For me a wonderful tidbit in the happy conclusion is that it was spotters in a Twin Otter who found them, way off the trio's intended course.

I love the Twin Otter, aka the pickup truck of the sky.  

 This past summer I spent 17 days flying all over the high arctic to celebrate the iconic plane's 50th anniversary. I was with a team from Victoria's Viking Air, the company that has successfully brought the plane back into production after de Havilland stopped producing it in the late 1980s. The trip was homage to the places that made the Twin Otter famous, where it built its reputation as a workhorse and the most hardy, reliable STOL plane in the sky.

Many friends have asked, puzzled, "Why were you on that trip again?" Let's just say it was a confluence of luck and circumstance, an adventure of a life-time that I could not turn down, even if it was far outside my usual day job as a health care communications consultant.

Over the 17 days we flew to Yellowknife, Cambridge Bay, Resolute, Pond Inlet, back to Resolute, back to Yellowknife, Whitehorse, Inuvik, Fort Good Hope, and Norman Wells. Fog kept us out of Gjoa Haven, Tuktoyaktuk, and Sachs Harbour.

 My title was "Ground Lead," which meant I was in the advance plane, a faster Beechcraft King Air turboprop that arrived first in our locations.  I'd put out treats for the kids, and set up a display of colourful flags and banners and a table with a wing rib for locals to sign. A wing rib is an inner supportive strut that gives the wing strength, lightness and lift. We had some 20 ribs with us, all destined to be installed in the 100th Series 400 Twin Otter plane, which should be under construction any day now at Viking's Sidney plant.

 In some places the crowds were small but eager. In Pond Inlet, the lineup waiting to meet us snaked out the building. I, the crowds, and a documentary film crew traveling with us, would all be ready when the slower Twin Otter made a dramatic entrance in the sky, landing on the strip to applause from the locals. The dignitaries (the Viking Air President and the company owners) would disembark from the Twin Otter and the celebration would begin with speeches, commemorative gifts and the wing rib signing.

I was amazed how much people loved signing the wing rib—it had real meaning to put their name on something they valued that would soon be flying the skies. "You will go up in history," I would quip at each location and locals would laugh, pleased. The best part was hearing the Twin Otter stories of the people who signed. 

Many had a personal connection why they had come to the airport to greet the plane and sign the rib. A midwife told me of the babies she had delivered, in mid air, transporting labouring Inuit women in the Twin. "Some of those deliveries were so scary because of the difficult labours, but I never once worried about the plane. I knew it would get us through." She described her favourite time, after the mom and babe had been happily transported back to their home community, when the pilots would fly home low along the landscape. "It was so beautiful and peaceful." 

Geologists told me of the prospecting they'd done with the Twin. Pilots told me of the fun they'd had flying it, "There is nothing like that baby on skis," said one. Others joked how the Twin in the north "always smelled of kerosene and whale meat."

In Inuvik a young woman named Lanita Thrasher, who is one of the first female Inuit pilots, told me how the Twin Otter made her decide to learn to fly: "I was 13 and it was a very scary flight — very bad turbulence and bad weather. My mother and all the other women on the flight were crying, but the pilots were really calm. I decided I wanted to learn all about flying so I could be calm like them." 

In Cambridge Bay, Rick Ekpakohak told me how when he was 13 years old, in 1967, he and his 8-year-oldRick Ekpakohak and his wife Mary. He was rescued at age 13 by a Twin Otter  cousin got lost on the tundra while hunting with relatives in mid February. They were lost for almost three days. Legendary Cambridge Bay pilot Willy Laserich was out looking for them night and day in his Twin Otter. He found them, huddled by a rock on a high point of land. Ekpakohak told me Laserich flew over a few times, took a bright orange toque, put food and a note in it and dropped it from the plane so it landed near them. The note told them to go a location nearby where he could land. It was very rough ground, heaving with wind sculpted ice. Laserich got the plane down, rescued the boys, and was able to take off in near impossible conditions. "He gunned it, put the flaps down and it hopped into the air in a few feet," said Ekpakohak. "The Twin Otter saved my life." 

As the technical manuals boast, the plane was designed for “high lift performance in marginal conditions.” I witnessed some of the Twin Otter's renowned capabilities first hand. Coming back from Pond Inlet to Resolute strong cross winds bedeviled the single landing strip. The King Air got in, but with the Twin Otter more than an hour behind us, the winds continued to build. "They may have to bail and go back to Pond, it is getting too dangerous," our King Air pilots said. We watched the Twin Otter approach in gale force crosswinds. It did a looping fly over and appeared to be turning around. "They're heading back to Pond," we thought. But no. Pilots Ariel Pettigrew and Sylvain Breault did another approach, this time sideways to the strip. They flew head into the strong wind, as slow as a hovering hummingbird, over the top of the airport. Astonishingly, they landed and stopped in the width of the narrow runway. We were jubilant on the apron.

A NAV Canada technician, Francois Gravel, caught it all on his cell phone."Holy Shit!" he says on the footage. "I’ve never seen nothing like that!"  Later, when he showed the clip to me, he said he was sure he was filming a plane crash. "I'd heard the Twin Otter could do that, but I'd never seen it done."

During our tour I rarely got to fly in the Twin Otter myself. So on the final day, when a volunteer was needed to join pilots Breault and Pettigrew and our mechanic on the slower Twin Otter flight back to Victoria, I happily complied.  The King Air left with 6 passengers and two  pilots the night before. The next morning, Saturday July 19, in a plane chock full of our gear and luggage, the two Twin Otter pilots, the mechanic and I left Norman Wells for the 10+ hour flight back to Victoria.

"On the first stretch, we have to go up over the mountains, but the weather is pretty bad, so we may have to go pretty high," said Breault showing me the route. Since the Twin is an unpressurized plane, anything over 13,000ft means we would need to use supplemental oxygen. 

We took off and began to climb, first through rain, then sleet. The mountains were 9,000 feet . We climbed 11,000 ft, 12,000 ft, 13,000 ft,  all the time in hard driving sleet and snow.  I looked out the window to see ice building up in thick layers on the wings and struts of the plane. It was two inches thick and building. Ice was flying off the propeller and hitting the plane skin and windows: ding, ding, ding, like pebbles on a metal can. I decided it was best not to look out the window. 

 Pilot Breault came back and put on the supplemental oxygen – tubes and a mustache-like bolus of plastic under my nose. He put a pulsimeter on my finger to measure whether I was getting enough oxygen and showed me how it increase the flow with a valve on the line.  “What happens if I don’t get enough?” I asked. “You’ll black out,” he said.

He seemed calm, matter of fact. I took my queue from him. I’d panic if they panicked. He and his partner Pettigrew have thousands of hours flying Twins.   As a pair they deliver brand new planes off the Viking production line to clients all over the world. They fly planes filled with bladders of fuel in the fuselage, like flying with a huge bomb. They have flown in everything. The highest altitude they'll take a Twin Otter is 22,000 ft. That is when a delivery route takes them over North Korea. “We have to go that high but it’s not fun that high,” said Pettigrew. 

 I could see them in the cockpit constantly refreshing the weather map, over and over, this green enormous mass of ugly precipitation all around.  “We are going to have to go higher to get out of this stuff,” said Breault — 14,000 ft, 15,000 ft. Still sleet was building up ice on the wings. I don’t know if it was thin air or pure terror, but I found it hard to breathe, 16,000 ft, 17,000 ft. The potato chip bags in our snack supply exploded. I put on my iPod, to classical music shuffle, hoping relaxing music might calm the quiet trapped panic I was feeling, but the songs didn’t help: Mozart Requiem, Brahms Requiem. Acck, try pop!! Up came Taylor Swift’s “Last time.”  Dylan’ “Knockin’ On Heaven’s Door." I'd laugh under less alarming circumstances. 

