Category: reminiscence

When Should Psychiatrists Retire?

In answer to the question in the title, I’ll confess right away I don’t know the answer. The impetus for my writing this post is the Medscape article about an 84-year-old physician who was forced to take a cognitive test required by her employer as a way of gauging her ability to continue working as a doctor. She’s suing her employer on the grounds that requiring the cognitive test violated the American with Disabilities Act (ADA), the Age Discrimination in Employment Act, and two other laws in her state.

I didn’t retire based on any cognitive test. I recall my blog post “Gauging My Readiness for Retirement,” which I posted in 2019 prior to my actual retirement. In it I say:

I spent 4 years in medical school, 4 years in residency, and have worked for more than 23 years as a psychiatrist, mostly as a general hospital consultant. Nothing used to jazz me as much as running around the hospital, seeing patients in nearly all specialties, evaluating and helping treat many fascinating neuropsychiatric syndromes, teaching medical students and residents, and I even wrote a book.

On the other hand, I don’t want to hang on too long. When people ask me why I’m retiring so early (“You’re so young!”), I just tell them most physicians retire at my age, around 65. I also say that I want to leave at the top of my game—and not nudged out because I’m faltering.

In it, I mention a blog post written by a physician blogger, Dr. James Allen. The title is “When Physicians Reach Their ‘Use By Date.’ At the time I didn’t make a link to his post because the web site was not listed as secure.

Since that time, the web site has become secure, and you can read the post here. Dr. Allen lists anecdotes about physicians who ran close to or past their “use by” date.

Dr. Allen’s point is that we often don’t realize when we are past our “use by” date. That applies to a lot of professions, not just medicine.

There’s been a shortage of psychiatrists for a long time and it’s not getting better, the last I heard. All in all, I’m OK with the timing of my retirement.

I note for the record that I have not seen any mention in the news that the Rolling Stones have ever been required to take a cognitive test to continue working. I also want to point out that they are around 80 years old and their 2024 tour is sponsored by the AARP, the organization formerly known as the American Association of Retired Persons. I heard that the Rolling Stones new song, “Angry” is up for a Grammy.

I doubt anyone is angry about the obvious fact they’re not even thinking about retiring.

On Retiring from Psychiatry

I found this very uplifting and thought-provoking article on retiring from psychiatry by Juan C. Corvalan.

He sounds like he’s successfully navigating his retirement. On the few occasions I’ve felt compelled to make a remark about my own retirement, I typically say something like “It’s a mixed blessing.”

My retirement is a process, unfolding as time passes. It was difficult in the beginning, which was only a little over 3 years ago. It’s not what I would call easy even now.

What gave me joy since I retired were getting messages from the learners I was privileged to teach. Some of them I’d not heard from in many years. Someone from my department said, “We miss you.” I answered that, in some ways, I never left.

Time itself feels different. The days go by so quickly that I want time to slow down.

I like Corvalan’s way of expressing himself. He’s a writer and likes to talk about words and their meaning. He talked about the definition of the Spanish word for retirement, which is jubilacion, which reminds me of the English word “jubilation.”

Retirement has been, at times (perhaps often), anything but cause for jubilation.

On the other hand, I can think of several things I will never miss about being a psychiatrist. I don’t write about them, as a rule. In fact, I tend to write about anything but psychiatry: cribbage, juggling, making wisecracks about extraterrestrials.

I really appreciate colleagues like George Dawson, MD (who writes the blog Real Psychiatry), H. Steven Moffic, MD (who writes the articles “Psychiatric Views on the Daily News”), Ronald Pies, MD, Editor in Chief Emeritus of Psychiatric Times, and Jenna, the psychiatry resident who writes the blog “The Good Enough Psychiatrist,” who is very far from retirement, unlike me and the other writers just mentioned.

And I appreciate Dr. Corvalan’s excellent essay on retirement from psychiatry.

Reference:

Corvalan JC. A Retired Psychiatrist on Retirement: Rejoicing Jubilatio. Mo Med. 2022 Sep-Oct;119(5):408-410. PMID: 36338006; PMCID: PMC9616447.

Happy 46th Wedding Anniversary!

It was 46 years ago today Sena and I were married at the Little Brown Church in the Vale in Nashua, Iowa. I was a skinny guy with a big afro. She was and is a beautiful bride.

We cut the wedding cake together. We fed each other big bites. It was the biggest event of our lives.

