reflections – 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.

About Those Stages of Retirement

We got our new wall clock on the wall the other day. It got me to thinking about how I view time and other matters now that I’ve been retired for about two and a half years.

I actually tried to ease into retirement by getting a 3-year phased retirement contract. I thought that might help me get adjusted to not being a fire fighter as a consultation-liaison psychiatrist. I don’t know how helpful that was.

So, I looked up the stages of retirement on the web. There are slightly different versions but most of them have 5 stages:

Realization
Honeymoon
Disenchantment
Reorientation
Stability

I guess I’m somewhere at the tail end of disenchantment and the beginning of reorientation. I have to point out a few things about me and the clock on the wall to help get my point across.

When I was running around the hospital, I used to pay a lot of attention to the clock. One example is how I helped medical nurses and doctors diagnose and manage catatonia. That’s a complicated and potentially life-threatening condition linked to a lot of medical and psychiatric disorders. It can make people afflicted with it look like they have a primary mental illness and they can look and act spooky.

Most people with catatonia are mute and immobile. They could also have wild, purposeless agitation but the mute and immobile type is more common. I would recommend administering injectable medicine in the class of benzodiazepines, often lorazepam.

Often the catatonic person would wake up and start answering questions after being like a statue only minutes before the injection. I watched the clock very closely, and the nurse and I watched the vital signs even more closely.

The recovery from a catatonic state looks like a miracle, which often made me look like a hero—despite the fact I could not explain exactly the mechanism of how catatonic states begin or how injectable benzodiazepines work to reverse the state. In most situations, on the general medical and surgery wards, the cause was not infrequently a medical emergency.

That made retirement difficult. I often didn’t notice time passing when I was working. In fact, my job as a C-L psychiatrist was marked by a series of emergencies, hence the fire fighter feel the job held for me.

Somehow, interrupting my schedule (if you can call firefighting a schedule), didn’t help me very much in my adjustment to retirement.

Right from the start, I noticed I missed being a hero. By the time I got to the first stage, Realization, I was already part of the way into the Disenchantment stage. I don’t really recall the Honeymoon stage.

Time passed slowly after full retirement for me. Not even the phased retirement schedule prepared me for it. It was excruciating. I have never slept very well, but my insomnia got worse after retirement.

I had fleeting thoughts about returning to work, and that’s the surprising thing. You’d think I would have just dropped the whole retirement thing and get right back in the fire truck.

But I didn’t. Part of me knew that the job consumed me and burnout was a consequence. My focus on work did not help me be a good husband. On the other hand, retirement by itself didn’t help either.

It’s still hard, but not as difficult as it was at first. I would say that I’m somewhere between the latter part of Disenchantment and the beginning of Reorientation. I’m not anywhere near Stability.

I have replaced my schedule to some degree. Most days, I exercise and practice mindfulness meditation. I have also recently taken up juggling, as many of my readers know.

But any YouTube videos of me “cooking” are bogus. Sena takes video of me messing around making pizza and whatnot as if I know what I’m doing—but she’s giving me cues every step of the way. I’m allergic to kitchens and I probably always will be.

Anyway, I have a different relationship with the clock nowadays. I’m still hoping that I’ll evolve into somebody who knows how to manage not just retirement better, but a whole lot of things in a more adaptive way.

I sure hope so. According to some statistics, at my age I’ve got a limited time to improve. So, I need to get busy.

How the Feathered Half Lives

We were out on the Terry Trueblood Trail and saw a lot of different kinds of birds doing the things that birds—and humans do. Looking for mates, mating, nesting, hunting, feeding. We’re a little more romantic about it, at least sometimes.

Often, I wonder. Who are the real bird brains around here?

Snow Day Reflections on Elevator Pitches

I got up early this morning, partly because I knew I wanted to shovel the snowdrifts from last night, and partly because I heard my neighbor’s snowblower, shortly after 5:00 a.m.

I don’t have a snowblower. I’d rather shovel. It was the wet, heavy stuff. It was still coming down when I charged outside without breakfast, not even coffee.

