Today we took another walk on the Terry Trueblood Trail. This time there was a different feel. We wore face masks and there were new signs directing one-way traffic in order to facilitate social distancing. We noticed a few people wearing masks, but not many more than the last time we were out there.
Sena got a kick out of picking up groceries the other day. The guy who brought out the groceries was wearing a face mask—just not covering his face. He knew the guidelines and could recite them, but he had complaints about the mask: “I can’t breathe!”; “It’s hot!”; “It fogs up my glasses!”; “It gets in my way!”
I heard that. But there’s a right way and many wrong ways to wear a face mask.
The robins are building their Hurrah’s nests in our back yard again. That’s about the only thing that has not changed. The COVID-19 (C-19) pandemic has changed just about everything else in our lives.
I wear a face shield now at the hospital. We’re told to wear it as much as possible, like putting on our clothes in the morning. Don’t we leave them on all day? The shield keeps you from touching your face, which is why it’s better than a face mask. However, I’ve noticed something about wearing the face shield for much of the day. Before I describe it, let me give you analogy: If you’ve ever worked detasseling corn when you were young a long time ago, you might remember what happened when you closed your eyes at night and tried to go to sleep. I saw corn fields—miles and miles of corn fields. When I opened my eyes, the vision would disappear. But as soon as I closed my eyes again, I saw the vast corn fields.
It’s crazy, but I have a similar sensory after-effect when I doff my face shield–sometimes I still feel the headband. The pressure of it is just the same as if I were still wearing it. I suppose it’s because I cinch it too tightly. But if I don’t, it slips down my brow, pushing my eyeglasses down my nose.
Another change—I’m a Consultation-Liaison (C-L) Psychiatrist, so I’m used to washing my hands in between patients in the hospital. Now, I’ve got something I’ve never had before–alligator hide patterns on the backs of my hands. They’re dry and cracked. I don’t count the number of times I wash my hands, but it’s a lot more frequent than I used to do. It’s not uncommon for health care professionals to wash hands 75-100 times a day in the C-19 era. I have to use hand cream conscientiously—something I almost never did.
I’m less comfortable being closer than several feet away from people. I tend to hug the walls and corners in stairwells, where I now encounter more people than I ever have before. I guess the message everyone hears is “Stand by me—six feet away if you please.”
I don’t shake hands anymore. The lines into the hospital sometimes lead to crowding while we wait to have our temperatures taken and answer the screening questions about whether we’ve had fever, cough, shortness of breath, etc. It’s perfunctory most of the time, because virtually always the answer is “no” and everybody is in a hurry.
I don’t carry my little camp stool with me anymore, which allowed me to sit down with patients and have face to face, eye level interaction. I’m distinctly uncomfortable standing over them because I haven’t done that in years. If there is a chair in the room, I’m hesitant to use it because, like the camp stool, I worry that it might carry C-19 virus on its surface.
I used to evaluate psychiatric patients in our emergency room by simply going there and seeing them face to face, either in their rooms or, when it was really busy (which is most of the time), in the hallways.
I just used a remote telehealth interface platform using an iPad the other day, which allows me to interview patients from my office, in order to avoid the risk of contagion. It was a little slow and awkward, and I was uncomfortable that a health care professional had to be in the emergency room to hold it up for the patient—who was covered in blood. I felt a little guilty.
I used to round with medical students and residents on our patients. We were the movable feast, a sort of MASH (Mobile Army Surgical Hospital) unit, more like Mobile Unifying Shrink Hospital (MUSH). Unifying means unifying medicine and psychiatry. The medical students are not permitted on the wards now, in order to protect them. It’s awkward rounding with only one resident at a time, although another resident can do other things like chart review and telephone relatives for collateral history. I get in the hospital earlier nowadays, and see many non-C-19 patients alone without trainees, preparing for the C-19 surge when I expect we’ll get many more consultation requests to help care for C-19 patients with delirium and depression. It’s a one-man hit-and-run psychiatry consult service and efficiency is mandatory to meet the demand.
I see patients by myself for another reason. Try as we might, C-19 positive patients will slip through the screens. Many are asymptomatic but contagious, and any test will have false negative results. The idea is to expose the least number of health care front line staff members as possible. Faculty capacity is stretched pretty thin, which is pretty much the situation everywhere. I have to choose. I’m older. I’m weeks from retirement. I’m afraid.
But robins don’t have the burden of choice. They obey their instinct every spring, just the same.
