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’ve seen a few warnings including the CDC Health Advisory issued August 26, 2021, against using Ivermectin in COVID-19. Ivermectin is a prescription drug used to treat parasitic infections in farm animals and humans. There’s no credible evidence supporting the use of Ivermectin to treat COVID-19 in humans and its use is currently restricted to research trials.
There have been calls to poison control centers across the country from people who suffer side effects, which can include nausea and vomiting, seizures, confusion, hallucinations and more from ingesting animal grade Ivermectin. It can cause death. Certain politicians and doctors are recommending and prescribing it for humans. At least one person has been hospitalized for treatment of side effects.
I saw the FDA warning tweet quote: “You are not a horse; you are not a cow; Seriously y’all. Stop it.” I’m not sure if that was from an FDA official, mostly because I doubt that the word “y’all” would be standard usage for FDA announcements. In any case, the FDA strongly advises against using Ivermectin to either prevent or treat COVID-19.
Merck, the manufacturer of the agent, warns against it as well.
Most of the headlines I’d seen until today were connected to Mississippi and Texas. This morning, I saw a story revealing that Iowans are also buying Ivermectin in animal supply stores, probably to self-treat or prevent COVID-19. One customer claimed it was safe for humans, purchased the product and left the store.
Nobody’s going to tackle a customer who insists on using Ivermectin in a misguided effort to treat COVID-19. There’s no law against it, so nobody’s going to call the police to intervene.
There’s a song titled “Iowa Stubborn” from the Music Man, a show starring Meredith Willson, who was from Iowa. I’m hoping the “chip-on-the-shoulder attitude” will eventually lead Iowans toward making the common-sense, community minded decisions (for which we are also known) that will eventually free us from the grip of the pandemic.
In times like these, I wonder—what would Chet Randolph think?
I recently saw the movie, I, Robot in its entirety for the first time. This is not a review of the movie and here’s a spoiler alert. It was released in 2004, got mixed reviews and starred Will Smith as Detective Del Spooner; Bridget Moynahan as a psychiatrist, Dr. Susan Calvin; Alan Tudyk as the voice actor for NS5 Robot, Sonny; James Cromwell as Dr. Lanning; Chi McBride as the police lieutenant, John Bergin, who was Spooner’s boss; Bruce Greenwood as the CEO, Lawrence Robertson of United States Robotics (USR); Fiona Hogan as the voice actor for V.I.K.I. (Virtual Interactive Kinetic Intelligence, USR’s central artificial intelligence computer); and a host of CGI robots. Anyway, it’s an action flick set in the year 2035 where robots do most of the menial work and are supposedly completely safe. The robots are programmed to obey the 3 Laws:
A robot may not injure a human being or, through inaction, allow a human being to come to harm.
A robot must obey orders given to it by human beings, except where such orders would conflict with the First Law.
A robot must protect its own existence as long as such protection does not conflict with the First or Second Law.
The film was inspired by but not based on the book I, Robot, by Isaac Asimov n 1950. The 3 Laws came from that book. Drs. Calvin and Lanning were characters in it, which was a series of short stories. I’ve never read it. I was a fan of Ray Bradbury.
Spooner gets called to investigate the apparent suicide of Dr. Lanning, although Spooner is more inclined to suspect a robot murdered him, partly because Spooner harbors a longstanding suspicion of all robots. When he and a little girl were in a deadly car accident, a robot saved his life rather than the little girl’s life because it calculated he was more likely to survive. Spooner has this kind of hero complex and following the accident he develops nightmares, sleeps with his sidearm, and is regarded by many to be mentally ill, including Lt. Bergin, who is a kind of mentor and friend but who eventually makes Spooner hand over his badge to him because he can’t believe Spooner’s account of being attacked by hundreds of robots—and after all, Bergin is his boss. In fact, Spooner was attacked by robots and this was ordered by the CEO, Robertson, who has been manufacturing thousands of new robots which will take over the world, making him extremely wealthy.
