reminiscence – Go Retire Psychiatrist

All That Digital News

I guess you have to be a certain age to develop the habit of doomscrolling. I’m not minimizing the problem. I just can’t see how anybody gets into it. I’m talking about digital news websites. It’s a tableau of yawners every day. It’s full of models, goggle-eyed golden retrievers, and ads for knuckle removers (“Do you want to remove your knuckles? Well, you’ve come to the right place and for just $19.99 and your first-born child….” It’s a real tabloid thing.

I used to deliver print newspapers, specifically the Des Moines Register. When I was a boy, I used to deliver it in Mason City, my hometown. I even got a certificate for making Honor Salesman. I never just tossed the paper on the driveway so it could get soaked in the rain or snow. I stuck it inside the storm door, which was nearly always unlocked. Remember those days? Of course not!

Winter deliveries were rough. I had to drag my wagon with all the papers in it through 2-foot-high snowdrifts. I needed a dog sled some days, especially with the Sunday edition.

I had to deliver to an old guy who cultivated giant Hollyhocks, some more than 7 feet tall with huge blossoms which attracted dozens of bumblebees as big as my head. His whole backyard was a small field of Hollyhocks. His front door was surrounded by them too and I was scared I’d get stung. I would hold my breath, approach slowly so as not to startle them, snatch open the screen door and fling the paper inside. The bumblebees would float toward me rumbling like they had Pratt & Whitney engines. I swear one of them growled “Who goes there?” at me.

I folded my newspapers, but I never banged them or threw them like the guy in the video talks about. If I ever tried to pitch my newspapers, I probably would have busted a window.

One of the things I enjoyed about the print newspaper back in the day was reading Dave Barry’s syndicated column. I was working at a hospital during a practicum rotation while working toward a Bachelor’s degree at Iowa State University. I got funny looks from people because I couldn’t keep from laughing. You can find a few of his vintage columns on his website.

And if you can’t scroll further than the length of your thumb on your smartphone screen without seeing a picture of a golden retriever—put your phone down.

John Heim aka Big Mo Retiring from the Big Mo Blues Show

We were listening to the KCCK radio Big Mo Blues Show last night when John Heim aka Big Mo announced he’s retiring as of May 15, 2026. Iowa musician Ed English (Uncle Ed of the Beaker Brothers band) was also in the studio and remarked that he’ll be taking over the show sometime after that. The Beaker Brothers Band will also be retiring around the same time frame. It was a surprise to us.

I’ve been listening to the Friday night blues show off and on probably for about 18 years. And here’s a shout-out to Bobby DeForest who first started “da Blues” back in 1992 (Little Village news story). After that John Heim (aka Big Mo) came on. Bob DeForest still has a blues music show on Saturday night.

I don’t remember who was doing the Friday blues show during the times when I was listening (although Sena says it was Big Mo) which probably started back in the mid-1990s or so—but I do remember that Iowa blues star and member of the Iowa Blues Hall of Fame Kevin Burt substituted for a couple of weeks sometime between 2005 and 2011. Despite my faulty memory for some things, I’m pretty sure about that. There’s no mistaking Kevin Burt’s voice.

Ed and his band will be retiring sometime this summer. They have several gigs planned in June. Ed mentioned he might record some of the Friday night blues shows after May 15^th. By the way, I’ve got a blog post from last August about my post from April 14, 2024 entitled “KCCK Big Mo News and More.”

Ed left a comment on it: “Always available on the web and the KCCK App, too… ;0).”

The first part is clear, although the emoticon puzzled me. I looked it up but couldn’t find anything about it except that it might mean amazement. It looks like wink.

Other than the music, I like Big Mo’s sense of humor, which he often displayed in little comedy bits which are about “Sponsors de faux.” The main one is MayRee’s Hand-Battered Catfish. There are a few others like Shorty’s Adult Diapers (they’re ready when you aren’t) and Big Furry Shaving Products. There was a podcast about those. And I can’t swear to it but I think he tried to start another one about “fish psychics” back in October 2025. But I can’t swear to it and I’ve not heard it since.

I have suggested that KCCK make a tee-shirt with a MayRee’s hand-battered catfish logo on it, but apparently that’s a non-starter.

Anyway, we wish Big Mo all the luck in the world after his retirement and hope he enjoys it as much as he can. I retired from psychiatry 6 years ago and look how well I turned out! That reminds me, I always like to pretend that, during the shout-out part of his show, when he mentions “Jim the Shrink” he means me.

