At 9 AM, he met with the realtor. Local guy. Had lived there all his life. Showed him a log Condo that he could buy for the interim. Price $175,000. Yes, he could resell it with no problem. Even with all the foreclosures. Sure. There are no foreclosures here. Then he showed him 22 acres on a hill just outside of Radford for $250,000 and the owner would build a road to he house site. He would have to put in a well. Yes, he would find water. It might cost $40,000 to find it but he would find it. Yes, the land perked. He could divide the lot into two-acre particles that he could sell for $125,000 each. No problem. Even in a bad economy. This is good land. You will get 22 acres of land free. Great deal. He dropped him off at the Inn of Virginia Tech around noon. He called his wife and then began to explore the territory by himself. So many choices. Beautiful land. Great climate. Moving is scary.
Sunday, July 27, 2008
LOOKING FOR LAND
Friday, July 25, 2008
64 AND STILL INTERVIEWING
Most people are making retirement plans at 64. He was interviewing for a new job. Found it on the Internet after his children had asked one more time that he and his wife move from Texas to North Carolina. This possibility was in Blacksburg, Virginia. Close enough. He had planned to work until 66 and then retire. When the economy went south, his financial security became Antarctic. Besides this job had tremendous possibilities. He worried about his age. How could they choose him? If they didn’t he would be stuck in Texas, getting older, and dying away from his children. His body would have to be flown to North Carolina for burial. That would be expensive. He didn’t feel like he was 64, but they were going to test his stamina—six interviews in the morning, a luncheon with 18, four interviews in the afternoon, and a dinner with eight. He survived with energy to spare. Indeed, he had more energy after all was said and done, than he had in the morning. He was excited. 64 is awfully young.
Thursday, July 24, 2008
Traffic Congestion Predicts Presidential Winner
His plane left at 9:50. The airport was 101 miles from his drive way. He counted on his fingers. He had a medical degree, but still counted on his fingers like a second grader---1...2…3. He could leave at 6:30 AM and still get the plane with time to spare. He figured his time of arrival using what he had recently learned: traffic congestion can be eliminated if four out of 100 cars stay home. With gas prices at $4/gallon, he figured that four would stay home. He worried about what he would do when he got to the airport two hours early, but to be on the absolute safe side, he decided (counting on his fingers again) to leave at 6:30 AM and work crosswords when he got to the airport early.
Evidently, $4/gallon gasoline bothered no one. None of the four stayed home. Traffic was bumper to bumper once he reached the outskirts of Houston. He couldn’t believe the automated traffic congestion sign that told him it would take 56 minutes to get to I-10, only 12 miles away. He should have believed the sign. 56 minutes later, the creeping congestion failed to let up at I-10. Don’t people know that gasoline costs $4/gallon?
It took him almost three hours to drive 101 miles. He knew then that Obama was going to be elected President of the United States.
Carilion Clinic
Carilion Health System, now known as Carilion Clinic, is a large, Roanoke, Virginia-based not-for-profit health care organization. Carilion owns and operates eight hospitals in the western part of Virginia. The company also operates primary care clinics, residency and fellowship programs, laboratories, health clubs, an aeromedical program, and sub-specialty medical practices. Carilion originated with Roanoke Memorial Hospital, which is located at the base of Mill Mountain in southwest Roanoke. The hospital eventually expanded into related health care services and the acquisition of other hospitals. Most prominent was the acquisition of the competing Community Hospital of Roanoke Valley in downtown Roanoke. The deal took several years to complete because of anti-trust concerns by the United States Department of Justice that two of the three major hospitals in the Roanoke Valley would now be under the same ownership. In the early 1990s, Roanoke Memorial adopted the name Carilion for its consolidated health care business. Approximately 6,200 of Carilion's 9,600 employees are in the Roanoke Valley, making it the area's leading employer.In addition to traditional hospital-based services, Carilion has established the Carilion Biomedical Institute in Roanoke in association with Virginia Tech and the University of Virginia. The Institute is a business incubator designed to introduce advanced medical devices into the marketplace. A related goal is the development of a cluster of such firms in the Roanoke area. One such company is Luna Innovations, which is partially owned by Carilion and has oved its corporate headquarters to the Institute's business park. Carilion's management has warned that trends in the health care sector threaten to undermine the organization's financial position. Carilion has gross revenues of approximately $2 billion per year and ran a $93.6 million surplus in the last fiscal year. In response, Carilion has announced plans for a significant business reorganization which will change its emphasis from running hospitals to hiring more doctors in a larger number of medical specialties, with a primary goal of better coordination of patient care and an emphasis on medical education and research. There are currently no plans to sell its eight hospitals. The plan was developed after visits to the Mayo Clinic and other similar organizations. As part of the reorganization plan, Carilion has renamed itself Carilion Clinic. Some local doctors have expressed concern that their independence could be eliminated and that the scale of the reorganization, if it is not successful, could imperil the organization and the quality of health care in the Roanoke area and have formed the Coalition for Responsible Healthcare to express their concerns.As part of the Carilion Clinic's focus on education and research, Carilion and Virginia Tech recently announced plans to establish a small medical school in Roanoke. Carilion currently operates the Jefferson College of Health Sciences which offers a master of science in nursing and 13 associate and baccalaureate allied healthcare programs.
