Saturday, June 25, 2011
Friday, June 24, 2011
Emergency medicine healthcare delivery
The Hamilton Spectator article on emergency services in the area.
The issues highlighted are common healthcare delivery issues in North America and the UK (I can't comment on elsewhere because I don't know).
ER worst at Jo Brant
Just not enough beds,
Joseph Brant Memorial Hospital is battling the worst emergency room waits in Ontario, two years into a public monitoring program.
Ninety per cent of the sickest patients spent up to 25.2 hours in the Burlington hospital's emergency room in April before being discharged or admitted.
That's the longest total ER wait time for seriously ill patients at any Ontario hospital measured that month. It's virtually identical to the 26-hour statistic Jo Brant reported in 2009, the first year Ontario made wait times public online at the Ministry of Health website.
Emergency room wait times remain a problem for Jo Brant, said Mary MacLeod, vice-president of patient care services. But she said the problem isn't the ER — it's the lack of beds for patients admitted to hospital.
MacLeod pointed out Jo Brant's reported wait time for less serious ER patients, who are often usually treated and discharged, is 4.9 hours.
That's not far off Ontario's target of four hours.
By contrast, the hospital sometimes triples the province's eight-hour wait time target for seriously ill patients.
Like most hospitals, Joe Brant has many acute care beds “clogged” with older patients who no longer need hospital care but must wait for beds to open up in a long-term care facility or nursing home.
About 52 of the hospital's 248 acute care beds, or 21 per cent, are filled with patients in limbo.
MacLeod said the high percentage is due partly to an increasingly elderly population in Burlington. About 15 per cent of city residents are 65 and older, according to census data, but MacLeod said she's noticed a “significant” bump in patients over the age of 80.
The Local Health Integration Network is working with hospitals and associated agencies to help keep more complex-care patients in their homes, rather than in hospital, said Donna Cripps, the executive director for the Hamilton-area LHIN.
For example, the LHIN found one-time funding last year for the Community Care Access Centre to provide more hours of “home care.”
MacLeod said Jo Brant simply needs more beds.
The hospital has pitched a $300-million redevelopment plan to the province that would add at least 70 acute care beds.
“We're hoping for approval … The plan calls for us to add (beds) by 2013 or 2014, but we need them now.”
Burlington isn't alone in its struggle to cut wait times.
In Hamilton, no hospital serving adults came anywhere close to the eight-hour wait time target for seriously ill patients — or even the provincial average in April of 11.4 hours.
April was a “tricky month” for all Hamilton ERs after McMaster converted its emergency room to a children-only operation, said Ida Porteous, administrative director for emergency services at St. Joseph's Healthcare.
Porteous said she's “cautiously optimistic” the hospital's wait times will improve this summer, especially after the addition of several “short-stay” beds funded by the province in May.
Over time, average ER wait times in Ontario are creeping down, said Dr. Chris Simpson, a spokesperson for the Wait Times Alliance that represents more than 14 Canadian medical associations.
The alliance just released a report card on wait times nationally for major medical procedures such as hip replacements, knee replacements, cataract surgery, radiation oncology and cardiac services.
“We have to give credit where it's due: Ontario scored straight As for those indicators,” Simpson said.
Bed shortages are a national problem, so nobody gets good grades for ER wait times.
“But most provinces aren't even making wait times public,” Simpson said. “I give kudos (to Ontario) for being brave enough to report it.”
The issues highlighted are common healthcare delivery issues in North America and the UK (I can't comment on elsewhere because I don't know).
ER worst at Jo Brant
Just not enough beds,
Joseph Brant Memorial Hospital is battling the worst emergency room waits in Ontario, two years into a public monitoring program.
Ninety per cent of the sickest patients spent up to 25.2 hours in the Burlington hospital's emergency room in April before being discharged or admitted.
That's the longest total ER wait time for seriously ill patients at any Ontario hospital measured that month. It's virtually identical to the 26-hour statistic Jo Brant reported in 2009, the first year Ontario made wait times public online at the Ministry of Health website.
Emergency room wait times remain a problem for Jo Brant, said Mary MacLeod, vice-president of patient care services. But she said the problem isn't the ER — it's the lack of beds for patients admitted to hospital.
MacLeod pointed out Jo Brant's reported wait time for less serious ER patients, who are often usually treated and discharged, is 4.9 hours.
That's not far off Ontario's target of four hours.
By contrast, the hospital sometimes triples the province's eight-hour wait time target for seriously ill patients.
Like most hospitals, Joe Brant has many acute care beds “clogged” with older patients who no longer need hospital care but must wait for beds to open up in a long-term care facility or nursing home.
About 52 of the hospital's 248 acute care beds, or 21 per cent, are filled with patients in limbo.
MacLeod said the high percentage is due partly to an increasingly elderly population in Burlington. About 15 per cent of city residents are 65 and older, according to census data, but MacLeod said she's noticed a “significant” bump in patients over the age of 80.
The Local Health Integration Network is working with hospitals and associated agencies to help keep more complex-care patients in their homes, rather than in hospital, said Donna Cripps, the executive director for the Hamilton-area LHIN.
For example, the LHIN found one-time funding last year for the Community Care Access Centre to provide more hours of “home care.”
MacLeod said Jo Brant simply needs more beds.
The hospital has pitched a $300-million redevelopment plan to the province that would add at least 70 acute care beds.
“We're hoping for approval … The plan calls for us to add (beds) by 2013 or 2014, but we need them now.”
Burlington isn't alone in its struggle to cut wait times.
In Hamilton, no hospital serving adults came anywhere close to the eight-hour wait time target for seriously ill patients — or even the provincial average in April of 11.4 hours.
April was a “tricky month” for all Hamilton ERs after McMaster converted its emergency room to a children-only operation, said Ida Porteous, administrative director for emergency services at St. Joseph's Healthcare.
Porteous said she's “cautiously optimistic” the hospital's wait times will improve this summer, especially after the addition of several “short-stay” beds funded by the province in May.
Over time, average ER wait times in Ontario are creeping down, said Dr. Chris Simpson, a spokesperson for the Wait Times Alliance that represents more than 14 Canadian medical associations.
The alliance just released a report card on wait times nationally for major medical procedures such as hip replacements, knee replacements, cataract surgery, radiation oncology and cardiac services.
“We have to give credit where it's due: Ontario scored straight As for those indicators,” Simpson said.
Bed shortages are a national problem, so nobody gets good grades for ER wait times.
“But most provinces aren't even making wait times public,” Simpson said. “I give kudos (to Ontario) for being brave enough to report it.”
Monday, June 20, 2011
More on the protester of Westminister
Brian Haw: The ultimate protester
By Alex Stevenson Talking Politics
The traffic continues to flow around Parliament Square, the tourists continue to bustle. But something is unmistakeably missing.
Early on Saturday Brian Haw died of lung cancer. It was the end of a life whose last ten years had been among the most unusual in modern British history. He had devoted himself to a solitary protest against Britain's foreign policy, earning himself an unusual place in the history books. His dogged unshakeable stubbornness was as British as the red buses constantly passing by.
Haw's message was all the more powerful because, somewhat paradoxically, he shunned attention. "I will not be a media whore," his website declared. His target was MPs, the men and women who had authorised the invasion of Iraq and the suffering it and its aftermath caused. The media, so often viewed as part of the establishment, were invariably treated with suspicion.
I caught a glimpse of this during the heavy snowfalls of early 2009. Central London was brought to a standstill and many MPs were forced to stay away from parliament altogether. But Haw was there, in the midst of the blizzard, and so an obvious candidate for interviewing.
