humor – Page 43 – Go Retire Psychiatrist

What Kind of Mailbox Does the USPS Really Want from Us?

I just saw the latest headline about the United States Postal Service (USPS) new recommendation that we all get a nice, big mailbox. Huh?

I gather one reason for the suggestion is to cut down on mail theft. I don’t think I’m allowed to put a lock on a mailbox, no matter how big it is.

In fact, the only way I’ve seen to reduce (notice I said reduce, not eliminate) mail theft are those big mailbox clusters you see everywhere in neighborhoods nowadays. Those are the neighborhoods with Homeowners Associations (HOAs), which require you to paint your window trim with beige (not taupe, read my lips!) or face lawsuits.

You know about those clusters, they’re a block away from your house. And you know how small your mailbox is there, yet the postal service is also big on recommending that you use them, probably because it makes their job easier. Which is it? Big mailbox with no lock or big locked mailbox cluster with small boxes?

Is the postal service in charge of maintenance on those mail cluster boxes? Of course not. We’re responsible for clearing away the ice and snow. And is theft not a problem with the cluster boxes? Scan the web for stories about armed bandits who hold up the letter carrier for the key. It happens.

Bigger mailboxes are not the answer to the postal service problems. They can attract the Halloween pranksters showing off their Hank Aaron batting skills (look him up!) and sadistic city snowplow drivers who like dragging your mailbox into the next county after plugging your driveway.

I can remember when the letter carrier walked the delivery route pushing a cart filled with mail. He stopped at every house in the neighborhood to put your mail in the mailbox, which was attached to the front of your house, or to drop it in the mail slot in your front door.

I’m not saying mail theft was not a problem in those days, but I don’t recall hearing about it on the news broadcasts or reading about it in the newspaper—which I hand delivered, sometimes risking injury from big dogs. The only theft I recall was by customers who avoided paying when I tried to collect:

“Do you have change for a hundred-dollar bill, sonny?”

“I’m a paperboy, not a banker!”

“Come back next week.”

Here’s an idea. What if some scientist invented a mailbox which contained a device which would trip only after your mail was delivered? This device would spray concentrated poison ivy resin all over the inside of the mailbox, teaching thieves a lesson. Of course you would have to wear gloves to collect your mail.

Another idea is to make your own mailbox, which would be big enough for a Ninja warrior to hide inside. That would surprise the crooks! I think you can get a Ninja for a fair price on eBay.

Big Mo Pod Show: “In Search of Good Company”

When I listen to the Big Mo Pod Show, I tend to almost free associate to memories which the songs sometimes evoke. The 5 songs this week came from, as usual, his Big Mo Blues Show this past Friday night. The theme of the pod show was “In Search of Good Company.”

I’m not so sure about good company thoughts, but the comments about Muddy Waters song “Long Distance Call” reminded me of something way back in my past. Big Mo talked about making long distance calls a long time ago, which he connected with pay phone booths.

I don’t think I’ve seen an actual pay phone booth in decades, since the invention of cell phones and that kind of technology. But the conversation about phone booths reminds me of my youth.

I used to live at the YMCA and the rooms didn’t have phones. No cells phones were available back then because it was well before the 1980s. The only way you could place a phone call was to use the one phone booth in the building, which was on the second-floor landing. The rooms were on the third floor, and they were for men only, of course.

Also on the third floor was an old snack vending machine and I’m pretty sure I’ve told this story before as I recollected while writing this post.

I got a Butterfinger candy bar from that vending machine one time. I took a bite out of and saw half a worm wiggling around in it. You don’t want see a worm at all, but half a worm has a whole different meaning.

I was worried and used the pay phone to call the local emergency room. I think I paid less than a quarter to place the call.

I guess I would have been relieved to hear the ER doc tell me that I would be OK—if he hadn’t been laughing so hard. Good thing it wasn’t a long distance call.

Reminiscence of My Younger Days

The other day we had some stormy weather roll across central Iowa, although it was not as bad as the tornado that swept through Greenfield. We hope the best for them. We didn’t actually get a tornado, but I remember wondering why the siren went off about 6:00 a.m. It woke me up and I wondered what was the matter. Turns out it was a tornado warning and we had to sit in the basement for a little while. It was a little scary, but the storm moved east pretty quickly northeast out of our area.

For whatever reason, this eventually led to my reminiscing about my younger days. Maybe it was because of a temporary scare and increased awareness of our mortality.

