James Amos

Should Doctors Be Funny?

I ran across an interesting Medscape article, “Should Doctors Be Funnier? These MDs Are Real Comedians.” I don’t know if they should be funny, but it probably wouldn’t hurt.

I think a sense of humor is a good thing for anyone to have and it’s probably not that hard to develop. There’s even a Wikihow article on how to develop a sense of humor.

I usually look for the funny edge in most things that happen to me. I was always very nervous about presenting Grand Rounds when I was on staff at the hospital. I would try to come up with a good case example illustrating both medical and psychiatric features. It was pretty challenging.

I often used humor to help me get through my stage fright. I didn’t tell jokes, but I did clown around a bit. One day, I arrived too early for the Psychiatry Dept. Grand Rounds and accidentally walked in on another scheduled event in the conference room that was obviously not for psychiatrists—only not immediately obvious to me. I got a few chuckles from the audience just from having to back out. Later, during the real Grand Rounds I clowned about my mistake as a sort of opener to my presentation.

Unfortunately, I then had to stumble through my PowerPoint slides (every presenter’s worst nightmare) because I evidently had not organized them correctly. I survived by joking about it. That resulted in a digital award from the residents for being “Improviser of the Year.”

Humor can get you through some pretty sticky situations.

Another Blast from the Past

Today is Labor Day, and I was looking at some of my old blog posts from my previous blog The Practical Psychosomaticist. I found one that I think I haven’t reposted on my current blog called “Going from Plan to Dirt.”

It’s a funny post, at least I think so. It draws a comparison between blue collar and white collar work, similar to what I did the other day (“Why Can’t I Wear Blue After Labor Day?”).

I wrote it in 2011, when I was on a hospital committee to improve detection and prevention of delirium in the general hospital.

“Our work on the Delirium Early Detection and Prevention Project reminds me of my early formative experiences working as a draftsman and land survey technician starting in 1971 with an engineering company, Wallace Holland Kastler Schmitz & Co. (WHKS & Co.) in Mason City, Iowa. I remember being amazed at how a drawing on paper could be turned into a city street, highway, bridge, or airport runway. They have a website now. I can now find written there what was modeled for me then:

“WHKS & Co. is committed to the continuous improvement of the quality of service provided to our clients.”

Then and now WHKS & Co. worked hard to create the infrastructure that we depend on and then put it into the world in a “safe, functional, and sustainable” way. Out in the field we sometimes joked about how a designer’s drawing was flawed if we couldn’t go from plan to dirt.

It’s common to believe that engineers and land surveyors deal with complex mathematical formulas, structural materials, things instead of people—an applied science in which the emotions and motivations of people play a small role. Nothing could be further from the truth.

I was 16 years old when WHKS & Co. hired me. I had no idea what engineers and land surveyors did, had no experience, and I was at a crossroads in my life. They didn’t hire me because I had any talent or asset they needed. They hired me because they were as committed to the people in the community, not just to things.

And if you think land surveying doesn’t have anything to do with people’s emotions, consider property line disputes. The survey crew I was attached to had been sent out to find the property corners of two neighbors. This involves locating iron pins that mark the corners of the lots that houses sit on. Little maps or “plats” are used as guides and let me tell you, often enough we found the map is not the territory.

Anyway, while we were out there in the back yard of one of the neighbors, they both came outside. One of them was a diminutive elderly lady and the other was a tall, big-boned elderly man. They started arguing about the boundaries of their lots and it got pretty heated. Pretty soon they were yelling in each other’s faces and the lady reached down in the garden in which we were all standing. She picked up the biggest, juiciest rotten tomato she could find and it was clear to us what she planned to do with it. They were both pretty old and neither one of them could move very fast. My crew chief, sensing that something violent was about to happen, moved in between them (a decision I still can’t fathom to this day).

What followed seemed to happen in slow motion, in part because the combatants were so old. The man could see the lady was about to hurl the rotten tomato at him. Ducking must have been beyond his power, probably because of a stiff back. He bent his knees and leaned forward. She cocked the tomato as far back as she could and let fly, screeching, “You’re nothing but an old Norwegian!” My crew chief probably caught a seed or two. Amazingly, the tomato only grazed the top of the man’s head.

I think the altercation took a lot of both of them. They both went back in their houses after that.

