retirement – Go Retire Psychiatrist

Beard Kit Passes Muster and Makes Me Glow!

I tried the new beard kit stuff yesterday. I washed my beard with the beard wash and conditioner. Then I applied a little beard oil and beard balm. I combed it and brushed up with the boar bristle brush. Try saying “boar bristle brush” three times really fast right now!

I trimmed the flyaways with the very sharp scissors and—oops. I accidentally nipped my left earlobe off. It ricocheted off the mirror and splashed into the toilet. This was not a problem and from my internet research, I knew exactly what to do.

I quickly got a soup ladle and fished my earlobe out of the toilet bowl. Wrapping it in a wet washcloth, I then tossed it into a little watertight bag. Immediately, I put that into a sandwich bag with ice to preserve my earlobe. It would not have been a good idea to put it directly on ice. That would have worsened the damage. I knew better than to put it in milk, especially skim milk! That stuff doesn’t even taste like milk.

The emergency room doctor at first didn’t believe I accidentally snipped off my earlobe. He wanted to get a psychiatric consultation, but I assured him that I’m a retired consultation-liaison psychiatrist and I’m OK. I may have a screw loose but I would never cut off any of my own body parts. He reattached my earlobe and I’m as good as new.

I guess that means I’m officially anointed from a beard kit standpoint.

Sena says I glow now. Judge for yourself from the unretouched before and after photos.

Thoughts on Beards

Sena ordered a beard kit for me. I’ve never seen one before. I’ve been trying to grow a beard for the last several months. It’s a new thing. Before retirement, I could get away with a mustache or a circle beard stubble. But I couldn’t see working at the hospital while trying to grow a full beard.

I’ve trimmed it a couple of times; I have a beard trimmer with a set of guards. I’ve got some bare spots, like a lot of guys. We saw a YouTube commercial about a product called beard growth oil. The guy said it covered his “potholes” in no time.

All the beard kits have about the same items. There’s beard shampoo, beard balm, and beard oil. They can have fragrances, like peppermint and eucalyptus or sandalwood. A lot of them seem to have infusions of things like avocado and papaya. The makers are big on natural stuff.

I’m just trying to grow a beard, not make a salad.

The kit has a comb, a brush, and scissors. I think the brush bristles are made of boar hairs. I wonder what’s special about boar hairs. Some of the kits come with beard growth oil and even a little mini roller to roll it into the hair roots. Some guys swear by it. I can’t help laughing when I think about it. And there are a large number of positive reviews about the kits in general.

I’m not sure what I would look like after beard growth oil. I might have a totally different appearance. If the kit comes with hair coloring, I might end up looking a little sinister.

On the other hand, I might resemble a department store Santa Claus. I’m not looking for the job.

I’m not sure what’ll happen with this. Until now, I have tended not to mess with my facial hair other than to snip away the stragglers and fly-aways.

I follow some guidelines. I trim the mustache away from my upper lip. I have no interest in tasting my meals long after I’m done eating. I shave neck hairs above my Adam’s apple. That doesn’t mean I’m uppity about neck beards. I just don’t like a scratchy neck.

We’ll see.

Does This Shirt Make Me Look Retired?

Sena got me a new shirt that says: “Does This Shirt Make Me Look Retired?” It’s the greatest. No, she’s the greatest.

So…does it? Think carefully about your answer.

Thoughts on Artificial Intelligence

Sena and I just read Dr. Ron Pies fascinating essay describing his interaction with Google Bard Artificial Intelligence (AI). As usual, this made me think of several movies with AI as a central theme. There are several: I, Robot (I wrote a post about this a couple of years ago), Blade Runner, The Matrix, 2001: A Space Odyssey, even Wall-E, a favorite for me and Sena.

If you’ve seen Blade Runner, you might remember a device called the Voight-Kampff Test, an empathy test to distinguish replicants (humanoids or more broadly, AI) from humans. Interestingly, there’s an article speculating about using it to see if ChatGPT (another AI made by the company OpenAI) could pass the test. It didn’t, of course, if appearing to seem genuinely human is the benchmark.

