Girly Mag one copy tid prn lust, disp. # 10, no refill

Here’s a new one: this morning a nurse asked if I wanted to write an order for porno mags. This was requested by a male patient, who recently has been bedding (or perhaps “bathrooming”) multiple females from the ward. I don’t know whether buying him porn will improve or worsen the situation. Probably I played hooky the day they taught us about porno mags in med school. My first reaction was to say “Porno mags are not a medical device or intervention”, and punt the question to an administrator. A little asking around, though, revealed that a female patient already has a stash of Playgirls in her room. “But that’s different,” said one staffer, “she’s a girl.” Is it different? How? Does it matter? Why do these questions land on my desk?

I think I am not going to touch this one with a ten-foot vibrator. I can see all manner of legal trouble heading my way if I get involved-- sexual harassment, gender discrimination, civil liberty, first amendment, ADA, who knows. Plus, I’m not even sure our pharmacy stocks porn. They’re still getting over my inquiry about condoms the other week.

Big Trash

Each year in the Smallish City there is one day, and one day only, when you can dispose of Big Trash. “Big” here means anything larger than an average kitchen trash can—so, TV’s, old appliances, mattresses, large pieces of bad art, bodies, etc. all get stored up throughout the year and vomited onto the sidewalk in one great communal purge.

Of course, there’s a certain amount of scrounging and looting that goes on. This year I didn’t have much to dispose of, but a chair I put out disappeared within an hour. I also tossed a defunct computer printer, a turntable, and, with remorse, at last, the remains of my LP collection. Well, almost all the remains. Some I just couldn’t part with. Here’s what I kept, and why:

For the album art that is imprinted on my brain: Asbury Park (Springsteen), Banana Album (Velvet Underground), American Beauty (Dead), Abbey Road, Untitled (aka Zofo or Led Zeppelin IV), Dark Side of the Moon.

-Because they are close to original pressings: Beatles ’65, Sgt. Pepper’s, Yellow Submarine, Revolver

-For the liner notes: Harvest (Neil Young), London Calling

-For the indelible effect on my youth: The Clash

-For the actual working zipper on the cover: Sticky Fingers (Stones)

-Because I borrowed them from my parents at least a decade ago, and should return them: Strangers in the Night (Sinatra), Jazz Sur Seine (Percy Heath et. Al.), Bert & I, and Other Stories From Down East.

Tonight, after the big dump trucks had come and gone, a neighbor pounded on my door. He looked irritated. He held up a shipping label with my name and address, written in the hand of TurboMom, which must’ve been on the box holding the LP’s. He related that an enormous pile of plain-old, non-Big-Trash-eligible garbage was extant on the corner by his house, he was about to call the city to report it, he had found THIS in the pile, and did I have anything to say for myself? For the similarity to Alice’s Restaurant I cracked up laughing. I almost said it out loud: “Yes sir, officer Obie, I cannot tell a lie—I put that address label under that garbage.” But Mr. Neighbor, who, by the way, often “entertains” the entire neighborhood by playing the accordion in his front yard, was not amused. “Just didn’t want you to be blindsided,” he said. “They give out pretty hefty tickets.”

I went down the lane to investigate for myself, and saw that there was, indeed, a huge pile of illegal refuse—none of it mine, with the exception of one cardboard box (someone had taken the LP’s). We’ll see what happens next. If they put me in the Smallish City jail, I do hope they forget to remove the toilet paper—because I’d just love to “bend the bars, roll the toilet paper out the window, slide down the roll and have an escape.”

Letter

Dear { },

I don’t know who you are, or when you did it, but I wanted to thank you for planting that crabapple tree in the backyard. I wish I could tell how old it is without sawing it down to count the rings. 40 years, maybe? If you weren’t a young person when you planted it (and how many young people plant trees?) there’s a good chance you’re dead now. I’m sorry about that, but it may mean you can read this through the ether, and that would please me.

Anyway, I wanted to let you know that tree is the most beautiful thing in the neighborhood. It blooms every other year, as you probably know, sometime around May 20th. It’s in full glory right now, every square inch covered with white and yellow flowers. When I come home I pull into the driveway and sit in the car staring at it. Then I get out and bury my face in the blossoms, sucking in the intoxicating, sweet smell. I cut off a few spangled branches and put them in a vase in the kitchen (along with some lilacs—did you plant those, too?) and the scent drifts through the house.

The tree got me thinking about beauty and questions of less and more. Two of these trees together would not be twice as lovely. Fifty together might bore the eye. Yet this one by itself stuns every passerby. On the other hand, I estimated this one tree may have 50,000 or more flowers. Am I missing the beauty of the individual flower, due to their numbers? Probably. This spring, before they opened, I couldn’t even remember if they were going to have four or five petals (they have five).

I haven’t pruned the tree since I bought the house, and feel I’m letting you down a little there. Frankly, I prefer things a little wild, and normally am not inclined to tame or restrain natural objects. But I know the tree needs it, so I promise I’ll figure out how to do it sometime soon.

