Posts Tagged ‘schizophrenia’

Looking for the illness behind the addiction

October 24, 2018

I saw some addicted to meth

I want them to keep up their breath

And not lose their molars

Because some are bipolars

Predisposing to a too-early death

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with a return to traveling and adventures in temporary positions in Alaska, rural Iowa, suburban Pennsylvania, western Nebraska and northern British Columbia. I have returned to Canada now for the 4th time.  Any identifiable patient information has been included with permission.

I dealt with a number of methamphetamine addicts today.

Far too often the medical profession in general and this doctor in particular yield to the temptation to judge substance abusers. Such an exercise in self-indulgence on the part of the physician fails to benefit the patient at the same time it saps the energy of the doctor.  I learned those lessons from a doc 18 years my junior.  I wish I learned it earlier in my career.

Most physicians find it easier to focus on the human being in the substance abuser if we also can find a major psychiatric diagnosis.

People do not decide to acquire the diseases of schizophrenia or bipolar (formerly known as manic-depression); such illnesses come to them gratuitously. And, if they had the choice, almost all the sufferers would choose to be sane.  Society in Canada and the US has failed the mentally ill; in both countries they comprise a disproportionate number of the prison population and the homeless.  All over the world, they face a life expectancy 20 years shorter than average.

Thus, confronted with an addict, I’ve started to ask my touchstone bipolar question: “Have you ever had an episode lasting at least 4 days during which you felt great without drugs, slept less than 4 hours a night, and didn’t miss the sleep?” If I get a blank stare, I ask, “Have you ever felt so good without drugs that you didn’t need to sleep?”  and if I get a positive answer, I ask if it lasted more than 4 days.

All the meth addicts I attended today met the diagnostic criteria for bipolar. Each one came from unique circumstances, had unique considerations, and got a different treatment.

During my 3 years in Community Health I took care of a lot of the mentally ill. I learned that schizophrenia, bipolar, and substance abuse overlap so much that trying to tease them apart for therapeutic purposes comes close to useless hairsplitting.

I hadn’t learned those things during my private practice years because that patient population lacks the resources to access upscale medical offices: for the most part they have no insurance, money, or transportation. Too many of them constitute the homeless and the incarcerated.

So I did my best. I prescribed the patients medication and asked for follow-up.  If they don’t come back, I won’t think less of them, because their illnesses include impaired thinking.  And I won’t think less of myself.



Shared delusions and eggs over easy

April 25, 2018

It’s called a folie a deux

When delusions are shared by two

Or possibly more

But who’s keeping score?

When our breakfast we’re trying to chew.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with a return to traveling and adventures in temporary positions in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska. 2017 brought me adventures in Iowa, Alaska, and northern British Columbia. After a month of part-time in northern Iowa, a new granddaughter, and a friend’s funeral, I have returned to British Columbia.  Any identifiable patient information has been included with permission.

During my work time here, I get housed in a hotel a short kilometer walk from the clinic. The accommodations comprise what amounts to a 1 bedroom apartment.  We have a small kitchen, a stove with a real oven, and a decent-sized refrigerator.  The bedroom has a door that closes.

But the room also comes with a continental breakfast at a nearby restaurant. You can’t call the meal fancy, but we can get eggs cooked to order.

The hotel business runs light at this time of year, a far cry from last summer when one could hear loud conversations around the building all night. We haven’t had to share the breakfast room since before Bethany got here.

Today I greeted another breakfast guest as we walked in; he promptly said, “You look like an old professor.”

“I like to teach,” I said, “but that’s not what pays the bills.”

We nodded at another patron as we put bread in the toaster.

The owner by now starts my two eggs, over easy, as soon as I walk in the door.

As we sat down, the two other customers started an animated conversation, in volumes large enough to fall far from the bounds of what could be called a restaurant voice. In short order, I recognized the linguistic tells of mania (rapid speech, flight of ideas, grandiosity) for one and schizophrenia (in plain English, he didn’t make tracks) in the other.  But they found each other’s conversation fascinating.

