Category: reminiscence

‘ay, this here be international talk like a gentleman o’ fortune day

The title of this post is a translation of “Hey, This is International Talk Like a Pirate Day.” I used a Pirate Speak translator to generate it.

Sena reminded me about this holiday, which got started back in 1995 by a couple of guys from Albany, Oregon.

She says she heard about it on the Mike Waters radio show this moring, Waters Wake-Up on the Iowa radio station KOKZ 105.7. Sena either heard Waters call it National Pirates Day or she misheard him. She also said that Waters denied that any pirates ever said “Arrr,” back in the heyday of pirates.

I beg to differ, arrr, Matey! The Wikipedia entry says that the dialect was real and probably was based on the dialect of sailors from West Country in the southwest corner of Britain.

Sena and I couldn’t find any holiday called National Pirates Day. I did find National Meow Like a Pirate Day, which, interestingly, is also a holiday today. It got started in 2015.

But the main event be international talk like a gentleman o’ fortune day—which I darn nearrr forgot!

I have a dim memory of writing a blog post using the pirate translator several years ago. It was on a different blog, which I canceled in 2018. I didn’t keep that particular post. I think the topic was teaching internal medicine doctors and medical students about delirium so that they would know when they actually need consultation from a psychiatrist.

So, in honor of International Talk Like a Pirate Day, I’m going to post a piratical translation of one of my similar posts from way back in 2011:

“Do ye ‘ave to be interested in psychiatry to volunteer fer the delirium prevention project?”

“I’ve been thinkin’ about what a couple o’ the medical students said when I broached the idea o’ some o’ them volunteerin’ to participate in the multicomponent intervention o’ the delirium prevention project.

 they said that there the first an’ second yearrr students might want to volunteer—especially the ones interested in pursuin’ psychiatry as a career.

 now think about that there a minute. Why would ye necessarily need to be interested in psychiatry? ‘ere be a few facts:

1.Delirium be a medical emergency; it just ‘appens to mimic psychiatric illness because it’s a manifestation o’ acute brain injury.

 2.The most important treatment fer delirium be not psychiatric in nature necessarily; the goal be to find an’ fix the medical problems causin’ the delirium.

 3.Many experts in delirium ain’t psychiatrists; the authors o’ the new book “delirium in critical care”, valerie page an’ wes ely, ain’t psychiatrists—they’re intensivists.

 4.Some o’ the best teachers about delirium be geriatric nurse specialists an’ geriatricians.

 I thought that there by reachin’ aft further into a physician’s trainin’ career, I would find people less biased toward thinkin’ o’ delirium as a primary mental illness. It turns out that there bias runs deep in our medical education system.

 it isn’t that there psychiatrists shouldn’t be interested in studyin’ an’ ‘elpin’ to manage delirium. Psychiatrists, especially them specializin’ in psychosomatic medicine, be among the best qualified to inform other medical an’ surgical disciplines about the importance o’ recognizin’ delirium fer what it is—a medical problem that there threatens the brain’s integrity an’ resilience, raises the risk o’ mortality by itself regardless o’ the medical problems causin’ it, prolongs medical ‘ospitalization, an’ makes discharge to long term care facilities more likely, especially in the elderly.

 delirium be a problem fer doctors, not just psychiatrists. So it makes sense fer all medical students, regardless o’ their goals fer career specialty, to be interested in learnin’ about delirium.

 delirium be also a problem fer nurses, who frankly ‘ave led the way in education about delirium fer many years now. You’ll find few experts pointin’ to the american psychiatric association practice guidelines fer the treatment o’ delirium as the ultimate authority these days—because they’ve not been updated formally since 1999. All one ‘as to do be spell out “delirium prevention guidelines” in web browser search bars an’ choose from several sets o’ free, up-to-date guidelines that there be supported by the research evidence base in the medical literature to within a yearrr or two o’ the present day. Some o’ the best ones be authored by nurses.

 so maybe the pool o’ volunteers fer the delirium prevention multicomponent intervention might be nursin’ students.

 on the other ‘and, from what pool does the ‘ospital elder life program (help) recruit volunteers? an’ the australian resource center fer ‘ealthcare innovation multicomponent program, revive (recruitment o’ volunteers to improve vitality in the elderly, ‘ow do they do it?

they think outside the box an’ include people who care about people. That’s the really the key criterion, not whether one wants to be a psychiatrist or not.”

