My running habit is now six weeks old. And when I say “running”, I mean “plodding somewhat quickly”.
I’ve been running for twelve consecutive minutes, walking briskly for one minute, then running for another eight minutes. Tomorrow, I advance to fifteen minutes of running, one minute of walking, and five minutes of running. The prospect of ultimately running for twenty consecutive minutes excites me.
This is not to suggest that I love running, because I don’t. I still get all sweaty and gross (say “all sweaty and gross” with that California inflection) well before the initial ten minute mark. The sensation of uncomfortable heat associated with self-consciousness envelopes me when the occasional people running (invariably faster) in the opposite direction and I exchange glances: Their faces are dry and lack a rosy red hue. My face, in contrast, suggests that I am afflicted with scarlet fever and recently dunked my head into the spray of a drinking fountain.
It’s a fine line between high metabolism and endocrine malfunction.
Though I am not smitten with running, I do not loathe it, either. If I’m honest, I’ll admit that I like it—but I don’t “like like” it.
Running especially appeals to the morning person within me. With summer upon Seattle, the sky is already filled with light—of the unfiltered, non-grey variety, if we’re lucky—by the time I step outside around 5:45am. The birds and squirrels are also rising to greet the day, but most people are not. Few cars are on the road; usually the only vehicles that share the streets with me are the city buses and a couple of empty taxis. Three or four people—some with blue collars, others with white—may linger silently at a bus stop, clutching their paper cups steaming with coffee and skimming the newspaper headlines. We usually make eye contact, but infrequently do we greet each other. It’s apparently too early—and maybe too quiet—to do that.
Few people are at the park, though those who do appear are generally regulars. One homeless man habitually sleeps in the same corner, completely oblivious to the roars of the buses that roll past not even twenty feet from him. Another homeless man occasionally walks through the park to watch the garbage disposal truck make its early morning rounds.
One of the two men inside the garbage disposal truck makes a point of saying hello to me, pausing while in the midst of tying a knot in a garbage bag. If my throat is dry, my voice cracks when I say hello back to him.
Sometimes, a man strolls through the park with his dog. He yells. His loud voice disturbs the otherwise tranquil morning. He shouts about the injustices of the pet laws, the corruption of the city police, and the outlandish prices of watermelons. Maybe he’s conversing with his dog. Maybe he’s just trying to hear himself. I avoid making eye contact with him.
On Fridays, two young women usually play tennis. They’re not very skilled, but they are clearly enjoying themselves. They also avoid making eye contact with the Man Who Yells.
On Wednesdays, a man carrying one of those travel coffee mugs leisurely walks to the middle of a field, places the mug on the grass, and practices what appears to be tai chi. He has broad shoulders, a slender waist, and good posture. He usually wears a white tee shirt.
Occasionally, two older women also jog in the park. One woman always wears the same outfit—blue tee-shirt and black capri pants. (That’s not a derisive comment, because I wear the same outfit every time I run, too.) The other woman wears different color-coordinated outfits—she dresses better than anyone else in the park. The last time I saw her she sported a bright yellow tee-shirt, white capri pants, yellow socks, white sneakers, open white track jacket, and a yellow-and-white colored handkerchief wrapped around her head. Dark sunglasses completed her outfit.
Every morning I run, I eagerly anticipate the dawn soaking into my skin and filling my lungs. When it’s raining, I listen to the wet breeze rustle past my ears and thank the sky for providing me the opportunity to appear wet from the rain, versus sweaty from running. If clouds are in the sky, I watch them glow orange-purple from the rising sun before they transform into grey-white streaks reaching across the heavens. I notice the leaves quietly moving in the patient trees. As the sun climbs into the day, my eyes adjust to the increasing brightness and the warmer colors that slowly fill the world.
Each morning is a gift and, while running, I can watch it silently unwrap itself.
(P.S. Thank you, Wesley in Eastern Washington, for sending me a book from my wishlist!)
(Part of the ongoing Relationship Series.)
24 Jun 2007 | 6 comments.
I Make Great Cookies, I Know.
Jesse generously offers corroborating evidence (okay, fine, just an opinion) that my chocolate chip cookies are quite good!
No bribes or other coercive methods were applied, of course.
