reminiscence – Go Retire Psychiatrist

The Beard Kit and the Promise of Beignets Arrive

Yesterday, the beard kit and other items were delivered. The other items were a barber cape and Café Du Monde Beignet Mix. I took a picture of all of them and can’t readily explain why the odd item out seems to be the Beignet Mix. Sena cuts my hair and the old cape just needs to be replaced.

We got the Café Du Monde mix and the rolling pin because Sena plans to make Beignets in the near future. We were in New Orleans while I was attending an Academy of Consultation-Liaison annual meeting in November 2015. We actually got Beignets while we there and we’re pretty sure it was at the Café Du Monde. It was sprinkling rain and a bit chilly that day, but the Beignets were delicious.

Maybe Sena plans to sprinkle powdered sugar in my beard after I get it rehabbed with the beard kit.

Anyway, the unboxed beard kit, which is made by a company called Viking, was very well packed and contained many tools and products. A couple of them are worth commenting about because they raised puzzling questions, at least for me. The beard wash and beard conditioner both contain cautions about using them if you’re pregnant, advising consultation with your physician. I’m sure about the wording because I had to use a magnifying glass to read the labels.

Initially I was not sure why women would use them at all. I searched the internet and it turns out that a woman can use beard oil (which also comes with my new kit) for the hair on her head, face, cuticles, and more. I guess when you think about it, beard wash and conditioner are not that different from products women use for their own hair. I’m still not sure why they should consult a physician before using them.

The kit came with beard balm. I gather from reading on the internet that it conditions and softens the beard. The beard brush is used after applying beard balm, to spread it out. It looks kind of like softened butter. Wild boar bristle brushes are frequently recommended for exfoliating skin and distributing the oils on skin. Brushing with it actually feels good. I’m not so sure about claims that it can promote more beard growth, but the bristles are stiff enough that I can spread the hair I do have over the potholes!

Sometimes badger bristles are used in brushes instead of wild boar hair but it’s far less common. I suggest avoiding this topic with anyone from Wisconsin, especially if he played football in college.

The kit also came with both a beard comb and a smaller mustache comb. Many advise using both but caution against using a brush on wet hair. The small pair of scissors is very sharp. My first use of it was to cut the foil seals glued very tightly to the bottles of beard wash and beard conditioner. They’re very good for snipping off the flyaways.

There’s a lot more to know about getting this beard thing right than I ever imagined. And Sena has a rolling pin and will make Beignets. We’ll pretend we’re in New Orleans. I’ll get powdered sugar in my beard and I won’t have to brush it out with a wild boar bristle brush because my beard is already white.

Thoughts on Gaming Disorder

I just read an interesting article in the latest print issue of Clinical Psychiatry News, Vol. 51, No. 5, May 2023: “Gaming Disorder: New insights into a growing problem.”

This is news to me. The Diagnostic and Statistical Manual lists it as an addiction associated with the internet primarily. It can cause social and occupational dysfunction, and was added to the DSM-5-TR in 2013 according to my search of the web. I’m not sure why I never heard of it. Or maybe I did and just failed to pay much attention to it.

There are studies about treatment of the disorder, although most of them are not founded in the concept of recovery. The research focus seems be on deficits. One commenter, David Greenfield, MD, founder and medical director of the Connecticut-based Center for Internet and Technology Addiction, said that thirty years ago, there was almost no research on the disorder. His remark about the lack of focus on recovery was simple but enlightening, “Recovery means meaningful life away from the screen.”

Amen to that.

That reminded me about the digital entertainment available thirty years ago. In 1993, the PC game Myst was released. Sena and I played it and were mesmerized by this simple, point and click adventure game with intricate puzzles.

Of course, that was prior to the gradual evolution of computer gaming into massive multiplayer online role-playing and first-person shooters and the like. It sounds like betting is a feature of some of these games, which tends to increase the addictive potential.

Sena plays an old time Scrabble game on her PC and other almost vintage age games. I have a cribbage game I could play on my PC, but I never do. I much prefer playing real cribbage with Sena on a board with pegs and a deck of cards. We also have a real Scrabble game and we enjoy it a lot. She wins most of the time.

