Saturday, January 28, 2012

Your Father is Dead. Grieving Children-Fathers and Sons.

It was 34 years ago today January 28, 1978, The residents of  Cleveland and Buffalo and Erie PA (where I was), remember it as the "blizzard of the century". It was a Saturday Morning and the wind was howling and the mountains of snow were piling up. In Cleveland. it was and still  remains the lowest recorded barometer reading in history.
 I had just turned 16 a month before. On that  morning, I stood in the driveway trying to jump start our car, as somehow my father in the hospital at Cleveland Clinic 100 miles away from Erie, had taken a turn for the worse. We had to somehow get the car started and make it 100 miles in the blizzard to see him. No one including myself, believed in his mortality. It wasn't magical thinking, it was just that my father the strongest, smartest person, whom could provide all forms of safety and security, like no one else in the world ever would or could.
As I stood in the driveway, that phone call came- the one that in an instant changes the course of your life-   'we didn't need to come to Cleveland now'. My Mother in a panic shouted  to my sister and brother, "Dad just died."
My first thought was, "Oh no. Now what am I supposed to do?"  34 years later I am still trying to figure out the answer. It is a timeless question for the ages maybe only asked and answered in a way between fathers and sons. I do wish I would have asked him when he was on earth, but I am not sure I would have been ready for the answer then. It might be something that is demonstrated through life, a question we go back to and revisit over the life span.
In that blizzard. I knew then that life would never be the same. I wondered what it would be like for my father to be dead. Would he be all right? How could he leave us? What would the world be like now? What was I supposed to do right then and what was I supposed to do for the rest of my life?
I had a lot of questions and there was now a fundamental problem that has plagued me forever. If the most secure thing in the world -my Father , could die, then there really was nothing secure at all in the world.
I had lost part of myself and part of my identity. When you lose part of your heritage, you roots and your essence, it might figures that one would not know where they were supposed to go or what they were supposed to do from then on in the future.
My life has never been the same, The world has always been a bit more uncertain, and maybe a little cruel, without that safety and security. His loss has colored every aspect  of my life. All the success and all the failures, all my roles as a man have been touched by this loss. From father to husband, brother, uncle, friend. personally and professionally.  All of the good and all of the hardships, since he died, oh so many hardships, the pain, the sorrow and agony, which I mostly as a man have kept to myself- all these have been colored by his loss, and they have been experienced and endured without him.
On earth I was nobody's son anymore. My mother soon took sick with Alzheimer's. It is a foul, lost feeling not being anyone's son, not belonging to anyone. We create relationships through out life, some are fostered and  nurtured, some are lost and decay, but there is no bond like a father and  son. There is only one.  

Tuesday, January 3, 2012

Forget the Politics...Sorry....Doctor vs Provider what is difference between a psychiatrist and a psychologist??

"Uhm same thing?" psychiatrist or psychologist? Nope. "Uhm ( from the sophisticated smarty pants of society) a psychiatrist can prescribe meds and a psychologist can't. True but is that the only difference, is that the defining divergence?"
As you probably know I am now from what I can see the most politically incorrect PRO-PHYSICIAN Blog I can find on the world wide web in the English Language. As you know I don't side step stuff by providing the same constant SAFE-helpful information on common medical problems that you can find in a thousand places on the Internet. Granted my blog is true honest and candid, it is highly opinionated, and I like to think I speak for a lot of doctors whom are simply terrified to say some of the things I say about the adversity a physician is up against in this day and age in the practice of medicine. Of course I don't provide SAFE blog posts on all the latest medical technology ipod and ipad apps and all that BS. Another good clean and SAFE fun topic for doctors to blog about.
So I have an opinion on this question and some facts. I even discuss  it somewhat in When Can I Go Home?
Yes psychiatrists are physicians and they can prescribe medication,
But so can Clinical Nurse Specialists and Nurse Practitioners, and Physician Assistants, all have varying degrees of prescribing authority and autonomy and this varies by state. In a couple states psychologists can ever prescribe psychiatric meds.
The honest to God truth is that this physician extender, or mid-level practitioner model had its origins and motivations in necessity. No one wants to go into the Field of Psychiatry. There is a shortage of psychiatrists.