(Back story: I solicited many people a few months ago to donate money to support my participation in the MS Walk for research and education for multiple sclerosis. To encourage people to donate money, I promised that I would bake a batch of my infamous chocolate cookies for the person who donated the most money. Jesse donated eight kajillion dollars and, today, two months after the walk, I finally baked and delivered my cookies to him. And they were worth the wait, dang it!
Another person donated eight kajillion dollars, but he told me that he doesn’t like cookies!
What?!
So he got a loaf of pumpkin bread instead.)
Making cookies is just as wonderful as eating them. Mmm.
22 Jun 2007 | 5 comments.
#23: Saying Good-bye.
I’m still not completely sure of the optimal way to proceed with termination.
Termination refers to the end of the therapeutic relationship between patient and physician (or, more specifically, psychiatrist). There are essentially three ways termination can occur:
- Patient exits the relationship (patient stops attending appointments; physician fires patient; s/he dies)
- Physician exits the relationship (s/he dies; patient fires the physician; physician disappears)
- Patient and physician mutually agree on a final appointment date and time and complete the session
Ideally—for both parties—the last option occurs. This allows “closure”. And, no, I’m not entirely sure what comprises “closure”, but the lack of “closure” is why many break-ups suck. Think about it: Break-ups are uncommonly mutually agreed upon events; usually one party decides to unilaterally bail, resulting in negative emotions all around.
In therapy, we do not want to recreate break-ups; instead, we want to model and engage in the graceful end of effective and meaningful relationships. (Psychobabble.)
Saying good-bye is difficult. The white coat-wearing medical doctor within the psychiatrist bristles at the idea of termination; there is something about our medical training that promotes the idea (”virtue”?) of emotional distance and independence from our patients. So many things about our profession (both intentionally and unintentionally) facilitate this: Doctors wear white coats. Doctors wear gloves. Doctors ask a lot of questions, but rarely answer any. Doctors aim for objectivity and evidence.
So when we psychiatrists terminate with patients, the experience is weird and we are often surprised with how difficult it can be.
It’s never too early to initiate termination, so I had informed the adolescent male three months prior to our last appointment together that our time was drawing to a close. At the time, Andrew said nothing.
It’s not that he didn’t have anything to say about it; I had learned by this time that he heard practically everything I said, even though his behavior often purposely suggested that he was ignoring me.
A month prior to last our last appointment together, I reminded him again of my departure.
“Have you seen that Geico commercial? You know, the one with the little kid imitating a monster?” he replied.
As the days passed, he spontaneously mentioned the limited time we had together, though he tossed his remark within a smokescreen:
“I can’t believe that happened; it kinda makes me sad. You and I have three sessions left; we have to make the most of them. So I think I am going to try asking her again, maybe when she’s not so depressed, but it’s hard to tell….”
And that’s the way it had been the entire time we spent together; he would share bits of himself—often only a sentence here, another one there—at random intervals. Sometimes he would acquiesce if I asked a few questions to clarify his remark; most times, he simply changed the subject. One day, I called him on it.
“You’re really good at changing the subject when I ask you questions.”
“Yeah, I know,” he nonchalantly conceded, “I don’t like it when people care about me. It makes me feel weird.”
And when I tried to ask him more about that, he promptly commented on the weather. I smiled—sadly—at him.
The last time I saw him, he greeted me warmly.
We learn in the course of our training that therapeutic termination includes reviewing the time spent together and commenting on progress and goals attained. It’s like a summary statement, an opportunity to reflect upon how the patient has changed and how the patient can continue to effectively pursue his goals.
I already anticipated that, though he would hear my monologue of the above, he would not respond. My hypothesis bore true.
I commented on our very first meeting and what he stated were his goals at that time.
“Did I tell you the joke about the buffalo?”
I continued to commend him for the significant progress he had made in several spheres.
“What did the mother buffalo say to her kid as he left for school?”
I then reiterated his strengths—he had so many: he was so good with people; his integrity was admirable; he was intelligent and thoughtful; he was fiercely independent and more than capable of taking care of himself.
“Bi-son!”
I expressed my hope to him that he would continue to pursue his dreams— I was (and still am) confident that he could reach all of them.