At 18,000 ft we finally broke through the heavy precipitation into clear blue sky. The relief was palpable all around.  The ice fell off. We flew for about an hour at this high altitude. My hands swelled up, rings tight on my fingers, dull headache.  Then it was time to descend, back down through the ugly black cloud of sleet and snow. We iced up again; ding, ding ding on the fuselage. I closed my eyes. When we landed safely, I felt drained but exhilarated. 

“Was that as bad as I thought it was?” I asked Breault and Pettigrew once we were safely on the ground in Watson Lake. 

“It wasn’t pleasant,” said Pettigrew. “We wanted to get out of it.”

 “Was all that ice dangerous?”

 “The Twin Otter can take about 5,000 lbs of ice on its wings before having trouble.”

 “How much did we have?”

 “Hmm, maybe 2,000-3,000lbs. But we had a really heavy cargo load. So we wanted to get out of that weather.”

 The rest of the flight from Watson Lake to Smithers to Victoria was phenomenally beautiful. We flew at about 1000 ft, or lower, over the rolling Chilcotin, past the Lillooet Ice fields and stunning Mount Waddington, out Bute Inlet, over Desolation Sound and the Gulf Islands. At times we were flying so low it was as if we could see what people were reading on their Gulf Island decks. They’d look up and wave.

We arrived back into Victoria at 6:30 pm. That day I had the full Twin Otter experience, from a white knuckle, bad weather nightmare to the glorious soaring of blue sky flight.

And when I step back on the ground I thought, I really do love this plane.

-30-

.   

Recently, Justin Trudeau and his wife Sophie Gregoire have come under fire for having two nannies on the payroll of the Prime Minister's staff. Here is what life might be like if they had to arrange sitters for evening childcare.

"Honey, we've got that state dinner with the Thai Delegation next Thursday, have you lined up Emily?

 "Well, I called her but she has an exam. So then I tried Sarah, but she's getting her wisdom teeth pulled that morning." 

"How about Jessica? The kids love Jessica."|

 "Jessica? You said 'Never again!' for Jessica after she tried to sneak her boyfriend past security!..."

 "Oh yeah ...right....What about Hannah?"

 "Well, we really need someone who drives, because Xavier has judo after school and needs to be picked up."

 "My mom could pick up Xavier. She could stay with them over dinner. The whole night is too much for her, but then Hannah could do it for the rest of the evening....Mom would love that."

"We're using your Mom way too much. I know she likes it, but then my mom gets feeling all left out and I never hear the end of it. Every time she calls she says, in that way of hers, 'I wish I could be closer. I see on Facebook that Margaret is doing this and that with the kids.' I honestly don't need that right now. "

"Well, Xavier could miss judo.  Then we could get Hannah."

"He loves judo! And I don't want him to miss any more. He really needs it right now. We've had so much change and upheaval.  And, besides,  I don't want Hannah..."

"What's wrong with Hannah?" 

"She always leaves a mess and I think she spends more time texting friends then interacting with the kids. "

 "Hannah's great. I like her."

 "Of course you do,  she flirts outrageously with you!  'Mr. Hottie Prime Minister'  And you lap it up!  Just watch it,  buster! I've been thinking of setting up a Teddy-cam."

 "Oh for godsakes ...Okay,  so we won't use Hannah. ...

 The next day.

"We still don't have a sitter? Why don't you call Catherine McKenna, she's got three young kids, maybe she has some names..."

Sophie calls.

"Hey Catherine, it's Sophie..... Oh just great thanks,  how 'bout you? Ready for Christmas?.... No, me neither. .. Well that's what we get for going to Paris to fix climate change so close to the holidays, eh? (light-hearted laugh).

"Look, I won't keep you, I know you're really busy with the whole Environment portfolio.  We've got this state dinner with the Thai delegation next Thursday.... Oh, you're going, too? Of course!... Look we've gone through our list and no one's available....Have you got any names? .... Oh yeah? .. Uh huh....Sounds interesting....

Writes down a name and number.

Have you used her? .... No? Well okay....  Thanks so much. Hey, hope to see you at yoga! Bye Bye."

"Okay, so Catherine says the ambassador of Madagascar has a teenage daughter who's keen to do some sitting so she can get out of the house. ...She's fluently bilingual, so that's great. Catherine doesn't know anybody who's used her yet, but she was talking to another mom at Rockland Kindergym last week and got her name and cell. Maybe we should give her a try....?

"Well if you think so..."

"Well, she has a car with diplomatic plates so parking outside of judo won't be a problem. That can be such a nightmare at 5:30 pm.

Calls number

"Hello is this Hanitra? It's Sophie Gregoire, the prime minister's wife.....Well, thank you, yes,  we were very pleased with the election results.

"Look, I hear through some Rockland Moms that you do some babysitting... You do? Great! Are you free next Thursday night?  

"Well that's fantastic..... We'd need you at 5pm. You'd have to put Ella-Grace and Hadrien in your car —we'll leave the car seats out.  Then you'd go pickup of Xavi from judo at 5:30. The cook will have dinner all prepared, but you'd have to eat with the kids. Is that okay? ... Oh that's just wonderful. We'd likely be home before 1 am.

"You're double time after midnight?  No, no,  that's just fine, makes sense on a school night. Look I'll  let security know your coming and they will buzz you in at the gate. And I'll text you the address for the judo .... Great. See you Thursday. Bye-Bye."

(Big sigh) "Okay, that's got next Thursday covered.....Now when's that dinner with the Obamas?

-30-

Part Two: The Art of the Pitch

Editors want the classic three to four paragraph pitch. It is not because we are stodgy old farts, it is because we don’t know you and we are taking a HUGE risk if we assign to a writer we don’t know. We are keeping two to three pages of our precious magazine open for someone who must be able to come through with a story that is accurate, well-researched, well-written and right for our magazine. If we make a mistake and back the wrong writer with the wrong idea, we are hooped. We don’t have a lot of inventory. The better the pitch, the more confident we feel about taking a risk.

How to write a winning pitch

1. Open with how it might open in our mag. (This shows us you know our style and what will fly in our pages.)

2. The second paragraph details what the story is all about— what it will cover, who it will interview and what style it will be ( profile, investigative feature) (This tells us you have a good handle on the subject matter and have a general workable approach for the story.) Be succinct: make it visual, so we can “see” the characters, the place, the scene.

3. The third paragraph tell us why the story is right for the magazine and its readers. Why our audience? Why now? Why do we care? (This tells us you know our audience and why they will read this.) Ask yourself, would you read it?

4. The fourth paragraph tells us why you are the person to write it. Summarize your experience, give us a brief précis of your CV or expertise, your publishing track record, your clips. If you haven’t yet got a magazine track record, still let us why you are a good risk for this story. (This tells us we can rely on you to come through with the story, that you are a good risk for us and we are not going to be left with a gaping hole in our magazine or a piece of dreck.)

How to send the pitch

Send the pitch as an email, with “Pitch” and a short description in the subject line (e.g Pitch -- Profile of Joe Smith.) Put the four paragraph pitch both in the body of the email and as an attachment in a Word document. Some editors want it in the email, some as an attachment. Give it to them both ways. (Or better yet, give it to them the way they have asked for it on their website or in The Writer's Market.)