I used to work for a consulting engineers company called WHKS & Co. in Mason City, Iowa. This was back in the days of the dinosaurs when it was challenging to set stakes for rerouting highways around grazing diplodocus herds.

I was young and stupid (compared to being old and stupid now by way of comparison). I lived at the YMCA and took the city bus to the Willowbrook Plaza where the WHKS & Co. office was located on the west side of town.

I usually got there too early and stopped for breakfast at the Country Kitchen. The waitress would make many trips to my table to top off my coffee while I sat there waiting for the office to open. That was fine because I had a strong bladder in those days. I left tips (“Don’t cross the street when the light is red”).

My duties at WHKS & Co. included being rear chain man and rod man, at least when I first started. A “chain” was the word still being used for a steel tape for measuring distances. It was well past the days when land surveyors used actual chains for that purpose. You had to use a plumb bob with the chain to make sure you were straight above the point (usually marked by a nail or an iron property corner pin) you measuring to and from.

You and the lead chain man had to pull hard on each end of the chain to make sure it was straight. It was challenging, especially on hot days when my hands were sweaty and the chain was dirty. Callouses helped.

The rod was for measuring vertical distances and an instrument called a level was used with that. One guy held up the rod which was marked with numbers and the guy using the level read the elevation. Another way to measure both horizontal and vertical angles used a rod and a different instrument that we called a theodolite (older instrument name was “transit”).

We worked in all kinds of weather, although not during thunderstorms. In fact, when it was looking like rain out in the field, a standard joke for us sitting in the truck waiting for rain was to draw a circle on the windshield (imaginary, you just used your finger although if your finger was dirty which it always was, you left a mark) and if a certain number of drops fell in the circle, you could sit in the truck and play cards.

When we played cards, it was always the game Hearts, which I could not play skillfully at all. I always lost. But it kept us out of the rain. If a big thunderstorm blew in, we just headed back home.

We never got caught in a tornado.

Old Blog Post on Decisional Capacity Assessment

I just found a blog post I wrote about assessing decisional capacity. It’s over 13 years old and you can tell I was a little frustrated when I wrote it. It was back in the days when consulting psychiatrists were called psychosomatic medicine specialists. Here’s to another blast from the past.

Blog from 2011: Thoughts on Assessment of Medical Decision-Making Capacity

Listen very carefully to what I’m about to say. A patient’s ability to make decisions about her medical or surgical treatment does not depend on knowing her surgeon’s name.

Let me put it differently. Simply because you can recall your surgeon’s name doesn’t mean you have the decisional capacity to give or not give informed consent to have surgery.

If that’s too obvious to most of you, then maybe I can stop worrying that it isn’t to so many doctors, who sometimes misunderstand or are simply unaware of the basic principles of assessing decisional capacity regarding medical treatment. Believe it or not, some physicians actually believe the above is part of an adequate decisional capacity assessment.

Psychosomaticists are frequently called to assess decisional capacity to participate in the informed consent discussions that are such an important part of the doctor-patient relationship today. Many non-psychiatric doctors simply don’t feel confident that they can do it themselves. And when they try, their description of the process often indicates an alarming deficit in their medical school education about this basic skill.

In order to give informed consent, you need to have enough information from your doctor, be able to voluntarily make a decision without undue pressure from others (including your doctors), and be competent to decide. Exceptions to obtaining informed consent include but are not limited to “incompetence” (the inability to decide) and medical emergencies.

In a nutshell, the basic elements of assessing decisional capacity are:

Any physician can do it; a psychiatric consultation is not obligatory though it may be helpful in difficult cases in which delirium or other mental illness may be substantially interfering with decision-making.
The patient’s ability to understand her medical condition and the risks and benefits of the main and alternative medical interventions proposed as treatment.
The patient’s appreciation of the nature of her medical condition and the potential consequences of the treatment options or no treatment in the context of her values and wishes.
The patient’s ability to reason through her choices regarding treatment.
The patient’s ability to express a choice.

Notice that nowhere in the above list is recall of the surgeon’s name even mentioned. Remembering your surgeon’s name may be flattering but it’s not essential to the assessment of decisional capacity.

There are several reasons to assess decisional capacity including but not limited to an abrupt change in the patient’s mental status. This is commonly caused by delirium, which by definition is an abrupt change in affect, cognition, and behavior that fluctuates and is by definition related to medical causes.

