Martin Luther King Jr – Page 2 – Go Retire Psychiatrist

Dr. Feranmi Okanlami MLK Distinguished Lecture

Today, Dr. Feranmi Okanlami, MD, MS, director of student accessibility and accommodation services at the University of Michigan, delivered the Martin Luther King Jr. Distinguished Lecture: “Disabusing Disabilities.” It was sponsored by the University of Iowa.

I attended Dr. Okanlami’s lecture by Zoom. I noticed he was wearing a handsomely carved wooden bow tie, which I don’t have an image for, but you can order them on Amazon, if you’re interested. I’m not the only attendee who noticed it. I used to wear cloth bow ties when I was a much younger man. I gave up wearing any cloth ties shortly after the Covid-19 pandemic began because, as everyone knows, fabric neckties of any kind generally almost never get laundered and carry all kinds of germs. The wooden bow tie is easily wiped down with sanitizers.

But this post is not about wooden bow ties. It’s about what Dr. Okanlami called “ableism” which naturally brings to mind other terms like “racism.” He showed a few images on his slides which showed another point he expanded on, which is the difference between equality and equity. The quick way for me to explain this is to quote the Milken Institute School of Public Health definition:

“Equality means each individual or group of people is given the same resources or opportunities. Equity recognizes that each person has different circumstances and allocates the exact resources and opportunities needed to reach an equal outcome.” — MPH@GW, the George Washington University online Master of Public Health program.

Dr. Okanlami impressed me in many ways, but one of them is his ability to give unrehearsed presentations. He hates to “give talks” as he put it, but likes to talk.

I should explain the reason for this post’s featured image, which might seem puzzling. It’s a photo of the curb ramp connected to the sidewalk outside our home. The city requires homeowners to clear the snow from curb ramps, which, ironically, the city plows plug with snow after every snowstorm. These used to be called “handicap ramps.” I suspect Dr. Okanlami would object to the use of this label and in general it’s probably insulting, but that is what they were called for years. They are an accommodation for those who use wheelchairs.

The word accommodation can have a negative connotation, which Dr. Okanlami clarified. Many believe accommodations give an “unfair” advantage to some people. Actually, they provide opportunities for those with a different set of abilities or altered abilities to participate in society in ways that allow them to contribute to society, and even change it—sometimes in major ways.

Our curb ramp is interesting. The short length of sidewalk beyond it leads to a pile of construction rubble because there is no sidewalk extending beyond our property line on that side. I call it the sidewalk to nowhere, which is now a misnomer. There is a new subdivision under development leading north of our neighborhood. There are houses being built and many have moved in. But for now, you have to walk in the street, which is often muddy and blocked. It’s difficult to walk through it because of heavy equipment and trucks parked along the street. But that doesn’t stop people from walking there. I have never seen anyone in a wheelchair attempt to use the curb ramp. But many people use it who don’t have a visible disability. But it’s there if someone needs it, and we keep it clear of snow on principle.

Dr. Okanlami mentioned those with invisible disabilities. There was not enough time to discuss this in detail, but they include those with mental health challenges. As a consulting psychiatrist working in the general hospital, I saw many of them. They deserve a seat at the table, too.

And I remember one of my medical school classmates who did need to use a wheelchair. There was a special ramp made for him that allowed him to participate in gross anatomy class. Dr. Lance Goetz, MD, graduated with our class and has been a practicing physiatrist in Richmond, Virginia for the last 21 years.

Although Dr. Okanlami’s lecture was recorded today and will, I hope, soon be available for public view, I’m including a YouTube recording of a presentation he gave in 2018 which has the same title and very similar content as the talk he delivered today.

I think his talk evolves every time he gives it. The environment in 2018 was very different than it is now because there was no pandemic and there was a live audience which interacts in a very different way than Zoom allows. That said, the slides were essentially the same today on equity and equality, as were his essential points. He shared a lot about himself in 2018, maybe a little less today mainly because of time constraints and the difficulties inherent to virtual lectures. But he has a great sense of humor.

