Olfactory Oligarchy

She was a very nice lady, always deferential as true southern ladies are. She would come into my office, holding it together and trying not to cry about her life situation. She was on the downside of middle age, morbidly obese, unhappy, and feeling quite stuck. On the outside, she was always bright and shiny, dressed neatly and cleanly, makeup on, hair done perfectly, nails a bright fire engine red. Underneath it all, she felt used, abused, dirty, depressed, fat, and hopeless. It took her many months, years even, before she would even begin to let me in on those very well defended feelings.

And yet, the one thing that stands out very vividly in my mind about her, about each and every visit with her, was her smell. She used the old fashioned Ivory soap, the white bar, the classic stuff. How did I know? The smell was unmistakable, and for someone like me with a very sensitive system that is allergic to anything that looks at me sideways, it was a true irritant every time she came to see me. I would see her for thirty, forty, sometimes even sixty minutes, and in that time my breathing would change, my eyes would water, and I finally learned that before I went out to the waiting area to get her, I would open my office window just a crack, just enough to let clean outside air circulate and keep me from a coughing fit as she told me about her latest woes.

As we have talked about in previous posts, olfactory memories are extremely vivid ones.

I was reminded of that lady, a patient of mine from many, many years ago, today.

Now, a psychiatrist uses several senses many times each day as he goes about the business of treating patients. Sight is important, in that watching how a patient walks, looking for tremors or other abnormal involuntary movements, assessing dress, makeup, general level of grooming, affect and a myriad other variables is important from the very first moment of a visit. Listening is our stock-in-trade, so naturally a good sense of hearing and being able to truly listen to patients is of utmost importance. And of course we may use our sense of smell. You might not think about that as the most important arrow in a shrink’s quiver, but it is one of them.

There were many varied smells in my office today.

There was the clean, just-showered-for-the-doctor’s-appointment smell, the person who had prepped themselves, put on clean clothes and come to talk with me about the latest situations in their life.

There was the ubiquitous (at least in the mental health field) coffee and cigarette smoke smell. If you’ve ever smoked or spent much time around those who do, you know that the smell gets into everything and stays there, including in clothes and on the breath.

There was the acrid, pungent, unwashed-for-days-if-not-weeks smell that connotes a state of beyond dirty. One wonders sometimes if the folks who come to the doctor’s office dressed in clothes that could prop themselves in the corner at night, with a smell so offensive as to be almost unhealthy, are themselves immune to it. Some of them, of course, are simply so depressed or psychotic that all efforts at self-care simply stop. Others, I have come to believe, take on this aromatic mantle and wear it without a second thought.

Finally, there was today the over-perfumed, overpoweringly sweet smell of someone who is in the habit of drenching herself with Yves or Ralph or Gucci, the more the better. Unlike the nauseatingly acrid smell of the unwashed above, this person overwhelms with sweetness and fruitiness or whatever the smell of the season is. Not altogether unpleasant, this can still lead to stinging eyes and coughing fits if there is no circulating air in the small consulting room.

So, my clinic day today was, as it often is, a microcosm of life.

If I could not hear and could see but through a glass darkly, I could still get a wealth of information from my patients by simply paying attention to the smells they bring to my office.

The reasons behind each smell and the extent of it are myriad and fascinating. One must not only use his sense of smell, but must tie that data together with oral history, visual cues and other things that make each person unique as they present for mental health care.

One more reason that I love what I do.

We would do well to remember the words of the Bard penned in Romeo and Juliet.

“A rose by any other name would smell as sweet”.

Joy

I guess there are just times that you have to write about joy, you know?

It’s Thanksgiving week in the United States (yes, I have at least two other readers in foreign lands, count ‘em, I do indeed, so they may not get all this turkey and cranberry stuff), and that means giving thanks for the people and the things in our lives that make us truly grateful. Now, I’m not one of the sentimental mushy types who will throw a bunch of fluff at you and see how many times I can make you cry. That’s not my style.

