Author: Maria Yang, MD

Categories
Observations Public health psychiatry Seattle

How Atmospheric Rivers Affect People in Jail.

An atmospheric river is a river in the sky.

I don’t remember these from my youth, though they seem to happen most years now on the West Coast.

An atmospheric river that reaches Seattle is often called a “pineapple express” because the long band of moisture in the atmosphere originates around Hawaii. When the pineapple express arrives, the temperatures here become unseasonably warm (mid to high 50s°F / 12 to 15°C) as the rain falls.

The thing about rain in Seattle is that it usually isn’t rain. It’s more like a mist, a quiet visitor that stops by maybe for an hour or two, then slips away. Within the hour the drizzle returns again, just to make sure you didn’t forget about it. This is why most people here don’t use umbrellas. Raincoats are enough; umbrellas are a burden.

In contrast, the rain of atmospheric rivers demands your attention. The droplets are heavy and full. The water falls in sheets. It’s the mob of young people dressed up like Santa who sing Christmas carols off-key on a crowded light rail platform.

A particularly long river in the sky recently passed above Washington State. Grey clouds rushed overhead, churning past each other like currents of a river, dark water soaring through the heavens. Mud slid, highways collapsed, and lakes formed.

Walking around in it was like walking through a warm blizzard: My face stung from all the water droplets slapping against my cheeks. I had to squint to keep the water out. One afternoon, despite only walking for about 30 minutes, the hems of my pants were soon dragging on the ground. The rain had penetrated every thread and the weight of the water stretched everything down.

There is a small city in South King County that operates its own jail. It has only around 100 beds. (Compare this to the main county jail, which operates two adult facilities with around 1500 beds.)

This small city jail is near one of the rivers whose levee failed. Even as of this writing, the major roads on three sides of the jail are closed, one of which is a state highway. At the height of flooding, the state ordered people to evacuate.

What do jails do when the state orders people to evacuate because of a flood?

Reputable word on the street is that this jail took two actions:

Some people were released from jail. I don’t know what system jail officials used to determine who should be released. Presumably there was some consideration about the severity of the alleged crime. Releasing people from jail, though, results in the former inmates themselves holding the hot potatoes: If people have been ordered to evacuate and roads are closed, how do they return to their homes? (What if they don’t have homes?) People leave jail with only the belongings they came in with (and sometimes not even that), so if they didn’t come in with rain gear, oh well.

Other people were sent to a jail on the other side of the Cascade Mountains. This means inmates piled into secured vans or buses and travelled about 150 miles to Central Washington. Again, I don’t know what system jail officials used to determine who to relocate. Jails are meant to serve the local community and people can be released from jail unexpectedly. Will these people get a ride back to this small city? Will they have to figure out their own way back? With the exit of the atmospheric river, a polar vortex has taken its place. There is snow on the pass.

May our federal government stop manufacturing artificial disasters through inhumane policies. Natural disasters are distressing enough.

Categories
Nonfiction

Inconsequential News.

Guys, I am excited to share inconsequential news with you: Something I wrote was published in the New York Times!

Michelle Cottle wrote a poignant essay, ‘We Had No Idea What Was Coming’: Caring for My Aging Father (free gift link). On a whim, I wrote a response in a letter to the editor.

Editors are supposed to edit things, so of course my letter got edited. Here’s what got published:

Michelle Cottle’s excellent essay on the growing caregiver crisis includes the comment, “Never have I been so grateful not to be an only child.”

I, too, cared for my aging father. My mother was already deceased, and I have no siblings. The responsibilities were thus all mine.

As my father disintegrated, I was grateful that there was no ambiguity about next steps in his care. My friends with siblings who were also caring for aging parents experienced otherwise: They disagreed about how to manage finances, where their parent should live and the levels of care and interventions they should receive. As an only child, I was spared those burdens.

My beloved father was liberated this past February. There is a painful realization as the only child: No one else remembers my dad the way I do.

I guess the New York Times doesn’t like Oxford commas. (Probably because they take up valuable space.) And I’m honored to represent only children…?

You can read my beloved dad’s obituary here. That the New York Times chose to publish my letter seems, I suppose, like another gift from him. (Thanks, Dad.)

Categories
Blogosphere Reading

Links Around the World Wide Web.

Some interesting items for your consideration:

Why are people poor? (short video) The intelligent and incisive Jamelle Bouie comments on the recent immoral fiasco surrounding SNAP benefits.

Zohran Mamdani Wants Civilians to Replace Cops. Will It Work?

Civilian alternative programs are controversial—a prominent police abolitionist has lauded Mamdani’s plan, while one retired NYPD sergeant called it “probably the worst idea I’ve heard of in a long time.” But most coverage has failed to ask: what do we actually know about what civilian alternative response does? Are they a brilliant intervention, or a disaster waiting to happen?