Sena Finds a Red-tailed Hawk Sitting on a Nest

Sena found a Red-tailed hawk on a nest in the outlot beyond our back yard. At first, I thought it was too early for that sort of thing. Sure enough, today we went for a walk and both saw it.

This has been a common theme for us. Over 20 years ago she saw a coyote in the back yard of another house in a different neighborhood. I didn’t really believe it—until our next-door neighbor asked us if we’d seen that “coyote” out in the back yard. We never got a chance to get a picture of it.

And then there was the time she saw (actually heard it before she saw it) a pileated woodpecker in the backyard of another house we lived in about 12 years ago. I doubted it then, too. But she got a picture to prove it. It just goes to show you—I never learn.

We Heard a Barred Owl Last Night

We both heard a barred owl last night. This was a line of thunderstorms rolled through the area. Sena thought it was in the front yard, but there are no trees out there and it’s more likely it was in the back yard.

I searched my photo files and couldn’t find one of a barred owl, although I remarked on seeing one about 11 years ago. It was on top of a street sign and I found an old blog post about it that I wrote about on the same day. I’ll repost it below.

I found a YouTube of a barred owl making typical calls. It might have been calling for a mate. Most articles will point out that this sounds like “Who cooks for you?”

I did a google search about barred owls. When a barred owl visits you, it could mean you’re in a transition in your life. About the time I saw it in 2015, I was a couple of years away from entering the phased retirement transition of my career as a consultation-liaison psychiatrist at University of Iowa Health Care.

I’ve been retired for six years now. I wonder why a barred owl would be visiting now?

Barred Owl Visit Post 2015:

So, the other day as my wife and I were out driving we saw this owl sitting on top of a street sign on the intersection not far from our house.

He looked straight at me. I remember thinking, “Where were you when the voles were gorging on our lawn?”

I’ve never seen an owl up that close, especially roosting on a street sign at a crossroads. Of course, it got me to musing on the crossroads in which we often find ourselves at different times in our careers and at pivotal moments in our lives.

There are big and little stages, the minor and major crossroads we navigate every day and at other transitions: childhood, adolescence, college, medical school, residency, graduation, marriage, divorce, and the birth of children, the death of parents, retirement, and our own approaching death.

Recently I got a funny and thought-provoking essay about this from a former resident who is now an attending herself staffing a psychiatry consultation service at a big university hospital in Cleveland. The title of Dr. Jeanne Lackamp’s perspective article is “The Stages of Consultation-Liaison Psychiatry.” In it she describes the stages, the crossroads if you will, of the psychiatric resident in a large general hospital from the perspective of an experienced teacher [1].

I was going to say she does it with the wisdom of a wise owl, but then I thought of the owl sitting on the street sign, whose wisdom I doubted. The owl’s eyesight is keen but there was nothing but concrete on the roads leading away from its perch.

There aren’t any voles out there.

Anyway, short excerpts (which I hope are considered fair use) from Dr. Lackamp’s stages are:

Anticipation: “As though hypomanic, you will eagerly accept the CL challenge….” This is it—Your Big Chance.”

Initiation: “Coping with patient death will become real…and will make you feel sad.” You will wonder how you can possibly do multiple months of this.”

Mastery: “Cockiness may backfire…errors still occur.” “…you feel confident that No One Else could have done better given the circumstances.” “This feeling lasts; until it does not.”

Anger: “Anger will manifest in several ways…” “…it will be tempting to start second-guessing your life choice of going into medicine in general, and Psychiatry in specific.” “Sleep will be rare now too…”

Acceptance: “…you will know what you are doing—but more importantly you will realize that what you know is not everything. “…you will know that you have endured something intense and were changed by it.”

I thought of this as I listened to one of our current senior residents talk about her approaching crossroads. She’ll be a consulting psychiatrist at a private hospital.

She’s excited about it and also wanted to know that her old teacher (which is me, the wise old owl) will be available for collaboration if she needs it.

I suddenly have this craving for voles.

Reference:

Lackamp, J. M. (2015). “The stages of consultation-liaison psychiatry.” Acad Psychiatry 39(2): 217-219.

Thoughts on House Finches

This morning, I got a snapshot of a male house finch sitting on the back porch fence post. He’s a proud looking fellow. I saw the female a minute earlier but could not catch a picture of her.

