Sunday 21 November 2010

charity

Peter Singer, a world-renowned philosopher, tells a story: You are walking by a river in your nice new brown shoes on your way to work when you see a small child floundering in the water, in fear of drowning. Do you jump into the river to save the child, knowing it will ruin your shoes, or do you walk on by and let the child drown? I think it would be safe to say that almost everyone would indeed make an effort to save the child, even if it did mean ruining those nice shoes you just bought.

Now, let's extrapolate this example a little bit. There is a child in a faraway African country who is starving for want of food and won't survive past this Christmas season if nothing is done. You've been saving up for your Christmas shopping, and have some money that if properly spent, will tide the child over until the next harvest. What do you do? In this scenario, I imagine a most people would choose to spend the money on gifts rather than on saving this child.

I imagine there are a few big reasons for this:

1. Distance: in the first scenario, the child is in front of you - you can see him thrashing about, perhaps hear his cries for help, whereas there is no such direct connection with the African child. But should that really make a difference? Is the child in front of you more morally valuable than the child faraway? Is the notion that all men are created equal not impressed from us from the earliest moral teachings? If we truly believe that all people are indeed equal, then an argument of distance is not an argument at all, but rather a willful ignorance of the values who supposedly profess to support so strongly.

2. Effectiveness: In the first scenario, it's quite obvious that you can save the child (assuming you can swim!) whereas in the second, people are often skeptical that the dollars they spend are going to the right places. Now, I don't doubt that there are a lot of pretty poor charities out there, but I also am sure there are good ones as well. As per my earlier entry, using sites like givewell.org (incidentally started by a couple of young hedge fund wizards who wanted to make a difference) and charitynavigator.org really can substantially simplify navigating the morasse of charities that exist. They do the work so you know what you are giving to is effective.

3. Overwhelmed by the problem: Presumably, children aren't always going to drowning in rivers on your walks to work, but the number of impoverished children who are at risk of starvation must seem overwhelming. This is somewhat true, but the fact is the dollar value to eliminate to poverty in the world is absolutely paltry compared to military spending or TARP bailouts, etc... On a more personal level, I think one of the key differences between poverty alleviation and something like climate change is that the beneficaries are individual and discrete: what I mean is that if you decide to donate, you are assured that you will be making a significant diference in the lives of 10, 100, or even a 1000 people. On the other hand, being more green will not stem the tide of global warming unless a helluva lot of other people do it too (not to knock enivronmentalism, because it's very important to). My point is simply that we all can make a substantial difference in the lives of a significant number of people because of the huge imbalance of resources between us in Canada and those who are in extreme poverty abroad. To say that you have saved the lives of an entire family, what could be more rewarding or meaningful than that?

4. I really want to do Christmas shopping: The fact is, you can do both your Christmas shopping AND make those vital charitable donations. We are lucky to be blessed by such an abundance of wealth in Canada that I think we don't actually need to make any major sacrifices to make a big difference. I know that most of the people who read this blog are professionals / soon-to-be-professionals, and I know that all your PTs and engineers, and doctors will be making far, far in excess of the average Albertan family (which is ~65,000/year). I think the average Albertan lives pretty well at that wage, and knowing that many of you will make hundreds of thousands a year, sharing some of that with others who need it more shouldn't hurt too much at all.

I think charitable giving is often framed as some sort of sacrifice that we have to make - "if I give to charity, I won't be able to buy this TV, this stereo, this new car". But I don't think that is how we should think. Rather, think of it like this - that child I sponsor will be able to learn to read and to write and be able to work their way out of poverty, the vaccines I help purchase will prevent that group of people from developing a debilitating illness, the food packages I help will literally save the lives of a family from starvation.

People are always looking for meaning, and what greater meaning and purpose can there be than giving the basic needs so people can live - live to make lifelong friendships, live to fall in love, live to know the joys of family, live to find dreams and aspirations and to realize them - this is what we value in our lives, and this is really what charity is all about.

Christmas charitable giving

'Tis the season to be jolly, and generous - you know what they say, it's better to give than to receive. If you were planning to donate some money this Christmas season, make sure what you are donating to does a good job (http://www.nytimes.com/2010/11/21/opinion/21kristof.html?ref=opinion)

Consider using www.givewell.org or charitynavigator.org to look up the charities you plan to donate to in order to see how good they are, or simply to find a really, really good charity to give to if you don't know where to start.

sex vs love

http://www.theglobeandmail.com/life/family-and-relationships/the-growing-appeal-of-sex-without-commitment/article1804708/

I came across this fascinating article on the 'growing appeal of sex without commitment'. It discussess the growing ascendancy of the notion of friends with benefits (FWB) beyond one's earlier years and well into professional life. I watched a bunch of the trailers that they suggested, but the funny thing was at the end of them it seems that the notion of love is deemed to be more meaningful, deep, and satisfying than the more casual sexual encounters - particulatly because it is love that draws them away from their initially FWB, playboyish lifestyles.