And he does wear very handsomely carved wooden bow ties.

MLK Human Rights Week 2022: Transforming Ourselves and Others

Sena and I thought today’s Zoom presentation “Racial Perspectives on the Institution of Medicine” by Director and Chair of Emergency Medicine Jenice Baker, MD, from Chestnut Hill Hospital in Philadelphia was fascinating. It was an early feature of Martin Luther King Jr. Celebration of Human Rights week. This presentation stimulated a long discussion between us. The theme of this year’s MLK week is “Whatever Affects One Directly, Affects All Indirectly.”

Dr. Baker cautioned that some of the content of her talk would make us feel uncomfortable about the issue of racism in the social realm of our society extending to the medical realm as well. Sena and I were a little surprised about some of the historical facts, such as that white patients always had to be treated first before black people in emergency rooms, regardless of the severity and urgency of the trauma.

This led me to look up the term “implicit bias.” It doesn’t always denote racism per se. It does mean that we’re all prone to making broad generalizations. This accentuates the conflict between political parties, races, and other groups. People on both sides of the color line can overgeneralize, leading to stereotyping.

I told the following anecdote in a blog post from last year’s MLK Human Rights Week:

When I was a first-year resident on rotation in the inpatient psychiatric wards, one of the patients assigned to me roared at me “I don’t want no nigger doctor!” more than once. I discussed the issue with my supervisor. It was a difficult conversation. It was a long time ago and I recall mostly the sense that we both felt awkward. I asked that the patient, who clearly didn’t want anything to do with me, be transferred to the care of another resident. I don’t recall whether he offered to talk with the patient and he deferred on asking another trainee to take over the patient’s care. My recollection is dim about how I handled it. I suspect that’s because it was emotionally painful. Although I had to see him prior to rounds every day, I think I excused myself as soon as he spat the word “nigger” in my face—which was practically every day. I told him I didn’t’ have to tolerate that.

The flip side of this is a conversation I overheard in the distant past between my father (a black man) and his friend (also black, who I’ll call Mark). My father took Mark in, who had just been released from jail and was homeless. He was wearing poorly fitting clothes he probably found because he was penniless and jobless. While he paced the living room floor, he cursed and said angrily, “Man, I will never let this white man do this to me again.” My father just snorted in a way that made me think he didn’t believe that Mark was in his predicament because of any white man—it was probably Mark’s own bad decisions that led to his problems.

As in past years when Sena and I are intellectually stimulated by MLK Celebration of Human Rights week speeches, our discussions get long and spirited and tend to range widely over the spectrum and durability of human weakness, human evil, and the seemingly accidental nature of human wisdom and human kindness.

We talked at length about James Alan McPherson, long time Iowa City resident and nationally renowned writer, the first African American to win the Pulitzer Prize for short fiction, and acting director of the Iowa City Writers Workshop. He died in in the summer of 2016. An Iowa City neighborhood park was recently renamed James Alan McPherson Park in his honor.

But judging from news stories, this didn’t happen until members of the Iowa Freedom Riders suggested that a park be named “Black Lives Matter Park” in the summer of 2020. In response, more than a dozen people recommended that Creekside Park be renamed in McPherson’s honor instead.

Was the suggestion of renaming the park after McPherson simply a maneuver to avoid naming a park after BLM—and possibly to avoid extremist consequences? Why did it take Iowa City so long to honor him after he died? It is puzzling given that his peers called him the heart and soul of the Iowa Writers Workshop and given that McPherson himself called Iowa a place where he felt welcome. He was even in psychotherapy delivered by a white psychiatrist, Dr. Dorothy “Jean” Arnold, the first female psychiatrist to open a private practice in the state of Iowa in 1957. They were both from the racially polarized South. I wonder how they ever connected.

