I know that what I’m writing here this evening is going to sound foolishly sentimental and maybe even a little spooky, but I was struck by this weird experience I had tonight. It was just a little odd and too fortuitous. I’m not going to talk at any length about the politics of it, just the strangeness.
We have these two books by Ray Bradbury, and when I was a kid, I loved his science fiction stories. I read many of them, but never like the one I read tonight.
The way this started was I was looking for something to do. I thought about watching old reruns of The Red Green Show on YouTube, which always struck me as funny when I watched them long ago. I still do, but couldn’t get into it tonight.
I turned on the TV and flipped through the channels which, as always, were reruns. I was not even interested in the X-Files reruns and I’m a fan. And I couldn’t stand the thought of seeing any more in-your-face commercials about total body deodorant.
So, I picked up the hefty paperback of a big collection of a hundred of Ray Bradbury’s short stories, entitled oddly enough, “Bradbury Stories.” I just opened up the book with no particular story in mind and it fell open right to one I’d never read before, “I See you Never.”
It’s all of 3 pages long and it’s about a Mexican immigrant named Mr. Ramirez. He’s been brought by the police to the front door of the rooming house where he’s been living on a temporary visa, which has been revoked. He’s just there to say goodbye to his landlady. He’s being deported and has this sad conversation with her on the doorstep. He just keeps telling her in broken English, “I see you never.” The landlady, Mrs. O’Brian (no accident she has an Irish name, of course) just says repeatedly that he’s been a good tenant and that she’s sorry. Then he leaves with the police. She goes back inside and can’t finish her dinner with her family and realizes she’ll never see Mr. Ramirez again.
There’s a much better summary and analysis than mine written by a professional reviewer. This story was published back in 1947 and is set in the historical context of post WWII America.
I hate politics, and I’m not going to say anything specific about how this little story struck me with its irony given what’s going on this country right now. I was just looking for a little science fiction distraction and instead got irony. I didn’t go looking for this and I’ll be brutally frank—I actively avoid political news and I hate like hell to get reminded of it every day. All I did was open a damn book. I wish I had never seen this story.
I guess maybe that’s what I get for my avoidant approach to certain things. How’s that for a Mental Health Awareness month event?
This post is sort of my thinking out loud about whether or not I should get the Covid vaccine ahead of this summer that was approved last year as being appropriate to get twice a year by the CDC—once in the fall along with the flu shot and once to protect against the Covid summer surge that some experts argue has been happening every summer since the pandemic onset.
The trouble is that the dominant subvariant is no longer the JN.1 or KP.3.11. The currently dominant circulating bug is LP.8.1 according to the CDC Nowcast chart.
And what confuses me is that one expert still recommends getting the September 2023 updated vaccine, but recommends getting the “bivalent booster.”
And a recent article from the University of Minnesota Center for Infectious Disease Research and Policy (CIDRAP) says that a preprint study (not yet peer-reviewed) says the current Covid vaccine was only 53% effective against hospitalization and 39% medically attended Covid-19. Most patients got the vaccine targeting the XBB.1.5 variant. I think that’s related somehow to the KP.2 variant. I have a vague memory of hearing about the XBB.1.5 during the CDC meeting in September 2023.
I’m a retired psychiatrist, not a retired virologist. The information available to the public seems confusing to me and I imagine I’m not the only one so affected.
The CDC is recommending the 2024-2025 Covid-19 vaccines, which target the JN.1 variant, which is now 0% of circulating variants on the list. But I’m not sure whether the current vaccines would be as protective against the different variants now dominant.
The CDC April indicators show downward trends for test positivity, ER visits, hospitalizations, and deaths.
On the other hand, an August 2024 article from Johns Hopkins warns that Covid-19 rates have consistently risen in July-August risen since 2020. The author says that it’s still unclear whether Covid-19 will continue to have dual seasonality. Other factors that affect this in addition to the emergence of more transmissible variants are human behavior, such as staying in air-conditioned spaces more and traveling.