This is in contrast to what I did many years ago. I had a PlayStation and spent a lot of time on it. But I lost interest in it after a while. I don’t play online games of any kind. I’m a little like Agent K on Men in Black II when Agent J was unsuccessfully trying to teach him how to navigate a space ship by using a thing which resembled a PlayStation controller:

Agent J: Didn’t your mother ever give you a Game Boy?

Agent K: WHAT is a Game Boy?

Nowadays, I get a big kick out of learning to juggle. You can’t do that on the web. I like to pick up the balls, clown around, and toss them high, which occasionally leads to knocking my eyeglasses off my head. I usually catch them.

Juggling is a lot more fun than playing Myst. I would prefer it to any massive multiplayer online game. I never had a Game Boy.

Celebrate Teacher Appreciation Week!

Teacher Appreciation Week this year started on May 8, 2023. I found my old report cards from Lincoln Elementary School in Mason City, Iowa. Lincoln was torn down many years ago to make room for expanding the Post Office. But I have my memories. I rediscovered reasons to celebrate the dedication of teachers. I don’t know how many people keep their grade school report cards. My mother kept mine along with old elementary school photos, including class pictures.

Jimmy!

Brief remarks on my grade cards remind me how supportive my teachers were—and how they expected me to buckle down. I was kind of a handful and there are indications that I had difficulty focusing my attention. My fifth-grade teacher, Mrs. Cole, was instrumental in identifying my near sightedness, which helped me to get my first pair of eyeglasses.

It wasn’t a bed of roses. My third-grade teacher, Mrs. Myrton (who always smelled like cigarettes), once slapped me so hard it made my nose bleed because I bumped into her when I was running around the classroom. I don’t remember why I was doing that. She was really sorry for slapping me.

And there was the time me and another kid got caught throwing snowballs on the playground (I can’t remember what grade I was in), which led to the usual penalty levied by the school Principal, Esther Ahrens. We each had to draw really small circles (signifying snowballs) to fill a sheet of paper.

We (meaning the kids) thought Ms. Ahrens was a witch. On the other hand, on a really hot day shortly before summer break, my 4^th grade teacher, Ms. Hrubes, started acting really strange and was sort of wobbling at the open window in the classroom. There was no air conditioning in the school. Ms. Ahrens happened to be walking by the room and rushed into the room just in time to catch Ms. Hrubes as she was falling backward in a dead faint from heat exhaustion.

But other than that, along with the usual physical and psychological cuts and scrapes of elementary school, I remember those years as instrumental in turning me and other kids into smarter, nicer people and better citizens. We also learned how to make really tasty homemade ice cream the old-fashioned way, using nested containers, the larger of which had a mixture of salt an ice and a hand crank.

The notes and letters with my report cards often had illuminating comments:

“Jimmy has done well in Physical Education class. He has excellent aim and can hit a moving car’s windshield with a rock (yelling ‘bombs away’) with fair accuracy.”

“During this quarter, I was able to dissuade Jimmy from trying to fly like superman from the second-floor window of the classroom.”

“Jimmy reads well. He could apply himself more carefully in science. We were finally able to remove all the exploded paint from the gymnasium. It took only a few weeks this quarter.”

“Jimmy’s command of spatial relationships has improved a great deal! He can figure out how to fill his emptied milk carton with spinach in seconds, often without attracting the attention of the lunchroom monitors.”

I’m giving a great big thank you to all the teachers! You deserve it!

Racial Affinity Group Caucusing Separate But Not Equal to Segregation

I read the New England Journal of Medicine perspective article “Racial Affinity Group Caucusing in Medical Education—A Key Supplement to Antiracism Curricula.”

I did not see the word “segregation” anywhere in the paper, although the Daily Mail news item used it frequently in a manner that I suspect was intended to incite indignation over separating White and Black, Indigenous, People of Color (BIPOC) medical students into Racial Affinity Group Caucuses (RAGC). This was for the purpose of ultimately integrating them with the goal of defeating racism.

Words matter. The word “segregation” used in the way some news reporters did is bound to conjure up 1960s images of the effect of Jim Crow laws and remind those old to remember it the speech of Alabama governor George Wallace pledging “Segregation now, segregation tomorrow, segregation forever.”

Separating people into groups for the purpose of working out a solution to racism can be called segregation only in the strictest sense of the definition. If you can separate denotation from connotation, I think you have to question the use of the word in the news article, which was heavily freighted with negative connotations.

