Seattle has a social reputation known as the “Seattle Chill“. The people who usually note this phenomenon are immigrants to Seattle. With my return to Orange County, California (where it is currently an unbelievable 65 degrees with clear skies and a wonderfully balmy sun), I am reminded of the asocial nature of Seattle. And, lo, more people have acknowledged my existence with eye contact, verbal greetings, or social smiles in the span of one hour in Orange County than in a week in Seattle. (Not randomized, not double-blinded, not placebo-controlled—make what you will of it. But you get my point.)
In addition to the reasons outlined in the Craigslist link above, some people have hypothesized that the stoic, ungreeting nature of Seattle-ites is due to its Scandinavian heritage. As I am unfamiliar with that topic, I am unable to comment further upon it. My personal theory for the “Seattle Chill” is based primarily on climate.
In Southern California, the sun shines and the weather is warm. It is November 21st and men are ambling about in board shorts and tee shirts. Young ladies are wearing skirts (that are too short for my tastes) and tank tops. Yes, there are the few people who are wearing cute knitted hats and scarves, but this is clearly for style purposes only. People generally show skin: Men have short and clean haircuts with limited, if any, facial hair; women pin their hair back or tuck it behind their ears; shoulders are bared; legs are shown; and toes are visible for all to see.
We look at each other.
In Seattle, the sun rarely shines and the weather is frequently wet and cold. It is November 21st and people are milling about in multiple layers, with one of the following on the surface: a hoodie, a North Face/Helly Hansen/REI/etc. Gortex jacket with a hood, or a trenchcoat with a hood (or at least a long lapel which can be flipped up). Those who carry umbrellas tend to carry them low to prevent water from dripping onto their bags and backs. Those who do not carry umbrellas are either wearing a hoodie (see above) or a hat that hovers over the eyes. Those who do not have a cover for their heads frequently look down to prevent raindrops/mist from collecting on their eyelashes and dribbling into their eyes.
We do not look at each other.
In Southern California, if one looks up, one will see the sun, tanned skin, and fashionable clothes… and perhaps catch a brilliant smile.
In Seattle, if one looks up, one will see grey clouds, rain, and people lolling about in dark, wet clothes… and perhaps catch an umbrella spoke in her eye.
What is there to look forward (or up) to in Seattle? Particularly when people are grousing about the rapidly waning hours of daylight (”greylight”)—not a smile to be seen anywhere!
And, thus, Seattle-ites train the “strap muscles” in their necks to direct their chins towards their chests and alas, there is no eye contact. There are no greetings. There are no acknowledgments of people, only tacit recognition of the disagreeable weather.
Hence, the Seattle Chill.
(Just to be clear, I have been outside already today and plan to spend some time at the beach this afternoon. One must generate as much vitamin D with the available sun while she can.)
21 Nov 2007 | 10 comments.
Natural Change.
My decision to take up running was impulsive. A friend of mine (hi Lynn!) informed me that she had elected to start running and was headed to the shoe store to purchase a pair of running shoes. With no hesitation, I asked if could join her.
“When did you decide to take up running?” she asked.
“Oh, I don’t know. I’ve toyed with the idea, but I never seriously considered it. I figure, though, if I spend the money on a pair of shoes, I’ll start running and stick to it,” I answered.
“What if you don’t like it?” she rightfully asked. “Then you’ll have an expensive pair of shoes that you won’t use.”
Indeed, her logic was sound. I smiled and said, “I’m not worried.” That was over six months ago and I’ve been running regularly since then.
I recently learned that her decision to take up running came from her friend in Minnesota (or Wisconsin?). This friend has no idea how she has affected my exercise habits.
Furthermore, Brad’s wife (for all purposes, a stranger) left a comment for me to curse inform me of her decision to start running.
Thus, we’ve all inadvertently influenced each other to change.
