Blood, Sweat, and Imperfections – Mommy Don’t Look!

Naked and Voyer

Naked and Voyer

Blood soaked and layered with fallen governments, the Acropolis remains, a witness and teacher to a summer fling. 

A tour of the Acropolis and its new museum taught much. #1 – Never go on such travel without a tour guide. She made all the difference. Without her, I might have lasted for an hour, or an hour and a half. I would have thought, “Check! Did the Acropolis! Next?” With her, I felt like I couldn’t get enough. Four hours later. Evi was an intelligent, independent woman, making her way in the world, with the talent of putting ideas together. Another mentor to pick up along my life journey. #gratitude.

(I’m going to try to describe Athens, as seen by a psychiatrist. Smile.)

Evi integrated the paradigms at play, seamlessly, and in flow, from the 800’s B.C. to the 400’s A.D. She spoke about the mathematics involved in The Parthenon architecture, the classical culture seen in the architecture such as the emphasis on the human senses, the development of language and democracy, and more.

None of the construction of The Parthenon is “perfect.” The columns slant, and the stairs bow in their middle. All of this is done to capture the human senses. It was constructed so that when you stand at one corner, you can see almost the entire construct, like inflation of air rounds a balloon. When you look straight on, you are almost able to see entirely around the balloon’s girth. The architect sacrificed perfection toward the ultimate and most valued goals – to experience all the human senses to their fullest, and the classical construction. 

The Greeks developed the idea that whatever is created by man, (scantily garbed statues, architecture, ship making, etc…) should demonstrate, but not surpass the excellence of the human at his or her absolute best. Perfectionism smechsonism.

The kids were a bit horrified by the genitals everywhere. “That’s inappropriate!” or “Mommy, don’t look!” with a hand posturing the Stop! sign, improved my experience 10-fold. 

The Greeks in the 400 A.D.’s recognized the irony in the loveliness of human senses; sight, emotions, spirit, intellect, etc, integrated with the flaws. We are greater, in the best of our imperfect self, than the perfect, mathematical, or any other kind of perfection, eg., 1 + 1 = 2, in a perfect world. 

For example, by tilting the columns, the architect understood that it would give an illusion of straight columns, yet still capturing more of the circumference as seen by the individual. Straight would be perfect. Tilted but looking straight is more representative of a human at her best. Never perfect. And the illusion created by the tilted columns made the construct look shorter, thus not surpassing “the human” capacity to sense it’s grandeur. 

Also, the government ruler at the time, Pericles, was the first known leader to integrate a form of democracy. He used citizens and slaves for the labor. Yet he paid them, including the slaves! Furthermore, he gave them freedom in their work to form independent decisions, stating that someone who is told what to do, doesn’t learn anything. Someone who makes their own mistakes, has the opportunity to learn from his mistakes. This was the fulcrum which our civilizations turned on toward human rights and free thought. Pretty powerful.

The Greeks gave their alphabet to the world, from which Latin developed, and thereafter the Latin languages. For example, I never knew that “Agoraphobia,” comes from the location, named at the time, “Agora,” where all the debates were held, again, inspired by this ruler during the 400’s B.C., spurring on freedom of thinking. You can imagine what happened during heated debates. Some people would suffer anxiety in that context, which would deteriorate into a disabling fear of being humiliated by another potential panic attack when in public places.

The priests of the Greek gods served also as their community’s medical practitioners. For example, they used snake venom to both treat headaches and prophylactic against strokes. It turns out that snake venom is an anticoagulant. Totally brilliant. Snake venom in Greek, is called, “physika”, which means “venom.” The caduceus, a symbol that we still use for the physician’s medical practice, shows a snake wrapped around a staff. Later Aristotle used “physika” to name his treaty on nature and the work evolved into “physician.” Way cool. 

The self-care tip: Work your damndest, while embracing and integrating your imperfections along the way, and in this Grecian effort, you will gain the greatest sensorial experience with the world around you, the individual beside you, and your own self.

Question: 1. How do your imperfections enhance your best self? Please tell us your story!

A Tiffany Diamond Isn’t This Good

Patient-noncompliance-terrorism

I’m in San Bernardino today, working in a small community clinic. I am in the company of four licensed and practicing physicians who are donating their time. I am blessed.

One physician I’m working with tells me he has taken care of himself in his medical practice, “basically by not being a hypocrite.” He describes this by lifestyle choices of diet, exercise, etc… He likes surfing, which surprised me! “That’s why I’m skinny.” The man is not wearing california-traditional surf-wear. He’s wearing a general Sears-white button up with black slacks and comfort shoes. And he is old! He is in disguise. The age-disguise. I judge people too often by what I “see,” and this guy is a total surprise. Mr. cool.