‘appy international talk like a gentleman o’ fortune day, arr, matey!

Thoughts on Suicide Risk Assessment

I know the term “suicide risk assessment” sounds very clinical. That’s because I did it for many years as a consultation-liaison psychiatrist in the general hospital.

The human part of it was using the suicide safety plan, which I got from the Centre for Applied Research in Mental Health & Addiction (CARMHA). You can download it yourself and adapt it by writing in the National Suicide Prevention Lifeline: 988 Suicide and Crisis Lifeline. That’s because the phone numbers on the form are specific to Canada.

Most often I interviewed patients in the intensive care units, where they were admitted after a suicide attempt. The interviews were very short if they refused to talk to me or were still delirious—often the case.

If they were awake and able to converse, the interviews were often pretty long. One way to connect with the patient was working on the safety plan together. I was often able to tell whether they were sincere or not by the level of detail they gave me about support persons they could get in touch with or things they could do to help them cope with whatever was troubling them.

A lack of detail in the plan, or refusal to work on some parts of it were areas of concern. If there were comments about friends, pets, or pastimes that spontaneously led to laughter (yes, that happened occasionally!), I was more confident that the patient was able to look toward the future and make specific plans for staying alive.

There is healthy debate about how useful specific suicide risk assessment scales are for predicting and preventing suicide. They are an essential part of the computerized medical records now, whatever anyone thinks of their reliability at predicting imminent suicide. I never used no-suicide contracts because well before the time I entered professional practice, most experts agreed that they don’t prevent suicide.

What was more useful for me as a clinician was to sit down at the patient’s bedside and, after getting the details about what the patient actually did in the suicide attempt and the events connected with it (along with a comprehensive and thorough history), I would get the safety plan from my clipboard, hold it up so they could see it and say, “Now let’s work on this; it’s your safety plan.”

I can’t tell you how often working on those plans, frequently for more than half an hour, led to laughter as well as tears from the patient. When it worked, meaning the relationship between us deepened, I sometimes did not find it necessary to admit the person to the psychiatric ward. While this occasionally alarmed the ICU nurses, things usually turned out fine later.

What Happened to Miracle Whip?

Okay, the update on the Mayo vs Miracle Whip thing is not going as planned so far. A couple of days ago, we had tuna fish sandwiches using Miracle Whip.

This was not the Miracle Whip I knew growing up. Neither of us could appreciate much of a taste at all. It’s a crisis.

Even the label on the jar looks strange. Since when does Kraft call it “Creamy Mayo & Tangy Dressing?” Why do they need to use the word “Mayo?” And it didn’t have the tangy flavor I remember.

This is all because of aliens. I’m pretty sure this is a violation of the Intergalactic Federation for Preservation of Tanginess Standards (IFFPOTS). Look it up.

I never made Miracle Whip sandwiches with just Miracle Whip on two slices of bread. I also had a slice of lunch meat on them. In fact, I ate one Miracle Whip nitrate-rich lunch meat sandwich a day for lunch for years. Its’ a good thing scientists discovered that nitrates aren’t bad for you.

But the point is the Miracle Whip tasted tangy back in those days. What happened?

Maybe it’s because my taste buds are older. More likely it’s because aliens kidnapped me and altered my taste buds. Or maybe they altered the Miracle Whip itself.

We’re not done yet. There are other recipes to try.

What Would Make Psychiatry More Fun?

I just read Dr. George Dawson’s post “Happy Labor Day” published August 31, 2022. As usual, he’s right on the mark about what makes it very difficult to enjoy psychiatric practice.

And then, I looked on the web for anything on Roger Kathol, MD, FACLP. There’s a YouTube video of my old teacher on the Academy of Consultation-Liaison Psychiatry (ACLP) YouTube site. I gave up my membership a few years ago in anticipation of my retirement.