Today we took a break from the intensity of the pandemic and went out for a walk on the Terry Trueblood Trail. We were a little surprised at the crowd. There were more people there than we’ve ever seen before.
We’re social creatures. After a while, we get a little tired of everything being about coronavirus and making homemade masks out of bandanas and rubber bands. I made one of those—but I didn’t wear it out on the trail. Most people didn’t.
Sena bought me short sleeve shirts so I can be bare below the elbows at the hospital. I’ll think about it tomorrow.
Today we listened to the Eastern Meadowlark’s song and watched Tree Swallows kiss each other on the beak. We saw American Coot up close for the first time.
They were catching bass in the lake. Nobody wants to clean them so they just throw them back. The frogs are cheeping.
We found a little American flag laying on the walkway. We stuck it in the ground and watched it wave. The Tree Swallow nest boxes were stamped “Made in America.”
I wondered how all of these things came together on a sunny afternoon in the spring. I can’t figure it but it sure was nice.
Today was my first day back on the hospital consultation-liaison service and I’m a little tired. I put about 2 miles and 22 floors on my step counter, which was a nice pace for starters. It’ll get busier as the COVID-19 surge develops over the next couple of weeks.
Being in phased retirement means I’m away for weeks, sometimes more than that. The pandemic changed many processes and policies while I was gone.
I think the biggest challenge I had this morning was just getting used to donning and doffing the face shield. I passed many people in the halls who are wearing them. My clumsiness was a little embarrassing. It took me a while just to figure out how to adjust the head band. But those who recommend them are right–they keep you from touching your face, which the masks don’t do.
You may have seen my YouTube video and the post on how to trim beards so they don’t interfere with the seal of the N95 masks. I even shaved mine off. Come to find out, I’ll probably never have to wear one given the shortages of masks generally.
I’m learning a lot of things on the fly and that includes how to use electronic gadgets to facilitate remote interviewing in order to cut down on spread of the virus.
I saw a lot more people in the stairwells and elevators were much less crowded.
I remember when we were kids, we used to get gifts of fruitcake from well-meaning older ladies in our church. I think that’s where I first learned how to lie. If my little brother and I didn’t praise the weaponized loaf of glazed, syrupy candied fruit studded with rotten walnuts, we caught hell from Mom. Lying gets a bad name, I know. But if you don’t learn this essential social skill early in life, you end up with a sore backside from the paddle in the corner of the family room. Ironically, the paddle was a repurposed paddle ball toy we got for Christmas—which was always the time the old ladies from church would gift us with fruitcakes from outer space, obviously via wormhole vortex.
Speaking of friends, we occasionally had dinner with an older couple, RellaMae and Ray, who owned a gargantuan mongrel dog, part bull mastiff and part mastodon. His name was Moose. When he was tied to a post out in the back yard, he spent a lot of his time barking and snarling at anything living that passed by, especially the paperboy. On the other hand, he played like a puppy with me and my brother. At the dinner table, he would lay his head on my knee, mournfully staring at every forkful and leaving a pond of drool on my pants.
RellaMae was tickled to death with her old Chrysler which had a push-button transmission. I bet you thought that was a modern invention. I know next to nothing about cars, but Chrysler made some of these in the 1950s and 1960s. We went for a drive in it and I half-expected it to fly. It was pink, if I recall correctly. Ray was a cab driver with bad heart disease who chewed on but did not smoke cigars the size and consistency of Black Angus bull turds. The cab dispatcher where he worked had a singular talent. The phone was always busy but because she was the only dispatcher, she had to make her bathroom breaks very speedy. The legend was that she could be in and out in less than a minute.
The push-button Chrysler reminds me of a car my wife and I owned for a while sometime in the 1980s to 1990s which talked to you. I believe it was a New Yorker. It said things like “A door is ajar” which everyone made jokes about (When is a door not a door? When it’s ajar). Har! That chatty car got me across Iowa, Missouri, Illinois, Michigan, Indiana, and Ohio when I was interviewing for residency. I got stranded along with a lot of other motorists at a rest stop on the way back from Ohio because of a snowstorm. That was brief, uneventful, and we were on our way after the plows went through in a couple of hours.
But that does remind me of another time I got stranded in Wyoming on my way back home from college in Texas. I traveled by bus back in those days and me and my fellow passengers were stuck in a hole in the wall sandwich and gift shop at the bus depot. A couple of us sat at one of the tables and were entertained by what sounded like tall tales from a couple of local guys bragging about their criminal exploits. One of them finally pushed up his sleeve, exposing his arm which was covered with about a half dozen or so wristwatches—which he hinted were stolen and he was trying to sell.
