Category: reflections

Iowa State University African American Science Graduates

I was thinking about what to write for the first day of Black History Month, which starts today on February 1, 2023.

As usual, I started to reminisce about my time at Iowa State University (ISU) in Ames, Iowa. I usually don’t talk about my undergraduate days. In fact, I had a little trouble finding my diploma. It was in storage in the first place I should have looked. I graduated from ISU in 1985.

The Iowa State Daily ran a story, “Black scientists from Iowa State,” published on February 4, 2021, obviously in honor of Black History Month. Of course, it featured ISU’s most illustrious graduate, George Washington Carver, who earned his graduate degree in 1894. Carver also loved poetry and painting, which I didn’t know.

This work is in the public domain in the United States because it was published (or registered with the U.S. Copyright Office) before January 1, 1928

Carver was a scientist and put it to practical use. It fits with the ISU motto, which was short and to the point: “Science with Practice.”

I transferred credit to ISU in the mid-1970s from one of the country’s Historically Black Colleges and Universities (HBCUs), Huston-Tillotson College (now Huston-Tillotson University). I submitted a poem to the college’s annual student poetry contest sponsored by one of the English Professors, Dr. Jenny Lind Porter-Scott. My poem didn’t make the cut, but many students got their work published in the little book, Habari Gani (Swahili for “What’s Going On”), which published the best poems.

Part of the reason I went to ISU was the encouragement I got from my bosses at WHKS &Co, consulting engineers. I was a surveyor’s assistant and drafter. I was the only African-American employee working there.

The idea behind going to ISU initially was to pursue a degree in engineering. That didn’t happen because frankly, I didn’t have a head for the mathematics. On the other hand, I got interested in biology, chemistry, and zoology and finally ended up in medical school at The University of Iowa in Iowa City. The rest is history, as they say, which allows the usual cover up of a multitude of sins.

At the time Sena and moved to Ames in the early 1980s, it was a quiet little town, except during VEISHEA, an annual spring celebration on campus. The event got out of hand many times and it was finally banned in 2014.

Back in the days of George Washington Carver, African American students were not allowed to room with other students who did not have black skin on campus. By the time we moved to Ames, the most uncomfortable racial incident I can recall personally was being the butt of a “nigger” joke at a barbershop. I had to find another place to get my hair cut.

I still had a lot of science to digest at ISU after switching my major from engineering to the life sciences. I remember a chemistry professor who looked like the typical hippie who demonstrated how electrons get excited by stacking chairs on top of the counter in front of the chalkboard (which teachers were still using) and climbing to the top and nervously doing a shaky little dance showing what an excited electron he was. I think all of us collectively held our breath, waiting for him to tumble to the floor.

I really had a tough time learning organic chemistry. You had to draw diagrams showing how the molecules and atoms connected after each reaction. I will never forget an Asian Teacher’s Assistant who patiently tutored me, despite my having a very bad cold and a bad attitude to boot.

I graduated and then returned to get more credits to try getting into medical school after finding it very difficult to find employment with my Bachelor of Science degree. It took about 9 months before I finally landed a job in the clinical lab at one of the hospitals in Des Moines. The lab director worked there for a very short time while I was there, and then left to go to medical school.

That was my cue. I think it worked out for the best. By the way, the engraved crystal in the featured image is an appreciation gift from The University of Iowa for my years of service.

And I guess that’s about enough reminiscence for now.

KCCK Big Mo Blues Show Brings Back Memories

Last night on the KCCK Big Mo Blues Show I listened to something I haven’t heard since the mid-1970s. It was a radio commercial for the Green Beetle and Frank’s Liquor Store. It ran right after the song, “Memphis Women and Fried Chicken.”

I think I first heard this radio ad while I was a student at Huston-Tillotson College (now Huston-Tillotson University) in Austin, Texas in the mid-1970s.

I heard it early on in the evening in my sweltering college dorm room. Later on, I heard a stirring rendition of the opening song, “Lift Every Voice and Sing,” for another radio program, the name of which I can’t recall. I don’t know who sang it, but her voice was breathtaking. I have not heard a better version of it since.

The contrast between the “Old Crow Boogie” and “Lift Every Voice and Sing” was striking. No matter what race, culture, gender we are, we struggle to reconcile these opposites.

Exercise or Weaponize My Privilege?

