Author: Maria Yang, MD

Categories
Observations Seattle

Impressions of MLB All-Star Week From Someone Who Doesn’t Follow Baseball.

For those of you who follow baseball, you likely know that All-Star Week is happening here in Seattle. For those of you who don’t follow baseball (like me), All-Star Week lasts less than a week and is a celebration of baseball and baseball players. (For example, the World’s Largest Baseball is currently here in Seattle. More on that below. You can already see how I’m focusing on the wrong thing.)

This is the only event I can recall in the 16-ish years I’ve lived in Seattle where the city has put in extraordinary effort to make it shine for its citizens and visitors. (I enjoy living in Seattle, but let’s be honest: the effort is for the visitors.) Because Seattle is tucked in the northwest corner of the country, people just don’t routinely pass through. People seem to equate visiting Seattle with visiting the Galapagos Islands: Neat places with oddities, but so out of the way!

In an effort to be a better spouse, I have been learning about baseball over the past few years, but my fund of knowledge is superficial. For example, when our Mariners made it to the playoffs last year, that’s when I learned what a “rally cap” is, though I had to learn about this via the “rally shoe“. (Again, I’m still missing the point.) It takes me a while to offer a complete definition of a “perfect game“. I know just enough about certain baseball players to ask questions one expects from a child: Do you think Shohei Ohtani the pitcher could strike out Shohei Ohtani the batter? (Can you imagine being married to a psychiatrist who also asks unsophisticated questions about baseball???)

So, for our mutual amusement, here are random, initial impressions from the beginning of Major League Baseball’s All-Star Week from someone who doesn’t follow baseball.

It costs a lot of money. Well, at least the Home Run Derby and the All-Star Game cost a lot of money. The event that most interests me is the inaugural Historically Black Colleges and Universities (HBCU) Swingman Classic, created by former Mariner Ken Griffey, Jr. (There’s a statue of Griffey in front of Seattle’s baseball stadium, which has the phenomenally boring name of T-Mobile Park.) Tickets are all sold out, so I can’t attend, though I’m inspired with Griffey’s efforts to do what he can where he can.

The World’s Largest Baseball is here. I’m suspicious, though: Is it an actual baseball composed of cork and rubber and yarn and leather? (Here’s a promotional video of Play Ball Park that features this giant baseball stationed outside T-Mobile Park; it appears around 0:14. There’s what appears to be a panel near the base of the ball. That doesn’t seem right.) I’ve been wondering about the World’s Largest Baseball all week. If I actually go to Play Ball Park, I’ll provide an update.

The young people are excited. A couple of shockingly pink tour buses featuring Mariner’s star Julio Rodriguez’s smiling face parked in front of a hotel within walking distance of the stadium earlier today. Children and adolescents in baseball uniforms spilled out. Adults corralled their wandering, jumping, and chatty bodies through the revolving doors. Other young people and their accompanying adults are roaming around, proudly wearing jerseys and ball caps that declare their allegiances. (I am particularly impressed with the Milwaukee Brewers logo: The glove contains the letters M and B! So clever! Designed by an art history student!)

This may be the most excited people have been about baseball in recent memory. The Mariners is the only team that has never been to the World Series. People are perennially disappointed with them. (The Seattle Times recently published this piece: Why fans dislike this Mariners team so much. YIKES.) Whenever I see a televised Mariners game, the seats are never full. The only Mariner who made it onto the All Star roster by public vote was pitcher Luis Castillo. Now, none of us can get away from baseball: Posters emblazoned with ball players are plastered all over utility boxes downtown! The local paper has published numerous articles about baseball (not all of them supportive, as noted above)! The city made an assertive push to remove/house all the people living outside near the stadium in the weeks leading up to All-Star Week! The beautification of downtown and Pioneer Square (flowers! new trees! pocket beaches!) has all been in the service of sports! (It seems that the All-Star game was also the catalyst to fix the escalators in the downtown light rail stations that haven’t worked in over two years.)