It’s not hard for me to see the connection between my past and the present. WHKS & Co. was and still is committed to continuous improvement. And they were and still are all about finding a practical way to do it. If we’re going to improve the quality of care we provide patients and we propose to do it by preventing delirium, we’re going to have to use the same principles that my first employer used. And we’re going to have to be just as practical about how to go from plan to dirt.

We’re still trying to refine the charter for our delirium detection and prevention project, which is a kind of map, really. And even though the map is not the territory, it’s still a necessary guide to remind us of the goal.”

Men in Black Movies on Cable TV This Month!

I’m pretty excited because all of the Men in Black movies are going to be on cable September 9, 2023, which is a Saturday. It’s on Paramount HD and several other streaming services. They start with the original Men in Black at 10:30 a.m. (Central Time), which I don’t care for. The other three sequels run right behind it in sequence. But then they restart at 5:30 PM—which means I would need to stay up way past my bedtime.

The one movie in the series you can see almost every night is the 4^th sequel, Men in Black International. The other 3: Men in Black, Men in Black 2, and Men in Black 3 all seem to run every couple of months on cable or streaming services.

Anyway, I almost never miss an opportunity to watch the first 3 whenever I find out they’re on. I watched the 4^th one a couple of times and that was enough. I like the chemistry Will Smith and Tommy Lee Jones had.

There’s an article on the web you can read to get up to speed on the movies. I disagree with the author on one point. Technically speaking, it was not Agent J who neuralyzed Beatrice. It was Agent K who zapped her with his neuralyzer. Agent J just refined Agent K’s memory adjustment script, which made it a team effort.

The AARO Finally Has a Website And is it Part of a Zero-Sum Game?

The All-Domain Anomaly Resolution Office (AARO) finally has a website—more than a year after it was formed.

It looks like there’s an intriguing message in the section “Coming Soon: US Government UAP-Related Program/Activity Reporting.” It says AARO will accept reports of UAP from current government employees who know of any programs or activities related to UAPs dating back to 1945.

One sentence tells you “This form is intended as an initial point of contact with AARO; it is not intended for conveying potentially sensitive or classified information. Following the submission of your report, AARO staff may reach out to request additional detail or arrange for an informational interview.”

Several other sections provide further information and pictures and videos on UAP.

I wonder if all this is a reaction to the House Oversight Committee Hearing on UAP on July 26, 2023. Either the website has been under construction for all of last year and was just finished a couple days ago or it was just thrown together recently.

This makes me think of a couple of things, one is Dr. George Dawson’s blog post “Is This An Episode of the X-Files?” The other is an X-Files episode itself, “Zero Sum” which Sena and I just saw a couple of nights ago. We don’t remember seeing it when it first aired in 1997. You can read the Wikipedia article about the episode.

The gist of it is that Assistant Director Skinner makes a deal with the Smoking Man in which the latter will save Agent Scully’s life (she’s dying of cancer related to alien experiments) if Skinner hides the death of a postal worker who was killed by a swarm of bees carrying smallpox. This is part of a complex plot by a group called the Syndicate which is either trying to work with extraterrestrials to either exterminate the human race or save it (depending on which episode you watch) by using bees as a vehicle to transmit either smallpox or a vaccine to cure the Black Oil, which screws you up pretty bad. Part of this is my interpretation because the storyline sometimes is not clear about this to me.

Anyway, the back-and-forth actions and reactions of the characters, especially Skinner and the Smoking Man, are pretty good examples of a Zero-Sum game, loosely defined in that neither gets much of an edge on the other as they both try to counter each other’s efforts in what is probably just a power struggle from the Smoking Man’s perspective and a desperate effort to save Scully’s life from Skinner’s perspective.

Anyway, I wonder if the UAP reporters and the government (including the AARO) might be in some kind of zero-sum game. UAP reporters try to get the government to admit that Extraterrestrial Biological Entities (EABs) and Extraterrestrial spacecraft exist. But the government denies it. Neither side ever seems to get much further ahead of the other.

Why Can’t I Wear Blue After Labor Day?

I have a few thoughts on the upcoming Labor Day weekend. It occurs to me that Labor Day often evokes images of blue-collar workers. On the other hand, I think in a broader view of the holiday, most of us can think of ourselves as working toward improving our society no matter whether our jobs are in the white-collar or blue-collar sector.

Many eons ago, I was a blue-collar worker. I was a surveyor’s assistant and drafter for a consulting engineers’ company in Mason City, Wallace Holland Kastler Schmitz & Co. (WHKS & Co.). I got attached to my job because it was the first real job I ever had.

