Open complaint to College of Physicians and Surgeons of Ontario

I have filed the following complaint to the College of Physicians and Surgeons of Ontario, and am making that complaint a matter of public record by posting it here on my blog.

NB: This post has been edited from the original letter, omitting names of the physicians.

re: --------------------------------------------------------------------------------------

Overview

I first saw Dr. ------- October 7, 2013 as a new patient. Although very pleasant, from the outset it was clear Dr. ------- was determined to recommend not only outdated and ineffective practices regarding obesity, but cast into doubt the veracity of any of my statements.

The appointment was concluded, and I was told to book another for follow-up, which I did.

The second appointment took place on October 21. I was immediately informed this appointment was to be a complete physical, with an array of blood and urine tests to follow, none of which I had consented to undergo. I refused the physical, and obtained prescriptions for rampipril 10mg, and atenol 50mg, prescribed by my former physician for hypertension.

I made a third appointment which took place November 8, at which time Dr. ------- terminated our doctor/patient relationship.

Areas of Concern

No understanding of, or sympathy with, the dynamics of chronic pain

I deal with chronic pain from both osteoarthritis and sciatica.

Around 2007 I was treated by Dr. ------------ in ------- for osteoarthritis and sciatica, which resulted in long-term prescription of Tylenol 3, 30mg, to be taken as required, not to exceed six tablets/day. I usually only took 2 tablets before bed in order to dampen the pain enough and allow me to fall asleep.

In 2009, I was treated by Dr. ------------- for osteoarthritis, with the end result he prescribed 375mg naproxen twice daily in order to better address arthritis pain, with full knowledge of my hypertension and medication history. The result of that treatment resulted in a dramatic improvement in my quality of life.

I continued to take T3s when necessary at night, as Naproxen does not address nerve pain.

Upon my first visit with Dr. -------, he immediately told me to discontinue use of Naproxen because it can elevate blood pressure. I asked how I was to deal with the pain of arthritis, and he had no answer, and instead discussed obesity. I subsequently refused to discontinue use of naproxen, knowing without it my daily mobility and function is greatly impacted.

My third visit to Dr. -------was to refill my prescription for T3s, and to give him a copy of the medical report I’d received from Dr. ------------- regarding his diagnosis and treatment for my arthritis. At that time, I also gave Dr. -------a detailed chart of my daily food consumption, with daily blood pressure and pulse records, to prove his assertions of over-eating were erroneous, and that at home, in a stable, controlled environment, my blood pressure is within acceptable levels.

Dr. -------became quite incensed when he glanced at Dr. -------- report, and even further incensed when he read my daily record. When I then asked for a prescription renewal of T3s, he vehemently, even angrily, stated he would not prescribe narcotics. I asked how I was to manage sleep without pain relief. He stated I was already on naproxen. I pointed out naproxen addressed arthritis pain, but would not touch nerve pain from sciatica. It was then Dr. ------- tossed the reports back at me and stated our relationship is over.

It became clear to me that because I had refused to accept his path of treatment, and his dismissal of my chronic pain difficulties, that Dr. ------- would brook no questioning of his authority. A patient has a right to access an informed, understanding physician, without prejudice or bias. It is clear Dr. ------- is incapable of accepting a patient’s will, and is lacking in understanding in the area of treatment of chronic pain.

Adherence to outdated practices regarding obesity

During my first visit with Dr. -------, he naturally focused on the fact I am obese. Quite understandable. However, he immediately zeroed in on the highly questionable (and now under intense research and investigation) theory of thermodynamics, and made it clear he doubted my veracity when I asserted I do not over-eat, the fact I’m obese is not a matter of quality or quantity of food. I explained I have been either over-weight or obese all my life, that even on 600 calories a day and vigorous exercise I can still gain weight.

Because of his dismissal of my assertions, he then wished me to see a bariatric surgeon. I emphatically refused. He asked why, and I responded the research clearly indicates bariatric surgery is ineffective over the long term, quite outside of the enormous monetary consideration for treatment not covered by government health care, and often the equivalent in cost of a very expensive new vehicle. I was not prepared to mortgage my home for treatment clearly proven ineffective.

Dr. ------- then asked if I have difficulty sleeping, which I confirmed, adding pain was usually the reason. He ignored the latter and asked if I snored. I confirmed that from time to time I snore, especially when over-tired. He then asserted I snore because I’m obese, and he wished me to see a sleep therapist in order to address sleep apnea. He further asserted I’m obese because I snore (bit of circular thinking there), because if I wasn’t sleeping, I was eating. I made it clear I remained in bed and read when I couldn’t sleep, which he dismissed. Again, I refused to see a sleep therapist, because, quite frankly, by this time I suspected the snake oil was going to come out at any moment, you will please pardon the unprofessionalism of that statement.