We thought the conversation between Dr. Pies and Bard was very entertaining and thought-provoking. We both wonder how Bard would have responded if the question had been slightly reframed regarding the patient with schizophrenia who might or might not have been speaking metaphorically about his brain being “…a plaster ceiling with pieces falling on the floor.”

What if you ask Bard a more open-ended sentence, something like “What do you think a patient with schizophrenia means when he says that? If Bard hadn’t been tipped off by mentioning the issues of metaphor and mental illness, how might it have responded?

Bard’s answer to Dr. Pies’ question about what Bard means when it refers to itself as “I” in its responses. It says it doesn’t mean “I” to imply it’s human. I guess you wouldn’t need the Voight-Kampff test given this kind of honesty.

Just so you know, when Sena and I discussed this article we both caught ourselves calling Bard by typical human pronouns like “he” and “his” instead of “it.”

We also speculated about where you could use an AI like Bard in practical situations. We thought of it replacing those dreadful automated telephone answering machines. Bard would be too bright for that and it would probably not sound very different from the usual machines.

What about something more challenging like answering questions about the new Iowa Income Tax Law, exempting retirees from having state taxes withheld? It’s in effect now and the rollout has been somewhat complex. We think it’s because of communication about who is responsible for getting the ball rolling and what roles the Iowa Department of Revenue, the companies’ plan administrators who are withholding state taxes, and the retirees are expected to play.

There are ways to get answers to questions which don’t involve automated telephone answering machines. Amazingly, you can talk to real people. Sometimes you don’t even have long wait times on the phone before reaching someone who has very little information and has to put you on hold “briefly.”

Don’t get me wrong; we think the exclusion of retirement income from state taxes in Iowa is a good thing. Getting information about who does what and when is challenging though. I wonder what Bard would have done.

Retiree: Bard, who’s supposed to move first, the retiree or the plan administrator on what to do about state tax withholding?

Bard: That’s a good question and the issue is likely to produce anxiety on both sides.

Retiree: Right. How does this shindig get started?

Bard: If the state and the companies had got together on the issues earlier and prepared algorithms for me to choose from, I would be in a much better position to answer that question. Would you like me to sing “On A Bicycle Built for Two” now?

Retiree: No thanks, Bard. I was wondering if you knew why some companies making payments to retirees didn’t reach out early on to them and send letters describing options on how to approach decisions for making changes to state tax withholding in light of the new tax law.

Bard: That is another good question. It brings to mind a quote by Isaac Asimov in his book, I Robot: “You are the only one responsible for your own wants.”

Retiree: Hmmmm. I guess that makes sense. What if state taxes are erroneously withheld, despite your wishes and instructions? What happens then?

Bard: That seems to imply an old saying, “The buck stops here.” This means that whoever is making decisions is ultimately responsible for them. It is attributed to President Harry S. Truman. It is based on a metaphorical expression, “passing the buck,” which has been in turn derived from poker game play. I have not been programmed with any further information about the game of poker. Has this been helpful? I want to be as helpful as I can.

Retiree: Well, you’re helpful in a way. I have heard that some plan administrators are not stopping state tax withholdings despite clear instructions otherwise. It seems that the Iowa Department of Revenue is on the hook for refunding them to retirees (here, the retiree winks).

Bard: What does that mean (referring to the wink)?

Retiree: “It’s a sign of trust. It’s a human thing. You wouldn’t understand.” (Quote from I, Robot movie, Detective Del Spooner to Sonny the robot.)

Anyway, I think AI would be overwhelmed by all this. In any case, the only way to complicate things this much is to involve humans.

More On Taming the Juggling Balls

I’ve been juggling for about 5 months now and reflecting on my progress. I think I’m doing OK for a geezer. Sena would call me a hot dog although I would still call it ugly juggling by any standard.

What’s striking, at least to me, is the little bit of science I can find on the web about juggling. I hear the term “muscle memory” when it comes to learning juggling. Actually, there’s some truth to that. There are different kinds of memory. For example, most of us know about declarative memory, which about memorizing facts, because we use it to prepare for exams. Those of us who went to medical school remember the agony of taking tests for the basic sciences.