WHAT A DIFFERENCE A TIME ZONE MAKES
After leaving the congested traffic of Houston, he flew to Atlanta, stepped off the plane took the rail from terminal B to terminal D got on another plane, left on time, bags arrived a Roanoke, rented a car, and enter I-81. His first thought: “Where are all the cars?” He thought, maybe, a mass evacuation had occurred. Later climbing a hill a few trucks slowed on the steep grade, but he was able to keep his cruise control on 72 all the way into Blacksburg. The temperature was 83 instead of 103. There were trees and green grass instead of asphalt and dirt. The Inn at Virginia Tech was pristine, the campus gorgeous. He drove around the area—Christiansburg and Radford and Radford University with a student population of 9,000 that he had never heard off. At night he returned to have a peppercorn filet and then to bed and dreams of green, cool fields and mountain streams.
Wednesday, July 23, 2008
THE NEUROBIOLOGY OF PLACEBO
Placebos have been misunderstood as resulting from the “power of positive thinking.” This misconception fails to take into account the complex neurobiology that occurs in any treatment regimen.
DEFINITION OF THE PLACEBO EFFECT
Ø The placebo effect is a phenomenon in which a person’s expectations determine a particular outcome.
o Drinking decaffeinated coffee (placebo) thinking it is regular coffee (active agent) may give a stimulating effect similar to regular caffeine.
DEMONSTRATIONS OF THE PLACEBO EFFECT
Ø Post-operative patients given an open-view saline injection (placebo with the expectation of analgesia) compared with patients who received a machine-infused intravenous administration of 8 mg morphine (active drug with no knowledge of when the drug would be infused) experienced the same level of pain relief.
Ø After participating for a month in a placebo controlled antidepressant trial evaluating the effects of a new antidepressant, a patient overdosed on 29 of the drug-study pills. His blood pressure dropped to 80/40; he began to hyperventilate, became tremulous, and was given intravenous stabilization for four hours. Within fifteen minutes of being notified that he had been taking a placebo, the patient’s blood pressure rebounded to 126/80 and he felt fine.
Ø A meta-analysis study that examined clinical trials for antidepressant medication versus placebo showed an increase in placebo effect over the last two decades that mirrored the increased response to active drugs.
o For example: When Prozac was initially studied, approximately 40% of subjects responded to the antidepressant effects of Prozac while depression lifted in 20% of patients receiving placebo. Currently, about 60% of depressed patients respond to Prozac while 30% of depressed patients receiving placebo respond with an improved mood.
Ø When the brains of patients with Parkinson’s disease were analyzed by positive emission tomography following placebo saline injection increases in dopamine levels in the caudate nuclease and the putamen were comparable to those seen after an injection of levodopa.
PLACEBO EFFECT IS MORE THAN POSITIVIE THINKING
Ø Naloxone (an opioid receptor antagonist) blocked the expected analgesic effects of saline injections when subjects thought the saline injection that there were given was morphine.
o This important study shows that because naloxone blocks the effects of the saline induced opioid release, a chemically inert agent (saline) can trigger the release of endogenous opioids.
Tuesday, July 22, 2008
Respect
“Do you think I am a team player and show respect for others?”
