Look on the Bright Side

Yesterday was the first day of Autumn. Happy Autumn! Was that too cheerful? You know, I used to watch the show Monty Python’s Flying Circus years ago. I thought it was outrageously funny.

What reminded me of the show was Sena telling me that on Wednesday night, a member of the Flying Circus cast, Eric Idle, was on The Masked Singer, one of her favorite shows. I didn’t watch it. He was Hedgehog and sang the Beatles number, “Love Me Do.” Eric said something about how you should look on the happy side of life. He mentioned there was song with that title.

We looked it up and found “Look on the Bright Side of Life.” It’s a catchy tune and reminded me of Monty Python’s Flying Circus attitude. I guess Eric Idle wrote the song and sang it on The Life of Brian.

While the song seemingly is about looking steadily on the bright side of life, it has that slightly edgy, ironic attitude to it which was typical of the Flying Circus.

While some think that the Covid-19 pandemic is over (not mentioning names), there’s probably a more balanced way of looking at that and other challenges in life. The PennStateExtension published an article on June 12, 2020, “Realistic and Optimistic: Managing Mindset in Challenging Times,” by Suzanna Windon, Ph. D, Assistant Professor, Youth and Adult Leadership, and Mariah Stollar, Former Part-Time Research Assistant, Penn State University.

Their list of ways to look on the bright side while being mindful of potential pitfalls attributable to things like overweening pride and fantasy are good to remember in these trying times (see original article by the authors for full details):

  • Practice mindfulness. 
  • Observe and adjust your patterns of thinking.
  • Believe in yourself, but do not underestimate challenges. 
  • Look forward to the future, but be realistic things may not quickly change. 
  • Keep yourself informed, but limit media intake.
  • Reflect on messages you are sending to employees, volunteers, and loved ones. ” 

    In other words, look on the bright side but don’t kid yourself.

    ‘ay, this here be international talk like a gentleman o’ fortune day

    The title of this post is a translation of “Hey, This is International Talk Like a Pirate Day.” I used a Pirate Speak translator to generate it.

    Sena reminded me about this holiday, which got started back in 1995 by a couple of guys from Albany, Oregon.

    She says she heard about it on the Mike Waters radio show this moring, Waters Wake-Up on the Iowa radio station KOKZ 105.7. Sena either heard Waters call it National Pirates Day or she misheard him. She also said that Waters denied that any pirates ever said “Arrr,” back in the heyday of pirates.

    I beg to differ, arrr, Matey! The Wikipedia entry says that the dialect was real and probably was based on the dialect of sailors from West Country in the southwest corner of Britain.

    Sena and I couldn’t find any holiday called National Pirates Day. I did find National Meow Like a Pirate Day, which, interestingly, is also a holiday today. It got started in 2015.

    But the main event be international talk like a gentleman o’ fortune day—which I darn nearrr forgot!

    I have a dim memory of writing a blog post using the pirate translator several years ago. It was on a different blog, which I canceled in 2018. I didn’t keep that particular post. I think the topic was teaching internal medicine doctors and medical students about delirium so that they would know when they actually need consultation from a psychiatrist.

    So, in honor of International Talk Like a Pirate Day, I’m going to post a piratical translation of one of my similar posts from way back in 2011:

    “Do ye ‘ave to be interested in psychiatry to volunteer fer the delirium prevention project?”

    “I’ve been thinkin’ about what a couple o’ the medical students said when I broached the idea o’ some o’ them volunteerin’ to participate in the multicomponent intervention o’ the delirium prevention project.

     they said that there the first an’ second yearrr students might want to volunteer—especially the ones interested in pursuin’ psychiatry as a career.

     now think about that there a minute. Why would ye necessarily need to be interested in psychiatry? ‘ere be a few facts:

    1.Delirium be a medical emergency; it just ‘appens to mimic psychiatric illness because it’s a manifestation o’ acute brain injury.

     2.The most important treatment fer delirium be not psychiatric in nature necessarily; the goal be to find an’ fix the medical problems causin’ the delirium.

     3.Many experts in delirium ain’t psychiatrists; the authors o’ the new book “delirium in critical care”, valerie page an’ wes ely, ain’t psychiatrists—they’re intensivists.

     4.Some o’ the best teachers about delirium be geriatric nurse specialists an’ geriatricians.