Back in November 2022, while on our way to the Stanley Museum of Art, we saw the two murals on the East Burlington Street Parking Ramp. It was the first time we saw them in person although photos were available last fall. The Little Village article published an article about them on September 30, 2021. It’s the Oracles of Iowa mural project, conceived by Public Space and the Center for Afrofuturist Studies partnered with the artists, Antoine Williams and Donte K. Hayes. The artists sought to stimulate a conversation in the community about how black and white people relate to each other.

The murals are painted on parking ramp at two locations along East Burlington Street. One says “Black Joy Needs No Permission” and the other says “Weaponize Your Privilege to Save Black Bodies.”

The Little Village article points out that a survey of public perception of the murals revealed that 64 percent of white respondents supported the murals while only 40-50 percent of minority respondents supported them. The stickler for minorities was the use of the word “weaponize” and the phrase “Black bodies,” which were thought to raise impressions of “violence” and dehumanization.

Because I’m a writer, retired psychiatrist, and a writer, the word “weaponize” made me wonder what other word might have been chosen in this context. The only definition of “weaponize” that I can find which makes sense to me is from Merriam-Webster: “to adapt for use as a weapon of war.”

I’m a retired physician, so I have a perspective on the “privilege” to “save” lives, and by extension to enhance health and well-being. I’m also Black. I grew up in Iowa and I can recall getting bullied and being called a “nigger.” I can remember my psychiatry residency days, which includes a memory of a patient saying “I don’t want no nigger doctor.” I didn’t have the option to switch patients with another resident. When I saw the patient on rounds, I did my best and every time the “nigger” word erupted, I left the room.  It was one of a few episodes which were marked by frank racist attitudes.

I was given the University of Iowa Graduate Medical Education Excellence in Clinical Coaching Award in 2019, one of several esteemed colleagues to be honored in this way. Many of those who nominated me were white. It was one of many joyful experiences I had before my retirement in 2020, when the pandemic and other upheavals in society occurred, including the murder of Black persons, resulting in many consequences prompting the creation of the murals.

I have other memories. I was privileged to be given a scholarship to attend one of the Historically Black Colleges and Universities (HBCU) in this country, Huston-Tillotson College (now Huston-Tillotson University). It’s one of the oldest schools and is the oldest in Austin, Texas. The scholarship was supported by one of the local churches in my home town of Mason City. I don’t think it had any black members. Although I didn’t take my undergraduate degree from H-TU, it was one of the most valuable learning experiences in my life. It was the first time I was ever not the only Black student in the class. It was marked by both joy and a struggle to learn where I belonged.

The murals did for me what the artists hoped it would do. It stimulated me to reflect on the meaning of racializing life. They stir me to seek perspective on whether joy has any color and why anyone needs permission for it. And I believe I would rather exercise my privilege to respect and care for others than to weaponize anything, including my sense of humor.

MLK, Jr and me

More Thoughts on Physicians Going on Strike

I noticed Dr. H. Steven Moffic, MD had written another article in Psychiatric Times asking whether it’s time for psychiatrists to consider going on strike. Often the issue triggering discussions about this is the rising prevalence of physician burnout. I’ve already given my personal opinion about physicians going on strike and the short answer is “no.”

One of my colleagues, Dr. Michael Flaum, MD, recently delivered a Grand Rounds presentation about physician burnout. The title is “Everyone Wins—The Link Between Real Patient-Centered Care and Clinician Well-Being.”

Fortunately, I and other are able to hear the substance of his talk on the forum Rounding@Iowa. During these recorded presentations (for which CME can be obtained), Dr. Gerry Clancy, MD interviews clinicians on topics that are of special interest to medical professionals, but which can be educational for general listeners as well.

I remember meeting Dr. Flaum when I was a medical student. At the time, he was very involved in schizophrenia research. He’s been a very busy clinician ever since. As he says, while he may be Professor Emeritus now, he’s definitely not “retired.” He’s still very active clinically.

Dr. Flaum identifies both systems challenges and physician characteristics as important in the physician burnout issue. Interestingly, he bluntly calls the systems challenges as virtually unchangeable and focuses on bolstering the physician response to the system as the main controllable factor. His main tool is Motivational Interviewing, which is more of an interview style than a separate kind of psychotherapy.

I think the kind of approach that Dr. Flaum recommends, which you can hear about in the Rounding@Iowa presentation, is what most psychiatrists would prefer rather than going on strike. See what you think.

My Two Cents on The Embrace Sculpture Honoring MLK Jr and Coretta Scott King

I first saw a photo of the sculpture honoring Dr. Martin Luther King Jr and Coretta Scott King, called “The Embrace” a couple of days ago. I remember my first impression being that it would have been nice to see a full sculpture of the couple rather than disembodied arms.

