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The Current Transcript for July 26, 2017

Host: Laura Lynch

STORIES FROM THIS EPISODE

Listen to the full episode

Prologue

[Music: Theme]

SOUNDCLIP

DONALD TRUMP: As the scout laws says: “A scout is trustworthy.” Loyal we could use some more loyalty, I could tell you that.

LAURA LYNCH: Well, U.S. President Donald Trump started this week speaking to thousands of Boy Scouts touting the virtues they stand for and in the process slamming those he believes aren't displaying the fealty he thinks he deserves. The accusations about collusion with Russia just won't go away and they keep forcing Trump on the defensive. Today a closer look at the current state of play in Washington. And then:

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It's dark. When it rains the water pouring through the ceiling. The powers intermittent at times, not often joy is felt that in that small tin room.

LL: James Maskalyk like does his best to save lives at the blackline hospital in Ethiopia where he finds little joy but deep meaning in his work. Working there and in Toronto the doctor has become acutely aware of the issues that surround life, death and how we're all vulnerable, near and far. I'm Laura Lynch and this is the summer edition of The Current.

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U.S. doesn't have system 'set up for a Donald Trump': expert

Guests: Daniel Dale, Charlie Sykes

SOUNDCLIP

DONALD TRUMP JUNIOR: I'm more than happy to be transparent about it and I'm more than happy to cooperate with everyone. For me this was opposition research they had something, you know, maybe concrete evidence to all the stories I've been hearing about but there were probably underreported for years, not just during the campaign. So, I think I wanted to hear it out but, really, it went nowhere and it was apparent that that wasn't what the meeting was actually about.

JARED KUSHNER: I did not collude with Russia nor do I know of anyone else in the campaign who did so. I had no improper contacts. I have not relied on Russian funds for my businesses and I have been fully transparent in providing all requested information.

LL: What was really behind the meeting between Team Trump and a group of Russians in June of last year well, nothing of any consequence, according to President Trump's son, Donald Junior, and son in law, Jared Kushner, both of whom you heard there. Also present at that meeting was Paul Manafort Trump's, former campaign chairman. But despite those assurances, U.S. lawmakers have plenty of questions for that trio. They are all speaking before congressional hearings on Russian connections that are underway this week. Meanwhile a separate investigation into Russian ties continues its work. That is the one headed by former FBI Director Robert Mueller. Of course no one knows for sure where those investigations are all leading. But over the weekend, President Trump let it be known he was preparing for certain outcomes by tweeting about his absolute power to pardon. It's anything but a quiet summer in the American capital and we have the Toronto Star’s Washington correspondent, Daniel Dale, with us now to help bring us up to speed. Hi Daniel.

DANIEL DALE: Hello.

LL: It's hard to know where to start and I'm betting you're not getting a lot of sleep this summer. Let's start by looking at Donald Trump Jr. and Paul Manafort. There are supposed to be testifying in front of a Senate committee, what is happening with that?

DANIEL DALE: Well there are various questions about them. The most pressing probably has to do with that meeting you mentioned last summer about which Donald Jr. provided changing series of explanations. You know, first said he hadn't met with Russia then conceded he had had a meeting but it was supposedly about adoption. And then we got this e-mail released, Trump Jr. released it just before the New York Times is going to, in which he was told that someone connected to the Russian government had damaging information about Hillary Clinton, to which she responded I love it. And so that was sort of the first real evidence we've had that someone in the Trump circle was willing to do something that looks at least at least a little bit like collusion. So there are questions about that meeting were Paul a Manafort was as well. And then around Manafort, there were a whole bunch of other questions. You know, Manafort has various Russian ties. We don't know if they're nefarious but he received millions of dollars in payments from a Ukrainian political party that is favored by the Kremlin, by Vladimir Putin, and has a whole bunch of other connections with Russian business figures. So they're there. In short there are many questions about both of them, even more questions about Manafort and about Trump Jr..

LL: And then there's Jared Kushner who testified behind closed doors and then released a statement to the public denying any collusion with Russia. What did we learn from that statement?

DANIEL DALE: Well, we learned about what we expect to learn, if you can call it learning, that Kushner denies that he did anything wrong. The inaccurate financial disclosures he filed were an innocent mistake, a mistake by his assistant in fact, wasn't him. We learned that you know he did in fact discuss the possibility of using a secure communication line in the Russian Embassy to communicate with the Trump campaign, which is highly unusual. But he framed that as innocent as simply the logical thing to do, not to be a permanent back channel, as some of the media presents it as. So, basically, he denied a bunch of allegations and then he framed others in the most innocent possible light.

LL: He also sort of seemed to blame his own naivety, when it came to politics. How is that playing?