I asked Dr. ------- if he had read any of the current research regarding obesity, in particular:

http://thesocietypages.org/socimages/2013/08/19/whats-causing-the-rise-in-obesity-everything/

and:

http://www.aeonmagazine.com/being-human/david-berreby-obesity-era/

or if he’d read the fascinating research presented by Gary Taubes in: Good Calories, Bad Calories.

The answer to all of these was no. So, it was clear Dr. ------- was simply repeating outdated, ineffective, uninformed and sometimes dangerous medical practice, rather than pausing to consider the most recent research into this global problem.

Frankly, I’m weary beyond expression of doctors who simply will not listen to patients, who are not keeping current. And Dr. --------- dismissal of any of my statements was an expected and disappointing repeat.

No respect for patient’s wishes

After these three visits to Dr. -------, and his subsequent refusal to treat me, it is clear he will brook no disagreement with his authority, his opinion, or his theories. I am tired of being poked and prodded for tests which will come back negative. I am tired of doctors looking for diseases which I don’t have. I am tired of doctors looking at me like I’m a revenue generator. And I’m tired of doctors calling me a liar, albeit in very politic and polite terms.

It is clear Dr. -------is no exception from what has become the norm in the paradigm of medicine. When the Hippocratic oath was replaced with imperative of profit and business, patient care went out the window. I imagine if I had been like so many other patients, and particularly female patients, and simply accepted his statements as truths, never questioned, never bothered to research my own health and conditions, I would still be under his care. But I’m not. And despite the fact I am once again without a physician, there is a relief, also, that comes with knowing I won’t have to deal with someone so autocratic and ignorant.

Lest we forget.

In remembrance.

Review: The Luminaries, by Eleanor Catton

The Luminaries by Eleanor Catton
My rating: 2 of 5 stars

I've often said art is subjective. The Luminaries, by Eleanor Catton, is certainly a prime example of that adage. Winner of the Booker Prize for 2013, lauded, praised, esteemed by critics and readers alike, I was prepared for this literary whodunnit to amaze and delight. Unfortunately, for me, I felt like the child in the Emperor's New Clothes fable, pointing at Catton's naked majesty while others apparently better informed praised their mighty leader for the beauty of her raiment.

So, then, what was it that failed to impress? Certainly the concept of carrying the plot through multiple characters with an unreliable narrator's voice is a known, respected and often brilliant literary device. Sequencing back and forth through time periods is also a respected and often brilliant literary device. Using astrological charts to preface every section of the novel was a touch of ingenuity, albeit one lost on a reader unfamiliar with the nuances and language of astrology. Including phrases of Cantonese and Maori is also laudable, were it not for the fact there was no contextual reference to give weight and meaning to the phrases so that they became nothing more than white noise.

The execution of many of these devices was, in my opinion, clumsily handled. The leaping around through time sequences often left me confused, in that there was rarely any linear progression to these sequences, so that one was unsure if we were in 1864, or 1857, or whenever.

The constant recapping of events ended up reading very much like a modern reality TV show, wherein we are told over and over again after each commercial break of disaster past or pending. For the first half of the novel we are endlessly regaled with this person's experience of a particular event and relationship to a particular background character, only to be followed by another chapter from a different person's perspective, and so on, and so forth for about twelve chapters. After about the third viewpoint I'm afraid I started to go a bit tharn, much like one of Richard Adam's unwitting bunnies.

Character development ended up feeling somewhat flat because of the cool distance of the voice of the unreliable narrator, and sometimes I had to wonder if Catton was in fact attempting to write farce instead of an historical mystery.

Catton chooses to open each chapter with a 19th century literary device by way of a synopsis of what is about to unfold, which is fine, up to a point, which I will reference later.

The denouement, which occurs somewhere around the two thirds mark, ended without resolution because although court sentence is passed upon villainous and guilty parties, we never really are given a complete resolution of the mystery, or what is to happen as a result, and instead the latter third of the novel again transports the reader to various, disparate points in the past.

And here we return again to the synopsis which prefaces each chapter, in that in those last chapter the synopses, which employ run-on sentences and breathless writing, end up becoming the narrative or story, with the actual events of the chapter little more than a few paragraphs of some almost irrelevant vignette. And these chapters hurtle on in a race, almost as if Catton wished done with the novel, to the point of being little more than drafts.