You can tell when somebody is in his anecdotage. Anybody out there with a story?
It’s snowing today, starting this afternoon. It’s not a blizzard. It comes down slowly and peacefully. Occasionally I see people and their kids and dogs out walking in it, likely grateful for the fresh air. It’s hard to be stuck indoors, self-isolating because of the COVID-19 epidemic. We play cribbage.
Sena tried the grocery pickup thing in order to avoid crowds. She ordered yesterday and picked up this afternoon. For the most part, the shoppers did OK. We noticed that as she was ordering, items would be sold out even before and sometimes after (we found out later) the ordering was done.
But we were able to get toilet paper.
This epidemic changes your life in many ways. I’m in the latter stage of phased retirement and I’ll go back on the consultation-liaison psychiatry service in April. I expect it to be busy, but I’ll likely not do as many face-to-face interviews, depending on the situations in the emergency room and the general hospital.
I probably won’t carry around my camp stool, which I use to sit with patients when I interview them. It’s just another item that the coronavirus can stick to.
We’re told not to wear neckties because they’re germy, but I gave that up a long time ago for banded collar shirts. But now I’ll have to remember to keep my arms bare up to the elbows.
We’re also reminded to avoid elevators so as to maintain social distance (6 feet or 2 meters, roughly). I’ve been taking the stairs for years. Many people avoid the stairs.
I’ve gotten used to handwashing because I’m a hospitalist. I’ll wear masks a lot more frequently as well as don and doff personal protective equipment as needed more often.
I’m older and I worry a little bit about belonging to a higher risk age group for COVID-19 and being exposed more. On the other hand, I’m pretty healthy compared to a lot of patients younger than me.
I’m glad the next generation of doctors will be taking over, though.
I was just notified about the National Neuroscience Curriculum Initiative (NNCI) “Quarantine Curriculum” this afternoon–the program starts tomorrow. It’s a 14-day program. It’s free and all you need to do is register (also free) to log in so they can track usage.
The Zoom web-based conferencing app will be used to facilitate the program. It’s being launched in response to the COVID-19 challenges to providing classroom teaching, one of which is to prevent spread of the virus by cancelling in-person classes. The course description and the Zoom link is here.
The recommendation for social distancing to reduce exposure is leading to school closures (I can hear children playing outside; it’s an all–day recess), and recommendations to find alternative ways to approach the didactic component of medical education. The Quarantine Curriculum is one way.
NNCI is designed by medical educators to meet the need for building a strong neuroscience knowledge base for residents across many disciplines in medicine and psychiatry. I think it’s an excellent platform and one of our faculty members is on the NNCI executive council.
NNCI makes learning neuroscience fun. Check it out!
I finally got DeLynn Colvert’s book Play Winning Cribbage yesterday after it traveled a circuitous delivery route starting in Missoula, Montana, and seemingly stopping at several U.S. Postal Service carrier facilities along the way—some of them in the reverse direction from the destination.
The book is the 5th edition, updated as of 2015 (not 2018 as Amazon advertises). On the cover is, presumably, an illustration of Sir John Suckling, (who invented cribbage almost 400 years ago) holding a tournament cribbage board which was designed by Colvert himself. We have one in our small collection. He not only wrote the book but did all the illustrations as well. It was originally published in 1980. In a sense, it’s sort of a vintage item (like the old calculator next to it in the picture).
Tournament cribbage board
As the cover indicates, he was the No. 1 Ranked Player for 26 years, a 4-time National Champion, and was inducted into the Cribbage Hall of Fame in 1989.
I’ve just started reading it. It’s pretty entertaining. A cribbage master named Frank Lake once said cribbage is 85% luck. That’s from an Oregon news item published on line in 2005 in The Bulletin. Frank was 83 years old at the time and the story mentions Delynn Colvert who played cribbage with Frank for 20 years. Colvert said Frank was a good player although age was starting to take a toll on his game.
I’m not sure whether Colvert would have agreed with Lake’s opinion about how big a role luck plays in cribbage. He has many tips for improving skillful play and even came up with a special “Twenty-Six Theory” about the game. If applied consistently, the theory is said to improve a player’s winning average by 6%. It doesn’t sound like much, but if you’re into tournament play, it is the winning edge. I haven’t read that chapter yet and I don’t have aspirations to be a tournament player.
