Categories
Nonfiction Observations

Trump and Bundy.

When I read what Donald Trump said, it immediately made me think of comments by Ted Bundy.

From today’s New York Times:

“Ownership is very important,” Mr. Trump said as he discussed, with a real estate mogul’s eye, the landmass of Greenland….

When asked why he needed to possess the territory, he said: “Because that’s what I feel is psychologically needed for success. I think that ownership gives you a thing that you can’t do, whether you’re talking about a lease or a treaty. Ownership gives you things and elements that you can’t get from just signing a document.”

From the Wikipedia page about Ted Bundy:

Possession proved to be an important motive for rape and murder as well. Sexual assault, [Bundy] said, fulfilled his need to “totally possess” his victims. At first, Bundy killed his victims “as a matter of expediency … to eliminate the possibility of [being] caught”; but later, murder became part of the “adventure”. “The ultimate possession was, in fact, the taking of the life”, he said. “And then … the physical possession of the remains.”

And further elaboration:

“[Bundy] said that after a while, murder is not just a crime of lust or violence”, [FBI Special Agent] Hagmaier related. “It becomes possession. They are part of you … [the victim] becomes a part of you, and you [two] are forever one … and the grounds where you kill them or leave them become sacred to you, and you will always be drawn back to them.”

When one covets this much, it is no longer possible to recognize the humanity of others.

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
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?

Categories
Homelessness Nonfiction

Neither Sex Nor Drugs.

While it was happening I recognized that it didn’t look great.

My outreach colleague was driving and slowed down. After rolling down my passenger side window, she leaned over and shouted a name.

The Woman she was shouting at was walking on the sidewalk towards us. Her stiletto knee-high boots were the same color as her miniskirt. The bustier did not fully cover her waist. Bright eyeliner and false eyelashes made her eyes pop. The purse slung over her shoulder swung with each confident step she took.

The Woman didn’t hear my colleague, so I shouted the same name out the window. She turned and took a few steps towards the car. I pointed at the driver. The Woman smiled in recognition, revealing many missing teeth, and came to talk with us through the window.

It could have looked like we were negotiating money for sex.

“I’ve been looking for you,” my colleague said, turning on the emergency lights. “I have a lot of mail for you.”

The Woman and my colleague discussed meeting at the office so she could get her letters. A toothless smile again bloomed on The Woman’s face as she blurted out, “Oh! I haven’t used fentanyl in 14 days!”

Dear reader, I had no idea who this person was; I just met her. That didn’t stop me from bursting into applause. I was the only one clapping. It was a reason to celebrate! She beamed.

“Where are you staying now?” my colleague asked after congratulating her.

“I live in That Neighborhood now,” The Woman said. “Near That Street and That Avenue. There’s a hole in the fence near that intersection. Go through that hole and a little further back through the trees, and you’ll find me there.”

Through a fence and then on a dirt path in stiletto heels!

Don’t judge a book by its cover.