If any of you fine readers are in town for All-Star Week, enjoy the next few days! If you’re going to any of the games, one of my favorite things about the stadium is the sculpture of the baseball glove at the left field gate. It’s called “The Mitt” (it’s in the photograph accompanying this post). You can learn more about the artist and this sculpture here.

Categories
Observations Reflection

Catastrophization.

There are valid reasons why people catastrophize (to imagine the worst possible outcome of an action or event): Terrible things happen. Uncommon calamities occur, things that we never thought would happen to us. Common catastrophes occur, too, things that we know will happen, and yet all of our preconceptions do not provide adequate preparation.

Are common catastrophes really “catastrophes”? Like death and dying? Death by “catastrophic implosion” is a catastrophe by definition. What about migrants drowning at sea? People dying from heart disease? overdoses?

Do the reactions and opinions of other people determine whether something is a catastrophe? If you’re the only one who thinks it is a catastrophe, is it still a momentous tragic event?

To catastrophize is to have an active and creative mind, one that brims with possibilities. These options are unlikely to happen, but they could.

One function of catastrophization is to provide mental rehearsals. Practice gives us a sense of mastery: We thought about a Thing, we considered the consequences of that Thing, and now we have plans to avert disasters related to that Thing.

Doesn’t “Emergency Preparedness” sound better and induce less anxiety than “catastrophization”?

However, “catastrophization” often omits the “preparation” part of “emergency preparedness”: We get lost in loops of apocalyptic ideas. Paralysis (and perspiration) ensues.

More recently I’ve wondered if catastrophic thinking reflects a lack of self-confidence, or at least a fear that we are incapable of dealing with disasters. We are terrified that we will not survive.

It seems the most debilitating aspects of catastrophization do not always involve material things. We may fear the flames engulfing our home, but we fret more about the potential destruction of our pets and loved ones who live with us.

Material destruction is distressing, though annihilation of our identities is intolerable. Who am I if my children die? What does it mean if I’m the only person left who has these memories? What will happen to “me” if I can’t deal with this Thing?

Maybe this is a lesson that only comes from time and experience: We can survive more than we think we can. The world can shatter our hearts in unimaginable ways, but we persist. What was unimaginable becomes part of our personal history. We weren’t eradicated; we endured.

This is not to say that the experience was “fine” or that we are “fine”. The external and internal wreckage is real, but we are still here.

How do we persevere among the ruins, though? What do we do when catastrophic thoughts descend upon us, demolishing the tenuous safety and security we think we have now? What do you do when your thoughts take you to a world that doesn’t exist right now (and may never come into being)?

It sounds trite and overdone: Bring yourself back again and again to this world and yourself. What is actually happening right now? Where are you? What are you doing?

See the summer trees, their limbs full of luscious leaves. Hear the wind rustle the branches, a green applause filling the air. Feel your toes in your shoes, the way the small bones in your feet support all of your weight. Do you feel your tongue in your mouth?

Indeed, what is the texture of the pain in your lower back? Is it mostly sharp right now? Or a monotonous throb? Can you trace the direction of the sensation? How do you respond to it? How does it respond to you?

The sirens that wail: Can you hear how they change pitch? When does the “WOOOOoooo” finally disappear? Did you hear it dissolve, or did you only hear its absence a few minutes later?

What are the shapes of the letters in that text message? What punctuation is present? What are the colors in the emojis? What might happen if you took a full breath before sending a message? What message are you sending yourself with a short breath? A long one? A noisy one?

Life, in all its beauty and ugliness, continues to unfold whether or not you are giving it your full attention. You could live your life entirely in your thoughts, one catastrophe to the next. What might you miss in the world outside your head if you do that?

And have your catastrophic thoughts diverted any disasters? Thinking about all the things that could go wrong might help us feel like we have control over something, but do we really? Things will go wrong whether we think about them or not… and things will go well even when we think they won’t. Thoughts are magical, but magical thinking is ultimately a collection of ideas in our minds.

