18 November 2013

Tomorrow will be the 13th of July 2014, the third anniversary of Randy's death in the ICU at VGH.  The only thing I am able to do is think abut what happened when Dr. Dunne and the staff of GPC arranged to have Randy boxed.  I was able to save him then (November 18 2013) but after I got 100%$ banned from GPC I couldn't save him any more. Not even the police could help.  No one.  I am vomitoid with the horror of it all.

.

Death by Dehydration

 Death by dehydration is also happening in Canada.

 The Sad Fate of Casey Kasem: Death by Dehydration

by Bobby Schindler | Washington, DC | LifeNews.com | 6/12/14 5:21 PM

A Los Angeles Superior Court Judge reversed his own ruling, permitting Casey Kasem’s daughter, Kerri Kasem, to remove her father’s food and hydration (via feeding tube), which will result in his death by starvation and dehydration. Kasem’s wife of 33 years, Jean Kasem, is fighting for the life of her husband, with her attorney, Steve Haney, calling the judge’s decision, “the functional equivalent of a death sentence.”
Growing up in the 70’s, I was introduced to Casey Kasem’s easy to recognize voice as each week he counted down “American Top 40″ hits for almost four decades on a radio show heard around the world. Kasem was also the voice of the character Shaggy on “Scooby-Doo” cartoons for 40 years.
According to reports, Kasem is stricken with dementia and Parkinson’s; typically, treatable conditions. Once Kasem begins the process of dying by having his food and water removed, he will endure a death that no family member should ever have to witness. It is cruel and barbaric and could take days, and often weeks to play itself out, torturing not only the patient, but those who love him as well.In stark contrast, St. John Paul II who also had Parkinson’s, was afforded a feeding tube as part of his end of life care, and subsequently died naturally.
I watched my own sister, Terri Schiavo, anguish through almost two weeks without food or water and there are no words that can properly describe the inhumanity. In her last days, we would not permit our mother to visit Terri, in an effort to spare her additional torment, as blood pooled in Terri’s eyes, and her skin and lips were terribly cracked because her tissues were lacking any moisture. Terri’s body turned different colors of blue and yellow and her breathing became so rapid, it was as if she was outside sprinting. I could go on.
Indeed, the disagreement between Kasem’s family also raises the issue of the dangers of health care initiatives. It places the interpretations into the hands of “quality of life” minded family members, healthcare professionals, hospital boards and ethics committees, not to mention some Judges who have no regard for the dignity of human life.
Make no mistake about it, countless conscious and unconscious persons die by deliberate starvation and dehydration every year. Typically, we only hear of the cases in which there is a family disagreement or in cases where there is a celebrity involved. And with an accepting culture, laws that permit this behavior, and a government controlling our health care system under the guise of “compliance”, this scenario will become more common and the pre-mature death of our medically vulnerable loved ones will increase significantly.
We live in a very troubled and an increasingly dangerous America. Our culture has lost sight of God’s supreme right over when life begins and when it ends, and has “turned on its head” the true meaning and value of suffering and compassion.Those of us who wish to defend life in all stages, especially for the most vulnerable, are demonized when we ask the obvious question: where is the humanity in deliberately denying someone’s most basic rights – food and water? Tragically, what was once considered barbaric has now become part of everyday life.

Share this post:

The House of God

I just finished reading the classic novel of life and death in a American Hospital: The House of God, by Dr. Samuel Shem.  With over two million copies sold, The House of God, has been said to be the most important medical novels of the twentieth century. It was published in 1978.

It was written before DNRs and when doctors did everything to keep patients alive.  The most important reason for reading the book was I was looking for swear words used 40 years ago and they were all there.  These words are still being used now so they are not swear words; they are part of our everyday language.

The mindset of Vancouver Coastal Health is still in the 1950s.  All one has to do is go to an emergency room at VGH and listen to what patients and doctors are speaking.  So called swear words are used in everyday speak; they are nothing more than an expression in shorthand of fears/feelings/conclusions of patients.

SLURPERS: Doctors striving to lick their way up the academic medical cone towards the top.  (from House of God).  The reason why health professionals refuse to say anything negative publicly about their colleagues.

On Sunday July 13 2014 will be Randy's third month since he died at VGH.  I gave him a green burial.  It was a perfect funeral with good memories.  I laid bunches of carnations on his grave.  Carnations have a long life span (three weeks).  When I get some extra money, I will purchase the space next to him.  It is wonderful and peaceful under the trees among nature.    .

Randy's Stuff

I haven't been able to unpack Randy's belonging yet.  I just couldn't.  I was afraid that if any of his belongings were missing and I would become upset and I am tired of being upset.  GPC won't even let me on site to pick up his stuff.  A friend of my went there and she said that Randy's stuff was in garbage bags in a common area that anyone could rifle though.  I asked for an inventory but GPC refused to do one.  I know his memory foam pillow which I purchased for him went missing in December 2013 and his stand for his television was thrown out without notifying me.

I want to know why Karen Marshall, a security guard, put a choke hold on me when I was attempting to remove Randy lawfully from GPC: October 2013.  Paladin Security isn't suppose to touch anyone so why did she do this to me.  Practising her martial arts on an old lady.  I told the police I wanted her charged and the police did nothing. And there was Brad who stood at the entrance to the visitior's room when I was inside in a boxing stance with his fists up threatening to punch me if I attempted to leave the room.  Once you get labeled by VCH you are open season for abuse. Where do these people come from that encourage violence.