However, after this weekend of food, friends, family, football, and all other manner of things that go fffft as you say them, I simply must thank the Universe and God as I understand him for the abundant joy in my life. Sometimes, stubborn as I am, I don’t let myself see it and experience it fully, but that’s my problem to sort out, not yours.

In the meantime, I am very thankful for:

Food to eat, a warm bed to sleep in, and worthwhile work to do.

Family who love me no matter how many times I disappoint them. My grandkids have that special gift of lighting up like Christmas trees, smiling and running to me every time I come to their front door. That feeling is like no other in the world.

Old friends who are there even when I neglect them, give me honest advice and feedback when I ask for it, a listening ear when I need it, and the promise to help me re-engage with my own life at the pace I need to do so.

New friends who are as dear as old ones, who challenge me, call me on my BS, and love me unconditionally even after they know about some of my worst flaws.

The warm, comfortable glow of tradition, music, liturgy, and ceremony. Without these, our institutions would not stand the test of time, and we would be poorer for that fact.

Like many of you, I will have a short work week. I look forward to the holiday and being with my family. I look forward to slowing down, even for a few short hours.

I look forward to reconnecting with joy.

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One and Done

You’ve heard it before.

Get ‘er done!

Finish the drill.

I saw a newsletter that I follow talk about what it was like to get to the end of a project, to be done, to be finished. It was touted as a very good thing to finally get to the end of a task list or a punch sheet or an outline for a project that was started with the idea of finishing in mind.

I got to thinking about life in general and my life in specific, in the context of finishing things.

Now, I keep lists with the best of them. I use Field Notes notebooks, notepads, note taking template sheets and all manner of things that help me keep track and organize the many things that happen in my life. Of course there is the electronic aspect of that task as well, with calendars and to do lists and email reminders and the like. I’l bet that each of you also has his or her own way of organizing things and planning and executing tasks so that projects may be brought to their logical conclusions.

What I thought about was not how I organize to complete, but how I plan to keep learning and doing and experiencing life flexibly, with the goal to never finish that task, at least not in the near future.

I am learning more every day of my adult life about how much I do not know. I’m made aware time and time again of my shortcomings, but I’m also reminded of my strengths and my talents as well. I am participating in a longterm project which is my own life. As long as I keep learning and experiencing and growing, that project will be active and ongoing, and it will be designed not to end, but to continue to feed upon itself and change in a positive way.

If I stop doing those things, that is, if I stop learning and moving and going and feeling and risking, my life will gradually wind down.

In sports, one and done means that you win one game, as in the playoffs, but then you lose the next one and you’re out.

In life, thank goodness, that rule does not apply. Win one, lose one, learn from it, and win another one down the road. Lose a few more, but stay in the game and come back to win again.

One of these days, I will cease to move forward. I will cease to grow, to experience and to live. That will be the time when I can, with no reservations at all, put down my papers and pens and pads, and schedules and project plans and let it all go. That is when I will have earned a long rest.

For now, I hope that time is very far away.

I’m not quite ready for one and done.

A Routine Should Be Just That

So, I was on vacation last month.

A seven thousand mile trip in my little red car, zooming from Chicago to Fargo to Billings to Seattle to Salt Lake.

I had a blast. Maybe you’ve read about it.

It was funny to me how many of my friends and readers and acquaintances, how many of you, worried about me. Not about my safety or my driving or my being run down by one of those triple rig FedEx trucks in North Dakota (I must admit, I did have a few moments of fear and trepidation around those monsters). You worried that I was not slowing down enough. That I was not sleeping in. That I was (gasp!) going to the gym and (oh, my GOD!) exercising every day. On vacation! Away from home, where the air is sweet and the food has no calories and dessert comes automatically with every meal.

When I would post that I was walking or biking at the Hampton Inn in Portland, someone would tell me to take it easy, relax, skip a day, take a nap.