We didn’t interrupt or join in. We just listened.

The manic customer very quickly convinced the schizophrenic customer.

You can find bipolar disease at the same frequency in every population in the world. My opinion runs something like this: in the manic state the bipolar functions as an irresistible leader with an uncontrollable libido.  He or she can convince the group to go places where, literally, no man has gone before.  On arrival, that person leaves a disproportionately high number of offspring with the same propensities.

At the restaurant, I listened to the founding of a folie a deux. Where insanity usually runs a solo game, a folie a deux relies on a two person delusional system.  Such cases notoriously resist treatment.

But I did not serve as their physician and thus cannot claim them as patients. They spoke loudly in a public place.  And, after all, such a scene almost certainly played out in more than one venue today.

So I can write about it. Rules of confidentiality do not apply.


At the end of another Arctic assignment

November 27, 2017

After the lessons not learned

And the good advice has been spurned

Sometimes slow, rarely quick,

People get sick,

I do my best though the bridges are burned.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with a return to traveling and adventures in temporary positions in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska. After 3 months in northern British Columbia, and a month of occasional shifts in northwest Iowa, I just finished a month in the Arctic.  Any identifiable patient information has been included with permission.

Aside from well child checks, perfect people do not come to see me. Most of my patients have made a lot of decisions they regret, and, whether they realize it or not, when the consequences add up they get ill.

In my years in Community Health I learned that schizophrenia, bipolar (formerly called manic-depression), and substance abuse overlap so much as to be indistinguishable.

Sometimes patients are difficult to talk to. Schizophrenia, for example, can rob the face of expression and make speech slow and monotonous; Parkinson’s disease can do the same thing.

Alcoholics, marijuana abusers, smokers, meth heads, and narcotics addicts get sick more often and more severely than those who lead orderly, substance-free lives. Leaving the start line with mental illness that hampers learning from experience gets compounded with substances that do the same thing.

I do my best to focus on my job: fixing what can be fixed and preventing what can be prevented. Bringing up a person’s past mistakes brings nothing good to a medical visit.

Every day I attend patients in desperate circumstances. I do my best to listen to what they say, and what they don’t say.

When I start to fall into the trap of judging people who have come to the inevitable consequences of reality avoidance, I remember the many mentally ill I’ve cared for who tried so hard to stop the voices in the heads. Because it’s easier not to judge if the person has a diagnosis.

I sit and talk to someone who has burned a lot of bridges, brain cells, and assets using recreational chemicals, and I do my best to tease out the story from a wandering narrative. I nod and look into the face of devastated youth and beauty.  I listen to speech patterns that some find annoying, and when the patient finishes talking I ask the right questions.

I do my best to get them to the correct medicine. Often the patient requests drugs that will make their problems worse, not better, and I explain the rationale for avoiding them.  Mostly they follow the logic, sometimes they don’t.

A lot of the people here have asked me if I’m staying. I don’t plan to, but I’d like to come back.

Inevitably, I don’t get along with some people.

But then, perfect people don’t come to see me.



Schizophrenia should not be a death sentence

May 1, 2014

Even the worst of the cynics
Support the function of clinics
It’s a seasonal flow
They come and they go
The homeless bipolar schizophrenics