Perhaps it was the suit, or the notebook, or the fact I had clearly emerged from the Palace across the road. Whatever, he didn't answer my first few remarks. He just stood there, glaring contemptuously. "Look," I said desperately, "I just want to know what you think of all the MPs not bothering to come in." Slowly, like an ancient tortoise, he craned his neck towards me. "I'm still here," he growled. And then began showing me, half-covered by snow, pictures of dead babies.
Haw's comment was an appropriate one. He had begun his protest on June 2nd 2001 over the economic sanctions being imposed on Iraq. Doing so was an extraordinary step for anyone to make: after a couple of years sleeping in the square he and his wife divorced, after all. Even before the 2003 invasion an attempt to remove him was made. It was the first of many defeats for those seeking to end his vigil.
Haw was an irritant to many in parliament. So MPs decided they could get rid of him on security grounds in 2003. Their recommendation became part of New Labour legislation two years later, by which time public anger at the Iraq war was at its peak. It was now combined with frustration by civil liberties campaigners. The court of appeal overturned the measures.
The transition from an angry carpenter to a global icon was not quite complete. Even as fresh attempts were begun to oust him, he won an award for being that year's 'most inspiring political figure'. In 2007 a reproduction of one of his protest banners by artist Mark Wallinger won the Turner Prize. He appeared on CNN regularly.
Wallinger has described Haw as a man of "tenacity, integrity and dignity". "Brian showed us what a quiescent and supine country we've become," he wrote in an article for the Independent newspaper. "What Brian was saying was never really reported properly, nor was the depth and heroism of his struggle. People who should know better would describe him as a crank and wouldn't bother to hear what he had to say."
It had looked as if the days of his protest were numbered, for he had lost an appeal in March against eviction from the grassy area of Parliament Square. But in the end, it was to be lung cancer, not politicians or officials, which forced him from Parliament Square.
Haw was never interested in becoming a legend. He was a pain, a thorn in the government's side, nothing more. Those inspired by his example who attempted to join him were often surprised when he turned out to be irascible and grumpy. His purpose was not to charm, like a politician, or tell a story, like a journalist. It was to make a point — an enduring reminder that the decisions made in Westminster have real consequences.
By Alex Stevenson Talking Politics
The traffic continues to flow around Parliament Square, the tourists continue to bustle. But something is unmistakeably missing.
Early on Saturday Brian Haw died of lung cancer. It was the end of a life whose last ten years had been among the most unusual in modern British history. He had devoted himself to a solitary protest against Britain's foreign policy, earning himself an unusual place in the history books. His dogged unshakeable stubbornness was as British as the red buses constantly passing by.
Haw's message was all the more powerful because, somewhat paradoxically, he shunned attention. "I will not be a media whore," his website declared. His target was MPs, the men and women who had authorised the invasion of Iraq and the suffering it and its aftermath caused. The media, so often viewed as part of the establishment, were invariably treated with suspicion.
I caught a glimpse of this during the heavy snowfalls of early 2009. Central London was brought to a standstill and many MPs were forced to stay away from parliament altogether. But Haw was there, in the midst of the blizzard, and so an obvious candidate for interviewing.
Perhaps it was the suit, or the notebook, or the fact I had clearly emerged from the Palace across the road. Whatever, he didn't answer my first few remarks. He just stood there, glaring contemptuously. "Look," I said desperately, "I just want to know what you think of all the MPs not bothering to come in." Slowly, like an ancient tortoise, he craned his neck towards me. "I'm still here," he growled. And then began showing me, half-covered by snow, pictures of dead babies.
Haw's comment was an appropriate one. He had begun his protest on June 2nd 2001 over the economic sanctions being imposed on Iraq. Doing so was an extraordinary step for anyone to make: after a couple of years sleeping in the square he and his wife divorced, after all. Even before the 2003 invasion an attempt to remove him was made. It was the first of many defeats for those seeking to end his vigil.
Haw was an irritant to many in parliament. So MPs decided they could get rid of him on security grounds in 2003. Their recommendation became part of New Labour legislation two years later, by which time public anger at the Iraq war was at its peak. It was now combined with frustration by civil liberties campaigners. The court of appeal overturned the measures.
The transition from an angry carpenter to a global icon was not quite complete. Even as fresh attempts were begun to oust him, he won an award for being that year's 'most inspiring political figure'. In 2007 a reproduction of one of his protest banners by artist Mark Wallinger won the Turner Prize. He appeared on CNN regularly.
Wallinger has described Haw as a man of "tenacity, integrity and dignity". "Brian showed us what a quiescent and supine country we've become," he wrote in an article for the Independent newspaper. "What Brian was saying was never really reported properly, nor was the depth and heroism of his struggle. People who should know better would describe him as a crank and wouldn't bother to hear what he had to say."
It had looked as if the days of his protest were numbered, for he had lost an appeal in March against eviction from the grassy area of Parliament Square. But in the end, it was to be lung cancer, not politicians or officials, which forced him from Parliament Square.
Haw was never interested in becoming a legend. He was a pain, a thorn in the government's side, nothing more. Those inspired by his example who attempted to join him were often surprised when he turned out to be irascible and grumpy. His purpose was not to charm, like a politician, or tell a story, like a journalist. It was to make a point — an enduring reminder that the decisions made in Westminster have real consequences.
Sunday, June 19, 2011
Poem: The Five Stage of Grief
The night I lost you
someone pointed me towards
the Five Stages of Grief
Go that way, they said,
it's easy, like learning to climb
stairs after the amputation.
And so I climbed.
Denial was first.
I sat down at breakfast
carefully setting the table
for two. I passed you the toast---
you sat there. I passed
you the paper---you hid
behind it.
Anger seemed so familiar.
I burned the toast, snatched
the paper and read the headlines myself.
But they mentioned your departure,
and so I moved on to
Bargaining. What could I exchange
for you? The silence
after storms? My typing fingers?
Before I could decide, Depression
came puffing up, a poor relation
its suitcase tied together
with string. In the suitcase
were bandages for the eyes
and bottles sleep. I slid
all the way down the stairs
feeling nothing.
And all the time Hope
flashed on and off
in detective neon.
Hope was a signpost pointing
straight in the air.
Hope was my uncle's middle name,
he died of it.
After a year I am still climbing, though my feet slip
on your stone face.
The treeline
has long since disappeared;
green is a color
I have forgotten.
But now I see what I am climbing
towards: Acceptance
written in capital letters,
a special headline:
Acceptance
its name is in lights.
I struggle on,
waving and shouting.
Below, my whole life spreads its surf,
all the landscapes I've ever known
or dreamed of. Below
a fish jumps: the pulse
in your neck.
Acceptance. I finally
reach it.
But something is wrong.
Grief is a circular staircse.
I have lost you.
Linda Pastan
someone pointed me towards
the Five Stages of Grief
Go that way, they said,
it's easy, like learning to climb
stairs after the amputation.
And so I climbed.
Denial was first.
I sat down at breakfast
carefully setting the table
for two. I passed you the toast---
you sat there. I passed
you the paper---you hid
behind it.
Anger seemed so familiar.
I burned the toast, snatched
the paper and read the headlines myself.
But they mentioned your departure,
and so I moved on to
Bargaining. What could I exchange
for you? The silence
after storms? My typing fingers?
Before I could decide, Depression
came puffing up, a poor relation
its suitcase tied together
with string. In the suitcase
were bandages for the eyes
and bottles sleep. I slid
all the way down the stairs
feeling nothing.
And all the time Hope
flashed on and off
in detective neon.
Hope was a signpost pointing
straight in the air.
Hope was my uncle's middle name,
he died of it.
After a year I am still climbing, though my feet slip
on your stone face.
The treeline
has long since disappeared;
green is a color
I have forgotten.
But now I see what I am climbing
towards: Acceptance
written in capital letters,
a special headline:
Acceptance
its name is in lights.
I struggle on,
waving and shouting.
Below, my whole life spreads its surf,
all the landscapes I've ever known
or dreamed of. Below
a fish jumps: the pulse
in your neck.