DANIEL DALE: I think people are sort of scoffing. I mean, it is it is plausible that he was caught up because he was naive. You know he's a young man in his mid-thirties, who had no real political experience before the campaign. But it's hard to square this argument that he was extraordinarily naive with the portfolio he's been given by the president. You know he is in charge of the administration of dealing with everything, from the Middle East to China to Canada and Mexico to the opioid crisis. And so this is a man with massive power and responsibility who's now telling us that that he is sort of a young fool who doesn't know anything. It's hard to reconcile.

LL: How worried then is the president about the special prosecutor Robert Mueller's investigation into the campaign's alleged collusion with Russia?

DANIEL DALE: We don't exactly know. But I think it's possible to guess, from his public behavior, you know his frequent railing about this. He is complaining about Mueller. He is complaining more recently about Attorney General Jeff Sessions recusing himself from Russia related matters which allowed Mueller to be appointed. I think we can we can sort of infer that Trump is thinking about this a lot. You know whether he is truly worried about his fate or is just sort of bitter and angry, we don't exactly know. But it's certainly on his mind and he's certainly not treating it like something to be dismissed.

LL: And certainly when he starts talking about his power to pardon those around him, and even himself.

DANIEL DALE: [Unintelligible] Yes. That's a very good point. You know, that was sort of the first clause of a tweet. Under any other president I think that would have been just a massive long lasting story; The president just sort of casually saying on Twitter: “Everyone agrees the president has complete power to pardon”. And so, it's really remarkable that at this early stage of his presidency, and at this early stage of the Mueller investigation, pardons are on the president's mind.

LL: Is there any consensus around that, Daniel? Whether he would? Just to answer that question of whether the president does have the power to pardon himself.

DANIEL DALE: No there is not a consensus. Some legal scholars think that the president does have the power to pardon anyone he wants, including himself. Others say, no, that the president can pardon others but not himself. So, Trump was claiming a consensus that does not exist.

LL: Yesterday the U.S. House voted overwhelmingly for additional sanctions on Russia and to curb the president's authority to waive penalties. Why is that bill significant?

DANIEL DALE: Well, it's significant because it represents a pushback from congressional Republicans against Trump on Russia. You know, I think there are a lot of complaints from liberals that Republicans aren't doing enough to stand up to Trump, to speak out on whatever ties he may have with Russia. But this was a really substantive, actual initiative by congressional Republicans to limit the president's power to deal with Russia. That sanctions bill, which we don't know of is going to sign yet, says that the president has to come back to Congress if he wants to weaken those sanctions, so it removes a traditional presidential power. So I think that's significant.

LL: And so far Trump, or the White House is saying that they aren't giving any guarantees that they will actually sign this.

DANIEL DALE: No, there are indications on the weekend that Trump is going to relent and sign it. I mean overwhelming margins in both the House and the Senate, is 419 to three in the house, 98 to 2 in the Senate. Usually presidents don't mess with vetoes of things that have such bipartisan support. But now Trump has signaled more recently in the last day or two that he's undecided. So we'll see.

LL: Now we're moving around a lot of territory here but only because there's so much to cover because also yesterday Senate Republicans first voted to advance debate on their efforts to repeal and replace Obamacare, only to lose the first vote on an actual bill itself. So, what does that mean in terms of that debate?

DANIEL DALE: Yeah it's really complicated. So basically, yesterday the big news was that Senate Republicans revived the effort to repeal and replace Obamacare, that seemed to have been dead in advance of it when a number of senators came out in opposition to it. So they revive the effort, that's the big deal. On the first vote on an actual bill, they voted it down and that was the main bill that the Senate had been pushing for a couple of weeks. So that's a temporary victory for opponents. But what it looks like will happen, was that the Senate will write a new bill, maybe a number of new bills, and very possibly find a way to pass something. It may not be as ambitious as the bill that they voted down last night and maybe what they're now calling skinny repeal, a more limited modest repeal. But no one who favors Obamacare is relaxing yet.

LL: Planning to take any time off, this summer, Daniel?

DANIEL DALE: I am, in the last two weeks of August [laughs].

LL: [Laughs]

DANIEL DALE: So I hope nothing happens in those two weeks.

LL: Good luck with that. Thanks Daniel.

DANIEL DALE: Thank you.

LL: Daniel Dale is the Washington correspondent for The Toronto Star, he was in Washington D.C. Well, with the latest developments in the Russia investigation, some commentators are wondering if any red line exists. What will it take for Republicans to break ranks with their president? Trump's inner circle has reportedly already tried to discredit Special Prosecutor Robert Mueller leading the investigation but what if he's fired? And what if Donald Trump pardons himself and members of his family? It sounds all like a bit of a soap opera. For his take on these questions, I'm joined by Charlie Sykes. He is a conservative political commentator, a former conservative talk show host and the author of How the Right Lost its Mind. Charlie Sykes is in Milwaukee, Wisconsin. Hello.

