The Board of Directors Here at Spo-Reflections sent an email thanking me for the ‘most excellent posts’ this week but added a small critique: it was high-time to write something light-hearted or they will be forced to hang me by my wrists until I cheer up. They sent along a little booklet titled “House of correction for bellicose bloggers”. The little tome is quite illustrated and there isn’t a dull page to it.

So here it goes.

This morning Urs Truly went to Home Depot. I always have a mild neurotic trepidation when going to the hardware store. I am not handy. My usual approach to something gone wrong is to hire someone who knows what he is doing or go ask Someone. Alas, Someone is miles away today, engrossed in his work,  and I am home alone with much that needs doing. So it was off to Home Depot I go.

Mind, there is consolation in eye candy of big-butch types. They are a heartwarming spectacle while I look around for the items on my scavenger hunt. Compared to them I feel like I am wearing a pink neon boa with a sign around my neck, and the sign reads “Nelly!”

Walking into HD immediately evokes bewilderment as to where the heck lies my items.  Most things on my list are small items, worse luck, which aren’t easily located among the mammoth rows of lumbar and paint buckets. I walked around looking bewildered and lost.  I passed several employees but no one asked me if I needed help. I finally got someone to point me in the right direction to find the vacuum cleaner bags and the Dobie sponges and it wasn’t too bad.

Back at home I managed to get out the folding ladder, climb up and open the AC vents to remove and replace the filters. My worst suspicions were confirmed. The old filters were covered in grey dust and dog hair, a remarkable contrast to the clean white new ones I was trying to juggle on top of a ladder.  I managed to change them all without breaking my neck.

Then came the changing of the vacuum bag. A week ago I opened the Eureka to discover the dust bag was as bloated as Trump’s ego. I found a replacement bag but it did not fit. It was for an old vacuum long discarded. I learned this the hard way by turning on the vacuum only to have dust blow out of all sides, spreading contagion in an instant.

Now I am taking a break from my industry. I have replaced the filters, the vaccuum bag, and exchanged defunct light bulbs for new ones. It may not be much it all made me feel quite butch. I may next try to fix the broken coat hanger in the closet.  Soon I can go to Home Depot with my head held high, proud that I belong there. By the way, Home Depot does not sell boas, neon pink or otherwise.

Every physician (except pathologists) experiences death. The death of patients often reflects the speciality. For example, cardiologists usually lose patients from heart attacks while oncologists see they patients die from cancer.  When a psychiatrist loses a patient so it is often from suicide.

Today the office of the county coroner faxed over a request for chart notes on X. X is dead. The request doesn’t say how X died. The cause may be a car accident, or a murder, or a heart attack.  Given the patients I treat the main reason is usually suicide.

I don’t know what is the usual emotional response when a doctor loses a patient through suicide but I become very sad by the tragedy. Why didn’t X reach out to someone or call me? I go through the chart of the deceased trying to get answers.  Sometimes a patient is at high risk for suicide and it if happens it is ’understandable’ but this provides no comfort. In today’s case of X, my last note indicates X was doing well, in good mood, and looking forward to things. X recently had a break up. X felt sad by this but empowered as it was right thing to do (X was the one who broke it off). Is this why X committed suicide? Perhaps X did not share with me all the story. Had X been plotting death all along or  did something horrible happen since our last appointment that made X believe death was the only way out?

Patient suicides often have no meaning and no closure. Because of this – and doctors being ‘good people’ – it is all too easy to start doubting oneself and one’s worth as a physician. “What did I do wrong?” and “What could I have done differently/“ are two questions we all consider when someone dies or commits suicide.

Along with sorrow of the loss of a life doctors develop fear of legal retaliation. Will I be sued for this we all ask ourselves? It is almost grim humor death is often considered a sort of negligence. If a patient dies something must have gone wrong and it is someone’s fault it happened.

The sad truth is if a person decides to kill his or herself no one can stop them.  Treatment plans, contracts, 24 hour call centers etc. can not guarantee life or prevent death.

