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| Quest4Sanity |
| Not your average Shrink. Hip trip with The HEADoc. |
| Language: English |
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| Unique Visitors: 0 |
| Total Unique Visitors: 23996 |
| Visitors Out: 632 |
| Total Visitors Out: 632 |
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| DENIAL is Not a River in Egypt |
| 2008-01-10 20:01:46 |
Feeling a bit like I've lost my mojo lately.
In the writing department that is. By that I mean it seems much harder than usual to find something to passionately write about. Usually politics or the frustrations of our health care system are enough to get me started but as of late the angst and fervor have failed me. Just the fact that Bush will be gone in less than a year should be plenty but I'm not feeling too excited about even that. I think I may have become disillusioned by the political system over the years, expecting more of it than it can really deliver. I no longer have any trust in the system and see the politicians mostly as actors that paint an illusion of reality for the citizens. I should be elated and jubilant for the accomplishments of Barack Obama but when I think of him I see images of John and Robert Kennedy followed by the voice of Dr. Martin Luther King, Jr. playing over in my mind. I'm not a pessimist by nature nor am I a true conspiracy theorist but I do feel that some skepticism and no gullibility diminish disappointment.
I remember the feeling when I found out Santa was a fake. Christmas was never the same. I wasn't bothered nearly as much about that cheap tooth fairy. As an adult, I questioned the validity and plausibility of the Good Book. Still haven't quite got that one worked out. We need things to believe in so that we can make some kind of sense out of this sometimes senseless existence. I've grown to define my job as helping people find their way back on track. The stressors encountered during life often lead to such derailment. Since that person may be on a different track from myself it's amazing to witness the clarity of his or her problem or situation when exploring these things with a patient. Many patients end up in treatment for the very reason of overlooking their own problems to try and help another fix theirs. I can say that at least I do get paid for it, most of the time.
I thank God for the ...
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| Ready To Change in 2008 ? |
| 2007-12-29 16:54:16 |
The time is once again upon us to usher in the new and release the old. . .
at least in a symbolic or intentional manner. Turning such intentions into reality is quite a difficult task. After a string of failures to accomplish New Year's resolutions, the very idea of changing a behavior itself can become part of the stagnation of the procrastinator's world.
Most people change unwanted behaviors exclusively through a process of accepting their current state of reality and then recognition of the unwanted result of that behavior, followed by commitment, will power, and perseverance to reach the goal committed to. There are no shortcuts to changing behavioral patterns. Compulsions must be countered repeatedly and consistently in order to neutralize and eradicate the obsessive thought patterns that drive our unwanted behaviors. Think of an unwanted behavior as a mathematical integer such as negative 10. The ideal desired behavior would be positive 10. Much of ones initial efforts receive no psychological reward (positive re enforcement) since even a major effort would not be enough to even come close to even zero. (U R HERE) (-10) -9 -8 -7 -6 -5 -4 -3 -2 -1 >>> ZER0 >> +1 +2 +3 +4 +5 +6 +7 +8 +9 (+10) (GOAL)
It has been stated that it takes 50 times repeating a bad behavior for it to become hard wired into the brain as a reflex behavior, or so called bad habit. On the other hand, it will require 100 times of repeating the opposite behavior in order to neutralize and reverse that bad habit. One with several bad habits cannot realistically expect any genuine change without hard work over time and commitment to rehabilitate.When people look me in the face and tell me they have made a 180 degree turn around after a few weeks it can be assured that person is quite naive or a damn liar.
There is ...
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| Holiday Ranting |
| 2007-12-15 10:17:15 |
Had another birthday on the 14th.
To me it was just another day. I think birthdays were invented so everyone could have at least one day out of the year to feel something special. The Christmas Holiday has always seemed to overshadow my birthday, meaning that there is already enough to celebrate. I also sometimes think that even Jesus' Birthday seems to be upstaged by the commercialization of Christmas. I hate seeing people depressed because they lack the funds to buy for their children all the things on their list. A list that is essentially programmed into their minds by corporate America. Maybe the tragic circumstances of the lead poisoning associated with the toys in China will wake some people up. My parents talked about getting a bag of fruit and nuts on Christmas morning and being happy to get that. The real joy came from the thought and not so much the cost or designer name on the gift. We all love to receive nice things but I still believe there is more joy in giving than receiving, from a purely spiritual perspective. True love is fueled by giving and making sacrifice for others. Is that not what the word Christ really represents, since he made the ultimate sacrifice.
Sometimes I'm sickened by spoiled kids. I do not condone violence by any means, but it sometimes gets difficult to block out the thought from my mind of what good a few pimp slaps might do for the child with the audacity to talk back disrespectfully to adults or call his mother a bitch or worse with relative ease. Of course it is usually the fault of the parent for letting the situation get so out of control in the first place without seeking help. No need to blame the teacher, preacher, or doctor at this point. Enough of this, I'm beginning to sound like my age.
I'm preparing for 2008 to be a spectacular year. I want the past 2 years to serve as memories of a place I want to try and avoid going in the future. We all need to bottom out from time to time in or...
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| Let's Go 2 The Movies |
| 2007-11-26 23:02:48 |
Hope Thanksgiving was happy for all.
Time off, for me, is always greatly appreciated. I Had a movie marathon over the weekend, which I tend to do from time to time. Nothing beats a well done flick when one is in the mood. Viewing can be the next best thing to traveling and experiencing. I know I'm not Ebert or Roper but I like doing my own reviews from time to time. Not that I expect them to be read or taken seriously but it just gives me something to write about.
