Shelby Cobra

This morning we awoke to a moderate breeze. The sky was clear but for a few floating vestiges of last night's monsoon.

The air was warmer than typical for the high desert. And there was calm...before the storm.

After we put on our Levi's, pulled up our socks and tied our shoes, we placed caps on our heads. nodded at each other, and headed out the door.

We got in our car and drove up Oracle Road to Mike Treece's home. This was one of Anna's birthday presents. A ride in Mike's Cobra. There exist only a few hundred originals in the world. The Cobra, manufactured for only three years in the sixties, can easily be worth over one million bucks. Mike built his from a kit.

The first thing he told me when he offered to give Anna a birthday ride was, "This thing has had problems. When it used to shift it literally jumped off the road, then fishtailed to the left."

The only time I like my cars fishtailing is when I decide they fishtail. That's besides the point. Mike knows his stuff, I hoped.

"As a matter of fact, yesterday the fuel line was leaking", he told us. He was going to take his wife out for her birthday. She never made it because they had to repair the line. After finding out about the leaky line, I made a mental note to locate the fire extinguisher in the car, which I'm sure Mike had.

After a brief tutorial on getting in the car and buckling up, Mike took Anna off on her birthday ride. She had a great time. But we all know the real reason I arranged this present. My turn came.

And what a sweet ride it was. I came to realize that car aficionados drive on another plane than the lay public. The road becomes their playground. They literally become oblivious to other cars, except when they say, "that guy thinks he's going fast." Besides that infrequent reference, they are in another world. Red lights become their friends. It gives them a chance to flex their motor muscle. Now, Mike says his Cobra is the fastest car in Tucson. Whether that's true or not, it was an adrenaline rush.

Life is fun when you can dip into another person's hobbies. People like to share their hobbies and it gives you a chance to learn something new. So, cheers to wife's birthdays! And for Mike's birthday I might get him a fire extinguisher.

A Shift

An addiction specialist lectured us today.

Some interesting trends and facts.

He says abusers of opioids are wising up to the damage they are causing to their livers by abusing Percocet and Vicodin. So they are turning to Oxycontin. So, if you abuse, oh be wise.

Also, a sobering fact. The most common cause of mental retardation in the United States is maternal alcohol use. Sad, but can be prevented with some attention by good homes.

What to do?

My attending asked us today whether or not it was society's place to judge whether a pregnant, psychotic patient should have a choice of conceiving a child when there is substantial risk to the well-being of the fetus.

Hmm....

Electro Convulsive Therapy

Friday was a knockout, literally. It was a comedy of errors too. Thursday afternoon I was reading the case of two rabid dogs in Michigan. About 130 people were treated with post-exposure medication, causing quite a ruckus. So Friday morning I headed out to find a dead battery in my car. I hopped on my bike, rolled up my pant legs, pulled my socks over them like a Scottish school boy, and pedaled up the hill towards Northwest Hospital.

Off to the side of the busy street, under a Palo Verde, stood a leaning dog who in my mind looked rabid. You know the dogs that kill in "Lady in the Water?" This is what it looked like. And he charged...

So there I am kicking the dog with my Scottish school boy leg while pedaling up hill trying to get to the hospital on time. Dr. Weigand, concerned, called for my whereabouts.

"I'm on my bike...should be....there....soon!"

And I was. And it was a fun day. After two weeks of non-procedural work I was given the crash course to electro convulsive therapy. As hands on as you can get in psychiatry. In a nutshell, this procedure is for those with major depressive disorder, schizophrenia, OCD, and bipolar mania who do not respond well to medication. It can also be used in the autistic spectrum of patients. It basically involves applying a surge of electricity to the brain of patients, inducing a real seizure.

It's a factory, filing patients through quickly. Nurses prep the patients in their gowns. Then we ask the patients how they're feeling, why they are here, what meds they are on, what concerns they have. Then the anesthesiologist puts them under. Following that, we apply gel to two pads for good conduction, and stick two paddles on opposite sides of the head. "In between the tragus of the ear and the eye, and one inch superior." After the paddles are applied, we hit the big yellow button, and a patient seizes, usually from 10 to 30 seconds. Of note, we use caffeine to lower the seizure threshold. Think about that before your next Pepsi, though you'd have to drink 12 Pepsis to equal the dose administered.

Included is a picture of the seizure of a man from whom I applied the paddles. It was a remarkable experience. I also walked away thinking it was under-utilized. We medicate so many but ECT has proven un-harmful and beneficial. One mom flies her son out for daily treatments, from California. California HMOs do not support ECT. So this mom pays $1500 per treatment and sleeps up at Star Pass Resort. She has some money for her autistic son, thankfully.

Twice in the morning were cultural references to "One Flew Over the Cuckoo's Nest." So I need to watch it.

An amazing morning of medicine in practice.

Mania and Fans of sports

In lecture today we discussed mania. We wrote a mnemonic to memorize the symptoms.