There are medical students, college students, and nursing students here as well. One of them is a phenomenally gorgeous import to the US with a magical accent. Currently she’s eating a large bagel with cream cheese, dressed in a pencil skirt, stethoscope slung around her neck. Maybe I hate her just a little. She told me about her own “really good” personal experience with psychiatry and counselling. Her parents divorced when she was in college and “it helped” her get what she needed to get through it. Maybe I love her a lot. A woman of courage.

A patient I saw is a mother of seven. You may think, “Let’s just stop right there.” Anyone who wants to use “all her eggs” would need “help.” This woman has had to be sooooo strong! She’s been abused, used, neglected, and more since she came into this world. Even so, she pushes forward. She demonstrates self-value and Love. Where did this come from, I wondered.  Who taught her or gave her that? Today, she has even finally come into a willingness to get in the space of cultural dissonance, and consider for the first time, medical care for her emotional and behavioral needs. “I need it! I will do anything to get out of all ‘this.'” These words should come in a velvet lined blue and ribboned box. Gimme. Gimme.

We are talking now in the break room about patient and self-experienced medical health care stories. A hospitalist is explaining the difference he sees in his patients between noncompliance versus nonadherence to clinical directives. It’s a like a rocket just shot off! Every one is bothered in some way. You may remember from previous posts in this blog site about the “Number one Reason for Relapse” – treatment noncompliance. I now renege. Let it be known, I was wrong. I’d like to say, “nonadherence.” Forgive me! Noncompliance is an arrogant judgment, implying a decrease of mal intent or purposeful disobedience. There are many paradigms of reasons that interplay into any of our choices and performance in our personal medical care. I love that! Yes.

My colleagues here today, our patients, we all have much to teach each other, much to learn from each other. Today I came here thinking, I want to treasure the person in front of me “right now.” It makes a difference when I engage that way in “whatever.” #Gratitude for one more day where that happened. Those day are surrounded too often by many others when I forget.

Self-care Tip: Treasure the person in front of you.

Question: Who is in front of you right now? How can you treasure this person, this experience, this…? What are you getting from it? How is this perspective and what you get, kind to you?

Be a friend to yourself. Keep on!

Memorial Day – My Graduation Thank you

IMG_3342My Mom saved a bunch of “stuff” from years gone by (sniff) and I came across this. I was moved to snuffles. Thank you Mom for valuing my life.

I remember it so poignantly, working on these words with my brother Cam, and laughing a lot. Then before I knew it, there was the after graduation party, standing at the mike and those many faces. I blubbered mostly. Mortifying. But I do remember who I saw.

You! You! You! It’s all about you! We’ve done this together, and it’s God in you people that got me through. Thank you.

Medical School was hard for me. All that book work was as exciting to me as my acne, one of those things you hope just sort of goes away. I found that whenever I had some book in front of me, I suddenly became the best conversationalist. In fact, I learned to start taking them on dates. I started having a lot more success… with dating.

But still, all those years of book work were a form of security. There’s security in book work.  When third and fourth year came round, I got a little nervous. You know. You’ve got to perform.  By now I’ve learned if flirting doesn’t work, hey! I can always cry! I can do that because I’m a girl. Being a woman in medicine is neat like that. The only problem I really ran into with being a woman in medicine, is that guys are soooo competitive!!! Aren’t they!!! In med school especially. But you know what I like? I like to just CRUSH THEM!!! No I’m just kidding. I wouldn’t crush anyone …irreparably.

Growing up with Dad being a doctor was inspirational. From him, I thought what you mainly learned in medical school was that if it hurt, all you needed to do was put ice on it. Now I know you have to use tape too.

But on bad days, it was Jesus and Jesus in you that got me through.  You my friends who sent notes, you my family, brothers, Mom and Dad, who know me so well and survived my selfish demanding life, who kept me laughing and smiling and inspired, you all, you who prayed.

And I know this is just the beginning of a lot more practice of depending on God and God only for power. So here we go, together. You and me and Jesus. Thank you. You you you. It’s really all about you.

And 18 years later, even without the security of book work, the distance between me and medical school could still not get far enough! Thank you for trolling down that lane with me. May you all celebrate your history. Happy Memorial Day!

Keep on!

I Can’t Make Friends – Anxiety

voyagerMr. Clark stopped talking and walked to the ringing rotary phone on the wall.

We were experts, as 7th graders, in anticipating what phone calls would be about. I’m surprised we never got around to making bets. I missed my chance to be a bookie. When the phone rang, it could mean someone was in trouble and had to go to the principle’s office.