CHARLIE SYKES: Good morning.

LL: How closely are the testimonies by Jared Kushner, Donald Trump Jr. and Paul Manafort being watched on the Hill?

CHARLIE SYKES: Well, they have got a lot of things to pay attention to but obviously the Russia story is not going away and it's not going away because Donald Trump continues to escalate all of this. This is really one of the extraordinary things. It's really not his critics, or even the investigators, that push Russia back into the headlines. It is the kind of things that you have been talking about. You know, it's the attacks on the attorney general, the attempt to discredit the special prosecutor and this open contemplation of the possibility of pardon.

LL: Well, then is there an answer to that for Trump? He seems to keep attacking back. Do you think there's a better way for him to respond?

CHARLIE SYKES: Yes would be. First of all, to say, if in fact he has nothing to hide, to say: “I have nothing to hide and I'm going to be as transparent as possible. And I will respect the rule of law and will cooperate with any investigation to the full extent that I can”. The fact that he's doing exactly the opposite, really raises the question and I think that this goes to the question of: Is there a red line? I think on the Hill, and even among the Trump supporters, there's this nagging question: What must he be hiding, to behave in this particular way? And I don't know. I'm not going to speculate about this. But clearly he's acting as if there is something that poses an existential threat to his president. Otherwise, why would he be constantly disrupting his administration and the Republican attempts to pass legislation in the way that he is?

LL: Could there be other reasons for it? Could it just be the nature of a man who has run his own business for many many years and isn't used to this rough and tumble world of politics?

CHARLIE SYKES: That's certainly one, a question, you know. He simply is a thin skinned narcissist who doesn't like any sort of scrutiny. But there was a very interesting editorial in The Wall Street Journal last week which urged him to be more transparent, but it also made the point that President Trump needs to understand that the special prosecutor will get everything, will know everything. We'll look at his income tax returns and we'll be able to unravel all of the intricacies of his family business. That may have had the opposite effect, rather than encouraging the president to be more transparent. It might have to use the technical term freaked him out to realize that someone, who has always enjoyed a cloak of secrecy, might be exposed in this particular way. Because look there's no way to underplay how stunning it is, to have a president of the United States openly talking about and openly attacking his own attorney general and musing about his unlimited power of pardoning.

LL: Let's talk about more about Jeff Sessions and Robert Mueller. What would happen if Trump actually did fire Sessions and or Mueller?

CHARLIE SYKES: Well, this is interesting. Almost minute by minute, Republicans in the U.S. senate are tweeting out or issuing statements of support for Jeff Sessions. I don't think that getting rid of sessions is itself a deal breaker because, at the end of the day, The President gets to choose his attorney general. However, he himself has made it clear that it's all about Russia and it's all about Jeff Sessions’s refusal to protect him from this Russia investigation. So that would be, I think a lot of Republicans and Conservatives would be deeply troubled by the firing of Session. But then you get to the question of what if he fires the special prosecutor? So far there has been no red line for Republicans in Congress. But if there is a red line, that would be I think the red line. There would be a huge firestorm. The question is whether or not the Republican base the Trump base would stick with him.

LL: Are you talking to Republicans on the Hill? What are they telling you?

CHARLIE SYKES: Well yes. They continually shake their heads. I mean, they're trying to keep their heads down, they're trying to pass legislation with mixed success and yet here you have the president, who continues to show his lack of self-control and discipline by raising these issues that are genuinely alarming. I mean, if you're Republican on Capitol Hill, you have to make the calculation: “Am I going to vote for a deeply unpopular health care bill because President Trump wants me to, at the moment when the president seems to be toying with the idea of pulling the pin on a full blown constitutional crisis?” So no one knows what happens next. I mean this is the reality here in the United States. We wake up every single morning not knowing what the president is going to do or what's going to happen next.

LL: That's I was going to ask you, because this is to a large degree, for politicians in Washington especially members of the House of Representatives, a political calculation. They are always almost always in a constant election cycle. So, when do they decide that they need to break with Trump in order to preserve their own political futures?

CHARLIE SYKES: Well, that of course it is a very interesting question. If for Republicans, right now, until the polls change, I don't think you're going to see a jailbreak. And specifically I'm talking about the polls showing 80 plus percent of Republicans still supporting Donald Trump. Until the Republican base moves, you won't see a lot of movement, I think, among Republican elected officials. See right now, I think we've really, this is not original obviously, that we have descended into pure base politics. The tribal politics where Republicans are apparently not that concerned about reaching out to Democrats or independents but they have to keep that Republican base intact. And right now the dynamic is that any Republican that breaks with Trump or criticizes Trump is going to face the prospect of a backlash among the pro-Trump Republican voter base and the pro-Trump media, which will attack them viciously.