I think one of my best memories about my psychiatric training was the rotation through the Medical-Psychiatry Unit (MPU). I remember at one time he wanted to call it the Complexity Intervention Unit (CIU)—which I resisted but which made perfect sense. Medical, behavioral, social, and other factors all played roles in the patient presentations we commonly encountered with out patients on that unit where we all worked so hard.

Dr. Kathol made work fun. In fact, he used to read selections from a book about Galen, the Greek physician, writer and philosopher while rounding on the MPU. One day, after I had been up all night on call on the unit, I realized I was supposed to give a short presentation on the evaluation of sodium abnormalities.

I think Roger let me off the hook when he saw me nodding off during a reading from the Galen tome.

Dr. Dawson is right about the need to bring back interest, fun and a sense of humor as well as a sense of being a part of what Roger calls the “House of Medicine.” He outlines what that means in the video.

What made medicine interesting to me and other trainees who had the privilege of working with Roger was his background of training in both internal medicine and psychiatry. He also had a great deal of energy, dedication, and knew how to have fun. He is a great teacher and the House of Medicine needs to remember how valuable an asset a great teacher is.

On the Other Hand Thoughts on HBCUs

Historically Black Colleges and Universities (HBCU) are in the news lately. It reminds me of the short time I spent at Huston-Tillotson College. It was renamed Huston-Tillotson University (H-TU) in 2005. I was there in the mid-1970s.

A new President and CEO was just named this month, Dr. Melva K. Williams. And H-TU was recently added to the National Register of Historic Places last month. It has been renovated and modernized. Pictures show a well-kept campus pretty much as I remember it over 40 years ago. I didn’t graduate from H-TU, but instead transferred credits to Iowa State University where I graduated in 1985.

My favorite teacher was Dr. Jenny Lind Porter-Scott, who was white, taught English Literature. Another very influential teacher was Reverend Hector Grant who was black. He taught philosophy and religion. He was instrumental in recruiting me to matriculate at H-TU. He helped me to process my loss on the debating team when the question was whether or not the death penalty played any role in the reduction of crime.

My opponent won the debate mainly because he talked so much, I couldn’t get a word in edgewise. I can’t remember which side of the question I argued, but I thought I could have done better if he had just shut up for a few minutes and let me speak. Reverend Grant used the word “bombastic” in describing the approach my opponent used. On the other hand, he also gently pointed out that sometimes this can be how debates are won.

There’s this “On the other hand” tactic in debating and in reflective thought that my debating opponent managed to repeatedly deflect.

I don’t know what ever happened to Reverend Grant. We spoke on the telephone years ago. He sounded much older and a hint of frailty was in his voice.

I could find only a photo on eBay of a man who closely resembles the teacher I knew and the name on the picture is Reverend Hector Grant. The only other artifact is a funeral program for someone I never knew, which lists Reverend Hector Grant as being the pastor and some of the pallbearers were members of one of the Huston-Tillotson College fraternities.

I think it’s unusual for people to disappear like that, especially nowadays when we have the world wide web. Reverend Hector Grant was an important influence for me. He was one of the few black men of professional stature I encountered in my early life.

On the other hand, contrast that with Reverend Glen Bandel, another clergyman who was a white man and another important influence starting in my early childhood. Reverend Bandel persuaded me to be baptized at Christ’s Church in Mason City, Iowa. He radiated mercy, generosity, and kindness. He died in June of this year. I can find out more about him on the web just from his obituary than I can ever find on Reverend Grant, who apparently disappeared from the face of the earth.

Both of these men were leaders for whom skin color didn’t matter when it came to treating others with respect and civility.

My path in life was largely paved by these two clergymen. Reverend Bandel sat up with our family one night when my mother was very sick. His family took me and my little brother into their home when she was in the hospital.

On the other hand, Reverend Grant was instrumental in guiding me to an HBCU where I saw more black people in a couple of years than I ever saw in my entire life. The First Congregational Church in Mason City was instrumental in making that possible because they helped fund the drive to support H-TU (one of six small HBCUs) by the national 17/76 Achievement Fund of the United Church of Christ.