My big question is should an old guy get the 2024-2025 Covid-19 vaccine or just wait and see, especially in light of the difficult political situation with HHS sounding like it might require new, placebo-controlled trials of some vaccines before “tweaking” them to target more current variants—which could take several months.
But it doesn’t look like there’s a plan to tweak the 2024-2025 Covid-19 vaccine in any case. I’m probably worrying too much, but I’m on the fence. I’m already too good at procrastinating.
How many farts can old fart fart if an old fart walks to fart? I’m sure you’ve heard that one by now after a recent news article suggested that farting while going for a walk on the street after dinner (or any meal) could make you healthier.
It’s not like the only reason is that you get rid of gas and increase intestinal motility to prevent constipation. Some medical experts say it can help control blood sugar.
But you have to fart walk within an hour of finishing a meal to control the glucose spike. You could call it the fart walk sweet spot. There are social implications, especially if the fart walk becomes a growing trend.
What the heck should you wear on fart walks? Windbreakers.
For some reason, Artificial Intelligence (AI) has a lot to say about flatulence, but I usually pass gas over it to move on to other websites to find what might be more reliable information than you get from AI.
While farting a couple dozen times a day can be normal, if you can’t leave your house because of your Frequency Of Odoriferous Farting Impulse (FOOFI), you might want get it checked out.
Eating a lot of fiber-rich foods can lead to digestive problems that can lead to excessive flatulence. Have you noticed that when you’re in a crowd, people tend to sprint away from you? When you’re in an elevator, do people push any button to get off, even if it’s in the basement, or even between floors?
By the way, did you hear about the guy who farted on an elevator? It was wrong on so many levels.
The food choice thing can be the downside of what often happens when you follow the advice of health care professionals who tell you to avoid carbs and eat more fruits and vegetable. This can happen to guys who hit middle age and start to get that big belly. I’m not sure that the diet change will help much, especially since new studies show that guys can produce more belly fat cells as they get older.
What do you call a large, hairy cryptid who eats too much beef jerky? Bigfart.
Certain diseases can be linked to farting, like irritable bowel syndrome, celiac disease, bowel obstruction, and constipation. Funny, I thought farting was supposed to prevent constipation.
What do you say to someone who has made a commitment to daily fart walks? Conflatulations!
Today is designated Earth Day although there is such a thing as Earth Month. Among the several trees Sena planted in our back yard trees are a few that we hope exemplify the Earth Day theme, which is Our Power, Our Planet.
One of them is a dogwood, which we’re hoping will bloom soon. Dogwoods represent joy and rebirth. There are a couple of crab apple trees, a red jewel and a perfect purple. Crab apple trees represent love and all are very special to Sena and me.
Love, joy, and rebirth. They can all be linked to power, which can be the power of will. The will to respect the planet also implies respecting each other. Practicing humility can be a kind of power.
The power to be still and listen to each other can make us more open to change.
On that note, because I can’t go for long without joking around, I should retell the story about me and the walking dead meditation. About 13 years ago, I had an even more serious case of not listening to others than I do now, if you can believe that. It eventually led to my choosing to take the Mindfulness Based Stress Reduction (MBSR) class ( see this current University of Iowa mindfulness essay). I wrote an essay for the Gold Foundation and it’s still available (I updated the links):
How I left the walking dead for the walking dead meditation (August 13, 2014)
About a year or so later, I bought Jon Kabat-Zinn’s book on Mindfulness-Based Stress Reduction (MBSR), Full Catastrophe Living, because I was dimly aware of the burden of stress weighing on me as a consulting psychiatrist in an academic medical center. I didn’t get much out of Kabat-Zinn’s book on my first read. But then in 2012 I started getting feedback from colleagues and trainees indicating they noticed I was edgy, even angry, and it was time for a change.
Until then, I’d barely noticed the problem. Like most physicians, I had driven on autopilot from medical school onward. I had called myself “passionate” and “direct.” I had argued there were plenty of problems with the “system” that would frustrate any doctor. I had thought to myself that something had to change, but I never thought it was me.
