I sometimes wonder about whether I’m a mover and a shaker or
just shaky. I think it’s the latter. I’ve known plenty of movers and shakers
and they tend to be great planners. On the other hand, I tend to take the path
of least resistance. Often, I don’t consider enough options and just settle for
what’s expedient. That has not always turned out for the best. My wife, Sena,
is more likely to shop around for things which cost the least and reward the
most—although that process can seem very long to me.
Take the time I decided I wanted to try private practice. There
were actually two times and neither worked out in the way I intended. I learned
valuable lessons, one of which was that I was a better teacher than I gave
myself credit for.
I guess if I had thought things through more back when I thought
the grass was greener on the other side of the fence, I might have qualified
for the early retirement benefit from the place I left—twice.
On the other hand, I’ve made what seemed like hasty decisions other times in my life and made out all right. One of them was marrying Sena.
House Hunting Disorder might be my suggestion to add to the
Diagnostic and Statistical Manual (DSM) of Mental Disorders, whenever the
American Psychiatric Association gets around to updating.
Shopping is not one of my favorite things to do. Shopping
for houses (especially a retirement home) is something I would suggest running
away from if you have any choice—which you won’t, trust me. We’re not yet ready
for the Vintage Cooperative, a condo-like setting for seniors. I’m almost ready
to settle for an apartment.
I’m remembering our first “apartment” when we moved to Hawkeye
Drive in Iowa City over 30 years ago. It was University of Iowa housing and my
wife wept openly when she saw it. The moving van sat in the office parking lot
for at least a couple of hours while the truth sunk in. The only other choice
was Hawkeye Court, but that was not the one to which we were sentenced—I mean,
which we, like a lot of other students, signed up for, sight unseen, when we
moved here so I could start medical school. They were painted cinder block
buildings described as resembling “minimum security prisons,” and had been
around since the 1960s. They were all torn down to make way for new student
housing around 5 or 6 years ago.
We were on the 3rd floor so we had to lug our
furniture up to the top. I had problems with my knees then, which, miraculously,
I don’t have now that I’m decades older. Over time, the place developed a
constant buzzing noise from a vibration which I think began in the shared 1st
floor laundry room where all the poltergeists lived. It drove me nuts—from which
I obviously never fully recovered. I couldn’t convince the maintenance man that
the noise even existed. He looked at me sort of wide-eyed and edged away from
me as I placed his hand on the sofa to demonstrate how you could actually feel
the vibration all over the apartment.
The neighborhood was a little scary occasionally. On one
Halloween night, we got a visit from some very tall kids who were not wearing
costumes, smelled of beer, and held out what looked like giant lawn and leaf
bags. They said “Trick or Treat” in pretty deep voices for children. I probably
shouldn’t have asked, “Aren’t you a little old for this?” as I dropped a few
candies into the bags, which I could have stepped into and been completely concealed.
When I closed the door, we could hear the candies shatter against it.
The next apartment we rented had a small blister in the
ceiling which grew quickly over a day or so into a beach ball-sized bulge. It
happened over a weekend and the manager claimed he couldn’t get anybody to fix
it until Monday. We spent some tense moments just watching and waiting for the bleb
to explode all over the living room.
OK, so maybe apartments are out. We’ve lived in a several
houses here since then, which are really markers for my career in medicine as
well as domiciles. Things have changed in the real estate market. Homeowners
Associations (HOAs) are just one of the changes.
HOAs are something I would rather avoid but may not be able
to escape. I could weep openly about them, but it won’t help. The explanation
for them, which comes from developers most of the time, is that the Post Office
doesn’t want to deliver mail to each and every house nowadays. This has led to
the proliferation of mailbox clusters, which have to be maintained at HOA
expense. Sometimes it amounts to scooping snow off the concrete pad on which
the mailbox cluster sits.
HOA fees are a nuisance. They can run from a few dollars to a few hundred dollars a year, which I admit is better than association fees for condos, which can run into the thousands. What the fees cover is sometimes difficult to discern. A lot of developers and builders nowadays erect subdivisions in locations which I suspect would have been avoided in decades past. Some of these areas tend to be called “wetlands,” which are ponds surrounded by tall grasses and which foster the evolution of various life forms that sometimes crawl up on land to feed on small mammals.
