mindfulness – Go Retire Psychiatrist

Holes in Our Heads

I remember getting a trephination of my fingernail a long time ago when I was working as a surveyor’s assistant. We were out taking elevation shots with a level and a rod measuring the depth of sewer pipes.

This required us to remove the manhole covers, which are very heavy. I got one of my fingers pinched and man that hurt. My crew drove me to the emergency room where an ER doctor drilled a tiny hole in my fingernail. The immediate pain relief resulting from the release of the subungual hematoma pressure felt miraculous.

That was trephination of the fingernail. I’ll bet some of you thought of my skull when you read the word in my first sentence, though.

Trephination is just the word for the medical procedure of making a hole in the body for some reason. In order to relieve pressure and severe pain from getting your finger mashed, a doctor can make a hole in your fingernail.

Trephination can also mean making a hole in your skull to treat brain injuries or to let the evil spirits out. That was done thousands of years ago, but making burr holes in the skull for other medical reasons is still being performed, including to relieve pressure.

It’s the origin of the old saying, “Well, I’ll be bored for the simples,” where the term “simples” means feeble-mindedness and “bored” refers to the obvious treatment.

Anyway, boring holes in either your mashed finger or your head can relieve certain kinds of pressure and pain.

Figuratively speaking, we can feel under pressure in our heads for all kinds of reasons. In fact, we’re born with several kinds of holes in our heads that can lead to the pressures of anger, anxiety, sorrow and fear.

Our eyes can fool us, even to the point of making us believe we see Bigfoot when all we’re really seeing are pictures or videos that are very blurred and pixelated. I didn’t say nobody ever sees Bigfoot. I’m saying that there’s a term for some forms of visual misperception, one of them being pareidolia—the tendency to perceive meaningful images in random or ambiguous visual patterns.

Our ears can also fool us. Mondegreens are misperceived song lyrics. One of the most common mondegreens is a line I was very embarrassed by for years, “Wrapped up like a douche, another runner in the night” from the song Blinded by the Light by Manfred Mann’s Earth Band. It’s actually “Revved up like a deuce, another runner in the night.” A deuce is a kind of automobile that was often converted into a hotrod in the 1930s, usually a Ford.

Those are just a couple of examples of how holes in our heads can sometimes lead to trouble getting along with each other. All you have to do to prove this is to look at news headlines. Everybody’s slamming each other.

There’s no magic cure for interpersonal conflict, although there have been plenty of efforts to help us understand how it may arise from misperceptions and misunderstandings, often arising from missteps in communication. I doubt making more holes in our heads would be helpful.

For example, I could have chosen to show you a picture of which one of my fingers got pinched in a manhole cover. How I might have done that could have been unnecessarily provocative and even offensive—even if I only meant it as a joke. A prominent scientist recently published a picture on social media of what he called a new star he said was taken by the Webb telescope. It later came out it was actually a picture of a slice of chorizo, which is a sausage. Many people didn’t think it was funny, but that was his explanation for the post.

I don’t have to say anything more to convey the message that being mindful of what and how we are communicating is vital to making ourselves understood while remaining respectful and kind.

Practicing mindfulness is one way to facilitate clear communication that can help solve problems without hurting the feelings of others and triggering vengeful counterattacks. We’ve all been there.

Not everybody gets the idea about mindfulness. I think the blogger thegoodenoughpsychiatrist does a great job discussing it in the post “Reflecting on DBT and Mindfulness.”

As the blogger says, “Sometimes, you just need to be brought back down to earth.”

And if that doesn’t work, we can always try trephination.

Do You Get the Zoomies or the Zennies?

Does your pet dog, cat, or sloth ever get the zoomies? We don’t have pets; I just read about animals getting the zoomies the other day. It’s an interesting phenomenon. Right after a bath, a dog might race around the yard, getting all dirty again. They look like they’re having great fun and veterinarians say it’s harmless.

