It was Memorial Day weekend 2005 that we moved to Phoenix. Someone got a job at Wells Fargo. We had lived all our lives in the Midwest; moving to Phoenix seemed like going to the moon. We traveled over a three day trek in a one way rental van in which contained our most important items. This included a couple of cats, Claudius and Tiberius, and several plants I didn’t want to leave behind in Michigan. I had no job; we had to find a house. It was at the height of the buying frenzy of the housing market.

Now it is Memorial Day 2015, ten years later. Someone lost his job years ago in the banking recession. The cats have died, as did all those plants. I’ve been in the same job for nearly ten years. Our house is upside down or underwater or whatever you call it when your house is worth a fraction what you paid for it. We both miss living near by relatives but it would be hard to move back to Michigan. I am gainfully employed with a good local reputation in a job with health insurance for us both. We we tried to sell it we would take a ponderous loss on the house. So here we will stay, indefinitely, as there are no long term plans or goals. Michigan is nasty anyway with its draconian laws to rival Texas and Alabama.

I don’t regret the move, for living in Arizona has been an adventure. The weather is preferable although I admit I miss snow. My disappointment is our failure to create or join a local network of friends even after ten years. Phoenix is so spread out and dependent on driving even the simplest of social dates requires time and driving.

There is a sense of existing for ten years with pleasant pastimes to mark the season which come and go in a regular rhythms and seasons. Yet there isn’t a sense of great accomplishment other than I’ve done my best to see and treat countless patients. The house hasn’t improved (one could argue it is in disrepair) and the jury is still out if I am in better shape than a decade ago.

It makes me think where will I be in another ten years – here still? Will there be the same sense of having nothing great to show for it?

It is a thoughtful time; I wonder what happens next.

On Tuesdays and Thursdays I work in the branch of the clinic where there are nine others: two billing staff, two receptionists, the house manager, and four counselors. This ennead is noteworthy it is all women.

I am curious about the ethos and ambience of work environments when it is composed of nearly all of one sex or of equal proportions of both. All day long I watch the interactions and goings-on of these Medical Muses as I pop in and out of appointments. I have heard tales all women staff can be difficult.  They say ‘too many women’ (and worse: ‘all women”) makes for a tense working environment full of catty cliques. I would dismiss this but the majority of people who have told me such have been women.  So, like Margaret Mead among the Bantus I try to observe and wonder: is there any truth to this?

There are no palpable tensions or frictions among my co-workers; they seem to get along and they don’t seem to fuss about themselves or each other. However, I often walk into a group which suddenly goes mum, which makes me suspect I have just crashed a party. Their giggles and talk suddenly drops off. If there is something juicy or gossipy going on they ain’t letting me in on it. I am outcast to these chin-wags. Sometimes I ask if everyone is getting along; I am told always oh, everyone’s fine. I have enough professional intuition (and BS meter) to know they are not entirely telling the truth. Perhaps testosterone-filled MD macho masculine redolence provides just enough authority and stability to keep things quiet and preventing reenactments of scenes from “The Women” . This one rooster makes the henhouse peaceful. Maybe. Maybe not. I wish someone would clear the air for me and fess up. Another conclusion ( more prosaic and less paranoid) is they are just fine and ‘all female worker tension” is rubbish.

I have never worked in a majority male or all-male working environment. I suspect these have their own rubric and challenges. This is even more ineffable for me than the all-female version.

I am cross as my allergies are active and they are getting in the way of just about everything I want to do this evening. I am also cranky from filling out ‘Prior authorization forms’ from insurance companies demanding justification why I do anything  and why haven’t I cured anyone. Not too long ago I reread “The Inferno” but I don’t recall which level of hell Mr. Dante put medical insurance companies. I suggest level 7 1/2 which places them between ‘Violence’ and “Fraud”.  Since I am meditating on uncharitable thoughts here is little list of villains and toad-suckers to accomplish them.

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Urspo’s level of hell.

Floor 7.5

People who pull out in front of you in traffic and then proceed to go slow, rather than waiting until you pass them. 

The makers of pop-up ads. 

Whoever dreamt up the ‘selfie-stick”

People who stand up in “theatre discussions” to ask a question but really show off how much they know about something, more than the actor/director on stage.  

Politicians who champion ‘family values’ and anti-gay bills only to be “outed” via gay apps, where they are found figuratively and literally with their pants down.

Youngsters who reply to “thank you” with ‘no problem” *

The rest of the Fox News reporters who aren’t already there.

SUV and truck drivers who park their contraptions in the ‘compact only’ sections straddling two if not three spaces. 

Bobby Jindal.

