Complaint against Dr Alpha and Dr Beta (part I)

Complaint against Dr Alpha and Dr Beta

a reformational discourse experiment in medical philosophy and ethics

I've been expelled as a patient at the Nameless Clinic, a satellite facility of one of downtown Toronto's Catholic Hospitals, expelled by Dr Alpha who apparently is authorized to act in such an arbitrary way at the Nameless Clinic. My crimes and misdemeanors there apparently boil down to “angry outbursts” and “aggressive language.”

I counter Alpha's effort to stigmatize me on the basis of one of my disabilities by affirming that my rational-and-emotional response to Alpha's actions were more than justified. I don't believe I'm called to docility in the face of whatever injustice an experienced physician may hand out.

Background: Behaviourist Techniques (Some minutiae important to me)

The negative pattern Alpha set in motion against me goes back to his manipulation of my drug prescriptions by foreshortening them to a month, on some occasions, instead of the usual (and for me, the normative) duration of three months. I'd take his prescriptions without checking them over in his office, and deliver them directly to my pharmacist. Over and over, I found he had held back on granting me a 3-month horizon on refills, instead limiting me to 1-month and necessitating an additional appointment with whatever scheduling problems that entailed, and necessitating another expense for TTC streetcar fare. The pharmacy over and over woud try to get him to adjust his prescription error by fax; but that was forbidden by Nameless Clinic or Dr Alpha himself, or both. I had to explain to him at length that I simply can't afford to take the TTC streetcar from my home location near the intersection of Gerrard Street East and Jones Ave to the clinic near the intersection of EastWest St and NorthSouth St.  I live in poverty. Indeed, the possiblity now of leaving my home's frontdoor, immediately crossing EastWest St to the Toronto Transit Corp's streetcar stop, makes Nameless Clinic's location ideal for my medical needs. Now I have only about a half block to walk north on NorthSouth from the EastWest nexus, a block uphill to Nameless. Yet I had to mobilize all the meagre energies of my soul to fend off Alpha's behaviourist methods to get Dr Alpha to not withhold the medicines he himself prescribed in order to manipulate me to return to the Clinic in only a month's time. Now the TTC fare for seniors has been reduced to $4 for the trip and return, not $6 as it had been; but each trip to and from the clinic is a cost I have trouble paying from my monthly budget and income (a new pair of support hose for my dermatosic and swelling legs, alone costs $90). Of course, when Alpha schedules an extra visit to the clinic (but not his office) for blood tests, each such visit costs me another $4. Just on costs alone, I have to keep visits to the clinic down to an absolute minimum. So, on that basis, I had to fight him for the apparent privilege of going to the clinic for my needed prescriptions only 4 times a year, once every three months. Also, the wear and tear on my legs (diabetes dermatosis and swelling) has increased over time and I have more trouble walking at all.

Nevertheless, I depend on Dr. Alpha's good regimen of pills (for various components of my illness) and ointment/cream for my diabetes dermatosis on an extensive area of my legs, more specifically. I gratefully thank Dr Alpha for the suite of medications he has gradually lined up for me; and, again, I'm dependent upon his pills-prescriptions, ointment/cream, and from time to time the blood tests he prescribes. These are his forte as a scientist of medicine. Combined with the ideal location of the clinic for my transportation needs in getting to the doctor, I'm cared-for as optimally as possible in the scientific aspect, given my meagre means. But, at the same time, Alpha's inappropriate adventures in behaviourist manipulation related to his obvious reliance on a mechanistic model of medical practice (focussed solely on pill-prescriptions and reading blood-test results) nevertheless work against my health. Below, I'll try to bring this respectful analysis up-to-date, starting with the Christmas season 2011-12 when Apha and the Nameless Clinic left me stranded without my medications, resulting in a mental-health crisis. He apparently learned nothing from that misadventure, and the same process repeated itself more recently after his Easter/Passover vacation, resulting in him expelling me from care at the clinic – among other things, disrupting my attempt to get further care from the Diabetes Education Initiative at Nameless, and being sent by him on a wild-goose chase to the shut-and-locked office door of a freelance diabetes eye-examination doctor to whom I was assigned. For me, the details of these lapses are medical lapses. So I have to drag myself here thru the minutiae events and episodes to communicate the utterly negative effect on my health of his bad habits, outside his scientific skills which I appreciate deeply. Well, I can analyze too, tho not in his forte and speciality (ironically he is called a practioner of “family medicine,” doubly a misnomer because I'm not a family, I'm alone, and a misnomer in how he conducts himself in my case, lacking inter-human skills required on especially on the doctor's side of the doctor-patient relationship). Analysis is always aggressive in that it establishes a Geganstand-relation (philosophers Herman Dooyeweerd and Hendrik Hart) with the object of analysis, in this case the object I'm examining and aggressively so, is a medical practice by Dr Alpha.  But I stand in a Geganstand-relation to his scientific analysis of my medical problems, whereas he shoud also stand in an inter-human dialogical relation with me outside his strictly scientific functions.  This alternative kind of practice is extent in North America (Duke U partnershp between Divinity School and Medical School) and in the Netherlands (Dr Gerrit Glas, MD PhD).

