When you take a look around this place, medical school can't be all that hard.

I started working in hospitals in 1973, when I was still in high school. The experience over the years has provided exposure to me of hundreds of doctors and thousands of nurses. Like any profession, one can experience the entire spectrum of skill and competency, from world-class to "they should be in jail".
Fortunately my good experiences have far outnumbered the bad, but the negatives tend to be better remembered, much like you would  remember a clerk in a store more clearly than you would a polite one. In my early years as a nurse, I found that surgeons (or at least the majority of those I met) were extremely entitled "because we make money for this place and you don't". In one hospital where I worked, the Medical Records Department had refreshments available to entice them to show up and finish incomplete medical records. The physicians never worried about having their privileges suspended, because they were needed to be on-call.
I recall another physician who had totally illegible handwriting. It was basically a squiggle broken up to imply words. The hospital got denied payment from insurance companies because they could not read his handwriting. One would think the hospital would require him to write legibly but, even though he was an ass, he was an ass that generated a lot of revenue, so he was disinclined to straighten up. In the end, the hospital provided a person to take his dictation and type up his documentation for him to sign.
I found that working with physicians who had privileges, rather than being employees of the hospital, could sometimes be a challenge. They came into the hospital to see the patients on their service, and were gone by lunchtime to their offices to see patients in their private practice. If you needed them to come back to the hospital for anything, they simply wouldn't do it, but were more then willing to provide orders you might need over the telephone. I recall one physician I worked with when I was a staff nurse who, when I would call him at night, was always drunk. Before I called him, I prepared a list of what I needed. I would then call him and go through the list. His response was always "fine" and he would hang up the phone.
I have to admit that I would never want to be a physician. What one has to learn to graduate from medical school is staggering. After that comes a multi-year residency. This is an opportunity for new doctors to not only apply the knowledge from medical school, but to also expand and refine that knowledge. While residency gets better as it progresses, the beginning can be extremely stressful. You could always tell the new residents by the amount of "stuff" in the pockets of their lab coat (stethoscope, flashlight, reflex hammer, numerous reference books, etc.) compared to the senior resident, who only carried a pen in his shirt pocket. Today, with the advances in electronics, the reference books are gone, so the difference in what they carry is a bit less.
Where many young physicians get in trouble is being able to apply their knowledge in a practical and safe way. They have learned the subject material in school, they have passed the exam, but now they have to be able to use it to care for patients.
Enter Rachel. Rachel was a nurse in the Emergency Department at the hospital where I worked at the time and who had been one of my mentors. She was older ("seasoned" is probably the preferred term) who tolerated me because I was there to learn from her and took advantage of her wisdom and experience. Many new residents, on the other hand, thought they knew everything, and did not seek advice from Rachel and others when it would have been extremely prudent to do so.
While most residents caught on and learned the importance of listening and collaborating, the new ones who didn't get it were sometimes an ordeal to tolerate.
The title of this piece is a quote from Rachel when a new crop of residents started in July, and she was exposed to some know-it-alls. I think we have all be exposed to individuals at one time or another who have impressive academic credentials, but it really doesn't matter because they can't think their way out of a paper bag. Another one of my favorite quotes from Rachel: "Those two couldn't diagnose a decapitation."
From my perspective, I am less focused on the letters after someone's name; I really don't care what degrees or certifications they have. To me, the most important thing is that you know their job and do it well. That's how you avoid Rachel's wrath.

People have every right to send me letters, and I have every right not to read them.