.

I am so sorry, Randy.

I am so so very sorry Randy that I did not fight hard enough to keep you safe.  How could they do this to us in our counrty at the hands of our most educated physicians in the world. Every single time you were at VCH or St. Pauls I begged them not to send you back to GPC as it was not safe, and they did it anyways.They won't even investigate  GPC was not his home; it was purgatory from where there was no escape. How could they have allowed this to happen. He was suppose to have gone to GF Strong but at the last minutes they decided that he was never going to be a productive member of society so he was sent to GPC. Them deferring to a head nurse.  This is what this terrible terrible injustice came down to Tanu and her control freak management.  She even scared staff so that they would report things the way they knew that Tanu wanted.. She even scared off visitors that came to see Randy..  And management also would collude and back her up as well.  Her bullying forced every manager of GPC to quit but like all successful bullies she is still there dictating that she was able to ban me one hundred percent from GPC from my Randy in life as well as death and she can continue and no one can stop her..I am still angry over the fact that I was not notified of Randy's memorial service at GPC.  I wonder who went,  You would never think that a health facility would treat people like they do but they do. 

I am sorry Randy.  I am so sorry.
.

Forgive but Do Not Forget

Forgive But Do Not Forget.  I do not know what this means.  I was told to do this but I do not understand it.  How can you forgive a bunch of professional health care providers that put Randy and me through hell for four years with their over cautiousness as if I would harm someone.  What about them, them that are guilty of culpable homicides like the Timer "accidental' death.  Them putting on Randy two Do No Transfer Orders when he was in need of acute care so that he would die if he needed care more than what George Pearson Centre could offer.  What legal right have doctors to do this.

On two occasions I found Randy needing acute care and him having a do not transfer order on him and then what happens I get banned from seeing Randy for ninety days with management saying it will be extended forever..  They wanted Randy to die without me being with him as I might call 911 again.  Ro Ang the manager of George Pearson Centre said that all patients have a DNT on them.  I was shocked and still am as on November 18 and December 26, 2013 staff refused to send Randy to VGH because of these orders.  I had to force a call to 911. If Randy didn't go to VGH, he would have died a not good death at GPC.

It has been nine months since I contacted the College of Physicians and Surgeons to do something.  I haven't heard anything from them.  If I am to follow the advice of forgive then the college must be assuming that I am forgiving Dr. Dunne for his culpability.

Because of what Dr. Dunne did and when previously we asked that Dr. Dunne be removed as Randy's physician: this never happened.  Something about policy.  Once you have a physician in residential care you can't have him removed. You are forced into a deadly alliance.  Randy knew Dr. Dunne wanted to kill him but he couldn't do anything about it and neither could I.

Read: LifeNews.com

.
.

Nurse Jennifer Timer and the death of her mother

Yesterday in the Vancouver Sun (front page) is a report by Pamela Fayerman after her talking to the daughter of Rosemarie Timer. Rosemarie fell while in hospital and died from a head injury which Jennifer thought could have been prevented.

Deaths from falls in hospitals happen often but no one takes the deaths seriously, especially the media. I am sure there should be a criminal charge of endangerment or homocide for this careless behaviour on part of hospital staff but I suspect it is not in the public interest to arrest those that are responsible. It would be against the public interest for us to know that there were 456 preventable deaths (BC Coroner) from falls last year 2013. The public might demand criminal charges or worse yet patients would refuse to be admitted to hospitals in the first instance.

I am surprised that the report was even published. It must have fallen through the cracks of the editorial staff at the Sun. When Randy Michael Walker died I had to have a court order to access him at his death in the ICU and the media didn't comment on that, nor anyone else. I also had complaints about his care. (The media reads all Supreme Court Orders.)


Again, if anyone wants a full version of my blog let me know and I will have Blog2Print print the contents and mail it to you. The Blog2Print paper book edition (its cost) is $50.00.

23 June 2014

I was hoping my grieving would be getter lesser but it hasn't. I see Randy wherever I go or not go. I did not know he was going to die. He has had pneumonia many times and he always recovered.

Yesterday I went to the Oakridge Senior's Senior for breakfast and at 10:30 NIDUS was scheduled to give a talk about representation agreements. The young women made it sound like it was some sort of answer to some sort of problem. I told the group of my experience with Randy's representation agreements and the failure of Vancouver Coastal Health to honour them.

I got upset when the girl said that representation agreements could ONLY be registered online for $25.00. I asked her could they be filed manually. No. Only by computer. I said that most of her target audience (us oldies) are uncomfortable with computers. And on top of it if you want to register a representation agreement a person would have to have a credit card for the $25.00 fee. I do not understand why there is a fee when the United Way is funding the project and its staff of three.

When I got home I had to face Misey who had a serious eye infection, the size of a golf ball. So with difficulty I had to arrange for a ride to the vet. $32.00 it cost for the eye drops. I had a hard time gettng Misey to walk home as she walks three hundred steps then sits down for a rest. Finally and slowly we got home and now she refuses to leave the apartment. She is on strike. I think she is afraid of being abandoned. Just like me having to abandon Randy because VCH deemed that was best for Randy. GPC bans people because they do not want anyone to see bedsores on patients which Randy had one when he died at VCH. GPC tried to hide it. Maybe he died of blood poisoning rather than pneumonia. I do not know and I still haven't got the autopsy yet. I hope that the pathologist wasn't too busy to recognize a wound the size of a toonie.

