Ruminations

Blog dedicated primarily to randomly selected news items; comments reflecting personal perceptions

Sunday, May 31, 2015

The Ethics and Practicalities of Preemie Survival

"They told me every absolute horror story in the book. They told me that he wouldn't survive, and if he did by some miracle survive, he would have no quality of life ... and most likely be a burden on me."
"He lights up my whole entire life. It's incredible."
"I am so happy. I am so proud of him and everything he has done."
Jennifer Lake, London, Ontario
Tyler Anderson /  National Post
Today, despite some disabilities, Carter Lake is a happy six-year-old preparing to enter Grade 1.   Tyler Anderson / National Post

"We have to get our hands dirty, and not just lie to people to keep it simple."
"Doctors don't actually say, 'We don't think it's worth ...' They say, 'it doesn't work', and 'That's a lie. It's not true ...' When you realize you have been lied to by doctors, it's extremely hurtful."
Dr. Annie Janvier, neonatologist, St.Justine Hospital, Montreal

"You can imagine a family caring for a severely handicapped child, they certainly cannot express in a negative way the fact they have to care for their child. But there is still a struggle, there are consequences on brothers and sisters, on the parents themselves."
Dr. Thierry Lacaze, neonatologist, Children's Hospital of Eastern Ontario

"It's a kind of red flag. Maybe we shouldn't go here, maybe this is pushing our scientific, technical abilities beyond a point where they are of benefit to families and society and, most of all, the tiny babies."
"Some of the time I had to struggle to suppress the thought 'How unlucky for these families that their child was born with access to an NICU [neonatal intensive care unit]. Wouldn't they have been more fortunate if they had been living in a remote area ... where the baby would have died instead of being put through days and weeks of intensive, high-tech medicine, with virtually no chance of surviving, or surviving without overwhelming impairments."
Arthur Schafer, head, Centre for Professional & Applied Ethics, University of Manitoba
As in most areas of medical treatment and bioscience there is never full agreement. There will always be some opinions based on personal experience, study and perception of any issue where disagreement relating to therapies and outcomes, purpose and practicality intersect whose result is a minefield of doubt for those affected, having to make decisions based on winnowing out what appears most reasonable to their untutored minds, given the advice they are exposed to.

And what could be more polarizing than making life-and-death decisions based in conflicting advice, frightening and intimidating, whose outcome in retrospect may have been directed toward what would later be considered to be a wrong decision leading to anguish and misery?

Handout
Carter Lake in London's St. Joseph's Hospital after being born at just 22 weeks' gestation. Doctors had said they wouldn't keep him alive if delivered before 24 weeks, but he ended up in the ICU after being born unexpectedly at home and rushed to hospital. Handout

When Jennifer Lake spontaneously gave birth to a 22-week-old baby at home, she knew beforehand that doctors would allow the baby to die if it was delivered under 24 weeks' gestation. Doctors had informed her that resuscitation and life support were considered futile. But her baby was rushed to hospital by ambulance and staff there absorbed him into the intensive care unit. Even though doctors and nurses at St. Joseph's Hospital in London, Ontario recommended he be taken off life support.

At the conference this past week of the Canadian Bioethics Society, attendees heard from a variety of people with various views on the Canadian Paediatric Society's recommendation that babies born at 22 weeks or less be allowed to die naturally. Some doctors and ethicists feel that individual babies' gestational ages differ so that the cut-off at 22 weeks represents an arbitrary threshold, where flexibility and open communication might serve a better purpose.

Dr. Thierry Lacaze, head of the Canadian Bioethics Society fetus and newborn committee agreed that basing life-and-death determinations on the standard convention of gestational age is imperfect. He made a vow that the guideline is in line for an alteration post-consultation among health-care professionals and the parents of these vulnerable preemies. But he spoke also of small local hospitals whose doctors haven't the expertise to make such decisions even though they are exposed to care for 20 to 30 percent of preemies.

Still, insists Arthur Schafer from his academic perch, reliance on the tradition of gestational age in judging the viability of a preemie provides a yardstick for those without experience to rely upon, as they grapple with these decisions affecting parents of babies who may if they survive have multiple quality-of-life-affected physical abnormalities. Often such decisions whether or not to allow a struggling baby to live or die must be made in the delivery room.

Babies born partway through normal gestation are unable to live for much longer than a few hours on their own. Their lungs are not fully formed so they must be dependent on an artificial breathing machine and they require tube feeding as they are incapable of feeding normally. They face a high risk of disabilities such as blindness and deafness, and cerebral palsy and cognitive impairment. The Canadian Paediatric Society recommends palliative care "since survival is uncommon".

For neonatal births of 23 to 25 weeks counselling and discussion with parents relating to decisions on intensive care is suggested. But what might seem to be standard policy is not actually that, differing from region to region, hospital to hospital. And to make for even more confusion, a new American study published in the New England Journal of Medicine found that 23 percent of 22-week-babies survived under active treatment, and nine percent survived with little impairment.

By the time very premature babies have reached their teenage and adult years most personally consider their quality of life, despite any disabilities, to be equal to that of others without their birth background, according to research findings by McMaster University neonatologist Saroj Saigal. As for Carter Lake, now six and prepared to enter grade one, he is intelligent, speaks well and is a happy boy, despite that he relies on a wheelchair and suffers from vision problems in one eye.

Tyler Anderson /  National Post
Tyler Anderson / National Post    Jennifer Lake and her six-year-old son Carter pose for a portrait at their home in London, Ontario, Thursday May 28, 2015.

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Saturday, May 30, 2015

A New Era Dawns in Afghanistan

"I don't do politics. [I am] a counsellor ... a listening post."
"I seem to have answered a need that was there. I think previous first ladies were not accessible. And I am accessible."
"What I've said from the beginning is that I am going to try to help all the vulnerable populations in Afghanistan -- and to a certain extent that's the majority of Afghanistan."
"One of my roles is to tell the world that they are very strong women [Afghan women] indeed, living in very challenging conditions, showing a lot of resilience, a lot of resourcefulness, and that they need to be recognized for that, not for their weakness, their alleged weakness."
"The whole fight to reduce violence against women is within the fight of reducing (all) violence, period. It is within the process of trying to bring back peace to this country."
Rula Ghani, Afghan First Lady
Afghan presidential candidate Ashraf Ghani Ahmadzai, right and his wife Rula Ghani, left, attend a campaign rally for women on the occasion of the International Women's Day in Kabul, Afghanistan, Wednesday, March, 9, 2014. Ten Afghan presidential candidates are campaigning in the presidential election scheduled for April. (AP Photo/Massoud Hossaini)

The wife of President Ashraf Ghani is not presenting herself within her country as would a typical Afghan woman, a quiet, unseen and unnecessarily modest woman never to be seen in public. Her husband, President Ghani  took the unusual step of introducing his wife to the public, both internal and external, during his inaugural speech eight months ago. Since then Rula Ghani has attended public events beside her husband.