As X didn’t have a spouse or children I can’t call someone to offer condolences and find out what happened. I may find out ‘how’ via the coroner’s report but that is of little value for closure. I want to know ‘why’ rather. It leaves you with a sense of failure even when you know you did not err or deviate from standard of care.

It’s the hardest part of being a physician.

Office

Procrastination is much on my patient’s minds these days. They often complain they have things to do, they know they need to do them, but they don’t do them anyway. Often some deadline looms, they go into a panic and the do a rushed job at the last minute, only to vow ‘never again’ – and repeat the cycle.

I was trained to think procrastination as either a) a symptom of illness like in depression or ADD or b)  a bad habit.

In a) if the depression and/or ADD is treated the procrastination will dissipate.

in b) procrastinators merely need to change their slothful ways; a few insightful pointers should do the trick.

It turns out neither work. Procrastination does not usually improve when depression goes away. Telling procrastinators next time to start working on a project as soon as you hear about it is similar to telling a person with a drug habit to stop smoking or drinking. They already know what they should be doing. A lack of insight isn’t the problem.

It turns out procrastination has neurological and evolutionary basis. In the recesses of the lizard-parts of our brains we are hard-wired to be cautious, to assume danger, to think the worst – and to procrastinate.  The concept is unpleasant. Like anxiety, the frontal lobes (where reason, intellect, and insight originate) have to overcome the more primitive parts that want to avoid long term matters or discomfort. Lizard-brain lives in the moment; it likes immediate pleasure and pay-off, for there is no such thing as ‘next week’.  However, lizard-brain does respond to panic. A threat arises – like the project is due tomorrow – this surges the flight and fright system, which stimulates the lizard-brain to do whatever the F it needs to do to survive the attack. After the threat dies off (the deadline is met) things calm down and lizard-brain goes back seeking out shiny distracting pleasantries. The frontal cortex looks on in despair.

I am hearing more about procrastination as archaic primitive lizard-brain has found its soulmate in 21st century technology. Picture it: you should be ‘doing that task’ when lo! the cellphone goes off announcing a text or email – or WordPress relates there is a new comment on your blog (hohoho). Lizard-brain, never one to miss out on an instantaneous dopamine-stimulating diversion, lunges towards the distraction. The internet is its smorgasbord. Facebook maybe the worst, with its continual call to ‘check in’ and see what’s up. Youtube, Podcasts, the latest on CNN – it is all bedazzling.

How much time do you spend on the internet at home or at work, distracted from what you ‘ought to be doing”.

There is a more subtle type of procrastination that looks like work.  Checking our email, writing notes, etc. looks superficially like productivity but in the long run it is mere procrastination from ‘real work’.  In the FB example you are aware you are goofing off and procrastinating, but with busywork you feel productive and you don’t register it as procrastination.  This type of put-off leaves one with the feeling you have worked all day long but you didn’t really accomplish anything.  Imagine expanding this to a life time of such.

The goals with deadlines at least have the advantage the panic mode can prod lizard-brain out of procrastination. But what about goals without concrete deadlines or dire consequences?  These don’t elicit panic; there is no prod.

An example: a patient complained she procrastinates all the time at home and the house is mess. She has a job too but she doesn’t procrastinate there, for if she did she would be fired. At home all she has is a grumbling spouse who (she relates) is not going to leave or stop feeding her or take away her spending money. There is no consequence to her procrastination. She plays games all day as the dishes pile up – until her spouse does them himself – which he always does. She is not likely to change, is she?

There are a myriad of Youtube and Internet articles on ‘How to stop procrastinating’; I defer you to them. With my patients I try to get them to set up consequences in the ‘no panic’ types of procrastination. I try to get them to be conscious of this natural proclivity to procrastinate and act accordingly. The prognosis is rather bleak, but I am no longer trying to treat procrastination with medications or calling procrastinators lazy or lacking willpower.

For some time I have pondered on the preservation of my blog. There is ten years of industry into this project and I would like it saved.  Even though it is on the internet I don’t quite trust this as a guarantee of indefinite security.   WordPress may not always be.  Maybe the site is prsently planning regular fees to continue or even to access my work.  Perhaps someday I will go on line and poof! the website and all my work is gone in a click!  Some villain could hack into the blog and demand ransom to release it.  These are pessimistic if not paranoid conjectures but in the infamous words of Judy Tenuta “It could happen.”