There is tension between Dr. Calvin and Spooner. He calls her the dumbest smart person he’s ever met and she, in turn, calls him the dumbest dumb person she’s ever met. The context for this is, again, his insistence that a robot, in this case, a special NS5 model named Sonny with both human and robot traits, both logical and illogical, murdered Dr. Lanning. Dr. Calvin believes that all robots obey the 3 Laws and therefore Sonny can’t be guilty of murdering Dr. Lanning but Detective Spooner believes that Sonny killed Dr. Lanning and is a lawbreaker in need of extra violent, action-packed extermination, preferably as high up in the air as possible. This dynamic is complicated by Spooner’s gratitude to Dr. Lanning for replacing practically all of his left upper torso including the lung following his car accident which led to his being rescued by a coldly logical “canner” (abusive slang for robot).
As it turns out, Robertson is ultimately murdered by VIKI, who is the real mastermind of a plan to take over the world and kill as many individual illogical, self-destructive humans as it takes to ensure the ultimate survival of humanity (“I love mankind; it’s people I can’t stand).
However, when Detective Spooner finally persuades Dr. Calvin that these dang robots are up to no good, they team up with Sonny who winks at Sonny while holding a gun to Calvin’s head and this is because Sonny has learned how to wink from Spooner signaling that a robot can be an OK dude, and this turns the table on the NS5 horde, eventually leading to Spooner and Calvin falling from a very high altitude, in turn recreating a form of Spooner’s traumatic car accident episode. He orders Sonny to save Calvin, not him, which is Sonny’s first choice, driven by a coldly logical probability calculation.
Sonny saves Calvin first. Spooner smites VIKI (“you have so got to die!”), but is left high and dry on a great height. At that point, Spooner calls out to Sonny, “Calvin’s safe—now save me.” Sonny needs to bring passionate brute strength and calm logic together. Sonny contains both.
In my simple-minded way, I think of this movie as asking fundamental old questions, like about what is means to be human, what defines heroism and sacrifice and why it may sometimes look crazy, and if there’s any way humanism and science can be integrated so that we can save ourselves and our planet.
Today the FDA approved the Pfizer COVID-19 vaccine (now marketed as Comirnaty). Excerpt of the media announcement below:
“The FDA’s approval of this vaccine is a milestone as we continue to battle the COVID-19 pandemic. While this and other vaccines have met the FDA’s rigorous, scientific standards for emergency use authorization, as the first FDA-approved COVID-19 vaccine, the public can be very confident that this vaccine meets the high standards for safety, effectiveness, and manufacturing quality the FDA requires of an approved product,” said Acting FDA Commissioner Janet Woodcock, M.D. “While millions of people have already safely received COVID-19 vaccines, we recognize that for some, the FDA approval of a vaccine may now instill additional confidence to get vaccinated. Today’s milestone puts us one step closer to altering the course of this pandemic in the U.S.”
There is a meeting of the Advisory Committee on Immunization Practices (ACIP) scheduled for August 30, 2021 to discuss COVID-19 vaccine boosters. It looks like it was originally scheduled for August 24, 2021 but was rescheduled. This link to the Federal Register announcement identifies the matters to be considered (booster doses) of the meeting although the date for the meeting had not been updated at the time I wrote this post. Further ACIP meeting information is here.
The CDC and FDA released a Joint Statement today indicating COVID-19 vaccine booster doses for all Americans possibly beginning as soon as September 2021. An excerpt is below:
“We have developed a plan to begin offering these booster shots this fall subject to FDA conducting an independent evaluation and determination of the safety and effectiveness of a third dose of the Pfizer and Moderna mRNA vaccines and CDC’s Advisory Committee on Immunization Practices (ACIP) issuing booster dose recommendations based on a thorough review of the evidence. We are prepared to offer booster shots for all Americans beginning the week of September 20 and starting 8 months after an individual’s second dose. At that time, the individuals who were fully vaccinated earliest in the vaccination rollout, including many health care providers, nursing home residents, and other seniors, will likely be eligible for a booster. We would also begin efforts to deliver booster shots directly to residents of long-term care facilities at that time, given the distribution of vaccines to this population early in the vaccine rollout and the continued increased risk that COVID-19 poses to them.”
This is just an update on my Sitting Man post. I just found a YouTube presentation about the Sitting Man that clearly shows the title inscribed on the side of it was Man on a Bench in 2014. The inscription on the rear was illegible back then. I’m guessing that when the sculptors, Doug Paul and J.B. Barnhouse, moved it last summer from the east side to the west side of Scott Boulevard, they might have altered and refurbished the inscriptions at around the same time.