 One pitch per email. Sometimes writers pile in three or four pitches in one email. Editors need to file pitches into the best months or by priorities (we are not going to assign three stories to one writer in one month. That is too many eggs in one risky basket.) Or we like two and hate two, so we want to kill off the two we hate and file the two we like. So keep them separate. You may make three pitches at once, but keep them all in separate emails so the editor can read and decide quickly and file accordingly.

How to follow up

It is important to follow up on a pitch, but do it in a way that does not piss the editor off. Here are a few tips:

• Follow up nicely in about two weeks: Editors are very busy. In the monthly publishing cycle we can be dealing with any number of fires. If I have been so busy not to have read and filed your pitch, it can get buried under emails. (An editor can get 200+ emails a day.) If I don’t know your name, if you didn’t put pitch in the subject line, I may never find it again. If you don’t hear, it may be that the editor has not rejected it, or even read it, but has no way to find it in the huge volume of material we get. Email and say: “About 2 weeks ago, I sent you this pitch (and send the pitch again) and I wondered if you had time to consider it. Let me know if there is anything more you need.” Be nice!! Be understanding, be patient, but be persistent. We like persistence. It is a good quality in a journalist.

• If they get back to you and reject the pitch, thank them for their consideration, ask if there was anything that you could have done to make it better, and very soon (a week or two) send another completely different pitch. (Don’t keep pitching a story that was rejected, unless you have a different angle or are fixing up and presenting more of what they said they needed.)

• If you don’t hear, or they don’t outright reject the pitch, follow up a month later – freshen the pitch if new information has come in (the interview subject is up for an award, a new book will be released.)

• And follow up again. Even write something on spec to show your talents. (But be damn sure it is good.) A bad spec article will close doors. A good one will open doors. If you think they are not giving you a chance and you really can do it, show us you can. But make it fantastic. No factual errors, no name errors, no typos, make it a story we can see in our magazine.

•  Pleasant persistence will eventually be rewarded because it shows you are dogged and we want that in a writer.  So we will finally give in and take a chance on you, if not on one of your ideas, on one that we have kicking around that we are looking for someone to do. For writers new to us it will likely be a brief.

• Do not pitch the same story to another magazine in the same market at the same time. This will seriously harm, if not destroy, your reputation. If you want to take it elsewhere and the editor has not yet responded, ask (nicely!) whether they have decided so that the idea can be released. This will often make the editor decide. Do not say that you have another magazine interested in the idea as that will tell us you sent the idea to another magazine while we were considering it. That is very bad form.

• If your story is rejected, do not take it personally, Many reasons keep editors from buying stories, including a lack of money to do so, lack of space in the magazine. The story is not your baby and it may not be fantastic just because you wrote it. At all times in this process, “get over yourself.”

Next up, Part Three: Writing the story.

Part One: Before you pitch

Study the magazine

• Get as many back copies as you can. Read the departments, note how many features they have, see which ones have regular designated writers, which ones seem open to freelancers. What is the tone, the timing, the balance of articles?
• Check out the magazine's website. Writers’ guidelines or back copies are often posted on their site. Books like The Writers Market also detail the magazine's requirements and pitch processes. The Writer's Market  is also online now for a subscription fee. See writersmarket.com
• Check the masthead and find out which person is the assigning editor, but these days it may just be the editor in chief or managing editor. If you have not found pitch information on the magazine's website or in The Writer's Market...email that editor for writers’ guidelines and pitch cycles – but keep email short and to the point and don’t send your resume yet. The editors only want to know about you if you have a story to pitch.  Just ask about how to pitch to the magazine and what sort of pitches the editor is looking for, how and when the editor would like to get them. (After you have made sure that info is NOT on the website.) Some editors take pitches monthly, some quarterly, some just annually. Ask if they will consider spec submissions. Find out how far in advance you need to pitch for seasonal stories. It could be six months to a year ahead.
• Try to go back at least two to three years. Libraries will often have back copies. You do not want to pitch an idea they have already done. You will be forgiven if it was more than 18 months ago, but if it was within the last year, we know you have not looked at our magazine. We will frown and be disappointed with you. If it is an idea that we already have in the hopper but not yet published we will think you are prescient and in tune with our needs.
• Who is the magazine's audience, the demographic? Then think about all the ways to interest them that fall within that audience. Magazines differ from newspapers: this kind of writing must not only be newsy, it must also be a pleasant experience for the reader to take the time to read it. Magazines are also a visual medium. What will your story look like illustrated, or with photos and/or graphics?

Come up with a great idea

Do your research to know that there really is a good story there that you can bring to life for that magazine's audience. Some don’ts:

• Don’t pitch a profile of some big celebrity if you have no idea whether the celebrity will consent. Don’t pitch an insider scoop on some industry, if you have not yet established insider status.
• Don’t pitch a topic. Pitch a theme and an angle. Be FOCUSED. Zero in on some new aspect of a story.
• Don’t pitch a story geared for parents of young children when your research shows the magazine demographic is 35+; or don’t pitch how to find deals at Value Village or stretch the food dollar when the magazine is aimed at the affluent reader. Don’t pitch a 3,000 word feature when the magazine’s longest feature is 1,500 words.
• Don’t pitch a whole new section of the magazine, or a series of articles (when the mag doesn’t do series) or that you write a new column. The magazine is not going to remake itself for you no matter how great the idea!! Mags have templates and structures. Pitch within the structure — different enough that we haven’t yet done it, but not so different that we can’t imagine doing it. Once we know and love you and we will do anything for you, then you can pitch the column, series or new section…
• Don’t pitch a story with a short time line. If you have done your research in point one, you will know how far in advance the magazine plans stories. Most national magazines work six to eight months ahead at least.  Local or city magazines work four to five months in advance.
•  But if you have a seasonal story that can be done now, that will stand up for publication a year from now do pitch it. Say: we can get colour, details and pictures right now and let us know why the story will stand up for a year. That is thinking ahead! We love that.
•  Don’t pitch the predictable. See things that others don’t see. Take a new angle. Find the hidden story. Tell us something about the region we cover that we have never heard before, something that is sitting there under our noses that we have never thought about.
• Don’t forget to talk about what kind of art might work, and let us know if you can take pictures. Most magazines will assign photographers, but some want research photos to help plan layout or to get photos in a pinch.

For new writers wanting to break in, the best “starter” articles are short briefs or quirky "evergreen” stories that can run anytime. Editors always need a few flex stories – stories that we can drop in if we suddenly get more pages or if another assigned story falls apart. If it is an evergreen we can take time to work with a new writer to polish it to get it right rather than assign a story with a strict time frame or seasonality that makes it unusable if it doesn’t run in that month.

Next up: The Art of the Pitch.

You can read their online commentary here, http://bit.ly/1yVovzH/ ,but the headline sums up their stance pretty succinctly:"Was BC's push for better primary care a $1-billion bust?" The article is based on their study, published in the May2014 Healthcare Policy, which examined 20 years of patterns of family doctors' fee-for-service billings in BC. They use this administrative data to come to the conclusion that patients have not been served by the program of incentive payments to GPs brought in under this joint doctors/government culture. You can read the abstract of their study here: http://www.longwoods.com/content/23782

"Isn't this at direct odds with your perspective, Anne?" I was asked in an email by one of my thoughtful blog readers.

It is, indeed. But I think their study has serious limitations, makes assumptions not backed up by their own or other research evidence, and comes to conclusions that cannot be made from their data. Moreover, they completely ignore patient health outcomes, which as I explained in the previous blog, was the unifying factor that got the perpetually-wrangling docs vs government to agree on a program in the first place. As I noted in the previous blog, I am working with these committees to explain their rationale and activities.