I repeat: I only use the services of Alpha and the Nameless Clinic four times a year, except in regard to additional visits he may assign for blood-tests, and if possible in the future for visits to the Diabetes Education Initiative (I don't know how many sessions the programme woud entail and, in any case, my ability to participate has now been placed in jeopardy by the arbitrary action of the doctor chiefly in question here).

First, my illness consists in large part of several conceptually-isolable components (but medical-philosophical conceptual-isolation does not mean the components can be treated in isolation, or even optimally treated in isolation; philosophically this is the issue between scientism which stresses the “science” in medical science, and integral medicine (tho not much in evidence in NewAgey "holistic medicine," neither of which Alpha practices). Integral medicine woud stress the interaction of problems – for instance, of mental health problems and physiological+biochemical problems – that a doctor must discern in accord with a broad and integral human-to-human understanding in an authentic doctor/patient relationship). See: Adrian van Kaam, The Experience of Really Feeling Understood as a Person (1952 dissertation, Case Reserve University, Pennsylvania, USA). In my case -- because of its complexity, particularities, and peculiarities – the necessity of feeling understood as a person in the doctor/patient relationship is paramount. But it seems that Dr Arbess is only forthcoming on the science side of medicine. The way he pursues the analysis of his patients who stand as his objects, his Geganstands (to anglicize the German philosophical term) precludes for him apparently understanding them as persons perhaps with an integral illness symptomizing in a complex of perhaps several diseases, conditions.  This becomes more intense usually in persons who are aging, in seniors, like me.  The question of optimality of practicing an integral medicine and doctorhood is this:  In many cases, perhaps, a less-than-integral medical set of Best Practices is sufficient, even optimal, for many or most of the patients a doctor sees on any giveh day in a busy practice. But one size does not fit all in this matter. In my medical case, it does not fit at all. Dr Alpha has a huge blindspot which is the result of his massive professional worldview; he can't see me. Please let me help him see me.

In my case, the problems are:

1.) mental-health deficiencies

I've been to many shrinks over the years, but that's another story, regarding which I do pause to say

that the first doctor who diagnosed me regarding my mental health wrote me up as “borderline” and I

asked him “what does that mean?” to which he replied “borderline between crazy and sane.”

2.) sleep apnea and other sleep disorders (I wake up 500 times a night, I kick hundreds of times a night, toss and turn a lot, and suffer from what I call a precession-of-the-stars phenom – the sleep cycle shifts in the night sky, so to speak, so that I don't have any discernible regularity of awake and sleep, altho with the C-PAP machine I do have some better control on this phenom. My stories of abuse by the sleep studies department at Doctor's Hospital and by the medical-equipment contractor in not repairing my first C-PAP and leaving me stranded for several months is another story. My apnea existed at least as far back as 14 yrs old, when I woud get shoes thrown at me while “asleep” in the orphanage dorm — punished for my loud snoring since early adolescence.