It would be great if we could catch a sloth with the zoomies. Not only would that be a first for zoology. Maybe it would outrun the fungus and other parasites growing on its hair, making it easier to gather by scientists. Some of that stuff might have potential for use in developing medicines for humans.

Other animals including those in the wild can get the zoomies, and some version of it might be done by Springbok antelope, although it’s called pronking. They just run around and leap, maybe for no apparent reason. Some claim that dogs occasionally pronk, but I wonder if it’s just a special case of the zoomies.

The veterinary term for zoomies or (and maybe pronking) is Frenetic Random Activity Periods (FRAP).

Technically, I don’t think humans get the zoomies although some would debate the issue. Many of us try to do the opposite, especially nowadays. One example is mindfulness, which I’ve been doing for the last 8 years. It’s difficult for me to describe, but you’re really not trying to do anything, not even trying to relax, per se.

But I try to be still and notice whatever is unfolding, nonjudgmentally. It’s a little hard not to scratch that itch right next to my temple. I’ve seen on the web that some people call it the zennies—maybe we could call it Focused Regular Awareness Periods (FRAP).

I guess dogs and cats enjoy their brand of FRAP, or at least it looks that way. It’s really hard to tell what’s going on if you just watch people doing the human brand of FRAP. Sometimes they just look like they might be asleep—which occasionally happens.

Zoomies or zennies; could they be different paths to the same place?

My Updated Easy Exercises

Okay, so I’m nobody’s personal trainer, but I have an update on my exercise routine, which I’m doing daily for the most part. I spend about a half hour on the “workout” which starts with a floor yoga warm up. I get on the exercise bike for 5 minutes. Then I do 3 sets of body weight squats, dumbbells, and planks. I finish off with another 5 minutes on the bike.

Obviously, my goal is not to be ripped. I just want to keep my bowels moving, to sleep OK, and stay reasonably fit for a geezer. I also do daily mindfulness meditation.

I still have a lot of work to do on being more well-rounded. And I mean a lot.

Watch Yourself

I watch the Weather Channel TV shows Highway Thru Hell and Heavy Rescue 401 and I hear a lot of the towing guys say “Watch yourself!” Often, they say this as they’re about to pull a jack knifed semi out of a ditch. Sometimes a rigging line breaks and a large hook will snap back at lightning speed, which can take your head off, even if you are watching out for it.

I notice many of the older tow crew members are now saying while grinning at the camera things like, “I think it’s really important to teach the younger generation the things I know because I’m not going to be doing this forever, and I’d like to retire sometime in the near future and let somebody else watch out for flying snatch blocks and tow hooks which can take your head off, which would not necessarily be painful because you might die instantaneously, but then there are those other inconvenient consequences like funerals and insufficient life insurance policies with bizarre exclusion clauses disallowing benefit payouts to grieving widows and children because of deaths caused by non-Underwriters Laboratories certified flying snatch blocks and tow hooks, unpaid mortgages and loans for things like exorbitantly expensive snatch blocks, tow hooks, not to mention multi-ton wreckers and rotators.”

Anyway, the expression “Watch Yourself” could also figuratively mean being mindful. Mindfulness meditation has taught me to notice more about what’s going on inside and outside my head.

I do daily sitting meditation, although I may miss a day here and there. And by sitting, I want to make it abundantly clear that I don’t assume the lotus position. My joints are stiff enough that, when I try to stand up, they might have enough spring steel energy stored to whip loose, similar to flying snatch blocks and tow hooks.

While I’m sitting, I do a lot of thinking. By the way, it’s not a mistake to think and feel a lot of different thoughts and emotions during mindfulness sessions. That’s one of several myths about mindfulness. It’s not mandatory or even possible to shut off your yammering mind. I can choose to focus my attention on it or not.