GPC:Hospital for special care.? Quality of Life okay for most.

New York Times June 23 2014

NEW BRITAIN, CONN. — Propped up in a hospital bed, a 75-year-old man with amyotrophic lateral sclerosis, or Lou Gehrig’s disease, must make an agonizing decision. Should he keep struggling until the illness inevitably kills him, dependent on a ventilator, unable to walk or eat or move? Or should he choose a day and a time to have the ventilator disconnected, and die?

The man, who asked not to be identified to protect his privacy, was a patient at the Hospital for Special Care here, one of 400 long-term acute care hospitals in the United States. These are no ordinary hospitals: Critically ill patients, sometimes unresponsive or in comas, may live here for months, even years, sustained by respirators and feeding tubes. Some, especially those recovering from accidents, eventually will leave. Others will be here for the rest of their lives.

These facilities often are tucked out of sight, and even many doctors do not know they exist. This one sits on the edge of a decaying industrial town.

“People don’t want to think about us,” said Dr. Paul Scalise, chief of medicine at the Hospital for Special Care. “I don’t want to think about us, either.”

But more experts and policy makers are likely to have to start thinking about them soon. The cost of long-term acute care is substantial, about $26 billion a year in the United States, and by one estimate the number of patients in these facilities has more than tripled in the past decade to 380,000.

There are two reasons, said Dr. Judith Nelson, a critical care specialist at Mount Sinai Hospital.

The population is aging, increasing the chances of a catastrophic illness like blood sepsis or acute respiratory distress syndrome that eventually may land patients in a hospital like this one. And doctors are getting better at keeping people alive when they are in intensive care. The result is an increase in the number of highly dependent patients who survive the intensive care unit but must remain on a respirator. They cannot go home or to a rehabilitation facility. Many are too sick even for a nursing home. Long-term acute care is “where you go when you survive but you don’t recover,” Dr. Nelson said.

And yet this Connecticut hospital is not a place of unrelieved misery. The campus is leafy and green, and the windows are wide and filled with sunlight. Paintings by residents and local artists decorate the walls. On nice days patients can visit a landscaped garden along a path of paving stones and lined with respirator hookups.

Dedicated doctors and staff tend cheerfully to patients who require nearly constant care, some of whom are managing to make lives for themselves. Recently two patients with muscular dystrophy, both in wheelchairs, married in the courtyard outside. The bride was given away by her weeping father.

“It’s remarkable,” said Dr. John Votto, the hospital’s chief executive. “You are on a ventilator, you can’t move, you can’t walk, you can’t breathe. You and I would say, ‘Oh my God, you must have this terrible quality of life.’ But they really don’t. Honestly, many are quite happy.”
Photo
Tammy Bohmer, a nurse, assisting Murray Zack with telephone conversation with his son. The outlook for patients usually isn’t hopeful, but the hospital is not a place of unrelieved misery. Credit Richard Gershon for The New York Times

Often they arrive here because ordinary hospitals do not want to keep them. Reimbursement is tied to diagnosis and treatment, but most of these patients no longer need a diagnosis; they need treatment and care. Most start out being covered by Medicare, but when that benefit runs out — at 150 days — long-term-care hospitals either discharge the patients anyway or Medicaid usually takes over.

Medicare, concerned about the high price of long-term acute care hospitals, is trying to trim reimbursements. Nearly half of the $7.3 billion cut from its budget by the Affordable Care Act came from reductions in payments to these facilities. Medicare officials argue that perhaps these patients could stay in regular hospitals or nursing homes instead, and say it’s unclear whether care is better in long-term acute care hospitals.

But nobody knows what “better” means for these patients, and that makes it difficult to assess how well these facilities are operating.

“We don’t know how to measure quality,” said Dr. Jeremy Kahn, associate professor of critical care, medicine and health policy in the University of Pittsburgh School of Medicine. “The current Medicare quality measures are borrowed from I.C.U.s. Whether they apply in long-term acute care hospitals is unknown.”

The Hospital for Special Care is unusual because 70 percent of its patients are on Medicaid. Yet just 30 percent were on Medicaid when they were admitted, Dr. Votto said. Even with government support, many families are financially devastated when a relative lands in one of these hospitals.

The facility may be several hours from a family’s home, so relatives end up staying away from their jobs, living in hotels to be near a parent, child or spouse. Some deplete their life savings. “It’s a tragedy, a real tragedy,” said Dr. Christopher Cox, a critical care specialist at Duke University School of Medicine. “A heartbreaking situation.”

The road to a long-term acute care hospital often starts in an I.C.U. somewhere else when a doctor suggests placing a tube in a patient’s throat so he or she can be hooked up to a ventilator. “Once that happens, your future is not bright, unless you are quite young,” Dr. Nelson said.
Photo
A ceiling tile above a patient’s bed at the hospital was replaced by a scenic image. Credit Richard Gershon for The New York Times

Deciding to have a tracheotomy should be a difficult decision for family members, she added. But, she said, “people misunderstand — they think it is a sign of hope.” Few doctors discuss the likely consequences or the alternatives.