3.) diabetes type 2

4.) heart attack / stroke (I'm h+risk for these)

6.) kidney failure (I'm h+risk for this)

My mental health problems are these:

My mental-health problems have 2 chief components, each of which has too many facets to itemize all of them individually.

One chief component can be summed up under the heading “psychic trauma” (personal history of fundamental emotional pain, as in philosopher Herman Dooyeweerd's “psychic modality,” and addressed by Freud, Jung, Adler, and Reich, among others; see also philosopher-psychiatrist Gerrit Glas's related work). To make this matter of psychic trauma accessible to onlookers, I list these raw facts:

my father died when I was 3½ (he died when he was 40, of heart attack)

source of a massive guilt-complex for me

my brother died when I was 21 and he was 18 (he died of lightning)

re-inforced my distorting guilt-complex

my mother died when I was 30 and she was 54 (she died of pills and a plastic-bag, a suicide, death with dignity in a time of her own unendurable pain).

I felt guilty for decades after her death

I have just passed the anniversary of my brother's death, and am approaching the anniversary of my mother's death with dignity. It woud really be help to me if Nameless Clinic coud restore me to my medical-community status at Nameless Clinic of Catholic Hospital, at least a few days before November 6-7, the date on which she died and I discovered her dead in the morning.

Anyone with the minimal psychological training and awareness shoud certainly take cognizance, including all family doctors, of the import of this pattern of trauma medically for any adult person who, in the stage of childhood indicated, experiences the death of a parent and becomes subject to guilt-producing mechanisms, mechanisms generative of a life-long propensity toward chronic depression (dysthymia).

When it is multiplied by the death of a beloved younger brother at our ages at the time; it became exponentially re-inforced, and even it becomes paralyzing, when a parent dies in a son's care at our ages at the time. The boundary between the two traumatic events, in my case three, becomes obliterated. Thereafter, I was rather much a functionally-crippled person for decades.

But it was ramified in my case by my coming to awareness (at age 13 at the orphanage) that I was homosexual. This had to be kept secret since I woud have been savaged by some of the other boys (a total of 1,200 of us at the orphanage, but 100 or so in my age cohort – by law we were boys whose father's had died, most of us with surviving mothers, many of the mothers living in poverty, or re-married to an abusive husband, and stepfather, or these of our mothers were working to support themselves). Awareness of homosexual feelings also created tension with my own deeply internalized Christian faith; our family was evangelical Protestant. I was tested and went into the orphanage when I was 6 years old and graduated High School there when I was 16 (my brother entered 3 years later than I, also at 6 years of age). This dualism between my homosexuality and my faith persisted for many years, until finally I worked thru it to self-acceptance. However, this additional psychic trauma for much of that time was intertwined with the first threefold psychic traumas, together also masked the deeper sources of my false guilt. It took consultation with Dr Rosemary Barnes at the Anti-Suicide Clinic that then existed at Toronto General Hospital and with the Chief of Psychiatry there at the time, for me to come to awareness of the formative enduring power for a life-time perhaps, of this structural trauma-effect over the personality of a child who experiences the death of a beloved parent when just 3½. A dead parent and a deeply-wounded mother with 2 young sons, and an older dawter by a previous marriage.

The other chief component combines the more physiological and bio-chemical features of the interactive set of maladies and conditions composing my illness:

severe sleep apnea – I knew about the heavy loud snore symptom since, at least, my early adolescence as mentioned. Later, I had to fight the private-practice doctor who was writing me up for Ontario Disability support for dysthymia -- who had himself availed himself of a Sleep Diagnostic Centre (before the hospitals included these services) – in order to get referred to a centre. It took 6 years after I had heard of large oxygen tanks and face masks “curing” sleep apnea, but I didn't have even a vocabulary, much less concepts, to press the point with my private-practice entrepreneurial family-doctor at the time. Such is the sociology of knowledge in Toronto's medical system. After 6 years, I coud no longer stand the suffering of sleeplessness and so I pressed that private-practice doctor by making it the only point of my appointment. In our conversation, it came out that he had availed himself of a sleep diagnosis; but he never made the connection that sleep apnea may have been a deeper physiological and bio-chemical modal layer of my own over-all illness; but I pressed him and he referred me to a Centre. The results were sent to a specialist who tested me way out in the no-man's land in the far north of Toronto (a bewildering and torturous journey on the TTC subway for me); and he pronounced that I indeed had “severe sleep apnea” (a specialist at Mount Sinai hospital later claimed my apnea was not “severe”). I had to fight standard medicine in Ontario over and over on questions of apnea, and had to do independent study to become clued-in to the fact that I had a cumulative sleep deficit, since at least 13 years old and deep into my adulthood, having been denied most of my life of a sufficient supply of oxygen to my brain. The condition also had interaction with my metabolism (regarding which interaction one dietician at Mount Sinai Hospital told me “They don't know that!”). Oxygen is needed to metabolize the transformation of food into deployable physical energy, instead of just excrement and fat. The interaction between the bio-chemical stratum of my illness and the psychic-trauma stratum left me with little sleep, an overload of irritability, often high anxiety, occasional panics on the street where I became confused as to what to do next and where to go next, all of this under the diagnosis “chronic depression.” And as it turns out a deep Well of Anger which we learn about in the poets (philosophers when they analyzed an emotion under Rationalism and Empiricism (really they're twins as shown by Canadian reformational philosopher Peter Schouls). Eventually, late in life (my Sixties), I was finally able to acquire a Continuous-Pressure Air Pump (C-PAP) and a breathing mask so that I coud at last get some sleep. But to fall asleep, I still had problems. Because of my mother's means of ending her life, I was extremely leery of taking sleep pills (her forte), or psychotropics (which had some very negative effects on me and others, before I started getting some that worked for a period, allowing me a modicum of normalcy (prescribe by a shrink at Mount Sinai). I used marijuana and eating to get to sleep both before and after I obtained the C-PAP machine. I also was left stranded by the government-contracted medical-equipment company when my original C-PAP went defunct. I was left for months without a usable machine; the new company (Medigas) tried deliberately to cut out corporate obligations inherited from the previous company (RespirCare) which the former had meantime bought out. They woudn't even grant me access to the medical-equipment nurse (Ruth, same name as my mother) who had previously delivered the machine to me and who was my link for its maintenance; she had been absorbed into management of the new company and was kept isolated from patients under its new owners. I was denied access to her and to a “loaner," a loan-machine (as the repairmen called the temporary-replacement C-PAP machines) while mine was being repaired. This resulted in an agonizing no-sleep hell again; I tried to fight this self-serving neglect on the part of these corporations as well.

But as one can read, I've had to fight over and over again from being silenced and put into discard by the medical system.

diabetes type 2: All the foregoing in this section occurred before I arrived at Nameless Clinic, a part of Catholic Hospital. It shows who I was medically when I arrived at Nameless. In due course, as my years went on, burdened by faux guilt for my father's, brother's and mother's deaths (she was in constant pain, and discouraged with life, all while in my care), sleepless in Toronto while undergoing the war with Bad Medicine, a friend approached the then-leading-light of Nameless, Dr Who (I've never actually met him), a friend (a patient of his) explained my medical situation to him, got me a card of introduction to Nameless Clinic – where I was taken in, only to be passed around from resident to resident, hotshot young doctors biding their time until they took off for advanced-study grants hither and yon. The clinic was permanent; the doctors were not, and all of whom that I ever met or was placed for a period under the “care” of, had their own agendas and used the clinic to advance their career moves. In contrast, at least Dr Alpha seems relatively permanent at Nameless. Still, abandonment is a major trauma-source for me since childhood, and the recent expulsion from Nameless by the good scientist, an affable man when secure in his unquestioned professional authority, but Bad Medicine in my case, is another instance of the long string of abandonments in my life (father's death, mother's placing me in the orphanage while she worked, etcetera, and now being expelled from my medical community by Dr Alpha.

— end of part I — continued Guinea-Pig at Nameless Clinic Part II of "Complaint against Dr Alpha and Dr Beta"