Glue Myself to My Biography

There’s a reason for why I so often tell Dad jokes. In keeping with my post from yesterday about Dr. Martin Luther King, Jr’s biographies:

I glued myself to my autobiography. You may not believe it, but that’s my story and I’m sticking to it.

We’ve ordered a couple of biographies about Dr. King. One of them is his autobiography and the other is Jonathan Eig’s book, “King: A Life.”

I’m getting to be too old to write my own autobiography—guess it’ll have to be done by autopen. Sorry about that one (no I’m not).

I’m a psychiatrist so I know when I’m using humor as a defense mechanism. A lot of good that does.

I’ve never seriously considered writing my autobiography. I could have it tattooed on my back—it would be my backstory.

Seriously—no, I guess that’s impossible. On the other hand, every year about MLK Day, I think about the blog I wrote that the Iowa City Press Citizen published in 2015 on January 19th. It’s becoming almost something like a tradition. I think I need to repost it annually around this time. The title is “Remembering our calling: MLK Day 2015.” 

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

-Martin Luther King, Jr.

That quote is interesting because Jonathan Eig’s biography of MLK can be said to reveal more of the staircase, so to speak, at least from the standpoint of his flaws as well as his strengths. But I stray from the tradition:

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 used to joke that they would erect a playdoh statue of me in the Quad (Quadrangle Hall was there) on the University of Iowa campus someday. Unfortunately, the Quad was demolished in 2016, so I guess I can’t put that in my autobiography.

Since I retired in 2020, I keep meaning to write my memoirs, but I never get around to it. I guess that makes it my oughta biography.

Kudos to Dr. George Dawson on Today’s Blog Post!

I want to give a shout-out to Dr. George Dawson on his post today, “Enthusiasm is a plus…” It’s right on the mark.

Having a zest for medicine is the reason why many physicians undertook the rigorous training in medical school, residency, and beyond. A sense of humor is evident in George’s essay—and he doesn’t need to be comedian.

His essay reminded me of the many trainees who took their rotation through the psychiatry consultation service when I was running it (or tried to, anyway!). Many deserve a shout out as well for not only working hard on the service but teaching as well. I prevailed on them to make a short presentation during the rotation. I called it the Dirty Dozen.

They picked a topic often about an interesting consultation case we had seen and put together a talk with a dozen slides. They gave a Dirty Dozen called: “Neurology and Psychiatry: Divided or United?” It included some of Dr. Ron Pies ideas on a subtopic of whether psychiatry and neurology can ever be combined as a discipline (three diagrams of his are in the slides). You can also see a sense of humor, especially in the first slide.

Note: Because I couldn’t locate all of the trainees to get their permission to leave their names on the title slide, I chose to identify them as “Trainees.” I’m still very proud of all of them.

Slides from trainees on Neurology and Psychiatry: Divided or United? from UIHC Psychiatry Consultation Service, 2017. Figures included from Dr. Pies’ article in Psychiatric Times (see below):

Citations:

Arzy, S. Danziger, S. (2014).. “The Science of Neuropsychiatry: Past, Present, and Future.” The Journal of neuropsychiatry and clinical neurosciences 26.4 2014): 392-395.  

Daly, R. Pies, R. (2010). Should Psychiatry and Neurology Merge as a Single Discipline? Psychiatric Times.

Fitzgerald, M. (2015). Do psychiatry and neurology need a close partnership or a merger? BJPsych Bulletin, 39(3), 105–107.

Pies, R. (2005). Why psychiatry and neurology cannot simply merge. J Neuropsychiatry Clin Neurosci; 17: 304-309.

Schildkrout, B., Frankel, M. (2016). Neuropsychiatry: Toward Solving the Mysteries That Animate Psychiatry. Psychiatric Times.

Price, BH., Adams RD., Coyle, JT. (2000). Neurology and psychiatry, closing the great divide. Neurology January 11, 2000 vol. 54 no. 18         

Ronald W. Pies, M., & Robert Daly, M. (2026, January 5). Should psychiatry and neurology merge as a single discipline?. Psychiatric Times. https://www.psychiatrictimes.com/view/should-psychiatry-and-neurology-merge-single-discipline?