Acceptance. I finally
reach it.
But something is wrong.
Grief is a circular staircse.
I have lost you.
Linda Pastan
Literature and medicine
Intenstive Care by Danielle Ofri
Winthrop Cohen - An elderly man is treated by a psychiatrist for depression. But the depression is caused by his reflections on his actions as a young man during the war. The psychiatrist treats him according to the guidelines - on the surface appearing to be successful, the Mr Cohen is able to return to work. However, he does not thank the psychiatrist, instead, a question is asked...
'Winthrop Cohen’s clinical depression responded to a short course of antidepressant medication and psychodynamic psychotherapy focused on clarifying and interpreting his wartime trauma in the context of his biography and intimate relations. After eight weeks, he no longer stared off into space or looked agitated or seriously depressed. He returned to work. His wife and daughter thanked me for treating this ‘breakdown’. But Winthrop Cohen never thanked me. To the contrary, at our last meeting, he implied that I was part of the societal collusion to cover up the threatening implications of war experiences such as his.
"I can put it away again. I don’t feel the same pressure. I can sleep, and eat, and fornicate again. But you know as well as I do that what’s bothering me can’t be treated or cured. Job said: ‘I will maintain my integrity. I will hold on to my righteousness’. I did neither. I soiled myself as I was soiled. I lost my humanity as those around me did the same. You don’t have any answers. Nor do I. Save to live with it. To realize I did the worst is to understand how ordinary men do bad things. How ordinary Americans were so anti-Semitic at that time. How ordinary Germans did what did during the Holocaust. How all of us are capable of murder. In the midst of war when all hell breaks loose and you are empowered to act with impunity, you can do horror and be decorated for it. And you can dine out for decades telling war stories, stories that are untrue. Because who can face up to the reality of the evil we did? Only the patriotic memories last. The killing is forgotten. The suffering remembered, because it is legitimate to speak of it. What can’t be said – I mean in public – is what I did. What dos that tell you about the soul?" '.
The words of Mr Cohen are more reflective than that of the psychiatrist.
Winthrop Cohen - An elderly man is treated by a psychiatrist for depression. But the depression is caused by his reflections on his actions as a young man during the war. The psychiatrist treats him according to the guidelines - on the surface appearing to be successful, the Mr Cohen is able to return to work. However, he does not thank the psychiatrist, instead, a question is asked...
'Winthrop Cohen’s clinical depression responded to a short course of antidepressant medication and psychodynamic psychotherapy focused on clarifying and interpreting his wartime trauma in the context of his biography and intimate relations. After eight weeks, he no longer stared off into space or looked agitated or seriously depressed. He returned to work. His wife and daughter thanked me for treating this ‘breakdown’. But Winthrop Cohen never thanked me. To the contrary, at our last meeting, he implied that I was part of the societal collusion to cover up the threatening implications of war experiences such as his.
"I can put it away again. I don’t feel the same pressure. I can sleep, and eat, and fornicate again. But you know as well as I do that what’s bothering me can’t be treated or cured. Job said: ‘I will maintain my integrity. I will hold on to my righteousness’. I did neither. I soiled myself as I was soiled. I lost my humanity as those around me did the same. You don’t have any answers. Nor do I. Save to live with it. To realize I did the worst is to understand how ordinary men do bad things. How ordinary Americans were so anti-Semitic at that time. How ordinary Germans did what did during the Holocaust. How all of us are capable of murder. In the midst of war when all hell breaks loose and you are empowered to act with impunity, you can do horror and be decorated for it. And you can dine out for decades telling war stories, stories that are untrue. Because who can face up to the reality of the evil we did? Only the patriotic memories last. The killing is forgotten. The suffering remembered, because it is legitimate to speak of it. What can’t be said – I mean in public – is what I did. What dos that tell you about the soul?" '.
The words of Mr Cohen are more reflective than that of the psychiatrist.
'Doctor Talk to Me'
Doctor Talk to Me - An article from the New York Times from just over 20 years ago. An editor, turned patient, gives his viewpoints and experiences. He lays out his prejudices, reflects on them, and what he would have wished to have and see in an 'ideal doctor'. This is very much one man's perspective, and obviously not reflective of all people. He makes some interesting points, made me notice some aspects that I previously did not think particularly important (e.g. having 'style'), although there are some points that I completely disagree with. But, overall it does make for a reflective and thought provoking read, and it was very brave, and even honourable, of him to write and share such an honest piece of his personal experiences and musings.
The bits I've put in bold are pretty much parts I would have highlighted or underlined if this were in a book.
pdf
By Anatole Broyard; Anatole Broyard is a former editor of The New York Times Book Review
Published: August 26, 1990
When, in the Summer of 1989, I moved from Connecticut to Cambridge, Mass., I found that I had difficulty urinating. I was like Portnoy, in ''Portnoy's Complaint,'' who couldn't fornicate in Israel. I had always wanted to live in Cambridge, and the thought passed through my mind that I couldn't urinate because - like Israel for Portnoy - Cambridge was a transcendent place for me.
When my inhibition persisted, I began to think about a doctor, and I set about finding one in the superstitious manner most of us fall back on: I asked a couple I knew for a recommendation. To be recommended, for whatever unreasonable reasons, gives a doctor an aura, a history, a shred of magic. Though I thought of my disorder as a simple matter - prostatitis is common in men of my age - I still wanted a potent doctor.
I applied to this particular couple for a recommendation because they are the two most critical people I know: critics of philosophy, politics, history, literature, drama, music. They are the sort of people for whom information is a religion, and the rigor of their conversation is legendary. To talk with them is an ordeal, a fatigue of fine distinctions, and I wanted a doctor who had survived such a scrutiny.
They could only give me the name of their internist, who referred me to a urologist. The recommendation was diluted, but it was better than none, so I made an appointment to see the urologist in a local hospital. The visit began well. The secretary was attractive, efficient and alert. She remembered my name. I was shown into a pleasant office and told that the doctor would be with me in a few minutes.
While I waited, I subjected the doctor to a preliminary semiotic scrutiny. Sitting in his office, I read his signs. The diplomas I took for granted; what interested me was the fact that the room was furnished with taste. There were well-made, well-filled bookcases, an antique desk and chairs, a reasonable Oriental rug on the floor. A large window opened one wall of the office to the panorama of Boston, and this suggested status, an earned respect. I imagined the doctor taking the long view out of his window.
On the walls and desk were pictures of three healthy-looking, conspicuously happy children, photographed in a prosperous outdoor setting of lawn, flowers and trees. As I remember, one of the photographs showed a sailboat. From the evidence, their father knew how to live - and by extension, how to look after the lives of others.
Soon the doctor came in and introduced himself. ''Let's go into my office,'' he said, and I realized that I had been waiting among someone else's effects. I felt that I had been tricked. Having already warmed myself to the first doctor, I was obliged to follow this second man, this impostor, into another office, which turned out to be modern and anonymous. There were no antiques, no Oriental rug and no pictures that I could see.
From the beginning, I had a negative feeling about this doctor. He didn't seem intense enough or determined enough to prevail over something powerful and demonic like illness. He had a pink, soft face and blue eyes, and his manner was hearty and vague at the same time, polite where politeness was irrelevant. He reminded me of a salesman with nothing to sell but his inoffensiveness.
I didn't like the way he spoke: it struck me as deliberately deliberate, a man fixed in a pose, playing doctor. There was no sign of a tragic sense of life in him that I could see, no furious desire to oppose himself to fate. I realized, of course, that what I was looking for was extravagant, that I was demanding nothing less than an ideal doctor, yet isn't that what we all want?
