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Benadryl.

They spotted her in the hallway of the hospital. Sensing people approaching, the doctor turned around and saw two young men walking briskly towards her. She recognized one of them. They both looked eager.

“Hey Doc! Here’s a question you can answer,” the familiar face said. Though not even old enough to legally purchase alcohol, he unfortunately had many experiences with hospitals and emergency rooms. His young body, for now, was able to keep up with his often frenetic mind that often propelled him into conflict.

The other one, a close friend of his, had never been a patient in a hospital. He looked at the doctor and gave a half smile in greeting.

“Okay,” she said, inviting them to speak.

Benadryl,” the naive one said. “That’s an allergy medication, right?”

“No, no, Benadryl is a sedative, right?” the experienced one said. After exchanging glances with both his friend and the doctor, he blurted, “That s— keeps you down!

An uncomfortable smile crept onto her face. “It’s both. It can help with allergies and, well—”

“—they put it in the needles in the emergency rooms all the time when people are out of control, right?” the experienced one said again, pushing his shoulders back and grinning as he looked at his friend.

She paused.

“Right,” she eventually said. Though her voice was even, her eyebrows furrowed. “Sometimes it’s mixed with other medications to help… people calm down.”

By now, they weren’t listening. The naive one looked surprised. The experienced one was waving his arms in triumph as he exclaimed, “See? What did I tell you?”

“Yeah, but it’s an allergy medication, too,” the naive one countered. They walked away, absorbed in their conversation.

Her eyes watched them slip into the stream of people. She caught herself rubbing her shoulder.

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Leadership.

The white coats formed a small circle in the hallway. Rounds were under way and the intern finished presenting the patient. He looked up at the attending physician. The two medical students and other intern followed suit. The senior resident looked blankly at the attending. The nurse taking care of the patient walked by and slowed down, hovering outside of the circle.

Other small circles dotted the hallway, all different teams rounding on their patients.

The door to the room was open. After telling the young physicians that he was tired, the patient asked them to come around another time. He then rolled over and ostensibly fell asleep.

The attending took a sip of coffee from the small paper cup and swallowed.

“Nice presentation,” he began. “But, you all should know that this patient is an sociopathic s—head and should be treated as such.”

The nurse looked down and stifled a cough. The medical students reflexively glanced at each other and raised their eyebrows. The intern scratched the back of his neck. The senior resident looked blankly at the attending.

Thereafter, they all avoided that room as much as possible.

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Restaurants and Self-Monitoring.

For fun, some people collect things like stamps, coins, and music. I apparently collect data.

One of my goals in 2010 was to keep a record, using Google Maps, of all the restaurants I dined in. New York City has 24,000 restaurants, many of which feature dishes from countries around the world. I wanted to make a record of my culinary travels.

Other than that, I didn’t have further goals in collecting this information. I did wonder what the map and list would look like at the end of the year: What types of cuisines did I eat? Where did I tend to dine? How many restaurants did I visit?

The act of collecting this information is called “self-monitoring”.

It appears that I visited 146 unique restaurants in 2010. Most of them, marked by blue icons, are in Manhattan:

Map of Manhattan restaurants

I apparently did not eat in the Upper East Side in 2010. (The lone blue marker near Marcus Garvey Park is Taco Mix, which is essentially an indoor taco truck. The staff there do not speak English and there are no menus, but the tacos are tasty.)

Here is a a graph that describes the types of cuisine I most frequently ate:

Top cuisine choices

That American category includes diners, those establishments that are open 24 hours a day and feature hundreds of items of their menus, ranging from silver dollar pancakes to broiled lobster tails. The “Mexican fast food” category includes two different Chipotles and one Taco Bell. (I had not eaten at a Taco Bell in over a decade and went there for that exact reason.)

Here is the remainder of the list:

  • Korean
  • Middle Eastern/Mediterranean
  • Burgers
  • Vietnamese
  • Italian
  • Lodging (1 hotel restaurant and 2 bed and breakfasts)
  • Greek
  • Jewish deli
  • Vegetarian/Vegan
  • South American
  • American fast food
  • Malaysian
  • French Caribbean
  • Asian fusion
  • Caribbean
  • Russian
  • Cambodian
  • Himalayan
  • Airport (not a type of cuisine, but a class in its own right—Charlotte, NC, in this case)
  • Polish
  • Filipino
  • Bagel
  • Cuban
  • Peruvian
  • Venezualan
  • Indonesian

I apparently favored restaurants that feature cuisine from the Asian continent. Foods from Africa, Australia, and Antarctica (…) are missing. Now that I know this, I could seek out foods from those regions. (I am surprised that I did not eat any Ethiopian food in 2010. There is an Australian savory pie shop in Manhattan that I visited in 2008.)

While most of the restaurants I ate at were in the state of New York, I also ate elsewhere:

State distribution

Other things I could look at:

  • What was the average cost of my meals over the year?
  • Who did I eat with most often?
  • On which day of the week was I most likely to go out to eat?

