Chaos

Can't find a thing. Boxes are everywhere. It's moving day.

Here's a birds-eye view of our route:

Buzzards over Autzen Stadium, originally uploaded by L. A. Price.

(Are those really buzzards?) Back and forth we go, from our old place (near the right edge of the photo, three-quarters down from the top), to the new one (near left edge of photo). The photo was taken from the top of this hill. It's only a few miles, but the move seems...huge.

We're rummaging through years of piled-up stuff, pondering: keep or toss? Yarn stash, insect collection, art supplies: keep. Frying pan collection: do we really need so many? Awhile back, we were on a quest for the "perfect" pan. Maybe some of the runners-up could go. Some things are baffling: did I have to buy every painting-instruction book in existence?

Friends are arriving to help - hello, thanks so much! We need some music for moving. Any suggestions? Here's the playlist, so far:

"Strange Things," Randy Newman
"Diggin' Up Bones," Randy Travis
"Busload of Faith," Lou Reed
"Watermelon," Leo Kottke
"Werewolves of London," Warren Zevon
"I Have the Touch," Peter Gabriel
"Tangled Up in Blue," Dylan
"Sharkey's Day," Laurie Anderson
"Lamb Lies Down on Broadway," Genesis
"I've Got the Sun in the Morning and the Moon at Night,"
from "Annie Get Your Gun"
Nielsen's Clarinet Concerto, Opus 57

That should get us started. Okay, time for more packing.

Grand Rounds are up...

at Dr. Sanity's blog. Go, marvel at Da Vinci's drawings, while exploring this week's roundup of health-related posts!

"Here be dragons!"

Blogging tips, and a warning, from the Sunday Times:

The absolute golden rule of blogging — it is literally made of gold — is: “Do not blog.”

Who are you trying to kid? There were 70 billion blogs in the world yesterday, there will be 70 billion billion by next week, and what crazy hubris makes you think you have anything new or interesting to say? Yet you, like all the other lemmings, assume your blog will be one of the tiny fraction that is brilliant, and you’ve already got your gleeful little paws over the edge of the cliff. So all Doors can do is offer a few invaluable tips to stop you embarrassing yourself, ruining your love life, alienating your friends and getting the sack. If you follow them. Which you won’t...

(Tip number one: does the world really need to know what you had for breakfast?) A recent Gallup poll showed that, in spite of Time magazine declaring 2004 the year of the blog, half of America’s supposedly wired population had never heard of blogging. On the other hand, most Americans couldn’t place America on a map of America, so what does that mean? Well, it means this: don’t assume your friends and family know what blogging is. This is important because, when you start, these are the only people who will read what you write. Whether they keep reading or not is up to you...The easiest way to ensure your blog does not look noticeably awful is to start with a free template (see box). When your blogging delusion has deepened and you want the extra credibility of designing your own page, make things easy by using a dedicated program such as Movable Type (www.sixapart.com/movabletype).

A survey conducted by the Massachusetts Institute of Technology suggests you will probably join the 80% of blogs devoted to “personal musings”. It is easy to mock the drones writing about cats and shopping — see, I just did it — but the American Heather Armstrong, whose www.dooce.com won several Bloggies this year, says that this shouldn’t put you off. Since you can’t control your audience, “you should always write for yourself”, she says. “If what you’re saying has a heart and a soul to it, the audience will come.”

She carefully adds that there is nothing wrong with having nothing interesting to say... There is room for everyone in cyberspace, and mundane, boring blogs aren’t hurting anyone — just don’t expect an audience.

More advice:

If you choose a collection of words that people are likely to search for, you may be able to cheat your way up Google’s charts. Try possible future headlines (“War with France”) or song lyrics (“Way to Amarillo”).

It is also helpful to keep an eye on who is reading your musings, so you can pander slavishly to their prejudices. Check up on your visitors through Technorati...

If your sex life is not much to write home about, there are other ways to attract a burst of helpful fame. One is to blog so unwisely about your work that you get sacked. Armstrong, who was fired after writing about her co-workers, now tells others, “Be ye not so stupid”, but the press certainly helped her towards blogging fame and glory.

On "pro-ana" websites

With sinking heart, I've learned why my hits have surged lately. Last week, a study of "pro-anorexia" websites was released:

"Pro-ana" forums...are sprouting throughout the Web, and a new study finds that teens with an eating disorder who visit these sites fare far worse than other young anorexics or bulimics.

According to researchers at Stanford University and Lucile Packard Children's Hospital (LPCH) in Palo Alto, Calif., 40 percent of patients interviewed had visited such sites. Teens with an eating disorder who frequent these sites were hospitalized three times more than nonusers, the researchers said.

