Category: Observations

Categories
Nonfiction Observations Seattle

Bridges, Frustration, and Coping.

The longest floating bridge in the world is in Seattle. It is 7,710 feet (2,350 meters) long and spans beautiful Lake Washington. Locals call it the “520 bridge” and, in its current incarnation, only cars may use the bridge.

Yesterday, the Washington State Department of Transportation hosted the grand opening of the new 520 bridge. On the bridge were several food trucks, booths with information related to the engineering and construction of the bridge, and equipment and heavy machinery used in its creation.

To get to the event from Seattle, people had to take shuttle buses that originated at the University of Washington campus. The buses drove about three miles on the old bridge and delivered the crowds to the start of the new bridge.

Tens of thousands of people took the opportunity to walk across the bridge and enjoy the surrounding views that, prior to then, one could only enjoy by car.

In the early afternoon hundreds of people got in line to get back to Seattle. A young man wearing an orange vest carried a sign that read “End of the Line Here”. He folded the line back and forth to compress hundreds of people into a narrow area while we awaited the shuttle buses.

Behind us were two women who appeared to be in their 60s. One wore a visor that pushed her short white hair out of her face. The other had a greying bob.

“This is ridiculous!” Visor exclaimed. “This isn’t organized at all! We’ve been waiting in line for over 30 minutes and I don’t see any buses coming!”

“I know!” Grey Bob agreed. “We haven’t moved at all. This is terrible. This is ruining the entire event!”

Thin white clouds were streaked across the bright blue sky. A refreshing breeze swept around us. Mt. Rainier stood in the distance, a lenticular cloud atop its peak like a floating hat.

“OH MY GOD we’re actually moving!” Grey Bob squealed as the line shuffled forward. “We might actually get off this bridge!”

“I’m not going to be that optimistic,” Visor replied. “I’m going to wait until we actually get to UW before I say that.”

Shimmering white light danced on the dark blue ripples of Lake Washington. As the clouds dissolved under the sunlight the snow-capped peaks of the Cascade Mountains revealed themselves. A media helicopter, less than 100 feet above us, drifted past.

“HELP US!” Visor screamed at the helicopter.

When we could no longer hear the helicopter, Grey Bob sighed, “It’s been over 45 minutes. This is unacceptable.”

“If I have to wait in line any longer, I’m going to jump over the side of the bridge and kill myself,” Visor squawked.

Grey Bob laughed before commenting, “The barriers aren’t that high. Someone could really jump over. It wouldn’t be that hard.”

“Oh yeah, you’re right,” Visor said, her voice non-plussed. “That’s not good.”

At around 55 minutes the line was no longer still. We walked in quick strides towards five buses. Two of them faced West to go to UW. Three of them faced East.

“All the buses are gonna go to Seattle,” the event planner shouted at us. “Get on any bus on the other side of the barrier. All the buses will go West.”

I smiled as I watched my father scramble over the barrier—while not a spring chicken, he is still spry—and my husband and I made a point of scurrying away from Grey Bob and Visor. The three of us got on a bus facing East.

Nearly 100 of us packed into the bus. My father sat to my right. A woman in her 50s wearing a bicycle jersey sat to my left. My husband gave up his seat in an act of chivalry for her. He stood near the rear exit of the bus.

The bus headed East towards the fancy-pants neighborhoods of Medina and Hunts Point. Once the bus was off the bridge, it passed an exit. Then another.

“WHAT?” Bicycle Jersey exclaimed. She leaned forward and barked at her friend, an older woman with glasses reading a newspaper, “Why is the bus driver not turning around? Doesn’t the driver know that we’re supposed to go to SEATTLE?”

Someone pulled the wire to signal the bus to stop. People snickered.

The bus slowed to a halt at an intersection with several other shuttle buses. It did not move for nearly 15 minutes.

“This is so disorganized,” Bicycle Jersey said. “This is not worth it. This has ruined the entire day for me.” Her right thumb scrolled through an article by Nick Kristof: “When Whites Just Don’t Get It”.

The bus then crept north towards Kirkland.

“WHAT?!” Bicycle Jersey shouted. “Why are we going to Kirkland? We’ve been on this bus for over half an hour! We should’ve gotten on a bus that was going the other way. They’re already back home.”