Why should this matter so much to us? Just like Dr. Baker’s presentation, it’s a very uncomfortable discussion. Sena is very good at doing what MLK suggested in his Letter from a Birmingham Jail, where the quote “Whatever Affects One Directly, Affects All Indirectly” comes from—creating “constructive nonviolent tension.” King always advised against violence or anything other than nonviolent methods of protest, saying that what we need is to create a type of constructive nonviolent tension, which he proved can be more effective than violent confrontation.

Some extremists say that King’s nonviolent approach is no longer relevant for our times, but I doubt violence is the answer. Somehow all of us need to learn how to not just tolerate an atmosphere charged with constructive nonviolent tension—but to somehow transform ourselves directly and thereby transform others indirectly into peaceful agents of change.

Martin Luther King Jr. Celebration of Human Rights Week 2022

The 2022 Martin Luther King Jr. Celebration of Human Rights Week gets kicked off on January 12, 2022 with Chair of Emergency Medicine Jenice Baker, MD, from Chestnut Hill Hospital in Philadelphia giving a lecture via Zoom, “Racial Perspectives on the Institution of Medicine.”

And on Wednesday January 19, 2022, Dr. Feranmi Okanlami, MD, MS, director of student accessibility and accommodation services at the University of Michigan, will deliver the Martin Luther King Jr. Distinguished Lecture: “Disabusing Disabilities.” You can register on line for this lecture and see the following link for a full list of events which will be updated.

Silence Is Not Always Golden

I don’t know where the saying “silence is golden” came from but I suspect silence is sometimes not golden. I notice that The University of Iowa quote from Martin Luther King, Jr. for MLK Human Rights Week is “We will remember not the words of our enemies, but the silence of our friends.” Although I could not find the exact words, that doesn’t mean it’s not written in one of his books or letters. I found a similar statement in one of his speeches which I think captures the sense of it:

In Dr. King’s, Address at the Fourth Annual Institute on Nonviolence and Social Change at Bethel Baptist Church, in section VI: A Plea to the White Community: “If you fail to act now, history will have to record that the greatest tragedy of this period of social transition was not the strident clamor of the bad people, but the appalling silence of the good people.”

Pertinent here is a presentation given by University of Iowa Health Care psychologist and professor of psychiatry Dr. David Moser, PhD and medical student Destinee Gwee, entitled “Responding to Mistreatment.” One of the first bits of advice is to speak up if you see racism happening.

In that situation, the silence was deafening and certainly not golden. This kind of insulting scenario was not common, but it was not the only one.

I wasn’t exactly shocked. I was born and raised in Iowa. While Iowa historically has been more tolerant of African Americans, I grew up hearing the word “nigger” and was called that enough times to become pretty sensitive.

I had plenty of positive experiences over the course of my medical school and residency years. But they never erased the memory of that incident.

That’s why the approaches recommended by Dr. Moser and Destinee are so vital today.

“Bending the Arc Toward Equity and Social Justice”: MLK Lecture by Dr. Joan Y. Reede, MD, MPH, MS, MBA

Today, Dr. Joan Y. Reede, MD, MPH, MS, MBA delivered the Martin Luther King, Jr Distinguished Lecture. It led to a long discussion between me and Sena, which is a good sign that the presentation was superb.

I noticed that the title of the lecture sounded familiar. Dr. King said something very much like it in his speech, “Remaining Awake Through a Great Revolution”:

“We shall overcome because the arc of the moral universe is long, but it bends toward justice.”

Dr. King adapted the phrase from abolitionist Theodore Parker who thought the abolition of slavery would be successful and said:

“I do not pretend to understand the moral universe; the arc is a long one, my eye reaches but little ways; I cannot calculate the curve and complete the figure by the experience of sight; I can divine it by conscience. And from what I see I am sure it bends towards justice.”

Now that is according to a Wikipedia article, which was just edited today. Call it coincidental.

Sena mentioned to a couple of persons yesterday while out picking up groceries that we were planning to observe the MLK holiday by listening to the MLK Distinguished Lecture. Both of them were store employees. One of them was a white woman who said simply that she had to work, evidently meaning she would not be participating. The other was a young Black man who looked like he was in his twenties. He gave the same answer, simply saying that he had to work. Neither gave any indication that they even knew who Dr. King was.