I am going to explain here why I think this study is weak and inconclusive. It is going to be a bit of a long entry, so bear with me. You can see whether or not you agree with me. I welcome debate and discussion.

First I will summarize what the authors did and what they say they found. They used administrative health data linking patients' anonymous personal health numbers to individual general practitioner's fee-for-service billing data, beginning from 1991/92 through to 2009/10.

They looked at what they called four main "conceptual" measures : access, coordination, continuity, and comprehensiveness. In essence that meant they looked at, from the billing data, where the care was provided (doctor's office, house call, hospital, nursing home) who it was provided by (one doctor or more than one over the year); what time of day it was provided (after hours or in office hours), and what was done (they looked at PAP screens, mental health, maternity care, glucose and lipid testing.)

They concluded that access, coordination, continuity had all continued to decline. Interestingly for comprehensiveness they found only the number of individual GPs doing maternity care had decreased during the study period, but the number of GPs doing mental health care, PAP screens, and preventive tests like glucose and lipid testing had actually increased — remember that, because I will come back to that at the end. They conclude in the Globe commentary that patients would be better served by putting BC doctors on salary.

Here are my problems with the study:

1)It studies trends from 1991 through to 2010. The decline of primary care was well underway for more than a decade when the joint General Practice Services Committee (GPSC) was formed in 2003. The bulk of the GPSC incentives and the Practice Support Program that teaches doctors and staff both clinical and administrative skills on how to use the incentives started late 2007 and didn't gain force until 2008/9. Some incentives came in after 2010. How can the CHSPR study make blanket statements about success or failure based on 2 or 3 years of 18 years of trends data?

2.)There is no control group, or no comparison to what happened with GPs in other jurisdictions over the same time period. BC's changes applied across the board to all doctors, anywhere, but it was completely voluntary. CHSPR, by using billing codes cannot distinguish who was "on the program" and who was not. As with all programs there were early and late adopters. All these are in the same sample. They cannot show what might have happened to their data if no changes had been applied or a different model was taken in BC, in light of a huge decline in family practice across all Western nations.

3.)They make the assumption that seeing more than one doctor is bad for care (without showing its impact on patient outcomes.) We do know that going to walk in clinics, for a single issue and that doctor not being able to access the patient's full medical record, is not as good care as having a doctor know the whole patient history and seeing the full record. But in BC now many doctors are working in group practices, such as my GP. That means when I make an appointment at her office, if she is not available, I may see one of her associates but they all have access to my health record, my Rx history, my pap screen record etc. In the last year I have seen four doctors, all in my family doctor's office, all of which coordinated around my care. The CHSPR study of billing number patterns cannot distinguish group practice from walk in clinics, when an increasing number of GPs this past decade are working in group practices.

4.)They equate house calls, hospital care, and after hours care with patients having higher quality care and being seen in doctors' offices, during office hours, with patients having poorer quality care. Where is the evidence that house calls, hospitals and after hours is better care and being seen in the office is lower quality? BC has been focusing on managing chronic diseases, planning care and avoiding crises and hospitalizations. This data finding could equally mean that fewer patients are having crises. A doctor that does a house call takes more than five times as long —- keeping other patients who need care waiting. It is very inefficient. Does it lead to better care? We cannot say. It is likely better not to need a house call at all. BC has also introduced in 2010 incentives for telephone calls from GPs to patients at their home, which greatly reduces the need for house calls, which this study also did not pick up. How can they conclude patients are worse off now from this finding of location of care? They cannot. There is one finding, however, that concerns me: A 20-year steady decline in GPs visiting their long time patients in nursing homes. If we want GPs to support patients to the end of life, how we stop this trend should be examined.

5) They say patients are not being seen after hours by doctors and equate that patients are therefore being less well served. They cannot make that assumption in BC because if a doctor's practice or group practice has decided that they will regularly have one or more nights a week where they provide service into the evening, as many have done in the last 10 years, there is no fee code difference for time. There only is a fee code difference if the doc is called out on an emergency after regular hours. BC's changes are all aimed, again, at avoiding the crises and emergencies, and going to better managed care. It is better for doctors and better for patients to avoid those after hours emergency calls.

6)They don't look at system outcomes over the time frame. CIHI data shows that BC is now leading the country on a number of key health indicators of system performance:

• Ambulatory care sensitive conditions:  Since 2005 we have the lowest "ambulatory care sensitive conditions." This is a horribly obtuse term for acute and chronic diseases that with good primary care management outside of hospital (ambulatory care) leads to reduced or fewer hospitalizations. It is seen, world-wide, as a measure of an effective primary care system. So BC has the lowest hospitalization rates for diabetes, asthma, COPD, congestive heart failure, high blood pressure, vaccine-preventable conditions, pneumonia and gastroenteritis.  This is good.
• Avoidable mortality: BC has the lowest avoidable mortality in Canada, meaning we have the fewest people dying before 75. This is seen as a measure of the general health of the population — in BC we have the fewest smokers, the most exercisers, and the lowest rate of obesity, which really has nothing to do with our health system — but avoidable mortality is also seen as a general measure of overall health system performance.
• Avoidable mortality for treatable causes: BC has the lowest rate of death under age 75 once a disease is found. So if you are diagnosed with diabetes, or high blood pressure, BC's death rate is the lowest in Canada. This is an important marker of quality of health system performance. Could it be lower? Yup, particularly among the poor in BC. The wealthy in BC have among the best rates for this measure in the world. Our poor very much less so. But socio economic status (SES) has a huge impact on health outcomes. The next huge jump in health improvement is making sure the poor are as healthy as the wealthy. No one has cracked that yet, but systems like Scandinavia and Netherlands, which have less inequality in wealth, have less inequality in health outcomes. If you are interested in reading more about national health indicators, and the impact of SES on health , read the 2013 CIHI Health Indicators Report, available for download here: https://secure.cihi.ca/estore/productFamily.htm?locale=en&pf=PFC2195&lang=en
• Per capita spending on health by province. BC has the second lowest per capita spending on health, second only to Quebec. The Fraser Institute always uses this to say that BC is under spending, but our health indicators do not show this. In Quebec, the health indicators (near the bottom half) would suggest they may be under spending. In BC our lower per capita rate, coupled with better national health indicators noted above, would suggest that we are spending less money because we are keeping people healthier and out of hospital — which is what we want. That means we have a more cost efficient system. Could it be better? Yes compared to other countries.
• Per capita spending for physicians. Highest rates according to CIHI are in Alberta and Ontario ($986 and $942) and BC is in the lower half of the pack at $844. So this shows that what we have been spending on physicians this last decade is actually less than other provinces and not so out of line, despite the "$1-billion bust" headline. CHSPR's focus on $1 billion is taken of proportion to the overall costs. Health care is mind-blowingly expensive. Our provincial system is $17 billion a year, so $1 billion over 10 years actually works out (when you factor the various growth rates of expenditure) to about 2.6 % of the annual health budget. In BC the health system burns through $1.2 million ever hour, so in the time I wrote this blog close to $3million was spent in BC! Check out this CIHI report for national and provincial health expenditure data if you want more info:  https://secure.cihi.ca/free_products/NHEXTrendsReport_EN.pdf

7.) The authors suggest that Ontario's primary care reform has been more effective. Ontario underwent changes at the same time in BC, but that province now actually has three systems of primary care for doctors. In another blog post I am going to take a closer look at the pros and cons of Ontario, compared to what BC has done, because that is a huge and complex topic. I know that this blog post has been going on too long and, you dear reader, are getting tired.