The first two times I watched SICKO by Michael Moore I'm a bit ashamed to say that I went to sleep half way through it. It seemed like I was just hearing the same stuff I try to tell people every week and as I have said repeatedly in this blog, No one really seems to care. By the third viewing of the DVD I began to realize that the information in the film wasn't boring but that so much information concentrated into a 2 hour film was apparently causing my brain to shut down because there was no way to comprehend the magnitude of what the film was actually saying in such a short period of time. By the fourth viewing I was starting to feel angry but also afraid in the sense that there was now confirmation and documentation of the things I've been thinking all along but somehow hoping that I was wrong. People are actually dying by the thousand every year simply because they don't have access to health care. The propaganda we are fed seems to make us as a society not have a problem with that fact.
The Brits, French, and even the Cubans receive superior care per capita than Americans and for a fraction of the cost per citizen.Something just ain't right about that. We need to fix it. How? I do not know. Considering what has happened to Medicare under government hands over the past four years, I suggest not letting the corrupt profiteers of government anywhere near the health care budget. Dealing with Medicaid and it's bureaucratic foolishness has led me to the brinks of ban...
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| Does Prayer Really Work? |
| 2007-11-16 06:51:03 |
Does prayer really work or is it just a figment of the imagination?
Most of us are really frightened of taking an honest look at such a question. Somehow we seem to fear that God will strike us down with a bolt of lightening for doubting such a thing. If one really thinks about it, it's not too hard to realize that believing that a bolt of lightning will surge from the sky with the specific purpose of incinerating a living being for a thought that person is having is just simply downright insane. I mean really. I think God would have eventually made the bolt of lightening theory one of the laws of physics, just like the law of gravity, if we were truly struck just a fraction of the times we deserved to be struck. How many people do you know that have have been struck down? Are you aware of any person that could benefit from a good jolt but just hasn't received it? In the context of analyzing this common absurdity of being struck by a lightening bolt, the question of whether prayer works or not is a perfectly sane and legitimate question. The atheist would immediately answer no, where as the agnostic answers I doubt it, and the person of strong faith considers one a fool for posing the question in the first place.
I love psychology and psychiatry because they allow an observer to take a step even beyond philosophy, in my opinion. Philosophy doesn't offer a satisfactory definition for the reality of intuition and intuitive thought. I have no doubts of whether or not intuition exists for I have experienced it many times on different occasions. Intuition can be described as that gut feeling we sometimes experience. Intuition is the act of knowing something to be true by just knowing. Explanations or scientific proof are not required in matters of true intuition. However, there is a thin line between intuition and delusion. Most of the truly great individuals in history were thought by certain others to be a little nuts to the point their fate may have inc...
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| Reflections |
| 2007-11-03 08:12:42 |
Three days ago I clicked enter to save my entry and something went wrong.
Somehow every word was deleted and lost forever. I wrote it off as an exercise in patience and tolerance since there have been times in the past when such an occurrence would have resulted in great anguish and frustration for me. I'll be more careful with today's' effort. It's hard to believe it will be a new year in less than two months. 2007 thus far has been a period that has been an endurance test for me personally. A female aquaintance recently described her impression of me as being miserable. Being quite fond of this person caused me to feel a bit troubled by such a perception for I know that is not who I am as a person. My suggestion to her was to reserve judgment a while longer. My personality traits consist of unusually high degrees of thinking, feeling, and intuition. This translates to a tendency to often react intensely to acute threats of change or actual change in circumstances. The past couple of years for me have been filled with such threats and changes.
As seen in my writing, I tend to often deal with adversity and controversy through cynicism or sarcasm. Some people refer to it as dry humor. I don't mind occasionally playing the role of devil's advocate just for the sake of argument. Some people don't seem to get this. Others are totally down with the program. To survive in my particular line of work it is essential to have effective ways of venting and maintaining some sort of personal mental balance. Daily reality for me involves facing issues of unexpected deaths from overdose, child sexual abuse, unfixable patients, managing risk to minimize the risk of being sued (lawsuits and threats of lawsuits are inevitable), trying to stay caught up on paperwork, staying in compliance with guidelines of the DEA, Medicaid/Medicare, and the IRS, Continuing Medical Education requirements, credententialing and licensing requirements, medical billing requ...
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| Metaphorically Speaking |
| 2007-10-16 18:12:00 |
spirituality and mental health
The cliche', the parable, and the metaphorical figure of speech are effective means of communicating a point to another individual...
I don't know what I would do if these did not exist. Once I incorporate the use of a particular phrase I tend to practice its use until one that is more fitting enters my mental collection.
Of late, one of the more popular phrases that has become common is "When it Rains it Pours." This truth has been true of my own life as well as the lives of many of the patients I treat. The storms of life can at times become quite turbulent and a true test of ones faith. Many will question if they are being punished or if there will ever be sunlight again.
The unknowability of a situation is what makes it an authentic and genuine life test. I have grown to believe that God and Nature cleanse us spiritually by allowing a cascade of negativity to occur in a manner that allows us to clear out all of the garbage and allow us a fresh start. The toxic people and circumstances are faced before falling to the wayside, the pain is felt followed by new opportunities and situations to deal with. Nietzsche writes "That which does Not Kill Us Makes Us Stronger." The Bible teaches us that God will never place more on us than we are capable of enduring.
I view life as a series of peaks and valleys. Always push forward when in a valley for the next peak lies ahead. You only lose if you quit trying. Suicide and addiction are the truest forms of surrender. There is no such thing as failure but only new experiences where things don't always turn out the way in which we planned or expected. Learn from your mistakes so not to repeat them.
Make the welfare of your children your top priority and you will be blessed. Placing other personal desires in this position of priority is one of the roots of misfortune. Go as far as you can with a problem then turn it over to your higher power. Learn your personal limits. Anger and fear...
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| Clarence Thomas Was On My Mind |
| 2007-10-05 21:54:02 |
I woke up in a bad mood this morning.
