Category: reflections

Thoughts on a Study of Sitting with Your Patients

I saw this interesting article on a study about the effect of chair placement on physicians’ behavior when in a patient’s room, specifically whether it altered the length of time a doctor spends with a patient or the level of satisfaction patients had with the interaction. In this study, it didn’t lengthen the time, but seemed to strengthen patient satisfaction with interaction with the physician. It’s a concept I recognize because I took this one level up—I carried my chair with me on hospital rounds in my role as a consultation-liaison psychiatrist.

I got a gift of a 3-legged camp stool from a colleague who ran the palliative care service at University of Iowa hospital. Other members of the palliative team had been using them as well.

Patients got a big kick out of a doctor who carried his chair around with him and actually sat down to talk with them. The way the camp stool folds up apparently made it look like nunchucks to some patients, so I got jokes about that occasionally. It really helped build rapport.

The only drawback with the camp stool was that my one of my legs would go numb the longer I sat on it, and could lead to a challenge getting up from it gracefully because it was partly a balancing act. Even so, I often spent much more than 10-15 minutes with patients.

Once, the stool actually broke and I dropped unceremoniously on my butt while evaluating a patient for catatonia—who proved not to be catatonic by the apparent facial expression of mirth as I fell on the floor. In that sense, the chair actually became a part of the evaluation—accidentally.

Thomas Hackett knew all about this. He was a famous consultation-liaison psychiatrist and a past president of the Academy of Consultation-Liaison Psychiatry (ACLP). One of his quotes from an early edition of the Massachusetts General Hospital Handbook of General Hospital Psychiatry fits perfectly in this context:

“As a matter of courtesy, I sit down when interviewing or visiting patients. Long accustomed to the ritual of making rounds, many physicians remain standing as a matter of course. Standing, physicians remind me of missiles about to be launched, poised to depart. Even if that is not necessarily true, they look the part. Patients sense this and it limits conversation. In addition, when standing, the physician necessarily looks down on the patient. This disparity in height is apt to encourage the attribution of arrogance. Looking down at a patient who is prone emphasizes the dependency of the position. Sitting at the bedside equalizes station. Sitting with a patient need not take longer than standing with him.”— Hackett, T. P., MD (1978). Beginnings: liaison psychiatry in a general hospital. Massachusetts General Hospital: Handbook of general hospital psychiatry. T. P. Hackett, MD and N. H. Cassem, MD. St. Louis, Missouri, The C.V. Mosby Company: 1-14.

Reference: Effect of chair placement on physicians’ behavior and patients’ satisfaction: randomized deception trial BMJ 2023; 383 doi: https://doi.org/10.1136/bmj-2023-076309 (Published 15 December 2023)

African American Women in Iowa History

In light of March being Women in History Month (as well as Iowa History Month), I’d like to share some history stories about an African American librarian from Mason City, Iowa named Esther J. Walls. In 2020 during the Covid-19 pandemic, there was an essay about her, “Esther J. Walls: The Role of a Black Leader.” Her life story as a librarian, traveler, and educator is fascinating.

I looked through the list of women elected to the Iowa Women’s Hall of Fame and couldn’t find her name. However, I recognized Deborah Ann Turner’s name on the list. She was the first African American woman to be certified by the American Board of Obstetrics and Gynecology in gynecologic oncology. She was also from Mason City, Iowa. Her life story and list of accomplishments is also impressive.

I identify with both of them because they were born and raised in my hometown, Mason City, Iowa. Esther J. Walls was employed at the Mason City Public Library, my favorite haunt because my love of reading and writing began in early childhood.

An archived news item about Esther J. Walls entitled “A Mason City woman’s globe-trotting career” highlights her travels and her sense of humor.

CDC ACIP Meeting on the RSV Vaccine and Some Dad Jokes

We watched the section of the CDC ACIP meeting about RSV vaccines on February 29, 2024. There was a lot of discussion on the safety of the vaccine. It looks like it will still have a requirement that you have a shared clinical decision-making meeting with your physician. I think that still implies you’d need a prescription. However, there are only a handful of states which would require a prescription from your doctor. Iowa is one of them.