Anyway, thank you again for your foresight, which has brought me a lot of happiness. Someday I’ll plant a tree, somewhere, to continue the favor.

Best wishes,

Turbo

Smart Food

This evening at Pricey Health Food Store I parked the (non)TurboMobile next to an identical twin of itself. The other car's owner and I arrived back at the cars at the same time. "Thought maybe if I parked them together, they'd have babies", I said.

"Look at my rear window!", she said, "I can't afford any more babies!"

She closed her hatchback, revealing the following stickers:

BATES
CONNECTICUT COLLEGE
JOHNS HOPKINS
BOSTON COLLEGE
U PENN

Wow. Maybe I should eat more food from that store...

Rainman

This afternoon I finally set out on a systematic, empirical investigation of the source of the roof leak. This is not unlike locating the source of the Nile, and may take as long (actually, I understand they still haven't quite decided on that.) This project involves using a garden sprinkler to spray different areas of the roof until I find one that produces water through the bathroom ceiling.

Makes perfect sense to me. But here's what the neighbors saw: "This afternoon, the first in two weeks that could be described as sunny and dry, Dr. Turbo was observed to climb up a ladder to his roof. He carried a backpack and pulled along a garden house. Fifteen minutes later he returned to ground level. Shortly thereafter, it began to rain on his backyard, but no one else's. Torrents of water came flowing off his roof flooding his just-barely-dried-out deck and driveway. Half an hour later, he's still making it rain on his own house. He, surely, is a total wingnut."

I did my best to prevent any rain from impinging on my neighbors' properties, but the quarters are tight here in the Smallish City. Moreover, I fretted about the psychological impact this project may have on my abutters. After two weeks of rain, seeing this artificial deluge could really distress someone.

But the fretting was pointless and the project itself has stalled. Because an hour after I turned on the hose, it started raining again. Sigh.

"I don't know why I spend my time writing songs I can't believe, with words that tear and strain to rhyme"

The thought to re-tool in a different medical specialty comes to me now and then. Something that makes more use of what I learned in medical school. Something more technical or more tangible. Something where the results are more noticeable.

At times I'm not sure I have the ego strength to continue in psychiatry, or at least this particular flavor of it. I was just lying in bed doing a rough calculation of how many of our patients really get better, how many of those improvements can realistically be traced, even in part, to my efforts, and how many of those can appreciate what's happened. I estimated about 2%. By the way, the fellow I mentioned a couple weeks back, who said he was about to be be discharged and thanked me for my help, was not actually leaving, nor much improved. He's still upstairs, back to refusing medications and threatening people.

The other night I chit-chatted with another MD of about my age at a dinner party, a specialist in a surgical field. He told of a patient who he had treated emergently after an unfortunate accident, who turned out to have a slip in the same marina as the doc's boat. Ever since, out of gratitude, the patient has informally looked after the doc's boat when the latter wasn't around. Jus an unspoken thank-you. That sort of thing doesn't happen in my world. On the contrary, I sometimes awaken at night to a noise in the TurboPalace and wonder if it might be one of the several very paranoid people who have "promised" to do one thing or another to me after they get out of Green Acres.

Besides these intangibles, I later learned that the specialist owns a home actually worthy of the title Palace, as well as two big boats (one sail, one power), three luxury vehicles, and two ski homes (one in Smallish State, one out west). Not that I want, or could even keep track of, all those things. But it does say something about the relative societal value of our work, and that, I'm afraid, I do care something about.

I also discovered this week that I could probably make about twice as much per hour as a courtroom "expert witness" in psychiatric lawsuits as I can actually practicing psychiatry. Not to mention that while practicing psychiatry you constantly run the risk of winding up the defendant in such a lawsuit; simply being a witness would be much preferable. Which all is starting to make me wonder if the entire purpose of psychiatry is the generation of lawsuits to support the legal and insurance industries.

Today's cynicism session ends here. I'm going out to plant impatiens and morning glories.

P.S. Lest you think ill of the specialist-- much of our conversation centered around his assertion that the wealthy don't pay enough taxes, and a proposal he had that out-of-state vacation-home owners should pay double the property taxes of local residents.

Lucky Number?

The Smallish City has had rain every day for the past 11 days. Also, I just heard we have had a total of 11 inches of rain so far this month. Perhaps this number means something.

Can't Live Without It

Stopped by the soda machine just now for my habitual Diet Coke. There I ran into the same social worker mentioned in the previous post about potato chips. Her eye grew large. "Whoa!", she cried out, "you drink soda! Oh my god! That blows me away! I thought you were perfect!" Apparently I need to work on my squeaky-clean image here.

Later an elderly patient came running down the hall after me.

Pt: "Dr. Turbo! Dr. Turbo! I'm going shopping today. I have a very important list of things I need!"
Dr. Turbo (hoping against hope that the list includes a badly-needed brassiere): "Well, show me your list, let's have a look."