Although she steers clear of politics, leaving that to her husband, a man whom Afghans in a spirit of hope and renewal elected in a free democratic vote despite threats from the Taliban and grumbles from the Islamist orthodox, she speaks before audiences on topics relating to current issues. She also listens, carefully, to what people have to say. She receives them in a meeting room, enabling ordinary Afghans to air their grievances and problems, seeking her advice.

Her predecessor, wife of Hamid Karzai, was spoken of as the "invisible first lady". Not that invisibility of 'first ladies' of Islamic presidents is unusual. Zinat Quraishi Karzai once spoke her belief in a rare interview that the time had not yet arrived in Afghanistan when its people were prepared to accept the presence of a first lady alongside her presidential husband.

Afghanistan's first lady Rula Ghani breaks taboos
In this Monday, May 25 photo, Afghan first lady Rula Ghani speaks during an interview with The Associated Press at the presidential palace in Kabul. (AP)

Political antagonists of her husband's presidency claimed that neither Rula Ghani nor her children were Afghan or Muslim and as such unacceptable to the people of Afghanistan. She had been quoted as expressing her approval of France's ban on the burqa or the niqab in public. That occasioned a ferocious backlash from both conservative Islamists and religious figures in the country.

Lebanese by birth, but Afghan by ethnic heritage, she speaks fluent English, French, Arabic and Dari. She was brought up in a Christian family, meeting her future husband at a university in Beirut. Upon marriage, they moved to the United States and lived there for 30 years where she studied journalism at Columbia University and had two children. Their daughter is an artist in Brooklyn, their son an economist living in the U.S.

They are Afghans, but they are also cosmopolitan in their nature, experience and outlook, a combination that the backward country badly needs to help in the process of  bringing it into the 21st Century. In the aftermath of 30 years of war, the society that was primitive in many ways had also become brutalized. And in such societies women are the most vulnerable among the population.

The "horrible, barbaric tragedy" of Farkhunda, a young Islamic scholar who was beaten to death at a Kabul shrine by a mob of men after being accused of burning a Koran, horrified her. Four defendants were sentenced to death and eight of them to 16 years in prison over that atrocity. Eleven police were charged with dereliction of duty for not intervening to prevent the death of the young woman, their sentence one year in jail.


Afghan protesters demand justice for Farkhunda
Afghan protesters demand justice for Farkhunda, the woman beaten to death by a mob in Kabul in March. Photograph: Hedayatullah Amid/EPA
The case, said Rula Ghani has "shaken the nation". Its barbarism, and the fact that among the crowd of hundreds of men no one intervened to stop the mutilation and murder of a defenceless young woman on a rumour of having defiled the Islamic holy book "really opened up the eyes of people ... we don't want to live in a society in which violence is the rule", she said in her calm way.

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Friday, May 29, 2015

Proto Human Emotions

"Murder is an ancient feature of humanity."
"Other humans went to the top of this vertical shaft and deposited dead members of their social group down into the site, and in this way formed a kind of primitive cemetery or kind of an early manifestation of funerary practices."
"Clearly this is an intentional human disposal of the dead."
Rolf Quam, Binghamton University, New York

"Unfortunately, the intentions do not fossilize, so it is impossible to interpret the motivation of the killing."
"Not even Sherlock Holmes could help us in that."
Nohemi Sala, Archaeological study, lead author
Photo of skull 17.
An early Neanderthal skull uncovered from the Sima de los Huesos cave. Seventeen skulls have been discovered there. Photograph by Javier Trueba, Madrid Scientific Films

Proto human communities existed almost half a million years ago, according to archaeological paleontologists. A study published in the journal PLOS One reveals that scientists have hypothesized the reason for the presence of one fractured skull among at least 28 others whose skulls have been found intact. The remains of early proto human species , lying in a mass grave known as the Pit of Bones have brought a mystery to scientists who have deciphered that mystery as a murder.

The Pit of Bones or as it is called, the Sima de los Heusos pit, since it is located in Spain, is a deep depression over fourteen meters below a surface shaft. Under which a layer of dirt exists and it is replete with cave bear bones. But the pit also contains a collection of human fossils, In fact, 6,500 bones representing 28 individual bodies' skeletal structures of ancient remains have been discovered through excavating the pit since 1976.


Fragments of one fractured skull found alongside the remains of 27 others northern Spain have been interpreted through reconstruction as having resulted from a primitive murder. The violence done to the skull has convinced the examining scientists that the holes in the forehead of this skull represent a deliberate murder, given the shape, size and location of the holes. A face-to-face conflict, they theorize, was responsible for the head-on trauma leading to immediate death.

That the fractures indicate no signs that healing took place before death indicates to the scientists that death occurred immediately; no healing process of recovery from the injuries sustained took place. Judging from the location and the size of the holes scientists theorize a single instrument was used to strike the victim twice, in a face-to-face conflict that represented a deadly, frontal attack.

The bone pit remains are not those of modern humans, but members of Homo heidelbergensis, who were the first to live in colder climates, and routinely hunted large animals, and were able to alter their environment by building shelters. The existence of the Pit of Bones also suggests that they cared for their dead. The 28 skeletons discovered in the pit appear to indicate their placement was intentional.

Photo of skull 17.
Paleontologists unearth fossils at the Spanish cave site. Photograph by Javier Trueba, Madrid Scientific Films

The pit, on the evidence, represents the oldest evidence of ritual burial. Leaving the impression that those early humans mourned the death of those they cared for. An emotion of sorrow that lies deep in the emotional psyche of present-day humans representing the attachments of love and concern. Emotions that are generally shared by all humans, along with the emotions of hatred, suspicion and rage leading to violence.

What was once representative of an emerging species given to reacting to their genetic inheritance of emotions motivating them to preserve their genetic code through procreation and caring, is also representative of the species that since evolved, carrying with it down through endless time those other all-too-human emotions related to territoriality and advantaging survival of the fittest, advancing evolutionary traits not much different from those of our predecessors.

Photo of skull 17.

