A couple of days ago we were at the Terry Trueblood Recreation Area and it was pretty windy. The birds were challenged just hanging on in the trees. Eastern Kingbirds didn’t hardly ruffle a feather. The Tree Swallows seemed to be pretty good acrobats high up in the trees. The Cowbirds, not so much.
Month: May 2020
Kudos to the Goodenough Psychiatrist for Blog Post “The Perfect Balance”
I almost never write more than one post a day, but I’m pretty impressed with the blog post “The Perfect Balance” by The Goodenough Psychiatrist. It was very thought-provoking and the Stuart Ablon Ted Talk on Collaborative Problem Solving was refreshing.
A little over 3 ½ minutes into the video, Ablon says something interesting about conventional wisdom which helps cast doubt on blindly trusting it. When he remarks that conventional wisdom commonly fosters misconceptions including teaching that the earth was flat, it reminded me of a scene from Men in Black (I confess, one of my favorite movies). Agent K says, “A person is smart. People are dumb, panicky dangerous animals and you know it. Fifteen hundred years ago everybody knew the Earth was the center of the universe. Five hundred years ago, everybody knew the Earth was flat, and fifteen minutes ago, you knew that people were alone on this planet. Imagine what you’ll know tomorrow.”
His remarks highlight the challenge to those who break with conventional wisdom, which can sometimes be isolation.
It takes courage.
Please Take Your Seat
I brought my camp stool home from my office at the hospital yesterday. For the past several years and up until the time of the COVID-19 pandemic, I used it while interviewing hospitalized patients as part of my job as a consultation-liaison psychiatrist in the general hospital. I stopped only when I wondered whether carrying around an object which could be contaminated with the virus was a safe thing to do.
A colleague lent me the little chair when he and his colleagues on the Palliative Care Medicine consultation service started using them. I asked him whether he wanted it back and he graciously said I could take it with me now that I’m retiring—and use it as a camp stool (in a way, saying “Please take your seat”). For many years prior to getting the stool, I had been finding a chair or sending my trainees to find one for me. I felt more comfortable sitting eye to eye with patients and I got the impression that my patients appreciated that as well.
I got a lot of positive feedback from patients, family members, and other hospital staff about the little chair. I think it helped break the ice with patients and was a great opener, especially if they felt well enough to express a sense of humor— “Hey, doc; you don’t need nunchucks; I promise I’ll be good!”
There are a few papers in the medical literature supporting the usefulness of sitting with patients. Most authors assert that it helps build rapport and increases the patients’ perception of how interested their physicians or other health care clinicians are in their welfare (see the reference list below).
Once, when my original little chair broke beneath me during an evaluation for catatonia in one patient, the stool abruptly became a novel catatonia assessment tool.
The patient was mute but there was little evidence otherwise for catatonia, one of the chief features of which is the inability to react to any stimulus in the environment. I was seated on the chair explaining in detail the intravenous lorazepam challenge test for catatonia (which often interrupts the episode of muteness and immobility).
I was sitting in front of the patient but facing the family and the consult service trainees while expatiating on the topic. As I was droning on, I heard a sudden pop—and I fell flat on my fundament as the chair collapsed beneath me.
My audience exploded in loud laughter, and pointed at the patient. When I turned to look at him, he was convulsed with silent mirth.
I considered this a negative test for catatonia in this case, though impractical for regular use.
My colleague gave me a replacement camp stool, more securely built. However, he mentioned he might give up using his as a result of my accident which, incidentally, befell (rimshot) another doctor on his team. I’m not sure whether I’ll use the little chair. If I sit on it too long, my legs go numb. I think that’s about 10-15 minutes, about the length of time mentioned in one of the studies below. It didn’t seem to influence the positive perception of the visit—but it did make me walk funny.
I probably spend about the same time with patients now that I don’t use the little chair. But I don’t feel right about it. I’m always reminded of what Hackett said:
“As a matter of courtesy, I sit down when interviewing or visiting patients. Long accustomed to the ritual of making rounds, many physicians remain standing as a matter of course. Standing, physicians remind me of missiles about to be launched, poised to depart. Even if that is not necessarily true, they look the part. Patients sense this and it limits conversation. In addition, when standing, the physician necessarily looks down on the patient. This disparity in height is apt to encourage the attribution of arrogance. Looking down at a patient who is prone emphasizes the dependency of the position. Sitting at the bedside equalizes station. Sitting with a patient need not take longer than standing with him.”—Thomas Hackett, in MGH handbook of general hospital psychiatry, 1978.
