"How do you get up in the morning after that kind of loss?"

NYT: Deborah Solomon interviews Carlos Fuentes.

At 77, do you think much about age and mortality?

I don't think about it at all. What will come will come. I have two children who died before reaching 30, so who am I to complain about being alive?

You've had more than your share of sorrows.

Most of all not having my son around. I was very proud of him. He was a very good painter. He had hemophilia. He died six years ago. Natasha, my daughter, just died last summer.

How do you get up in the morning after that kind of loss?

You go on. You go on. You bring the person you love inside you. That is how you cope. You make him or her live within you. The whole experience I had with my children is in me. It is nowhere else I can see. I can see a photograph, I can feel sad, I can read a poem, but the experience of having them within myself is what matters.

A richly deserved thrashing

...for a NYT article. Men's life expectancy is increasing; good-bye to the "merry widow!" Dr. Helen is having none of it: "In this pathetic excuse for an article, the theme appears to be that because men are living longer, this might put a cramp in women's lifestyles."

Was it Dorothy Parker who said: "This is not a book to be taken lightly. It is to be hurled against the wall with great force"? This article would serve well for pitching practice. Read Joan Didion's "Year of Magical Thinking," and then we'll talk about bereavement. "Merry widow," indeed.

Stare-down

NYT Magazine:

"On the day after Hitler arrived in Vienna, a gang of Nazis stormed into Freud's apartment, at 19 Berggasse. They ransacked the place and made off with a fairly large sum of money. ('I never got so much for a single session,' Freud, never at a loss, observed.) They only left, it is said, when the old man, trembling and frail, appeared from out of his consulting room and fixed them in his long-practiced stare. The Nazis, the story continues, scrambled for the door."

If Nazis invaded my office...my stare would be...useless.

"I believe the psychological profiling of Islamic terrorists is a complete waste of time."

Dr. John Horgan, psychologist, at an anti-terror conference:

"It will not work. It means different things to different people and there is the wrong assumption that if we can identify the traits of known terrorists we can move into predictions.

"The terrorists are not a homogenous population and we simply do not understand why some move from legal activities to illegal.

"Too much is based on a limited range of people and we are seeing only the tip of the iceberg."

Despite Dr Horgan's comments, there was a good deal of profiling on display at this conference.

Peter Nessen of the Norwegian Defence Research Establishment had analysed the London suicide bombers and came up with a typology, which, he said, provided important lessons.

He identified four types of terrorist in the four young men who blew themselves and others up:

* the entrepreneur
* the protégé
* the misfit
* the drifter.

-"Seeking out the suicide bombers." Paul Reynolds, BBC News.

"To all of the mentally ill people reading this: I am sorry."

A junior psychiatrist rants. "I feel for you. I understand why you feel so bitter." At Trick-cycling For Beginners:

A nurse in our meeting, a senior nurse, the head of the community mental health team, who has never met this patient, gave us this very helpful and thoughtful recommended treatment plan (I quote her, verbatim):

"You need to turf her - a waste of space like that."

All through the meeting, at any mention of any patient with, say alcoholism, or self-harming behaviour, she gave a derisive snort and a roll of the eyes.

How can I keep standing up for my profession when this is the sort of attitude exhibited by my colleagues? Why on Earth should people feel anything but bitterness and antipathy towards a profession displaying this kind of bigotry towards the people they are trained to help? Why the **** should I expect psychiatric patients to understand that the system is in place to help them when this is the kind of crap they have to face?

She's right. Some of the worst stereotyping and stigma can be found in our own field (and not just among nurses). It is spoken, and unspoken. It's horrifying. It's tremendously discouraging.

It's also immune to rants, unfortunately.

More on stigma and the mentally ill: here, and here, and here, and here.

"Blogaholism"

Adam Christian in Slate:

Sarah Hepola's confessional piece on her recent decision to shut down a long-running blog prompted fraysters to share their own struggles of addiction...

TheNate discusses the successive stages of his own detox:

"My nine months as a blogaholic ended in August. It was a gradual withdrawal that began with accepting a higher media than myself and ended with me carrying the message to others. I went from constantly rereading my own entries and checking a dozen other blogs daily to never visiting mine and only occasionally visiting a few big-name sites. These days I can occasionally check blogs socially without fear of getting addicted again..."

A Very Brief History of Art, Featuring Mr. Potato Head

SobekPundit:

"In this urn, we see the potato figure again, but this time in a more stylized form than at Lascaux. Recent discoveries on the island of Crete have created a near-consensus that this urn represents an ancient myth, in which Zeus transformed himself into a tuber of some sort, in order to seduce the Minoan Queen. The fact that three such potatoes appear has led some to speculate a proto-trinitarian religious theme, but such a theory has very little support."

