Borderline_Traits's Xanga

Friday, July 25, 2008

Fri, 25 Jul 2008 23:53:56 GMT

About Me, Becoming A Child Psychiatrist

Finishing my last year of post-medical school training, Chief Resident in the Child Adolescent Psychiatry program. I'm proud of what I've accomplished in these last 10 years, late life career shift with all its insecurities and blunders. This year is a journey onto itself. Trying to navigate my way through and find my own clinical style within a field full of as many contradictions as value (and a widely diverse set of values at that and not all of them palatable).

I am finding my skills and joys at being a child therapist, more confident about working with families, respecting their expertise and intentions for their children, but still feeling comfortable with offering my clinical expertise, confident (and humble) suggestions about what might be operating and unfolding within their children and their families and their communities. My direct work with kids has progressed. I am more at ease listening, being interested and curious without needing to establish diagnostic certainty. I've been working more dimensionally than categorically, and I take pride in being conservative and patient about choosing to prescribe medications.

My life is full with my work, and what's left I try to surround myself with my wife and kids and our lives together. We have such a sweet and exciting family. I don't spend enough time "meditating," on the joys in our little household, the interdependencies, rituals, deep love and (at one step remove) comical conflict.

I'm seeing kids in two outpatient clinics, one county run, more a clinic of last resort, and the second a UC Davis affiliated clinic, part of the training program. But I feel my relationships with my patients and their families are our own, these relationships we create together being a necessary component of any healing or supporting of their normal development. I am surprised to notice I have been seeing some children consistently for two years now, therapy expanding their potentials and scaffolding their successful and (hopefully) satisfying movement through childhood and adolescence. At the MIND Institute I see children with their families in an autism clinic, families with the worry and icy fear (although at rare times it seems more like a an entitled wish or insistance) that their children have Asperger's disorder or autism. I evaluate for autistic spectrum disorders and aim to help shape the choices that will best address these uniquely idiosyncratic children in their unique families. Other time I work in the local child and adolescent inpatient hospitals, stabilizing acute crises of psychosis, mania, abuse, behavior, inappropriate medication regimens or family dysfunction. Shriner's Hospital where I see kids with devastating burn injuries or spinal cord injuries and try to help them withstand these irreparable life altering wounds and maintain the hope that seems to be so abundant in children if their are encouraged in meaningful authentic ways and ultimately "allowed" to experience it.

Then there is my outside work, outside the training program that is. Weekends and holidays at the county psychiatric hospital, assessing patients for admission or discharge in the crisis unit. I wish you could be behind my eyes to see the magnificence of human beings' broken thinking, absurd delusions, bizarre phantasmal hallucinations, mania, anger, methamphetamine psychosis, delirium, depression and personality disturbance. The things I hear. You wouldn't believe me if I told you, and often I don't when I am there.

And none of this could have happened without my wife to work her magic in the family, inspire the kids to levels of creativity, imagination, friendship, responsibility, sense of self, character and love. I suppose I could have done it if I were single or if I didn't give a shit about the family, but to have done it together and make the choices we have for staying close, active, engaged with each other as a family. No, that I could not have orchestrated, that's her.

So meanwhile I still struggle with midlife angst, death panic, neurotic Jewish anxiety, feeling like an imposter, wishes for youth and the freedom of an open book of limitless choices, abundant energy (no need for naps...hehe). But I have a terrific therapist (have even considered going into formal analysis with him but a person can only handle so much, there are limits). I bought a beautiful acoustic guitar for myself, a rare generosity on my own behalf. That was a good thing. Makes me happier. And we have 5 chickens, 1 for each member of our family (Lulu, Fabrice, Cola, Crispy and Cleopatra) roaming around our tiny back yard, laying eggs in their coup and making more huge piles of bird shit (on the lawn, on our porch, in their coop etc...) than I ever imagined was possible, not that I spent any significant time imagining chicken shit prior to owning our own producers.

And then at the end of this academic year, next July, it finishes, finally, after post-bac-premed, med school, internship, residency, and fellowship. Then we have to pick our spot. Where to live, where to work, do we buy or keep renting etc...