Natural change remains an enigma. Consider tobacco smoking or alcohol consumption. Some people simply decide one day to stop—and they do! Sometimes there is a prompting event (insert here the oft-told story about the man who was supposed to pick up his kid from school: It’s pouring rain and the guy realizes that he doesn’t have any cigarettes, so he drives past the school to go to the gas station. He sees his kid standing in the rain, realizing that he was choosing to purchase cigarettes over picking up his kid. Ashamed and horrified, he turns his car around and quits smoking that day…); sometimes it’s a covert decision. Psychotherapies (such as motivational interviewing) are geared towards promoting change, presumably at a faster rate than it would occur on its own, but no one can confidently state how effective psychotherapy is at facilitating change. There is already bias in the population; generally, only those people who have considered change (even if they feel ambivalence about it) pursue therapy. Perhaps their behaviors would have changed on their own without any interventions. (There is data to suggest that psychotherpeutic interventions can reduce some harmful outcomes when related to substance abuse.) Some people speculate that up to 50% of behavior change results from this “natural change”—we never hear about these individuals. (No citation because there is no way to accurately measure this.) They’re out there, living their lives in a different—and hopefully improved—way.
Just how does that happen? Man, if there was a way to bottle that stuff, the pharmaceutical companies would be making a killing.
I can’t explain why I decided to take up running on May 13th, 2007. Some variant of natural change was at work.
A similar situation occurred with my father’s reaction to my decision to enter psychiatry. My Original Plan was to become an infectious disease physician or an oncologist. (I had also toyed with the idea of becoming a nephrologist.) I had sworn that I would never go into psychiatry for the usual reasons: It’s not real medicine. I don’t want to lose the physical exam. I want to be a real doctor. Etc. etc. etc. I don’t think I can completely credit natural change for my own career—the time I spent in my psychiatry clerkship revealed that I possessed a skill set that was useful in psychiatry. And though I found internal medicine stimulating and interesting (as with all of medicine—what an amazing area of study!), I noticed that the topics within psychiatry consistently tickled my curiosity. The “right” decision seemed obvious.
My father, however, thought it was “wrong” decision. He was displeased.
He spent the entire summer after my announcement trying to convince me to go into another branch of medicine—anything but psychiatry! He presented the usual arguments about its questionable utility and diminishment of my status as a physician. He also (inaccurately) suggested that I would not have any job security upon completion of my training—anything to convince me to become an internist, a family practitioner, an actual doctor.
Mental illness, he exhorted, does not exist. There are only character flaws. That are all easily corrected with self-discipline.
There was a lot of sighing that summer. From both of us.
Realizing that his daughter was not going to change her mind (is stubbornness a heritable trait? or simply learned?), he did what any some disbelieving fathers would do: He started to read about psychiatry and mental health.
“I read this interesting article in Business Week,” he said one autumn morning about a year later. “It talked about neurobiology.” (Note: I never expected neurobiology to appear in Business Week, either. Something about nanobots, I think.) “The brain is fascinating! So is this what you’ll be doing?”
He was a bit disappointed to learn that, no, I did not have plans to work with nanobots. However, I encouraged his reading—you gotta take what you can get from stubborn people, you know.
I later worked at an Asian clinic and enthusiastically shared my experiences with him—I appreciated the opportunities to educate and offer support for our people.
A question mark lingered over his head. What? his voice seemed to ask. Asian people are seeing you? Really?
Only after he read some patient information sheets about schizophrenia in his native Asian language did he finally comprehend my training:
If medicine can cure this problem, this is a great achievement in humanity.
I guess compassion and reality is the thing.
That’s when he revealed how much his perception of mental health (and of my job!) had shifted. His ideas had changed.
There’s a lot more to this story. In fact, it is the only story of mine that I believe has any chance of being successfully published in printed media—
—except I just can’t get myself to write it.
I’m waiting for that natural change….
19 Nov 2007 | Comments Off
Discordant.
It was chilly inside her car. The fuzzy white glow of her dashboard lights dimly illuminated the interior of the parked vehicle. We both still had our seatbelts buckled. I was watching the raindrops splash onto the windshield and dribble down the glass.
“I was really pissed at you during conference,” my good friend said to me.
Surprised, I turned to look at her. “You were? Why?”
“Because you’re going to New York,” she answered. “I wanted to make a paper airplane and write ‘I’m really angry at you’ on it and throw it at you.”
I turned my head back and smiled sadly.
“But I didn’t,” she continued, “because that probably would have been disruptive.”
“Yeah,” I lamely agreed, before launching into a Warm and Fuzzy Moment™ with her.
It has started.
“Wait—you’re moving to New York?” a lead asked as we started to dance. He has this habit of consistently leading me into other couples while dancing—it’s never intentional, but somehow always works out that way. It’s now a running (dancing?) joke.
