SHRINK TALK, THE DOCTOR IS IN

NEW YEAR’S EVE AND DAY

The Civil War: On Dec. 30, 1862, Union troops near Murfreesboro, Tenn., played “Yankee Doodle” and “Hail Columbia.” Their Confederate foes answered with “Dixie,” and the two sides ended the night playing “Home, Sweet Home” together. The battle that followed, fought between New Year’s Eve and Jan. 2, 1863, was among the war’s deadliest.
Also on New Year’s Eve 1862, abolitionists held vigils as they waited for President Lincoln to issue the Emancipation Proclamation. He did so the next day, freeing enslaved people in the states that had seceded from the Union. The vigils became the origin of the New Year’s Eve services that some African American churches still hold.
World War I: America entered World War I in 1917, and Times Square on New Year’s Eve that year was “thoroughly sedate and solemn,” The Times reported. Soldiers and sailors, forbidden to drink, sat in restaurants and hotels. Sugar was rationed, and dinner at the Waldorf Astoria was meatless. Broadway, “ankle-deep in confetti” a year before, was “gloomy, deserted and silent.”
Flu pandemic: New Year’s Eve 1918 also took place during a pandemic. A brutal fall and winter wave had killed tens of thousands of Americans. By Dec. 31, some cities had loosened their public health measures, inviting a more joyous holiday. “Hotels and clubs and other places where revelers congregate to greet the new year are overdoing themselves in the way of entertainment,” The Chicago Daily News reported.

HOPE EVERYONE IS SAFE.

rob 

Today, the world lost a treasured and valuable man. John Madden died today, causes unknown, at the age of 85. He is in the hall of fame as a player, coach and commentator. Coach Madden was known for his passion for the game and was commonly known as a a player’s coach. He always allowed them to play, and was only concerned with their performance on the field. The world lost a treasured person today.

The quickest way to dominance, is by seducing her mind and gaining her trust before moving onto her body. What are some actual examples of seduction of the mind and cravings and fantasies you desire the most?

Every woman is unique and different and has different needs.

Many times, women write the words, “control and dominate my mind and i will be yours”, but very rarely, are examples given. I get it, they love the intrigue and not knowing what comes next, but We, as dominants are not mind readers. 

Enlighten us, share your seduction to your mind…………

Hi again, i dont know why i am doing this. I often talk with my friend , who i have known a great many years, that its time to pass the baton, figuratively, to the next generation of doctors. We as physicians, all share a burden of despair and irrepairable grief, but thats another story and another time. Today, i want to focus on the more positive moments of medical school. Medical school is a bitch. There is no other word to describe this, there is no other feeling, in my opinion. This is all my opinion, and my opinion only.  

As a junior medical student, i went through my surgical rotation. I cant remember how long it was, but this was the general surgical rotation that everyone must do, and then you could pick some electives for further surgical training. So one day, the four of us, started rounds with the surgical attending physician. And the question came, what nationality has the most fat content. So the professor, asked us, one at a time, and we each answered, and then instead of giving us the answer, he asked us again, round two. Well no one got it. And i remember, my team, we had some studs on our rotation. One of the studs was a woman, and hell, if she didn’t know it, then forget about all the rest of us.  Lol. So round two, came and went , quickly, very quickly. And the professor got angry and started berating us, with , “where did you get ur license, from sears and roebuck”. “You call yourselves doctors, you guys are nothing but quacks” , “i would be ashamed and i would go home and cry, because no one is going to make it through this surgical rotation” , “Did you buy your license at the Mall” , “Was there a special going on, two for one”, “Did you cut out a coupon in the newspaper to get ur degree” I had never seen my professor as angry as i had that day.  He had stopped rounding on the patients and was just yelling at all of us. At that moment in time, the key is to look down, never make eye contact with the professor, and hope one of the nurses on the unit could distract him. No such luck this time. Well we waited for the answer, the answer finally came, and it was the the Eskimo because of all the blubber they eat. I started to laugh at loud, but quickly held that. And then i got angry. And once rounds were over finally, we talked amongst ourselves and all of us felt, he had taken this way too far. No one in my entire group had ever seen an Eskimo, let alone treated one. EVER, and we were all quite sure, an Eskimo had never been seen or treated at the hospital we were at. So all of us, felt, this was a step too far, by this professor, and he had a reputation for this.

