Autumn Walking Colors

Sena got some new pants with an autumn leaves print. It fit really well with the colors we saw on a walk down Scott Boulevard.

We always see something a little different along the way. We never noticed that the Sitting Man pedestal has a hole in it shaped like a heart. It could have been chipped into the stone intentionally.

There was a lot of golden rod but we didn’t see any ragweed—which I’m very allergic to this time of year.

The trees around the Harvest Preserve property are changing colors. The old barn across the street from it looks a little more weathered. We don’t know whether the staff will decorate it into a haunted house again for Halloween. They did that last year and it was a hoot.

The walk up the hill to the Sitting Man seemed a little steeper this year. I don’t remember exactly when I got so bow-legged. A runner easily ran up the hill and still had breath to say “Hi” on the way back down. He never missed a step, even though I personally know there are a lot of irregularities in the ground.

Get your walking pants on.

Autumn Miracles

We saw the miracles of autumn the other day, out on the Terry Trueblood Recreation Area. It was quiet, only a light breeze set the flowers and grasses swaying.

There were almost no birds out. No ducks were out on Sand Lake.

On the other hand, I guess there were birds, sort of. We greeted other walkers, an older couple who turned out to be snowbirds. They’ll be heading to Florida soon for the winter. They had no worries about the weather down there. They’ll be in the middle of the state, presumably far away from storm surges. They stay in an RV park over the winter months. It’s not far from a place called The Villages, which is a famous planned retirement community, which got a reputation for being a haven for older but wilder swingers. They have a very large Homeowners Association (HOA), which is sort of a very large and expensive Disney World for older retirees. It’s often called a golf cart community because that’s how most residents get around the place. While there are no HOA fees per se, there is a community development district fee of around $120-220 a month. Dave Barry wrote a chapter about The Villages in his book “Best State Ever: A Florida Man Defends His Homeland.” I told the couple about Dave Barry’s take on The Villages. I don’t think they ever heard of him. They’re excited about returning to the RV park soon.

I was a little alarmed by a loud voice, calling out like a policeman, “Get on the ground!” I looked up ahead and didn’t see a policeman. But occasionally, we heard the barking order, “Get on the ground!” Eventually we saw a young man on a walk, apparently under someone’s supervision. This was the man who was yelling “Get on the ground!” He greeted us politely. As he passed by, every so often he blurted out, “Get on the ground!” I wondered if he might be someone with a form of Tourette’s Disorder, compelled to blurt out something every few minutes. The supervisor was walking side by side with a man who seemed uncomfortable, holding his hands up to his eyes which appeared sunken in the sockets. He made no sound at all. I wondered if, peaceful as we thought the day was, whether he found it difficult to bear what might have been a sensory storm for him. The supervisor was polite to us and paid close attention to the other two men.

Mostly we watched the breeze blowing the grasses and the flowers–and were grateful.

CDC Recommendations for Fall-Winter Immunizations

The CDC recommendations for Fall-winter immunizations were updated as of September 29, 2023. A few states require a physician’s prescription for the RSV vaccine. Information varies on the web on which states require a prescription for the RSV vaccine. The Iowa Board of Pharmacy website is clear on the matter–you’ll need a prescription.

Most states don’t require a prescription for the RSV vaccine. The CDC recommends having a shared decision-making discussion with your doctor to help you decide about whether the RSV vaccine is right for you. The best thing to do would be to call your doctor, the state board of pharmacy, or your local pharmacy to find out how you should proceed.

Covid-19 and Flu Vaccines Today

Today I got the new Covid-19 vaccine and the flu shot. I scheduled on line late last week and got right in. I didn’t have to wait long in line—and there were others getting the same vaccines. Sena will get them tomorrow.

It’s up to you.

Dr. Igor Galynker and The Suicidal Crisis Syndrome

I was looking at my bookshelves and found the copy of the book, “The Suicidal Crisis: Clinical Guide to the Assessment of Imminent Suicide Risk.” It was written by Dr. Igor Galynker. It’s a fit topic for this month because September is National Suicide Prevention Month.

This brings back memories. I still have a gift from Dr. Galynker. It’s a stuffed animal called Bumpy the Bipolar Bear.

It arrived at my office at The University of Iowa Hospitals & Clinics in 2011. It was in a box addressed to:

WordPress

Attn: James Amos

200 Hawkins Drive

Iowa City, IA 52242

 I’m still not entirely sure why he sent me Bumpy. There was no letter of explanation. I was writing a blog at the time called “The Practical Psychosomaticist” and I might have posted something about some research he published on suicide risk assessment.

I bought a copy of his book a few years ago. I barely had time to skim a few of the chapters because I was too busy conducting suicide risk assessments in the emergency room, the general hospital, and the clinics in my role as a psychiatric consultant. In fact, I think it’s an excellent resource.

I also found a YouTube video (posted about a month ago) in which he describes his suicide crisis syndrome assessment. You can find the actual set of questions for the assessment here and in a link posted in the description below the YouTube.

Thoughts on Jack Trice

I was outside doing yard work the day before yesterday and my neighbor across the street walked over to say hello. We got to talking about sports and football came up. His wife stopped watching football because it was so violent—but then switched to watching hockey. He wondered when the Iowa Hawkeye vs Penn State game was going to be on. No, I’m not going to discuss that any further.

Anyway, that led to my mentioning how brutal college football was back in 1923 when Jack Trice, Iowa State University’s first black athlete was killed on the field during a game with the University of Minnesota. My neighbor was incredulous. He’s in his 80’s and he’s never heard the story.

In fact, I had just learned about the whole Jack Trice story and commemoration event in his honor the day before that, only because Sena told me about it.

All this year long there has been a 100-year anniversary commemoration of Jack Trice, Iowa State University’s first African-American athlete. The program will culminate on October 8, 2023 with the closing ceremony.

Football was a rough game in that era—but rougher still because Trice was black. Many believe his injuries were deliberately and maliciously inflicted because of his race. It’s more than plausible. In 1997, the football stadium was renamed Jack Trice Stadium. It’s the only major college football stadium named for an African-American.

Sena and I moved to Ames in 1981 so that I could enroll in Iowa State University. I was so immersed in my studies that I never gave a thought to Jack Trice. I don’t remember the football field being named Jack Trice Field in 1984.

As I looked through the commemoration website, I wondered how it was possible for me to have ignored the story of Jack Trice while I was there.

I think it’s for the same reason I never knew anything about James Alan McPherson, the first African American to win the Pulitzer Prize for fiction and who was teaching at the Iowa Writers Workshop during the entire time I was in medical school, residency and a faculty member at The University of Iowa Hospitals & Clinics.

I was working hard. I finally found out about McPherson after reading a news item about a neighborhood park being named after him in 2021.

I should pay more attention. Anyway, Iowa State University did a tremendous job putting this commemoration event together.

RSV Vaccine Prescription Necessary for Some States

Sena and I were wondering if you need a prescription to get the Respiratory Syncytial Virus (RSV) vaccine.

It turns out only four states require doctor prescription to get RSV vaccine: Iowa, Georgia, Missouri, and Utah. Washington D.C. is working on making the RSV vaccine available without a prescription.

The Iowa Pharmacy Association blog post about the issue makes it clear a prescription is needed to get the RSV vaccine.

How to Find Covid-19 Vaccine Availability By County

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

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

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

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

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

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.”

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.