Everyone was quiet waiting to see if their name would be called. No. That wasn’t it.

It could mean there was a school announcement. It could mean there was something wrong with our bathroom plumbing! But it had never meant that a space ship had exploded. Seventh grade was not the time to grasp what this meant. If we couldn’t grasp it, if our perceptions were unable to see it, then it could not actually exist. Right?

We kids had other things we were trying to sort out. Boys and girls. Getting your period or facial hair. Zits. What Melissa said about you when you thought she was your friend. These were space occupying in our minds. There was little room for understanding that this phone call announced the end of 8 lives, a billion-plus dollars blew up, nor especially not what it meant politically! Spouses and children, watching and cheering in the bleachers live, front row and center, witnessed as their own individual loved one exploded into tiny particles.

Mr. Clark walked, white-faced and perspiring, to the radio, asked for silence over the hum that had built up, and we heard. The challenger, the 8 people aboard (one of them a teacher), in 1986, was gone.

A spaceship exploding is about what anxiety feels like. That may sound extreme but it is the truth. And those who have experienced it, as if their were going to come apart, will do anything not to experience it again. This urge to avoid anxiety expresses itself in emotions and behaviors. But often, when anxiety doesn’t reach a full explosion, the afflicted individual doesn’t even know that they are sensing the urge to avoid, nor how they are responding to this avoidance. The afflicted person and those who know him get think that these medical symptoms are actually the afflicted’s personality. “It’s just the way I am.” 

You may be someone who feels inner congruence with decisions. By temperament, you like closure! But even so, against your own hard-wiring, you find that you have trouble making decisions. How you talk is driven by indecision. You’re couching what you say, being careful. Your self-esteem erodes.

Manuel had some similarities to this, but also, on top of his medical condition with avoidance symptoms, his personality was one that got energy from being alone. That doesn’t mean Manuel didn’t like people or interpersonal relationships. It just means that he got energy from being alone. And he did stay alone most of the time. When around others, the energy poured out of him like lemonade through an open spigot. However, he wanted others. Being lonely was not his goal. But there he was, more energy when alone combined with a thrumming buzz of nerves when he tried to make friends, when he tried to date, or when he was approached by someone spontaneously in public who asked the time.

Fudge! She only wanted to know the Blinking! Time! he screamed inside.

Manuel had some friends with whom he was deeply bonded to by shared experiences. But he had gone on to college and his friends had not. It was niggling in whispering thoughts that he might still be hanging out with them because they didn’t disrupt him. Because he came apart. Terror, like a spaceship exploding in the atmosphere after take-off, filled his perceptions, if he tried to hang out with anyone else! And Manuel didn’t like thinking about his friendships that way. They lost value when tattered by that persistent wind. Nor did Manuel like thinking about himself as someone who couldn’t get other friends if he wanted to. As someone who would use the faithful. Friendship by default? No. He felt shame just thinking it and he knew it’s falseness. In his most essential self, he knew he loved them for more than proximity. But he really didn’t know if he was weak. It was a possibility. And besides! What girl would want a weak man?

People with anxiety have barriers to any number of connections in life, like coming up to an energy force field we can’t see. There are interpersonal connections we might have had, but never initiated or explored because the anxiety held you in place. This is what anxiety does to us. Anxiety takes away our freedom to choose. And as the consequences and fruition play out, we live out the related losses.

Manuel came to me because, “Mom told me I better come and talk to someone.” Mom was fed-up with his isolation, hours of video games, and she had noticed that he was spending even less time with his childhood friends. 

Talking to Manuel, unearthing these patterns in his life, his insight grew a bit. But once he looked at anxiety, even with a sideways glance, which was anxiety provoking in itself, he came up against the need to decide,

Should I treat?

Deciding to treat is a decision to make between the patient, perhaps including their support system, and their treating clinician. When there isn’t a clear answer though, like a blood test that shows the vitamin D levels are low, we respond with vitamin D replacement therapy, but in these areas of diagnosis, it often feels nebulus to the patients on what to do.

When the decision doesn’t have clear form, like an undefined space, go toward the data. You may trust your clinician to know that data integrate it into all the information that goes toward deciding on treatment. Or you may choose to spend time researching and evaluating the data on your own and then go forward. Either way, if you stay with what you’ve been doing, you will remain ill and the illness will progress over time.

So either way, going with the data, either via your clinicians recommendations directly, or indirectly. Accept treatment. In fact, run toward it! You will have a much higher quality of life. And… those around you will too.

Self-care tip – Go toward the data!

Questions: What had influenced your choices in treatment or not to treat? Please tell us your story. We need your voice!

