The Board of Directors Here at Spo-Reflections nearly had apoplexy over this one. They only allowed it through provided I warn my relations and those with weak constitutions to come back tomorrow.

A friend is coming to visit next week. He recently texted us wanting our opinion whether “Flex” or “Chute” is better. Naïvely I thought he was talking about work-out whey powder.  Upon edification these are the two in-town bathhouses. Said Friend proposes we three make an outing of it, a sort of bar-hopping.

Jolly good fun. Maybe.

Urs Truly has never been to a bathhouse. When I lived in Chicago I literally lived kitty corner to one of Windy City’s more notorious and salacious ashrams. I was too timorous to enter in. Later, when I was more courageous, I was not comfortable to do so for I had established a small private practice;  several of my patients and analysands who regularly went there.  Psychotherapy is intimate enough but to encounter one’s patient literally naked is even more ticklish. So I never went.

Mind! I am curious to know what goes on in one of these places and see what all the fuss is about. I am tempted to take up Friend’s invitation. I see it as a sort of anthropological expedition like Margaret Mead among the Bantus, observing tribal rituals. Friend says it is more fun to go with someone than by one his own and I can’t imagine why. I suspect (since he is more handsome than I) I may act as a sort of foil viz. a gentleman caller sees us and opts for him rather.  Is there something more/else to do in these places? I imagine the halcyon days of Rita Moreno-types singing in the pits providing entertainment ala “The Ritz” went out decades ago.

I wonder too how negotiations occur viz. haggling over what one does and doesn’t want to do and (more important) the disclosure of one’s health history and status (perhaps there are forms?).  Just my luck I go on my first outing only to pick up something unwholesome like athlete’s foot.*  I surmise in this day and age of Grindr**  going to a bathhouse for companionship seems time-consuming and unnecessary; perhaps the ones who go to yon places don’t have cellphones. Or perhaps everyone there carries their phones around the place, walking around in towels looking down not ahead, absorbed in their cellphones, texting others rather than conversing with those right in front of them – like any usual group of gay men.

In the end I probably won’t go not out of prudence or squeamishness but out of fatigue. Friend gets picked up from the airport quite late this Friday night and I will have been up since 5AM.  I am at the age where the night is meant for sleep. I may drop off Friend at the most convenient of the two places and see him in the morning.  This won’t be the first time I’ve woken in the morning, made some tea, and waited for his return from the walk of shame.

 

 

* Do they provide slippers or does one bring your own? So many questions.

** Something else I have not experienced. Should I call Auntie Mame or count my blessings?

 

I shouldn’t write blog entries when I am cross but this past week and weekend had issues. Mind! There was nothing truly bad about the events – I am talking lumps in the oatmeal, not lumps in the breast* – but the accumulation of disappointments and let-downs (or my ‘saving throw’ didn’t work ) resulted in a magnificent Sunday night gloom. I would go to bed but it is only 630PM.

One of the disadvantages of being a psychiatrist (or someone who has been through therapy/analysis, or just plain good at knowing themselves) is you know the reasons for your emotions and subsequently what NOT to do, but there is a strong urge to do just that. It’s like being trained for good manners and composure when what you really want is to curse, eat bad things and smack heads together. My inner-Mrs. Danvers (or one of that crowd) is whispering in my ear I should do some sort of outrage. Emotional acting out is calling me like the Sirens.

My trouble is when in a pique I still want Mother or Father to tell me it’s alright. I’ve been told this is typical of a Cancer Man.

Dad Chris and Alexander

In my doldrums today I had a sudden recollection of a book from my childhood. It is about a boy telling his father at day’s end “Alexander the Horse” was a total bitch** and ought to be punished in some way. Brilliant book! It covers the Archetype of the Child (negative aspect) projecting all his Shadow onto another. Father-cum-analyst-cum-Ego listens without judgment, attunes the affect, and lets on he knows someone else who must have had a bad and tomorrow things can be better.