And finally –

People who talk loudly on the cellphones in waiting rooms, elevators, buses, and any other areas where people are trapped. **

Spo-fans are welcome to leave in the comment section other yahoos in need of excoriation. 

* OK, level 7.5 may be too harsh for this type. They can go up to Level 2.5 to keep company with the folks who don’t clean up after themselves in fast food joints and outside cafes.

** Come to think of it, these types can go directly to level 9.

Work today was rather frightful: its pace and intensity were of the sort I would expect on a Wednesday. I hope this doesn’t portend a week requiring roller-skates. Many patients elicited the inner emotion ‘What on earth am I going to do with you?” People who think I sit back all day long listening to people’s unfulfilled sex lives should think again. I remind myself I went into psychiatry as I found cardiology boring.

The apricot chicken recipe was OK. The ingredients came together to make a sort of BBQ sauce. I would make it again but I need to move on to recipes new and adventuresome. I was recently reminded I vowed to make a ‘new soup every month’ which is (alas) now three soups behind. It is getting warm enough to turn to cold soups. I have one using smoked salmon and avocados. This involves a blender which is an appliance I distrust; it is worth a blog entry in itself.

I am recently hearing from new Spo-fans, many of them are women. I am pleased as punch of course to have new readers and of a feminine nature (and female at that). I hope the scribblings of a 52yo queer shrink (who well over four feet) are entertaining enough to hold their interest. The pragmatic Board of Directors Here at Spo-Reflections, smelling comments, immediately sent me an email suggesting I post:

Cute photos of puppies and cats, and less rubbish about your sex life”.

The male readers of my blog I fear will be uninterested but here is goes:

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Harper 9 (1)

For dinner I made apricot chicken, which is a recipe from my grandmother. I haven’t had it since the mid-80s. I had a fancy to try it having rummaged through the accordion files of loose recipes, the majority of which are torn out of various magazines. Spo-fans may recall (or don’t know) these recipes are for a nebulous ‘someday’. Perhaps this means retirement or a “bucket list” item. Either way this is not likely not happen. So I thought I will make some of them now before I am becoming decrepitude to the point I won’t be physically able to make them or my doctor forbids me.  Apricot chicken is chicken baked in a pastiche of Catalina or Russian dressing, dried onion soup mix, and a cup of apricot preserves. It is simple enough. Most of the clipped recipes in the accordion file are simple endeavors based on my desire for cooking not to resemble a surgical operation.

I am feeling pensive this evening, and it is not from the chicken. I often feel a schmidgen melancholy on Sunday night as I face the upcoming week. In my youth this was either dread about the start of school or the return to a job. Nowadays these Sunday night feelings originate from the sense of Time going swiftly by.  Another week came and went in what felt like the twinkling of an eye. It’s like each week has a few less minutes to it, an acceleration towards – what? Perhaps among the quotidian activities of the week something marvelous may happen. I can always try a new recipe.

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A Spo-fan recently posted a link to a news article about an alleged expert who reports (all) antidepressants and other mood-altering drugs are dangerous and have very little benefit. Indirect conclusion: don’t prescribe them and patients should not take them. Reports like this drive me to distraction, not because I merely disagree but what this touches upon: truth in medicine. What is the data behind such blanket statements?  Are his conclusions really based on careful and well-researched data?

As a doctor and scientist it is my ethical obligation to keep up with what is called ‘evidence-based medicine”. This is not easy. All of us – scientists and doctors as well – are subject to ‘cognitive bias’. We are more likely to see ‘the facts’ that support or predijuces and beliefs and disregard the things which shed doubt (if not downright demolish our beliefs). Those looking for reasons to not take Rx will wave this man’s report under my nose as hard evidence while the patients benefiting from medications are not likely to stop theirs.

Global warming deniers are another example of cognitive bias; they look at the (minority) reports and science that doubts and dismiss the overwhelming data that says otherwise. They refuse to alter their beliefs in light of data. As a physician I may not do this.

The best way to get truth is to ‘go to the research’ as it called. This is based not one or even a few papers but on the ‘whole literature’. Even then it is not easy. Most of medicine has ‘mixed data’ as to treatments being helpful or ineffectual. We continually learn more; we change are minds on things – much to the frustration of all. This is because we all want black and white ‘this works or it doesn’t work’.

If the research suggests some time-held belief or protocol really doesn’t work, then I should change my approach. There is research to show doctors are not very good at changing their practice ways when confronted with material telling them what they are doing is overall not useful.

Evidence based medicine is important so as not to do harm, but also not to waste time and money.  Insurance companies get more particular about what they will reimburse and pay; they want to see evidence based treatments.

