Sunday, 3 March 2013

Nine Months, Two Weeks: All Things Must End

Forever Young

Then Judas, who had betrayed him, when he saw that Jesus was condemned
repented and brought again the thirty pieces of silver to the chief priests and elders.
Saying, "I have sinned in that I have betrayed the innocent blood". And they said "What
is that to us? See you to that yourself"
And he cast down the pieces of silver in the temple and departed, and went and hanged himself.
And the chief priests took the silver pieces, and said, "It is not lawful to put them into the treasury,
because it is the price of blood".

 King James Bible. Matthew 27:3 through 6
The people that know me and my family know that religion is not part of our lives. Certainly I was raised in a "lip service" Christian household, attending church weekly into my early teens, and Calista endured 13 years of Catholic school during which she actually once read scriptures from the pulpit at a school mass. Personally, prior to Calista's death, I probably could have been classified as a sceptical atheist: I was sceptical of everything, even atheism. Calista, on the other hand, was one of those quiet atheists who would loudly snicker at anything vaguely religious, but never bothered herself with any of the ongoing debates.  Calista was atheist enough to never feel obliged to defend her position; she had her beliefs and was happy to let others believe in whatever they wanted. On the other hand, both of us agreed that the Bible is and will always be one of the seminal works of literature ever written. In the Western world, if you don't have decent knowledge and understanding of the Bible, you have neglected a key part of your education. The Christian Bible and its Church is the basis for much of the beautiful, the good, the bad and the ugly found in Western culture.

Judas Iscariot is a pivotal character in at least two of the four commonly published gospels: he is the disciple who betrayed his master Jesus for thirty pieces of silver and has been subsequently damned as a traitor ever since. Judas' motives have been hotly debated since time immemorial: some say it was for the money, some claim it was a patriotic act done on the behest of the Judean occupational government (the Vichy government of the Roman era), while others suggest that Judas was merely carrying out God's plan in collusion with Jesus. Many religious scholars are actually at a loss to find any concrete proof of the existence of Judas Iscariot period.  Today I would like to suggest an alternative motive behind the Biblical tale of Judas Iscariot: it is a cautionary tale included in the bible to remind all of us to never completely trust the "authorities".

Thirty pieces of silver. Cali 2009.
In my Bible stories, the Romans were always painted as the villainous executioners who crucified Jesus because they considered him an upstart Messiah and possibly the leader of a Jewish uprising. If one objectively studies the history of the Roman empire, one would realize that the empire survived almost a thousand years by acting as a benevolent despot, allowing the local governments and cultures huge amounts of independence. As long as the taxes were paid and the Roman government appeased, the locals were left to carry on as they always had. It is highly doubtful that the Romans, specifically Pontius Pilate, cared one whit about Jesus and his twelve followers. The local bureaucrats of the occupational government were a whole other matter.

If you have not read the scriptures lately, I suggest you have another look: Jesus was basically a minor threat and irritant to the Judean theocracy and was condemned by the temple bureaucrats who feared anything that might disrupt the sweet deal they had under the Roman regime. The Romans themselves had no idea who Jesus was and when Pilate stood in judgement over Jesus he basically saw a "just man" and was prepared to pardon and release Jesus.  It was only when faced with opposition from the angry crowd, goaded through fear mongering by members of the occupational government that Pilate "washed his hands".  The symbolic washing of the hands is another typical bureaucratic policy repeated throughout the ages.

When Pilate saw that he could prevail nothing, but rather a tumult was made,
he took water and washed his hands before the multitude, saying
"I am innocent of the blood of this just person; do as you will"

King James Bible, Matthew 27:24 
To me, the message in this scripture is pretty darn clear: don't trust the bureaucracy. They will lie to you to get their way, it will usually be all about money, and when faced with a challenge, they will wash their hands of the entire issue.

The coroner's report on Calista's death has finally been completed and her case is closed.

She always returned to macro photography of flowers. Right to the end.