It’s spring; they’re probably a mating pair and we saw them last year. So, there will soon be eggs somewhere out in the woods past our back yard. There will probably be chicks soon.

Maybe the chicks will survive. I remember during the month of May in 2019, I was keeping watch on a nest of house finches just outside of my office window. I would go out every day to a skinny little juniper tree, part the branches, and snap pictures of the eggs and later, the squirming hatchlings.

One day, I heard a noise like the flapping of big sheets outside my window. When I finally looked out, I saw the biggest crow I’d ever seen, just taking off with all of the nestlings clenched in its beak.

The mother house finch arrived minutes later and searched frantically for her chicks for over half an hour.

It wasn’t until then that I learned I was at fault for exposing the hiding place of the nest in the tree. I went there daily and spread the branches, probably while the crow watched me from high above in the sky.

I thought I learned my lesson, but I didn’t. In May of 2024, a mating pair of house finches built a nest in our artificial Christmas tree right on our front porch, a step away from the front door. The ruddy male would feed the female, who had laid 4 eggs.

I set up a critter cam on a tripod and filmed them for days. Every time I hustled out there to get the camera to download the videos, I scared the birds off. We watched for 17 days. The typical time to hatching is about 14 days. I finally tossed the whole thing out in the back yard.

There are a red tail hawks, turkey vultures, and crows all over the sky. I hope the house finches know better than to build a nest in any of the big pots on our porch. I know better than to draw attention to them now.

Upcoming Sven Squad Movie “Friday the 13th”

The upcoming movie with the Svengoolie Sven Squad this Saturday the 14^th comes a day late. It’s the very first “Friday the 13^th.” I’ve never seen it, but I think I’ve seen a couple of the 35 sequels. I always have to stop and think about how to distinguish the 1978 slasher “Halloween” from the 1981 slasher “Friday the 13^th,” which I think I saw.

I can’t, but that’s OK because I’ve been too busy trying to figure out why the name of the star of the first Friday the 13^thfilm sounds familiar to me. You’ll be thrilled to know that I finally remembered it’s Betsy Palmer from the old 1960’s TV show “I’ve Got a Secret.”

I think she wanted this movie to be a secret until it started making some real money.

Anyway, the movie starts with some guy in a hockey mask slashing various people who then hire a guy in a fancier mask to slash the first guy so they can go back to having casual you-know-what-kind of relations and shoplifting candy cigarettes from K-Mart, which by the way used to be Kresge’s which I am old enough to remember although I never shoplifted anything I swear. What happens next is that Slasher 1 and Slasher 2 meet on the street at high noon and threw samurai swords at each other, often missing and breaking Kresge’s windows until this wakes up Chuck Norris who is pretty annoyed and roundhouse kicks both Slashers into Saturn’s orbit although they manage to hitch a ride on one of those newfangled UFOs which resemble orbs, the extraterrestrial pilots of which hit the warp drive and shoot through a wormhole portal sending them backwards in time to 1977 and boy does that ever mess with the gyroscopes and scorch the spark plugs making it necessary to jettison a load of poorly mixed nuclear grade molten metals into a field in Council Bluffs, Iowa which for some reason did not lead to that fine community becoming a major tourist attraction, so…well, the film probably doesn’t go exactly that way but then I’ve never seen it so it doesn’t hurt to speculate a little bit.

Clinical Problems in Consultation Psychiatry and The Break-Dancing Koala Bear

I ran across an old Clinical Problems in Consultation Psychiatry (CPCP) presentation by a couple of sharp medical students in 2014. They presented it at one of my morning consult rounds and it’s about Charles Bonnet Syndrome.

They did a very nice job and it compares fairly well with the University of Iowa Ophthalmology Dept summary. One of the authors of that summary is my retinal specialist, Dr. Ian Han, who did the surgery on my detached retina about 4 years ago. It also has a link to a great YouTube video of a woman who has Charles Bonnet Syndrome. It’s not a psychiatric disorder although ironically one of the treatments for it may sometimes be antipsychotic medications.

The other thing about this presentation is that the students’ fictional case description mentions that the patient had visions of “a break-dancing koala bear” among other things. I can’t remember whether I was the one who told them about a video on the internet that showed a break-dancing stuffed koala bear—or if it was the other way around! At any rate, I remember seeing it around that time, but of course I can’t find it now.

Do We Really Need Artificial Intelligence to Help People Who Are Demoralized?