There were other big events. The trip to Vegas and marveled at the Bellagio fountains. The helicopter ride over the Niagara Falls. The view over New York City from the Empire State Building. That was my first senior discount ticket. Sena holding a little alligator in Miami. The Lincoln Book Tower in Washington, D.C. Festooned with the birds of Hawaii.

Wherever we went, whatever we did, we were always together. She’s always fearless. She’s gone with me wherever I went, even when I was wrong. I am often wrong—but I was right about marrying her.

Food for Thought

I’m giving a shout-out to a couple of child psychiatrists, one I know only from a blog, The Good Enough Psychiatrist. The other is an assistant professor in the University of Iowa Child Psychiatry Dept. I’ve never met her.

Since Jenna gives her name in the About Me section of her blog, I’m going to call her that because it’s easier. Jenna writes many thought-provoking posts, but I really admire the one titled “Amae.”

Dr. Ashmita Banerjee, MD wrote an essay titled “The Power of Reflection and Self-Awareness.” It’s published on line in the Mental Health at Iowa section of The University of Iowa web site.

As a relatively recently retired consultation-liaison psychiatrist who is also a writer, I feel a strong connection to them. In addition to being very glad that extremely talented persons are filling the ranks of a specialty which suffers from a serious manpower shortage, I get a big kick out of reading what really smart people write.

Here’s where a geezer retired psychiatrist starts kidding around. Jenna, a fellow blogger, is used to my habit of deploying humor, admittedly often as a defense. Dr. Banerjee doesn’t know me.

What is it about these essays that reminds me of the X-Files episode “Hungry”? It’s a Monster of the Week episode from the monster’s perspective. This monster looks like a human but sucks brains out of people’s skulls. He’s conflicted about it and even sees a therapist. But in the end his dying words were, as Agent Mulder shoots him down, “I can’t be something I’m not.”

If you read Dr. Banerjee’s essay and followed one of the links, you would have caught the clue that I actually read it because I consciously substituted the word “What” for “Why” in the previous paragraph. I could have as easily asked why instead of what—but it’s less helpful in gaining self-awareness.

And I haven’t sucked anybody’s brains out of their skulls in, what, over two weeks now! Upon reflection, I’m very aware of being incorrigible. Food for thought.

Jenna’s description of the Japanese concept of the word “amae” and Dr. Banerjee’s examination of the Japanese word “kintsukuroi” fascinated me. What made both writers consider human emotions using a language which captures the nuances so deftly?

I was a first-generation college student. There was a time in my life that a path to medical school seemed impossible. At times I probably thought I was trying to be something I’m not.

I’m just grateful for the new generation.

Speaking of Spanish

Every once in a while, I get an urge to try to learn to speak, or at least read Spanish. Recently, Men in Black was on the Telemundo broadcasting network. I tried to watch it but gave up after a few minutes. The dubbing was disappointing because the actors don’t speak Spanish and the dialogue sounds weird.

I enjoyed my basic Spanish courses in my freshman year of college at Huston-Tillotson University (then Huston-Tillotson College). I think I impressed my teachers simply because I could mimic the sound of Spanish. That’s only because our family lived next door to a Spanish-speaking family. As a child, I got so used to hearing it that I must have absorbed the sounds and cadence.

That didn’t help me in actually learning to speak Spanish in college, though. My teacher, Dr. Whitby, gave me a book of jokes and funny stories titled “Risas Y Sonrisas.” I think he gave it to me because I did my homework and, at least on paper, did well on written exams. I found a book with the same name on Amazon that was originally published in the late 1940s. The title can be translated as “Smiles and Laughter.” My teacher translated it more loosely as “Giggles and Grins.” I kept the book for many years, but it got lost in a move. Toward the latter part of the first semester, Dr. Whitby invited a native Spanish-speaker who was a senior to class one day. The idea was for us to use what language skills we had tried to learn to communicate with her. None of us could even bring ourselves to say Como Esta used! I was extremely shy and embarrassed.

When I was working as a consulting psychiatrist, I always used a translator service that health professionals could access by telephone. It was a little awkward, but handy when a Spanish-speaking translator was not available in person.

There are free Spanish lessons on the web and other ways to learn that cost money. I’m leery of both. If I could find a course in Spanish that didn’t cost an arm and a leg, I would consider trying it.

