There was once a time when American professionals believed that their choice of work was a response to a calling. In the origin of the word “vocation” is the implication that the call comes from a noble place beyond the self, perhaps from God. That belief implies that fiduciary duties attach to the service provided to clients. Such quaint notions have been, sadly, expunged from the motives of those who toil in what, today, passes as professional practices of most all kinds. Caveat emptor now applies to you doctor, lawyer, as well as your priest, minister, rabbi or imam. Would that we could refrain from buying the sundry outputs of the state and its monopolist co-religionists like big tech, but choice is not involved, rather compulsion. It’s what lawyers call “a contract of adhesion”. You take it or leave it.
The organizations of such professionals, in turn, once expounded on the pinnacle of what America could create - the best of the best. Professional associations looked to the ethics and performance aspirations of their constituents so as to assure continuation of superb practice in service to clients - even as generations passed. That was before these associations were co-opted, became toadies of the state and finally threw in completely with leviathan so to effectively merge themselves with authoritarian state bureaucracies. The hallmark of these latter, even as they function to a small extent as pale remnants of professional organizations of yore, is that they no longer actually serve the public. Rather, notwithstanding high - sounding mission statements of service to the public, these Lilliputian tyrants indeed work furiously, but at propagandizing and terrorizing the public to convince it of the latest prevented threats to their wellbeing by additional rules. In reality, they act to implement their own ever more Byzantine internal algorithms with a two aims in mind: power and fulfillment of their ever - metastasizing political directives. These agencies have been incrementally bloated by hasty accretion of every passing political fad and fancy plausibly pertaining to their bailiwick. The day of actually serving the needs of clients as fiduciaries or even as customers, honestly, is over. Any question as to who serves whom can be instantly answered by an interaction with, say the DMV in any state or the IRS with the feds.
That malignancy which is politics, we have been painfully schooled, has been eternally incapable of containing itself when it comes to power. Its incontinence in grasping for ever more has overflowed into every single bureaucracy - even as it continues to erect ever more of them. Taken together, these comprise the pulleys and levers of our rule - the omnipresent, omni-incompetent corruption of what was once a decent, self-critical and improving society. It is of such a magnitude as the founders never dreamed possible when they made the above observation of HRH King George III. Unlike our rulers, kings of old at least had some natural incentive to preserve the sound function, productivity and satisfaction of their subjects for his heirs - his family. We should be so lucky, under the “consent” we now give our rulers. “Of the people, by the people and for the people” is a pitiful, hollow joke.
Examples of corruption of government “services” abound. Mere mention of, “the legal system” the department of justice” (sic) or “a nation of laws” evokes cynical disbelief at the suggestion anything vaguely resembling service to the public is afoot. The ongoing Trump “prosecutions” signal then end of even pretense that this is a system of laws. Most now understand that this this misbegotten, corrupt assembly of power brokers, exploiters and users in every branch of government at every level - who pass themselves off as principled “public servants” - are little more than automata, small parts of a vast Rube Goldberg machine, whose only real output is self - aggrandizement. My own recent experiences with my wife in the health “care” system, is a clear example of how America the corrupt now works. The tale will show how “Tracking With Closeups” is a technique of context analysis which gives great insight into the “big picture”. In this case, we will see how, when it comes to “healthcare”, the system is bereft of actual caring. It , like every other “regulated” system, has been redacted, to use a current term - i.e., surgically excised by our betters.
This small example is a close up which stands for much that is wrong with the original system by which human beings offered their services to others. Before the state stepped in to “improve” the relationship between doctors and patients, the individuals had what the law called a contractual relationship. In service contracts, the doctor offered his expertise in to patients - diagnosis and/or treatment - in return for compensation in terms of money or goods or even a return of services of some sort. State inclusion in this contract stemmed from the difference in knowledge between the parties. English Common Law took note of this differential and added a legal requirement of consent. This imposed upon the physician a duty to obtain the express consent to any physical interaction or “touching” to use the legal term of art. Touching another without consent is a battery, for which damages accrue. more could be said, but that suffices here.
Now, American law extended this legal duty in the early 20th century by adding a requirement that the physician - having far greater knowledge than the patient - inform the patient of sufficient fact that the patient can make a decision while armed with facts as to his condition, diagnostic procedures and proposed treatment. Naturally, this being America and lawyers being lawyers, much litigation ensued as to the requisite information necessary and what evidence is required of its having been given.