So why is society so obssessed with love, specifically the romantic, passionate love between two people? We are brought up to think that a vital and necessary part of life is to meet that special someone and then spend the rest of your days together - and that people who don't are somehow defective in some way. What drive this imperative? Is it something instinctually written into our DNA? Many would argue that this is not the case, that humans are not designed for monogamy, and that rather the primary biological directive of the male is to inseminate as many women as possible and the primary biological directive of the female is to be able to raise and protect her offspring. If monogamy is not evolutionary, then perhaps religion is the culprit, with a litany of mores on proper sexual practice (adultery, premarital sex, etc... are generally big no-nos), but even then I believe that polygamy is not uncommon in the Bible and the Qu'ran. So society then? Perhaps monogamy was designed as a means of preserving societal stability, so that kids would have two guaranteed parents to grow up with to take care of their wants and needs. But now, does society still need the institution of monogamy to stain intact?

Could you envision a world where we formed deep and close relationships with a network of friends, but there was not one only one person that sex was shared with (somewhat like the FWB notion put forth by the globeandmail)? Or perhaps one in which polygamy was accepted, rather than despised? A little strange, but I have to wonder, in something like 'what sort of relationships are the best', is there really any absolute right or wrong answers, or do we merely become creatures of culture and habit?

Saturday 20 November 2010

parents/children

One morning this week we finished rounds and sat about doing sharing circle. Typically our conversation revolves around typical water cooler talk, for example what happened in Vampire Diaries or one of the seven most current reality TV shows, how bad the traffic and/or weather was during the drive this morning, or how wedding plans are going because wow Becky just got her invitations finished and they look fantastic.

It just so happened that there was an excess of estrogen that day and everyone was in the mood for a particularly teary type of morning, so all of the physios talked about some of their previous patients with incredible stories. In my other blog, I talked about a patient I had who was just the sweetest man and always said thank you very much! whenever I did something. I remember talking to my CI who told me to go do a chart read on him, because somewhere in there it says how he had both of his legs broken by the Nazis, and just barely scraped by and made it here.

So this leads me to the story of one of my colleague's patients she had a few years ago. I actually don't know the patient's name, so we will call him Jack. What I do know is that Jack lived in Germany as a kid, growing up as a tot before Germany converted to Reich-ism. Then Hitler came to power and his life was not the same. Instead of playing with toy cars and tricycles and whatever action figures are appropriate for little children, Jack spent his time carrying ammunition for Nazis to use to kill people. His father was blond hair blue eyed and his mother was Jewish. When he was young his dad sent his mother to a concentration camp and he never saw her again.

Jack ran away from home sometime after that, and nobody blames him. He never talks about his father other than to spit bile and hatred, and nobody blames him. Jack came to Canada, the land of opportunity, and forged a life and met his wife and just tried to live normally.

I don't know what age he was when my colleague saw him in hospital, but I can only assume it was late in life because he was old and his wife was dying. They came together, he was on ortho and she was on medicine. My colleague remembered back to a specific day (and this is where the tissue comes out and she begins rubbing her red-rimmed eyes) when she went to look for Jack for his PM joint class, and she went to his room but couldn't find him there. She went downstairs to medicine figuring he'd be in his wife's room and he was, and she stood there in the doorway and watched them for a second, assessing whether it was rude to interrupt because as cruel as we are as physiotherapists, we are still people and can still be polite. She watched as he held the hand of his dying wife, tears flowing through the wrinkles and crow's feet on his face, and thanked her from the bottom of his heart for being with him and loving him and for giving him the most wonderful life.

Who knew that an inversion of love could exist so? The parent, who is supposed to be the golden role model, burning his wife while the son, who was supposed to follow in his father's footsteps, instead burned with a love for his wife. How dare we complain about our day - our mundane and banal distresses - when we do not understand hardship?

I learned a lesson last week and it is not new but it bears repeating. Be thankful from the bottom of your heart for everything that is beautiful in life.