“No not really. I think you mean well, but you tease people too much and they take it wrong. You enjoy being teased, but others may take your teasing the wrong way. Teasing is sort of like sarcasm—it’s hostile humor. Also, you are too demanding and gruff when you don’t get what you want immediately. You are too impatient with people and you look like you are trying to get away as soon as possible when they are telling you something. You expect things to be done for you right away and you get gruff if you don’t get it. You are too much in a hurry. You neglect to thank people when they do something nice for you. If you want to check yourself on whether you show respect to others, ask yourself if you are doing these things,” she said. Then she listed them:
Ø Don’t embarrass, insult or make fun of someone
Ø Compliment them
Ø Be polite by saying “please” and “thank you.”
Ø Be a good listener by paying full attention to the person talking. Don't get in a big rush.
Ø Be caring and empathetic
Ø Be honest – If you do something wrong, admit it and apologize.
Ø Help others grow by encouraging them and giving them responsibility
He made a zero on all the points. He thought he was respectful, but he wasn’t. The blinders had been lifted and he didn’t like what he saw. Well, tomorrow was a new day. He had a lot to work on.
Monday, July 21, 2008
Volunteer
She said that she delivered mail to patients because she wanted to volunteer. “Everyone else does. That’s what America is famous for. I wanted to see what it was like so I volunteered to deliver mail to patients. I love it. I get to meet a lot of interesting people and I love doing something for others. I see why Americans are such big volunteers.”
If he hadn’t introduced himself and began talking with her, he would have thought she was a high school kid instead of a medical doctor doing post doc research on brain tumors—gliomas. And, yes, there is a higher incidence of brain tumors in people who use cell phones, or at least her preliminary research seems to indicate a connection between brain tumors and cell phone use. “Especially if the cell phone is low on batteries.”
She came to MD Anderson from China to do research, but she was equally interested in trying out volunteering. “We don’t volunteer in China. No one does it. Its fun. Makes you feel good. Helps you get to know people.” She received her medical training in China, but was never very good at feeling the pulse and making the diagnosis of varieties of heart disease and other maladies. “Some of the older doctors are good at it, but I’m not.”
Her plans: “I will go back to China to practice medicine, continue research after my post doc, and teach others what I’ve learned here. Especially about volunteering.”
Sunday, July 20, 2008
THEY SAID I WOULD GET OVER IT
“They said I would get over it. I murdered my mother when I was 14 and I’m 44-years old and still haven’t gotten over it.”
“You never get over that.”
“”My sister came in screaming that my step-father and mother were in the driveway fighting. I was tired of the fighting so I grabbed a pocketknife, ran out, slashed my stepfather in the face, and stabbed my mother in the chest. She kept asking for water. I cut her artery. The police came before the ambulance and took me to jail. The next day they told me she didn’t make it. I went to TDC for three years. I have been in prison five times for a total of 17 years. They kicked me out of the mission, because I broke my curfew and was out on the streets with the wrong kind of people smoking crack. I was homeless so I went to MHMR and told them I was suicidal, but because the state hospital was full, the county said they would pay for my hospitalization in this private hospital. It’s nice here, but I don’t think I will ever get over murdering my mother even though they say I will get over it.”
Saturday, July 19, 2008
FINDING BALANCE
There are individual differences for the need for vacation time. Some people become bored when they are away from the office too long. Others begin to lose a sense of worth when on extended vacations. Balance is the key to the successful use of vacations. Here are some ideas both for benefiting from vacation time:
Ø Schedule vacations and keep them.
Ø Quit work early or take time off when fatigue builds. Sustained effort toward a goal is best balanced with laughter and play.
Ø Plan an occasional long weekend away from work.
Ø Returning to work tired after a vacation or time off indicates the wrong approach to leisure time.
Ø Have you ever noticed how people on the tennis court or the golf course shout and act as if they are fighting alligators in a swamp? If they aren't having a terrible time, they're certainly making life miserable for everybody around them. Those who enjoy life, play for the fun of playing. Paradoxically, when they're playing for the fun, they play better. Play—-free and spontaneous activity—-emphasizes enjoyment not achievement.
o Emotion, not effort, enhances play. Attitude, not activity, determines whether we work or play.
o Leisure activity should be fun, not a drain on the emotions.
o Sports and games should bring more laughs than frowns.