Writing this out has helped.

Let’s hear it for sublimation.

Going for a dog walk with the cleaned and pressed pooch will also help to burn off the bummers.

How adult.

I still want to eat a large pizza after committing some outrage. :-)

* The one possible exception is the matter in Indiana. I suspect it is a harbinger of things to come; it is only a matter of time before nearly all states pass such laws and all the recent advances are for naught.

**  I don’t think he uses these precise words, but close to them.

Office

It is the fifth year anniversary of The Affordable Care Act. (1) I don’t like to write about politics on my blog (The Board of Directors Here at Spo-Reflections loathes it) but I like to write about physician/medical matters.  So here is my thoughts on the matter.

Patients sometimes ask me if ‘it is working” (2). So far as I can tell, the answer is ‘yes’ viz. there are less uninsured now although it is a far cry from universal health care some of us covert, the type of care which would place us in with other western civilized nations.  The ACA hasn’t evoked ruin, nor has it destroyed the conglomerate of corporate insure companies whose primary goal is not the health of patients but the purses of their stockholders.

The ACA doesn’t provide universal health care, but it is providing some health to those with no health care.  I remind my patients the government was already providing health care to some popluations viz. those over 65 (Medicare) and some have-nots (Medicaid).

According to the medical journals, health care premiums are going up, but when have they not? But, there is no sign the premiums rises are accelerating due to ACA.

The job market doesn’t seem to be negatively effected.

There are no “death panels”.

New patients still have to wait 2-3 months to see me. This was so five years ago and it is still true.

The outside influences getting between me and my patients remain the insurance companies and not the federal  government.

Prior to ACA: there were maybe forty-forty five million people without health care. When they got treatment in hospitals and /or in ER (for they are not turned away) their bills are paid for by all of us through taxes and/or higher health care premiums.

Twelve million of that forty-five now have health care – which is less than 5% of the nation. I see signs of hope this  act promotes freelance work and independency.  Before ACA those with pre-existing conditions (3) usually had to work for a corporation to obratin health insurance, rather than make their own businesses. I’ve had a few patients ‘stuck’ in bad jobs because of healthcare coverage; now they are building their own businesses and feeling far less depressed (shocking isn’t it? )

We still spend far more on health dollars on health care compared to other countries and we continue to get far less for it. This was true prior to ACA and still true. The ACA hasn’t altered this either way.

Have I seen any great changes at work as the result of the ACA? I’ve had a few new patients most grateful they can now get help and these improvements ripple through life towards others. I have less turning away patients because of no health insurance.

I am seeing ‘more paperwork’ from Aetna, BC, Healthnet, etc. who demand justification why I prescribe what I do. (4)

The two shrinks in the office have opposite hypothesis why there is an acceleration of prior authorization forms. The Other Doctor feels ‘this is all due to Obamacare “ viz. it is forcing insurance companies in putting out more forms. I sense the insurance companies are doing this to make doctors more annoyed into thinking it is the fault of the ACA – so physicians will grumble and vote to reject the ACA.  Fascinating.

I tell patients not to be worrying; the ACA is a work in progress.

(1) Names and words are important. I prefer ACA rather than Obamacare as the term is a) more accurate in conveying its intent and b) less incendiary.

(2) Most of the time they tell me rather, saying it is or isn’t working, depending on which way they vote. Them’s on the right have almost as knee-jerk conviction there is nothing about it that’s working.

(3) Which is basically everybody.

(4) My written response to these inquiries is along the line of finding some polite way to say: “I am prescribing Prozac as this patient has been taking Prozac for ten years now and they are doing well on it and to stop it means a relapse into depression and putting them back into thoughts of suicide. That’s why I am prescribing it – assholes.”

Justice-League-Alex-Ross-Art

Jungians see the Universe constantly trying to achieve balance. Yesterday’s entry with about the Demons of Ignorance. I create balance, today’s is about The Pillars of Wisdom. These are the archetypes of Strength.

