Y’know, I was recently at a national conference. There, I attended an interesting presentation where the clear message appeared to be that pharmacists have a need to be liked.I suppose most professions like to be liked just like most people like to be liked, but it appears that pharmacists have it bad—real bad.In the presentation, they discussed a few different interventions that pharmacists had either made or hesitated to make.The reasons for their failure to act was in some way that need to be liked; that need to not create friction; that need to be pleasant and friendly, collegial and respectful. In other words, pharmacists, instead of standing up for themselves and what they know, deferred to politeness.The rest of the discussion pointed to the need to populate our profession with professionals who will stand up for what they know they can do as a pharmacist and in so doing stand up for their patients. After all, the sensibilities of others should take a backseat when the health and welfare of our patient is at risk.So it’s in that vein that I feel the need to stand up for my comments in a recent blog. I should first, and completely unapologetically, mention that I’ve been writing columns and blogs for almost 20 years and I always assumed that people understood the attempt, if not the success, at humour. After all, poking fun at others and ourselves is one way of remembering humility.Humility, however, is not the same as deference. While I’m at it I should point out that I thought that applying non-pharmacy issues to the pharmacy world was a theme that seemed to be self-evident. It appears some don’t, well, get the joke.I guess I should also point out that I wasn’t quite sure how or if I should respond to some of the denigrating comments levelled my way. Perhaps feeling myself lumped in with the comment about pharmacists not standing up for themselves provided the impetus to respond.So here goes.Context is everythingI think I’ll start with a comment about people taking things out of context. I wrote a rather lengthy blog riffing on assisted suicide (among a whole lot of other things, but that is an observation for a bit later), a sombre topic to be sure.While some of the comments were rather pithy, people with a healthy sense of humour will recognize that comedy is how we deal with many things that make us uncomfortable or squeamish.However, the comment “I am disturbed that a fellow health care professional would say that any kind of suffering becomes ‘insignificant’ in any context” failed to recognize something important—in suffering, context is everything.I could go into a lengthy discussion of how quality-of-life is always relative to someone else’s, or what one’s own once was or could be. I could talk about how the idea of ending the life and whether it should or should not happen carries an unfathomable amount of context.But perhaps I’ll just respond by saying that the person who made the comment’s suffering while taking my comment completely out of context is insignificant compared to the real suffering of the patients we deal with every day. And I suppose I should say the patients that I deal with every day. Since people feel free to pick apart my commentary, turnabout is fair play.Even science is faith-basedThere is something disingenuous about a suggestion to “stick to the facts rather than appealing to faith-based conclusion”. The majority of the things we take for facts are faith-based.As pharmacists, most of the scientific knowledge that we use every day is based on our faith that what we’re being told is factual.When patients tell me of their belief systems about their treatments or their illness, I respect it and simply share with them that I will provide my knowledge and belief and it is always their choice what to believe and to do.To suggest that I am smarter than them is disrespectful, and I have seen proof that patients are smarter than me more than enough times in my career.And suicide is a bad thing. Although, to be fair, I think I called it stupid. I made no comment about the legality either way. But I understand the need for someone to launch a diatribe about their beliefs. It is just disappointing that such railing would contain so many inaccuracies.The concept of an afterlife is neither religious nor scientific. It is an unknown. Science requires proof—no one can’t prove it exists and no one can prove it doesn’t exist.Suggesting medieval thinking might be insulting if it were not such a pathetic attempt. I find suffering for other people’s ignorance to be character building. And I didn’t expect you to speak to a fruit fly but I can certainly see a meeting of the minds there.Before you complain about analogies, it may be helpful to consider that comparing wanting to win the lottery when one has had money to wanting to die when one has never died before is, well, just the opposite of similar (kind of required for analogies) and not all that clever.Working with the sufferingAs far as going out and appreciating the struggles of people suffering at life’s end, let me remedy your knowledge gap.Professionally, the people I see are the sickest of the sick. More than half of them were abused as children. Many of them already have life-threatening and quality-of-life lowering problems, including missing limbs, visual impairment, cognitive problems, kidney and liver failure including dialysis, chronic neuropathic and musculoskeletal pain, mood disorders and psychoses.I prefer to spend my time helping them towards that quintessential human quality—hope. In the process I do what I can to support them, not just by reducing their suffering but also by teaching them to thrive and live despite it. Perhaps that’s why I’m not as bitter as some people sound.In 27 years of community practice, including 20 in the same small town, people I knew for a long time suffered and died, and I practised in a way in which I really got to them. I saw firsthand how they suffered