We both think that was astonishing. It’s incredible to think that knowledge about Dr. Martin Luther King, Jr. would belong mainly to those in my generation and older. It’s not like cribbage, a favorite two hander card game Sena and I enjoy, but which I’ve often seen described as being a game popular mainly among older people.

It was with this thought in mind as we listened to Dr. Reede’s presentation. The history of America is full of “firsts” for minorities: first ever to attend a white college, first ever to become a physician, and so on. But from there it seems extremely difficult to trace a clear path to full access to positions of authority, influence, and power in this country for anyone who is different from the mainstream. This is not news to any of us.

But Sena and I wondered at the apparent difficulty in recruiting and retaining leaders from the wider pool of humanity: people of different races, women, the LGBTQ community. There were no pat answers. Dr. Reede wondered aloud about how and where will we get more leaders like Dr. King? Will it be through crafting more well-conceived outreach programs? I wonder about that approach if the twenty-something young Black man Sena spoke with did not even seem aware of who MLK was. And if people like him are too busy working in order to just survive, how will they ever get the time to learn another way to live? And how will they learn how to lead? We’ll need more beacons like Dr. Reede—and maybe you and me.

I remember singing in Sunday School, “This Little Light of Mine.” Leaders like Dr. Reede are beacons who show us how to carry our lights. In fact, the title of an article describing something just like that is “This Little Light.” The subtitle is “2018 Dean’s Community Service Awards celebrate service to others.” Dr. Reede herself presented the awards to the recipients, who she described as people who “don’t only talk the talk, but walk the walk.” Her closing remarks at that ceremony was a reminder:

“Service comes in many forms, and one’s contributions need not be heroic or hugely financial in scope; it is about giving of your time, your talents, making a difference, and having an impact.”

MLK Human Rights Week Distinguished Lecture Jan 20, 2021: Dr. Joan Y. Reede, MD, MPH, MS, MBA

Dr. Joan Y. Reede, MD, MPH, MS, MBA is scheduled to deliver the Human Rights Week 2021: Distinguished Lecture on January 20, 2021 from noon to 1:00 PM. This is by Zoom because of the pandemic, a commonplace method nowadays. I’m registered for it so I hope Sena and I can zoom in.

Dr. Reede has a list of accomplishments as long as my arm. She’s the dean for diversity and community partnership and professor of medicine at Harvard Medical School. She also holds appointments as professor in the Department of Social and Behavioral Sciences at the Harvard T.H. Chan School of Public Health, and she is an assistant in health policy at Massachusetts General Hospital. The title of her lecture is “Bending the Arc Toward Equity and Social Justice: Addressing the Imperative.”

Dr. Reede’s life journey has been fascinating and she has had a lot of thought-provoking and inspiring things to say about how she got to where she is in her career and how to help others succeed. In her 2016 interview “Strictly Business—Women of Influence” she answered a question about how American could improve its standing in providing excellent health care to all people, she broadened the concept of what providing medical care means. In fact, health care doesn’t just happen in a clinician’s office. Many factors influence a person’s health and how they take care of themselves, including whether they are impoverished. Poverty inhibits access to food, education, and jobs and there can be unrealistic expectations about what disadvantaged people can do on their own about this lack. She said: “It’s having expectations of people to ‘pull yourself up by your bootstraps’ but not giving anybody any boots.”

That rang a bell and I found a speech by Dr. Martin Luther King, Jr in which he said almost exactly the same thing in the broader context of addressing racial injustice:

“Now there is another myth that still gets around: it is a kind of over reliance on the bootstrap philosophy. There are those who still feel that if the Negro is to rise out of poverty, if the negro is to rise out of the slum conditions, if he is to rise out of discrimination and segregation, he must do it all by himself. And so, they say the Negro must lift himself by his own bootstraps.”

And again, King said: “It’s all right to tell a man to lift himself by his own bootstraps, but it is a cruel jest to say to a bootless man that he ought to lift himself by his own bootstraps.”