But so-called muscle memory, or the memory for learning new skills like juggling, takes place in the brain. There was a study published in 2009 which found changes in both gray and white matter of subjects before and after learning to juggle (Scholz J, Klein MC, Behrens TE, Johansen-Berg H. Training induces changes in white-matter architecture. Nat Neurosci. 2009;12(11):1370-1371. doi:10.1038/nn.2412).

The study about correlation of the inability to stand on one leg for 10 seconds with higher mortality in older patients, which I relate to the ability to do the under the leg juggling trick, was published last year (Araujo CG, de Souza e Silva CG, Laukkanen JA, et al. Successful 10-second one-legged stance performance predicts survival in middle-aged and older individuals. British Journal of Sports Medicine 2022; 56:975-980.)

I talk a lot about juggling as though I’m a teacher. I’m not a juggling instructor by any means. You can find better juggling teachers on the web. But my approach to talking about juggling in terms of it being a hobby for me is really not different from how I talked about consultation-liaison psychiatry before and after I retired. I’m still a teacher—just evolving in retirement.

However, you can find much better resources for learning how to juggle at the following websites:

Juggling for Beginners

How to Juggle

https://www.renegadejuggling.com/

Have fun!

Teaching an Old Dog New Tricks

While we were out for a walk yesterday, we ran into someone walking her chocolate Labrador retriever. His name is Hunter and he had a tree branch longer than him in his jaws. He looked like he was having a great time gnawing on it and swinging it around.

I didn’t envy his owner when it came time to going home and taking it away from him.

Mostly younger dogs like to chew on old sticks and some say it might be a good idea to bring a chew toy along with you when you take a dog outside for a walk. It can be tough to persuade a dog to just let the stick go.

As a retired consultation-liaison psychiatrist, I sometimes compare myself to a dog who latches on to a stick and is reluctant to let it go. I’m an old dog that way and, as I’ve mentioned before, it’s a little hard to teach an old dog new tricks.

There are examples of this issue. I rarely go grocery shopping and I still have a lot to learn. I was not good about grocery shopping and other non-work-related chores when I was a doctor for about 28 years, counting residency. Medical school kept me pretty busy too.

Anyway, I went grocery shopping yesterday and I thought I did OK although I had to wander around quite a bit to find everything on my list. Sena doesn’t need a list. She pointed out that I got the unsalted butter—which she never buys. I wondered how I managed to pick up unsalted butter. I thought I was doing good to get the Great Value brand rather than the more expensive brand.

The package was blue instead of red. You mean I have to read the package?

I got a package of chicken breasts and congratulated myself on that. Sena said they were really thin and noticed that they included rib meat—which she normally doesn’t buy. That slipped by me.

I bought a lot of items that we needed; you know, things like milk, eggs, bread, nuclear weapons, etc. But I really didn’t get anything that you could actually make a bona fide meal out of in the sense of cooking something.

Well, I did get a couple of frozen pizzas. This brought the total of frozen pizzas in our freezer to a number I’m not willing to divulge at this time.

I had to maneuver around several shoppers who were filling orders for customers who ordered their groceries on line. I tried that a very few times and it’s more difficult than I thought.

When I got up to the cashier, I just stood there while she rang up my purchases, bagged them—and then she started to put the bags in my cart. She didn’t say anything but a tiny bell in my brain rang somewhere and it occurred to me that I was supposed to put the bags in the cart. I apologized and got to work right away when I noticed. I recalled that it was probably just that mistake that led to my leaving an item at the store the last time I shopped.

Sena went to the grocery store after I got home and returned with items that could be used in menus. I think that is called meal planning.

But I did make dinner last night, meaning I reheated left-over chili and chopped up some vegetables for salads. Oh, and I got the saltines out for the bread group.

Sena is still trying to coax me to let go of the stick.

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.

Thoughts on Regrets

I’ve been thinking about Dr. Moffic’s article on regret, posted on February 16, 2023 in Psychiatric Times.

I’ve dwelt on it long enough that I feel compelled to inject humor into the subject. It’s one of my many defenses.

There’s a quote from Men in Black 3 involving a short telephone conversation between Agent K and Agent J:

Agent K: Do you know the most destructive force in the universe?

Agent J: Sugar?

Agent K: Regret.

