Who's Afraid of Angela Rasmussen?

Once upon a time, scientists explained their findings and opinions in peer-reviewed journals or in carefully worded lectures delivered at scientific meetings. Now science moves at  internet speed and Twitter has taken the place of learned societies as a favored forum.  In the white hot propaganda war over the origin of SARS-CoV-2, scientists on opposing sides of the lab-leak versus nature debate have taken to Twitter like penguins in search of lunch in Antarctica's waters. There they heave nasty adjectives at their opponents with all the subtlety and care of the late Rush Limbaugh. Recently, a virologist named Angela Rasmussen (who claims over 200,000 Twitter followers), formerly of Columbia University's Mailman School of Public Health, and now with the University of Saskatchewan's Vaccine and Infectious Disease Organization, threw certain adjectives at me. I had been a guest on a Canadaland podcast explaining the findings of my new book, On the Origin of the Deadliest Pandemic in 100 Years, to Jesse Brown. Ms. Rasmussen, who, since the pandemic began, has turned into a one-woman defender of globalized virological science on as many TV shows, newscasts, magazines, and newspapers as are willing to quote her (see her cv), got herself invited to the Canadaland podcast to denounce my book and her version of the main theory it propounds.  

I  don't normally fuss over critiques of my published work. Journalists who throw stones are used to stones being thrown back and a good critique improves the work.  I also try to live by a line made famous by champion boxer John L. Sullivan when some drunken twerp challenged him in a bar: "If you hit me," said Sullivan, "and I hear about it...."On the Origin of the Deadliest Pandemic in 100 Years exposes undeclared competing interests, cover-ups by China's officialdom, the manipulation of Canada's National Microbiology Laboratory by China's civilian/military virological establishment, and that labs outside the reach of US regulation have been doing dangerous gain-of-function experiments with USAID and NIH money given to them via a New York charity. The book follows the money and it names names. It shows that science done in authoritarian regimes cannot be trusted and why. So I expected pushback and I welcome it. 

Nevertheless, I must respond to Ms. Rasmussen. She makes too many untruthful claims to ignore. While Ms. Rasmussen is entitled to dump on my book if she's read it, her critique on the Canadaland podcast made it clear she hadn't. Though I wrote to Jesse Brown, as did my publisher, asking him to attach my rebuttal of her false assertions to her podcast episode, Canadaland decided not to "re-litigate" the matter. Thus, this blogpost.

I listened with amazement as Ms. Rasmussen began by accusing me of publishing a book  that is "riddled with error starting with the title." Why was the title in error? Ms. Rasmussen insisted that HIV/AIDS is the deadliest pandemic in 100 years, not SARS-CoV-2/COVID-19. While it is true that HIV/AIDS has killed about 35 million people over fifty years, Ms. Rasmussen must know that the WHO--which is the international body charged with declaring pandemics---did not declare HIV/AIDS to be one. Killing 35 million over fifty years is bad, but killing at minimum 6 million people around the world (while infecting hundreds of millions) in 18 months is the worst pandemic in 100 years.   

Ms. Rasmussen then asserted that my publisher failed to fact check the book as evidenced by the title. In fact my publisher had four fact checkers go over it from the cover to the acknowledgements--400 pages with over 400 end notes drawn mainly from scientific publications but also from interviews with virologists--  starting with the title.

Ms. Rasmussen insisted that if only I'd bothered to interview virologists, I would have been set straight on a number of points, including the function of a genetic sequence conserved in all coronaviruses known as the RdRp ( which stands for the RNA dependent RNA polymerase). That's when it became quite clear that she had not bothered to read the book but was responding to what she thought I said in the interview I'd given Jesse Brown. If she had read the book, she would have known how many virologists I tried to interview, and who among them finally agreed to speak with me. One who did consent to be interviewed, virologist Linfa Wang, is a close associate of Shi Zhengli, the so-called Bat Woman of China. It is Shi Zhengli's lab that has become a focus for those arguing that a leak from a lab may have caused the pandemic. I interviewed others as well, but in particular a Canadian government virologist, Basil Arif, who ,since 1998, has worked on the journal Shi edits, Virologica Sinica, which is  published by the Wuhan Institute of Virology. Arif has also done  important papers with Zhihong Hu, the former director of the WIV and the former boss of  Shi Zhengli. Arif has been going annually to the Wuhan Institute of Virology for more than twenty years, which cannot be said of Ms. Rasmussen who admits she doesn't know Shi Zhengli, but knows "friends" of hers, and that she is "honest." Unfortunately, as my book shows, that claim is also far from true.

When Brown asked Rasmussen why, if my book is riddled with errors, the well-known science writer and editor, Nicholas Wade, had praised it, she replied that Nicholas Wade should be ignored on the grounds that a book he wrote in 2014  defines him as a racist. (Racist is a word she hurls around fairly frequently, along with the epithet grifter.) Wade's views on the subject of intelligence, the subject of his book, are beside the point. The article he wrote in the Bulletin of Atomic Scientists-- describing, among other things, his concern about how leading scientists tried to label as conspiracy theorists all who raised the possibility that SARS-CoV-2 leaked from a lab--finally made it possible for leading major media in the US to publicly consider the question.  Instead of speaking to Wade's points, she used a vile name to try to write him off.

Similarly, she mis-characterized what I wrote about the unusual five year relationship between the National Microbiology Laboratory in Winnipeg and the leading military/civilian virologists in China, including George F. Gao and Major General Chen Wei of the Peoples' Liberation Army.

She also insisted that I believe the genome sequence known as RaTG13 is the viral ancestor of SARS-CoV-2. In fact, the book makes clear that I believe RaTG13 is a red herring and a symptom of the many things we have not been told about work done in Shi Zhengli's lab. While until recently RaTG13 was the closest published viral sequence to SARS-CoV-2, it is fairly distant and does not have the furin cleavage site which makes SARS-CoV-2 so efficient at causing infection. (We now know that Shi Zhengli, Linfa Wang, and American colleagues Ralph Baric and Peter Daszak sought $14 million from DARPA in 2018 to, among other things, insert furin cleavage sites into SARs-related coronaviruses isolated by Shi's lab. They didn't get that grant, but we don't know if Shi Zhengli got grant money elsewhere and did the planned experiments herself.) My book makes clear that I like best a quite different origin theory proposed by plant virologist Jonathan Latham and his partner,  Allison Wilson. They sought to explain why SARS-COV-2 appeared to be so well-adapted to human beings from the start of the pandemic. If it originated in a bat or jumped to humans through an intermediate animal, why were there so few mutations in the first few months of its circulation? This adaptation to humans from the start was pointed to by Alina Chan and colleagues who compared it to SARS's rapid mutation in the first quarter of its circulation. Chan's work was only published as a pre-print (and poohpoohed as such by Rasmussen) but many other scientists in peer-reviewed papers pointed to the same issue, including one paper published in the journal Cell and commented on by Rasmussen herself. 