Sena mentioned it today because it was unveiled at Boston Commons. This was just before my mindfulness meditation, so I just told her that I saw the picture of it and said I would have to think about it some more.

As I sat in meditation, it occurred to me that “The Embrace” expressed what I think is a basic abstract idea, which is the challenge for us to embrace the notion that we’re all humans who ought to accept each other, and be kind and generous to one another.

That’s what I think the Kings did. That’s why Dr. King won the Nobel Peace Prize.

You could make a sculpture of the King as a couple embracing each other after he won the Nobel Prize. It would have been beautiful. On the other hand, you could make a sculpture which tries to do more than that. How difficult would it be to make a representation of what it might look like if all of us embraced our humanity—and each other?

It sounds too difficult. Yet the artist managed to do just that. Anyway, that’s my two cents.

MLK Week Redux for the New University of Iowa Psychiatry Fellows

I discovered the University of Iowa Dept of Psychiatry had a very successful match, filling key residency slots in Child Psychiatry, Addiction Medicine, and Consultation-Liaison fellowships. Congratulations! That’s a big reason to celebrate.

This reminds me of my role as a teacher. I retired from the department two and a half years ago. But I’ll always remember how hard the residents and fellows worked.

And that’s why I’m reposting my blog “Remembering My Calling.”:

Back when I had the blog The Practical C-L Psychiatrist, I wrote a post about the Martin Luther King Jr. Day observation in 2015. It was published in the Iowa City Press-Citizen on January 19, 2015 under the title “Remembering our calling: MLK Day 2015.”  I have a small legacy as a teacher. As I approach retirement next year, I reflect on that. When I entered medical school, I had no idea what I was in for. I struggled, lost faith–almost quit. I’m glad I didn’t because I’ve been privileged to learn from the next generation of doctors.

Faith is taking the first step, even when you don’t see the whole staircase.”

Martin Luther King, Jr.

As the 2015 Martin Luther King Jr. Day approached, I wondered: What’s the best way for the average person to contribute to lifting this nation to a higher destiny? What’s my role and how do I respond to that call?

I find myself reflecting more about my role as a teacher to our residents and medical students. I wonder every day how I can improve as a role model and, at the same time, let trainees practice both what I preach and listen to their own inner calling. After all, they are the next generation of doctors.

But for now they are under my tutelage. What do I hope for them?

I hope medicine doesn’t destroy itself with empty and dishonest calls for “competence” and “quality,” when excellence is called for.

I hope that when they are on call, they’ll mindfully acknowledge their fatigue and frustration…and sit down when they go and listen to the patient.

I hope they listen inwardly as well, and learn to know the difference between a call for action, and a cautionary whisper to wait and see.

I hope they won’t be paralyzed by doubt when their patients are not able to speak for themselves, and that they’ll call the families who have a stake in whatever doctors do for their loved ones.

And most of all I hope leaders in medicine and psychiatry remember that we chose medicine because we thought it was a calling. Let’s try to keep it that way.

You know, I’m on call at the hospital today and I tried to give my trainees the day off. They came in anyway.

An Old Post on Breaking Bad News

I’m reposting a piece about a sense of humor and breaking bad news to patients I first wrote for my old blog, The Practical Psychosomaticist about a dozen years ago. I still believe it’s relevant today. The excerpt from Mark Twain is priceless. Because it was published before 1923 (See Mark Twain’s Sketches, published in 1906, on google books) it’s also in the public domain, according to the Mark Twain Project.

Blog: A Sense of Humor is a Wonderful Thing

Most of my colleagues in medicine and psychiatry have a great sense of humor and Psychosomaticists particularly so. I’ll admit I’m biased, but so what? Take issues of breaking bad news, for example. Doctors frequently have to give their patients bad news. Some of do it well and others not so well. As a psychiatric consultant, I’ve occasionally found myself in the awkward position of seeing a cancer patient who has a poor prognosis—and who apparently doesn’t know that because the oncologist has declined to inform her about it. This may come as a shock to some. We’re used to thinking of that sort of paternalism as being a relic of bygone days because we’re so much more enlightened about informed consent, patient centered care, consumer focus with full truth disclosure, the right of patients to know and participate in their care and all that. I can tell you that paternalism is not a relic of bygone days.