The news is replete with stories, some of them tragic, about how Greek fraternities haze their pledges. On the other hand, H-TU was pretty rough on pledges too. Upper classmen would make the pledges roll down the steep hills around the campus. They looked exhausted, wearing towels around their necks, running in place when they weren’t running somewhere in the Texas heat.

One H-TU professor said that H-TU was “small enough to know you, but big enough to grow you.” Although I can’t remember ever seeing him on campus because he was traveling most of the time, I at least knew the name of the President was John Q. Taylor (1965-1988). On the other hand, when I transferred credit to Iowa State University, I never knew the name of the President of the university.

Habari Gani is Swahili for “What’s the news?” or as it translated in the context I’m about to set, “What’s going on?” Habari Gani was the name for the annually published book of poetry by the H-TU students. Dr. Porter supported the project. I submitted a poem for the 1975 edition, which didn’t make the cut. When I transferred to Iowa State University, I left without getting a copy.

On the other hand, years later, I got a digital copy of that edition. I tracked it down to the H-TU library in 2016. The librarian was gracious.

Habari Gani has always been a reminder of the reason why I went to H-TU in the first place. I grew up in Iowa and was always the only black student in school. I grew up in mostly white neighborhoods.

On the other hand, when I finally got to H-TU, one of the students asked me, “Why do you talk so hard?” That referred to my Northern accent, which was not the only cultural factor that made social life challenging.

Once I tried to play a pickup game of basketball in the gymnasium. I’m the clumsiest person for any sport you’ll ever see. I was terrible. But the other players didn’t give me a bad time about it. They softly encouraged me. This was in stark contrast to the time I played a pickup game with all white men years before in Iowa. When I heard one of them yell, “Don’t worry about the nigger!” I just sat down on the bleachers.

On the other hand, when I was a kid and our family was hit by hardship, Reverend Bandel was the kindest person on earth to us—it didn’t matter that he was white. And my 2nd grade teacher, who was black (the only black teacher I ever had before going to H-TU), slapped me in the face so hard it made my ears ring—because I was rambunctious and accidentally bumped into her. It’s far too easy to polarize people as good or bad based on the color of their skin, especially when you’re young and impressionable.

It takes practice and experience to learn how to say and think, “On the other hand….”

Thoughts on Doctors Going On Strike

I read Dr. H. Steven Moffic’s two articles in Psychiatric Times about the strike by mental health workers at Northern California Kaiser Permanente (August 16 and 26, 2022). So far, no psychiatrists have joined the strike.

However, this piqued my interest in whether psychiatrists or general physicians have ever gone on strike. I have a distant memory of house staff voicing alarm about a plan by University of Iowa Hospital & Clinics to reduce health care insurance cost support many years ago. It led to a big meeting being called by hospital administration to discuss the issue openly with the residents. The decision was to table the issue at least temporarily.

It’s important to point out that the residents didn’t have to strike. I don’t recall that it ever came up. But I think hospital leadership was impressed by the big crowd of physician trainees asking a lot of pointed questions about why they were not involved in any of the discussions leading to the abrupt announcement that support for defraying the cost of house staff health insurance was about to end.

That’s relatively recent history. But I did find an article on MedPage Today written by Milton Packer, MD (published May 18 2022) about what was called the only successful strike by interns and residents in 1975 in New York. I don’t know if it included psychiatric residents; they weren’t specifically mentioned.

In 1957, the Committee of Interns and Residents (CIR) in New York City and voted to unionize to improve appalling working conditions. They won the collective bargaining agreement, the first ever to occur in the U.S. because they went on strike, which hamstrung many of the city’s hospitals. Medical faculty had to pitch in to provide patient care.

After 4 days, the hospitals agreed to the residents’ demands. However, the very next year, the National Labor Relations Board ruled that residents were classifiable as “students,” not employees, which meant they weren’t eligible to engage in collective bargaining. This led to a reversal of the gains made by the strike.