D - distractability

I - irritability

G -grandiosity

F -flight of ideas

A - risky activities

S -little sleep

T -tangentiality

Okay. First, if you listen to a group of sports fans (probably guys) talk about sports,they practice tangentiality in their conversation. One idea leads to another idea which leads to another idea. There is sometimes no connection or logic to the topics of conversation. Each fan is out to prove he knows what's going on in coach's' or players' heads right now even though all his information is from ESPN.com or SI.com. But you must articulate your chromosomal relationship with the gridiron, no matter how cliche you sound. I, Spencer, am tangential when I talk sports. But I'm not a manic fan. Or am I?

I do get distracted from life by sports. I do get irritable when I can't watch what I want or if my team loses. I suffer from grandiose feelings of superiority (my email is sunsfanyesiam). I do have flight-of-ideas. I can lose sleep for sports. But risky behavior? I think not. And I think to be a manic sports fan, I would have to engage in risky behavior. The photos below depict three recent sporting events where manic fans were present. One is of a riot in Vancouver after the Stanley Cup when the home team lost and fans proceeded to lay waste to their city. The other shows a manic fan trying to catch a baseball on a wobbly table. And the last, sadly, is of a Giants fan who was beat up in front of his children in the parking lot by Dodgers fans. This happened months ago, April 5th, to be exact. He is still in the hospital with permanent brain damage. There is real psychosis in sports. Think about that the next time you "boo" your opponent.

The Social Worker

A social worker in the hospital is a professional "Hey,- is-there-anything-I-can-do-for-you?" person.

And they do it.

If I could select my next door neighbor, it would be a social worker.

If I had to send our kid to be babysat by anyone and I knew they were a social worker, I would have less qualms than a palm tree to drop them off there.

I hope they make $100,000 a year. They deserve it.

The Team

On the psych ward there is a very even ratio of health-care professional to patient. On the geriatric floor I'm working there are 12 patients. Many of them are "train-wrecks," and require a lot of back effort and forward planning. Their stay on the floor averages out to anywhere between two weeks and a month.

To coordinate the effort to care for these 12, Team A - of which I'm a part- (mostly silent part) gathers every Monday, Wednesday and Friday morning at 9:15. Around the table are pharmacists, nurses, social workers, case managers, physicians, insurance agents, and students. Friday I counted 12 at the meeting. One health care worker for each patient.

Now let me take you back to Kum-Kundi-Yilli. Just north of this village, down a long, red dirt road sits a hospital. Green weeds and trees border the building and pools of water reflect all over the grounds. The entrance to the hospital is enclosed by a metal gate, like the kind you see around elementary schools. Outside are vans with people sitting. They are either bleeding or waiting for someone that is bleeding. Leading up to the hospital is a line of villagers doing the same thing. Inside the gate is a giant courtyard with concrete seats lining the walls. Each seat supports a patient. And off in the northeast corner of the courtyard is a little office. Inside the office is a well-groomed gentleman with glasses. He wears a tie and wields a pen. He's the physician. All his supplies lay scattered on the desk. He is also nurse, surgeon, primary care physician, pharmacist, and hospital administrator. The nurses are on strike, so today his job, theoretically, is to treat all the patients outside his office.

That's Kum-Kundi-Yilli, in northern Ghana, at least how it was when I visited for a month a few years ago. Our health care system is broken, I hear. But on the battle front I still see something good. I see American brothers and sisters working for the idea that life, any life, is worth saving. I don't know if it gets any more complicated that treating a majorly depressed man who comes in after his 8th suicide attempt. Yet the team works as if he were their own flesh and blood Grandpa.

I know comparing the Ghanaian health care system to ours is apples and oranges, but it's worth reflection that as Americans we budget ourselves into the red because we believe in the cure. Call it hubris. All I see, so far, is courage. But I'm biased, I work on Team A.

My challenge the next five weeks is to formulate my own opinion on the best way to reform health care. I'm a naive knave...

The Brain

Dealing with psych patients today was very memorable. I saw geriatric patients in wheel chairs sitting at the end of the hallway in the sun, like potted plants soaking up the light. They didn't move for hours. Perhaps they know something I don't.

I saw women yelling at anything that moves. I saw men doing things I thought only adolescent boys did.

I saw old, seasoned veterans of the earth acting out like children.

Yet despite all this obvious disorder from the norm, I kept thinking about two things I read this morning.

Half our genome goes to building the brain. And, there are more neurons than stars in the Milky Way. I think our Creator values the individual. The human brain holds more star power than the Galaxy.

So, why disorder among us? Their has to be a constellation that can be drawn from all the scatter-brains that populate the psychiatric wards. I'm not expecting to find it. But I bet someday we might know.

Back in...

The opening line to my textbook today read:
"Knowledge does not keep any better than fish."

And that's what I can testify to after day one of my fourth year, after a year off.

But oh, was it worth it.

Today was orientation in the psychiatric ward of the hospital. A pretty light day with my only patient interaction being with a 350 pound man who thirty minutes earlier threatened the life of himself and the attending physician across the room. I was unaware of these threats until a nurse saw me bump into him in the lock-down hallway on my way to the bathroom.

The rest of the blessed day was spent reading for tomorrow's activities.

In God We Trust

[P]roclaim liberty throughout all the land unto all the inhabitants thereof...

Leviticus 25:10