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Big Mo Pod Show: “Spiritual IV”

I’m trying to figure out what the meaning of the title is of this week’s Big Mo Pod Show. It’s “Spiritual IV” and I looked at all of his past pod shows looking for Spiritual I-III. I can’t find them.

The other thing I noticed about the pod show is that the theme of many of last night’s songs is less about spirituality and more about carnality and brutality. Now, that doesn’t mean I’m preaching. I just wonder if the title “Spiritual IV” is ironic.

Take the song “Talk to Me Baby” by Elmore James, or “44 Blues” by Little Arthur Duncan. One song that didn’t make the pod show list was “The Circus is Still in Town (The Monkey Song)” by Rick Estrin and the Nightcats. And Buddy Guy sang his new song “Been There Done That,” meaning he’s been to hell and back. He’s 89 years old and still does gritty blues. The music often seems only about sex, violence and drug addiction.

And the discussion gravitated to guns, specifically the .44 caliber handgun. I never knew Muddy Waters carried a gun. Hey, even Big Mo owns a .44. I didn’t make that up; he said so. It weighs about 7 pounds, by the way.

This morning’s pod show is a reminder that a lot of blues music sounds more earthy than spiritual. However, you can usually find at least one spiritual note letting in a little ray of hope. One of the songs featured in the pod show is Sugaray Rayford’s “How the Other Half Lives.” One line seems to offset the misery and injustice in the rest of the lyrics: “Take it slow, find the flow.”

I’m going to put my nickel down on one of last night’s songs that didn’t make to to the pod show list and it’s “Don’t Wanna Go Home” by Eric Gales, featuring Joe Bonamassa. It’s not spiritual. It’s about having a good time—but notice, he paid all of his bills first.

In Memory of Leonard Tow, Founder of the Tow Foundation and Humanism in Medicine

I just found out that Leonard Tow died on August 10, 2025. In humility, I express my gratitude and respect for his creation of the Tow Foundation, a big part of that being the Humanism in Medicine Award, of which I am one of the many recipients over the years. I hope this great tradition goes on forever, a reminder to doctors, patients, and families of the great rewards and greater responsibilities in medicine.

I thank Dr. Jeanne M. Lackamp, now Chair of the Department of Psychiatry, Psychiatrist in Chief for University Hospitals and Director of the University Hospital Behavioral Health Institute for nominating me and Dr. Jerold Woodhead, Professor Emeritus in Pediatrics at University of Iowa Health Care for placing the pin in my lapel. That was in 2007.

Leonard Tow established the Humanism in Medicine award to foster the development of humanistic doctors. They exemplify compassion and respect for others, humility and empathy.

That is how I will remember Leonard Tow.

Pride or Rhetoric? What Would Dr. Melvin P. Sikes Say?

I noticed the headlines about the DEI flap at The University of Iowa, the one with the official apparently spilling the beans about University of Iowa’s DEI program not going away despite being illegal while maybe being unaware of being filmed. I’m not going to retell the story.

However, it does remind me of a time back in the 1970s in the days of affirmative action when I was a freshman student at Huston-Tillotson College (now Huston-Tillotson University) in Austin, Texas.

I learned about tenacity to principle and practice from a visiting African American professor in educational psychology from the University of Texas. It was 1975. Dr. Melvin P. Sikes paced back and forth across the Agard-Lovinggood auditorium stage in a lemon-yellow leisure suit as he talked about the importance of bringing about change in society.

He was a scholar yet decried the pursuit of the mere trappings of scholarship, exhorting us to work directly for change where it was needed most. He didn’t assign term papers, but sent me and another freshman to the Austin Police Department. The goal evidently was to make them nervous by our requests for the Uniform Crime Report, which Dr. Sikes suspected might reveal a tendency to arrest blacks more frequently than whites. He wasn’t satisfied with merely studying society’s institutions; he worked to change them for the better. Although we were probably just as nervous as the police were, this real-life lesson about the importance of applying principles of change directly to society was awkward.