LL: Except that now we're seeing some pro-Trump media attack the president for his position on Sessions.

CHARLIE SYKES: Which is fascinating. I think you're referring to Breitbart.com, which is basically the state media it's the Trump White House, criticizing him for his criticism of Jeff Sessions. Jeff Sessions does have a constituency. He was one of the first, if not the first member of the Senate, to endorse Donald Trump and he's been a leader on this really hard line immigration position. So, I think t they are sending a shot across the President's bow that their support is not completely unconditional. But again, Donald Trump has made it very clear that he's going to do what he does and he's made it a very crystal clear that he no longer has confidence or faith in his attorney general, who by the way, recused himself from the Russian investigation because he was legally obligated to recuse himself from the Russian investigation.

LL: The United States, the political system, is known for checks and balances. What do you think Americans are learning about that system right now?

CHARLIE SYKES: I think they're learning, if they're paying attention, that it's more a metaphor than a reality. I think, and then I am going to quote Gary Kasparov, who is a former world chess champion and Russian dissident, who said that a lot of Americans are realizing that that our system of checks and balances has really been based on the honor system, rather than hard and fast rules. And the honor system assumes that you have a president who is honorable. We really don't have a system set up for someone like a Donald Trump. And I think the recognition that the president can literally make himself and his family and his cronies above the law using the pardon policy I think comes as something of a shock for people who believe that we have all of these hard and fast institutional protections in place. Donald Trump is going to test the limits of that.

LL: I'm going to ask you to answer briefly a pretty difficult question. How much longer do you think Donald Trump is going to be president?

CHARLIE SYKES: Oh. I don't think he's going anywhere soon. I think it's naive to think that he will not serve out his term and, unless the Democrats get their act together, I would not write him off for 2020. Our politics are very very partisan, they're very tribal. Until something happens that will break the Republicans loose and indicates the Democrats pose a plausible alternative, I think he'll remain in office.

LL: Fascinating. Charlie, thank you very much.

CHARLIE SYKES: Thank you.

LL: Charlie Sykes is a conservative political commentator. He is in Milwaukee, Wisconsin.

[Music: Ethiopian Song]

LL: This is a song from Ethiopia biggest musician right now, Teddy Afro. The title track from his latest album called Simply Ethiopia. And that's where we'll be heading to after the news with Dr. James Maskalyk, a Toronto physician who saves lives in emergency rooms here and there. He'll share the lessons he's learned straddling two continents. I'm Laura Lynch. And you're listening to the summer edition of The Current.

[Music: Ethiopian Song]

Back To Top »

ENCORE: From Toronto to Addis Ababa: Life lessons from an ER doctor

Guest: James Maskalyk

LL: Hello I'm Laura Lynch and you're listening to the summer edition of The Current.

[Music: Theme]

LL: Up next, lessons in life and death from ERs near and far.

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[Sound: sirens, beeps and busy chatter]

LL: The rush of a busy emergency room. The roaring sound is such an integral part of the E.R. experience. The Toronto St. Michael's Hospital pipes in the sound during crash simulations, to prepare doctors in training for the noise and the commotion. Well, it's a sound that James Maskalyk knows well. He is an emergency room physician who also teaches the ways of E.R. His medical students are in Toronto, as well as an adult Ababa, Ethiopia. No matter where he's teaching, he needs to prep them for the stresses of the job.

SOUNDCLIP

Dr. JAMES MASKALYK: Everyone is fourth year right? You guys are going into your exams and then your residency program. Has anybody ever seen someone bleed to death before? So watching someone bleed to death sucks because you have what they need. We have blood. It's sometimes not possible, no matter how much blood you give them because it's a physics equation. How much is going out versus how much you can put it. So if someone comes in and they’re multiply injured, if they endured a blunt trauma, no matter how much blood you give them they're going to die. And so it's a hard job.

LL: That is Dr. James Maskalyk talking to students at the University of Toronto. And as much as he's taught, he's also learned from his time in the emergency room. His new book is Life on the Ground Floor: Letters From the Edge of Emergency Medicine. It details some of the lessons he learned in the E.R. and what he'd like those of us who visit the E.R. to know about those who work there. Dr. Maskalyk spoke to Anna Maria Tremonti, in our Toronto studio, in April.

ANNA MARIA TREMONTI: Welcome.

DR. JAMES MASKALYK: Thank you, I’m glad to be here.