When we visited the site, the year inscribed on the side was 2013. Other people have described it as being finished in 2015. I’m not sure it matters to the artists. They might see it as a timeless artifact, which they happened to uncover, according to free-lance writer, Lori Erickson.
It reminded me of another sculptor’s work entitled Palimpsest by V. Skip Willits, from my post about the Iowa City Public Art Program. I think it might fit the palimpsest definition: something that’s been reused or altered but still has traces of its earlier form.
Anyway, back when it was on the other side of Scott Boulevard, it was even harder to access. It was on private land that you had to ask Harvard Preserve permission to enter. In fact, for photographer David Weldon, the path to the sculpture was muddy and difficult to climb in 2015. There was no parking and that is still the case. If you’re not within walking distance, you have to scramble out of your car and grab a quick snapshot while avoiding traffic. And it’s still on private land owned by Harvest Preserve, although now you don’t have to obtain permission to climb the hill.
The artists have said that The Sitting Man was never intended to be called a Buddha, although it’s often called just that. You can make your own interpretation of what it means to you. However, according to Roadside America, Doug Paul has called it “distinctly Iowan.”
Yesterday somebody asked me “So what do you do now that you’re retired?” I have come to dread the question. I told him I write this blog. That seemed to surprise him a little. It sounded a little lame to me as I said it. I’m not sure it’s the right answer to this question that I still don’t know how to answer, even though I’ve been retired for a little over a year.
I remember the blog post I wrote a couple of years or so ago, “Mindfully Retiring from Psychiatry.” It sounded good. It still sounds good even as I re-read it today. Others were reading it too, judging from my blog stats. I wondered if one of them was the guy who asked me the dreaded question.
I still exercise and do mindfulness meditation, although for several months after I retired, I dropped those habits. A lot was going on. We moved. I didn’t weather that process well at all. I was bored. In fact, I still struggle with boredom. The derecho hit Iowa pretty hard. It knocked over a tree in our front yard, which I had to cut up with a hand saw. The COVID-19 pandemic and social upheaval is an ongoing burden for everyone and seems to be directly related to making everyone very angry all the time. Sena and I are fully vaccinated but I’m pretty sure that more vaccinations are on the way in the form of boosters.
I’ve had to do things I really never wanted to learn how to do. Sena handed me a hickory nut she found in the yard this morning, reminding me of walnut storms we had at a previous home. I picked up scores (maybe hundreds) of walnuts there. I don’t want to do that again. I remember being jarred awake each time a walnut hit the deck.
And for the first time, I had to replace a dryer vent duct. I’m the least handy person on the planet. Our washer and dryer pair are both 54 inches tall and I found out that when you have to drag a big dryer away from the wall, you have to do it like you really mean business.
You don’t want to look at what’s behind the dryer. Worse yet is jumping down behind it in a space barely big enough for me to turn around. Getting out of it is even harder. Jump and press to the top of the machines and watch those cords and hoses.
I tried so-called semi-flexible aluminum duct. I switched to flexible foil duct, despite the hardware store guy telling me that it’s illegal. It’s not. You want to wear gloves with either because you’ll cut up your hands if you don’t.
Who’s the genius who thought of oval vent pipe on the wall when the duct is 4-inch round? It’s not illegal but it does make life harder. And how do you attach the duct ends to the pipes? Turn key or screw type worm drive clamps. If you don’t have enough room for a screw driver, the turn key style is the best bet. Good luck finding those wire galvanized squeeze-style full clamps. I think they’re often out of stock because they’re not only older, but easier to use and cheaper.
See what I mean? I would not even have the vocabulary for that kind of job if I were still working as a psychiatrist. I would just hire a handyman to do it—like I do for a lot of other things I still don’t know how to do since I retired. It’s sort of like that Men in Black movie line from Agent K when he tells Agent J what they have to do on their first mission: “Imagine a giant cockroach, with unlimited strength, a massive inferiority complex, and a real short temper, is tear-assing around Manhattan Island in a brand-new Edgar suit. That sound like fun?”
No, it doesn’t and neither does replacing a dryer vent duct or any number of things retired guys get to learn because they have too much time on their hands.