In the end, it didn't matter whether my reading of this particular man was just or unjust - I simply couldn't warm up to him. Choosing a doctor is difficult because it is our first explicit confrontation of our illness. ''How good is this man?'' is simply the reverse of ''How bad am I?'' To be sick brings out all our prejudices and primitive feelings. Like fear, or love, it makes us a little crazy. Yet the craziness of the patient is part of his condition. I was also aware of a certain predisposition in myself in favor of Jewish doctors. I thought of them as the trouble-shooters -the physicians, lawyers, brokers, arbiters and artists - of contemporary life. History had convinced them that life was a disease. My father, who was an old-fashioned Southern anti-Semite, insisted on a Jewish doctor when he developed cancer of the bladder. A Jewish doctor, he argued, had been bred to medicine. In my father's Biblical conception, a Jew's life was a story of study, repair and reform. A Jewish doctor knew what survival was worth, because he had had to fight for his. Obliged to treat life as a business as well as a pleasure, Jews drove hard bargains. To lose a patient was bad business. In his heart, I think my father believed that a Jewish doctor was closer to God and could use that connection to ''Jew down'' death.
This other, all-too-human doctor took me into an examining room and felt my prostate. It appeared to me that he had not yet overcome his self-consciousness about this procedure. Back in his office, he summed up his findings. There were hard lumps in my prostate, he said, which suggested tumors, and these ''mandated'' further investigation. He used the word ''mandate'' twice in his summary, as well as the word ''significantly.''
But he was the only urologist I knew in Cambridge, and so, a few days later, I allowed him to perform a cystoscopy, a procedure in which a small scope was inserted through my urethra up to my prostate and bladder. During surgical procedures, doctors wear a tightfitting white cap, a sort of skullcap like the one Alan Alda wears in ''M*A*S*H*.'' To this, my doctor had added what looked like a clear plastic shower cap, and the moment I saw him in these two caps, I turned irrevocably against him. He wore them absolutely without inflection or style, with none of the jauntiness that usually comes with long practice. He wore them like an American in France who affects a beret without understanding how to shape or cock it. To my eyes, this doctor simply didn't have the charisma to overcome or assimilate those caps, and that finished him off for me.
I want to point out that this man is in all likelihood an able, even a talented doctor. Certainly, I'm no judge of his medical competence, nor do I mean to criticize it. What turned me against him was what I saw as a lack of style. I realized that I wanted my doctor to have style - which I think of as a dash of magic - as well as medical ability. It was like having a lucky doctor. I've described all this - a patient's madness - to show how irrational such transactions are, how far removed from any notion of dispassionate objectivity. To be sick is already to be disordered in your mind as well. Still, this does not necessarily mean that I was wrong to want to change doctors: I was simply listening to my unconscious telling me what I needed.
Now that I know I have cancer of the prostate, the lymph nodes and part of my skeleton, what do I want in a doctor? I would say that I want one who is a close reader of illness and a good critic of medicine. I secretly believe that criticism can wither cancer. Also, I would like a doctor who is not only a talented physician but a bit of a metaphysician too, someone who can treat body and soul. I used to get restless when people talked about soul, but now I know better. Soul is the part of you that you summon up in emergencies. You don't need to be religious to believe in the soul or to have one.
My ideal doctor would be my Virgil, leading me through my purgatory or inferno, pointing out the sights as we go. He would resemble Oliver Sacks, the neurologist who wrote ''Awakenings'' and ''The Man Who Mistook His Wife for a Hat.'' I can imagine Dr. Sacks entering my condition, looking around at it from the inside like a benevolent landlord with a tenant, trying to see how he could make the premises more livable for me. He would see the genius of my illness. He would mingle his daemon with mine; we would wrestle with my fate together. Inside every patient, there's a poet trying to get out. My ideal doctor would ''read'' my poetry, my literature. He would see that my sickness has purified me, weakening my worst parts and strengthening the best.
To most physicians, my illness is a routine incident in their rounds, while for me it's the crisis of my life. I would feel better if I had a doctor who, at least, perceived this incongruity. I don't ask him to love me - in fact, I think the role of love is greatly exaggerated by many writers on illness. Of course you want your family and close friends to love you, but the situation shouldn't become a hunting season for love, or a competition, a desperate kiss before dying. To a critically ill person, love may begin to resemble an anesthetic. In a novel by Joy Williams called ''State of Grace,'' a character asks, ''What can be beyond love? I want to get there.'' The sick man has got there: he's at a point where what he wants from most people is not love but a spacious, flaring grasp of his situation, what is known now in the literature of illness as ''empathetic witnessing.'' The patient is always on the brink of revelation, and he needs someone who can recognize it when it comes.
Just as I see no reason for my physician to love me, I would not expect him to suffer with me either. On the contrary, what would please me most would be a doctor who enjoyed me. I want to be a good story for him, to give him some of my art in exchange for his. If a patient expects a doctor to be interested in him, he ought to try to be interesting. When he shows nothing but a greediness for care, nothing but the coarser forms of anxiety, it's only natural for the physician to feel an aversion. There is an etiquette to being sick.
I wouldn't demand a lot of my doctor's time; I just wish he would brood on my situation for perhaps five minutes, that he would give me his whole mind just once. I would like to think of him as going through my character, as he goes through my flesh, to get at my illness, for each man is ill in his own way. Proust complained that his physician did not allow for his having read Shakespeare. I have a wistful desire for my relation to my doctor to be beautiful - but I don't know how this can be brought about. Though I see us framed in an epiphany, I can't make out the content.
Just as he orders blood tests and bone scans of my body, I'd like my doctor to scan me, to grope for my spirit as well as my prostate. While he inevitably feels superior to me because he is the doctor and I am the patient, I'd like him to know that I feel superior to him too, that he is my patient also and I have my diagnosis of him. There should be a place where our respective superiorities could meet and frolic together.
Since technology deprives me of the intimacy of my illness, makes it not mine but something that belongs to science, I wish my doctor could somehow restore it to me and make it personal again. When my father's father died in the French Quarter of New Orleans 60 years ago, the popularly accepted story was that on a humid night in mid-August, he had eaten a dozen bananas and then taken a cold bath. He was a man of 87 whose life had been a strenuous assertion of his appetites, and this explanation suited him, just as it suited his friends in the French Quarter. It would be more satisfying to me, it would allow me to feel that I owned my illness, if my urologist were to say, ''You know, you've beat the hell out of this prostate of yours. It looks like a worn-out baseball.'' Nobody wants an anonymous illness. I'd much rather think that I brought it on myself than that it was a mere accident of nature.
It is only natural for a patient to feel some dismay at the changes brought about in his body by illness, and I wonder whether an innovative doctor - again, like Oliver Sacks - couldn't find a way to reconceptualize this situation. If only the patient could be allowed to see his illness not so much as a failure of his body as a natural consumption of it. Any reconciling idea would do. The doctor could say, ''You've spent your self unselfishly, like a philanthropist who gives all his money away.'' If the patient could feel that he has earned his illness, that his sickness represents the decadence that follows a great flowering, he might look upon the ruin of his body as tourists look upon the ruins of antiquity. (Of course I'm offering these suggestions playfully, as experiments in thinking about medicine.) Physicians have been taught in medical school that they must keep the patient at a distance because there isn't time to accommodate his personality, or because if the doctor becomes ''involved'' in the patient's predicament, the emotional burden will be too great. As I've suggested, it doesn't take much time to make good contact, but beyond that, the emotional burden of avoiding the patient may be much harder on the doctor than he imagines. It may be this that sometimes makes him complain of feeling harassed. The patient's unanswered questions will always thunder in his stethoscope. A doctor's job would be so much more interesting and satisfying if he would occasionally let himself plunge into the patient, if he could lose his own fear of falling.