The next day, we were in surgery. It was an exploratory abdomen, and this may have been my first surgical operation. That part i can not remember. But all of a sudden, the heart stops and the ekg started flat lining, and the alarm went off. Now at that time, there is a nurse, assigned specifically to start the 5 minute clock, because after 5 minutes, with no oxygen to the brain, the patient’s brain is dead.  So pretty immediately, i hear over the intercom, they are paging the professor to come to the OR stat. Meanwhile, the surgeon, probably the 3rd year resident , i can’t remember, was trying to fix the problem. And after every minute, the nurse would count it down, “4 minutes”, then “3 minutes”, then “2 minutes”, then “1 min”. By that time, they had paged the professor multiple times. Suddenly, with perhaps 25 seconds to go, the professor enters the operating room, and i can’t remember if he had gowned up. All i remember is this, without saying one word to anyone, including the chief resident, he stuck his left hand into this woman’s open abdomen, turned his hand backward to get around the stomach, and with his one hand, (his left hand, and i cant remember if he was a lefty or not) tied off the bleeder, the machines started to chime again, the heart began to pump normal and we had normal EKG functioning with seconds to spare, i am sure. As quickly as he had come into the operating room, he left just as quickly, without saying a word. The operation continued and there was a successful outcome. All of us understood the significance of this man. After that, for the rest of the time, i was on his rotation, i called him , Sir and he was G-D to me.  (OH, and I also read about eskimos and i am not ashamed to admit that one) In all my years of medicine, i have never seen something like that again, and i never really want to either.   

I went back for my 25th medical school reunion and on the surgical board, this professor had become chairman of the surgical department. I smiled at that, and felt,  what a fitting end for him. 

This is a day dedicated to  all the fallen heros of all the American wars.  Memorial Day is a day of thanks and sadness. Thanks for your service to the United States of America. It is with tremendous gratitude and appreciation that others have come before me, and layed down their lives for the ideals and freedoms of being an american. It is with sadness, that Memorial Day which is usually associated and spent with family, the breaking out of the barbecue, the beginning of summer, the start of summer vacation for the kids in school (or close to it, depending on when you end the school year), that these fallen heros wont be coming back to their families.  

“Any man’s diminishes me because I am involved with mankind. There fore, never send to know for whom the bells toll, it tolls for thee”

                    John Donne

Memorial Days tolls for the fallen heros.  Thank you. 

 Ego integrity versus despair is the eighth and final stage of Erik Erikson's stage theory of psychosocial development. This stage begins at approximately age 65 and ends at death. ... Individuals who reflect on their life and regret not achieving their goals will experience feelings of bitterness and despair.

According to Erikson,achieving a sense of integrity means fully accepting oneself and coming to terms with death. Accepting responsibility for your life and being able to undo the past and achieve satisfaction with one’s self is essential. The inability to do this results in a feeling of despair.

It is with this in  mind that I talk about the following. I was 26 years old, starting my psychiatric residency. I always wanted to know about people. I was fascinated by it. Psychiatry was not a job for me, it was a love and a passion. I had started my psychotherapy training, where we were assigned therapy patients, and a supervisor. I was always to tape our therapy sessions and every week, go through the session, with my supervisor. 

I had a patient, that was in the Vietnam war, and since coming back to the states, had trouble re connecting with life, friends, relatives and others. It turned out that he had lost his entire platoon, and was the only survivor of his company. (I have changed all the names, so no one can identify him)  And I must state, i discussed this fully with my supervisor, before i even attempted any of this, and we went through different options and variations and scenarios, before I even attempted any of this.  But i was still very nervous and anxious. My supervisor, was a tough taskmaster, who demanded perfection. She was very passionate about our Vets, and not only demanded perfection, but expected this of herself. 