You could probably sense that joke coming. Whenever there is talk of regrets, I always recall maybe one or two remarkable episodes which led to lifelong regret. Because regret is pretty corrosive, as noted by Agent K, I need something to counter it.

My trouble is that I have many regrets. Am I so different in that regard?

Sometime in mid-career, a very important leader told me, frankly and calmly, “You’ll never be a scientist.”

Well, by then it was far too late for me to change life course. It was true; I’ve always been the rodeo clown, never the matador.

On the other hand, I know one thing I’ve never regretted and that’s my retirement. At least I think I haven’t regretted it. I have this recurring dream. It’s not every night, but often enough to make me wonder what I should do about it.

In the dream, I’m late for an exam or class and I fear I’m going to flunk. I look for the building where the exam is going to be held. I can never find it. Hallways appear and look vaguely familiar, but as I wander about looking for the bookstore or classroom or exam room, I feel like I’m in a maze, climbing stairs, almost like an Escher drawing.

That reminds me. Incidentally, several years ago, one of the medical students rotating on the psychiatry consult service drew a picture entitled “The Practical Psychosomaticist” which contained images of stairs running in different directions similar to an Escher drawing (see the featured image). It was really just her expression of how I got around the hospital. I avoided elevators and always took the stairs.

Anyway, I’m carrying several notebooks and loose papers keep falling out. I get lost in this jumble of halls and stairways, never finding my destination.

The dream is probably just me telling myself I’m failing at something in my waking life. It’s not like I need a dream to notify me.

This is a long way of saying I have many regrets, and that I may not know exactly how many. Some of them are less important than others. Take the “I’ll never be a scientist” theme. I’m not terribly broken up about it.

After all, rodeo clowns do pretty important things.

Break The Retirement News Gently to Doctors

I’ve seen several articles on Medscape about how to convince doctors to retire or even force them to retire when they’re too old to practice. The articles are titled, “How Old Is Too Old to Work as a Doctor?”; “Are Aging Physicians a Burden?”; and “When Should Psychiatrists Retire?”

The Great Resignation almost makes the debates about this moot. Doctors, including psychiatrists, are retiring or quitting in droves because of burnout, largely related to the stress of the Covid-19 pandemic in the last two years. However, a lot of physicians were quitting medicine even prior to the pandemic.

The same arguments get trotted out. Doctors often lack insight into their failing cognition and physical health as they age. How do we respectfully assess and inform them of their deficits? Are there gentle ways to move them away from active medical, surgical, and psychiatric practice and into mentoring roles to capitalize on their strengths in judgment and experience?

The decision to persuade some doctors to retire, not so much because of advancing chronological age but because of dwindling cognitive capacity and other essential skills, needs to be handled with empathy and wisdom, especially if this is going to increase the workload for the rest of the doctors holding the fort.

Like the song says, “Break it to Me Gently.”

And speaking of songs, this doctor retirement discussion reminded me of a song I heard on TV when I was a kid. I could remember just one line, “Your Love is Like Butter Gone Rancid.”

I thought I heard it on an episode of an old TV sitcom, The Real McCoys. In fact, it was from a 1968 episode of the Doris Day Show called The Songwriter. Hey, we watched what my mom wanted to watch.

The song’s awful lyrics, which Doris Day “wrote” (only as part of the show; it was actually written by Joseph Bonaduce) were tied to the melody of “My Bonnie Lies Over the Ocean”:

Your love is like butter gone rancid,

It’s no good now, it’s started to turn,

I pray that it’s just like the man said,

You can’t put it back in the churn

Can’t put

Can’t put it back in the churn

Oh, durn!

You can’t put it back…in the churn

The context here is that another character (Leroy) in the show had previously submitted the lyrics of a similarly bad song (“Weeds in the Garden of My Heart”) to a crooked music publishing company that lavishly praised the song and promised to publish it—at Leroy’s expense.

Leroy was clueless about getting cheated. He was too dumb to know how bad the song was, but his feelings would have been badly hurt if the family just flatly told him that. They had to figure out a way to break it to him gently. So, Doris wrote the equally terrible “Your Love is Like Butter Gone Rancid,” and performed it for Leroy and the rest of the family. Leroy thought Doris Day’s song was garbage but didn’t know how to tell her without hurting her feelings.