Applying to other friends, following new recommendations, I found another urologist. He's highly regarded in his field, and he inspired such confidence in me that my cancer immediately went into remission. My only regret is that he doesn't talk very much - and when he does, he sounds like everybody else. His brilliance has no voice - at least not when he's with me. There's a paradox here at the heart of medicine, because a doctor, like a writer, must have a voice of his own, something that conveys the timbre, the rhythm, the diction and the music of his humanity, that compensates us for all the speechless machines. When a doctor makes a difficult diagnosis, it is not his medical knowledge only that determines it, but a voice in his head. Such a diagnosis depends as much on inspiration as art does. Whether he wants to be or not, the doctor is a storyteller, and he can turn our lives into good or bad stories, regardless of the diagnosis. If my doctor would allow me, I would be glad to help him here, to take him on as my patient.
Although I hope to live for a while, my urologist is young, and I see us as joined till death do us part. Perhaps later, when he is older, he'll have learned how to converse. Astute as he is, he doesn't yet understand that all cures are partly ''talking cures.'' Every patient needs mouth-to-mouth resusitation, for talk is the kiss of life.
Yet it's too easy to accuse the doctor, to blame the absence of natural talk on him. It's also true that some of what the patient asks is ineffable. Even a doctor like Chekhov would be hard put to answer him. For example, I would like to discuss my prostate with my urologist not as a diseased organ but as a philosopher's stone. Every patient invites the doctor to combine the role of the priest, the philosopher, the poet, the scholar. He expects the doctor to evaluate his entire life, like a biographer.
Of course, a physician may reasonably ask: ''But what am I supposed to say? All I can tell the patient is the facts, if there are any facts.'' But this is not quite true. The doctor's answer to his patient is yet to be born. It will come naturally - or at first unnaturally - from the intersecting of the patient's needs with the physician's as yet untried imagination. Just as a mother ushers her child into the world, so the doctor must usher the patient out of the ordinary world into whatever place awaits him. The physician is the patient's only familiar in a foreign country.
To help the doctor reach the patient, and the patient to reach the doctor, the mood of the hospital might have to be modified. It might be less like a laboratory and more like a theater, which would be only fitting, since no place contains more drama. The laboratory atmosphere can probably be traced back to the idea of asepsis, to the avoidance of contagion. Originally, the patient was protected by the sterility of the hospital. Only the sterility went too far: It sterilized the doctor's thinking. It sterilized the patient's entire experience in the hospital. It sterilized the very notion of illness to the point where we can't bring our soiled thoughts to bear on it. But the sick man needs the contagion of life.
Not every patient can be saved, but his illness may be eased by the way the doctor responds to him - and in responding to him, the doctor may save himself. But first he must become a student again; he has to dissect the cadaver of his professional persona; he must see that his silence and neutrality are unnatural. It may be necessary to give up some of his authority in exchange for his humanity, but as the old family doctors knew, this is not a bad bargain. In learning to talk to his patients, the doctor may talk himself back into loving his work. He has little to lose and much to gain by letting the sick man into his heart. If he does, they can share, as few others can, the wonder, terror and exaltation of being on the edge of being, between the natural and the supernatural.
The bits I've put in bold are pretty much parts I would have highlighted or underlined if this were in a book.
By Anatole Broyard; Anatole Broyard is a former editor of The New York Times Book Review
Published: August 26, 1990
When, in the Summer of 1989, I moved from Connecticut to Cambridge, Mass., I found that I had difficulty urinating. I was like Portnoy, in ''Portnoy's Complaint,'' who couldn't fornicate in Israel. I had always wanted to live in Cambridge, and the thought passed through my mind that I couldn't urinate because - like Israel for Portnoy - Cambridge was a transcendent place for me.
When my inhibition persisted, I began to think about a doctor, and I set about finding one in the superstitious manner most of us fall back on: I asked a couple I knew for a recommendation. To be recommended, for whatever unreasonable reasons, gives a doctor an aura, a history, a shred of magic. Though I thought of my disorder as a simple matter - prostatitis is common in men of my age - I still wanted a potent doctor.
I applied to this particular couple for a recommendation because they are the two most critical people I know: critics of philosophy, politics, history, literature, drama, music. They are the sort of people for whom information is a religion, and the rigor of their conversation is legendary. To talk with them is an ordeal, a fatigue of fine distinctions, and I wanted a doctor who had survived such a scrutiny.
They could only give me the name of their internist, who referred me to a urologist. The recommendation was diluted, but it was better than none, so I made an appointment to see the urologist in a local hospital. The visit began well. The secretary was attractive, efficient and alert. She remembered my name. I was shown into a pleasant office and told that the doctor would be with me in a few minutes.
While I waited, I subjected the doctor to a preliminary semiotic scrutiny. Sitting in his office, I read his signs. The diplomas I took for granted; what interested me was the fact that the room was furnished with taste. There were well-made, well-filled bookcases, an antique desk and chairs, a reasonable Oriental rug on the floor. A large window opened one wall of the office to the panorama of Boston, and this suggested status, an earned respect. I imagined the doctor taking the long view out of his window.
On the walls and desk were pictures of three healthy-looking, conspicuously happy children, photographed in a prosperous outdoor setting of lawn, flowers and trees. As I remember, one of the photographs showed a sailboat. From the evidence, their father knew how to live - and by extension, how to look after the lives of others.
Soon the doctor came in and introduced himself. ''Let's go into my office,'' he said, and I realized that I had been waiting among someone else's effects. I felt that I had been tricked. Having already warmed myself to the first doctor, I was obliged to follow this second man, this impostor, into another office, which turned out to be modern and anonymous. There were no antiques, no Oriental rug and no pictures that I could see.
From the beginning, I had a negative feeling about this doctor. He didn't seem intense enough or determined enough to prevail over something powerful and demonic like illness. He had a pink, soft face and blue eyes, and his manner was hearty and vague at the same time, polite where politeness was irrelevant. He reminded me of a salesman with nothing to sell but his inoffensiveness.
I didn't like the way he spoke: it struck me as deliberately deliberate, a man fixed in a pose, playing doctor. There was no sign of a tragic sense of life in him that I could see, no furious desire to oppose himself to fate. I realized, of course, that what I was looking for was extravagant, that I was demanding nothing less than an ideal doctor, yet isn't that what we all want?
In the end, it didn't matter whether my reading of this particular man was just or unjust - I simply couldn't warm up to him. Choosing a doctor is difficult because it is our first explicit confrontation of our illness. ''How good is this man?'' is simply the reverse of ''How bad am I?'' To be sick brings out all our prejudices and primitive feelings. Like fear, or love, it makes us a little crazy. Yet the craziness of the patient is part of his condition. I was also aware of a certain predisposition in myself in favor of Jewish doctors. I thought of them as the trouble-shooters -the physicians, lawyers, brokers, arbiters and artists - of contemporary life. History had convinced them that life was a disease. My father, who was an old-fashioned Southern anti-Semite, insisted on a Jewish doctor when he developed cancer of the bladder. A Jewish doctor, he argued, had been bred to medicine. In my father's Biblical conception, a Jew's life was a story of study, repair and reform. A Jewish doctor knew what survival was worth, because he had had to fight for his. Obliged to treat life as a business as well as a pleasure, Jews drove hard bargains. To lose a patient was bad business. In his heart, I think my father believed that a Jewish doctor was closer to God and could use that connection to ''Jew down'' death.
This other, all-too-human doctor took me into an examining room and felt my prostate. It appeared to me that he had not yet overcome his self-consciousness about this procedure. Back in his office, he summed up his findings. There were hard lumps in my prostate, he said, which suggested tumors, and these ''mandated'' further investigation. He used the word ''mandate'' twice in his summary, as well as the word ''significantly.''
