Stuck in My Craw

One of the things I was taught in medical school: common things are common. 

These things have been more common lately. I know I’m starting the grumpy old man phase of my blogging life, but good grief, people. Really?!?


No direct eye contact. No acknowledgement, verbal or otherwise, when greeted with a cheery good morning. Annoying behaviors designed, quite consciously, to actively annoy and derail the time in the office. Texting, typing, talking and playing games on phones in the office when active input would be appreciated! Ignoring questions outright or refusing to answer. 

Sullen mood: 

No, I’m not talking about serious depression or active psychosis. I’m talking about deliberately hostile, staring, scowling, defiant presentations designed to minimize communication. Really?

Lack of responsibility: 

“I don’t know why I had to come here.”

“I’m not sure how that gun/knife/weapon got in my gym bag, but it’s the kid’s fault that found it and turned me in that I got in trouble.”

“My teachers suck. They don’t know how to teach. They’re stupid.”

“Because I don’t like to do chores, that’s why.”

“I just don’t do the work. I don’t feel like it. No, I never turn my homework in.” 

“They can’t do this! They can’t take away my iPhone/iPad/Gameboy/PlayStation/XBox/flat screen TV just because I have four Fs and a D!”


It’s the teacher’s/principal’s/parents’/other kids’/government’s/doctor’s fault.

Anger for anger’s sake.

Refusal to problem solve or to see anything positive at all in a situation. 

Adversarial stance (kids and parents both!)

“Fix me!”

“We’ve tried everything and nothing works for him.”

“Nothing you can do will help.”
This was a week, friends. 

This is not entirely a mental health crisis. 

This is a crisis of investment in parenting, house rules, expectations, empowerment, upbringing, respect for elders, and establishment of normalcy in childhood. 

Enjoy your weekend. 

Next week, we all have more work to do. 

At My Best

I have felt a little ill at ease lately.


A tiny bit anxious.

Have you?


My country, my immediate world and indeed the larger world, are in flux. Change is afoot, change that in many regards I have no direct control over. Change that I am forced to watch and to endure the best way I can.

Personally, I am the happiest I have been in some time. Years, truth be told.

The world, though, seems  a little irritable.

What are we to do?

Well, I can only speak for myself, but when I get these unsettled feelings, for any reason at all, the best thing for me to do is to fall back on my tried and true methods for centering myself. I need to pay attention to what I am doing, what I am feeling, how it affects me and how it affects those around me-spouse, family, friends, patients, and coworkers.

I am at my best when I take good care of myself.

I am at my best when:

  • I am well rested. My propensity is to stay up late and get up early, which I have been able to do for many decades. It started in college in earnest, and medical school and residency only cemented those not- so-good habits. I still like to get up at five, because my quiet morning time gives me space to read, listen to news, have that first cup of coffee, or plan my day. However, in order to get up that early, I now understand that my body expects me to go to bed earlier, like ten PM, eleven at the latest. Just ask my wife (who has my number in more ways than one) how difficult that has been for me to incorporate into my regular daily schedule. She will most likely add five years to my life expectancy because of the way she helps me live healthier. (Thank you, my love.)
  • I exercise regularly. Today was a federal holiday of course. After sleeping until 9:30 AM (hey, my wife is in Amsterdam and I didn’t have to work today! See how that works?) I got up and had a leisurely morning. Then, at about 1:30, I struck out on a wonderful, three and a half hour, eight mile exploration of the beauty of spring in my neighborhood. That plus cold brewed coffee as a mid-walk break. I know that I feel better when I walk, lift weight a couple of times per week, ride a bike, hike a mountain, or otherwise push myself. I even got a standing desk setup this week so that those long telepsych shifts will not entail sitting for hours at a time.
  • I am learning something new or stimulating. Trina and I went to a neighborhood concert of Irish music in a local home this weekend. We heard three wonderful Irish musicians play and sing music that is not what I normally listen to. I sat next to a man from Ireland who had married a Georgia girl and works here now. It’s a very small world, and there are things to be experienced and learned!
  • I am “in the zone”. Whether working or writing or exercising, it is better for my general health and wellbeing if I give my entire attention to the task at hand and “get in the zone”. You’ve felt that way I’m sure. That time when things flow, when  you have to expend very little effort to get stellar results and when you seem to be moving effortlessly through your day.
  • I reveal just a little bit of myself to those around me. As I have been reading in multiple articles this week, physicians and especially psychiatrists are often trained to be stoic, resilient, and in our case, “blank screens” that divulge little of what they feel and less of what stresses them out. I have found over my career that this does not work well any more, especially when I am working with those with major psychotic mental illnesses. They often need to know that I am “real”, that I have a team I pull for in the Super Bowl, that I do have grandchildren, and that I like to hike to relieve my own stress. I was very well-trained in my youth, but the older me now knows that there is something to be said for judiciously and professionally sharing some of oneself with others when it is indicated. and that both parties will leave the relationship or encounter the richer for it. Do I also need to mention that this works well for friends and family and spouses? I am (still) learning that as well.
  • I enjoy the stories that I hear every day. I have already written a recent post about this, but I need to say again that if I do not regard work as a stressful chore, but look at it as a way to learn about others and hear fantastic stories that they trust me to hear, that I can have fun and help others at the same time. We cannot change the way that life throws stress at us sometimes, but we can certainly decide how we are going to respond to it.
  • I let myself be human. Your struggles are my struggles. Mine are yours. I know some things and have some specific expertise. So do you. Contrary to what some have espoused, we cannot do this alone. Life is a team sport, a contact sport. If we let someone have our back and we have theirs, whatever comes can come.
  • I give time  to my family, friends and my spouse. Let’s face it. We are all busy. I work two jobs. My wife travels internationally. My children live in three states and my four grandchildren are an eight-hour round trip from my home. If I want to see people, I sometimes have to make time to travel and see them! My new bride and I love our time together because we already know how precious it really is. Our parents are aging and need our phone calls (Yes, I called my mother this morning to catch up) and our personal visits. We are at our best when we give of ourselves, our time and our attention to those we love and who really love us. That time is never wasted. Never.

So, if you feel a little anxious, a little stressed, a little out of focus in the weeks or months to come, figure out what grounds you, replenishes you, recharges you and feeds you, body and soul.

Make time for those things. Take care of yourself, because you know as well as I do that others are not going to do it for you. It ain’t happening, so get over that right now.

Figure out what makes you the best you can be, and do it.

Have a great week!




He came to see me for his annual visit. He had been stable for many years, taking his medication and not having any of the psychotic symptoms that had gotten him to me in the first place two decades ago. This visit was pretty much like all the rest-at first.

Check on his symptoms. Check on his medication, the dose, any side effects, the last time he had routine lab work drawn to check liver functions, blood glucose, lipid levels. All routine.

He was, as usual, quiet, subdued, soft-spoken, looking mostly at his shoes and not making any direct eye contact. No hallucinations, no delusions. No suicidal ideation. Mood good. Sleep and appetite good.

Then, quite abruptly, he looked up, straight at me.

“How long you been seeing me?” he asked.

“Probably twenty years or more, I think,” I said.

“That long? How long you been working here?” he was curious.

“Twenty six years,” I answered. “I started with the mental health center in 1991.”

“That long? ”

“That long.” I said.

“Oh, yeah!” he suddenly sat up straighter, looking right at me, like he was seeing me for the first time in two decades. “I remember you. That, that there (and he pointed in the general direction of my beard) used to be black, dark, black, didn’t it? And that up there (he made general hair mussing gestures over his own short-cropped hair) was dark too. Now, it’s all white. It’s white, ain’t it?”

I smiled. What else could I do?

“Yes, it is a little whiter than it used to be,” I answered.

He looked dead at me again.

“You old.”

There it was. Simple.To the point. True. Sort of.

I smiled bravely again.