That made the comment by one of the committee participants thought provoking. I believe she got the RSV vaccine from a pharmacist, who asked no questions. There was no shared clinical decision-making discussion with that pharmacist.

But there was a discussion during the meeting with a pharmacist who was in the room. She made it clear that pharmacists had plenty of training (“20 hours” along with additional learning) and could handle the shared clinical decision-making piece with patients.

Sena and I have had all of our vaccines including the Covid-19 shots administered by pharmacy techs. I hardly know what the pharmacists look like because they are a blur, managing the drive-up window and all other customers. It’s clear that a large proportion of vaccines are available at most pharmacies and the techs give the shots. They are pleasant and happy to apply the Band-Aid.

You can’t even telephone the pharmacy and talk to a live person. Sometimes you’ll get a recording which replies to most of your questions with “Sorry, I didn’t get that. Did you say you want a vaccine or a cheeseburger with fries?” Scheduling vaccine appointments are generally done on line. Scheduling a visit with the pharmacist is probably not easier than scheduling one with your doctor, who might confuse you with “the colonoscopy” in room 5.

I’ve looked at the health care professional section on the CDC website pertaining to the age and medical conditions necessary to qualify for getting the RSV vaccine. I’m pretty sure I’m in the right age category, although I stopped keeping track after the evolution of asparagus. I don’t have any chronic medical conditions, unless you count dad jokes. I exercise, juggle, take only a multivitamin a day, meditate, and regularly leap tall buildings in a single bound. I’m pretty sure I don’t need the RSV vaccine, but what do I know? I’m a retired psychiatrist.

It looks like the risk of getting Guillain-Barre Syndrome (pronounced “GBS”) is not zero and may or may not be associated with the RSV vaccine. It’s pretty clear that 2 of the 3 major manufacturers of the vaccine who attended the meeting were pretty sensitive to any hints their product might have anything to do with GBS and might challenge you to a no holds barred thumb wrestling match if you say otherwise.

We think there’s a long way to go before everybody’s clear on who gets the RSV vaccine and when, and also where. But you can’t get it at the pharmacy drive up window.

Flight of Ideas on Junior Bald Eagles

A couple of days ago the temperature was in the mid-seventies, which is pretty balmy for February. We took the opportunity to get out for a walk on the Terry Trueblood Trail. It’s coincidental, but we did the same thing on the exact same date last February. It’s under the same condition for the most part—escaping from the bad news on the web. The difference was the temperature; it was only in the fifties last year.

The remarkable thing last February was that another trail walker claimed to have seen 16 bald eagles. I’ll have to say that we doubted it, at first. But shortly after that, we caught sight of half a dozen. There were also the quilted hearts we saw, connected to the “I Found a Quilted Heart” project, the goal of which is to make you happy.

This time, although we didn’t find any quilted hearts, we saw a young bald eagle in flight. It was a little hard to tell what it was at first. Bald eagles don’t look bald when they’re in the juvenile stage. I had to look it up. Juveniles look pretty mottled. I wondered if its parents were the bald eagle pair, which we saw at Trueblood in December of 2023. Probably not, given that nesting begins in January, incubation lasts over a month and the eaglets take their first flight over two months later, according to the Iowa Dept of Natural Resources. But it’s fun to think about.

This junior bald eagle looked a little clumsy, both in the air and near the water’s edge. It looked like it might have caught a little fish. It seemed like it was trying to learn how things work in the world and how it’s supposed to fit in.

Instinct takes care of most of that for a bald eagle. Humans have a lot of figuring out to do. We ran into somebody on the trail who told us a great deal about local history. Over time, a lot of things have changed in Iowa City. That goes for the world, too. Much of the time, the changes don’t always seem to make life better, at least according to older people who talk about them.

But the seasons come and go. Bald eagles lay eggs. Eaglets fledge. They don’t gaze up at the moon. Humans do look up at the moon, and occasionally fly there. It’s hard to know why.