     I thought that there by reachin’ aft further into a physician’s trainin’ career, I would find people less biased toward thinkin’ o’ delirium as a primary mental illness. It turns out that there bias runs deep in our medical education system.

     it isn’t that there psychiatrists shouldn’t be interested in studyin’ an’ ‘elpin’ to manage delirium. Psychiatrists, especially them specializin’ in psychosomatic medicine, be among the best qualified to inform other medical an’ surgical disciplines about the importance o’ recognizin’ delirium fer what it is—a medical problem that there threatens the brain’s integrity an’ resilience, raises the risk o’ mortality by itself regardless o’ the medical problems causin’ it, prolongs medical ‘ospitalization, an’ makes discharge to long term care facilities more likely, especially in the elderly.

     delirium be a problem fer doctors, not just psychiatrists. So it makes sense fer all medical students, regardless o’ their goals fer career specialty, to be interested in learnin’ about delirium.

     delirium be also a problem fer nurses, who frankly ‘ave led the way in education about delirium fer many years now. You’ll find few experts pointin’ to the american psychiatric association practice guidelines fer the treatment o’ delirium as the ultimate authority these days—because they’ve not been updated formally since 1999. All one ‘as to do be spell out “delirium prevention guidelines” in web browser search bars an’ choose from several sets o’ free, up-to-date guidelines that there be supported by the research evidence base in the medical literature to within a yearrr or two o’ the present day. Some o’ the best ones be authored by nurses.

     so maybe the pool o’ volunteers fer the delirium prevention multicomponent intervention might be nursin’ students.

     on the other ‘and, from what pool does the ‘ospital elder life program (help) recruit volunteers? an’ the australian resource center fer ‘ealthcare innovation multicomponent program, revive (recruitment o’ volunteers to improve vitality in the elderly, ‘ow do they do it?

    they think outside the box an’ include people who care about people. That’s the really the key criterion, not whether one wants to be a psychiatrist or not.”

    ‘appy international talk like a gentleman o’ fortune day, arr, matey!

    Ever See Bigfoot Splooting?

    I wonder if anyone ever got a picture of Bigfoot splooting? Why not? It’s a large furry animal which has no way of cooling off other than by panting or lying on its belly with its limbs splayed out, which is the definition of “splooting.”

    I found a news item about splooting squirrels and quickly found other examples of animals who sploot including but not limited to bears, dogs, and rabbits.

    The word “sploot” turns up on a web site called Language Log, devoted to people who study word etymology.

    And words definitely do matter, according to the authors of an opinion piece recently published in the Annals of Clinical Psychiatry (Black DW, Balon R. Words matter. Ann Clin Psychiatry. 2022 Aug;34(3):145-147. doi: 10.12788/acp.0072. PMID: 35849767).

    I agree with Drs. Black and Balon. I dislike the word “issue,” for the same reason the authors do. It’s too vague. I have the same problem with “address” which I see in many news items headlines. which doesn’t give me a clue about what kind of action is being taken to solve a problem—other than just paying attention to it.

    The word “sploot” drives my spell checker crazy. It’s not in the Merriam-Webster Dictionary. Neither is it in the Scrabble Dictionary. But it’s in the Collins English Dictionary, listed as British English.

    Why “sploot” is any better than “splayed” is beyond me. If you have a picture of a splooting Bigfoot, let me know.

    Featured image credit: Pixydotorg.

    Thoughts on Doctors Going On Strike

    I read Dr. H. Steven Moffic’s two articles in Psychiatric Times about the strike by mental health workers at Northern California Kaiser Permanente (August 16 and 26, 2022). So far, no psychiatrists have joined the strike.

    However, this piqued my interest in whether psychiatrists or general physicians have ever gone on strike. I have a distant memory of house staff voicing alarm about a plan by University of Iowa Hospital & Clinics to reduce health care insurance cost support many years ago. It led to a big meeting being called by hospital administration to discuss the issue openly with the residents. The decision was to table the issue at least temporarily.

    It’s important to point out that the residents didn’t have to strike. I don’t recall that it ever came up. But I think hospital leadership was impressed by the big crowd of physician trainees asking a lot of pointed questions about why they were not involved in any of the discussions leading to the abrupt announcement that support for defraying the cost of house staff health insurance was about to end.

    That’s relatively recent history. But I did find an article on MedPage Today written by Milton Packer, MD (published May 18 2022) about what was called the only successful strike by interns and residents in 1975 in New York. I don’t know if it included psychiatric residents; they weren’t specifically mentioned.

    In 1957, the Committee of Interns and Residents (CIR) in New York City and voted to unionize to improve appalling working conditions. They won the collective bargaining agreement, the first ever to occur in the U.S. because they went on strike, which hamstrung many of the city’s hospitals. Medical faculty had to pitch in to provide patient care.

    After 4 days, the hospitals agreed to the residents’ demands. However, the very next year, the National Labor Relations Board ruled that residents were classifiable as “students,” not employees, which meant they weren’t eligible to engage in collective bargaining. This led to a reversal of the gains made by the strike.

