retirement – Page 23 – Go Retire Psychiatrist

Gauging My Readiness for Retirement

I’m noticing something about my readiness for retirement. Certain activities are starting to be at least as interesting as my work as a consultation-liaison psychiatrist at the hospital—maybe even more so.

For example, my wife and I are hoping that the cardinals will come back to our backyard evergreen tree. They were building a Hoorah’s Nest in there a week ago, which I took a picture of and then they left when they saw us spying on them. This evening, my wife noticed they were back. We rushed to the window (me with camera in hand) and I swear, they peered at us with intense suspicion. Pretty soon, they flew off in a huff.

They are among the most stand-offish backyard birds I’ve ever seen.

Why is this so important? It’s because I am getting so absorbed in birdwatching again now that I’m in phased retirement that I find it fascinating enough to look forward to more than going to work. I think that’s a sign I’m finally beginning to adjust to retirement.

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.

I saw a blog post that identified that reason for retirement. It was entitled “When Physicians Reach Their Use-By Date,” by James Allen, MD. The site is identified as “Not secure” unfortunately, so I’m not giving a link to it. However, the web site is The Hospital Medical Director and it’s sponsored by Ohio State University–so it’s probably safe.

Now if you do read Dr. Allen’s post, you’ll think I’m flattering myself as a “master clinician.” I don’t think of myself that way. I’m actually more of a demigod.

I’m just kidding. The descriptions of how physicians finally reach retirement sound fascinating. I’m not sure I could just abruptly stop—that’s why I chose phased retirement. Staying on as a preceptor is not appealing to me because I liked the clinical action too much. I’m actually afraid of becoming someone who knows only medicine. It’s one of the best reasons for me to retire sooner rather than later. You’d think I’d identify with the consultant model; I’ve briefly thought of carrying my resignation letter around with me, although not in my coat pocket and not with malice in my heart.

Although I joined the fraternity of medicine, so to speak, I’m really not a joiner. In fact, I’ve gradually given up membership in organizations like the Academy of Consultation-Liaison Psychiatry, the American Psychiatric Association, and the American Medical Association. I’ve let go of social media accounts like Doximity and LinkedIn—all of them actually, including Twitter and Facebook; I just couldn’t get the hang of those.

There’s a National Association of Retired Physicians (NAORP) that I’ve peeked at. There’s the University of Iowa Retiree Association (UIRA) that I learned about a couple of years ago when my wife and I attended a seminar about retiring from the university. I probably won’t join either one.

I’ve been getting invitations from AARP for many years now (who doesn’t?). The tote bags look nice and I am glad that somebody is lobbying for people my age. I haven’t joined so far.

And I joke about my own fictional organization, Retiree On My Own Time (ROMOT). No dues, no meetings, no minutes, no Robert’s Rules of Order. I’m the President, Secretary, Treasurer (Har!), and the only member—for now.

I’m keeping my schedule open.

Wes Ely Brings House Down

I know I’d been saying that I probably wouldn’t have time to attend Wes Ely’s Grand Rounds presentation yesterday, “A New Frontier in Critical Care: Saving the Injured Brain.” But against all odds, I actually got to go, along with some medical students and a Family Medicine resident.

As I expected, Dr. Ely brought the house down. His talk was similar to the one he gave at Emory University in Atlanta, Georgia, but not identical. He described the results of the study “Haloperidol and Ziprasidone for treatment of Delirium in Critical Illness,” published last October in the New England Journal of Medicine. There’s a YouTube video of that in my March 28, 2019 post announcing his visit to Iowa City.

He also discussed in detail the ABCDEF bundle for protecting the brains of patients in the ICU.

When he outlined the history of intravenous haloperidol for the treatment of delirium in critical care units, I had to cringe because I remembered the continuous IV haloperidol infusion protocol (running at 5-10 mg an hour) developed by Riker and colleagues. I mention it for historical reasons only. I don’t recommend using it.

Riker, R. R., G. L. Fraser and P. M. Cox (1994). “Continuous infusion of haloperidol controls agitation in critically ill patients.” Critical care medicine 22(3): 433-440.

After his presentation, Dr. Ely asked for questions. I asked him what he thought the role of the psychiatrist is regarding ICU delirium. He actually recognized me; we met very briefly at a meeting of the American Delirium Society in Indianapolis several years ago.