Synopsis: I’m a family practitioner from Sioux City, Iowa. I danced back from the brink of burnout in 2010, and, honoring a one-year non-compete clause, went for adventures working in out-of-the-way locations. After jobs in Alaska, New Zealand, Iowa, and Nebraska, I returned home and took a part-time position with a Community Health Center. I just returned from my second locums trip to Petersburg, Alaska.
The young man I talked to in the clinic recently brought a distressingly familiar story; because so many have similar tales I can talk about the non-unique elements. From out of town, he couldn’t give me a good reason he had landed in Sioux City; he had no work or money and the word “tenuous” described his housing arrangements. As we talked the contradictions in the history started to add up, but I carefully avoided bringing inconsistencies to his attention.
I won’t discuss his “admission ticket,” the physical illness he described came second to his main problem.
A long, involved medical history with improbable descriptions of other health care facilities, led me to conclude that he maintained an uncertain relationship with reality, and, eventually, he mentioned his history of schizophrenia.
My 22 years as a co-owner of an upscale clinic brought me little contact with schizophrenics, but my current position has. Our facility cares for most of the schizophrenics in the city.
I have learned that schizophrenia, bipolar disease, and substance abuse overlap each other with terrible frequency. Most schizophrenics smoke, and trying to get them to stop ranks with trying to stop the tides. The majority of schizophrenics have difficult-to-control diabetes.
We have drugs to treat the bipolar, the diabetes, and the smoking. Yet we lack good, effective treatment for the basic disease process, where a person’s thoughts loses touch with reality.
(One very effective drug, clozaril, shows dramatic improvements not only in symptoms but functionality; the worst side effect, occasional and unpredictable bone marrow shut down, makes it too toxic for all but the most severe cases.)
Our society has failed our mentally ill. A Republican President with bipartisan support closed the mental hospitals and dumped the patients onto the streets. They form a disproportionate percentage of our prison and jail population and a majority of the homeless. Unable to cope with the real world, they can’t hold jobs, manage money or maintain interpersonal relationships.
If someone in our town stumbles out from under a bridge and into a clinic, they stumble into our clinic. They truly can’t afford to pay for their services.
The most conservative, fiscally stingy, small-government supporters I know agree that schizophrenia should not be a death sentence.
Some of my schizophrenics can maintain a semblance of a normal existence with regular medication; a few can manage part-time employment. But many just keep drifting, north in the summer, south in the winter.
I do what I can for them, recognizing the fleeting nature of the relationship.

Scenes from a weekend on call

September 29, 2013

The weekend covers days three

And guess who’s on call?  It is me!

With period and comma

I document drama

You wouldn’t believe the stuff that I see.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  I danced back from the brink of burnout in 2010, and, honoring a one-year non-compete clause, went to have adventures and work in out-of-the-way locations.  After jobs in Alaska, New Zealand, Iowa, and Nebraska, I returned home and took up a part-time, 54 hour a week position with a Community Health Center.  I’m just back from a working vacation in Petersburg, Alaska.

Scenes from a weekend on call

Saturday Morning

I sit in a hospital room with a new admit and I take a history.  Sunlight streams through the window, the first day of fall gleams outside with perfect temperature.  When I get to my 84-question Review of Systems, where I ask about every conceivable symptom, violence from the next room shatters the mood.  A domestic disturbance has broken out in the adjacent room and spilled into the hallway along with items of furniture and things that can be thrown.  A mother hurries away with an 8-year-old in tow.  I read the child’s face and the look of wonder and awe, and I see he has been handed a script loaded with dysfunction.  Overcoming what he accepts as normal will take intelligence, persistence, insight, determination, optimism, and, probably, help.

Saturday Morning

I sit beside the patient’s bed.  “What do you think the CT showed?” I ask.

“I don’t know.”

“Do you want to guess?”

“I don’t know.”

The patient knows, and I know it.  I make small talk and then start the trip around the track again.  “What do you think the CT showed?”

After four laps I get the patient to say “cancer.”

Saturday Afternoon

“Yeah, I know I got cirrhosis and I know I should quit drinking but hey, you know, I was about oh I don’t know probably about 3 or 4 weeks and I hadn’t had a drink then, oh I  don’t know, I got pretty hammered.  But I didn’t do it that much and I only did it a couple of times.  And sometimes, geez since July I blow up and then I’ll pee off like about 25 pounds and it comes and goes and now my belly hurts up here on the right.”


Saturday Afternoon

“I think she has decided to die.”  The patient’s children look at each other and their faces carry nuance beyond description.