Any physician can conduct a decisional capacity evaluation, yet a psychiatric evaluation is frequently requested. The reason for that may arise from the assumption that the Psychosomaticist is a sort of “informed consent technician”[1]:

“Efficiency model” scenario
1. Incompetence is presumed.
1. Psychiatric consultant is expected to remove legal barriers expeditiously to obtain a surrogate decision maker.
“Pseudoconsultation” scenario
1. Consultation requestor lacks the patience, interest, or time to do an assessment.
“Persuasion” scenario
1. Psychiatric consultant is expected to persuade the patient to reverse his refusal of needed treatment.
“Protection” scenario
1. Psychiatric consultant is expected to provide documentation to protect against potential litigation.
“Punishment” scenario
1. Stigma associated with psychiatric evaluation is used unconsciously to punish treatment refusal behavior.

In all fairness, psychiatrists are sometimes just as guilty of this buck-passing; for example, when we request a cardiology consultation to “medically clear” a patient for electroconvulsive therapy to treat life-threatening depression.

In an ideal world, a decisional capacity evaluation would be requested in and accepted in “the true spirit of dialogue as the result of a genuine evaluation of the patient’s mental state as a whole”[1].

We don’t live in an ideal world. So when a doctor is truly stuck and needs help with decisional capacity evaluations, she can confidently call a practical Psychosomaticist in the true spirit of collaboration as a result of the genuine appreciation of the importance of the patient’s medical and psychiatric care as a whole.

1. Zaubler, T.S., M. Viederman, and J.J. Fins, Ethical, legal, and psychiatric issues in capacity, competency, and informed consent: an annotated bibliography. Gen Hosp Psychiatry, 1996. 18(3): p. 155-72.

Thoughts on the Big Mo Pod Show: Theme “Music Changes Context”

I heard the Big Mo Pod Show, which relates to the quiz about 5 songs he played on the Big Mo Blues Show last Friday night. He got all the artists right, just missed 3 song titles!

I had a couple of thoughts about the song lineup related to the theme “Music Changes Context.” Actually, the point was that one of the songs had what might have made some people mad. It was “Funky B***h.” The idea was that some words might be offensive if you say them, but when words are sung, that might make them not offensive, in a way. It’s a matter of opinion.

How that happens is not clear. Big Mo’s example of it was in a historical context related to slavery. Slaves could not say certain words while they were working in the fields. But the overseer would let them get away with if they used the words in a song.

I heard one song that was not part of the Big Mo Pod show that might put a different spin on the idea of how music changes context. It’s about brotherly love, in a manner of speaking—or in a manner of singing, I should say.

Another Look at the C-L Psychiatry Pecha Kucha

Back in 2018, one of my emergency room staff physicians asked me to do a Pecha Kucha on what a consultation-liaison psychiatrist does. If you know what a pecha kucha is, you can understand why it was challenging for me to put it together and present it.

Although you may have seen the video I made of the pecha kucha 5 years ago on this blog, I think it’s OK to present it here again.

Briefly, PechaKucha is Japanese for “chitchat.” It’s a presentation format using 20 slides displayed for 20 seconds each. It took a while to rehearse to get it right.

I think it’s also worth emphasizing because most of the ideas in it are still relevant to consultation-liaison psychiatry. See what you think.

The Most Interesting Thing About the Svengoolie Movie House of Frankenstein

We saw the movie House of Frankenstein last Saturday night and, spoiler alert, everybody dies!

Anyway, the main impulse we had when listening to Boris Karloff (who played Dr. Gustav Niemann) was to think of something I’m not even sure I can say on this blog due to the strict copyright laws governing even the utterance what I’m going to call NAME. I’m using only the word NAME because I’m afraid Dr. Sues Enterprises will track me down and sue me for copyright infringement if I actually say NAME.

Yes, Dr. Sues Enterprises is intentionally spelled that way because I’m not even sure I can say their name without getting slapped with a lawsuit.

No kidding (and this is no joke by the way), I read a lot of scary stuff on line about how NAME is not in the public domain and what can happen to you if you even say it out loud.

I think I can get away with saying that Boris Karloff was 79 years old when he voiced NAME in the movie which I guess will have to remain nameless.

There are people who get away with it, though. Maybe it’s because they pay for the privilege of uttering NAME.

Here’s an interesting thing. Pixabay has a lot of pictures that are royalty-free. You want to guess what I found there? Pictures of NAME! I don’t know how they get away with it. OK, so maybe it’s because they don’t charge a fee for use.

On the other hand, there’s this guy who wrote in to some kind of ask-a-lawyer website that he sells a tee shirt that has NAME printed on it. He got a copyright infringement notice and asks why he can’t get away with it. All the lawyers who answered said he can’t sell shirts with NAME on it because Dr. Sues Enterprises has a federal trademark registration on NAME.