“How about the one about the cowboys?”
I looked at him, willing him to participate in the conversation—but I knew saying good-bye was not his strong suit. His parents had abandoned him when he was young; there was no such thing as a “healthy” good-bye in his experience.
“Because they are too heavy to carry! HA!”
“Take care of yourself,” I said, patting his shoulder. “Good-bye, Andrew.”
He had already started to walk away when he answered, “Alright.”
I watched his lanky figure amble down the hallway. I then quickly turned to go.
(Part of the ongoing Relationship Series.)
21 Jun 2007 | 5 comments.
#22: Perspective.
When it’s bad, it’s bad:
One of the patients on the ward has every single risk factor for a heart attack and, right now, he is experiencing chest pain.
The neurology resident has two patients on his service that he wants to immediately transfer to psychiatry: “They overdosed on Medication X in suicide attempts; they’re medically cleared and all yours.”
The general surgery resident is angry with psychiatry because he has admitted the same patient to his service four times in the past two months: “He stabs himself in the belly because of his psychiatric problems—but we have to deal with him.”
The board in the ER is full and there are five people waiting for evaluation.
The nurses on the psychiatric ward are distressed because a woman is screeching at the top of her lungs, demanding discharge from the hospital right this second!!!
There are still three new consults to see: An elderly man with thirteen medical problems is delirious and agitated. A woman just delivered her first child and she’s confided in the nurses that she is thinking about killing her newborn son. A young man survived the car crash; his girlfriend did not. He’s depressed and sullen.
And I hadn’t had the chance to snack on anything in the past eight hours!
Somewhere along Highway 20, I stopped singing.
Of course I had already noticed the beauty that surrounded me: The caps of snow on the dark grey mountains glittered under the yellow-white sun. A single puff of cloud floated in the celestial sea of endless blue. The millions of trees crowded together as far as the eye could see. The waters of the rivers crashed blue-green over boulders and pebbles alike towards the ocean.
It was spectacular.
I stopped singing, though, because I remembered—again—that all of this would soon disappear.
More accurately, I remembered that my experiences would soon disappear.
As I weaved my way through the mountains, I tried to capture each passing moment. I so desperately wanted to remember all of the details—the way the broad, glossy leaves of the trees tremble from the wind and scatter the light from the sun, the whooshing of the water over the rocks, the perfect reflection of the arid hills on the glassy lake, the shadows from the mountains stretching over the two-lane highway—and catalog them neatly into my brain for future recollection.
I was so busy thinking about remembering the moments rather than experiencing the moments.
Before I was born—before I was even a thought in the minds of my parents—these mountains and trees and sky and rivers and lakes existed. The sun floated above them, the wind breezed through them.
After I die, they will continue on. I have come; I will go; they will stay.
While I listen to a patient mourn the loss of his wife from cancer, the snow continues to melt atop the distant mountain.
While I briskly eject a man from the ER for asking for potentially addictive medications that he clearly does not need, the trees continue to shiver at the touch of the cool alpine wind.
While I write admission orders for a woman at 3:30am, the moonlight silently falls upon the still lake.
While I indulge in my feelings of frustration and stress with my inability to do four things at once, nature and time move forward at their graceful, patient paces.
The world out there—up in the mountains, by the lakes, near the rivers—is so different from the world in major metropolitan areas. That world is so different from the worlds within our own heads. There is something about standing alone within the shadow of a large mountain while peering down at a expansive lake in the company of millions of trees that puts things into perspective.
Why do I get so anxious about stuff?
What really matters?
The memories in my head from my trip around the Cascade Loop have already lost their fidelity, I know. The teal hue of the lake I see in my mind isn’t the same shade of the actual lake. The fragrance of the mountain air is already gone. The sound of the waterfalls crashing onto the boulders in the rivers is dulled.
This is loss. And I feel sad.
And although I cannot take nature with me, nature has become a part of me—even if only through fading memories. The hubris that can accompany overeducation and academic laurels quickly disappears upon witnessing the glory and power of the natural world—how can anything I have ever done compare with the astonishing splendor that lies all around me? What is the significance of my stress compared to the unending change that the elements exert on each other? How can I possibly complain about my life when that same life has allowed me the opportunity to witness the stunning beauty that is around me all the time?