Funny, that, because if you know me well, as many of you do, you know that I do NOT do well with down time. I do NOT relax if I am lying on a bed or in a chair trying to make my eyelids close for a late afternoon nap before dinner. I do NOT feel good if I skip the morning workout and sleep an extra hour, then eat two plates of free breakfast that includes pancakes, sausage, and plenty of syrup.

Oh, I’ve tried. I have. I have tried to lie down in the evening and watch television. I have tried to not set an alarm on vacation and just sleep until the sun smacks me on the eyelids and says, “Get up, rise and shine, buddy!” Every once in a while I’m successful.

But you know what, dear readers of mine? As we get older, we get set in our ways, for better or worse. Now, we can argue until the cows come home what is better for you, healthier for you, what makes you happier, calmer, lowers your blood pressure, etc. I’m not writing this to do that.

I’m writing to tell you that I firmly believe that we all have set-points, mid-points that we naturally settle into. Places and states (not literal states, no, though Washington state was killer…) where we feel our best, have the most energy, eat the healthiest for our own metabolism and where we are the most creative, productive and happy. I believe this. I think you should give it some thought.

No matter how hard I try, I keep coming back to what my body is trying to tell me is a good place, a happy place, a contented place where it wants to do what I tell it to do with minimal muss and fuss. Now, for many of you this will sound absolutely crazy, and thats okay.

It’s my set-point, not yours. Get your own!

I do best if I get up at five AM. At that time of the day, which I love, I can make coffee, eat some breakfast, read the paper, process my email, and acknowledge comments here on the blog and elsewhere. I do not need to worry about the day, because I’ve already thought it through. I can take my time, not feel rushed, get ready, and get out the door by seven or so most days depending on where I need to be.

I do not exercise in the morning, with one exception. In the winter months when basketball season is upon us, like now, I like to go watch the Aiken Pacers, who play a mile or two down the road from me in the evenings. This cuts into gym time, so I must work an hour walk into my morning routine. No problem. It just needs to get done, people. Make it happen!

I count on working until the day is done. Some clinic days, that means five PM and finished. Days that I tack a telepsych shift on after clinic, the day is done at midnight or one AM. I feel much more content if I do NOT worry about the crazy hours I work. For now, I choose to work these hours. That will change one day, no doubt. For now, I work until the work is done.

Exercise usually comes in the evening, an hour and a half or so at the gym. If I don’t have time to exercise today because I’m working sixteen hours, that’s okay. If I’m not working the whole day and I have time to exercise, there is no excuse to deprive my fifty-seven year old body of what it needs to stay active and healthy-movement. This is not a chore after you get used to it. You miss it if you miss it.

I try to eat “real” food, when my lifestyle is much more conducive to eating junk or whatever I can grab on the way from one place to another. My body has repeatedly told me, very clearly, that it does NOT like and does NOT feel good if it is topped off with sweets or excess carbs or junk food. The insulin rush and crash after candy bars and Pop Tarts is not for this boy. That said, I LOVE sweets and had rather eat that kind of stuff more than almost anything on earth. I just know that if I want to feel strong and healthy and alert and awake, I’d better not overdo it. It’s just not worth the blahs and the bloats and the mental dulling that comes with that short-lived binge of sweetness.

I use a Jawbone Up24 (Yes, I have pre-ordered the Jawbone Up3, to be shipped December 1st and it looks awesome) to help me track activity and sleep primarily. I have learned about my own non-patterns (again, I work crazy hours, have an insane schedule and most people think I am slightly off for doing so). The software for this device has told me in no uncertain terms a couple of times that it cannot figure me out! There are not enough patterns for it to process and give me meaningful feedback about. Wow.

That being said, sleep is not normal for me, but I’ve learned that this is okay too. I can try to get seven to nine hours of sleep per night as suggested by those who know, but I will just be constantly frustrated because I NEVER sleep more than six and half hours on a normal night. I have found, again, that I feel much better if I get up at the same time every day (which I CAN control most every day) and get to bed just as soon as I am finished work (which I usually CANNOT control at all most days) I do okay. I get enough sleep. I could be getting more, but in my life right now, that is not going to be the routine pattern for me. No worries. I run with it.