Residents who are unionized voted to strike at three large hospitals in California in June of this year. They reached a tentative contract deal at that time. The news story didn’t mention whether there were any psychiatrists in the union.

There has never been a union of residents at The University of Iowa Hospitals & Clinics. I was a medical student and resident and faculty member for 32 years. I saw changes in call schedules and work loads that were the norm for the exhausting schedules that led to horrors like the Libby Zion case in New York.

Even as a faculty member on our Medical-Psychiatry inpatient unit, the workload was often grueling. I co-attended the unit for years and during the months I was scheduled to work there I shared every other night call with an internist for screening admissions. I was sometimes scheduled for several months at a time because it was difficult to find other psychiatrists willing to tackle the job.

If residents had wanted to unionize and voted to strike then, my internist colleague and I probably could have filled in for them.

But I would never have considered going on strike myself. It would have been next to impossible to find any other psychiatrist to fill in for me. And if other psychiatrists had gone on strike? We might have won a better deal—but only by hurting the patients and families who needed us.

I suspect my attitude is what underlies the impressions shared in Robert G. Harmon’s article, “Intern and Resident Organizations in the United States: 1934-1977,” in the 1978 issue of the Milbank Quarterly.

The house-staff choice of unionization as a formal process has disturbed some health professional leaders. One has pointed out that for a house officer to don another hat, that of striking union member, in addition to those of student, teacher, administrator, investigator, physician, and employee, may be a regrettable complexity that will further erode public confidence in physicians (Hunter, 1976). Others have seriously questioned the ethics and morality of physician strikes (Rosner, 1975). -Milbank Memorial Fund Quarterly/Health and Society, Vol. 56, No. 4, 1978.

When I graduated from medical school, I believed in the cultural view of the physician as a professional. My first allegiance was to the patient and family. I paid dearly for holding that stance. Sena reminds me of the times my head nearly dropped into my soup when I was post call. And I did struggle with burnout.

But I retired because I thought it was time to do so. I don’t think of it as a permanent strike. I hope things turn out all right.

Memories and Condolences

I was thinking of my hometown, Mason City, for some reason today. Then I just happened to think of my childhood pastor, Reverend Glen Bandel. The last time I looked him up on the web was about a year ago and saw a news item dated in 2019. He was celebrating his 90th birthday.

I looked him up today. He died on June 3, 2022.

 My deepest condolences to the Bandel family. Reverend Glen Bandel was the definition of the caring family pastor in Mason City. He sat up in the chair with us nearly all night at our house when my mother was sick and my brother and I were little. He had a great sense of humor. The Bandels shared their home with us when times were hard.

They took us with them to visit a family up in Minnesota one winter. I don’t think my mother was with me and my little brother at the time. I think she was in the hospital and the Bandel family took us in.

The family in Minnesota lived and worked on a farm. They didn’t have indoor plumbing. I think Reverend Bandel had a particular reason to visit them. It might have been to try to persuade them to change the way they lived. They had several children.

I had to use the outhouse at night. I was too cold to move my bowels. My family was poor, but not as poor as this one.

I caught the father singing to his little baby daughter. I think the baby’s name was Dolly because he was singing “Hello Dolly” to her. I walked in on them while he was singing the lyric “It’s so nice to have you back where you belong.”

He was having a great time singing to her. But when he looked up and saw me watching him acting like a doting dad, he stopped and looked a little sheepish. I wished he hadn’t seen me.

Reverend Bandel was a hero in the eyes of the many people he served and in my eyes for sure.

I will remember him and the rest of his family for their kindness and generosity as long as I live.

Overdiagnosis of Psychiatric Disorders Still Happens

I read an excellent article in Clinical Psychiatry News recently in the Hard Talk section. The title is “A prescription for de-diagnosing” by psychiatrists Nicholas Badre, MD and David Lehman, MD in the July 2022 issue (Vol 50, No. 7).

The bottom line is that too many psychiatric patients have too many psychiatric diagnoses. A lot of patients have conflicting diagnoses (both unipolar and bipolar affective disorder for example) and take many psychotropic medications which may be unnecessary and lead to side effects.