Even better, he knew enough to mention the catatonic variant of delirium and the irony of using a benzodiazepine to treat it, which you would avoid like the plague in delirium (except for alcohol withdrawal, for example). However, benzodiazepines can reverse catatonia. See my post from April 10, 2019 (“Delirium and Catatonia: Medical Emergencies”). He thought psychiatrists would know more about that and would be important collaborators in managing catatonia.

It’s difficult not to be excited by the advances in medicine and psychiatry when an inspirational scientist, humanist, and visionary leader like Wes comes to town. It makes me wonder how I’m going to get a buzz like that out of anything I do in retirement.

On the other hand, I get a kick out of making silly videos.

Meaning and Purpose in Retirement

As you know, I’m back in the saddle at work, according to the terms of my phased retirement contract. When I’m off service, I feel less pressured. However, when I’m on service, I’m like a fireman, thriving on pressure. I’ve done Consultation-Liaison (C-L) Psychiatry for so many years that, when I stop to think about it, I realize I get a good deal of my sense of meaning and purpose through my job.

I sometimes tell residents and medical students that I “do it for the juice.” That means I work for the adrenaline: rushing to emergencies, making quick decisions (some of them far from perfect), teaching on the run, telling funny stories about how my work as evolved over the years.

When I spent less time on the job during the first two years of phased retirement, I felt lost. There’s no better word for it. That’s not as much of a challenge now, but meaning and purpose in retirement can be difficult for a fireman to define.

I had a blog called The Practical C-L Psychiatrist until I dropped it last year. There were a couple of reasons. One of them was the expectation that bloggers write their own Privacy Policies in response to the European Union’s General Data Protection Regulation (GDPR) going into effect. I rebelled against it.

Please read my Privacy Policy on this blog. I worked pretty hard at it. I asked a few attorneys for guidance and only one of them got back to me, humbly admitting he didn’t know anything about it really, but had a helpful suggestion nonetheless.

The other reason I dropped The Practical C-L Psychiatrist was that it was less relevant to my stage of life in that I’m not racing all over the hospital nearly as much nowadays. I don’t have as much to write about that life anymore.

But I still love to write and so I swallowed my pride, wrote the Privacy Policy and decided on making a chronicle of my transition into retirement, which is this new blog, Go Retire Psychiatry. So far, I’ve more or less just made jokes about it. I realize that’s a defense. I need to move on and confront the search for meaning and purpose in retirement.

I’ve done a lot of fun things on the job over the years. I used to have mascots for the C-L service, like the one below. You can tell that it was from some time ago. The mascots were usually inflatable animals I bought from the hospital gift shop. The residents, medical students and I gave them silly names. The trouble was that the mascots, being balloons, were always running out of gas.

And that meant that somebody had to take the mascot for a walk all the way across the hospital back to the gift shop to get a healing shot of helium—and walk all the way back. The volunteers there got a big kick out of an old geezer doctor walking the mascot. It was an exercise in humility, which I admit I often needed.

And I took group pictures of trainees and me at the end of rotations by using an app on my old iPad. It’s called CamMe. The way it worked was that I set the iPad up on a stack of books or something; then we all stood for the shot. I would hold up my hand and make a fist to start a 3-2-1 countdown, which gave you just enough time to make a big smile for the automatic group selfies. Everybody got a kick out of it.

I was so proud of those pictures I thought nothing of posting them on my blog, with nary a thought about their privacy. All of them thought they were fun.

That’s about enough on meaning and purpose for today.

Fine Weather for Ducks

Today we had fine weather for ducks—who waddled across our front yard lawn and across the street. They sampled the worms the robins evidently wouldn’t eat. They didn’t like them much either.

I wonder what kind of romance life ducks have—probably about the same as humans.

That reminds me; my wife made another Hoorah’s Nest under her dining room chair this afternoon. She told me I could show you this.

Fine weather for ducks today

Who’s a Hoorah’s Nest?

I asked my wife this morning if she ever got any food in her mouth, pointing to the floor under her dining room chair—where there was a small pile of crumbs and whatnot.