Latham and Wilson argue that SARS-COV-2, or its direct ancestor, became well-adapted to humans in the lungs of six miners back in 2012. They had been hired to clear bat feces out of a copper mine in Yunnan, China. They got terribly sick with a SARS-like pneumonia. Three died. Samples of serum from them, taken over the course of several months, were sent to Shi Zhengli  at the Wuhan Institute of Virology because she was by then expert in SARS-like coronaviruses. Shi only admitted she had those samples after a Masters thesis and PhD thesis describing the miners' illnesses, treatments, and where their samples were sent, were discovered by members of a group of curious volunteers called DRASTIC. Shi Zhengli has still not published anything about what she found in those samples but has confirmed that they remain in her lab and that she revisited those samples "recently." Latham and Wilson argue that studying those samples would have given Shi a ringside seat  as a bat virus evolved in real time into something that could easily infect humans. When challenged by Jesse Brown on that point, Ms. Rasmussen said Latham and Wilson are plant virologists, so their argument holds no water. In fact, their argument had already been supported by a study done in the UK  and published in a medical journal in February. Doctors there took a series of samples of the virus over several months from a man infected with SARS-CoV-2. These samples were sequenced and showed in real time how the virus adapted through mutation to evade the different treatments tried.

Toward the end of the podcast, Brown asked Rasmussen if she knew why W. Ian Lipkin-- one of the coauthors of an early paper published in Nature Medicine that claimed a lab leak to be highly unlikely-- had changed his mind and wanted a proper investigation of that possibility.  Over most of 2020, that Nature Medicine paper was pointed to again and again as the refutation of any who dared to say a lab leak might have been possible. That paper served the propaganda interests of China, but also the interests of the American institutions that had funded Shi Zhengli's work--USAID, the NIH/NIAID--through EcoHealth Alliance, also a major funder of Lipkin's work at Columbia's Mailman School. Most of the paper's coauthors, including Lipkin, failed to acknowledge any competing interests, such as their relationships with those funders and with China. Ms. Rasmussen told Brown that though she used to work for Lipkin  (until 2020),, she did not know why he'd changed his mind. Yet Lipkin had been widely quoted on that subject. He said information had emerged about very dangerous gain-of -function experiments done by Shi Zhengli and her colleagues in low security labs. This is "unsafe." Even if Ms. Rasmussen did not read those articles, if she'd read my book she would have known exactly why Lipkin changed his mind.

Ms. Rasmussen may be a terrific virologist but critiquing a book she did not read is a dubious scientific practice. She might want to reconsider as well her strong support of global cooperation among scientists without regard to the conditions under which some scientists work. In particular, she should rethink whether we can rely on science done by colleagues working in authoritarian regimes. Early in the pandemic, China's officials made clear to its scientists that they must get official permission to publish anything on SARS-CoV-2, or else, and that getting that permission would depend upon whether an article fit the propaganda interests of the government of China. Scientists in the West need to take care to avoid being dragged into China's propaganda machinery, which is extensive. The Propaganda Department of China regards scientific publishing as part of its purview and reports directly to the highest leadership.

Ms. Rasmussen's appearance on the Canadaland podcast was clearly useful to China.  CGTN-- the China Global Television Network-- took note of it and published on its website an  article that bears this false title: "Virologist refutes Dewar's theories....'"  

Virtual Book Launch for On the Origin of the Deadliest Pandemic in 100 Years: An Investigation

Please join me for the virtual launch of my new book, On the Origin of the Deadliest Pandemic in 100 Years: An Investigation. Dan Wells, founder of Biblioasis, my publisher, has asked the wonderful novelist, non fiction author, and former Harrowsmith Editor, Wayne Grady to interview me. While the book has garnered interest from the CBC, the Globe and Mail, and the Toronto Star, there is a lot to discuss that newspaper articles and national news reports cannot convey which might be of interest to anyone getting ready to cast a vote in the federal election. The format permits us to take questions from any who have them.

The interview will be live-streamed starting at 6 p.m. on Wednesday, September 15, 2021. You can view the live stream and participate on Facebook or YouTube.

Hope to see you there.

Elaine

My new book: On the Origin of the Deadliest Pandemic in 100 Years: An Investigation

On the Origin of the Deadliest Pandemic in 100 Years: An Investigation is the title of my new book. It is the product of more than a year's hard digging into the origin of the SARS-CoV-2 virus. It will be out by the end of August in Canada, the first week in September in the US. 

It is without doubt the hardest book I've ever written. Doing an investigation during a pandemic required me to reinvent the tactics I used when I started in journalism in the early 1970s. My first job for Maclean's Magazine was to research a story on the planned Montreal Olympics for a writer who had strong opinions about why it shouldn't go forward, but no facts to back them up. To do that project, I rarely left the periodical section of the University of Toronto's Robarts Library because what I found there about past Olympics --all had involved financial boondoggles-- was great support for the writer's argument. ("You found this in the library? In the newspapers? In magazines? Really?") To do this one, I rarely left the house, working instead on two computers and a smart phone which provided instantaneous access to a tsunami of information. In the beginning, when we were locked down, no one was allowed to leave their home for any reason other than to buy food (and toilet paper) or for a medical emergency. Even if I'd ignored those rules, it wouldn't have got me anywhere. Most of the researchers I wanted to interview don't live in Canada and weren't in their labs anyway.  The borders were shut. Most government officials were working from home. Parliament was closed. So I was forced to develop my own imperfect version of the method of inquiry once wielded like a broadsword by the legendary US journalist I.F. Stone. His most important scoops came from careful reading of public documents and deft use of the Freedom of Information Act.   

I read everything I could find in learned journals, in pre-print literature and on academics' blogs about the nature of SARS-CoV-2, its relationship to other coronaviruses, its chemistry, its evolutionary history, the very unusual structure of its genome and its near perfect adaptation to human beings from the very start of the pandemic. I scoured the worldwide daily press, dived down many internet rabbit holes, made too many access to information applications. Most knowledgeable researchers, to my surprise, didn't answer my emails. That was a first: usually scientists want to discuss their work with journalists. It helps them climb the tenure ladder to get their ideas circulating in the broader community. More astonishing was the lengths to which civil servants went to protect themselves and their political masters from embarrassment by means of improper redactions and outright refusals to comply with the access to information law. As I figured out who I had to talk to, if they responded (a few did) I  interviewed them by means of email and telephone. But it was mainly through their published works that I came to know then. What I learned about the way globalized virological science has been practiced over the past twenty years surprised and enraged me. Certain names kept coming up: Shi Zhengli, Linfa Wang, Peter Daszak, Ralph S. Baric, Kristian Andersen, Zhihong Hu, Xianguo Qiu, Keding Cheng, Chen Wei, E.C. Holmes, George Gao. 

The book is both a detection narrative and an exposition of the political and scientific context for the worst public health disaster since the great flu epidemic of 1918/19. It points fingers. It names names. It describes the way in which the government of China, from the very beginning, withheld vital information and promoted false-by-omission scientific narratives in order to deflect blame even as it permitted the virus to spread. China's relentless PR campaign began at the end of December, 2019 even as the first mention of a nasty pneumonia circulating in Wuhan found its way to social media sites and from there to the West. China was helped in its efforts by the WHO, whose job is to protect the world from such disasters, and even more shockingly by some of the world's best scientific journals, our leading coronavirus experts and the US institutions which fund their work. All were more anxious to protect their interests than to pursue the truth. The book describes in detail how China used the globalization of biological science as cover for dual-use research that could not be done at home, reaching into the most secure laboratory in Canada for the study of the most dangerous pathogens  (Ebola, Marburg, Nipah). China's top military/civilian scientists (there is no boundary between them) used it as if it were their very own lab for years. 