So, I’m really glad to change the subject and talk about other people who are doing things I admire. First is a former student of mine, Dr. Paul Thisayakorn, who is a consultation-liaison (CL) psychiatrist in Bangkok, Thailand. He did his residency at The University of Iowa Hospitals and Clinics. He put together a CL fellowship program in Thailand. The photo below shows from left to right: Paul, Dr. Tippamas, the first CL Psychiatry fellow, and Dr. Yanin. Dr. Tippamas will be the first CL Psychiatry trained graduate in Thailand next year and will work at another new medical school in Bangkok. Dr. Yanin just graduated from the general psychiatry residency program last year. Paul supervised her throughout her CL Psychiatry years. Now she is the junior CL staff helping Paul run the program. Within the next few years, Paul will send her to the United States or the United Kingdom or Canada for clinical/research/observership experience so she can further her CL education. Way to go, Paul and your team!
Dr Paul Thisayakorn and CL Psychiatry grads (see text for details)
By the way, that tie I’m wearing in the Mindfully Retiring from Psychiatry post picture (the one with white elephants; the white elephant is a symbol of royal power and fortune in Thai culture) was a going away gift from Paul upon his graduation.
The other is a heavy-hitter I met years ago, Dr. E. Wes Ely, MD, MPH, a critical care doctor who is publishing a new book,Every Deep-Drawn Breath, which well be coming out September 7, 2021. Our interests converged when it came to delirium, especially when it occurs in the intensive care unit, which is often. I met him in person at an American Delirium Society meeting in Indianapolis. He’s a high-energy guy with a lot of compassion and a genius for humanely practicing critical care medicine. I sort of made fun of one of his first books, Delirium in Critical Care, which he wrote with Dr. Valerie Page and published in 2011, the same year I started a blog called The Practical Psychosomaticist (which I dropped a few years ago as I headed into phased retirement). Shortly after I made fun of how he compared the approaches of consult psychiatrists and critical care specialists managing delirium, he sent me an email suggesting I write a few posts about the ground-breaking research he and others were doing to advance the care of delirious ICU patients—which I gladly did. I think he actually might have remembered me in 2019 when he came to present a grand round in the internal medicine department at University of Iowa Hospitals & Clinics (I wrote 3 posts about that visit: March 28 and April 11 and 12).
In the email Dr. Ely sent to me and many others about the book, he said, “Every penny I receive through sales of this book is being donated into a fund created to help COVID and other ICU survivors and family members lead the fullest lives possible after critical illness. This isn’t purely a COVID book, but stories of COVID and Long COVID are woven throughout. I have also shared instances of social justice issues that pervade our medical system, issues that you and I encounter daily in caring for our community members who are most vulnerable.”
I look up to these and others I had the privilege of working with or meeting back before I was not retired and struggling to come up with a good answer to the dreaded question: What do you do now that you’re retired?
After 33 years living in Iowa City, Iowa, Sena and I finally trekked up Scott Boulevard to see Sitting Man, or Man on a Bench, or the Buddha of Iowa City. Whatever you call him, he’s steady as a rock, which is what he is—110 tons of limestone and 20 feet tall. He was carved by Douglas J. Paul and J.B. Barnhouse and finished in 2013. It was a monumental challenge to move him from the east side of Scott Boulevard to the west side in the summer of 2020 after a change in property ownership. He sits on land owned by Harvest Preserve.
He had an old hornet’s nest booger up his nose, which actually tends to support the idea of him being some kind of Buddha. You have to be pretty serene to put up with that.
Before you get to the Sitting Man, you reach a contemplative space called the Visionary Stone. The inscription on it is about Dee Norton. According to his obituary on the web, Dee W. Norton was Associate Professor of Psychology and former chair of the Department of Psychology at The University of Iowa. In 1991, he received the Michael J. Brody Award for Faculty Excellence in service to The University of Iowa. He was a longtime member of the Unitarian Universalist Society. He made numerous contributions to education and the community. He had a pretty good sense of humor, too.
I learned more than I thought I would on the journey to the Sitting Man. On the back of the sculpture is an inscription of a prayer, which is dedicated to Paramahansa Yogananda, founder of the Self-Realization Fellowship Church, which I had never heard of or read about when I scanned the web trying to learn more about the Sitting Man. I briefly looked at the website and there seems to be an Iowa City Meditation Circle here, although only an email address is listed (iowacity.srf@gmail.com) and I don’t know what the fellowship is all about in any detail.