Seen any small mammals?
You can sometimes escape the HOA madness by buying older
homes in what are called “established neighborhoods” where the residents raise
chickens, hunt for mastodons, and park RVs in their driveways that are bigger
than their houses. There are unwritten rules which include but are not limited
to animal sacrifice. But at least they don’t have covenants that require you to
have an 8-foot-tall lamp post which must remain on 24/7; a stamped and gaily-painted
driveway (multi-cultural themes only), stone columns quarried in Portugal, and
a bat-infested entry and those bats better be neutered or spayed, vegan, rabies-free,
defanged and declawed, and be multi-lingual.
HOAs require at least 4 officers (President, Treasurer,
Secretary, Executioner), elected as soon as the last nail goes into the last
house on the last empty lot in the subdivision. The President should carry
personal liability insurance against the possibility the neighbors will file a
lawsuit about the conservation areas being infested with non-native vegetation,
such as lichen or cobwebs.
HOAs can’t protect you against builders, which are another hazard which you can’t avoid unless you are capable of building your own house, which you are not because, as you well know, there are only two kinds of people in the world—builders and victims of builders. You know who you are.
Nope
Speaking of building, what’s up with mud rooms being placed
in the layout not where they make the most sense, which is immediately in from
the garage door entry, but in what I think is called the Jack and Jill arrangement?
This puts the mud room next to the laundry room next to the walk-in master
closet which is off the master bathroom, which leads from the master bedroom,
all in a straight line and all separated by the mandatory pocket doors which
must be filthy and get stuck halfway out according to the building codes.
Needless to say, the mud room need not be in close proximity to the garage
entry and is often close enough to the front door that you have to track mud
from there to the mud room—or across the front room to the kitchen, which makes
about as much sense. The obvious conclusion here is that Jack and Jill were sadistic
fiends called up using the Ouija board. At least that’s who the builders will
tell you to blame.
I could go on but I’ve got other stuff to do today, like
shop for houses. I know it’s a sickness and I should get some help—but there’s
no treatment.
We saw a double rainbow while out for a walk during a gentle
rain. I know they’re not rare, they form because light bounces off raindrops,
and all that. I’m not after the science angle here. I’m just hoping this was a
sign of good luck to come. I’m pretty sure I’ve probably seen a double rainbow
before. I just can’t remember when. And I doubt it was as striking as this
beauty was.
Double rainbow!
These days I’m wondering what’s over the rainbow or the double rainbow. Going for a walk the other day helped me put things in perspective—at least for a while.
Out for a walk in the fall
My life is slower when I’m not on service in my role as a general
hospital psychiatric consultant. And I’ll be fully retired in June. I just came
off service earlier this week, when I was going at my usual fireman’s pace. Things
seem to move so much faster nowadays.
I’m on service at 50% time now. That feels a lot different
than the previous two years, when I was at 65% time. When I’m on, I’m going at a
dead run. When I’m off, I just mosey along. It’s a little jarring to go from 0
to 90 and back again every so often—even though it’s less and less often.
I don’t mind telling you, I get a little bored sometimes. It helps to do something different every once in a while. I hadn’t made a pizza from scratch in over a year and a half. I guess it’s not completely from scratch. I’m still better at just sticking a frozen one in the oven.
Ruthie is a good name for a beer. It’s a craft brew made by Exile Brewing Company in Des Moines, Iowa. It was named the official craft beer of the Iowa State Fair this year.
Who needs a tray?
There’s a cute picture of Ruthie on the bottle pouring beer
into a couple of glasses balanced on her bosom. Where else?
It turns out that Ruthie Bisignano was the owner of Ruthie’s
Lounge in Des Moines, open from 1950-1970. She was nationally famous for this
kind of serving style. She was married sixteen times to nine men, by her
account, according to a Des Moines Register clipping from 1988. This was the
year my wife, Sena, and I moved from Des Moines to Iowa City in a U-Haul truck
so I could start medical school.
Exile was established in 2012 and they serve community healthy living awareness as well as beer and food. For example, they started the Ruthie Breast Cancer Campaign in 2018 and for every case of pink-labelled Ruthie beer sold, a dollar was donated to Susan G. Komen Greater Iowa. They have a well-balanced attitude toward health and life—sort of like the well-balanced way Ruthie served beer.