Curiously the demand for evidence based medicine is seldom high on the patient’s list of priorities. They take more direction from what they read on social media and in chat rooms than from those whose job it is to sort through the rubbish. Dr. Oz is the most popular of physicians with the public, while his colleagues see him as a dangerous quack for promoting things without a shred of evidence based data.

There there is its opposite: ‘time honored treatments”. These have no good research behind them but clinical experience. This is actually most of medicine. For example, in my field I often prescribe a Rx called trazodone as a sleeping pill. I have twenty years of positive feedback from my patients ‘this works’ and they are pleased with the drug. So I keep using it – pointing out this is ‘off-label’ and there is no good overall evidence-based data that says it is truly efficacious as a hypnotic.

The dark side of time-honored treatments is the bogus stuff dies out slowly and often with doctors kicking and screaming as they are dragged away from them ‘But we have always done this!’ is heard as the data is revealed. The classic example of this is bloodletting, which was once upon a time was the panacea for many ills and is now only good for certain hematological disorders based on (you guessed it) evidence-based medicine.

Back to the expert who says antidepressants are dangerous and/or of little benefit. The summarized research supports otherwise: yes they can be of benefit- alas, not as much as we would like – but definitely ‘yes’. They can be dangerous, but what medications are not? I have no evidence to support they are no more dangerous than blood pressure medications or those used to treat seizures.

I hope I have probity if ever there is objective research to tell me to stop using these treatments, I will.  Meanwhile, I present to my patients the latest evidence based treatments and a few off-label/time honored things too. Patients get the options,we try something, and (bottomline) if it doesn’t work or it is intolerable we try something else.

dreamstimefree_39604161I have just come from having a facial and a forehead bath provided by Harper, who likes to lick my cranium. She doesn’t give such slobbery service to Someone. Perhaps I am more tasty. Whatever her reasons, I am grateful for the attention for  I am in need of some loving; it wasn’t a good day. I planned on going out this evening rather than spend it in the usual way at home, doing paperwork. I left work at 5PM, ready for happy hour, and  I could not find the keys to the car. I still don’t know where they are. Someone had to drop everything and bring me a spare set. I was annoyed at myself for this blunder so I went home ate some dinner and – you guessed it – did paperwork. I mislay a lot but losing the car keys is the worst. I am ready for my Aricept Mr. Demille. I have sets of keys for work, car, and gym and in order not to lose them I use bulky key ring attachments. I like them big, bold and colorful, like my men. Cynosure colours like kelly green and jungle red are preferable to drab tones.* Large bulky attachments are helpful – a pie plate if they had such a thing. The key rings are continually replaced when they become worn or lost. There is one exception: I have a brass “R” which was given to me by my grandmother sometime back in the 80s and it is a miracle it is still around. Happily it wasn’t on the car key ring. I poo-poo most tech-gadgets but I would gladly pay for a device to attach to my keys that lets out a stentorian and vociferous howl whenever we become fifty yards apart. Better yet, would there was an app named “Find your #$%& keys” which would tell me in acrimonious tones where they are (push notifications accepted).  Alas, it is too late now.  I feel stupid. I think I will contact St. Anthony and ask him if he would intervene on my behalf. I promise to connect the prodigal keys to a fluorescent green tennis ball or to a stick, the sort one gets when you ask for the restroom key at the gas station. Perhaps it is time for a body piercing upon which to connect my keys when they are not in use.  An ear ring of this sort would make for interesting party conversation, no? 5f69b0d6d214891fb9256cdbeb27240c

Revision in the text: St. Anthony (the dear!) was contacted and soon after the keys were retrieved! They were n a hidden pouch in the blue sack I use for transporting lunch and utensils to and from work. I have no idea how the keys got into the tea-things, let alone into this inner pouch (which up until now I did not know existed).

* The missing Elantra keys were on a nondescript metal ring because Someone would not allow otherwise. And look what happened.

WordPress sends me an email when somebody is ‘now following my blog”. I am pleased and honored of course whenever anybody bothers to stop by and read my scribbles. Alas, WP doesn’t tell me their motives so I am left to surmise ‘why’ they are following and how did they found me in the first place. It is mere conjecture but I imagine “X” and I read mutual blogs; my comments rouse up enough curiosity for ‘X” to drop by.

It does up the ante a bit for me to ‘put out’ something witty, erudite, or profound.  The Board of Directors Here at Spo-Reflections sent a text note today not to go to bed until I have composed something, anything. In a way it was a Hobson’s choice. They have the photos and know the store where I bought the equipment.