Shoveling Through Retirement Thoughts

I was just musing on Philip Rivers. You know about him. I blogged recently about his coming out of retirement to play quarterback for the Indianapolis Colts. I guess you already know this, but he retired again.

Unlike Philip Rivers, I’ve not even considered coming out of retirement since I left my position at The University of Iowa Health Care (UIHC) over 5 years ago. I never looked back.

But that doesn’t mean I never think about looking back. I look back a lot and that’s mostly because I’m an old guy. I was a consulting psychiatrist in the general hospital.

Anyway, occasionally I search my name on the web and laugh at what comes up. I never went to Baylor College of Medicine, much less graduated from there.

I did a few things when I was a doctor. Not all of them were about work, but most of them were.

Those who know me know that I always hated Maintenance of Certification (MOC). I checked the American Board of Psychiatry & Neurology website and my MOC contribution to continuing education is still there. It’s a clinical module on Delirium, which a lot of doctors and other health care practitioners see every day in the hospital. Dr. Emily Morse worked on it as well. She’s still working at UIHC.

I co-edited a book about consultation-liaison psychiatry with my former chair of the Psychiatry Dept, Dr. Robert G. Robinson, may he rest in peace. It’s “Psychosomatic Medicine: An Introduction to Consultation-Liaison Psychiatry.” You can buy it on Amazon—please.

I wrote a case report on catatonia caused by withdrawal from lorazepam (a benzodiazepine), and it’s still available. It was first published in Annals of Psychiatry.

But one of the things I’m proudest of doing was writing a short article for the University of Iowa Library for Open Access Week.

In it, I tell a short anecdote about my lofty (OK, a better word is “greedy”) thoughts about how much money I could make shoveling snow. I was just a kid and I never made it outside to shovel anybody’s walk because I was too busy calculating my income. I wrote that way back when I had another blog, The Practical Psychosomaticist. The photo of me shows my Leonard Tow Humanism in Medicine pin fixed to my lapel—another thing I’m proud of. By the way “Tow” rhymes with “Wow.”

Libraries have always been my one of my favorite places to hang out. Anyway, I’ve got more time to do things like hang out in general. I think Philip Rivers will adjust.

Thoughts on Comebacks

I watched the first half of the Colts vs 49ers game last night and I thought Philip Rivers didn’t look half bad for a 44-year-old guy who’s been out of the game for five years. Did you know he has 10 kids? OK, now that I’ve got that out of my system and that would be, what—the 44th time you’ve heard that since he took the field?

So what the Colts lost? His big family was up in the stands going crazy, cheering him on.

I read an article this morning which had Steve Young saying he could make a comeback at his age—which is 64. I couldn’t believe it. The same story mentions that George Blanda played for the Oakland Raiders when he was 48 back in 1975.

It got me wondering whether I could make a comeback as a general hospital consulting psychiatrist. Could I gallop up 6-8 floors of University of Iowa Health Care? You bet your bottom dollar—I couldn’t.

It’s hard to retire. Every once in a while, I miss hiking up and down the hospital with my camp stool, deftly swinging it around and sitting with the patients and families, telling medical students and residents all kinds of lies (I mean “wise old adages and pearls of clinical wisdom”).

I get a kick out of just wondering what it would be like. I get a vision of myself with a big, golden glowing aura of greatness around my head—until I come to my senses. Hey, nobody’s going to pay me a quarter million dollars to run the consult service for the few months I’d be able to limp around the hospital, falling off my camp stool when my legs go numb or the chair breaks.

It’s not like I can just throw a football like it’s nothing after 5 years. I’d have to prove I still have enough clinical smarts to figure out how to introduce myself (Hi! I’m Philip Rivers and you need to go long!”).

The Maintenance of Certification Circus is still a thing and it’s worse. I’m not saying doctors don’t undertake the arduous task of essentially retraining to be what they once were—because that’s not good enough anymore.

Last night, the camera caught Phil more than once being just as hard on himself as he was with other members of the team who weren’t in the right spot at the right time. Most physicians are perfectionists and if you’ve been out of the game for a while and you try to squeeze back in, you could wind up mumbling to yourself, “They don’t make footballs like they used to!”

I didn’t stay up for the second half of football game. It wasn’t because of anything Philip did or didn’t do on the field.