“Yes, I guess we’re both getting older, aren’t we?”


Time goes by much faster than we realize.

We form relationships, big and small, acquaintances and deep friendships, professional and casual, lasting and fleeting.

Patients age. Customers age. Teachers and mentors age. We age.

We don’t really want to. Not consciously. Not really. But we do, all the same.

We have developed institutional memories of our most cherished places, we have gained expertise, and we have developed confidence.

We think that it will last forever, but deep inside, in those places that we hear late at night as we drift off to sleep or first thing in the morning as we rub the sleep from our eyes at first light, we know that it can’t. It won’t. It shouldn’t.

Eventually, we will find ourselves being cleaned from the grimy window of time so that the generation following us may see clearly into the future. As it should be.

Now, those of you who know me know that I don’t consider myself remotely close to being old yet. I have a whitening goatee and my hair is now visibly salt and pepper when I look at my recent wedding pictures, but I pay that little mind.

I will continue to work because I find it a challenge, travel because it broadens me, and love because it gives me a reason to live another day for someone other than myself.

My work life?

It will end, if all things go according to plan, on April 2, 2032. I will be seventy-four years old. I have made an appointment with myself for that day to start the rest of my life. I have a lovely lady I would like to spend more time with one day, and an insatiable urge to see more of the world.

I’m quite sure that before I do anything else that week  I will be right here, where I am tonight, sitting at my dining room table,  writing something for you to read.

I have no doubt that I will have something to say.



Do You Want It More?

I made arrangements to have someone cover the last half of my Sunday telepsychiatry shift (thank you, Jimmy!) so that I could come home, grab a bowl of chili and a beer and watch the Atlanta Falcons win Super Bowl LI. I live back in Georgia now, so I figured that the Dirty Birds were now my default team to root for, especially since it had been eons since they had played in their first super contest.

I really felt that they had a chance to beat the juggernaut that is the New England Patriots, led by their quarterback Tom Brady, already winner of four Super Bowl rings and tied with Joe Montana and Terry Bradshaw in that regard. Matt Ryan had just been crowned the NFL MVP for the season the night before, after all, so there was only one way to go-up. I was confident, and I knew it was going to be a great game.

Lord knows, none of us realized how good a game it would be. One for the ages.

Atlanta was quick out of the blocks, and they played true to the expected game plan. Get out there, run hard, score early, build a commanding lead, and then hold on for dear life to win the Lombardi trophy. They built a 21-3 lead at halftime. It looked fluid and poetic. It looked too easy.

It was.

The Patriots, lead by that same Tom Brady who had been slapped with a Deflate Gate penalty of four games on the bench to start this season, roared back, scoring thirty-one points in the second half, the last twenty-five of which were unanswered by the flightless birds. And to add insult to injury, this was the first Super Bowl in history that went into overtime to decide the winner.

The Patriots. Seven Super Bowl appearances. Five wins. The biggest comeback in the history of the game, probably in all of sports.

The Falcons. Second Super Bowl appearance. Two losses, this one an epic free fall that had to even make Greg Norman shake his head in wonder.

What happened?

The Patriots wanted it more.

Was it to vindicate themselves? To get back at the Commissioner? To assuage Tom Brady’s guilt?

It doesn’t matter.

In the end, they just flat-out wanted it more, and they did everything they had to do to get it.

We all make plans. We dream. We fantasize. We think we know exactly what we want.

Do we? Really?

Do we really want to buy that (fill in the blank) if it means saving every nickel we can for the next five years to do so?

Do we want a better body enough to go to the gym, hit the road, lift the weights, and ride the bike for the hours it takes to get there?

To be the best, to have what you want, to rise up (sorry Atlanta) to the top of your field, or to make your mark in the history books, you have to want it more than the next guy, or lady. You have to make a plan, have the drive and the guts to execute that plan, and then go out in the blazing sun or under the hot spotlights of scrutiny and show what you’ve got.

On this particular Sunday, New England  did. They have a fifth ring to show for it.

Do you want it more?