An Allegory

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The Foot & The Elephant (an allegory on the Canadian medical system and wait times for surgery)
Once upon a time, I was a great wanderer, happily flitting about to and fro over great distances. One day as I frolicked merrily on my way, there was this crushing feeling on my foot. Because my wife was a medical practitioner, I called for her to give me her opinion. After asking what happened and how it came about, she hummed and hawed and not one to take chances on medicalish things, she decided to take me to her place of employment to be checked out.
Upon arrival at the “institution”, the staff appeared fast and efficient running about waving charts in the air, stacking files, taking blood pressures and doing all sorts of important medical stuff. After poking me, prodding me and rinsing off a rectal thermometer in a jar, a couple of the specialists came to view my predicament. They looked at each other, looked at me, looked at each other and looked at me, whispered in a huddle and announced that I had a sore foot. Being naive and a mere mortal, I asked the question why.... The specialists consulted each other in a huddle, casting the occasional furtive glances over their shoulders at me, until one eventually stepped forward and replied, “well, sometimes a foot can get sore at your age, lots of older men have a sore foot”. Not sure what to make of this, my wife said that I was not one to complain unless there was something really wrong, so perhaps they should run another test. Because she worked there and was a fellow staffer, they decided that was a reasonable thing to do. The first specialist came back, puffed out his chest and said, “we have discovered the problem, we think your foot is missing”. That seemed plausible although I kind of thought it was strange that it would just fall off like that, in fact I could not find where it was unattached no matter how hard I looked. I was still wiggling those apparently non-existent toes and trying to figure that out when shortly thereafter, another specialist came in. He saw my confusion, turned on his heel and left. A few minutes later he came back and said, “we took some pictures and discovered your foot is still there. However, the real cause is that there is an invisible 3 ton elephant standing on your foot. It only shows up when we take this special kind of picture.” “Well how are we going to get his elephant to move off my foot” I asked. The specialist replied that it was a very special technique known only to a few wise specialists and I would be going to see an Elephant foot remover specialist to do the procedure. Meanwhile they would run some tests.
One of these tests involved taking pictures from the inside and they indicated that they would run a camera on a wire conveniently poked through one of my legs. I was not suppose to worry though, because it was a simple procedure with only one in a two thousand chance of anything going wrong. What I didn’t know, was than nineteen hundred and ninety-nine had just finished this procedure just before me. After the resulting stroke, I was blind in one eye for a few months and told by another specialist, I would probably never gain my vision back properly again and could expect to be partially blind for the rest of my life. Thank goodness for medical accurate predictions because two months later I was fortunate enough to have my vision back to normal.
After a few weeks in the institution, I was sent to see the Elephant foot remover who looked at the pictures and said, “hmphh, this Elephant is only 2.5 tons, normally we don’t remove the Elephant until he is 3 tons.” So I replied that the previous pictures where of a 3 ton Elephant and he replied that his pictures were from a better camera and that the other specialists’ camera always added weight to the pictures. Therefore we would just watch and wait until the elephant gained weight. Somewhat confused but reassured that there was no immediate danger of my foot being crushed, we went home.
As time progressed, my foot became worse, the pain increased, and I was unable to walk very well. I went to my foot monitor specialist who indicated that small elephants on your foot don’t hurt unless they crush your foot completely and since my foot was not crushed, it could not be the Elephant causing the pain. Unable to argue with such outstanding logic, I was even more confused. I asked what we should do because the pain sure felt like crushing. He decided that I should see a bunch of other kinds of foot specialists to discover whatever other reason that it must be, because you see,......everyone knows, small elephants on your foot do not cause pain. (Footnote: Apparently that is everyone except medical journals and studies who all indicate it can and does.)
Four specialists were booked, Peter, Paul, Tom and Mary. Peter looked at my foot and stuck pins and electrical gadgets taking measurements and readings and came back saying there were no electrical problems. So I went to Paul, he took fluid and measured it, held it up to the light and swished around and said all the hydraulics looked fine and it wasn’t that. Moving on to Tom, he asked what Peter and Paul had said, “well, if they don’t know, I don’t either”. Mary was the next in line. She said, “well you have seen three specialists already, I am not going find anything different”, and did not test anything but rather wrote a great report on the tests she had done and charged the medicare system multiple fees. My family foot specialists said that was enough specialists, I was making “a career” out of seeing them and he would refer no more. Meanwhile, my foot was getting worse and worse with no alternative reasoning presented.
Very confused I began to read up on Elephants and spent a lot of time gathering stats and other information. I discovered that it was often hereditary problem. I went to my new family foot specialists (I fired the other), and indicated that I had discovered that certain patients had a predisposition for elephants to stand on their feet. She said this was true and in that case they would remove elephant at 2.5 tons. Well as it happened, shortly after they had found my elephant, my father had had an elephant removed from his foot, (a very large elephant, almost 8 tons). I told the doctor this important information figuring they would then act to relieve my pain and remove this elephant. “yes but that elephant was on your father’s right foot” he said, “Your elephant is on the left foot so they are unrelated”. Now, all the new material I had read was updated to indicate that which foot the elephant was on did not matter, but the specialist said, the old material was still the guidelines and the guidelines are the guidelines (unless they disagree, then they are only guidelines).