In catastrophization we have great confidence in our thoughts. When living in this world, let us have more confidence in ourselves. We can make it, even if we don’t believe it.

Categories
Reading Seattle

Recommendations.

Here’s a small selection of things I humbly recommend for your consideration:

The Disadvantages of an Elite Education. “Our best universities have forgotten that the reason they exist is to make minds, not careers.” (Incisive writing from William Deresiewicz, who is also the author of one of my favorite essays, Solitude and Leadership.)

Ice Merchants: A Father and Son’s Daring Cliff Dive. This is a beautiful, wordless animation that left me speechless.

Why Are These Italians Massacring Each Other With Oranges? Every winter, Ivrea erupts into a ferocious three-day festival where its citizens pelt one another with 900 tons of oranges. (Yes, oranges.) (Thoughtful, descriptive, and hilarious writing from Jon Mooallem.)

The Complete Maus: A Survivor’s Tale. I bought this book on a whim. I don’t understand why some schools have banned it—more people who read it.

E-Jae Pak Mor: These TikTok-Famous Dumplings Deserve the Hype. If you live in or around Seattle and if you like Thai food, give this place a try. (The owner and I met years ago when she was working as a cook at Turkish restaurant. E-Jae Pak Mor is her first restaurant—how thrilling it is to make your dream come true! This is Thai street food and it is delicious.)

Emmett Shear: “I’ll be 40 years old soon. I thought I’d take a look back and see how I’ve spent it….” (Includes a link to a spreadsheet so you can make your own.)

Categories
Lessons Medicine Nonfiction

Treatment Options.

Reading this essay, A Major Problem With Compulsory Mental Health Care Is the Medication, made me think of the following anecdote. I’ll say more about compulsory mental health care (also called involuntary psychiatric treatment) and involuntary medications in a separate post.

Long time readers (from 2004—close to 20 years ago! thanks for spending decades with me!) will recall a physician I dubbed the Special Attending. (In this post from 2019 I identify him by his first name, Matthew.) I am certain that I wrote about the following anecdote at the time it happened; I was upset and distressed. The Special Attending was not a desirable flavor of “special” at this point. Frankly, I believed he was unnecessarily cruel and unfeeling.

I was an intern on the general medicine service. The patient was an elderly, frail woman with multiple medical conditions. She looked and sounded ill; the numbers from her blood and imaging studies confirmed her health was deteriorating.

The senior resident, the other intern, and the medical students all expressed concern about her viability. She looked miserable; she told us with her weak voice that she felt exhausted and uncomfortable. Why are we still poking and prodding her? we wondered. What are we doing?

“We should put her on comfort care,” someone offered. This quickly became the team consensus. We all knew the adage: Cure sometimes, relieve often, comfort always. With confidence that bloomed from the shallow earth of inexperience, we believed that none of our interventions would cure her. The pathway to relief, from our distressed perspective, was only through comfort care.

We—probably me, since this was my patient—proposed this plan with certainty to the Special Attending.

“No,” he replied. It wasn’t that he uttered only one syllable and nothing more. He was frowning. Though I had only worked with him for a few days, it was clear that he was radiating disappointment and disapproval.

Maybe it was me; maybe it was someone else with more courage who finally sliced into the uneasy silence by asking, “Why?”

Because we haven’t tried everything yet, he tersely answered, making no eye contact with any of us. There are still things we could do.

After rounds, we grumbled as a team. “Why is he making us do this?” we whined. “We’re the ones who have to tell her about next steps and do all the things. She’s not going to want this. She’s already suffering so much.”

See, the thing is, we couldn’t tolerate her suffering. We couldn’t bear to witness the deterioration of her body. We didn’t want to try another thing that would fail and prolong our mutual suffering. And what better way to help us escape than by limiting options and withdrawing?