There are plenty of earthly mysteries. We saw small black handprints on the Trueblood sidewalk, not far from the shelter. I can’t figure out why they would be there, and what’s more, I can’t find out anything on the internet that explains it. So much for the internet. I supposed I could take a chance and ask Artificial Intelligence (AI) about it, but I’m not confident it wouldn’t just make something up.

We also found a little badge on the ground. It was labeled National Museum USAF Junior Flight Crew. This time, when I checked the internet, I found out there is a lot of information about it on the internet—but none of it helped me understand why it would be on the ground along the Terry Trueblood Trail. You can find a very long article on the internet about how items from the National Museum USAF might not have been handled the way they should have been. You can buy one for about $20 or so on eBay, if you’re interested.

I think it’s more interesting to see how the junior bald eagles learn their way around the world. They earn their wings the old-fashioned way.

Thoughts on the Mason City 1884 Civil War Statue

Sena and I got to talking about Central Park in Mason City, Iowa. I remember my brother, mother and I taking a walk there occasionally. One time we saw a man who lost his legs and who got around using a small platform on wheels. Later in life, I wondered if he was a disabled war veteran.

That reminded us of the 1884 Memorial Civil War Statue in the center of the park. We looked it up and found it has a complicated history. In the late 1990s it was under repair for about 3 years in Cincinnati, Ohio. When it was finally returned, it was noticed that it had not been repaired correctly. The city decided to keep it anyway, partly because some people, including a Civil War re-enactment supporter, thought the flaws were relatively minor.

Anyway, there are relief busts of famous persons on the statue. We could identify Abraham Lincoln, Ulysses S. Grant, and a Civil War soldier. After a brief web search, we confirmed that the 4th relief bust was that of George Washington.

There are a couple of topics of interest here. One of them is the George Washington relief bust and the other is Civil War re-enactments.

The connection of the Civil War to George Washington is a little puzzling because he owned slaves. We’re aware he freed them upon his death. On the other hand, when we visited Washington D.C. in 2015, we took a tour of Mt. Vernon. It was a scenic boat trip out there. We took a picture at the dock with the dog of the guy who helped people on and off the boat. We also took pictures of the slave quarters. There were no re-enactment persons and we were told we were on our own when viewing those exhibits.

This also reminds me of the news item about a bill recently (on February 9, 2024)) introduced in the West Virginia legislature to remove the statue of former Senator Robert C. Byrd from the West Virginia State Capitol and replace it with 4 other statues: Abraham Lincoln, James Madison, Arthur I. Boreman, and George Washington. Nothing is mentioned in that news story about Senator Robert C. Byrd having been a leader in the Ku Klux Klan in the past, and filibustered against the Civil Rights Act of 1964. This is from a news story posted on the web in 2020 under a link titled “time to remove monuments to senator byrd.”

Again, I struggle a bit with suggesting that a statue of George Washington, a former slave owner, would be an appropriate substitute for that of Senator Byrd. And James Madison, despite saying that slavery was incompatible with Revolutionary principle, owned slaves and made profits on their sale. Arthur I. Boreman is described as not being an abolitionist but a unionist. However, in 1865 he signed a legislative act banning slavery in the state of West Virginia.

Maybe a nice set of abstract sculptures for the corners of the rotunda of the West Virginia State Capitol?

Turning to Civil War re-enactments, I’m ambivalent about them. I remember reading a couple of anecdotes about re-enactments in the book “Our Hidden Conversations” by Michele Norris.

One of them was about black woman re-enactor who played the role of a house slave. This was in Chapter 4, “Coins in the Couch.” The six-word Race Card (p.160) said “Why Do You “Play” A Slave?”  Nicole is a slave interpreter. She makes sure that visitors to former plantation sites portray slavery accurately to tourists. She’s a public historian by training who works at the National Center for Civil and Human Rights in Atlanta. She teaches tourists about the reality of chattel slavery, including the sale of relatives to other plantations and the ingenuity of enslaved men in improving farm implements.