The list:

PURPLE BATHROBE WITH PINK AND YELLOW FLOWER
PURPLE SLIPPERS (FURRY)
BARBIE (PURPLE DRESS)
PURPLE EARRINGS
COLORING BOOK

Dr. T: "My, you sure do like purple, don't you?"
Pt, emphatically: "I would die without my purple!"

Perfect Timing

We have four more days of rain in the forecast starting tomorrow, but today, for a few hours, the sun came out. And just at the same time, the crabapple burst into flower (was it holding off?)

During this week in 1851, Thoreau wrote: "If you have an inclination to travel, take the ether. You go beyond the furthest star." The same might be said of putting your head in the midst of a flowering crabapple and breathing in deeply. The aroma is exotic and delicious. I felt transported to someplace far beyond my back yard.

Change Of Scenery

Good news! I’ll be switching units at Green Acres shortly, from the acute civil ward to the long-term forensic ward. When I say “civil” here I don’t mean to imply “polite and well-mannered”—it’s been anything but. “Civil” in this context means “not currently in the custody of the correctional system.” The forensic side, on the other hand, houses our patients who have become seriously ill in jail, or are under evaluation for competence to stand trial for a crime, or have been found not responsible for crimes due to the influence of their mental illness.

It’s that last group that I’ll be working with primarily, and I must say, I’m looking forward to a break from the frenzy and hazards of my current ward. You might think this sounds backwards, seeing as I’m about to pick up a dozen murderers, attempted-murderers, arsonists, rapists, and so forth. But the truth is, some of these are among the least ill, least dangerous, and most motivated people in the hospital. They’ve been remanded to G.A. indefinitely, until they can prove to the courts that they are “no longer a threat to society”. That’s a vague and exceedingly difficult standard to reach. So they’re with us a long time, getting treatment, every six months allowed a hearing for incremental steps towards release. In the best-case scenario, this will take several years. Possibly many years. Not so much because treatment necessarily takes that long—often it does not-- but because society takes a dim view of releasing these folks, no matter how sane they become. “Lock ‘em up and throw away the key” is the common sentiment after a grim, publicized crime. As these patients come up for review by the courts, the victims and community at large often rally again and again in attempts to keep them hospitalized. Media attention and photos published in the papers serve only to exacerbate anxiety; at these times some patients receive death-threats and other harassment.

In my opinion, it’s very misguided— for every stable forensic patient making the newspaper because he is asking to increase, say, his supervised employment from four to eight hours a week, there are several extremely ill civil patients teetering on the edge of committing serious crimes but getting no attention. Many civil patients leave the hospital sicker than the forensic patients who have years more hospitalization in front of them.

Once fully treated, some forensic patients have barely perceptible mental illness. They are routinely mistaken for staff around the hospital. You would not glance at them passing on the sidewalk. If I had to choose one particular patient from Green Acres to have as a roommate, it would be one of the murderers.

Anyway, as so much in the world of mental health, what seems like up is really down, and the front door is actually the back. But no matter— for this shrink, the switch to working with “the criminally insane” is going to be a bit of a vacation.

All-Natural Poison!

It was another long day of patients offering to knock my block off if their tobacco-related demands were not met. One fellow slept through one of the five smoke breaks (officially and euphemistically called “fresh air breaks”), then demanded that staff take him out for a “make-up” break. When this didn’t happen, he paced the unit with clenched fists. When I offered some nicotine gum, he threatened “ninja-level violence”. Another big guy was transferred from a different (smoke-free) hospital; the transferring team coaxed him into going along with the move by the promise of smoking at Green Acres. They neglected to tell him that we do not actually supply people with cigarettes, we simply let them smoke 'em if they got 'em. (Although at times beleagured staff, legitimately fearing for their personal safety, will break the rules and buy patients cigarettes out of their own pockets.) Anyway, since this guy came with no cancer sticks, he had none to smoke. My offer of nicotine inhalers was met with a tirade against “gas chambers” which I shall not reprint here.

Came home and was reading Newsweek. I found in the middle of the magazine an ad for “American Spirit” brand cigarettes, which touts “Made with 100% organic tobacco”. Excuse me? What bizarre niche market are these aimed at? The health-conscious smoker? This is rather like marketing organic cyanide or mercury-free lead paint. In fact, you might well be better off smoking tobacco-free chemical fertilizer than chemical fertilizer-free tobacco.

Shrinks and Lawyers, IV

Amusing tidbit of news from the Smallish State this morning:

"SMALLISH CITY, Smallish State (AP) -- Prosecutors say J.T. walked into a pharmacy in Very Small City in October 2004 while wearing a disguise and carrying a CO2 pistol that looked like real gun.

He demanded Oxycontin from the pharmacist, but made off with two bottles of Ritalin instead after becoming impatient and jumping over the counter when the druggist took too long to open a locked safe."