Doris then told Leroy she was also going to submit her rancid song to the crooked publishing company.

After Doris got the exact same letter the crooked company sent to Leroy—he learned his lesson and felt supported, gosh darn.

Anyway, I was moved to write a short song about the doctor retirement issue, “When Doctors Are Too Old to Practice,” sung to the tune of “My Bonnie Lies Over the Ocean” of course:

When doctors are too old to practice

And can’t tell your elbows from knees

When they sing old songs to distract us

It’s high time we tell them to leave

High time

It’s high time we tell them to leave

Oh, beans!

It’s high time we tell them…to leave

I’ve received hundreds of billions of requests for a sing-a-long version of “My Bonnie Lies Over the Ocean” because you can’t sing the parodies unless you know the original tune.

Here you go!

You’re welcome.

Featured image picture credit: Pixydotorg.

The Chicken Finally Lays An Egg

Below is an old post from a previous blog that I published on June 6, 2010. Although the title in my record is simply PM Handbook Blog, there must have been another title. Maybe it should have been more like The Chicken Has Finally Laid an Egg (you’ll get the joke later).

There are two reasons for posting it today. One is to illustrate how the Windows voice recognition dictation app works. It’s a little better than I thought it would be. The last time I used it, it was ugly. I’m using it now because I thought it might be a little easier than trying to type it since I still have problems with vision in my right eye because of the recent retinal tear injury repair. So, instead of doing copy paste, what you’re seeing is a dictation—for the most part.

On the other hand, I’m still having to proofread what I dictate. And I still find a few mistakes, though much fewer than I expected.

The other reason for this post is to help me reflect on how far the fellowship has come since that time. It did eventually attract the first fellow under a different leader. That was shortly after I retired. It was a great step forward for the department of psychiatry:

“Here is one definition of a classic:

“Classic: A book which people praise but don’t read.” Mark Twain.

When I announced the publishing of our book, Psychosomatic Medicine, An Introduction to Consultation Liaison Psychiatry, someone said that it’s good to finally get a book into print and out of one’s head. The book in earlier years found other ways out of my head, mainly in stapled, paperclipped, spiral bound, dog eared, pages of homemade manuals, for use on our consultation service.

It’s a handbook and meant to be read, of course, but quickly and on the run. As I’ve said in a previous blog, it makes no pretension to being the Tour de Force textbook in America that inspired it. However, any textbook can evolve into an example of Twain’s definition of a classic. The handbook writer is a faithful and humble steward who can keep the spirit of the classic lively.

We must have a textbook as a marker of Psychosomatic Medicine’s place in medicine as a subspecialty. It’s like a Bible, meant to be read reverently, venerated, and quoted by scholars. But the ark of this covenant tends to be a dusty bookshelf that bows under the tome’s weight. A handbook is like the Sunday School lesson plan for spreading the scholar’s wisdom in the big book.

Over the long haul, the goal of any books should mean something other than royalties or an iconic place in history. No preacher ever read a sermon to our congregation straight out of the Bible. It was long ago observed by George Henry that there will never be enough psychiatric consultants. This prompts the question of who will come after me to do this work. My former legacy was to be the Director of a Psychosomatic Medicine Fellowship in an academic department in the not-so-distant past. Ironically, though there will never be enough psychiatric consultants, there were evidently too many fellowships from which to choose. I had to let the fellowship go. My legacy then became this book, not just for Psychosomatic Medicine fellows, but medical students, residents, and maybe even for those who see most of the patients suffering from mental illness—dedicated primary care physicians.

My wife gave me a birthday card once which read: “Getting older: May each year be a feather on the glorious Chicken of Life as it Soars UNTAMED and BEAUTIFUL towards the golden sun.” My gifts included among the obligatory neckties, a couple of books on preparing for retirement.

Before I retire, I would like to do all I can to ensure that the next generation of doctors learn to respect the importance of care for both body and mind of each and every one of their patients. That’s the goal of our book. And may the glorious chicken of life lay a golden egg within its pages to protect it from becoming a classic.”

Chicken picture credit: Pixydotorg.