Anyway, Mark Twain has a great little story about this called “Breaking It Gently”. A character named Higgins, (much like some doctors I’ve known) is charged with breaking the bad news of old Judge Bagley’s death to his widow. She’s completely unaware that her husband broke his neck and died after falling down the court-house stairs.  After the judge’s body is loaded into Higgins’ wagon, Higgins is reminded to give Mrs. Bagley the sad news gently, to be “very guarded and discreet” and to do it “gradually and gently”. What follows is the exchange between Higgins and the now- widowed Mrs. Bagley after he shouts to her from his wagon[1]:

“Does the widder Bagley live here?”

“The widow Bagley? No, Sir!”

“I’ll bet she does. But have it your own way. Well, does Judge Bagley live here?”

“Yes, Judge Bagley lives here”.

“I’ll bet he don’t. But never mind—it ain’t for me to contradict. Is the Judge in?”

“No, not at present.”

“I jest expected as much. Because, you know—take hold o’suthin, mum, for I’m a-going to make a little communication, and I reckon maybe it’ll jar you some. There’s been an accident, mum. I’ve got the old Judge curled up out here in the wagon—and when you see him you’ll acknowledge, yourself, that an inquest is about the only thing that could be a comfort to him!”

That’s an example of the wrong way to break bad news, and something similar or worse still goes on in medicine even today. One of the better models is the SPIKES protocol[2]. Briefly, it goes like this:

Set up the interview, preferably so that both the physician and the patient are seated and allowing for time to connect with each other.

Perception assessment, meaning actively listening for what the patient already knows or thinks she knows.

Invite the patient to request more information about their illness and be ready to sensitively provide it.

Knowledge provided by the doctor in small, manageable chunks, who will avoid cold medical jargon.

Emotions should be acknowledged with empathic responses.

Summarize and set a strategy for future visits with the patient, emphasizing that the doctor will be there for the patient.

Gauging a sense of humor is one element among many of a thorough assessment by any psychiatrist. How does one teach that to interns, residents, and medical students? There’s no simple answer. It helps if there were good role models by a clinician-educator’s own teachers. One of mine was not even a physician.  In the early 1970s when I was an undergraduate at Huston Tillotson University (when it was still Huston-Tillotson College), the faculty would occasionally put on an outrageous little talent show for the students in the King Seabrook Chapel. The star, in everyone’s opinion, was Dr. Jenny Lind Porter, who taught English. The normally staid and dignified Dr. Porter did a drop-dead strip tease while reciting classical poetry and some of her own ingenious inventions. Yes, in the chapel. Yes, the niece of author O. Henry; the Poet Laureate of Texas appointed in 1964 by then Texas Governor John Connally; the only woman to receive the Distinguished Diploma of Honor from Pepperdine University in 1979; yes, the Dr. Porter in the Texas Women’s Hall of Fame—almost wearing a very little glittering gold something or other.

It helps to be able to laugh at yourself.

1.       Twain, M., et al., Mark Twain’s helpful hints for good living: a handbook for the damned human race. 2004, Berkeley: University of California Press. xiv, 207 p.

2.       Baile, W.F., et al., SPIKES-A six-step protocol for delivering bad news: application to the patient with cancer. Oncologist, 2000. 5(4): p. 302-11.

New Season for Highway Thru Hell

There was a countdown on Sunday for the new season for Highway Thru Hell. That’s the explanation for the featured image. The show has been on a while; this is season 11.

Season 11, for the first few episodes will deal with the catastrophic floods that devastated British Columbia in November of 2021. It took a huge toll on everybody, including the tow truck businesses. That’s one reason why I think, out of the plethora of reality shows that are faked on TV—Highway Thru Hell is not.

There are times when I wondered about the show’s authenticity, of course. One episode featured a potential new hire named “Jack Knife,” which brings to mind what the heavy tow trucks do, which is to drag huge jack-knifed semi-trucks out of ditches along the highways. The episode actually showed a segment of Jamie Davis, the owner of the major tow truck business on the show, in which he confirms that Jack Knife is the guy’s real name. It doesn’t look like he was hired.

There is a kind of irony about the kinds of jobs I’ve had and how similar or not they were to the Highway Thru Hell type of work.

You’d think that when I was working as a survey crewman back when I was a young, I would think it was similar to Highway Thru Hell. In fact, I worked for professional consulting engineers. I had a regular schedule with set hours. I had the right equipment for the right job. When work slowed down, meaning the company didn’t have a big contract for a highway relocation or whatnot, I and other guys would fill the time and to look busy, we would tie up redheads.

I’ve set up that joke before. We didn’t tie up red-headed women. You tied red ribbon as flagging around nails to use as measuring points for property or airport runway lines and the like. It makes them easier to see. If you were lucky and had some drafting skills, like me, in the winter months you’d work on drawing up survey plots and other plans for blueprints. I worked in pretty bad weather sometimes, in the winter. I never had to do anything that was dangerous. I got plenty of sleep.