“It could be that physicians are not confident in their prognosis and therefore don’t want to share it, or it could be that physicians do share it and families don’t want to hear it,” said Dr. Shannon Carson, a critical care specialist at the University of North Carolina School of Medicine, who has studied what families expect when a relative enters a long-term acute care hospital.

But the likeliest reason for the disconnect, he said, is that families are initially dealing with I.C.U. physicians who are focused simply on keeping the patient alive: “They are discussing how the patient is doing today, not how they will be doing in six months,” he said.
Continue reading the main story Continue reading the main story
Continue reading the main story

The result is predictable, experts say.

“People are not prepared,” Dr. Nelson said. “There is one intervention after another. Ventilator, feeding tube, permanent feeding tube, permanent intravenous access. ‘Should we treat this infection?’”

The initial optimism soon vanishes after the patient arrives at the long-term acute care hospital. Some patients and their families eventually must confront an extraordinarily difficult question: When is it time to stop the interventions?

In one of their studies, Dr. Nelson and her colleagues telephoned people six months after they entered long-term acute care hospitals, intending to give them a brief set of questions to assess their mental functioning. But, they found, almost no one they called could respond to the telephone.
Photo
Dr. Paul Scalise, left, of the Hospital for Special Care, with Joy Franklin, a patient, and staff members. “People don’t want to think about us,” he said. Credit Richard Gershon for The New York Times

Dr. Cox and his colleagues have found that about half of the patients who enter these facilities are dead within a year, and most of the rest are in custodial care. Just 10 percent to 15 percent return to an independent life.

At the Hospital for Special Care, 100 patients, including babies and children, are on ventilators. Seventy-five of them, Dr. Scalise said, “are on ventilators forever.” That’s why there are hookups in most of the hallways.

But while many of these patients may occupy a frightening middle ground between death and the lives they once knew, some do find happiness. The children, some abandoned by their parents, gurgle happily in the hands of volunteers careful not the disturb their respirator hoses. The couple who recently were married, Chris Plum, 38, and Margaret Lavigne, 43, share a room crowded with medical equipment, attended at all hours by determined aides. They kiss each other good night before being lifted into separate hospital beds.

“Everybody wants ‘the One,’ ” said Ms. Lavigne. “I did not expect to find him here, of all places.”

Other patients face tougher choices. The man with A.L.S. knows he will never eat again, that he will never walk again. He knows that the little muscle movement he has left will go. But it is not easy to pick a day and decide that is the day you will die.

Dr. Scalise visits the patient, who signs and mouths the words that he does not want to live like this any longer. But Dr. Scalise wants to be certain the man is sure. He asks a psychologist, a psychiatrist and another doctor to talk independently to the patient about what he wants to do.

Dr. Scalise, the nurse and the respiratory therapist are haunted by that first difficult conversation. “He does not want to live here, and he does not want to die,” Dr. Scalise said. “There is no training that deals with any of this.”

The man waits a week, speaking with the other doctors, thinking about how hard it would be to leave his family, including four children, two of whom were still in college. Then he asks the hospital staff to disconnect the ventilator.

On Wednesday, Feb. 27, at 8 p.m., the man’s nurses began giving him intravenous medications to deeply sedate him. The next morning, they turned off his ventilator. The man’s family was gathered at his bedside. Death followed in about 20 minutes.

“It was very hard to lose him,” his wife said. “I think it took a lot of courage.”

A version of this article appears in print on June 24, 2014, on page D1 of the New York edition with the headline: Where Recovery Is Rare.

Beware of the medical-industrial complex

Dr. Arnold Relman, Outspoken Medical Editor, Dies at 91

By DOUGLAS MARTINJUNE 21, 2014

Photo
Dr. Arnold S. Relman in 1979 at The New England Journal of Medicine. He led it for 23 years. Credit Associated Press

Dr. Arnold S. Relman, who abandoned the study of philosophy to rise to the top of the medical profession as a researcher, administrator and longtime editor of The New England Journal of Medicine, which became a platform for his early and influential attacks on the profit-driven health care system, died at his home in Cambridge, Mass., on Tuesday, his 91st birthday.

His wife, Dr. Marcia Angell, said the cause was melanoma.

Dr. Relman and Dr. Angell filled top editorial posts at the journal for almost a quarter-century, becoming “American medicine’s royal couple,” as the physician and journalist Abigail Zuger wrote in The New York Times in 2012.

The couple shared a George Polk Award, one of journalism’s highest prizes, for an article in 2002 in The New Republic that documented how drug companies invest far more in advertising and lobbying than in research and development.

His extended critique of the medical system was just one facet of a long and accomplished career. Dr. Relman was president of the American Federation for Clinical Research, the American Society of Clinical Investigation and the Association of American Physicians — the only person to hold all three positions. He taught and did research at Boston University, the University of Pennsylvania, Oxford and Harvard, where he was professor emeritus of medicine and social medicine.

Early in his career, he did pioneering research on kidney function.

He was also editor of The Journal of Clinical Investigation, a bible in its field, and he wrote hundreds of articles, for both professional journals and general-interest publications. Days before he died, Dr. Relman received the galleys of his final article, a review of a book on health care spending for The New York Review of Books, to which he was a frequent contributor.

In a provocative essay in the New England journal on Oct. 23, 1980, Dr. Relman, the editor in chief, issued the clarion call that would resound through his career, assailing the American health care system as caring more about making money than curing the sick. He called it a “new medical-industrial complex” — a deliberate analogy to President Dwight D. Eisenhower’s warning about a “military-industrial complex.”