If you’d like to see photographs from my trip around the Cascade Loop, you may see them here. I’m more facile with words than with cameras.
(Part of the ongoing Relationship Series.)
20 Jun 2007 | 3 comments.
#21: Laughter is Not Necessarily the Best Medicine.
“What’s he like?” I asked.
“Giggly,” the nurse replied. “But he’s nice.”
He had wandered into the ER to obtain a prescription for lithium. Though this chief complaint hardly constituted an emergency, it was a welcome diversion from the delirious patients who had either fallen from great heights, sustained multiple gunshot wounds, or inhaled excess amounts of sherm (PCP-laced marijuana that is thereafter dipped in formaldehyde—ick!).
He was a youngish man with close cropped hair, dark eyes, and broad shoulders. A tattoo of a colorful dragon wrapped around the entire length of his left arm, with the ferocious head resting at his shoulder. Dirt was under his trimmed fingernails and lightly dusted across his jaw. Reclining on the gurney, he smiled at me when I walked into the room.
After introducing myself, I inquired, “What brings you here today?”
“I need lithium—I’m in a manic phase and it’s exhausting,” he said before succumbing to a fit of giggles. His torso heaved with each chortle and he eventually toppled over onto the bed, holding his hand over his mouth in a futile effort to stifle his laughter.
“Okay,” I said, already skeptical about the authenticity of his laughter. “Tell me more about your ‘manic’ phases. What are they like?”
He propped himself back into a sitting position and began to tell his story, unsuccessfully trying to maintain a serious demeanor.
“I’m sorry—I’m trying not to laugh—” and then he lost it, crumpling into a jiggling mass of boyish resignation.
I bit the insides of my cheeks to prevent myself from smiling. His laughter was infectious.
And as the interview unfolded, I suspected that his laughter was genuine, particularly since it wasn’t appropriate. His story, though not tragic, wasn’t hilarious, either.
“So… other than the tonsil surgery, appendix surgery, and ankle surgery—any other surgeries?”
He was wiping his eyes, trying to recover from his last bout of laughing. I avoided looking at his face for fear that I would start giggling, too.
“No—I mean, isn’t that enough?” he answered before the BWA HA HAs overtook him. He turned his face away from me and laughed, lightly pounding the gurney with his left fist.
“Oh God,” he said between breaths, “I can’t stop laughing—I’m sorry—I’m trying not to—hee hee hee….”
My lips puckered in my lame attempts to prevent a smile from appearing on my face. We both looked ridiculous.
When I asked him for psychiatric history in his family, he coughed and was clearly trying to prevent his lips from curling upwards in an ear-to-ear grin.
“Yeah… my uncle…”
He took a deep breath, the left corner of his mouth starting to rise.
“… my uncle…”
He was starting to lose it, but he hadn’t given up yet.
“… he… he…”
He buried his face into his elbow, again trying to pre-emptively prevent the laughter from seizing his body. He failed.
“… he… hee hee… he committed suicide… hee hee… HA HA HA HA HA…!”
Keeping his face in his right elbow, he began to hit his left shoulder with his right hand, as if trying to pound his laughter into submission. He lifted his face up to take a breath and again tumbled into a chortling heap on the gurney.
And then, to my dismay, that’s when I lost it.
No, I couldn’t lose it when he was talking about his medical problems or his current employment; I had to lose it after he mentioned that his uncle committed suicide.
I laughed. I turned my head away and laughed. I covered my mouth with my hands and laughed. I looked down and laughed. I finally looked at him, still laughing, to apologize.
“I’m sorry,” I said, wishing I would stop smiling. “I know that isn’t funny—I’m sorry—”
“It’s… okay,” he breathlessly replied, still laughing while he rolled around on the gurney in giggling agony. “I know… hee hee hee… it’s not… hee hee… funny… I… I… HA HA HA HA… can’t stop… HA HA HA HA…!”
The Paging Gods took pity on me; my beeper began to quiver with its own laughter. I quickly excused myself—still laughing, he graciously understood—
—and, both annoyed with myself and perplexed with my ongoing reaction, I giggled all the way to the phone.
(Part of the ongoing Relationship Series.)
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