Will Smitherman clean up Toronto’s soggy bottom? The man with the incontinence product runs for mayor

The Globe and Mail reported today on the official entry of George Smitherman into the race for mayor of Toronto.

A former health minister and deputy premier, Smitherman is renowned for much more than merely having been Ontario’s first openly gay MPP. Over the years the aggressive politician dubbed “Furious George” left a trail of arched eyebrows and stares of incredulity as he blundered into modest notoriety.

Two years ago, in what will surely be remembered as the nadir of his public career, Smitherman demonstrated appalling, cringe-making insensitivity as he made a bad mess worse in responding to criticism of the treatment of the elderly in the province’s largely private nursing homes. He told the media that he was prepared to don an adult diaper — and use it — to justify his government’s policies. Not surprisingly, this deranged outburst did not sit well with an outraged public.

The criticisms Smitherman’s health ministry received were justified. The Ontario Association of Non-Profit Homes and Services for Seniors claimed that seniors in nursing homes should be getting at least three hours of personal care; it said the average in the province is about 2.5 hours a day. The Canadian Union of Public Employees (CUPE), which represents many nursing home workers, called for a standard of 3.5 hours. Many studies have shown that without proper staffing and adequate standards the quality of care plummets. Front-line nursing home staff in Ontario report that residents are sitting in deplorable conditions. Incontinence products are often kept under lock and key, and many homes are directing staff to change residents only when the product is 75% soiled.

On February 27, 2008, two long-term care workers used four bottles of water to fill an adult diaper at a CUPE press conference in Toronto. They wanted to show how much urine had to be in a diaper before care aides were allowed to change it under current legislation. With stunning insensitivity Smitherman said in response that he was ready to test out an adult diaper to show criticism was unfounded. “I’ve got one of these incontinence products — albeit a new one, not the ones that tend to appear at committee — on my desk and I’m really giving this matter very serious contemplation,” Smitherman said. It wasn’t only critics of the Liberal government who were angry. There were loud calls for the minister’s resignation, even within his own caucus.

Wags and cynics sharpened their quills. In March the National Post published an imaginary Smitherman diary entry, with entries like this:

TUESDAY
Major confession, diary. I tried out an incontinence diaper today. It was so … freeing. I had three large coffees … and then I sat through a three-hour meeting with a bunch of bureaucrats. No pee breaks! It was so much more efficient. Made a bit of a stumble at lunch, though, by having the side dish of asparagus. Won’t make that mistake again! I think this will really help in my discussion with the nurses’ union. Five hours seems to be the limit before things get a little soggy. I think I’ll publicly float the idea tomorrow. Right after I shoot up an eight-ball of smack to get a better feel for drug addiction.

Of course, an apology followed immediately. “I wasn’t trivializing the matter,” Smitherman said. “I take it really, really seriously.” The minister could not be reached for comment for a long time after that; but his “diary” entry gives us some insight into why:

FRIDAY
After I came in from my night on the streets yesterday morning, Dalton [Premier Dalton McGuinty] called and ordered me to apologize for the diaper “stunt.” I explained that I only thought it would gain a better understanding of the issue, but he wouldn’t listen. “Also, George,” he said, “please tell me you weren’t wearing one in my office the other day. Because I thought it smelled like asparagus, if you catch my drift.” I told him my cellphone was cutting out and I hung up.

Sam Solomon, writing in his blog Canadian Medicine, addsed that this wasn’t the first time that “Furious George” has run off at the mouth:

Speaking about new building plans suggested by some hospital boards in Ontario, Mr Smitherman dismissively referred to the expensive proposed upgraded facilities as “Taj Ma-hospitals.”Another classic outburst was featured on Stephen Colbert’s American parody politics talk show in 2005. Talking to none other than an assemblage of the Ontario Association of Optometrists, Mr Smitherman called optometrists “a bunch of terrorists, and I don’t negotiate with terrorists.” “Bravo, sir,” Mr Colbert said. “Optometrists are a menace. You have to be careful with a group that gets their kicks blowing air into our eyeballs.”

During the “incontinence product” controversy in 2008 Smitherman’s bizarre antics were dismissed by Sid Ryan, president of CUPE’s Ontario chapter, who said the minister completely missed the point. The problem wasn’t the products, but the cruel reality that residents in long-term care facilities were forced to wear soiled diapers through the night and sometimes up until noon the next day. “If the minister wants to play silly games, well then, let him put on a diaper and sleep in it all night long and come into the legislature and wear it up until 12 o’clock,” Ryan told the Canadian Press.

Could the problems so clumsily dealt with by Ontario’s health minister possibly be related to the fact that in Ontario 60% of all publicly funded long-term care beds are in for-profit institutions, as compared with 15% in Manitoba [1]? There is ample research to show that public investment in not-for-profit, rather than for-profit, delivery of long-term care results in more staffing and improved care outcomes for residents [1,2]. Instead of experimenting with adult diapers, perhaps Mr. Smitherman should have tried absorbing some of those important statistics and the advice of experts. There are a lot of excellent health libraries within throwing distance of the Ontario legislature.