Both quotes are from “Remaining Awake Through a Great Revolution” published in A Knock at Midnight: Inspiration from the Great Sermons of Reverend Martin Luther King, Jr.

The web says the bootstrapping idiom probably had its beginnings around the mid to late-19^th century, in which it was clearly meant to express an absurdity. The image of someone trying to lift himself by the straps on the back of his boots shows it’s laughably impossible. The idea that you could lift yourself up without any outside help was mocked. However, over decades it evolved so that it somehow came to mean that you could succeed without any outside help—although with difficulty.

Bootstrapping

I think one way The University of Iowa College of Medicine tried to address the bootstrapping idea was to create the medical school summer enrichment program for minority students many years ago. I recall being one of a handful of minority students entering the summer enrichment program in 1988 at the University of Iowa. The summer enrichment opportunity was intended to be one way to assist minority students excel in the basic sciences courses that would be coming up in the upcoming regular academic year.

I have always appreciated that boost but not all of my peers saw it that way back then. Nowadays there is a well-established Office of Diversity, Equity, and Inclusion.

Looking forward to Dr. Reede’s presentation tomorrow!

Loving-Kindness Meditation in the Real World

Today is the first day of Martin Luther King, Jr. Human Rights Week and I’m giving a shout-out for acts of kindness as well as the Loving-Kindness meditation. A neighbor with a snowblower helped clear our driveway a couple of weeks ago. A couple of days ago he did the same for his next-door neighbor. I’m going to go out on a limb and speculate the city snowplow driver was kind enough to avoid plugging the driveways on our street. No kidding, we watched the snowplow use what was obviously a different plowing technique which left our driveways relatively clear of snow.

The Loving-Kindness meditation is a mindfulness practice that Dr. King would probably have supported. It’s a way to send love to yourself and others, including those with whom you might be in conflict—even your enemies. King might say, “Now is the time” for something like that.

I’m reestablishing my mindfulness and exercise practice after a several month lapse. I first took the Mindfulness-Based Stress Reduction (MBSR) course several years ago through The University of Iowa Hospitals and Clinics. It made a difference in how I approached problem-solving and conflict. I was on autopilot most of the time and wrote a blog post about my experience before and after my mindfulness training experience, “How I left the walking dead for the walking dead meditation.”

Part of that program included instruction on the Loving-Kindness meditation. I’m still a beginner at mindfulness, although my approach to life is still ironically more like the expert’s in Shunryu Suzuki’s quote:

“In the beginner’s mind, there are many possibilities, in the expert’s mind there are few.”–Shunryu Suzuki

I need to keep working on being more open to different ideas, interpretations, and ways of getting things done—approaching challenges with a beginner’s mind.

One recent challenge is hanging pictures. Sena and I hung a picture yesterday. I wanted to measure everything and she wanted to estimate. She had misgivings about my measurements but went along with it. After the picture was hung, even I had to admit it was not in the right spot. Funny thing, after a short while, she admitted that the misplacement was not that far off and that she was getting used to it. If you’ve ever hung pictures, you know I’m leaving out a lot of the back-and-forth negotiation about how we finally arrived at that middle ground. It involved loving kindness on both sides.

We’ll see how the next picture hanging goes.

Now is the Time to Do Something

I know I promised to observe National Nothing Day, but I learned something new today about Dr. Martin Luther King, Jr, and I figured I’d write a little something. Actually, I was not idle. So much for Nothing Day.

Dr. King liked jazz music, especially bebop. Dr. King said this about jazz: “When life offers no order and meaning, the musician creates an order and meaning from the sounds of the earth which flow through his instrument.”

Sena and I like smooth jazz, which doesn’t highlight improvisation as much as bebop—and that’s about all I know about jazz. I’m really more of a blues, rock and roll, and classical fan. I’m not really much of an improviser, I guess. I rely on recipes and frozen pizzas when I fix meals, which thank goodness is infrequent. Sena doesn’t use recipes and changes things up a lot, not just in the kitchen.