Bureaucracy has not really changed much since Pilate looked away 2000 years ago. If I ever trusted government before, my faith is permanently broken (Hey, church and state are finally least by my contempt).  Vote for anyone you want; its the bureaucrats that really run the show and they are not doing anything to rock that boat.

Several months ago, after reviewing the autopsy results and the toxicology screens, the local coroner called me with some news and a request. The news was that Calista's case was being bumped up to the head coroner's office (I guess I should have been wary, but I was optimistic); her mysterious death had exhausted the local resources and the regional coroner felt more experienced eyes should review the file.  The coroner then continued on to say that they would like to see Calista's medical records from Saskatchewan. Due to jurisdictional issues, the request for those records would have to be arranged through Roni and I rather than the BC Coroner's Office. I felt a bit energized by the request because it felt like the case might have some momentum and we might finally get some answers.  I made all the necessary calls, signed a flurry of requisition documents and anticipated a quick return on my efforts. I trusted a bureaucracy; how foolish.

That was the last I heard from anyone at the coroner's office since October, over four months ago.  Allowing for the expected bureaucratic red tape and paper shuffling, I thought one month or maybe two at the most would be appropriate to get a look at the records. By the time Christmas had come and gone, both Roni and I were starting to assume one of two things: the file had been lost on somebodies desk down in Victoria or something unexpected had come up and the investigation had taken a new turn. By the end of January both of us had developed a fair bit of cynicism about the entire issue. I kind of expected that nothing was ever going to come of the coroner's investigation and we would hang in limbo forever. Then I got an e-mail from the regional coroner last Wednesday morning.
Submitted for an early photo contest before high-school courses, Jack or Courtenay

The coroner seemed to have some news and asked that I contact her as soon as possible. I called with high expectations (what was I thinking?), hoping to hear that a conclusive decision had been made. I was surprised and a little depressed to hear that the coroner's office had not even received any of the old medical records yet. In fact, the office had not even sent in their requisition yet.  It seems that there was a small fee involved; $125 for the private medical records from Calista's G.P. and another $50 for some electrocardiogram records dating from 7 years ago.  The situation, in a nutshell, was that the case had sat in complete limbo for over four months while the BC Coroner's Office dithered over $175 in file transfer fees.  I dithered for about 5 seconds, three of which were taken up finding my wallet to retrieve my credit cards. It seems laughable that after nine months, during which tens of thousands of dollars were spent on police investigations, an autopsy, histopathology examinations and toxicology tests, the entire process was being held up by a paltry $175 dollar bill.  Only a government bureaucracy could be so anal.

Now I am at a complete loss as to why the head coroner took over four months to admit there was a snag on requesting the medical records, but I would bet that three of those months were occupied by the file gathering dust in some bureaucrat's "in-tray".  Between "earned days off", family sick days, group therapy sessions and team building exercises, I am sure the office flunkies down in Victoria have very full agendas, but I believe someone there could have called the regional coroner and told her to ask me to obtain the pertinent records myself.  The actual act of getting those incredibly expensive records (in the end,all we really needed was those $50 electrocardiogram traces) took me all of twenty minutes and a single fax to Regina General Hospital.  Four months of puddling around and it only took one ageing veterinarian twenty minutes to actually get the job done. Just goes to prove that you should never trust anyone to do something for you that you can do yourself. 

The final blow to my faith in the BC Coroner's Office came late Wednesday afternoon. The regional coroner called to tell me that her boss in Victoria had decided the case was closed and no further investigation was warranted. Without any look at the records that I had already requested and paid for, a nameless mandarin ensconced behind some desk in Victoria had decided they had wasted enough time and resources on Calista.  The final decision?  Wait for it.....  Calista died of "natural causes".