But he was the only urologist I knew in Cambridge, and so, a few days later, I allowed him to perform a cystoscopy, a procedure in which a small scope was inserted through my urethra up to my prostate and bladder. During surgical procedures, doctors wear a tightfitting white cap, a sort of skullcap like the one Alan Alda wears in ''M*A*S*H*.'' To this, my doctor had added what looked like a clear plastic shower cap, and the moment I saw him in these two caps, I turned irrevocably against him. He wore them absolutely without inflection or style, with none of the jauntiness that usually comes with long practice. He wore them like an American in France who affects a beret without understanding how to shape or cock it. To my eyes, this doctor simply didn't have the charisma to overcome or assimilate those caps, and that finished him off for me.
I want to point out that this man is in all likelihood an able, even a talented doctor. Certainly, I'm no judge of his medical competence, nor do I mean to criticize it. What turned me against him was what I saw as a lack of style. I realized that I wanted my doctor to have style - which I think of as a dash of magic - as well as medical ability. It was like having a lucky doctor. I've described all this - a patient's madness - to show how irrational such transactions are, how far removed from any notion of dispassionate objectivity. To be sick is already to be disordered in your mind as well. Still, this does not necessarily mean that I was wrong to want to change doctors: I was simply listening to my unconscious telling me what I needed.
Now that I know I have cancer of the prostate, the lymph nodes and part of my skeleton, what do I want in a doctor? I would say that I want one who is a close reader of illness and a good critic of medicine. I secretly believe that criticism can wither cancer. Also, I would like a doctor who is not only a talented physician but a bit of a metaphysician too, someone who can treat body and soul. I used to get restless when people talked about soul, but now I know better. Soul is the part of you that you summon up in emergencies. You don't need to be religious to believe in the soul or to have one.
My ideal doctor would be my Virgil, leading me through my purgatory or inferno, pointing out the sights as we go. He would resemble Oliver Sacks, the neurologist who wrote ''Awakenings'' and ''The Man Who Mistook His Wife for a Hat.'' I can imagine Dr. Sacks entering my condition, looking around at it from the inside like a benevolent landlord with a tenant, trying to see how he could make the premises more livable for me. He would see the genius of my illness. He would mingle his daemon with mine; we would wrestle with my fate together. Inside every patient, there's a poet trying to get out. My ideal doctor would ''read'' my poetry, my literature. He would see that my sickness has purified me, weakening my worst parts and strengthening the best.
To most physicians, my illness is a routine incident in their rounds, while for me it's the crisis of my life. I would feel better if I had a doctor who, at least, perceived this incongruity. I don't ask him to love me - in fact, I think the role of love is greatly exaggerated by many writers on illness. Of course you want your family and close friends to love you, but the situation shouldn't become a hunting season for love, or a competition, a desperate kiss before dying. To a critically ill person, love may begin to resemble an anesthetic. In a novel by Joy Williams called ''State of Grace,'' a character asks, ''What can be beyond love? I want to get there.'' The sick man has got there: he's at a point where what he wants from most people is not love but a spacious, flaring grasp of his situation, what is known now in the literature of illness as ''empathetic witnessing.'' The patient is always on the brink of revelation, and he needs someone who can recognize it when it comes.
Just as I see no reason for my physician to love me, I would not expect him to suffer with me either. On the contrary, what would please me most would be a doctor who enjoyed me. I want to be a good story for him, to give him some of my art in exchange for his. If a patient expects a doctor to be interested in him, he ought to try to be interesting. When he shows nothing but a greediness for care, nothing but the coarser forms of anxiety, it's only natural for the physician to feel an aversion. There is an etiquette to being sick.
I wouldn't demand a lot of my doctor's time; I just wish he would brood on my situation for perhaps five minutes, that he would give me his whole mind just once. I would like to think of him as going through my character, as he goes through my flesh, to get at my illness, for each man is ill in his own way. Proust complained that his physician did not allow for his having read Shakespeare. I have a wistful desire for my relation to my doctor to be beautiful - but I don't know how this can be brought about. Though I see us framed in an epiphany, I can't make out the content.
Just as he orders blood tests and bone scans of my body, I'd like my doctor to scan me, to grope for my spirit as well as my prostate. While he inevitably feels superior to me because he is the doctor and I am the patient, I'd like him to know that I feel superior to him too, that he is my patient also and I have my diagnosis of him. There should be a place where our respective superiorities could meet and frolic together.
Since technology deprives me of the intimacy of my illness, makes it not mine but something that belongs to science, I wish my doctor could somehow restore it to me and make it personal again. When my father's father died in the French Quarter of New Orleans 60 years ago, the popularly accepted story was that on a humid night in mid-August, he had eaten a dozen bananas and then taken a cold bath. He was a man of 87 whose life had been a strenuous assertion of his appetites, and this explanation suited him, just as it suited his friends in the French Quarter. It would be more satisfying to me, it would allow me to feel that I owned my illness, if my urologist were to say, ''You know, you've beat the hell out of this prostate of yours. It looks like a worn-out baseball.'' Nobody wants an anonymous illness. I'd much rather think that I brought it on myself than that it was a mere accident of nature.
It is only natural for a patient to feel some dismay at the changes brought about in his body by illness, and I wonder whether an innovative doctor - again, like Oliver Sacks - couldn't find a way to reconceptualize this situation. If only the patient could be allowed to see his illness not so much as a failure of his body as a natural consumption of it. Any reconciling idea would do. The doctor could say, ''You've spent your self unselfishly, like a philanthropist who gives all his money away.'' If the patient could feel that he has earned his illness, that his sickness represents the decadence that follows a great flowering, he might look upon the ruin of his body as tourists look upon the ruins of antiquity. (Of course I'm offering these suggestions playfully, as experiments in thinking about medicine.) Physicians have been taught in medical school that they must keep the patient at a distance because there isn't time to accommodate his personality, or because if the doctor becomes ''involved'' in the patient's predicament, the emotional burden will be too great. As I've suggested, it doesn't take much time to make good contact, but beyond that, the emotional burden of avoiding the patient may be much harder on the doctor than he imagines. It may be this that sometimes makes him complain of feeling harassed. The patient's unanswered questions will always thunder in his stethoscope. A doctor's job would be so much more interesting and satisfying if he would occasionally let himself plunge into the patient, if he could lose his own fear of falling.
Applying to other friends, following new recommendations, I found another urologist. He's highly regarded in his field, and he inspired such confidence in me that my cancer immediately went into remission. My only regret is that he doesn't talk very much - and when he does, he sounds like everybody else. His brilliance has no voice - at least not when he's with me. There's a paradox here at the heart of medicine, because a doctor, like a writer, must have a voice of his own, something that conveys the timbre, the rhythm, the diction and the music of his humanity, that compensates us for all the speechless machines. When a doctor makes a difficult diagnosis, it is not his medical knowledge only that determines it, but a voice in his head. Such a diagnosis depends as much on inspiration as art does. Whether he wants to be or not, the doctor is a storyteller, and he can turn our lives into good or bad stories, regardless of the diagnosis. If my doctor would allow me, I would be glad to help him here, to take him on as my patient.
Although I hope to live for a while, my urologist is young, and I see us as joined till death do us part. Perhaps later, when he is older, he'll have learned how to converse. Astute as he is, he doesn't yet understand that all cures are partly ''talking cures.'' Every patient needs mouth-to-mouth resusitation, for talk is the kiss of life.
Yet it's too easy to accuse the doctor, to blame the absence of natural talk on him. It's also true that some of what the patient asks is ineffable. Even a doctor like Chekhov would be hard put to answer him. For example, I would like to discuss my prostate with my urologist not as a diseased organ but as a philosopher's stone. Every patient invites the doctor to combine the role of the priest, the philosopher, the poet, the scholar. He expects the doctor to evaluate his entire life, like a biographer.