Free psychiatric advice to the lawless with attention-deficit disorder: take your Ritalin before doing your crime. Otherwise, you will not have adequate focus to pull it off.

Smallish City Natural History

Pouring buckets at bedtime, pouring buckets at wake-up, pouring buckets all the way to Green Acres. The regions between Smallish City and Major Metropolitan Area are under water, suffering their worst flooding since the hurricane of 1938.

Stuck in my head is a line from Frost:

"The roadside flowers, too wet for the bee,
Expend their bloom in vain."

At the Turbopalace, this is the week when my favorite trees bloom. The huge lilac reaches its upper branches to the windows outside my second-floor bedroom. Usually, for four or five nights each year, I can fling open the sash and drift to sleep under the narcotic romance of fragrant lilacs drifting into my chamber. At the other end of the yard is a lovely old crabapple, which flowers in an aromatic firework of bloom, but only every other year. I've been waiting two years to enjoy it again; it's about to happen. But all of this will go to waste. The windows are closed against the cold and wet. The delicate petals of the apple seem destined to be swept away the moment they open. There are no bees out and about.

"Oh, come forth into the storm and rout
And be my love in the rain."

Smallish State Water Torture

Just in case you're playing along from home:

Yes, it is still raining. Eighth straight day, virtually nonstop.

Yes, the roof is still leaking. Ditto.

Yes, my leak-collection-and-redirection system seems to be holding up.

Yes, the 10-day forecast still goes like this: Showers, Rain, Rain, Showers, Rain, Showers, Showers, Showers, Showers, Partly Sunny.

I am being driven mad by the sound of droplets. I cannot bear to hear the windshield wipers. Pray for us.

Optional Reading: A Ramble

You might think that I’d have better, or at least other, things to think about beyond the leak in my roof. I suppose I do. But somehow, when this one problem is active, it consumes me. Why?

Do you recall reading somewhere about the “basic necessities of life”? They are usually listed as food, water, and protection from the elements (some touch-feely types add “human interaction”). I recall one of my anthropology professors stating that the first three are the only things elemental to human existence; everything else we add is “culture”. Also, many of the writers I’ve most enjoyed—from Thoreau to shipwreck survivors—have purposefully or accidentally come to “front only the essential facts of life” (HDT) and have considered the shifting lines between actual necessity, perceived necessity, and luxury.

Now, when you’re steeped in these traditions, having a persistently leaking roof can be philosophically threatening. There is a small part of me that feels I am failing at the “three basic necessities”, so long as I cannot keep the rain out of my house. Only three things I have to do: eat, drink, and keep out the weather. Lately, I am scoring 66%. I feel, ever so slightly, that I am not living up to the general performance expectations of the higher apes.

At the same time, I have been pondering the greater meaning, if any, of this leak. On the one hand, I do feel somewhat cursed by this persistent affliction. But, consider these facts: the ceiling area of the TurboPalace top floor is roughly 450 square feet. Of that, only about 12 sq. ft. is situated directly above a toilet, sink, or bathtub. Yet the leak sprung right over the bathtub drain, a happenstance which has prevented the entire Palace from turning to goo. The chance of such good fortune is only 2.6%. So, considering that aspect, you could argue that I won the roof-leak lottery. What does it mean when the universe dishes out a significant, seemingly random punishment, but accompanies it with a smaller, but seemingly intentional bit of ameliorating protection?

Lastly, I’ve been considering the ethics of the following plan: put a big container between the roof and ceiling, under the leak; patch up the ceiling behind it; sell the house and run. I’ve done some rough calculations: Based on empirical data (such as the rate of drips per minute from the leak, and the rate at which 9’s water bowl evaporates) I estimate that I need a vessel with about 10 gallon capacity and 500 sq. inch surface area. This would be sufficient to capture the leak produced a four-day maelstrom, and then evaporate it within a week. If the storms are longer, or more frequent, trouble. But I’ll be out of the country by then.

No, I have nothing better to do than calculate such things. I could go for a bike ride, or paint the kayak, or plant some ferns. But you’ve forgotten—it’s pouring out.

I Ain't Seen The Sun Shine Since-- I Don't Know When

It's been raining in the Smallish City, almost constantly, for six days. I just looked at the ten-day weather forecast; every single day is marked for "rain" or "showers", with the sole exception of next Thursday, which will be "mostly cloudy".

The roof is leaking non-stop. I've devised ever more clever and elaborate mechanisms to absorb, collect, channel, and dispose of the water after it comes through the roof, but before it hits the ceiling. This morning I will go to the hardware store and buy some plastic tubing, silicone sealant, and other supplies for what I envision as the ultimate drip-container-- a system which, if successful, will have the dual benefits of preventing further ceiling damage and allowing members of the household to shower with actual rainwater. They say this is good for your hair.