“We kinda thought that since we read that book.”  They refer to Love, Medicine, and Miracles.


Sunday Morning

“I gotta be outta here tomorrow for a court appearance.”

I nod.  I have a patient with a heart attack waiting for me in the ER across town and I need to move.  “So how are things going for you?”


“You know, life in general.”

“Real good.”

“Do you really believe that?  When you just told me you girlfriend left with your kid and you have a court appearance?”

“Yeah.  (pause) Well, no.  No.  I got a country and western song in my head.  It’s my life.”

Sunday Evening

It’s past midnight and I’m talking to a judge by phone.  I explain that the patient’s brain function, loosely connected by an accident of genetics, has not improved with a major electrolyte imbalance occasioned by and coincident with severe hypothyroidism and failure to take meds as prescribed by a psychiatrist and endocrinologist.  After non-stop clinical work starting 19 hours previous I can remember the patient’s name and age but not birthdate.  I can, however, relate details about the request for hospitalization, docility in the ER and a quiet hour on the medical floor followed by increasingly loud, bizarre, and violent behavior over the subsequent 2 hours (which responded temporarily to 1 mg of Haldol, but which will necessitate a 48 hour court hold).  The call takes twenty minutes and ends at 1:30.  Vigilance robs my sleep for the next 3 1/2 hours and then I get up, shower, eat, and start rounds again.

Short call on Labor Day weekend

September 3, 2012

Labor day spent making rounds.

You wouldn’t believe the diagnoses I found!

It wasn’t quite call,

I avoided a brawl,

And sent four to their homes out-of-bounds.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  In May 2010, I left my position of 23 years, and honoring my non-compete clause, traveled for a year doing locum tenens work.  In June of 2011 I joined up with the Community Health Center, which provides care for the underserved.  I’m now working part-time, which, for a doctor, means 48 hours a week

Our hospital service has grown to the point where two docs get assigned every weekend, one each for a long call and a short call.  I drew the short call this holiday weekend, not the same as the short straw.   I requested, and received, assignment to my preferred hospital, where I’ve done morning rounds now for four days. 

My natural tendencies wake me early, but today I ate a leisurely breakfast before Bethany dropped me in the deserted doctor’s parking lot.  I printed my patient list in the doctor’s lounge at 6:58 AM and took the elevator to the 5th floor. 

I returned to the doctor’s lounge, emotionally tired, at 11:30.  I had rounded on 13 patients, each one a unique human being whose illness brings drama and irony to their lives and the lives of the people around them.  Each has a marvelous story, rich with details, triumphs and tragedies enough for a series of novels.

While I can’t discuss patients in particular, I can talk about the patient population in aggregate.

Four patients carry the diagnosis of schizophrenia.  Eight qualify as hard-core alcoholics requiring treatment for alcohol withdrawal.  Bipolar disorder (previously called manic-depression)afflicts three.

Eleven of the thirteen didn’t quit smoking soon enough, such that they required treatment for nicotine addiction or emphysema or both. 

More than one has chronic kidney failure necessitating dialysis. 

Others had cancer, HIV, depression, gallbladder disease, broken bones, dementia, urinary infections, lupus, and coronary artery disease.

The nurses on the psych floor warned me about a violent patient after a near confrontation.

I didn’t even bother to count the number of patients with the garden variety problems of diabetes, high blood pressure, and high cholesterol.

I had to deal with two patients with adverse drug reactions, their hospitalizations complicated by the very medications their doctors ordered.

I discharged four patients and dictated their discharge summaries while leaning my back against the wall; I wrote prescriptions for three of them.

One of those represents a triumph of medical care; we cured the problem and sent the patient home in less than 72 hours.  Such satisfaction comes rarely and I relish it when it does.

The doctors’ lounge stood deserted at noon on Labor Day, and I power napped ten minutes before the next task, reviewing transcriptions.  I had 37 in my queue.  After that I dictated six discharge summaries.

I left the hospital at 12:40PM, the rest of a fine summer day right in front of me, and headed home for lunch.