If I try to shut my internal talk off for any length of time, it’s like gripping a slippery valve. Sooner rather than later, my grip slips and thoughts explode like flying snatch blocks and tow hooks. I watch myself and I notice when I’m thinking my hands get tense. As soon as I notice that, my hands relax and I focus on breathing—or maybe it’s the other way around.

Watch yourself.

Elevator Pitch for a Very Slow Elevator

This is a follow up to yesterday’s post about elevator pitches. I’m using one of the standard formats below. The first step is to find a really slow elevator.

Who am I?

I’m a retired consultation psychiatrist, slowly evolving beyond that backwards in time to something else I’ve always been. I’ve been a writer since I was a child. My favorite place was the public library. I walked there from my house. I stayed there as long as I could. It was place of tall windows where I could look out and see trees which swayed like peaceful giants. I borrowed as many books as I could carry in my skinny arms and walked all the way back home. Then I picked up a pencil. I wrote short stories which I bound in construction paper. I read them to my mother, who always praised them and called me gifted whether I deserved it or not. I lived inside my head. My inner world was my whole world.

What problem am I trying to solve?

The problem was that I forgot who I was as I got older. I forgot for a long time about being a writer. I evolved into the outer world, adopting other forms. I put down the pencil, but never for very long. I changed what I did and made, but I always lived in my head. People told me “Get out of your head.” I tried, but didn’t know how. I wrote less and less. When I did write, I realized that I was no genius, not gifted—but still driven to write. I was so busy in college, medical school, residency, and in the practice of consultation psychiatry, I didn’t write for a long time. But later I returned to it as the main way to teach students. I even co-edited and published a book, Psychosomatic Medicine: An Introduction to Consultation-Liaison Psychiatry, with my former department chair, Dr. Robert G. Robinson. On the Psychiatry Department web page, in the Books by Faculty section, the book is in the subsection “Classic.” Inside the cover of my personal copy is a loose page with the quote:

A classic is something that everybody wants to have read and nobody wants to read.
Mark Twain

I’m pretty sure I put it there. Part of the preface was my idea because of my admiration for Will Strunk, who I learned about in an essay by E.B. White (“Will Strunk,” Essays of E.B White, New York, Harper Row, 1977). We informally called the work The Little Book of Psychosomatic Psychiatry:

The name comes from Will Strunk’s book, The Elements of Style, which was, as White says, “Will Strunk’s parvum opus, his attempt to cut the vast tangle of English rhetoric down to size and write its rules and principles on the head of a pin. Will himself hung the title “little” on his book and referred to it sardonically and with secret pride as “the little book,” always giving the word “little” a special twist, as though he were putting a spin on a ball.”

I guess our little book was, in a way, my own parvum opus.

Obviously, I don’t write the way Strunk would have wanted. But it’s my way, and I’m finding my way back to it, back to the path I was on in the beginning of my life, back to who I am.

What solution do I propose?

Almost two years ago, my solution to the challenge of rediscovering who I am, I suppose, was interrupting my medical career, but that would be dishonest. I did it because of my chronological age or least that was what I told myself. Burnout was the other reason. That said, despite my love of teaching students, I missed something else. And I knew if I kept working as a firefighter, which is what a general hospital consultation psychiatrist really is, I might lose what I loved best, which was writing for its own sake and for sharing it with others. It sounds so simple when I say it. Why has this been so hard, then? Obviously, I’m not going to recommend to those who are writers at heart lock themselves in a garret and do nothing but write. We would starve.

I think this is where mindfulness helped me. I couldn’t ignore my love of writing. I was better off just accepting it. But until I learned mindfulness in 2014 as a part of a Mindfulness Based Stress Reduction (MBSR), which I took mainly because I was struggling with burnout, I would either just ruminate or act on autopilot. I still do those things, just less often. Mindfulness is not miraculous. It’s not for everyone. It can be a part of transitioning to a healthier life. I exercise too. I don’t rigidly always without fail adhere to my schedule. I miss some days. I accept that and just go back and try again.

What is the benefit of my solution?