Then I could say some of my favorite Men in Black quotes in Spanish. I found out Tommy Lee Jones (who plays Agent K) actually can speak Spanish. I have to use the Google Translate application:

Men in Black quote:

Edwards: Why the big secret? People are smart. They can handle it.

Agent K: A person is smart. People are dumb, panicky dangerous animals and you know it. Fifteen hundred years ago everybody knew the Earth was the center of the universe. Five hundred years ago, everybody knew the Earth was flat, and fifteen minutes ago, you knew that humans were alone on this planet. Imagine what you’ll know tomorrow.

Men in Black quote in Spanish:

Edwards: ¿Por qué el gran secreto? La gente es inteligente. Pueden manejarlo.

Agent K: Una persona es inteligente. Las personas son animales peligrosos, tontos y asustados, y tú lo sabes. Hace mil quinientos años todo el mundo sabía que la Tierra era el centro del universo. Hace quinientos años todo el mundo sabía que la Tierra era plana y hace quince minutos sabíamos que los humanos estábamos solos en este planeta. Imagínate lo que sabrás mañana.

Falling Leaves

The leaves are falling everywhere, including our back yard. Just watching them drop like a snowfall is mesmerizing. It feels like it’s going to snow. Temperatures have been low enough for frost and freeze warnings around here. The mowers were bundled up, wearing stocking caps and gloves yesterday.

Fall is Sena’s favorite season. Temperatures are cooler and the changing colors of the leaves makes us wonder how the trees know when it’s time to drop them.

When I was a kid, I and a lot of neighborhood kids jumped off a small cliff at a park into a huge pile of leaves. It was a big deal to take the leap. We felt like we were flying. The bits of dry, brown leaves got in your hair and down your back under your shirt, making you itch.

I remember raking leaves in an old guy’s yard once. I got blisters on my hands and he didn’t pay me much. I didn’t like that part of fall and still don’t.

That’s why spring is my favorite season.

Kindness Is Still Out There

The other day, Sena and I were talking about growing up in Mason City, Iowa. As kids, both of us were the ones who lugged the groceries home. That was back in the days of paper sacks and, for me and her, food stamps. The food stamp program got started during the Great Depression. The goal was to keep people from starving and farmers from going under. In other words, it was kindness.

Food stamps were a sign of hard times and I don’t think that has changed much, except now I think you get a debit card instead of stamps.

I did grocery shopping at Fareway Store, which got its start in Boone, Iowa. Sena did hers at Grupps Food Center.

When it comes to shopping, I followed what my mother put on a list. I got the items and paid with food stamps. I can’t remember ever coming up short. I think I just gave them the cashier the stamps and they took what was needed to cover the price. I walked to Fareway and then I just walked home carrying two or three paper sacks of groceries. It was about a mile trip up and a mile back. My arms were pretty sore when I got home.

On the other hand, Sena came up short on stamps one day. It was embarrassing enough to have to pay using food stamps. But it was awkward as hell when you didn’t have enough to pay. At that time, the cashier was a guy named Bud Grupp. Bud was Carl Grupp’s son. Carl bought the store in the early 1960s.

Bud counted out the stamps and had to tell Sena that there wasn’t enough. She didn’t know what to say. People were lined up behind her and they could probably tell something was wrong. Bud just said “We’ll put you on credit,” and that was that. He sacked all of the groceries like there was nothing out of the ordinary. Sena didn’t know what was done about the balance on credit, whether it was ever settled or it became just a running bill that never got paid off.

Sena also had to walk home carrying bags of groceries. One winter day during a light snowfall, she dropped all of the bags in the snow. They got wet and all torn up. A woman saw it, came out of her house with some bags and helped Sena get the groceries sacked up again. She got home alright.

About a year ago, Sena was in line waiting to check out groceries. An elderly woman was ahead of her and came up short on money to pay for her few items. She fished in her purse and looked embarrassed and pathetic. Sena was thinking about paying for them herself but just before she could, a guy behind her handed the cashier his credit card and told her he would cover it.

Regardless of what you see in the news, kindness is still out there. Our Christmas cactus is already blooming.

Butch Haircut Fixes the Bozo Effect

Sena gave me a butch haircut the other day. What led up to that?

About a month ago, I got a haircut at a local shop. Usually Sena cuts my hair (she’s been doing it for decades), but I occasionally go out for a haircut. I was pretty impressed with the guy who asked me if I was getting the bozo effect.

I immediately knew what he meant. I’m going bald on top and Sena sometimes may not cut the sides a little shorter to offset that—which I didn’t consider until the barber mentioned that bozo thing.