Weekend rounds in vignettes

August 5, 2012

This morning I rounded on nine

Three of them now feeling fine

It’s only a slip

That can fracture a hip

An ankle, a neck, or a spine.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  In May 2010, I left my position of 23 years, and honoring my non-compete clause, traveled for a year doing locum tenens work.  In June of 2011 I joined up with the Community Health Center, which provides care for the underserved.  I’m now working part-time, which, for a doctor, means 48 hours a week

I rounded on nine hospital patients this morning.  The oldest 86, the youngest 19, all of them had more than one diagnosis.  I can’t give identifying information about specific patients because of confidentiality, but drama and irony fill the stories of the people who fill the hospital beds.

Schizophrenia makes a person more susceptible to disease, and the disease process is worse for having schizophrenia on board.  Most schizophrenics smoke, and a frightening number acquire insulin dependent diabetes.  They face problems at the time of discharge, if they can’t take care of themselves and lack financial resources, though most have government-funded insurance.

Anyone unable to care for themselves, with no money or insurance, represents a problem for the hospital.  A lot of nursing homes would go bankrupt if they kept more than one non-paying patient, and some couldn’t afford even one.  Nonetheless, the attending physician has to round on those patients, and has to deal with Utilization Review, a committee that politely and professionally asks why the patient has to stay in the hospital at a frightful cost.

Everyone who smokes knows they shouldn’t, and most intend to quit, but I get a lot of business from people who don’t quit soon enough.  Contrary to popular belief, most smokers die of heart disease and emphysema rather than lung cancer. 

Some people arrive in this world with bad diseases that they didn’t ask for.  Some give up hope at a young age, and bring me a lot more business than those who decide the make the best of a bad situation and take care of themselves as best they can.

Mathematical ability dissolves in alcohol, nobody can count after they’ve had more than two.  Which leads people to think that alcoholics lie, when in truth they’re just lousy estimators.  Continued alcohol use with hepatitis C, viewed by many doctors as an active death wish, leads to cirrhosis and a horrid, stinking death, frequently accompanied by dementia.  The combination affects a disproportionate number of people too young for Medicare, and, again, discharge becomes problematic.

The elderly come to the end of their road with or without dementia; their mental status has little to do with how much their families love them.  Whether beloved or not, the drama of the hospital scene transcends culture and language.

Though most alcoholics smoke, not all smokers drink.  The two most addictive drugs in our culture usually go hand in hand, and the presence of other mental or physical disease brings layer on layer of irony and problems, some of which can’t be solved. 

Bones break, most fractures don’t require hospital care, but while a person heals from a fracture they tend to get illnesses requiring hospitalization, which complicates the fracture care while the fracture care complicates their other problems.

Fourteen hours of a zoo of a day.

February 17, 2011

I don’t do this because of the pay,

Going straight into the fray

     From eight until ten

     Like the old headless hen,

It’s been a zoo of a day.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  Avoiding burnout, I’m taking a sabbatical while my one-year non-compete clause winds down, having adventures, visiting family and friends, and working in out-of-the-way places.  Currently I’m on assignment at the hospital in Barrow, Alaska, the northernmost point in the United States.

I’m writing this after fourteen continuous hours of caring for sick people trying to get better, sick people trying to stay sick, well people pretending to be sick, and a few well people just wanting to go back to work.

I tried to take care of five people who came out and said they didn’t trust me, then tried to bully me into narcotics prescriptions.  I pointed out to them that if they really didn’t have confidence in my judgment they wouldn’t accept anything I would prescribe, and the only thing they should take from me is an arrangement to see another doctor.

A recurring theme today, just like an episode of a TV doctor show, involved a schizophrenic with a horrendous medical problem that cannot be dealt with on the North Slope.  We discussed the patient at morning rounds, I made several calls to Anchorage and received varying combinations of arrogance and sympathy from the Big City.