So Ben, my patient came on his regularly scheduled therapy day, entered the room. I immediately said, “quite, get down, enemy at .....and i stated the coordinates of  their position, as Ben had explained all this to me in many previous sessions. I had turned a VA desk, an old heavy metal desk on its side, and was behind it. I pushed Ben down on the floor, behind the desk, and told him, the coordinates, where we had taken enemy fire. I had already turned down the lights. This was an attack at night. Ben sat down with me, and for the next 45 or 50 min, we took turns saying good bye to all of his group. We discussed in detail, all of his friends, and i knew, where all of his company was, during the attack. Each one, we said, our good byes too. There were many tears that day. It was one of the most emotional experiences I have ever had. But I didn’t realize this at the time. I was young, naive, and very inexperienced. I remember i went through that session, always trying to separate the emotion, from the actual facts of the experience. Because thats what psychotherapy is, separating the emotion from the experience, in hope that one may resolve an unresolved emotional conflict.  I so desperately wanted this for Ben.

Afterwards, I reviewed this session with my supervisor, and we went through it. I will always remember the smile, Dr. V gave me when we were done. 

I never saw Ben again. I often think about Ben and what he has accomplished since that time. I always felt he was destined for greatness. With integrity versus despair, this one is for you, Ben. 

I have always loved the Olympics. I love the competition, and seeing these young athletes compete against the best of the best. And i love hearing the stories behind the scenes too. For example, Michael Phelps, the most famous American swimmer ever , in his last race to take  home the gold medal, when he entered the water, his glasses flogged up so badly, he was unable to see, so he swam by rote, by memory. He had done this so so many times, he counted his strokes and then did his under water turn, not knowing where he was, and swam home to victory. Now if that isn’t greatness, i dont know what is. Credit to him and his coach, and his family for support!

Well Japan is getting set to host the Olympics on July 23, 2021. During this horrific pandemic. With covid rates surging in the world, (India and people still dying of this infectious disease).  However, Japan has a number of things going to them. They have contained Covid 19 far better than most other large countries. In fact, an amazing statistic, Japan’s over all death rate has decreased, thats right, decreased for the year 2020, even with the Covid pandemic. That’s amazing.  They are a nation, that is used to wearing of masks, and the Government closed their borders very early on. However, to balance that,  currently only 2% of the population has received the vaccine. And they are wanting everyone age 65 and over to be fully vaccinated by July 23, 2021. I dont know if that will happen. 

Even if that happens, though, Japan will not be free of risk. After months of allowing few international visitors, the country will be letting in tens of thousands of people. They will then interact with nearly 80,000 local Olympic volunteers, who will drive athletes and officials around Tokyo, serve as interpreters and do other tasks. A Covid-free Olympics seems unlikely. The question will be whether Japan can quickly identify, isolate and treat people who get the virus.
In this way, the Games may present a particularly intense version of the balance that many countries will be trying to achieve in 2021 — moving back to normal life while avoiding a new wave of a deadly virus.

GOOD LUCK TO ALL OF THE ATHLETES 

I wanted to add more and give you the latest definition of DSM-5 with regards to PTSD. DSM-5 is the latest classification, and how psychiatry defines mental health conditions. 

The condition lasts at least 1 month and result from experiencing actual or threatened death, serious injury, or sexual violence as manifested by at least one of the following: 

*directly experiencing or witnessing a traumatic event(s)

*becoming aware of close friends or family members suffering a traumatic events)

*repeated exposure to aversive aspects of traumatic events

INTRUSION SYMPTOMS:

Presence of at least one of the following after experiencing traumatic event(s):

*recurring distressing memories of the event

*frequent nightmares involving the traumatic event(s)

*flashback that may be accompanied by dissociative reactions as if the individual were reliving the traumatic event(s)

*intense reactive distress when in the presence of cues that serve as reminders of the traumatic event(s).

AVOIDANCE SYMPTOMS:  Chronic avoidance behaviors beginning after occurrence of traumatic events(s). As manifested by at least one of the following: attempts to avoid distressing thoughts, feelings or memories reminiscent of the traumatic event(s): avoidance of external stimuli that may serve as reminder of the traumatic event(s).