You might not know about the bozo effect unless you’re old enough to remember Bozo the clown. If you ever find a picture of him, he’s bald on top and has big, bright orange wings of hair sticking out from the sides of his head. When I was a kid, I got to sit in the studio audience once to watch his show. I remember there was a TV cartoon show segment which I couldn’t see because the TV set was way too small from where I sat in the bleachers. That was the technology back then.

Anyway, I was really happy with the haircut the guy at the shop gave me. It was the first time in my life I ever gave a tip to a hair stylist or barber.

It was time for another haircut and I had decided that I was going to get my haircuts at the shop. I tried to get an appointment at the same place. I found out the hard way that you can’t telephone to schedule appointments, you’re not entitled to see the same stylist every time, and the on-line check in system was out of order at both of the two shops in town. The wait time was 2 hours. The waiting areas were the size of many walk-in closets.

Sena was very sure that she could do just as good a job, though. She got a new hair cutting kit with all the different colored clipper guards and followed the instructions. She was scared at first and I was a little nervous. As it turns out, she gave me a great butch cut, which I haven’t had since I was old enough to watch Bozo the Clown.

I think it looks pretty good.

Dr. Igor Galynker and The Suicidal Crisis Syndrome

I was looking at my bookshelves and found the copy of the book, “The Suicidal Crisis: Clinical Guide to the Assessment of Imminent Suicide Risk.” It was written by Dr. Igor Galynker. It’s a fit topic for this month because September is National Suicide Prevention Month.

This brings back memories. I still have a gift from Dr. Galynker. It’s a stuffed animal called Bumpy the Bipolar Bear.

It arrived at my office at The University of Iowa Hospitals & Clinics in 2011. It was in a box addressed to:

WordPress

Attn: James Amos

200 Hawkins Drive

Iowa City, IA 52242

 I’m still not entirely sure why he sent me Bumpy. There was no letter of explanation. I was writing a blog at the time called “The Practical Psychosomaticist” and I might have posted something about some research he published on suicide risk assessment.

I bought a copy of his book a few years ago. I barely had time to skim a few of the chapters because I was too busy conducting suicide risk assessments in the emergency room, the general hospital, and the clinics in my role as a psychiatric consultant. In fact, I think it’s an excellent resource.

I also found a YouTube video (posted about a month ago) in which he describes his suicide crisis syndrome assessment. You can find the actual set of questions for the assessment here and in a link posted in the description below the YouTube.

Thoughts on Jack Trice

I was outside doing yard work the day before yesterday and my neighbor across the street walked over to say hello. We got to talking about sports and football came up. His wife stopped watching football because it was so violent—but then switched to watching hockey. He wondered when the Iowa Hawkeye vs Penn State game was going to be on. No, I’m not going to discuss that any further.

Anyway, that led to my mentioning how brutal college football was back in 1923 when Jack Trice, Iowa State University’s first black athlete was killed on the field during a game with the University of Minnesota. My neighbor was incredulous. He’s in his 80’s and he’s never heard the story.

In fact, I had just learned about the whole Jack Trice story and commemoration event in his honor the day before that, only because Sena told me about it.

All this year long there has been a 100-year anniversary commemoration of Jack Trice, Iowa State University’s first African-American athlete. The program will culminate on October 8, 2023 with the closing ceremony.

Football was a rough game in that era—but rougher still because Trice was black. Many believe his injuries were deliberately and maliciously inflicted because of his race. It’s more than plausible. In 1997, the football stadium was renamed Jack Trice Stadium. It’s the only major college football stadium named for an African-American.

Sena and I moved to Ames in 1981 so that I could enroll in Iowa State University. I was so immersed in my studies that I never gave a thought to Jack Trice. I don’t remember the football field being named Jack Trice Field in 1984.

As I looked through the commemoration website, I wondered how it was possible for me to have ignored the story of Jack Trice while I was there.

I think it’s for the same reason I never knew anything about James Alan McPherson, the first African American to win the Pulitzer Prize for fiction and who was teaching at the Iowa Writers Workshop during the entire time I was in medical school, residency and a faculty member at The University of Iowa Hospitals & Clinics.

I was working hard. I finally found out about McPherson after reading a news item about a neighborhood park being named after him in 2021.

I should pay more attention. Anyway, Iowa State University did a tremendous job putting this commemoration event together.