8.) Comprehensiveness.  I told you to remember the finding that mental health care, Pap screen, lipid testing and glucose testing had all improved over the time frame of their study. This is a point the study completely dismisses, yet this is precisely what the incentives were geared towards. These are the kinds of actions that appear to have an impact on patient health outcomes.

9.) Maternity care: One last point, I promise. Fewer doctors doing maternity care is concerning, but that is a finding that is happening everywhere across North America and has been declining for decades. In BC, the maternity incentive HAS NOT focused on supporting solo doctors doing maternity care because that is not so good for patients and most doctors do not want to do this alone. Solo doctors can only do so many deliveries a year and we know the more you do the better you are. Rather, BC has focused more on providing incentives to support a group of doctors joining together in group practice to share maternity care, to which other GPs in the region refer their pregnant patients. You can read about the details of the "Maternity Network Initiative" here: http://www.gpscbc.ca/family-practice-incentive/maternity-network-initiative . Evidence shows this concentrated care is better for patient outcomes and better for doctors' lives, meaning more docs are willing to deliver under this kind of model. We still need to find more ways to provide good maternity coverage outside of population centres. That is a real challenge. But the CHSPR study, finding fewer individual doctors are doing maternity care, cannot jump to the conclusion the situation is worse for patients now than prior to the incentives.

In closing, BC is by no means perfect. We still have a ways to go. One huge task is to ensure that everyone who wants a family doctor has one. One very promising change since the BC program is that more new medical graduates are choosing family practice, up from the nadir of 23 % in 2002 before the changes took effect to 39% in 2014. More family doctors are in the BC system and that helps more patients find doctors. It is not solved, but believe me this is a focus of a whole bunch of activities.

I believe we have a much better chance of doing the changes we need in a culture of collaboration between doctors and government that asks the question "what is truly best for patient care?" We should never be afraid of looking at evaluations to see whether we are actually accomplishing that.

 I fear, however,  the damage that can be done to this fragile cooperative relationship with simplistic studies that claim patients aren't benefiting, that only doctors are, and that don't look at the big picture.

Thanks readers, for staying with me on this long post. Again, I welcome debate and discussion. I don't have the answers, but I do try to present things as clearly as I see them.

I wrote my first "Health Care is in Crisis" story in 1981 as a cub reporter. I was to write at least two or three, if not a dozen, such stories every year thereafter as a health reporter for the next two and a half decades.

While the details varied, the essential elements tended to fall into one of two narratives lines: 1)Doctors railing against stingy, short-sighted government, warning patients will be harmed. Or 2)Government blaming greedy doctors for fostering unsustainable system, warning patients will be harmed.

I grew so tired of that constant, divisive narrative — that incessant wrangling and finger pointing that always used patients as pawns — that I left health care coverage for awhile for the more pleasant pastures of running a lifestyle magazine.

But in the interim these last six or seven years, unbeknownst to many, a dramatic shift has occurred in the BC health care narrative. In fact, a new collaborative culture between government and the medical profession has been emerging that is creating positive health care change. And moreover, patients are no longer the unwitting pawns in a battle for dominance, but the winners in a cooperative conversation that aims to put their needs first.

"It really is a new era," says Dr. Bill Cavers, new president of the Doctors of BC (formerly called the BC Medical Association.) Cavers, a Victoria-based GP since the early 1980s, has lived through previous decades of doctors vs government animosity and has been at the vanguard of the new culture of collaboration.

Others agrees that the culture has changed from animosity to cooperation: "There has been a really palpable change," notes Dr. Ron Collins, a Kelowna anesthesiologist. In the past Collins avoided the rough and tumble of health care change because of its acrimony and divisiveness, but with the new cooperative culture he has become much more involved, now working to improve physician engagement in contributing to better patient outcomes, particularly in surgery. "There is the realization now that there is no ‘dark side’, no good guys and bad guys, we are all on the same side."

Much of the credit for this new era of cooperation belongs to the creation of four collaborative joint committees of doctors and government. These joint committees are the first of their kind in Canada, but their story has not yet been widely told either inside or outside of the province. The committees are:

1) The General Practice Services Committee (GPSC), which deals with issues of primary care through family doctors offices;

2) The Specialist Services Committee (SSC), which is aimed at improvements to the specialist care system.

3) The Shared Care Committee (SCC), which aims to help integrate GPs, specialists and other allied health professionals.

4.) The Joint Standing Committee on Rural Issues which deals with health care issues in BC's hinterlands.

Each committee consists of four appointed doctors, primarily from the Doctors of BC, and four Ministry of Health officials, with doctor and government reps as two co-chairs. All decisions are made by consensus. Health Authority representatives and patients are invited to partake of the discussions as guests. The committees now also have significant administrative and executive support for their increasing number of programs and activities.

For the sake of full disclosure, I should state clearly that I am now working as a consultant for two of the four committees (SSC and SCC) and worked in the past for the GPSC. In fact, I joined them because I was impressed by their refreshing cooperative mandate and ground-breaking activities, by their ability to put aside more than three decades of fighting to find common ground. I decided that, rather than stand on the side as a reporter critiquing their actions, I would jump in and offer my skills to help them achieve positive change in health care. Part of my role is to tell more people about what they are doing and why -- hence this blog post. So here are some interesting tidbits to know:

All of the committees are funded out of the Physician Master Agreement, the envelope of money in the BC health system that goes to doctors' compensation. In the past it mostly went to the fee-for-service payments and therefore directly to doctors' incomes. Now a portion of the money earmarked for doctors' pay is going to these committees and their programs in a way to "fund change." The annual amount for all three committees and their many programs in 2014 is now around $400 million. BC's annual health budget is now $17 billion so this represents just about 2.4% of the annual health spending in the province. In the scheme of things, it is a small investment to try some new things in new ways, but nevertheless $400 million a year can buy an awful lot of positive change.

Rather than fighting over what is good for government or good for doctors, the committees found if they focused on what is best for patients they could find common ground. Asking the question, "how do patients benefit from this change?" has depoliticized the whole process.

The General Practice Services Committee, (www.gpscbc.ca,) was the first to be formed in 2002/3. It is focused on supporting GPs in the province to provide full service family practice — the cradle to grave care of a good family doctor. Tactics included special payments for maternity care, or to manage complex chronic diseases, and other financial incentives to take on more time-consuming patient issues; training programs to enhance their clinical skills and job satisfaction, and even training to promote more efficient offices. About 50% of BC doctors are GPs, and the GPSC has the biggest budget of the three committees (now about $200 million annually.) One of the GPSC's most successful creations is the Practice Support Program, which develops modules for training and pays doctors and their office staff to attend the programs which includes everything from how to schedule patient appointments so less patients are waiting, to chronic disease management, to difficult issues like end of life care or youth mental health care. Practice support is now being offered to specialists, too. http://www.gpscbc.ca/practice-support-program

The success of the GPSC spurred the creation of the other two committees. The Specialist Services Committee, SSC (www.sscbc.ca) was formed in 2006 and its role is to foster improvements and close the gaps for patient care in the specialist care (acute care) system. It is funding a number of physician-led quality and innovative projects such as Collin's project to improve patient outcomes from surgery. Other funded, physician-led projects include a redesign of BC hip fracture care, a prostate cancer support program, youth-to-adult transition protocols, telemedicine consultations, training in new techniques like hand-held ultrasound, and the creation of a special province-wide program of inherited heart arrhythmias. The SSC has a new round of funding for more quality innovation projects led by specialist physicians that will be announced later this year.

