Author: Maria Yang, MD

Categories
Nonfiction

Tourist.

“I wanted to see Boeing and Microsoft,” he said. He wiggled his bruised fingers that poked out from the white cast on his arm. The red uniform was too big for him.

“And now he’s in jail,” the interpreter murmured.

Three weeks prior, he bought a plane ticket online. He wanted to visit Seattle.

When he boarded the plane three days ago, he felt uneasy. Something wasn’t right. Something was going to happen.

He prepared himself for the long flight. Seated next to him was someone who looked like him, one of his people. They greeted each other in their native language. The dull roar of the plane engines lulled him to sleep…

… and when he woke hours later, he muffled his gasp. The person sitting next to him now had different hair and eye colors, and only spoke English. And yet it was the same person he had greeted only hours before. How could this be?

It would only get worse. He said nothing on the tour bus and retired to his hotel room, though was called back out again for dinner.

Something still wasn’t right. He ate quickly.

After dinner he sat in the lobby of the hotel. He chewed on his finger.

Someone else is in my hotel room. It’s not safe.

A man wearing dark clothing walked through the lobby and looked at him. A few minutes later the same man walked through the lobby and looked at him again. And then it happened a third time.

Fed up with this surveillance, he tried to ask the hotel staff to call the police. They didn’t understand or speak his language, so they didn’t understand why he wouldn’t return to his room. He couldn’t understand or speak English well, so he didn’t understand that they were calling the police because they were worried about him. There was no man in dark clothing.

When the police arrived, they asked him to go to his room. He refused.

He then grabbed one of the police officers and bit him.

There was a scuffle and he started yelling. One of the bones in his arm broke. The police took him to the hospital.

The physicians at the hospital all agreed that he was quiet and polite. He said nothing to them about the uneasiness he still felt, the transformation of the person on the airplane, the man in dark clothing who was watching him, or the person who invaded his hotel room.

“If we don’t operate on your arm now, the bone won’t heal right. Your arm will be crooked for the rest of your life.”

“I understand, but I don’t want to pay for the surgery. I don’t have enough money. I can get the surgery done when I go home.”

“You can pay for the surgery once you get home. You really need to get it done now. Your arm might even hurt for the rest of your life if we don’t fix the bone now.”

“I understand that. It might be crooked, it might hurt, but I don’t want to pay for it here. I will get it fixed at home.”

He didn’t tell the phone interpreter that God would heal his arm in the next few days. Why ask man to fix his arm when God would heal it with perfection?

His bail was set at $50,000.

“Where is he going to get $50,000? Does the consulate know about him? Does he know anybody in America? Does his attorney speak his language?”

He stood up whenever the jail officers approached his cell. He learned to say “thank you” and repeated those two words whenever the jail nurses tended to his arm and gave him medicine. He folded his blanket and the leftover wrappers of his meals into neat squares.

“Everyone has been nice to me here,” he said. A smile bloomed across his face.

He finally agreed to take a shower. It had been nearly a week. After he rubbed the thin towel across his skin and put a clean uniform on, he left the dripping cast outside of his cell.

Psalm 34:20: He protects all of his bones, not one of them will be broken.

While he was at the hospital to have the cast reapplied to his arm, someone posted his bail. The jail officers who had accompanied him there came back alone.

Where did he go?

Who paid his bail? Did someone pick him up from the hospital? Did he return to the jail to pick up his wallet and clothes? How did he get to the airport? Did he go to the airport? Did someone already purchase a plane ticket for him?

How did he tolerate the plane ride home? Did he go home?

Did the government of his home country post his bail? Did it also buy his plane ticket? Did he undergo surgery for his arm at home? Did they know that he believed that God would heal his arm? That someone was following him?

What did he tell his friends and family? He wanted to see Boeing and Microsoft. He was a tourist and ended up in jail.

Would they believe that?

Categories
Uncategorized

Luke 24:5.

During my visit to the optometrist this past week, the technician reviewed what I had told him before about my family history of illnesses.

“Anything else?” he asked.

“My mom had lung cancer.”

“Ah.”

After typing this into my medical record, he asked, “How is she doing now?”

“She is deceased.”

“From that?”

“Yes.”

We sat in silence as he continued to skim through my medical chart.

While it is true that I think about my mother every day, it’s not like I think about her every day. It’s more like a reaction: Someone has eyes that are shaped like hers. An older woman walks through the grocery store clutching her purse the same way my mom did. I purchased that Sakura Pigma Micron Pen during a visit home before she died.

Then there was that one time I was walking through a park in Seattle and I saw a tree. The branches were full of pink flowers. Half of the tree was dark with shadow; the other half was doused in sunlight. I know it sounds weird, but that tree was my mother. After staring at the tree for a few moments, I gave up trying to understand why I believed that tree was my mother.