Within minutes, legions of Googlers began searching high and low for these sites. Google checked its pockets and found a post I wrote last October, when almost no one was paying attention: "WebMD explores pro-anorexia websites..."

So many have flocked to that post! It's a wonder that they don't bump into each other, or knock out pieces of my template. Are they finding what they really want - the pro-anorexia sites? They don't linger here. I had second thoughts about posting at all:

There's a risk that, by pointing out these sites, I might be showing anorexics a way to stay sick. I hope that risk is outweighed by physicians' need to know about what patients are reading.

We don't know whether mainstream journalists had qualms about reporting on these sites. But based on my Sitemeter, interest in these sites has increased enormously.

Let's be absolutely clear about what these sites are promoting. Complications of eating disorders include cognitive impairments, heart attacks, infertility, osteoporosis, hypotension, and, I repeat, death. Recovery can be arduous, and sometimes recovery is incomplete. These patients suffer. Furthermore, it's blindingly obvious that the illness can present in teens and pre-teens, and that children may wander into (or seek) these sites.

I've since learned that web servers have been eliminating sites that encourage others to starve themselves into a state of emaciation, misery and death. It seems futile to try to suppress any sort of information on the web, but "pro-ana" websites may have more staying power than most. Anorexics often strive for control - control of their drives, control of their bodies, and control of others. It may seem like willfulness, but sometimes there is abject fear behind the facade. The need for control is so strong that coercive measures - like shutting down websites - may not succeed with this illness. (Yes, I said "illness"...not "lifestyle.") For more on anorexia nervosa, try here and here.

Hellbound Alleee is well acquainted with these sites, and has little patience for them:

Don't get me wrong. I think that the Pro-ana girls should write poetry and make websites and start anorectic rock bands and write anorectic cookbooks and decorate anorectic birthday cakes to their hearts' content. If they can't manage to believe they deserve physical, material space and mass in the world, they should at least take up as much material space they can in the form of bandwidth. Perhaps some of it will rub off.

She doesn't try to talk them out of it. But she tells those who wish to make themselves disappear: You deserve to take up space in the world! She concludes with an exhortation to enjoy life's pleasures, which include food. She even adds her favorite chili recipe, for inspiration (it calls for corn, potatoes, bacon, steak, Italian sausages, kidney beans, and tomato paste). Bon appetit! It's a message that many anorexics will reject outright. For a host of complex reasons, they believe that to be perfectly in control, they must - nearly - disappear. Their websites, most likely, will not.

Wanted: stories of stigma

From Boston University's Center for Psychiatric Rehabilitation:

"Although there is agreement that stigma is one of the major factors affecting the recovery of people with psychiatric conditions, we still know very little about the variety of more subtle ways people encounter stigma in their everyday lives."

They've posted an online survey, asking patients to describe their experiences with stigma and discrimination. They'll use this data to develop programs to help patients cope with stigma.

"Who can participate in the study? Persons in recovery who have encountered stigma and discrimination because of their psychiatric condition...

Descriptions of stigmatizing experiences people in recovery have encountered in various social situations (i.e., in their neighborhood, workplace, school, in health settings, etc.) and of the ways they dealt with such experiences will help us develop training materials for this new intervention."

-via NAMI.

A glimpse of our future?

Washington Post:
Study Says Lakeland, Fla., Looks Just Like the U.S. of 2025

The Lakeland area, from Lakeland proper to Winter Haven 15 miles away, population about half a million -- is a demographic dead ringer for the United States of 2025, according to research by Wake Forest University economists. While other economists strain to project current economic trends into the baby boomers' retirement years, the Wake Forest team devised a novel approach: Find the future today.

What they found was Lakeland, with its Wi-Fi Internet connections and well-tended downtown, and an economy that diverges from the national average in interesting ways. Sure, sales of furniture, garden equipment and cars are booming here as they are in many other places. But grocery stores, restaurants and bars, clothing stores and department stores are pulling in far less of the consumers' dollars than in cities with more representative age demographics.

Health care and golf are in; fast food and musical instruments are out. And forget about doughnuts.

"It is unlikely that the future will look much different than Lakeland," said Sherry L. Jarrell, Garst Reese and Gary L. Shoesmith of Wake Forest's Babcock Graduate School of Management.

By 2025, boomers born in 1955 will be 70. Just less than 20 percent of the U.S. population will be younger than 15, slightly less than today, according to the U.S. Census Bureau. But the middle of the age spectrum will hollow out, while the number of those 65 and older will swell from 12.4 percent of the population to 18.2 percent.