Whenever I encounter the Demons of Ignorance and I feel weak or important it helps me to remember The Strong. These are the men and women who help me avoid succumbing to despair. Some of them are fictional; they come from movies and literature. Some are boisterous warriors and some are quiet rocks.  What they have in common is they give me courage. I have a whole household of them in the recesses of my pumpkin. I don’t always remember they are there, but they never fail to come to my aide when I call them. The Strong ones (who are friends or family) you would not recognize, but here are a few you will know:

Yoda

Gandhi

Mrs. Moorehead

Spock

Mame

Boadicea

When I can’t focus on any of them I always have my ancestors. In “The Manticore” by Robertson Davies the main character David is trapped in a small tunnel deep underground. He is having a panic attack and he’s lost control of his bowels he is so frightened. Behind him his companion demands he conjure up his courage and move on. He can’t. She suggests he pray to his god, but then sarcastically remarks his type has no god. She tells him to think on his ancestors. So he remembers his great grandmother, who valiantly left Ireland barefoot and pregnant out of wedlock.  He imagines her bravely going around town gathering money for the boat ticket to Canada. The vision of this Strong woman gets him to move and out of the cave.

I too like to think upon my ancestors as courageous folk who first left Scandinavia for Normandy, then Normandy to England, and finally England for New England, each time daring fate and circumstance.

Despite it all – the news from Indiana, The NOM, ISIS, the nasties in Texas and Alabama, and The GOP I will stand tall and stalwart with my Strong ones.

They comfort me; they stiffen my spine.

RWS_Tarot_08_Strength

This post is rather pugnacious, but I felt better to get it out of me. Come back tomorrow when I have something more jolly. 

DOI_chuck_jones

I haven’t had time (or inspiration) to write lately, what with covering The Other Doctor. I had a few nice encounters at work this week when patients asked me for my expert opinion on this, that, or the other. They seemed grateful for my knowledge, which I try to be based on objective research, science, and data analysis. I got the impression they were actually going to follow my advice. Usually it is the other way around viz. people come in with convictions or what is true, and when I try to correct and educate I am told I am either a) wrong or b) in cahoots with (fill in the blank).

I’ve said it before: Ignorance drives me crazy. Not just ignorance but the firm conviction without willingness to change if given material to negate  assumptions. Worse is people proud of their ignorance. Am I remembering wrong? I think I recall a time when people wanted to learn as much as possible.  I don’t seem to run into too many of these types anymore.  Recently I learned Americans believe the following :

18% believe the earth is the centre of the universe and 25% believe the sun revolves around the earth. 

25% don’t believe Darwin’s theory has any truth to it. 

~ 30% of Americans believe climate change is from natural influences.

~ 33% believe sexual orientation is a choice. 

7% believe the 1969 moon landing didn’t happen. 

And maybe one in four suspect President Obama as the Antichrist.

And one in five think we gained independence from some country other than The United Kingdom. 

This all is particularly depressing for I hear Mr. Cruz has equivocated people who believe in global warming are no different than those who believe the earth is flat.

I am beginning to believe Mr. Cruz should be President; he is what this country deserves. Not that I would be here to witness this debacle, for I will have emigrated to New Zealand or have died of illness (from lack of health care) or have been stoned to death by those feeling I am destroying religious freedom.

Truth is never loud or glamorous. One can only hope it wins in the end.

why-the-hell-is-that-moron-ted-cruz-over-nasa-and-science

Office

Today at work Patient “A” conveyed while in a manic phase “A” shoplifted for the first time in “A”s life. In a hypomanic state, “A” took a shirt from a department store, was caught, and now has legal consequences. After “A” finished his/her narrative s/he asked if I had any questions.

Yes: Was s/he able to keep the shirt ?