Ø Every day ask yourself, "Am I having fun yet?"
o Surround yourself with people who fill you with joy and laughter.
o Be an inverse paranoid-think the world is out to do you good. Decide to be hopeful and fun loving.
o Don't take yourself so seriously. Those people who have a cosmic view of life cultivate a lifestyle that allows them to tolerate outrageous fortune. They laugh at themselves and their situations. They develop a "hang-loose" philosophy of life.
o Read or listen to humor regularly.
o Keep a humor scrapbook.
o Marry someone who thinks everything you say is funny.
o When a situation becomes stressful, pretend it's all a Candid Camera episode.
o Practice LOL—it's internal jogging.
o Remember: He who laughs, lasts. A sense of humor - that goes beyond joke telling embraces laughing at oneself and life's absurdities. When we learn to "think funny" our life becomes enriched with friends and fellowship.
o Play golf. Golf is just like life: Difficult and unfair. Par is 18 laughs a round.
Ø Cultivate creativity. Creative people see connections between things when others see separation. Creativity requires knowledge, for many creative ideas come from old concepts rearranged in a new way.
o Break the rules by questioning the reasoning behind them. Alexander untied the Gordian knot by chopping it in half while others had failed for centuries because they followed the rule and tried to untie it.
o Ask "what if' questions. Einstein conceived the theory of relativity by asking, "What if I could ride a light beam?"
Friday, July 18, 2008
The Apocrypha in the Venacular
The Apocrypha is a bunch of books between the Old Testament and the New Testament in the Catholic Bible. Protestant Bibles don’t have them.
After Alexander the Great conquered the world around 330 BC, Greek became the predominate language. Just about everybody no matter what country you lived in spoke Greek at the time, sort of like all countries speak English now. The Hebrew authorities decided to translate their Hebrew Bible into Greek so more people could read it. They approved 70 scholars to translate the Hebrew Bible into Greek and they named this translation the Septuagint because septuagint is a Greek word meaning “70.”
For some reason, the Septuagint came to include a bunch of Jewish stories that were not in the Jewish Bible. Around 90 years after Christ was born a bunch of Jews got together and decided that they weren’t going to approve the Septuagint translation any more because it had these extra stories. The Jews rejected the Septuagint translation, but the Christians—all of whom belonged to the Catholic Church at that time—decided to keep these so called “apocryphal” stories in their Bible.
After the Protestant Revolution in the sixteenth century, the Protestants decided to remove the apocryphal stories from the Protestant Bible. The Roman Catholic Bibles still have the apocryphal stories, but the Protestant Bibles and the Jewish Bibles don’t include the apocrypha.
The word “apocrypha” means hidden. The Catholics call these extra stories “apocrypha” because they are missing (or hidden) from the Jewish and Protestant Bibles.
The most important stories in the Apocrypha are First and Second Maccabees that tell about how the Jews got their independence from the Greeks. These two books also describe the bad things that Antiochus IV did to the Jews. He made the Jews worship the Greek gods. Antiochus also sacrificed a pig on the altar of the Hebrew Temple. This was dastardly thing to do and is called the “Abomination of Desolation.” The Maccabee family got mad and led a revolt against the Greeks and won. (Afterward, the Jews had an independent state for about eighty years until Rome took over in 63 BC, but the Apocrypha doesn't tell about this .)
Another book in the Apocrypha, Judith, tells about a beautiful Jewish princess who gets the Assyrian king drunk, decapitates him, and smuggles his head out of the Assyrian camp by hiding it in a food bag. Susanna is a good courtroom drama that tells how Daniel tricks two evil Jewish elders into contradicting their story about a young virgin who they accuse of adultery.The Bel and the Dragon tells how Daniel solves the mystery of disappearing food from the temple. Some of the other books are songs, prayers, wisdom writings, and fables. It doesn’t take a scholar to tell why the Protestants and Jews left the Apocrypha out of their Bible. At the same time, we can appreciate the Catholics for leaving some juicy stories in their Bible.
Thursday, July 17, 2008
Vacation Values
Research clearly demonstrates that an annual vacation significantly cuts risks of most diseases by 20-30 percent. The Multiple Risk Factor Intervention Trial of 12,000 American men revealed that during a 5-year study period those who took the most vacations had 20 percent less risk of dying from any cause than those who took the fewest vacations. A 1999 Dutch study found that overcommittment to work without an annual vacation increased physical and emotional illnesses.