I'm not sure how much we should generalize from this study. Aging boomers might differ from their parents in important ways. Can we be sure that they will trade in their musical instruments for golf clubs?

Those prognosticators would also do well to consult Night Nurse Kelly, whose patients are elderly. Her reports suggest another aspect of Gray America that can only become more prevalent in the future:

Neurology floor. Elderly people. Dementia.

Here are some of the places my confused patients wanted to go tonight:
To the Army National Guard building to get signed up (90 year old man)
Upstairs to turn off the lights
Under the bed to get the glass that broke
That little diner down the street to get some breakfast
"I want to get dressed and go to that place I need to go to."

Actual places I suggested my demented patients go last night:
Back to bed
Back to bed
Well, I think you should go back to bed
Back to bed

(via Respectful Insolence)

Move in progress

At last, our search is over. We've closed on our new house in Eugene. It's quite a change from the house we're leaving (seen here, here, and here), which Mike's uncle calls "a view lot with a house on it."

But it's larger, quieter, and more convenient. It's "lighter and brighter," in real estate parlance. It's five minutes from shopping (and a Borders!). It's ten minutes from each of our jobs. It's ten minutes from downtown, twelve minutes to the Hult Center with our beloved Eugene Symphony, and fifteen minutes from the university. It will be easy to see patients here, if that ever becomes necessary.

Here, take a look! (But that's not our furniture. These photos were taken by the listing agent, before we bought it.)












(Above, that's the "sunroom." It has a nice view of the garden.)




(That pink brick is no more. The painters are taking care of it, as I blog.)

So, we are excited. We've begun packing and sorting. (How did we accumulate so much...stuff? What were we thinking? And what will we do with it all?)

Ten things I've never done

I heard Dr. Sanity's page this morning: a self-disclosure meme is making the rounds, and she's passed the baton here. Let's see...I have never:

1. Climbed a mountain.
2. Played the violin.
3. Found enlightenment.
4. Balanced my portfolio.
5. Travelled to China.
6. Taken a cruise.
7. Attempted suicide.
8. Used a digital camera. (We have a slide scanner.)
9. Watched the Sopranos (or House, or Gray's Anatomy).
10. Met another blogger, in person (at least, not knowingly).

Now, who will be next? Codeblog? Medmusings? Medical Madhouse? Botanical Girl? Sanity Optional? Anyone? It's in your hands now. (Excuse me, while I think about #4...)

Bad news for Blue States

NYT: Research Finds That Red Is for Winners

"Across a range of sports, we find that wearing red is consistently associated with a higher probability of winning," Dr. Russell Hill and Dr. Robert Barton, researchers in evolutionary anthropology at the University of Durham, wrote in a paper that appears today in the journal Nature.

The research began a year ago with a hunch based on observations in the animal kingdom, where red coloration is often associated with male dominance, Dr. Barton said in an interview. Zebra finches fitted with red leg bands tend to become dominant, while those given blue bands are more submissive. In humans, anger reddens the face, which may send signals of fierceness.

(The next time I get a flaming red sunburn, I'm going to flaunt it. I'm a winner!)

This does not mean that a bad team can reverse its fortunes by wearing red, Dr. Barton said. The study applies only to closely matched competitors. "If you're hopeless," he said, "then wearing red isn't going to make you start winning."

In London, a representative of William Hill, a leading betting company, called the study "absolute rubbish." "There is no such thing as equally matched opponents in any human activity," and there are too many individual factors to pronounce a trait like color decisive, the representative, Graham Sharpe, said in an e-mail message.

Dr. Barton acknowledged that the work might not hold up under further analysis. "All scientific results are a bit provisional, of course," he said.

Sky pictures

originally uploaded by L. A. Price.

She was 82 years old, and had a dozen chronic illnesses. She used a walker, but could only walk a few yards unassisted. Her grandchildren were grown. What did she do?

Last week, we found out: she stood at her doorstep, clutching her walker with one hand and her camera with the other, and took pictures of the sky. Polaroids. Hundreds of them.

Red skies. Lavender skies. Every shade of blue, orange, and gray skies. Every kind of cloud pattern. Threatening storms. Skies reflected in her front windows. Spectacular sunrises and sunsets.

No photos of grandchildren or other relatives; no other subjects. What was she thinking? It was too late to ask. What should we do with these? Make a collage, of course. A tribute.

We bought poster board and a frame. We arranged the photos carefully. A pale one here, next to a vivid one; purple, then yellow - wait, no, purple, then orange...