It takes time to get to know patients in order to ensure you’re not dropping diagnoses too quickly. Discussing them thoroughly in clinic or in the hospital is an excellent idea. And after getting to know patients as people, it makes sense to discuss reduction in polypharmacy, which can be quite a burden.

This reminds me of the Single Question in Delirium (SQiD), a test to diagnose delirium by simply asking a friend or family member of a patient whether their loved one seems to be more confused lately. It’s a pretty accurate test as it turns out.

This also reminds me of the difficulty in making an accurate diagnosis of bipolar disorder. I and a Chief Resident wrote an article for The Carlat Report in 2012 (TCPR, July / August 2012, Vol 10, Issue 8, “Is Bipolar Disorder Over-Diagnosed?”) which warned against overdiagnosis of bipolar disorder. Excerpts below:

Some argue that bipolar disorder is actually under-diagnosed. They have support from abundant literature showing that bipolar disorder tends to present more often with depression than mania or hypomania (Judd LL et al, Arch Gen Psychiatry 2002:59(6):530–537). As many as 10% of patients with unipolar depression ultimately are shown to have bipolar illness instead, according to some experts (Goodwin GM et al, Eur Neuropsychopharm 2008:18(7):535–549). (See this month’s Q&A with Claudia Baldassano for more on this.) In addition, a new emphasis on subthreshold mood symptoms and more rapid mood shifts has led some psychiatrists to promote the concept of a “bipolar spectrum disorder” (Youngstrom EA et al, Curr Psychiatry Rep 2010;12(6):479–489).

While it’s important to remain vigilant about a history of manic and hypomanic symptoms, we think the problem of over-diagnosis is probably greater. For instance, in a 2008 study, Zimmerman and colleagues performed a comprehensive diagnostic interview on 700 patients, nearly 21% of who self-reported a history of “bipolar disorder.” However, when using the gold-standard SCID (structured clinical interview), only 13% had the diagnosis; they also had more first-degree relatives with bipolar disorder than the others (Zimmerman M, Ruggero CJ et al, J Clin Psychiatry 2008:69(6):935–940). The authors hypothesized that over-diagnosis of bipolar disorder might be a consequence of efforts to improve recognition of it and avoid under-detection. In fact, the same authors studied 40 depressed patients previously diagnosed with bipolar disorder and found that, by the SCID, they had specific phobia, PTSD, drug abuse/dependence, or a personality disorder instead (Zimmerman M et al, Compr Psychiatry 2010;51(2):99–105).

Over-diagnosis can also occur when apparent mood episodes are defined as psychiatric when in fact, they have a different etiology altogether. Decreased need for sleep, disorganized or racing thoughts, increased activity and agitation, and delusional thinking, even when they occur together, can represent a sort of “final common pathway” for medical conditions and other syndromes. The manic phenotype can occur in patients with agitated delirium, brain tumors, corticosteroid treatment, and of course substance intoxication (Bunevicius A et al, CNS Spectr 2008;13(11):950–958; Brooks JO and Hoblyn JC, Am J Psychiatry 2005;162(11):2033–2038). These other phenotypes can be distinguished by recognition of key features such as the fluctuating nature of consciousness in delirium, neuroimaging findings, and positive urine drug screens.

Unfortunately, physicians may also be susceptible to diagnostic shortcuts. When faced with limited time for diagnostic interviews and the pressure to prescribe by patients and their families, well-meaning clinicians may give the diagnosis after a single brief interview. Not uncommonly, we find that it was diagnosed on the basis of mood fluctuation over minutes, temper tantrums, and fleeting insomnia. The rapidly expanding repertoire of medications approved for bipolar disorder, and their relative ease of use, may also contribute to over-diagnosis. Unfortunately, in some cases the treatment may be worse than the symptoms themselves (Iordache I and Low NC, J Psychiatry Neurosci 2010;35(3): E3–4).

I was accustomed to asking what I called the Single Question in Bipolar (SQiB). I frequently saw patients who said their psychiatrists had diagnosed them with bipolar disorder. I would ask them, “Can you tell me about your manic episodes?”