After reflecting on the feedback from my colleagues and students, I enrolled in our university’s 8 week group MBSRprogram. Our teacher debunked myths about mindfulness, one of which is that it involves tuning out stress by relaxing. In reality, mindfulness actually entails tuning in to what hurts as well as what soothes. I was glad to learn that mindfulness is not about passivity.
But I kept thinking of Kabat-Zinn’s book, in which he described a form of meditation called “crazy walking.” It involved class members all walking very quickly, sometimes with their eyes closed, even backwards, and crashing into each other like billiard balls. I hoped our instructor would not make me “crazy walk” because it sounded so—crazy. I dreaded crazy walking so intensely that I considered not attending the 6-hour retreat where it might occur.
We didn’t do crazy walking. Instead, we did what’s called the “walking meditation.” Imagine a very slow and deliberate gait, paying minute attention to each footfall—so much so that we were often off balance, close to crashing into each other like billiard balls.
I prefer to call this exercise the “walking dead meditation” because it bore a strong resemblance to the way zombies move. One member of the class mentioned it when we were finally permitted to speak (except for the last 20 minutes or so, the retreat had to be conducted in utter silence). It turned out we had all noticed the same thing!
Before MBSR, I was like the walking dead. I was on autopilot — going through the motions, resisting inevitable frustrations, avoiding unstoppable feelings, always lost in the story of injustices perpetrated by others and the health care system.
In practicing mindfulness, I began noticing when my brow and my gut were knotted, and why. Just paying attention helped me change from simply reacting to pressures to responding more skillfully, including the systems challenges which contribute to burnout. About halfway through the program, I noticed that the metaphor connecting flexibility in floor yoga to flexibility in solving real life problems worked.
Others noticed the change in me. My professional and personal relationships became less strained. My students learned from my un-mindfulness as well as my mindfulness, a contrast that would not have existed without MBSR.
As my instructor had forewarned, it was easy for me to say I didn’t have time to practice meditation. I had to make the time for it, and I value the practice so much that I’ll keep on making the time. I will probably never again do the walking dead meditation.
Today we gather to reward a sort of irony. We reward this quality of humanism by giving special recognition to those who might wonder why we make this special effort. Those we honor in this fashion are often abashed and puzzled. They often don’t appear to be making any special effort at being compassionate, respectful, honest, and empathic. And rewards in society are frequently reserved for those who appear to be intensely competitive, even driven.
There is an irony inherent in giving special recognition to those who are not seeking self-aggrandizement. For these, altruism is its own reward. This is often learned only after many years—but our honorees are young. They learned the reward of giving, of service, of sacrifice. The irony is that after one has given up the self in order to give back to others (family, patients, society), after all the ultimate reward—some duty for one to accept thanks in a tangible way remains.
One may ask, why do this? One answer might be that we water what we want to grow. We say to the honorees that we know that what we cherish and respect here today—was not natural for you. You are always giving up something to gain and regain this measure of equanimity, altruism, trust. You mourn the loss privately and no one can deny that to grieve is to suffer.
But what others see is how well you choose.
Leonard Tow awardGetting the pinOn my lapel; in my heart
I’m still practicing mindfulness-more or less. Nobody’s perfect. We hope the dogwood tree blooms soon.
I noticed the other day that I was having trouble doing the one leg stand. It has been getting harder to sustain it past 10 seconds even. It’s not like I’ve been laying off exercising, including the one leg stand. Hey, I can even do a one leg sit to stand (barely). I posted about the one leg stand, including a video, about 2 years ago.
I found another news item and study about old farts like me and it included a new recommendation about the one leg stand. According to this study, if you can’t do a one leg stand for more than 5 seconds, you’ve got one leg in the grave. If you can do 30 seconds, then you’re all good.
So, I practiced a little more and I even tried the one leg juggling trick, which I also tried two years ago—and clearly faked on a video. Well, one leg clowning is back—and this time it’s for real. I think the Latin quote Ars Longa, Vita Brevis fits for this activity. This one leg stand thing is a skill and you have to work at it, even as you age and your life grows shorter.
I still don’t know if this would be called aging gracefully?