We noticed that one of the menu items was something called
Mexican Rarebit. It reminded me of a
Gomer Pyle episode back in the 1960s. If you’re not a baby boomer, you might
not know anything about this old TV comedy involving the stormy relationship
between a naïve Marine private and his grumpy drill sergeant, Vince Carter. It
ran for 5 seasons and, while it was one of the few programs my mother liked,
Sena hated it mainly because of Gomer’s over-done North Carolina hick accent.
Anyway, one of the episodes was “Gomer the Welsh Rarebit
Fiend.” In it, whenever Gomer or Carter ate what Gomer always sounded like he
called “Welsh Rabbit,” they would sleepwalk and switch personalities. An
article on the web about the episode showed many snapshots from it, one of them
including a sign on which was printed “Psychiatric Unit.”
Of course, that piqued my interest since I’m a retiring psychiatrist. I didn’t remember that part of the episode. I searched the web and discovered that Welsh Rabbit was the original name of the dish, which is a simple dish of mainly melted cheddar cheese on toast. I admit I don’t understand the etymology of the name. Somebody either couldn’t catch rabbit or pronounce it.
However, it’s been associated with causing vivid nightmares, especially if you eat too much of it late at night. Maybe it’s the mustard.
In fact, there was an early 20th century comic strip called “Dreams of a Rarebit Fiend” by Winsor McKay. It was about spectacular dreams caused by eating Welsh Rarebit. The dreams often portrayed Freudian themes including phobias. Some speculated they might have inspired iconic movie creatures like King Kong.
Anyway, Exile’s Mexican Rarebit sandwich involves ground
chuck in a spicy queso, bacon, and corn salsa. I wonder if the recipe calls for
beer, which might be another way to enjoy the Ruthie. The web site doesn’t warn
the diner to avoid eating it just before bedtime.
You can find a lot of different recipes for Welsh Rarebit, limited only by the cook’s imagination.
Sena just returned from the store and among the items was cheddar
cheese and pumpernickel bread.
I made what we’ll call Ruthie Rarebit today—with a heck of a
lot of coaching from Sena. The recipe was pretty traditional:
A stick of butter, about a tablespoon of flour; aged cheddar cheese, about one and a half cups, enough for both of us; a small carton of whipping cream; about a teaspoon of dry mustard, half of a 12 ounce bottle of Ruthie Gold Lager (could as well have used the whole thing); salt and pepper, a little paprika and cayenne pepper.
Toast a couple of big slices of bread (we used pumpernickel) with a little olive oil in a pan. Melt a stick of butter in a saucepan, add about a tablespoon of flour, a bottle of beer or ale, whipping cream, add the cheddar cheese, and keep stirring. Pour it over the toast and add whatever else you want on top.
Ruthie Rarebit
No Welsh Rarebit recipe calls for rabbit—that I’m aware of,
anyhow. I’m not expecting any nightmares tonight. In fact, I think it might be
as helpful for sleep as melatonin.
This is just a post to offset the grumpy one from a couple of days ago. Sena and I took a walk on the Clear Creek Trail and she broke me up with her shenanigans.
Along the way, we found a painted rock in a tree which had
the word “corridor rocks” printed on it.
It looked like something you could google—which I did. It’s a cute story titled “The Corridor Rocks! —Brightening Days One Stone at a Time” by Sara C. Painting rocks, hiding them and giving people like us a fun time discovering them. Sara says it was a way to stop and smell the roses.
It’s one way to remember how happiness works. It leaks…sort of. We put the rock back where we found it. The only clue we’ll give you is that it’s somewhere out there on the Clear Creek Trail. Have fun!
It’s been a long while since my last post. I’ve been busy looking for signs to help guide me in adjusting to this retirement gig. It’s a tough skill set to learn.
I saw this bug on our house the other day. It turned out to
be a Praying Mantis. Don’t quibble about the precious difference between mantids
and mantises—I don’t have the patience for that. Anyway, this one didn’t have
the typical pose, with the long forelegs cocked into a prayerful posture. It
looked more like it was just trying to find its way—kind of like how I feel.
I read a little bit on the web about the Praying Mantis. One
culture says seeing one is good luck and another says it’s bad. I read just
enough to hope there is no such thing as reincarnation. I hope never to come
back as a male Praying Mantis, if you get what I mean. Look it up.