A study by the World Tourism Organization study showed that vacation time for Americans lags well behind other industrialized countries. The WTO listed the average annual vacation days by country as follows: Italy (42), France (37), Germany (35), Brazil (34), Britain (28), Canada (26), South Korea (25), Japan (25), the United States (13). More than one third of Americans fail to use their full vacation times. Of those who do take full time away from their regular jobs much of their vacation time is spent on activities other than rest and relaxation:
Ø 19 percent spend their vacation time on family or personal responsibilities, including illness, funerals, caring for sick children or parents
Ø Another 13 percent spend vacation time going to school, working at another job, or participating in reserve military service.
Ø One in five vacationers are contacted about work matters during non-work times
Ø 23 percent of employed adults in the United States report checking work email or voicemail while vacationing
Causes of THE VACATION VOID
A vacation-less life may be caused, in part, by cultural factors. Emotional conflicts that contribute to the overwork syndrome may be associated with the following:
Ø Compensation for feelings of inferiority or insecurity
Ø Identification with a demanding parental expectations
Ø Recompense for physical limitations such as poor health or aging.
Ø A solution for problems of aggression and guilt
Ø A need for approval
Ø Excessive competitive drive
Ø An attempt to enhance self-esteem
Ø The desire to improve social status
Ø The need for excessive financial gain
Ø A fascination with the accumulation of material objects
Ø The inability to refuse the requests of others
Ø Self-imposed demands for perfection
PROBLEMS ENGENDERED BY LACK OF VACATION TIME
A self-induced increased workload causes deterioration in marriage and family life, undermining the main source of non-work related support. Likewise, avoiding vacation time leads to a decline in efficiency and initiative resulting in an increasing spiral of mistakes and complaints from associates and customers. Paradoxically, rather resulting in approve from others overwork eventually results in criticizes from family, colleagues, and employers.
Usually those who fail to take regular vacations become cynical, negative, rigid, and inflexible. Accompanying poor work performance is the inability to relax and enjoy
recreational pursuits.
A DAY-BY-DAY VACATION: PREVENTING OVERWORK
Vacation, a time of rest and freedom from work, can be experienced each and everyday. Duke University psychiatrist, John Rhoads, MD, studied successful, effective, and healthy executives who worked at least sixty hours weekly and compared these individuals with executives who developed burnout from working over sixty hours weekly. The following table summarizes those findings.
| THOSE WHO EXPERENCE WORK SUCCESS | THOSE WHO EXPERIENCE work burnout |
| Postpone thinking about problems | Ruminate about work problems |
| Take time off when productivity begins to diminish | Take their computer and cell phone on their vacations to keep-up with work activities |
| Use exercise, hobbies, and sports to deal with work stress | Use drugs or alcohol to deal with work stress |
| Enjoy scheduled vacations | Tend to postpone vacations |
| Cultivate a stable family life | Spend very little time with their family |
| Maintain friendships | Have a difficult time cultivating friendships |
| Exercise regularly | Watch television regularly |
| Have varied interest outside of work | Feel uncomfortable away from work |
| Can laugh at themselves | Take life and themselves too seriously |
DO YOU KNOW HOW TO HAVE FUN?
| | LITTLE OF THE TIME 1-pt/each √ | SOME OF THE TIME 2-pt/each √ | A LOT OF THE TIME 3-pt/each √ | MOST OF THE TIME 4-pt/each √ |
| I enjoy hobbies without feeling guilty about not working. | | | | |
| I am optimistic and cheerful. | | | | |
| I surround my self with happy, positive, and fun-loving people. | | | | |
| I correct my mistakes and blunders, but don’t continue to worry about them | | | | |
| I take a long weekend away from work when I begin to feel burned out and tired. | | | | |
| Leisure activity helps me feel rested. | | | | |
| Sports and games bring me more laughs than frowns because I play to have fun not necessarily to win. | | | | |
| I enjoy creative play—dancing, painting, party games, playing a musical instrument, etc. | | | | |
| I laugh at least once a day. | | | | |
| I take vacations without worrying about the job. | | | | |
| Multiply √ by the value given in each column | | | | |
Add the total for each column to get the GRAND TOTAL = ________
Scoring
10-14 points = President of Eeyore International
15-24 points = Party pooper
25-34 points = Fun to be around
34-40 points = Life of the party
Wednesday, July 16, 2008
HOW TO BECOME A NUCLEAR ENGINEER
When I was in high school, I worked at my father’s gas station. At that time we filled the tank with gas, checked the air in the tires, popped the hood and checked to oil level, and washed the windshield.