The title of this piece is a quote from the author William Faulkner. While I am not a fan of his work, I can certainly appreciate his curmudgeonly attitude toward unwanted communication. We live in a world in which we are bombarded with emails, phone calls, and snail mail from people and organizations that don't have a clue who we but who would be glad to have our business.
While I welcome hearing from people I know, I sometimes get a tad bit annoyed with the other intrusions upon my solitude. My home email address must have been sold to a bunch of people and organizations. I get unwanted emails for free credit reports, jobs (I didn't know Jiffy Lube was interested in me), teeth whitening, gym memberships (one of the last things on earth I would buy), romantic getaways, waffle makers, laser treatments for hair loss, cordless electric knives, and a host of other things that make me glad my laptop has a "delete" button.
Unfortunately, there appears to be no way to totally escape these unwanted intrusions, but I have learned some ways to reduce the annoyance. When I bring in the mail, I go through it while I am next to the recycle container. I always tear up credit card applications (my name and address are pre-printed on the applications). Anything from an insurance company that is not the one I use goes into the recycle container. Catalogues from places I never patronize go in as well. Advertisements for replacement windows, siding, trash collection, etc., never make it any further. It is a shame to think about all of those trees  dying for nothing, but at least things get recycled, so it is not a total waste.
For telephone calls, I have found that registering for the "Do Not Call" list is of limited value, since non-profits are exempt, and many hire professional fundraisers, whom I detest. Almost all of them, though, use computers which dial multiple phone numbers simultaneously. When someone answers, the solicitor connects and starts the pitch. When I answer the phone and hear nothing, I know it is a telephone solicitor, so I hang up before the computer connects me. I don't know how many "worthy causes" I am missing the opportunity to support, but I am OK with the loss.
My email has a "Junk Mail" option which adds the email sender to a list of email addresses that are blocked, but I have not found this to be totally effective (it seems like some of them use multiple email addresses). One thing I have found helpful if to look at the bottom of the emails for a link to "unsubscribe". Clicking on this either instantly takes me off their list or does so within ten days, and I am finding fewer unwanted emails in my in box these days.
It is a shame that I can't prevent mail, emails and phone calls that I don't want in the first place, but my recycle container and Trash folder in my emails get a workout, and we all have William Faulkner to thank for pointing out that we do not have to feel the least bit guilty about it.

Things you didn't think you needed to know...and probably don't

One of the reference books on my bookcase (next to the Australian Dictionary of Vulgarities and Obscenities) is the Book of Useless Information (an Official Publication of the Useless Information Society). You may think that reading this book is a total waste of time but, before you go that far, ask yourself, as Shakespeare did: "Just how useless is useless?"
My response to this question? Well, you just never can tell; knowing this might just come in handy some day. Then again, maybe not. Let me share a few examples, and you can decide for yourself.
- Andrew Jackson was the only president to believe that the world is flat.
- Leonardo Da Vinci spent twelve years painting the Mona Lisa's lips.
- Sigmund Freud had a morbid fear of ferns.
- Hitler and Napoleon both had only one testicle.
- Christopher Columbus had blonde hair.
- Keanu Reeves's first name means "cool breeze over the mountains" in Hawaiian.
- In 1953, Marilyn Monroe appeared as the first Playboy centerfold.
- Clark Gable used to shower more than four times a day.
- Ringo Starr was born during a World War II air raid.
- The bagpipe was originally made from the whole skin of a dead sheep.
- The first CD pressed in the United States was Bruce Springsteen's Born in the USA.
- Elvis loved to eat meatloaf.
- Every day, more money is printed for Monopoly  than by the U.S. Treasury.
- According to Pope Innocent III, it was not a crime to kill someone after a game of chess.
- Miss Piggy's measurements are 27-20-36.
- One in every four Americans has appeared on television.
- The characters of Bert and Ernie of Sesame Street were named after Bert the cop and Ernie the taxi  driver in Frank Capra's It's a Wonderful Life.
- Mel Blanc, the voice of Bugs Bunny, was allergic to carrots.
- Donald Duck cartoons were banned in Finland because he doesn't wear pants.
- Because metal was scarce, Academy Awards given our during World War II were made of wood.
- Smokey the Bear's zip code is 20252.
- Keeping Warm with an Ax is the title of a real how-to book.
- Sherlock Holmes never said "Elementary, my dear Watson."
- The last word in the Bible is Amen.
- Arachibutyrophobia is the fear of peanut butter sticking to the roof of your mouth.
- The phrase "rule of thumb" comes from an old English law stating that you could not beat your wife with anything wider than your thumb.
- Clans long ago who wanted to get rid of their unwanted people without killing them used to burn down their houses - hence the expression "get fired".
- The Old English word for sneeze if fneosam.
- A klazomaniac is someone who feels like shouting.
- Spat out food is called chanking.
- The oldest word in the English language is town.
- No word in the English language rhymes with month, orange, silver, or purple.
- November 19 is Have a Bad Day Day.
- Coca-Cola was originally green.
- Beer foam will go down if you lick your finger and then stick it in the beer.
- Peanuts are cholesterol-free. They are one of the ingredients in dynamite.
- Grapes explode when you put them in a microwave.
- There is no such thing as blue food - even blueberries are purple.
- The only food that does not spoil is honey. It is used as a center in golf balls and in antifreeze mixtures.
- A can of SPM is opened every four seconds.
- Vanilla is used to make chocolate.
- Chewing gum while peeling opinions will keep your from crying.
- Salt is the only rock humans can eat.
There are currently twenty-nine members of the Useless Information Society. Do you have a burning desire to be number thirty?