    Residents who are unionized voted to strike at three large hospitals in California in June of this year. They reached a tentative contract deal at that time. The news story didn’t mention whether there were any psychiatrists in the union.

    There has never been a union of residents at The University of Iowa Hospitals & Clinics. I was a medical student and resident and faculty member for 32 years. I saw changes in call schedules and work loads that were the norm for the exhausting schedules that led to horrors like the Libby Zion case in New York.

    Even as a faculty member on our Medical-Psychiatry inpatient unit, the workload was often grueling. I co-attended the unit for years and during the months I was scheduled to work there I shared every other night call with an internist for screening admissions. I was sometimes scheduled for several months at a time because it was difficult to find other psychiatrists willing to tackle the job.

    If residents had wanted to unionize and voted to strike then, my internist colleague and I probably could have filled in for them.

    But I would never have considered going on strike myself. It would have been next to impossible to find any other psychiatrist to fill in for me. And if other psychiatrists had gone on strike? We might have won a better deal—but only by hurting the patients and families who needed us.

    I suspect my attitude is what underlies the impressions shared in Robert G. Harmon’s article, “Intern and Resident Organizations in the United States: 1934-1977,” in the 1978 issue of the Milbank Quarterly.

    The house-staff choice of unionization as a formal process has disturbed some health professional leaders. One has pointed out that for a house officer to don another hat, that of striking union member, in addition to those of student, teacher, administrator, investigator, physician, and employee, may be a regrettable complexity that will further erode public confidence in physicians (Hunter, 1976). Others have seriously questioned the ethics and morality of physician strikes (Rosner, 1975). -Milbank Memorial Fund Quarterly/Health and Society, Vol. 56, No. 4, 1978.

    When I graduated from medical school, I believed in the cultural view of the physician as a professional. My first allegiance was to the patient and family. I paid dearly for holding that stance. Sena reminds me of the times my head nearly dropped into my soup when I was post call. And I did struggle with burnout.

    But I retired because I thought it was time to do so. I don’t think of it as a permanent strike. I hope things turn out all right.

    59th Anniversary of MLK’s “I Have a Dream” Speech on August 28, 1963

    Sena reminded me that today is the 59th Anniversary of Reverend Martin Luther King Jr’s “I Have a Dream” speech in Washington, D.C. After she reminded me about it, I found this anniversary mentioned in only a few headlines on the web.

    But that’s no excuse. It doesn’t matter that I was just a small child on August 28, 1963. And when I hear the speech, it still makes the hair on the back of my neck stand up.

    FDA Removes N95 Respirators from Shortage List

    I think it’s ironic that about the same time a PLOs One study and news articles came out announcing a new method using 8-inch rubber bands for improving the fit of the surgical mask to approximate that of the N95 respirator, the FDA removed the N95 respirator from the medical device shortage list. This is relevant to help protect people from infection with Covid-19 because even vaccinated older people are getting hospitalized with the Omicron variant of the virus.

    I’m not saying that the new rubber band method to tighten the fit of the surgical mask is not an improvement. It might come in handy when there is another shortage of N95 respirators.

    The method mainly targets health care professionals. It would be difficult to persuade everyone in the community to adopt the technique. It’s tough enough to get people to wear masks even in crowded buildings in high transmission areas.

    This is despite the CDC study showing that the elderly population continue to be at high risk for hospitalization from Covid-19 despite being vaccinated with the initial series and one or more boosters.

    I think it’s hard to achieve a good fit even with the N95 respirators. The free ones distributed by the Federal government early this year were not widely available and fit poorly because the straps were elastic (similar to rubber bands, only flimsier) and loosened quickly, even after using only 2 or 3 times. At least the ones I got did. Prior to retiring, I was never able to pass a Fit test at the hospital using that type of mask.

    I think my surgical masks fit better than the N95 respirators, especially after using the knot and tuck method to get a tighter seal.

    Now the newer rubber band method to get a better seal uses two large 8-inch rubber bands to make the mid-face portion of the mask fit closer to your face. It looks a little easier to do than the earlier 3 rubber band technique developed a couple of years ago. That one was even tested at the University of Iowa Hospitals and Clinics by emergency room health care professionals, resulting in a small published study (the “double eights mask brace”).

    All of the rubber band mask braces techniques were a response to the shortage of N95 respirators. What’s interesting to me is that, as the authors of the PLOs One study point out, there is a fair amount of variability in how well the N95 mask fits. Differences in the shape of a person’s face can account for some of this.

    And there’s no shortage of N95 respirators—for now, at least according to the FDA.