Call me old fashioned but I think my best bet for peace and posterity is to print it all on paper and bind it in a book. It would be a ponderous project.  Ten years of near daily writing (with more coming out on a regular basis) is a long tedious task of cut and paste.  And I would want to ‘edit’ the mistakes before saving each entry.   Do I really have time and energy to do this?

Unless I can come up with an alternative – recommendations from Spo-fans are greatly appreciated! – I feel no choice if I want some serenity on the subject.

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In the book “I, Claudius” the Emperor Claudius sets out to write the history of his family for he knows after he dies ‘the truth’ will be eliminated by his loathsome relations. He wants to outwit them; he wants someone someday to know what happened. A Sybil told him no one will find it for centuries but then “Claudius will speak clear”.   He knows he need not worry about assuring the project’s safety. History shows things are often better saved if they are left forgotten on some back shelf or stuffed in a cupboard to be stumbled across without intent to do so.

This Roman vignette inspires me to print out the entries, bind them in a tome, and leave it among my papers and hope my niblings or their descendants discover it. Perhaps it will become a family heirloom, a memoir of the late dotty uncle (“you know, the queer one who lived out in Arizona”). Maybe Spo-Reflections will be published posthumously.

OK, this is a silly whim and fanatasy. I will be content with a paper copy lest Spo-reflections, WordPress, or the internet cracks up or I drop dead this week from poisoned mushrooms.

In the final scene of the TV series of “I, Claudius” the dead emperor talks with the Sybil who inspired him to write his memoir. “They burned your book you know.” she tells him.  There is a pregnant pause and then she adds “Lucky for you, you made a copy and buried it!”.  They chuckle at having outwitted Fate and family.  I will get a similar smile while holding a fuddy-duddy binder with its papers of my art.

My Mondays are the most predictable day of the week; they have not varied in ages. I know exactly when and what shall happen from dawn to dusk. My work day has two or three new patients surrounded by med-checks. There are a handful of weekend calls and prescriptions to do. There is a pharm-rep lunch at noon.  After work I go to the same gym and I do thirty minutes on the elliptical machine. Then I go home, do some paperwork, read something and go to sleep. It is a pleasant regularity without surprise or agitation.

Recently I’ve begun to interpret Mondays in a more sinister slant is as busy work without progress. After ten years of predictable Mondays there is no sense of growth or forwardness. Monday is a sort of weekly “Groundhog’s Day”.  It has pleasant work, for which I am well-paid, and I can take satisfaction of a day’s job well done.  I go home feeling  tired but OK. Yet the day’s efforts seem to interfere with ineffable personal growth or goals.  One could go through life like this too readily, arriving at old age knowing you did the job but feeling somehow it interfered with something else, something that did not have time to blossom as you were too busy doing the mundane.

It gives one pause as to wonder what is missing. Personal growth? Achieving my bucket list? Reading those ‘someday’ books gathering dust on the shelf? It is not clear.

Later this week I plan to write about procrastination. Apart from the obvious types, there is a more subtle variety which takes satisfaction from work and mundane tasks as it all looks ‘busy’/not doing nothing yet puts off the real tasks in life. It does this as well as being a couch potato watching reruns. It reminds me of the C.S. Lewis quotation the safest road to hell is the gradual one with gentle slope without milestones or signpost.

While you do the things you need to do today, keep an eye out for the greater things in life to which you aren’t paying attention. Don’t become too lost in the daily tasks, no matter how nice they may be.

For too long dinner has been a clueless procedure of impromptu dishes which are a) not too healthy and b) not too inspiring. At the end of a very long day when I am too tired to cook my knackered mind remembers only 3-4 recipes.  Most of the time I have a ‘why bother” feeling and dinner may not happen at all. A week ago I decided I would plan a weekly menu. I riddled through my extensive cookbook collection and decided on the theme of ‘Midwest cooking’.