His targets were not the old-line drug companies and medical-equipment suppliers, but rather a new generation of health care and medical services — profit-driven hospitals and nursing homes, diagnostic laboratories, home-care services, kidney dialysis centers and other businesses that made up a multibillion-dollar industry.

“The private health care industry is primarily interested in selling services that are profitable, but patients are interested only in services that they need,” he wrote. In an editorial, The Times said he had “raised a timely warning.”

In 2012, asked how his prediction had turned out, Dr. Relman said medical profiteering had become even worse than he could have imagined.

His prescription was a single taxpayer-supported insurance system, like Medicare, to replace hundreds of private, high-overhead insurance companies, which he called “parasites.” To control costs, he advocated that doctors be paid a salary rather than a fee for each service performed.
Continue reading the main story

Dr. Relman recognized that his recommendations for repairing the health care system might be politically impossible, but he insisted that it was imperative to keep trying. Though he said he was glad that the health care law signed by President Obama in 2010 enabled more people to get insurance, he saw the legislation as a partial reform at best.

The health care system, he said, was in need of a more aggressive solution to fundamental problems, which he had discussed, somewhat philosophically, in an interview with Technology Review in 1989.

“Many people think that doctors make their recommendations from a basis of scientific certainty, that the facts are very clear and there’s only one way to diagnose or treat an illness,” he told the review. “In reality, that’s not always the case. Many things are a matter of conjecture, tradition, convenience, habit. In this gray area, where the facts are not clear and one has to make certain assumptions, it is unfortunately very easy to do things primarily because they are economically attractive.”

Dr. Relman edited The New England Journal of Medicine from 1977 to 2000. Founded in 1812, it is the oldest continuously published medical journal in the world, reaching more than 600,000 readers a week.

When he took the journal’s helm, interest in health news was booming, and newspapers and magazines competed to be first in reporting new developments. One policy he instituted was to ask general-interest publications not to disclose a forthcoming article in advance, a request almost always honored, albeit sometimes grudgingly.

He also began requiring authors to disclose any financial arrangements that could affect their judgment in writing about the medical field, including consultancies and stock ownership.

Dr. Relman and Dr. Angell met when she was a third-year student in one of his classes at Harvard Medical School. They published a paper on kidney disease together in The New England Journal of Medicine, then did not see each other for years.

After he became the journal’s editor, he asked her to come on board as an editor, which she did, abandoning her career as a pathologist. They began living together in 1994 — both were divorced by then — and married in 2009.

They became the ultimate medical power couple, not least because they were gatekeepers for one of the world’s most prestigious medical journals. Their outspoken views further distinguished them.

“Some have dismissed the pair as medical Don Quixotes, comically deluded figures tilting at benign features of the landscape,” Dr. Zuger wrote in The Times. “Others consider them first responders in what has become a battle for the soul of American medicine.”

Arnold Seymour Relman was born on June 17, 1923, in Queens (in an elevator, according to Dr. Angell) and grew up in the Far Rockaway neighborhood. His father was a businessman and avid reader who inspired his son’s love of philosophy. His mother nicknamed him Buddy, and friends called him Bud the rest of his life.
Continue reading the main story Continue reading the main story
Continue reading the main story

He skipped grades in school and graduated at 19 from Cornell with a degree in philosophy, but he chose not to pursue the field because it “seemed sort of too arcane,” his wife said. He earned a medical degree from the Columbia University College of Physicians and Surgeons at 22. His first marriage was to Harriet M. Vitkin.

In addition to Dr. Angell, he is survived by his sons, David and John, and a daughter, Margaret R. Batten, all from his first marriage; his stepdaughters, Dr. Lara Goitein and Elizabeth Goitein; six granddaughters; and four stepgrandsons.

Last June, Dr. Relman fell down a flight of stairs and cracked his skull, broke three vertebrae in his neck and broke more bones in his face. When he reached the emergency room, surgeons cut his neck to connect a breathing tube. His heart stopped three times.

“Technically, I died,” he told The Boston Globe.

He went on to write an article about his experience for The New York Review of Books, offering the unusual perspective of both a patient and a doctor.

“It’s both good and bad to be a doctor and to be old and sick,” he told The Globe.

“You learn to make the most of it,” he added. “Schopenhauer, the German philosopher, said life is slow death. Doctors learn to accept that as part of life. Although we consider death to be our enemy, it’s something we know very well, and that we deal with all the time, and we know that we are no different. My body is just another body.”

A version of this article appears in print on June 22, 2014, on page A23 of the New York edition with the headline: Dr. Arnold Relman, 91, Outspoken Medical Editor, Dies. Order Reprints|Today's Paper|Subscribe

Purgatory

Randy was first scheduled in 2010 to go to GF Strong for rehab but instead at the last minute he was sent to live at George Pearson Centre in purgatory. Why was the direction of his treatment changed?

Coerced Sterilization in Virginia

From: Bioedge June 2014

A petty criminal sentenced to become sterile. Commentary from Bioedge:

Perhaps Ms White lacks a sense of history, or she would have sensed the irony of compulsory sterilization in Virginia. In 2002, the 75th anniversary of a notorious Supreme Court decision, Buck v. Bell, Virginia Governor Mark Warner publicly apologized for the state’s past involvement in eugenics. He said, "The eugenics movement was a shameful effort in which state government never should have been involved."