Patient “B” announced s/he had found Jesus and consequentially no longer needs medications or psychiatric care, please close the case. As a parting gift “B” gave me a couple of Chick Publications comic booklets. I would have preferred B had given me the co-pay.

“C” reported he was taking a medication for over five years and it doesn’t do anything but it causes a lot of side effects so I proposed he stop it.  He thinks I’m a genius.

Today’s counseling was influenced by the poetess Mary Oliver, who said:
“Tell me, what is it you plan to do with your one wild and precious life?”

This was surprisingly efficacious: at least two patients decided upon hearing this they will leave their marriages.

Several patients admired the purple Spo-shirt I wore to work today because my office with its southern exposure gets quite hot at this time of year. It seems whenever I dress down and chance the APA secrete police will show up and drag me away for failing to dress up to contemporary professional standards I get compliments rather.

It’s time to renew the license that allows me to prescribe controlled substances. The toad-suckers raised the price from 500$ to 731$. Skunks. What am I going to do, say ‘no”? I can understand 700$ but the 31$ part is a mystery.

A pharmaceutical representative came today for a luncheon. He brought in a plate of sandwiches and he talked about his product which is indicated for adult binge eating. The Other Doctor and the counselors were not in today, so he had an audience of one, Urs Truly. There was something ironic about hearing about a Rx to curtail binge eating while snarfing down several sandwiches.

white noise app At the moment I am sitting listening to waves of the pacific ocean waves breaking on a regular basis onto the shore. It is very soothing and peaceful, and it is much better than the rain storm I heard an hour ago. Both sounds are emanating from a speaker which is connected to my iPhone via “bluetooth”; I have an app for white noise.

I am very fond of the sounds of nature and this app seems to have most of my favorites: country field, wooden boat rolling on the water, babbling brooks, and campfire, along with the breaking wave and thunderstorm (my favorites).

The app has several choices I find odd. For them’s who wants them, there are urban options such as “vacuum cleaner”, “washing machine”, “city traffic”, and (of all things!) “crowded subway”. There are also abstract sounds in colours ranging from white to green to brown.  For those who fancy such, combinations are available. I’ve made one titled ‘Desert night’ which has a soft wind, a cracking ampfire, and some coyote howls.

Someone and I seldom fall asleep at the same time, but when we do we both desire ‘something to hear’ but disagree on what. Someone prefers the voice; plays or lectures have him out within five minutes. In contrast he finds white noise unsettling it evokes insomnia. Someone uses the TV to induce sleep while I can’t fall asleep in front of a TV to save my life.  We agree real silence is not good and something must be making noise, whether it’s Henry V (works swifter than Ambien) or “Gentle forest rain” (a combination of frogs, babbling brook, and raindrops).

I am most grateful for my white noise app for I miss water in all its forms. Running water, rain, and ocean waves sooth me like nothing else. I wish somebody would capture ‘snowstorm’. This displaced midwesterner would pay dearly for it.

Walking the dog

It is Bach’s birthday today so I listened to a few of his cantatas. “Widerstehe doch der Sunde” is my favorite and for fun I listened to “The Coffee Cantata” and had a cuppa with it. As a consequence I became shaky and restless. The Solution?: Go for a dog walk. Harper is always grateful for that.

Widerstehe doch die Hunde.

The veterinarian told Someone Harper she must lose 2-4lb so dog-walks are paramount. *  More walks please and make them longer and more frequent.  Walking the dog is more pleasant what with the sun coming up early enough to make the morning strolls not entirely in the dark. It’s warmer too; sweatpants and shirts are no longer required.  All too soon it will be bright even as we wake and too hot to go out after twilight.

Harper tends to ‘lead the way’ these days for I let her direct which way to go, which is usually always towards the park. Sometimes I  take lead and take her in the opposite direction.  This often evokes a forceful tug at crucial corners to go back home, as if she decided if it isn’t my way then screw you we are going home. Bitch.

