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.

The Intergalactic Angle on Your Point of View

I finally watched the movie “The Hitchhiker’s Guide to the Galaxy” the other night. It was released in 2005 and based on Douglas Adams’ book of the same title. In fact, he co-wrote the screenplay. A lot of it was not in the book. I thought a couple of scenes were noteworthy and pretty funny. I made connections to Dr. Martin Luther King, Jr. annual observance, which is this month.

One of them was the Point of View Gun. It’s probably unfortunate that the main prop was a gun, but hey, it was a ray gun. It didn’t kill anyone and in fact, it caused the person “shot” with it to be able to understand the perspective of another person. It was just temporary, but for a short while it enabled persons or extraterrestrials to understand another’s point of view. It was designed by the Intergalactic Consortium of Angry Housewives to influence their husbands to understand them better.

One of Dr. Martin Luther King’s main points was how important it is to try to understand and validate someone else’s point of view.

One drawback of the Point of View gun (besides the obvious associations with gun violence) was that the effect was specific to whoever was using it. So, when the ultra-maladjusted robot Marvin mowed down a gang of Vogons (hideous and cruel extraterrestrial bureaucrats who destroyed Earth in order to make room for an intergalactic bypass), they all collapsed from depression.

The other scene I thought was funny was the Vogon planet’s slap-happy encounter between the heroes and the creatures shaped like spatulas that popped out of the ground and smacked anyone in the face who had an idea.

I didn’t think the movie was nearly as good as Adams’ book. But I wonder if you could cross the spatula creatures with the Point of View gun that would take the perspective-taking power of the gun and give it to the spatula creatures who would slap you silly whenever you failed to even try to understand another’s point of view. I could use that kind of a slap sometimes.

It’s remarkable the connections you could make between Dr. Martin Luther King, Jr and The Hitchhiker’s Guide to the Galaxy.

CDC Weekly Snapshot Shows Respiratory Virus Activity High

As of January 5, 2024, CDC is reporting that respiratory illness is increasing across the country. The levels are generally high in almost all regions.

“Activity Levels Update:

  • The amount of respiratory illness (fever plus cough or sore throat) causing people to seek healthcare is elevated or increasing across most areas of the country. This week, 39 jurisdictions experienced high or very high activity.
  • Nationally, emergency department visits due to influenza and COVID-19 are elevated in all age groups and increasing in all but school-aged children. Recent, holiday-related school closures and associated changes in healthcare seeking behavior may be impacting trends in influenza- and COVID-19-related visits among school-aged children. RSV-related emergency department visits decreased slightly nationally.
  • Nationally, COVID-19 wastewater viral activity levels and test percent positivity—indicators for infection levels—are higher than the same time last year (currently estimated as being 27% higher and 17% higher, respectively). However, indicators for illness requiring medical attention are lower, including emergency department rates being 21% lower than the same time last year.”

How to Cope with Pea Pods

The other day, we got to talking about sugar snap pea pods. The last several times we’ve had pea pods, I’ve had to deal with them the same way I always deal with foods, like coconut, that have the texture of processed wood—I spit them out.

Well, I don’t actually spit them out. I carefully yank the stringy, weaponized pea pods from between my teeth and hurl the mess into the parallel dimension where they obviously belong. Sena had the same problem, but politely removed the stringy mess and placed it carefully in my hair.

I did a web search on this problem, which evidently doesn’t get much attention. Almost everyone else loves pea pods, despite the tendency for them to immediately assume the texture of industrial strength confetti.

I found only one exception. It’s a short question and answer section on the Home and Garden Information Center of Maryland Extension. One thing I learned is that sugar snap peas that are grown from a special cultivar (a plant variety produced by selective breeding by an entity known as Satan) on the planet Whacko in a galaxy far, far away.

What happens is that the snap pea pod becomes as fibrous as an ancient redwood tree. The person says that “…pods are so fibrous they are barely worth eating.”