Carrie Buck was a young woman whom the commonwealth of Virginia wanted to sterilise because she came from bad stock. The case went all the way to the US Supreme Court, which ruled, in an 8-1 decision, against Ms Buck. The majority ruling was written in 1927 by the legendary Oliver Wendell Holmes Jr, whose imperishable argument was:

“It is better for all the world, if instead of waiting to execute degenerate offspring for crime, or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind. The principle that sustains compulsory vaccination is broad enough to cover cutting the Fallopian tubes. Three generations of imbeciles are enough. "

After nearly a century, perhaps the commonwealth of Virginia has come full circle in its attitude toward eugenics. Except that now, two generations seem to be enough.
.

Blog2Print

As it is difficult to read and put in context my blog posts, I can print copies of my posts in paper form (soft cover book). This professional service is provided by Blog2Print. The cost is $50.00, so if you want a printout, just send me a cheque or money order. My Blog2Print book is easier and thus more interesting to read and refer to. The cost of the Blog2Print book is its cost and I will send you a photocopy of the Blog2Print invoice. .

13 June 2014 Two Month Anniversary

Today is the two month anniversary of Randy's death. I am in terrible grief. It isn't because he died but rather the way he died. Vancouver Coastal Health treated us like we were less than human.

Only the sociopaths knew what was good for Randy and I. No one showed any compassion for his death; no one even went to his memorial service at George Pearson Centre. His home. I wasn't even invited as if I was a what I do not know.

All I see from the nursing staff from GPC and also VGH is indifference; not a kind word; or even a small tear. Nothing.

If I didn't have a BC supreme court order to be with Randy should he be in intensive care, VCH would have got away with its threat of me never being with him at his bedside when he died. Thank you Linda Rose.

I still do not know what he died from. I asked for an autopsy but it never came. Why did they keep fighting: Roberts and Dunne about where Randy should go. Roberts did not want him at VGH as his care was too costly and neither did Dunne want him at GPC as GPC did not have personnel to properly look after Randy. Since he would never get well I suspect they put a futile order on him and let him die. VCH does not have a policy re futile, a doctor just decides and that is it.

Forget about a doctor talking to a family, he will only talk to a family if he knows the family will agree with him. Randy was in no pain, he just wanted to live.

And to make it worse most of this had nothing to do with Randy but everything to do with me and my behavior as defined by a star chamber The star chamber was first defined to me as the team of doctors and techs who looked after Randy however when I asked the team one by one over the years if they were aware of my banning all of them negated except for Tanu, Marion, and Bob Chapman. I believed that no majority would have denied me access. And the majority of the team didn't as they did not know what was going on. And of course the residents and visitors knew nothing of the banning as well. VCH are so used to banning visitors and they never coming back and there is no effective way of complaining as the complainer is always at fault. The cause for the banning is never made public. The person just goes away. I remember asking what did I do wrong and I was told you knew what you did. No, I do not know what I did to cause Randy such psychological pain.

GPC has so much control over its residents that GPC reads every single piece of mail as well as every single email that goes in and out of GPC. As for cameras they are all over the place except viewing the resident in his bed so that any wrongdoing done by the nurses are not recorded. And nurses report everything you say to management. And VGH has "baby monitors" so they can hear everything that is going on and they might even be recording everything.

I am so sorry Randy. I should have fought harder for you. You trusted me and I failed you.

.

Grieving and Euthanasia

Monday, June 9, 2014 Euthanasia threatens the lives of the grieving. My son Frank died in a car accident in 1997. He was 19. He was my oldest child, my only son (I have 3 daughters). In the first year after his death, I wanted to die. I wanted the agony and pain I was feeling to end. Death seemed to be the only way. Yet, I did not REALLY want to die. I wanted the PAIN to die. The second year after his death was even worse. It was not until the third year that I started to heal. I became involved in Bereaved Families of Ontario in Kingston Ontario, and I soon realized that almost all mother's feel the same way. I met a mom - both of her daughters were killed on the same day in a car accident (they were 19 and 16) and she had no other children. We hear stories similar to this often on the news. This pain of the bereaved parent is felt physically, emotionally and spiritually. Some parents build shrines in their homes for their lost child, and never really heal. Some are mad at God. I felt torn apart, physically. I hurt all over. It was as if my body was rebelling against Frank's death. Emotionally I was a mess. It doesn't matter if you have other children when one of them dies. Sometimes, the other children suffer more because at a time when they need you the most, you are least available to them. I can see the problem of euthanasia extending its deathly grip on the bereaved. What about the widows and widowers who can't bear to live without their spouse? We need our governments to put more money into programs to help the bereaved before this is another group targeted by the euthanasia movement. Bill 52 which was just passed in Quebec frightens me. Sincerely, Caroline Yates Kingston, Ontario Posted by Alex Schadenberg at 4:44 PM

A neighbour

I just spoke to a man who told me a story about his mother-in-law who was diagnosed with an enlarged heart and was dying. It was in the days when family members could decide would is best for their members and he quickly took her out of the hospital to her home where she continued to live for one year more. Another friend of mine took her grandmother out of the hospital who also had a serious heart condition and she lived three more years. So how many stories like this are out there.