I had a dream that I had finally lost my mind for good. I recall screaming and yelling and escorted from the building after talking to the bank on the phone and being told that the Attorney General had frozen my account. I then ran over a fire hydrant in a car I drove (badly) via remote control and challenged the police and an angry mob featuring an extremely obese cop with a hypodermic needle for me. I didn't care if they killed me at first then I changed my mind and decided to run for it. I outran all of them but one or two. They finally forgot why they were chasing me. The colors were vivid reds, greens, browns, and the sun came out as the water stopped coming down. The next thing I remember was awakening with the thought in my mind of I hate Clarence Thomas. How is that for crazy?
I haven't been able to get that thought out of my mind. I actually began to start to like Justice Thomas for the first time after viewing some of his 60...
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| Grief and Recovery |
| 2007-09-26 00:32:15 |
spirituality and mental health
Haven't touched the computer to write in about two weeks and my head is about to explode with thoughts and ideas.
My better entries seem to occur when it seems I initially have very little going on in my mind, just the opposite of what I'm feeling tonight. Oh well, I'll just hit the keys and see what happens. My father was buried two days ago. The whole illness death experience was one of the most difficult things I've experienced in my life. I am glad his suffering is over but it will be hard readjusting to life without his presence. It didn't really hit me hard until the actual funeral procession began. I've always had a phobia of funerals and unconsciously searched for ways to avoid them, whenever possible. One of the worst panic attacks of my life occurred at a funeral when I was a teen. I've learned much about grief since that time. Anxiety was not a problem with the loss of my father. I worry about my mother but sadness and a sense of loss has been what I have felt mostly. I take comfort in knowing my father lived a long life and meant a lot to many people. The symbolism provided by the Navy's contribution of playing Taps and the release of the white doves, and the Masonic presence and ritual I found to be comforting and represented a side of my father's life that I barely knew existed.
Death seems to become increasingly more intriguing to me in many ways. Mostly the spiritual aspect since this presents a challenge for most with a strong science related background. My nature has always been most consistent with that of a Doubting Thomas. I want to see the wounds. The more I work with grieving and dying patients and experience my own grief the more convinced I feel that God does truly exist and has loving concern for us. I never dismiss as coincidence the dreams, visions, and other signs people share with me when going through an experience. After the nurse called about worsening in ...
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| Substance Abuse Update |
| 2007-09-13 11:28:34 |
Some things never change.
That is a great truth I have discovered. Many things are not what they appear to be and if we don't want to see something we usually won't see it until we choose to. As a behavioralist, one constantly learns just as much about oneself as will be discovered about the subject of therapy or treatment. The accurate diagnosing of a condition improves with repeated exposure to similar cases. Strong intuitive instincts can be quite useful and must never be ignored.
In this life I believe there is a reason for everything that happens. I once believed that God allowed substance abusers to cross paths with me as punishment for some terrible sin I may have committed at some past time. What other explanation could there be? Over time I've grown to learn that many times it's not even remotely about this sick and clueless individual who chooses to slowly poison themself into oblivion and eventual death of the spirit, mind, and body. Reality often turns out to be that I deluded myself into believing it was my purpose to heal them, only to eventually discover that the only help I can dispense is to expose them to the truth about themselves and then remove myself as completely as possible from their life, allowing them to advance or decline to the next stage of their journey.
Substance abusers with narcissistic or antisocial personality disorders can be the coldest people on earth if you aren't aware of whom you are dealing with. I have found them not to be frightening but mostly disappointing, frustrating, and ultimately a proverbial pain in the ass. I say that without malice because they teach me more about my own weaknesses and assets as a person than any other type of patient I have encountered. I have found my greatest liability to be that I have a tendency to be too trusting of others. Addicts over time have developed a predatory nature with a highly keen sense of detecting those who commit to trying to be honest and trusting. They have years of experience practicing on those closest to them and usually find themselves on a perpetual search for another bridge to burn in their quest to relieve their psychic pain. It is crucial that the psychiatrist never forget that everything is a game to these individuals and you to them are just an ace waiting for the opportunity to be played. This ace status is directly related to having control of the prescription pad and in no way suggests superior value as an individual. Objectivity must be preserved at all costs and one must never allow their ego to enter the treatment arena, for the patient has a great advantage when it comes to emotional manipulation in such a case. It must be remembered that the goal isn't always cure with this type patient. The main goal, once again, is exposure of truth then allowing the chips to fall. I really hate this game but have become much better with it over time.
Experiments with lab mice have been performed where the subjects receive a choice between cocaine or food and water by pressing a lever. Every single mouse hits the cocaine lever until death occurs from starvation and dehydration. The ability to save their own lives is over-ridden by the addiction to the cocaine. Despite a more highly developed brain the outcome for humans with addictions, over the long haul, is similar. The addiction does something to the common sense center of the brain in humans. It never ceases to amaze me how predictable the behavior of an addict actually is. It's almost like a worn out script what they are going to say or do. I must admit that it is more interesting as the doctor/therapist after learning how to see it coming, which it takes a while to do. The true narcissist might actually read this post (some have read my book) and conclude they now know me and would seize the opportunity to use this information to their advantage. To the average reader I know that may sound a bit absurd. I find it absurd for a person to choose a psychiatrist of all doctors to attempt a dupe or scam on. Any fool could get away with it once but who would try it repeatedly and not expect to get busted. I then remember that the person has a damaged brain from chemical abuse and think of the rat experiment. The total number of patient dismissals from my practice should reach 200 by the end of the year. We have become much more efficient at identifying those just looking for a way to get high. I find it despicable the lengths people will go to to obtain narcotics.
There is such a thing as a point of no return for an addict. I find the disease to be worse than AIDS and just as bad as cancer. The worst addict doesn't see a serious problem, however. I believe this point of no return is reached when the addict is eventually confronted with the choice of family or drug. If the wrong choice is made at this juncture the ballgame is over for all practical purposes. They may verbalize the choice of family but that is totally worthless if a consistent change in behavior and attitude isn't observed over a sufficient period of time. If the denial and minimizing continues, and there are enough enablers available, there is zero chance for successful recovery. A popular movie line is "never trust a junkie." I wouldn't put it that way but my experience tells me that is probably true. I will still always look for the good in people first with the understanding that we all are as good as the choices we make. When a person is involved in a pattern of persistently making bad choices, sometimes the only thing that can be done is to let them know that you won't be a part of that and do whatever necessary to make that happen. Doing so can save hours of conflict and pain.