While I was slogging away at the snow, I kept thinking about how to update my YouTube trailer. It’s been about a couple of years since I made the last trailer. I’m evolving since my retirement from the hospital where I worked as a consulting psychiatrist. I guess it’s time to update my About page on this blog as well.

The further I get in time away from work, the more I wonder what I’m evolving into. Work is not my focus. Sena and I got a big kick out of doing the Iowa cribbage board video. It brought back memories of our travels in Iowa.

I noticed my YouTube trailer is long by usual standards. It’s about 2 minutes. I found instructions for making it on YouTube. It’s supposed to be no longer than 30-45 seconds. Technically it’s supposed to be sort of like an elevator pitch.

I tried to develop elevator pitches back when I was working. There’s all kind of guidance for them on the web.

The framework is designed for those who are job seekers and students and salesmen. I tried googling “elevator pitches for retirees” and didn’t get any real hits.

I’m not trying to sell anything. I’m not competing for a job. The basic format for an elevator pitch could include:

Who are you?
What problem are you trying to solve?
What’s your proposed solution?
What’s the benefit of your solution?

I guess the answer to the first one is that I’m a retired psychiatric consultant. I’m not sure who in his right mind would be interested in that. If I shorten it to just “retiree,” that doesn’t seem to gain much traction.

The second one is even harder. Frankly, the problem I’m trying to solve is deeply personal although arguably could be applied to any retiree. I’ve been trying to adjust to no longer having a professional identity. I know George Dawson, MD remarked that he had little trouble with the meaningfulness issues with which one could wrestle after retiring from one’s profession, some after several decades of work.

I’m actually still wrestling with it and I would say it’s normal, at least for me. The loss of my professional identity was a real struggle for at least a year after my last day of work on June 30, 2020. I often failed to cover it up with a sense of humor, although I never fully lost that trait.

I don’t have a solution, and therefore can’t propose one. I have discovered other interests, which have gradually overtaken the one which kept my mind on the hospital most of the time, even when I was not at the hospital. I know I never really seriously considered the solution of going back to work in my former role. Some of my colleagues did, though. I hope they were happier when they did.

Since I don’t have a solution to the problem of adapting to retirement, I can’t really talk about the benefit. On the other hand, I notice I’m changing very slowly from being the firefighter psychiatric consultant to whatever I am now.

I think mindfulness meditation has been helpful, which I started in 2014 mainly as a way to cope with burnout. I was in a class with several others who had various reasons for being in the Mindfulness Based Stress Reduction (MBSR) class at the hospital. The class is no longer given there, and my teacher, Bev Klug, retired. However, resources for it are available elsewhere on the University of Iowa campus.

Maybe I have the beginnings for an elevator pitch after all.

The Fourth in the Series Uncovering Hawkeye History: The Next Chapter: Blazing New Trails (1998-2047)

The final installment of the series of Uncovering Hawkeye History, which is The Next Chapter: Blazing New Trails (1998-2047) was recorded and is now posted on the University of Iowa Center for Advancement website. You can view it below here:

Proof of Simulated Reality—Or Cool Camera Trick?

I watch the History Channel TV show “The Proof is Out There” hosted by Tony Harris. Early this year (I think January), an episode featured a snapshot showing a woman who’s mirror reflection didn’t match her facial expression. It was striking. The question was whether this proved we live in a simulated reality (think of the film “The Matrix”). At that time, I think Tony and his panel of analysts (including a digital imaging expert) called the photo unexplained but stopped short of declaring it proof we’re all living in a simulation.

A couple nights ago, on an episode of the new season, Tony had to admit he and his colleagues got it wrong—because the snapshot can be created using the smartphone camera panorama mode. Somebody submitted a couple of photographs duplicating the effect of the one submitted in January along with an explanation of how to make them.

Sena and I checked this out. When I googled the term “panorama mirror trick,” I got several hits with step-by-step instructions and several YouTube presentations. Depending on what search terms you use, I could find internet references going back several years.