I found out that King even alluded to a jazz musician’s composition in his “I Have a Dream” speech at the Lincoln Memorial in Washington, D.C. in 1965. A friend of King shared that the civil rights leader had used the refrain “Now is the time” from Charlie Parker’s 1945 classic tune.

“Now is the time to make real the promises of democracy. Now is the time to rise from the dark and desolate valley of segregation to the sunlit path of racial justice. Now is the time to life our nation from the quick sands of racial injustice to the solid rock of brotherhood. Now is the time to make justice a reality for all of God’s children.”

I’m just guessing, but I think Parker probably improvised his music a lot. On the other hand, as I’ve grown older, I’ve pretty much scripted what I do in my life. When I was much younger, I improvised more. It’s a common path. There’s nothing especially wrong with regularity and predictability—bowel movements come to mind as one example. I’m a geezer after all.

But sometimes my relationships with others might have been helped if I had been a little more spontaneous, a little nimbler and more flexible with my attitude and responses. I guess that goes for all of us.

Now is the time to do something about that. It’s not too late.

The Most Constructive Force in the Universe

As I struggle to remember to write and say the year “2021” I noticed the University of Iowa Health Care quotation selection by Dr. Martin Luther King, Jr this month pertinent to the upcoming MLK Human Rights Week, starting January 18, 2021:

“Love is the only force capable of transforming an enemy into a friend.”

It’s funny because, as usual, the way my sense of humor works, I also recall quotes from the movie Men in Black 3. Agent K asks Agent J, “Do you know the most destructive force in the universe?” Agent J answers with a wisecrack, “Sugar?” Agent K replies, “Regret.”

Then what is the most constructive force in the universe? Dr. King thought it was love.

Since my retirement in July of last year, I’ve had a lot of time on my hands. It leaves me with too much time to reflect on my current life as a retired psychiatrist—and my past life as a consulting psychiatrist. As my thin veneer of authority, responsibility, and other lies I tell myself drop away, I become more aware of my flaws in both roles. I find deep holes in my identity as a person as my identity as a doctor fades. Just being a person who has a lot to learn about life despite being a psychiatrist—is hard. I have regrets and remorse. My sense of humor sometimes helps me get by.

Dr. Martin Luther King, Jr and me in Vegas.

Regret can indeed be a destructive force. Though it’s similar to regret and painful, remorse could help me be a better person. It becomes more and more important that I find something constructive, both to do and to be.

Maybe love is the most constructive force in the universe. Because quotes are sometimes misquoted and inaccurately attributed, I googled the quote “Love is the only force capable of transforming an enemy into a friend.” I found the sermon from which I think the quote is derived on a Stanford University web site. It’s called the “Loving Your Enemies” sermon and it’s published in the book, A knock at midnight: inspiration from the great sermons of Reverend Martin Luther King, Jr.

There are YouTube and Vimeo videos of an audio recording of the sermon as well. The internet being what it is, you apply hyperlinks to these and other works at the risk of the links being broken at some point, which I have found and which might be due to uncertainty about whether the text of the sermon is in the public domain.

As an aside, I’m reminded of a quote variously attributed to Charles Schulz, creator of the Peanuts comic strip, Fyodor Dostoyevsky, and others: “I love mankind; it’s people I can’t stand.” This probably betrays my skepticism about the ability to love your enemies.

You know, it’s funny. I didn’t find the Dr. King quote, word for word, the first couple of times I scanned it in the Stanford University transcript. What I did was the thing most junior medical students do when they discover the vast load of information they have to memorize and digest. I scanned the sermon for the key words and didn’t see them.

Nor did I find it on the third read, in which I finally abandoned the scanning method and actually read the sermon. But I got the point.