English Common Law courts in cognizance of the American shift to the doctrine of informed consent, declined to “go down that path” for a period of several years before succumbing. The only inquiry in England, at first was “Did the patient consent”? Yes or no. All the case law regarding consent was over the years, gathered into statutes and regulations at federal and state levels. The compendium of regulation (the Code of Federal Regulation or CFR) has expanded in size over the years. The number has grown since 1951 from about 5000 to nearly 200,000 pages! Anyone surprised? Many have severe criminal penalties attached and these were mainly created and enforced by the executive branch. So much for division of powers.
I mention this codification of law in light of their having been completely ignored regarding Covid. There are pages and pages of high-minded requirements for ordinary citizens working in any medical field, who have contact with patients. They sound highly ethical and proper an require that much information be offered before any diagnostic or treatment procedure may be legally performed. Do you recall any such process before receiving your jab?? These ethical rules were ignored by the very state charged with their enforcement. no consequences to anyone. One reason there are no consequences is that side effects and bad outcomes have been (and are still being) ignored and/or hidden by the very authorities charges with protecting us from harmful medical treatments - like “vaccinations”.
So thorough is official propaganda regarding Covid (and everything else about which you might want information), that finding anything not supporting the official “narrative” has become remarkably difficult. Once upon a time, Google gave unbiased search results. For example, finding the number of pages in the Code of Federal Regulations (CFR) or their rate of growth, used to be quick and results prominent in any search engine. Since it is an irrefutable measure of the growth of state intrusion, it is no longer easy to find. Like every single fact or opinion (Google et. al. make no distinction, to the extent it promulgates the official narrative), search results are highly slanted. Any fact or opinion which is not consonant with “left leaning” (89 degrees or less counterclockwise to the left of vertical = 0 degrees) displays prominently in search results. Opposing opinion is most often completely absent from search results or, if eventually found, categorized as “conspiracy theory” or “right leaning” (1 degree of more to the right clockwise from vertical). This is the approved “new normal”.
So this exposition of “tracking with closeups” was precipitated by a meeting with my wife’s gynecological surgery oncologist to plan a “de-bulking” operation for her abdominal cancer. This will be an open laparotomy for removal of any visible cancer. This malignancy originated in the peritoneum - the thin membrane which lines the inside of the abdominal wall and the surface of all the abdominal organs. The cancer, too, is a thin coating and is described like “icing” coating the peritoneum. It’s not like a solid tumor which can be separated from normal tissue and cut out. Most of this is removed with laser or electrocautery. Based on the PET scan and markedly decreased blood levels of cancer antigen, the surgeon is optimistic there won’t be a lot of cancer to remove. I pray she is correct.!
Near the end of the discussion, we talked about management of post op pain. She (the surgeon) said my wife would probably be in the hospital 3 days with IV opioids and that the prescriptions for post op pain after discharge would be sent to our pharmacy so we wouldn’t need to scramble to get them on the way home from the hospital (as was usually the case until recently). Then came the politics which caused me to grit my teeth. The surgeon will prescribe acetaminophen (Tylenol), ibuprofen (Motrin) and only a limited amount of opioids! Here is a perfect example of political decision making in patient “care”.
Now I have 50 years experience managing post op pain of all kinds. In my experience, acetaminophen and ibuprofen will not touch most types of post op pain - particularly the severe pain after an open laparotomy with an extensive incision from top to bottom of the abdomen. So why would a surgeon - who surely knows the inadequacy of those two medications - resort to such an order? Answer - because somewhere, someone, somehow has abused opioid medications! The state, via the captive medical profession, is thus doing something!! and more importantly it is doing so on the record, with official orders for over-the-counter medications already present in the medicine cabinets of most everyone.
They’re demonstrating with this evidence on the record that they’re telling the patients they must take Tylenol and Motrin (these prescription medications are exactly the same as the over the counter ones - only it’s about 10 times the price and wastes pharmacist time and effort!! No matter. The state and their captive “providers” can say they are doing something - although everyone knows it will make zero difference in the “fentanyl epidemic” or its associated deaths. Non-enforcement the open southern border is of no consequence in this regard, we are told. Instead of cutting off some of the illegal fentanyl supply, lets get tough with law-abiding surgical patients who are legally prescribed these medications and deny them pain relief. See?? We are such good guys acting to reduce fentanyl OD’s and deaths!!
And what are they really doing? They are denying adequate opioids to the very patients who need them and for whom they are entirely appropriate. I have witnessed this kind of thinking in action and can tell you the results are serious post-op complications, unnecessary pain and suffering and preventable deaths. You’ll never hear that truth from the MSM. These practitioners completely ignore the well known fact that not only does pain tolerance vary among individuals, but so does the dose of required pain medication vary among patients for adequate relief. The only way to find the necessary dose is empirical. It is to give a dose to a patient in pain, observe the result and adjust the dose accordingly. This means that to adequately relieve pain in 95% of patients (a reasonable goal from the patients’ point of view), doctors must prescribe more medication than required for those who will adequately respond to the mean dose.
