She was a 33 year old raven-haired exhausted woman who had probably been a beauty before she bore children, now aged 9, 6, and 4. She wanted a renewal on her sleeping pills. She did not want the antidepressant or anything else, just sleeping pills. She said that since the children all slept through the night, now she could, too. She had not only a tubal ligation at her final pregnancy, but an ex-boyfriend who was no more than a distant memory.
Her last doctor, apparently a rarity, had actually started by prescribing the sleeping pills every third night. That had not lasted more than four weeks or so. She wanted, and felt she “deserved,” sleep every night. She was convinced that was what the insurance doctors gave the rich people, so she was not going to let anybody skimp on her. Sleeping pills every night. She would not have to think about anything other than keeping a bottle by her bed and getting it into her mouth. Sleep would be automatic and life would be sweet.
The last doctor had been, to his credit, assertive enough to tell her that if this was what she wanted, she would be coming in every three months for the rest of her natural life on planet earth, to get sleeping pills. She thought that was just fine; that it was what everyone did and should do, since we had something as wonderful as sleeping pills in the world. Read more on Pharmaceutical Companies Are Stealing Our Dreams…
Filed under prescription drugs, Sleep, Substance Abuse by on Jul 1st, 2010. Comment. 
I was with my husband and a friendly couple, admiring the natural beauty of a mountain pass with snow capped peaks in the distance, when the other gentleman told us that a major natural food chain was removing all of the krill oil from its shelves, because the harvesting of krill was not a bio-sustainable practice.
Now I am usually pretty cool about science; looking at data, revising opinions. I have never really considered myself an ecologist, since the politics are often richer than the data. (Ask someone if they actually think the globe is getting warmer and it is not usually necessary to inquire about their political affiliation.)
I just looked him right in the eye and said “No way, this is nuts!” Read more on Don’t Worry — We Won’t Run Out Of Krill…
Filed under medicine, News by on Jul 2nd, 2010. Comment.
It was a community clinic where everyone was poor and most seemed spiritless, but this woman was 55 and had fire in her eyes.
“I want the same damn medicines for three months. Write the prescription. I won’t kill myself or anybody else, and I don’t have any side effects or problems.”
She knew the routine; so I did what she said.
“I got a half an hour with you. I want to talk.”
I usually asked patients what they wanted to talk about after we had transacted the business of medication management. Sometimes I got some surprises. So I told her she could talk. Read more on Not All The Questions Are Medical…
Filed under medicine by on Jul 7th, 2010. Comment.
He was a new patient to a community clinic. They warned me to be careful with this 48 year old, thinking he was “really crazy, schizophrenic or something.” The social worker had tried to do the intake and told me he was confusing, “not your average bear.” Strangely enough, most of my female staff already had told me they were attracted to him; an unusual state of affairs.
I was struck first by his clothes and demeanor. A little like Michael Douglas as Gordon Gekko.
This is not usually what new patients look like, schizophrenic or not, when they come in. No wonder the front desk staff already had a crush on him (“sigh!”). We didn’t get men in designer suits in these parts. Read more on Otherwise, The Patient Was Normal…
Filed under Diagnosis by on Jul 7th, 2010. Comment.
Most of the really effective compulsive lying folks are not patients. Such people, if ever seen as patients, do not stay as patients very long.
I remember a young woman, the daughter of a woman scientist who befriended me in France. She was beautiful, I could tell from her photographs, in a way I knew I would never be beautiful. Sometimes a poet, sometimes a singer, more often, this young woman in her late twenties, was manipulating (sleeping, I think) her way into bit parts on the Paris stage. We were interested, her mom and me, in the manifestations of the powers of the brain, ranging from raw intelligence, which we both knew we had, to the sort of metaphysical magic her daughter, who was calling herself LaFleur at the time, definitely had. I remember we knew someone who allegedly read photos. He was a “serious” person, an effective hospital administrator in one of the larger Parisian hospitals. Among his occult practices, he read photos. We asked LaFleur to submit him one, with no information other than her age (28 at the time) and name. She gave us a photo. It was one of the strangest photos I had ever seen. The lens distorted her myopic gaze in the vague direction of the camera. She wore some kind of soft cloth that descended low enough to reveal a single nipple and not the other. Of course, the “reader” declined the photo. He said a simple photo that would be used for a passport or drivers’ license would be helpful. LaFleur never submitted one. Read more on My Own Breakfast At Tiffany’s…
Filed under Personality Disorders by on Jul 8th, 2010. Comment.
The 94th Aero Squadron is my favorite restaurant in San Diego. I have been surprised to learn it is some kind of a chain, with restaurants in the Los Angeles region and Ohio and God knows where else, but this does not matter to me.
I have had their luncheon buffets, where sometimes things that are supposed to be French are confused with Mexican things. I have visited their “artifacts” and decorations and I think they are poor historians, confusing World Wars I and II. There is a vague notion of being part of the American military hanging around in France, enjoying things European, presentation that seems formal enough to a San Diego human that it is definitely European, and the opportunity to watch inept pilots take off and set down on a local airfield.