“I never take the bus,” a woman standing over my dad said to no one in particular. “I’m never doing this ever again. Unless it’s a shuttle bus at a really nice wedding. And I mean a REALLY nice wedding.”

A young man with facial stubble near my husband hugged a pole. “We’re almost out of water. We’re going to die on this bus.”

“It’s like we’re hostages on this bus,” Bicycle Jersey spat.

The bus stopped at the Kirkland Park and Ride, but not at the curb.

“He better not make us get off this bus,” Bicycle Jersey said.

One man got off the bus.

“Did we come all the way here just for that one guy?” Bicycle Jersey continued. “What about the rest of us?”

The bus rolled back down the hill and stopped at an intersection.

“WHY WON’T THE DRIVER GET BACK ON 520?” Bicycle Jersey shouted. “TURN RIGHT HERE.”

“We’ve been on this bus for almost an hour,” Facial Stubble announced.

When the light turned green, the bus turned right and we were back on 520.

“We’ve been on this bus for almost an hour,” Facial Stubble announced again.

The bus rolled past the line of people waiting for buses. It was nearly a mile long now.

“DON’T GET ON A BUS HEADING EAST,” Bicycle Jersey shouted at them. None of the windows of the bus were open. The bus was going over 40 miles an hour.

“We’ve been on this bus for an hour now,” Facial Stubble said. “This is the worst mistake of my life.”

Some people have to wait over an hour every day just to get food and water.

I’m going to guess that you ate breakfast this morning. I’m also going to guess that you’re going home. Because you didn’t have to work today.

You’re not showing any overt signs of dehydration. Shut up. You’re not going to die.

The only person holding you hostage right now is you. Your bitterness isn’t going to make us get back to Seattle faster.

If you are joking about suicide because you’ve been waiting in line outside on a beautiful day for 45 minutes, how do you deal with actual stress?

Maybe you sustained a brain injury in your frontal lobe and that’s why you have low frustration tolerance.

Maybe your prefrontal cortex hasn’t fully developed yet. That process isn’t complete until your mid-20s, at which point you’ll hopefully have better impulse control.

Maybe no one ever taught you emotion regulation and distress tolerance skills. So maybe this is a skills deficit.

Maybe you’re having a rough time in life right now. Maybe a relationship you value is ending. Maybe someone you care about is sick and dying. Maybe, under different circumstances, you’d exercise more patience.

Maybe you’re a victim of specific operant conditioning: Maybe you’ve learned that people only pay attention to you and value what you say when you’re expressing snark or distress. And that people will only take you seriously the louder you talk.

My dad shrugged.

“We just had bad luck today.”

Categories
Observations Reading Reflection

Year in (partial) Review.

One of my goals in 2015 was to post something here at least once a week, for a total of 52 entries. Including this one, I posted 48 entries this year. (I did not have a similar goal in 2014 and, as a consequence, I posted only 25 entries last year.)

The post I wrote this year that received the most views discussed whether people choose to be homeless.

The post from this year that came in second place for most views discussed the experience of grief.

The post that received the most views this year wasn’t even a post I wrote this year; it was a post from 2013 about the DSM-5 criteria for schizophrenia.

Another goal I had for 2015 was to read more books. I didn’t keep track of the number of books I read in 2014, but I think I read more books this year (23) simply because I had a goal. In addition to the books listed in the footnote here, I also read:

Stitches (Lamott)
Bossypants (Fey)
The Practicing Mind: Developing Focus and Discipline in Your Life (Sterner)
I Know Why the Caged Bird Sings (Angelou)
Boundary Spanning Leadership (Ernst) – not yet finished

I do recommend all of them, with the exception of the last one, only because I have yet to finish it.

Thank you for reading my writing this year, particularly those of you who have been reading my words and sentences for over ten years. See you in 2016.

Categories
Consult-Liaison Education Lessons Observations

More About Questions.

Last week I riffed on the importance of “what is the question“. This week I will riff on a related topic: “How will the answer affect what you do next?”

If the answer to your question won’t change what you will do, then perhaps you don’t need to ask the question.[1. This I definitely learned in medical school. It was usually phrased, “How will this affect your management?” If you’ve made the decision to prescribe an antibiotic for pneumonia, then there’s no reason to get a chest X-ray. It doesn’t matter what the answer is to the question, “What will we see on the chest X-ray?” Thus, don’t order the X-ray.]