I guess what you can do is write to the producer and complain bitterly about the fibrosity monstrosity.

Or is there another solution? Sena found a YouTube which suggests the problem is the stem of the pea pod. You just cut the stem away, and the stringy mess should strip off with it.

So, there you have it. First strip away the stem—and then throw the pea pod away.

You’re welcome.

Martin Luther King Jr Day 2024!

Dr. Martin Luther King Jr Day is officially the third Monday of January every year. It’s January 15, 2024 this year. It’s really a community affair, which hopefully expands more broadly out to all people.

There are a number of events planned. In the spirit of emphasizing the community projects, here’s the high points:

The University of Iowa general announcement highlights the food drive and service goals.

The City of Coralville web site lists many activities, including an opportunity to help paint a community mural on January 15th!

The Iowa City web page lists several activities as well, including an MLK Day Family Storytime on January 15th.

Thoughts on “An Occurrence at Owl Creek Bridge”

Sena and I got to talking about a Twilight Zone show we saw over the holidays. It was a 1964 episode, not the regular program but short film that won a Cannes Film Festival award in the early 1960s, “An Occurrence at Owl Creek Bridge.”

The quick summary is that a Southern plantation owner is being hanged by Union soldiers for trying to set fire to the bridge to prevent the Union Army from attacking Confederate troops. The plantation owner seems to miraculously escape the noose, evades bullets and cannon fire, running all the way back to his plantation in an escape which lasts hours, finally almost rushing into his wife’s arms—but he can’t because at that moment his neck is snapped by the hangman’s rope. All of the action during his escape is a hallucination which happens in the blink of an eye.

It’s based on a short story of the same title by Ambrose Bierce. I vaguely recalled reading it years ago, possibly in a science fiction/fantasy anthology. At that time, I didn’t know the author’s background, which was that he’d been a Union soldier in the Civil War. He fought in a lot of battles and witnessed horrific injuries and death. He disappeared without a trace, and there is no explanation why or how.

As Sena and I talked about it, she wondered more about the details of the Civil War as context, while I thought the main point was about the time compression of a miraculous escape from execution that spoke of the nature and meaning of life and death.

When I searched the web to find out more about the story and the life of Ambrose Bierce, I saw her point.

I read the original story on the Internet Archive. It’s very short. Now, I’m not sure I ever really read it. I’m just a blogger and unworthy to really talk about it other than to acknowledge that it’s a work of genius. How the author’s spare and yet meticulous attention to every terrifying detail of war can be so ugly and yet so mesmerizing is beyond my understanding.

CDC Reports Respiratory Virus Activity Increasing

The Centers for Disease Control (CDC) reported respiratory illness leading to visits to the emergency room and hospitalization are rising across the country.

  • “Seasonal influenza activity is elevated and increasing in most parts of the country.
  • COVID-19 activity also remains elevated overall and is increasing in many areas.  Based on the biweekly period ending 12/23/2023, JN.1 is predicted to be the most prevalent SARS-CoV-2 lineage nationally.
  • RSV activity remains elevated in many areas of the country, though decreases have been observed in some areas.
  • Hospital bed occupancy and capacity, including within intensive care units, remain stable nationally.”

Complexity Intervention Units Past And Present

Here’s another blast from the past about Complexity Intervention Units (CIUs) or what used to be called Medical-Psychiatry Units. I co-staffed one for 17 years at Iowa Health Care, the organization formerly known as Prince. No wait, that used to be called the University of Iowa Hospitals & Clinics. They’re rebranding.

I was looking up CIU on the web. It’s a common search term now, so Roger Kathol, the guy who built the CIU at Iowa Health Care, was right.

On the other hand, I was also puzzled when the results showed that a hospital in Wisconsin has what’s called a brand new CIU-only it’s not a psychiatric unit.

