Tuesday, September 26, 2006


Soon comes the window-closing time. Down with the sashes that have stayed open all summer. Out with the screens, in with the storms. Caulking putty in all the cracks, one by one, sealing out both cold and sound. Goodbye, screams and squeals of backyard children. Goodbye, strains of neighbor's cheesy accordion. Goodbye, chirps of late-migrating songbirds and caws of early-roosting crows. Goodbye, rustle of morning-glory vines and woosh of wind in the maple leaves. Goodbye, patter of rain on the deck and thrump of rain on the overturned kayak's hull. Goodbye, bang of the kitchen screen door. Goodbye, skrattle of squirrels on the stockade fence. Soon comes the silent season. In spring I will hear you all again, and you will deafen me.

Tuesday, September 19, 2006

Local Flavor

You know you're practicing psychiatry in The Smallish State when, on your first day back at the hospital, 3 out of 12 patients demand to be discharged before hunting season opens.

Monday, September 18, 2006

WWFS? (What Would Freud Say)?

I assume that my colleague’s progress note was supposed to read: “…the next logical choice in the pharmacologic armamentarium…” But what the transcriptionist typed was: “the next logical choice in the pharmacologic omeletarium…” Which is pretty funny.

It reminds me of a discharge summary I dictated in residency, in which I noted that the patient (who had severe pulmonary disease) was sent home with a home oxygen system— typically referred to as “home oh-two”. The transcription returned that I had discharged the patient “with homo, too.” Now truly, that would be an unusual medical service.

Once More Into The Breech

Fade time has come to an end again. It was back to Green Acres for me this morning. The first 30 minutes of each day is Nursing Report, where we hear what happened overnight. Here’s what it sounded like this morning:

“She was testing limits, hypersexual, kissed [Mr. X], sleeping only in naps, believes she’s leaving today… Won’t take his medications until someone buys him cigarettes, took a fork from the cafeteria and brought it back under his shirt… Asked the nurse if he could masturbate in front of her, punched the fire extinguisher box, ice placed on his hand, x-rays negative… Up all night, now asleep, doesn’t want to see his mother… Agitated, hitting into the air, screaming, turned the picnic table over, threw his mattress down the hall… Blood sugar elevated to 260 after she had a Blizzard from Dairy Queen and sugar in her coffee, stable behavior… Refused lab draw for the sixth time, hasn’t had a shower in five days so he wasn’t allowed on the van ride, then slamming doors screaming, eventually got in the shower… Isolative, irritable, told [Mr. Z] “I’m going to kick your ass”, Sunday only got out of bed for meals… Has a rock that she brought in from the yard, says she will cut herself with it unless she gets cigarettes… Threatened to “flip out” in the smoking yard so he could get injectable medications, harassing a girl by telephone and her parents called to complain… Stable, pleasant interactions, went on the van ride… Offered his Mental Health Worker a blow job for money… Sleeping well, complained that her husband calls her too often, has run out of cigarettes… Up all night delusional about the mob and CIA, no bath in five days, foul language, filling out grievance forms against several staff… Very agitated, demanding a female Mental Health Worker, grabbed nurse on her buttock, made suicidal statements, stood in room and peed on his blanket… Helpful, doing his job in the kitchen, ready to go as soon as housing is ready for him…”

Saturday, September 16, 2006


Went down Major Metropolitan Area last night for a brief visit to Turboparents. Picked up Turbomom at the MMA Airport, which was bustling beyond belief at 12:30 am. Really made me appreciate the Smallish City "International" Airport, which operates on a more human scale.

Returned today to find glorious return-of-summer weather in the Smallish State. No one was free to go sail, but clearly that's what had to be done. So I went out alone. I think this may be the first time I've completely singlehanded a keelboat. Hoisting sails was a bit of a trick, but I got all three up. Sandra Lee cantered genteely out of the anchorage close-hauled in the late afternoon sun, just as a cadre of much faster boats were completing a yacht-club race and running under spinnakers back to their moorings. They were of similar length but had crews of five or more; I felt slightly superior to be operating solo. Racers have always puzzled me. So much emphasis on going fast, but so little emphasis on going anywhere. And when the race is over, it's back to the yacht club-- gorgeous sunset sailing forgone. Also due to the racing there was a great deal of cannon-firing, which I find startling and out of keeping with the tranquility of the sea, sun, and wind.

I tacked back and forth, practicing different ways of holding the wheel, sheets, and winch handles all at once, imagining how it would be to do the same in heavy weather. I practiced heaving-to, which is a method of backing the sails against each other so that the boat comes to a near-stop and you can go below to get a cookie. I tried halfheartedly to fix a few of the remaining boat problems, but got nowhere. At sunset the wind died and I started the engine, admiring how it stays the right temperature since I replaced the heat exchanger. I glanced out the sound, past a half-dozen islands, to the open ocean, and ached to aim that way. But I had only a half-box of Cheerios and two packets of ramen aboard. That's not enough for a week-long passage to Bermuda. I rowed the dinghy to the dock and had a beer back in the city.