That's about it for me, hope someone finds it interesting.

Monday, December 24, 2007

Mon, 24 Dec 2007 05:55:46 GMT

Friday, September 28, 2007

Fri, 28 Sep 2007 16:13:17 GMT

"One of the schools of philosophy on Tlon goes so far as to deny the existence of time; it argues that the present is undefined and indefinite, the future has no reality except as present hope, and the past has no reality except as present recollection." J.L. Borges.

"Many people need desperately to receive this message. 'I feel and think much as you do, care about many of the things you care about, although most people do not care about them. You are not alone.'" K. Vonnegut.

It's a cheap stunt to garner attention by noticing the genius of other people's fictions, but if I had said any of these things myself, I would have meant them just as genuinely.

Tuesday, September 25, 2007

Tue, 25 Sep 2007 19:07:29 GMT

Memory Residue

This must be what is meant by associations. Memory residues, sometimes long enduring but infrequently presented for reflection, other times rediscovered as if for the first time, but always familiar. Recalled liked fragments of a dream poorly remembered.

Standing in Harvard Square at a crowded outdoor musical performance, I am seventeen. The square is across the street from the noble archaic brick building where I share a dorm room with another summer session student. Sunny and chilly, this summer's late morning smells of pavement, cold blue air, tobacco smoke, soft sharp breezes. Like a rising feeling of nausea I find myself aware of an older man watching me surreptitiously from across a smaller intersection. He is in his twenties, unshaven and gruff appearing, weathered skin, his face in a scowl, looking right at me but shifting his eyes away from me as I notice him. This is important, why now though? Driving to my work, thinking about my patients for the day, unfinished clinical notes, my weekend moonlighting schedule, I wonder about my unintentional recall of this event as I take control of the memory and follow its course, intentionally now, through the foggy narrative, rich with emotional resonance. He appears different from the rest of the crowd, in sharper relief, more real or more important than the multitudes engulfing us.

Everything is quiet in my mind, the music, the crowd noise fades away. Two more figures become a part of our private sphere as if all three are connected by dotted lines. Two men, associates of the first, dressed in street clothes, not unkempt but dangerous. They too appear to be working hard at paying attention to me without attracting my awareness. I move to another area of the crowded square, but quickly notice their triangulation of my position once again. This is absurd. Am I paranoid or at risk? Do I work through my anxiety or act to protect myself against potentially imaginary blackguards? They are closer to me now, distant enough to be out of physical contact but raising the ante of my sense of amorphous risk. My skin crawls.

The story has by now unfolded itself to completion in my memory. What's left is rumination and pondering the relevance, if any, of this event and its need to be recalled. The summer has been a rich experience of learning and novel activity. Apart from sitting in undergraduate law classes (my older never realized ambition to become a lawyer), I have been working with an acting troop from Brown University, performing Hair at the Hasty Pudding Theater. I am a "hanger-on," working as a volunteer usher for the performances, in love with the cast and their off stage explorations into the life style portrayed in this 60's psychedelic love fest. I have felt myself on the margins all summer, not quite in my element, but this day I am alone, and feeling it profoundly. I move again trying to blend in with the crowd like I'm dancing with my demons, temporarily out of site.

It is clear to me I am an intended victim, but of what I am not sure. I am only certain of the nightmarish quality of my fear and the constant guarded vigilance of the three men. In the crowd there is a large black cop in uniform. How does one explain this need for help? What trumps the day, my fear or the humiliation of asking for succor against a real but unexplainable threat. My emotions are high in my throat as I explain the impending crisis to him. As I speak his massive figure looms over me, listening with a passive accepting face. He may think I am making things up, manipulating for some devious gain myself, but I ask if he can help me get back to my dorm. The first, "dangerous man," still stands across the street, no longer watching us but still outlined as if in a spotlight in my mind's eye; the crowd vanishes away as I point him out.