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Thursday, May 28, 2015

Nature versus Culture

"The male may not survive pregnancy. He may not survive childhood. And, if he survives, he will be in relatively poor condition and not able to compete with more robust males for mating privileges."
"[The Quebec referendum on sovereignty] naturally generated significant stress in the Quebec population."
"I remember looking at the referendums -- the last one especially was almost like a Maltese election. There was a very real possibility Quebec would choose sovereignty. The 'No' side barely won."
Dr. Victor Grech, associate professor of pediatrics, University of Malta
Photo of fetus in utero at 28 weeks

There have been reports in the past of animals 'reabsorbing' the initial stages of pregnancy at times of existential crisis. Certainly when women suffer from malnutrition or simply haven't sufficient stored energy in the form of normal body fat on their skeletons, the result is a lack of normal hormonal activity, and menstruation ceases. Pregnancy is highly unlikely to occur under such circumstances.

And now research published in the latest edition of the Journal of Obstetrics and Gynaecology Canada points out a bizarre phenomenon where mental stress is instrumental in pregnancies producing female babies to the detriment of male babies. It appears that it takes more energy from the pregnant mother's stores to produce a male baby than it does a female baby.

Not only are miscarriages more likely to occur during times of great physical and mental stress but when babies are lost through spontaneous abortion (miscarriage), the odds are that the higher number of such miscarriages will be male babies. Normal  gender ratios have males with a slight edge at birth over females (51.5% versus 48.5%).

Photo of fetus in utero at 36 weeks

Dr. Grech pointed out in an interview that male babies suffer greater incidents of congenital abnormalities and increased illnesses during childhood. But his studies also point to male foetuses being more physiologically vulnerable to stresses and trauma that their mothers are exposed to during dramatic events impacting on their lives.

In New York, for example, the numbers of male babies born dropped three months after the attacks of 9/11. The same phenomenon was observed in Germany after the reunification with East Germany. In Canada, a First Nation community in Sarnia, the Aamijiwnaang reserve, in the midst of chemical plants and refineries experienced a sharp drop in male babies being born.

One hypothesis has it that during times of stress, pregnant women have a tendency to spontaneously abort male foetuses more frequently than females "because males exert a higher metabolic demand on the mother", according to Dr. Grech, and as a result when they're born they may present with greater frailties.

Dr. Grech compared the annual births in Quebec and in Canada as a whole during the 1980 and 1995 referendum years, to the preceding year and the five years that followed, in each instance. The male birth ratio appeared lower in the two referendum years; the dip statistically meaningful only after the second referendum when it fell from 51.7% in January 1996, three months post-referendum, to 50.2% in May 1996, and then recovered.

"The effect seems to occur well into pregnancy", observed Dr. Grech, appearing to make pregnant women particularly vulnerable around the fifth month of pregnancy. "All of this is nothing", he went on, when compared to "gendercide", the selective abortion of female foetuses, a symbol of Asian preference for male babies and a tendency to destroy female foetuses.

"It has been calculated that at least 100 million women are missing, simply because they're female ... All of these studies pale to insignificance when compared to the deliberate destruction of female babies in utero", he stated, pointing out that Asian communities in Western countries continue to prefer male children, destroying female foetuses in the process.

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Wednesday, May 27, 2015

Science Prodigy

"I met with him and I was blown away with his ideas."
"Immunology is not an easy subject... But he handles the complex and understands it at the higher level, the big picture, but also the minutiae of detail that's required at the cellular level And he's able to connect different disciplines together."
Angela Crawley, Ottawa Hospital Research Institute

"A lot of this is based on research that I've done outside school. Just reading the journals and collaborating with scientists was something I developed in an interest for in my spare time."
"I had these ideas, and to test them out I knew I would need a mentor and knew I would definitely need help. I emailed pretty much as many professors as I could find."
"They're [scientists at the HIV lab of the Ottawa Hospital Research Institute] still supervising me and still helping me out a lot, but they're definitely giving me a bit more independence and (showing) more confidence that I won't blow up the lab."
"I'm in an interesting situation where I'm kind of collaborating with multiple labs."
"The biggest thing that motivates me in science is the feeling of coming up with new ideas and testing them out."
Aditya Mohan, 18, Grade 12 student, Colonel By Secondary School, Ottawa
Aditya Mohan, 18, poses with a computer showing a graphic from his nationally-recognized science project that studies viruses that kill cancer cells. Mohan won a national science competition.   Darren Brown / Ottawa Citizen
Exactly how bright and talented at the age of 16? Well, even when Aditya Mohan was in elementary school he was fascinated with medical science. Reading medical literature whose content would confuse most adults, let alone a teen. But read them he did, journals like Nature, Cell, and PLOS One. His interest focused on cancer and on immunology.

So he began a letter-writing campaign addressed to medical researchers, enquiring about the feasibility of his helping out in their laboratory work on HIV and cancer research. Audacious and far-reaching, you bet. All the recipients of his enquiries failed to respond positively. And then, a researcher with HIV was intrigued enough to haul him into her lab.

Now 18 and getting set to graduate from high school Aditya has won the Sanofi Biogenius Canada competition. It's a nationwide biotechnology competition aimed at high school students. And if the goal is to search out promising future scientists they found one in Aditya Mohan. He re-engineered an existing virus by enabling the common cold virus to become a targeting messenger to search out cancer cells.
Video thumbnail for Curing cancer with the common cold?
Cure for cancer via the common cold virus?

The idea is a new approach to fighting cancer cells. Such a virus is envisioned as an agent that would dispatch all the cells in a tumour, leaving healthy cells untouched. "It seems to be very promising", said the young man. Several laboratories at the Ottawa Hospital Research Institute are working on cancer-killing viruses and, said Professor Crawley, Aditya is able to make a comfortable fit with them.

When he first arrived at the lab two years earlier he was exposed to basics such as how to use reagents, how to use pipettes, to begin with. But he took to the processes with huge enthusiasm, spending three to six hours after regular school hours several times weekly. Aditya aspires toward a combined medical degree and a doctorate to enable him to treat patients while also performing related research.

He isn't yet certain where he will begin his academic post-secondary education, considering universities both in Canada and the United States. He's just been in the United States on a trip, the country where he was  born, though he was raised in Canada. He had been in Pittsburgh to attend another competition, the Intel International Science and Engineering Fair.

And from that venue he brought back with him a $3,000 award. That and the Sanofi win for which he received $5,000 and the opportunity for an internship at Canada's premier research establishment, the National Research Council, represent a broad-based acknowledgement that this energetic, bright and ambitious young fellow will go far in medical science, in the future.

