Ode to Joy

I stood in the bright, warm San Diego sunshine outside the entrance to the Museum of Man, in the shadow of the California Tower. I had just walked the one hundred fifty steps to the Tower’s observation deck, then back down. The three hundred sixty degreee view of downtown San Diego, Balboa Park, the San Diego Zoo, and the most colorful and vibrant flora I’ve  seen in ages left me feeling exhilarated, humbled, and thankful. Such wonderful beauty is almost excruciating. It’s impossible to fully describe in words. 

Then, as I contemplated my next activity, I was witness to something even more beautiful. 

She was about three, thin and tanned with the flowing blond hair of an angel. She was crossing the street in front of me, trailed by her pregnant mother, watching her closely. She was excited, jerkily running along as only toddlers can. She pointed towards the steps leading to the museum entrance, balancing herself with the other arm pointing behind her. 

“Gwamma, Gwampa! Gwamma, Gwampa!” 

I looked to my right and saw them, an older couple, faces beaming, accompanied by who appeared to be the little angel’s father. 

She ran at a steady pace, making the small transition over the curb, then reaching the steps, then taking them one, two, three, four, slowly and deliberately, never taking her eyes off her goal. 

“Gwamma, Gwampa, I MISSED you this morning!” she exclaimed with toddler glee. 

They embraced, this little family. They loved each other in public. They affirmed, with tiny movements and shouted I love yous that beauty and love and family and belonging are alive and well in this world, not only in this idyllic part of Southern California but in every corner of the globe that humans call home. 

I heard the joy in the little girl’s excited shouts to her grandparents today. 

I saw the joy in exquisite works of art from the fifteenth century. 

I smelled the joy in flowers so meticulously crafted that only One who knows beauty can perfect them. 

I even saw joy in the agonized responses of those who gave succor to the victims of the Manchester bombing. 

We are here. 

We love. 

We care. 

Fear and terror cannot win, because there is joy in the voices of children, the petals of flowers and the centuries-old artistic mind of man. 

Joy will prevail. 

Joy will always prevail. 

Gait, Gait, Do Tell Me

Two sisters (religious order, not biological relation, as far as I know) live in one of the condos across from us. They are very nice, older ladies, warm and pleasant, always ready with a kind word and a smile as they see others in the complex come and go. They seem, at least on casual observation, to lead very busy lives. They rise early, heading out to do whatever it is sisters do in the world nowadays. One drives a minivan, one a small nondescript sedan. All pretty ordinary, I suppose, except for one thing that always strikes me about one of them.

Sister gets up early most mornings. She almost always beats me out of the parking lot, and I’m an early riser and starter myself. When she exits her front door she heads for her minivan, parked about fifty feet away if that, with the speed of a sprinter and the determination and conviction (again, at least as I perceive it) of a person who is going to change the world. She is diminutive, casually dressed, doesn’t stand out, but she is driven to get to her vehicle and start the day. She walks determined, rapidly, not wasting a moment of her early morning time. If I am leaving at the same time and she sees me, she will offer a cheery hello and a wave. Then she is off.

Now, come with me to my office a little later in the morning. We walk up the clinic hallway to the waiting room up front, open the door, and call out a name. The patient is in her mid-twenties, somewhat disheveled, is chewing gum, and has earphones in her ears connected to an oversized phone. She saunters to the door from the couch on the far side of the room. She is wearing dark sunglasses, which she does not remove.

I have never met this young woman, so I welcome her, introduce myself, and thank her for coming to see me. She makes no eye contact, looks straight past me, does not acknowledge my greeting, and continues her slow roll through the door and into the hallway. We stroll, no other word for it, down the hall to my office at the far end of the building. As I begin my usual interview questions, she looks at me blankly, shades still hiding her eyes, offers one word answers, and looks quite bored. This young lady does not appear to be the least bit interested in being here, in acknowledging me, or in moving the process along toward any definable goal.

What would you say about these two women, knowing only what I have told you? Granted, we acknowledge that there is  lot more about both of them, their stories, their motivations, that we do not know. However, I am being intentionally superficial in my description of them for the purpose of this post.

