Go Retire Psychiatrist

Random Connections

Today, I read Dr. George Dawson’s blog post, “How I ended up in a high-risk pancreatic cancer risk screening clinic.” As usual I was impressed with his erudition, scientific literacy, and rigorous objectivity, even as it pertained to a deadly disease which runs in his family genetic history. I couldn’t help admiring his courage.

And, whether this is a random connection or not, this somehow led to my remembering Dr. George Winokur, a giant in the scientific study (including genetics) of psychiatric diseases, especially mood disorders. He died of pancreatic cancer shortly after he was diagnosed with it in the spring of 1996.

Dr. Winokur was chair of the University of Iowa Department of Psychiatry from 1971 to 1990. He remained on faculty, actively involved in research and teaching up until the day of his death in October of 1996.

I was a resident in psychiatry at University of Iowa from 1992-1996 and I have a clear recollection of meeting with Dr. Winokur in his office during my last year, when I was preparing for job interviews. I knew he had been diagnosed with pancreatic cancer.

He had been actively recruiting me to accept a position in the department and did so even as we spoke briefly. I remember noticing that he gripped an electrical conduit on the wall next to his desk so tightly that I wondered if he were in pain.

He was the main reason I stayed in Iowa. He had a great sense of humor. All of us residents loved him. There was even a list of his “commandments” all new residents received when they began their residencies at Iowa.

Winokur’s 10 Commandments

Thou shalt not sleep with any UI Psychiatry Hospital patient unless it be thy spouse.
Thou shalt not accept recompense for patient care in this center outside thy salary.
Thou shalt be on time for conferences and meetings.
Thou shalt act toward the staff attending with courtesy.
Thou shalt write progress notes even if no progress has been made.
Thou shalt be prompt and on time with thy letters, admissions and discharge notes.
Thou shalt not moonlight without permission under threat of excommunication.
Data is thy God. No graven images will be accepted in its place.
Thou shalt speak thy mind.
Thou shalt comport thyself with modesty, not omniscience.

I never got the impression that George Winokur recruited me because I was black, although it was pretty obvious to me that I would be the first black University of Iowa psychiatry department faculty member. He had too much class to make that an issue.

I’ve known a few classy psychiatrists. Maybe the connection is not so random.

Exactly When Were the Good Old Days?

I just saw a short web article about Baby Boomers and their opinion of what’s going on these days and comparing it to the “good old days.”

There were the usual complaints about bad music, lack of teamwork, no effort to maintain social bonds, and the like.

I’m not sure I can identify any such good old days. I can think of good and bad times. I tend to think of them as being a byproduct of good experiences with people you enjoy being with—which don’t always fit with the times.

I grew up in the 1960s during the Civil Rights struggle, and I would be hard-pressed to call it the good old days. I can recall my mother trying her best to straighten out the curls of the hair of my younger brother and me with a lot of hair oil. It was almost painful as she tried to press the evidence of our mixed white and black parentage out of our hair.

I think the perception of what the good old days were might depend on your place in society at the time.

There’s this old Twilight Zone episode about a guy trying to make it in the tough business world and he wasn’t doing too well.

Spoiler Alert: I reveal what happens in the ending, just in case you want to try to find a YouTube.

On the train home from the office, he would dream of a place called Willoughby. It was a place years before his time. It was sunny. People were friendly, enjoyed picnics, went fishing and it was always summertime. He longed for it. His boss was a tyrant and his wife pretty much called him a failure. He got off the train at the Willoughby stop a few times and really enjoyed the good old days feel to the place. But he always got back on the train.

One day, he had that “last straw” moment. His boss was tyrannical; his wife belittled him and called him a loser. He got off the train at Willoughby, determined to stay in the good old days.

OK, this is the spoiler:

Willoughby turns out to be the name of the undertakers who pick him up where he jumped off the train and died.

Anyway, this “train” of thought led to Sena and I reminiscing about the trip to Hawaii we made way back in the day. The flight was long and excruciating. My ears were plugged most of the way there. We were both exhausted, but the tour group we traveled with were raring to go after we got to the hotel in Waikiki. They were mostly 3 decades older than us. I can’t remember if one of them or somebody else at the airport made a disparaging comment about Waikiki, something like: “I don’t know why anybody thinks Waikiki is anything special; what the hell, it’s just like Des Moines!”

While we camped out in our hotel room, the older folks went out to see Don Ho perform. When they got back, they said Don was drunk, they had a few drinks, and we just marveled at their energy.

We developed a friendship with a married couple in the tour group named Leota (Lee for short) and Norman. Lee took exception to Norman having a beer with the rest of us on some outing. I think it was about a health problem he had. He grumbled a little and we toasted the event anyway. Norman, who had been in the military, shed a few tears at the Pearl Harbor monument.

We traded Christmas cards with Lee and Norman until their children sent us a card telling us that Lee had died. Norman died several years later. We still have a photo of Sena with Lee and Norman taken while we were having a great time in Hawaii.

I guess you call those the good old days. Maybe you could even find a reason to call the present times the good old days after a while—if you were as drunk as Don Ho during the whole era.