Is this sort of data gathering self-indulgent? Sure. But, ample evidence supports self-monitoring as a means of changing behavior. This kind of data gathering helps people figure out (1) where they are now and (2) where they want to go. It helps with setting and reaching goals, even if there is no initial intention to change.

Tracking weight over time is a strategy used to help with weight loss. Doctors and nurses encourage people with diabetes to track their blood sugars regularly because the act of following it increases the likelihood that the values will fall within a healthy range. Measuring how much time you spend checking your e-mail each day may give you some information about how connected—or disconnected—you are.

Consider tracking some data about yourself in 2011. It doesn’t have to be anything “serious” like tracking your finances. If you’re not already doing that in some capacity, jumping straight into that may actually be punishing. The initial exercise should ideally be interesting and fun. (Try Joe’s Goals.) Once you’re comfortable with self-monitoring and have found it useful, then you can tackle more “serious” topics.

Self-monitoring can help you change your own behavior and your own story for the better.

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A Lot of Prescriptions (IV).

During the drive to the clinic, Ms. Blue thought about what she would tell her doctor. She didn’t want to come across as whiny, but she also wanted him to understand how she felt. Maybe he could give her something that would take the discomfort away.

Shortly after she was escorted into the examination room, Dr. Fixit walked in.

“Hello, Ms. Blue,” Dr. Fixit said. “How can I help you today?”

“I’ve been really tired lately.” Ms. Blue paused. “My dad died about a month ago. I haven’t been able to sleep.”

“Sorry to hear that,” Dr. Fixit said.

“Yeah. My mom has dementia and he was taking care of her. Since her memory has worsened, we’ve helped each other out. He and I were really close. Since he died… well, I’m not sleeping, I’m tired, I’m not eating, and there’s a lot of stuff I have to do, like take care of Mom. Is there a pill I can take for all of this?”

“Can you tell me more about how you’ve been feeling? Hopeless? Depressed?”

“Depressed? My dad just died. I think it’s normal to feel not so great when that happens. Look, I’m getting over it, but I need to feel a little more energy, a little better. Maybe you can give me an antidepressant for a short while?”

“Yes, some people find antidepressants helpful, though I’d like to know more about your symptoms—”

“Doctor, I appreciate that, but, really, my dad just died and I don’t want to talk about it. I just want to feel better. If there’s a medicine that can help, I’d like to try it.”

Dr. Fixit searched her face for emotion. She looked back at him blankly.

“I understand, but I do need more information. Have you felt hopeless about this? Crying a lot?” he asked.

“Nope.”

“Are you eating?”

“Like I said, not much.”

“Have you lost weight?”

“I wish.”

“Have you had any thoughts about wanting to be dead?”

“Nope.”

Dr. Fixit wrinkled his brow.

“Given what you’ve told me, you might find it helpful to talk with someone about—

“—but I’m not interested in that. When people have the flu, you don’t ask them to talk about it, right? You prescribe whatever it is that you prescribe to treat flu so that they’ll feel better. I don’t feel good because my dad died. I don’t want to talk about it. I just want to feel better so I can get stuff done.”

Dr. Fixit searched her face again. “Right,” he finally said. “But let me listen to your heart and lungs, just to make sure they’re all right.” His gaze settled into the middle distance as he moved his stethoscope first across her back, then over her chest. After pushing on her belly, he said, “Everything seems fine.”

After writing something onto his prescription pad, he handed the top sheet to her. “This is an antidepressant. It takes a few weeks for the effects to kick in. It may take less time, it may take more. Some people have problems with dry mouth, feeling sleepy, stomach upset, and sexual difficulties, like a longer time to climax. I’d like to see you in a month to see if things are better.”

“Great. Thanks for the medicine. I hope it helps,” Ms. Blue said, collecting her things.

While walking out of the building, she checked her watch. She hoped that there wouldn’t be a long line at the pharmacy.


Later on in the day, Dr. Fixit pulled Ms. Blue’s chart from the file and reviewed his notes.

It’d be nice if more patients were like her, he thought. They know what they want and they don’t go on and on about their problems. Maybe she’ll even be one of those people who responds to antidepressants in a few days.

After scribbling his signature on the note, he closed the chart and tossed it onto the others across the desk.


This is part of a series about why some physicians write many prescriptions for psychiatric medications. You can read more stories here.

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Aging.

In the waiting room of the laboratory was an elderly man. Hearing aids plugged his ears. Wiry hairs stuck out of his ears and nose. The thick lenses of his glasses made his pale blue eyes look smaller. He was slouching in the chair.

People quickly walked in and out of the room, each on a mission. His head swiveled on his neck as he followed them with his gaze. As one person was about to exit his field of vision, another person appeared and he rotated his head back again.

Several people passed in front of him in rapid succession. His mouth was hanging open as his head swept through several oscillations.

His head was rotating to the right when a young woman looked at him. She smiled.

“Getting dizzy,” he commented.

She laughed and kept walking. He smiled and rotated his head back.