Posted on Thu, September 13, 2007 at 03:05AM by
Tags: headoc, cd, substance abuse update, q4s...
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| TV NEWS vs BLOG: 3rd Anniversary Post |
| 2007-09-07 07:13:03 |
Exactly a month ago marked the third anniversary of this blog.
I'm asking myself tonight why I have maintained this weekly ritual since such compliance in practically all other aspects of my life does not exist. I'm also wondering if I would continue to write so faithfully if no one bothered to read my entries. I think I just love writing and find it to be therapeutic in many ways. I probably would. I believe I have a lot to say but understand how limited the audience reached will be. In many ways psychiatrists are still stereotyped and misunderstood. I'm trying to change that as best I can. My view still remains that the total number of readers is much less important to me than the enthusiasm and degree of interest a potential reader may show. The fact that a reader from thousands of miles away can instantly share my ideas and emotions through the miracle of the Internet continues to amaze and intrigue me. Less than twenty years ago this was unimaginable. This medium has made the world a much smaller place and provides a voice to any individual with access to a PC.
My initial motive for Thoughts From the HEADoc was simply to vent the anger and frustration I felt about some of the things I witnessed among my journey as a psychiatrist involved with treating patients in an often dysfunctional mental health care system that continues to become perpetually more dysfunctional over time. I felt that if people knew more about some of the inappropriateness that was often concealed or overlooked some might share some of the outrage I sometimes felt. I now realize that was just wishful thinking, for the most part. Much of the pessimism felt is due to the challenge that ordinary bloggers face when overshadowed by the professional media which often seems to have agendas other than what may be in the public best interest. Al Gore writes in his book Attack On Reason about how majorityof Americans are programmed for TV sound bites and reading is not fundamental. Despite our super power status we still rank pretty low in terms of literacy as a nation when compared to other industrialized countries. This creates a perfect spin zone environment in that it doesn't matter what the actual truth is about a particular matter because it can be presented over the air waves in a manner that may trigger a strong emotional response resulting in the viewer believing the direct opposite of the actual truth. This happens all the time. Since all of the American media is owned by about five very rich individuals, the objectivity of the news reported is undoubtedly compromised. I believe that much of the news reported has been edited with unknown amounts of omissions. Irrelevant stories worthy of The National Inquirer often are substituted if the important news is detrimental to those controlling the media. Important stories are sometimes released at times when the least number of viewers are likely to be watching TV. This form of manipulation of the professional media also can work in reverse if favorable news is available.
My favorite news show is Jon Stewart's' The Daily Show because it has twice the news accuracy of Fox and admits to the intention of entertainment. Stewart and Colbert don't claim to deliver the gospel but do a reasonable job of addressing the most pertinent current topics in a humorous and entertaining manner. If I want objective information I find the Internet to be a more reliable source than TV because of the option of deciding for myself what is more likely to be accurate. I don't care for spin.
As I did a year ago, the time is again ripe to reassess the usefulness of my blog and determine if it's worthwhile to continue posting. I conclude that it is still fun most of the time and I plan to just play it by ear and keep free lancing. When people no longer find my thoughts to be of interest I'll probably quietly fade the Quest 4 Sanity site into the archives of blog heaven.
Posted on Thu, September 6, 2007 at 11:37PM by HEADoc in Weekly Entry | Post a Comment | Email | Print
Tags: headoc, media commentary, q4s...
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| Mental Healthcare Reform Update (Opinion) |
| 2007-08-28 05:06:16 |
I've probably always been too much of an idealist and a dreamer when it comes to social problems and the realities in which we live today. Avoiding challenges has never been my style. Even when selecting what types of patients to treat, the more difficult cases have seemed to find their way to me. I have learned so much about human behavior, and the world, over the past several years. I have learned my limits much better over time. I went to medical school hoping to one day make a difference. Upon graduation I felt I could do this most effectively as a psychiatrist and set out to meet the necessary requirements for practicing this art. I have engaged in the practice of psychiatry for over a decade now and feel another crossroad is inevitable in the near future.
I chose to practice within the public sector because the need seemed so great and I felt my efforts would be most rewarding here. I have worked in clinics hospitals, jails, detox units, nursing homes, and office based. The work was always interesting but the systems did not always agree with me or me with them. Private practice has been the most fun, in most aspects, excluding the business component. Even with above average business skills (which I clearly lack) it has become quite difficult for one to get out and stay out of the red. It almost makes me want to cry when I think of the money owed to me that will never be collected and the ongoing game playing with third party insurers who will do anything to avoid paying you what is owed.
Even the North Carolina General Assembly Members in Raleigh admitted during a public forum on UNC TV Sunday that no doctor can afford to keep their doors open if they treat mostly Medicaid and Medicare patients. One in eight citizens in the state receive Medicaid. Cigarette smoking has been identified as a major contributor to consumption of health care dollars but lobbyist have fought to avoid further taxing of cigarettes. They admitted that North Carolina had taken the biggest hit in the nation in regards to lost and outsourcing jobs. Doctors in the town where I work have begun to go out of business. The ones closing up shop seemed to be seeing similar patients to the ones I see. The writing is on the wall, especially for mental health care. I felt better knowing that the General Assembly at least is not ignorant of the situation. They are quite aware of the fact that our state is screwed big time in continuing coverage for those in need of mental health services. They openly admit to having no solutions to the problem. Meanwhile, the area mental health programs slowly grind to a halt and the state mental hospitals begin to shut their doors as predicted over the past years.