If you know that you friend isn’t the biggest fan of cake, but you’re going to serve cake at the party anyway, there’s no point in asking your friend, “Do you like cake?” or “Do you mind if I serve cake?”

Sometimes we ask questions not because we want to learn the answer, but because we want to say something. In the above example the question “Do you mind if I serve cake?” may actually mean “I hope you won’t feel angry or disappointed that I am serving cake”.

Consider meetings or conferences where audience members have opportunities to ask the speaker questions. Sometimes the people who raise their hands to ask questions either (1) never ask an actual question, or (2) ask a question that they then answer themselves, whether the group wants to hear it or not.

To be clear, I’m not saying that we should never ask questions unless the answer will influence our next actions. Asking questions is how we learn about ourselves and the world around us.

When I first moved to New York from Seattle, many of my colleagues in New York asked me about how much it rains in Seattle.

“It actually rains more in New York than it does in Seattle,” I would reply, sometimes with unnecessary smugness.[2. I do like the Merriam-Webster definition of smug. It makes it clear that it is always annoying and never necessary to be smug.]

The question was, “Does it rain more in Seattle than it does in New York?” The answer was “no”, but it didn’t change anything anyone did. No one moved from New York to Seattle to experience less annual precipitation. It didn’t stop me from moving to New York. I still wore trench coats in both cities (though got one with more style in New York) and covered my head as needed. That there is more annual precipitation in New York is just interesting.

It is nonetheless worthwhile to consider the reasons behind questions you ask. Sometimes the answers to your questions will affect what you do next. Sometimes your questions help you learn more about other people or phenomena in the world. Sometimes your questions address only your own psychological needs, which often has bad outcomes for everyone involved in the conversation (e.g., “Do I look fat in this?” or “Are you getting your period?”).

Be careful what you ask for.

Categories
Observations Reflection Seattle

10,000 Windows.

“I think I can see 10,000 windows,” my dad said as we looked out of his apartment. On the other side of the glass was a view of downtown Seattle.

“10,000?” I did not mask the incredulity in my voice. “Is that a good thing?”

“Yes, it is,” he replied. “More windows means more people. We all need people in our lives. According to feng shui, the more windows you can see, the more influence, more popularity you will have.”

“But 10,000?” I asked again.

“Yes,” he said. “I can see the Columbia Tower and that alone has several hundred windows. Think about all the other windows of the skyscrapers….”

“Yes,” I said. “10,000 windows.”

We had lunch at a hole-in-the-wall restaurant in Chinatown. He expressed his pleasure with the food to the waitress. She had immigrated to the US about ten years ago. My father had immigrated to the US nearly 45 years ago. When he spoke to her in Mandarin, he used a phrase to describe his immigrant status that I didn’t understand.

“There’s a special term for us,” he said. “We were born in China, so when we fled to Taiwan [to escape the Communists], we were considered ‘mainlanders’. We were different. Not everyone from Taiwan had the opportunity or means to immigrate to the US. So we were considered different again. When we immigrated to the US, we were considered ‘Chinese’ and still different—”

“—an alien no matter where you went,” I finished.

“Yes!” my father exclaimed with a smile.

My father always insists on picking up the bill when we go out to eat. He and the waitress began talking again:

“Have you lived in Seattle since you immigrated?” the waitress asked.

“No, I moved up here to be with her,” my father said as he pointed to me. “She’s my daughter. My wife passed away last year.”

“Oh. She was born in the US, wasn’t she?”

“Yes, I was born here,” I answered in Mandarin. “That’s why my Chinese isn’t very good.”

“It’s not that your Chinese isn’t very good. You speak with an American accent,” the waitress said to me. Turning to my father she continued, “She’s very well-mannered. I could tell when you both walked in.”

Suddenly, I was eight years old again. I sat still, said nothing, and kept my face neutral. This is what you’re supposed to do when your elders say nice things about you.

My father nodded and smiled. “She is courteous; she has class.” After taking a sip of tea, he continued, “My daughter is also a doctor.”

I winced. They only saw me blink.

Daughters must be humble so their parents can show their pride. I swallowed my embarrassment with my tea.

My mother used to do that all the time, too: Out of nowhere she would tell strangers that I was a physician.

“Why do people need to know?” I used to complain. It never changed their behavior, so I stopped sharing my objections with them.

There are now other things I don’t share with my father.

“How’s work?” he asks.