No, I am not sponsored by them — this is a free plug, and I’m hoping it guides others to experience the pleasures there. I did not say the food was extrordinary — although it is absolutely marvelous — or had anything to do with why this is my favorite restaurant in San Diego. It doesn’t.
It is my favorite because it plays into my personal story. I do not think many people even collect or remember their personal stories, or know how those stories can enrich their lives. I have been here before with a couple of friends. Today, a cherished friend (who happens to be from France), my husband, and someone who was my friend’s friend (visiting from France), who listened with a gaze akin to a deer in the headlights when I told my story. Read more on But Don’t Worry About Me ……
Filed under Memory by on Jul 9th, 2010. 1 Comment.
She was a friend. Other people sometimes live their entire lives in one place and keep friends for life, but she was more distant, clinging to me loosely, trying to live off free advice. Like almost all the friends I have in one particular region, she was a therapist. Not a bad thing to be, and I believe her to be a competent therapist. But she had the same problem most people in my age group have. She wanted help fighting it.
I suppose the name for it these days is “cognitive loss for age.” Not Alzheimer’s, that “presenile” (the earliest cases described by Kraepelin himself was in mid-fifties) dementia, but getting older.
Mainstream medicine comes up with names and categories and prescriptions, that may or may not offer significant clinical improvement. The human spirit comes up with, well, at least a little good anger. If there is one piece of poetry I quote more than any other, it is Dylan Thomas “Do not go gentle into that good night/Rage, rage, against the dying of the light.” Of course this brilliant Welsh poet, the way I heard it, died of alcohol poisoning in New York; not exactly how I plan to rage against the dying of my light. Oh, how many people who have tried to feed me alcohol I have told I cannot afford to lose any brain cells by that method. I need everything I have to continue to live by my wits. Read more on Advice From A Poet About Memory Loss…
Filed under Alzheimer's Disease, medicine by on Jul 13th, 2010. Comment.
It has been over ten years since my husband and I visited this often-quiet community in Nevada. Gambling, resorts, a legal whorehouse not far out of town, pawn shops, bars; standard Nevada. Only the faintest echoes of the silver boom, people grasping for the romance, the all-night party feeling. We are not big gamblers, but we did some shows, and the party feeling was good for a weekend.
That was ten years ago. Now, there are a bunch of people looking for free beer, not caring about its quality. People talking about getting “wasted” and nobody, but nobody, talking about having “fun” doing it. There is a pall over the gambling halls. People are counting their pennies on 99cent specials. There are certainly no echoes whatsoever of the silver boom, and no evidence of romance, and only two or three people sitting in a room full of slot machines.
Some of what I do is very analytical. I actually figure out how many mg. of medication or supplement someone needs as a function of their weight. I think of the chemical reactions in their body that are either not working at all, or are working overtime. Some of what I do–sometimes I am surprised to know just how much and how effective it is–is feeling; is intuitive. Whether we are where the rich people go or where the poor people go, I feel fear. I am sure that this fear comes from feeling that the economy is “bad.” Read more on Don’t Get Wasted — Get Busy!…
Filed under Substance Abuse by on Jul 13th, 2010. Comment.
This one makes my blood boil. Being a doctor, a good doctor, is not easy. It requires a lot of thinking, taking every patient who comes before you not just as a human, but as a clinical care problem. Knowing the facts, making judgments. It is because we have a tendency to abscond this role that “doctor extenders,” cheaper people, rush in to fill the void.
One of the things we have to do is to weigh the advantages and risks of every procedure.
Sure, there are some mechanisms in place to help us. Things like videotaped informed consents. Things like meters and technology and such.
In the case reported above, a woman who had Bell’s Palsy, a fairly common (and often, spontaneously receding) hemifacial paralysis was subjected to a CT scan. She got too much radiation and became quite ill; someone did not notice the excessive radiation noted on a panel somewhere. Read more on Should FDA Regulate CT Scans?…
Filed under medicine by on Jul 14th, 2010. Comment.
He was not a day over 35; actually, he looked younger to me; almost childlike. He rattled off everything they had brainwashed him with in the military. Yes, brainwashed. Do you actually think young men would go into combat if they were not convinced it is fun and glorious? Really, I do not think we have come all that far from the Romans who would say sometime early in their service “dulce et decorum est pro patria mori” (“It is sweet and beautiful to die for one’s country”) The hard part comes after the combat. Maybe some painful wounds, treated by an overextended medical system, but the memorized ideology remains. The young and impressionable repeat what they have been told so often that they believe it.
“The military teaches self-discipline. It is a fine preparation for the working world.” Wrong. It teaches following orders, stamping out individual ideas and initiatives like so many cockroaches who have dared to enter the kitchen. They could appreciate if you find a faster way to process internal paperwork. They neither encourage nor reward the kind of initiative that makes entrepreneurs, a pretty good way to rise like cream. Read more on So You Expect A Job?…
Filed under News by on Jul 15th, 2010. Comment.