I was proud of what I did, even though I didn’t make much money. I had to travel around the state a lot. I lived at the YMCA and ate all my meals in cafes because I was often out of town on jobs and when I was not, there was no kitchen in my tiny sleeping room at the Y.

I wore blue jeans and tee shirts, flannel shirts when I wasn’t out in the hot sun. I liked being outside except when the ragweed was out in the late summer. I had bad hay fever. I tried desensitization shots, but all they did was make my arm swell up. Winters were cold, especially if I had to stand in one place for a long time, either holding up the rod or running the gun.

I was mostly a rear chain man and rod man early on, but moved up to “running the gun” which meant operating the level and theodolite, the former for measuring elevations and the latter for measuring angles. I was proud of my job.

It took me a while to transition from blue-collar to white-collar mindset. In college, I often returned to work for WHKS during the summer breaks. That was where I formed my identity.

Some aspects of the job were simple. You hammered a stake, an iron property marker, or a frost pin if the ground was frozen. Measuring distances, angles, and elevations were often repetitive tasks, yet satisfying because they marked progress toward a concrete goal, like building an airport runway, establishing the outline of a tract of farmland, or raising a bridge. As one of my bosses on the survey crew put it, the work helped you see “the lay of the land.”

Land surveying, mapping, and drawing up plans set my perspective on life when I was a young man. At one time, that perspective made me think I wanted to be an engineer. I respected engineers because they built the subdivisions, highways, dams, and other real things from ideas.

I respected my teachers at WHKS, but couldn’t do the math. And they respected my change of heart.

I eventually became a doctor, after a short stint as a medical technologist in clinical laboratory medicine. You’d think, given my hands-on background, I would have become a surgeon, but I wasn’t made for that either.

I learned basic things at WHKS like being steady, reliable, and focused. I had to learn other things to be a doctor, especially a psychiatrist. On the other hand, in this white-collar environment, especially in a research-oriented academic medical center, I often looked and acted more like a blue-collar worker.

One of the Family Medicine residents who rotated on the psychiatry consultation-liaison service left me a gift of a fireman’s helmet. It fit my head and my approach to psychiatry in the general hospital. What I did mostly was put out the fires, metaphorically speaking, of behavioral eruptions related to delirium which were caused by medical problems. Often, I had to apply blue-collar approaches in a white-collar world. So, can I wear blue after Labor Day?

Happy Labor Day.

CDC Update Today on Covid-19 Variant BA.2.86

Today’s update by the CDC on the Covid-19 variant BA.2.86 is at this link.

Highlights:

“The variant has been identified in at least four states in the United States in samples from either people or wastewater.
This variant is currently being studied in the laboratory to help understand how the immune system may interact with this virus.
The current increases in cases and hospitalizations in the United States are likely being driven by infections with XBB lineage viruses, not the new BA.2.86 variant.”

“CDC’s current assessment is that the updated COVID-19 vaccine, which will be available in mid-September, will likely be effective at reducing severe disease and hospitalization. Immune responses generated from prior infection also help protect against severe outcomes of COVID-19. There is currently no evidence that this variant is causing more severe illness. That assessment may change as additional scientific data are developed. CDC remains committed to releasing updates on trends and observations of this variant.”

“Immune Impacts: Approximately 97% of the U.S. population has antibodies to SARS-CoV-2 from vaccination, previous infection, or both (hybrid immunity). Immune responses to vaccines and infections are complex and involve both humoral (antibodies) and cellular immunity. It is likely that the humoral and cellular immune responses will continue to provide protection against severe disease from this variant. Laboratories are currently working on measuring antibody neutralization of BA.2.86 as well as other immune responses. This is an area of ongoing scientific investigation.

Therapeutics: The assessment as to the impact of BA.2.86 on currently approved or authorized therapeutics is unchanged. Examination of the mutation profile of BA.2.86 suggests that currently available treatments like nirmatrelvir-ritonavir (Paxlovid), remdesivir (Veklury), and molnupiravir (Lagevrio) will be effective against this variant. This assessment is from the SARS-CoV-2 Interagency Group (SIG), which comprises experts from multiple United States government agencies. Monitoring is ongoing, and CDC will update this document as additional data on the impact of this variant on therapeutics become available.”

