Wednesday, December 29, 2004

Plan for a Better World

A few things I wish would just stop:

1) Stickers on fruit and vegetables. This is just one step shy of putting stickers on people. It's just wrong.
2) Cigarettes thrown from car windows. Often still burning.
3) Dog crap in the middle of the sidewalk on my dark nocturnal walks.
4) The unstoppable thrice-daily spam I now receive from the hospital switchboard, advising me of the current temperature and windchill (while I am stuck indoors at work.)

A few things I hope don't stop:

1) The lighted time & temperature sign high above my city. Which, on rare days, is reprogrammed to read "SNOW BAN" or "SOX WIN!" or some such. It's been there for 40 years.
2) The person, or people, or crew, who snow-blow a skating space on the pond in the park.
3) Subaru all-wheel-drive. Even though I don't have one at the moment.
4) My cat's monthly empirical check to see if the "no cats on the counter" rule might have been repealed without notice.

Tuesday, December 28, 2004

Substituted decision making, with clam juice.

Last year, I approached my hospital's Ethics Committee following a heated debate with nursing staff and administrators. The dilemma involved an older woman with an unusual sort of mental illness-- one which, when treated with a simple medication, was almost undetectable, but which left her entirely disabled (ranting, spitting, screaming) when untreated. She was brought in by police in the latter state, after running out of meds for a few days. She was unable to recognize what had happened to her, and adamantly refused to resume her medications. She threw food, ran naked in the hallways, refused to bathe.

A family member had years ago been appointed by the courts as this patient's legal guardian, empowered to make all health care decisions. The guardian implored me to resume Medication X at once, noting that this had always returned the patient to normal within days. Unfortunately, Medication X comes only as pills and syrup-- which (unlike injections) are virtually impossible to administer to a person who doesn't want to ingest them. So the guardian requested we use the syrup, dissolved in juice or soda, to provide treatment without the patient's awareness. Weighing the alternatives-- doing nothing, or forcible injection of a less appropriate medication-- I agreed. However, nursing staff refused, stating they could not deceive the patient. Next stop, the Ethics Committee.

I felt that the guardian had the full legal and ethical right-- perhaps even responsibility-- to make this request. His ward was languishing, suffering needlessly, endangering herself, and unable to make remotely rational decisions regarding her care. The guardian, who also testified before the committee, wished to provide the most effective and least invasive possible treatment. He had weighed the potential risks of being less than fully open with his ward, and found them far outweighed by the benefits. I argued that, ethically, the case was little different from a parent with a critically ill three-year-old who refused his antibiotic syrup. No one would question the mom's ethics if she quietly put the syrup in Orangina, if that's what it took.

Ultimately, though, the committee disagreed with us. They determined that it was unethical to give anyone medication without full disclosure--even when that person had a guardian making the decisions. In effect, the committee felt that it was preferable to do nothing, or to use painful but obvious injections using sub-optimal medication. Shortly thereafter, all staff received a memo from the chief administrator of the hospital, stating that it was henceforth forbidden to give any patient any medication without that patient's knowledge, at any time, for any reason. I immediately wondered what we should do with a patient who was unconscious and needed medication. But I chose to keep my mouth shut.

Eventually, after many days in the hospital, the patient agreed to resume Medication X. Within 48 hours she transformed into a completely different person. Although exhausted from her ordeal, she was conversant, coherent, delightful. She showered and did her laundry and asked after her community commitments. I discussed with her at length what had happened, of which she had little memory. I asked her what we could have done to help her faster-- "You should've put Medication X in a ginger ale and given it to me," she said unequivocally.

This week, my dear old cat, a big ex-stray, had to begin taking thyroid medication. He is my ward, because my brain is bigger and works more logically. But he resolutely does not want to take medication. I abandoned one previous round of medication-giving, two years ago, after many days of restraining, scratching, howling, clamped jaws, and a pet who ran from me every time I came home from work. This time around was no better-- however, it seemed more critical to succeed. So last night I crushed up his pill, and kneaded it into a mini-croquette using soft kitty treats and clam juice. Even before I was done molding it, he was pacing in front of me, demanding to have it NOW. I placed the morsel in his bowl and he gobbled it up. Then asked for another. Then he jumped in my lap and purred. Then we cuddled in bed, him happy with clams in the tummy, me happy that his thyroid was going to get better.