Anyway, that’s the most interesting part about the movie House of Frankenstein.

Guys and Gals Birds

The other day we went birding on the Terry Trueblood Trail. You couldn’t ask for better weather. We saw a lot of birds paired off and checking into the nest boxes or building from scratch.

I don’t know how we got so lucky. We saw male and female red-wing blackbirds, tree swallows, sparrows, and goldfinches.

The difference between the guys and gals is that the female birds tend to be drab. It’s mainly for protection. The females don’t want to attract attention from predators. The males tend to be flamboyant, as if you didn’t know that from your own experience with humans.

The red-wing blackbird male has stunning red and yellow epaulets on its wings. The female is mostly brown.

The tree swallow male is startling bright greenish-blue. The female is a bit duller.

The goldfinch male is a loud yellow while the female is kind of drab olive.

And so on.

Big Mo Pod Show 006 on KCCK Radio Iowa!

I got an update to the Big Mo Pod Show on Iowa’s only jazz and blues radio station KCCK 88.3 in Cedar Rapids (translator 106.9 in Iowa City). Last Friday on the Big Mo Blues Show, host John Heim (aka Big Mo) played a lot of tunes, which he gets quizzed about a day or so later on the Big Mo Pod Show.

He gets quizzed about the name of that tune, the artist, and why he picked that tune for the show. He got them all except for one; he said “East Coast Blues” instead of “West Coast Blues” as the song by Blind Blake. He was almost perfect.

I was listening that night, but the Seasick Steve number I missed. It’s misspelled on the KCCK website on May 5, 2024 as “Internet Coyboys,” but it’s “Internet Cowboys.” Maybe by the time you read this, it’ll be corrected. It’s all about spending too much time on the internet. We need to disconnect. I’m sort of a fan of Seasick Steve, ever since I heard him do “You Can’t Teach an Old Dog New Tricks.” It means something special to old dogs like me.

Ahm a Fan of the Svengoolie Movie The Land That Time Forgot

We watched the Svengoolie movie, The Land That Time Forgot last Saturday night. Doug McClure stars as Bowen Tyler. He and others passengers of a ship are taken prisoner by the crew of a German U-Boat (World War I era) which torpedoed the ship. Officers of the torpedoed ship and Tyler overpower the U-Boat crew. They all end up on the island of Caprona somewhere in the South Atlantic.

The island is crawling with thunder lizards of every kind including diplodocus. The dinosaurs are evolving alongside primitive humans who evolve by migrating north on the island “…instead of by natural selection” according to Wikipedia). Various humans both primitive and modern are casually slain and eaten and the rapidly evolving primitive humans pick off the moderns at random.

Only one primitive doesn’t seem to evolve beyond being a goofy guy named Ahm, who has trouble operating a handsaw and who refers to himself in the third person:

“Ahm out of breath!”

“Ahm goin’ back down

To Kansas soon

Bring back the second cousin

Little Johnny Coocheroo

Ahm a man

Spelled M-A-N

Man

Ohoh, ah-oh…” and so Ahm and so forth.

Ahm is very loyal to the moderns, even after he supposedly evolves to the status of the Galoo, who hate the moderns and try to kill them at every opportunity. But Ahm saves Tyler from being snatched up by a pterodactyl—sacrificing his own life, yelling “Ahm a loser and Ahm not what Ahm appear to be,” waving his arms and legs helplessly in the pterodactyl’s bill as it flies off into the great blue yonder.

I couldn’t remember what actor played the evil German who ultimately was responsible for getting the U-Boat destroyed at the end during a volcanic catastrophe. But he was the same guy who was the 4^th actor to play the role of Doctor Who’s major archenemy, The Master. Svengoolie revealed that the actor’s name was Anthony Ainley and he played Major Dietz in The Land That Time Forgot.

The reason I bring that up is not just because he looked vaguely familiar to me because I used to watch Doctor Who. I searched the web for his name and the first answer that appeared at the top of the page was the Artificial Intelligence, now called Gemini, (not Google Assistant as Gemini claims), the artist formerly known as Bard), which is crazy wrong: “Doug McClure, an actor known for his cowboy roles, plays one of Dr. Who’s greatest enemies in the 1974 film The Land That Time Forgot.”

This is why you should be skeptical of almost everything AI says.

How evolution is affected by migratory patterns is not well explicated in The Land That Time Forgot although it probably does play a role. When somebody invents a time machine, we could just go back and ask Darwin.