More than 4 million people are known to have died from SARS-CoV-2 since December, 2019. That number is at least twice as high if suspected, but not certified, COVID deaths in India are factored in. It will continue to grow as the virus wends its way throughout the mostly un-vaccinated developing world, mutating as it goes, stumbling on ever more clever means to infect humans and the susceptible animals that live near us. These deaths are not and will not be the result of an unavoidable accident of nature: they are and will be the product of the very best human minds.

As the 4th wave begins, it's time to hold some of those humans to account.

Stay tuned.

Part III: Reflections on the Second Wave: A Feminist Journalist Remembers Herself

In Feminist Acts, Tessa Jordan suggests that hundreds of small, Xeroxed feminist newsletters plus a few magazines and journals with tiny circulations, carried Second Wave ideas to Canadian women. Apparently, Canadian feminist scholars refer to these homemade publishing ventures as the Print Project. But again, that is not the whole story, not even the main story. Television may actually have played a more formative Second Wave role in Canada, thanks to Bonnie Kreps.

Kreps, a Danish immigrant to the US, was a Phi Beta Kappa graduate of Reed College with an MA in English from University of Pittsburgh when she arrived in Toronto in the middle 1960s. Her husband had been appointed an assistant Professor of high energy physics at U of T and they had a young daughter whose care had fallen primarily on Bonnie's shoulders as she was earning her Ph.T. ( otherwise known as Putting Hubby Through). She knew the Problem With No Name from hard personal experience and was a committed radical feminist. She was in close contact with women in New York, especially her sister Anne Koedt, who were reformulating de Beauvoir's ideas, women whose seminal feminist works would be published only a few years later.

Kreps, representing no one but herself, presented a Second Wave brief to the Royal Commission on the Status of Women in 1968. She set out the radical feminist analysis of the damage done to women by socially constructed and discriminatory gender roles, and why there must be a radical change in belief systems, not just laws, if women were ever to get out from under them. In other words, she demonstrated how it is that the personal is political, the core idea of the Second Wave, an idea later reflected in the Commission's report. By 1969, Kreps was working at CTV. She launched what became a distinguished filmmaking career with a special documentary for CTV's flagship public affairs show, W-5, called After the Vote: A Report from Down Under. The show went to air before an audience of millions and introduced many Canadians who did not read Chatelaine to Second Wave ideas-- even to those of Ti- Grace Atkinson who called for female separatism. That show was made five years before Branching Out published its first issue, ten years before Broadside was launched.

My husband, Stephen Dewar, was Krep's colleague at CTV which is how I met her, became her friend, and joined the radical feminist group she co-founded called The New Feminists. Its meetings, its consciousness-raising sessions, allowed me to hash through with older and more experienced women the ideas still burning in my brain from reading de Beauvoir. They shared with the group their lived experience of how gender roles oppress: how raising children fell unequally upon women regardless of how much they earned; how men at the top of institutions thought it reasonable to promote men ahead of women regardless of competence simply because they were men; how rape and other forms of physical brutality were used by men to keep women in fear and in their place; how ignorance of our bodies denied many women sexual pleasure; how Patriarchy amounts to a socially organized and socially sanctioned abuse of power. At first there were only a few women in this group. By the time it fell apart a few years later it had 300 members and many other such groups had formed across the country. In a few short months as a New Feminist I learned that if I didn't set aside the notions drummed into me since childhood concerning motherhood, wife-hood, and femininity, I would live and die without ever having a voice of my own. And I wanted that voice.

To give Jordan and Masters their due, their books made me remember my own feminist history. Until Jordan described Branching Out's organizational issues, I'd forgotten how important it was to Second Wave feminists that our organizations be feminist in their internal operations. A vital insight of the Second Wave-- a corollary of the dictum that the personal is political--is that socially approved abuse of power in all its forms-- legal, economic, social, but especially physical-- is what circumscribes women's lives. Radical feminists argued that the way out of bondage was to be the opposite of the male slave master, to embrace egalitarianism, to operate through consensus and without leaders so as to refrain from imposing new structures of power on the previously voiceless and powerless. The opposite of the feminist was the Queen Bee--a woman who fought her way to the top of an organization only to use her power to suppress her sisters.

Both Jordan and Masters discuss how this discourse on power permeated operations at both Branching Out and Broadside. Though Broadside was incorporated as a for profit entity ( to avoid being "taken over" by hard left groups trying to foment a different kind of revolution), it functioned as a leaderless collective. Masters asserts that not one single vote had to be taken in ten years, because, as she put it, its members knew to step back when someone else knew more. By contrast, Branching Out started as a non profit, consensus-driven feminist collective, but according to Jordan, soon discovered that a rudimentary hierarchy was needed. There had to be an editor to drive the publishing process or deadlines would be missed and the magazine would not get to the newsstands. Editing was also necessary for clarity and readability (though at other feminist journals editing was deemed to be power abuse and therefore verboten). Instead of power-free egalitarianism, Branching Out offered its volunteers colleagial autonomy, similar to the way we worked at Maclean's Magazine at that time. We had a boss, Peter C. Newman, who could fire us if we screwed up, but we dreamed up our own story ideas which were then thrashed out further in editorial meetings. Submitted pieces were circulated to all editors for comment and if there were disagreements they had to be resolved or the piece would not be published. At one editorial meeting when Maclean's still had an outside editorial board, I had a fight with Barbara Frum, then a member, over whether or not I should ask Myrna Kostash to write a piece on rape as a crime of power aimed at the mental as well as physical subjugation of women. Frum insisted rape is an assault like any other: I countered with Brownmiller's argument, that it is the very definition of the abuse of power by men over women, the fear of which keeps women in their place. Maclean's ran Kostash's story.

But as with so many theories about social change, the main product of this insight about power was not freedom from it, but endless disputes in feminist groups over who was acting like a leader when there weren't supposed to be any, who was hogging the limelight, who was actually making decisions while merely pretending to honour consensus. While we recognized how we suffered from the abuse of power, we failed to appreciate that social hierarchy is basic to all primate societies and not easily curtailed. More to the point, we failed to appreciate how consensus could become a vise throttling the ambitions of the women who drove the Second Wave.

Renowned sculptor and fellow New Feminist Maryon Kantaroff explained this to me when I interviewed her in 1977 in Toronto for a story in Weekend Magazine on why the New Feminists folded. ( This piece is referred to in Inside Broadside with some disdain). Kantaroff explained that she had grown tired of moving at the pace of the slowest, but even more tired of being the group's workhorse. "All of us who were the real driving forces were, without exception, very personally ambitious women. Feminism liberated our personal ambitions," she said. "...There came a time when we could say, now, my work. I've got to go ahead." Kantaroff by then had come to believe that to make change, power had to be grasped, it would never be given up voluntarily by those wielding it. That's why she intended to start a political party --The Feminist Party-- that would be "totally elitist, totally elitist...They'll be knocking down the doors to be in this elite group of feminists who are organizing a political structure."