The author, Charles Fain Lehman, is a fellow at the conservative think tank Manhattan Institute. I recommend his Substack, The Causal Fallacy, where he consistently uses data in a good faith to make his arguments.

Full Days and the Long Walk. Craig Mod continues to walk many kilometers and notes,

The more people with control of their attention, the better our art, music, scientific research, political legislation, and, I believe, the more kindness and empathy in the world. Also, the more prepared you can be to fight. Without understanding and cultivating fullness, you lose sight of the battles worth fighting, and lack the energy to go after them.

And here’s an abrupt transition:

The Goon Squad: Loneliness, porn’s next frontier, and the dream of endless masturbation. A link to this was in Craig Mod’s essay above. Maybe don’t read this at work.

What are these gooners actually doing? Wasting hours each day consuming short-form video content. Chasing intensities of sensation across platforms. Parasocially fixating on microcelebrities who want their money. Broadcasting their love for those microcelebrities in public forums. Conducting bizarre self-experiments because someone on the internet told them to. In general, abjuring connective, other-directed pleasures for the comfort of staring at screens alone. Does any of this sound familiar?

The Map on the Wall. This essay now seems quaint given the drastic changes in the Department of Defense, but highlights the influence we each have as individuals.

But I can’t control what goes on “out there.” All I can do is try to foster a culture within my hangar — within our squadron — where we address things like race, gender, sexuality, and religious difference in a mature way that reinforces some very basic truths: we’re better because we’re different. We’re stronger because we come from everywhere. And, we’re much more dangerous to any potential adversary because we don’t all approach difficult problems the same way.

I Am a Drug Historian. Trump Is Wrong About Fentanyl in Almost Every Way. (gift link) The author gives a succinct summary of the history of drugs in America, then highlights why the federal government’s current approach (i.e., tariffs, threats of war, and extrajudicial murders) is wrong. He notes more effective strategies:

These successful policies all do one thing: They make drugs boring again. Drugs are not magic, they are not demonic, they are not fundamentally different from all the other problems society faces. They are highly desirable and highly dangerous consumer goods. They are not unique in that regard.

How to Be a Good Neighbor. This is from J Wortham’s Substack, where the writing is more casual and spiritual, though is just as thoughtful and genuine as their essays in the New York Times.

Good neighboring feels like an active term, and clearer to me than the vagaries of community, a noun that gets tossed around with such abandon that it has become semantically satiated and bleached of all intention and meaning. Good neighboring feels like tapping into the actual network of people and place that make up a shared ecology.

We Followed the Rules. ICE Jailed Us Anyway. (video, gift link) What ICE is doing across the nation is already horrifying in its own right. As someone who has worked as a psychiatrist in a county jail, I am sorry to say that the conditions of the detention facilities described in the video are far worse than anything I ever encountered. (To be clear, I’m not saying that it’s okay to detain people for no cause as long as they are held in more humane settings.)

Categories
Consult-Liaison Lessons Nonfiction

Approach, Don’t Avoid.

I don’t think the crisis center had been open for even one week. There were dozens of staff and fewer than five patients. Most of the staff were young, eager, and brand new to social services. Only the nurses and I had experience working in higher acuity settings.

One late afternoon, an elderly woman using a walker got a hold of a pair of scissors. One arthritic hand wielded the scissors while the other gripped the walker. Her feet were heavy; she plodded across the floor, chanting, “Kill, kill.” The walker swiveled because her torso wobbled with each step.

Our colleagues fled; doors to staff-only areas clattered shut. A nurse and I looked at each other when we realized we were the only people left in the room with this patient. We both sighed. I used my chin to signal that I would follow him.

Later, I asked to meet with all the staff working that shift. Why did you all leave the scene?

“Because she had scissors and was talking about killing people,” they said. “She had a weapon.” We were fearful that she was going to kill us, dummy!

Because this was my first job as a medical director, I thought I always had to “direct”. I didn’t realize that I could keep asking questions:

  • How do you know that she wanted to kill other people?
  • What else might have happened if everyone left her alone with a pair of scissors?
  • What realistic damage could she have done with the scissors?
  • What unspoken message did we send to each other when we all left?
  • What unspoken message did we send to her?
  • Are there things we could have said to get more information from her?
  • What steps could we have taken to separate her from the scissors?

You can’t always believe what you think.

(To be fair, people who don’t know what to do often run away. Avoidance is a common strategy to cope with fear and anxiety.)

The nurse approached the elderly woman from one side. He took three steps for every one step she took.

“Hi. Can you put the scissors into the basket of your walker, please?” he asked.

“Kill, kill,” she continued to chant, holding the scissors in the air. She continued to plod forward.

“Hi. Put the scissors here, please,” I echoed, pointing at the basket.