Natural causes. What in hell's half-acre is natural about a twenty year old healthy, athletic young woman dropping dead less than five minutes after waking up in the morning?   Only a completely insensitive ass could believe for a second that answer is sufficient for a parent who has lost their only child.  Of course, if you look up bureaucrat in the dictionary, the word is practically synonymous with insensitive. (They could just put a picture of a dead donkey frozen in ice...a truly "insensitive ass")

After nine months (and two weeks), the bureaucracy down at the BC Coroner's Office has saved their thirty pieces of silver, told their convenient version of the truth, and washed their hands of my Calista.   At least the temple priests who paid off Judas discarded the thirty silver pieces as "blood money", but I suspect the 175 dollars they saved by calling the case closed will support the office coffee fund for almost a month. I would hate the Coroner's Office to miss their Starbuck's (or Timmy's, since this is Canada, eh?).

I love the detail here. You have to love the incredible beauty of a flower. None of us look this
great with the macro treatment.

The regional coroner tried to soften the blow by telling me that Roni and I did not stand alone; during her term as regional coroner she had dealt with two other sudden, unexplained deaths in young adults. Both of those cases were closed without a specific cause of death attributed: "a Natural Death" was the final determination. There was an assumption that some form of acute cardiac arrhythmia such as Long QT Syndrome had been the true cause of death, but, of course, there was never any concrete proof. All three cases were similar in one very important way: the corpses were perfectly healthy but still dead. The basis for the diagnosis of "cardiac arrhythmia" was the very absence of disease. I know the regional coroner, who as always been very helpful and understanding, had only good intentions, but I am afraid she missed the point. The absence of disease can never be used as the basis for a diagnosis.; it is merely a sign that the doctor failed to find the truth. The fact that Roni and I were not unique in our curse was no help to us at all; it merely compounded our grief to know that there was two other families out there without answers.

There is a primary failing in the logic that attributes most sudden unexplained death in young people to cardiac arrhythmias. The diagnosis is one of "rule out": the pathologist does every appropriate test available and, when everything else is eliminated, whatever is left remains a possibility. The statistically most likely cause is then attached to the case. That little toe-tag is far from a confirmation; it is barely more than a best guess. 

Robert H Thouless wrote the seminal text on argument and debate, "Straight and Crooked Thinking". My father gave me a well used copy of the short book when I was just a young teen-aged blockhead. I believe he had visions of a future lawyer and hoped that by mastering rhetoric I would become a master of the courtroom (my entry into Veterinary College was a disappointment to him on so many levels). Between my many moves I lost that gift, to my great regret.  Years later, early in our Regina years, I managed to replace that old paperback through the magic of the Internet; the price was lofty due to it's rarity, especially in light of the fact the books had originally sold for less than dollar when they were first published. Mr. Thouless lists strategies of argument, both correct ("straight") and faulty ("crooked").

One of the most common faulty argument strategies can be grouped under the term "All and Some".
The basics of the tactic is to extend a "some" statistic to include "all". Thouless uses a political slogan of the twenties as his example.  "If Liberty is Lost, Slavery Reigns: Vote Repeal!". The first phrase is an argument that suggests that any loss of liberty allows slavery to become paramount. In this case, prohibition was the liberty lost. Obviously, equating prohibition with slavery is overstepping reality. The loss of some liberty does not equate the loss of all liberty. "Some" is not "All". The argument that, when faced with no other apparent cause of death in a young person we can just assume cardiac arrhythmia and wash our hands of the case is another example of "some" becoming "all".  In this case it is likely a matter of bureaucratic expediency.

Life will spring eternal. Even from stone.

In the practice of veterinary medicine we are faced with statistical diagnoses frequently. When I am faced with an elderly dog presented with acute weakness, pale gums and a swollen belly; my first thought is going to be internal bleeding due to a cancerous tumour of the spleen. Years of experience has taught me that, but that same experience also tells me that there are lots of other causes that I need to consider. Even if I confirm a splenic mass with my ultrasound machine, I need to keep in mind that if I just throw a blanket diagnosis of "cancer" on those I will be wrong some of the time. Some pathologists suggest "cancer" might be wrong as often as 40% of the time if I consider only my ultrasound examination. To safely diagnose cancer in these cases I need to look at more than just my ultrasound image.  No diagnosis should be based on one single parameter, especially when that parameter is as nebulous as "absence of overt disease". (Or, as so succinctly put by Calista's pathologist "The healthiest corpse he had ever worked on").