NEGATIVE MOOD :  Negative transformations of mood or thought related to the traumatic event(s), with onset after the event transpired, and manifested by at least two of the following:

*dissociative amnesia—inability to remember details of the traumatic event(s)

*chronic and exceedingly negative attitudes and expectations about oneself, others, or surroundings

*self blame, or blame others due to chronic inaccurate thoughts about the cause of effect of traumatic events)

*chronic negative feelings

*loss of interest in significant activities 

*Alienation from others 

*chronic inability to experience a positive emotion or feeling

AROUSAL SYMPTOMS. Significant changes in sensitivity to traumatic event(s) starting or worsening after the traumatic event(s) as indicated by at least two of the following:

*unprovoked irritability and temper tantrums 

*irresponsible self-destructive activities 

*hypervigilance 

*heightened startle reaction

*difficulty in focusing and concentrating 

*disrupted sleep patterns

Each person’s potential PTSD may be unique and different but you must have these signs and symptoms to be diagnosed with PTSD.

Hope this helps, a bit more.  Knowledge is power. 

• Rob 

Post Traumatic Stress Disorder (PTSD) is a mental disorder in which the person has difficulty recovering after experiencing or witnessing a terrifying event. This can be emotional, physical or sexual abuse, accidents, war and other natural disasters. The condition may last months or years, with triggers that can bring back memories of the trauma accompanied by intense emotional and physical reactions. 

PTSD is very common. There are more than 3 million U.S. cases per year.  In general, people experience flashbacks , hyper vigilance(become super sensitive to their surroundings),  panic attacks and insomnia. Additionally many people with PTSD often develop other signs and symptoms of depression and/or anxiety.

 It is important to note, that not everyone who has experienced a traumatic event will develop symptoms of PTSD. Even if your immediate reaction and response was extreme, this does not necessarily lead to PTSD. It is perfectly normal to have an intense reaction to a potentially traumatic event and not develop PTSD. Research HAS NOT SHOWN which brains lead to PTSD and which brains do not, and why. Please go back and re read this last statement. There is nothing you could have done to prevent or cause this from happening. We do not know the reason. Please stop blaming yourself for this unfortunate occurrence. However, research has shown if one does experience a traumatic event, to keep them up. Do not allow them to fall asleep. Sleep, somehow, solidifies these intense events and emotions and “preserves” these emotions, allowing PTSD to possibly develop.

There is help and treatment. The combined use of psychotherapy and medication, (usually an SSRI) have been successful in alleviating many of the PTSD symptoms.  Please see your doctor for an evaluation. There are also some pretty good self assessment tests online. I do not have one in particular in mind, so i will just refer you to the internet. Pick one. 

Lastly, I want to mention, what i hear pretty frequently, masochistic women and perhaps others, often state, they enjoy the pain, because it calms the thoughts and feelings and anxieties. I have often wondered if these are PTSD symptoms. I am not here to judge, and the Cage is an accepting group of people, that I am proud to be a part of. I do not know. But I am here to help.  I am writing this blog to further educate and possible help anyone in distress. 

Happy kinking my friends

Rob

I want to tell you a true story.

This young man, wanted to go to medical school, so badly, but his grades were just fair. So he applied, was turned down, the first year, and he got another degree, i cant remember, what it was, a master in pharmacy, but something to do with medicine, he improved himself, and then he applied again, got turned down. It’s hard to get into medical school, so he improved himself again, got his masters in something else, then applied again, a 3rd time, got turned down, then got another masters degree in something, applied again, but this time, he went to the house of the Dean of Admissions, and sat at his door step the entire night. When the dean walked out, to go to work the next day, he found Joe sitting on his porch step. He asked joe , what he was doing? And joe said, “sir, with all due respect, i want to become a doctor and will do anything to get in, so please tell me , what i need to do to get in. I will do it. The dean shook his head,  and said, Joe, your grades are not good enough, and i dont know if you would be able to make it through medical school.”  Joe stood tall, and faced the Dean,  and looked him , right in to the eyes, and said, “i dont know either, but i want that chance to find out”.  The Dean shook his head, and and walked off to work. Joe applied again, and got in.

The moral of the story, follow your passion to wherever it takes you.