# # #

Part II: Reflections on the Second Wave: A Feminist Journalist Remembers Herself

Betty Friedan's ideas were old hat in Canada by the time The Feminine Mystique was published in 1963. Canadian women had been writing and publishing on legal and cultural means of suppression ever since Doris Anderson became the Editor of Chatelaine in 1958. Doris' managing editor, Jean Wright, refused a chance to excerpt The Feminine Mystique because Chatelaine had already covered everything in it.

Yet Tessa Jordan appears to accept Branching Out's founding Editor Susan McMaster's claim that in 1972, before Branching Out was first published, " there was no feminist periodical in Canada that sought a national audience and had the newsstand appeal of Ms. or Chatelaine." She is right about the newsstand appeal of Chatelaine, but this suggests Ms. and Chatelaine were equivalent, though they were not, while simultaneously implying that Chatelaine was not a feminist magazine. And yet it was. Regardless of its ads and fashion features, under Doris Anderson's editorial direction Chatelaine carried feature after feature, column after column, editorial after editorial, detailing the unfair laws and social restrictions which hedged women (and men) in coffin-like sex roles. Her editorials urged women to get up off their knees and change them. She raised Chatelaine's circulation from about 460,000 to over a million not by shying away from feminism, but by featuring it, and pointing out that thanks to the First Wave, her readers had the right to vote, to make their views known to MPs, to stand for election and get things done.

Without Chatelaine and its wide audience, there would have been no Royal Commission on the Status of Women in 1968. When feminist activist Laura Sabia threatened then Prime Minister Lester Pearson that he'd better set that Commission up or she'd have two million women on the front lawn of Parliament Hill protesting, Chatelaine's popularity and seriousness made that threat credible. And without that Royal Commission reporting its 137 recommendations in 1970, (the same year Germaine Greer's The Female Eunuch, Millett's Sexual Politics, Anne Koedt's The Myth of the Vaginal Orgasm, Firestone's The Dialectic of Sex were published) there would have been no National Action Committee on the Status of Women, better known as NAC, funded by Ottawa. NAC hounded politicians on important issues year after year: its arguments about how and why immigrant and racialized women were being left behind ushered in the Third Wave in Canada.

Without that Royal Commission, there also wouldn't have been an Advisory Council set up to advise the Minister of the Status of Women (another product of the Royal Commission). The story of the blow-up over that Council is only touched on in Inside Broadside but it really matters. Doris Anderson was appointed to it and then became its President after she left Maclean-Hunter in a blaze of fury because its board did not appoint her Editor of Maclean's. She then ran but failed to get elected in a federal by-election as a Liberal. By the time she joined the Council in 1980, it had become a tame extension of the Status of Women's Minister's will. Thinking of Doris Anderson as a political hack who would do what he deemed to be politically useful may have been the biggest political mistake ever made by Lloyd Axworthy, then Minister of the Status of Women.

By 1982, a joint committee of the House of Commons was voting on the wording of the Canadian Charter of Rights and Freedoms, the framing document for the about to be repatriated Constitution. Needless to say, the Charter mattered to the future status of Canadian women. It was well known that some leading feminist constitutional lawyers were very concerned about how the Charter's proposed wording would affect women. Yet Axworthy twice cancelled a national conference on the Constitution organized by his own Council. So Doris Anderson resigned. Inside Broadside republishes a report of the eruption that followed written by activist Kay Macpherson. Her piece is interesting, but it is only one woman's view of events, not journalism. It took a mainstream, ad-driven, controlled-circulation women's magazine, City Woman, and its Editor (and my friend) Dawn MacDonald, to help raise a national hue and cry called the Butterfly Campaign to get women's views proper attention on Parliament Hill. In three weeks flat, an ad hoc group including Macpherson, Linda Ryan Nye, and Marilou McPhedran organized an alternative national constitutional conference in Ottawa. The 1300 self-selected and self-financed attendees who came from across the country, met for two long days in premises supplied first by Ottawa Mayor Marion Dewar and Conservative MP Flora MacDonald. They voted on a list of recommendations, including that the Minister of the Status of Women resign. ( He did not. But Prime Minister Pierre Trudeau eventually replaced him with MP Judy Erola.) Attendees lobbied all political parties on what women wanted to see in the Charter. And it was ad-driven City Woman which, several months later, carried a long and careful piece of real journalism about these events and their aftermath, written not by a participant with only her own part of a big story to tell, but by then journalist Anne Collins. Collins interviewed most of the important actors and was able to lay out what happened, why, and what it might mean.

# # #

Field Notes from a Medicare Disaster: Sixteen

The day he came home is a blur. Yet I have one strong recollection--like an overhead shot taken from a room above Providence's main door-- of me standing outside at the curb in the brisk morning air as they loaded him on a gurney into a medical transport van. There is a bright red jacket in this image yet I am not certain whether he wore it or I did. This obliteration of boundaries happens all the time when one has been part of a couple for more than 50 years. His body becomes yours, his memories are events that happened to you, and vice versa. I think I was elated but maybe that emotion was his. It's more in keeping with his nature. It's more likely I was anxious.

They bumped him in a transfer chair up the front steps to the house and into the front hall. They also brought home his wheelchair while I brought the metal walker I'd purchased for him at Providence in our car. They helped him get to the stairlift and he rode it up to the second floor. It was hard for him to get settled on its chair, hard to put his feet in the right place on the fold down platform, hard to learn how to use the controller that sends the chair up or down, hard to change the chair's orientation, to make the seat-belt work. It was even harder to remember how to turn the damn thing on after we inadvertently turned it off. With each mistake, I panicked. What if I couldn't get the stairlift going again? He'd be stranded. I probably phoned the company that installed it five times over the next three days. Yet the stairlift worked well, it was me who kept screwing up. And the bathroom was fine too, all the handholds were exactly where they needed to be, there was plenty of room for a big man using a walker.

He'd been away for two and a half months. In the US, if he'd been ill in hospital that long without sufficient insurance we'd be bankrupt. Give thanks for where you had the good sense to be born, I wanted to shout. Dad, you were right but also wrong.

 My guy seemed pleased to be home.

The first night, I didn't sleep much, listening in case he needed help. And he did.

The next morning, the first of a series of personal support workers arrived at about 8 in the morning, sent by the Local Integrated Health Network's contracted supplier of home care. A worker was supposed to come every morning for the next week to help get him up and dressed. He was entitled to one hour of care (which in real time as opposed to care time is no more than 45 minutes because 15 minutes of each hour is travel time). During that week, my guy would also be assessed by senior coordinators who would determine his actual allotment of publicly-funded care and the duration of same. It didn't matter what some doctor or hospital physiotherapist had to say about his needs, the LIHN makes its own decisions. He was in no condition to be left alone in the house, yet in that first schedule no time was allotted for me to go out for simple things like groceries.