If the Stanford version and my reading are accurate, what I found were probably the main ideas I needed to make sense of the sermon. King said that I have to look deep within myself first before attempting to understand anyone else, much less to love my enemies. I also would do well to look for the good in people who I judge are bad. Moreover, I gain nothing by trying to defeat my enemies. He even mentions the theories of psychologists and psychiatrists to support his profound conclusions. As I read them, I was acutely reminded of my shortcomings as a psychiatrist. You would think a psychiatrist would know how to analyze himself (and psychoanalysts do undergo analysis in training). I am not a psychoanalyst. But I am capable of reflection.

The exact quote might not be discoverable (at least to me) in King’s sermon. Nevertheless, the transformative and redemptive power of love is clearly expressed. The quote is distilled from the text of the sermon. That doesn’t mean that there might not be a different version of the sermon which could have contained each and every word. According to one writer, that may be the case. Perhaps it’s in the book, A Knock at Midnight: Inspiration from the Great Sermons of Martin Luther King, Jr.

What is more important for me at this time of my life is to accept that my search for the most constructive force in the universe will proceed in baby steps.

What I need to do is reflect on my own shortcomings and find ways to improve while avoiding making excuses. Stephen Covey said that we often blame our parents or our grandparents for our flaws. This was part of his three theories of determinism to explain man’s nature. Genetic determinism says I inherited my flaws from my grandparents (whom I never met), which implied my mistakes were encoded in my DNA. Psychic determinism supposedly explains what I got from my parents because of their mistakes in rearing me. Hmmm, I was exposed to fruitcake at Christmas. Environmental determinism implicates says that other people in my workplace, my school, my neighborhood or my country (politicians perhaps?) caused my flaws.

Covey disputed these ideas by the example of Viktor Frankl’s personal triumph over his experience as a prisoner in a Nazi death camp. His captors controlled his liberty to move about his environment. They could not control his freedom to choose what he thought and felt. He controlled his self-awareness, imagination, conscience, and independent will to draw meaning from his experience [The Seven Habits of Highly Effective People: By Stephen R. Covey. New York: Simon and Schuster, 1989].

How can I see the good in my enemies, despite their obvious flaws in comparison to my own angelic perfection? And how to avoid acting on the urge to defeat them, despite the reality that there have to be winners and losers at all levels in society, including elections, sports, cribbage (at which my wife regularly beats me)? Something tells me I’m getting off to a shaky start here.

I have to crawl before I can walk; I have to walk before I can run—before I fall flat on my face for the umpteenth time. Now more than any other time in my life, I must keep trying. I must get up and try again.

ADDENDUM January 11, 2021: I tried to access the King Library and Archives (KLA) today at The King Center website. There is a message indicating the KLA page is down indefinitely and redirects the reader to the Stanford University site noted above.

Bridges: An Essay on MLK Day of Service 2020

The Martin Luther King Jr. Day of Service is today and the University of Iowa has taken a quote from King to set the tone each year for this event. This year it is:

“Let us build bridges rather than barriers, openness rather than walls. Rather than borders, let us look at distant horizons together in a spirit of acceptance, helpfulness, cooperation, peace, kindness and especially love.”—Dr. Martin Luther King, Jr.
Dr. Martin Luther King, Jr.

As I look back on my career in medicine, it’s only natural for me to think of my role as a consultation-liaison psychiatrist as a sort of bridge between medicine and psychiatry. I’m pretty sure most would agree that as I chased around the hospital up and down the stairs doing the 3 and 30 (3 miles and 30 floors; I never take the elevator), I was doing my level best to bring psychiatric care to the patients in the general hospital who were suffering from medical illness as well.

The featured image shows the cover of a little book of kind remembrances I received from colleagues and trainees when, during one of my two such lapses in good judgment, I left the University of Iowa to have a try at private practice. The book has an image of a bridge on it. At the time, I thought of it as a depiction of my path between academia and community psychiatry. We need bridges there too, although one person let me know that someone has to teach new doctors.

I also got a fancy birdhouse as a going-away gift. I still do some bird-watching.

As I head into retirement, I hope that I’ve been a bridge of sorts between the old ways and the new to the next generation of doctors. After all, I’m the institutional memory of psychiatry on the medical and surgical units, in a manner of speaking.