It was a regular Hoorah’s Nest (also known as Hurrah’s Nest). That’s just about anything (hairstyle, person, place, situation, my so-called cooking) that’s a big, disorganized mess. Don’t worry, she gave me permission to blab about this. I still have a place to live. You can send cash donations to my GoFundMe campaign if you want, though. I’ve got renovations planned.

My new digs, before renovation.
My new digs, after renovation.

My side of the floor is immaculate, of course. No Hoorah’s Nest on me.

You can look on the web for definitions of Hoorah’s Nest and the origin of the term, which includes speculations about a cryptid bird called a Hoorah. It doesn’t excite cryptozoologists as much as Bigfoot does.

On the other hand, we think we saw the Hoorah about three years ago. I have several snapshots of its nest—which was a certified mess and a sign the bird needed professional help.

We tried to assist this Hoorah. Every time it started to go wrong in the construction of the nest (which was immediately), we tried removing the mess from the spot it chose to erect it.

The site was between our house and the back porch rail. Apparently, it was unfamiliar with trees.

Hoorah!
Hip Hoorah!
Hip Hip Hoorah!
Hip Hip Hip Hoorah!

It might have been high on drugs. On the other hand, the only bird I know of who has a substance abuse problem is the Cedar Waxwing. It overeats fermented berries and gets so drunk it can’t find its way home, much less build one.

But this bird might have been from another planet—a world where trees don’t exist and nest-building skills are optional. I could get only one picture of the Hoorah—also known as a Robin. Their nests get the big Hoorah.

The shy and rarely seen Hoorah…otherwise known as a robin.

Other birds make really messy nests, though: Mourning Doves, even the Cardinals (on the right) who we might have already scared away just by staring at them through our window.

Holler if you see a Hoorah.

Remembering My Calling

Back when I had the blog The Practical C-L Psychiatrist, I wrote a post about the Martin Luther King Jr. Day observation in 2015. It was published in the Iowa City Press-Citizen on January 19, 2015 under the title “Remembering our calling: MLK Day 2015.”

I have a small legacy as a teacher. As I approach retirement next year, I reflect on that. When I entered medical school, I had no idea what I was in for. I struggled, lost faith–almost quit. I’m glad I didn’t because I’ve been privileged to learn from the next generation of doctors.

“Faith is taking the first step, even when you don’t see the whole staircase.”
Martin Luther King, Jr.

As the 2015 Martin Luther King Jr. Day approached, I wondered: What’s the best way for the average person to contribute to lifting this nation to a higher destiny? What’s my role and how do I respond to that call?

I find myself reflecting more about my role as a teacher to our residents and medical students. I wonder every day how I can improve as a role model and, at the same time, let trainees practice both what I preach and listen to their own inner calling. After all, they are the next generation of doctors.

But for now they are under my tutelage. What do I hope for them?

I hope medicine doesn’t destroy itself with empty and dishonest calls for “competence” and “quality,” when excellence is called for.

I hope that when they are on call, they’ll mindfully acknowledge their fatigue and frustration…and sit down when they go and listen to the patient.

I hope they listen inwardly as well, and learn to know the difference between a call for action, and a cautionary whisper to wait and see.

I hope they won’t be paralyzed by doubt when their patients are not able to speak for themselves, and that they’ll call the families who have a stake in whatever doctors do for their loved ones.

And most of all I hope leaders in medicine and psychiatry remember that we chose medicine because we thought it was a calling. Let’s try to keep it that way.

You know, I’m on call at the hospital today and I tried to give my trainees the day off. They came in anyway.

I’ll Have to Make Time

I suppose you’re wondering why I’ve been saying that my wife has got me this or that item, like the pink dumbbells and whatnot. She also got me an extra yoga mat.

Part of the explanation is that I’ve recently had a birthday, which reminds me of the importance of time in my life–mainly because I have a shrinking supply of it. After all, I’m heading into the sunset of my journey on Earth.

Occasionally, I wonder what I ought to be trying to accomplish, if anything.

To achieve great things, two things are needed:
A plan and not quite enough time.
Leonard Bernstein

Bernstein’s quote is encouraging in a way. Hey, I’ve already got half of it–I don’t have enough time. Now all I have to do is achieve some great things.

I could go on the road to promote my idea for a hit song, “Put your hand in the hand of the man with a plan to get a tan, lead a band, roam the land, avoid the bladder scan, zippity do dah shazam.”