Happy St. Patrick’s Day!

This is St. Patrick’s Day and, although I didn’t wear green today, Sena got me some Irish beer. It’s Guinness Extra Stout. The back label extols the virtues:

“Intense characterful and bold, Guinness Extra Stout is the pure expression of our brewing legacy. Bittersweet, with subtle hints of hops, dark fruits and caramel, this stout is a testament to great brewing.”

That dark fruit better not be dates or prunes. It’s brewed in Ireland.

This being Friday night, I wonder if John Heim (aka Big Mo) will mention anything about St. Patrick’s Day tonight on the KCCK Big Mo Blues Show, radio station 88.3 in Cedar Rapids or 106.9 in Iowa City.

Maybe he’ll mention May Ree and her hand-battered catfish. It’s better because it’s battered. Maybe the recipe includes a couple of bottles of Guinness Extra Stout, with notes of dark fruits and caramel. Dark fruits which are not dates, I hope. Allowable notes can be sharp or flat, blue, high, or low—but not dates.

Happy St. Patrick’s Day!

Ugly Juggling Hits the Shower

OK, I’ve found out that there’s more than one way to hit the shower pertaining to the juggling trick called “The Shower.”

As usual, my form is ugly because I’m in the early practice phase of trying to learn the shower. But then, even when I think I’ve got a trick down—it’s always ugly.

Anyway, different experts have different instructions for the shower trick. A couple of them tell you to throw the two balls in your dominant hand one right after the other. “Go for it” the guy says, who wrote the Learn to Juggle manual I still use. A YouTuber also tells you to just throw the two balls up there. Another expert doesn’t suggest that—but I can’t do it at all unless I toss two balls up sequentially.

I keep my two hands two close together and too high for the “slap” part of the pattern, which is tossing a ball straight across from my nondominant hand to my dominant hand. I also throw a ball too far out from the pane of glass (which is a pain in the ass!).

As usual, you can see all my mistakes in my ugly juggling on my own YouTube video, which you should not use as an example of anything but the wrong way to learn the shower.

By the way, Sena is making progress learning to juggle!

Catatonia Education Resources

I noticed what is, for me at least, a new educational resource for catatonia. There’s an aricle about it in the March 2023 issue (Vol.51, No. 3) of Clinical Psychiatry News. The resource is available at University of Rochester Medical Center website. They include pdf files and training videos for assessment of catatonia.

There are also links for information about catatonia:

Catatonia Information Center

University College London

The University of Rochester presentation has has demo videos using a standardized patient (a physician, Dr. Joshua Wortzel) and a teacher, Dr. Mark Oldham.

I saw cases of catatonia while I was a consultation-liaison psychiatrist at The University of Iowa Hospitals & Clinics and they often had medical causes. My YouTube video lecture on Catatonia, Neuroleptic Malignant Syndrome, and Serotonin Syndrome is still getting views after 4 years.

Sena Learning How to Juggle!

Big news flash—Sena is learning how to juggle. She just started doing the single and two-ball practice throws on the way to learning how to do the 3-ball cascade, just like I did about 5 months ago.

Just like she heard me dropping balls—now I hear her doing it. It’s a gas! It’s fascinating to watch her gradually improve.

On the other hand, I’m trying to learn how to do another juggling trick called the shower. If you look this up on the web, you’ll find a comical entry that reads “How do you juggle 3 balls in the shower?”

It’s not a trick you do in the shower.

The shower is what some call an intermediate level trick which, I think, historically was how everyone started learning to juggle. Instead of learning the cascade, you started by learning the shower. The way the balls fly, they sort of look like they’re raining. And it’s a lot harder than the cascade.

There’s a half shower trick that I learned pretty quickly. And I can sort of handle the two-ball practice for the shower. I’m stuck when I add the 3^rd ball, sort of how I got stuck learning the behind the back throw. You have to throw two balls up from your dominant hand in perfect arcs just before throwing one ball across from your non-dominant hand to the dominant hand. Catch them all. Right.

You can find YouTube videos of this that make it look easy. But that’s only because the teachers are very well practiced!

Remember Spring Forward All Your Clocks Tonight!

Today is the day to move clocks forward by one hour for Daylight Saving Time. Well, technically, we’re suposed to change the clocks at 2:00 a.m. on March 12, 2023, which is Sunday.

I usually do this in the afternoon of the day before (which would be today), which drives Sena crazy.

However, today Sena changed all the clock times this morning. Payback?

See this website for more information about which states have tried legislating this time change. Iowa is on record with a bill supporting permanent DST, but it won’t go anywhere without federal approval.

Fathers Can Be a Pain in the Ass

I’m going to talk a little bit about fathers. Mothers are important too, but I’m a guy and I can talk about mothers another day. Because it’s a touchy subject, I’m going to begin with a Men in Black (MIB) joke, like I always do when I’m being defensive. There’s this MIB 3 scene in which Agent K and Agent J have this exchange:

Agent K: I used to play a game with my dad, what would you have for your last meal. You could do worse than this (explanation for this: they’re sitting in a restaurant and an eyeball in Agent K’s soup swivels around and stares at him).