What does physical gait, movement, and apparent drive tell us about each other?

Of these two women, who do you feel is most likely to have set a goal, or multiple goals, for herself for the day? Which of them is more likely looking towards accomplishing something measurable before lunchtime? Of the two, which one knows what she is trying to achieve by being in the physical place she occupies this morning?

We telegraph our demeanor, our intentions, our plans, our desires, and our energy levels  to others all the time. Without saying a word, we look motivated, driven and highly focused on whatever is coming next, or we appear tired, bored, lackadaisical and aimless.

How will you present yourself to your coworkers, your boss, your spouse, your friends and to strangers today?

Will they see you as leaning into the day, full of energy and vigor, ready to accept whatever challenge comes your way?

Or, will they see you as someone who has no plans, no energy, no spark, and no reason to move any faster?

 

 

Easter Eggs

There are these little pieces of code or images or popup surprises that sometimes lurk in the nether regions of a computer program or DVD or computer game. If you are not aware of them, or do not know to look for them, you may never see them. The programmers that put them there know they are there and they are happy just knowing that, whether you ever find them or not. It’s like an inside joke for geeks. Sometimes the benevolent geeks leave little direct or indirect clues to help you get at these surprises, and what fun that is when you get there! Sometimes you are on your own and may never find them. You still enjoy the game, but not the secret.

These little hidden jewels are called Easter eggs.

Now, you may be celebrating the Easter holiday today or you may not be. That’s your thing, not mine. Easter, the religious holiday, is about atonement, redemption, dying to the old and arising again to start anew. A religious reset button for the game of life, if you will allow me to extend the metaphor.

Children all over have been furiously hunting for Easter eggs, getting baskets full of pink plastic straw and chocolate bunnies wrapped in golden foil and jelly beans galore. It’s a serious religious holiday, more impactful than Christmas if you are a believer, as commercial as Halloween if you are not.

What I want you to think about are those hidden Easter eggs. Not in the grass behind the shed. Not in the computer game that came in the colorful DVD package.

The Easter eggs that are hidden in our daily lives.

I got home about one AM this morning after a long telepsychiatry shift. As I walked into the downstairs bedroom and deposited my stuff and got ready for sleep, I could see that my wife had left a little card on the bed where I usually shed my clothes. It was a little German card, with bunnies wearing golden crowns and Happy Easter Holidays in German on the front. A sweet note graced the inside.

I (and one of the nurses who works with me) got another unexpected card at work the other day from the sister of a long time patient whom we had helped to secure and maintain her United States citizenship. It was sweet, heartfelt and expressed the kind of thanks that does not have to be documented formally but that warms your heart and makes you feel good pretty much forever after you get it. We had done only a little for her, but she was so grateful to us.

I got a phone call the other day, right out of the blue, with good news that was as unexpected as it was wonderful.

Easter eggs.

They are hidden everywhere. No, you don’t have to look for them or even see them at all. Your life can be rich and rewarding without them. You can live your life, be happy and be quite comfortable never having seen one.

But that day that one of those little surprises pops into your life, unexpected, refreshing, wonderful, can be one of the best days you’ve ever had, maybe one of many best days if you become more attuned to the hidden mysteries that surround you.

I hope you enjoy your Easter holiday if you celebrate. Even if you don’t, I hope that as spring settles in and stays with us that you will pay attention, look for the clues that the Programmer puts in your path, and that every once in a while an Easter egg will provide you with that true, unbridled joy that makes this life worth living.

 

Smallville

“No, I cannot forget where it is that I come from

I cannot forget the people who love me

Yeah, I can be myself here in this small town…”

Kenny Chesney, John Mellencamp
When I began my psychiatric training in earnest thirty three years ago, after a challenging rotating internship, the indoctrination that began was regimented, sanctioned, scripted and complete. I knew from a very young age, training-wise, that my job was to ask a few very open ended questions, listen, formulate my thoughts about my patient and his reason for coming to see me, and then to discuss this with my supervisors in order to come up with a treatment plan. A plan that sometimes was, oddly enough, kept a secret from the very person it was supposed to help. The name of the game in those days was to figure the patient out before he did it himself, and then to guide him with judicious rigor and well-timed and brilliant interpretations toward increased insight and mental health. Yes, I was trained in a predominantly psychoanalytic program that was only beginning to bring in the psychopharmacologists, who would later dominate the agenda. 