When I was a student at Huston-Tillotson College (now H-T University, one of the Historically Black Colleges and Universities) in the 1970s, the Greek fraternity and sorority pledges were segregated from those who chose not to pledge, including me. I was really happy to be segregated when I witnessed the hazing of the pledges.

The women and men students at H-TU who lived on campus were segregated into male and female dormitories. This did not stop certain activities like dances and fraternity events.

I recall reading news stories a year or two ago about some black college students wanting to be segregated into different dormitories at predominantly white college campuses. I don’t agree with the idea, but it sounded like some black students preferred it.

I like my socks segregated from my dress shirts. But that’s just me.

Gators OMG!

The other night I saw a spot on a paranormal TV show that apparently ran out of anything supernatural to talk about. Instead, it showed a few videos of real events that could make you say “OMG.” In fact, that was part of the title of the episode.

One of them was a surveillance video of a Florida man saving his puppy’s life by wrestling with an alligator. While the Florida man was walking his dog, somehow it managed to escape its leash and plunged into a pond.

The pond was full of gators and one grabbed the puppy. Florida man jumped into the water and wrestled with the gator, which was actually not much bigger than the pup. The guy had a cigar in his mouth before the fracas. And he still had it during the desperate struggle. Even after he ducked underwater, he burst out—still clenching the cigar in his teeth.

The little gator still clenched the puppy, which was limp initially, but came back to life and cried pathetically while Florida man pried apart the jaws of the reptile, eventually freeing the dog (which got puncture wounds or a crushed rib cage depending on which version of the narrative you believe, the paranormal TV show or the TV news video).

I keep calling the guy “Florida man” because the TV news broadcast on YouTube with a few comments about how dangerous a Florida man (or almost any Florida resident) can be, even to a gator. You can get a better sense of the bias leading to jokes about Floridians by reading New York Times bestselling author Dave Barry’s book, “Best State Ever: A Florida Man Defends his Homeland.”

The only way that video would have been more spectacular is if a full-grown gator had clenched Florida man, the little gator, and the puppy—with just the cigar poking out of big daddy gator’s jaws. It could have happened. The pond was full of the reptiles. OMG!

We’ve seen Florida gators. I think tour guides steered us clear of Florida man.

Where is Juggling and Foosball on the Homunculus?

I saw an interesting article published in Nature about the homunculus being outdated because of a new brain MRI study indicating that there’s a mind-body connection between the motor cortex and neural networks controlling planning and thought. There’s a mouthful for you.

It makes me wonder about a few things. For example, can I improve my juggling skills simply by thinking about it? Actually, I spend quite a bit of time both practicing juggling and thinking about it.

Sena has recently started thinking about and practicing juggling. And I made a little video about the cascade practice in an effort to help her get unstuck from the 3-ball toss and catch at the 1-2-3 and catch stage. It’s a slow-motion video of me demonstrating the 1-2-3-4 and catch stage. It’s intended to help her visualize how to let go of that pesky ball in her non-dominant hand after the third toss.

The implications of the new brain study for helping patients recover from the effects of stroke are fascinating.

It reminded me of the game foosball. What do you mean you never heard of foosball? It’s a table football game which was enormously popular in the 1970s. You could probably find one in any bar, along with pong, a sort of electronic table tennis game that was also popular in the ‘70s.

The foosball table was usually located at the back of the bar, across the mandatory squishy carpet and kitty corner from the bathroom.

You could never get on the foosball table at one of the local bars in my hometown. It was always monopolized by a gang of local tough guys who would slam the ball so hard into the goal slot you’d swear it would burst through the end of the table.

In a way, it was a good thing foosball occupied those guys. It distracted them from what they liked to do most of the time, which was to bash anyone who got in their way. I think foosball might have cut down on the number of bar fights in small towns.

There was this guy I used to work with who told me stories about bar fights, some of which he enthusiastically got involved in—when he was younger, of course. Somebody named Stumpy (or maybe Stubby?) was a friend of his who had a wooden leg and never missed a chance to mix it up despite his prosthesis. When a fight broke out in a bar, Stumpy would just back into a corner, brace the wooden leg against a wall and whale away at anyone dumb enough to throw a punch at him.