I waved good-bye to the tree.

Sometimes I’m not prepared to think about my mother, but the occasion requires it. Like when the optometrist’s technician asked me about my family history. I was chiefly prepared for questions about which image was clearer: one, or two.

Or when the website asked me a security question because I changed my browser: “What is your mother’s maiden name?”

You mean, what was her maiden name.

Today is Easter Sunday. Christian clergy across the world shared verses from the Gospels today, perhaps even this one from the Book of Luke:

Why do you look for the living among the dead? He is not here; he has risen![1.
Luke 24:5-6.]

Sometimes we do not even seek the dead among the dead. We know that they will be there; we know that they have not risen.

We don’t need to seek the dead among the living. They appear throughout our lives, sometimes when we least expect it.

Categories
Nonfiction Observations Reflection

Reflections from the National Council Conference.

So I attended the National Council for Behavioral Health conference[1. The National Council also named me a “top tweeter“. Two people suggested that I add that to my CV.] last week with close to 7000 other people, the vast majority of whom were not my closest friends. When I reflect back over the conference, three and a half talks come to mind as noteworthy:

Mess Up Your Costing and It Will Cost You Everything. I was not the target audience for this talk. Scott Lloyd, the president of a consulting company associated with the National Council, noted that the intended audience included CEOs and CFOs. And, indeed, much of his talk focused on managing costs in a behavioral health organization so expenses don’t exceed revenue. Like many other talks at the conference, he highlighted the use of data, making it transparent to all staff, and encouraging financial leadership at organizations to explain what the data means so staff understand what they’re looking at.

What struck me most about his talk, though, was the amount of time he spent telling the audience—repeatedly—that they cannot demand their clinical staff to “do more”. He recognizes that clinical staff are already doing as much as they can. He instead urged the audience to do whatever they could to make the lives of their clinical staff easier (e.g., reduce documentation burdens). That helps organizations retain staff and promotes staff satisfaction.

It’s always nice when an administrative leader advocates for the workforce. And I got to learn more about the lens CFOs and CEOs use while at work.

Fireside Chat with the Surgeon General. I’ve already written about my impressions of the Surgeon General when he spoke to a room of about 30 people. This time, Admiral Murthy was on a stage in front of several thousand people. He told stories; he spoke about the important people in his life who have shaped his worldview; he spoke with humility about his role.

He didn’t share groundbreaking policies or ideas. He simply shared himself and his values with the audience. His wisdom and grace seems uncommon in people of his age and status.

Listening to him speak made me reflect upon what I do in my professional roles. His talk inspired me to do and be better.

Fireside Chat with CMS. I don’t understand all the regulations that come out of the Centers for Medicare and Medicaid Services (CMS), which is why I decided to hear what CMS had to say.

I was surprised when the CMS representative identified himself as the chief medical officer! Of course CMS would have a medical director, though I didn’t expect that he would speak at this non-physician conference. I was delighted to learn that Dr. Patrick Conway continues to see patients as a pediatrician. He asked for ideas and feedback from the audience and didn’t run away when his scheduled time was over. (A mob of close to 30 people, out of an audience of several hundred, came up to him afterwards to ask him more questions.) He acknowledged that the regulations that CMS imposes get in the way of innovation.

Sometimes I forget that some people who work in bureaucratic administrations want things to change, too. It’s also hard for a single person to change the direction of a bureaucracy. However, I appreciate the efforts of these single individuals because at least they’re trying. I also appreciate Dr. Conway making himself open and available to field questions from a room of people who may not have the warmest feelings towards CMS.

Social Determinants of Health. Two speakers shared the hour to discuss their respective activities. One speaker was Dr. Michael Sernyak, who spoke about his efforts in addressing “food insecurity” and nutrition in a community mental health center he oversees in New Haven, Connecticut. He shared his story about working with community partners to improve the quality and nutrition of food served in the center, which included cultivating a community garden, hiring a nutritionist, and providing explicit training to both staff and patients about the role and importance of nutrition in (behavioral) health care. He also spoke about the unintended benefits of this program: Apparently residents who live near the community garden have reported that the neighborhood is now safer.

The National Council is not a physician conference. He noted that, when his gave this exact same talk at the American Psychiatric Association conference, which is a physician conference that also has an attendance of thousands of people, only four people attended. At this conference, the room was packed: People standing at the perimeter of the room and others sitting on the floor in the aisle.

I liked both the simplicity and elegance of his vision, particularly since food affects health in more ways than one. I also appreciate that, while this intervention was simple, it was not easy.

I’m grateful that I was able to attend the conference and learn what other people are thinking and doing. I won’t lie: I also followed all the suggestions for coping with the conference and still felt cognitively impaired by the second day. Quiet and solitude are wonderful things.