The next anecdote about re-enactment in the book is in Chapter 10, “So, You Want to Talk About Lynching?” The six-word Race Card (p. 386) said “Confederate re-enactor chose intimidation as spoils.” A black man and his biracial but white looking friend were at a barbecue in Texas. Two big white guys dressed in Confederate-era uniforms were passing by and one of them placed his rifle on his knee and tried to stare down the black man. The black man stared back and this went on long enough for his friend to get nervous enough to suggest they just leave. Finally, the other re-enactor pulled the sleeve of the intimidator and they were the ones who finally left. Despite this episode, the black guy “…made a choice to accept people as I receive them.”

Apparently, there are regular Civil War re-enactments in Mason City. It looks like the most recent was from Sept 8, 2023-Sept 10, 2023. It was The Battle of Chickamauga, TN. It was held in East Park, where I used to play as a kid. Iowa soldiers in the Civil War fought on the Union side. However, I found out the battle of Chickamauga was won by the Confederates, and it had the second highest number of casualties after the Battle of Gettysburg. There was a battle demonstration and the camps were open all weekend to talk to the re-enactors. And there were food vendors.

There is a newer Mason City Veterans Monument in Central Park. It was built in 2004. It has 12 handsome black granite stones with room for the names of 4,600 veterans. We have seen pictures of it on the web. There are no relief busts.

Essay “Forget Me Not” on the Web About Leaving a Legacy

Sena found a great essay on leaving a legacy. It’s titled “Forget Me Not” written by Jonathan Clements and posted on the website HumbleDollar on February 17, 2024. I think it’s worth sharing.

The comments are still coming in. One commenter (Newsboy) wrote the one below:

“The late great author, Steven (sic) Covey, once suggested: “To live. To love. To learn. To leave a legacy – That’s what we all want.” 

How appropriate it seems that a willingness to embrace the first three items on his list (live / love / learn) typically results in the “dearly departed” achieving some meaningful degree of the last one (leave a legacy).”

This reminded me that I shared Stephen Covey’s concepts with junior residents when I was the chief resident in psychiatry. He wrote many books, including The 7 Habits of Highly Effective People.

I took the 7 Habits of Highly Effective People Signature Program many years ago. All of us who attended got the course book and the Talking Stick. Back then Covey called it the Indian Talking Stick; I guess nowadays you’d call it the Indigenous People Talking Stick. The idea was to pass the stick around and you’d have to respect the person holding it and listen carefully while they have their say until they feel understood. Only then could the stick be passed on to someone else, once again to allow them to say their piece until they are understood. There could be no interruptions.

I wonder if the Talking Stick really works. I’ve never tried it. I guess that’s the problem.

I think Covey left a legacy. I doubt that was his main goal.

More Thoughts On “Our Hidden Conversations” Book by Michele Norris

I need to correct something I got wrong in my first post about Michele Norris’s Distinguished Lecture on January 23rd. While reading her book, “Our Hidden Conversations” I ran across this race card in the chapter “Black Babies Cost Less to Adopt:”

“Vote (for) Obama! He looks like me!”

That was the 8-year-old daughter said that. The person who sent in the card was her father, Dr. Val Sheffield and he was a medical student in Iowa at the time. Once you know that, you realize why he wondered whether he should have been “…happy or dismayed by this comment.”

Anyway, I’m a little over halfway through the book, “Our Hidden Conversations.”

The title of the chapter above, “Black Babies Cost Less to Adopt” is troubling and it has a lot to say about how it was common in the past to discount the cost of adopting black babies. Foster care of non-white kids was also a subject in the chapter. Identity conflicts are common and can lead to reminiscing about things like:

“I was not Black enough.”

“I was not Asian enough.”

“I was not Hispanic enough.”

What matters is being kind enough.

Preliminary Thoughts on “Our Hidden Conversations” Book

This is a short post about my initial impressions about the book, “Our Hidden Conversation” by Michele Norris.