Nothing like confronting social issues head on, right?

We would have preferred a term paper. We sat in the police station looking at the Uniform Crime Report, which was the only resource we could get. I think we were there a couple of hours; it felt a lot longer than that. The officer who got us the paperwork was polite, but a little stiff and wasn’t really open to anything like an interview or anything close to that. I can’t remember what we came up with as a write-up for what felt like a fiasco. I’m pretty sure we didn’t bring about anything even close to change. It was a humbling experience. Maybe that was the point but I’ll never know.

Dr. Melvin P. Sikes was a member of the Tuskegee Airmen although he didn’t see combat. He was the dean of two historically black colleges, a clinical psychologist, and a University of Texas professor. He died in 2012 after a long and successful career as a psychologist, teacher, and author.

I found a podcast about him which was sponsored by the Hogg Foundation for Mental Health and which aired February 15, 2024. It’s an hour long, but there are segments of interviews of him in 1972 that I consider fascinating. A couple of times he says something which I wish the interviewer had allowed him to expand on. The gist of it is that we need to have a system of education which allows people to speak from the standpoint of pride rather than rhetoric. I think what he might have meant is that it would be wonderful if we felt secure and confident in ourselves to express our minds sincerely. The word “rhetoric” makes me think of talk that is persuasive, even impressive, but maybe insincere. I think it still fits today.

Shout Out to Dr. George Dawson for Post “The Autocratic Approach to Homelessness”

I want to give a shout out to Dr. George Dawson for his post today “The Autocratic Approach to Homelessness” in reference to President Trump’s most recent executive order, “Ending Crime and Disorder on America’s Streets.” As a retired psychiatrist, I look back and remember seeing the problem of the homeless mentally ill a lot. You can read my take on it from last summer’s posts:

What About Bob?

Thoughts on the Homeless Mentally Ill

Thoughts on Hobos and Homelessness

I spend a lot of time joking around on my blog, but this is no joking matter. I think the President gets it wrong.

A Small Update to a Pseudo-Rap YouTube Video and a Big Tribute to Dr. Robert G. Robinson

I just noticed something about one of my YouTube videos that I made sort of as a combination gag and educational piece about pseudobulbar affect. It needed a couple of updates—one of which is minor and which I should have noticed 10 years ago when I made it.

It’s a pseudo-rap performance (badly done, I have to agree although it was fun to make), but it’s one of my most watched productions; it has 18,000 views.

One minor update is about the word “Dex” in the so-called lyrics of this raggedy rap song (see the description by clicking on the Watch on YouTube banner in the lower left-hand corner). It stands for dextromethorphan, one of the ingredients along with quinidine in Nuedexta, the medication for pseudobulbar affect. Dextromethorphan has been known to cause dissociation when it’s abused (for example, in cough syrup).

The most important update is about Dr. Robert G. Robinson, who I joked about in the piece. He passed away December 25, 2024. He was the chair of The University of Iowa Dept. of Psychiatry from 1999-2011. He was a great teacher, mentor, and researcher. He published hundreds of research papers and books on neuropsychiatric diseases like post-stroke depression and pseudobulbar affect. He lectured around the world and was widely regarded as a brilliant leader in his field.

Early in my career in the department, I left twice to try my hand in private practice psychiatry. Both times Dr. Robinson welcomed me back—warmly. He was my co-editor of our book, Psychosomatic Medicine: An Introduction to Consultation-Liaison Psychiatry, published in 2010.

All who worked with Dr. Robinson will never forget him.

The Hummingbird is a Blur!

Yesterday I noticed a hummingbird hovering about the flower pots on our porch. I hurried to get my point and shoot camera and shot video, through a window as usual and it was getting a little late in the evening too, so light was low.