Don't misunderstand me: I am not suggesting that the coroner's office is incorrect, though I certainly have found at least one other plausible cause of death that would perfectly fit the circumstances. Calista probably did die of a sudden fatal cardiac arrhythmia. I just resent the appearance that the decision was made as a matter of financial expediency without considering all the available evidence. I am not sure if anyone really sat down and considered the evidence contrary to the Long QT scenario  before they decided they did not need to fully support their final ruling.

Long QT syndrome has many different variations. The vast majority of the incidents of acute collapse (and death) in young adults are associated with athletic endeavours.  Aquatic sports appear to really exacerbate the Long QT syndromes, probably because they involve strenuous activity combined with strictly controlled breathing. Certainly some of the variations of Long QT are associated with awaking from sleep, especially if it is a "rude" awakening by a loud alarm. The instigating factor there seems to be the act of being startled awake which causes a sudden increase in heart rate.  These "awakening" deaths are extremely rare (I am not a big believer in "rare" diseases; the doctors should conclusively rule out the most likely disease before you start looking for exotica).  All of these syndromes often have, hidden somewhere in the patients history, an incidence of sudden collapse or syncope.

So what did Calista give us?  She was an athlete; competing for years in swimming. She never once showed any sign of cardiac issues in all her years of training. She did faint once for unknown reasons back when she was 14. That incident was investigated and that cardiology work-up is the file that I am awaiting right now. The morning in question she was not "startled" out of sleep; she woke up to the relatively benign sound of her iPhone humming and jingling.  I know that sound well since her phone sits next to my bed and still goes off at the fateful hour of 6:10 am every morning.  (I guess my assessment of that alarm is a little unfounded since I hardly sleep much anymore, so it takes next to nothing to wake me.) There appears to be a balance here and the coroner's office, with very little effort and just a few dollars more could have tipped the scales and closed the door with authority. The coroner's office obviously did not care to do that; our peace of mind and the lifting of the cloud of mystery that hangs over Calista's death is not a priority compared to maintaining their budget and case closure rate.

I found this while surveying her multiple external hard drives. I have no idea when she took it.

Calista's cardiology study from almost a decade ago is on its way to my doorstep. When it arrives I will turn it over to the only two people I would trust with my future peace of mind: my brothers Dana and Ivor. With decades of experience in the operating room between the two of them, I know they will find the signs of Long QT Syndrome on those ECG tracings if it is there to be found. The coroner could have postponed the closure of her case for just a month more and included the ECG in their file. They could not be bothered.

 Long QT Syndrome has been associated with several well known DNA markers.  There are still a few bits of pieces of Calista stored in formalin floating around out there. The coroner could have ordered the DNA testing without much difficulty. The coroner could have arranged for both Roni and I to be tested for those markers. We have blood and we would have been willing to be tested if it would clear this case conclusively.  Hell, I would have paid for the testing myself if money was the issue; just send me a nurse to draw the blood and an address of the lab that does the testing. DNA testing needs not be considered now because some desk-jockey down at the BC Coroner's Office wanted the case closed before the end of the month.

Pilate washed his hands and looked away. 

Always trust a bureaucrat to take the easy way; especially if there are thirty pieces of silver involved.

So ends the sad case of Calista Jasmine Fleming. Not with a flourish and a bang, but with a government mandated ruling. There really is not much more to say about my Calista, my family and my life. I have covered everything I care to tell and everything else is either too private or too mundane to put to print. I always said I would finish this blog when the coroner completed her report. That time has come now. Some of it has been magic, but all of it has been tragic, to paraphrase Mr. Jimmy Buffet. There is only so much weeping in my cups I can do before it just becomes obsessively pathetic; life will go on for the rest of the world. As it should.

