National Day of Racial Healing Today

I just found out about the National Day of Racial Healing, which is today. It follows the National MLK Day, which this year was yesterday. The annual National Day of Racial Healing was started in 2017. The website tells what the event is about:

“The National Day of Racial Healing is a time to contemplate our shared values and create the blueprint together for #HowWeHeal from the effects of racism. Launched on Jan. 17, 2017, it is an opportunity to bring ALL people together in their common humanity and inspire collective action to create a more just and equitable world.”

Read more about the origins of the National Day of Racial Healing here.

My Two Cents on The Embrace Sculpture Honoring MLK Jr and Coretta Scott King

I first saw a photo of the sculpture honoring Dr. Martin Luther King Jr and Coretta Scott King, called “The Embrace” a couple of days ago. I remember my first impression being that it would have been nice to see a full sculpture of the couple rather than disembodied arms.

Sena mentioned it today because it was unveiled at Boston Commons. This was just before my mindfulness meditation, so I just told her that I saw the picture of it and said I would have to think about it some more.

As I sat in meditation, it occurred to me that “The Embrace” expressed what I think is a basic abstract idea, which is the challenge for us to embrace the notion that we’re all humans who ought to accept each other, and be kind and generous to one another.

That’s what I think the Kings did. That’s why Dr. King won the Nobel Peace Prize.

You could make a sculpture of the King as a couple embracing each other after he won the Nobel Prize. It would have been beautiful. On the other hand, you could make a sculpture which tries to do more than that. How difficult would it be to make a representation of what it might look like if all of us embraced our humanity—and each other?

It sounds too difficult. Yet the artist managed to do just that. Anyway, that’s my two cents.

MLK Week Redux for the New University of Iowa Psychiatry Fellows

I discovered the University of Iowa Dept of Psychiatry had a very successful match, filling key residency slots in Child Psychiatry, Addiction Medicine, and Consultation-Liaison fellowships. Congratulations! That’s a big reason to celebrate.

This reminds me of my role as a teacher. I retired from the department two and a half years ago. But I’ll always remember how hard the residents and fellows worked.

And that’s why I’m reposting my blog “Remembering My Calling.”:

Back when I had the blog The Practical C-L Psychiatrist, I wrote a post about the Martin Luther King Jr. Day observation in 2015. It was published in the Iowa City Press-Citizen on January 19, 2015 under the title “Remembering our calling: MLK Day 2015.”  I have a small legacy as a teacher. As I approach retirement next year, I reflect on that. When I entered medical school, I had no idea what I was in for. I struggled, lost faith–almost quit. I’m glad I didn’t because I’ve been privileged to learn from the next generation of doctors.

Faith is taking the first step, even when you don’t see the whole staircase.”

Martin Luther King, Jr.

As the 2015 Martin Luther King Jr. Day approached, I wondered: What’s the best way for the average person to contribute to lifting this nation to a higher destiny? What’s my role and how do I respond to that call?

I find myself reflecting more about my role as a teacher to our residents and medical students. I wonder every day how I can improve as a role model and, at the same time, let trainees practice both what I preach and listen to their own inner calling. After all, they are the next generation of doctors.

But for now they are under my tutelage. What do I hope for them?

I hope medicine doesn’t destroy itself with empty and dishonest calls for “competence” and “quality,” when excellence is called for.

I hope that when they are on call, they’ll mindfully acknowledge their fatigue and frustration…and sit down when they go and listen to the patient.

I hope they listen inwardly as well, and learn to know the difference between a call for action, and a cautionary whisper to wait and see.

I hope they won’t be paralyzed by doubt when their patients are not able to speak for themselves, and that they’ll call the families who have a stake in whatever doctors do for their loved ones.

And most of all I hope leaders in medicine and psychiatry remember that we chose medicine because we thought it was a calling. Let’s try to keep it that way.

You know, I’m on call at the hospital today and I tried to give my trainees the day off. They came in anyway.

Corn Removal Comedy

Sena does a lot of gardening, which means she uses a shovel frequently. She has quite a few corns on her feet for which she’s tried a number of remedies that run the gamut from scraping with a variety of simple tools to—sand paper. There, I said it and I’m glad.

Maybe a little foot scrub?

The old shovel probably contributed to her developing a number of corns on her feet. She got a new shovel with a special footstep which we hope will cut down on corns.

CDC Identifies Preliminary Covid-19 Vaccine Safety Signal

The CDC announced that a prelimary Covid-19 Vaccine Safety signal has been identified in a recent update on their website:

“Following the availability and use of the updated (bivalent) COVID-19 vaccines, CDC’s Vaccine Safety Datalink (VSD), a near real-time surveillance system, met the statistical criteria to prompt additional investigation into whether there was a safety concern for ischemic stroke in people ages 65 and older who received the Pfizer-BioNTech COVID-19 Vaccine, Bivalent. Rapid-response investigation of the signal in the VSD raised a question of whether people 65 and older who have received the Pfizer-BioNTech COVID-19 Vaccine, Bivalent were more likely to have an ischemic stroke in the 21 days following vaccination compared with days 22-42 following vaccination.