My hybrid private practice now open to referrals from the Mental Health Center has about reached its capacity. The phone continues to ring but the inn is full. There are zero other providers in town accepting Medicaid or Medicare. Daily, I become more resentful of being told what I can and cannot prescribe. It only gets worse. Most of my joy came from autonomy and having control over major treatment decisions. This was even more important to me than the financial losses. I do not care for managed care organizations in the least. It is quite clear that they run the show. A perfect storm between managed care and the pharmaceutical industry is imminent. At least the pharmaceutical companies provide a useful service and product. Managed care organizations have one goal, which is to save money for their own use. I feel suspicious of any business whose purpose is to deny one their own benefits. In my opinion, that is why 50 million Americans don't have access to health care, the money is being siphoned away for administrative purposes to deny care to those who are insured. The bottom line once again is "who really cares?"
I once hoped I could retire from the type practice I'm doing now but must face the reality that things are not going to get any better than what the current state of affairs are. I really like the vast majority of the patients I treat and most of the time thoroughly enjoy the work I do. Taxes and overhead are unavoidable realities. For most politicians, whether my practice survives or not is irrelevant. When the 2008 election comes, many voters will again vote against their own best interest. According to Comedian Al Franken, voters will likely be swayed again by campaigns of Fear, Smear, and Queers. I have done the job I do out of choice, not necessity. Out of curiosity, I have found employment offers out in the private sector that would offer several times the yearly money I make with what I am doing now. At some point it becomes foolish not to consider entertaining such offers. Why should I struggle if I don't have to? I have no idea what will become of public sector mental health care but I predict it will not be good. It's a fact that funding for prisons has risen as funding for mental health care has been slashed. However, I will not speculate on that matter. I consider myself a voice in the wilderness and though I never found an effective means for changing things for the masses, I always cared about what the fate of the system would be. I still do. I suspect in 30 years after all the foolishness has failed, I'll probably hear of some young genius using my ideas to advise the leaders of how to fix the catastrophic mess they made of the mental health care system.
Posted on Mon, August 27, 2007 at 08:38PM by HEADoc in Weekly Entry | Post a Comment | Email | Print
Tags: headoc, mental healthcare reform...
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| Into Each Life... |
| 2007-08-14 03:31:43 |
Not a bad day today. No substance abusers. Mostly saw real people with real problems and several no shows for appointment.
The subject of grief and loss is unavoidable in my line of work, mostly because such a process is at the root of much of the unhappiness we experience during our lifetime. I'm thankful for the last couple of months even though there has been more than the usual amount of grief in my own personal life. I visited my father in the nursing home last night and talked with him during a fit of sundowning, better known as acute delirium. He's down to about 85 pounds and confined to the bed in a diaper. His hallucinations seemed a bit frightening for him but there was a child-like quality to his voice as he urged me to pull and push him through whatever place he was trying to escape.
He asked me to not let him die. I asked if he were afraid to die? He replied he wasn't afraid but he didn't want to die. Here I was, the mighty physician, reduced to utter helplessness. I could try soothing him and telling him that he was okay and everything was going to be alright. That actually seemed to help. Just last week I had told a grieving and guilt ridden patient that at a certain point of illness it doesn't matter what we humans do because it is out of our hands. Still I felt useless. I was able to hold his hand and tell him he was loved. For me that is a major accomplishment for such words usually come with great effort.
Hospice teaches us that a time comes when we can give our loved one permission to go. I couldn't quite find the appropriate words for that. I wondered what motivated him to fight so hard to hang on at this stage. His 90th birthday is in a week. Maybe that's the reason. I gave him a sip of water and he would not release the straw from his lips. I felt numb as I looked at the empty bed his roommate left as he departed this life as I exited the room. I felt guilty for leaving but the imagery was more than I could emotionally continue to deal with. Death in the theatre and story books does not happen this way. I began my grief in June and I don't think I'll cry again until I learn of my father's passing. I'm thankful and glad that God allowed these extra weeks for me to try and prepare, as much as one can prepare for the passing of a loved one. I realize that some things are even worse than death. Suffering with no quality of life is one such thing.
Medical School introduces the physician to the art of healing. Soon we learn the limits of this art and realize that without the cooperation of our patient and the will of God we can easily be rendered useless. My last patient today was a 20 year old young man amidst his first psychotic break. I started him on medication a couple of months ago to which he responded but struggles with compliance issues. He is uninsured, unemployable at this time, and his mother works 2 jobs. She has payed out of her pocket for his visits. He opened up more to me today about his impaired thought process and thoughts of suicide. I've worked in the Mental Health Center and I don't feel it in his best interest that I send him there just because he cannot pay. I believe he is worth saving and as long as he and his mother remain committed I will try and work with him and help him pursue disability. I suppose the reality of not being able to help my father has helped me see more value in helping someone not beyond the benefit of human intervention and compassion.
Tags: headoc, grief...
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| Real Time Sicko |
| 2007-08-04 20:10:40 |
I just spent an hour trying to order Real Rhapsody from the Internet when it should have taken five minutes at most.
Am I really that retarded? It's just like I've always said. The world is crazy, not the individual. I set out to research why this elementary task of using a Visa could become so difficult for a reasonably intelligent person. Okay, I did mess the numbers up during the first attempt. I proof read and made the necessary corrections then re-entered them. I then received a message my address was wrong so the order couldn't be processed. I put in my address every way imaginable but still no luck. I put in my old address, still no cigar. Alas! I remembered that the bank had made an error with the street number when I applied for the card 3 years ago. I had instructed them to fix it at least 10 times over the past but the thought that they probably never had done so dawned upon me and I decided to try entering an address where I don't live and never have lived. This was crazy. It worked beautifully. What the heck, at least I won't receive any junk mail and I'm enjoying my favorite music today at last.