Can I blame the bird for always looking like a blur—or not? Anyway, the video looks similar to others I’ve managed to capture in years past, except this one was the closest I’ve ever gotten to one. I tried messing with the clip using my video editing software, but I ended up believing it best to leave it mostly unmessed around with.

On the other hand, the one I got about 6 years ago was pretty fair for an amateur backyard birder. Same camera, same software although I was closer to the birds and I’m pretty sure I was sitting outside and very patient. They were very interested in our little feeder.

I think the hummingbirds we’ve seen are ruby-throated species partly because that’s the most common in Iowa. Typically, I think it’s just the males who have ruby-colored throats; our visitor didn’t.

I guess the usual way to attract hummingbirds is with a feeder but other people say there are other reasons hummingbirds visit us. More common to the indigenous peoples, they may be thought of as the spirits of those who recently died and are visiting those they were close to.

I don’t remember the movie “The Curious Case of Benjamin Button” so well but I’ve glanced briefly at web articles which connect it with hummingbirds, which has something to do with their ability to fly backwards or in a figure 8, maybe connecting that with reverse aging or infinity. Other symbolic connections are with joy, healing, and partnership. There are so many connections they seem to blur together—sort of like the bird itself as it hovers and flits from flower to flower.

I think this hummingbird just really liked Sena’s flowers.

Starting Without the Big Mo Blues Show Today!

Well, I’ve been waiting all morning for the Big Mo Pod Show and it usually shows up long before now on Saturday morning. In spite of this, Big Mo did say on the blues show last night that the first two songs on the show would be on the pod show and I know what they are. So I’m going to go ahead and start without Big Mo and Producer Noah today.

The first one is a song by someone Big Mo mentioned last week, Monster Mike Welch, “Keep Living Til I Die.” It just happens to be related to my post yesterday on death doulas—only it’s full of raw and feisty humor in how it approaches the usual ideas about death, which can be morbid.

In the lyrics, I think there’s even a classical Greek mythology reference to the river Styx, “I pay my toll at the river…” It could be referring to the river which separates the living from the dead in Hades.

There’s nothing morbid about death in this tune. The singer doesn’t seek death, but neither does he try to run away or hide from it. He’ll just keep living till he dies.

I’m less sure what to think of the next song Big Mo would be on the pod show. It’s by Lil’ Ed & the Imperials, “Walking the Dog.” I can’t make sense of the lyrics.

That’s about as far as I can go so far without the pod show. On the other hand, there was another song on the blues show by an artist I didn’t know about until last night. “Been Here Before” is a striking song because right away I wondered if was about reincarnation. It is sort of related to the idea of what happens after we die.

In fact, the artist, Christone Kingfish Ingram speculates in an interview he might be open to the idea of his have been reincarnated. This is not that different from a few of Dr. H. Steven Moffic’s thoughts about the death, reincarnation, and the afterlife in some of his recent Psychiatric Times columns. A couple of examples are “Past Lives and Psychiatry” and “Past Lives, Death, Dying, and the Afterlife.”

And that’s the “old soul” side of the story about death.

How Will I Get to Heaven? Rounding at Iowa Podcast: End of life Doulas

I listened to the Rounding@Iowa podcast “End-of-Life Doulas” twice because I’m at that difficult age when I think about my personal death. I don’t think about it at great length, mind you, but when I think about it, I feel afraid. Early mornings tend to be the time I wonder how much time now until…?

There was the usual podcast format, Dr. Gerry Clancy interviews Mary Kay Kusner, who is certified death doula to get the overview and details about what death doulas are all about.