The city is divided into regions each served by a single contracted supplier of public home care--they employ RNs, practical nurses, physiotherapists, occupational therapists, personal support workers. They are supervised by the district LIHN's care coordinators. You'd better get on well with them unless you have sufficient funds to hire private care. (The cost of private help is about $100 for a minimum of four hours. Personal service workers do not get paid $25 an hour, though they clearly deserve it. Their cut of the private take is just a tad higher than minimum wage.) I'd had a few run ins with the care coordinators of the home care supplier in my mother's district. There were many, many failures to arrive on time, and failures to assist her private caregiver as required by their own determination of her needs. I'd become used to dealing with that sort of trouble: I had learned to keep asking for the supervisor, and then the supervisor of the supervisor, going all the way up the food chain until I got to the CEO. This is not easy. Staff members don't want to attract the attention of the CEO when a complaint is involved. Yet CEO's of organizations delivering publicly funded home care generally like to keep their clients happy, and are determined to prevent them from running to the LIHN or the Ministry of Health to complain. Journalists are good at getting through the bureaucratic spread-the-responsibility-so-no-one has-to-fix-anything evasive maneuvers that result. So it's those not so good at raising a ruckus who suffer when things go wrong. As they did, and right from the start.

The LIHN's assessment personnel had been to see my guy after his previous hospitalizations, had ordered physiotherapy for a few weeks after the last concussion.  They had been notified by Providence to reopen his files and had made appointments with me to come to see him again. I remembered the occupational therapist very well, a cheerful, bright woman very determined to work the system as hard as possible to get her clients as much help as possible. The LIHN's overall care coordinator was not so cheerful, more soulful, but very able and equally determined to help as best she could. The level of help we would get would depend on their professional judgement leavened by the available budget, a budget which has barely moved over the last ten years in spite of a 40% growth in demand for help in the last five years. That budget had already been stretched to the break point by late spring because 2017/2018 was a bad flu season. Did he need physio? I thought that was obvious. At Providence they thought it was obvious too. Our doctor asked for it.  Yet the LIHN could refuse it. Did he need a specially measured walker, a specially designed wheelchair? Did he need a wheelchair at all? The wheelchair became a matter of  contention. If he was able to walk a little and wasn't sitting in it all day, why did he need one specially designed to fit his body? The need to use it outside didn't matter. He could have an ordinary wheelchair for that. The one he'd been sent home with was really expensive.

In my area, public home care is provided by a non profit affiliated with a downtown teaching hospital. In the daily forty-five minute period actually allotted to him, the personal support worker assigned to him by that organization was expected to help him get out of bed, get to the bathroom and to the shower bench where he would wash, shave, and dress, then help him get to wherever he was having his breakfast. They were also tasked to make the bed, carry down the dirty laundry or any garbage.  I only repeat what their orders said: I know because I was given a copy.

But that's not what happened.

The first morning a tiny woman knocked on the door. She was late yet actually on time, as is explained on the non profit's voice message system when you call in to find out where the hell your worker is. On time means 15 minutes on either side of the appointed hour.  I had to give her a short lecture on my guy's condition, because she knew nothing about him when she arrived, and to explain what she could expect given his unnamed disorder, how to use the new shower without getting soaked herself, where his clothes were, and his shaving equipment. She had arrived without plastic shoe protectors so I had to tell her to take her shoes off to use the shower. She didn't like that. She looked at my guy with something akin to fear. She said she did not shave people: she said she was not allowed to. So after I showered him, with her looking on, I shaved him too. She helped him get dressed, took a poor stab at the bed-making which I decided then and there I would do myself, left the laundry and the garbage disposal to me, and went on to her next client. I got on the phone and explained to the supplier's care coordinator that we were going to need a man or woman big enough to help my guy, that the small woman they had sent had quite obviously been afraid, and perhaps did not have the necessary skills to deal with a big man with movement issues on a damp floor.

The young care coordinator, a woman who spoke extremely quickly on her voice mail message, as if seriously pressed for time yet also sad and tired, said there weren't many men available, that would be a problem.

I explained that they'd have to dig up someone big enough somewhere, or there would be an accident. I explained I had ended up doing most of the showering. And the shaving.

The next day, they sent a man.  Again, I had to explain my guy's condition, had to explain about his slow movements, had to make sure the worker learned how to use the shower without getting soaked himself. This worker also said he was not allowed to shave anyone. So I did it. And I made the bed, and took down the laundry, and the garbage, and brought up the breakfast.

The next day again someone new arrived--a woman. Once again, I had to train her in my guy's issues, to make sure he got safely into the shower, to make sure she learned how to use it without getting soaked. Again, this person said she was not allowed to shave him. So I did it.

By the fourth day I was beginning to wonder why they sent anyone at all since I was either doing the work or supervising it.  While they stood behind him watching him struggle to the bathroom, I was making the bed, fishing out his clothes, then running to the shower whenever the worker called for help. Which was frequent.

On the fifth day, no one came. When I called in, I was told the worker, yet another new one, was going to be late, very late, more than an hour late. I told the care coordinator to tell that worker not to bother, I wasn't going to leave him lying in bed that long. That was the morning I discovered that I could do everything that needed doing, including showering him myself and that he preferred that I do it. And why wouldn't he? Four mornings in a row he'd had to stand stark naked in front of total strangers as they washed him. My guy is not shy. But many people are. (If it had been me, I would have said I don't care how dangerous it is I'm going to shower myself, you wait outside.) There was no time for him to get to know these people, unlike at Providence where the same small group of nurses helped him every day. I wondered: how upset would a person with Alzheimer's or some other form of dementia become when faced every day with strangers yanking them out of bed and pulling their clothes off?

And yet, looked at from the worker's point of view, they had more to complain about. Every new client was a steep learning curve. The fact that they managed to address each person's needs at all was a testament to their adaptability.  Almost all were new immigrants, most with very different styles of life in their former countries. In this job, they were poorly paid members of the precariat. They were under constant stress to get on to the next client waiting in the queue.  They had to arrive on time, leave on time, get to the next household on time and a lot of them did it for 10 hours a day, six days a week, if their employer asked them to. This would be barely manageable even if all the clients were mobile and didn't hold them up. One slow poke would blow the whole schedule. Toronto traffic is so bad that getting from one point to another on time is more than difficult. In small communities up north, the geographic range covered by personal service workers can be very large. My guy is a terrible challenge to this system. A movement disorder means he can be extremely slow getting from bed to shower and out again. Rushing will end in disaster. Forty-five minutes is not time enough to get it all done. If my guy was having a slow morning, and he has plenty of slow mornings, though they tried to conceal it most workers became agitated, keeping careful eye on their watches, which bothered him. Being a nice guy, he tried to send them on their way early, even if they weren't done.

That morning, I was tempted to tell the LIHN to forget sending workers, we'll manage ourselves. Yet I didn't. After only a week of being on call 24 hours a day, I knew I would buckle under the strain without help. Not only was I doing most of the work of caring for him, I was doing all the meals, the clean ups, the laundry, helping with his business, doing my own.  And somehow I had to get out of the house to get food.

So I kept my mouth shut.