I haven't seen Sicko yet but I felt it several times during the past week. I saw at least a dozen Pharmaceutical Reps during the week who updated me on how wonderful their drugs were for my patients. I must say the detailing is usually pretty good and I like having a break from just talking to patients every now and then. It's nice that the drug companies care so much about my patients.
At this point the number of prescriptions rejected by the managed care people are about at 30 to 40%. This means I have to fill out a form to explain why I want my patient to have this particular medication. I thought that was settled with the Pharmaceutical Rep earlier. It's suppose to be the state of the art treatment for what I have diagnosed the patient with. Now some unknown entity in some unknown location is giving me hoops to jump through before I can see the Wizard and get my wish granted. After the 7th or 8th time of going through this for the week, I am so frustrated and pissed that I feel like letting somebody have it. The last time I talked to a real person on the phone I spent 30 minutes on hold to finally be told that half the dose prescribed would be approved but that they might reconsider if I could produce 2 epidemiological clinical studies supporting the treatment dose I was prescribing for the patient. I thought I was the expert, but certainly not in medical economics. Since that day I abstain from talking to idiots because it's a big waste of time and it makes me homicidal.
I think it's better to fill out the forms most of the time than to give in and prescribe the generic product I'm pressured into prescribing. Sure it takes a bit of time and if the wrong box is checked the med is still not approved. The process has greatly damaged the clinical science in treating a patient. It is reduced to the Dr. taking an exam for the managed care organization. Can we give them the answers they want. I'll play their little game for now to get the medication I want to use in my patient but I know that the rules will continue to change as soon as I catch on to the answers they want me not to give.
Is this not just sicko. The Pharmaceutical Industry is not regulated and can charge a thousand dollars for a bottle of pills it cost them five dollars to manufacture while the Managed Care companies have the incentive of saving their funds to satisfy their shareholders. The product intended to help the patient may never reach them because it's priced higher than what their third party payer wants to pay. So whose getting screwed the hardest here? If I choose to be passive and not play the game or fight back it will indeed be the patient. If managed care wants to be the clinical decision makers I think they should be forced to do their research scientifically and should carry the liability malpractice insurance.
Let's face it. This system is total bullshit (for the consumer) and we can and must do better than this as a country. When I think of the billions spent in Iraq unnecessarily and the lives lost it enrages me. We've been told there isn't money for healthcare and education. Don't be fooled, there is not an endless supply of fossil fuels but it is guaranteed the rich in America will never run out of money. If they do they will just print some more and make the middle class and poor pay for it.
Thank you for supporting this emergency vent, it may have saved my sanity and my life.
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| Negative Perspectives |
| 2007-07-31 14:44:20 |
Time for another entry, I suppose. Not feeling too inspired to write. My idea today is to just free associate a little about random topics that may only have meaning for me. Should you find this exercise meaningless and not worth reading I do understand. Maybe I'll be back on track next week.
People that trouble me
Michael Vick
My judgment is reserved but I fail to see the how and why he could allow himself to be associated with such activity. I had envisioned him becoming the greatest quarterback ever. He possesses the talent to become the top NFL icon. Unfortunately, that can never be because of irreversible harm to his off the field image. This scandal has tarnished him permanently, regardless of the future outcome of his career on the field.
Barry Bonds
Hank Aaron was a source of great pride for me as a teen. For the most part his character was unimpeachable. He has upheld the all time home run record gracefully. I don't think it matters whether Bonds used or didn't use steroids to enhance his performance. His situation is representative of the times in which we live. Just as Babe Ruth remains Champ to those of his era, I believe Hammering Hank will remain Champ to me even after his record is broken. George W. Bush
Nothing delights me more than knowing that he will be a thing of the past in 16 months. I can't think of a single good thing to say about this man. Almost every time I write something truthful, but negative, about him it leads to a word fight among some narrow minded supporter. Should you be a multi-million dollar business owner with kids of drafting age it is quite reasonable for you to attack anyone who bad mouths your guru. If you are working class, you need to wake up.
Rudy Giuliani
If we stay the course, events shall unfold that guarantee him to be our next President. I don't like it but the Democrats don't have the balls to stop him any more than stopping the other atrocities of the past seven years.
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Organizations I Hate Strongly Dislike
IRS
Get them on your back and you will learn why. They would rather see you dead than owe them a dime. Seriously.
DEA
War on Drugs is B.S.
DMV
Emissions Inspections
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Life Situations I Despise
Mondays
Mondays should be abolished and replaced by a Pre-work day that allows all working people an extra day to prepare for return to the job. Unemployed individuals are not entitled to such a day.
Death
We should be able to take a rocketship to Heaven when our earthly contract expires. Anyone bound for Hell should have to do it the old way.
Bills
There should be a 10% rebate for every bill payed on time just as there are late fees.
People who Lie too much
Their tongue should fall out one week for each lie told.
People who Steal
Their hands should turnbright yellow and smell of skunk oil.
Cocaine Connoisseurs
Should be locked in a room with an endless supply of crack with no lighter or pipe to smoke it with.
Wife Abusers
Should be forced to wear high heels and hot pants and pimp slapped five times on a nationally televised program.
Predatory Sexual Offenders
24/7/365 camera surveillance
Posted on Mon, July 30, 2007 at 06:07PM by HEADoc in Weekly Entry | 1 Comment | Email | Print ...
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| Sleep Disorder With Benefits |
| 2007-07-21 16:53:49 |
Healthy sleep is essential to maintaining overall good health.
Missing a couple of nights of sleep can render the best of us dysfunctional throughout ordinary daily activities. In treating any mental condition sleep must be addressed, because a problem here could be the root of whatever the presenting complaint is. The exact reason we require sleep has never been scientifically proven but it is reasonably believed that physiological and psychological restoration and repair occur during sleep. The nervous system is the most complex and interactive system of the body and during waking hours it must constantly be engaged with a constantly changing environment. These changes in the environment are representative of stress which is essential for us to thrive in life but can also be deadly if managed inappropriately or it exceeds coping capacity for too long.