86: Cancer Rates in Iowa – Rounding@IOWA

Iowa's cancer rates are among the highest in the country, and they are rising. In this episode of Rounding@Iowa, Dr. Gerry Clancy and guest experts Dr. Mary Charlton and Dr. Mark Burkard discuss the data, risk factors, and prevention strategies clinicians can use to make a difference. CME Credit Available: https://uiowa.cloud-cme.com/course/courseoverview?P=0&EID=81274 Host: Gerard Clancy, MD Senior Associate Dean for External Affairs Professor of Psychiatry and Emergency Medicine University of Iowa Carver College of Medicine Guests: Mark E. Burkard, MD, PhD Professor of Internal Medicine-Hematology, Oncology, and Blood and Marrow Transplantation University of Iowa Carver College of Medicine Director, University of Iowa Health Care Holden Comprehensive Cancer Center Mary Charlton, PhD Professor of Epidemiology Director, Iowa Cancer Registry Iowa College of Public Health Financial Disclosures: Dr. Clancy, Dr. Burkard, Dr. Charlton, and Rounding@IOWA planning committee members have disclosed no relevant financial relationships. Nurse: The University of Iowa Roy J. and Lucille A. Carver College of Medicine designates this activity for a maximum of 0.75 ANCC contact hour. Pharmacist and Pharmacy Tech: The University of Iowa Roy J. and Lucille A. Carver College of Medicine designates this knowledge-based activity for a maximum of 0.75 ACPE contact hours. Credit will be uploaded to the NABP CPE Monitor within 60 days after the activity completion. Pharmacists must provide their NABP ID and DOB (MMDD) to receive credit. UAN: JA0000310-0000-25-090-H99 Physician: The University of Iowa Roy J. and Lucille A. Carver College of Medicine designates this enduring material for a maximum of 0.75 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Other Health Care Providers: A certificate of completion will be available after successful completion of the course. (It is the responsibility of licensees to determine if this continuing education activity meets the requirements of their professional licensure board.) References/Resources: Iowa Cancer Plan

I listened to the podcast in the late afternoon and discussed it only briefly with Sena. I felt out of sorts for a few hours afterward. I was in a funk until later in the evening when my thoughts almost abruptly switched to something funny. It was about a topic I’m thinking of for another blog post which has a humorous angle to it. I even chuckled a little out loud. I didn’t force that line of thought—it just happened.

But I know why it happened.

I didn’t know what a doula was until I listened to the podcast. Because I’m a writer by inclination, I looked for the original definition, which is a female servant who helps women with birthing. That didn’t enlighten me much, obviously; I can’t remember the last time I was pregnant (see what I did there?). An end of life-or-death doula helps people come to terms with impending death, death when it happens, and with whatever comes up after death has happened.

The title of this post comes from the Mary Kay Kusner’s short anecdote near the end of the podcast. Early in her career as a chaplain, she met with a 4-year-old child in the oncology unit who had a terminal illness, evidently death was coming and asked her, “How will I get to heaven?” They talked about it and the next thing the child said was, “So it’s like another dimension?” which Kusner evidently validated in some way. It’s a really cute story.

Anyway, there was a thread running through the podcast which pointed to what is apparently an ongoing psychological disconnect medical professionals have about death because we’re so focused on cure. It’s disappointing, but there you go. Death doulas are around to fill the role of talking calmly and matter-of-factly about it with patients and families.

There are some nuts and bolts about the profession, some of which I get and others which I scratch my head about. There are a couple of doula organizations in Iowa City which Kusner mentions: Community Death Doulas and Death Collective Eastern Iowa. Mary Kay Kusner is certified as a death doula via online training through INELDA.

Interestingly some people do not believe that this is a profession which can be certified, at least without some practical clinical experience. There’s a web site in which the question-and-answer section is longer than the article itself about this. The author recommends specific courses.

Death doulas are not covered by health insurance, so the practitioners arrange for payment, often through a sliding scale hourly fee. Part of the reason for the training of and demand for death doulas is that hospice nurses have heavy caseloads.

This reminds me of the hospice where my younger brother died after his battle with cancer. He was in his forties. Before he entered hospice, I had to be one of his doctors on the medical psychiatry inpatient unit after he accidentally overdosed on his pain medication.