Spring is here! I heard this rustling outside my window this afternoon and when I opened the blinds, I saw flocks of Robins and Cedar Waxwings on our trees, feasting on the berries and little cones. Boy, can they party!
I began rereading the book Invisible Man by Ralph Ellison today, which is Leap Day. Given what little I know about Leap Day and Leap Year in general, there isn’t a connection.
I first read Invisible Man well over 40 years ago. It was a paperback and I took it with me to Huston-Tillotson College in Austin, Texas (now Huston-Tillotson University), one of the historically black colleges and universities (HBCUs) in the United States.
It was very hot in Austin in my freshman year and the students didn’t have air-conditioned dormitories in those days. It must have been over 90 degrees. The glue melted on most of my paperback books, including Invisible Man. I suppose that’s why I eventually threw the book away, because it was falling apart.
After all these years, I bought a hardcover edition. We have air-conditioning now. I was motivated to read it again after I read Invisible Hawkeyes: African Americans at the University of Iowa during the Long Civil Rights Era, edited by Lena M. Hill and Michael D. Hill. See my blog posts, Milestones, and The Iowa River Landing Sculpture Walk, for background.
When I was a young man, I identified with the protagonist in Invisible Man. The Prologue still strikes a chord.
On the other hand, I googled my name today and found a few links that made me feel less invisible. Probably the most surprising link was to an interview with me entitled “James Amos, MD,” which you can read here. The piece evoked memories of a past version of me—which has not changed much since then. It mentions my former blog The Practical Psychosomaticist which I later renamed The Practical C-L Psychiatrist (C-L stands for Consultation-Liaison) after the flagship organization, the Academy of Psychosomatic Medicine changed its name to the Academy of C-L Psychiatry in response to a poll of its membership asking whether the name should be changed.
This biography makes me more visible, at least on the web. On the other hand, the blog no longer exists, due in part from my concerns about the General Data Protection Regulation (GDPR), which was enforced in 2018. I posted a lot of educational material about C-L Psychiatry on the blog along with pictures and presentations of my trainees. In a way, I did not protect their privacy and I was uncomfortable about that.
Other web pages surfaced during my self-googling. They included my article on delirium, “Psychiatrists Can Help Prevent Delirium,” posted on Psychiatric Times in 2011.
I also found my blog post on physician burnout, “How I left the walking dead for the walking dead meditation,” published on the Gold Foundation web site in 2014.
And there was my other Gold Foundation post about rude doctors, “Are doctors rude? An insider’s view,” posted in 2013.
There are a couple of petitions left over from years ago as well, about the controversial Maintenance of Certification (MOC) and the closure of state mental hospitals in Iowa several years ago.
I also found my review of Dr. Jenny Lind Porter’s book, The Lantern of Diogenes and Other Poems (published 1954).
The book seller’s note to me when Porter’s book was delivered in 2011 read as follows:
“Thanks for your purchase! It’s rare to find a book of this age that when you open the pages, it creaks like it is unread. I guess someone liked the way it looked on their bookshelf! Haha! Enjoy the book and Happy New Year, Rob J.”
An unread author is an invisible author. The first poem in the book is below:
The Lantern of Diogenes
by Jenny Lind Porter
All maturation has a root in quest.
How long thy wick has burned, Diogenes!
I see thy lantern bobbing in unrest
When others sit with babes upon their knees
Unconscious of the twilight or the storm,
Along the streets of Athens, glimmering strange,
Thine eyes upon the one thing keeps thee warm
In all this world of tempest and of change.
Along the pavestones of Florentian town
I see the shadows cower at thy flare,
In Rome and Paris; in an Oxford gown,
Men’s laughter could not shake the anxious care
Which had preserved thy lantern. May it be
That something of thy spirit burns in me!
Dr. Porter’s house in Austin, Texas was demolished a few years ago. There were plans to build a house there reminiscent of the architectural style of her original home and also a remembrance of her published work. I just noticed a satellite image of the property. There is no visible evidence that anything of that nature was ever built. Dr. Porter is, in a sense, invisible although her lantern still burns.
Visibility is a relative term. My advancing age and approaching retirement sometimes lead me to feel like I’m becoming invisible, gradually vanishing from the landscape of consultation-liaison psychiatry and general medicine.
Ralph Ellison’s book Invisible Man is a visible legacy. My legacy is small—yet the flame flickers, visible after all.
Go Retire Psychiatrist 