All I have to do is come up with lyrics…and a melody…and an agent…and a band…and a voice coach…and some talent.

Now, if I’m going to accomplish something great, it would make sense to keep working on building a more harmonious balance in my everyday life. I’m doing some of that, including regular exercise, mindfulness practice, and healthy eating.

That reminds me, the birthday cake was excellent, especially topped with white chocolate vanilla ice cream.

Every so often, my former mindfulness teacher sends out an email message about the upcoming mindfulness classes. She always includes an inspirational quote, like the one below:

Be a person here. Stand by the river, invoke
the owls. Invoke winter, then spring.
Let any season that wants to come here make its own
call. After that sound goes away, wait.

A slow bubble rises through the earth
and begins to include sky, stars, all space,
Even the outracing, expanding thought.
Come back and hear the little sound again.

Suddenly this dream you are having matches
everyone’s dream, and the result is the world.
If a different call came there wouldn’t be any
world, or you, or the river, or the owls calling.

How you stand here is important. How you
listen for the next things to happen. How you breathe.

William Stafford – “Being a Person”

There was also a couple of suggestions for yoga and meditation techniques specifically to help you sleep. I recognized one of them as the body scan. The body scan is one of the first things they teach you in Mindfulness Based Stress Reduction (MBSR).

The body scan invariably put me to sleep, which made me feel like I wasn’t doing it right. Early on in the course, that was not exactly the “goal” of the body scan. Except mindfulness is not exactly a goal-oriented activity.

That’s hard to conceptualize. And so, the other class that is offered to those who make mindfulness practice a regular part of their lives are follow-up groups. It helps reaffirm the regular commitment to practice mindfulness.

I noticed one of the follow-up groups is entitled “Embracing the Paradoxes of Mindfulness.” The description of the course makes the point that mindfulness really isn’t about reaching a goal or achieving great things. It’s about being rather than doing. It’s hard for me to get my head around that after getting into and through medical school, residency, and practicing psychiatry for umpteen years. And now I’m making a transition to retirement.

One of my biggest fears about making and sticking to a mindfulness practice was that I often didn’t think I would have enough time for it. My teacher just advised me that I would simply have to make time.

Maybe I could accept the time I do have left and just be the geezer I am.

Talk About Change

Let’s talk about change. I’ve had a couple of brand-new tie bars (gifts from my wife) in my dresser drawer for a couple of months now. I’d forgotten them until last night. I used to wear a tie bar many years ago. I’m discovering that I probably wore it wrong, according to fashion experts who know a lot about these things.

I never knew you were supposed to wear a tie bar between the 3^rd and 4th button of your shirt (counting from the neck). I guess I always wore it too low. It was always coming loose from the shirt, and that’s why I quit wearing it for years. It’s long gone. I think I probably just threw it away, or maybe it got lost in one of our many moves. And I never knew that the part of the shirt you attach the tie bar to is called a “placket.”

There are different kinds of tie bars. Most of them are made with what resembles an alligator clip. I guess you’re supposed to call that a slide clasp. Another kind of bar is difficult to manage without wrinkling your tie. It’s an awful lot like a cotter pin, but you’re supposed to call it a pinch clasp—I think. I have one of each. Pictures don’t always seem to match up with the names.

Look close to see the tie bar; it’s there. It’s just not in the right spot according to GQ.

I also used to wear bow ties. You don’t need a tie bar for those. They were very colorful. They’re long gone.

I also used to wear the old-style suspenders and even had buttons on the inside of my trousers to secure them. They’re long gone, maybe because I felt insecure without a belt. That was back before I got a paunch—which is now starting to shrink, probably because I’m exercising daily.

And speaking of daily exercise, my wife got me a pair of 5-pound dumbbells. She says pink was the only color left. Anyway, I began using them this evening. I’m not sure, but I may need some liniment.

I used to wear a heavy pair of wingtip Oxford brogues. Believe it or not I would tramp all over the hospital in those shoes. I still thought they looked sharp, but they also looked dated—kind of like me. I used to keep the old-fashioned cedar shoe trees in them, just to keep the creases out of the instep. They’re long gone. Now I wear lighter shoes. When I exercise, I wear Velcro tennis shoes.