AMT: It's a tough job huh?

DR. JAMES MASKALYK: It is yeah. But, you know, with time you learn to appreciate it more and more.

AMT: And what does it, do you have to be tough to work in an emergency room?

DR. JAMES MASKALYK: I think that's a bit of a misconception or, you know, it's changed for me as I've gotten more mature in my career. And I think the rewards that I find are there when I'm softer, when I don't put up the barrier that, you know, it's possible to do. But when I let in the emotion, it's kind of guides me to be a better doctor.

AMT: In that lecture you go on to say that the job of an emergency doctor is to pay attention. What's at the core of what you're paying attention to?

DR. JAMES MASKALYK: Well I think that, you know, if you retreat back to, you know, deeper and deeper questions it is, you know, how can I do the best for the person in front of me with as little bias as possible? So the more I pay attention to that intention the better the outcome is in terms of making decisions, even in ones that require haste. And how to care for myself in the midst of all that. How to treat my colleagues. How to like I said, mourn when it's time.

AMT: There's something called the knack, what is that?

DR. JAMES MASKALYK: Yeah, it’s, you know, a friend of mine Brian [unintelligible], he was a teacher and a colleague now. But he talked about it, just how being able to glance around in a room full of sick people and pick out the one who you know is not doing well, even though you haven't asked them a single question, even though you haven't looked at their blood work. Just that energetic read of someone who's got a deep struggle energetically inside of them. Whether it's an infection because they're bleeding badly and it's you can see it often in their eyes, how their consciousness is able to reach out and engage because the sickest people they're dimming, you know, that light is gradually fading.

AMT: It's not always the one who is screaming the loudest is it?

DR. JAMES MASKALYK: No, very rarely is that the case. That's why, you know, it's in Ethiopia where, you know, I write about in my book, that sometimes people come alone, I write about one of those people in it and they don't have anyone to advocate for them. You know, they’d taken buses because they've heard about Black Lion Hospital, maybe they've come from, you know, a day away. And so they don't have that person at the front, you know, saying hey my friend is sick. So you really have to be active in that process. At St. Mike’s, you know, that’s already exists, we have people looking in the waiting room and scanning it. But that really deep teaching is that people who sometimes need the help the most have the weakest voice.

AMT: And before we get to Addis Ababa, let's just stick with Toronto emergency room first. So there's a lot going on a really busy night, because you always work the night shift?

DR. JAMES MASKALYK: No, when I have to, like all my friends. But often.

AMT: Yeah, you've got to then be aware, you got to have like every spidey sense going I guess huh?

DR. JAMES MASKALYK: Mhm.

AMT: Like, you have to be aware of everything. But you also said you have to take care of yourself. What does that mean?

DR. JAMES MASKALYK: I think, you know, it’s changed, like I said, over the years. And I think it means that, you know, take care of my mind and continue to learn and grow in my skills. I think there's nothing I want more of my future than to be clinically excellent because it's what my patients deserve and take care of my body. You know, sleep and rest and turn my phone off and be in nature and reflect on why you're struggling so mightily to help people. Well because life is beautiful. And so be in that contact with it as much as I can is what my patients need from me. So that's part of it, you know.

AMT: Mm. Because you're making split second decisions that affect how they will survive.

DR. JAMES MASKALYK: Sometimes that's the case, yeah.

AMT: Yeah. And you see death.

DR. JAMES MASKALYK: Mhm.

AMT: You see it a lot.

DR. JAMES MASKALYK: Yeah, yeah. I've certainly developed a relationship with that part of it.

AMT: So let's go to Addis Ababa, because you end up at the Black Lion Hospital, which has an emergency room that is different from a Western emergency room because who shows up in an emergency room in a place like that?

DR. JAMES MASKALYK: You know, it's someone who has run out of options basically. You know, at St. Mike’s in Toronto, it's our pleasure to help anyone who comes through the door. But sometimes people don't want to wait to see their family doctor for instance. At Black Lion, it’s people who have exhausted, you know, any other treatment they might have. And you know the truth is, as you can appreciate, when you're working in somewhere like Ethiopia, there's a large number of people who are subsistence living, meaning they make enough daily to live daily. So when they get sick the option isn't well I’m just going to go hang out for a couple of days and make my way to a Black Lion. They don't have the money to get into the taxi, so they maybe borrow some of that, they give a goat, they leave their children and they arrive sometimes after the disease has gotten advanced. So at Black Lion there's no one there holding their thumb, right? There's people there with badly broken legs or who have advanced cancer. So as hard as the job is in Toronto, it's even more so to stay well from the doctors who have left in Ethiopia.