“Yes,” I confirmed.
“Oh, man—that sucks,” he commented. After leading one swing out, he then concluded with the enthusiasm of a popped balloon, “Well… congratulations.”
I’m not going anywhere soon, but a quiet urgency now exists.
“Why don’t you just rent out your place?” another friend asked, futzing with the ends of her bright scarf.
“Because I don’t want to be a landlord who is 3,000 miles away,” I replied.
“But you should rent out your place,” she insisted, “it’s a reasonable thing to do.”
Smiling, I playfully demanded, “Why do you care if I rent out my place or not? Are you looking for a place to live?”
My smile melted a bit when she just as forcefully shot back, “Because if you rent it out, that means you’ll come back!”
(That’s not a logical argument, but she made her point, nonetheless.)
It’s not all sad, of course—people beam with enthusiasm upon learning about my future destination:
- “You’re going to have so much fun in New York.”
- “I have a feeling you’ll really like it there.”
- “There is so much art and culture there! It’ll be amazing!”
- “I think it’s great that you’re going there—what a wonderful opportunity!”
Many plan to vicariously live through me, whether they’ve ever lived in New York or not.
And then:
- “So… do you think you’re going to come back?”
And then I wonder, Why am I doing this again…?
Seattle has been (and continues to be) good to me: I’ve met wonderful people here, been blessed with close and meaningful relationships, and learned new and amazing things.
I could say that about every place I’ve lived: Life has been generous to me. I’ve had the pleasure of walking barefoot on the soft, bleached sand of the beaches in Southern California during sunset. I’ve seen world-famous magicians perform at The Magic Castle, performed in a world-renowned marching band (was in the “U” for one year, in the “A” for three years), and enjoyed some of the best Persian food outside of Iran. I’ve seen the unbelievably blue waters of Lake Tahoe with my own eyes, eaten some of the best burritos in the country, and walked across the Golden Gate Bridge—more than once. I’ve had the opportunity to learn medicine!
… and what about all of the lovely individuals who I was lucky enough to walk with in the world?
It is both a blessing and a curse that humans are able to simultaneously experience discordant emotions. Yes, of course I am excited, thrilled, eager, etc. about my upcoming adventure—
—and sad, a bit scared, uncertain, etc. about my pending departure.
17 Nov 2007 | 3 comments.
Three Contemplations.
>> What is “mental health”? How do we define it? If mental disorders are social and cultural constructions (consider antisocial personality disorder, which within its very definition is “failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest”…. though this does not mean that all mental disorders do not exist—consider someone with highly impairing schizophrenia), that means that society defines mental health.
So what is the definition?
Is there a “majority”? Should there be a “majority”? Do we measure the means of certain variables across the population? Do we talk about standard deviations and confidence intervals? Do we assess behaviors only? Do we judge behaviors that only (adversely) affect other people, or do we also judge behaviors that affect the individual himself? What about thoughts? If one believes thoughts are precursors to behaviors (a concept that is not universally embraced), what about monitoring thoughts? How about emotions? What does it mean to be “overly emotional”? Or even just “emotional”?
Must “normalcy” be first defined before “abnormalcy”?
How do we know when something is a problem and when it is not? What is the difference between “problem” and “diversity”?
Who determines what is healthy and what is not? How rigid are the standards? What happens if the standards waver? Do treatments help define “abnormalcy”? What exactly are people trying to “fix”?
What exactly is “quality of life”? Is there a universal yardstick (meterstick? what units do we use?) for “quality”? Are our expectations too high? too low? invalid? unreliable? Who set these expectations? Why do we accept them? reject them? Why do we even care?
Don’t believe everything you think.
>> Someone offered this definition of love (versus infatuation, lust, etc.): “Love is the willingness to extend yourself consistently for another person.”
>> How do I explain the pager? Periodically, while dancing, a lead’s hand will brush or land on the pager on my waist. Some leads never touch that area and never realize I’m wearing one; others somehow discover it moments after the dance starts.
Recently, a lead asked me to dance and within the first four bars of the song, suddenly remarked, “Whoa—you’ve got a pager.” I don’t think he even touched it.
“Yes, I do,” I confirmed.
“That’s, like, totally old-school,” he continued.