Her forward movement stopped. The scissors remained in her raised hand. We stood in stillness together.

Mumbling, she dropped the scissors into the basket. I plucked them out. After thanking her, we asked her to please sit down. “And please don’t do that again. It scares people.”

“Please don’t leave when things like that happen,” I said, directing the team. “When there’s a situation, approach. People might need you to do something. Your presence alone can help de-escalate situations. And someone will send you away if it gets too crowded. But don’t immediately leave.”

For the remainder of my time there, staff never disappeared again during a crisis.

(inspired by claims that RFK, Jr., left the scene of Oval Office medical emergency)

Categories
Homelessness Medicine Nonfiction Policy Public health psychiatry Seattle

Who Gets to Be Sad?

For those of you who don’t follow baseball, the Seattle Mariners were in the running to go to the finals in baseball, called the World Series. (So American, of course, to call the finals the “World Series” when it doesn’t involve the entire world!) The Mariners are the only team in all of Major League Baseball that has never been to the World Series.

As such, you can imagine how much of a frenzy the city was in. The Mariners flag was hoisted to the top of the Space Needle twice! The downtown skyscrapers coordinated their night lights to glow in Mariners colors. The mayor raised the Mariners’ flag at City Hall.

Game 7 in the semi-finals, which happened last week, was the “win and go to the World Series, or lose and go home” game. The Seattle Mariners lost.

Over the past week, since that loss, the city has been distraught.

Immediately following game 7, there were brutal postgame interviews. Sports journalists, for obtuse reasons, asked weeping baseball players how they felt.

Here’s Cal Raleigh, our inimitable catcher, showing what his face looked like when he was seven years old and heartbroken:

See how he ran his hand through his hair? That was a desperate act of self-soothing while multiple cameras gave him no place to hide his flushed face and wet eyes.

Meanwhile, here’s Bryan Woo, who turned out to be the team’s ace pitcher this year. He’s not crying, but he is also just trying to get through the interview. A wail of despair interrupts him:

The man whose heartache was heard, but not seen, was our cool center fielder, Julio Rodriguez.

So, are grown men allowed to cry or not? Here were professional athletes caught in the throes of disappointment and sadness. They were crying. Sports journalists pushed microphones into their faces and asked them how they were feeling.

On the one hand, I appreciate this exercise: It’s a chance for these robust young men to model (to other males) how to use words to describe internal experiences. They’re not smashing bats into the walls or punching the journalists. You can talk about unpleasant emotions without resorting to violence or destruction.

On the other hand, asking people about their feelings on camera when they are obviously distressed seems unkind. Sure, baseball players, as public figures, have training about and responsibilities to the media. But such pointed questions do nothing to soothe or support the person. Reporters can also learn the exact same information — how do you feel about losing the biggest game of your professional career to date? — an hour later, when people have had the chance to cry and wail in private. Show some respect, give people some dignity!

But we apparently want to see our heroes cry. We want to know that they feel just as sad as we do.

There are many other people throughout the nation who are crying. They are not professional baseball players; they are not famous. Many of us will never know any of their names.

Some of them were looking forward to leaving the street and moving into an apartment! With winter right around the corner, the anticipation of living somewhere dry and warm was thrilling. Because of the government shutdown, though, the mainstream vouchers that would have paid for those apartments are invalid. So they will have to wait for the government to open before they can move inside.

Many of these same people have Medicaid for health insurance. There are also millions of other people with Medicaid who do know where they will sleep tonight.

The federal government has somehow concluded that it’s not worth it to spend money on health insurance for poor people. But, it is somehow cool to take that money to give tax cuts to people who are wealthy. Yes, it is true that, one day, we will all die. Taking health insurance away from poor people, though, is spiteful. It only makes it more likely that they will needlessly suffer while they are alive.

You know what makes suffering worse? Hunger.

The government shutdown, if not resolved by November 1st, will also shut down the Supplemental Nutrition Assistance Program (SNAP). This program, also called “food stamps”, gives financial aid to poor people to help them buy nutritious food. Food banks are already struggling to provide enough food to visitors. Furthermore, here in Washington State, many grocery stores have closed.

Some people are already hungry. More people will join them.

Yes, you’re reading this right: Soon, the same group of people will have increasing struggles to access food, health care, AND housing. What they all have in common is poverty. Literally no one ever says, “When I grow up, I want to be poor and rely on welfare!” Being poor is not a moral failing. No one, regardless of how much money they have, deserves to have the foundations of wellbeing — food, shelter, and health — taken from them.

But we apparently don’t want to see poor people cry. We don’t want to know their sadness. Some people think poor people deserve to be sad. Others think that poor people are not people.

What would we have to admit to ourselves if we felt their sadness? What would we have to change if we acknowledged that their sadness is real?