AMT: When you first started working there, they didn't really have an emergency room to speak of did they?

DR. JAMES MASKALYK: You know, they would call it an emergency room and what’s so interesting for me and where the title of the book comes from is every place I've ever been has an emergency room. It's like an emergent phenomenon. So, you know, whether it's in Cambodia or Bolivia, and it's just one room or one nurse or one doctor said there seem to be people who come at all hours. And I kind of wish I could go home too but I'm going to stick it out for a little bit longer because I've heard about this person that's going to come and someone told me they're on their way and they're kind of sick. And so that flourishing of care is something that is why it looks this way in Toronto and why it looks this way in Ethiopia is, you know, a question I'm going to live my entire life, you know, in the way I write or what I do.

AMT: Mm.

DR. JAMES MASKALYK: Mhm.

AMT: You have a former student there who's now an emergency doctor. Finot?

DR. JAMES MASKALYK: Finot.

AMT: Finot Debebe. We called her.

DR. JAMES MASKALYK: Oh boy.

AMT: in the hope of including her today. We couldn't get a clear enough phone line, which tells you again something about, you know, some of the technology sometimes. But we did record her and we voiced over what she had to say. And she told us about some of the difficulties of emergency medicine in that hospital in Ethiopia. Let's listen.

SOUNDCLIP

FINOT DEBEBE: [through voiceover] The hardest day is when you cannot choose to give the resources for patients, especially for example if you have two patients and they need a machine and you have only one machine. That's one of the hardest days. And the way you don't know where to put the patients because the number of beds in the hospital are small. Sometimes we’re forced to put two or three patients on the floor and it's frustrating.

AMT: James Maskalyk, it's got to be frustrating to choose which patient to go to. And you have to do that anyway, but in a place like the Black Lion emergency room, just take us through some of the other struggles.

DR. JAMES MASKALYK: You know, [sighs] it's, I’m going to point out that because of the attention that these young doctors have been able to give this emergent phenomenon, they're building a new ER. And in fact, some of these students are working in a new ER so. But the one thing that exists now, the one that I try to evoke in the book was one room and now it's a good bit expanded but it's dark, when it rains the water pours through the ceiling. The power is mostly there but it's intermittent at times. It's very crowded. There is very little air flow, so as soon as you step over the threshold you get the sense of the smell of sickness and people who've traveled a long way. And there is no, it's not often joy is felt in that small tin room. Yet successes are growing. I mean, there is now a triage and trained nurses who are asking the same questions we do at St. Mike’s. There are now doctors 24 hours a day soon, to be covering the sickest and most injured people. But as you walk through, you know, the striped curtains and you work your way to the back, there are still people, particularly with broken backs and broken legs and as you may know, you know, in places like Ethiopia, emergencies happen most often in the poor people because they're the ones who are walking beside the side of the road because they can't afford bus fare because they can't be in a taxi.

AMT: Mm.

DR. JAMES MASKALYK: Certainly if they're in a taxi it's not one with seatbelts. So, you know, as you walk to the back hall you see these young broken men and women who are waiting for surgery if the parts, if the implements come in, and they can be there for days. So unfortunately one of the most difficult parts for Finot and her colleagues is taking care of these people for days and days and days, which is something I don't even know how to do.

AMT: Right, because in emergency here you deal with them and then they either go to another floor or they leave, right?

DR. JAMES MASKALYK: There's a whole system that takes care of that.

AMT: How long have you been going back and forth?

DR. JAMES MASKALYK: I think went 2008. That was the year after I got back from Sudan. I went in for the first time.

AMT: Yeah. Why do you do this?

DR. JAMES MASKALYK: [sighs] Well, you know, I believe so much in the idea that life is valuable and sacred no matter where it happens to be. And when I first stepped off a plane as a medical student, it was clear that if I was being told it was my job to take care of the sick ones and if you're on a plane you put up your hand no matter where you are or what stage of training you're in. It appeared the sicker people were in other places. And, you know, that's the general part of it. But in particular in Ethiopia working with MSF as I've done and I hope to do again soon, when I left those missions in, you know, in Sudan and Dadaab, I left with a feeling of, you know, now what? And what's going to happen in Ethiopia is the what.

AMT: And you have seen it grow because you've gone back, you go back and you teach like three months a year now right?

DR. JAMES MASKALYK: Mhm.

AMT: And so you've seen all of this grow. How difficult is it to get donations? How much is that the reliance for a place like that?