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Tuesday, May 26, 2015

A Solomonic Conundrum

"You are both going to continue to be the parents to this young man. You’re going to have to learn how to deal with that in an amicable, friendly, civil manner. You’re going to have to always take into consideration what’s in your child’s best interest. To the extent that you may differ on things, you’re going to have to talk them out. That’s what parents do in a civilized society. You do not take the law into your own hands."
Judge Jeffrey Gillen, West Palm Beach, Florida


Brought before Judge Jeffrey Gillen on Friday, Hironimus again declined to sign a consent form for the surgery but when she was told she would be jailed Indefinitely then she agreed
Brought before Judge Jeffrey Gillen on Friday, Hironimus again declined to sign a consent form for the surgery but when she was told she would be jailed Indefinitely then she agreed

A 31-year-old mother of a four-year-old boy was jailed in Florida, held behind bars for nine days as punishment for contempt because in February she disappeared with the little boy and their whereabouts were unknown. She had taken that dramatic step to evade a disagreement with the child's father who wanted the little boy to undergo circumcision. The mother of the child fought having her child circumcised.

When she appeared back in court she was informed that it was the court's intention to return her to prison unless she signed consent for the surgery to be performed. The child's father, Dennis Nebus and the mother Heather Hironimus, had argued bitterly for years about having the child's foreskin removed. It is the father's contention that for the health of his son it represented "just the normal thing to do."

An extremely emotional Ms. Hironimus felt she had no choices left to her but to obtain her release from prison by signing the document representing her legal permission for the circumcision to proceed. There are many people who feel that circumcision represents an unnatural outrage against a child, that as a man he would prefer to have had his foreskin left intact. This, despite that medical science has proven that the transmission of sexual disease is drastically reduced with circumcision.

Men who have been circumcised have far fewer health problems. Simply put, removal of the foreskin makes it far easier to maintain cleanliness in that area. There are far fewer cases of penile cancer among circumcised males. HIV transmission is greatly reduced because of the state of hygiene. Some argue that circumcision should only be performed when a boy reaches the age of consent.

Circumcising an infant is far less medically traumatic than performing the surgery on a young man or teen-age boy.

At one time it was perfectly ordinary, and no one questioned the routine of circumcising babies before their release from hospital after childbirth. The rise of "intactivists", damning the pedestrian nature of circumcision in society, calling it unnecessary and barbaric and destructive to an adult male's self-esteem has seen a huge reduction in the once-routine surgery. Unsurprisingly, anti-circumcision activists have been supportive of Heather Hironimus's position.

Last Friday, Ms. Hironimus invoked her fifth amendment rights when she was asked whether she had signed the consent agreement. Justice Gillen informed her that she would be jailed indefinitely until such time as she signed the consent form. At which juncture, sobbing in frustrated misery, she signed her consent to surgery for the little boy. The choice to agree or not to agree aside, this is a most peculiar situation.

Details that have been released about the relationship of intimacy between the two parents of this child were brief, but telling. The pair had a six-month relationship outside of marriage. He was obviously not committed to a long-term relationship, but is committed, it would appear, to the needs of a child he helped to conceive and who carries his genes. But it was the woman who carried the child through a pregnancy, gave birth to the baby and is raising him.

Presumably, both have some measure of shared custody. However, since the woman's role is primary in the child's life, far more so than that of a biological father whose presence in the child's life is relatively peripheral, it is puzzling that the kind of child custody that appears to have been awarded to the biological father has impaired the mother's ability to make choices on behalf of a child she is responsible for in a major way.

The mother previously said she wanted to protect her child and was 'scared to death' by the procedure
The mother previously said she wanted to protect her child and was 'scared to death' by the procedure

Little wonder that she absconded with the little boy in February and her presence with the child at a Broward County shelter wasn't discovered until May 14. Judge Gillen, in his judicial wisdom has given the biological father sole authority on a temporary basis for the boy's medical decisions, granting a motion to permit him to travel out-of-state for the procedure to be conducted.

Presumably because of the profile given the case, and the situation of the prevalence of advocates against circumcision, many doctors would refuse to take on this surgery "If anyone finds out the circumstances under which she [the mother] signed, a doctor would be insane to carry out that surgery", stated Georganne Chapin, executive director of Intact America.

Why does this man's opinion carry more weight in the legal arena than the mother's?



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Monday, May 25, 2015

A Cautionary Tale

"If misleading information about gross medical error was provided by a hospital chief of staff, a caution -- even one delivered in person -- does not reasonably address the impact of such conduct on others involved in health-care delivery, and the erosion of public trust in the profession.
Lawyer Taivi Lobu, Health Professions Appeal and Review Board, dissenting board member

"It is disheartening to see that people responsible for the administration of a hospital were involved in misleading the family in this very sad case."
Barb MacFarlane, malpractice lawyer, Toronto

"We believe the changes ... will make our care safer in the future and improve our disclosure process when errors do occur."
Grand River Hospital, Kitchener, Ontario
An Ontario doctor has been censured by regulators for misleading family members about the role of "gross medication error" in a patient's death, an almost unprecedented case of alleged secrecy around medical error leading to disciplinary action. The physician, chief of staff for Grand River Hospital in Waterloo, Ont., had insisted that an excessive dose of the narcotic painkiller dilaudid played no role in the elderly man's death, a day after he was admitted to hospital.
Google Maps   An Ontario doctor has been censured by regulators for misleading family members about the role of "gross medication error" in a patient's death, an almost unprecedented case of alleged secrecy around medical error leading to disciplinary action. The physician, chief of staff for Grand River Hospital in Waterloo, Ont., had insisted that an excessive dose of the narcotic painkiller dilaudid played no role in the elderly man's death, a day after he was admitted to hospital.

An unidentified [in respect of privacy concerns] 85-year-old patient was admitted in June 2010 to Grand River Hospital in Kitchener, Ontario, with a suspected case of bowel obstruction. One to two milligrams of dilaudid to be administered by subcutaneous injection [hypodermic] into the epidermis every three hours was prescribed. Instead the correct drug was erroneously administered directly by IV, altering the drug's potency to the extent that it caused the man's death.

The man's condition became deleteriously impacted as his breathing became depressed; he contracted pneumonia and the following day he was dead. The hospital's chief of staff, Dr. Ashok Sharma, an emergency physician, along with other hospital officials informed the family that the error in administering the drug was irrelevant to their family member's death. The dose that assumed 'excessive' proportions when administered by IV, was merely incidental, they claimed.

The family thought otherwise, and expressed their doubt by handing material from the patient's charts to the coroner. And since this was the official conclusion of the hospital itself, the coroner initially simply accepted the hospital version. He changed his mind on contact by the family and reversed his findings on the death. His final statement affirmed that overdose of the opiate in fact was likely to have been the source of the death.

A subsequent appeal board hearing chided the hospital and rebuked the chief of staff, upholding an official caution from the College of Physicians and Surgeons. A dissenting board member felt the rebuke was inadequate to the situation, feeling the college should have given the case a more intense level of professional censure, resulting in an open disciplinary hearing, rather than the private caution.