I was just going through the many files on one of my old thumb drives that I still keep after I retired from consultation-liaison psychiatry over 5 years ago. I found a file that I must have typed from a source on how to help medically ill persons who are demoralized. Demoralization is not the same thing as depression or adjustment disorder. What I have copied from the original source is below, along with the reference.

Treating Demoralization

Ask first: “how are your spirits today?” Then ask “what is the most difficult thing for you now?”

Coherence Versus Confusion

1. How do you make sense of what you’re going through?

2. When you are uncertain how to make sense of it, how do you deal with feeling confused?

3. To whom do you turn for help when you feel confused?

4. (For religious patient) When you feel confused, do you have a sense that God has a way of making sense of it? Do you sense that God sees meaning in your suffering?

Communion Versus Isolation

1. Who really understands your situation?

2. When you have difficult days, with whom do you talk?

3. In whose presence do you feel a bodily sense of peace?

4. (For religious patients) Do you feel the presence of God? How? What does God know about your experience that other people may not understand?

Hope Versus Despair

1. From what sources do you draw hope?

2. On difficult days, what keeps you from giving up?

3. Who have you known in your life who would not be surprised to see you stay hopeful amid adversity? What did this person know about you that other people may not have known?

Purpose Versus Meaninglessness

1. What keeps you going on difficult days?

2. For whom, or for what, does it matter that you continue to live?

3. (For terminally ill patients) What do you hope to contribute in the time you have remaining?

4. (For religious patients) What does God hope you will do with your life in days to come?

Agency Versus Helplessness

1. What is your prioritized list of concerns? What concerns you most? What next most?

2. What most helps you to stand strong against the challenges of this illness?

3. What should I know about you as a person that lies beyond your illness?

4. How have you kept this illness from taking charge of your entire life?

Courage Versus Cowardice

1. Have there been moments when you felt tempted to give up but didn’t? How did you make a decision to persevere?

2. If you see someone else taking such a step even though feeling afraid, would you consider that an act of courage? (If so) Can you imagine viewing yourself as a courageous person? Is that a description of yourself that you would desire?

3. Can you imagine that others who witness how you cope with this illness might describe you as a courageous person?

Gratitude Versus Resentment

1. For what are you most deeply grateful?

2. Are there moments when you can still feel joy despite the sorrow you have been through?

3. If you could look back on this illness from some future time, what would you say that you took from the experience that added to your life?

Griffith, J. L. and L. Gaby (2010). “Brief Psychotherapy at the Bedside: Countering Demoralization From Medical Illness.” Focus 8(1): 143-150.

There are a couple of resources I routinely used as a psychiatric consultant in the general hospital. One of them was the general outline of how to recognize and help someone who is demoralized (above). Another was a free online (non-AI) cognitive behavioral therapy resource that is still available called The MoodGym.

These are not the same thing as Artificial Intelligence (AI), which I think in some cases might be the wrong way to help someone with depression and anxiety that is more reactive to situational and medical stressors. AI can also be harmful to some people.

I have seen the brief psychotherapy guide above published and referenced in different articles on the web, one of them published as recently as 2025. Griffith and Gaby first published the guide to help those who are demoralized in 2005. It’s been around for 20 years and in my opinion is better than AI will ever be.

References:

James L. Griffith, Lynne Gaby,

Brief Psychotherapy at the Bedside: Countering Demoralization From Medical Illness,

Psychosomatics,

Volume 46, Issue 2,

2005,

Pages 109-116,

ISSN 0033-3182,

(https://www.sciencedirect.com/science/article/pii/S0033318205701006)

Abstract: Bedside psychotherapy with medically ill patients can help counter their demoralization, which is the despair, helplessness, and sense of isolation that many patients experience when affected by illness and its treatments. Demoralization can be usefully regarded as the compilation of different existential postures that position a patient to withdraw from the challenges of illness. A fruitful interviewing strategy is to discern which existential themes are of most concern, then to tailor questions and interventions to address those specific themes. Illustrative cases show how such focused interviewing can help patients cope assertively by mobilizing existential postures of resilience, such as hope, agency, and communion with others.

https://psychiatryonline.org/doi/full/10.1176/foc.8.1.foc143

Alyssa C. Smith, Jonathan S. Gerkin, Diana M. Robinson, Emily G. Holmes,

Consultation-Liaison Case Conference: Management of Demoralization in the Medical Setting,