P.S. If anyone knows anything about heaving-to a boat with a self-tacking stays'l, please comment.

Thursday, September 14, 2006

All I Need Is This Patch Of Grass

9 returned last week from a monthlong vacation with his grandparents in Major Metropolitan Area. He was certainly doted upon there, but the downside was restriction to the indoors. Back home, he has taken every opportunity to doze in the backyard. He moved his favorite napping spot-- it used to be over by the crabapple tree, but now it's a patch of lawn next to the lowest-hanging morning glory blossom. In fact, he has spent so much time in this one spot that he's completely killed the grass there. I've been trying to encourage him to rotate his sleeping location-- if only to be less predictable in case Enemy Cat is planning an assault-- but he won't pay attention.

Dream Deferred

“Walked last night on the beach in moonlight. An elemental scene, created only in black and white, in lightness of silver and shadow of nothing. The ceaseless breakers rose from void, turned existent as the froth caught the moon, then dissolved again out of form. For some reason I am dying to be on a sailboat and heading for nowhere. There’s a paradoxical dualism in my constitution—a craving for motion and travel, yet a deep need for privacy and a ‘home’, however, small, that is all mine. I think nothing would satisfy me so much, in these regards, as a bit of fiberglass or wood with some sails attached.
So here’s a plan: Finish residency. Move to some port city. Buy a small condo. Live simply, save as much as possible. After two or three years buy a boat. Maybe buy it in the fall, spend the winter working on it. In April or May, rent out the house, put things in storage, and move onto the boat. Spend the summer fine-tuning. Then, in autumn, sail to the Caribbean and keep going around the world… Let’s see, I’ll be 32 when I finish residency. I’d like to have achieved this adventure, if I’m going to do it, before I’m 40. If it’s going to take two years, that means leaving when I’m 38. Is six years enough time to save the money?” -- Journal of Turboglacier, 4/26/97 (Durban, South Africa)

“You have to understand that for a trip like this to happen, you had to break ties. You had to be a bad son, a bad brother, a bad boyfriend, and you had to leave. Otherwise, you wouldn’t go.” -- Alberto Grenado, speaking of his famed South American odyssey with Che Guevera

“But you have to go. You have to! I’m living vicariously through you!” -- Co-Chief, two weeks ago.

Today, I live in a port town, just as planned, and now I have a boat. Sandra Lee is imperfect but stout and could be modified to be an around-the-worlder. There’s a condo, just as planned, though the Turbopalace is actually half of a 150-year-old house that is in constant need of attention. I have six feet of books on boats, weather, celestial navigation, liferaft survival, disasters at sea (thanks mom), transoceanic routes, and the memoirs of at least eight circumnavigators.There’s enough money, even, thanks to frugal living for quite a few years, and very generous help with student loans from the Turboparents.

But where is the enthusiasm that drives to embark? Where is the willingness to spend every nickel on the dream, rather than earmark them for next year’s malpractice insurance premiums and the college education of children I don’t even have? Why now this worry about being away from the people in my life, this concern that my friends will evaporate, that I won’t be there if misfortune comes to my family? Why do I spend my days caulking the windows of the Turbopalace against winter and arranging to put Sandra Lee to bed till spring, instead of selling the Palace and aiming Sandra Lee for Bermuda at a lively clip?

Plans for the circumnavigation have been progressively scaled down. First I thought, maybe just to New Zealand. Then I thought, well, I’ll get to the Caribbean, at least, and see how I feel from there. Then I thought, at minimum, I should spend this whole summer exploring the remote regions of the Smallish State coastline. But the boat didn’t materialize until July, so I figured at least all of August could be spent aboard. But mechanical issues and social commitments lead to more delays. A friend agreed to come up and, at very least, join me for two weeks in September. But then he signed up for a SCUBA class, which ate into that time, and the voyaging plans were reduced to a four-day weekend. Which was supposed to start today. But there’s a cold rain about to settle in for the next 48 hours, so I’m about to call him and suggest waiting a day to come up, or canceling altogether. The circumnavigation reduced to a couple of daysails.

Perhaps my 28-year-old self misjudged my 38-year-old self. Perhaps there should have been a much smaller boat, on a much shorter shoestring, much earlier. Perhaps I never wanted to go at all.

Sunrise, sunset

Thoreau once wrote, "Really to see the sun rise or go down every day, so to relate ourselves to a universal fact, would preserve us sane forever."