The amazing thing about "medical marijuana"

...is that it never causes any adverse effects. Whatever physical or emotional symptom is present, it's always due to "something else." At least, that's what some patients tell me. Example:

"I'm hungry all the time. I've gained 8 lbs this month." Are you still smoking medical MJ daily? "Yes, but that has nothing to do with it."

And: "I can't get out of my chair, I have no energy and I can't concentrate. I'm not getting anything done." Let's see, are you still smoking medical MJ every day? "Yes, but that's not it."

(Please, don't ask me for Adderall for your poor attention span!) I also hear variations on this theme:

"I have so many late fees on my credit cards that I can't afford my medical marijuana!" Sorry, we don't have any samples in our cabinet...and it will be interesting to see what happens to your other symptoms, if you have no access to medical MJ...

"Proper procedure for shutting down a blog."

Bora explains:

Every now and then a blog shuts down. There are as many reasons as there are bloggers, ranging from getting bored, through getting Dooced, to dying. Every blogger goes about shutting down the blog in different ways. I tried here to put down, in more or less systematic way, the dos and donts of shutting down a blog. If you disagree with some of the points or have additions, please state your opinion and rationale for it in the comments.

1) DO NOT DELETE THE BLOG!

First, spammers are mighty quick at taking over abandoned blog addresses and placing various shady businesses, including porn, on those addresses. Everyone who has ever linked to you is now linking to porn. Bad idea...

He also posts a rant from a very irate blogger, who is incensed that a favorite blog has been deleted. He argues that, once posted, a blog is part of something larger than its creator, and therefore must not be deleted. If I delete my blog, I am disrespectful to all who've ever linked to it! This has to be satire, Bora!

"The Balance of Risk"

"Sometimes things intended to make us safer may not make any improvement at all to our overall safety, and in rare instances they may actually make us less safe. The human tendency to take risks may trump all the efforts of the safety engineers." Cynthia Wood, at Damn Interesting:

"Dr. Gerald Wilde of Queens University in Ontario proposes a hypothesis he calls risk homeostasis. In a nutshell it proposes that human beings have a target level of risk with which they are most comfortable..." When an activity seems too risky, people adjust their behavior, and stay in their "target zone." But if people perceive that safeguards are in place, then people may be more likely to throw some caution to the winds. They take more chances. They increase the level of risk, back to their target zone.

"An additional complication for the already beleaguered safety engineers is that risk homeostasis is dependent not upon actual danger, but rather the perception of risk. Much of the gender and age differences in risk-taking behavior appear to stem less from differing desires for risk, and more from the individual's different evaluation of risk. Young people, and particularly young men, tend to evaluate their level of risk as much lower than older people would, even in identical situations. This implies that promoting safer behavior depends more upon altering the perceptions of the target population, rather than improving the safety of the environment– a much trickier proposition.

"What it all boils down to is that the law of unintended consequences is extraordinarily applicable when talking about safety innovations..."

The latest "super food" is...

this? Yes, says BBC News:

It's "rich in Vitamins B and C, and has ten times more iron than cow's milk." Can't wait for the marketing campaign.

Complaint of the day

"I'm astral travelling, and I don't like it."

"I'm no good at this!"

Primary Care Doc is on the line. Three times, he has sent his patient to ER with suicidal ideation. Three times, the patient told ER he was fine, and was sent home.

"He's back in my office, and what do you suppose he's telling me...again? I'm no good with psych patients. I don't know what to do with them! Now the ER's asking if he's bipolar.

"I've had him on Zoloft, Prozac, Effexor, you name it! You know, I can treat MI's, sepsis, pneumonia, all night long, it doesn't bother me at all. But this...! I can't do this!"

"All right, all right," I'm saying. "Yes, this is tough...we'll see him."

(This doc seems more distressed than the patients I saw today!)

Barbie speaks.

...the first real life Barbie is a 24-year-old graduate of Kent State University School of Performing Arts called Erin Coors. She was about to accept a minor role in a fringe production when Mattel selected her as the one to bring Barbie to life.

...Barbie will be travelling across America for the best part of a year, stopping off at 80 small towns, and the occasional large one, to perform the hour- long musical. It is hoped that, by panto season, contracts will be signed and the show will be performed all over Britain.

“Just listening to them all chanting ‘Barbie, Barbie, Barbie’ as I walk on means the world to me. It is a very special job and a great responsibility,” Ms Coors said.

As she spoke, an eight-year-old called Victoria pushed past a group of fans waiting for autographs and screamed: “I want your dress, and I want your tiara and I want your shoes.”