References:
Johnson RL, Sadosty AT, Weaver AL, Goyal DG. To sit or not to sit?. Ann Emerg Med. 2008;51(2):188‐193.e1932. doi:10.1016/j.annemergmed.2007.04.024
Swayden KJ, Anderson KK, Connelly LM, Moran JS, McMahon JK, Arnold PM. Effect of sitting vs. standing on perception of provider time at bedside: a pilot study. Patient Educ Couns. 2012;86(2):166‐171. doi:10.1016/j.pec.2011.05.024
Strasser F, Palmer JL, Willey J, et al. Impact of physician sitting versus standing during inpatient oncology consultations: patients’ preference and perception of compassion and duration. A randomized controlled trial. J Pain Symptom Manage. 2005;29(5):489‐497. doi:10.1016/j.jpainsymman.2004.08.011
Orloski CJ, Tabakin ER, Shofer FS, Myers JS, Mills AM. Grab a Seat! Nudging Providers to Sit Improves the Patient Experience in the Emergency Department. J Patient Exp. 2019;6(2):110‐116. doi:10.1177/2374373518778862
Merel SE, McKinney CM, Ufkes P, Kwan AC, White AA. Sitting at patients’ bedsides may improve patients’ perceptions of physician communication skills. J Hosp Med. 2016;11(12):865‐868. doi:10.1002/jhm.2634
Let Nature Speak
While we were out for a walk on the Terry Trueblood Trail today, for a change, my wife gave me the idea that we should just let nature speak. The frogs were in full voice. It was impressive. As we walk, we usually start off by talking a lot. We point out interesting birds and flowers and comment on all we see and hear. The further we go on the trail, the quieter we get. Pretty soon, we don’t talk much at all. We walk at a slower pace. We just listen.
Usually, after we return home, I make a video and try to match it with some kind of music. Nature has its own music, though. Today, we just let that happen.
Mother’s Day for a Robin
Happy Mother’s Day! The blog post for today is a little unusual because it’s about a “mother” robin who built a nest on April 9, 2019 and is still sitting on it as of today. It’s unusual because she’s been sitting on the nest for at least a couple of weeks now even though there have been no eggs in it. We can’t figure why she’s sitting on an empty nest.
Things got started relatively well. In fact, after building the usual sloppy nest, the mother robin laid two eggs in it. That was the largest number of eggs we ever saw. The number went down from two eggs to one to none over a couple of days or so.
“And then there were none.” I never read Agatha Christie’s book by the same name or saw the TV miniseries on which it was based several years ago. On the other hand, death played a role—a natural one—in the case of the very devoted mother robin.
The robins built their nest in an evergreen tree right below one of our windows. What was nice about that was that I never had to creep up on them, see them thunder out of the tree, mess with the branches around the nest, snap photos—and leave a scent trail for large predatory birds.
Now, speaking of predatory birds…I never saw any of them this time. I know last year I heard a heavy flapping noise (like bedsheets on a clothesline) outside of my office window and opened the blinds just in time to see a huge crow or turkey vulture take off from our front yard tree. Its beak was full of house finch nestlings. I swore I would never again engage in monitoring bird nests in that way.
This time there was only circumstantial evidence of nest robbery. My wife saw broken egg shells on the ground under the tree but it’s not clear exactly when she saw that.
But mother robin still sits on the nest. I have not been able to find any information about this behavior in nesting birds.
It’s not that birds never display odd nesting behavior. One of E.B. White’s essays, “Mr. Forbush’s Friends,” published in the Essays of E.B. White (White, E. B. (1977). Essays of E.B. White. New York [etc.: Harper and Row), describes a great number of these peculiar behaviors. One quote: “Had pair of Carolina wrens build nest in basket containing sticks of dynamite. No untoward results.”
I did wonder why our mother robin built a nest so visible from the sky. That was as bad as building a nest in a basket of dynamite. I know we have a tendency to anthropomorphize animal behavior, but I’m having trouble explaining this mother robin’s persistence in sitting on an empty nest. There are no new eggs; yet she acts as if eggs are there. Is she grieving? Is she hallucinating? How long will this go on?
Maybe some of you know what this is all about and I welcome your comments. Until then, it looks like for this robin, Mother’s Day is endless.
Face Shield Assembly—If You Dare
At the hospital where I work, face shields are preferred over medical grade masks, mainly because they keep you from touching your face. We now wear face masks and shields, according to CDC guidelines.
We got a couple of face shields through Amazon. It’s a kit you have to put together. I wish I had known that beforehand. The instructions in the package were not helpful and the picture guides on Amazon were not much better, but they at least got me started.
I put a few scratches in the plastic cover while putting one of the shields together. I did a little better with the second shield. I’m hoping that wearing these out in the community won’t become part of the new normal.
Go Retire Psychiatrist 