Author: James Amos

I'm a retired consult-liaison psychiatrist. I navigated the path in a phased retirement program through the hospital where I was employed. I was fully retired as of June 30, 2020. This blog chronicles my journey.

I Got Skunked in Cribbage!

It’s not common to get skunked in cribbage—but it happened to me yesterday. Sena has a way of getting very high scoring hands and this led to her winning the first of three games in a big way.

I was stuck well behind the skunk line. This led to some questions by both of us as to what exactly happens in a tournament when a player gets stuck behind the 91-hole on the peg board after the opponent reaches the winning 121 hole.

The American Cribbage Congress (ACC) website says the winner gets 2 points. I think that’s because the scoring in tournaments is done by points.

Other references say that the winner gets 2 games. That means something if you’re playing the best out of, say, 3 games and the like.

There is such a thing as a double skunk, which is getting stuck behind the 61-hole after the opponent reaches 121. Then the winning opponent wins 3 games.

Many cribbage boards will not mark where the skunk and double skunk holes are. Tournament board makers often don’t mark them—but will if you ask them to do so.

We have a so-called tournament V-tournament board which marks both skunk and double skunk lines. You can see the V-shaped track on it, which is supposed to help players avoid pegging errors.

This reminds me to mention the brand-new Sasquatch cribbage board we just ordered. It’ll be a hand-carved walnut board in a circular shape. Sasquatch will be carved in a deep 3-D relief. We are very excited about it. We hope it arrives around Christmas time. There will be no skunk lines.

By the way, I ended up winning two of three games because we typically ignore the skunk rule.

Going for the Juggler Gold Trophy!

I’ve been working on my juggling form—and it’s only somewhat improved, but I’m getting 30 throws (good for the personal Gold Trophy milestone) without dropping more consistently just since yesterday.

I’ve got about a dozen video clips with me getting at least 30 throws, one with 36 although I’m weaving, lunging, rearing, rocking and rolling all over the room, nearly crashing into the computer. You can read my lips to see I’m counting in the video.

I’m hoping that getting to my Juggling Gold Trophy milestone will help make it easier to do tricks.

University of Iowa Psychiatry Residents Get Shout Outs

Recently, University of Iowa psychiatry residents worked hard enough to get shout outs. One of them was exemplary performance on the consultation and emergency room service. The service was following over two dozen inpatients and received 15 consultation requests in a day. This is a staggering number and the resident on the service did the job without complaints. In addition, the resident was the only trainee on the service at the time. Other residents were working very hard as well.

This high level of performance is outstanding and raises questions about health care system level approaches to supporting it.

I read the abstract of a recently published study about Mindfulness Based Stress Reduction (MBSR) compared to medication in treating anxiety in adults (Hoge EA, Bui E, Mete M, Dutton MA, Baker AW, Simon NM. Mindfulness-Based Stress Reduction vs Escitalopram for the Treatment of Adults With Anxiety Disorders: A Randomized Clinical Trial. JAMA Psychiatry. Published online November 09, 2022. doi:10.1001/jamapsychiatry.2022.3679).

On the day I read the abstract, I saw comments which were cringeworthy. The commenter is an outpatient psychiatrist in private practice who had some criticisms of the study. He thought the report of results at 8 weeks was inadequate because symptoms can recur soon after resolution.

Another problem he mentioned is worth quoting, “A course of treatment that requires as much time as the MBSR course described in the study would be out of the question for most of my patients, most of whom are overworked health care professionals who don’t have enough time to eat or sleep. Telling people who are that overworked they should spend 45 minutes a day meditating is the “Let them eat cake” of psychotherapy.”

That reminded me of a quote:

“You should sit in meditation for twenty minutes every day—unless you’re too busy; then you should sit for an hour.”

Zen Proverb

I know, I know; I should talk—I’m retired. Actually, I took part in an MBSR course about 8 years ago when I noticed that burnout was probably influencing my job performance on the psychiatry consultation service. I thought it was helpful and I still practice it. I was lucky enough to participate in the course after work hours. The hospital supported the course.

The residents who are being recognized for their hard work on extremely busy clinical services may or may not be at high risk for burnout. They are no doubt extra resilient and dedicated.

And the University of Iowa health care system may also be offering a high level of system support for them. I don’t see that University of Iowa Health Care is on the list of the American Medical Association (AMA) Joy in MedicineTM Health System Recognition System, but that doesn’t mean they aren’t doing the kinds of things which would merit formal recognition.

Anyway, they all get my shout out.

Listen to Dr. Wes Ely, MD on Talk Radio Europe Discuss His Book: Every Deep-Drawn Breath

Listen to Dr. Wes Ely on the show Talk Radio Europe as he talks about the devastating consequences of severe disease that results in admission to critical care units, specifically in the context of the Covid-19 Pandemic.

The title of the presentation is “Understanding the Long Shadow of COVID and ICU Care.”

Big Mo Blues Show KCCK Iowa City

This song is by Iowa’s own Kevin Burt. I heard it on the KCCK Big Mo Blues Show. I don’t know anything about music, but “Smack Dab in the Middle strikes me as being about dichotomies, which can be reduced to the old saying, being between a rock and a hard place or being neither fish nor fowl.

But it can be about not wanting to make a choice, or feeling like both sides of a person or issue are important.

I think the lyric “went down to the crossroads” in the lyrics might be an allusion to Robert Johnson, who went to the crossroads and sold his soul to the devil in exchange for his guitar playing gift.