I thought a CIU was, by definition, a combined specialty unit, with facilities for acute care of both psychiatric and medical problems. But Froedtert Medical Center in Milwaukee has a new CIU and yet says: “The department is licensed as a Medical Unit – not a Psychiatric Unit.”

In fact, Medical College of Wisconsin says essentially the same thing about the CIU: “Please note that the CIU is not an inpatient psychiatric unit, but rather a facility dedicated to integrated care.”

OK, so I probably missed the memo about what a CIU is nowadays. It’s tough to find out how many CIUs are in operation in the U.S., maybe partly depending on how you define it and who you ask. Anyway, this is what I wrote about them 12 years ago:

The Complexity Intervention Unit for Managing Delirious Patients

Is there such a thing as a specialized unit in the general hospital where patients with delirium could be treated, where both their medical and behavioral issues could be managed by nurses and doctors specifically trained for that purpose? It turns out there is. Although they are usually called medical-psychiatry units, an internationally recognized expert about designing and staffing these specialized wards, Dr. Roger Kathol, M.D., F.A.P.M., would prefer to call them “Complexity Intervention Units” (CIUs). It’s a mouthful, but it’s a better description of the interaction between physical and psychiatric illness, along with social and health care system challenges typically managed in these units.

We’ve had one at Iowa since Dr. Kathol started it in 1986. It was one of the first such units built and now that it has been redesigned, updated, and beds with cardiac monitors added, it’s arguably the only unit of its kind in the country. The CIU allows us to provide both intensive medical and psychiatric interventions that would be all but impossible to deliver on general medical floors with psychiatric consultation. The essential features of the CIU include:

  1. Both medical and psychiatric safety features in the physical structure.
  2. Consolidated general-medical and psychiatric policies and procedures.
  3. Location in the general hospital under medical bed licensure and with psychiatric bed attributes.
  4. Moderate-to-high medical and psychiatric acuity capability.
  5. Physicians from combined residencies general medicine and psychiatry co-attending model with consistent communication and coordination of medical and psychiatric care.
  6. Nurses and other staff cross-trained in medical and psychiatric assessments and interventions.

The unit is used to optimize management of a variety of patients with both medical and psychiatric diagnoses. The focus is on providing care for the 2%-4% of patients admitted to general hospitals who are too complicated to manage on either psychiatric or medical units. And it’s an excellent teaching resource for helping new doctors learn about the inevitable interaction between medical and psychiatric disorders in an environment that fosters both/and thinking. Trainees learn that delirium mimics nearly every other psychiatric disorder and how to distinguish delirium from primary psychiatric illness.

I co-staff the unit with a colleague from internal medicine when I’m not staffing the general hospital consultation service. That helps me blend the perspectives of each role. Often, acting in the role of psychiatric consultant, I can assist the generalist in managing patients with less complicated delirium without transferring them to the CIU. And for those whose behavioral challenges would be overwhelming for nurses and physicians on open medical units, it’s helpful to have the CIU option available.

While the CIU is a great resource for managing delirious patients, they are expensive to build and generally have a limited number of beds. So it’s still important to continue work on developing practical delirium early detection and prevention programs in every hospital.

Plate!

I was listening to the Big Mo Blues Show last night on KCCK radio, 88.3 on your FM dial. I didn’t hear him mention his favorite cook, May Ree. She cooks hand-battered catfish; it’s better because it’s battered. Often, he’ll add a little to the legend, like where you can find May Ree’s establishment where you can buy her hand-battered catfish, which is filled with nitrates, cooked to perfection with manic delight, and which you can pair with any one of three flavors of moonshine, including the famous Classic Clear.

I don’t know whether Classic Clear has fruity, nutty, or extraterrestrial notes. You’ll have to try to find her joint, which is somewhere at the intersection of a highway and a street the name of which I can never recall. The story gets a new variation every now and then. May Ree has many facets to her character.