The two senior care coordinators came separately to see him. They had both assessed my guy before. They were amazed that his parkinsonian syndrome diagnosis had been chucked out, that he was no longer on any medication, that without the Sinamet he was actually improving. This never happens to my clients, cried the occupational therapist, this is thrilling!  The other coordinator was so happy to see him doing better without medication that she promised to speak to the lead physiotherapist and beg him to send help. But she also warned me. She said: you know the people they'll send are fresh out of school and won't have much experience with neurodegenerative disorders, but I'll try to get it done. And she did. She also ordered 10 hours a week of care for the next five months, including three hours on Friday afternoons so I could do grocery shopping. But none of that dealt with the real problem, the never-ending turnover of workers, the daily need to train a new person.

The film crew arrived and shot their film ( he performed almost as well as he used to when he was an on-camera public affairs TV reporter/director years ago). By then, the junior care coordinator had sent in a new personal support worker each day for eight straight days. After the film crew went home, I got on the phone and raised hell.






I know what you're thinking: how dare you complain about a publicly funded system that cares for a person in hospital, and then, after the patient is sent home, provides trained people with real skills to come to the door to make sure that patient is properly washed, dressed, fed and any wounds attended to. It is a testament to this society's determination to take care of everybody that we have such a system at all.

But even the most well-meaning systems can break down, especially when starved of funds year after year, as the home care system has been.  And because it is starved, people who might have managed well at home if they'd been attended to sufficiently, end up back in an acute care hospital or in longterm care both of which cost a hell of a lot more. The home care system was invented to take the pressure off both, not to be part of a revolving door problem in which sick people are sent home from hospital too early and either end up right back on a ward, or permanently warehoused in long term care places so understaffed that someone like Wettlaufer can go undetected for years.

When I picked up the phone to complain, it wasn't just about helping him, it was about saving me. I had finally understood that if this pace kept up, and I got sick from overwork and lack of sleep, we would be in a disastrous situation.

I forced myself up the hierarchy of the home care provider, starting with the junior care coordinator who got the brunt of my rage, a blast sufficient to make her cry which made me ashamed. I was passed to a supervisor, and from there to another, and with each handover I kept saying: are you the CEO? No? That's who I must speak with. Finally I got a call back from a young man. He asked what I was calling about. I said: are you the CEO? No, he said, he was the CEO's assistant. I want to speak to the CEO not to you, I said. I need to speak to the person responsible for this system. I am a journalist and this experience has been so bad that I am going to have to write about it.

Lo and behold--the CEO herself called me back the next day.

After I explained what we'd been dealing with---eight straight days of new faces, eight straight days of me training each caregiver, eight days of no phone calls when the caregiver was going to be late, but with me having to call in to find out if someone was coming, eight days of carrying down the laundry, the garbage, making the bed, supervising the showering and doing the shaving-- I said I had had enough. I said this was a completely incompetent way to manage a home care system and I wasn't going to stand for it. And I was going to write about it.

She apologized. She told me stories of what happened when her own mother needed care, how she herself, for many years an RN, had been helpless to get the help she knew her mother needed. She sent me documents demonstrating plateaued funding in the face of the growth of demand, lobbyist papers arguing for more investment in home care, as opposed to hospital care. One pointed out that there might be a strike of personal care workers in Ontario this fall-- because personal support workers are getting unionized and a first collective agreement is being negotiated. Inevitably, and appropriately, labour costs were going to go up.

She promised that her organization would try to do better, starting with a meeting of  coordinators at our house. An RN would come along with them.

When they arrived, they trooped up to my guy's office.  At first they were defensive as I told them what had been going on. They weren't happy to hear it. When I told them I didn't blame them, I just wanted to know how it could be fixed, they promised changes would be made, that my guy would be assigned the same workers who would be instructed to call when they were going to be late or early, who would be instructed to provide the services required.  He would not have to face strangers every morning anymore, and I would not need to instruct on a daily basis.

I said fine, but I'm still going to write about this.

I could see they were actually pleased by that. Why? Because they don't like being unable to deliver, they don't like having to say no to the provision of care they believe will prevent their clients from relapsing,  they don't like having to ration what they know is essential. They wanted someone on the outside to shake the politicians' cages, to get things moving, to raise Cain, to get more money from the public purse spent where it's really needed, not wasted on some shiny atrium with a shiny donor plaque on a shiny new hospital filled to the brim with patients but chronically understaffed. The medical system is a human endeavor.  Machines are well and good, but without sufficient humans to manage and deliver care, they are useless.The people who provide care deserve to be properly paid and to work reasonable hours. They should not have to struggle through terrible schedules in order to make a living.

In the end, I found myself thinking the only reason this system works at all is because of the determination of the individual caregivers who try to make a go of it no matter what.

Unfortunately, and yet predictably (my Dad did predict it and he was not alone) no matter what is what we've got.

Field Notes from a Medicare Disaster: Eight

I told myself that I must have misheard when the neurologist described the narrative arc of  Parkinsonian syndrome with one word--"worse." No one talks to patients like that, I said to myself, not in my father's day, and certainly not now when devotion to patient-centered medicine is claimed by every hospital seeking donations and governing party hunting votes.

But I'm a reporter. I have trained myself over many years to listen for that quotable line and remember it. I knew that's what he'd said because a single word reply to a reasonable query was so unexpected that it instantly lodged in my brain -- in both our brains, as I soon confirmed. My guy heard it too.

Maybe this was his way of expressing his irritation at all the Google-derived questions he had had to field from patients. If he'd asked, I would have explained that we were painfully aware that much of what we'd gleaned about Parkinson's Disease and Parkinsonian syndrome came not from scientific papers but from websites written by disease advocates. I knew that their claims are not always supported by what careful thinkers would consider actual facts. Sometimes they derived from their scientific advisors' interesting relationships to drug companies and medical device makers.

A magazine story I did on osteoporosis taught me these lessons. In the mid 1990s, osteoporosis suddenly became the new disease of the month, an epidemic about to unfold, we were told, unless....Various osteoporosis society websites claimed that, without treatment, almost half of North American post-menopausal women would suffer from fractures. But good news! A new scanning machine had become available capable of measuring the density of human bones, and--oh happy day-- two drugs were available to bolster that density and thereby hold osteoporosis at bay. Hormone replacement therapy was already used for this purpose. Merck was bringing out an old drug for this new use, a bisphosphonate.

I became interested when almost all my female neighbors, friends, and relatives of a certain age mentioned to me over a short period that they had been sent by their doctors to have their bones scanned and, as a result, were told they were osteopenic. They were told they would likely develop osteoporosis and suffer nasty fractures without treatment. Some had gone on hormone replacement therapy, some were trying the new/old drug.  That so many women were told they were at risk of fracture seemed odd to me. I asked my Dad how many osteoporosis-induced fractures he had seen in his 50 plus years of family practice. Hardly any, he said. When I told him that an osteoporosis society in the US was claiming that as many as 50% of post menopausal women were at risk of such fractures, but there was a new drug to treat it, he just laughed. Of course my Dad had a love/hate relationship with drug companies. Their salesmen took up space in his crowded waiting room in the hope that he would try their samples on his patients and then prescribe them. Sometimes he did, if he thought it helped. More often he told the salesmen to go away.

