now scorchingly hot and we had a long hill to climb back to our apartment. About a block from our abode, we decided to venture into one of the Blue painted bars for some rehydration. Inside we sat at resin chairs and a table like you might find on a patio and a waitress took our orders in my very bad French. Three large beers appeared which we drank gratefully before returning to our apartment.

One thing that had become apparent on our walk, was that while there were lots of bars in our neighbourhood, there was nothing we would recognize as a restaurant. This became more acute later that evening when we got hungry and decided to find somewhere to eat. Most of the restaurants in our guidebook were around the centre of town where we had been earlier that day. On our map was a restaurant called the Green Corner which a previous volunteer said they had heard was okay. It looked like it was an easy walk from our apartment. Therefore we ventured out into the night and turned left on the Nyamirambo road. According to our map we should have been able to reach the Green Corner by travelling due west but due west would have involved unlit dirt roads so we took the long way eventually arriving there with some relief.

The Green Corner was an outdoor bar and restaurant with some covered tables. A lady met us and I asked to see the menu in my bad French. There was no menu said the lady, we have chicken or fish. I made an executive decision that fish was safer and about an hour and several beers later some barbecued Tilapia arrived. It was one of the best meals we had. Just before the fish arrived a man came over with a kettle of warm water and some soap so we could wash our hands. As we learned, we were supposed to eat with our hands although when we asked for forks, they brought some. At the end of the meal the man with the kettle and the soap came over again.

We retraced our steps through the busy and crowded streets back to our apartment. We had survived our first day in Rwanda.

Monday, August 15, 2011

Cart Wars

While not as sexy as the anaesthetic machine, the pulse oximeter or any of the other toys we get to use, the humble anaesthetic cart is an essential player on the anaesthetic team. Basically the cart is where you store your drugs, syringes, needles, ETTs, LMAs etc etc. The surface is where you keep your induction drugs and your emergency drugs. You draw up your medication on the work surface and write your chart up there. Every couple of months, we get some patient with a superbug shows up in the OR, out goes our cart, replaced by what equipment and drugs we anticipate we might need, piled onto a Mayo stand or the machine top and we wish we had been more appreciative of our Friend the anaesthetic cart.

Boy do I need to get a life.

This is all prompted by our recent attempt to get new carts which has stirred up some memories and reminded me again of how and why healthcare is so expensive.

Our hospital is going through accreditation. This is my first as site leader although I have lived through many. Accreditation usually results in a rush of questionable "improvements" which if they were so important should have been done gradually over the last 3 years instead of being rushed into place in the last three weeks.

The carts in our OR are probably the best I have worked with. That is because they were actually custom made in the last millennium. They are a trifle large but have lots of storage space, are well organized and have a large work surface. Unfortunately they don't meet accreditation standards apparently. The problem is that we store our non-controlled drugs out in the open instead of in a drawer. (Our carts actually don't have drawers). Labour and delivery picked up on this first and modified (without asking us) our carts to put little trays in which the drugs could be stored out of sight and mind. Of course everybody on principle hated this if only because Labour and delivery did it and after about fifteen minutes of fruitless discussion at our staff meeting, in the most brilliant move of my administrative career I assigned the biggest loudmouth to design a better cart.

Fortunately someone had already done that. Our friends in the other large city in our province had in an exhausting process, which produced an article in the CJA, had come up with the optimum drug configuration in the cart. Down south went the loudmouth accompanied by two administrators to look at the wonder carts.

Consequently we decided to try out the anaesthetic carts designed by the wise men from the south. First we had to obtain a cart to try out. Our head anaesthetic tech who apparently can do this just picked one she liked in a catalogue and bought one directly from the company for about $2400. Our purchasing department however found out about this and lambasted her. "You should go thru us," they chided, "we can get you a better deal." This they did by going thru a medical supplies company instead of contacting the supplier directly. Cost: $4000.

The new cart arrived early this summer. One of the advantages of the cart is that the top drawer can be locked to keep your drugs safe. It unfortunately has an auto-lock function which means someone immediately auto-locked the keys inside the drawer. Nobody owned up and after a few phone calls, the company sent out a new set of keys and the new cart was back in action. Nobody likes it but I figure if everybody is equally unhappy, it must have something going for it.

The next problem is that the hospital doesn't have any money in its budget for the $44,000 it will cost to get the 11 more carts we need (how about out of the $800,000 I saved by turning down the anaesthetic machines we didn't need or want). And accreditation is coming up in October which means the administration which means me has to figure something out.

I lamented this morning in the coffee room that we could buy an automotive cart at Sears or Costco which would work just fine as an anaesthetic cart. The problem is that there is no way the hospital will spend $500 when it could (not)spend $4000. An OR supervisor at a small hospital near us did just that. She was sick of complaints about the old anaesthetic carts and the lack of money in the budget to buy a "real" cart. So she got her pick-up truck, headed down to Sears, picked up two carts for her two ORs, loaded them in the box of her truck, brought them to the OR, submitted the bill, got reimbursed and her hospital has new "anaesthetic" carts.

I am so jealous.

Wednesday, August 10, 2011

Counting Numbers

I couldn't sleep last night so instead of counting sheep, I counted all the numbers by which I am counted.