A guy used to come in every Saturday to get gas. He had a ’57 Chevy Bel-Air 2-Door Hardtop and he always brought his girl—the most beautiful woman I had ever seen. I was 15-years old at the time. I would wash and wash his windshield looking at the girl’s legs. This guy was handsome and looked rich. He dressed a little richer than anyone else I had ever met. I always wondered what he did for a living to get such a beautiful girl and such a cool car. Finally, my curiosity overcame my shyness. When he was paying for the gas, I got up the nerve to ask him.
“I’m a chemical engineer.”
I didn’t know what a chemical engineer was so the next day I asked my chemistry teacher. When he told me and said what it took to become a chemical engineer, I figured I could do it because I was pretty good at science and math.
I was kind of what they call a nerd today. All the pretty girls went out with the football players not the nerds, but if this guy could get a girl that pretty, I decided to become a chemical engineer.
I was real poor. When I found out they were giving scholarships to people who majored in nuclear engineering, I decided to change my major to nuclear engineering. If it hadn’t been for that girl’s legs and nuclear engineering scholarships, I would probably still be pumping gas at my father’s station…except maybe I would own it by now.
Tuesday, July 15, 2008
DOES IT HURT?
"Tried to burn myself to death. I was drunk and couldn't take it anymore. Poured gasoline all over my body and lit a match."
"Did it hurt? I mean when you get third degree burns, it doesn't hurt. Did it burn right through the skin real fast so it didn't hurt or did it take awhile to damage the nerves?"
"It hurt like hell."
"Pulling off the burn scars was just as bad, I bet."
"That was even worse. Pulling those clothes off that stuck to your body and then pulling off that dead skin everyday."
"Looks like the doctors did a good job. You've healed up great."
"Yeah. Now my back's killing me. The doctors say my back has slipped out and is rubbing the sciatic nerve."
"Is that why you are walking U-shaped? I never saw anybody walk U-shaped before. Your walk is not from burn contractures is it?"
"No. Its from climbing too many ladders painting houses."
"I figured you were a painter--using paint thinner to burn yourself. You were drunk at the time. How many painters are alcoholics?"
"About 99% of 'em?"
"How come?"
"I don't know. Associations I guess. They drink, you drink. You drink, they drink. Climbing ladders with the wrong crowd."
"Drinkin' and slippin'. Bad combination for back problems. I can help you though. Need to get you on some medicines that will work. First I want to do an MRI on the back--see how much damage you've done"
(I figured correctly that there would be very little serious damage to his back. Bet two nurses two dimes that he would have no disk disease. They took one look at that walk and were suckered in. The way he walked told me there was nothing anatomically wrong with his back. People who are hurt don't walk that way. I got the MRI to build rapport so I could outline a treatment program that I knew would work--Lyrica, Effexor XR, high doses of Motrin, physical therapy, and--a medicine that most doctors would avoid given the patient's alcohol history--Valium. Valium was necessary to cut the muscle spasm. When you walk like a U, your muscles get tight. Valium loosens them up. Within 4-5 days, he was walking straight. There were a lot of nuances to his treatment that I won't discuss in detail, but it begins with talking the persons language, treating him with dignity, treating him like a regular guy, being a friend, asking questions that most people wouldn't ask, questions that a 5-year old would ask another 5-year old--"Did it hurt?” --discussing all the medicines with him and telling him how they are going to work, expecting him to get better, discussing the MRI with him in a way that he understands and doesn't feel criticized, trusting him with Valium, telling him to walk upright, congratulating him with each improvement, telling him I am proud of his progress, using humor and good cheer and just generally liking him.")
In less than a week, he was a changed man. Happy, hopeful. How long this good outcome will last is the great unknown, but if he does slip back into drinking or become depressed again, when he comes back to the hospital, he will make more positive advances and little by little he will learn to live a better live. I know in the long run he will do OK. I'm proud of him.