“Work is fine,” I say. Work is always fine. I don’t tell him the terrible things patients have said to me. I don’t tell him about the injustices of the system: Was it designed this way? Are these perverse outcomes from good intentions? I don’t tell him that I hustled him into a restaurant to avoid an encounter with a patient I worked with in jail.

Every time we see each other I tell him I love him—a brash thing to do in a culture that values stoicism. I don’t tell him how anxious I feel when he doesn’t respond to my text messages within an hour: Did something happen to him? Is he okay? Did he die?

I don’t tell him how I still feel sorrow for the the death of his wife. I simply cannot imagine his loss.

He must know, though, just as I know about the heartache he still feels. It’s in his face, the way he looks into the distance, as if the past was just beyond the horizon.

We instead go out to lunch. I let him buy it for me and listen to him speak of the beauty and power of 10,000 windows.

Categories
Consult-Liaison Education Medicine Observations Reflection

Pay It Forward.

Prior to starting medical school, I had no desire to work as a psychiatrist. I had a plan: I’d become an infectious disease physician[1. I studied microbiology and molecular genetics in college. My fondness for bacteria persists.] or an oncologist.

During my psychiatry rotation as a medical student I spent four weeks on a consult-liaison service. I worked with an attending who was smart and excellent with patients. Though everyone agreed he wasn’t warm, he was genuinely kind. (He also wore bow ties and suspenders. His clothes never had wrinkles in them. Was this due to his military background?) My plans started to change.[2. It wasn’t a single moment that made me abandon my original intention to go into internal medicine. I still remember the case, though, that tipped me to go into psychiatry: One of my patients on the medicine service was a firefighter who had suffered a significant bleed in his stomach. I was able to talk about the cells and chemistries in his blood, the risk factors that contributed to his condition, and what he could do in the future to prevent this from happening again. Yet, I couldn’t tell anyone anything about him as a person, how he came to have those risk factors, how he perceived those risk factors, and if he had any desire or intentions to change his behaviors so that he could prevent this form happening again.]

Before starting my psychiatry residency, I had no particular interest in working with people experiencing psychotic symptoms (e.g., hearing voices, holding firm beliefs that are not rooted in reality, etc.). I had a plan: I’d become a consult-liaison psychiatrist and spend my days in hospitals spanning the boundary between acute medical care and psychiatry. There was a little of everything in consult-liaison psychiatry: the full spectrum of psychiatric conditions; brief psychotherapy; teaching patients, families, and, often, the staff of the primary medical service; starting and stopping medications to reduce distressing symptoms.

During my residency I found myself finding the most meaning when providing care to people with limited means: refugees from Southeast Asian countries; military veterans with few supports upon their return from wars ranging from World War II to the wars in Iraq and Afghanistan; people living in homeless shelters or on the streets. Medications were not always useful or indicated. The senior residents and attendings in these settings were astute, unpretentious, compassionate, and just good with people. My plans started to change.

Now, as an attending, my interests are a mix of all those things: I like working with people with significant psychiatric symptoms who often have limited means. I like working in teams to help people get better and out of the system, whether that is the hospital, the jail, or the mental health system entirely.

I spent over eight years of medical training under the supervision of “attendings”. It took me a few years to get used to people calling me “Dr. Yang”.[3. I still find it jarring when colleagues who routinely call me “Maria” suddenly address me as “Dr. Yang”.] I guess I’m not yet used to the idea that I am now an attending and people expect me to “know”:

  • a high school student who wants to interview me to ask about my work as a psychiatrist
  • college students who want to learn more about non-traditional work in psychiatry[4. Thanks for helping to inspire this post, Anna!]
  • medical students who want to know which psychiatry residencies they should apply to if they want specific training in working with indigent populations
  • residents who want to know which fellowships they should apply to if they are interested in public sector clinical and administrative duties
  • fellows who want to know where they should apply for work in non-traditional settings

It’s weird. Impostor syndrome persists: These people think I’m qualified to tell them?

When I think about all the people who guided me—intentionally or not—to where I am today, I find that the second best way to thank them is to pay it forward.[5. The first best way to thank people, of course, is to directly thank them for the specific things they said or did.] We need people who have the will and energy to serve the community, who are willing to think about and do things differently. Yes, interests change, plans change, people change. However, we never know how our words and actions may inspire those around us.