References:
Rezaei A, Bhat SG, Cheng CH, Pignolo RJ, Lu L, Kaufman KR. Age-related changes in gait, balance, and strength parameters: A cross-sectional study. PLoS One. 2024 Oct 23;19(10):e0310764. doi: 10.1371/journal.pone.0310764. PMID: 39441815; PMCID: PMC11498712.
Araujo CG, de Souza E Silva CG, Laukkanen JA, Fiatarone Singh M, Kunutsor SK, Myers J, Franca JF, Castro CL. Successful 10-second one-legged stance performance predicts survival in middle-aged and older individuals. Br J Sports Med. 2022 Sep;56(17):975-980. doi: 10.1136/bjsports-2021-105360. Epub 2022 Jun 21. PMID: 35728834.
There’s a CDC ACIP Meeting scheduled to start at 8:00 AM EST today (caught me off guard). The slides are here.
Noteworthy: Dr. Denise Jamieson, MD, MPH is chair of the CMV Working Group. She is Vice President for Medical Affairs and the Tyrone D. Artz Dean, Roy J. and Lucille A. Carver College of Medicine at University of Iowa. In the Q&A session following the Covid-19 vaccine presentation, Dr. Jamieson expressed a preference for a universal recommendation (citing implementation and uptake challenges, which other attendees mentioned as well) for the Covid-19 vaccine as opposed to a risk-based or permissive recommendation. See slide labeled “Discussion” below:
There was no vote scheduled for today’s meeting on the Covid-19 vaccine.
The presentation by Moderna on the new Covid-19 vaccine, mRNA-1283, was helpful. I gather there will be an FDA meeting about it in June.
The title of this post, which is admittedly the lead-in to a lame joke, is inspired partly by the news headlines today and partly by an essay, “Laughter: Better Than a Sharp Stick in Your Eye,” I found on The University of Iowa’s Well-Being at Iowa website. The author, Megan Gogerty, MFA, BA has some pretty sharp opinions about laughter being the best medicine. It’s not always the best.
Anyway, Reuters carried the story “China raises duties on US goods to 125%, calls Trump tariff hikes a ‘joke’,” by Joe Cash and Yukun Zhang, accessed April 11, 2025.
China is pretty upset. So, why did China tell President Trump his tariff strategy is a joke? Because they don’t get it.
Just half-kidding there; actually, I think that might be President Trump’s reply, but I really don’t understand tariffs. That’s probably why I also had trouble with the economist joke below:
Why did the Keynesian psychiatrist get fired? He told his patients to spend their way out of depression.
I found this joke on a YouTube by Jacob Clifford, an economics teacher. I didn’t get the joke, so I repeatedly replayed it because I couldn’t understand the first part. That’s because I didn’t know anything about Keynesian economics. It turns out that it’s based on the belief that proactive actions from the government (like spending) are the only way to control the economy. Get it? Neither do I but it was the only economy joke I could find that included a psychiatrist on a quick internet search.
Here’s twenty economics jokes from Jacob Clifford. They’re pretty lame, but then so is most of the political news.
I’ve been looking over some of the web articles on the Goldwater Rule, which is the APA Ethics Committee guideline enjoining any psychiatrist from making public psychiatric armchair diagnoses of public or political figures without a formal evaluation or permission to conduct one. It was originally made in 1973, years after Fact Magazine in 1964 sent out a questionnaire to psychiatrists asking for their public opinions about the mental stability of then candidate Barry Goldwater who was running for President against Lyndon B. Johnson. Many thought he was psychotic, although there was no evidence for that. Goldwater won a lawsuit against Fact Magazine, which led to the publisher going out of business. It was a big embarrassment for psychiatrists, which contributed to the creation of the Goldwater Rule.
Over the last few years and currently, many psychiatrists question whether the Goldwater Rule should be revised and abolished, making it permissible for psychiatrists who believe they have a duty to warn the public about political leaders they think might be a threat to national security, specifically President Donald Trump.