But when foosball tables got installed, the tough guys tended to take out their aggression by slamming balls. You could always spot a foosball gang. They braced themselves, one leg back and one knee sort of braced against the table. They could twirl the little men with great skill and could fake, pass, and finally kick the ball like a rocket into the goal. It was often sort of a grim spectacle. They didn’t look like they were enjoying themselves so much as making believe they were tearing people apart limb from limb.

I’m not sure where the foosball neural network is in the brain, but I’m pretty sure it’s on the hands of the homunculus in the motor cortex.

That’s also probably where the juggling network is.

Earth Day 2023: Water What We Want to Grow

Happy Earth Day! Yesterday, Sena worked pretty hard out in the garden spaces. She has planted ten river birch trees. I did my usual spring lawn edging, which followed the first mow of the season a couple of days before by the lawn mowing service.

The vinca is coming up in the garden circle in our back yard. It reminds me of a time many years ago when I chopped a bunch of vinca out of a substantial portion of the back yard of a previous house. This became Sena’s first big garden. We’ve moved several times since then and there have been a number of other gardens.

True, vinca is invasive and I think it’s also called creeping myrtle or periwinkle. I found out later after I chopped out a few bushels of it that the plant has organic compounds called alkaloids which inhibit the growth of certain cancers. Vincristine and vinblastine are approved for use in the United States.

The reason I’m mentioning vinca is that way back early in my career as a consultation-liaison (C-L) psychiatrist at The University of Iowa Hospitals & Clinics, I dimly recall giving a short acceptance speech for winning a Leonard Tow Humanism in Medicine award from the Arnold P. Gold Foundation in 2006. I was nominated for it by one of the psychiatry residents and another faculty member.

Getting the Leonard Tow Humanism in Medicine pin

In my speech I mentioned cutting out all of the vinca (which I thought was a weed) in the back yard. I was pretty proud of getting that job done—until Sena got home and found out. She was less than thrilled about my accomplishment and explained that vinca was not a weed. In fact, she wanted it to grow.

I still have the speech and one of the points I made was, “…we water what we want to grow.” The speech is below:

Good morning distinguished guests including graduating medical students, Dean______.

Today we gather to reward a sort of irony. We reward this quality of humanism by giving special recognition to those who might wonder why we make this special effort. Those we honor in this fashion are often abashed and puzzled. They often don’t appear to be making any special effort at being compassionate, respectful, honest, and empathic. And rewards in society are frequently reserved for those who appear to be intensely competitive, even driven.

There is an irony inherent in giving special recognition to those who are not seeking self-aggrandizement. For these, altruism is its own reward. This is often learned only after many years—but our honorees are young. They learned the reward of giving, of service, of sacrifice. The irony is that after one has given up the self in order to give back to others (family, patients, society), after all the ultimate reward—some duty for one to accept thanks in a tangible way remains.

One may ask, why do this? One answer might be that we water what we want to grow. We say to the honorees that we know that what we cherish and respect here today—was not natural for you. You are always giving up something to gain and regain this measure of equanimity, altruism, trust. You mourn the loss privately and no one can deny that to grieve is to suffer.

But what others see is how well you choose.

I didn’t write down the anecdote about the vinca. I think I was also trying to make the point that vinca can be thought of as an invasive “weed” as well as a pretty garden plant. Furthermore, while the vinca alkaloid (for example, vinblastine) can be an effective treatment for some cancers, it can also cause neuropsychiatric side effects, which can mimic depression. That’s where a C-L psychiatrist could be helpful, showing how medicine and psychiatry can integrate to move humanism in medicine forward.

Anyway, ever since then, vinca has often been a part of Sena’s garden, including the one where we live now. And, whenever we walk on any of the trails in Iowa City or Coralville, we always notice it carpeting the woods.

We can probably apply the little law “we water what we want to grow” to many things in life. We can choose to apply it to the world in which we live by creating a safe home to shelter a happy family, doing useful work in the garden while practicing kindness, gratitude, and patience.

We can start by planting an idea like a tree.

Palm Sunday

Today is Palm Sunday, the beginning of Jesus’ last week on earth. The palm tree reminds me of the time we spent in Hawaii. We saw a lot of coconut palms. The featured image is from 1997, when we were there.

I remember seeing a picture in a storybook of Jesus riding into Jerusalem on a donkey. The road was strewn with palm leaves. I was just a child.