Some of you need eight or ten or twelve hours of sleep a night. That’s great and I’m glad you can do that. I can’t.

Any time that I have more than just a day or two off work, I plan to DO something. Go somewhere, see something new, hike, fish, travel, take pictures, visit, see a show, eat in a new restaurant. This is routine for me right now. (See down time above). I love football and basketball games. I like to see my family. I have dreams to make a few more big trips.

The take home?

Routine should be just that, whatever that means for you.

Figure out what keeps your body feeling physically good, energized and ready for action.

Eat healthy as much as you practically can.

Exercise.

Sleep as much or as little as you need to perform at your peak level.

Seek out stimulation that makes you learn and grow.

Be responsible for your own happiness.

In the end, you’re the only one that has that duty in the present.

Don’t let your future self down.

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For Example…

My youngest child will graduate from college in December.

College.

My youngest child, who by definition is no longer a child.

She is taking her certification exams today and tomorrow to teach in South Carolina, her home state.

My oldest child, my namesake, is a mother of three. She sings. She dances. She acts. She throws Frozen-themed birthday parties like nobody’s business.

My middle child lives in Denver. She is passionate about all the right things. She is tender hearted, but she has learned to be bolder and stronger and to make her opinions known at both the local coffee shop and the Colorado ballot box.

At times like these, at times of great achievement and wonderful milestones, I am transiently consumed with anxiety about whether or not I have been a good parent. Have I been a good example for my children? Have I just talked the talk or have I walked the walk?

When your children are very young, they look up to you physically, mentally, and emotionally. You’re taller, stronger, smarter, and certainly more emotionally stable. They carry this grand delusion forward for years, and you bask in the parental warmth and glow of knowing that you need never lose a chess game or foot race or impromptu swim meet. They know they can’t beat you, you know they can’t beat you, so you let them beat you. Sometimes.

As time goes on, they begin to discover that your loafers are dusted with clay. Your arguments have holes in them. Your faith is not as rock solid as you once told them it was. Santa becomes real to them in that he is not.

They grow, and isn’t that what we dream about and pray for? They grow tall and strong and witty and funny and emotional and beautiful and intelligent and creative and passionate.

They become, at the same exact moment it seems, us and not us in the twinkling of an eye.

Do they see my struggle? Do they feel my ambivalence? Do they sense my intellectual gamesmanship with myself? Oh, I can try to keep these things, these changes of my own, to myself, but I know better. Just as our children may have thought we had eyes in the back of our head, they have always had tiny invisible emotional divining rods coming straight out of their smooth, wrinkle-free foreheads. With ancillary bullshit detectors hanging like earrings off their ears.

We parents have never seen them, but we know they are there.

Have I been a perfect example for my children? Heavens, I gave up on that decades ago. Have I been a good example of a work in progress? I hope so.

I have wrestled , am still wrestling, with the meaning of it all, globally. My values have not changed greatly in my fifty seven years, but my adherence to them has been tenuous at times. Faith has been the most powerful force driving me rapturously from within, and other times has been the most oppressive fetter binding me tightly with indecision and fear.

My internal world has not always mirrored my external world. Some of you know this intimately. Others have never had a clue.

So, have I been a good example for my children? Only they can answer that.

The quest goes on, though. I have three grandchildren and hope to one day have more. I want to be a good man to these precious little folk who light up and call me Papa whenever I come through the front door to visit.

I am not a perfect man and know that I never will be.

Life is not a stenciled, cut and pasted, color matched exercise.

It’s messy, it’s sometimes painful, and it’s always full of surprises.

The best example I can hope to provide, I think, is to more clearly show others how I move through the morass. How I try to make sense of it all, while making the world a little better than it was before I got here.

My children are healthy, happy, productive women who are already making their marks on the world and the next generation. They are moving away, and yet they will always be with me, and I with them.

Isn’t that what being a successful parent is all about?