Of course, a physician may reasonably ask: ''But what am I supposed to say? All I can tell the patient is the facts, if there are any facts.'' But this is not quite true. The doctor's answer to his patient is yet to be born. It will come naturally - or at first unnaturally - from the intersecting of the patient's needs with the physician's as yet untried imagination. Just as a mother ushers her child into the world, so the doctor must usher the patient out of the ordinary world into whatever place awaits him. The physician is the patient's only familiar in a foreign country.
To help the doctor reach the patient, and the patient to reach the doctor, the mood of the hospital might have to be modified. It might be less like a laboratory and more like a theater, which would be only fitting, since no place contains more drama. The laboratory atmosphere can probably be traced back to the idea of asepsis, to the avoidance of contagion. Originally, the patient was protected by the sterility of the hospital. Only the sterility went too far: It sterilized the doctor's thinking. It sterilized the patient's entire experience in the hospital. It sterilized the very notion of illness to the point where we can't bring our soiled thoughts to bear on it. But the sick man needs the contagion of life.
Not every patient can be saved, but his illness may be eased by the way the doctor responds to him - and in responding to him, the doctor may save himself. But first he must become a student again; he has to dissect the cadaver of his professional persona; he must see that his silence and neutrality are unnatural. It may be necessary to give up some of his authority in exchange for his humanity, but as the old family doctors knew, this is not a bad bargain. In learning to talk to his patients, the doctor may talk himself back into loving his work. He has little to lose and much to gain by letting the sick man into his heart. If he does, they can share, as few others can, the wonder, terror and exaltation of being on the edge of being, between the natural and the supernatural.
Westminister peace protester dies - RIP
Anti-War Campaigner Haw Loses Cancer Battle
.Veteran anti-war campaigner Brian Haw - who spent years living in a tent opposite the Houses of Parliament - has died after a long battle against cancer.
A statement by his family on brianhaw.tv, said: "It is with deepest regret that I inform you that our father, Brian, passed away this morning.
"As you know he was battling lung cancer, and was having treatment in Germany.
"He left us in his sleep and in no pain, after a long, hard fight."
Mr Haw, who was 62, had been battling for his right to remain living in a tent in Parliament Square.
He had been stationed in the square for 10 years, and had fought off a series of legal objections to his presence there.
The latest saw the Greater London Authority get him and his supporters thrown off the grass area at the centre of the square.
Later this year Westminster Council will attempt to get the camp moved off the pavement, which could see it removed permanently.
Mr Haw, began his round-the-clock protest opposite the Houses of Parliament against the UK's policy in Iraq and elsewhere on June 2, 2001.
It began as an angry response to economic sanctions and British and American bombing raids on Iraq.
But the scope widened after the 9/11 attacks on New York and Washington DC, and the invasions of Afghanistan and Iraq that followed.
Mr Haw's tent and ragtag collection of horrific pictures of war victims and hand-written posters with slogans like "baby killers" was a familiar sight in the square.
Civil rights campaigners got behind him as he saw off various attempts to force him to move.
In November 2004, ministers announced provisions in the Serious Organised Crime and Police Bill that could have seen him removed from Parliament Square.
Initially, the High Court ruled Mr Haw's protest was not covered by the Act because it started before the new law came into effect.
But the case was taken to the Court of Appeal which, in May 2006, ruled he would have to apply to the police under the Act for permission to continue his protest.
Fellow members of the Parliament Square Peace Campaign said the authorities "should forever be ashamed of their disgraceful behaviour towards Brian".
.
.Veteran anti-war campaigner Brian Haw - who spent years living in a tent opposite the Houses of Parliament - has died after a long battle against cancer.
A statement by his family on brianhaw.tv, said: "It is with deepest regret that I inform you that our father, Brian, passed away this morning.
"As you know he was battling lung cancer, and was having treatment in Germany.
"He left us in his sleep and in no pain, after a long, hard fight."
Mr Haw, who was 62, had been battling for his right to remain living in a tent in Parliament Square.
He had been stationed in the square for 10 years, and had fought off a series of legal objections to his presence there.
The latest saw the Greater London Authority get him and his supporters thrown off the grass area at the centre of the square.
Later this year Westminster Council will attempt to get the camp moved off the pavement, which could see it removed permanently.
Mr Haw, began his round-the-clock protest opposite the Houses of Parliament against the UK's policy in Iraq and elsewhere on June 2, 2001.
It began as an angry response to economic sanctions and British and American bombing raids on Iraq.
But the scope widened after the 9/11 attacks on New York and Washington DC, and the invasions of Afghanistan and Iraq that followed.
Mr Haw's tent and ragtag collection of horrific pictures of war victims and hand-written posters with slogans like "baby killers" was a familiar sight in the square.
Civil rights campaigners got behind him as he saw off various attempts to force him to move.
In November 2004, ministers announced provisions in the Serious Organised Crime and Police Bill that could have seen him removed from Parliament Square.
Initially, the High Court ruled Mr Haw's protest was not covered by the Act because it started before the new law came into effect.
But the case was taken to the Court of Appeal which, in May 2006, ruled he would have to apply to the police under the Act for permission to continue his protest.
Fellow members of the Parliament Square Peace Campaign said the authorities "should forever be ashamed of their disgraceful behaviour towards Brian".
.
Sunday, June 12, 2011
Film: Koudak va fereshteh (Child and Angel)
2009, 95 mins, Iranian feature.
Director : Masoud Naghashzadeh.
Producer : Hassan Kalami.
Set in a town in southern Iran in the summer of 1980, the film follows the experiences of a school girl as was descends, and sets in. A carefully and sensitively told story.
16th International Children's Film Festival India page 3 of the document
SCHLINGEL International Film Festival - 2009 Cinestar Youth Film Award
Profile from the Schlingel archive - in German
... and translated into english, courtesy of google translate. Somewhat cumbersome translation unfortunately.
Nominated for best film editing in 27th Fajr International Film Festival
Director : Masoud Naghashzadeh.
Producer : Hassan Kalami.
Set in a town in southern Iran in the summer of 1980, the film follows the experiences of a school girl as was descends, and sets in. A carefully and sensitively told story.
16th International Children's Film Festival India page 3 of the document
SCHLINGEL International Film Festival - 2009 Cinestar Youth Film Award
Profile from the Schlingel archive - in German
... and translated into english, courtesy of google translate. Somewhat cumbersome translation unfortunately.
Nominated for best film editing in 27th Fajr International Film Festival
Friday, June 03, 2011
Poet arrested
The Independant
Locked up for reading a poem
Ayat al-Gormezi, the woman who symbolises Bahrain's fight for freedom
By Patrick Cockburn
Thursday, 2 June 2011
Bahrain's security forces are increasingly targeting women in their campaign against pro-democracy protesters despite yesterday lifting martial law in the island kingdom.
Ayat al-Gormezi, 20, a poet and student arrested two months ago after reading out a poem at a pro-democracy rally, is due to go on trial today before a military tribunal, her mother said. Ayat was forced to turn herself in when masked policemen threatened to kill her brothers unless she did so.
She has not been seen since her arrest, though her mother did talk to her once by phone and Ayat said that she had been forced to sign a false confession. Her mother has since been told that her daughter has been in a military hospital after being tortured.
"We are the people who will kill humiliation and assassinate misery," a film captures Ayat telling a cheering crowd of protesters in Pearl Square in February. "We are the people who will destroy the foundation of injustice." She addresses King Hamad bin Isa al-Khalifa directly and says to him: "Don't you hear their cries, don't you hear their screams?" As she finishes, the crowd shouts: "Down with Hamad."
Ayat's call for change was no more radical than that heard in the streets of Tunis, Cairo and Benghazi at about the same time. But her reference to the king might explain the fury shown by the Bahraini security forces who, going by photographs of the scene, smashed up her bedroom when they raided her house and could not find her.