Agent J: Oh, okay, I used to play a game with my dad called catch. Except I would throw the ball and it would just hit the wall, cause—he wasn’t there.

Agent K: Don’t bad mouth your old man.

Agent J: I’m not bad mouthing him, I just didn’t really know him.

Agent K: That’s not right.

Agent J: You’re damn right, it’s not right. A little boy needs a father.

On one level, this scene is just another way of showing the father/son, teacher/student, mentor/mentee relationship Agents K and J had with each other. By extension, their interaction says something about what happens in similar real-life relationships—in the shallow, cliché ways that movies always do.

I sometimes think about the relationship I had with learners when I was a teaching consultation-liaison (C-L) psychiatry. Often, I say to myself that I never had a mentor and I was never a mentor.

That’s not true. Although I never had a mentor who was formally assigned to me, there was more than one faculty member in the psychiatry department with whom I had an informal mentor/mentee relationship. And I was an informal mentor to at least a few trainees.

However, I was middle-aged by the time I entered medical school, which probably set the stage for awkward relationships with my fellow students and some teachers, partly because I was either the same age as or older than them.

That doesn’t mean I was wiser than them. It just means that I was conflicted about them. Later, in residency, I learned about transference and countertransference. In fact, I focused on the psychodynamic as well as the medical issues in teaching trainees. In the first C-L manual I wrote (the forerunner to the book I and my co-editor published later), I devoted a large section to psychodynamic factors relevant to doctor-patient relationships.

So, if you’re wondering when I’m going to start bad-mouthing my old man, you can stop wondering. I’m not going there. He wasn’t a hero, like Agent J’s father was (you need to see the movie to get this angle).

My dad was funny. I don’t think I got my own sense of humor from him, but it makes sense why I would have one—and just because “he wasn’t there” doesn’t explain everything. It never does.

Fathers can be a pain in the ass, not just because of dad jokes. Fathers can be a pain in the brain, too. Ask anybody who was a latchkey kid; I was one of those. We really don’t belong to any specific generation.

We also can’t just up and time travel like Agent J and find out about the father we never really knew. Mostly, it’s just bits and pieces, like a matchbook with a name and address from somebody on your paper route. The path it can lead to doesn’t always mean you find out that “Your daddy was a hero,” like a young Agent K tells young James (who becomes Agent J in the future) after he neuralyzes him to shield him from the hard truth about his father.

You’ll have to watch the movie to get that one.

University of Iowa Stanley Museum of Art Wins Prestigious Master Builders of Iowa Award

The University of Iowa Stanley Museum of Art, won the highest Master Builders of Iowa Award. See the Russell Group Inc. website for more details about the award.

It’s a very impressive space and a must-see marvel when you visit Iowa City.

Behind the Mask Policy

Tomorrow I’ll get to see how the new Covid-19 face mask policy works at the University of Iowa Hospital & Clinics. It goes into effect today. I’m going to see the dentist, as I have periodically for years, even during the Covid-19 pandemic. Of course, the idea of masked dental patients is ironic.

The rule change about masks being sort of optional is a little confusing.

It’s sort of optional because it looks like it’s not optional for unvaccinated health care employees. They still have to wear masks.

I wrote about this back in May of 2021, “Unmasked Means Fully Vaccinated?” That was back when bandanas were acceptable as face coverings.

So does being masked mean “not vaccinated?” It’s confusing because if masking is optional for patients and visitors, why are health care workers the exception? I’m not sure how anyone would enforce the policy.

If you can wear a mask just because you want to do that, how does that separate you from the unvaccinated person?

If masks are optional, then why are the entrance and exit policies not changing, including screening of patients, visitors, and staff? I didn’t see the guidance about what to do if anyone says they are symptomatic or unvaccinated and prefers not to wear a mask, other than to offer a mask (which is free!).

If it’s disrespectful to ask a patient or visitor to put on a face mask, why is it not disrespectful to require an unvaccinated health care worker to do so? There is one bullet point in the question-and-answer section about whether you can ask anyone to wear a face mask which says you can’t ask anyone, including “employee, colleague, patient, visitor, etc.” In the same section is the statement: “Whether or not to wear a mask is a personal decision that each person must make for themselves and for their own reasons.” Does that apply to getting a Covid-19 vaccine as well?

That said, I’m a staunch supporter of everyone getting a Covid-19 vaccine, if they don’t have medical or other exemptions. They don’t make you magnetic!

And I don’t think the recent Cochrane Review results on face masks really means they’re useless, which some news stories tend to convey. I think the Cochrane review does what most such reviews do, which is point out the problems with some controlled studies. And the reviews themselves may have unintended biases.

What’s the most important part of all this? Well, maybe the predicted snowstorm coming to Iowa tomorrow will prevent my dentist from getting to the clinic. And if that doesn’t work, maybe I could just exercise my right and privilege to wear my mask as a barrier to any nefarious procedures.