Dr. Sharma himself is a member of the College of Physicians and Surgeons' discipline committee, and as such engages in overseeing hearings for other physicians whose professional conduct may come under scrutiny, as his has done. Studies estimate that up to 23,000 Canadians die on an annual basis as a result of preventable medical errors committed at acute-care hospitals. It would appear that a minuscule number of those cases are ever internally reported, much less publicly disclosed.

In this particular case, the family had appealed the college's response, inadequate to their way of thinking in response to the coroner's investigation resulting in a statement that death likely resulted from "narcotic overdose". The chief of staff was ordered to appear for a verbal caution which held that he should have been fully transparent in his interaction with the family and the significance of the "very large" dose of dilaudid administered to an elderly, dehydrated man whose reaction to powerful opioids killed him.

In response to the family's appeal, feeling that under the circumstances a rebuke was inadequate to the cause of their loss, the majority on the three-person appeal board supported the college's cautious response. But did state that had the College of Physicians and Surgeons taken more robust action to reflect the seriousness of the chief of staff's "evasive and vague" response to the family, it would have been fully justified.

If patients and their families cannot place their full trust in the professional veracity of a doctor whom their hospital has entrusted as chief of staff, who can they trust? Well in this case, a coroner whose own professionalism was quite evident, in assigning responsibility for an unfortunate death which was attributed where it rightfully belonged.

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Sunday, May 24, 2015

Examining, or Re-Writing History?


Where Are The Children? The Exhibition
Though some students have spoken of the positive experiences of residential schools and of receiving an adequate education, the quality of education was low in comparison to non-Aboriginal schools. In 1930, for instance, only 3 of 100 Aboriginal students managed to advance past grade six, and few found themselves prepared for life after school – on the reservation or off.
As late as 1950, according to an Indian Affairs study, over 40 per cent of the teaching staff had no professional training. This is not to say that past experiences were all negative, or that the staff were all bad. Such is not the case. Many good and dedicated people worked in the System. Indeed, their willingness to work long hours in an atmosphere of stress and for meager wages was exploited by an administration determined to minimize costs. The staff not only taught, they also supervised the children’s work, play, and personal care. Their hours were long, the pay below that of other educational institutions, and the working conditions exasperating.
Legacy of Hope Foundation extract

"In order to educate the children properly we must separate them from their families. Some may say that this is hard but if we want to civilize them we must do that."
Public Works Minister Hector Langevin, 1883

"When the school is on the reserve, the child lives with his parents who are savages; he is surrounded by savages, and though he may learn to read and write, his habits and training and mode of thought are Indian. He is simply a savage who can read and write."
Sir John A. Macdonald, Prime Minister of Canada, 1883

"I don't think I had a childhood."
"We were always fearful. I think we lived with fear all the time. Fear of being beaten or of being abused in different ways."
Doris Young, Manitoba
My mother is 75 and attended the Cecilia Jeffery School outside Kenora, Ontario. In the 60-some years that have passed since her experience, she has become a mother, grandmother and great-grandmother. She lives in a small house on a reserve outside Kenora.
When you enter my mother's house, there's one thing more than anything that strikes you. It's incredibly neat.
She cleans fastidiously. Every surface in her home gleams and everything is organized and arranged to make the most out of the living area.
There is a cross on the wall, a Bible by her bed and a picture of Jesus in the living room. It's a home not unlike the home of any grandmother anywhere in Canada.
She credits the residential school experience with teaching her domestic skills. While she was at the school, she learned how to cook, sew, clean, launder and take care of a home. Her house on the reserve is known as the neatest and cleanest and even though she's an elder, she takes care to maintain it. Her lawn is the only cultured lawn on the whole reserve, shorn, immaculate, stunning.
My mother has never spoken to me of abuse or any catastrophic experience at the school. She only speaks of learning valuable things that she went on to use in her everyday life, things that made her life more efficient, effective and empowered
Richard Wagamese, writer, Calgary Herald
Dene children at work in this undated shot from the Catholic-run residential school at Fort Resolution, Northwest Territories. The academic quality in most of the schools was very low.
Dene children at work in this undated shot from the Catholic-run residential school at Fort Resolution, Northwest Territories.  Canada. Dept. of Mines and Technical Surveys / Library and Archives Canada

Canada has been struggling for the last few decades with the knowledge that well-intentioned people a hundred years ago felt it was important to give aboriginal children the opportunity to have an education that would benefit their future years. The government of the day, when it initiated the first of the residential school programs exhibited a breathtakingly arrogant, Euro-racist attitude toward Canada's First Nations peoples in wishing to expose young aboriginals to European culture to pattern them as European-extracted future citizens, while hoping to expunge the 'Indian' in them.

An undated class photo at St. Mary’s Indian Residential School in Mission, B.C.
Courtesy of Mission Community Archives    An undated class photo at St. Mary’s Indian Residential School in Mission, B.C.

To that end, young children were taken from their families to be enrolled in a school system that was to teach them European values and customs with the purpose of draining their aboriginal culture from their immediate consciousness. The children mostly attended their residential school during the week, and returned home to their families on week-ends, although for some, returns home were far less frequent. When one thinks of the upper-class British social custom of sending young children off to boarding school it was a privilege of the wealthy, but a miserable experience for British children.

When Prime Minister Macdonald had a cabinet decision passed to create the initial three residential schools they were to be operated in conjunction with the Catholic and Anglican churches out West; the rationale was for complete assimilation of the indigenous youth into the European-based culture that prevailed in Canada. From the 1880s forward until the last of the 130 residential schools that were operated over the years closed in 1996, 150,000 indigenous children were placed in the schools. For some the experience was a worthwhile one, for many others it was a dramatic shift in their lives that left them devastated.

It is estimated that some 80,000 former students of the residential schools are still living. Estimates also give a figure of 7,000 for children who died at the schools, from accidents, from illness and diseases such as tuberculosis. Some researchers contend that deaths like those from tuberculosis were not more numerous among residential school children than they were among the general population of the time. There are accusations of underfunding of the system, of food in short supply, of children inadequately nourished. With no fire escapes and locked windows it was said that if fire consumed some poorly constructed buildings, children perished in them.

Much of the problems seen in aboriginal communities, on reserves, have been attributed to the culture shock and trauma experienced by former residential school students, unable to find their place in life, incapable of functioning normally, finding themselves confused and unsettled by their experience, turning to alcohol, struggling with suicidal tendencies, ignoring and failing in their duties as parents toward their own children whom they left to their own devices. And the violence in aboriginal communities where women are targets and children's lives totally neglected, also attributed to the residential school experience.

