Stop Me If You Heard This One Before

I saw one of my favorite X-Files episodes the other night. It’s titled “Monday.” Mulder goes through the day repetitively doing the same things, including fumbling his chance to thwart a bank robber who blows up the bank and everyone in it, including Mulder. See the Wikipedia for a full spoiler alert but I’m going to spill the beans here anyway.

A lot of people think the idea was stolen from the movie “Groundhog Day,” which I’ve never seen. Actually, it was stolen from a Twilight Zone episode called “Shadow Play,” which I have seen.

“Monday” got good reviews overall, which is saying a lot. I never got the part about how a bank robber (Bernard) who can only land a job mopping floors would be smart enough to build a bomb jacket.

That said, the scenes are mostly everybody going through the day doing the same things over and over. Mulder and Scully both meet Bernard and his girlfriend Pam, who was always waiting outside in the getaway car and is the only one who remembers what has happened each and every time, which is about 50. Pam thinks Mulder is the key to disrupting the endless cycle. She has been trying to get Mulder to change what he does every time he walks in the bank just to cash a check and interrupts Bernard in the process of robbing the bank.

Mulder never gets it right away, but does wonder aloud that he’s getting a sense of déjà vu. Déjà vu is the sense that an experience is something you had before but could not have. The medial temporal cortex triggers the false memory and, normally, the frontal lobe says, “No, this is not a memory.”

Eventually, Mulder gets the idea of repeating to himself over and over that Bernard has a bomb and changes his approach by giving his gun to Bernard and telling him he knows he has a bomb. This approach is based on the assumption Bernard will walk out without setting off the bomb because Mulder will let him go without trying to arrest him.

Then, Scully brings Pam into the bank, and Bernard almost surrenders to Mulder, until he hears police sirens—and tries to shoot Mulder but instead kills Pam because she steps into the path of the bullet. He gives up and doesn’t set off the bomb. Pam changed the ending and notices just before she dies that it never happened in any of the previous enactments.

There’s the brain-based definition of déjà vu and then there’s a more mundane definition, both of which are in the Merriam-Webster dictionary on the web. The mundane definition is “something overly or unpleasantly familiar,” mainly about situations that happen repeatedly (“here we go again”).

We all recognize the second definition. We sometimes say or do something which we would not if we just recognized that it’ll trigger a pattern of events we would like to avoid. Something has to change in order to interrupt the pattern.

Psychiatrists and psychotherapists are usually experts in helping people change repetitive, maladaptive patterns of thought and behavior.

Medications can be helpful, for example in the repetitious thoughts and behaviors of obsessive-compulsive disorder (OCD). Some cases of that may respond better to a combination of psychotherapy and medication.

One of the challenges is that there are not enough helpers to help those who need it. Another challenge is that the ones who need help often don’t recognize they need it. That’s called lack of insight.

The cycle of lack of insight and unpleasantly familiar, repetitive patterns sometimes resulting in explosive consequences is ubiquitous in our society.

Can somebody please bring Pam into the consulting room?

How to Find Covid-19 Vaccine Availability By County

I’m finding out that maybe the best way to learn what the local public health issues are concerning Covid-19 infections as well as vaccine availability are through the county public health agency in my area.

According to the Johnson County Public Health department, hospital admission rates in Johnson County currently low. I can search the map and see that admissions are rising in certain areas of Iowa.

I also learned that the new Covid-19 vaccine will more likely be available closer to the end of the month or early next month rather than in a few days as suggested by presenters at the CDC meeting on September 12, 2023.

The county public health agencies may not have the most current information. Johnson County’s last update as of yesterday was September 1, 2023.

You can also check local pharmacies for availability of the Covid-19 vaccine.

This is National Suicide Prevention Week

Thanks to Dr. H. Steven Moffic for his Psychiatric Times article, “A Psychological Autopsy on My Only Patient Who Died by Suicide.” In it he describes his own experience with a patient who committed suicide. He also reminded us that this is National Suicide Prevention Week. It’s also National Suicide Prevention Month.

The quote I’m familiar with about psychiatrists and patients who die by suicide Moffit is by forensic psychiatrist, Robert Simon:

“There are two kinds of psychiatrists—those who have had a patient die by suicide and those who will.”

I have been through that experience. It led me to focus on my role as an educator to psychiatry residents and other trainees to learn as much as I could about the process of suicide risk assessment.

On the other hand, my first experience with someone who died by suicide happened long before I became a psychiatrist. It was in the early 1970s and I was working for a consulting engineer company. I was just a kid, learning on the job to be a drafter and surveyor’s assistant.

One of my teachers was a man I would come to respect a great deal. Lyle was a land survey crew chief and part time photographer. He was gruff, but kind and had a great sense of humor. We all liked him.

He was so tough that, while perched high in a tree and trimming a large branch to enable a line of sight for the instrument man running a theodolite (used to measure vertical and horizontal angles)—he accidentally cut a significant gash in his hand. We on the ground were aghast because blood was dripping from his hand.

He just laughed and said, “I don’t sweat the small stuff.”

One day, he told me and another survey crew member that his girlfriend left him, saying she was tired of picking up after him. He was crying. We felt sorry for him and didn’t know what to say. We never saw him cry before. This image was strikingly different from the tough guy persona he usually had.

As I look back on it, I wondered why he didn’t think the breakup was just more “small stuff.”

The next day, one of the leaders of the company made a short announcement, saying that Lyle had “passed away,” the night before, by suicide. A little later, the rest of the story gradually emerged. Lyle had shot himself in the chest. One of the guys said that it took a long time for him to die, that somebody found him early the next morning, and all Lyle could say was “It hurts.” At first, I thought he meant physical pain. Later, I wondered if he meant physical and emotional pain.