“What a lovely little girl, what adorable hair you have,” said Barbie.

Another few dozen little girls stood in awe of the life-sized doll before them. Barbie told them all to be good, and to be always honest and to always have courage before bidding them farewell.

“That’s her,” breathed Nicole Satchetti with about as much amazement as a 3-year-old can muster.

Frontiers of medical research: hair-growth treatments

Los Angeles Times:

Probably the most promising recent discovery has been that of the role of a gene called "sonic hedgehog" in hair growth. The gene (which is indeed named after the Sega video game) is known to be vital to the development of organ systems in embryos. In adults, one of the few "organs" that continues growing and relying on the gene is hair.

Curis Inc., a Cambridge, Mass.-based biotechnology company, is developing a drug based on this gene. The company has produced a small molecule that mimics the effects of sonic hedgehog and can penetrate the skin and home in on the follicle directly.

Last year, it presented findings at a meeting of the American Academy of Dermatology showing that the molecule causes mouse hair follicles to jump into action. First researchers shaved the mice, then they rubbed the molecule into the animals' skin. A thick patch of hair developed quickly — far faster than it would have naturally...

-e-mailed by Nikki (thanks!).

Big Mama Doc's Grand Rounds!

Fat Doctor hosts our weekly roundup of medical blogging. Don't miss it!

Candyland

...or, as we call it: "our hospital, at Easter." Match each hospital area to its treats:

1. ICU
2. Emergency Room
3. Cardiac Unit
4. Information Desk
5. Psych Unit
6. Med-surg Unit

_____Chocolate bunnies

_____Marshmallow peeps

_____Jelly Beans

_____Chocolate-covered marshmallows

_____Foil-wrapped designer chocolates

_____Easter-themed cupcakes

_____Miniature chocolate bars

_____Chocolate eggs

(More than one answer may apply.) For those of us who trek through each area in a typical workday...this is deadly!

Easter links

From Me To You..., originally uploaded by **Anna.

Flickr Easter clusters: here. (Who is that model who's wearing nothing but marshmallow peeps?)

Flickr Spring clusters: here.

And have you seen Laura's gorgeous flower portraits? (Here, and here.)


I'm on call again! More blogging later.

"Hi, Shrinkette. Got a minute? I have this case."

Very Important Doctor is on the line. "Sure, go ahead!" He speaks quickly. Better write this down. He must want a consult.

The patient is in her 60's. He's known her for years. She had pain. He started a pain med. She got dizzy and sleepy. She fell. She had a fracture. She had surgery...then complications. They were bad complications...

"How awful," I say.

Pause. Silence. He goes on:

She had more surgery, and more complications. She's not doing well. She may have had a stroke. She's in the hospital now.

"What room? I'll see her today. What's her name?"

Another pause. "You don't have to see her."

"No? Okay...what's the question?"

There's tension in his voice. He knows this woman, knows her family. He's treated her for years. She's so sick now. She might not make it. He gave her that med...this all started when he gave her that med. Everything went downhill after that...and now she's in a coma...

And finally, I get it. This call isn't for his patient. It's for the doctor.

I lay my pencil down. I shut my mouth. I listen.


-modified, fictionalized account of an actual phone call (see disclaimer in sidebar). Related post: here.

"On Exploding Cats..."

Professor Batty:

Workers in veterinary clinics have a name for it: "Exploding Cats." No quite as gruesome as it sounds, but a spectacle to be sure. When a cat has lived in isolation, never having seen a dog or other animal before, it is quite liable to "explode" in a fury of clawing, writhing and spitting. In the wild, it is an effective survival technique....

Sometimes the human animal has its explosive episodes as well. The ancient Norse Berserkers were renown for the fits of mayhem of which they were capable. The modern human, sociopaths and psychotics aside, will sometimes vent with a flurry of hurtful words and cutting insults. Is this also a defense mechanism? It is certainly an effective means to drive others away. And when it is regrettable (which is usually the case), what steps can be taken to prevent its recurrence? Are the neural pathways too deep, in a too primitive a section of the brain to allow change?

A fish tank made of cocaine?

New Scientist:

"Evidence from a clandestine lab in eastern Europe suggests that gangs are trying to hide cocaine by incorporating it into a host of innocent-looking transparent plastic consumer products, such as fish tanks, DVD cases or light fittings for cars. These could be imported en masse with no customs officer giving them a second look.

"The trick came to light after police searched an abandoned tenement building in Ljubljana, Slovenia, where they suspected cocaine was being produced. There they found a makeshift lab complete with mixers, drying systems and containers filled with various solvents, plus translucent lumps of plastic littering the floor.