In the attempt to rid the children of the appeal of their aboriginal culture in favour of the European-based culture, children were forbidden to speak their aboriginal languages, their long hair was cut and tidied, many had their names changed, siblings were separated and many claim to have suffered physical and sexual abuse. Claims that their experience led to their later living in poverty and being the cause of social problems that plague reserves, from alcoholism to the commission of crimes all attributed to the residential school system.

Apologies, official in nature, from the government to the aboriginal community, by both Prime Ministers Jean Chretien and Stephen Harper have acted as admissions of wrong-doing by previous administrations. Financial settlements were sent to former students of residential schools, in a broad effort to bring about a sense of closure through moral and financial restitution. A Truth and Reconciliation Commission was launched that criss-crossed the country to hear first-hand accounts by former students, and the anguish they suffered in separation from their families; in other instances, how well the residential school system had prepared them for their future lives as adults.

While we can decry past decision-making impacting on the lives of so many we cannot change what has occurred. Clearly, for some among the aboriginal communities their experience was a positive one, one that enhanced, not degraded their lives. The Truth and Reconciliation Commission made no effort to probe whether testimony they heard reflected the truth, or was in some instances a reflection of a robust imagination by people eager to be seen as entitled to restitution. Alcoholism among First Nations people was not a voyage of discovery dating from the residential schools; it existed long before.

It is not quite possible to separate out the dysfunction that exists among aboriginal families on reserves, to determine how responsible, as it claimed it is, the residential school system was in the outcome that is now largely attributed to the experience of young aboriginals in that system, or whether the entire episode, unfortunate as it was for so many, simply serves as a handy excuse for a people insisting it has the right to live with its heritage and traditions, while living largely backward lives, where achieving an education and striving for a profession to be independent and have pride in themselves remains on the back-burner of the future.

An historical shot of the Anglican-run residential school in Alert Bay, B.C.  Natives have filed lawsuits alleging abuse while detained in the school.  An undated photo from the book, Shingwauk's Vision by J.R. Miller.
An historical shot of the Anglican-run residential school in Alert Bay, B.C. Natives have filed lawsuits alleging abuse while detained in the school. An undated photo from the book, Shingwauk’s Vision by J.R. Miller. Vancouver Sun

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Saturday, May 23, 2015

True North/erner

"We were a family of four kids. There would be a certain amount of talk that we would allow him to get away with at home, but then it was like, 'OK, come on, Dad!"
"He ... really loved the landscape, the wide-openness, the wildness of it. It got in his blood."
"Fairly soon after he started with the GSC [Geological Survey of Canada], he started going up north, to the Arctic."
Linda Hobson

"George cared passionately about mentoring young scientists and supporting science in the north, and involved northerners as best he could in that."
"[George consulted with northern communities] and as a result he built up a group of contacts in most if not all communities in the Arctic, because he really made a point of reaching out to northerners. A lot of scientists don't have that background, don't know how to talk to people. But George really made an effort in that."
"This included younger scientists, [he] brought them into the fold and made sure they had someone to work with."
Michael Schmidt, Geological Survey of Canada

"My attitude was to get the job done. I got my knuckles rapped a few times, even at the Treasury Board level."
"I just wanted to share what I've been able to see. The Arctic is about one-third of our [Canada's] land mass. Most Canadians live along a narrow strip and have never been able to see the North."
"It's just in me."
George Hobson, Canadian Geographic Magazine interview

George Hobson photographed on an ice island in the Arctic Ocean. Hobson died in April at age 92.

George Hobson, trained in geophysics began his career in the Edmonton and Calgary areas in the late 1940s and 1950s, heading seismic crews during oil exploration expeditions. In 1958 he moved to eastern Canada to join the Geological Survey of Canada, located in Ottawa. His daughter Linda recalls being terrified that polar bars and the darkness would spell danger for her father.

By 1972 he was appointed director of the Polar Continental Shelf Project, and he remained in that position until his retirement in 1988. The Polar Continental Shelf Project began as an initiative for Canada to explore, in the modern era, the country's northern continental shelf. It was later transformed into an agency supporting broad-based northern research.

It functions as a base where some services [time on the base or in a helicopter] were provided free of charge [or subsidized] to visiting scholars and scientists to enable them to study the land, the sea and the life that prevails there. George Hobson's position was to control the logistics involved in arranging for academics and government scientists to travel to the Arctic for study and experience.

He was a man fully committed to what he loved to do, and what he loved to do was, in essence, the job he undertook with the Polar Continental Shelf Project. He arranged for annual meetings to take place in Ottawa where Arctic researchers could meet and confer and trade ideas and remain connected with each other's research projects. The Internet makes all the contact and transmission of ideas and data more readily accessible now.

He was a down-to-earth, practical man who used the barter system to enable himself to get work done. This casual kind of exchange, hugely practical in its setting, but anathema to accounts-dependent bureaucrats often landed him in hot water. He was advised it was critical to lock up oil drums to avoid pilfering. An Ottawa functionary recommended chaining drums to a tree. A practical suggestion but not in a treeless landscape.

This intrepid northerner-at-heart operated for years  on an ice island on the Arctic coastline that had broken away from the Ward Hunt Ice Shelf at Ellesmere Island. On the ice island there were wood buildings and a runway for aircraft. But it was a solid ice foundation, floating on the Arctic ocean, however stable; not a tree has yet been seen that could grow on ice.

After retiring, Mr. Hobson took up the position of base commander for the Royal Canadian Geographical Society's expedition to climb the highest peak in Canada, Mount Logan. The expedition, taking place in 1992, was a success, enabling the intrepid scientist-summitteers to accurately measure the height of the Yukon's Mount Logan.

George Hobson received recognition in being awarded the Massey Medal in 1991, for his extensive Arctic work. The Sir Christopher Ondaatje Medal for Exploration was added last December. This was a man, the geophysicist with an extraordinary fascination for the North, who was also involved in the search for the Franklin Expedition's missing ships; he joined three such expeditions.

Mr. Hobson died on April 16, at age 92. That date also was the birthdate of Sir John Franklin. And yet another search was undertaken with divers looking for the wreck of Sir John Franklin's flagship Erebus the very same day. "The one thing he wanted to know before he died was to know where the ships were", noted his daughter.

This photo has become nearly emblematic of the Royal Canadian Geographical Society, the non-profit educational organization that publishes Canadian Geographic magazine. Fun fact: it was taken on this day 20 years ago on the 150th anniversary of the Geological Survey of Canada, when a group of climbers took celebrations to a new level.