We played with the camera. It took a little practice, but we got the hang of it quickly. These are rough instructions:

Mirror trick:

Open the camera app and swipe to panorama mode.

Subject stands adjacent to the mirror, at an angle partly facing it and partly turned toward the camera operator.

Camera operator taps the shutter button while panning from one direction toward the subject and moving past, keeping the arrow centered on the straight horizontal line.

When camera operator has panned just past subject and before reaching the mirror, stop moving the camera and have the subject change position. This should take only a moment or so. If the camera is still moving, you’ll get a lot of motion artifact.

After subject has assumed the new posture, start panning again toward the mirror and a bit beyond, then tap the shutter button to end the shot.

You should get an image with the subject in one posture and the subject’s mirror reflection in a completely different posture.

Doppelganger trick:

I call this the doppelganger trick because the maneuver creates an image with two different images of the same subject in two different spots, creating a twinning or doppelganger effect.

Set up is the same as for the mirror trick but have the subject stand in one spot to the left of the camera operator and strike a pose.

Camera operator starts panning to the right, then stops briefly.

Subject zips behind the camera operator on the left side and takes up a new position on the opposite side.

Camera operator restarts the pan right and completes the shot after moving past the subject.

It may take a few tries, but when you get it right, the result looks startling. It’s fun.

Now here’s a question for Tony Harris. Do Doppelgangers exist?

Snow Moon Reflections

I’m having a little trouble keeping all of the different moon names straight. Last night was the Snow Moon. I managed to get a snapshot of it. It doesn’t look different from any other full moon. It’s called the Snow Moon mainly because February tends have the winter’s heaviest snow fall, according to the Old Farmer’s Almanac. It’s also known as the Hunger Moon or the Bony Moon, because this time of year could mean starvation for some back in the days when you had to hunt for your meals.

I got that mixed up somehow with the Wolf Moon—which was in January. I missed that one. On the other hand, you can think of being hungry as a wolf, or the wolf being at your door, meaning not having the means to fend off starvation. Anyhow, that’s my excuse for getting the Wolf Moon mixed up with the Snow Moon. However, according to the Old Farmer’s Almanac, some Native Americans actually called the January full moon the Snow Moon.

We did get a lot of snow in both January and February. We shoveled a lot of it. I guess there’s no official name for the problem I have flexing my stiff, sore left ring finger, which I’m pretty sure results from my grip on the snow shovel handle. I also occasionally get a stiff, sore left big toe, which I can’t flex. I believe this is from the way I tend to lean into my left instep when plunging the shovel into a big snowdrift.

Before you get after me with critiques about my body mechanics when snow shoveling, let me say this: I quit twisting my back and throwing the snow over my shoulder this season.

That said about the basic meaning of the Snow Moon according to the Old Farmer’s Almanac, there are other interpretations. This can be a time for reflection on transitions in one’s life.

There have been a lot of big and little changes in my life, the biggest one recently being retirement. It has been difficult to release my grip on my identity as a psychiatrist. I’ve been a doctor for a long time. It’s hard to remember what I was before I started medical school in the summer of 1988, which was a pivotal time for me. I joined several other students who were members of minority and disadvantaged groups, including but not limited to African Americans, in the summer enrichment medical school program. It has since developed into what is now the Summer Health Professions Education Program (SHPEP) at the University of Iowa.

In fact, it was a pivotal time for the University of Iowa College of Medicine. Leaders, including Philip G. Hubbard, were trying to navigate the controversy surrounding the concept of affirmative action. Not everyone accepted the idea with open arms at the time.

These days, I sometimes find myself remembering how I’ve changed over the past several decades. I recall the sometimes-awkward feeling of being a freshman at Huston-Tillotson College (now Huston-Tillotson University) in the mid-1970s. I had grown up in in a small town in Iowa, where I was often the only Black student in class.