My wife also got me an autographed copy of Dave Barry’s new book, Lessons from Lucy: The Simple Joys of an Old, Happy Dog. I’ve always been partial to his sophisticated humor—classic booger joke style.

However, I think Barry’s new book is more about how he’s changing as he ages. I haven’t had chance to read it yet except just enough from the jacket to suspect that the booger joke style will be there, but there’ll be something beyond that. He’s 70 years old and likely reflecting—about the mechanism of action of booger jokes. I used to have nearly all of his books, but they’re long gone. Just like the tie bar, I lost most of them in the many moves we’ve made.

The point is I’m changing in a lot of little ways. The big change coming up is, of course, retirement. I’m changing from a physician to a retiring physician—a retiring psychiatrist. Not all of the changes are to my liking, either about myself or my path.

“A flower falls even though we love it; and a weed grows even though we do not love it.”
Dogen

Change is not always comfortable. I have not stayed the same across the decades. Some changes have been painful. Others have been so much fun that I wouldn’t mind reliving them. They’re all long gone. We’ll just have to make new ones.

Jim’s Exercise Routine

In my off-service time, I discovered that you need to exercise 150 minutes a week or a little over 20 minutes a day. Exercise guidelines come from the Department of Health and Human Services and the World Health Organization who are behind this conspiracy, I mean this recommendation.

I’ve adopted this to some extent, at least what I consider reasonable for a geezer in his mid-60s. I even added something for speed and dexterity. The video shows an abbreviated version of my routine as a demo.

I divide up my mindfulness and sitting meditation with the exercise when I’m on service. I do floor yoga and sitting meditation on alternate mornings and exercise in the evening after I get home from work.

You’ll notice I don’t have a fancy exercise machine. My exercise equipment is simple. I’m an older guy and I’ve got other stuff I need to spend my money on—health insurance, muscle cream, beef jerky.

I realize my plank is not absolutely the best form, but I’m working on it.

I would not make this regimen a requirement for membership in a new retirement club I’m considering. I think a good name might be Retiree On My Own Time (ROMOT). There would be no membership dues. You could make your own card, similar to the one I made. Meetings would be optional because many retirees are actually pretty busy, believe it or not.

Toeless Mourning Doves

I’m an amateur bird watcher. Last August, I saw a toeless Mourning Dove with what some people would call String Foot, a foot deforming condition that might be caused by a variety of injuries. I had never seen anything like it.

Toeless Mourning Dove

In the slide show you can see a bird seemingly sitting in its own poop, which is said by some to cause the problem—which I suspect is doubtful. The last shot is that of a pair of doves trying to nest in our window box, which was full of sharp, plastic artificial plants. It was painful to watch and I wonder if their hazardous habits could lead to injuring their feet.

I’ve seen Mourning Doves do strange things, mainly nesting in areas that don’t make much sense. Years ago, we could not dissuade a pair of them from building a home on top of one of the audio speakers mounted outside on our deck. Cranking up the volume didn’t work.

I clicked around the web trying to find out about the problem. Speculation about the causes of these injuries range from something called String Foot (string or human hair used to build nests getting wrapped around toes leading to amputation), sitting in poop leading to infections, and frostbite.

I think frostbite is plausible, and so did a birdwatcher named Nickell, who published an article about it over a half century ago; Nickell, W. P. (1964). “The Effects of Probable Frostbite on the Feet of Mourning Doves Wintering in Southern Michigan.” The Wilson Bulletin 76(1): 94-95, complete with hand-drawn illustrations that look exactly like the one in the slide show.

In the book, Birds of Massachusetts and Other New England States by Edward Howe Forbush, you can read one of the many anecdotes from amateur ornithologists about bird behavior that Forbush collected for his book, which was published circa 1929 (I actually plucked it from one of E.B. White’s essays):

“Mrs. Olive Thorne Miller. Reported case of female tufted titmouse stealing hair from gentleman in Ohio for use in nest building. Bird lit on gentleman’s head, seized a beakful, braced itself, jerked lock out, flew away, came back for more. Gentleman a bird lover, consented to give hair again. No date.”– Forbush, Edward Howe, 1858-1929. Birds of Massachusetts And Other New England States. [Norwood, Mass.: Printed by Berwick and Smith Company], 192529.

I wonder why a bird would risk String Foot by using hair in nests?