I think the benefit of adopting mindfulness and other healthy practices, at least for me, is that sooner or later (in my case much later), I made a sort of uneven peace with the loss of my professional routines, my professional identity, my work, as the single most important way to live. I still have a lot to learn, including how to be more patient, how to listen to others, how to get out of my head for what I know will be only a short time. Most of all, I’ve reintegrated writing into my life and it brings me joy. If you’re going through anything like that, then maybe seeing my struggle, my wins and losses, will help you keep going. It gets better.

This elevator pitch is way longer than 45 seconds.

Featured image picture credit Pixydotorg.

Moderna Booster Jab Today and Mindful Zombies

I got my Moderna Covid-19 booster jab this morning. That was quick. A guy (probably about my age, I’m not sure) waiting for his booster behind me chuckled and asked, “Did she even let you sit down for it?” I was in and out that fast. It’s the same as the primary series, only half-dose. Sena and I are now both fully vaccinated and boosted.

According to the FDA and CDC guidelines, I could have gotten a heterologous booster, but I stuck with what I got for my primary series. There was no problem with vaccine supply; it was already on the shelf, so the only thing different was the smaller dose. Since there’s not much else to say about it, we’ll move on to other more exciting news.

Sena ordered the Zombie cribbage game I just had to have. It won’t get here by Halloween, but that’s OK. I know the board is a folding plastic affair and there’s only enough peg holes for what would be half a full game (61 instead of 121). The pegs are zombie figures—which may or may not fit in the holes.

But it’s zombies! This is what happens to you in retirement, people. My gratitude to Sena for getting Zombie cribbage will be to play Scrabble with her.

That reminds me of a cribbage story I read on the web about a game between a couple of old guys in a senior community in Minnesota. One of them, Harry, was 108 years old and the other, Don, was 105. They were long time cribbage players, but they’d never played each other. The young guy won. As soon as he did, he got back on his walker, saying, “Just another game,” and left. In fact, neither player got as excited about the affair as everyone else including spectators, family, and staff, talking it up like it was a championship boxing match. Don’s family said that his attitude about the win was probably part of the reason for his longevity.

I liked Don’s reaction to winning the game. I don’t know if Don’s approach to cribbage is the same as it is to life in general. Maybe it’s about living in the present. When something is over, it’s in the past and it’s time to move on. There’s probably no point in worrying about the future either, especially when you get pretty old. There’s not much of it left.

Maybe this mean that retirees should be more like zombies—we should just play cribbage, eat brains mindfully, and forget about tomorrow. You’re welcome.

Worm Moon for March 2021

The full moon for this month on March 28, 2021 is called the Worm Moon. According to the Old Farmer’s Almanac, it’s “spectacularly bright.” It is indeed. I took the picture below around 8:30 PM.

It’s also known by other names including the Eagle Moon and the Crow Comes Back Moon, Wind Strong Moon among others. By the way we had a Fire Weather Warning around here for today and tomorrow advising against outdoor burning because of elevated grassland fire risk due to windiness.

It’s not clear what kind of worm is connected with this moon. It could be a beetle larva or an earthworm. Maybe the earthworm is connected with the return of robins, who eat the earthworms. Which makes me wonder what earthworms eat. They commonly eat parasites so you don’t want to snack on any raw earthworms.

Yes, in fact you can eat earthworms. You can but I won’t. I’m a finicky eater and I’ve been called the slowest eater in the world. I prefer to call my pace mindful eating. It becomes slower (I mean more mindful) when I encounter stuff like shredded coconut, which I chew forever because somehow, I can barely bring myself to swallow it. It has the consistency of cellophane, to which I have a personal policy against eating. I’m not sure you could eat earthworms mindfully, but I bet you couldn’t get your mind off what you’re eating.