But I never worked as hard as tow truck operators. When it’s slack time for them, some are laid off, which is never a good thing. But when they’re busy, they’re up all day and sometimes all night. The calls to haul trucks out of the ditch are unpredictable. And the conditions are always dangerous.

The irony is that it wasn’t until after I graduated medical school, got my medical license, and finished my residency in psychiatry that, as I look back on it now, that my work sort of resembled the chaos of workers on Highway Thru Hell. And being on call as a resident did sometimes result in my face nearly falling in my dinner because of sleep deprivation.

Like Highway Thru Hell, working as a psychiatric consultant was a lot like being like a fireman, which is similar to towing. I got called, often to emergencies, and had to work in conditions which were dangerous, mainly because of violent patients. Like towing, the work load was feast or famine. The job often called for creative solutions to apparently impossible challenges.

Much of the time, the Highway Thru Hell workers’ worst enemy was Mother Nature, just as it was in during the catastrophic floods of November 2021. For many psychiatrists and other physicians, it seems like the worst enemy was burnout, especially during the Covid-19 pandemic.

There is no quick fix in either case. We can work together and help each other.

Giving Credit Where Credit is Due

Here’s another vintage post from around a decade ago after my former Psychiatry Dept chairperson, Dr. Robert G. Robinson and I published our book, Psychosomatic Medicine: An Introduction to Consultation-Liaison Psychiatry” in 2010.

Blog: Who Gets The Credit?

When I think about peak moments, I remember this guy back in junior high school who decided to try to break the Guinness Book of World Records for skipping rope. I don’t remember his name but the school principal and his teachers all agreed to let him do it during class hours. They marked out a little space for him in our home room. He was at it all day. And he was never alone because there was always a class in the room throughout the day. We didn’t get much work done because we couldn’t keep our eyes off him. It was mesmerizing. The longer he jumped, the more we hoped. We were very careful about how we encouraged him. We didn’t want to distract him and make him miss a jump. And so, we watched him with hope in our hearts. It was palpable.  As he neared the goal, we were all crowded around him, teachers and students cheering. He was exhausted and could barely swing the rope over his head and lift his knees. When he made the time mark, we lifted him high above our heads and you could have heard us yelling our fool heads off for miles. Time stood still. He was a hero and we were his adoring fans. It didn’t occur to us to be jealous. His achievement belonged to all of us.

Another peak moment occurred more recently, when my colleagues and I published a book this summer. It’s my first book. It’s a handbook about consultation-liaison psychiatry which my department chairman and I edited, and the link is available on this page. This time, the effort was collaborative with over 40 contributors. The work took over 2 years and often, being an editor felt like herding cats. But we worked on it together. Many of the contributors were trainees working with seasoned psychiatrists who had much weightier research and writing projects on their minds, I’m sure. Like any first book, it was a labor of love. The goal was to teach fundamental concepts and pass along a few pearls about psychosomatic medicine to medical student, residents, and fellows. The book grew slowly, chapter by chapter. And when it was finally complete, this time the achievement was ours and again it belonged to all of us.

I made a lot of long-distance friends on the book project and occasionally get encouragement to do something else we could work together on. I suppose one thing everyone could do is to propose some kind of delirium early detection and prevention project at their own hospitals and chronicle that in a blog to raise awareness about delirium—sort of like what I’ve been trying to do here. We could share peak moments like:

  1. Getting the Sharepoint intranet site up and going so that group members can talk to each other about in discussion groups about how to hammer out a proposal, which delirium rating scale to use, or which management guidelines to use—and avoid the email storms.
  2. Being invited to give a talk about delirium at a grand rounds conference or regional meeting.
  3. Talking with someone who is interested in funding your delirium project (always a big hit).

That way if one of us falters, we always know that someone else is in there pitching. Copyrighting ideas and tools are fine. Hey, everybody has a right to protect their creative property. I’m mainly talking about sharing the idea of a movement to teach health care professionals, and patients about delirium, to help us all understand what causes it, what it is and what it is not, and how to prevent it from stealing our loved ones and our resources.

“It is amazing what you can accomplish if you do not care who gets the credit”-Harry Truman, Kansas Legislature member John Solbach, Ronald Reagan, Charles E. Montague, Benjamin Jowett, a Jesuit Father, a wise man, Edward T. Cook, Edward Everett Hale, a Jesuit Priest named Father Strickland.