Beside us were old photos that we had brought with us, snapshots of her past: a solemn girl in faded sepia, wearing a long pinafore and buttoned shoes. A picnic photo, a wedding photo, an anniversary photo.

"You know," said Mike, "with those old photos, we remember her. But in these photos..." He gestured toward the sky pictures. "In these photos, we discover her.

"But don't tell anyone that!" he said.

Too late.

originally uploaded by L. A. Price.

Grand Rounds is up...

at Galen's Log. Top billing goes to Dr. Charles, with the first post. Be sure to check it out!

We're back.

Katie's funeral is over. Again, many thanks for the kind e-mails, which continue to arrive. (How will I ever answer all of them?) The trek East was fairly smooth, from Eugene to Delaware (via Portland, Chicago, and Philadelphia). I wanted to give the family my full attention, so I didn't post.

Dr. Charles sent a wish that this experience would bring our family closer together. I think that did happen. We appreciate that our time together is too brief.

I once had to teach residents and interns about bereavement. I talked about the pain of learning to live in a world that does not have the deceased person in it, and of the necessity to forge an identity that matches the new reality. I emphasized that grief does not proceed in regular "stages" or "phases;" that it gets better, then worse, then better, then worse. We observe never-ending manifestations of grief, rather than resolution.

We're just beginning, here. (It's especially hard for Mike, whose job sent him to Taiwan yesterday, after he dropped me off in Eugene. He's had scarcely a moment to think.)

But let's get blogging.

Thank you

We're a bit stunned by all the e-mails, sending condolences and prayers. Please know that each one is appreciated.

Things will likely be quiet around here for a few days, while we fly east and attend the funeral. Again, thanks, everyone.

Sad news

We've just learned that my mother-in-law has been hospitalized with pneumonia, and is not doing well. In fact, she's unresponsive, and her oxygen saturation hovers at 70% despite the best efforts of her doctors.

She's 82 years old, and has been struggling for the last few months. She has diabetes and congestive heart failure, and has had at least three strokes. Last month, she was treated for urosepsis. After each medical crisis, she has "bounced back," to greet her four sons (and inform her doctors that they don't know what the "bleep" they are doing).

But this time, she's not bouncing back. It seems increasingly likely that she will die on Mother's Day, if not before.

No one needs to be told this, but: Hug your mothers, everyone.

Update: We just got the call. She's gone. (She died as we were trying to book a flight, to be at her bedside.) Mike is dazed. Mother's Day won't be the same for us, ever again, I'm afraid.

Empathy Award for 2005

goes to Dr. Sanity, for "The Sad Problem of Terrorist Morale."

Have you heard? Terrorist morale is at an all time low in Iraq. How sad.... And, if we aren't careful, soon their self-esteem will be impacted; and then just think of all that psychological pain. Oh, the horror!

I feel for them. I really do.

(Stop, you're breaking my heart!)

She also offers a musical accompaniment to Kofi Annan's troubles. How creative these medbloggers are!

Do you blog about your work?

If so, then Dr. James Richards would like to hear from you. He's a lecturer at a university in Scotland, and he's researching workblogs. He has amassed an impressive collection of specimens, and is looking for more.

He asks, "Please let me know if you come across any blog where work is a central theme." He invites you all to fill out his questionnaire, at Work-related Blogs and Work. Drop him a line!

The first Carnival of Nursing Blogs!

Head over to Thinking Nurse's blog:

This is it! The very first carnival dedicated to the ways of thinking, feeling and acting we call 'nursing', an activity of 'Head and Heart and Hand', the place where science and art meet, clash and fuse in the strange and wonderful synthesis of daily life.

Managers of health services say that they see nurses as 'valuable human resources'. These pieces of writing demonstrate that we are more than human resources, we are 'human beings', engaging on a daily basis with other human beings in a way that no other health profession can - people see nurses for the most crucial and intimate of reasons, at all stages of the lifespan, at all times of day and night. Nursing is about life and quality of life, about health and human potential, about the mutual support and solidarity of the human species.

And a huge round of applause to my sister, who graduates this weekend with a PhD in nursing!

"Some of em get to you..."

"Why can a bloke ninety percent of the time wade through the misfortune of peoples lives with empathy but remain emotionally untouched. But just occasionally some simple little thing gets through..."

That's Country Paramedic Australia, blogging about a "Pedestrian V car" accident. The victim is a "little (30yo) sweety," a "slightly mentally disabled person." She "left the scene (ran back to work)," but they track her down: "sobbing her heart out telling all and sundry it wasn't her fault." The driver of the vehicle that struck her "was speeding and left the scene," and "the coppers were rabid. I wouldn't want to be him when they caught him."