The Shared Care Committee (www.bcma.org/partners-patients) was also formed in 2006, and while it works closely with the General Practice Services Committee and the Specialist Services Committee it is a distinct group with its own mandate and projects to address the care provided by both family physicians and specialist physicians. Its aim is to improve the patient journey and integration of the system. Patient safety, quality, prescription drug issues and allied health care integration are all part of its mandate. One of its biggest and most important programs that it is funding is a collaborative project to improve the access to and integration of child and youth mental health care.

The final committee, the Joint Standing Committee on Rural issues, is primarily focusing on issues of physician recruitment retention and health care education and provision in the less populated regions of BC, as well as travel issues for patients living in those regions who need to access more specialized care in the Lower Mainlaind, Okanagan, or Southern Vancouver Island. www.health.gov.bc.ca/pcb/rural_jsc.html

While health care will always demand innovation and effective funding, there is evidence that BC is making good progress. The rate of growth in health care spending is slowing down significantly. After years of frightening 7 to 9 per cent annual increases in budget, the annual hike is down to a respectable, almost sustainable 2.6 per cent. BC has some of the best health care indicators in the country such as the best cancer survival rates, lowest maternal mortality rates and longest life spans. We have the lowest per capital spending on health care but have the best avoidable mortality rate for treatable causes of any province or territory in Canada, as well as the lowest hospitalization rate for conditions that are best handled outside of hospitals in primary care. These indicators show that while there is always room for improvement, our health system in BC is working relatively well compared to other provinces.

While this blog post just skims the surface of these committees and their activities, it does show, that at least for now, that the culture of health care has been changing for the better in BC.

-30-

But now hand-held ultrasound devices, about the size of a large cellphone, will soon be in every physician's pocket. Each hand-held unit costs about $8,000 and is designed to be used and owned by a single physician. Ultrasounds can easily give more detailed information about a patient’s condition, allowing a physician to more quickly respond to the patient’s needs. And two groups of BC physicians across the province are now being trained in their use.

"It is game-changing technology. It is portable and it provides information well-beyond anything you can hope to get from the stethoscope," says Dr. Danny Myers, general internal medical specialist who splits his practice between Salmon Arm, Revelstoke, and Victoria.

Myers' research into the devices, their growing use in remote locations like Africa and rural India, and the training requirements needed to achieve competency in their use, prompted him to apply for funding from the Specialist Services Committee (SSC) to establish a pilot program that trains rural and community internists in hand-held echocardiology — ultrasounds of the heart.

The SSC is a joint committee of the BC Ministry of Health and the Doctors of BC (formerly the BC Medical Association) and it supports the improvement of the specialist care system throughout the province through targeted funds from the Physician Master Agreement. 

Myers can pinpoint the moment when his enthusiasm for hand-held ultrasounds first took hold. It was the 2010 Vancouver Olympics, and Myers saw a news item that physicians at the games would be the first in history to use the devices in the mobile medical units. Athletes or spectators with chest and abdominal pain or any multi-system injuries would be assessed with the devices as part of their initial exam. 

"It struck me how valuable something like that would be for my specialty in remote BC communities, where we have limited access to diagnostic technologies for our patients," said Myers, who at the time was president of the BC Medical Association's Section of Community and Rural Internal Medicine (CRIM). CRIM has more than 200 members, all of whom all internists practicing in various communities across BC.

 "Our members have a need in particular for echocardiology. It can be days, even weeks — or hours away in another city — to access a formal echocardiogram. With this technology we can see most of the heart functions, fluid around the heart, and valve functions right at the bedside."

 Emergency medicine specialist, Dr. Michael Ertel, of Kelowna, also applied around the same time to the SSC for funding to help cover training costs for ER doctors to upgrade their skills in the use of a bedside ultrasound for emergency diagnosis. In emergency departments the ultrasound technology includes both the personal devices, as well as laptop-sized ones used by multiple physicians which cost about $60,000. 

"These are wonderful instruments that we use a lot in the emergency department for rapid assessments of trauma. We can see collapsed lungs, internal bleeding, free fluid, fetal heart beats and more. It is revolutionizing emergency medicine," says Ertel.

 The technology is also avoiding the need for CT scans, which require radiation. "Patients love it. But since this is an emerging technology, most emergency physicians over the age of 40 have not had the opportunity for training," said Ertel.

 Both proposals received funding from the SSC this past year. Any emergency physician in BC who wants to attend the ultrasound course, as well as two other skills-upgrading programs put on by the Canadian Association of Emergency Physicians, can have the course costs covered by the SSC funding. "The result is a huge benefit in patient care for BC," said Ertel, who says the aim is to eventually have every ER doctor skilled in bedside ultrasound. Myers with hand-held ultrasound

The echocardiology course for rural internal medicine specialists also has  been going on this past year, taking place over four, two-day weekends in the spring and early fall. Developed and delivered by internal medicine specialist Dr. Jean-Paul Lim, who splits his practice between Terrace BC and Vancouver, the course is not only training eight physicians on the use of the devices, but subsidizing by up to 50 per cent the cost of the hand-held units.  And it is already having an impact in patient care.

 Dr. Chester Morris, an internist in Port Alberni, who has no local access to echocardiology, diagnosed a critically-ill patient with pericardial effusion — fluid around the heart — after the first weekend of training. "I am now using the device every single day in my practice," says Morris.

 Myers is, too. "I take mine everywhere I go. I love it. But more importantly, it is improving patient access to timely care."

I must confess to a certain smug satisfaction in seeing the pages of ads in the Saturday Globe and Mail from the big three cell phone companies desperate to sway Canadians to their side.

In January 2009 I wrote this letter, below, to the head office of Rogers Communications. Receipt of the letter was never acknowledged. I was not alone in my complaint, I later learned. The website "ihaterogers.com " had many, many more. Now, it is stories like this that are coming back to haunt all three of the cell phone companies when they want and need our loyalty to keep out a U.S. competitor.

I feel I was rather prescient in my prediction that one day Rogers would regret not focusing more on customer support and satisfaction. While I believe we should have a level playing field, I also believe Canadian cell phone companies must provide fairer prices and policies and better customer service.

January 2009

Dear Rogers,

In August 2005 I got two cell phones for my two teenage daughters, then 14 and 12, and signed a three-year contract with Rogers.

The two numbers were linked to my name on one account. Within four months, the youngest lost her phone. The cost of replacing it was more than $150 for the cheapest option. I determined it was more cost-effective to have her join my plan with Telus, in which she would get a better free phone and lower over-all rates, than to pay the Rogers charges to replace her phone or exit the contract. We let her Roger's  number go dormant and I paid the minimum $25 a month for no service and no phone. I planned to quit the contract in August 2008 and marked the date.

In July 2007, with one year left on the contract, my older daughter, then 16,  dropped her phone in a puddle, rendering it useless. She took it to the local Roger's store to see if it could be fixed, but was instead "given" a "free" replacement phone. Neither she nor I knew that by doing so, automatically the two numbers rolled over to another three-year contract until July 2010.

It was August 2008, when I tried to quit the younger one's dormant number and stop the $25 a month payment, that I learned that due to my underage daughter's actions on her phone,  I was now on contract to 2010 for both daughters — without my knowledge or consent as the signee of the original contract — and that I would have to continue paying the $25 fee for another two years or pay $800 to get out of the contract for the younger one's non-existent phone.

Then, the older daughter's replacement Rogers phone was lost  just a few weeks later. I made sure I went with her this time to the Roger's store. To get a replacement would cost $150, or we could "upgrade" the one phone but either way we would be forced to sign another three-year contract to 2011 -- for two phones!!