The Medical-Psychiatry Unit (MPU) at University of Iowa Hospitals & Clinics was where I learned how this ward of patients with both medical and psychiatric illness served as a bridge between the departments of psychiatry and medicine. My teachers were doctors who were and still are great leaders. I still recall Dr. Roger Kathol, MD, an internist who also trained in psychiatry, and who designed and started the MPU decades ago, gave readings during sit-down rounds in the unit conference room. He read passages from the works of Galen, the Greek physician, surgeon, and philosopher in the Roman Empire.

Dr. Kathol assigned to me a task one day, which was to give a short presentation the following day on hyponatremia and how to distinguish psychogenic polydipsia from the Syndrome of Inappropriate Antidiuretic Hormone (SIADH). That night I was on call and got 4 admissions on the unit, which was chaotic. One patient actually broke a bed. I didn’t get any sleep. I was up running around until we all sat down to discuss patients.

I struggled through presentations of the 4 patients I had admitted the night before. I could barely talk. I had actually looked up a little information for my assigned presentation on hyponatremia but I was sweating it because I could barely stay awake. I was not the first resident to have episodes of microsleep on rounds and I knew Dr. Kathol saw it happening to me. That was in the days of 32 hours of call. They don’t make trainees do that now.

Dr. Kathol gave me sort of a sidelong glance as we finished discussing patients, which was usually when trainees were expected to give short educational talks. That day, he skipped me.

I should mention that he thought the proper name for the MPU was the Complexity Intervention Unit (CIU), owing to not just the medical and psychiatric complexity of our patients, but also to their social environments and the U.S. payer system which often led to many having inadequate, dis-integrated health care, meaning that there was no bridge between psychiatric and medical illness treatment and split health insurance coverage even though research showed that mental illness definitely lessened quality of life and increased health care costs. He has his own company, aptly named Cartesian Solutions, and it’s a major organization dedicated to helping hospitals and clinics set up collaborative ways to bridge the needs of patients with comorbid psychiatric and medical illness.

The University of Iowa model for the MPU has been disseminated to a number of other hospitals in the country, one of them in Pennsylvania, which I mentioned in a previous post, “Brief News Item,” on May 23, 2019. I’ve just received word a couple of days ago from Dr. Kolin Good that the unit, called the Medical Complexity Unit (MCU), a name which bridges the underlying intent of MPU and CIU, has saved the hospital a great deal of money, has drastically cut the use of sitters doing one to one observation (an extremely expensive intervention), is treasured by patients, and popular with trainees. They are very proud of it and have every right to be so. They are bridge builders too.

Dr. Louis Kirchhoff has been one the most notable internal medicine co-attendings on the MPU. He’s an infectious disease specialist, but has a knack for communicating effectively with patients who are mentally and medically ill, even speaking fluent Spanish with some of them. He and I shared triage call to the MPU every other night before the triage system was changed to a more humane schedule. He was a bridge between internal medicine and psychiatry trainees rotating on the ward. He could explain psychiatry to the medicine residents as well as I could.

I have had a penchant for finding a chair to sit down when I interview patients in their hospital rooms. There are usually not enough chairs in the rooms. A few years ago, Dr. Tim Thomsen, a surgeon and Palliative Care Medicine specialist as well, lent me a camp stool which I carry around with me so that I’m never at a loss for a chair. Everyone likes it. I think the camp stool helps build an emotional bridge with patients.

There are special combined specialty residencies at the University of Iowa Hospitals and Clinics which bridge Internal Medicine and Psychiatry and Family medicine and Psychiatry. Slowly but surely the siloed departments of academic medical centers are broadening their curricula and training regimens to rebuild the bridge between mind and body.

It’s been evolving for years. I’m proud to have played a small role in it. This is a place where teachers, researchers, and clinicians build bridges in many ways, foster openness, and search the “distant horizons in a spirit of acceptance, helpfulness, cooperation, peace, kindness and especially love.”