Thank you to everyone that took this journey with me. It was harrowing, I know, but hopefully there was enough humour and amusing stories about my girl that the reading was worth it. I will always miss Calista and I hope, by sharing her with everyone, some of you will miss her too. 

She turns to leave, her door has appeared.


She would laugh at the devil
"End? No, the journey doesn't end here. Death is just another path, one that we all must take.
The grey rain curtain of this world rolls back, and all turns to silver glass, and then you see it."
J.R.R. Tolkien

                Many novels end with an epilogue; a short chapter that gives us all final closure, some idea of what the final consequences of the story might have been.  That is all very fine for fiction because that is the nature of fiction; it provides us with an escape from the reality of life. In the real world there is no closure because there is no “beginning” or “end” to anyone’s story. All our lives are just a series of interlinked waves stretching infinitely back and forward in time.  Some of those waves created who we are and what we accomplished while some of those waves are the results of our having been here. 

                On the other hand, every telling of a story has to conclude eventually.  This is my conclusion.  I would like to have provided answers to everyone’s questions, some worldly advice to those who feel I might have something worthwhile to say or maybe something optimistic to lift our hearts and fill them with hope. I am not sure I can do that. There really is nothing good to say about the loss of Calista. She was twenty, she was full of energy and ambition and to know her was to love her.  How can anything good come of that kind of loss?  Roni and I and perhaps the rest of the world, can only consider the rest of our life a pale shadow of what it could have been had Calista been allowed a whole life.  Just as her life was cut short, our lives have been fractionated.

                There will come a time when I come to terms with her loss. It may be years in the future or it may be next week, I’m not sure.  I have an idea how my acceptance will come about though.

                The rain will be pelting down, the winds will be kicking up as they do when the weather is about to change, and it will be dark as only Powell River can be; so dark your hand at the end of your arm disappears a foot from your face. I will fall asleep full of doubts and remorse as I do every night these days, the scar of her loss just as raw as that very first day.  Ten days, ten months or ten years from now, it will all be the same.

                I will awake to a new day, the sky a clear blue dome overhead. The sun will just be cresting the eastern mountains and across the wide blue straights its golden rays will be kissing the Comox glacier that greeted my girl each clear morning.  The breeze will be freshening off the Straights, scenting the air with the mixture of creosote and salt that always means home to me. It will be cool but not cold; just  refreshing.  The rains from the night before will have scoured the air, leaving the view of Comox from Powell River so clear the distant shore seems just at arm’s length.  I will be waiting down by the ferry docks at the little kiosk beside the ramp into the ferry, watching as the foot traffic, the “walk-ons”, depart ahead of the motor vehicles.  My eyes will scan the marching passengers, watching for that one special person.  She will be there, hanging back just a bit, watching for me just as I look for her.

                Her long dark chestnut hair will glisten in the early morning light and her smile will shine radiant white as she walks slowly up the ramp and finally comes home. She will be dressed just like she is in her best portrait; her leather jacket half closed, her favourite woollen scarf tied at her neck and her prized jeans still torn in all the right places.  I will be young again, maybe 46 years old (that was a very good year) but she will always be 20 in my mind and I will still have to look up to her just a little bit. She will hug me, maybe crack a joke at my expense, but my only words to her will be “Welcome home, I love you”. It won’t be necessary, but I will say it nonetheless.   Roni might be waiting with me, she might be at home putting the last touches on Calista’s room and making sure everything was just as my girl had left it.  Or maybe Roni will have already gone on ahead and they will both just be waiting for my homecoming.  It does not matter really, as long as we are back together with her once again. Finally.

                We are masters of our own reality and this is the reality I will hope for when my end comes.  At this time I really don’t have any death wish. Nobody needs to wish for death because it will come for all of us regardless. On the other hand, when my time does come, I do have a single wish; more time with my girl. It just that simple.

The sun will rise, the breeze will freshen and the ferry will arrive. I will be waiting and she will walk into my arms, no
words needed. She will be home, where she belongs.


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