Rather than do either, I am now paying $50 a month for no phones and no service until July 2010, a total of $1200. But to quit both numbers outright, I will have to pay close to $1600. I have repeatedly tried to talk with Roger's customer service agents since the first lost phone in 2005, but have been met with condescending agents who tell me that if my children can not be trusted to care for their phones then I should not have let them have them;  a contract is a contract.

Granted, the problems started with kids losing or breaking phones, and my frustration is also with my kids -- but they are teenagers, and notoriously irresponsible as a demographic (which is why, no doubt, cell phone companies market to them.) And despite giving my teenagers consequences for losing their phones I am still stuck paying $50 a month for no service to a company who seems to be taking advantage of this situation and who, in my mind, illegally extended the contract with a 16-year-old.

On a related manner, when my credit card expired to which the $50 was being billed, I tried to contact Rogers agents to let them know. I tried five times to get through to give my new number. After waiting more than 20 minutes, I would hang up. I also tried to use the Rogers website to update the information, with no luck. Astonishingly, even when I am trying to pay my extortionist bill, I receive bad customer service!

I finally figured, if Rogers wants the money you can come after me — which you did  this month.

The Rogers collection agent was very professional —almost kind — the first one in your company who listened to and commiserated with my story. She seemed to understand that it was very difficult, psychologically,  after all we have been through,  to pay a $300 bill when we have no working phones and no service. She transferred me to a customer service agent. I was put on hold for 15 minutes. When, yet again,  I told my story, the very rude and condescending young man actually LAUGHED and blamed my irresponsible teens and my "poor parenting" for my trouble.

His laughter and berating astonished and enraged me. Never in my life have I been subjected to such treatment. I told him he can laugh now, but customers will have the last laugh. A company that pays no attention to earning customer loyalty is, in the long run, committing business suicide.

I have consulted a lawyer and find that to fight you will come at a high financial cost. I am writing to you now to let you know that I while I find your practices appalling, and even illegal, I will pay the contract until July 2010, but I will never, ever use any Rogers service — wireless, cable, video —ever again.

And I feel certain that there will come a time when you will be sorry that you created a company culture in which it was more important to lure new customers into vice-like contracts than to earn and keep the loyalty and trust of the customers you have.

Sincerely,

Anne Mullens

I am on a whirlwind research trip. I've been to six cities in 12 days: Toronto, Hamilton, New York, Baltimore, Washington and finally Boston.

I am travelling fast and light with a small rolling suitcase, a brief case and purse.

The suitcase's weight is such that, standing just so, I can clean and jerk it into an overhead bin without conking another passenger on the head.

On my last day I do my final three interviews in Boston. I get to the airport at 3 pm for a 5 pm flight to Toronto, anticipating a late dinner with friends, a nice hotel and the plane home the next morning.

"Passport please," says the check-in clerk.

It is not in my purse. I have shown it dozens of times the last two weeks, used it the night before to board a flight from Washington, but it is not in the zippered pocket. I search everything, including opening my luggage in front of a line of people. I am tossing out underwear and dirty knee highs like a hyperventilating juggler. Nada.

Oh my god, I am going to miss my flights. This is going to cost me hundreds of dollars. This is a %$#&-ing disaster. I am barely fighting back tears of anxious frustration.

Wait, don't label. Calm down. It is as it is.

"You can't board," says the clerk who hands me the card of the Canadian Consular Services. I dial the after hours number and get the attaché, Josie, at a diplomatic function. I can hear chatter and the tinkling of wine glasses in the background. It is a Wednesday night and she tells me it could take three business days to get a new one.

"Be at our offices at 9 am sharp with all your documentation" she says. Fortunately, I always carry a photocopy of my passport, but my husband has to run up to the Victoria Passport office with my birth certificate. Josie advises me, if we have the right documents in hand at the dot of 9 am, she might be able to get a new passport for me in two days. Otherwise I'll be stuck in Boston until Monday or Tuesday. A huge expense.

One of my interviewees, whom I call to see if my passport fell out in her office, kindly offers to put me up in her guest room in the suburb of Watertown for the night. We have a lovely evening.

I get up very early and try my damnedest to get to the Consulate by 9 am, but glitches keep happening. Buses full of commuters heading to Harvard pass me by, refusing to pick me up. "No room," say the drivers. "This always happens," gripes a fellow waiting at the bus stop with me. He tells me it is at least five miles to Harvard Square where I can pick up the subway on the MTA line.

So I walk, on a beautiful fall day. "Accept what is." The trees are aflame in colour. The sun is shining. The air has that fall crispness to it. Soon I am smiling. Some forty minutes later I am at the MTA stop. I board the green line to Copley Square during rush hour. But after two stops the subway train breaks down in the middle of a tunnel. We creak into the nearest station where officials with megaphones order hundreds of us off into shuttle buses. I am laughing. Accept what is!

Of course, I only have directions to the Consulate from the subway. I get lost. Jeesh, the cosmos really does not want me to get there on time!  A lovely woman with google on her Iphone helps me find my way.

"You are late," says the attaché when I walk in at 10:25 am. "It doesn't look good for getting this done in two days," she says.

I am filling out forms in the waiting room while the attaché is in a back room about to void my passport when a woman and her friend walk in. She knocks on the glass window.

"Excuse me," she says to the receptionist. "The strangest thing has happened. I went to show my passport at the hotel last night and the clerk said: "This isn't you! Somehow I have another women's passport!"

"Is it Anne Mullens'?" I pipe up from across the room.

"Why yes!" she says.

"JOSIE, DON'T CANCEL THE PASSPORT!!" yells the receptionist at the top of her lungs into the backroom.

Turns out, she was in the row ahead of me on the Washington-Boston flight. When I heaved my bag into the overhead compartment, my passport flopped out of my purse onto her seat. She looked down, saw the Canadian emblem, assumed it was hers, picked it up. All in an instant. She had taken more than an hour to make the trip into the Consulate. "The MTA broke down!"

We laughed at the weird coincidence; how, if I had arrived by 9 am my passport would have been cancelled long before she arrived.

"You are so lucky," said the attaché.

Then, as I was walking out chuckling, my cell phone rings. It is a PR friend-of-a-friend offering me a free night at the four star Fairmont Copley Plaza — a gorgeous hotel. "I heard you were stuck in Boston," she said.

I had a delightful, unexpected 24 hours exploring wonderful Beantown. The airline reservation clerk starts laughing when I tell him why I'd missed my planes. "Let's see what we can do," he said, putting me on flights to Toronto then home the next day, waiving any penalties.

In all, the temporary loss of my passport turned into a 24 hour gift, filled with laughter and serendipity.

Indeed, maybe there is something to saying "Yes" to what is.

This Wry Eye column first appeared in the July 2013 Boulevard Magazine.

-30

 The first time I really saw Mercedes-Rae Clarke, she was standing in the schoolyard in Grade 7, a tiny bird of a girl with big brown eyes and an impish smile. She was 12 years old and my daughter Kate’s new friend.

I had heard about “Merch” from Kate for months. She had moved into my daughter’s Victoria B.C. French Immersion class earlier that year, a new kid originally from Calgary thrown among a tight group of students who had been together since Kindergarten. Soon she was among the most popular in the crowd. I knew that all the boys had a crush on her and that all the girls wanted to be her friend. Kate had been saying for weeks: “Merch says this” and “Merch does that.”

But this day, was the first time I’d had a good look at her. And I thought: “What a bubbly beautiful girl. What eyes!” She had a big smile and a big laugh for someone so petite and delicate. The other girls towered over her.