and endured, and was saddened by those who did not have the supports to go gently into the good night and celebrated those that did.I stayed after hours and sometimes delivered personally to those who could not get out of the house. I did what a good pharmacist does—I tried to help them live as comfortably and as long as possible. When I asked, “How are you?” I really meant it.A personal noteJust so you are certain I appreciate suffering on a more personal level, I will share with you what I experienced with my mother and father and, indeed, myself.My mother had two bones in her spine shatter because of multiple myeloma. Not only was she a lot shorter (her joke, not mine), but also you can imagine the pain she was in. And, of course, it was not going to get better.She endured with that for five years, but she filled that time with family. She appeared much diminished, but was no less an important part of our family, and by extension, society. So when we decide that folks who are suffering are no longer a valid part of society, where will we be next?My father also suffered. He endured dementia for more than twice as long. Then for several years after a stroke he was in total care, only responding with his eyes and occasionally a facial expression. He was certainly the kind of guy people in certain countries would like to put out of their suffering. So here is a little story.I was sitting at the long-term care facility in my dad’s room watching the hockey game on TV with him. A lady I had not seen before but who was clearly a resident came into the room, smiled at me, walked over to my dad, gave him a big kiss on the lips, said “Goodnight, sweetheart” and left the room.It was nothing unusual in long-term care but no harm done. About 10 minutes later, she returned to the room, and the same thing happened. I suppose some people may have been bothered, but no one was the worse for wear.And then, after about the same amount of time, she came in the room again and approached my dad’s bed. He had a big smile on his face before she even got there. I guess he could remember some things.So go ahead and ask anyone who cares for folks in these environments and they will tell you that people do respond to affection and compassion.I was always impressed by how the staff managed to do that, and how they were affected when he passed away. I realized after this event that my father was like an infant—total care and only responding to affection and love with a smile.We don’t end the life of infants because they are this way. Of course, they won’t stay that way, and in all likelihood will go on to be aware, to be healthy, and to be with the ones they love. But life still is brief either way, and forever is forever.I’ve been thereI have a little experience of my own with chronic pain as well. I’ve struggled with daily migraines for about 20 years now. I suffered for years with my hips before I finally got new ones. I have, at least for brief moments, understood the feeling of “kill me now”.I have learned that being a charter member of the chronic pain club actually improves my interaction with patients with chronic pain, and their reaction is different when they know I understand, at least a little.I do not measure that with the suffering of others far worse off than I. Nor do I minimize their suffering. It is simply that in the context of time and existence, our life is not all that long. Plus I suspect that more than half of all humans ever born died before a ripe old age, so dying early is nothing new.And every time that has ever happened it has been tragic, not a blessing. The need for assisted suicide is also tragic, not because it is wrong or illegal or immoral but because it seems necessary since we have failed to find a better way to ease suffering.There is simply no argument to refute the fact that mankind has always fallen down a slippery slope when deciding it is ok to take someone’s life. Indeed, the reasons always get more and more suspect.As for the proud atheist who said this dozy: “I believe the church pastor acknowledged you publically when you became chairman of the OPA. I must presume, therefore, that you do believe in life after death.”Are you suggesting that one should believe in life after death before enduring the suffering of being chairman of the OPA? I have to ask.If it doesn’t matter what people believe, why bring it up? Furthermore I made no comment about you choosing to end your life. I just don’t want to give people free license to do so with mine.A poor track recordThat reminds me of a harsh truth: the human race does not have a very good track record when it comes to deciding who should live or die.Remember the guys with the funny moustaches—Hitler, Stalin and, for a little more currency, Saddam Hussein? (What is it with moustaches anyways?)And it is still going on in the Middle East, Africa, Asia, and, before we get self-righteous, even Europe and the Americas.As for the comment “But I do find it slightly offensive and somewhat self-righteous to be told what to do with my life…” I have read your column—methinks thou doth protest too much.You know the really sad thing is that this topic was really just a small part of my last blog.Among the other issues were smoking cessation, chronic sleeping pill use, tobacco sales and pharmacy, managing side effects, what to do with medication adherence problems, shy pharmacists, making mistakes and learning from it and more.There’s no argument that all of these make the world a better place, and yet no real controversy.But are we surprised that people want to see, or bring, religion and freedom of choice and make a big deal about? No, not really. And that is the peril of blogging. It also should be the peril of blogging back.So what do you think of standing up for oneself? Let me know if you like it and (sigh) let me know if you don’t.Ken Burns is a pharmacist at the Diabetes Care Centre at Sudbury Regional Hospital.