When my brother was in hospice, I sat at his bedside. Most of the time, he was delirious. I watched and listened as one of the hospice workers as he asked him whether he was entering the dying process. He used those words. My brother was just as delirious as he was when he had to be admitted to the medical-psychiatry unit. I don’t know how much he heard.

I sat at his bedside, determined to hold some kind of death watch vigil. This was interrupted, ironically, by some friends of his who visited. They stood opposite the bed so that I had to look at them instead—and to listen as they told me stories about how close they’d been to him and how much they loved him.

By the time they were finished and I turned back to my brother, he was gone. It took me a little while to figure out I had not missed anything I really needed.

So, I think death doulas could be vital in building a bridge between those who are dying and those who need to connect with them. That’s the main thing.

Meet Mr. Slim Indigo!

Just like a few days ago, yesterday evening while we were playing cribbage, Sena spied a slim indigo bunting. This one flew right up to our window! It was probably not the same one we first saw. That guy was buff, likely because he’d been branch pressing in the gym.

This character was slim and trim and looked like a lot of other birds we saw charging at their reflections in our windows last month. He really wanted to tell that other bunting where to fly off. I think he should work out more if he’s going to strut like that.

If we’d been sitting by the window all day long with camera at the ready, we’d have been unlikely to ever catch Slim Indigo peering and posing like he was on the bird walk.

It’s a random surprise when lucky breaks like that happen. It can take your breath away. I’m not sure why we’ve been lucky enough to catch a look at Slim, especially after over 20 years since seeing the last one. One answer to that might be here. Sometimes it’s better to be lucky than good. By the way, that reminds me; Sena won the cribbage game—this time.

The one thing I couldn’t get by shooting video through a window is Slim’s voice. Clearly, you can see he was chirping at one point. So, here’s a link for that.

More Mall Walking for Everyone!

I don’t get out often to the mall to do mall walking, but I did today. I put on a little over 2.5 miles on my step counter. Mall walking is OK for exercise although I have to drive over there. Right next door to the entrance to the mall is the outdoor entrance to Planet Fitness, which is kind of ironic. But you have to pay a membership fee to use the facilities there. You can just walk through the mall for free and it opens an hour before the other shops just to accommodate mall walkers.

I think mall walking does wonders for my lower back. I see a lot of older people who look like they make mall walking regular exercise. They’re my age or older. Some of them have physical challenges that may be the reasons why they mall walk, that is, for conditioning. Their physicians might have even recommended it.

A minority of mall walkers I see are young, so this isn’t just for the elderly. Occasionally I’ll see a group who are challenged in various ways. Today it looked like the guy who was blind and using a cane was right out in front, actually leading the group.

Mall walking has advantages over, say, walking downtown. It beats getting clobbered by an exploding manhole lid, bit by a dog, or mugged.

There are some studies about mall walking, but the authors of a 2015 review mainly noted that there’s a need for more rigorous studies. Their conclusion sounds a little grumpy:

“We found the potential for mall walking programs to be implemented in various communities as a health promotion measure. However, the research on mall walking programs is limited and has weak study designs. More rigorous research is needed to define best practices for mall walking programs’ reach, effectiveness, adoption, implementation, and maintenance.”

Farren L, Belza B, Allen P, Brolliar S, Brown DR, Cormier ML, Janicek S, Jones DL, King DK, Marquez DX, Rosenberg DE. Mall Walking Program Environments, Features, and Participants: A Scoping Review. Prev Chronic Dis. 2015 Aug 13;12:E129. doi: 10.5888/pcd12.150027. PMID: 26270743; PMCID: PMC4552141.

Maybe the authors need to go for a walk.

It’s inspiring to see some of the mall walkers out there despite having major disability of one kind or another. I often see a lady who uses a wheeled walker and cannot hold her head up straight. When she sits down for a break, it looks like she’s collapsed. But she just gets up and at it again a few minutes later.

Mall walking may be understudied—but it’s also underestimated as a sign of resilience in anyone young or old.