But a solution to the leak itself appears far away, on the other side of this biblical deluge. Meanwhile, the lawns of the TurboPalace are growing out of control, unmowable due to the rain. Soon, I'll need a scythe to tame them. The minds of Smallish City residents are slowly but inexorably waterlogging into a collective depression and lethargy that may not lift until August. I'm dreaming of a particular overheated, sandblasted cactus plateau in southern Utah. I think I see mildew growing on my arms and spanish moss on the nape of my neck.

Seriously Not Right

I'm just back from a Friday afternoon break to the Green Acres snack vending machine. Recently, by Administration fiat, most of the candy bars were removed from the machine (an attempt to improve patient nutrition). Evidently, that left some vacancies for new items.

So what's appeared in place of the candy bars are three varieties of "Madhouse Munchies" brand potato chips. I am so not joking. They have on the front a graphic depicting a "crazy" crooked house with "wacky" off-kilter fence and two "insane" eyes peering out from the darkened front door. On the back of the bag, it reads "Call us crazy? Sure. Just don't call us your average potato chip!"

It's hard for me to imagine how anyone thought it was appropriate to order these for a mental hospital. But, truthfully, it's about typical for the decisions made around here. And, they're pretty good chips, too.

Infringement

To: K.L., In-House Counsel
From: TurboGlacier, CEO, Shrink Or Fade
RE: Possible Infringement

Dear Counselor L.,

It was called my attention today that the national pastry purveyor
"Dunkin' Donuts" (DD) appears to be infringing on the intellectual
property of this corporation. To wit, DD is promulgating a new
beverage which they have named the "Turbo Ice", the phrasing and
imagery of which is undeniably similar to our trademarked identity of
"Turbo Glacier".

Please review the enclosed exhibit, and comment by reply as to whether we have a case in this action, and, if so, how many millions I am likely to garner. As usual, you will continue to receive your retainer fee in lieu of any percentage of settlement.

Yours truly,

Turbo Glacier, MD

May 11, 2006

Small Wheels, Big Engine

A little ditty I half-plagiarized from Cake while in a meeting this morning. To the Tune of Short Skirt, Long Jacket:

Small Wheels, Big Engine

I want a vespa with a headlight like a diamond
I want a vespa that knows the way home
I want a vespa with tires that peel out
And tailpipes that burn like cigarettes

I want a vespa with the right gear ratios
That's fast, thorough, and sharp as a tack
She's playing in traffic
She's got a small rack
She's touring Smallish City
And picking up slack
I want a vespa with small wheels and a biiiiig engine.

I want a vespa that gets to speed quickly
I want a vespa that stops right quick
This vespa will bring me uninterrupted prosperity
She uses classic styling to cut through red tape

With bright green fenders that shine like justice
And a growl that is dark like tinted glass
She is fast, thorough, and sharp as a tack
She's touring Smallish City
And picking up slack.
I want a vespa with small wheels and a biiiiig engine.

I want a vespa with smooth acceleration
I want a vespa that's been well-maintained
At the TurboPalace we will meet every evening
We'll start right up and drive to the bay.

She is a vespa with a cupholder armrest
She is a vespa that will get me there
I'm changing my bike
To one with a motor
I got her in trade for an old pair of K2's
I want a vespa with small wheels and a biiiiig engine.

Never Dull

A few weeks ago a patient turned south without warning. We'd been doing pretty well together, I thought, with some ups and downs. He's a very powerfully-built guy, but I hadn't had particular concern about my safety around him. Then one morning he wanted to talk, and we (along with an older male nurse) went and sat down in a small room off the unit. Almost instantly I realized I'd made a mistake-- he was glaring, his jaw rippled with tension, and his knuckles were white while his figners drummed the edge of his chair. He demanded unsupervised time out of the hospital. He told me I needed to give him a specific medication. He wanted extra cigarettes. He told me my name was not Dr. Turbo, he'd found out, and I knew damn good and well what he was talking about. He told me I was purposefully trying to poison him with Medication A, and that his liver and kidney were rotting due to my deceit. Was I afraid of him, he wanted to know? Hmm? I talked, stalled, tried to compromise, reason, soothe, use non-threatening body language-- but everything I said and did seemed to have diabolical, hidden meaning that made him even angrier. He moved to the edge of his seat. Several times, I imagined the attack that seemed almost inevitable-- a leap across the tiny room, a fist towards my head, maybe I'd be fast enough to slide out of the chair and get my clipboard in front of my face. Maybe the nurse would be able to grab one arm. Would other staff be able to get through the locked doors into the little chamber before we got pulverized?

There seemed to be a moment where he was distracted by a movement in the hallway, and I jumped up to open the door, saying "Let's head back to the unit." He tried to get behind me at the next door, but by making an elaborate motion of gentlemanly-ness (which included a half-bow that served as preparation to duck) I got him through first. Then, a long decompression back in my office.

Later he was transferred to a different ward. I saw him today at the snack machine. He smiled and reached out a huge paw. I looked in his eyes, saw trust, and took his hand. "Thanks Dr. Turbo," he said, "I'm doing a lot better. I'm going home tomorrow." We bought sodas. He shook my hand again. "Thanks again." Off he went. Not sure what the moral of the story is.