I placed a cast with the advice to the patient for prompt follow-up if the cast got too tight.  Which it did.

Influenza and post influenza problems saturated the walk-in clinics.  People slip on the ice and sometimes break things, but mostly just hurt for a couple of weeks.  I explained to a lot of people that if it didn’t hurt bad enough to come in for the first five, six, or eight days that they didn’t narcotics today, and they should expect to be sore for several days.

The Inuit smoke a lot of marijuana, which has marginal legality here.  But they smoke it now like hippies smoked it in the sixties and a lot of folks haven’t been unstoned for decades.  Some of them hunt stoned.  I see health problems related to cannabis abuse.

Instead of eating dinner, I waited twenty minutes to talk to a pediatrician at ANMC (Alaska Native Medical Center) because the phone operator didn’t read the call schedule correctly.

When I finally connected to the surgeon/gynecologist/pediatrician, I received cogent, useful advice in a time efficient fashion.

Seventy percent of my business came from tobacco, alcohol, or marijuana. Twenty percent came from influenza.  Ten percent came from bad luck or overeating or both.

And I saw something I’d never, ever seen before.  I didn’t even ask for permission to write about it, even if the answer had been yes, I wouldn’t have written the details.

Hitchiking, mental illness, and picking up riders in bear country

September 5, 2010

I used to travel by thumb

Though now I think it was dumb.

     In the land of the bears,

     I’m a fellow who cares

I gave a few lifts, maybe some.

I used to hitchhike.  I was good at it.

In the late sixties and early seventies, back when I was still saying that I’d never be a doctor, I had no car and no money.  In the days of stagflation, even minimum wage work was hard to find. Like many in the prolonged adolescence of at the time I had wanderlust. 

I started hitchhiking in 1968.  By 1970 I learned to stand in front of my backpack, not behind it, not to wear a hat or gloves, and to stand where a car or truck could pull over safely and easily.  Good visibility and slow traffic speed were essential. Eventually I invented a four-step dance that pulled a lot of rides in.  I learned how to make a good, visible sign.

 I had a lot of adventures and a handful of times when I feared for my life.  Many times I rode with normal people who wanted conversation.  Sometimes I got a lift from hippies who wanted help with the gas money.  There were a few drivers who were running from the law.  Twice I exited a stopped vehicle without warning the driver.

But there were a lot of psychiatric patients, too.  People with severe manic-depression (now known as bipolar I) tend to delocalize geographically and talk a lot.  One fellow talked at auctioneer speeds from Kansas City to Julesburg.  I said Um-hmm every five miles or so and kept him happy but I couldn’t understand a word he said.  Eventually I gave up trying and just agreed with him. 

A few schizophrenics, having recently lost contact with reality, picked me up for reasons known only to themselves. 

Active alcoholics picked me up, and at the time I didn’t have sense enough to ask to be let out when the driver poured  whisky into his Seven-up can while he was driving  I drove for drunks and junkies who didn’t want to get picked up.

During those long rides I learned how to interview and how to be a good listener.

During my psychiatric rotation in med school I still didn’t have a car.  I bicycled 25 miles each way to the mental hospital, four days a week.  The inpatients I cared for had the same mental illnesses as the people I had been hitchhiking with.  But I had more room to move around and security to call if I things went bad (they never did).   The manic, the depressed, the psychotic, those with personality disorders and borderline personalities like to travel and want someone to listen to them.

I wasn’t in a position to pick up hitchhikers till I was twenty-nine and got my first car.  I gave rides on a regular basis, mostly to people who qualified for psychiatric care.  When I became a father, I got a lot more cautious; I  understood how being a family man meant making responsible decisions.

While we were in New Mexico, Bethany’s VW Rabbit had mysterious electrical problems, and one day just up and quit once on Interstate 40 between Grants and Acomita.   I did my four-step and  reeled in a driver with a sense of humor. 