When I was a child, I was lucky enough to have role models from both sides of the apparent racial divide. Although Paul ‘Blackie’ Espinosa was not African American, he took me and my younger brother to a Twins baseball game. While I don’t remember much about that day except that it was fiendishly hot—I remember how kind Blackie was to us.

I remember Al Martin, who was an African American artist in the community where I grew up. He took me to an art show where he displayed some of his paintings. Here again, while the Iowa weather was a small distraction (it was a very cold fall day), I looked up to Al as a leader.

I also remember a local pastor, Glen Bandel, who was white and who came to our house one terrible night when my mother was very sick. He stayed all night watching to make sure she didn’t need to go to the hospital. He slept sitting up in a rocking chair. I googled his name the other day. Much to my surprise, he’s still alive and is in his 90s. There was a news item announcing the celebration of his 90^th birthday a couple of years ago.

As I try to stitch my past to my present, I keep finding that the strongest thread over the last 43 years has been my wife, Sena. I don’t know where I would be without her. I don’t like to contemplate it. I don’t know how I’ll navigate the changes that are surely happening even as I sit here and, in turn, dread or welcome them. Change will happen, no matter what the shape or tint of the moon, and whether I want it or not.

A Pair of Cufflinks

My wife and I were watching an episode of Antiques Roadshow this evening and saw a spot about a pair of cufflinks that turned out to be worth a lot of money.

That reminded me of the first and only pair of cufflinks I ever owned. Back when I was an undergraduate in the mid-1970s at the private, historically black Huston-Tillotson College (now H-T University), in Austin, Texas, a wealthy, successful white businessman who was fond of my English professor bought me a suit, dress shoes, tie, and cufflinks.

I was ambivalent about the gift as I was being fitted for the suit at the men’s store in downtown Austin.

I wasn’t sure what cufflinks were supposed to do for me. I suppose I shouldn’t judge the guy too harshly. After all, he was just trying to be generous—and probably trying to impress my English professor.

It was the 1970s and it was not a great time for black people in America. There was violent racism of course. There was also a sort of paternalistic generosity which may have emphasized superficial symbols of economic success.

Anyway, after a while the shoes started to squeak. I outgrew the suit. Despite those losses, I became successful through hard work and good luck.

I lost the cufflinks.

Coming to Terms with Retirement

I’m in the off phase of phased retirement right now. It reminds me of the consuming question, “What are you going to do when you’re retired.” Coming to terms with retirement is not a one-step thing.

It’s probably easier to think of things I’m not going to do. I can think of at least a couple of books I’m probably not going to finish reading: “The Social Transformation of American Medicine” by Paul Starr and another title I rather not type but the picture of which I’m not squeamish about showing.

Deep
Also deep

I’ve already read a new book by Dave Barry, “Lessons from Lucy,” which is about coming to terms with getting older. And I’m going to reread a book I read years ago, “The Ultimate Hitchhiker’s Guide to the Galaxy” by Douglas Adams.

Wise booger jokes
Autographed
Worth re-reading

I read the Hitchhiker’s Guide and lost it in one of our many moves. I bought a new hardback copy a few days ago and just restarted it.

I can’t remember when I got The Ultimate Hitchhiker’s Guide. It was published in 1986. Around that time, I had graduated from Iowa State University and could not find employment for about a year. It was a difficult time. Anyone who has been through something like that might understand how hard it could be to retire.

I’m not going to write another work-related book. Editing a multi-author book was too much like herding cats. And as one of my friends put it, once you’ve done that, you ask, “Now what?”

I’m still checking my office email every day. You never know. It’s FOMO, I realize; on the other hand, there are still legitimate work-related things I need to do and some have deadlines.

This makes me think of my YouTube video, “A Day in the Life of a C-L Psychiatrist.” It’s a little tough to come up with something like “A Day in the Life of a Retired C-L Psychiatrist.” Of course, there would be nothing connected with psychiatry in it.

My day in the life after C-L Psychiatry?

I’m reminded of an exchange between Men in Black agents J and K (2^nd sequel) after K is deneuralized out of “retirement” to return to the active job of defending this little green planet from aliens.