Many people choose the escape of sleep to avoid or evade undesirable circumstances, while others find themselves unable to sleep at all. Lack of sleep is more detrimental to health, in the long run, due to excessive wear and tear on ones nervous system and tendency to worry constantly about things one has no control of whatsoever. At least with excessive sleep as the coping mechanism the individual can escape to dreamland and preserve the body's physiological function until the perceived threat diminishes to a conquerable level.
For many years I've experienced a condition known as sleep paralysis. I had an extended bout last night and feel very unrested this morning. Sleep paralysis is much like waking up in your grave and being able to do nothing about it. Your body is prepared for sleep so you cannot move a muscle no matter how hard you try. You try to roll over enough to fall off the bed so you can awaken but that too is futile. You try to scream loudly but not a sound escapes your mouth except on occasion a brief random blurb may make it through. Your bed partner or anyone in listening distance will usually find it amusing or totally ignore you, dismissing your behavior as a topic for conversation at some later time. Meanwhile, you are laying there barely able to tremble despite using every ounce of physical effort you posses trying to signal them to shake the hell out of you so you can awaken from this torture. After a few years of experiencing this phenomena it becomes more so a period of dread than torture as you reach a semi conscious state of awareness of what is actually happening to you during the time it is happening. Fortunately, my dreams last night were about childhood friends, playground competition, and flying kites. The dreams were not especially pleasant but definitely were not nightmares. A nightmare would probably have pushed me over the edge if combined with the paralytic state which seemed to go on for hours.
Unfortunately, there isn't a cure for sleep paralysis. Should you suffer from this disorder, like my cat and me, your best bet is to 1) never sleep alone and carefully and thoroughly 2) train your bed partner to not ignore the situation should they witness you shaking or talking in your sleep. Instruct them to 3) shake you or firmly 4) slap you immediately, and not only will you not be upset with them, you will owe them all of your gratitude. A sound facial slap in this situation is not abuse or domestic violence but, in my opinion, a life saving maneuver and should your partner harbor any resentment for any past misdeed you may have performed against them they have your full permission and your blessing to right that wrong at this particular time. It will be therapeutic for them. Make sure to get it in writing and make sure you instruct them to give you the opportunity to awaken before popping you again, for that would be bordering on abuse if they didn't.
When you do awaken you will be so thankful for their action that you, in your semi-hypnotic stupor, will uncontrollably confess anything and everything you have kept secret from your partner. You then should be able to sleep with confidence and security of not being terrorized by sleep paralysis and your partner can be confident of your fidelity. In my never ending search for the metaphorical silver lining, here it must be that sleep paralysis could save your relationship.
Tags: sleep paralysis, headoc...
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| Real Life and Hollywood |
| 2007-07-10 02:08:53 |
I try not to make as many entries when the content is likely to be of a depressive nature.
Even though I'm finding every aspect of my life, at the present time, going in a bad direction I feel pretty good tonight. Maybe because of taking a five day vacation which has been rather enjoyable. My father has been in a hospice facility for the last ten days and I realize he will not return home. This is saddening but right now I'm thankful for these few extra weeks he remained alive. It will be shocking when I learn that he has passed. This I know even though it is expected at any time. I have found the slow dying process of many cancer patients to help with the grieving process more so than many of the rapidly fatal diseases. Part of me dreads returning to work tomorrow.
I spent the evening in the country sitting on the porch with my mother after visiting my dad. I know it was difficult for her to verbalize certain unavoidable topics related to m...
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| Random Thoughts |
| 2007-06-27 17:25:48 |
I'm a bit late making an entry this week due to personal circumstances.
My father has somehow managed to hang on a bit longer under hospice care. I'm able to see this as a bonus since it wasn't expected and I suspect it has been the prayers of others responsible. Work seems to have brought an increase in cases of troubled teens and cases influenced by childhood sexual abuse, neglect, or abandonment. How any man could yield to such behavior is a mystery to me. Nothing troubles me more than seeing a child in distress because of the behavior of an irresponsible adult. At the top of my despicable list will always be repeated sexual offenders, deadbeat dads (or moms), and sociopathic crack users. Such behaviors are inexcusable and unacceptable, and in my opinion not part of what is considered mental illness because of such a strong voluntary component to the behavior.
My age has started to show relative to the evolution of thought content and closer consideration of certain view...
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| Silver Lining Search 2 |
| 2007-06-15 06:01:37 |
Sometimes life gets a little crazy for all of us. . .
At such times we can become totally out of control in regards to what will happen in our lives. Individuals such as fighter pilots, trauma surgeons, or astronauts are trained to feel in control of the situation at all times. The truth is that we only have control of the choices we make in any given situation, nothing more or less.
This is a core principle of addiction in that the addict has deluded them self into believing that they possess some degree of control over their drug of choice. In reality the person is completely out of control and cannot be helped until accepting this fact. My current circumstances seem to have awakened me to certain realities from a personal perspective. Life has so many lessons. I'm beginning to understand the contradiction between myself and the substance abuse community. With the cynicism and animosity sometimes felt, one would find it puzzling why I might continue treating so many pa...
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| Grief Stories |
| 2007-06-09 06:02:30 |
Last night I dreamed of . . .
being Gomer Pyle in the Marines going through basic training. The Sergeant really let me have it for not being up to snuff. I'm sure these dreams of late are representative of current real life struggles that cannot be avoided. It was more difficult than usual working with grieving patients this past week after seeing that dreaded look of death in my fathers' eyes last Sunday. For the first time the denial I have clung to weakened as I felt a little shock. He really is dying and there is nothing I can do about it. I placed him in his hospital bed and tried to adjust it to make him feel more comfortable. My mother spoke to me about concerns of a business nature but it was very hard to concentrate or think clearly. I have seen that look several times before in patients I treated in the hospital and they always died. It is an ominous sign but the exact time of death cannot be predicted with any certainty. Several months ago I had an...