They had decided to climb Mount Logan in the Yukon, whose actual height had never been measured. Surveyors had previously used a theodolite, a type of telescope, to measure the mountain’s height. To get a more accurate measurement, the climbers lugged two GPS systems to the summit.

Sponsored by the RCGS, Michael Schmidt (who took the photo), Lisel Currie, Leo Nadeay, Charlie Roots, J-C. Lavergne, Roger Laurilla, Pat Morrow, Karl Nagy, Sue Gould, Alan Björn, Lloyd Freese, Kevin McLaughlin and Rick Staley flew to Quintina Sella Glacier to set up their base camp in May 1992. On May 12th, the team of GSC members, surveyors, mountain guides and park wardens began to climb.

They faced steep slopes, battled storms and bore the brunt of heavy loads that included climbing and scientific equipment. GPS was not as developed in 1992 as it is today, so they needed two sets of GPS units in case one failed. They also carried nearly half a ton of food for the entire climb. 

On June 6, the first of four parties strapped on their skis and headed for Mount Logan’s summit with one of the GPS systems. Their original plan was to set up the system at the summit and descend and then have a second party return four hours later to check the GPS readings. The weather was so good that day that the first party stayed on the summit for four hours. That’s when one of the climbers pulled out the RCGS flag and posed for this photo.

It turns out Mt. Logan is 5,959 metres high, making its summit Canada’s highest peak.
Canadian Geographic Magazine

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Friday, May 22, 2015

Living A Delusion

"We [his musical band in North Carolina] became popular with the college crowd."
"I kept it very hush-hush [that he is Eric Clapton's half-brother]. I did not want to be known as 'Eddie Fryer, the half-brother of Eric Clapton."
"This writer came in and did a character assassination on the place where I live [rooming house in Vancouver's Downtown Eastside]. Granted, it is not the Hilton. It is a shelter that has a medical team and they do a good job of looking after me."
"He [Eric Clapton] played it [a demo tape of his music], and right away he wrote me a personal letter where he said he played the CD and it blew him away.Yes, he liked it and I sent him a letter back just to say I was glad you were able to get an opportunity to see what your brother's music was like."
"I have never asked him for money. A person is not entitled to another person's achievements."
"I gain nothing by being defeated [by heroin and illness]. I am a fighter and want to play again, maybe even with Eric."
Fast Eddie Fryer, Vancouver musician
Jason Payne/Postmedia News
Jason Payne/Postmedia News   At one time, Eddie Fryer was convinced he would meet his half-brother Eric Clapton.

Ah well, it is human nature to dream and to fantasize, and to believe and to have hope that one's dearest wishes will be realized some day. But Eddie Fryer is fast running out of time. He learned seventeen years ago that the famous Eric Clapton is his half-brother, both biological sons of a shared father. Correction: Eddie Fryer shared his early life with his father, Edward Fryer Sr., who'd had a wartime fling in Britain with Patricia Clapton who was left to raise her son Eric as a single mother.

Eddie Fryer Sr. was also a musician; he played piano. When he was demobilized at war's end, he set out on a dinner club piano-playing career in appearances across North America. Both his boys inherited his love of music; each of them played guitar. And both boys when they reached maturity struggled with addiction to heroin. But whereas Eric Clapton left his heroin addiction to the past and carried on with his career, his half-brother had no such luck.

And now he suffers from "end-stage" cirrhosis of the liver. And he is dependent on social services for a place to live, for social welfare assistance, and for medical treatment for his poor health condition and just as poor health outlook. At an age when new opportunities no longer present themselves, when age and failing health guarantees not too many years on the horizon, Eddie Fryer still has a fond hope that he will some day play guitar with his half-brother.

Jason Payne/Postmedia News
Jason Payne/Postmedia News   After discovering his lineage 17 years ago, “Fast Eddie” Fryer, now dying of cirrhosis of the liver, remembers how he was hounded by the press and just wanted to be left alone to deal with his own musical career — and his own demons.

Presumably, that hope sustains him. As for his brother, it seems that he is not that much given to brotherly affection for another man whom he has never met. Perhaps he feels nothing but resentment to have been abandoned, ignored by the biological parent he never met. In any event, that world-famous celebrity with wealth to spare, had none to spare for his indigent brother. While Eddie Fryer takes pride in never having asked his brother for money, perhaps his brother takes pride in never having offered any.

But it would appear that Eddie Fryer is a reasonable man, grateful for whatever life had to offer him, back when he was young and ambitious, and even now that he is old and ailing. A story written for the British media recently made the observation that Mr. Fryer lived in squalid conditions. A misunderstanding, says Mr. Fryer, of the rooming house where he lives, and where he is well cared for.

"They have been very much responsible for getting my medical condition under control", he observes of his subsidized "medical" housing. He still dreams of revisiting his musical career. He still believes that he will meet his half-brother, that Eric Clapton will make a magnificent effort to take the trouble to visit with his half-brother in Vancouver.

He would have to have surgery on his hands because of the tightened tendons, to enable him to hold a guitar once again. And if that happened, and if he met his half-brother, and if they played a duet, he would die a happy man. He feasts on his dreams of fulfillment, as a musician, as a man whose playing ability might match that of his famous, multi-millionaire half-brother.

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Thursday, May 21, 2015

On Being Invincible....

"I might have gotten a concussion ... have a headache again."
"How was your game?"
"Well I smashed it on the ground and then got kicked in the head."
"Doesn't that happen every time?"
"Which is why I probably have a concussion."
"Ya well. You need to stop dying. Are you still going to play on Wednesday?"
"Yeah. Nothing can stop meeee! Unless I'm dead."
"I'm sure you'll be fine by then."
"Unless concussion!"
"Are you going to get it checked?"
"Nope. Just see if it gets worse. Meh, what's some brain damage gonna hurt?"
Rowan Stringer, 17, Ottawa high school rugby captain; email exchange with friend Michelle Hebert

si-ott-rowan-stringer3-220
Rowan Stringer, seen here playing rugby, suffered two concussions in less than a week that led to Second Impact Syndrome. (Family photo)
"Rowan wasn't the sort of kid who would talk about how nasty other teams were. But she complained one team were pulling hair, elbowing, stepping in ankles with cleats and swearing."
"I don't know whether she would have told me, [had she asked her daughter directly about her headache], but (maybe) it could just take one question."
"What you need to do [is not restrict children participating in sports] is to find ways to prevent it [concussion during sports] happening again."
"You have to look after your brain. Without it you're nothing."
Kathleen Stringer, mother of Rowan Stringer

"I tried to hide my injuries all the time. My parents were worried what football would do to me. You try to get up and be as normal as possible [if you're hit and hurt your head], so you don't get taken out of the game."
"I wasn't smart enough to stop."
Matt James, high school football player, friend of Rowan Stringer

In early May of 2013, when Rowan Stringer played her very last game, she was captain of John McCrae high school's rugby team, a young woman who loved sports, excelled at what she enjoyed, and was proud of her position as team captain, utterly committed to her lead role for her team, and her high school. In the last few years the issue of head injuries with relation to sports like boxing, like hockey-playing, like football, has come under greater scrutiny.