DR. JAMES MASKALYK: Well I've been really blessed to be part of University of Toronto. And, you know, the departments of family medicine and medicine have given us a small amount of money to continue the program as well as the emergency doctor groups in Toronto believe in this idea too. It's been remarkable really. But what's so important and what I really like to continue with is the Ethiopians contribute as well too. They pay for the plane tickets of the teachers. They pay for the accommodations. So I really like that relationship because they have the right to expect things of us then. So what I tell my designates or my delegates I mean, when they go, my colleagues, is the point is to be 100 per cent effective as soon as you step off the plane. And this isn't a trip where you go leave early to buy scarves. It's one where you're in the ER with these young men and women, you know, full time. And they really get it and they do a great job. So the donations are partly money but a lot of the time of the volunteers that go.

AMT: What's it like for you to be to juxtapose your professional life that way. You're in an ER at the Black Lion hospital. You just explained how acute the need is and then you come to Toronto and you get a real mix of people who show up in ER, including people who are very impatient.

DR. JAMES MASKALYK: Mhm. Yeah, you know, I discover is that whenever I have less than a positive encounter in the ER in Toronto, it's always the do with me. It’s never to do with the person. They don't want to be there, most of them don't want to be there, pretty much all of them don't want to be there. And some of them have nowhere else to go. But if I take that personally that's my problem. So for me it's an opportunity to work on my myself in that way so I can get out of my own way, so I can actually do what's expected of me, which is address their deeper needs. Now, sometimes they don't know what that is or we have to spend some time figuring that out. But I think that it's rare that I feel the dissonance as much as I used to when I first started doing this work.

AMT: You use the example of a mother who comes in with a son who's got a suspected concussion and it's a night when there's lots going on. Do you remember that exchange?

DR. JAMES MASKALYK: I do remember that exact exchange.

AMT: What’d you say to her?

DR. JAMES MASKALYK: You know, I think that it's pretty common when you have more demands on your time than your emotions that you can keep up with. And in the ER we're not very good at taking breaks, we're not very, you know, there's so much inertia to see patients and pick out the sick ones and your colleagues expect it. You don't want to hand over a mess in the department, so you work diligently. And so it's almost with a sad pleasure that you say to someone when they ask, you know, how much longer is the wait? And you say I don't know, there's so much, you know, it’s so busy here today, almost diminishing the legitimacy of their complaint. But it's always a mistake. It's always a mistake. And I write about it because for that reason, you know, it's so much easier to say hey you must be worried, but we're going to get to you I promise. And they feel so reassured when they hear that. And sometimes I’d say you know what maybe it's too long I'm going to come back another day if they can. But that's why I write about that.

AMT: We need to understand that right? Because the doctors are facing and the nurses are facing those same pressures of wanting to get to everyone. The other thing you do in your book is you talk about your grandfather. How old is he?

DR. JAMES MASKALYK: He's 94.

AMT: Uh huh, and he lives alone?

DR. JAMES MASKALYK: He does, yeah.

AMT: Northern Alberta.

DR. JAMES MASKALYK: He lives in northern Alberta.

AMT: You’re an Alberta boy, you grew up in Alberta.

DR. JAMES MASKALYK: I am proudly Albertan.

AMT: What has your grandfather taught you about life and end of life that you can use in the work that you do?

DR. JAMES MASKALYK: I think that, you know, he, I watch with great love and interest the way he lives his life. And he's unafraid, you know, he understands that, you know, death has been part of this business right from the very beginning. You know, he was a trapper and taught me how to hunt and all those things. So right from the get go he understands that it's a process, you're part of a process. And yet he shows so little fear. He maintains such a sense of himself to everyone he meets that is a great teaching for me about how to live with that knowledge. Not to be afraid and to get up and take it day by day. And, you know, in the book I use him, you know, the book goes from the first part is about the body and the middle third is the system that takes care of the body and then it comes back to the body again. And I use him because I love him so much. And I think at the end of the day that's something we all share is that deep sense of love for a family and our friends and hopefully for ourselves. And from it come emergency rooms with all the stuff and from it come emergency rooms in Ethiopia that need more stuff and we open our hearts to them.

AMT: Mm. And so when you see someone with a loved one walking in.

DR. JAMES MASKALYK: Yeah.

AMT: You know, through those sliding doors, you understand at another level that that they're worried and what that connection is. Because of the connections you have.

DR. JAMES MASKALYK: Right. They want communion with that thing. Mhm.

AMT: How is your grandfather's health?

DR. JAMES MASKALYK: It’s OK.

AMT: He’s got a doctor grandson.

DR. JAMES MASKALYK: Yeah yeah. So we do a lot of patient doctor interactions. You know, 94 is not easy on a person's body. You know, it's hard for him to get around. I think your, you know, your spirit it's interesting, your body falls away around this quick of a spirit and it's still as it ever was, for him anyway. Yet he can’t move so well anymore. And your world kind of shrinks, you know, and you go from having this world that included something as far as a trap line to maybe now it's really hard to leave a single room. So we go to him, you know, my parents go to him quite a lot. I go to him when I can and I know he values that.

