After decades of strife, we've entered a golden era of cooperation between doctors and government

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.

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For more than a 100 years, the stethoscope has been the one personal piece of diagnostic equipment that every physician carries, slung around the neck or curled in the lab coat pocket, for the prompt listening to the gurgles, rasps, lub-dubs and whooshes of patients' tell-tale body sounds.

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

You know the sayings: Be in the moment. Don't label any event in life as good or bad. Accept what is. Buddha called it the secret of success and happiness, being "One with Life." It's not easy to live like that, but I think they may be onto something.

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.

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The Sunday New York Times, June 23, carried a story in its Style section about how the drug Ecstasy (MDMA) is now being widely used in fashionable circles. While a few experts urged caution about the drug's dangerous side, the story painted what I feel is a very dangerous, positive portrait of the drug. I feel compelled to share this story about my daughter's good friend, Mercedes, who took Ecstasy and died in September 2005. She was 13. With her family's support and input, I wrote Mercedes' story for Reader's Digest International, and it was published in the September 2006 Canadian edition. It then appeared in some 20 International RD editions, in more than a dozen languages. I hope it saved a few lives. Please read and share this reprint. Ecstasy is NOT harmless.

 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.

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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