I think there's a moral here somewhere.

Friday, December 24, 2004

Fear of flying

I've come to NYC for Christmas. On the plus side, chestnuts-- which were impossible to find in Maine-- are in plentiful supply here. On the minus side, there are several million other people here for Christmas, too. Luckily, not many are after chestnuts. Otherwise there could have been a scuffle.

The flight down began inauspiciously-- I received the full-suspicion go-through-all-your-stuff and pat-you-down-real-good search at the Portland International Jetport. As it turns out, they had good cause to be suspicious: I'd forgotten about a swiss army knife still packed in my bag from recent (terrestrial) travel. So, the TSA crew found that. Good TSA crew. They were nice about it; didn't get accusatory or preachy. They even told me how I could take it out to the newstand and have it mailed home for $5. But that would mean another trip through security, possibly missing my flight. So I had to part with the knife, which saddened me because it was a gift from at least 20 years back. So rare to hold on to something so small, and so much used, for so long. I wish I could remember every bottle of wine its corkscrew had openned.

The first half of the flight was spectacular. Mount Washington, which is barely visible from ground-level Portland on a crystaline day, leapt into glorious view seconds after take-off. All of New England appeared shades of dullness except that one mountain, glowing alabaster white like Moby Dick in his dark grey sea. And so close-- almost in Portland's back yard! Why don't I go there more often? For the moment, however, I was donning silly city clothes and flying to megalopolis instead of cavorting in snow and ice.

I'm a calm flier, but this journey ended with anxiety and fear. Part way through, the pilot began making strange turns-- west to Springfield, MA, then south to New Haven, CT (you can read N E W H A V E N spelled on the local aiport grounds), then west again along the CT coast. Just as we neared Laguardia, suddenly another turn west, with several disconcerting dips and climbs. Vague curiosity about this unusual flying progressed to mild concern as we cruised fast and low down the length of Manhattan. Roaring past the southern edge of Central Park, seemingly just about the rooftops, it was impossible not to think "Wy are we doing this? Are we aiming at the Empire State Building? Why can't I see the flight attendant? Is this where we should be getting the beverage cart and bashing in the cockpit door?" Several heartbeats skipped as the pilot made more maneuvers with an amateurish feel. I gripped the seat in front of me. Just then we cleared past Battery Park, banked hard left, and dropped over Brooklyn to the airport. I wonder if this is how it's always going to feel, now, flying into New York.

Tuesday, December 21, 2004

Why not holly, jolly, etc?

It occurred to me, as I slumped into my office chair this afternoon after scribbling numerous orders and dealing with a half-dozen peculiar crises, that I can't wait for "the holidays" to be over. Then immediately I felt like a traitor to Good Cheer and looking around to see if anyone had caught me. Putting my head in my hand, I realized it's been many years since I was truly ablaze with Christmas Spirit. The sort that leads other, better people to build snowmen, and put on community theatre productions, and make eggnog, and write scores of Christmas cards, and actually pick out a present for their postal technicians who bring the mail every day.

I used to have such Spirit, which is particularly impressive given my nominally Jewish upbringing. But it has lapsed. And I think the lapse began when I became a psychiatrist. This is not an easy time of year for people in psychiatric hospitals. And by extension, it becomes not an easy time of year for their psychiatrists. So many people longing for a little family... a snowball... a good glass of whisky... a Christmas Miracle that will wipe out their memory of what happened to them on Christmas, and every other day, when they were kids... something. And, hardly able to access and express these wishes, some take to punching, or screaming, or stopping their medications. Others, who seemed to be doing well out in the world, suddenly show up at the door, threatening suicide if not hospitalized. Here we at least have a tree, some green-and-red cookies, some gifts from Wal-Mart, a carol sing-along, and-- surely the best-- someone to say "Merry Christmas" to you on the proper morning.

I think my Christmas energy gets diffused and dispersed, trying to hold up other people's sanity, shedding a speck of glitter here, a speck there, weighing risks, protecting people from themselves in the hopes that things will look brighter in January. By the time Christmas Eve arrives, I just want to see mom and dad for a bit, smooch the cat, and go to bed early.