Congress: Monkeys With Guns

Even though the government shutdown is over, the trauma it created lingers on. The title of this piece comes from a description that someone I know gave to a group of individuals he was dealing with who thought they knew what they were doing but clearly didn't. I think it is also a pretty good description for Congress, a group that can be quite dangerous and destructive in their collective ignorance and ineptitude.
Whatever reason individual members of Congress may give for bringing about the government shutdown, none make any sense, and the outcome served no useful purpose. Mindless and destructive, just like the character in the picture.
Looking forward, it will be interesting to see what the next election cycle brings. I saw a poll in which 60% of the respondents said that all of Congress should be fired. It is hard to argue with that sentiment. If you or I acted like them, we would probably end up in jail.
As a result of the shutdown, will we see any changes in America's political system? I think it highly unlikely. The Monkeys With Guns who brought about the debacle in the first place would be the same ones who would need to initiate constructive change. From this buch, it's simply too much to hope for.

Congress: You Suck (but thanks)

Last week, I was driving with my wife to Mount Desert Island for a long-planned vacation. I had rented a cottage on the shore in Manset, part of Southwest Harbor. As I was driving through Trenton, approaching the causeway onto the island, my wife pointed out a sign in front of one of the local businesses which said, "Congress: You Suck".
Thinking of the government shutdown, truer words were probably never spoken. While there are no doubt some very nice individuals in Congress, they are, without a doubt, the most dysfunctional collective of jackasses on the face of the planet. It is sad to think that many functions provided by the government, such as food assistance to the poor, counseling for veterans, food inspections, research into cancer, and a host of other badly needed services were not being provided, with hundreds of thousands of people being basically laid off without pay. All of this going on, while the people responsible for causing it (Congress) are still getting paid, makes it hard to understand how Congress could possibly have an approval rating as high as 10%. (As a mental health professional, I am very much interested in meeting some of that 10%; they obviously need some help.)
In addition to all of the pain and suffering the shutdown was inflicting upon individuals, Acadia National Park, where I intended to spend much of my vacation, was closed. I was not pleased. I had rented the cottage 10 months before, and my oldest daughter and her husband were driving up from Pennsylvania to spend the week with us. Knowing that we couldn't go to the park was a major disappointment.
Fortunately, Mount Desert Island is over 100 square miles, and there are other things to do besides go to Acadia National Park. As we were enjoying some of these other pursuits, I heard from some people that one could park your vehicle outside the park boundaries and walk into the park, and no one would stop you.
In Acadia, Park Loop Road runs along the eastern side of the island looking out over Frenchman's Bay and the Atlantic Ocean and provides some of the most spectacular scenery you could ever imagine. Looking at a map. I found that Otter Cliff Road, which is not part of the park, runs into Park Loop Road near the Otter Cliffs. We drove down the road and, at the end, there were sawhorses and a gate providing a blockade, but we could park and walk onto Park Loop Road. A ranger was sitting in his vehicle chatting with tourists, and others just walked right by.
I have been coming to Acadia National Park for 50+ years, and I have to say that this was the best experience I ever had. Usually, one drives on Park Loop Road, stopping and getting out of the car periodically to enjoy the views. When you are walking on the road (or the shore path next to the road), you see many things that you would miss if you were driving by in a car. Even though there were hundreds of other people scattered along the road and the shore, there are usually thousands, with buses and cars parked along the road. The lack of congestion and the sense that you were pretty much by yourself was something to treasure.
In addition to Park Loop Road, we found other areas of the park that we could easily access on foot. While we could not go up Cadillac Mountain or go to Jordan Pond, we found plenty of other places in the park that we could go, some that I had never seen before.
So, Congress, while your stupidity and ineptitude have created pain and suffering for countless thousands because of the needless government shutdown, you managed to make my vacation something I will never forget. For that (and nothing else), I thank you.