Resurrection

I’ve hauled an old friend out of the cryogenic freezer this past week: my fire-engine-red c. 1990 Cannondale road bike. For a long while, back there, biking was a large part of my life. At times I commuted to work or school by bike, lived car-free in Major Metropolitan Area, and rode long trips with friends or led them for kids. The Cannondale (which was my sixth bike) and I traveled from the Oregon coast to Denver via Montana, from San Diego to Santa Fe, and four thousand-mile jaunts through Colorado and Utah.

Then in 1996 road biking came to an abrupt end. I’m not sure quite why—multifactorial, I suppose. I moved to live on a succession of dirt roads (and much later, to a smallish city.) I no longer had chunks of free time in the summers. The non-profit bike-tour group I’d started had one really rotten trip, then came to an abrupt and acrimonious end-- as did an engagement which was peripherally related. I found other pursuits on snow and water. The red bike languished in one cellar after another. Now it’s been a decade since I did what used to be second nature: put a tent and sleeping bag on my bike and ride into the sunset.

But lately there’s been some bike fervor around the TurboPalace, and it inspired me to get the old nag out and see if she still could run. I’ve been riding out to the lighthouse, and around the city, and it feels good. Well, except certain areas.

Here’s what’s happened since I was last a serious cyclist:

1) They invented clipless pedals. I need to go find some of these new-fangled gadgets. Yesterday I forgot I was locked in to my toe clips, and crashed sideways from a standstill at a crosswalk. That was embarrassing and moderately painful.

2) They changed all the wheels from 27” to 700mm. And pretty much stopped making fast, high-quality 27” tires. Which may mean I have to buy new wheels in order to buy new tires.

3) They doubled or tripled the price of a bicycle. I thought maybe I’d buy a whole new bike, seeing as I was heading for new pedals and new wheels-- till I got the sticker shock. Then I looked on eBay, where I found Cannondales a year or two older than mine listed as “vintage” bicycles and got truly depressed. Where did the years go?

4) They made everything lighter. Roommate’s boyfriend has a cyclocross bike with 14-spoke wheels. My wheels have 40 spokes.

5) The gel in my gel saddle evaporated or turned to rock. Meanwhile, I lost a certain amount of padding in the corresponding anatomical region. This needs to be rectified. So I’m drinking more beer.

6) Pearl Izumi started making bike jerseys featuring Cookie Monster and Oscar The Grouch. This alone is enough reason to get back into biking.

See you out there?

A Shrink Rap

I don’t want to discuss what happened at GA while I was away for the weekend (besides, our in-house counsel at SoF has advised me not to). So I thought maybe you’d all enjoy a quick update on the general news in psychiatry instead.

First, an encouraging development in the realm of psychopharmacology: coming out shortly, the first antidepressant in patch form. On the surface (so to speak) this sounds gimmicky, and smacks of yet another drug company trying to extend its patent on a medication by “inventing” a “new delivery system”. But in this case, may be some real benefits. The med involved, selegiline, comes from a class of antidepressants which are sometimes effective when others fail—- but are little-used because they require special dietary restrictions which, if transgressed, can cause serious hypertensive crisis. The patch, though, puts the medication right into the bloodstream, bypassing the GI system where the dietary problems arise. So, at least at lower doses, no changes in diet needed. I don’t get worked up about new drugs very often, but this one I’m optimistic about for some of my folks with intractable depression.

Also we’ve been talking a lot at the hospital about the results of the CATIE (Clinical Antipsychotic Trials of Intervention Effectiveness) studies. At a conference last week we reviewed some of the latest data, showing that people with schizophrenia who did poorly on their first antipsychotic trial tended to do best when switched to one particular antipsychotic (clozapine) compared to several others. They did better both in terms of fewer symptoms, and sticking with the medication. Unfortunately clozapine can cause a rare but potentially dangerous blood disorder, so patients taking it have to come in weekly for a blood draw. That’s caused people to speculate that part of clozapine’s benefit may not come from the medication at all, but from the mandated weekly contact with caregivers, a theory we tossed around again in the meeting. It suddenly crossed my mind that no one’s ever considered whether the blood-letting itself might be the therapeutic bonus. I mean, for hundreds of years, bleeding was considered excellent therapy for everything. I couldn’t resist bringing up the idea, but my colleagues were not favorably impressed. I’m considering how to do a study of this…

Lastly, some demographic observations. Below, a map from the latest issue of Psychiatric News, showing the variable concentration of psychiatrists around the country. Look familiar? Compare to the map of election results from the 2004 presidential election. Eerie, no? Consider: with the exception of Michigan, Minnesota, and Delaware, every state that voted for Kerry has more than 13 psychiatrists per 100k population. And, every state with more than 17 shrinks per 100k voted for Kerry. I started making a more detailed analysis of both sets of data, and the correlation started to look even stronger. Example: Washington, DC has the highest per capita shrink concentration in the country, and the highest percentage vote for Kerry. Massachusetts was #2 in the nation, for both.