Categories
Random

Suggestions for Coping with a 5000-person Conference.

So you’re about to attend a conference with five thousand other people. Maybe you don’t enjoy being around thousands of people for multiple hours over several days. Your reasons are your own, though they might include the endless small talk; walking with, through, and around hundreds of people just to get from one end of the building to the other; or the overstimulation of hearing the surrounding conversations, seeing the throngs of people, or sensing not only your restlessness, but also the restlessness of thousands of other people stuck in the same building.[1. I am always delighted if people find posts like this one helpful, though this one is clearly a reminder for me. I’ll be at the National Council for Behavioral Health Conference this week. And, while I am pleased with the opportunity to learn stuff, I’m not thrilled with the prospect of spending three days with five thousand other people.]

Here are some suggestions to cope with make the most of your time at the conference:

Sit up front and near the center aisle. By sitting up front, you’re more likely to forget about all the overstimulation people behind you. Sitting next to the center aisle (if there is one) does the same thing; you don’t have to look over an entire room of heads to see and hear the speaker. If you’re more comfortable with one-on-one conversations, this seating strategy mimics that interaction: You can tune everyone else out and focus on the speaker.

This strategy doesn’t work well for speakers presenting to enormous rooms because the seats up front are often pressed up against a stage… which puts you close to loud speakers and Powerpoint presentations with words that are wider than your head. In that case, I still suggest sitting near the middle, though you’ll have to decide how many dozens of people you want to climb over and can tolerate for at least an hour.

Bring your own meals, snacks, and beverages. If you don’t like spending time with thousands of people, I am going to guess that you also don’t like waiting in lines with dozens of people who are hungry and thirsty. Packing your own food will give you the freedom to find a quiet corner or hallway between sessions or during lunch while everyone else is waiting in line.

Learn the locations of the bathrooms that are a little out of the way. This is particularly useful for the ladies because it is entirely possible that several hundred women will use the women’s restroom at the same time. If you use the bathrooms that are a little out of the way, you are less likely to both wait in line and have to make small talk. You are thus more likely to have a few more quiet moments to yourself.

Bring a lithium battery charger for your phone. This ensures that you will have sufficient charge to text your other introverted friends and colleagues when you want to share something without talking. You also won’t have to worry about your battery draining when you’re live-tweeting the sessions. And, if you really need to tune out, you’ll have the power to plug in headphones between sessions and listen to music you like. The visual cue of headphones prevents most people from approaching you to talk.

Sit by yourself with your nametag out of sight. The more people at a conference, the more anonymity you can have. If you’re one of a thousand people sitting in a room, you can easily surround yourself with others who also don’t look interested in talking to strangers. Being alone all together often doesn’t feel overstimulating because that pocket of people is focused on the speaker, not on each other.

To be clear, sometimes this strategy backfires: You might sit down next to someone who looks uninterested in small talk, but then she starts asking for your name, where you work, and what you do there. This is my “woo woo” strategy, which is going to sound weird, but it works for me: If I’m not in a space where I want to talk to people, I make a point of “turning my energy down/making myself invisible” before I walk into a room. I literally tell myself, “Okay, Maria, make yourself invisible.” In my mind’s eye, there is a light—like a spotlight—that emanates from my chest outward into the world. When I make myself invisible, I dim that light in both color and intensity. My body language and “energy” must visibly change because people leave me alone.[2. Conversely, there are times when I want to make sure I’m visible. I “turn up” the light before I teach or give presentations. I also brighten the light when I’m crossing the street and a mob of people are walking towards me. Again, my body language and energy must change sufficiently because most people get out of the way.]

Remember why you’re there. Remember that you don’t have to talk to anyone. If your goal is to learn from others, you don’t have to do anything but listen. If you have questions, you’ll naturally ask them. If other people talk to you, you don’t have to have a conversation with them. There are ways to stop talking without coming across as rude, though many of these strategies involve avoidance. If these are people who don’t know you, though, they won’t think about or remember you or what you did. Provided that you were courteous and didn’t zip a sweater over your entire head when they started talking to you.

You’re not the only person who feels overstimulated at these sorts of events. There are plenty of other people who will feel relief that you’re not introducing yourself with the energy of a thousand suns, talking about the weather that lacks the light of even one sun, or asking questions to determine how you should file them into your mental catalog.

And, lastly, remember that you’re not a curmudgeon. You’re just an introvert attending an extroverted event in an extroverted world. Good luck.

Categories
Education Informal-curriculum Lessons Medicine Observations Reflection Systems

Thoughts on the Movie “Get Out”.

Have you seen the movie Get Out? If you haven’t, what follows might spoil part of the movie for you. You might want to watch it before reading this.

If you have seen Get Out, this post ponders the role of psychiatry in the movie. (Full disclosure: I enjoyed and recommend the movie.)