There are signs that Bahraini police, riot police and special security are detaining and mistreating more and more women. Many are held incommunicado, forced to sign confessions or threatened with rape, according to Bahraini human rights groups.
Bahrain is the first country affected by the Arab Spring where women have been singled out as targets for repression. Human rights groups say that hundreds have been arrested. Many women complain of being severely beaten while in custody. One woman journalist was beaten so badly that she could not walk.
A woman doctor, who was later released but may be charged, says she was threatened with rape. She told Reuters news agency that the police said: "We are 14 guys in this room, do you know what we can do to you? It's the emergency law [martial law] and we are free to do what we want."
The ending of martial law and a call for dialogue from King Hamad appear to be part of a campaign to show that normal life is returning to Bahrain. The Bahraini government is eager to host the Formula One motor race, which was postponed from earlier in the year, but may be rescheduled to take place in Bahrain by the sports governing body meeting in Barcelona tomorrow.
Despite the lifting of martial law, imposed on 15 March, there is no sign of repression easing. Some 600 people are still detained, at least 2,000 have been sacked, and some 27 mosques of the Shia, who make up 70 per cent of the population, have been bulldozed.
The protests started on 14 February in emulation of events in Egypt and Tunisia with a campaign for political reform, a central demand being civil and political equality for the majority Shia. The al-Khalifa royal family and the ruling class in Bahrain are Sunni.
The targeting of women by the security forces may, like the destruction of mosques, have the broader aim of demonstrating to the Shia community that the Sunni elite will show no restraint in preventing the Shia winning political power. Shia leaders complain that the state-controlled media is continuing to pump out sectarian anti-Shia propaganda.
The government is eager to show that Bahrain can return to being an untroubled business and tourist hub for the Gulf. Having the Formula One race rescheduled to take place on the island later this year would be an important success in this direction.
The New York based Human Rights Watch has written to the Federation Internationale de l'Automobile (FIA), saying that the race would take place in an environment of unrelenting "punitive retribution" against pro-democracy protesters.
If the race does go ahead it will be without a quarter of the staff of the Bahrain International Circuit, the host organisation, who have been arrested, including two senior staff. Most have been sacked or suspended, accused of approving of the postponement of the Formula One event earlier in the year.
The government has been detaining and beating local reporters. The one international journalist based permanently in Bahrain was ordered out this month. Even foreign correspondents with entry visas have been denied entry when they arrive in Bahrain.
Profile: Ayat al-Gormezi
Ayat al-Gormezi, a 20-year-old poet and student at the Faculty of Teachers in Bahrain, was arrested on 30 March for reciting a poem critical of the government during the pro-democracy protests in Pearl Square, the main gathering place for demonstrators, in February. She was forced to give herself up after police raided her parents' house and made four of Ayat's brothers lie on the floor at gunpoint. She was not there at the time. One policeman shouted at their father to "tell us where Ayat is or we will kill each of your sons in front of your eyes".
Masked police and special riot police later took Ayat away telling her mother that her daughter would be interrogated. Her mother was told to pick up her daughter from Al-Howra police station, but has not seen her since her arrest. She did speak to her once on the phone when Ayat told her that she had been forced to sign a false confession. Her mother has been told confidentially that Ayat is in a military hospital as a result of injuries inflicted when she was tortured.
Locked up for reading a poem
Ayat al-Gormezi, the woman who symbolises Bahrain's fight for freedom
By Patrick Cockburn
Thursday, 2 June 2011
Bahrain's security forces are increasingly targeting women in their campaign against pro-democracy protesters despite yesterday lifting martial law in the island kingdom.
Ayat al-Gormezi, 20, a poet and student arrested two months ago after reading out a poem at a pro-democracy rally, is due to go on trial today before a military tribunal, her mother said. Ayat was forced to turn herself in when masked policemen threatened to kill her brothers unless she did so.
She has not been seen since her arrest, though her mother did talk to her once by phone and Ayat said that she had been forced to sign a false confession. Her mother has since been told that her daughter has been in a military hospital after being tortured.
"We are the people who will kill humiliation and assassinate misery," a film captures Ayat telling a cheering crowd of protesters in Pearl Square in February. "We are the people who will destroy the foundation of injustice." She addresses King Hamad bin Isa al-Khalifa directly and says to him: "Don't you hear their cries, don't you hear their screams?" As she finishes, the crowd shouts: "Down with Hamad."
Ayat's call for change was no more radical than that heard in the streets of Tunis, Cairo and Benghazi at about the same time. But her reference to the king might explain the fury shown by the Bahraini security forces who, going by photographs of the scene, smashed up her bedroom when they raided her house and could not find her.
There are signs that Bahraini police, riot police and special security are detaining and mistreating more and more women. Many are held incommunicado, forced to sign confessions or threatened with rape, according to Bahraini human rights groups.
Bahrain is the first country affected by the Arab Spring where women have been singled out as targets for repression. Human rights groups say that hundreds have been arrested. Many women complain of being severely beaten while in custody. One woman journalist was beaten so badly that she could not walk.
A woman doctor, who was later released but may be charged, says she was threatened with rape. She told Reuters news agency that the police said: "We are 14 guys in this room, do you know what we can do to you? It's the emergency law [martial law] and we are free to do what we want."
The ending of martial law and a call for dialogue from King Hamad appear to be part of a campaign to show that normal life is returning to Bahrain. The Bahraini government is eager to host the Formula One motor race, which was postponed from earlier in the year, but may be rescheduled to take place in Bahrain by the sports governing body meeting in Barcelona tomorrow.
Despite the lifting of martial law, imposed on 15 March, there is no sign of repression easing. Some 600 people are still detained, at least 2,000 have been sacked, and some 27 mosques of the Shia, who make up 70 per cent of the population, have been bulldozed.
The protests started on 14 February in emulation of events in Egypt and Tunisia with a campaign for political reform, a central demand being civil and political equality for the majority Shia. The al-Khalifa royal family and the ruling class in Bahrain are Sunni.
The targeting of women by the security forces may, like the destruction of mosques, have the broader aim of demonstrating to the Shia community that the Sunni elite will show no restraint in preventing the Shia winning political power. Shia leaders complain that the state-controlled media is continuing to pump out sectarian anti-Shia propaganda.
The government is eager to show that Bahrain can return to being an untroubled business and tourist hub for the Gulf. Having the Formula One race rescheduled to take place on the island later this year would be an important success in this direction.
The New York based Human Rights Watch has written to the Federation Internationale de l'Automobile (FIA), saying that the race would take place in an environment of unrelenting "punitive retribution" against pro-democracy protesters.
If the race does go ahead it will be without a quarter of the staff of the Bahrain International Circuit, the host organisation, who have been arrested, including two senior staff. Most have been sacked or suspended, accused of approving of the postponement of the Formula One event earlier in the year.
The government has been detaining and beating local reporters. The one international journalist based permanently in Bahrain was ordered out this month. Even foreign correspondents with entry visas have been denied entry when they arrive in Bahrain.
Profile: Ayat al-Gormezi
Ayat al-Gormezi, a 20-year-old poet and student at the Faculty of Teachers in Bahrain, was arrested on 30 March for reciting a poem critical of the government during the pro-democracy protests in Pearl Square, the main gathering place for demonstrators, in February. She was forced to give herself up after police raided her parents' house and made four of Ayat's brothers lie on the floor at gunpoint. She was not there at the time. One policeman shouted at their father to "tell us where Ayat is or we will kill each of your sons in front of your eyes".
Masked police and special riot police later took Ayat away telling her mother that her daughter would be interrogated. Her mother was told to pick up her daughter from Al-Howra police station, but has not seen her since her arrest. She did speak to her once on the phone when Ayat told her that she had been forced to sign a false confession. Her mother has been told confidentially that Ayat is in a military hospital as a result of injuries inflicted when she was tortured.
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