Players no longer active, but once leaders in their field of sport, having suffered one too many hits to the head now attempt to lead normal lives, but suffer fallout from the physical injuries they sustained over time, re-injuring themselves constantly until they retired from the game that they played with pride and passion. Team managers focus on scores and wins, not on the condition of their players.

It's like that in professional sports and it's like that in amateur sports, and it's like that in sports played at public schools. Coaches may be exposed briefly to safety issues, but the emphasis is on training the players, coaching them to win. An inquest is being held in Ottawa to examine the issue of hard and potentially dangerous physical contact in some sport activities.

And it has focused on the death of 17-year-old Rowan Stringer, who suffered one concussion after another, until she finally succumbed to the grave damage she sustained. "If she got a bruise or something, she would wear it with pride -- a warrior wound", a friend who played alongside Rowan in her last game.

"There was a hit" recalled Judy Larabie, "I got tackled and threw it off to Rowan, who ran a few yards before she was tackled. She was still lying there. She sort of raised up and then dropped back down", explained Judy Larabie, speaking of her friend, a tough competitor and a natural leader. Rowan Stringer, treated at the Children's Hospital of Eastern Ontario never recovered consciousness.

"Second-impact syndrome"; a pre-existing brain injury from a previous game, added to an additional insult to the head causing further brain injury signalled her death knell. It is considered to be a relatively rare event. But it certainly killed Rowan Stringer. "It was a fluke accident. There aren't a lot of deaths in rugby. It isn't a violent sport. I sustained more injury playing soccer", said Judy Larabie.

Rowan's coach at her high school, Zachary Logue, testified that he had been required to take a mandatory three-hour Safe Rugby course before embarking on his coaching stint with John McCrae high school. Rowan had, shortly before her death, played three games in a tournament. She had complained of a headache after the second game, asking her mother for an Advil before starting on the third game.

"I didn't think too much about it", Kathleen Stringer testified at the inquest, of her daughter continuing to complain of a headache, which her mother, at the time, had attributed to playing all day in the sun. Her daughter hadn't shared with her parents the complaints about continual headaches that she spoke of to her friends.

Rowan exchanged text messages with her friend James, who had expressed his concern that she might have a concussion. "Once you get one it's easier to get them that's the only concern you should have", he evidently advised her. "Yay! Well, I'm not sure if I do so let's hope not", she responded, informing him that because of her headaches she would prefer not to play that final game.

He speculated in hindsight, that she had decided to play that last game after all, since she was team captain and obviously believed that she had an especial responsibility, as a result. A team player, particularly one in a lead position of captain, doesn't let down the team. A decision that cost her dearly; the last game she would ever play in her young life.

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Wednesday, May 20, 2015

Independent Living

It is not a situation of polite discussion. As the man once was said to have rhetorically stated: "Have you ever had your 85-year-old mother wipe your a--?" Not too likely. Nor might any 85-year-old woman ever begin to imagine in her wildest thoughts that a child of hers in his mature years would feel compelled to call upon her to perform an act she once thought little of when she was 22 years young, a new mother, tending to her baby.

Marie Summers, formerly a special-education teacher and consultant, did respond when her 63-year-old son called to ask her to hurry over to his apartment after he had experienced a bowel accident. Bowel accidents for her son, Gordon Summers, would represent an unscheduled bowel movement. With no one present to wipe his nether regions, a dilemma presents itself for the man who cannot perform this simple function for himself.

Gordon Summers, 5 feet, 5 inches in height with a weight of 375 pounds. High blood pressure, blood clots and obviously poor mobility, he had suffered as well with hepatitis C, believing that he contracted that condition when he was still employed as a registered practical nurse. He had acquired his nursing diploma in 1970, and practised as a nurse for 17 or 18 years. Then came a motorcycle accident, and his professional career came to a halt. It was the aftermath of the crash leaving him with poor functioning on his right side that began his slide into physical ill health.

One day in 2013 while speaking with his personal health worker assigned to him by the Champlain Community Care Access Centre, he had sarcastically stated his bemusement that a dissatisfied client hadn't yet descended in the CCAC's Cornwall office "to shoot a couple of people". Gordon Summers was clearly one very dissatisfied client.
Gord Summers says the situation the Champlain Community Care Access Centre has put him in is disgraceful and has robbed him of his dignity. Bruno Schlumberger / Ottawa Citizen

His statement alarmed the personal support worker and she of course repeated what she had heard. It was at that juncture, he feels that the relationship he had, however unsatisfactory from his point of view, went very bad indeed for him. Understandably, the CCAC considered the man's statement to be a threat, and withdrew the services of the personal support worker assigned to him. For his part, he insisted that the statement was meant to be jocular, although he did make allusion to the murder spree embarked upon by Marc Lepine at the Ecole Polytechnique in Montreal.

Mr. Summers, though he barely managed to look after himself, had two dogs, Roxanne and Rex, companions that he doted on and in whose company he clearly took comfort. He is reputed to have taken them everywhere he went himself. This is a man with a dire need. He required a health care worker to be on call nearby whom he could contact when he needed to be cleaned up after a bowel movement. On those occasions when he was unable to clean himself and there was no one he could call upon to perform that function for him, bacterial infections would result, of a serious nature, impacting his health even further.

Mr. Summers had a running battle with the Champlain Comunity Care Access Centre which clearly has many priority calls on services they attempt to make available to a large patient constituency, people requiring the assistance of personal care workers. He became increasingly frustrated with the CCAC's lack of response to his continued requests for a a personal support worker to aid him whenever he had a bowel movement. With stretched resources, the CCAC was unable to assign an on-call personal support worker for this man.

At eleven in the late evening of April 2, Mr. Summers telephoned his mother for help. He had been unable to contact the woman whom his mother paid herself to help him on those occasions when he needed that kind of assistance. So his mother, as mothers often tend to do responded to his request that she come over to his apartment. It wasn't much of a distance between his mother's home and his own, and walking in the rain, his mother arrived 20 minutes later, to clean up her son. Who insisted he would drive his mother home.

After which, stopping at a gas station, Mr. Summers suffered a fatal heart attack, in his car. He wasn't alone, his dogs were with him. "I know he's out of his misery because he was sick for so long", his mother said afterward.

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