Journal of the Academy of Consultation-Liaison Psychiatry,

Volume 67, Issue 1,

2026,

Pages 71-78,

ISSN 2667-2960,

(https://www.sciencedirect.com/science/article/pii/S2667296025005087)

Abstract: Demoralization has important implications for patients’ health, but consultation-liaison psychiatrists may be less familiar with diagnosis and management due to limited inclusion in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision. We present the case of a multivisceral transplant patient who experienced demoralization due to complications from her posttransplant course. We discuss the diagnosis of demoralization, including differential diagnoses to consider, followed by a discussion of management of demoralization in the inpatient setting using acceptance and commitment therapy. We then discuss the consultation-liaison psychiatrist’s role in assisting with management of teams’ counter-transference to difficult patient cases, including the possibility of teams experiencing their own demoralization.

Keywords: demoralization; transplantation; transplant psychiatry; acceptance and commitment therapy; consultation-liaison psychiatry

Try to Lift Just One Eyebrow Without Picking Your Nose!

I ran across a couple of interesting articles today and I thought I’d pass this along. One article is about kids who pick boogers out of their nose and eat them. Another is about how to lift one eyebrow only.

I bet a lot of people try to learn how to lift one eyebrow. I also bet that nobody would ever admit they pick their nose and dine on the boogers. Well, I never picked my nose but when I was in the 1^st or 2^nd grade, one of my classmates used to do this. The teacher would get really mad because no matter how many times she told him to stop, he would just do it anyway.

He tried to be sneaky about it, but pretty soon the whole class could catch him at it. We could barely get through class because we were so busy spying on him-and gagging when we caught him.

I tried to see if I could lift just my right eyebrow. I wondered if I could do it without much practice because I had surgery to repair a retinal tear on my right eye a few years ago. Does it look like my brow on the right is a little more wrinkled? See what you think. And can you tell if it’s more prominent if I stick an extraterrestrial up my left nostril? Examine the photos carefully. Take your time and get back to me. I did not eat the ET, I swear.

Thoughts on Martin Luther King, Jr. Day

Today being Martin Luther King Day, I’m reminiscing a little about my short time as a student at Huston-Tillotson College (one of this country’s HBCUs, Huston-Tillotson University since 2005) in Austin, Texas. It’s always a good idea to thank your teachers. I never took a degree there, choosing to transfer credit to Iowa State University toward my Bachelor’s, later earning my medical degree at The University of Iowa.

However, I was a reporter for the college newspaper, The Ramshorn Journal. That’s where the featured image comes from.

Although I didn’t come of age at HT, I can see that a few of my most enduring habits of thought and my goals spring from those two years at this small, mostly African-American enrollment college. I learned about tenacity to principle and practice from a visiting professor, Dr Melvin P. Sikes, in Sociology (from the University of Texas) who paced back and forth across the Agard-Lovinggood auditorium stage in a lemon-yellow leisure suit as he ranted about the importance of bringing about change.

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 police report, which our professor 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 I was probably just as nervous as the cops were, the lesson about the importance of applying principles of change directly to society eventually stuck. I remembered it every time I encountered push-back from change-resistant hospital administrations.

As a clinician-educator I have a passion for both science and humanistic approaches in the practice of psychiatry. Dr. James Means struggled to teach us mathematics, the language of science. He was a dyspeptic man, who once observed that he treated us better than we treated ourselves. Looking back on it, I can see he was right.

Dr. Lamar Kirven (or Major Kirven because he was in the military) also modeled passion. He taught black history and he was always excited about it. When he scrawled something on the blackboard, you couldn’t read it but you knew what he meant.

And there was Dr. Hector Grant, chaplain and professor of religious studies, and devoted to his native Jamaica. He once said to me, “Not everyone can be a Baptist preacher.” He tried to explain that my loss of a debate to someone who won simply by not allowing me a word in edgewise was sometimes an unavoidable result of competing with an opponent who is simply bombastic.

Dr. Porter taught English Literature and writing. She also tried to teach me about Rosicrucian philosophy for which she held a singular passion. Not everyone can be a Rosicrucian philosopher. But it prepared the way for me to accept the importance of spirituality in medicine.

I didn’t know it back in the seventies, but my teachers at HT would be my heroes. We need heroes like that in our medical schools, guiding the next generation of doctors. We need them in a variety of leadership roles in our society. Most of my former HT heroes are not living in the world now. But I can still hear their voices.