AMT: It's taught you a lot about life and death though, hasn’t it? In terms of just accepting.

DR. JAMES MASKALYK: Mhm. And, you know, in the book I write w is for waiting. And I don't know if you get the sense sometimes, I certainly did, this feeling is very strong, you're waiting for something to begin but you're not quite sure what it is. It's just like but it's life and it's right here and it's there to be lived. So, you know, make sure that you're able to spend as much time around people that you care about and live your truth.

AMT: And even the people that you only meet for a few hours.

DR. JAMES MASKALYK: Exactly.

AMT: You have that connection with them. But you talk about when someone starts to complain that it's cold, they're all wrapped up in blankets and they say I'm so cold. And that's your cue.

DR. JAMES MASKALYK: Mhm.

AMT: What's going to happen to them?

DR. JAMES MASKALYK: Yeah. You know, a few times that I've, one of my teachers again Brian Steinhart taught me that is that it's very commonly in young men with a lot of muscle mass and they're bleeding heavily inside and you don't know and their heart rate is high and but their blood pressure is normal. And then they say I feel cold. They're going to die. Their heart is going to go up to 150, the blood pressure is going to fall 180, 190 and then they're going to go into cardiac arrest. So as soon as that happens, you know to get two large [unintelligible] wide open, saline if you have it, blood is better. Yeah, it’s a hard feeling.

AMT: You know what to do, it's just instinctive huh?

DR. JAMES MASKALYK: Yeah. And not just me. You know, the nurses and doctors I know how to work with they’re all excellent. I'm really proud to be working at St. Mike’s and in Ethiopia too, to be sharing that with those Finot and her friends.

AMT: [crosstalk] St. Mike’s and Black Lion has that connection. Your grandfather does tell you life is not just one big funeral, that it is about living.

DR. JAMES MASKALYK: Mhm.

AMT: How do you see life, as someone who goes back and forth between these places?

DR. JAMES MASKALYK: Yeah. You know, it's something that is worth fighting for in all the ways that matter. And, you know, for me the ER and the promise that it holds, you know, that, and I'm kind of not the same person I was when I stepped off the plane with MSF to go into Sudan and that's fine. I wouldn't go back if I could. But once you see that world that is happening right now, this one can seem strange, that one seems to make more sense. And as you work and, you know, I think my friend James Orbinski says when you have questions like that, even if you don't have an answer, you have no choice but to live the question. So for me, creating something like an ER where once you pass the threshold it doesn't matter if you're a Muslim or a Christian or an old person or a young person, what matters is what's your pain on a 10 point scale? You know, and that's the antidote to some of, you know, what we're seeing in the modern world today where borders seem to matter more than ever before, where you're from seems to matter, you know, more than ever before. And it seems like a fiction because at least from where I stand it doesn't.

AMT: I get the impression that you need to write it out. This is your second book.

DR. JAMES MASKALYK: Yeah yeah. It's been this one was a long time in coming and it is, you know, trying to wrestle with the heart’s language and figure and get it wrong and then try to understand it as deeply as you can is something that gives me more clarity about this project and the human project of how to live and learn how to let go.

AMT: And when your ER shift is over and you go home, whether home is in Addis Ababa or here in Toronto, after an ER shift what stays with you?

DR. JAMES MASKALYK: Yeah, just the… My… I love my job. I get to go to work and practice being better to people on a day to day to day basis. And, you know, it's what the lucky part is I get to continue to focus on how to make myself happy, what freedom looks like to me. And so I do what I mentioned I think is part of the part of the process is try to figure out how to see the world, learn how to be alone with myself and learn how to spend time with people I care about and working on things that matter.

AMT: Thanks for your book. Thanks for coming in.

DR. JAMES MASKALYK: Thanks for having me, it's a pleasure to talk to you.

LL: That was Anna Maria Tremonti’s conversation with Dr. James Maskalyk from April. Dr. Maskalyk is an emergency room doctor at St. Michael's Hospital in Toronto an assistant professor in the Department of Medicine at the University of Toronto and a visiting professor of emergency medicine at Addis Ababa University. His book is titled Life on the Ground Floor: Letters From the Edge of Emergency Medicine.

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LL: That's our program for today. Stay tuned to Radio 1 for New Fire. This week host Lisa Charleyboy explores what it means to be young, Indigenous and intimate and talks to you the young point behind #IndianLovePoems. I'm Laura Lynch. Thank you for listening to the summer edition of The Current.

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Full Episode Transcript for July 26, 2017

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