Engagement

I just discovered a Carlton card addressed to me by Randy: it says Love. Everthing beautiful begins with love. May the two of us be more in love with ever passing day. and may everthing that makes you happy always come our way. We are engaged. He gave me a ring three sizes too large and he said he would desize it. I do not know what happened to the ring but I am sure I will eventually find it. It had a wide gold band and a little diamond on it. He and his friend picked it out for me. They were so delighted in their purchase. The card is one memory I can keep.

Post from December 2 2012

So what happened a year later ... why did staff at GPC attack me and cause a total banning of me at GPC and get the Public Trustee involved. The Ethics Committee did nothing. Randy got sick after December 23 2012 and spent Christmas at St. Pauls....GPC then started to ration his treatment and kept labelling him DNR even after Randy's lawyer said he wanted FULL CODE. Sunday, December 2, 2012 Things are a bit better at GPC.... Things are getting a bit better for me with Randy now that I am allowed to enter Ward 2 and stay with Randy for one-half hour sometimes it is extended to one hour. If he doesn't feel up to getting up I make sure he is comfortable, we chat a bit, and I make sure his television is on. I do not have to take my valium any more as I access George Pearson Centre without anticipation of the stress of waiting and waiting and waiting for staff to bring Randy to the visitor's room. I was so intiminated that I could not speak to anyone for the fear that I would then be subject to a report that I was combative and agressive. Now still under security of course I can go down to his open ward bed and if he wants to go to my place or to Oakridge for a few hours, I help him get dressed and we are off. I recently purchased him a $80,.00 rain cape that engulfs him while he is in his wheel chair outside. He also wears a Steelers hat. I purchased him a Steelers jacket for his birthday on December 10 2012 which I know will make him happy. He is a devote Steelers fan. The same is when I return. I call 4777 Paladin Security on my arrival. They immediatley escort me down to his bed and watch me and I spend a few minutes sometimes a 1/2 hour to make sure Randy is comfortable. There is no problem; no residents are shrieking that they are afraid of me. I am not even noticed by the other residents. Randy of course is more relaxed as he knows that I am looking after him at his bedside. Finally I am somewhat comfortable with this arrangement but of course I would prefer 24/7 access to him like other family members have to their loved ones. I am hoping to access the ethics committee for a ruling to say a two year ban based on staff and visitors who have nothing else to do but target a 70 year old lady and bully her until she had a verbal outburst with staff over giving a stuff toy to a resident is unreasonable. The LPN grabbed it out of my hand and he told me the resident did not need it and ripped it from my hands.He did not ask the resident and the resident to my mind was disturbed by his behavior. Since he could not talk I had to defend my kindness. It was a large stuffed toy. And after two years the LPN is till working there making decisions for residents. The Santa Clause stuffed toy remained for months in the nurses station. I suspect only to annoy me.

I am so sorry.

Randy, I am so sorry that I didn't try hard enough to save you. I am so very sorry. I could have save you for a few more months or maybe a year I do not know but VCH forcing me from your treatment and not seeing you and not being able to talk to staff I did not know what they were doing to you to keep you alive as long as possible. This afternoon a friend of Randy's took me to Canada Tire to purchase plastic buckets so I can store all my/Randy's possessions. Rearranging everything and repacking everything should take me a few days. I just can't throw any of Randy's belongings out yet. it is too soon. I hope all those that were party to what happen on October 22 2013, November 18, 2013, December 26, 32103, and the first week of April 13 2014 and January 29 2014 are feeling remorse for what they did. All of them should be investigated and moved to no human contact duty. .

My Randy

I do not think I will ever be free of Randy. I woke up in a cold sweat racing to the phone as I knew Randy was trying to call me. Of course no one was there as how could there be as Randy was dead. Today, another day lost in tears and guilt for not trying hard enough to save him.

Battery isn't confined to George Pearson Centre

Much like what happened to me at George Pearson Centre on 22 October 2013 The police refused to charge the staff for battery and imprisonment. And staff said it was my fault (GPC assaulted me and imprisoned both Randy and I) and I got banned. Every health care worker including management every six month should have to take psych tests to make sure that they are still suitable for their work. Also hospitals should all have video cameras everywhere and let the patient or family member decide if he wants privacy or not and not the union. When you work you have no privacy, you have exchanged your person for an hourly wage.

Staff at Forensic Psychiatric Hospital in Port Coquitlam accused of abuse

Vancouver, BC, Canada / (CKNW AM) AM980

Janet Brown

May 29, 2014 06:47 pm

Charges of battery have been leveled against more than  a dozen staff at the Forensic Psychiatric Hospital in Port Coquitlam.
Last summer, a disabled patient at the hospital witnessed another patient become violently ill in the open area of the facility.
According to documents filed in BC Supreme Court, the man was calling out for help for the ill patient, but when it didn’t appear to be coming, he became increasingly agitated and demanding.
In response, the documents say as many as 16 male staff at the hospital emerged and took the disabled man to the ground after shackling him.
The injuries are said to be many.
His lawyer says it amounts to “gratuitous violence and deviates from community standards.”
He’s suing for damages.

Saving $hospitalization

 Hosptial EMR are doing this now: encourage death for those who are chronic wtih disabilities and then insulting the disabled by saying that death is their decison..Do we have a hidden bonus $system in BC for hospitals and physicians who do this.