Never Kick a Fresh Turd on a Hot Day

The title of this piece is a quote from the late President, Harry Truman, and is sage advice on the potential dangers of acting (or reacting) impulsively. We all meet challenging people in our lives; sometimes we are married or related to them, sometimes we run into them at work, sometimes when we are just out in public. While we all know a lot of nice people, it's the ones that aren't so nice that get most or all of our attention, generate the most negative emotion (How can you be so effing stupid?), and tempt us to do or say something we might regret.
Being a Psych nurse, I have developed a tolerance over the years out of necessity. Awareness of the potential negative consequences to my bad behavior helps me to keep from doing something I would later regret, both at home and at work. I don't want to get fired, hurt, divorced, lose my nursing license, or go to jail.
When I am at home, it seems that I have much more control over dealing with people who annoy me. Fortunately, I am not required to interact with or even acknowledge the people who some might be tempted to euthanize. I don't have to like everyone (although there are many I do). For those I don't like, I need to tolerate them or just walk away. It may not be the choice everyone else would make, but it works for me.
Work, though, can be totally different at times, and not always in a good way. Some individuals, either as a result of their mental illness or their underlying personalities, can be just plain unlikable. Patients who are in psychiatric units present some unique challenges. When they behave badly, we cannot do anything which could be considered punitive (even though that's what would happen to us if we did the same thing). Filing legal charges, while sometimes desirable, often goes nowhere because the individual may not be competent to stand trial. We try to positively engage patients, treat them respectfully, and provide a safe environment for recovery. A few individuals with bad behavior, though, can totally negate all of the efforts we make. Interestingly, sometimes the person that you may have been tempted to strangle last week doesn't seem all that bad compared to the new patient who was admitted yesterday. Patients have their ups and downs, but often the bad behavior moderates or goes away over time. The challenge to us is to being able to tolerate them until then. Also helpful is the knowledge that not every day is a bad day, that you have good co-workers (or most of them, depending upon your perspective), and that, regardless, your workday eventually comes to an end and you go home.
For those days in which you are feeling challenged, angry, frustrated, and are struggling to keep your cool, just picture Harry whispering in your ear some advice about what not to kick.

The Two-Story Outhouse

                                                                                

The above cartoon is part of a collection that I have that illustrates pretty well what we all have probably experienced. The designer may have thought it was a good idea, but didn't clearly think about how functional it really was. Over the years, I have worked with people who were brilliant and highly skilled, as well as some who made decisions they were not the least bit competent to make.
I am pretty analytical, and I like to think things through when I have the opportunity. It doesn't mean I've never had a bad idea, but most of the ones I have had I allowed to die inside my head and did not  inflict them upon others.
I would like to say this has been my experience with others, but that would only be partially true. I can think of several examples over the years where an organization was faced with a situation that required changing how things were done. In the best case scenario, leaders would look at the desired end result, what was needed to get there, and what were the best resources available to get us there. Unfortunately, instead of pursuing the best item out there sometimes the decision is made: "We already own this, let's make it fit (or work)." Think of the square peg in the round hole, "reconditioned" equipment, installing one of an item when you actually need four, etc.
One of the deadliest terms you can potentially encounter is "low bidder". Things today are not as bad as it used to be, but, in the past, many organizations pretty much exclusively went with the low bidder. Sometimes, that is an OK decision, but other times you end up with something like the cartoon above and end up paying much more to fix the mess.
While you may or may not have much influence on decision-making in your organization, especially when it comes to spending money (I, for example, can approve expenditures of up to $250; even I am not impressed), you have control in your private life. While you don't think in terms of low bidder, you want to make sure that the decisions you make are sound. The next time you go to make a substantial purchase or other important decision, ask yourself: "Is this a two-story outhouse?"