I was taught to be the proverbial blank screen. I was to show little emotion, offer little to no spontaneous conversation or banter, and to never divulge anything of note or merit about myself except under the direst of circumstances. I embraced the psychiatrist persona that was the norm for that time. This therapeutic stance was just that, but it was not real or fun to me to practice that way. I will never forget how shocked, and yes, maybe a little hurt, I was when one of my long term psychotherapy patients (a lady who had a panic disorder that would be quickly and fairly easily treated today) blurted out, ” I might as well be talking to that doorknob over there as to be talking to you. You never say anything!” When I took this to my supervisor, a prominent psychiatrist who had literally written the book on these kinds of interactions, he praised me for maintaining my therapeutic distance and stance through this obvious transference-based outburst by my patient. He gave me pointers on how to proceed from there, mapping out a strategy for the next several months. I dutifully went back to work. The patient came to see me one more time and never came back. She was not getting what she needed to get better, and she quit. 

Today, I am working in a small South Carolina town. One of my duties this morning was to go over to the probate court at the courthouse building, five minutes away from my office by car, and testify about an evaluation I did a week ago. On arriving at the probate court office, I encountered the judge sitting at her secretary’s desk, taking  phone call. 

“Aren’t you in the wrong place?” I teased her. “Your office is in there.” 

“I know! One of my staff had a death in the family and the other one had already planned a vacation, so I’m doing it all today.” 

Soon afterward, we entered the hearing room, which is just that, a room with one long wooden conference table, a dozen mismatched chairs, a wall full of musty bound county record ledgers, and us. The judge was joined by me, a clinician, the patient, her appointed attorney, and an unsmiling bailiff. 

The format, unlike the proceedings one county up in another courthouse, was informal. Information was shared, the usual legal wrangling was dispensed with, and we all made it clear to the patient and each other that we cared about her, wanted her to get treatment and supported her in doing this. Even in her pre-psychotic state she seemed to grasp the feeling in the room, the common sense of purpose, and the unification of all involved. We even joked and laughed together a few times, which felt wonderfully good and real to me. I realized, mid-hearing, that I was doing something in this sunny small town courthouse that was going to make a real difference in someone’s life. 

I will always be grateful for my training, my supervisors, my colleagues and the experiences and baseline knowledge and skill set they imparted to me. I use those skills every single day. 

However, that can never hide the fact that “I can be myself in this small town”, and it feels good when I am. I’m proud of what I can do to help people here,  and that’s exactly the way it should be. 

Slow Hand

I did some continuing education this week, the old-fashioned way. I inadvertently signed up for both digital and CD forms of my CME programs from the provider the last time I renewed, and this week’s program arrived as a plastic CD in a paper mailer. Talk about a blast from the past! I have not listened to CDs for this type of education for several years now. I decided that I would use the CD in the car on the way to work, which was just fine.

Now, after one is finished listening to the program, one must complete a post test that is graded for credit. I am also used to doing these online, answering the questions quickly, hitting send and seeing instant feedback of scores and documentation of the completed course. As this particular program was not even showing up on-line yet, I had to (gasp) study the written summary of the material and then (double gasp) take the test on a sheet of paper, filling in those little answer bubbles. Remember those? Then I could either fax the completed form or mail it back the old-fashioned way.(I faxed it)

This whole process, one that I had not used in years, felt awkward, slow and cumbersome. I found myself flashing back to the first time I took my shiny new iPad in the car and FORGOT my beloved iPhone at the house. Both times, I felt like I was cheating on my previous technology.

The positives to this retro CME experience?

It slowed me down. Big time. After listening to the program on the CD, I already had a printed copy of the notes and references for the lectures, whereas before I would have to make the effort to print a copy myself if I did not want to simply read it on my screen. I actually looked some things up, read and re-read them, and could go back and use this printed material to research my answers to the questions.