Coincidence? What to make of this? The most obvious explanation, to me, is that vast portions of the country are suffering from untreated mental illness, causing them to vote erratically and irrationally. I am sure the counter argument can be made—that the northeast and California are full of shrinks because the people are so nuts. But my daily experience argues against that theory: every day in the mail I get multiple letters from headhunters in Red States promising me enormous salaries if I would please just consider coming to practice psychiatry in their communities. I’ve not had much interest in that, but after looking at this data, I’m wondering if it’s my political duty to relocate to Nebraska.

Sometimes it seems that the aspects of my life with which I am happiest are those which are least mutable. If something can be changed, I am likely to change it, out of dissatisfaction. If something cannot be changed, I am likely to find it perfectly acceptable or better. Unfortunately it's difficult to sort out what is cause, and what effect.

[Exception: The walls of the TurboPalace have been bare white since I moved in three and a half years ago.]

A Green Acres Interlude

Dr. Turbo: "So let's talk about these, um, liasons you've been having with Ms. X in her bedroom. How do they come to pass-- is she inviting you in to her room?"
Patient: "Oh yes. She's as interested in it as I am. The sex is totally conceptual."

Future Customer?

From nursing report this morning:

"Miss W. is still irritable and refusing to go to the cafeteria for meals. She's been losing some weight. But this morning I put a banana, some toast, and a Carnation instant breakfast in her room, and when I came back, the toast was gone."

On the roof, it’s peaceful as can be, and there the world below don't bother me, no

This J.T. song, which has been running through my brain today, offered some insight. Perhaps the problem is not with the roof. Perhaps the problem is me, and my relationship to the roof. If, the song says, I am on the roof, the world below the roof don't bother me. Of course! The roof cannot drip on me, if I am standing atop it. I could simply set up my tent on the roof. I have weathered many rainstorms in my tent. I'll just move up there every time it rains.

Or, I was thinkning about Chernobyl. They enclosed the reactor in a concrete sarcophagus, but the sarcophagus is cracking and beyond repair. So they're building a hanger over the whole thing, to enclose the sarcophagus that encloses the reactor. Maybe I could build a hanger over my roof, instead of continuing this charade of trying to repair it.

Stirred And Shaken

I spent much of Monday and Tuesday having meetings with patients around sexual activity, which has suddenly exploded on my unit in the past week. The hospital has no clear policy on the matter, other than to officially “discourage” sex and promulgate a sort of “don’t ask – don’t tell” approach. But it’s been going on, not very discretely, mostly in the bathrooms—with up to three partners in one week for one patient, and more than once each. Potentially very messy.

Anyway I thought I had a pretty good rapport with this fellow, but my attempts to discuss the situation with him have not been well-received, with much cursing and shouting. Last night he started slashing at his arms with broken bit of glass, and again this morning with a staple, leading to a number of sutures and being moved to a different part of the unit. When I went to see him there staff warned me that he was threatening to kill me, and indeed I found him pounding on the windows and screaming not-very-nice things at me. He bashed in a fire extinguisher cabinet with his foot. With four or five staff I met with him in the middle of the unit. He demanded to be discharged. When I told him that didn’t seem like a safe thing to do just then, he lunged and tried to punch me in the face, not quite making it. I moved behind the nursing station, and tried to discuss with him from a safer distance. He grabbed at his sutured wrist and flung out his arm, splashing blood across my shirt with some choice words about my sexuality, reproductive organs, and intellectual capacity.

Things unraveled from there. I’d like to say I handle these incidents with imperturbable aplomb, but that would be a lie. I wind up shaken, pretty well. I think about quitting on the spot.

I retreated into the chart room to catch my breath. I didn’t like having blood on my shirt, so I took a couple Little Mermaid stickers and pasted them over the spots as a temporary fix. Unfortunately, the patient for whom Green Acres buys these stickers as a reward for safe behavior saw them on me as I was leaving the unit, and also began to scream and pound—“Those are my [emphasis] stickers! What are you doing with my stickers, you [kind gentleman] doctor!” As I walked out the door, the guy who had tried to punch me yelled, "YOU'RE NOT GOING TO PRESS CHARGES AGAINST ME, RIGHT?" It hadn't crossed my mind until that point.

Later I walked over to the staff break room of another unit to sit for a minute in a different environment. A mental health aide I’m friendly with was sitting there with a cup of coffee.

“How long have you been here, L.?”, I asked her.
“Eighteen years.”
“Does it get any easier, at some point?”
She considered. “No, it stays about the same. Unfortunately, you get older, and you don’t heal as fast.”
“I hope I don’t get bashed in the head, and wind up here violently brain injured myself”, I speculated.
“If you do,” L. said, “just try very hard to remember: you like me.”