Firstly my social insurance number which I got when I was 16. The card is long since gone but I still remember the number. You got asked for it a lot back then, banks, universities etc. If you wrote a cheque they often wanted your SIN. In the 1970s the military used it as a service number(I had some friends in the military so I knew that), some provinces used it as your health care number and some universities (not mine) used it as your student number. People soon started objecting to having to give out their SIN and now the number is treated with strict reverence. I have often wondered what malicious information some hacker living in his parents basement could get by knowing my SIN that he couldn't just get by for example reading this blog or my facebook page.

Next was my student number. For 7 years I had to write this on applications, exams, essays, cheques at the bookstore etc. Consequently the number is burned in my brain. I actually had to give it out recently for some alumni thing and was amazed I could still rattle it off. The university of course also wanted your SIN so that they could send you your tax receipts.

When I became a doctor I was deluged with numbers. Firstly I have my provincial college number that I have to write on prescriptions now so I have it memorized although I recently got a rubber stamp to guard against early Alzheimer's. Very importantly I have a billing number which is 9 digits although as every doctor's number ends in 08 and there is a check number only 6 of them are used. I also have two business arrangement numbers both 9 digits. I also have a WCB billing number which is my old medicare billing number which is 5 digits and a letter. In addition every professional association I belong to gives me a number which I need to know to access their websites etc and the Medical Protective Association won't even answer the phone unless I have it handy. I also have my LMCC number and every province I ever worked in gave me a number.

A few years ago I read a news article in a medical journal where every doctor in Canada was going to be assigned a unique number. What a great idea, I thought. Unfortunately I read on and found out that this number was to be in addition to, not in place of all the other numbers. As an aside the registrar of the New Brunswick Medical Council wrote a very folksy apology for having to assign numbers in New Brunswick when they computerized.

Just about every patient I see has a healthcare number as do I. Our province has a 9 digit number although every number ends in 0 or 1 and there is a check digit for only 7 of numbers are being used. When I moved here the number was 11 digits but they managed to shed two of them. Every province has a different number. BC has 10 digits although every number begins with 9. Ontario likewise has 10 digits. Manitoba manages to get along with 6 digits. Newfoundland with its 500,000 population has 12 digits. Their number is unique as it can be generated by the patient's date of birth. Every military patient has a number which you usually have to chase down in order to get paid. WCB patients usually have at least one claim number and they also want the health care number and the SIN.

Our healthcare numbers are called ULIs which means Universal (or Unique I can't remember) Lifetime Indentifier. Just because a patient has a ULI, doesn't mean they have healthcare. To find out whether they do you can call a phone number.

When you check into hospital you are assigned a hospital number which is different from your ULI number. Just to things more complicated each hospital has a different numbering system. Because with regionalization, most patients will have visited more than one hospital patients will have several different hospital numbers. Private clinics of course have their own chart numbers.

To log on the province's shamefully inadequate EMR from outside the hospital I have to use a series of six numbers preceded by another 4 digit number specific to me. If I actually get through which is not a sure thing, I have to then enter my user name and another password (see below).

I also have 3 credit cards whose numbers I give out a lot on the Internet hopefully known only to me, the hacker living in his parent's basement and the guy who probably skimmed my cards yesterday. When I used to order a lot of pizza I actually had my credit card number memorized. I have two bank cards with incredibly long numbers which I have to type in, to log onto the online banking.

I have a number of phone numbers most of which I can't remember but fortunately I have them stored on my I-phone. For some reason I can still remember my parent's first phone number which was changed in 1972 to another when Victoria started running out of phone numbers for the 38 exchange. I also for some reason know my mother in law's old phone number but not her current one. Most other phone numbers I have had, I forget. I have had the same residential phone number for 19 years now. That is over one third of life. I also have a cell phone number and a voicemail number which I recently got.

Oh yes passport numbers. I wrote mine down so many times during my last trip to Africa where you couldn't check into a hotel without giving it that I finally memorized it. I have since forgotten it.

We are not even going to talk about the number of user names and passwords which many other people have vented on. These are at least easier to remember except that every site has different rules for user names and passwords and I have yet to find a combination that works for every site. Plus some of them make you change your password every few months. If you steal my I-phone you will get a reasonably up to date list of my user names and passwords.

All these numbers and I still didn't get to sleep last night.

Monday, August 8, 2011

Another aphorism

Just after my last post, I realized that there is another important aphorism that would improve medical care.

"Just because you can do something, doesn't mean you should."

Move over Hippocrates.

Sunday, August 7, 2011

Getting Away With It.

I often hear older surgeons rhapsodizing about their chief who apparently taught them everything they currently know. I can't really understand this because just about every academic chief of surgery I have known has been an idiot and I have worked in 4 different programs.

The only thing I learned from my chief was how to survive long periods of time without bathroom breaks or food.

And this:

My chief said:

The goal of anaesthesia is NOT to see what you can get away with.

What a great principle. Why not apply it to medicine. Post it on every ward and operating room

The goal of medicine (or surgery) is NOT to see what you can get away with.

Okay now I am really disgusted

Whilst grocery shopping yesterday, I was just turning the corner to go up the next aisle when the five letters spelling bacon caught my eye. Unfortunately the suffix "aisse" was attached to it.

Bacon is to men what chocolate is to women. It is a sacrament. Bacon belongs to breakfasts, hamburgers and sandwiches. Combining it with the evil despoiler of good sandwiches and salads is sacrilege.

Enough said.