I've often been tempted to offer this prescription to a patient. In many cases it seems as good a treatment as any, perhaps better than most, and with few side effects (just sleep deprivation around mid-summer.)

I also like how Thoreau doesn't split infinitives.

Wednesday, September 06, 2006

Great Vodka Taste-Off

I’ve been converted, over the past couple years, to vodka tonics (from gin). I’ve been wondering how much difference there really is between cheap vodka and expensive, fancy-shape-bottle vodka. So I procured a bottle of Kettle One (roughly $1.20/oz) and a bottle of Fleischman’s “Royal” Vodka (28¢/oz). The other night when Co-Chief and P.O.I. were over, we had a taste-off. Co-Chief is a known martini drinker, so I was particularly interested in his opinion.

I distracted the participants by telling them that we had three brands of vodka in the house—pricey, cheap, and middle-of-the-road—and presented them with three numbered glasses containing an ounce or so of vodka. In actuality, however, one glass contained Kettle One, and the other two contained Fleischman’s.

P.O.I. tasted each and wrote down her rank order. Co-Chief took longer, focusing on the “nose” and after-effects of each sample. I closed my eyes and sipped from each, with P.O.I. recording my rankings (since I knew there were only two vodkas, I tried hard to make my list consistent with the fact.)

Here, then, are the results.


Best: Fleischman’s
Middle: Fleischman’s
Worst: Kettle One


Best: Fleischman’s
Middle: Kettle One
Worst: Fleischman’s


Best: Fleischman’s
Middle: Kettle One
Worst: Fleischman’s

Discussion: It seems impossible to pick out expensive vodka from cheap vodka.
Implication: I will save a lot of money over my lifetime.
Confession: I’ll probably decant the Fleischman’s into a Grey Goose bottle so guests will feel pampered by the label.

Monday, September 04, 2006

What I'm Thinking About

I’m thinking about education, and health care, and drinking water, and what in this country we consider a “right” and what we consider a commodity or privilege. Perhaps it doesn’t show, but I received an excellent education. In my younger days I always believed I deserved this education because I was smarter than the average bear, and in our “system” smart people got the best education. Of course now that I look back on it, that’s at best half the truth. The rest is that my parents valued education highly enough to make enormous financial commitment to it, often at great sacrifice. Some of my classmates were not so smart, but their parents were very wealthy and tuition was a drop in the bucket. I never really knew all this as a kid.

Some education, Americans have decided, is a “right”—but only up to a certain point. Similarly, we consider very basic health care a right. Well, maybe we do. You can’t just “enroll” in basic health care the way you can take your six-year-old down to school with her birth certificate and sign her up, no questions asked. At best, if you want free health care, you’re going to fill out a mountain of paperwork, much of it incomprehensible and embarrassing. You’ll likely need a social worker to walk you through it. And certainly any health care the quality equivalent of a American public high-school education is not going to come freely. Our capitalism extends deeply into our health care consciousness; we all hope to be rich, and we all expect that, once we are, we’ll be allowed to buy the world’s best health care for ourselves and our families (the others be damned).

But then there’s drinking water. For some reason, we decided long ago that safe drinking water—tasty drinking water, even—is more or less an equal right of each resident of every city (which is most of us, now). So far as I know, the water in the loftiest upper-east-side Manhattan penthouse is the same as that piped into the most cramped public housing on Avenue D. Sure, you can pay more for spring water shipped from Fiji (don’t get me started on that) but there’s not much evidence that it’s any better for you.

Non-sequitur, but I’ve also been thinking about suicide. No, sorry to scare you-- not thinking of doing it, just thinking about it. This is normal for shrinks, remember. In particular I’ve been considering people who think that suicide is a sin, and how that alters their perceptions of it, and their likelihood ever to attempt it. I suppose I fall into an unusual sector of the sin Venn-diagram: I believe some things are sinful, but I don’t much believe in any kind of afterlife. So to my mind, if there’s a punishment for a sin, it’s simply having to live with the knowledge that you’ve committed it. By definition, you don’t live with the knowledge that you’ve killed yourself. So I’m not sure where I come out on that. Then again, maybe attempted suicide is also a sin? If so, how earnestly do you have to attempt, in order to cross the sin threshold? I’ll have to run this by some of my theologically-minded friends.

Dream Recalled

Last night I dreamed that there was a crawlspace behind the wall of the bathroom in my parents' house, and in this crawlspace there was a lemur. He was a very active lemur, and made quite a bit of nocturnal commotion, leading me initially to assume it was a squirrel back there. But when the noise started to irritate me and I removed the wall paneling to shoe the squirrel out, I found the lemur. He ran around the bathtub shrieking several times, then ran back into the shadowy space and disappeared. I was unsure if it was hazardous to have lemurs living in the walls, and so the dream ended with my resolving to Google the matter for further information.