Rounding@Iowa Presentation on Covid-19 Bivalent Vaccine Boosters

Give a listen to the Rounding@Iowa presentation “Update on Covid-19 Bivalent Vaccine Boosters. While these presentations are mainly directed to health care providers, they are very helpful for members of the community at large.

A Day Without Glitches in the Matrix

Yesterday was the one of those days where everything seemed to happen for a reason. If we had arrived at Terry Trueblood Recreation Area a few minutes too early or too late, we would not have seen the mesmerizing rise and fall of the shore birds on Sand Lake.

I thought of the word “murmuration,” which refers to starlings flying in tight, swirling patterns. I checked the dictionary and discovered that the word “murmuration” refers to the murmuring sound similar to low-pitched noises starlings make as they fly in flocks, swirling this way and that, presumably to avoid predatory birds.

This led to my wondering if starlings were the only birds that form a murmuration.

I wonder of shore birds also do it because we saw them flying in a sort of swirling pattern when there were no visible predators.

We might have missed the light shining just right on a majestic American Sycamore in all its glory, festooned like a Christmas tree with its seed balls hanging from almost every limb. In fact, some people do make Christmas tree ornaments out of them.

We might also have missed the squirrel munching on his lunch in a tree. It was not eating American Sycamore seed balls, probably only because it was not sitting in an American Sycamore tree.

We have walked the Terry Trueblood trail often, in every season, including autumn. We’ve never seen the seed balls before.

And we might have also missed the Subaru Outback with Wisconsin license plates in the parking lot. It was covered with decals. And later I discovered that the word “decal” is short for “decalcomania,” which is exactly how I would describe how the car came to be so heavily decorated—from an episode of decal-co-mania.

A lot happened yesterday which seemed somehow just right. Some people see so-called “glitches in the matrix,” which are events that seem out of place and ill-timed, leading to the idea we’re living in a poorly run computer simulation.

What about the times we see and feel everything occurring so smoothly that we’re surprised by the flow? Maybe we don’t call attention to it so as to avoid interrupting the miracle.

Taming the Juggling Balls

As of November 7, 2022 it has been 22 days since I purchased the Learn to Juggle kit from Barnes and Noble. So far, my learning experience reminds me of a story by Mark Twain, “Taming the Bicycle,” which was published posthumously—obviously after he succumbed from his injuries in the attempt to ride the high-wheeled bicycle in the early 1880s.

Just kidding of course, about his death from the bicycle riding adventure. He did mention using about a barrel of something called Pond’s Extract, which was a liniment for scrapes and other wounds.

Twain was writing about learning something new—a thing all of us are called on to do many times in our lives. He didn’t try to learn to ride the bicycle until he was over 50 years old.

I didn’t try to learn how to juggle until was well past my mid-sixties. How do you account for decisions to embark on new hobbies, adventures, and other nonsense at an age when most people would be content vegetating on the porch or in front of the TV?

I just answered the question, in case you didn’t notice.

Anyway, I am making some progress as juggling, although it’s uneven. It’s hard to believe, but sometimes I think I juggle better as I wander around. I think it might be because there is a natural tendency to throw the balls away from you. That way, I look more adept simply because I’m making a frequently observed beginner’s mistake. But I seem to be steadier even when I walk backward a few paces.

 When I stand firmly in one place and attempt to juggle, I can often barely make it past half a dozen throws. Wandering a little, I have made thirty throws.

But then, randomly, the opposite occurs and the theory fails.

Counting the number of each throw seems to help—occasionally. I also notice that unscheduled, short practice episodes for 10 minutes or less work better than struggling along for a half hour or so at set times.

I don’t dread the practice sessions; in fact, I have a sort of itch to juggle at various times during the day. Sometimes I believe I do it to help me collect my thoughts, to keep my hands occupied, or just to pass the time.

I remember learning to ride the bicycle for the first time when I was a kid. I fell down a lot, just like Twain did—until I got the hang of it. Maybe juggling will turn out to be the same.

But I won’t need Pond’s Extract for juggling mistakes—as long as I don’t try juggling while climbing or descending stairs.

Blood Moon of November 2022 in the Books

Well, it was cold rousting out of bed into the freezing temperatures to get an eyeful of the total lunar eclipse, otherwise known as a blood moon.

Sena still asks me questions about the whole event, including “And why can’t we see Earth?” She told me I could share that.

I was so keyed up about it I didn’t get hardly a wink of sleep. I wasn’t planning to see the whole thing, but since I was awake most of the night anyway, I got up at 2:00 AM and set up cameras out on the deck.

It was a spectacular view (although I admit you can hardly tell that from my pictures). Like I did for the last blood moon in May this year, I took shots with both my Nikon D3400 and Canon Powershot SX610 HS. I tried both on the tripod. I barely know anything about cameras. I just press the shutter button for the most part and hope for the best.

There were a lot of planes out last night in the general vicinity of the moon. I suspect the pilots were checking out the eclipse. I didn’t see any UFOs, but a couple of deer (or a huge buck, it was hard to see because it was so dark) crossed our yard.

I thought it was cold in May, but this morning I had to drag out my winter coat, hat, gloves, and considered building a fire on the deck, but I decided against it.

This event was special for a different reason. I took my first ever selfies with my 7-year-old smartphone. There’s a first time for everything, including tin foil hats.

You should protect yourself with a tin foil hat when you’re watching the sky. You never know what the extraterrestrials are up to, especially during a total lunar eclipse.

Seeing the stars and planets sometimes makes me want to juggle, an urge against which tin foil hats are ineffective.