What I really would appreciate is somebody telling me about
what would be the best way to adjust to retirement. Many days go by when I
struggle to shake the notion that I was never really any good at anything other
than being a doctor.
I need a sign. I need many signs, as a matter of fact. Just
to clear my head, I went for a long walk out on the Clear Creek Trail. I
noticed quite a few signs out there. Most of them seemed to have some special
significance. That’s just because I’m preoccupied with getting used to being
retired.
There were signs of September on the trail. Specific signs telling you to do something or not do something else. And there were signs that you generally see every September that tell you autumn is on the way.
It reminded me of that song, “Try to Remember,” which has always struck me as lugubrious.
I just need a sign and I don’t care if the Praying Mantis points it out or not.
Starting this month, I’ve got a 10-month countdown to retirement. I was reminded of that when I got a brochure in the mail for the University of Wisconsin 7th Annual Update and Advances in Psychiatry. It’s scheduled for October 11-12, 2019 at the Monona Terrace, which is the usual location.
I’ve received these announcements in the mail every year for
longer than 7 years. I’ve never had the time to make it to a single of these
meetings. I’ve always been on duty. I’m not sure why they are advertising them
as though they started only 7 years ago.
I can remember getting an announcement in 2009 in which the
title of the update was Nontrivial Neuropsychiatric Nourishment from Noble
Notable Nabobs. How’s that for a sense of humor? There were several like that
prior to 2009 but I never kept the brochures. I haven’t seen any brochures like
that for the last seven years.
I don’t know who came up with the humorous titles. I wonder
if it was Dr. Jefferson. I noticed this year’s brochure had an In-Memoriam notice
about James W. “Jeff” Jefferson, MD, who has been a luminary of psychiatry for
decades. He was also a major presenter at these psychiatry advances meetings.
He was active in psychiatry for over 50 years.
And me? I’m retiring after a much shorter career, by
comparison. I’ve been running all over the hospital as a Consult-Liaison Psychiatrist
during the busiest time in academic medical centers everywhere–July and the
early part of August when senior medical students become full-fledged resident physicians.
Newly-minted doctors tend to request many psychiatric consultations. On average
I’m putting close to 4 miles and 30-odd floors on my step counter (with C-L
psychiatrists, maybe it’s not the years but the miles that count—literally). I’ve
not taken vacation during the past 2 years of my current phased retirement
contract—and don’t plan one for this final year.
That reminds me of time in 2012 when my wife, Sena, and I went
to Madison, Wisconsin on a vacation, the first in a long time. The residents
were wondering when I was going to get away. Madison is a great place to visit
and we lived there briefly when I took a stab at private practice.
We stayed at the Monona
Terrace, which gives a great view of Lake Monona. We loved Olbrich Botanical
Gardens. We rented a couple of bikes at Machinery Row Bicycles and rode all the
way to Olbrich. The rental bikes were a far sight more affordable than a lot of
the ones you could buy. Many were priced at several thousand dollars.
And I found an old copy
of Robbins Pathologic Basis of Disease at Browzers Bookshop on State Street. I
used that book as a medical student. My class used the nearly 7 pound red 3rd edition
containing 1,467 pages. This book is hailed as an outstanding foundational
text, which it is. Dr Stanley Robbins has been eulogized as an exacting editor
who championed writing of the type espoused by Will Strunk in The
Elements of Style.
Not to be picky, but the book contained the phrase
“not excessively rare” in reference to some process or disease which I can’t
recall. I do recall that a majority of our class howled about this verbiage,
which seemed the antithesis of what Strunk tried to teach.
You could see a lot of interesting sights on State Street. During
a previous visit, we saw a guy walking down the middle of the street with a rattlesnake
coiled on his head, wore it like a hat.
We had a lot of fun in Madison. It’s that kind of relaxed,
good time that I want to retire to. Ten months to go.
We’re pretty dedicated to maintaining everything about our
property, including deck maintenance. Check that; actually, my wife is
dedicated. I’m usually hard to find when it comes to chores like that. When
it’s time for deck cleaning and sealing, there is always some emergency I need
to address on the other side of town or I’ve been temporarily abducted by
aliens.