"She had such a way of cutting through to my emotions that I only lasted anout 15 seconds before I bolted and left my partner to finish the checks

"I went and busied myself with calling her relatives and calming her coworkers. The tears were right there.

"Funny Business I guess"

Some of 'em do get to us.

Funny business, indeed...

"The horror"

Mr. Sun's eleven-year-old "flare" is curious about facial blemishes. Can a father prepare his young son for the miseries of puberty?

I hate to tell him the truth: soon he'll be able to singlehandedly bring down gas prices by pumping crude oil from his face with the standard teenage rigging of two inward-pointing index fingers working madly to extract petroleum at the rate of nine barrels a night.

My battle with zits began and ended during the self-esteem drainage period known as Junior High School. During that time: a) my hair took on a shape and consistencey that earned me the nickname 'Brillo Pad,' b) my nose became in every significant sense a 'snout,' and c) my primary extracurricular activity was 'having allergies.' Not a pretty picture. I spent a lot of time in front of the mirror searching for a look that would allow me to play past what I knew to be a case of Acute Uncoolness -- temporary, but severe. I settled on a little something I liked to call Zen Fonzie -- a brother who is righteous, but seeks it not. Keep in mind that there was no such thing as Zoloft at that time..."

Notes on choosing a spouse

From Dr. Gordon Livingston, MD:

So what is it exactly that we need to know to decide if someone is a suitable candidate for a lifetime commitment? Perhaps one way to approach this screening process is to learn more about who is evidently not suitable. To make this judgment, one needs to know something about personality.

...the formal definition of personality includes our habitual ways of thinking, feeling, and relating to others. Most of us understand that people differ in certain characteristics, such as introversion, fondness for detail, tolerance for boredom, willingness to be helpful, determination, and a host of other personal qualities. What most people fail to realize, however, is that the qualities we value - kindness, tolerance, capacity for commitment - are not randomly distributed. They tend to exist as constellations of "traits" that are recognizable and reasonably stable over time.

Likewise, those attributes of character that are less desirable - impulsivity, self-centeredness, quickness to anger - often cluster in discernible ways...

The psychiatric profession has taken the trouble to categorize personality disorders. I often think that this section of the diagnostic manual ought to be titled "People to avoid." The many labels contained herein - histrionic, narcissistic, dependent, borderline, and so on - form a catalogue of unpleasant persons: suspicious, selfish, unpredictable, exploitative. These are the people your mother warned you about. (Unfortunately, sometimes they are your mother.) They seldom exist in the unalloyed form suggested by the statistical manual, but knowing something about how to recognize them would save a lot of heartbreak.

And the qualities to seek:

At the top of the list would be kindness, a willingness to give of oneself to another. This most desirable of virtues governs all the others, including a capacity for empathy and love.

(from Too Soon Old, Too Late Smart.)

So hard to say no

Many bloggers are engrossed with the runaway bride, who faked her own abduction on the eve of her enormous wedding. Not all of them are forgiving: "...if I were the groom I'd be running away myself, now," says Instapundit.

I've promised, "no armchair analysis on this blog," because it is too easy, often baseless, and frequently boring.

But in deference to those who scan my blog, searching for some reference to "psychology" (I see you on my statcounter!), I offer the following:

The story of the "runaway bride" suggests certain themes that are common in our consulting rooms. In the simplest terms, they involve the need to be special, or admired; the need to be perfect, or unassailable; the need for approval; the need for a sense of control; and the inability to say "no" (especially if saying "no" brings humiliation and disapproval, in spades).

Fourteen bridesmaids, with groomsmen, may translate to 28 people that one is unable to say "no" to. The actual list may run to the hundreds - including, of course, her fiance, her parents, her church...perhaps, most of the town where she lives. What was it like to imagine their reactions, if she had simply called it off?

It's not easy to say "yes" to one's own needs and desires, when that entails saying "no" to so many, and when the thought of saying "no" causes intolerable conflicts and a feeling of entrapment. Fleeing might seem like the best of many poor options.

Often, these themes will come tumbling out during sessions. They are "issues" that are rarely sorted out in a PCP's office, when patients complain that they are sad, anxious, or overwhelmed. Antidepressants fall woefully short of addressing them.

Enter the therapist, who explores how these situations come about, and how they might change. In psychotherapy, patients can untangle conflicting motives, increase their self-understanding, and explore other options. Fleeing is not the only way to cope.

This is one reason why neurology cannot entirely "take over" psychiatry, and why we will always need psychotherapists. The meds are just one piece of the puzzle.