Monday, July 14, 2008
Foreign Philosophy
“Three or four times every year. Just like I did when I was in New Orleans. I would go into a psychiatric hospital to get some shots for my nerves."
“When you are not being admitted to psychiatric hospitals, what do you do? Do you have a job?”
“No, man. I’m on disability.”
“You look pretty healthy to me. What are you on disability for?
“My nerves, man. They’re bad.”
“As we say in Texas, ‘Work cures misery.’ Working would make you feel better. It would give you something to do and you would feel better about yourself.”
“But if I worked I would lose my disability and my mother needs my disability money.”
“You are 27 years old. You still live with your mother?”
“Yeah. She needs my disability money.”
“If you worked you would make more money than you get on disability and you could give your mother more money. There are lots of jobs around here. Getting a job would be good for you…and your mother.”
“Hey. You’re supposed to have sympathy for me. Why are you talking to me about getting work? I need some shots. I need sympathy.”
“My job is to help you get well. Work would help you get well. It would be good for you. Work would give you something to do. Work would build your self-esteem. You could make some money, move out of your mother’s house, and become independent. You would even have more money to give to your mother.”
“I need a shot, not work. I’m allergic to every kind of shot except Ativan. I’m not allergic to that and I need a shot of Ativan to settle down. I can’t take medicines by mouth. My stomach is too tender for pills. It’s been tender since I was a kid and went into psych hospitals. If I don’t get any Ativan shots I start to lose it and the nurses get scared.”
“Let me introduce you to our Texas nurses. Come on over to the nursing station and meet some of our finest nurses. This is Fender. He’s 6’2’’ and weights about 250. As you can see—all muscle. This is Billy Bud. He’s smaller, but wiry. Wrestles steers in local rodeos for a hobby. Broke a steer’s neck once. It was an accident, of course. His feet got tangled and he twisted too hard trying to get his balance... and pop. Ever hear a steer’s neck pop? Weird sound. You never forget it once you hear it.”
“Maybe I’ll try one of those nerve pills. My stomach might have toughened-up some since I was a kid in the hospital.”
“That’s a good idea. Those pills will help you settle down as you are making out a list of Louisiana towns you’d like to live in. They don’t have any work to speak of in Louisiana, but they make up for it with lots of sympathy. Fender and Billy Bud will take you down to the bus station when their shift is over. And don’t forget to call your mother and tell her to meet you at the station. She will need your disability money when you get to Louisiana.”
Sunday, July 13, 2008
19% of US Psychiatrists Are Over the Age of 65
There is a growing divergence between increasing demand and shrinking supply of psychiatrists. Psychiatrists less available today for providing integrated psychotherapy and pharmacotherapy. Even in their role simply as medication managers in split treatment, most psychiatrists in private practice seem accessible only to affluent, full-fee patients outside managed care.
Australia is currently experiencing widespread shortages of psychiatrists. The changing nature of the workforce and increasing demand mean that these shortages are unlikely to ease.
While Australian psychiatrists have previously been predicted to retire at age 70, data indicates that the majority (62 per cent) remain in the workforce beyond that point. Psychiatrists retire later than the general population in general and many do not expect to retire at all. Psychiatrists may choose to keep working well into old age. Fears about losing their professional role, letting patients down, and the inability to find a replacement to take over their practice contribute to a psychiatric career that extends into the seventh and eighth decade.
Saturday, July 12, 2008
Mendacity or Denial?
“No. I don’t drink and I don’t use drugs.”
“That’s interesting, because the ER doctor was concerned that you might have ingested more than Valium so he called the pharmacist who told him you had a prescription for 180 Xanax tablets filled two weeks ago.”
“I flushed those down the commode.”
“The pharmacists also told the ER doctor that he filled your prescription for 50 Vicodin last week.”
“I gave those to my boyfriend.”
“It says in your chart that you have Hepatitis C.”
“I got it injecting cocaine.”
“I thought you said you didn’t use IV drugs.”
“I forgot.”
“Your chart also indicates you have cirrhosis of the liver. From drinking? And your probation officer called. She said you had been in jail numerous times for public intoxication and driving under the influence. Sounds like you have a significant drug and alcohol problem. What do you think?”
“I just use because all my friends do drugs and alcohol. I can stop anytime that I want. It’s not a problem for me. Can I go home?”
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