So what does this anecdote have to do with involuntary psychiatric treatment?

My own view is that involuntary psychiatric treatment (inclusive of detention and medications) is a bad outcome. It means that multiple systems failed. The Big We either did not intervene earlier or care to intervene sooner. The Big We didn’t create or maintain enough options to avert this undesired result.

(To be clear: I have provided involuntary psychiatric treatment. It’s not an option I ever want to choose. I never feel great about it.)

We must create as many options as possible for people to receive care and treatment. We must tell people about these options and eliminate barriers so people can access them with ease. When you’re already feeling terrible, the last thing you want to do is climb uphill to knock on doors that won’t open.

It’s hard to witness suffering, but dealing with our discomfort is a problem for us to solve. For those who are suffering, they should not have to solve our discomfort, too.

In retrospect, I wish the Special Attending had explicitly talked with the team about our distress from witnessing the woman’s suffering. It doesn’t have to be a “processing” conversation or “touchy feely”. It could have been something like, “It’s hard to witness someone who is really sick. Our job, though, is to think of and share all treatment ideas with patients. They trust us to help them, so we must try. We can’t give up and look away, though, just because it’s hard for us. We are talking about this woman’s life.”

In the end, we talked with the woman about another treatment plan. She agreed to it. It didn’t help. And that’s when the Special Attending said, “Now we can talk with her about comfort care.”

Categories
Homelessness Observations Reading

The Guest Who Has No Place to Live.

Inspired by this tweet (“This book is viscerally upsetting, lol. What the fuck”), I read The Guest by Emma Cline.

The inside flap offers an accurate description of the story: Alex makes a “misstep at a dinner party” and ends up wandering around Long Island. She has “few resources and a waterlogged phone, but [is] gifted with an ability to navigate the desires of others.” She is indeed “propelled by desperation and a mutable sense of morality” and “a cipher leaving destruction in her wake.”

And, yes, the book is viscerally upsetting.

Is the story about status and hierarchies? Yes. Is it about appearances and identity? Yes. Is it about the transactional roles young women play in American society? Yes.

Is it about a young woman who has nowhere to live? Yes: Alex is homeless.

This is not the reason why I chose to read this book. (Honestly, the only thing I knew about the book was from that tweet. We can wonder together why I wanted to read something “viscerally upsetting”).

It’s not Alex’s status as a homeless person that turns the stomach. (I don’t even know how many readers use the frame of homelessness while reading this story.) It’s the odious nature of her choices, how unsettling her behavior is. She is not endearing. (Kudos to Cline for creating a character who is unlikeable yet compelling.) We readers get caught up in the appearances of luxury and decadence that we forget that Alex is trying to find a stable place to live.

We never learn Alex’s backstory; we don’t know where she is from, what happened to her in the more distant past, or how she came to behave this way. Part of the point of the novel, I think, is that we can never know: Appearances are what matter. You can tell any story you want to get your needs met.

For readers who want to make their lives more difficult (…), this book introduces uncomfortable questions related to homelessness:

  • If a young woman is despicable, does she deserve to be homeless?
  • What do we want to happen to young women we don’t like? Do we want them to suffer? Is homelessness a sufficient punishment?
  • Do we therefore assume that all people who are homeless must have done terrible things?

Then there’s the question of redemption. The events of The Guest unfold over the course of one week. Do we think Alex could ever redeem herself? What if it takes a year? or five?

Should people who are unlikeable be homeless until they redeem themselves?

Maybe Alex is a cipher, but, more importantly, she has no place to live. That’s why she’s “propelled by desperation and a mutable sense of morality”. Perhaps we take comfort in the idea that Alex is a character, that this is a novel.

  • Would we make similar choices if we were in Alex’s situation?
  • Could we also do such unlikeable things if we were homeless?

What if the homeless young women we encounter aren’t anything like Alex? Might we want to make different choices ourselves?

(And, yes, to be clear, I do recommend The Guest.)