We learn early on in the movie that Rose’s mother is a psychiatrist. Chris, Rose’s boyfriend, asks something like, “She’s a psychologist?”

The response Chris receives is something like, “No, she’s a psychiatrist.”

While I can’t know for sure, I believe that the writer of the film, Jordan Peele[1. If you are not familiar with Jordan Peele, please go watch some clips of Key and Peele.], wanted to highlight the difference between the two. Psychiatrists are physicians. And some physicians, under the guise of expertise, have promoted racist ideas.

Dr. Samuel Cartwright was a physician who practiced in Alabama, Mississippi, and Louisiana in the years leading up to the American Civil War. He defended slavery and wrote pieces that argued that blacks were inferior to whites.

One of his articles, “Diseases and Peculiarities of the Negro Race“, describes “drapetomania, or the disease causing Negroes to run away”. Because he describes drapetomania “is as much a disease of the mind as any other species of mental alienation”, it is clear that this is a psychiatric condition, such as kleptomania (compulsive stealing), pyromania (compulsive fire-setting), and dipsomania (the old name for alcohol use disorders).

In this article Dr. Cartwright asserts that God has ordained blacks as “submissive knee-bender[s]” and are “intended to occupy… the position of submission”. To support that blacks were destined to be “submissive knee-benders”, he states that “in the anatomical conformation of his knees, we see [it] written in the physical structure of his knees, being more flexed or bent, than any other kind of a man.”

To prevent the development of drapetomania, he states:

if his master or overseer be kind and gracious in his hearing towards him, without condescension, and at the same time ministers to his physical wants, and protects him from abuses, the negro is spell-bound, and cannot run away.

In Get Out, Chris (plus Georgiana, Walter, and Andrew) becomes obviously “spell-bound” through the hypnotic powers of the porcelain cup and silver spoon. One could argue that Rose is demonstrating faith in this practice as she was initially “kind and gracious”, “without condescension”, “ministers to his physical wants”, and “protects him from abuses” (remember the police officer who pulled them over?).

Dr. Cartwright comments that, in the course of drapetomania, slaves become “sulky and dissatisfied” before they run away. He advises that “the cause of this sulkiness and dissatisfaction should be inquired into and removed, or they are apt to run away or fall into the negro consumption.” However, if slaves were “sulky and dissatisfied without cause,” he states that the treatment was “in favor of whipping them out of it, as a preventive measure against absconding, or other bad conduct. It was called whipping the devil out of them.”[2. Wikipedia also comments that another treatment for drapetomania included “removal of both big toes”, which makes running difficult.]

Chris becomes understandably “sulky and dissatisfied” with his time at the Armitage home and seeks to flee. Though he wasn’t whipped to treat his drapetomania, it’s not a hard stretch to argue that the plan to remove most of his brain (“coagula”) is essentially whipping the devil out of him so that only his body remains.

Dr. Cartwright apparently published these ideas in the New Orleans Medical and Surgical Journal (as well as De Bow’s Review, a magazine of “agricultural, commercial, and industrial progress and resource” in the American South). This publication came from his work as the chairman Louisiana State Medical Convention committee. One of their tasks was to “examine the diseases peculiar to the Black slaves of the antebellum South”.[3. From a Lancet article called “Drapetomania“.] This was a professional medical opinion!

To be clear, not all physicians agreed with Dr. Cartwright’s opinion. Dr. Hunt, a physician who practiced in Buffalo, New York—that is, North of the Mason-Dixon line—lampooned Dr. Cartwright’s concept of drapetomania. He rightly wondered why drapetomania seemed to only exist in the South. He made wry remarks that drapetomania seems to affect the neurons of slaves so that they only flee in a northerly direction. He also pointed out that drapetomania resembled the condition of schoolchildren who ran away from school to play.

In essence, Dr. Hunt shouted, “Context matters!”

Dr. Cartwright sincerely believed that drapetomania was an inherent quality of black people.[4. Dr. Cartwright also described “dysaethesia aethiopica“, or “hebetude or mind and obtuse sensibility of body” that only occurred in blacks in the South.] As he was a fish in the sea of Southern slaveowning culture, he either could or would not believe that social and political context affects the definitions of psychiatric conditions. (He also could not believe that his ideas were wrong.) Maybe Jordan Peele was thinking about Dr. Cartwright and drapetomania when he created the characters in Get Out. Maybe he wasn’t; maybe he was pointing out the consequences and longevity of racism.

Psychiatry has been and can easily become an agent of social control. The moment we begin to think that we’re too good or too smart or too sophisticated to become agents of social control, we and the people under our care are doomed.

It is paramount that we remember this always in the current political climate. May we have the wisdom and courage of Dr. Hunt.