May Ree actually reminds me of the head cook at Huston-Tillotson College (now Huston-Tillotson University) in Austin, Texas. Back in the 1970s, I was a student there for a while. The head cook in the college cafeteria was Miss Mack. I don’t think you could say she cooked anything with manic delight. In fact, some of us were regular visitors who rushed with manic delight to Church’s Chicken because the H-TC cafeteria didn’t always serve what you’d call top of the line fare.

I guess Church’s want to call themselves Church’s Texas Chicken these days, mainly because they got the business started in San Antonio. Back in the day, Church’s Texas Chicken was a five-minute walk from the college. I checked a map recently, and now there isn’t a joint within an hour’s walk.

Anyway, I was a fairly frequent customer to Church’s Texas Chicken. You didn’t have a whole lot of choices about what to select. In fact, I don’t recall that there was a selection, per se. What you saw was what you got.

Sometimes, certain students were pretty frank about what they thought of Miss Mack’s cooking. One day, a guy who was fed up, in a manner of speaking, of course, held up his plate so that it was vertical, and weirdly, none of the food slid off. It just stuck there, like it was sort of a sculpture of a meal.

And then he called out loudly to everyone else in the cafeteria (not that there were many people there) as if he were offering to give to anyone there:

“Plate!” (no takers). “Plate!” (still no takers). “Plate!” (students just ignored him, but started making funny looks at their own plates).

I don’t remember what happened, but I think he just left his plate on the table and departed. I doubt Miss Mack was there. I was ambivalent about the whole deal. I liked Miss Mack, as did a lot of other students. She was kind and always had a bright smile for us.

Maybe he made a run to Church’s Texas Chicken. Funny, I didn’t see him there.

Who Gets the Credit?

When I think about peak moments, I remember this guy back in junior high school who decided to try to break the Guinness Book of World Records for skipping rope. I don’t remember his name but the school principal and his teachers all agreed to let him do it during class hours. They marked out a little space for him in our home room. He was at it all day. And he was never alone because there was always a class in the room throughout the day. We didn’t get much work done because we couldn’t keep our eyes off him. It was mesmerizing. The longer he jumped, the more we hoped. We were very careful about how we encouraged him. We didn’t want to distract him and make him miss a jump. And so we watched him with hope in our hearts. It was palpable.  As he neared the goal, we were all crowded around him, teachers and students cheering. He was exhausted and could barely swing the rope over his head and lift his knees. When he made the time mark, we lifted him high above our heads and you could have heard us yelling our fool heads off for miles. Time stood still. He was a hero and we were his adoring fans. It didn’t occur to us to be jealous. His achievement belonged to all of us.

In 2016, an article was published in Psychosomatics, the official journal of the Academy of Consultation-Liaison Psychiatry (ACLP), which detailed the success of a quality improvement program to co-manage patients with co-morbid medical and psychiatric disorders in the general hospital (Muskin PR, Skomorowsky A, Shah RN. Co-managed Care for Medical Inpatients, C-L vs C/L Psychiatry. Psychosomatics. 2016 May-Jun;57(3):258-63. doi: 10.1016/j.psym.2016.02.001. Epub 2016 Feb 2. PMID: 27039157.). This entailed making a psychiatrist an embedded member of the general medicine team in the hospital who actively comanaged medical patients.

It was so successful that it reduced length-of-stay and lost days to the hospital by a significant margin. It also supported the idea of liaison psychiatry. Dr. Muskin visited the University of Iowa Hospital Department of Psychiatry and gave a Grand Rounds presentation about the project. It also was funded in large part by a philanthropic donation. Who gets the credit? It doesn’t matter because the achievement belonged to all who participated.

“It is amazing what you can accomplish if you do not care who gets the credit”-Harry Truman, Kansas Legislature member John Solbach, Ronald Reagan, Charles E. Montague, Benjamin Jowett, a  Jesuit Father, a wise man, Edward T. Cook, Edward Everett Hale, a Jesuit Priest named Father Strickland.

For the full story on the history of this quote, see Quote Investigator.