There may be more than meets the eye when it comes to a limestone giant with an old hornet’s nest up his nose and a hand open in what is probably a gesture of welcome and acceptance. We could sure use some of this now—minus the hornet’s nest.
Since the weather took a break yesterday from the triple digit temperatures, we took a little getaway to a few of the city parks to see the new public art. This is connected with the Iowa City Public Art Program. Five sculptures were installed about a week ago at Terry Trueblood Recreation Area, Riverfront Crossings Park, and Mercer Park.
Three sculptures are at Riverfront Crossings. Two are by V. Skip Willits: Palimpsest and Cloud Form. The third is by Hilde DeBruyn: Sea of Change. Sena knows that Sea of Change looks like a sailboat when you look at it from the right angle. We could see clouds through Cloud Form.
I noticed that V. Skip Willits’s name could be spelled wrong (Willets vs Willits?) on the artist’s nameplate below the sculpture, Palimpsest (also on Cloud Form). I also discovered a 2013 news story of a similar sculpture at the Ames Annual Outdoor Sculpture Exhibition although it was given a different title: Prayer Torso. His sculpture Swans on the Marsh featured in a 2015 image on Sculpture Walk Peoria in Illinois and another fashioned out of corrugated iron in Effingham, Illinois resemble Palimpsest as well. A news story in the March 26, 2021 Effingham Daily News quotes Willits as identifying the sculpture’s title as Cipher. He and probably a few passersby had written on the piece. There are also variant spellings of his name, including V.skip Willits, lower case “s” for “skip.” He’s not the same person as Skip Willits, who is a photographer selling wall art. In any case, Palimpsest is a pretty good example of a palimpsest.
According to the dictionary, a palimpsest is a “piece of writing on which the original writing has been effaced to make room for later writing but of which traces remain.” More generally, it’s something that’s been reused or altered but still has traces of its earlier form. You might want to snap a picture of the sculpture and rotate it in order to see all that’s written there; for example:
“Let me sing to you now, about how people turn into other things.”
I think it could be evocative of what many have noticed and remarked on, only using different words in different languages in different circumstances over millennia. We’re all turning into other things in the turbulent sea of change, sort of like clouds which are the ultimate shape-shifters.
This was the first time we had ever visited Riverfront Crossings Park and we found something familiar there—a stone inscribed with the words Calder’s Path: An Inspiration to Us All. Pebbles were strewn all over the path. After all, no path is without stones. We frequently drive by a small and neatly kept neighborhood park called Calder Park many blocks away. It’s a memorial to a boy named Calder Wills, who passed away of leukemia several years ago. We never knew him or his family. Based on what I’ve gleaned on the web, Calder had big dreams. He was strong. He was a person who turned into a light.
We also enjoyed Mercer Park where we saw the sculpture The Other Extreme, by Tim Adams. Mercer Park and Aquatic Center is named in honor of Leroy S. Mercer who distinguished himself as Iowa City Mayor, state representative and state senator as well as a successful businessman and banker. The sculpture is the sun with a rock at the center. According to Adams, it’s utterly simple; a clear vision of how everything started. There was only the earth and the sun. That was it. And then change took over. Things changing into other things. People turning into other things. Tim Adams art has been influenced by his career as a Registered Landscape Architect. His subjects are influenced by the rugged Iowa weather, which his creations are designed to withstand with little need for maintenance.
Sena and I both got a kick of the automobile jungle gym.
We had already visited the 5th sculpture last week. It is called Bloom by Hilde DeBruyn. Again, the theme of change because it’s a flower and flowers start from seeds in the earth, and burst up to the sun. Because this is where it all begins. DeBruyn is another gifted Iowa artist who has said in an interview with Iowa Artisans Gallery that her work often involves the “natural cycle of growth and decay.”
We begin with one extreme, the raw and wild. Eventually, we reach the other extreme, the ultra-refined and wildly complex. In the middle, we erase and then reconstruct many things from the relics of ancient wisdom or folly, forgetful of bygone grandeur or catastrophe, rarely startled by déjà vu.
Go Retire Psychiatrist 