I was more focused on listening to the program and actually thinking about it somehow.

The testing process felt much more deliberate with the answer sheet and its little bubbles waiting for me to fill them.

Doing this again helped me to think back and remember what learning used to feel like before the age of the internet, podcasts, video lectures, audiobooks and TED talks.

It was not altogether a bad experience.

Which way is better for me personally?

Well, like Marty McFly, I don’t mind going back to a skateboard every once in a while as long as there is a flying DeLorean waiting to take me back home to my waiting Toyota Hilux 4X4 in the garage.

The Good Old Daze

I was driving to work this morning along the same road that I’ve used for almost thirty years. About halfway between home and clinic, off to the side of the highway, is an old textile finishing plant. It’s long since closed down, and the graffiti-scarred structure is rusting and collapsing. A shiny new pharmacy was built in front of it so one has to know it’s there or be very observant, or it is easily passed by, forlorn and crumbling, hiding in plain sight. 

One of my many jobs growing up was working in the local textile mill that was the mother’s milk of the small Georgia community I grew up in. The plant provided jobs, housing, a post office, a village doctor, decorations at holiday time, and a ready made social fabric in addition to the thousands of yards of cloth it produced. I enjoyed my time at the plant. I learned valuable lessons about people, hard work and the necessity of following rules during my time there. 

The textile mill I worked in, similar to the finishing plant on my route to work, has crumbled, and it has actually been torn down. 

I have good memories of my childhood, my teenage years, and my work experiences. I lived, learned and loved in a Norman Rockwell time and place. Cold, deep swimming pools of water doused the heat of scorching hot summers and the smell of wild onions and grass stains on blue jeans gave way to smoke from chimneys and the smell of turkey and dressing in November. The hill behind the pool became an Olympic sledding venue after the rare snows we had as kids. Life in the mill village was good. Really good. 

The memories of those times are pleasant and often surface when the stress of modern life threatens to overwhelm us. The nostalgia is a balm, a healing salve on the claw marks and scratches  and bites we get from sharp-edged technology, scathing commentary and biting sarcasm. The nostalgia is sweet, but like too much sugar ingested by a diabetic, it can quickly turn to a killing poison. The past is the past, and barring a miracle of time travel or a rip in the space-time continuum, it is never coming back. 

Some of us, including our leaders at the highest levels, revel in the nostalgic vision of that idyllic time and place, with its neatly ordered rows of houses and humming factories and simple social order. They long for a return to a more structured, locally controlled, face-to-face existence. They see a return to that time and place as a return to a strong, powerful, safe, and protected country and lifestyle. They lack insight into how the world is evolving, not at the speed of sound or even light but at the speed of electrons and bits and bytes that travel the circumference of the globe at a mind-boggling pace. They lack the vision of a world that is rapidly morphing into a new era of robotic manufacturing, artificial intelligence, augmented reality and social interactions on a scale we’ve never experienced before. 

This is not only short sighted but dangerous. 

Too much nostalgia, pleasant as the sugar coated predecessor of the poison is, leads to sadness about what we have lost. 

Too much division leads to anger and frustration about what we cannot do. 

We must pivot. 

Now. 

Today. 

Each of us. All of us. 

We must anticipate the changes of the future, both short term and long term. Burying our head in the sand about advances in technology, cyber spying, interference in our longstanding institutions and processes will not make these changes go away. 

We must plan for the near future,  paying attention to those things we have a modicum of control over, while allowing ourselves to dream of the distant future, imagining things that are not even concepts or inventions yet. This will keep us strong and productive in the now, but not hamper our ability to create and brainstorm and reorganize our world. 

We must allow ourselves to experience life as it evolves around us, with all its wonders of climate and energy and technology and transportation and entertainment and work. 

We must innovate. 

If we stand still, if we stop dreaming, if we give into the fallacy that the good old days can never be bested and so should be resurrected, then we shall surely watch ourselves drift slowly but inexorably into the sea of irrelevance. 

The future is coming. Of that there is no doubt. 

We must choose to move boldly and be part of it. 

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?!?

Disrespect: 

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!”

Blaming:

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.