This preliminary signal has not been identified with the Moderna COVID-19 Vaccine, Bivalent. There also may be other confounding factors contributing to the signal identified in the VSD that merit further investigation. Furthermore, it is important to note that, to date, no other safety systems have shown a similar signal and multiple subsequent analyses have not validated this signal:

  • A large study of updated (bivalent) vaccines (from Pfizer-BioNTech and Moderna) using the Centers for Medicare and Medicaid Services database revealed no increased risk of ischemic stroke
  • A preliminary study using the Veterans Affairs database did not indicate an increased risk of ischemic stroke following an updated (bivalent) vaccine
  • The Vaccine Adverse Event Reporting System (VAERS) managed by CDC and FDA has not seen an increase in reporting of ischemic strokes following the updated (bivalent) vaccine
  • Pfizer-BioNTech’s global safety database has not indicated a signal for ischemic stroke with the updated (bivalent) vaccine
  • Other countries have not observed an increased risk for ischemic stroke with updated (bivalent) vaccines”

The CDC says it’s “very unlikely  that the signal in VSD represents a true clinical risk…” The data and additional analyses will be discussed at the January 26, 2023 meeting of the FDA’s Vaccines and Related Biological Products Advisory Committee.

No changes are recommended to the current Covid-19 vaccination practice:

“CDC continues to recommend that everyone ages 6 months of age and older stay up-to-date with COVID-19 vaccination; this includes individuals who are currently eligible to receive an updated (bivalent) vaccine. Staying up-to-date with vaccines is the most effective tool we have for reducing death, hospitalization, and severe disease from COVID-19, as has now been demonstrated in multiple studies conducted in the United States and other countries:

  • Data have shown an updated COVID-19 vaccine reduces the risk of hospitalization from COVID-19 by nearly 3-fold compared to those who were previously vaccinated but have not yet received the updated vaccine.
  • Data have shown that the updated COVID-19 vaccine also reduces the risk of death from COVID-19 by nearly 19-fold compared to those who are unvaccinated.
  • Other preliminary data from outside the U.S. have demonstrated more than 80% protection against severe disease and death from the bivalent vaccine compared to those who have not received the bivalent vaccine.

Overall safety data for the bivalent COVID-19 vaccines are available here.

Once again, no change is recommended in COVID-19 vaccination practice, which can be found here.”

Bivalent Covid-19 Booster Protects Us

University of Iowa Health Care participated in research which demonstrates that people over age 65 who got the updated bivalent Covid-19 vaccine booster:

  • “84% less likely to be hospitalized with COVID-19 compared with unvaccinated people 
  • 73% less likely to be hospitalized with COVID-19 compared with people who received monovalent mRNA vaccination alone but had not received the bivalent booster dose.”

Amaryllis and Zygocactus Repotting

Remember that gorgeous Christmas Amaryllis flower? After it leaned over so far, we had to retire it, so to speak. We didn’t throw it out, but Sena kept it and performed some kind of miracle.

Apparently, she resurrected it by giving it a little water. A couple of new leaves grew a few inches overnight.

She knows that gardeners tell you to bury the Amaryllis bulb outside after the flowers die. I guess in the following winter you dig it up, put it in a new pot and a new set of blossoms should grow. She wanted to transfer it to a different pot instead, one with holes that will let the excess water leak out.

She was very industrious. She also repotted the Zygocactus. That’s the holiday cactus, another houseplant she got for the Christmas holidays.

And the most important question: how are extraterrestrials involved in this urge to repot? ? By the way, I was not involved in the repotting project because I’m allergic to gardening. I did make a YouTube video of her working on it, though.

An Old Post on Breaking Bad News

I’m reposting a piece about a sense of humor and breaking bad news to patients I first wrote for my old blog, The Practical Psychosomaticist about a dozen years ago. I still believe it’s relevant today. The excerpt from Mark Twain is priceless. Because it was published before 1923 (See Mark Twain’s Sketches, published in 1906, on google books) it’s also in the public domain, according to the Mark Twain Project.

Blog: A Sense of Humor is a Wonderful Thing

Most of my colleagues in medicine and psychiatry have a great sense of humor and Psychosomaticists particularly so. I’ll admit I’m biased, but so what? Take issues of breaking bad news, for example. Doctors frequently have to give their patients bad news. Some of do it well and others not so well. As a psychiatric consultant, I’ve occasionally found myself in the awkward position of seeing a cancer patient who has a poor prognosis—and who apparently doesn’t know that because the oncologist has declined to inform her about it. This may come as a shock to some. We’re used to thinking of that sort of paternalism as being a relic of bygone days because we’re so much more enlightened about informed consent, patient centered care, consumer focus with full truth disclosure, the right of patients to know and participate in their care and all that. I can tell you that paternalism is not a relic of bygone days.