The last chapter is astonishing, with its verbose synopsis and sudden end of the novel through a declaration of one lover to another that she can hear the rain, something apparently extraordinary in New Zealand which has been portrayed as very wet, with near constant rain. One might better declare she can see the sun, that she is transported by the light, because certainly the novel failed any kind of transport of the imagination, and, instead, very much called to mind one reviewer's comment that The Luminaries was a big box full of nothing.

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Review: The Orenda, by Joseph Boyden

The Orenda by Joseph Boyden
My rating: 5 of 5 stars

Simply put, Joseph Boyden's The Orenda is a timeless and imperative read for every Canadian. Even if you're not Canadian, you should read this novel. It will edify, illuminate, shatter, and complete your understanding of society during 17th century First Nations and European first contact. That The Orenda did not make the short list for either the Giller or the GG is quite incomprehensible. If ever there were a novel, and an author, worthy of our attention, our praise, and our accolades, it is The Orenda and Joseph Boyden.

Quite beyond The Orenda's importance in the canon of Canadian literature, it is a compelling read. (And for me one near and dear to my heart, given my own short story, And the Angels Sang, which formed the keystone story for my collection by the same name.)

Boyden tells the story of the Iroquoian pogrom against the Wyandot (Huron) peoples, which culminated in the destruction of the Jesuit mission at Ste. Marie among the Hurons in present day Midland, and the legendary torture and execution of St. Jean de Brebeuf.

While Boyden chooses fictional names for the people involved in this historic occurrence, the historical integrity and framework remains.

The story itself is told in first person, present-tense narratives through three voices, that of Snow Falls, an Iroquoian girl orphaned and captured by a Huron warrior; that of Bird, the warrior responsible for Snow Falls' plight and who subsequently adopts her; and Father Christophe, the Jesuit, or Crow, who comes among the Huron to bring his version of redemption and salvation to the sauvages.

Boyden sculpts these characters with a deft hand, so they are fully realized, living entities with voices so strong they haunt your thoughts. There is no confusion when progressing chapter to chapter who speaks, a feat not easily accomplished unless at the hand of a confident writer.

The pacing is brisk, tense, never flagging, and even if a reader weren't aware of the history about which Boyden writes, there would be a sense of drums thundering beneath the text, of doom echoing through the forests.

All of these components are fused together with Boyden's trademark style, employing spare language, each word chosen for precise impact. This is a lean story which is, in contrast, defiantly rich and satiating.

Whether you choose to immerse yourself in The Orenda by way of eBook or print, I assure you these hours you spend reading will be profound and memorable.

Bravo, Joseph. Miigwech.

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Review: The Memoirs of Cleopatra, by Margaret George

The Memoirs Of Cleopatra by Margaret George
My rating: 3 of 5 stars

To pick up a Margaret George novel is to experience a well-researched epic work. The Memoirs of Cleopatra is no exception.

George presents a very intimate story of the legendary Cleopatra, who took a bankrupt, teetering country to its pinnacle of wealth, prosperity and influence, despite overwhelming setbacks and obstacles.

My only quibble, as always with George's work, is a certain reservation in the depth of her characters which she tends to move around on the board of her story like set pieces.

Beyond that, an absorbing read.

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Response to Liz Bourke at Strange Horizons

Normally when a negative review (which thankfully are few) for one of my books appears I just shrug. We all have different aesthetics, points of view, something the Internet has allowed us to share through social media.

So it was when I raised the very public hackles of Liz Bourke, reviewer for Strange Horizons, I merely allowed Ms. Bourke her opinion about my novel From Mountains of Ice and carried on.

It would seem, however, her review garnered the notice of another blogger at Pornokitsch, under the heading of Extremist Reviewing. The author of Pornokitsch found great humour in Liz Bourke's evisceration (the author's term, not mine) of my novel, enough to Tweet and generally share around the multiverse. That, also, is fine. Again, we all must find humour, entertainment, and share opinion in order to expand our horizons and understanding of life.

One of Ms. Bourke's strident objections read thusly:

But the first and perhaps the most severe of my problems with From Mountains of Ice is its lack of willingness to abide by the usual conventions of English-language punctuation. Particularly where it comes to commas.

a fluid list of titles and salutations, professions of greatest love and longing, veiled accusations of betrayal through Sylvio's absence, enforced though it might have been, earnest wishes to redress absence. Just the fact Carmelo singled him out was fraught with potential, none of it with hope. (p. 75)

Phrases, especially descriptive phrases, come tacked together with commas when it would be more comprehensible (and less horribly irritating) to use more than one sentence. Several sentences have more commas than they need. Several suffer from a mysterious dearth of commas, where a comma would have added to comprehensibility or to the ordinary flow of prose.