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Still Waters Run Deep

There was an article in today’s Aiken Standard, my local paper, via the Associated Press wire. The title was “Robin Williams’ autopsy found no illegal drugs”. Aside from my annoyance at the misuse of the possessive, I did think about some things after reading this article.

The autopsy showed that Williams did indeed have evidence of therapeutic levels of his prescribed medications in his bloodstream. It is not a secret to anyone now that he had struggled for years with both mental health and addiction issues, and was in treatment at one time or another for both. He was being prescribed medications to help him with these conditions, and it appears that he was taking them.

He did not have any alcohol or illegal drugs in his system at the time of his death.

His wife, according to this story, was most likely home when he decided to kill himself and completed the act. He killed himself by hanging with a belt.

Even those with money to burn, success, achievements, loving family support, and ongoing treatment and medications can feel terribly isolated, alone, and hopeless. Depression can be devastating. Help can seem light years away.

I see so many hundreds, even thousands of people who struggle with addictions. Life on drugs and alcohol is sometimes overwhelming, fraught with relationship problems, legal problems and financial ruin.

On the other hand, sometimes life without drugs is just as hard to bear, maybe even more so if you have been addicted for years. The raw emotion of it, the demands and stresses and trivial annoyances of daily life seem just too big, too complicated, and too much trouble to deal with. They seem unsolvable.

For Robin Williams, even with treatment, fame, fortune, and family, it was all just too much. He decided that he could not go on.

I cannot and would never judge him or anyone who committed suicide. I have not been inside their heads, and I do not know what final thought they have right before they decide that they must die.

I do know that if someone needs help, if life is just too hard and whatever they are doing is not enough to sustain them, then action is imperative.

Sometimes still waters run deep.

Earbola

It took a day or two and maybe eight hundred miles for it to fade. Each Maroon Five song or MacOSKen podcast I listened to helped to deaden the aural assault. The sounds were soothing, calming, comforting.

Starting on Friday, October 3rd, I slowly but surely began to unplug from two dozen emergency rooms in South Carolina. I checked out of two clinics. I stonewalled and diverted work email. I shut down voicemail. I left the pile of professional reading at home. I pledged to not care about the news, to disengage in a very meaningful, positive, mindful way. The noise was fading.

I started the biggest vacation of my life (so far).

I was going to focus on fun, on leisure time, on sports, on photography, on sightseeing. I was going to meet and greet family, old friends and brand new friends.

I was going to have quiet, peaceful days on the road.

Then, Ebola happened.

There was a media frenzy. Healthcare media. Mainstream media. Fox News. CNN. Sanjay pouring chocolate sauce on his inadequate suit.

I wasn’t going to watch it or listen to it or read about it. Then, I would go to the gym and there it was. I would sit in the breakfast area and there it was. I would reach for a paper and there it was.

Texas hospitals. The embattled CDC. Doctors without borders. Nurses without supporters.

Patient death from Ebola in the United States.

Controlled panic.

There began a crescendoing cacophony of cultural conversational criticism the likes of which we haven’t seen since I taught mental health hospital workers how to roll a condom onto a banana in the early nineteen eighties.

I might have have been in the middle of a seven thousand mile driving trip around the country, but the country was in the middle of a bloody medical meltdown.

I’m home. I’ve got week one back at work under my belt and have just started week two. I’m getting several Ebola related emails each day. I’ve learned, or relearned I guess, that the world doesn’t stop spinning, stop changing and stop evolving just because you’d like it to join you on a break.

Our degree of attention, focus and investment in what is going on around us may vary, and vary significantly.

The world still goes on. Loudly. Relentlessly.

I would recommend that all of you unplug every once in a while, whether it’s for a three day weekend or an African safari. Disconnecting and recharging your batteries is good for you physically, mentally, emotionally, and spiritually.

Just remember that when you plug back in, turn the volume down just a bit. The world is also a very noisy place, and it will take time to acclimate to all the chatter again.

None of us wants to be a victim of Earbola.