From Eyeweekly.com here is a a taste of what to expect when Smitherman hits the Toronto campaign trail – a few Diaper George gems:

On announcing his candidacy intent: “A native son is coming home to serve.”

On wearing adult diapers to ensure nursing home residents are getting adequate care: “I’ve got one of these incontinence products … on my desk and I’m really giving this matter very serious contemplation.”

On controversial energy audits for homebuyers: “They taught me in some Grade 10 course — which was almost at the end of my stream of education — the notion of caveat emptor, buyer beware.”

On music: “I’ve been working out to the new Whitney Houston. I’m a gay man, so I love Whitney.”

On working with others: “Nobody should associate me with the status quo.”

References:

1. McGrail KM, McGregor MJ, Cohen M, Tate RB, Ronald LA. For-profit versus not-for-profit delivery of long-term care. CMAJ. 2007 Jan 2;176(1):57-8.

2. McGregor MJ, Cohen M, McGrail K, Broemeling AM, Adler RN, Schulzer M, Ronald L, Cvitkovich Y, Beck M. Staffing levels in not-for-profit and for-profit long-term care facilities: does type of ownership matter? CMAJ. 2005 Mar 1;172(5):645-9.

Prostate free Fridays

The other day I dropped into a supermarket with my sig other to pick up some laundry detergent. I decided I wanted something less harmful to the environment. After browsing through the vast selection on hand, I discovered a brand whose pleasantly green label promised a combination of vigorous cleaning action and ecological rectitude. “Oh look,” I said. “This detergent is prostate free.”

Now I’m prone to the occasional solecism, malapropism or sheer, hand-flapping howler, and this one brought a blush to my face as two or three other nearby shoppers looked my way with arched eyebrows. Sig other was swift on the uptake: “Lovely. It should work quite well on my sweater. You know, the one with all the colours of the rectum.”

There is just no avoiding the fact that the insertion of a medical term into a conversation is inherently funny, either due to its peculiar-sounding Greek or Latin root or especially when it refers to a taboo body part. I know. Just try saying “prostate” loudly in public, even in a hospital corridor. The word has a straightforward etymology, entering our language from the identical word in French, which in turn evolved from the Latin prostata, which itself echoes the Greek word prostates, “one standing in front,” a reference to the prostate gland’s position at the base of the bladder.

Men’s complexes over the state of their prostate gland (which, like many things with men, may be traced back to generalized genitalia anxiety) have produced a rich mine of humour. Here is just one example grabbed off the web:

“What is the difference between a prostate and a garden hose? There’s a vas deference.”

Which doesn’t even make any sense anatomically. But it still gets a laugh.

“Rectum” is another squirmer, even in its Latin guise not quite suitable for civilized company. “Rectum” is derived from the Latin intestinum rectum, “straight intestine,” in contrast to the convolution of the rest of the bowels. The comic overtones of this word and its cognates have not escaped the attention of humorists of every variety. Consider this old Woody Allen joke:

“They tried to expel me for cheating on my Ethics exam, when all I did was look into the rectitude of the boy next to me.”

I am digressing, but that is the point here. Computers too have been known to produce some good howlers. If you’ve ever used Google Translate you’ll know what I mean. But automated translation has improved a great deal in the past twenty years. Way back in the 1980s I saved an article about a state-of-the-art package being used by a major German auto maker to translate one of their technical manuals into English. Things got a bit out of hand. The German word for “suction pipe” (Saugleitung) became “pig gliding” (through misreading this compound word as Sau + Gleitung instead of Saug + Leitung). The overactive dictionary also turned Kathoden (cathodes) into “cat testicles.” German veterinarians would wince.

Medical terms have shown up in some limericks. Here is a good one:

Whenever he got in a fury, a
Dyspeptic from Upper Manchuria
Had pseudocyesis,
Disdiadochokinesis,
And haemotoporphyrimuria.

Too much to tweet, but great fun to share with medical students. If you haven’t Googled the terminology yet: pseudocyesis is false pregnancy, disdiadochokinesis is the loss of the ability to perform rapid alternate movements, and haematoporphyrimuria is the presence of porphyrins in the urine. Our poor Manchurian would have presented a rather pitiful sight with an enlarged abdomen, morning sickness in addition to heartburn, the loss of the ability to wind up his watch, and discoloured urine.

And here is a limerick for the pharmacologically minded:

There was an old lady from Leicester,
Whose numerous ailments obsessed her.
She found no allure
In a medical cure,
And sedatives simply depressed her.

Not leaving our topic too far behind, I am reminded of an anecdote about the Victorian poet Alfred Tennyson, which I had occasion to post about a couple of years ago. As a young man Tennyson was afflicted with a painful attack of piles. He visited a youthful but well-known proctologist and was so successfully treated that for many years he had no further trouble. However, after he had become a famous poet and had been raised to the peerage, he suffered a further attack. Revisiting the proctologist, he expected to be recognized as the former patient who had become Britain’s Poet Laureate. The proctologist, however, gave no sign of recognition. It was only when the baronial drawers had been dropped and the patient had bent over for examination that the proctologist exclaimed, “Ah, Tennyson.”