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Spo-fans may be interested to know there was a probable Henrik the Ghost sighting today. This afternoon I received a text from the security centre stating the home alarms were going off. The motion detector was observing some sort of movement and it reacted with a frisson of calls. The doors were locked and the windows were closed. There was no sign of an intruder.  Rationalists at the security centre (who were too sheepish to admit it could have been merely a mistake) suggested the dog or an oscillating fan set off the monitor. Only trouble with that theory is Harper was locked up in her kennel in the bedroom and there were no fans a-turning. Someone had to come home where he found all was intact.

Since it is not the season for Nargles it must be Henrik. Personally I am glad he’s back, for I haven’t heard from him in so long I figured he had departed. Being a timorous sort of spook the sudden stentorian sound of alarms probably frightened the dickens out of him. I won’t sleep well tonight sensing his disquietude.  I wonder why he is back, but I have a theory. Last week I watched “Ghosts” by Ibsen which had enough gloom and pessimism to attract him home. His doleful nature combined with his name makes me think he is Norwegian in origin although I haven’t any evidence to support this.*  If that’s true then I don’t have to pay for an exorcist if I wish to be rid of him. I merely have to watch something happy like SpongeBob Squarepants.  I know I would flee if that were on.

* Someone likes to point out I haven’t any evidence to support Henrik actually exists let alone his provenance. Perhaps today’s event will make him reconsider.

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I was raised to be a good boy. I come from a Midwest Protestant background which was combined with a sense of propriety towards good manners as fitting a gentleman. Psychoanalytical training has trained me to aware of my emotions so I don’t unconsciously act out on them. Then there is the austere professionalism I have cultivated as befitting a physician with probity (“Remember always you must represent the dignity of being a doctor!”)

Needless to say this leaves no room to be screw-loose bozo or bat-shit crazy.

On my bucket list is a curious item between ‘See the northern lights” and “Hear all of Verdi’s operas”.  It is ‘A day of drinking and debauchery”. What this means is I want to experience (just for once) a day in which I let my hair down and become a truculent yahoo for twenty-four hours. I want raw emotions without process or restraint. I want to be take the lid off the id as it were, and run amok. Rolling down grass hills (in a way) sounds jolly good fun. I shall be totally toasted and experience a myriad of degenerate and profligate activities including shopping for things I don’t need.

It’s not that I don’t have these attributes; they are merely locked up. I know exactly where they lay in the recesses of my pumpkin. By the cage door on a coat hook is the key to the cage. It is tied with a red ribbon on which there is the inscription “Release the Kraken if you dare !”.

If I am to transform into the Hulk I should go somewhere where no one who knows me will witness this salacious satori (imagine a chance encounter with a patient!). And I don’t relish friends taking photos for comment fodder on Faceback. (Oh the embarrassment! There goes my good Henly Street name!). Channeling the bad-idea bears sounds dreary to do it alone. I should get some chums to come along.

I sense most of my bucket list items are not going to happen, and this one seems even less likely than seeing the Northern Lights. As Someone likes to say Prudence is my middle name.

Here are some Spo-bits of little importance but perhaps of some interest.

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The sewing machine has returned from the repair shop, which allows me to get going on some long-delayed projects. I finally finished this groovy style creamsicle shirt for Sandy who lives in faraway Australia. Perhaps in gratitude he can send me some sort of Aussie imperial tid-bits to try. I have never had vegemite.

Last weekend Someone discovered we have a cactus growing on our roof. It is of the genus opuntia (prickly pear). How it got there is a mystery and how we failed to notice it is another. He climbed onto the roof and extracted it (no small feat). The handling and transportation of cacti is a ticklish endeavor for they are covered in needles both sharp and irritating. No gloves are impervious to them.  We managed to get it transported into a poolside pot but not before us suffering terrible pokes. Ironically the tiny needles are worse than the biggens, for they latch onto the skin and become ensconced like nobody’s business.  My hands still itch from the pricks.

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Last weekend I saw the new Avengers movie and I am happy to report I did not throw up. Spo-fans may remember I get motion sickness watching quick movements and scene changes on wide screens. There are only seven basic stories.* Marvel Comics follow the first universal story: “Slaying the Monster”. Usually this story starts with one or a few people realizing there is a monster out and about. In the second part of Slaying the Monster thems who know try to convince the others there is a monster loose. This is unsuccessful until phase #3 of the narration occurs when the monster is out and obvious. The Avenger movie was intriguing that it skipped parts #1 and #2 and got right to the battle. The movie presumes the viewer already knows the drama personae and let’s not waste time but get right to the fighting of the monster.**  Afterward the movie we went home to find the cactus on the roof. As far at that story went it followed “Slaying the monster” beautifully. I just hope there is no sequel.

 

* Details are provided upon request for those curious on the topic.

** Did I ever tell you I have been told on more than one occasion I resemble Robert Downy Jr.?

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