Press And Hold on The Keurig Coffee Maker

We got our new coffee maker. It’s a Keurig K-Supreme Plus, and it’s as fancy as the name sounds. It’s compact enough to save room for our other coffee maker, a Black & Decker, a model with a carafe and which you have to press and hold the “On” button to start the cleaning mode.

It has options for making your coffee stronger and hotter and you can save your choices.

You can save 3 favorites. You have to press and hold the “Favorite” button until you see the word “saved” in the little window.

I emphasize the “press and hold” because if you don’t strictly obey the rule, you can wind up thinking your brand new appliance is defective.

It does make the coffee hotter. But I think Sena will be looking into other options for cups which will keep the brew hotter for a longer time.

The Keurig coffee makers are normally pricey but Sena got a bargain. And there is nothing wrong with the press and hold maneuver when it comes to your wallet—as in hold it shut.

X-Files Notes: Alex Krycek Is Not from Tunguska

Sena and I used to watch the X-Files back in the 1990s, but I must have missed quite a few of them. My memory is at best spotty for a lot of episodes, probably because I was on call a lot as a resident and as a psychiatry faculty member at the hospital.

The other night I saw the Tunguska episode in which Mulder travels to a gulag in Russia to investigate the black oil contamination, which was of extraterrestrial origin. A lot of the episodes had titles which I had to look up on the internet to find out what they meant. Anyway, a rock of extraterrestrial origin is found and becomes the subject of an intense search after black oil spurts into the face of a scientist who was dumb enough to poke a drill in it and who then becomes catatonic.

Actually, if I have the Wikipedia facts right, the episode was not inspired by the Tunguska explosion in a place called Tunguska, Siberia in Russia in 1908. There’s a recent story about it posted on the web in June of 2023. The gist is that a large asteroid impact killed animals and destroyed millions of trees in the area. The mystery didn’t leave a crater, though. At one time, some people thought the devastation was caused by a crashing extraterrestrial spacecraft. Long story short, a similar event occurred in 2013 and the explanation is that the asteroid broke apart 15 miles above the ground, generating a massive shock wave that injured thousands of people and blew out a lot of windows. The importance of it is that events like that can occur every several hundred years, making it important to plan on how to prevent them.

OK, so the other science fact pertaining to the X-Files episode is that, despite it being named for the Tunguska episode, it was actually inspired by the Allan Hill 84001 event, which was the discovery of a Martian meteorite in the Allan Hills in Antarctica in 1984. In 1996 scientists thought they found fossils of bacteria in this rock, which led everybody to think this meant there had been life on Mars. Even United States President Bill Clinton made a speech about it, although later he was more often connected with a blue dress than with black oil. Eventually, there were other features of the rock which led to abandoning the idea that the features were bacteria fossils.

Confused yet? The black oil contamination thing is a weaponized extraterrestrial substance which infects humans and against which the Russians and the Americans were both working on a vaccine to combat it. As far as I know, neither planned a vaccine mandate.

This is a two-part show and, get ready for more confusing titles, the title of which is “Terma.” The episode has a tagline, “E pur si muove,” (instead of the usual “You can’t handle the truth!” No wait, it’s actually “The truth is out there”) which is not translated in the show, but which means “And yet it moves.” That’s about Galileo’s investigation of whether the Earth moves around the sun or vice versa. Galileo said the Earth moves around the Sun, but the Roman Inquisition forced him to recant it because the religious dogma was opposed to heliocentrism. He did but under his breath he supposedly mumbled “And yet it moves.” Galileo probably had Oppositional Defiant Disorder as a child.

I’m not sure what the tagline “E pur si muove” means in this context. This is just my guess, but maybe it refers to the persisting opposition of Mulder and Scully to the government hiding the “truth” of the existence of extraterrestrials.

I found out that terma (the word means “hidden treasure”) is a set of Buddhist secret teachings that are hidden from the world. A terma could be a text or object (like a rock) buried in the ground or a crystal, perhaps hidden in space. In the end, an old KGB agent manages to destroy the rock by blowing it up. He gets away and returns to Russia where he finds a guy named Alex Krycek waiting for him and who has an artificial left arm (with which he uses to stir tea) and who congratulates him on his success.

Now this Alex Krycek guy is a known villain who is in and out of X-Files episodes, even coming back from the dead. He’s this traitorous, murdering, lying devil who, judging from Mulder’s reaction to him every time he sees him, is Mulder’s favorite punching bag. This is partly because Krycek probably killed Mulder’s father.