Anyway, Mark Twain has a great little story about this called “Breaking It Gently”. A character named Higgins, (much like some doctors I’ve known) is charged with breaking the bad news of old Judge Bagley’s death to his widow. She’s completely unaware that her husband broke his neck and died after falling down the court-house stairs.  After the judge’s body is loaded into Higgins’ wagon, Higgins is reminded to give Mrs. Bagley the sad news gently, to be “very guarded and discreet” and to do it “gradually and gently”. What follows is the exchange between Higgins and the now- widowed Mrs. Bagley after he shouts to her from his wagon[1]:

“Does the widder Bagley live here?”

“The widow Bagley? No, Sir!”

“I’ll bet she does. But have it your own way. Well, does Judge Bagley live here?”

“Yes, Judge Bagley lives here”.

“I’ll bet he don’t. But never mind—it ain’t for me to contradict. Is the Judge in?”

“No, not at present.”

“I jest expected as much. Because, you know—take hold o’suthin, mum, for I’m a-going to make a little communication, and I reckon maybe it’ll jar you some. There’s been an accident, mum. I’ve got the old Judge curled up out here in the wagon—and when you see him you’ll acknowledge, yourself, that an inquest is about the only thing that could be a comfort to him!”

That’s an example of the wrong way to break bad news, and something similar or worse still goes on in medicine even today. One of the better models is the SPIKES protocol[2]. Briefly, it goes like this:

Set up the interview, preferably so that both the physician and the patient are seated and allowing for time to connect with each other.

Perception assessment, meaning actively listening for what the patient already knows or thinks she knows.

Invite the patient to request more information about their illness and be ready to sensitively provide it.

Knowledge provided by the doctor in small, manageable chunks, who will avoid cold medical jargon.

Emotions should be acknowledged with empathic responses.

Summarize and set a strategy for future visits with the patient, emphasizing that the doctor will be there for the patient.

Gauging a sense of humor is one element among many of a thorough assessment by any psychiatrist. How does one teach that to interns, residents, and medical students? There’s no simple answer. It helps if there were good role models by a clinician-educator’s own teachers. One of mine was not even a physician.  In the early 1970s when I was an undergraduate at Huston Tillotson University (when it was still Huston-Tillotson College), the faculty would occasionally put on an outrageous little talent show for the students in the King Seabrook Chapel. The star, in everyone’s opinion, was Dr. Jenny Lind Porter, who taught English. The normally staid and dignified Dr. Porter did a drop-dead strip tease while reciting classical poetry and some of her own ingenious inventions. Yes, in the chapel. Yes, the niece of author O. Henry; the Poet Laureate of Texas appointed in 1964 by then Texas Governor John Connally; the only woman to receive the Distinguished Diploma of Honor from Pepperdine University in 1979; yes, the Dr. Porter in the Texas Women’s Hall of Fame—almost wearing a very little glittering gold something or other.

It helps to be able to laugh at yourself.

1.       Twain, M., et al., Mark Twain’s helpful hints for good living: a handbook for the damned human race. 2004, Berkeley: University of California Press. xiv, 207 p.

2.       Baile, W.F., et al., SPIKES-A six-step protocol for delivering bad news: application to the patient with cancer. Oncologist, 2000. 5(4): p. 302-11.

Men in Black Movie Marathon

Sena and I have favorite movies. We both like “Up” and “WALL-E.” My favorites are the Men in Black trilogy. That doesn’t mean I think the 4th sequel was bad. But I have lost count of the number of times I’ve watched the first three.

I haven’t watched them in the last several months because I couldn’t find them on cable for some reason. I’ve just learned that that there will be a marathon of the trilogy on January 14, 2023 beginning at 2:30 PM. They’ll be on the Comedy Central channel.

I’m a fan of comedy and I like the chemistry between the two main characters, Agent J and Agent K.

I have favorite lines from each movie. In the first Men in Black film, I like the exchange between the two agents after the recruitment scene following Edwards’ (the soon to be Agent J) first visit to the MIB Headquarters. They’re sitting on a park bench and K is talking about people and what they don’t know about them and extraterrestrials.

Edwards: Why the big secret? People are smart. They can handle it.

Agent K: 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 humans were alone on this planet. Imagine what you’ll know tomorrow.

Another favorite where Agent K is showing Edwards a universal translator, one of the many wonders in the extraterrestrial technology room, which gives us a perspective on how humans rank in the universe:

Agent K: We’re not even supposed to have it. I’ll tell you why. Human thought is so primitive it’s looked upon as an infectious disease in some of the better galaxies.

In MIB II, the dialogue between Newton and the Agents makes you wonder what extraterrestrials really want from us:

Newton: Gentlemen, before I play the tape, there’s just one question I need to ask; what’s up with anal probing? I mean, aliens travel billions of light years just to check out our…

Agent J: Boy, move!

This is part of the Men in Black 3 dialog between Agent J and Jeffrey Price about how to use the time travel device:

Jeffrey Price: Do not lose that time device, or you will be stuck in 1969! It wasn’t the best time for your people. I’m just saying. It’s a lot cooler now.

I remember 1969. Things are not perfect now, but they are better. What we don’t need is a “big ass neutralizer.” As long as we remember what dark times were like, we have a chance to make cooler times.

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