What is ‘Midwest cooking” you ask? This is mostly  simple hot dishes consisting of several ingredients put together into a casserole dish and baking it until done. They aren’t high-cuisine nor are they PC-healthy but they have the advantage of being quick to make, hot, and comforting. Like my men.

I made the following:

Asian Chicken with rice bake

Tator tot casserole

Tuna pot pie

Easy chicken 

Campbells Cream of this-that-or-another Soup is the base of each dish. I have never known anyone actually eat these as soup. They are the backbone of recipes found in any Midwest cookbooks. Cream of Mushroom reigns supreme, although the mentioned Asian chicken dish called for Golden Mushroom (don’t ask).

A can opener and a casserole dish are vital kitchen tools, for most ingredients come out of a tin (soup. tuna, mushrooms, or vegetables). The Easy Chicken dish called for generous amounts of paprika. Otherwise exotic spices are conspicuously absent.

The tuna pie and the tator-tot dish came out gloppy. Someone didn’t care for them and neither did I.  The Asian chicken is worth repeating. It consisted of putting chicken breasts on top of uncooked rice, adding soup-glob and bake it.

The Easy Chicken dish is pending with thirty minutes still to bake.  I told Someone (away at work) this evening I was having easy chicken and he wondered what sort of sordid app he came from. Actually the recipe is out of The Lutheran Church Women’s cookbook from Oshkosh WI, so the joke is on somebody I am not certain who.

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I recently talked on the phone with Brother #2 who let out The Father-figure is having surgery to remove his R eye. This was news to me. Brother #2 conveyed surprise at my ignorance, a sort of ‘Oh I thought you knew this, this is common knowledge”. No, it wasn’t. Urs Truly lives in AZ; the rest of the family lives in southeast Michigan. I am frequently ‘out of the loop’ as it were.

I called The Father-figure afterwards to ascertain the rumor, which of course it is. He conveys he’s had no vision in that eye for some time. Worse, it drips and it is painful. I asked how does he feel about this losing his eye. In a typical Father-figure process he doesn’t complain but say he is glad to be done with the useless and painful thing. Without pause he changed the subject (as is the wont) to tell me about Brother #4 who called today my niece Warrior-Queen is going to take soccer lessons.

Ominous or worrisome news is interspersed with the banal. “Oh, we’re fine. On Tuesday so-and-so called he is in Ohio this week and this or that grandchild is taking a class now and your mother fell I couldn’t get her up so we called 911 to help and we are going to see the Potvins this weekend at the Yacht club did I tell you they have a new pool?”

I interrupt to back up to the Mother fell and couldn’t get up part for details. He gives a few details and assures me (as always) it was no big deal and proceeds into his narrative. He is not in denial, he doesn’t see it as important.

The Father-figure is a remarkable man that he never complains, or broods, or says things derogatory. He lives in a happy world with his wife and grandchildren, out of which I have never seen him set foot. He is not one to discuss feelings or doubts – no need to so for he is content with a capital ‘C”. He used to call me “Number one son” – now he seldom calls me at all. He is not angry or upset with me; he is always glad to hear from me when I call. It is just I am far away and I do nothing that particularly interests him (after all I don’t have children)

I give him credit. He truly is a happy man. He’s been married over fifty years to a woman he genuinely loves. He prefers her company and home activities to anything else. He has his happy hobbies. He adores his five grandchildren and his ‘Scotty dog’.  On occasion he indulges in a snort and likes to play cribbage. The loss of an eye is no more upsetting to him than burning off a suspicious mole.

So happy Father’s Day to The Father-figure. All he wants or needs from me is a phone call (but not too long of one) while he is surrounded by his local sons and progeny.

Father

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I am pleased as punch for on Monday last I came to work to find The Boss-man installed a water filter. The office tap water rivals that of Flint MI. When tea or coffee is made from the stuff and is allowed to cool there is a ghastly sheen on the surface. It’s chatoyant with a black gunge that forms loathsome pattern like a spiderweb. Nobody at work touches the stuff; we all haul in bottled water. Enough fuss was raised and now we have proper water.