NPR interviews Kitty and Michael Dukakis

In an interview with Kitty and Michael Dukakis, journalist Katia Hauser explores the benefits and risks of electroconvulsive therapy (ECT) in treating depression. Kitty shares her first hand experience with ECT and the ways it changed her life, and Michael provides the perspective of a family member.

Dukakis interview

Disrupt Your Work Agenda

4b6df56e68fed68a914582b8c2038c88

In the entire South wing of the LA Convention center, jammed packed with bodies, a teeming crowd was organized into sectioned exam rooms, per their needs. I’m writing to you at the tail end of “Pathways to Health” (PTH) in LA. There were some 4,000+ providers who gave their time and resources to many thousands of patients.

It was nice to  work with them for many reasons. The tossing of my standard business agendas was particularly refreshing. Many would have guessed, rather, the patients made it “special.” And the patients did bless me. But all my patients bless. Each person who comes to clinic or surgery, comes as an individual. One person. They are their own story, worth hearing. Worth serving. And worth receiving a blessing from.

When I go to work, I go mainly for three reasons; to serve the needs of my patients, to make a living, and to be to true to my spiritual mission. Going to PTH left two of those in my day and the other was gone, like it slipped into a parallel universe. Removing the agenda of making a living is disruptive, almost to point of being disorienting. And that is why it stands out to me. It was experiencing what was left when it was gone, that tossed my salad.

I’ll tell you one story, …nah. Patient confidentiality and all🙂. There were a lot of good ones though. Keep on!

Self-care tip: Do something disruptive to your work agenda and see what is left.

Questions: What is your agenda when you go to work? What have you done to disrupt it? What did you get for yourself when you did?

Please tell us your story.

I’m peaking in my career

  
Supposedly, I’m peaking. And this isn’t about egg yolk and marenge pie. I’m 43 years old, have been in medical practice for fourteen years, and am looking at a canyon in 360-degrees from where I stand. That’s what the data says. I wonder if I am going to do the electric slide or how I’ll boogie through the next years of medical practice. I try to think, “This is the best moment of my life, right now,” any time self stigma and fear of mortality creeps in. (That’s not saying, “This is as good as it’s going to get!” Ha!) I want to cherish the gift of practicing medicine, for however long I am blessed with it. 

It’s a popular discussion amongst my colleagues these days, about how long a physician should practice. There’s a newer’ish respected program called, PACE, that evaluates physician competency to practice as they get old.  This is a huge shift in the culture of medicine. It’s meant to respectfully assist rather than discriminate with ageism. I try to imagine what it might feel like if I were approached and asked to take the test. 

So what does a psychiatrist rocking her best jeans have to show for herself anyway, you may ask. Well, (tapping the mike), “I’d like to first say thank you to my sponsors….” Wink.  I mean my patients! Thank you. 

…Hey! This peak is crowded! Give me some room!

Ahem. But at my “peak,” at the best of my career, I thought it would be fun to play around with, “Why?” What’s in my doctor’s bag that is so special?

  • Ask, “Why do you want to be alive?”
  • Start all work-ups with a medical work-up. 
  • Give full informed consent with the 5-Treatment Paradigms of Psychiatry
  1. chemical (medication), 
  2. psychotherapy, 
  3. hospitalization (inpatient and outpatient), 
  4. alternatives (such as acupuncture, massage, sleep hygiene, lifestyle change, etc.), 
  5. stimulation therapies (such as ECT or TMS).  There’s nothing else (that I know of🙂 ) that anyone is going to offer you in psychiatry, no matter who’s clinic you go to. 
    • Push to full treatment response. 
    • Work toward quality of life, not cure, not perfect.  Ask again, “What makes like worth living for?” Design treatment toward those goals. 
    • Routinely and deliberately consider the flow of patient’s treatment agendas with physician treatment agendas. 
    • Mood journal. Nobody believes they were “that bad” after they feel better. Everyone wants to stop treatment when they feel better. (This is why there are so many repeat pregnancies, for example!). We all need our own voice (mood journal) to look back on and speak the truth. 
    • Fight for oxygen. If your patient has sleep apnea, don’t stop working toward treatment compliance. There are no medications that can take the place or make up for oxygen to the brain. 
    • Community. More community. 
    • The third eye – a therapist. None of us can be a mirror into ourselves. We all need someone outside of the “triangle” to speak.

    I’ll be thinking of more as I try to go to sleep tonight, but it’s bed time. I’m off! Sleep hygiene! Arg!

    Self-care Tip: Evaluate your position in your lifeline, and treasure where and who you are with deliberation. Keep on!

    Questions: Where are you in your lifeline? Are you struggling with ageism? What gives you value? Please speak! I, and the rest of us, really need your voice.