Often, they looked puzzled and replied, “What’s a manic episode?” I would describe the typical symptoms and they would deny ever having them.

The article by Drs. Badre and Lehman is a bit disappointing in that it doesn’t look as though we’ve improved our diagnostic acumen much in the last decade.

We need to try harder.

Thoughts on the Song “Against the Wind”

A couple of days ago, while we were playing cribbage, Sena asked me who sang the song “Against the Wind.” I offered a name, which later turned out to be wildly wrong. It bugged her so much she got up from the cribbage game and went to the computer to look it up.

Of course, Bob Seger wrote the lyrics and sang it. She asked me what I thought it meant. I wasn’t sure at the time. I hadn’t thought about it for a really long time.

I read about it on the web. I didn’t know what the lyric “8 miles a minute” meant and found a forum message saying that it corresponds roughly to the speed of a cruising airliner which is about a “480 mph.” That’s technically more like 480 knots, which converts to about 550 mph.

Anyway, it’s really fast and might be a way of saying you’re moving through life at breakneck speed. In Seger’s case, it might have had a more concrete meaning, referring to flying all over from concert to concert.

The song was released in 1980, which was about the time we moved to Ames so I could go back to college at Iowa State University (ISU). It was a big change from working as a draftsman and land surveyor’s assistant in my hometown of Mason City.

If you extend the “against the wind” metaphor a little bit, Sena and I were both moving against the wind in terms of our place in society, income level, location and educational attainment. I thought I wanted to be an engineer at the time, mostly because I had worked for years for consulting engineers.

Backing up in time a little, I had done some undergraduate college work previously at an HBCU (historically black college/university), Huston-Tillotson College (now Huston-Tillotson University) in Austin, Texas in the mid-1970s.

That was also a kind of move against the wind. I grew up in Mason City, and often I was the only black kid in grade school. I got used to that, although the racism was more overt back then and it was difficult sometimes to bear up against that kind of wind. On the other hand, I felt like a fish out of water at H-TC. I just felt like I didn’t fit in. It was part of the reason I left Austin.

It was also challenging to fit in at ISU. I figured out quickly that I would never complete the engineering degree program. The math and hard science courses were tough from the beginning and only got harder. I realized I was going against the wind there.

So, I changed my major and settled on medical technology, which led to working in a hospital laboratory. But it took about a year to get a job after graduation. Looking back, It was a frustrating time and that really felt like pushing against a headwind. I don’t know what I would have done without Sena.

I finally got into medical school at the University of Iowa. Biostatistics and Biochemistry were brutal. I was very close to quitting before the 3rd year of clinical rotations. I doubted I was cut out to be a physician. I thought about going back to surveying. But I didn’t.

Many deadlines, commitments, and struggles leading to brief forays from academia into private practice led me to think of myself as more of a fireman or a cowboy than an academician. Yet I spent most of my career at the University of Iowa.

Now I’m retired. Sena is my shelter against the wind. I guess if you look hard enough, just about anybody can relate to Bob Seger’s song. Let the cowboys ride.

Dumbphone Making a Comeback?

Here’s a side note on my recent post about using a smartphone to help you find where you parked your car. I just saw a few news items about something people are calling the “dumbphone.” I gather they’re making a comeback, and not just for old folks.

Hey, I used to have one of those. It was a flip phone. Several years ago, before I retired, residents rotating through the general hospital psychiatry consultation service suggested I graduate to a smartphone.

After I finally got one, I used it basically as a phone and did little else with it for a long time. It was my smart dumbphone.

I gradually added apps to it, including a step counter, epocrates, and whatnot. But I’m not constantly on it playing games and checking the news, mail, and so on.

The battery swelled up on it a couple of years ago, which worried me. But I took it to a cell phone repair shop where the battery was replaced and it’s been fine ever since.

I still use it mainly as a phone. However, I wonder what I’ll do, say, if the battery swells up again. I don’t know if it would make any sense to go back to the dumbphone.