I didn’t hitchhike or pick up riders for a long time after that, but as I edited this post for publication I remembered meeting a man in his early 20’s on the New York Throughway in 1971 in upstate New York.  He was hitchiking with his three-year-old son.  I could tell he didn’t want to say anything negative about the child’s mother in front of the child, but I could also tell that something bad had happened.  With no money and no possessions during the stagflation years, he was on his way west to try to find work and social support.  With sparse on-ramp traffic and approaching darkness, he excused himself and his boy; they were going to bed down in the adjacent cornfield for the night.  I kept my thumb out and didn’t get a ride till ten that night, but I’ve often thought of those two and wondered how the story came out.

On a usual basis I no longer pick up hitchikers, but while bear country we hesitated to leave someone in the wilderness with critters who regularly stalk and eat people.  We picked up three hitchhikers during our Alaska trip.  One, a native, had been working in Denali and was going to visit relatives for the weekend.  Another Denali Park employee had gotten homesick and left the park to go back to Florida

Back in March he took six weeks to walk from Anchorage to Denali.  We talked about literature and what does and doesn’t make a good read.  We discussed the importance of music in the world.

On the Kenai Peninsula we picked up a Polish national taking a break from work to go to church.  A biotechnology university student, he had been working 15 hours a day, 7 days a week, for the last two months and decided he needed a break. When the seasonal work is done he plans to buy a motorcycle in Seattle and ride the California coastal highway. 

In terms of risk, he’s better off hitchhiking.

I’m a family practitioner from Sioux City, Iowa.  While my one-year, thirty-mile non-compete ticks out I’m out on adventure.

Separation anxiety, heat intolerance north of the Arctic circle, and conversations with a sculptor/hunter

July 22, 2010

There’s a way of emotional grieving

When the time comes close for the leaving

     Separation anxiety

     Transcends all piety

Culture, and language, and believing.

The young man I attended gave me permission to write this information.  He came in with his supervisor after an on-the- job injury.  While treating him, we talked.  He’s an apprentice hunter, he holds a steady job, and he’s a sculptor with aspirations of doing animation.  He face sparkles when he talks. 

He makes tiny statues of people that he puts in corners where people do not expect to see them.   His sculptures adorn both home and workplace.

We talked about the artist’s moment; for him it’s watching the face of someone who noticed his art for the first time, seeing the reaction and delight.  For me, as a musician, it’s watching peoples’ heads bob in time to the music, even if they’re ignoring me as a musician. 

As a writer, I would like to think that people chuckle when they read the limerick, and, having been hooked, can’t stop reading till they get to the end.

We also talked about gill net fishing and subsistence hunting.

One of the perks of Barrow hanging out with hunters all day.

At morning conference today we talked about how maternal and paternal alcohol use contributes to schizophrenia later in life.

We exchange a lot of information in morning conference.  We talk about patients by name.  We talk about clinical problems.   I get much education from my colleagues. 

I brought up a particular patient with recurrent right lower quadrant pain whose CT showed a normal appendix.  I expressed my concerns that the image might not have had adequate resolution to show a carcinoid (a low grade malignancy occasionally found in the appendix).  It turned out that everyone around the conference table had taken care of the patient at one time or another and we all agreed the appendix needed to come out.

I am coming to the end of my tenure here tomorrow, and today I developed separation anxiety.

Separation anxiety is a universal human emotion.  It’s the reason roommates fight at the end of the school year or spouses fight just before one goes on a trip.  I knew that I would have it when the time for me to leave came close.   Bethany’s presence buffered the intensity.

Today the weather turned warm (fifty-one Farenheit), the wind stopped and the sun came out.  The heat in the outpatient area became intolerable, and I went to maintenance and complained three times.  I probably wouldn’t have been emotional in my declaration of impossibility of working conditions if it hadn’t happened towards the end of my tenure. 

I think the reason people have separation anxiety is because it softens the pain of emotional loss.  It’s a way of saying, “I have plenty reason to be mad at that person/institution.  So I won’t miss him/her/it when they’re/I’m gone.”