Agent J: “So what was it like on the outside, not doing this every day?”

Agent K: “It was nice; Sleep late on the weekends, watch the Weather Channel.”

My life is more or less like that, except every day is a weekend day…sort of. And the Weather Channel has gotten way too political for me.

I watch Men in Black reruns. I wait for the garbage truck. How does that guy know exactly where to brake in order to operate the automated side load mechanical arm grabber? I carry my POS camera on my belt. You just never know when an opportunity for great snapshots might arise. I trim and edge the lawn boundaries. I vacuum. I fold the fitted sheets, Hondo. I really don’t cook; I stick frozen pizzas in the oven and make microwave popcorn—not very often, Slick. I exercise and do mindfulness meditation and yoga. I take clothes out of the dryer and put away. I dry the dishes and put away. No, we do not use the dishwasher, pal. It’s about coordination and timing.

I realize that I might sound like Agent K. But I’m more like Agent J—still a rookie around the house and in the yard. This is going to take a while.

My Mother

Sometimes I think about my mother, Ruby, who died 15 years ago. She reared me and my brother Randy. Those were hard times. She had a sense of humor but the years wore on her, making life a burden. She was a lifelong resident of our hometown.

Jim Amos
Ruby Amos

In early life, she worked as a waitress. She often spoke with great pride of her ability to carry more hot dishes barehanded from kitchen to table than anyone else she knew.

She was an avid card player. If you couldn’t remember what tricks were played in a game of 500 — Ruby had you for lunch.

She lived in the heart of the downtown area on Federal Avenue for decades — and loved every minute of it.

She enjoyed the noise of traffic, the city waking up, the city eating lunch, and the city having a hard time going to sleep at night.

She lived high above the street, and didn’t mind the stairs at all, even late into her seventies.

Ruby loved going out for coffee. She was a great talker, and thoroughly enjoyed hearing a good joke. She knew that sharing troubles and laughter were both healing. In her own way, she reminded us to cherish our blessings wherever we found them. We will remember.

I am very lucky to have some snapshots of my family, and even luckier to find one of her smiling brightly. She suffered to put it simply. Religious faith helped. We went to church regularly for some time. My father never went to church as far as I know, but for some reason, at one time I remember there was some hint that he might attend Sunday service with us. A new pastor had taken over and I remember he said flatly that he would never allow some “Black buccaneer” in his church.

Over the years, I’ve thought about whether the pastor’s emphasis was on my father being black or just a buccaneer. He was both. Anyway, he never showed up and that’s just as well because he surely was not welcome.

At Christmas, we used to get gifts of fruitcake from members of the church. I think that was one of the first times I learned how to lie from my mother who didn’t want to hurt anyone’s feelings who was making a gift to us during the holidays. I hated that fruitcake so much; I can’t even begin to tell you. But I told anyone who gave that stuff to us that I loved it.

Television was about the only entertainment we had. We used to watch Ed Sullivan, Lost in Space, and all those other shows you can see on MeTV nowadays. We used to play Old Maid with a pretty creepy deck of cards.

Mom could climb a lot of stairs without any problems, well into her eighties. I climb a lot of stairs too as a C-L psychiatrist in the general hospital, and I’m well into my sixties. We’re alike in many ways.

One of the differences was that she could play cards better than I ever will. I’m just not so good at remembering what cards have been played. However, I try and my wife and I occasionally play a game called Schnapsen, in which remembering what’s been played is critical to winning. I lose more than my share of games.

Mom was a fast walker. We often walked from our house to Central Park downtown, which was quite a distance. We didn’t have a car, so walking was the only way to get around. I take after her because I’m a pretty good walker. Ask any trainee who rotates through the psychiatry consult service.

When she got very old, her health worsened and her nerves got the best of her more often than not. I remember she made me promise I’d never put her in a nursing home. I did promise—and I eventually had to break it.

Mom and I were very much alike. I treasure our differences.