Over the next 18 months I would get to know Mercedes, driving her in a carpool to dance class each week, often hosting the sleepovers that seemed to occur almost every weekend at someone’s home. This is the Mercedes I knew: an adventuresome, outgoing sparkplug of a kid who loved to shop and socialize, excelled at dance, loved to try out the new hairstyles. My daughter Maddy, two years younger than Kate, idolized Merch because, unlike some of the older girls, when Merch came over Maddy wasn’t excluded. She would brush Maddy’s hair, give her a new hairstyle and include her in all the talk.

She loved to be the centre of attention. A video of Mercedes from a Grade 8 school camping trip shows her sitting around the campfire at night, stuffing one marshmallow after another into her mouth until she reaches an astonishing 10, cheeks puffed out like a crazy chipmunk, while her classmates double over in laughter. That was a typical Mercedes moment:  an imp with eyes dancing in merriment, playing to the crowd.

A few times, on dance class nights, her mother Sherry would call to say she couldn’t get away from work just yet and to ask whether Mercedes could stay with us until she could pick her up. Sherry worked at a downtown Victoria funeral home as a mortician. I knew her call meant that a family was having trouble with a death and she needed to spend extra time with them. “Of course,” I said, knowing first hand the juggle that working mothers do to keep children safe, with friends. 

Sherry was a hard-working, compassionate and strong mother of three. Along with Mercedes, she had one son who was a grown and married adult and a second son, just a year older than Mercedes, who was Mercedes best friend. Sherry had mustered the courage to leave an unhealthy relationship with Mercedes’ father, to forge a new life on her own in Victoria with her two younger children. They lived in the suburbs of Victoria, but Sherry wanted Mercedes to have the benefits of a well-known French immersion program near her work, which entailed a long commute to and from town for the two of them every day. 

The last time Mercedes was at our house, before the fateful day that changed everything, Kate and Mercedes spent a lazy August afternoon, hanging around our backyard, jumping on the trampoline with Maddy, mugging and posing with our digital camera, the picture of happy girls on a summer day, still so innocent and fresh.

And then, a few weeks later, around dinner time on Monday September 5^th 2005, the day before they all were to start Grade 9, Kate burst out of her room, tears streaming down her face.

Mercedes, she wailed, had tried the drug Ecstasy. She had never tried any drugs before. She was now in hospital on life support. "She is dying" Kate wailed through her tears.

Our first reaction was utter disbelief. Surely it must be the exaggerated tales of teenagers on MSN, an Internet version of broken telephone where a message becomes hugely distorted in the retelling. 

In the flurry of phone calls that ensued, however, our disbelief turned to shock and despair. The story was true: For some reason that her family and we will never know – maybe peer pressure, maybe boredom, maybe the risk-taking side of her adventuresome spark — Mercedes the day before on a sunny Sunday afternoon, in a lush Victoria park, decided to swallow a tiny pink pill given to her by a friend. She was with two girlfriends, at least one who had tried Ecstasy before and said it was fun. That girlfriend had bought three pills for about $10 each from a guy selling it on the street in downtown Victoria.

For Sherry Clarke and her family and for everyone who knew and loved Mercedes, the questions and circumstances continue to haunt: Why did they do it? What were they thinking? If only tiny Mercedes, who was just 73 pounds, had been bigger and taller like the two other girls maybe her one rash choice would not have been so deadly. If only, if only…

 When the three girls swallowed the little pink pills Mercedes almost immediately began to vomit. Soon, she complained of a terrible headache and then that she couldn’t see. And then, her eyes rolled back into her head and her body contorted in a seizure. One of the girls ran to a nearby house of a family friend to get help.

When Sherry arrived at the hospital, about 90 minutes later, her tiny beautiful bird of a child was unconscious as medical staff worked around her. She'd had an inexplicable hyperthermic reaction to Ecstasy. No one really knows why some people, on exposure to a drug that many find harmless, have a deadly spiking of their body temperature. In some cases body temperature can soar so high - called hyperpyrexia -- that it exceeds 42 C.

Over the next 24 hours Mercedes continued to have repeated seizures, her blood pressure skyrocketed, she had multiple heart attacks and resuscitations. She was placed on life support on Sunday night. Everyone prayed through the night that somehow the dire effects of that tiny pink pill would wear off, that some miracle would save her from her one, terrible choice.

By Monday night everyone’s worst fears had been confirmed: Mercedes brain scan showed no activity. The tiny pink pill had rendered her brain dead. Her mother was then faced with what must be a parent’s most agonizing decision: to disconnect her beautiful Mercedes from life support, donate her organs and let her die. The medical staff gave the family time to say goodbye. On Tuesday September 6^th, the halls outside of Mercedes room where full of people: cousins, and aunts and uncles and friends of Mercedes. Sherry asked that close friends like Kate come out to see her.

For Kate and I, saying goodbye to Mercedes in the Pediatric ICU, is a devastating memory that will never leave us. She was lying pale and motionless in an ICU bed, surrounded by machines, tubes in her arm and throat, her lungs rising and falling to the whoosh of a ventilator.  Her beautiful big brown eyes, once so lively and bright, stared out vacant and dull.

The rumour that week abounded that the drug she took must have been laced with crystal meth – how could “fun” ecstasy kill so rapidly? In England the year before, in a case remarkably similar to Mercedes’, a 13-year old took Ecstasy and died, having a fatal hyperthermic reaction, in which the drug caused rapid dehydration, soaring blood pressure and body temperature, seizures, heart attack and brain death.

Mercedes organs were harvested for transplantation and Mercedes was removed from life support that evening. Instead of sending Mercedes’ body to the hospital morgue overnight, as is the usual practice, the hospital allowed Sherry, because she was a licensed mortician, to collect her daughter’s body directly from the operating room. Sherry and her trusted friend Bill, a transfer attendant from the funeral home, wrapped Mercedes in a blanket and with a few close family members took her that night to the funeral home. There Sherry washed and prepared her own 13-year old daughter’s body for her funeral. To me the tenderness and despair of performing such a final act for one’s child is heartbreakingly unbearable.

For Sherry there are important messages she needs the world to know: Mercedes was a good kid from a good home who made a single bad decision.

The coroners report a few weeks later made it very clear: the drug was pure Ecstasy. That too Sherry wants the world to know. “Ecstasy is seen as being the fun drug, the one to take to party and have a good time, not nearly as bad as crystal meth, but Ecstasy can kill, too.”

And Sherry wants other kids across Canada and around the world, if they hear friends talking about trying Ecstasy or other drugs, to remember Mercedes and have the courage to pipe up and say no. Tell them about the risks, tell a parent or a teacher – it could save a life.

“Mercedes made a mistake for all of you. Learn from her mistake,” pleads Sherry.

I know my daughters, through Mercedes death, will never try Ecstasy. “Other kids should know her story,” says Kate.

In the fall of 2005 a few months after Mercedes' death, we pulled out the digital camera for a family occasion. There, on the camera, we stumbled upon a forgotten picture of Mercedes, that last day in August, caught in mid air while jumping on our trampoline, big smile, hair flying, skinny arms and legs all akimbo – so alive and so vigourous. So full of promise.

And, for the hundredth time, my heart broke anew.

-30-

Some recent medical literature about brain hyperthermia induced by both prescription and recreational drugs

http://www.ncbi.nlm.nih.gov/pubmed/23274506

Review of deaths by Ecstasy

http://www.ncbi.nlm.nih.gov/pubmed/21264549

MDMA and body temperature

http://www.ncbi.nlm.nih.gov/pubmed/21924843