Mindful eating was something I learned about when I took the Mindfulness Based Stress Reduction (MBSR) course several years ago. Mindful eating guidelines include keeping the different tastes: salt, sweet, sour, bitter in mind, so to speak. In addition to those there’s another taste called umami (pronounced oo mommy). I think it’s close to savory, not to be confused with Smack Ya Mama, a Cajun seasoning, which you might use in gumbo.

Gumbo comes from a West African word for okra, another thing I would rather not eat because it’s slimy (sort of reminds me of earthworms). Mindful eating could include setting down your utensils or food in between bites. I could easily set down my utensils and okra—but I probably wouldn’t pick them up again.

There is no connection I know of between the Men in Black (MIB) Worm Guys and the moon. They don’t come from the moon but they’re definitely not from this galaxy. I don’t know what they eat but they like gourmet coffee and cigarettes. You can cut them in half and it doesn’t kill them; they just pull themselves together. If you cut an earthworm in the right place, behind the half that contains the head, several hearts, etc., it grows a new hind end.

The moon is a fascinating thing. It stabilizes the earth, keeping it from wobbling on its axis so that our seasons and temperatures don’t change wildly. It’s slowly moving away from us, according to scientists. But it’s a very long goodbye. It will be many Worm Moons before the moon goes. And by then, there won’t be anyone to notice.

I’ll Have to Make Time

I suppose you’re wondering why I’ve been saying that my wife has got me this or that item, like the pink dumbbells and whatnot. She also got me an extra yoga mat.

Part of the explanation is that I’ve recently had a birthday, which reminds me of the importance of time in my life–mainly because I have a shrinking supply of it. After all, I’m heading into the sunset of my journey on Earth.

Occasionally, I wonder what I ought to be trying to accomplish, if anything.

To achieve great things, two things are needed:
A plan and not quite enough time.
Leonard Bernstein

Bernstein’s quote is encouraging in a way. Hey, I’ve already got half of it–I don’t have enough time. Now all I have to do is achieve some great things.

I could go on the road to promote my idea for a hit song, “Put your hand in the hand of the man with a plan to get a tan, lead a band, roam the land, avoid the bladder scan, zippity do dah shazam.”

All I have to do is come up with lyrics…and a melody…and an agent…and a band…and a voice coach…and some talent.

Now, if I’m going to accomplish something great, it would make sense to keep working on building a more harmonious balance in my everyday life. I’m doing some of that, including regular exercise, mindfulness practice, and healthy eating.

That reminds me, the birthday cake was excellent, especially topped with white chocolate vanilla ice cream.

Every so often, my former mindfulness teacher sends out an email message about the upcoming mindfulness classes. She always includes an inspirational quote, like the one below:

Be a person here. Stand by the river, invoke
the owls. Invoke winter, then spring.
Let any season that wants to come here make its own
call. After that sound goes away, wait.

A slow bubble rises through the earth
and begins to include sky, stars, all space,
Even the outracing, expanding thought.
Come back and hear the little sound again.

Suddenly this dream you are having matches
everyone’s dream, and the result is the world.
If a different call came there wouldn’t be any
world, or you, or the river, or the owls calling.

How you stand here is important. How you
listen for the next things to happen. How you breathe.

William Stafford – “Being a Person”

There was also a couple of suggestions for yoga and meditation techniques specifically to help you sleep. I recognized one of them as the body scan. The body scan is one of the first things they teach you in Mindfulness Based Stress Reduction (MBSR).

The body scan invariably put me to sleep, which made me feel like I wasn’t doing it right. Early on in the course, that was not exactly the “goal” of the body scan. Except mindfulness is not exactly a goal-oriented activity.

That’s hard to conceptualize. And so, the other class that is offered to those who make mindfulness practice a regular part of their lives are follow-up groups. It helps reaffirm the regular commitment to practice mindfulness.

I noticed one of the follow-up groups is entitled “Embracing the Paradoxes of Mindfulness.” The description of the course makes the point that mindfulness really isn’t about reaching a goal or achieving great things. It’s about being rather than doing. It’s hard for me to get my head around that after getting into and through medical school, residency, and practicing psychiatry for umpteen years. And now I’m making a transition to retirement.