I just can’t stay up that late nowadays.

Dr. Susan Shen University of Iowa Psychiatrist Wins Prestigious Avenir Award for Research!

This just in! University of Iowa Psychiatrist Dr. Susan Shen, MD, PhD, is an assistant professor of psychiatry at The University of Iowa Carver College of Medicine and, hold on to your hat, she’s the first female psychiatrist, the first from Iowa, and only the third psychiatrist overall to receive to win the Avenir Award (French for “future), a highly competitive grant!

The $2.3 million dollar grant will help fund her lab’s research into the underpinnings of substance use and psychiatric disorders. The grant is administered through the National Institute on Drug Abuse (NIDA), one of the National Institutes of Health (NIH).

Give Dr. Susan Shen a big shout-out!

Thoughts on Retirement, MIB Style

Sena alerted me to an article about the 28th anniversary of when the first Men in Black movie hit the theaters in 1997. The author praises it and says it’s still pretty good.

I can’t remember the first time I saw it, but it was probably not in 1997. I was in my second year of being an assistant professor of psychiatry at the University of Iowa Hospitals & Clinics (now called University of Iowa Health Care). I was too busy to do much of anything except run around the hospital responding to requests for psychiatry consultations from medicine and surgery. I did that a long time.

I’ve been blogging since 2010. I cancelled my first blog which was called The Practical Psychosomaticist. I then restarted blogging, calling it Go Retire Psychiatrist. One blog that pays homage to my career and to the Men in Black films is “The Last White Coat I’ll Ever Wear.”

It’s part reminiscence and part comedy in the style of Men in Black dialogue and jokes. Since I retired, I have not been back to the hospital except for scheduled appointments in the eye and dentistry clinics. I don’t know if I’ve ever reconciled myself to being retired. If someone were to tell me “We have a situation and we need your help” (think Men in Black II), I would probably say something like “There is a free mental health clinic on the corner of Lilac and East Valley.”

Svengoolie Show Movie: “Tarantula”

I watched the Svengoolie show movie “Tarantula” last night, although I fell asleep for what turns out to have been about 20 minutes or so during the second half hour of this 1955 film about radioactive nutrient producing a giant tarantula. I had to catch up on what I missed on the Internet Archive.

Don’t get me wrong, the movie didn’t put me to sleep; in fact, there were various segments that reminded me of various tangents I’m about to go off on.

Anyway, the film was directed by Jack Arnold and starred John Agar (Dr. Mass Hastings), Mara Corday (Stephanie ‘Steve’ Clayton), and Leo G. Carroll (Prof Gerald Deemer, who I guess was in a lot of Hitchcock films including North by Northwest, which Sena has seen). Raymond Bailey (Townsend, Arizona dept of agriculture scientist) had an interesting line I’ll mention later. Bailey also played the banker Milburn Drysdale in the Beverly Hillbillies TV show in the early ‘60s-early ‘70s.

The short summary of this film is that it’s one of several related to the fear of radioactivity-linked science gone bad leading to the creation of really big bugs running amok in tiny towns in the desert southwest. The main angle here is Prof Deemer’s scientific work on preventing world starvation from overpopulation by creating a nutrient that would, if mixed with the evil radioactive isotope, cause hungry tarantulas to grow to enormous size, in turn leading to cattle mutilations that would prevent long wait times for motorists waiting for cows to cross Route 66, consequently unblocking the path to McDonald’s restaurants, although the food chain interruption from the beef shortage caused by tarantula predation would eventually result in the loss of big macs leading to cannibalism, thereby cancelling world hunger by population reduction.

Scientists never think this one through.

But there are other things to talk about with respect to this movie. One of them is the word “acromegalia.” I know about acromegaly, but the term “acromegalia” was a new one to me, although it turns out to be an old term. Acromegaly is the usual name for the medical condition. Why the writers chose this word is a mystery. Both mean a rare pituitary gland problem which produces too much growth hormone leading to gigantism in which the hands, feet, and face grow bigger.

Another fascinating thing about the film is that I think I can hear Dr. Deemer call the radioisotope a specific name, something that sounds sort of like “ammoniac.” In the internet archive version, see if you can hear it at about 27:47.