I had also read that people who have pain in their foot and have an elephant standing on it, are the most likely to be crushed and the prognosis was very poor.. Study after study supported those facts. In fact, even the original study that had set the guidelines was proven false because they only measured the weight of the elephants after they had crushed the foot. The facts were that elephants celebrate with victory cake and gain up to 30% in weight after crushing a foot. This obviously meant that skinnier elephants could and would crush a foot more often.
By this time, I was pretty much totally incapacitated, I could no longer work, barely walk (as you can imagine, walking with an elephant on your foot is not easy), and having a poor quality of life. Breathing was incredibly difficult, even at rest. (I think his butt was on my chest). I continued to have tests and press towards a resolution.
The follow up pictures indicated that the Elephant had recently gotten much longer but not much fatter so at that point so nothing was planned. You see, long elephants don’t weigh as much as short fat elephants, even though they occupy the same volume of space. Another fact of medical physics that I had not known. Even though the guidelines gave a list of reasons for removing the elephant at 2.5 tons, and I met them all, the elephant removers were determined that this elephant would reach 3 tons, or by gosh, I would die trying.....(funny thing, that is what the statistics said too). As time passed, the beast was found standing on my ankle too and starting to crush both feet. It might have been simple to remove him from one foot, but the procedure to remove him from multiple locations was deemed much more complicated. All this confusion came about because very few specialists know how to remove elephants.
The pain in my foot started to get worse, so I went to the hospital to have it assessed further. There I met a star trek nerd who liked to play with gadgets. He had even invented a real live working tricorder. Well in any event, it turns out that he was also a medical dude and one who knew all about elephants. In fact he was well read and current about their habitat and knew that living on my foot was not where they belonged. He said he would ensure that my elephant got removed ASAP. By contacting an elephant pest removal agency and taking all the right pictures and stuff, he set it up that I would soon find the relief I needed. However, when I got there, the elephant removal specialist decided that statistics apply to other patients and not to me. Apparently unknown to me, I was a super human who could withstand larger than normal elephants and due to unknown reasons, my elephant could defy gravity. Even still, it was then that one of the pictures revealed a nail in my foot to boot (pardon the pun). Part of the difficulty with the issues I was having, was the neurologic problems that come when the nail is piercing the brain (apparently my brain is in my foot). Removing the nail would alleviate a lot of the pain as you would imagine. However, amongst the many elephant specialists who had now noticed the nail, none were the type of specialists who could remove it. The nail was the excuse the elephant removal specialist required, to put off any repair, saying that the nail was the problem and removing the elephant would not remove the pain. Immediately after this visit, I got a call from the nail treatment specialist who indicated that the nail was not the problem and that the elephant needed removing immediately and why were they not doing it?
Well as you can imagine, I was somewhat confused and walking in a circle (the other foot of course being pinned to the floor). It seemed finding a nail remover was not easy. This of course involved more referrals and required that much more pain be experienced before I received an appointment. Some specialists had commented on the length of the nail, some even talked about the width and the point, the parts pierced along the way and the potential damage it could cause. None could or would provide any relief or recommended any pain medication. The only consensus was that, indeed, the nail would have to wait until the elephant was off my foot to be removed. In fact my new family foot specialist indicated that we could only do one thing at a time.
In addition, she said, only a very special kind of pain specialist could recommend medication for relief, in the meantime I had to suffer or go to the emergency room for relief. When I went to the emergency room, they said I needed to go to my family foot specialist and what was wrong with her for not treating the pain?
A few months earlier, I had had eventually gotten to see the elephant historical record keeper. This keeper said absolutely that this elephant problem was inherited and that I had a predisposition for having my foot crushed. I was way passed the safety mark and needlessly being exposed to greater risk by waiting to have it removed. She was going to send stern letters to all the other specialists involved indicating that this was so. This elephant should have been removed immediately and it was needless risk not to have done so.
After a few months passed and I heard no response from her stern letters, I became concerned. This was supposedly critical information requiring action. I called the multiple specialists involved to enquire as to how this life changing risk criteria was to be applied to my treatment and discovered that the letter had been lost and no one had received it. Well two months of increased pain and consternation taught me to speak up. I had all the letters re-faxed to the specialists. That resulted in everyone being informed and no action taken as I was waiting for the regular 6 month pictures to be taken in six weeks anyways. Time passed and eventually the new pictures were taken and the foot removal specialist said, “oh look it’s a 3 ton elephant...by the way, how come no one has removed it yet?”
The date was finally set for the removal, and I was able to sigh in anticipation of the relief I would soon experience.
Meanwhile, after 8 more months of suffering since the nail had been discovered, I finally got to see a booboo begone specialist. The bbbs recommended one of the most potent pain medications available and asked how come my family foot specialist had not recommended anything when it was so obvious? Another month past after that appointment and I had still not heard from my family foot specialist so I fired her and got yet another one. The new one reacted instantly and finally, after almost 3 years of increasing pain and suffering, I was granted some medication.