I have some new bells and whistles on my iPhone 6+ which tell me how many steps I take, how many ‘stairs’ I have climbed, and a lovely emergency button to press if I develop apoplexy and somebody needs to know my medical history.  There is also a bossy-boots who informs me I’ve paused and how about getting going. This is annoying to say the least, especially with a pooch who walks rubato not andante.  I should leave the dang phone at home I suppose. More embarrassing than dropping dead and having my phone reveal my medical matters are the text messages and visited websites done along the walk.

* Someone was told to lay off giving her treats from the dinner table. And I don’t mean Someone.

The almanac informs me the change in length of daylight went from less than twelve hours of light to more than twelve hours locally on March 18th. The same almanac also tells me the vernal equinox happens today, 20 March at 345PM, local time. I can’t envision how the local day=night ratio happens earlier than the sun actually crossing the equator, but there it is. There is a lot about astronomy and physics I find inscrutable, especially when it comes to relatively and space-time.  Quantum mechanics is another hellacious topic for my humming-bird brain to grasp. Happily, there a lots of lovely lectures on Youtube on these topics. I may not always grasp their nuances but I usually get the “gist”, just enough to make witty remarks at cocktail parties if someone should ask me my opinion on quantum entanglements or dark matter. I can’t recall all the names the moons of Jupiter which I think have multiplied since I last tried to memorize them. So far, nobody has approached me on these topics. It could be I am not invited to the right cocktail parties.

I struggle with a lot of other lofty topics, including economics, technology, and politics. I feel obliged at least make a go at them, on the noble grounds of diminishing ignorance or making another stab at those cocktail parties.

When I am invited at all to cocktail parties the conversation always seems more about pop culture celebrities and/or who is dating whom. These are topics even more ineffable than wormholes and no prettier.

Please excuse me as I pour myself a snort and cocktail party be damned.

imagesF9ZTVG13

I woke this morning around 3AM to a sound simultaneously soothing and unsettling. It took a second for my consciousness to catch up to my emotions. It was raining.  The positive feelings were mixed with the unsettled novelty of it, for it hasn’t rained in the night in many months.  The sensible part of the brain suggested I go back to sleep, but the emotional part wished to stay up to enjoy the sonorous solemnity.

It’s a pity I live in the desert, for rainy days provide me comfort and peace.  I think there is nothing more seraphic than the smell of petrichor and the drumming of raindrops on the rooftop.  Rainy days appeal to the introvert. They give one the permission to stay put and don’t go out. These are the days for hot cups of tea and good books, followed by the most blissful of events: a rainy day nap.  Even as I type this I feel a peaceful lull trying to lower my eyelids.

Rainy days needn’t be all indolence; there are always the ‘rainy projects’. These tasks are usually not strenuous, but mawkish or thoughtful, like organizing the photos files, or writing some letters, or tidying up a closet.

There is less noise on rainy days, so as not to interrupt the atmospheric concert of pitter-patter. TV and Youtube videos are verboten. If there is any music to be played it is something soft and pensive like Native American flutes.

The best rain is continuous and light, without much wind – perhaps just enough to stroke the wind chimes so they provides a low-grade ostinato to the rain chorus.  Meals on a rainy day are simple and hot, such as soup and a sandwich – grilled cheese preferably, for the warmth of rainy day food compliments the mild chill of the damp.

The reality is I am at my office, and my work-day begins soon. I will be indoors out of sight or sound of the weather, cut off from the rain.  Chances are the rain will stop and by day’s end the sky will be clear as crystal and we won’t have rain again until the summer.  But the memory of rain will have soaked into my heart if not my skin. Perhaps on a hot sunny day with too much work to do I can turn on the virtual rainy day that is now in my soul.

3/21/15 Update: I just learned of a lovely word:

chrysalism

n. the amniotic tranquility of being indoors during a thunderstorm, listening to waves of rain pattering against the roof like an argument upstairs, whose muffled words are unintelligible but whose crackling release of built-up tension you understand perfectly.

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