NDY Challenges NYS Medicaid Proposal to Save Money By Steering People to Choose Death Over Living With Disability

Posted: 28 May 2014 03:01 PM PDT

Not Dead Yet, the Center for Disability Rights, and 11 other NY based disability organizations, submitted public comments on the New York State Medicaid Delivery System Reform Incentive Payment Program (DSRIP) on May 28, 2014, alleging that one of the proposed projects would fund Medicaid providers to save money by steering people to choose death over living with disability.  NY is offering grants to Medicaid “safety net” providers with a high proportion of Medicaid patients to reduce unnecessary hospitalizations, and encouraging applicants to implement three possible palliative care projects along with other projects on various aspects of healthcare.
One of the three palliative care projects is entitled “Conversation Ready,” and promotes advance care planning as a means of reducing “unnecessary” hospitalizations.  For this to be effective, people on Medicaid would apparently be encouraged to refuse life-sustaining treatment as part of their advance care plan.
A recent Pew Research study found that:

. . . [A]bout two-thirds of whites (65%) say they would want to be allowed to die if they had an incurable disease and were suffering a great deal of pain, compared with 26% who say they would ask their doctors to do everything possible to save their lives in such circumstances. By contrast, a majority of blacks (61%) and about half of Hispanics (55%) say they would tell their doctors to do everything possible to save their lives if they had an incurable disease and were suffering a great deal of pain.  [Views on End-of-Life Medical Treatments, November 21, 2013]

The “Conversation Ready” project is focused on safety net providers and includes the following requirement:
Identify care coordinators to work with community based and faith based partners to facilitate End of Life planning in a socially/belief system compatible manner to increase patients (sic) acceptance of program. [Pg. 57, DSRIP Toolkit]
Giving provider networks financial rewards for being successful in this effort allows them to reduce hospitalizations and healthcare costs by encouraging individuals to “choose” death over treatment. The method by which the “Conversation Ready” Project proposes to influence people are set forth in The Conversation Project, a website listed on page 57 of the state toolkit for grant applicants.
The Conversation Project makes it clear that the fear of living with a disability is what drives the seemingly innocuous decision-making process designed to steer people away from receiving care.
The website, found at www.conversationproject.org, reads in part:

You’ll see that this isn’t really about dying—it’s about figuring out how you want to live, till the very end.

“What matters to me is _____.”

Think about the things that are most important to you. What do you value most? What can you not imagine living without?

Understandably, individuals do not want to lose their abilities due to an accident, illness, or age.  Yet disability is a natural part of the human experience and people adapt.  It is unacceptable that a government program will encourage people to choose death over disability to prevent “unnecessary” hospitalization and save money.
The Conversation Project goes even further in specifically eliciting fears of long term disability and translating them into decisions to forego live-saving treatment:

What to talk about:

Are there circumstances that you would consider worse than death? (Long-term need of a breathing machine or feeding tube, not being able to recognize your loved ones)

What kinds of aggressive treatment would you want (or not want)? (Resuscitation if your heart stops, breathing machine, feeding tube)

When would it be okay to shift from a focus on curative care to a focus on comfort care alone?

There is no indication that the need for such interventions could be either short term or permanent. There is no information on the tens of thousands of disabled individuals who are currently living a fulfilling life while permanently using these devices.
The role of the healthcare professional should be to provide thorough information and support that assists people to adapt to disability. The medical community should never leverage common societal prejudices against disability to persuade people to forego healthcare in order to save money.
The Conversation Project website also holds out the prospect of life in a nursing facility as the only choice a disabled person might have if they become too disabled.  But what about Olmstead and the New York adopted Community First Choice Option that establish the right to home and community based services under Medicaid?  The state should never promote death through refusal of healthcare, rather than home and community based services, as the alternative to institutional placement.
Our conclusion and final recommendation was that the “Conversation Ready” Project must be removed from the Toolkit of projects applicants could select due to the: a) transparent effort to steer safety net community members to sign advance directives that decline lifesaving healthcare and b) extreme bias against people living with disabilities.
On the other hand, we supported the other two palliative care projects and made three recommendations to strengthen those programs:

• Ensure the provision of information and services relating to the Olmstead decision, Money Follows the Person, and the Community First Choice Option to patients and their families.
• Ensure the provision of independent living information and services to patients and their families.
• Require the proposed “quality committees” to include representatives from disability and aging advocacy organizations.

The full comment letter is posted on the NDY website under “Public Policy” activities.
The Conversation Project provides an example of how common fears and prejudices about life with disability are used to steer people to decline healthcare and choose death, but it’s far from the only example.  Those who push these ideas and approaches are usually well meaning, but are ill informed about disability in all the typical ways.  Nevertheless, when New York Medicaid officials openly link this objectionable practice to saving money, we can’t be silent.  In fact, more disability advocates are needed to challenge this anti-disability approach to advance care planning across the country.  We’ve been excluded from “the conversation” for far too long.
P.S.  Thanks to the NY disability organizations that joined in these comments:  Center for Disability Rights, New York Association on Independent Living, Center for Independence of the Disabled, New York,  Westchester Disabled On the Move Inc., Southern Tier Independence Center, Independent Living Center of the Hudson Valley, Independent Living, Inc., Rockland Independent Living Center, AIM Independent Living Center, SKIP of New York, Inc., Harlem Independent Living Center, and Community Service Center of Greater Williamsburg.