So, not only is this the usual meat-fisted state response we a expect from the state. It is stunningly incoherent compared to its “safe and effective chorus” when it come to any other medical or especially vaccine cheerleading. In cheerleading favored medications and doses the state approves of, we are forever told we must err on the side of “safety” or “best practices”. Does the state adhere to it own cheerled advice? Like its advice to the little people as to the essential nature of “fully informed and knowing consent” (above) in our dealing with each other and that to “save a single life” demands that everything imaginable must be done - the state ignores its own principles when it see fit to just ignore its own rules.
It is not harmless to deny adequate pain relief, however great the political optics of “doing something” about opioid abuse. Beyond the obvious pain and suffering of the affected individual, their lives are actually and unnecessarily put at risk. Most of the risks of major surgery actually occur in the post op period - not during surgery or in recovery room. That’s because their vital signs are continuously monitored and aggressively kept at safe levels in the OR and PACU. The stress response does not become maximal, though, until 24 - 96 hours post op.
And guess what? That’s exactly when the authorities - you know, the omniscient ones who are incessantly telling us what’s good for us (with the active acquiescence of the doctors and hospitals who were once fiduciary patient advocates) and insurance companies want to throw the patients out of the hospital and send them home, completely unmonitored with intentionally inadequate pain relief for the sake of optics!
This post op stress phenomenon is neither my invention nor new. It has been well understood for decades and can be managed safely - beginning most simply and easily with adequate pain relief. You don’t need a medical education to know that uncontrolled pain is bad for your heart and blood vessels, which may burst under the stress. Any major insult or bodily injury results a stress response - in high levels of cortisol, epinephrine, nor-epinephrine among other mediators. These, in turn, cause an increase in cardiac output required for healing.
This increase in cardiac output is accompanied by increased heart rate and blood pressure, all of which greatly increase stress on the heart. Inadequate pain treatment is well known to be a - if not the - primary cause of preventable myocardial infarct, a stroke, or a bleed anywhere in the body, but especially in the brain or surgical site and especially around the time of discharge with intentionally inadequate pain medication. Oh, and this is all not to mention that fact that many surgeons will not allow their patients to use ibuprofen in the early post op period because - like aspirin the original NSAID - it interferes with platelet function and risks early post op bleeding! So, this order for ibuprofen functions as a sort of litmus test for those surgeons who knuckle under and toe the state’s absurd and harmful opioid line! Patients wo do bleed post op are net told the cause. Just - “You didn’t heal right”. There’s the remnant of patient advocacy by physicians on display.
This is less than the tip of the governance/harms iceberg. Such “unintended” consequences of purportedly well meaning policies and decisions, are actually known and hidden by our betters and that is the main point of this entire exercise. Despite the representations endlessly spouted by our superiors and their media henchmen, they actually care not one whit for us, outcomes, health, wellbeing, happiness or even sanity. All that is defined away by process measures designed to exclude big picture results. Rather, check off what we say you should have done. Like “prescribe Motrin for post op pain” “Check”. end of inquiry. They care about one thing: POWER and the continual acquisition of more. I am reminded of the ethos of our governance every time I watch a documentary about supermax prisons, with perfect regimentation, total control of inmates and zero possibility of unpredictable behavior - ever. Similarly public school process measures look perfect on the screen; there are check marks in every data field. No matter the graduated children are illiterate, innumerate or unable to think. We can’t or don’t measure that! “You vill own nutting”. “You vill eat ze bugs”. “You vill be happy”.
I have described here a small cause of morbidity and mortality and how it results from decisions intentionally made by our betters for the sake of mere appearances favorable to the media-preferred ruling party - that is, in furtherance of the blatant lie that they care about us and must keep us “safe” - in this example, “safe” from opioids - at any cost, regardless of whether they can actually accomplish such safety on our behalf or whether or not we even want them to “help” us in that way. The MSM, of course, blares the government line (Soviet Pravda was never even close to this performance). Finally, you can be sure you will never learn of the preventable morbidity and mortality among post op patients - however many there are. It just doesn’t fit the narrative. Truth dies amidst “hate facts” like these.
How many other harms are covered up for optics sake - direct results of our self-touting beneficent government? How many do you suppose there are - hidden by the state, with the collusion of the democrat media arm - the MSM. For instance, how many harms and excess deaths do you suppose have been covered up resulting from the Covid tyranny? From “gender affirming” “care”? From the “global warming” hysteria? From the unlimited money printing? Or the intentionally divisive identity politics? This is precisely what a complete failure of governance looks like, just before the whole house of virtual cards collapses.
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