The big policeman offers to drive me to the dorm in a circuitous route to avoid giving away my place of residence. He is the hero of this real world children's story. Why is he so cooperative when I feel so irrational? As I remember it, we don't speak during the drive, and he brings me to the other gates of the dormitories to drop me off. The entire event plays itself across my memory in less than a few seconds, this emotionally terrifying, humbling but ultimately benign adolescent experience. I never did see these men again or understand what they might have been after, although I can form an image of the first man, vividly, now some 25 years past. My dream state fear is palpable. Hair completed its run (full frontal nudity included), and for a few years after I tried to maintain friendships with my favorite cast members who tolerated my doting hero worship as we gradually drifted apart. I kept a weather worn copy of the poster advertising the play for many years, the cast members' faces huddled together in blurred red ink on thick yellow card copy, a tangible connection to a time of rich memories and change in my life. It is like a particularly favored song, hidden on a dusty and scratchy LP in the closet. My non-trauma plays itself unrequested on occasion, but I can't explain to myself or you what brings it to mind.

Friedrich Nietzsche

Wed, 19 Sep 2007 19:02:16 GMT

Can an ass be tragic?
To be crushed by a burden one can neither bear nor throw off?
The case of the philosopher.

Tuesday, September 19, 2006

Tue, 19 Sep 2006 16:29:19 GMT

Speaking to the Innocence

(me and my sister with a dead bird, circa 1969)

Is it a universal experience, holding life's departed in a child's hand? Not broken hearted, but deeply present, naively mindful. I cherish, I envy the fleeting memory of that presence, unpracticed fidelity of mind. I did not know or I would not have left the shadowy companionship of living in the moment, would that I had known. Thomas Wolfe wrote, "O lost, and by the wind grieved ghost, come back." But the bird nor my innocent confidence in living the immediate now...look homeward Angel.

Monday, August 07, 2006

Mon, 07 Aug 2006 17:34:08 GMT

Do you know what a "CSA" is?

It stands for Community Supported Agriculture...meaning an organic farm or farm cooperative, that is sustained and sustainable by membership or partial "ownership" of the farm. We pay in and we get a box full of vegetables, fruits and sundries like home made bread every week.

Our CSA is Good Hummus, and this weekend they had their yearly party to celebrate the "us," that makes them "them." The "them" is a man and his wife, or a woman and her husband depending on your perspective. 20 years ago they purchased some barren acreage in Yolo County, California. Nothing on it, not a tree, not a flower, just wild grasses.

Now it is a sprawling Garden of Eden, peach and apple orchards, tomato fields, vineyards, sunflowers, gianormous vegetable beds, cypress trees...and their home/barn/storage as well as the developing skeleton of their beautiful new home, being built by them and under construction.

Just like the >>> Full Belly Farm Hoes Down (the second entry on that blog page) this event was just full of joyful celebration of what a community can do and revelry in the celebration. I wish I brought my camera to take pictures of the bountiful food (huge baskets of tomatoes, peaches, home made pizzas, massive plates of lamb and goat meat roasted and blackened on an open fire covered by an enormous metal cooking surface, keg of beer, home made root beer, pastas, wine, etc...).

I wish I had brought my camera to take pictures of the children, the three piece Klezmer band (Bob with his huge long civil war era beard, mandolin and violin, a woman playing accordian and a cellist), the young people already excited by if not committed to the ideals of community and cooperation, and the farm itself.

We stayed from 5pm until 11pm by which time our kids were ragged floppy sated driftwood, carried to our car for a sleepy preambling ride to their beds at home. I am so happy I went (I had worked all day, Saturday, before we left, and I was cranky and passive aggressive about going, as were all three of our kids) because I was none to pleased at the prospect before we left. But I had such a magnificent connected joyful gluttonous social musical learning growing experience.

Sunday, July 30, 2006

Sun, 30 Jul 2006 19:01:48 GMT

Born Into Brothels

Another beautiful stunning documentary (I am turning into a movie reviewer...). A remarkable woman photographing life in the illegal red light district in Calcutta, India, becomes entangled in the charm and tragedy and talent and potential and vision and love of a group of children who live in the squalor of poverty and the sex workers industry. She teaches them to use photography to discover themselves and to reveal their world to others.

The story reminds me of the unique resiliance children can internalize and renews my hope as I move toward child psychiatry.