"Analysis of the plastic showed that it consisted mainly of polymethyl methacrylate (better known as plexiglas or perspex) laced with cocaine hydrochloride. 'The crime scene was obviously being used for the isolation of cocaine from polymethyl methacrylate resin,' says Tomaz Gostic of Slovenia's Forensic Science Institute in Ljubljana, who will be publishing his analysis in Forensic Science International."

"Who are these folks who don’t seem to know if they are asleep or awake?"

The Cheerful Oncologist, on a study of near-death experiences:

“A new study finds that people who have had near-death experiences are generally more likely to have difficulty separating sleep from wakefulness.”

"Oh, no…don’t tell me that after years of reverent admiration of those souls who stand at the shining gates of heaven, toothbrush in hand, and are told that it was not their time, then unceremoniously shuffled into the the next Earth-bound train, we now have evidence that it’s all just a fantasy of the mind...

"How discouraging to hear that an out-of-body-boogaloo may be just the product of our limbic system behaving like a toddler with a hammer left alone in a room with a sleeping cat."

If you miss the rapture.

Advice that's making the rounds:

1. DO NOT commit suicide, and stay extremely calm if you have missed the rapture. There will be a period of total chaos, suicides, and heart attacks. People all over the world will be in total chaos. Please understand the fact that you who remain here have missed the rapture, and are living in the tribulation period, and nothing you do can change that fact. Listen! Don’t look back. Face the fact you’ve been left, but there still is hope for you!!

Scroll down; there's another guide. Its author might be planning to miss the rapture.

1) Scope out the church parking lots and take whichever vehicle suits your fancy. After all, they won't be needing their stuff anymore!

My "Google Authority Sites."

"The urge to eat crayons."

"The psychology of Spongebob."

"Gonzo Emergency Medicine" (Strangely, the Cheerful Oncologist doesn't have the top spot. He should have it.)

"Blogging creates communities."

And:

"Psychiatrist blog."

(I'm so proud!)

Our favorite medical blogging

This week's roundup of health-care blogging (aka "Grand Rounds") is up!

Our host: "Anxiety, Addiction and Depression Treatment Blog."

Featured bloggers: GruntDoc, Kevin MD, Dr. Charles, Difficult Patient, The Blog That Ate Manhattan, and more.

Go there at once!

"The average woman worries about her body every 15 minutes"

"...more frequently than men think about sex." So says Times Online, citing a British magazine's survey of 5,000 women. Note: "...29 per cent worry about their size and shape every waking minute." (No word on study design or selection criteria, though. Too bad!)

Of those questioned in the poll, nine out of ten said that they dieted, with 41 per cent saying they were constantly on a diet. Half admitted to lying about their weight, and almost a third cut size labels out of clothes, the research revealed.

The least popular parts of their bodies are thighs, hated by 87 per cent of those questioned, and waists, disliked by 79 per cent.

More than half of those questioned were also disappointed by their breasts, feet, face, neck, hands and fingers, teeth, hair, chunky arms and legs and “muffin tops” — podgy rolls sticking out over their waistband.

And which body parts fared well? Brains, right?

Wait, sorry, no: it's ankles. Ankles are okay.

(Sigh.)

My inner life

(Scene: a simple stage. Spotlight on three dubious characters.)

Id: I want to blog!
Superego: Quiet. We're busy now.
Id: I don't care. I like blogging.
Ego: How can we blog now? Taxes...unfinished charts...what's this "alternative minimum tax," anyway?
Superego: Right, just blog about how we can't get anything done, because we're blogging. Brilliant.

Enter Giraffe.

Giraffe: Will you three pipe down?
All: What are you doing here?
Id: It's my giraffe. I like giraffes.
Superego: I told you what would happen if you let Id run things.
Ego (grabs giraffe, leading it away): Excuse us, please. We're having...a bit of a conflict here.
Giraffe (resisting, testily): That's obvious. Why aren't you blogging? I check in every day.
Id: See?
Superego (to Ego): Really now. Those charts...overdue! How do you feel about them? And have you found Schedule D yet?
Ego: Schedule D...charts...
Superego (to Id): And you! You want it all! You want to blog, sing, draw, paint, travel...bring giraffes around...and go to the gym every day!
Id: The gym was your idea. Listen, I can't stand this.
Giraffe: At least tell your readers that you aren't dead. They're starting to wonder.
Ego: Not dead...tell the readers...
Id (to Superego): Don't you feel guilty, leaving the blog alone, leaving your readers like this?

Shrinkette wishes to inform you all that she loves to blog, and that she misses it very much. When things are tidied up a bit, she intends to return. Thank you.