Carried by the outgoing tide they'd be swept out to sea, just as she. (p. 107)

Having laid that foundation, I would therefore entreat both Ms. Bourke and her followers to consider the following passage:

Also — for there had been more than a few migrants aboard, yes, quite a quantity of wives who had been grilled by reasonable, doing-their-job officials about the length of and distinguishing moles upon their husbands’ genitalia, a sufficiency of children upon whose legitimacy the British Government had cast its ever-reasonable doubts — mingling with the remnants of the plain, equally fragmented, equally absurd, there floated the debris of the soul, broken memories, sloughed-off selves, severed mother-tongues, violated privacies, untranslatable jokes, extinguished futures, lost loves, the forgotten meaning of hollow, booming words, land, belong, home.

The author of this passage is guilty, according to conventional wisdom, of egregious writing abuse. I remember clearly reading this passage a few years ago, and those which came before, and after, and the whole dizzying effect of this tumbling narrative. I sat stunned after closing the novel, aware I looked into the face of genius for the second time in my life. Suddenly all I had been taught meant nothing confronted with this monumental art.

I hear your disparagement even now. What kack, Lorina, you say. This is a run-on sentence, incomprehensible, nonsensical. Tripe, to be polite. Unmitigated shite if not.

So? Ah yes so.

The author: Salman Rushdie. The work: The Satanic Verses.

Something to give you pause, eh? A slight blush. Perhaps an ahem or two? I know the feeling.

Now, far be it from me to compare my work to Salman Rushdie's. But there is inspiration here. There is a great deal to study, to comprehend, to emulate. Think about the artistic and emotional effect of that passage by Rushdie.

It has long been said in order to create art you need to understand the rules. And then you need to understand how to break the rules.

And just as that work of art may not be everyone's taste, before slagging it, consider your own biases as a reviewer, whether you're reviewing painting, sculpture, music or literature. This is something I try to remember when I review literature. A review should not be a wholesale condemnation of the worth of a thing. A review is, and only ever will be, one person's opinion. Your trash may be someone else's treasure.

Just saying.

Aiming the pistol at the foot

Despite all my bluster chivvying authors into brave faces, preaching that the un-achievable is attainable, when it comes to my own career as an author I tend to shrink back into the shadows. I have no idea why I do that. But I do. Always have. Call it a character flaw.

However, every now and again I emerge from my cave, or shell, or whatever, and decide, HEY! I can DO THIS! And I summon courage and analyze stories and send out submissions to magazines, collections and the like, keeping careful log of their journeys through an Excel spreadsheet (yes, yes, I know all about Obsessive Compulsion Disorder.)

The current attempt to shoot off my feet comes in the form of the call for submissions for the Tesseracts 18 anthology. I've been trying to break that market ever since Judy Merrill first launched it way back. No joy. And I doubt very much there will be joy this time, but the point is I've at least tried.

Lester B. Pearson, former Prime Minister of Canada, and Nobel Peace Prize Winner, once said: The only failures are those who fail to try.

Hon. Lester B. Pearson

So Lester, ol' bean, old sport, I'm trying. I don't hold out much hope. But to the best of my knowledge I've targeted the right story for the right market.

Of course, this comes on the heels of finding out all the primary round of rejections for the Fearful Symmetries anthology have taken place, and the remaining 355 stories are either still being considered, or have now been forwarded to editor, Ellen Datlow. In this case, no news is good news.

Now, there is a synchronicity about the fact I haven't heard thing one as yet regarding my submission to that heady anthology, because back in the day when Omni was the nirvana of short speculative fiction (I was at Clarion the year Ted Chiang made his first short story sale with the first short story he'd ever written, which was to none other than Ellen Datlow at Omni) I had dreams of maybe, one day, breaking into that market, of having someone like Ellen Datlow pat me on the head and reward my closet scribblings with publication. Alas, it never happened.

Ellen Datlow

But here the gyre curves round again, and I find myself in six degrees of separation.

Dear god, there are days I truly wonder why I do this? Why do I peck at the keyboard, dreaming dreams of people and places, of hurt and triumph, of destinies and deeds? Why answer the sibilant whispers in my head who constantly narrate stories for which I am but a vehicle? I don't know.

But somewhere between editing other authors' stories, creating print layouts, rounds of meetings and discussions and all the trappings of being a publisher, I still pursue this calling of being a story-teller. Keep writing. Just keep writing. And the foot? Ack. It will heal.