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.
I’ve seen the news warning us about how facial hair can interfere with the N95 respirator mask seal. It’s connected with the concerns about the novel coronavirus which you no doubt have heard unless you live under a rock. The Centers for Disease Control (CDC) reiterated their warning about how certain beard and mustache styles can interfere with the recommended mask for helping protect you from infection.
As a health care worker, I’m required to be fit tested annually for the N95 respirator mask. “Fit” is not an acronym, by the way; it just refers to how well the mask fits. It’s a twenty-minute test in which a technician or nurse uses a special machine to check for how tight the seal is around the mask in order to ensure protection from airborne particles, including viruses.
I passed my fit test.
I saw the graphic yesterday of all the different facial hair styles that pass muster—most of them don’t. I’ve never heard of half of them. Believe it or not, I didn’t know that little tuft of hair under my lower lip is called a “soul patch.” I guess maybe I’m the one who’s been living under a rock.
I’ve read that some experts think that any facial hair is bad and recommend that you have to be clean shaven. I think some places won’t even allow fit testing on anyone who has facial hair.
However, I found a PubMed study published in the latter part of 2018 which showed that you can pass a fit test “even with substantial facial hair in the face seal area;” the abstract is below:
Floyd, E. L., et al. (2018). “Influence of facial hair length, coarseness, and areal density on seal leakage of a tight-fitting half-face respirator.” J Occup Environ Hyg 15(4): 334-340.
BACKGROUND: OSHA regulations state that an employer shall not permit tight-fitting respirators to be worn by employees who have facial hair that comes between the skin and facepiece seal. Studies have shown that facial hair in the face seal zone can increase penetration and decrease the fit factor (FF), although the relationship between the amount and characteristics of facial hair and the increase in penetration is not well quantified. This article examines the influence of facial hair length, areal density, and coarseness on FF for one model of half-face elastomeric negative-pressure air purifying respirator. APPROACH: Quantitative fit tests (QNFT) were performed on 19 subjects with beards initially 0.500-in long and subsequently trimmed to 0.250, 0.125, and 0.063 in, then after a razor shave. Three fit tests were performed at each of the 5 lengths, for 285 total tests. The average diameter and areal density of cheek and chin hair were measured. Penetration was modeled as a function of hair length category, beard areal density, and hair coarseness. RESULTS: FF decreased with beard length, especially beyond 0.125 in. However, passing FF scores were achieved on all tests by all subjects at the smooth shave and 0.063 in conditions, and 98% of tests were passed at 0.125 in; seven subjects passed all tests at all conditions. Chin and cheek areal densities were significantly different and were only weakly correlated. Beard hair diameters were normally distributed across subjects (mean 76 microm, standard deviation 7.4 microm). Beard length and areal density, but not coarseness, were statistically significant predictors of fit using an arcsine transformed penetration model. FF decreased with increasing beard length, especially beyond 0.125 in, although FF with a “stubble” beard did not differ significantly from a smooth shave. FF also decreased with increasing areal beard hair density. CONCLUSION: Beard length and areal density negatively influence FF. However, tight-fitting half-face negative-pressure respirator fit tests can achieve adequate fit factor scores even with substantial facial hair in the face seal area.
I generally have a stubble circle beard. When I don’t use the stubble guard on my trimmer for a while, I supposed my chin whiskers could lead to what some have called the “goatee leak.”
The CDC web site posted a funny article in 2017 on their web site entitled, “To Beard or not to Beard? That’s a good Question!” That facial hair chart is in the article. They also remind you check your mask seal every time you use it, no matter what your facial hair status is.
There’s a pretty funny YouTube video about this issue. The title is “The Bearded Guide to N95 Respirator Fit Testing.” My video is below.
Well, Sena and I played the official inaugural cribbage game on our new Jumbo Crib board from Ontario. That was a belated Valentine Day’s gift for us which Sena is only too happy to remind me about; but that’s OK, I deserve a little ribbing. You can get a sample of that from watching the video.
We have to stretch a bit more to reach across the table and the 8-inch-wide board. That’s good exercise. The 2-inch-tall pegs have a pleasing heft to them.
Making the video for our cribbage games is a big challenge. I think one of the best reasons for doing it is that we learn from our mistakes by watching them. We’re still rookies. It took us all day just to shoot a decent video—although it was fun to play. I’m pretty sure players out there will spot errors. Let us know what they are!
I just happened to come across an old newspaper article about a guy named Frank Lake who was a Grand Champion level player years ago. When the journalist interviewed him, he was around 83 years old—that was in 2005. Frank said that cribbage is “85% luck and 15% smarts.”
We think there has got to be more skill involved than that. Somebody once said that cribbage is a game which takes a few minutes to learn but a lifetime to master. At my rate, it’ll take more years than I have left in my lifetime just to learn.
Each game is different. In a two-hander, each player gets only 6 cards. The non-dealer ends up with only 4 after dropping two into the dealer’s crib. We take about 30 minutes to play a game, which is about half the time we took when we first started playing. I’ve read that you really can’t expect to play at the tournament level unless you can finish a game in 15 minutes. I doubt we’ll ever get there.
The Jumbo is the fourth cribbage board in our small collection. Frank Lake accumulated quite a few cribbage boards in his career, some of them trophies. I think he owned a collection of around twenty of them. One of them was in the shape of the state of Oregon. Hmmm…
Well, as far as this tardy Valentine’s Day gift is concerned, the Geezer is redeemed. The answer to the riddle in the 2/18/2020 post “I’m Late for Valentine’s Day” is a new Jumbo cribbage board (the Jumbo Crib).
This is the gift I forgot to order for our Valentine’s Day, which was a Canadian Hard Maple cribbage board. It arrived today from Ontario. It was shipped only this past Tuesday, so we were pleasantly surprised (almost shocked) that it arrived so quickly. It’s really big compared to our other cribbage boards.
The clues in the post a couple of days included a picture of us in rain gear at Niagara Falls, taken about 5 years ago. The picture of a bed of flowers in the shape of a Maple leaf with a bunch of falling Maple leaves was taken in Canada, just across the border.
Sena keeps telling me that she told me to order the board, but I honestly don’t remember her telling me that.
The board is made by Michaud Toys, a small, family-owned craft shop in Ontario not that far from the Niagara area. They are well-known for making excellent wooden toys, games, and puzzle boxes. They believe in family game night, which for me and Sena is almost every night.
I ordered it on Valentine’s Day, which was just last Friday. It shipped the very next Tuesday and we got it this morning.
It came with a nice storage bag, some metal pegs (2 inches long), a deck of cards, and a set of very accurate rules. It’s 27 ½” long and 8” wide. It’s great fun to play on.
Wow!
It has a handy little cubby on the board which can hold the card deck, pegs, and rule booklet. This is covered by a cap which fits snugly over the hole and is secured by “powerful rare earth magnets.” They work. I can turn the board upside down and shake it—nothing pops out.
Jumbo Crib stuff
The rare earth magnets remind me of the 1970s soul music band, Rare Earth. I went to one of their concerts when I was a teenager and it was so loud that I think I suffered some mild but permanent hearing loss.
Maybe that’s why I didn’t hear Sena when she told me to order the cribbage board. Anyway, we’re celebrating!
Go Retire Psychiatrist 