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| Dreams II |
| 2007-06-01 21:31:46 |
Much can be learned from dreams. . .
Freud once wrote a book entitled The Interpretation of Dreams. Actually I've never read it but have stumbled on many of its principles through different encounters along the way. Our dream life is much like the vacation home of the mind. Some philosophers have pondered whether the reverse is true or not. If you've ever seen Ashton Kuchner in The Butter Fly Effect it becomes easier to entertain this idea. This movie I consider the horror version of Ground Hog Day.
In real life our dreams are believed to possibly serve the practical purpose of allowing us a place where we are allowed to be completely insane in a way that is unacceptable during the waking hours. Most of our repressed drives and suppressed thoughts are free to express themselves while we dream. It is really the emotion felt during the dream that has value and not so much the plot occurring, as many are tempted to become more enthralled by. One can dream of war and kill th...
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| Advanced Psychotherapy 102 |
| 2007-05-17 05:59:15 |
My last two entries have been total losses. . .
battling at Battle of the Blogs, essentially losing every battle to every genre. I'm not really sure how to take that but probably best with a grain of salt. I suppose in the blogosphere every author, self included, feels their topics are of the utmost importance. Often I recall my youth when I was totally oblivious to current world events or any topic outside of popular media culture of Hollywood tabloids and the sports world. With age my interests have changed 180 degrees and the space in my brain reserved for starting line up rosters and stats of my favorite teams have been replaced by the Democratic and Republican Candidates for the next Presidential election. I've taken interest in 9/11 conspiracy theories and have even tried the stock market and reached a point where I could care less for the Super Bowl or the Final Four. I find myself turned on by excerpts from Jon Stewart, Stephen Colbert, and Bill Mauer. I'v...
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| HEADoc on Music and Movies |
| 2006-06-13 20:51:00 |
Newer isn't always better.
As we grow older and more mature this rings more true. As always, others might have a different view of things. Since this sight is about my thoughts, it really doesn't matter so much what others think. Being from the old school, I like to collect and listen to old recordings. For example, Al Green was always my favorite performer. I found that the hits that actually made it to the radio when I was growing up were only a small fraction of the work of his lifetime. Today, every time I play through a re mastered CD of old recordings there's usually a new gem to listen to that I may have never heard before. I may have been 12 years old when the album was released but it's brand new to me. It's a little like time travel of the mind. I've done the same with The Beatles, Smokey Robinson, and several other artists. Some things can't be improved.
One thing that was improved and that I was blown away by recently was the movie King Kong. On occasion, a m...
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| Sanity Check |
| 2006-04-01 14:36:41 |
Some days I can't help but ask myself WHY.
Why do I do such a job as the one I've chosen? The rule of thirds probably applies to cases I see. A third are an absolute joy to be a part of, a third are neither here nor there, and a third turn out to be an enormous drain of energy and total waste of time. Much time and energy has been used identifying and weeding out people from the latter group. I do learn from them and find it important to remain as objective as possible because often that person who presents as what seems to be a hopeless case turns out to be that person who finally gets it together and turns their life around. When that happens I realize once again the answer to my question. Hope. There is always hope.
The sooner the individual gets this crucial point the more salvageable they seem to be. It is an indescribable feeling to see little Johnny for follow up and learn that he has stopped disrupting the class, is now able to focus on his work, and is showing his true potential in the classroom as well as at home. Mom and Dad show gratitude because they realize they did make the best decision by seeking help from a system and process they knew very little about. There is little doubt in my mind at that time that my job is really worth any discomfort or inconvenience that may come along with it. Much of the unpleasantries really have little to do directly with patient care.
My greatest lesson learned has been to be less trusting of people. The more important measure of a man is what he does and what he has done. These two factors are a pretty accurate indicator of what he will do in the future. Talk is cheap. There are several different types of liars. I have learned not to give the liar so much credit. I used to assume that the person is bright enough to know that I know they weren't dumb enough to say what they just said to me and expect me to believe it. Notnecessariy so. Now I realize that most p...
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| MUDBONE |
| 2006-03-12 19:19:25 |
Mudbone was a character created by the late Richard Pryor back in the early 1970's.
Pryor started his routines actually speaking as the personification of an old slave-like character; "I was born in Peoria, Illinois. There was an old man named Mudbone born in Mississippi, Tupelo." Audience member: Where is Tupelo? Responding through improvisation to the inquiring audience member, he'd say "Tupelo? That's near One Below." The audience would erupt with laughter, begging for more of the story. "He drove up here, 750 miles on a tractor with one tank of gas because he had a job watching the levy and one day the levy broke. They asked him why didn't you warn the people? He said, Well I couldn't be runnin' through all that water warning nobody. There ain't a man in the world that can hold back all that water when it wants to go. Besides, they was gonna find out sooner or later anyway."
The last case I saw Friday evening was a 17 year old Caucasian boy who I've treated for Major Depression and Attention Deficit Disorder. His mother had noticed dramatic behavioral changes over the past couple of months. She was finally able to convince him to come in and talk with me. He is from a middle class home with both parents and a younger sib. There is not a more typical American family. He finally told me that he had been smoking large amounts of marijuana but had made up his mind to stop hanging out with associates he uses with. His mother had found paraphernalia he had carelessly left lying around his bedroom, so she wasn't too blown away by his pot smoking. The real shocker was when he told me he had used crack cocaine 6 or 7 times. As all cocaine addicts do he minimized the use and declared he was through with it and it wasn't a problem, and he didn't like talking about it. I know from experience that he is lying to himself and has started down the slope of addiction and deterioration of his social well being. His parents have...
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