In the course of doing that osteoporosis story, I interviewed a senior orthopedic physician/scientist who led the scientific advisory board of a Canadian osteoporosis society. He had helped establish the standard for the prevention and treatment of osteoporosis. The theory of osteoporosis disease at that time was that it resulted from low bone density. Osteopenia, supposedly the precursor to osteoporsis, is still defined as low bone density when measured by the new scanners.The standard of care he and his colleagues proposed was that the best way to prevent osteoporosis was to increase bone density with a bisphosphonate or to prevent its decline with hormone replacement therapy. It was asserted that these steps would save millions of women from harm and save governments and insurance companies millions too. However: bisphosphonates have serious side effects and can do serious harm if not taken properly. Taking one properly by mouth involves sitting up straight for at least one half hour in order to avoid damage to the esophagus. Studies done later determined that bisphoshonates can induce unusual fractures in about 10% of the people who take them. Hormone replacement therapy was soon found to be less than harmless also: it increases cancer risk. But in the mid 1990s, most major hospitals quickly acquired the new bone density scanners and population-wide screening for low bone density took hold fast, just like population-wide scanning by mammography for breast cancer, another sad story of practice getting ahead of science.

The more I dug, the more I learned that the theory of loss of bone density as the cause of osteoporosis was built on sand. Medical researchers studying how bones replenish themselves told me they were still in the dark about fundamental processes and were not convinced that low bone density necessarily causes fracture. Bone architecture and bone density are not the same thing and bone architecture, they thought, might matter more to bone health. In addition, epidemiologists were just beginning to do the necessary comparative studies of different populations to establish what normal bone density is, never mind how it relates to fracture risk. The bone density machines on offer had been calibrated by using data from one population (young women from Minnesota of Scandinavian descent). Their average bone density became the norm. Bone density is known to decline with the drop-off in sex hormone production as people age and is known to decline much more rapidly again when people enter their 90s. But in the middle 1990s, various epidemiological studies were just beginning to show that normal bone density differs from healthy population to healthy population, from region to region, and even from season to season. I interviewed a leading osteoporosis specialist in Montreal who had just organized a huge, Canada-wide study which had already shown that those most at risk of fracture were not post-menopausal fair-skinned, fair-haired women, as had always been assumed, but Quebecois men over age fifty who had worked as laborers. He had been forced to fund his work from grants (with some strings) from drug companies making bisphosophonates because the federal government wouldn't give him enough to get the job done. By then, most medical journals had begun to acknowledge that funding of science by drug companies with an interest in the result tends to skew results. Yet, as he said, what choice did he have? The work had to get done. And it was the same story with the physician/ scientist who had helped set the standard for treatment. When I'd asked him, almost as an afterthought, where the bulk of his research funding came from, he'd shocked me when he said 100% of it came from drug companies.

When the magazine began to fact-check my story, the Editor found herself on the receiving end of threatening phone calls from one very unhappy advertiser, a drug company. She published anyway. Not long after, she moved on from that job.

That's why I asked that neurologist so many questions. I wasn't satisfied that the Parkinson society websites reflected good science. When the neurologist didn't appear to know that Sinemet absorption is interfered with by proteins, and that dairy is a particular problem, I thought the websites had led us astray. My guy was really happy about that. He had always put milk in his coffee and in his porridge. He likes yogurt and he really, really likes cheese. Daughters One and Two had convinced him, given what various articles and websites had to say, that he should give up these favorite foods to improve Sinemet's action. For months he had been unhappily eating cheese substitutes made from soy (with a list of additives as long as your arm), and yogurt made from coconut oil. When we got home from the appointment with the neurologist, the first thing he did was put milk in his coffee. He had real milk and real yogurt on his cereal the next day.

That same morning, I went to the drugstore to pick up a prescription. I was standing at the counter waiting for the druggist to fill it when it dawned on me: who better than the druggist to tell me whether proteins, especially dairy, interfere with Sinemet's action?

I'll have to check, he said. He went to work on his computer, typed in a few words, came back to the counter. Yes, he said, you need to be careful with all proteins.

Is that new information? I asked.

Doesn't appear to be, he said.

By the time I got home with this news, my guy had already indulged himself with some cheese without regard to the timing of his Sinemet. The next day, he had a very hard time moving. We went back to the non dairy regimen, and we timed his drug intake with care.

And I also decided to look up the neurologist's publishing history. I found no papers by him on Parkinson's or on Parkinsonian syndrome. I did find old papers by him on various other neurological subjects, in particular, epilepsy.

On our next visit to the family doctor, we double checked the druggist's statement with her. Proteins and Sinemet, not good together, right?

Oh sure, she said, that's been known for thirty years.

Please, we said. We think we need to find another neurologist. Can you write a referral to one of the movement disorder places? Western? Baycrest?

She could, but she thought they had pretty long waiting lists.

How long? I asked.

Two years, she said.

Field Notes from a Medicare Disaster: Four

It was the Ides of February, 2016. Toronto was as grey and damp as an old dishrag. I was working hard on a new project that involved prying politically embarrassing information from the death grip of the University of Toronto and the even more secretive bureaucrats of the Department of Canadian Heritage. When I am on the trail of a good story, especially a hidden one, I tune the rest of the world out. I didn't hear him when he called the first time. I did hear a bump, but there are always bumps and thumps in our old house, usually emanating from its ancient radiators. I heard the second call though, because there was an edge to it, a determined calm stretched tight over panic like emotional plastic wrap. Daughter number two tells me I was on the phone with her when I suddenly said, gotta go, Dad needs help, and hung up on her. I have no memory of that. I do know that when I ran down to the kitchen, I found that he had fallen to the floor, couldn't get himself upright.

We had lately had a few of these moments of radical awkwardness, though nothing as serious as his fall at the cottage the previous summer. He had been finding it harder and harder to get his feet under him after a stumble unless he had something big, like a door, or a grab bar, to pull himself up on.  I am still strong ( not as strong as in my early twenties when I held back, with one hand, a tipped over 200 pound light stand about to squash my puppeteer colleagues in the middle of a show). Yet I found it hard to help him get up. He couldn't seem to cooperate with me. It wasn't as if I was trying to move dead weight, it was that his weight seemed to have a confused mind of its own working against my best efforts.

Being faced with my inability to do something always annoys me, and so I was annoyed. I looked for someone to blame-- him. How the hell had he managed to fall in our small kitchen which has so many things to grab hold of within easy reach? Like the counters? Like the fridge?

I don't know, he said. I don't know why I fell.