I’ve found a few articles on the web which helped me think about my own position about this. McLoughlin says the Goldwater Rule should change, but doesn’t tell us how. Glass calls the Goldwater Rule a “gag rule” and tells us why it should change. He resigned from the APA in protest. Ghaemi and others don’t agree on whether the Goldwater Rule should change, and one discussant says the rule only applies if you’re a member of the APA. Blotcky et al tell us how it could change, using sample conversations between reporters and psychiatrists.
I lean toward Blotcky et al. In fact, the final paragraph gives psychiatrists another way to express their opinions to the public. They can give them as private citizens without calling them professional judgments—which is their right.
On the other hand, if you want to know about my psychiatric interview of President Trump, you can see it below.
Mr. President, you have signed an affidavit allowing me to conduct a thorough psychiatric assessment today.
Yes, Dr. Amos, that’s correct.
Can you tell me why an Autopen was used to sign it?
I decline to answer that question on the grounds it may incriminate me.
Have you ever undergone a psychiatric assessment before?
Yes, but I had to fire her when she started asking questions about tariffs.
Very well, then. Can you tell me a little about your childhood?
It was perfect—as long as the other kids paid their tariffs.
Oh. Was there ever a time in your life marked by any problems with having access to the basic necessities of life?
Well, there was one thing. Water pressure was sometimes low, which is why I just wrote an Executive Order ensuring that low water pressure in faucets and showerheads will never again in my lifetime or yours be a problem. Make American Faucets Gush Again (MAFGA).
Thanks, I’m sure. Tell me, how would you typically go about solving an interpersonal conflict between you and others?
Raise tariffs by 300%.
I see. How about talking to people with whom you disagree?
I would say, “You’re fired.”
Would you try anything else first?
I would try tariffs.
Well, I think we’re done here. Thank you for your time, Mr. President.
Of course, this was satire.
References:
McLoughlin A. The Goldwater Rule: a bastion of a bygone era? Hist Psychiatry. 2022 Mar;33(1):87-94. doi: 10.1177/0957154X211062513. Epub 2021 Dec 20. PMID: 34930051; PMCID: PMC8886301.
Nassir Ghaemi, MD MPH.The Goldwater Rule and Presidential Mental Health: Pros and Cons – Medscape – Jun 07, 2017.
Glass, Leonard A. The Goldwater rule is broken. Here’s how to fix it. Stat News. June 28, 2018.
Blotcky, Alan D., PhD; Ronald W. Pies, MD; Moffic, H. Steven, MD. The Goldwater Rule Is Fine, if Refined. Here’s How to Do it. Psychiatric Times. January 6, 2022. Vol. 39, Issue 1
The big news for University of Iowa will be a NASA satellite mission to investigate how solar wind interacts with Earth’s magnetosphere. You can read the whole fascinating story in this issue of Iowa Magazine.
According to the story, “twin spacecraft known as TRACERS—Tandem Reconnection and Cusp Electrodynamics Reconnaissance Satellites—will begin their journey to study Earth’s mysterious magnetic interactions with the sun. The satellites will be packed with scientific instruments along with two small, but meaningful, tokens.”
The two small tokens happen to be purple guitar picks that belonged to University of Iowa physicist, Craig Kletzing, who died from cancer in 2023. Kletzing and colleagues got a $115 million contract from NASA for TRACERS. It’s the largest research award in University of Iowa history.
Kletzing played guitar in a few bands, and one them was named Bipolar—which is the only connection to psychiatry that I could see. He was dedicated to work in basic science, and he was often heard to ask “How can we make this simpler?” referring to chunking big scientific challenges into manageable goals. He was a rare person in that he was both a brilliant scientist and a great teacher. One example of his work ethic was that he skipped a meeting with NASA’s top brass in order to deliver a morning lecture on introductory physics to 275 students.
The members of the UI TRACERS team call the project “Craig’s mission.” I’m pretty sure he would have called it a team effort “… to help scientists better understand the powerful forces harmonizing throughout the universe—something the ancient Greeks described as the music of the spheres.”
And that’s what the purple guitar picks represent.
Go Retire Psychiatrist 