Sena can hear it too. But I can’t find any reviewers who mention it and even AI denies that the radioisotope is given a name in the movie. Also, if it was made just for the movie, it doesn’t make sense because most isotopes’ names end in “-ium,” so no made-up word for it should sound like “ammoniac” which makes you think of ammonia, something somebody would wave under your nose to smell if you fainted from the sight of the giant tarantula.

Another interesting thing is the dialogue between Dr. Hastings and an Arizona Agricultural Institute scientist, Dr. Townsend (played by Raymond Bailey). The gist of the interaction is that Dr. Hastings brought a specimen of giant tarantula venom for Dr. Townsend to analyze, but when he says he found giant pools of it, Townsend is incredulous and accuses Hastings of either having a nightmare or being the biggest liar since Baron Munchausen. On the internet archive this exchange happens at about 59:07.

This is priceless. I know about Baron Munchausen because, as a consulting psychiatrist for many years I saw patients who had the syndrome which used to be called Munchausen’s Syndrome (now called Factitious Disorder) which is essentially a mental disorder in which patients claim to have diseases which they don’t actually have but fake them and lie to doctors about it. I gave lectures about the syndrome. There’s a fascinating literature about it and, the odd thing is that the real Baron von Munchhausen was a famous adventurer and raconteur—but he was not a liar.

What many people don’t know is that it was actually a fellow named Rudolf Erich Raspe, a German scientist and scholar who wrote a book about the baron which was mostly made up. Raspe was the liar, not Baron Munchhausen.

A person with Factitious Disorder was hospitalized at University of Iowa Health Care back in the 1950s and a long case report about it was published in the Journal of the American Medical Association (JAMA). Further, a physician named William Bennett Bean, MD in the Department of Medicine at the University of Iowa wrote a very long poem about this which you can access. There was also a fascinating case report published in 1980 in the New England Journal of Medicine (NEJM) by medicine residents claiming they had seen a patient who lied about having Factitious Disorder (Factitious Munchausen’s Syndrome). The residents later admitted that they made up the story.  I summarized most of this in a blog post a few years ago.

Finally, there is a line by Dr. Hastings at about 1:04:45 which reminded me of a Verizon commercial years ago: “Can you hear me now?”

I think that’s more than enough about this movie, which I would give a rating of 4/5 mainly because it evoked so much from the deep recesses of my memory.

Shrilling Chicken Rating 4/5

Addendum: I couldn’t shake an urge to comment on a gesture of earlobe tugging that Dr. Matt Hastings engaged in while asking Prof Deemer about how quickly Jacobs developed his physical malformations. You can find this on the Internet Archive at time 28:36. Deemer dismisses it as acromegalia and nothing more but finally suggests Hastings could see that an autopsy be performed on Jacobs. I suspect Hasting’s earlobe tug might be dismissed as simple overacting, but there could be other interpretations.

CDC ACIP Highlights on Covid 19 Vaccine

There was a lot to digest in today’s CDC ACIP meeting on Covid-19 vaccines. I missed the morning sessions but managed to see a few of the afternoon presentations.

The presentation by Dr. Retsef Levi, PhD, MIT, ACIP Work Group Chair, the Covid -19 Vaccine Discussion Framing Work Group (WG) was basically pretty critical of the Covid-19 vaccines in general.

The opposing reply to this (favorable to vaccines) was put together by University of Iowa’s Dr. Stanley Perlman, Dr. H. Bernstein, and Dr. M. Miglis, Additional Workgroup Considerations in Covid-19 Vaccination Policy and Practice.

For a change, I listened to the Public Comment section. I usually have not paid attention to them because most of the speakers were opposed to vaccines. Today was different. All of them were strongly supportive of vaccines.

There is a bottom line to this. I watched the voting session, which was very interesting. There were 4 voting questions. I had to take pictures of them because they were not included in the on-line schedule. It was easily the most interesting session of the afternoon, at least for me.

Voting question 1: all but one member voted “yes,” the committee chair Kulldorff voted “no.”

Voting question 2: one member suggested striking this one, but they voted anyway. What’s worrisome is that it was split between the yes and no votes; only the chair, Kulldorff, could break it and he voted “no.” Looks like common sense won; otherwise it would have made access very difficult.