One of my biggest fears about making and sticking to a mindfulness practice was that I often didn’t think I would have enough time for it. My teacher just advised me that I would simply have to make time.

Maybe I could accept the time I do have left and just be the geezer I am.

Mindfully Retiring from Psychiatry

I’ve been off service for months and I’ll return to staff the general hospital psychiatry consultation service on Monday. It can be a stressful role and I’m “mindful” of how helpful mindfulness meditation has been. The featured image above shows my yoga mat and some might say a much too comfortable chair for sitting meditation. And of course, mindfulness is not really about relaxation; that’s just an old pillow.

About 5 years ago the editors of the Arnold P. Gold Foundation Humanism in Medicine Blog saw one of my blog posts (from a previous blog) describing my path to mindfulness practice, which included burnout, a problem for nearly half of all physicians, the causes of which include the health care system itself as well as physician vulnerabilities. It was posted under the title “How I left the walking dead for the walking dead meditation.” I was also the recipient of what was called in 2007 the Leonard Tow Humanism in Medicine Award, sponsored by the Gold Foundation.

This has me thinking about my motivations for retiring and what I’m going to do after I’m fully retired. Interestingly, the phased retirement program I’ve been in has given me a strong sense of how difficult this transition from full-time doctor to retired doctor entails. The meaning and purpose gap require more than a bridge made of recreational pastimes. The breath of relief after the great escape from work can soon become the sigh of boredom. On the other hand, my work as a psychiatric consultant has also been an enormous source of personal satisfaction. The video below gives a sort of Pecha Kucha account of what a Consultation-Liaison Psychiatrist does.

What C-L Psychiatry is about

It can get pretty hectic. Over the last two years of the phased retirement schedule, I’ve struggled to craft a daily routine at home that replaces the sense of accomplishment my work schedule provided—despite the pressures it exerted on my sense of well-being. Only now, in my third and final year am I starting to wonder the opposite.

For example, I’ve been exercising daily as well as practicing my mindfulness meditation. I’ve actually lost a little weight and my wife has noticed my shrinking paunch. I’m not laboring on my workouts by any means; my quads are not flopping over my knees. But I used to think that by climbing all those stairs and running all over the hospital I was staying in pretty good shape. It looked pretty impressive that my smartphone step counter logged around 20 floors and 2-3 miles a day. However, the consult service work demand can run hot and cold. It just doesn’t beat daily exercise.

How do I keep my daily exercise routine? I can hear myself saying that I won’t have time for it. I think my mindfulness teacher would probably remind me that my response could be to make time for it—just as I learned how to make time for mindfulness.

I’m looking for guidance in the literature on retiring psychiatrists, especially C-L specialists, and it’s pretty scant. So far, the best summary of it I’ve found were a couple of blog posts by H. Steven Moffic, MD on the Psychiatric Times web site. You can easily view them for free. In the first one, “Mental Bootcamp: Today is the First Day of Your Retirement,” published in 2012, he highlights the difficulty of psychological adjustment to retirement for psychiatrists. He advises, “Plan how to replace financial, personal, social, and generative needs that work has fulfilled.” There is no doubt I could do a better planning job.

In the second one, “Reviewing Retirement,” which was posted in 2014 (two years after he retired), he advises “Retire, even if you are not retired. Take enough time off periodically, and completely, with no connections to work, so that you can feel emotionally free from concerns about patients and practice.”

That speaks to me. In fact, the title of my blog site, Go Retire Psychiatrist, actually echoes this suggestion, although I never made the title with that connection in mind. I wish it were that easy to follow. You would be very lucky in today’s work environment to pull that off, even in academia. Phased retirement programs are one approach to preparing for retirement and could be effective for preventing burnout.

Go retire, psychiatrist.