But in this and every other episode in which they meet, Mulder evidently gets a charge out of repeatedly smacking Krycek. A typical interaction would be Mulder seeing Krycek, and then punching the crap out of him while grinning with great satisfaction. Notably, in just about any other fight Mulder gets into with anyone who is not Krycek, it’s Mulder who typically gets beat up. But the usual exchange with Krycek goes like this:

Mulder goes into a bar. Mulder sees Krycek. Mulder whops the stuffing out of him, just for the heck of it. Mulder gets tired and says:

“I’m tired of whopping the stuffing out of you, Krycek. I’m also hungry; so, while I snack on these sunflower seeds I’m incessantly eating in every episode—beat the crap out of yourself right now!”

And then Krycek beats himself up.

The only way to understand their relationship is to assume that Krycek is the worst turncoat double agent and compulsive liar you ever met and typically works for anyone who offers him the most money including most terrestrial countries and any extraterrestrial governments bent on taking over every fast-food franchise on the planet earth (“Yeah, I’ll have the mutilated cattle burger with black oil sauce, three and a half pickles, cheese, ketchup and secret vaccine on the side”).

If you have cable, you can see X-Files on the Comet network.

CDC ACIP to Discuss Covid-19 Vaccines on September 12, 2023

The CDC Advisory Committee on Immunization Practices (ACIP) has a scheduled meeting on September 12, 2023 to discuss Covid-19 vaccines. The information about it is a bit difficult to find. It’s announced as a notice on the Federal Register. On the agenda:

Matters To Be Considered: The agenda will include discussion of COVID–19 vaccines. Recommendation votes for COVID–19 vaccines are scheduled. Agenda items are subject to change as priorities dictate. For more information on the meeting agenda, visit https://www.cdc.gov/vaccines/acip/meetings/index.html.

Clicking the link as of August 28, 2023 did not reveal a meeting agenda, but I expect this to be updated in the near future.

“I Have a Dream” Speech 60 Years Later

Today is the 60^th anniversary of the Reverend Dr. Martin Luther King Jr’s “I Have a Dream” speech at the Lincoln Memorial in Washington D.C.

I was too young to remember it. However, I have a deep appreciation of the meaning it has not just for Black people, but for all of us. It’s not difficult to broaden the implication for all people.

My personal reflection about this started this morning with a look at one of my primary school class pictures. I’m the handsome guy 2^nd from the left in the top row. The other kids of color in the photo are Latino.

The photo shows not just a group of kids. It also illustrates, just by chance, pretty closely the percentage of black persons in the state of Iowa as of the 2021 U.S. census, about 4%. Historically though, in the county in which I was living at that time, the percentage of nonwhite persons was listed at 0.4%. This was a 28% drop from the previous decade. In 1980, the percentage of Black people in the state was only 1.8%. As near as I can tell from the web, the current percentage of Black people as of the most recent data is 3.74% (possibly as of 2021).

My father was black and my mother was white. In Iowa, the law against miscegenation (marriage between blacks and whites) was repealed in 1839. On the other hand, my parents got their marriage license in 1954 in Watertown, South Dakota—which was 3 years prior to when that state repealed its law against interracial marriage. Right below the license, though, is a certificate of marriage marked State of South Dakota in Codington County. It certifies that my parents were married in Mason City, Cerro Gordo County in the state of Iowa.

I’m not going to try to puzzle that one out. My mother kept a lot of old photos and legal records that anchor me in my personal history.

I have photos of my father with me and my brother, Randy. I also have photos of my mother with me and my brother.

What I don’t have are photos of all of us together. It’s understandable to ask why. I wonder if it has something to do with the culture and mindset of the time. Why was it not possible to find someone, black or white, to snap a family photo of us together?

We can pass legislation repealing anti-miscegenation laws as well as other laws to protect civil rights. That is a necessary (but perhaps insufficient) step toward non-exclusion of certain groups of people from basic human rights.

Ashley Sharpton, who is an activist with the National Action Network and daughter of Reverend Al Sharpton, said that Americans need to “turn demonstration into legislation.”

I agree with her. On the other hand, I also wonder what more has to happen in the minds of all of us to turn legislation into transformation—of our personal implicit biases, which are not in themselves always bad or inescapable.

And since we’re into rhyming, what about asking another question? Can we turn demonstration into legislation while encouraging transformation without bitter confrontation?