Somehow, I wrestled him up and onto a chair, which is when I  realized his neck was red with blood, and there was a red splash on the white fridge too, and ohmigod, a long smear across the floor. What the hell, I yelled, and then deliberately forced myself into a different state, a semblance of calm, because I also noticed, finally, that the bottom half of his left ear was dangling by a shred of skin, just hanging there beside his neck as his blood ran bright and free.  My father had been reliably cool in the face of frightening things such as this, including: eruptions of blood from my friend Ian's broken nose (Dad actually reached over and pulled Ian's nose sideways, back and forth, to make sure it was broken: yup it's broken Ian, he said); or, when I passed out during an asthma attack on another kitchen floor (he'd kept adrenaline in the fridge for just such an occasion). His capacity to cloak himself in deliberate calm helped make him a good surgeon. Yet it wasn't natural to him so he had developed interesting methods to soothe himself when faced with unexpected disaster --such as things going south in the operating room.  He told me that he just stepped back from the operating table, sometimes turning his back on it altogether, and then he hummed or sang a jaunty tune. Didn't the OR nurses find that strange? I asked. They never mentioned it, he said.

I don't sing when I'm scared. Instead I grab hold of my voice and wrestle it down from wherever it's perched to something steady and low which settles me as I hear myself speak.That allows me to step away mentally just long enough for thoughts to gather, so I can organize what to do and in the best order. I heard myself say, in a very neutral voice, hey, your ear doesn't look as pretty as usual, which is too bad because I've always liked your ears. And then I did what I'd learned in first aid class, age 16, from one of my Dad's partners, Dr. Noel Doig. He too had been a leader of the Doctor's Strike. He had immigrated to Canada to get away from Britain's National Health and spent many hours explaining to his Saskatchewan colleagues exactly why the National Health didn't work well, exactly what had to be avoided in Saskatchewan for doctors to do their jobs properly. He was a bright, ethical, empathetic man with musical talent: he built a clavichord in his basement one winter just for fun. And he had a talent for teaching too. He told a memorable story to my first aid class which encapsulated a simple way to slow a rush of  blood pumping from a limb  He described what happened when an older woman fell down on a London street and a varicose vein in her leg burst. A good Samaritan came upon her in a rapidly expanding pool of blood. He  tried to engineer a tourniquet from his necktie, but she was saved by another bystander who knew better, who simply lifted her leg above the level of her heart, then applied pressure. Remember, he said: first, elevate the limb, then apply pressure, then get help.

Elevation is not really applicable to a half- ripped off ear because, unless a person is already lying down, it's well above the heart. So I grabbed a pile of clean dish towels from a drawer and applied pressure, then replaced my hand with his while I called 911.

Why are you calling 911? he asked.

Because your ear is half off and there's a lot of blood pouring down.

Just get me a bandage. I'll be fine, he said.

You need someone who can sew it back together, I said. I mean I could try, but you wouldn't like it.

The paramedics got there very fast.They crowded into the kitchen. He told them what he hadn't told me, that when he fell, he'd caught his ear against the freezer handle on the bottom half of the fridge. All 220 pounds of him had landed on that ear. No wonder it was torn. Had he also concussed himself? Again? He was confused, I thought. So, probably. But his eyes tracked as they should according to the paramedics.

But we'd better take you in anyway, they said, and bundled him out the front door and down the front porch steps on one of those clever, step-climbing chairs.He kept trying to get his arms loose from the straps, even when they transferred him to a wider gurney. They weren't happy about having to push that gurney across our flagstone path to the curb-- well, we call it a path because once upon a time it was a path, but now it's a mess of broken stones heaved in all directions by frost. It's old. Like us. Not good Miss, they said, as if they knew they'd be coming back again, and again, and I'd better reno the access route before the next time.



Daughter number one made her way over to the St. Mike's emergency after the ambulance brought him in. She was not happy, in fact she was really, really concerned. I tried to assuage her fears.  Not so bad, I said, just a tear, they'll sew him up and that'll be that.

We waited for quite some time for a doctor  whose specialty included sewing ripped ears back together.  I would have thought any emergency doctor could do that, but apparently that is not the case. An otolaryngologist is required.We waited,  and we waited, jammed in a a cubicle.When said specialist finally appeared,  at least ten hours after the call went out, he was moved to another room down the hall where he could be sewn up, a room I mainly remember as large. The emergency doctor in charge, a nice woman, told me he'd be able to go home after it was done.

Daughter number one pulled me out into the hall.

We need to have him admitted, she said.

We do? I said.

Yes we do, she said. He keeps falling, and we need to find out why.

But the emergency doctor said he could go home, I said. And his MRI is scheduled for next week.

I don't know why I argued with her. Maybe I wanted to hold at bay the idea that something was seriously wrong. After all, that doctor who discharged him from this very hospital in the summer had insisted everything would be fine, all he had to do was count to ten after he stood up and before he took a step. The neurosurgeon had been concerned,  yes, but not certain what exactly the problem was.Thus the MRI.

The MRI is scheduled for the middle of the night, she said. They could do it while he's an inpatient much more easily. What if he goes home and falls again?

Good point, I said.

Please let me handle this, she said. Just let me do this, because you won't use the right words.

A fraught moment of decision: should I hand over my role as the adult person in charge of his care to a daughter who had been a child herself seemingly moments ago ( okay, okay she had two children of her own, but still...). Age makes itself known when a parent finally recognizes that her children have acquired skills not readily at hand in her own bag of tricks. I remember my Dad still deferring to my grandmother though he was a doctor with three kids and a huge medical practice, while she barely spoke English and her education was of a different order altogether. He considered her the smartest person in the family. I wanted to go to a convention in Vancouver with a youth group I belonged to. I'd had a bout of asthma that had almost killed me and he thought it wouldn't be safe. I appealed to her. Are all the other kids going? she asked him. Yes, he said. So she goes, said my grandmother, and that was that, I went.

Daughter number one had by then spent several years working  on policies related to physicians and their work. She knew the jargon and the rules; she knew which phrases would resonate, which policies could be referred to, trigger words in effect. I know  how to ask sufficiently probing questions to expose a system's failures but that is altogether different from getting systems to behave and do what they're supposed to. What we needed was relief from a patchwork of appointments and incoherent information with no responsible physician  to make sense of it. We needed a proper  work-up in the hospital by someone who had  access to all the gathered evidence and who could get more as needed. Okay, I said. Do it.

She took the emergency room doctor out in the hall. I know she explained the history, what remained to be explored, that  an MRI had been ordered by a staff neurosurgeon in this very hospital, scheduled to be done in a few days, that there had been a serious fall requiring hospitalization only a few months before, and several little falls since, and now this--yet there was still no diagnosis. She  pointed out the danger of letting him go home, the liability that could ensue.  I kept out of it as ordered, although that phrase of hers, you won't use the right words, had really got under my skin. After all, if I am anything at all it is a purveyor of correct words.

When the two of them came back from their huddle, I was told that he would be admitted after all, it was just a matter of finding a bed.

Is that how it works now? I said to daughter number one, after the doctor went away. Does one have to know trigger words to get the correct response, to get reasonable, responsible treatment?  Is that what this system has come to? That smacks of Israel where you need protectzia to get you in the right doors. 

Protectzia means exactly what it sounds like. You know somebody who knows somebody important who can take you out of that long line up with a wave of the hand. It means there is no real equality, only differing degrees of power.

It's not about protectzia, she said, it's about the right words.

But it's the same problem if only a few of us know what those words are.  Equality of care for all, regardless or bank balance or personal relationships, was the foundational concept underlying Medicare, wasn't it?