Sena is usually not one for moaning and groaning about these
jobs, but painting the deck rail spindles is an exception—each and every
spindle, separately and painstakingly swabbed with a brush so that every tiny
spot is covered with sealant.
The right kind of sealant is critical. She usually likes water-based
sealant, but the local hardware store salesman managed to sell her an oil-based
product that was on sale. There’s debate about the relative merits of
water-based vs oil-based sealants.
In general, the water-based products are a lot easier to
work with and provide excellent deck protection. Oil-based sealants have been
around a lot longer, penetrate better, and naturally repel water. Most of them
nowadays have a low risk rating as volatile organic compounds (VOC), meaning
they are environmentally safe. On the other hand, Sena is finding it takes more
than one coat of the oil-based product to get adequate coverage, and she has to
use a brush instead of a pump pressure sprayer. It takes longer to finish the
job—which elicits more moaning and groaning.
We’re not 100% sold on the assurance by experts that either one puts down a finish that will last for several years. We live in Iowa and shovel the deck several times a season, so moaning and groaning about this could happen pretty much every two or three years.
Just for the sake of full transparency about my role in this job—I was banned last year for reasons which would normally remain opaque but who cares?
That cleaning and sealing chore last year was a major challenge. I somehow had to figure out how to reach the yard side of the spindles to cover them with sealant. The trouble was that I was not tall enough to reach them. I think it is to my credit and possibly my eternal fame that I immediately came up with an ingenious solution—a boom lift truck. I have some simple instructions to pass on to those who learn certain skills quickly and don’t mind spending a little time in a state penitentiary.
Boom lift truck
Now, we didn’t own one but it just so happened that across the street there was a lot of construction going on in a new subdivision development. The average boom lift truck with a cage or bucket would have made a pretty big dent in our bank account.
You should pick a weekend day to successfully pull this
off—I mean execute this procedure. Usually the construction crews are
short-handed and they’re too busy smoking cigarettes to pay much attention to
what’s going on around them.
Pick a two-story house under construction, which is more
likely to need a boom lift truck for applying various exterior features like
windows, cedar shakes, shingles and escape hatches. It’s likely to be left
running with the key in the ignition. There might be a couple of construction
guys hanging around, which you can get rid of by shouting “Hey look, there goes
Elvis!”
This always works—pretty much. While they raced off,
fumbling with particle board scraps which they could possibly get an autograph
scribbled on using lumber crayon, I climbed into the nearest boom lift truck.
There’s usually a button to start it. The one I found was
already running. Reverse gear was difficult to find; it was just as easy to hit
the gas and dislodge the portico cover on the way back to the street. By this
time, a couple of construction workers and a rottweiler had spotted me and were
racing back across the lot, yelling and barking.
This was not a problem. I managed to get the rig up on two
wheels and whipped around. I contributed to their cardio workout as they
sprinted back the way they came. I finally caught all of the pursuers including
the dog in the basket. It didn’t take me long to figure out where to dump them.
There were plenty of basement holes dug. They were making quite a bit of progress
in that subdivision!
I made it back home in time for lunch. I had to eat fast
because I could hear sirens up the street. I could get only a few rail spindles
covered before I discovered that I might have to quick like find a hideout—I mean
alternative living quarters.
Anyway, you’ll have to do some calculations to figure out how much progress you can make with this method. I’ve refined it in several ways and I plan to post an update on these instruction when I’m out on parole—I mean back from vacation.
See you soon!
In any case, I think Sena is doing a great job. She’s been a tireless gardener, hospital volunteer, and the best wife a guy could ask for.
I updated my suicide risk assessment presentation today in
light of new data on suicide risk assessment stratification. It turns out that
using such tools might not be supported by the research evidence. That’s not
going to stop the use of such tools, which include the Columbia–Suicide
Severity Rating Scale, which is in wide use.
I found criticism of these scales in a recently published
article in Clinical Psychiatry News, published June 21, 2019, “Why we need
another article on suicide contracts,” by Nicholas Badre, MD and Sanjay S. Rao,
MD.
For many years now, psychiatrists and other health care professionals have learned that trying to use no-suicide or no-self harm contracts are controversial and don’t prevent suicide. Badre and Rao sound like they’re easing away from that contention although they still say that a thorough clinical suicide risk assessment ought to be done.