“I wear it for work,” I explained… except it really wasn’t an explanation.
We didn’t talk for the rest of the dance. We just smiled a lot.
I’m never sure if I should warn leads about the pager—it is a bit strange to expect a warm, pliable waist and instead feel a hard, squarish object. On the other hand, it also seems odd to provide a disclaimer before dancing. Most leads who discover it in the course of dancing express verbal surprise; some remove their hands quickly as if they touched a hot stove. There are the few, though, whose facial expressions betray something like shock or disdain. Maybe disbelief? I don’t know. They look better when they smile.
I could move the pager… though if I move it to the back, the same problem exists. Moving the pager to the zipper/rise of my pants also doesn’t seem right. It’s a weird place to have a bulge, squarish or not. (I’m just saying.)
15 Nov 2007 | 4 comments.
The Story of Fnu Lnu.
“His name is what?” the senior resident asked. “What kind of name is that?”
“I don’t know,” the junior resident answered. “But that’s what he goes by.” He shrugged.
Senior looked over his shoulder and looked at the name: Lnu, Fnu
“Fuh-noo Luh-noo?” she said no on in particular. The intern looked over her shoulder as a third witness.
“What does that mean?”
“It means ‘First Name Unknown, Last Name Unknown’,” Mr. Lnu said to Intern. He had clearly answered this question numerous times in the past—and with pride each time.
“When—how—when did you get that name?” Intern asked.
“I changed my name about ten years ago,” Mr. Lnu replied. “It was the right time to do it.”
“What was your name before you changed it?” Junior asked.
Mr. Lnu looked away and sighed before replying, “It doesn’t matter. It’s Fnu Lnu now.”
Junior shrugged and continued with rounds.
Mr. Lnu had come to the ER with chest pain. His workup revealed abnormal changes, which resulted in an admission to the hospital for observation. Since arriving to the floor, Mr. Lnu was no longer experiencing symptoms.
“My parents were not happy with my name change,” he continued. The lawn of his hairy chest sprung black wiry stems that ended in red, metal, cylindrical blooms that lay limp against his belly. He scratched his balding head with his stubby fingers before scratching his chest. His dark eyes, supported by dark bags underneath, focused on Junior. “They were concerned that I was disowning them. They’ve gotten used to it, though I think they’d prefer it if I changed it back. It’s hard to change your name, though—I had to fill out a lot of paperwork and I don’t want to go through all that again.”
Intern visited him later to inform him of his pending discharge, medication additions, and outpatient follow-up appointments.
“It was very nice to meet you, Mr. Lnu,” Intern said. Fnu Lnu had a nice ring to it; it rolled off of the tongue easily. Intern didn’t want to make a mockery of his name, however, and thus insisted on calling him “Mr. Lnu”.
“Thanks,” Mr. Lnu said, smiling. Intern recalled fondly the Shakespearean discussion they had had earlier:
“It doesn’t matter what your name is,” Mr. Lnu had pontificated. “What matters is what you do, what you believe in. If I don’t have integrity, it doesn’t matter if my name is George Washington or John F. Kennedy. Names are unnecessary; I don’t want people to remember me for my name—I want them to remember me for who I am.”
What’s in a name? That which we call a rose
By any other name would smell as sweet.
Intern smiled back. Would his behaviors and beliefs really overshadow the name “Fnu Lnu”?
They shook hands.
Less than a month later, Intern (who was now on a different service) heard from Junior that Mr. Lnu had not only returned to the hospital a few weeks later, but had subsequently died.
“What?” Intern exclaimed. “What happened?”
Junior explained, “It’s really sad. Fnu Lnu came back to the ER again, this time with significant chest pain. He was having a massive heart attack and was intubated. Something happened with the mechanical ventilator—there apparently weren’t any problems getting the tube in, but something went wrong with the ventilator settings.”
“What do you mean, ‘went wrong with the ventilator settings’?” Intern interrupted.
“I don’t know—what I heard is that the ventilator was somehow set so that he couldn’t exhale. So the machine just kept pushing air into him. Essentially, his lungs popped from all the pressure.”
Intern stared in disbelief at Junior. Junior nodded.
“Oh my God,” Intern finally said. “That’s terrible.”
“Yeah,” Junior said. “It is. And now I will never forget him or his name.”
13 Nov 2007 | 1 comment.