(I did a recent interview for the Minnesota Medical Associations monthly journal talking about the recession and the effect on depression. The sophisticated and educated Free-Lance Writer hired by the Association to conduct interviews had no idea that psychiatrists were just about the lowest paid specialty in Medicine.)

Okay so we know people don't go into psychiatry to make money and if they think they are , then they are misguided and ignorant, no big issue there.

I won't get into all the reasons why there is a shortage of psychiatrists, it isn't about the money, it is a host of reasons.

Now when you take the shortage issue and you couple it with that fact that politically and perceptually doctors are arrogant SOB's whom only care about making money and therefore just not good people, than you have the legitimization and flourishing of mid level prescribers in psychiatry.

Let me illustrate my point further by example.: I had a student nurse once, whom was getting a masters degree and essentially then getting her license to prescribe psychotropics, I was supposed to teach and train her. She was a good person and quite bright and caring toward patients. I asked her, "What is the difference between a physician and a nurse prescriber?" She advised spontaneously, " nurses are different than doctors. Nurses talk to their patients"
I will never forget that. To this day it irks me and hurts my feelings to no end. She truly believed that and was indoctrinated into believing that, She was not stupid just politically brainwashed.
All I do all day is talk to patients and give and give and give my energy all day. It has nothing to do with the biological mechanism of the meds. It is what a doctor- a good psychiatrist does, Nurses and psychologists do not have a monopoly on talking to patients.

So once I was at a music shop and buying my son some guitar strings the quintessential music story pony-tail guy saw my credit card signature and he said "Ahhh... MD making decisions"  he actually had it right. No one has ever signed anything since the day I graduated form medical school below my signature, An MD always gets to sign at the most bottom line, I swear to God. The signature underneath everyone Else's assures that individual is the master of all liability and assumes all responsibility when the rubber hits the road,

Now the reason I talk about liability and responsibility goes to making decisions. By the nature of training the physician is really not allowed to have a comfort zone for making decisions, Decisions imply ultimate responsibility and liability. Sure you can have colleagues to consult get second opinions, but in the end the physician really has no where else to go. By the nature of the training doctors make life and death decisions in the middle of the night after no sleep for forty hours. That is pressure. Psychologists don't have that kind of training,
I may have blogged about this in the  past but the point got driven home to me a couple weeks ago. Talking to some psychologists and one in training, this therapist trainee was overwhelmed and intimidated by a patient. She wanted to pass the patient off to someone more experienced, she did. no problem right? So how does that work. Will there always be someone more experienced and how did they get that way?
Training more Training and supervision.
Okay here's the bottom line as a psychologist in your training it is ethical and appropriate to give the patient away to someone Else if you are scared and over your head. No problem sounds like the right thing and it probably is, especially for the patient (psychologists call em' clients like lawyers and accountants and advertising executives have 'clients') I don't want someone who does not know what they are doing.

Now jump back 20 years, I'm in my residency I am overwhelmed and intimidated by a patient, I don't even want to see the patient behind a closed door. "Please someone more experienced take this patient off my hands. PLEASE! I'm just a resident,.... a doctor in residency training.
So an old supervisor long dead now says to me, you will have lots of patients over the years who are overwhelming, frightening, you have to learn to work through it, accept it deal with it, get good at treating them. There may be no one in the end more competent to fall back on. Get supervision guidance. Learn. I did, the patient lived and got through the year and things went okay, I did all right, and actually helped the patient. I did not have the luxury to dump the patient on someone more experienced.
Therein lies one of the most fundamental difference between psychiatrists and psychologists and nurses.
If a  doctor does not know what they are doing, they damn well better get some supervision and figure it out, they don't get to send the patient somewhere else because "ohh it's too hard"

Anyway I hope and pray for all of you blog readers caregivers around the world that you had a Blessed Christmas or Happy Hanukkah and have a wonderful and prosperous New Year.  And thanks for Reading my blog in 2011. I know most people are looking for the difference between delirium and dementia and depression, or questions about Alzheimer's being a mental illness. I will keep blogging in 2012.
I do not forget all of you caregivers world-wide, and we will hope and pray for some SIGNIFICANT Alzheimer's progress in 2012.

Talking about the book with the Lake Superior wind....... a calm day