Thursday, December 16, 2004

Be Funny Now

I have been urged to submit an entry into a particular humor-writing contest, with a deadline in three days. Now, it's easy to be funny in certain situations, such as medical staff meetings, because no one expects it and everyone is drunk. Much harder is when someone sober aims a firearm at you, hands you a pencil, and says, "They say you're a funny guy. Make me laugh, funny guy."

Not that this exact scenario has ever happened to me. Usually, the gunman wants oral or verbal humor, rather than written. That's the way gunmen tend to be-- looking for the impulsive, cheap laugh and not so much interested in the Mark Twain style humor. Often, sticking the pencil up a nostril suffices to defuse the situation, but if that doesn't work it's really a challenge.

But let's say, for the sake of argument, that I am going to lock myself in my condo-like mansion for the next three nights furiously penning a prize-worthy humor piece, but wish to expend the least effort possible. Which topic holds the most innate humor? Options:

1) The "skunks-as-pets" movement, which seems to be gaining momentum.
2) Fad toys of Christmas Past
3) Prizes that require no effort to win
4) My emerging sciatica (this is not a real suggestion-- I'm just looking for sympathy)
5) If a tree falls on a Blog in the forest, and it still has "0 comments", should the writer quit his day job?
6) Ex-Countries we don't miss (Part II)
7) Other suggestions?

Wednesday, December 15, 2004


A pharmaceutical company representative today was giving a talk to us. One of her Powerpoint slides (complex charts and graphs) was entitled "Failure to achieve remission increases risk of relapse."

Can anyone make sense of that?

Thursday, December 09, 2004

Pawns in Space

Another chess game last night. I lost (overall score now: Me, 2. S, 4). Yet in the larger picture, my opponent appears to be on the defensive. After feeling threatened by my first entry on this subject, she unleashed a veritable barrage upon me in her own blog. I shall not continue this pawn-for-pawn by countering her use of words such as "shallow", "dumb errors", "strategic oversights", "fool", "lies and misinformation", and, worst of all refering to this page as a "weblog, sort of".

Nay, let it end here. This exchange, however, raises an important question. Can playing a silly game like chess with a friend have deleterious effects on your relationship? Well, the Russians appear to think so, and they should know. I learned recently that cosmonauts on Soyuz were forbidden from challenging each other at chess, due to fears that this would incite conflict among the crew. Instead, each cosmonaut was invited to play via radio with Mission Control. And I bet Mission Control was under orders to "let them win once in a while". The importance of maintaining order on Soviet spacecraft was further emphasized when I learned that vodka is known to find its way aboard. Can you imagine the mix? "Yuri, you have delusion. Is silly idea to say I moved pawn extra space while you go to fridge for fifth shot of Stolichnaya. Please put down hammer before porthole is broken and Nikolai get sucked out of capsule again."

By the way, you can find the recipe for a Cosmonaut here. Mmmm...

Wednesday, December 08, 2004

Plays, checks, and mates

My friend S. has been on a chess-playing rampage. We've played five games in the past week, three of them in a pub by a fire, like we do that all the time. Thus far I've won 2, she 3-- though one of hers was technically discounted, because I let her take back a move, early on. It's a peculiar experience, playing such a game with a close friend. When it's my turn to move, I'm focused on nothing but the little pieces and their strengths and vulnerabilities. I might not even notice my pants being on fire, or one of my exes walking into the bar. The neurons flash and fire, possibilities zing and richocet. Finally, a decision, then the move, and suddenly it's S's turn. All purposeful thinking ceases. A zen state descends. I sip the Guiness I'd forgotten about. I stare into the fire, or at others in the bar where we sit, or make up mental stories about the bartendress being an agent sent by my exes to spy on me. I notice the table is wobbly. No chit-chat with S, though-- she's leaned over the board, scowling slightly, mentally computing moves while her mouth says "Bompf, bompf, bompf..." (reportedly a phrase used by a chess partner of her dad.) Then her move, the mental recess ends and it's focus time again. Who knows what she does during my turn? I have no idea. Not until the game ends do we start talking to each other; like coming up to the surface after an hour SCUBA diving with a pal.

"Chess", we kept saying in a bogus French accent, "ees lik leuve..." Followed by a metaphor which was supposed to be silly, but usually cornered some bit of truth. In chess, as in love, you play, check, and mate... whether that is the start of the game, or the end, this writer cannot yet say.