Until I saw this article, I was not aware of a recent review
of 70 studies showed that: “no individual predictive instrument or pooled
subgroups of instruments were able to classify patients as being at high risk
of suicidal behavior with a level of accuracy suitable to be used to allocate
treatment.”
Carter, G., et al. (2017). “Predicting suicidal
behaviours using clinical instruments: systematic review and meta-analysis of
positive predictive values for risk scales.” Br J Psychiatry 210(6):
387-395.
This was even more interesting because we recently changed our
practice regarding suicide risk assessments on the psychiatry consultation service
based on relatively new recommendations from the Joint Commission on
Accreditation of Hospital Organizations (JCAHO). The Joint Commission favors
the risk assessment tools.
Of course I’m not going to second-guess the Joint Commission
but after 27 years (counting residency) of struggling to assess suicide risk, I’ve
learned that it can hardly be reduced to any single rating instrument.
I have often said to patients that I don’t use no-suicide
contracts because they’re too much like promises—and promises are broken every
day. That segues into what I prefer which is to work with the patients on
developing a safety plan, which I compare to no-suicide contracts by saying “a
plan is better than a promise any time.”
Working on the safety plan with patients gives me another way
of assessing the strength of my alliance with them and a way to improve it as
well as a method for evaluating their ability to formulate a workable way to
stay safe that emphasizes their individuality.
On the other hand, the safety plan is no guarantee of safety,
any more than the no-suicide contract.
But often enough I’ve gotten the sense that some patients
and I have even had a little fun working on suicide safety plans—ironic as that
sounds. I find how important pets are, hear little anecdotes about a favorite hobby
or goal, aspirations, hopes, and memories of better times when they coped
really well.
Listening for understanding to someone who is contemplating suicide or who has attempted suicide is never easy. It’s the hardest thing I do. I can’t say that I’ll miss it when I retire. I have great faith in the next generation of doctors.
We saw this rabbit in our front yard
today, stretched out on the grass under our crabapple tree. It’s 117 degrees
this afternoon with the heat index and we won’t get out from under the Excessive
Heat Warning until later this evening. Thank goodness for air conditioning.
Rabbits don’t have air conditioning and can’t escape the heat.
Sena stands the heat better than I do; she waters the lawn and garden, keeping it beautiful. On the other hand, I felt body-slammed just walking out to get the mail.
Out in Sena’s garden
The old saying goes, “If you can’t
stand the heat, get out of the kitchen.” It means you if you can’t take the
pressure of a situation, then you should move and let somebody else take over.
It was popularized by President Harry S. Truman, who said the originator of the
proverb was Judge Buck Purcell of the Jackson County, Missouri Court—whoever he
was.
Anyway, I’m on call this weekend
and got to talking with a colleague who is thinking about retirement. We go
back a long way in our education and careers. He asked me about what phased
retirement is like. I told him I thought if I’d tried to retire outright, I
probably would have just come back to work.
That’s a twist on standing the heat. As a psychiatric consultant, I’m like a fireman (get it?) in the general hospital, putting out fires, so to speak, all over the hospital. Most often the problem still tends to be delirium, an acute change in mental status that should be considered a medical emergency rather than a psychiatric problem per se. It’s just one of many crises that I encounter every day. Over 23 years (not counting residency), I learned how to stand the heat in that kitchen. When I retire, somebody else will have to get in there and cook. Speaking of cooking—I still can’t.
I guess I’m mixing my metaphors
(fireman and kitchens, etc.). So what? I’m a retiring geezer and I guess I’ve
earned the right to mix my metaphors as much as I want.
But in my first year of the 3-year
phased retirement contract, I felt a different kind of heat–the heat of trying
to find something to do with my unstructured time. It was a struggle for a guy
who’s accustomed to being in almost constant motion, climbing up and down 20-30
floors (I hate waiting for elevators) and covering 2-3 miles a day.
The only trouble is—I can’t get out of the kitchen of retirement. I’m getting up there in age and even though most of the time, I seem to leave some of the trainees huffing and puffing getting up the stairs, I know they’ll replace me someday. But I can’t find a replacement to do my retirement time for me.
I have 11 months to go before I
retire. I can feel the heat.
Go Retire Psychiatrist 