As the date for the removal came closer, it was bumped once, twice, three times and finally a fourth time to two months even later. Finally I received a notice to go to the elephant removal clinic for a pre-event preparation. I was also about to get the pain medication I required, and I had tears in my eyes for the anticipated final relief I would receive from being treated. I spent 5 hours being poked, prodded, jabbed and stabbed as I prepared. The last part was to talk to the elephant removal specialist one more time just before I left. It was at that point, she indicated to me, “geeze, that elephant has been on there so long that I can’t remove it while there is a nail in your foot. You need to be able to walk it off afterwards and you can’t do that with a nail in your foot!’” A bit stunned, I asked “ but but, no one would remove the nail because there is an elephant on my foot, and how am I suppose to walk while he is crushing it?” “well, that elephant should have been removed a long time ago before the nail sunk in,” she replied, “ now we will have to wait until you can get it pulled it out so you can walk afterwards. Oh and by the way, that elephant was really 3 tons all along and should have been removed three years ago.”
At this point, they had to call security because I was damaging the wall by banging my head against it. Since it was time for new pictures again, (another 6 months had somehow passed) I went home to reassess the whole thing. Armed with copies of the pictures and a “How to remove an elephant from your foot” book for dummies, I read that everything I was experiencing was in fact normal for someone having an elephant standing on the instep of the foot. That was exactly where my elephant was. The nail was an altogether different issue that had nothing to do with the elephant. At this point the elephant removal specialist announced that she was going to be off work for another number of months due to some issue with children living in her stomach and not paying rent. She did expect to be back for some time after the eviction notice was given so I was referred back to the first specialist with the bad camera. Well that took another few months to arrange.
When we finally did meet, sure as rain in the Sahara, he decided that he needed his own pictures to be sure I really needed the removal. Yet again, somehow, despite four sets of pictures with professional grade photographers and engineers doing measurements, the young technician did a partial poorly visualized peek-a boo with a hand cam and determined the elephant was less then 2.5 tons and therefore all follow up appointments were cancelled.
Cancelled?? What was I to do now?? After 3.5 years of confusion?? One specialist was off evicting domestic parasites and the other refused saying it was unnecessary. (As it turned out, the second specialist had just taken a job overseas and was busily clearing off his caseload as quickly as possible...but of course that would have not had influence on his decisions.......) . The clock continued to tick and by this time new appointments were made and the confusion would be cleared up by a new set of professional pictures.
The new pictures indicated that the elephant was actually 3.2 tons and standing on more parts of the foot. The hand cam was a hand sham. There are no written guidelines that recommend not removing the elephant once they surpass 3 tons. My foot monitors said they would set up a new appointment with the removal specialist again. The eviction had gone successfully and she was back to work. After waiting a number of weeks for an appointment, I finally got a phone call from the monitors saying that they finally heard back to find out that only the specialists assistant makes her appointments so I would have to hear from them directly. Call me blue, still holding my breath.
Hear I sit, wading in despondency, with a nail too deep to remove and a now larger than 3 ton elephant causing more pain with every chuckle as he jams cake in his face. At least I have my M&Ms (morphine and marijuana). Finally I have received a call for a consultation and an echocardiogram. Will Dumbo finally be set free? We will find out on March 7th.
Well its now April and the specialist has once again refused to remove the elephant because I am not well enough to withstand the procedure. Every guideline in the world says it is time to remove the elephant, however, those guidelines only apply to mere humans. Apparently all I have to do to improve my situation is go jogging on my sore foot. “But there is an elephant on it”, I complained. “Not to mention the nail in it which hurts like crazy”, still no sympathy. Cause everyone knows, the best way to fix a broken leg is to jump up and down, ...or was it by going jogging?.... ahhh, taking the elephants for long walks. And the nail? We just pretend it’s not there, after all, pain is all in the mind, and most of the specialists don’t seem to mind at all.
What now Tonto, we are surrounded by native elephants on the warpath and there is no way out... Tonto turns to me and says, “what mean we lead foot” and runs away....... With nothing to lose at this point, I have started to research my herbs and spices prescribed by many specialists in many places at different times for who knows what reasons and never in consult with each other. Well you know what they say about too many cooks in the kitchen. It turns out that many of the difficulties I have had were due to the preponderance of poisons being stuffed in my gullet. My gullet is not happy with me so I have spoken to chef where they sell the spices, read many recipes on line and have taken a minimalist approach. After all, too much salt causes leavening to lump in the loaf ... or something like that.
So with my foot on the verge of collapse, the pain of the nail crippling my movement and my gullet in open rebellion cause I got the KFC secret recipe wrong or something, I am preparing to try and go jogging with dumbo on my foot. Maybe if got a helium tank and inserted it (somewhere not mentioning anything specific) into the elephant, I could make him light enough to carry and if I bit into a piece of leather (possibly elephant hide) I could bear the pain too........
TBC. (with any luck).
Question: Why does Canada have an opiod problem? Ask a specialist, defined as someone who knows more and more about less and less until they know everything about nothing at all .......