Palm Sunday is a day to get along with others.

The Easter Lily is already beginning to open.

Whitetail Deer Think Your Lawn is a Salad Bar

We have a small herd of whitetail deer who regularly visit our lawn because they think it’s a salad bar. They’re all over the neighborhood because the city apparently doesn’t have a consistent deer population management plan. I don’t know anything about the animals, other than what I care to look up on the internet.

We saw several bucks the yesterday. One of them was missing an antler. It might have been lost in a fight with another buck.

As far as we could tell, most of the deer seemed pretty healthy, although I guess you can’t really tell which ones might have chronic wasting disease just by looking at them.

One animal looked like it might have suffered an injury, possibly from a buck. The lesions looked like they might be healing.

I guess this time of year, they would be molting. That probably explains why some of them look scraggly.

Sena taps on the windows and orders them off the property. That doesn’t work. Sometimes they look up at you like they know you’re staring at them—but they usually ignore you and go back to munching on your lawn.

I wonder if I’d feel differently about culling the whitetail deer if I watched hunters actually cull them—or kill them. The word “culling” actually sounds like a nicer version of “killing.” The definition of culling is the reduction in the population of wild animals by “selective slaughtering.”

The origin of the word “cull” is interesting. It comes from the Latin verb colligere, meaning “to gather.” In general, it means to collect a group of animals into separate groups: one to keep and one to kill. Usually, it’s about killing the weak and sick ones.

On the other hand, the origin of the word “kill” seems to be obscure. Of course, it means to strike, hit, put to death. It might derive from an Old English word, “cwellan,” which means to murder, or execute.

Cwellan, cull, kill. I think it’s a coincidence they sound similar. None of them sound like “Bambi.” When me and my brother were little, we had a toy record player that played a simplified version of the Disney classic movie, Bambi. It had either a little storybook that came with it or a little slide show. It got a lot of use. One slide showed a shadowy image of a big stag. Eventually the record got stuck on a place that cried over and over, “Man!”

Maybe that’s why the city doesn’t have a whitetail deer culling plan.

Random Connections

Today, I read Dr. George Dawson’s blog post, “How I ended up in a high-risk pancreatic cancer risk screening clinic.” As usual I was impressed with his erudition, scientific literacy, and rigorous objectivity, even as it pertained to a deadly disease which runs in his family genetic history. I couldn’t help admiring his courage.

And, whether this is a random connection or not, this somehow led to my remembering Dr. George Winokur, a giant in the scientific study (including genetics) of psychiatric diseases, especially mood disorders. He died of pancreatic cancer shortly after he was diagnosed with it in the spring of 1996.

Dr. Winokur was chair of the University of Iowa Department of Psychiatry from 1971 to 1990. He remained on faculty, actively involved in research and teaching up until the day of his death in October of 1996.

I was a resident in psychiatry at University of Iowa from 1992-1996 and I have a clear recollection of meeting with Dr. Winokur in his office during my last year, when I was preparing for job interviews. I knew he had been diagnosed with pancreatic cancer.

He had been actively recruiting me to accept a position in the department and did so even as we spoke briefly. I remember noticing that he gripped an electrical conduit on the wall next to his desk so tightly that I wondered if he were in pain.

He was the main reason I stayed in Iowa. He had a great sense of humor. All of us residents loved him. There was even a list of his “commandments” all new residents received when they began their residencies at Iowa.

Winokur’s 10 Commandments

Thou shalt not sleep with any UI Psychiatry Hospital patient unless it be thy spouse.
Thou shalt not accept recompense for patient care in this center outside thy salary.
Thou shalt be on time for conferences and meetings.
Thou shalt act toward the staff attending with courtesy.
Thou shalt write progress notes even if no progress has been made.
Thou shalt be prompt and on time with thy letters, admissions and discharge notes.
Thou shalt not moonlight without permission under threat of excommunication.
Data is thy God. No graven images will be accepted in its place.
Thou shalt speak thy mind.
Thou shalt comport thyself with modesty, not omniscience.

I never got the impression that George Winokur recruited me because I was black, although it was pretty obvious to me that I would be the first black University of Iowa psychiatry department faculty member. He had too much class to make that an issue.

I’ve known a few classy psychiatrists. Maybe the connection is not so random.