I’m not finished with the book yet, but I thought I would let you know that the first chapter, “Bread Crumbs” was tough to read. I had to put it down and come back to it a few times because it brought back memories.

The chapter title “Bread Crumbs” means the clues that parents, grandparents, etc. might leave for subsequent generations to find which might shed light on one’s background, explain troubling circumstances, and so on.

I have some bread crumbs left to me by my family. Some are in the form of photos, although there is no family photo of all of us together.

I remember the hair combing routine my mom had with me and my brother every Sunday morning before church when we were kids. Our father was black and my mother was white. Dad was out of the home and we lived with mom. We were the only black kids in the church. In fact, all the members were white.

Mom used a prodigious amount of hair oil while vigorously combing our curly hair back. It took many strokes and the pulling pinched a bit. The ritual took a little while. When I look back on it, I guess the goal was to straighten our hair as much as possible.

Everyone in the church always treated us kindly and I was baptized there.

If you decide to read “Our Hidden Conversations,” give yourself a break whenever you feel like you need it.

Sweethearts on a February Stroll

Yesterday, we went out for a walk because it was a pretty nice day for February. All the snow was pretty much gone. We saw a hawk who also saw us. We approached the tree it was perched in very slowly. It tolerated our attention until we got too close for comfort—and flapped off in a huff.

It was a nice enough day to walk all the way out to the Sitting Man and beyond. Others were out taking in the sun as well. It’s good to do simple things; things like walking in the sun, drinking iced coffee, eating zucchini bread, waving at UFOs.

You know how it is.

Black History Month: James Spaights Concert Pianist

I was thinking about my time as a student at Huston-Tillotson University in the 1970s (then Huston-Tillotson College) and remembered somebody who was a student there. His name is James Spaights. In honor of his stature in music as it connects to the Black History Month theme of African Americans and the Arts, I just want to make special mention that Mr. Spaights is a concert pianist. I have not found his obituary (you know already about my habit of checking the obituaries) so I’m not going to talk about him in the past tense.

When I met him, Mr. Spaights was straightforward about his life goal, which was to be a concert pianist. Little did I know that he had already achieved that by the time I met him at H-TU.

He gave a fantastic performance for the faculty and students. I’m pretty sure we gave him a standing ovation.

I found some news clippings and other items about his career (unfortunately I couldn’t find recordings of his performances), which deserves to be better known. He was a member of the Alpha Phi Alpha Fraternity and a fraternity news letter shows his photo and bio in the 1977 issue of the SPHINX:

“Brother James Spaights, pianist, whom New York critics acclaimed “a virtuoso pianist and technician of the first rank” after his New York debut at Town Hall in 1965, was presented in concert on March 20, 1977 in Carnegie Hall, New York City, by the Behre Piano Associates of New York. Spaights is a former student of Madam Edwine Behre in New York City, also Freda Rosenblatt, Bronx, N.Y. and Emma Slutsky, Brooklyn, N.Y.

For three years Spaights served as Ambassador of Goodwill for the United States’ State Department as a concert pianist touring throughout Europe, parts of Canada, and the United States.

On his most recent United States tour, Spaights was presented by the Music Department at Morgan State College in Baltimore, Maryland, and Goddard College in Montpellian, Vermont.

Spaights holds his B.A. Degree in Music from Howard University and a Master of Arts Degree in Music from Columbia University. He is a member of the Lechetisky Association of America, The Behre Piano Association of New York, and a member of Gamma Eta Lambda Chapter of Alpha Phi Alpha Fraternity in Austin, Texas.

He is presently serving a post in the Music Department of Huston-Tillotson College of Austin, Texas.” (The SPHINX, Fall 1977, Volume 63, Number 3 197706303).

I guess I misunderstood what Mr. Spaights was doing at H-TU when I was an undergraduate there. I thought he was a student! He never mentioned his career or accomplishments (at least to me) and he had a great sense of humor. I was in the presence of a music luminary and never knew it.

Ref: The SPHINX Volume 63, Number 3, October 1977.