About a week later, one of the survey crew members was planning to pick me up and drive us to Lyle’s funeral. He never showed up.

Of course, I could not have foreseen Lyle’s suicide based on his being so upset about a breakup with his girlfriend. I was just a kid.

When I became a psychiatrist, I saw this quite a lot. I learned, a few times the hard way, how to make the best judgments I could about what might happen to a patient describing physical and emotional pain.

CDC Recommends Updated COVID-19 Vaccine This Fall-Winter Season

The CDC has posted a press release announcing that it has recommended the updated COVID-19 vaccine for the fall/winter virus season.

CDC ACIP Meeting Today on Covid-19 Vaccines

Today is the scheduled meeting for the CDC Advisory Committee on Immunization Practices (ACIP). It meets from 10 AM-4 PM EDT. The final agenda is here.

The presentation slides are at this link.

I also want to recommend the recent article on the new Covid vaccine published in Scientific American on September 1, 2023, entitled “When Will the Next COVID Vaccine Be Available, and Who Should Get It?

I think it’s a nice, balanced article which avoids extreme opinions and sticks to the scientific facts.

FDA Authorizes Updated mRNA Covid-19 Vaccines

Today, the FDA approved and authorized the updated mRNA Covid-19 vaccines, specifically for the monovalent XBB.1.5 variant.

See the announcement on the FDA website for full details. The CDC ACIP will meet to discuss clinically-based recommendations for the use of these vaccines tomorrow.

22nd Anniversary Commemoration of 9/11 Attacks

The 22nd Anniversary Commemoration of the 9/11 attacks and the 1993 World Trade Center will be observed today.

I remember where I was on September 9, 2001. I was climbing the stairs at the hospital on my way back to my office. I was on duty on the psychiatry consultation service. I happened to glance at the television in the lobby from the landing. A news story was showing one of the Twin Towers on fire.

I couldn’t believe my eyes. The rest of the day there was talk of the attack on America.

We visited New York City in 2017 and viewed the Memorial & Museum Plaza. We saw the Survivor Tree, the Callery Pear.

It seems like there is almost nothing else to remember about the date except the disaster and the tragedy.

But one of the local fire stations not far from our house has a Flag of Honor on the wall. It honors those killed in the terrorist attacks on 9/11.

Even if we can’t go to the Memorial in New York City, we can remember it and honor the brave.

Clumsy Juggling

We decided to kick it up a notch with our two-person ball passing juggle routine. We switched out three of the bean bag Zeekio balls for some glowing LED juggling balls.

The LEDs are bigger and heavier than the bean bags, which led to more challenging passes. They also look better in low light, so it was a little harder to see the balls flying at us. We really didn’t know when we’d have to change our grip—so we often ended up losing our grip.

Clumsy juggling is fun juggling.

CDC Update on SARS CoV-2 Variant BA.2.86

New update on the Covid-19 variant BA.2.86 as of Sept. 8, 2023. Highlights:

  • “The current increases in COVID-19 cases and hospitalizations in the United States are not being driven by BA.2.86 and instead are being caused by other predominantly circulating viruses.
  • Early research data from multiple labs are reassuring and show that existing antibodies work against the new BA.2.86 variant. These data are also encouraging because of what it may mean for the effectiveness of the 2023-2024 COVID-19 vaccine, which is currently under review. That’s because the vaccine is tailored to the currently circulating variants.
  • Since CDC’s initial risk assessment, BA.2.86 has been identified in additional countries from both human and wastewater specimens. The variant has been identified in nine U.S. states as of September 8, 2023, at 11:30 AM EDT— in people across Colorado, Delaware, Michigan, Ohio, Pennsylvania, Virginia, and Washington, as well as one additional human case that is being investigated. The variant has also been identified in wastewater samples in two states, New York and Ohio.
  • The U.S. SARS-CoV-2 Interagency Group (SIG) classified BA.2.86 as a Variant being Monitored (VBM) on September 1, 2023.”

Two Person 5 Ball Passing Jitterbugging Juggling!

Sena and I are going to break the internet with another video of two person juggling! OK, so maybe we won’t exactly break the internet—but we might give it a nosebleed. We had to think of a way to top our recent side hug version of tandem juggling with 3 balls. So, we tried the 5-ball passing juggle pattern.

This one was also inspired by Niels Duinker and his sidekick Piet. On the other hand, it was difficult to get started at first. I found the video tough to follow and was dumbfounded on how to even get started.

Overthinking can put the brakes on any endeavor. Once we just got rolling and quit sweating the details, the pattern just seemed to flow. You have to give it your undivided attention. And you both have to be able to juggle the 3-ball cascade.

There are a couple of rules to remember. The jugglers face each other rather than stand side by side. One juggler tosses balls straight to the partner while the opposite partner tosses them back diagonally to the partner’s opposite hand.

In this pattern, I start with 3 balls, 2 in my right hand and one in my left. Sena starts with 2 balls, one in each hand. The person with 2 balls in the right hand starts by tossing one ball straight to the partner’s left hand. The partner must toss the ball in her left hand (to empty it so she can catch the ball flying in) across to the other’s left hand. One person always throws diagonally and the other always throws straight across.

Even saying that is confusing. You really have to see it and that’s why we included a slow-motion clip. There’s a sweet spot in the distance between jugglers. If you’re too far apart, there’s a tendency for throws to be too long and either too high or too low. There’s a juggle space between you and your partner just as there is for you alone. It’s a little wider, but not much, because lobbing it upwards more than tossing it in a shallow arc duplicates juggling by yourself.

The more we practiced, the smoother and easier the pattern felt. I tend to jitterbug around while Sena tends to stand solidly in place. Nevertheless, we both compensate for imperfections in our throws.

The result looks almost like dancing.