My office gets the morning soon and is quite warm at this time of year. Urs Truly has a glass of water at his side nearly all times. Yesterday I went through several tall glasses with no signs of output. One can not be too rich or too hydrated, at least in Phoenix.

The water in Phoenix doesn’t taste very good. Most homes have water filters, as does ours. I am not a believer bottled water is ‘cleaner’ or ‘more healthy’ but AZ tap water is nasty enough it needs filtration before consumption.

In my alma mater medical school the panacea for all ills was to keep hydrated. It’s not a bad rule. Living in a roasting desert makes one continually think about the stuff and how to get enough of it. Visitors, who are not used to the low humidity and the high heat, quickly dehydrate and develop swoons.

This weekend we are going to see temperatures as high as 120F. There is nothing to be done but stay indoors to estivate and drink plenty of water. Happily I like the stuff. Whenever I tire of the stuff, there is always solar tea, of which there is plenty.

Someone hardly ever drinks water and yet he never seems to suffer for it. He is a fire sign while Urs Truly is a Cancer, a water sign, so may be that explains it.

Walking the dog

This is the time of year when morning dog walks are more regular and happen earlier. The sun rises at five AM and the sidewalk soon heats up to the point of it is too hot for dog-paws.  Harper, sensing the routine, is often up before the alarm goes off – snout in my face with ‘that look’ of anticipation that is not quite certain. If she senses a ‘yes’ she becomes instantly active as a child on Christmas morning.

Even at 5AM it is rawther hot and a brisk long walk isn’t too much fun. She is more likely than not to make a sudden early U-turn as if to say ‘I didn’t want to do this anyway’.

The evening walk is more capricious than the matutinal. Even after sunset it’s in the 90s and no fun for dogs. The morning stroll can be peripatetic but not so the night stroll. These last ~ 5-10 minutes; they are mostly around the block to catch up on the latest sniffs and bushes.  Still, she likes the notion of going even if once outside she realizes it’s too hot.

On these sweltering summer strolls I used to go a-walking sans shirt, but I am now too vain to do so. The young men who walk or jog bare chested are chiseled Adonis and they know it. Next to them I feel old, ugly, and a bit creepy. So I keep my shirt on thank you very much.

There is a new development to the north which is just opening up so Harper will have something new to explore. It also gives me the excuse to go snooping as to what’s there and are there any handsome hombres outside sans shirt. However it is too hot for anyone to be out of doors. Nobody out but the occasional other dog walker and his or her pooch.

Now I must adjourn. Harper is at my side, tapping her last year’s Pradas for me be done and get going. Last I checked it was 93F. I sense this will be a short one.

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We maybe light in the loafers with fashion sense etc. but we are still a couple of OBs.* The days are  long and tiring which often end with us at opposite ends of the house, engrossed in on-line entertainments (YouTube and cable TV, respectively) before we pass out around nine o’clock. We lead dull lives.

This has led to a negligence of house maintenance. Yesterday I saw dustbunny the size of the tumbleweed roll cross the front hall. Henrik has written “Help me” in the dust on the guestroom nightstand. Oh the horror! Oh the embarrassment! It’s time to tidy up or we will soon go over the edge into degradation of Hell (fifth level).

Whether this is due to laziness or embarrassment on our parts to get in the Grimebusters is anyone’s guess. Until I figure this out I realize I need to do it myself – now. This week is therefore christened “Tidy up one room per day Week”. I have a two-gallon bucket of Pine-Sol and a box of antihistamines. I’m ready.

I am not so haughty as to look down or pooh-pooh housekeeping. I am not proficient in housecleaning, probably from lack of practice. No doubt I’ll do half the job in twice the time and be exhausted for it. I imagine experience will increase efficacy of my efforts.

Perhaps it’s time to open our wallets and get in a maid, someone with unrecognized OCD tendencies. If not, then it’s time for Someone and I make regularly appointed “Date night”, not for romping through Cupid’s Grove but to mop, dust, and sweep. At my age I prefer sleeping in the clean room than romping in a foul and frowsty one.

 

*OBs=Old Bachelors.

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