Saturday 13 November 2010

run, but not too fast



I sat in the most depressing rounds yesterday. In health care, we like to think that we are making a difference to the human being, that we are curing or saving or helping to dispel sickness and the evil that is disease. Why is the classic grad school interview answer to "Why do you want to be a "insert health professional here"?" typically "Because I want to help people/I care about people"? It is because it is trite but true, however cliché it is.

We talked about a patient yesterday who had a psychiatric history of bolting. This is one of those patients that you have troubles putting in restraints because they are Prospero, they are Houdini, they are escapologists to the maximum who seemingly find a way to dissolve through physical binds and create a code white situation.

There were so many problems with the care of this patient. One of the facilities the patient was staying in previously had a fifth floor that was supposedly a secure wing, one of those where you pound five numbers and hit the pound key into the keypad on the wall onto to find an overweight security guard sitting on the other side with one eye on his portable DVD player playing re-runs of Seinfeld and the other eye on you. See the problem was that nobody thought about the design of the building and that the windows actually swivel open in the parlour, and so one day this patient managed to pop the window open and tumble out in their attempt to make a run for the border.

By the time yesterday rolled around, it had been a long time since that incident, but the question we discussed was her fractured pelvis. Our orders were rather backwards, constituting of providing rehabilitation but being ordered to not proceed to aggressively. Essentially, "get her to walk but don't get her too good at walking or she might run". So tell me the point of what we're doing here because I sure don't get it.

What is the failing here? Is the problem the patient for being a psychiatric nightmare? Is the problem the facility management and the federal and provincial funding systems that have not adequately provided an appropriate environment for this lady, bouncing her from subacute to subacute? Is the problem my health care team and its improper attitude towards this patient? Or is this the failings of psychiatric medicine, that the pills and therapies we use are primitive and barbaric?

I gravitated towards health care because I thought could make a difference in somebody's life; I thought I could help humanity one person at a time by being a good man. Instead I'm sitting at a meeting in the morning where we reflect on the number of dementia'ed out 90 year olds who are awaiting long term care placements, commenting that we should be able to sign something when we're younger and have full capacity that if we know we are going to end up this way, old, frail, confused and combative, we authorize society to mercifully euthanize us.

Monday 8 November 2010

evolution of political ideals

http://www.miller-mccune.com/politics/a-new-take-on-political-ideology-24683/

A fascinating article on the evolutionary reasons why someone might be liberal or someone might be conservative....

Sunday 7 November 2010

the hythe life

I am entering the last week of my rural rotation in Hythe/Beaverlodge, and I confess that I am eager to return home. The rural life probably isn't ideal for me, but I have tried to expose myself to some of its (more stereotypical) elements...

1. Guns: It seems >50% of the people around here hunt: rifles, shotguns, bowhunting (no jokes, Napoleon Dynamite). Not just men - the women too, and then they eat what they hunt. Cheap way to have some game meat, mind you. I had the chance to go shooting with an RCMP officer, a very nice fellow married to one of the nurses int the hospital. We shot clay disks with a couple shotguns, and boy they do have some recoil, and then we put up an upper torso target and used a scoped .22 to snipe at it. A pretty fun experience, all-in-all, something that I wouldn't do much of in the city...

2. Farming: I've been staying in the basement of an older couple who own a farm. We've had quite a few talks about farming - a really interesting field that I would imagine the average non ag-for college-educated student knows nothing about. Today, Mr D. took me out to the farm and gave me a bit of a tour. I must say, I was pretty amazed at the array of the machinery he had. Mechanization for the win. We sat in the combine, took a ride in the tractor, drove down country roads in a large trailer truck, and quadded around one of his eight quarters (a quarter is 0.5 mile x 0.5 mile parcel of land). 8 quarters apparently produced something like 900 tons of grain and 600 tons of canola this year. What surprised me was that he mostly works by himself, except during sowing and harvesting season, when he hires some help. He also seems to repair most everything by himself, which is amazing considering any given piece of farm equipment easily costs in the hundreds of thousands of dollars. What a world of knowledge there is out there!

3. Country bar: This one didn't seem much different from a regular bar, although I did end up seeing some of my patients there, which was a bit of an odd experience. Everyone really does know everyone when the population is low enough. This would have been better if I was drinking, but alas I was being a responsible lamer.

4. Stars: So this might not be stereotypically rural, but the stars outside large cities are absolutely gorgeous. You an actually see thousands upon thousands of stars, so many that the constellations get a little confusing. Even the milky way forms, well, a milky band across the sky that is quite visible - gorgeous!

All-in-all a bit of a cultural immersion that I am unlikely to repeat with any regularity in the future. Still, it's good to see a slightly different way of living that's not all that far from home.