The movie is equally tragic and life affirming, having won all sorts of accolades, it won my heart, I can't stop thinking about these children or their teacher.

I hope you have the space to witness this film and don't forget to see Why We Fight as well, see below for details (do drop me a comment if you happen to see either of these films, please.)

Friday, July 28, 2006

Fri, 28 Jul 2006 14:54:54 GMT

"Why We Fight."

This is a brilliant new release documentary....Eisenhower's Military Industrial Complex speech, his poignant chilling message to the American people as he finishes his second term and readies to leave his presidency....the relationship to our current involvement in Iraq....enormous profit making military industry....Congress.....Think Tanks....colonialism....a strong well presented movie documentary essay.

Ladies and Gentlemen, the President of the United States of America...

"This conjunction of an immense military establishment and a large arms industry is new in the American experience...We recognize the imperative need for this development. Yet we must not fail to comprehend its grave implications...In the councils of government, we must guard against the acquisition of unwarranted influence, whether sought or unsought, by the military industrial complex. The potential for the disastrous rise of misplaced power exists and will persist.

We must never let the weight of this combination endanger our liberties or democratic processes. We should take nothing for granted. Only an alert and knowledgeable citizenry can compel the proper meshing of the huge industrial and military machinery of defense with our peaceful methods and goals, so that security and liberty may prosper together."

This movie goes well beyond depressing, and perhaps might only appeal to people who already understand (preaching to the choir), but it left me feeling like everyone needs to sit though this since we are represented, we vote...

I will not try to represent in my words what this movie so eliquently communicates....please rent and watch it or if you have encourage others to.

Tuesday, July 25, 2006

Tue, 25 Jul 2006 14:47:55 GMT

I haven't felt particularly compelled or compelling lately. Perhaps it is daily the 100+ degree ambient temperature, maybe the increasingly disastrous state of world affairs, maybe I'm tiring of the blog venue.

We took a camping trip family excursion to Folsom Lake on the hottest 2 days in California history, quothe my 12 year old daughter from the tent (sauna) we shared, "...I can't sleep....everywhere I move I touch someone's flesh..."

I'm doing all office based work now in an outpatient psychiatric clinic for my residency while continuing to work side jobs at a methadone clinic, a residential drug detox/rehab program and an acute psychiatric hospital. The office work has its advantages and its problems.

I certainly feel more like an adult again having my own space with a door to close, my own phone and even business cards with M.D. after my name. But working in the acute psychiatric hospital full time, I was finished when I was finished, sometimes I could get out by early afternoon. With office based practice I have to stay until the last patient scheduled shows up or just as often does not show up.

Without any pictures to share or clever ideas I feel like I am just writing one of those impersonal mundane despotic family holiday update letters, so good luck getting through the rest of this. Maybe the change in color will catch your attention.

I did decide to apply to the Child Adolescent Psychiatry Fellowship, which would extend my residency by one year if accepted. I relish making connections with children who need psychiatric help, but I worry about my judgment toward the families who so often seem to be the rotten core over which the child's symptoms find root.

Not to say there are not families with children who have pathology outside their influence or who are alert to their children's needs and development, but "pathologic home environment," seems to be a regular fixture in the homes of the children I have seen in my weekly child clinic.

So, as you might imagine, being a parent, my heart bleeds for children where I feel (perhaps with too much arrogance, too much pomp or too much over identification with the child) that if only this kid lived in my family he/she would be fine. Even as I write it I know it is never really the truth, but it stings when I see parents who are blind to their own job description and pathologizing their kids.

The magical part of child psych is when the family is open to intervention and the collaborative work has the potential to free these kids from emotional, behavioral and psychiatric struggles. The kid, the family, the school, the community, everyone benefits. Pie in the sky, but it is a nifty concept.

I had an attending doctor in medical school who worked in pediatric heme/oncology (children's cancer and blood disorders). He was amazing, gentle, brilliant, humble, funny, Canadian (lol). I remember him saying that he felt like he was able to do his work because these kids were sick whether he was involved in their lives or not, and at least he could make it his purpose to make their cure, their remission or their last days as full, dignified, pain free and healthy as possible.