A Green Acres Interlude

Dr. Turbo: B., sometimes I see you coming down the hall running, flailing your arms and screaming. I think it might be good for you to cut down on the caffeine.
Patient: Nah. It ain't the caffeine. That's just my antisocial personality.
Dr. T: You have an antisocial personality?
Patient: Yeah. I like people, but after I'm around 'em for a bit, they start gettin' on my nerves, and I hate 'em.
Dr. T: Will you let me know if I start getting on your nerves?
Patient: Nah, that ain't going to happen. I have to like you, because you're a professional. Anyone hits you, you let me know-- I'll kill 'em for you.

I guess I did something really bad in a past life

I feel tonight like Sisyphus.

My longtime reader(s) may remember the leak my roof developed, over my bathroom, late last summer, which destroyed part of the ceiling. At first it seemed this would be a moderate annoyance-- would have to call a roofer to come, etc. I had not predicted that I would have to call a roofer to come, and call him to come again, and call him to come again, and call him to come again. And in between those calls, at night in whipping November rains, climb on the roof with blowing tarps and ropes and bricks and hammers and staple-guns and two-by-fours to try to stem the flood. And how I'd live for months with a big, dripping black hole over the shower, crumbling drywall on my head. By December, the leak in the roof had become one of the overriding facts of my daily life. The drooling maw in the ceiling was becoming a member of the household, and I began to form a nihilistic philosophy around it.

Finally, sometime in January, the roofer finally hit the magic spot. The day it poured rain and the ceiling did not drip was the best day of the year for me. I literally jumped up and down in the bathroom and did a little dance. I felt liberated. Pure joy. But, pessimist that I am, I didn't quite believe the problem was fixed, so I delayed repairing the ceiling. I waited and watched over two months, through half a dozen rainstorms. Half a dozen times I stood on a chair in the bathtub with my headlamp on, stuck my head up through the black hole, and looked everywhere for any sign of leaking. None. At last I allowed it could be true: the roof was fixed.

Over my last vacation, I spent a full day repairing the ceiling. I was pretty proud of myself. Last week I finished sanding out the feathered layers of joint compound. Just needs a little paint now, will be good as new.

And then. Tonight. I came home from a party. And. The. Fucking. Ceiling. Is. Dripping. The joint compound turned to goop, drywall falling down, paint peeling, joint tape coming off in globs. Had to drill big holes to let the water out. Drip drip drip drip from everywhere. And the forecast is for five more days of rain. Back to square one. Start all over.

Honestly, at this point, the simplest solution seems to be selling my home.

"Life, liberty, and the pursuit of happiness-- no, wait, strike the 'happiness' part."

Received an email at Green Acres this morning from some higher-up bureaucrat. Seems our Acting Commissioner has been promoted to Actual Commissioner, so we need to run around and change all the letterhead (I think the version in my computer still has the wrong governor listed-- whatever.)

More amusing, though, was this p.s. attached to the email:

"Additionally, the vision statement at the bottom of the letterhead should read 'Our vision is Smallish State people living safe, healthy and productive lives' instead of 'Our vision is Smallish State people enjoying safe, healthy and productive lives.' "

I swear I am not making this up. Living your life, fine. But enjoying your life, apparently, is considered just a little too hedonistic for this state.

Rocks In The Head

517 and I went over to the Smallish State Rock Gym earlier tonight, which reminded me that I do not know how to climb rock. Nonetheless, we had a good time.

There was a young fellow in there for about half an hour talking incessently, and fairly loudly, on a cell phone headset. He had thick, dark hair so the headset wasn't very noticeable, and he appeared to be talking to himself. And while talking, he traversed walls, did boulder problems, jumped on the mats, roamed around making strange stretching motions, batted at dangling ropes, tugged at anchor points, etc. This, pretty much, is what very psychotic people look like. However, he wasn't psychotic, just annoying.

Urban Mountaineering IV

Yesterday afternoon my neighbor H. rang the doorbell. I should've known not to open the door (I should've known this because her boyfriend was standing next to her, waving his hands, and saying "DON'T OPEN THE DOOR! DON'T OPEN THE DOOR!") But foolishly I did, and then, of course, I got enlisted into helping her move. From her current second-floor walk-up to her new third-floor walk-up. Both with pretty long front steps, too.

So I think I did about 40 flights, up and down, averaging about 40 pounds of stuff per flight. I swear, she has more stuff than any other 20-something I know.

They did buy me beer and pizza after, though, so I'm not complaining.

Inside Info

Things I learned yesterday about the Not So Small Bay Ferry Line:

1) When the boat from Smallish City to P. Island takes the slightly longer route around the south side of H. Island, rather than the more more direct route around the north side, it's probably because the captain and mate are planning to surf after work and want to get a better look at the swells breaking on Cape E.

2) Any time there is a mishap (such as running aground, colliding with another vessel, etc.) a number of crew may quit on the spot. This is because the next thing that happens is a visit from the Coast Guard and manadatory drug testing. Those who know they won't pass quit first, to avoid the consequences.