Voting question 3: The video lost audio for a long time, but eventually it turned out that the votes were “yes” unanimously on the assumption that pharmacists counted as “health care providers.”

Voting question 4: The votes were all “yes,” mainly because they decided that pharmacists could make this work. One member questioned the wording which suggested that you needed to talk to your doctor about getting the vaccine because of the wording “shared clinical decision-making.” They glossed over it.

It looks like access to the Covid-19 vaccine will remain mostly open for now.

University of Iowa Physician Wins Lasker Award!

How about some good news? This just in, University of Iowa Physician-Scientist, Dr. Michael Welsh, wins the 2025 Lasker Award for his research on cystic fibrosis.

His work and the work of two other researchers with whom he’ll share the award set the stage for the development of new drugs which saves the lives of those who suffer from cystic fibrosis.

I learned from the article that the cystic fibrosis gene was discovered in 1989; I was a second-year medical student then. Since then, the development of new treatments has meant that many people who died in early adulthood now can live into their 80s.

Congratulations to Dr. Welsh and colleagues!

Rounding@Iowa Podcast: “When to Suspect Atypical Recreational Substances”

There’s a new podcast in town from The University of Iowa Health Care and the title is “When to Suspect Atypical Recreational Substances.”

87: New Treatment Options for Menopause Rounding@IOWA

Join Dr. Clancy and his guests, Drs. Evelyn Ross-Shapiro, Sarah Shaffer, and Emily Walsh, as they discuss the complex set of symptoms and treatment options for those with significant symptoms from menopause.  CME Credit Available:  https://uiowa.cloud-cme.com/course/courseoverview?P=0&EID=81895  Host: Gerard Clancy, MD Senior Associate Dean for External Affairs Professor of Psychiatry and Emergency Medicine University of Iowa Carver College of Medicine Guests: Evelyn RossShapiro, MD, MPH Clinical Assistant Professor of Internal Medicine Clinic Director, LGBTQ Clinic University of Iowa Carver College of Medicine Sarah Shaffer, DO Clinical Associate Professor of Obstetrics and Gynecology Vice Chair for Education, Department of Obstetrics and Gynecology University of Iowa Carver College of Medicine Emily Walsh, PharmD, BCACP Clinical Pharmacy Specialist Iowa Health Care Financial Disclosures:  Dr. Gerard Clancy, his guests, and Rounding@IOWA planning committee members have disclosed no relevant financial relationships. Nurse: The University of Iowa Roy J. and Lucille A. Carver College of Medicine designates this activity for a maximum of 1.00 ANCC contact hour. Physician: The University of Iowa Roy J. and Lucille A. Carver College of Medicine designates this enduring material for a maximum of 1.00 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Other Health Care Providers: A certificate of completion will be available after successful completion of the course. (It is the responsibility of licensees to determine if this continuing education activity meets the requirements of their professional licensure board.) References/Resources:   
  1. 87: New Treatment Options for Menopause
  2. 86: Cancer Rates in Iowa
  3. 85: Solutions for Rural Health Workforce Shortages
  4. 84: When to Suspect Atypical Recreational Substances
  5. 83: Hidradenitis Suppurativa

This is a fascinating topic and the discussion ran for close to an hour, which is longer than usual because there’s a lot to say about it. The substances include a lot of chemicals that are not illegal and, in some cases, easily available in convenience stores and gas stations. In fact, the name for one of them is gas station heroin, which is tianeptine, approved in other countries as an antidepressant.

The discussion also included substantial information (or maybe better said, lack of enough information) about bath salts (usually cathinones), kratom, and something I’ve never even heard of: diamond shruumz (chocolate bars which can contain various substances not limited to psilocin). Remember that guy who chewed the face off of somebody in Miami in 2012? That was attributed to intoxication with bath salts.

This is way beyond the 1970s stuff like window pane or blotter (LSD) and pot. Many people end up in emergency rooms for evaluation of what looks like poisoning from multiple drugs. The stickler is the possibility that they got poisoned from something bought at a convenience store. Often it’s difficult to tell what the person ingested.

One of the takeaways from this podcast is that, whenever possible, try to get a history from the patient. They might just tell you what you need to know.