    If a non-health care professional wanted to use a rubber band brace, it would take some practice to get a good seal. There’s a bit of a learning curve even for a pro.

    I think it would be difficult to persuade the average person to get the rubber bands and the surgical mask out of a pocket or a purse and fiddle around to achieve a good fit if you’re just going to run into Wal Mart—where I could not find that the big 8-inch rubber bands are even in stock. They’re pretty much a “3-day shipping” kind of item and could cost as much as $20 a bag.

    Iowa State Fair Musings

    We’ve never actually been to the Iowa State Fair, but we really like listening to the Iowa Public Broadcasting TV shows about it.

    The first show covered a lot of activities. Food at the Fair is always intriguing.  We know there are a lot of foods on a stick, but we didn’t know you could get a rattlesnake corn dog—with venom sauce! It’s pretty good according to the food guy, Travis Graven. You probably won’t find it in your local grocery store.

    The big animals are impressive. I always wonder why the handlers sort of guide some of the animals (like that huge boar) using those little boards.

    The lemonade stand was a little thought provoking. Dad’s Old-Fashioned Lemonade stand sellers aren’t out there to make money. They do it for the nostalgia. I’m sure they do it for the tradition as well.

    That’s a nod to keeping tradition alive. One of those is the 4-H program. According to the Iowa State University 4-H Youth Development web page, the 4 H’s stand for:

    Head for thinking, planning, and reasoning

    Heart for being kind, true, and sympathetic

    Hands for being useful, helpful, and skillful

    Health for taking care of yourself and your community

    The Iowa State Fair is a longstanding tradition. It started way back in 1854. It was on hold in 2020 because of the Covid-19 pandemic and that was the first time since World War II it was cancelled and only the sixth time in the Fair’s 166-year history.

    A tradition is defined as the transmission of a culture’s customs, beliefs, knowledge, skills and more from generation to generation. In order to do that somebody has to do the passing down of all of that. And somebody has to pick it up.

    You can store some of it in electronic archives, but a critically important part of it relies on institutional knowledge in the hearts and minds of the culture’s older people. It’s a two-way street; the young listen, accept some, and improve more if we’re lucky. It’s more than facts and figures—it’s the wisdom we want to preserve.

    And we want to keep the rattlesnake corn dogs, with venom sauce.

    What About the Deer?

    I saw a very thoroughly researched article the other day about the issue of deer population management in Little Village, a monthly news and culture magazine. You get an idea of the conflict between deer and people when you read the title of the article, which contains the gentle term, “Rats with hooves.”

    I was reminded of it when Sena yanked the tall grasses out of her garden recently. Later, I could hear her tapping on the windows and yelling at the deer who could now see the garden is actually a salad bar.

    I have lost count of the number of deer who ask me to light their cigarettes for them after they breed on our front lawn.

    And I made a video in which they cavort and chew their way across our back yard on their way to parties. For some reason, it’s gotten over 1,280 views as of this writing (8/11/2022), and got about a 1,000 in one day.

    I’m not clear on exactly why deer management by bow-hunting is such a failure. Iowa City has contracted with an outside company which can cull the population by the hundreds using sharp shooters who apparently do this for a living. I guess bow hunters see this as a form of recreation.

    I’m ambivalent about people killing deer. On the other hand, a deer did run into Sena while she was driving the car a few years ago. They can leave a pretty good dent and can even kill motorists.

    The Little Village article quotes somebody who said that neighbors call deer “1,200-pound rats with hooves.”

    That sounded pretty heavy to me. I looked it up on the web and the average deer weighs a little over 100 pounds. If they’re seeing something that big in their yards, they might be confusing a moose for a deer. And that means we’ve got an even bigger problem.

    There are other ways to control the population besides shooting them. I learned that you can surgically sterilize them. It costs about $1,000 per animal. Would these be veterinarians who might call their clinic, Pay to Spay?

    The other way might be to introduce natural predators, such as wolves, into the areas where deer are making themselves a nuisance. Collateral damage could become an issue during backyard cookouts. And has anybody considered the risk of werewolf contamination?

    Mmmm, venison!

    Could we round up the deer and relocate them to a wilderness where wolves and other natural predators could control their population? I won’t mention the name of such a place, but it starts with the letter A-L-A-S-K-A.

    Could Bigfoot get involved somehow? Maybe, if scientists could come up with a way to alter the deer genetic code to make them smell like beef jerky.

    According to the article, the application for participating in the bow-hunt season runs through October 21, 2022. Property owners can fill out an application to allow them on their land. Anybody up for shish kabob at their cookout?

    %d bloggers like this: