After the Hurricane

I was riding the bus to my exam destination and it first had to stop at Charity Hospital and drop off some candidates scheduled to complete their exam there. I looked up at its towering presence, aging cement walls with somewhat art deco designs on them. The harsh environment that was New Orleans was evident as I looked upon the enormous towering monolith. Dripping down from the top of the building was the blackened soil of years of urban smog, oil wells and decay. It covered the top of the building and streaking down probably one third of the upper part of the building in ever thinning streaks, like streaks of chocolate syrup on a sundae. Only this did not have the appeal of ice cream at all. I looked up at that building and it gave me the creeps. I was thankful that I did not have to go in it. Something about it just made me uncomfortable.

At the time, I had no idea what fate awaited Charity Hospital.

That was in 2004, the year I took my American Board of Psychiatry and Neurology Board oral exam, the final step in the process of becoming fully board certified. The process is a tedious process and the exam is only administered once or twice a year at one site at a time. Every candidate in the country is expected to fly in from wherever they are to the designated location for what is ultimately a one hour long exam. As far as exams go, it has been very criticised for being very subjective, with results varying on the willingness of the patient being interviewed by the candidate to cooperate, the nervousness of the candidate, the mood of the examiner, etc. It is indeed a very nerve wracking time for a board candidate.

The oral portion is in fact, being phased out, but I was one of the "lucky ones" that got to endure the torture of an exam that has a 45% failure rate. To be honest, I did not pass it my first time, or my second. I passed one portion, but not the other, both times. I needed to pass this time. By now, I had relocated to a job where I had more colleagues to help me practice and felt better about the exam going in, but still nervous.

Through the whole process, candidates are loaded into buses and shipped throughout the city to various hospitals and outpatient psychiatric centers where we examine a live patient as part of the exam process. The first stop my bus made was at Charity Hospital. I honestly did look up at the grimy towers of the hospital and the building gave me the creeps. Perhaps it was my nervousness, perhaps the knowledge that this was not a safe part of town, perhaps just the whole feeling that there was a lot of suffering going on in this part of the city that got to me. I was glad I was not taking my exam in that building. It just made me uncomfortable.

I did not know at the time that it was the only hospital in town that treated uninsured patients. I now know I judged the hospital unfairly.

It is not in a good area of town, sandwiched between two interstate on ramps and surrounded by decaying slums. Location wise, Charity Hospital is not really all that near Lake Pontchartrain and the area that was most noted to have been flooded so badly. It actually was closer to downtown and the French Quarter, so I would not have expected it to have taken the hit that it did. Just that fact that the facility was damaged as badly as it was is a testimonial to the extent of the flooding that occurred. Charity Hospital is further away from the lake than the Super Dome. It now sits, fenced off with chains to keep people from entering. The building is considered a total loss and is somewhere on the long list of buildings that are scheduled to be demolished. The sordid tales of doctors and nurses euthanizing patients who they felt would not survive the ordeal continue to plague this facility, but I do not believe them in the least. One more ghost to haunt this facility.

To this day, there is a part of me that feels like my initial dislike of the building somehow played a role in its eventual demise. Like if I had not thought that it looked creepy, somehow it would have survived the flooding. Of course, the logical side of me knows that this is ridiculous. The city was going to flood regardless and the building is very old and outdated. It would not have taken much to render the building unusable. I know I am not the only person to look upon the dripping grime and soil on the towers and feel uneasy. My husband felt the same way for one. I am sure there are others.

I paid Charity Hospital a visit this New Year's to pay homage to the once so important institution in this city's history. Partially to make peace with myself that I was not the cause of the demise of the facility but also to honor any institution that cared for so many who had so little. The closure of Charity Hospital left a lot of people out in the cold. The gaps are slowly getting filled but like the lower ninth ward, the gaps are still larger than the areas that have been repaired.

My hospital cares for the uninsured quite a bit itself. It puts a big financial strain on the system, but people need care and they are human beings, not numbers. Sometimes I look up at the white cement tower at the hospital here, and it looks a little creepy, too. I have learned to see past the grime and look at the people inside.

Hurricane Katrina

"New Orleans is below sea level and if a serious hurricane were to hit them, they are all like sitting ducks. It's only a matter of time." - Former resident of New Orleans speaking before Hurricane Katrina hit.

It was five years ago today that Hurricane Katrina changed the lives of a lot of people. It was a day that I remember well. I was pregnant at the time and already emotional and easily teary eyed over sad things. I remember hearing the news reports on the radio at work saying that the roof of the Super Dome was starting to make strange noises and they were fearful that it would give. I have been in the Super Dome before and it is big, very big, and if the roof came down, countless lives would have been lost. I had this worried feeling but I cannot even begin to imagine how it must have felt to be in there. Fortunately the dome held although the chaos that occurred in there afterwards was almost as disastrous. I am not sure that anyone could have imagined the chaos in the city that ensued after that.

I took my psychiatric oral board exams in New Orleans and passed them so the city will always have a special place in my heart. We spent some extra time there just exploring the city and taking a mini vacation afterwards. We talked to people there and there were several people that came home with us in our memories. The patient I had to interview certainly stuck with me. There was an owner of a small store in the French Quarter that we talked to. And a worker at Cafe Du Monde. Sometimes I still wonder if these people survived, and if so, did they return? I tried to find the shop in the French Quarter when I was in New Orleans over New Years and could not find it. It is easy to get lost in those square grid streets so I will never know.

What I do know is that I knew real people, so they were more tangible, not just a demographic or number. I worried about those people I met. I felt badly for them. I still worried about those that I did not maybe becuase it was easier to extrapolate from the ones I did know. I got choked up when they showed women with sick babies or parents separated from their children, especially anything about mothers and babies. That was all the pregnancy thing, mother/child bonding, lives shared, blah, blah, blah. Only women can understand. Sorry guys. I saw a lot of real people suffer a real lot. Nothing was going to be able to stop the levees from breaking at that point, but the rescue efforts were pathetic and inexcusable.

So why did I not do more myself? I wanted to. My employer was allowing people go help out with rescue efforts, but like everywhere else in the country, there were not enough psychiatrists on staff for me to leave on short notice. There was no one to cover for me. And I was pregnant and it was not safe for me to be there. So I gave my money to the Red Cross and prayed for a miracle. The miracle never came. But the people of New Orleans are a hardy bunch and had continued to rebuild despite the disaster.

I salute you.

The Rest of the Story

I still have yet to fully explain the beauty of this particular Pacer Wagon I saw. From first looks, it had the usual POS appearance, falling apart, rust bucket type with some of the floor reinforced with plywood, a certain amount of duct tape as part of the body work, rust holes for decorations. Unless you live inland in the South or in places like Arizona, you have seen this sort of vehicle.


I was taken by a region below the gas tank. There was a strip about six inches wide and extending down to the bottom of the car of a sooty gray color. In the evening light, I had mistaken it for duct tape. Upon closer inspection, I realized it was some kind of grime built up, I guess from having leaded gasoline spilled on the side and never being washed off as the patch was most obviously emanating from the gas tank. The gas cap itself appeared to be a chrome door knob. It stuck out from the body several inches and I am not sure how street legal it is. The wheels were standard issue bland AMC wheels missing their hub caps, of course. It would have been better if three of them were mismatched doughnuts, but hey, you can't win them all. The body was standard issue paint with heavy patches of rust and holes permeating around the tire wells. The kind of car that might come equipped with a high tech eight track player and possibly even an FM radio if one were to really go all out. Us old farts will recall the row of buttons that one had to pull out and push in to save a radio station. Not that there was anything good on AM radio anyways.


Most of these cars had seats with the usual frayed fabric in the middle with a sort of houndstooth design with an outer edging of high quality pleather. Usually really worn seats are covered by either "faux" tiger fur seat covers or Tinkerbell ones if the owner is female. In the summer since many of these vehicles rarely had AC and if they did this has long since stopped working, they have those seat liners consisting of rows of wire coils covered by mesh fabric elevating one's butt and back off the seat slightly in order to provide some circulation as pleather does not feel all that great in the heat. Most hideous in appearance but better than the alternative of sitting on frayed fabric, rotting yellow Styrofoam and pleather in 90 degree weather.


I did not get a chance to inspect the seating arrangements of this particular vehicle as I was so quickly distracted by other features. This one was apparently not meant to die a slow POS death. It was in the process of being reborn into so sort of dorky redneck hot rod. Although the outer tires were bland, there was a very flashy chrome plated mag wheel spare tire in the trunk. One with one of those trillium looking projections coming out from the middle. Brightly polished, expensive and the tire was a high performance low profile tire at that. It was surrounded by, of course, the huge subwoofers that any "cool" car must have in the trunk.


The front was much more advanced in its progression towards awesomeness. The steering wheel was a highly polished chrome chain with a triple barred configuration that is always seen on true muscle cars, and impractically small in diameter. I would estimate no more than 12 inches. Being too small to control one's vehicle is really cool, at least that I what I am surmising from this as I have seen the tiny diameter chain link steering wheel before.


The gear shift was a very stylish chrome skull. Nothing like gripping shrunken model of a dead guy's head to shift gears to make one feel powerful. Personally, I prefer the one that blatantly advertises the gears with the six speed manual pattern clearly mapped out, signifying a high end performance engine, but if this guy wants to grab a dead guy's head, be my guest.


The hood was quite advanced in the customization procedure. It was obvious that it had been cleaned up, the color being a bright white with a good shine to it. It was the middle attachment that impressed my husband and I both the most. I was told the name of the type of body alteration this was, something like an air intake manifold which is often molded into the hood, but this is probably not readily available in a AMC Pacer so would need to be custom. Often they can be attached by welding, but also apparently by bolting, which was the owner's route of choice. I am not sure if this was particularly street legal as it looks and the job seems a bit botched as there are some gaps between the hood itself and the manifold. Note the sky blue bolts. Nice touch, huh?


My husband and I have had some debate about whether or not the final product will contain decals of naked women or not, he siding for the latter, me the former, but we both are expecting neon lights to show up somewhere. I am quite certain I would be very disappointed not to see flames painted somewhere. Whether they were done by a professional or done sloppily by hand has yet to be seen. Air shocks? Perhaps too 70's but remember this is a 70's vintage car and may be quite appropriate to round out the look.


If well done, this car could end up looking somewhat like "DJ" from the Disney/Pixar movie "Cars". If you have seen the movie and need a reminder, he's the one with all the CD's in the back. If you have not seen it, the movie comes highly recommended whether you have children or not. It really is a good movie despite its G rating.


The botched job on the air intake manifold, alas does not bode well for this poor vehicle and poorly done, it is going to look like any other failed attempt at rescuing a dorkmobile and making it a chick magnet and getting a dorkychick magnet instead.


My feeling is because it takes someone with los huevos muchos grandes to drive it in the first place, regardless of the direction this car takes, it is going to be one bitchin hot ride.

The AMC Pacer Wagon

As I had mentioned before, I have been on a two week sabbatical from work and partially out of touch with the world. Perhaps sabbatical is not an appropriate term since this implies it involved some form of scholarly activity which my time off most certainly did not. Last week, we spent a few days at a resort a few hours away from home and were stunned by a site that so overwhelmed me that I could not resist the temptation to write about it. It had nothing to do with psychiatry at all. But it amused me so much that I felt it was worth sharing with the world. Some stories are worth repeating.


The AMC Pacer Wagon has always had a certain geeky but cool mystique about it. Nerdy and awkward, but somehow the person who drove one was kind of a happening person. Sure they look like a Volkswagen Rabbit (the older ones) in the midst of anaphylactic shock, but the bubbly appearance just sort of works for some. I am not sure what the overall view of the Pacer was when it was made in the 70's, but in the 80's the view of the Pacer wagon could not have been better personified than in Wayne's World, the Movie where Garth drove a souped up version of a Pacer Wagon. His had cup holders, licorice dispensers and all other sort of additions to it. It was so nerdy that it was cool. It was cool that you did not have to take seriously.

Not that I would personally disparage AMC as a whole. Despite its image, I respect the company and mourn it's loss. AMC was the last of the independent car makers in the US and did make decent cars at one time. They were the owners of the Jeep line for one. That was why Chrysler bought them out in the first place. Their signature engine, the straight 6 certainly provided a surprisingly powerful configuration.* Porche has been using the straight 6 engine for some time in some models of the 911 for years so it must have some value. The AMX is still considered a classic in the muscle car circles. Perhaps not as popular as the Mustang, but still a car of note.

So the poor homely Pacer wagon comes out. I am not sure what the design team was thinking when they produced this bubble on wheels. Perhaps it was an attempt to completely reverse the boxy image imparted by the Ambassador. Maybe a poorly executed attempt at mimicking the AMX?

I have not seen a Pacer in years, but this one was the best one I have ever seen. An amalgam of POS (Piece of #&@) and souped up hot rod, this thing was an absolute laugh riot. We got a thumbs up from a passer by for even looking at this beauty. The details I will save for another post.

*As a testimonial to the power of the straight 6 engine, I have information that a 1972 brown AMC Hornet with a straight 6 configuration was driven in 1986 at 100 mph without difficulty on the Ohio Turnpike. The only reason for slowing was fear of the mighty Ohio State Troopers. This comes from a reliable source.

Back from Vacation

I have been absent as previously mentioned for one week, and have not able to access a computer, which is probably for the best. I truly believe that when I go on vacation, it is not healthy for me to be thinking about psychiatry or any aspect about work at all. As it ended up, I spent much of the time thinking about proper parenting for an overstimulated and often tired four year old little boy. The dynamics of when to say no, when to give in, how much to allow and not allow is never easy to figure out. Things on vacation are a lot different than home, and children do best with a routine. When that is changed, they tend to get worked up by it and test boundaries more than they would at home.

In reality these situations do give a real life example of where a lot of things have gone wrong in my patients lives. Especially in dealing with adolescent patients whose parents never did set limits and are now becoming dangerous. A four year old can hit and throw toys, but is unlikely to do much damage and I am bigger than him. This is not the case for a 17 year old whose outbursts can reach the point of being criminal. The parents all of a sudden try to exercise some control but get a very hostile response, one that they cannot control. So they drop them on our doorsteps and hope for a miracle. It had not happened yet. Nor has a pill that will make one good parents. Sad, and many of these kids end up in the legal system. If they have any hope of getting control of their lives, this is going to be the only place where it is going to happen.

We had a good vacation, but yes, there were a few days where there were a lot of rattled nerves, there was a lot of limit testing, and someone did not get to go on the rides because he was whining all day and was not the agreement. He also had his mini DVD player taken away and the "Toy Story" DVD was confiscated, because we think that it is teaching him some rather aggressive behaviors. Daddy was cranky, Mommy had a headache, it was a bad evening.

The next day we woke up, and the same little boy was a perfect angel. Amazing how a little persistence can make all the difference. He still loves us, too.

Vacation

I am going to be taking a much earned two week vacation and may not have much computer time to keep up so I will try to put in one last post before I leave. I will come to the crystal on my rear view mirror later.



I will be leaving my covering colleague with his job cut out for him. The unit cencus includes a unit full of depressed people who are having relationship problems and many of them have done something really stupid to get them in heat with their S.O. and are now trying to get out of trouble. This ploy usually works, until the next time. There is always a next time.

There is a large group of really sick people hearing a lot of sounds that no one else hears and seeing things that are not there. One is so disorganized that his behavior goes beyond description. Something about turning a tee shirt with a wolf on it into a tiger, or something similar. New age alchemy I guess. It is best not to try to think too hard about what this kind of patient is trying to relate as it is likely to cause one's brain to explode.

We have the usual selection of bratty teenagers who have never had limits set on them. Now they are uncontrolled and often violent monsters who are sent to us after they trash their parents house with the hopes that we will be able to find some kind of magic pill to fix their child's illness. What they need is a good dose of structure and discipline but by this time, most of them are beyond hope and if they are not in the legal system, are soon going to be.

We have several paranoid patients, often talking to themselves, very watchful of the other patients and mistrustful of staff intentions. I like these guys. They are the real deal. It is too bad that they think that I want to kill them.

There are victims of the downturn of the economy, but in reality, many of these people could have jobs. They just choose not to look for one and have set their sights on disability as a long term solution to their worries. Frustrating group to work with as they clearly can work. They just do not feel like it. A life of nothing but watching TV, drinking beer and smoking cigarettes seems like such a waste to me.

Of course there are some legitimately depressed people out there, too. The ones whom often are described during morning report as living the life in a country music song- loose your wife, your house, your truck, etc. It is easy to like these guys, but hard to know what to tell them. Surprisingly, these people usually pull through.

And lastly, the addicts. These can range from those pushed into treatment and came to the psychiatric hospital over detox because they did not really want to get pushed into rehab. They just wanted to look like they were quitting the drugs/alcohol. Some were too mentally ill to tolerate the rehab program where they were getting treatment and were sent to the hospital. Some of them were able to have enough clarity of mind to look back over their lives and see what they did have vs what they have bow. Many times they realize that they have nothing left- no home, friends, family- nothing. And they realize that they have nothing to live for. Some of these guys may not make it I fear.

But, I am going on vacation, the pager is turned off and I already chewed one staff member who dared page me after 5PM today when I was not even on call. The doctors who are covering are good doctors, I trust their judgement and know my patients will get good care. You may not hear from me in a while. I will be busy working on my heavy dose of high SPF and self tanner mix (defies logic, does it not?) and may not have access to a computer.

We are going in my husband's boring "crossover" type big POS monster vehicle with no satellite radio, no Bluetooth, no chrome tailpipes. Now if I could just get over the separation anxiety from MY car, I would be fine.

The Crystal on the Mirror

After a long hiatus, I am finally returning to why I have a crystal on my rear view window. The crystal on my rear view mirror probably does not have the same importance as my dreamcatcher, but I have always wanted one for my car and when I saw the right one at a craft festival I snatched it up.

As do most people who have them, I wanted it because crystals bend light in such a way to create a rainbow of the ray that hits it. I love the rainbows scattered throughout my car on a sunny day. They are beautiful, graceful, fascinating. The "New Agers" as they have been referred to have held certain beliefs in regards to crystals that I personally do not hold. A chemistry major is never going to be fully impressed by stories of magic powers in any form of rock. We know the chemical structure which takes all the mystery out of it. There is no mysticism about crystals, just that they hold great beauty. *

Rainbows are another story. In the old testament, the rainbow was said to be the covenant between God and mankind that he would never subject the Earth to such a devastating flood as the one he subjected the world to prompting Noah to build the ark. I am not one to view the rainbow in any kind of religious sense but the rainbow did come after a devastating flood and symbolized good news to the people who saw it.

They are fleeting things but especially here in the mountains, can be stunning beautiful. I have seen some of the better ones stop traffic. Rainbows here are more beautiful than I have seen anywhere else in the world. I was treated to my first double rainbow only after moving to central Pennsylvania and have been lucky enough to have seen several since. At times, it seems that they were meant to occur around times of happiness. I saw a stunning one around the time that a colleague gave birth to her son. The picture here was taken on the day we finally were moving from our cramped apartment to the dream home that we had finally been able to build after a long struggle. That was a very happy time for our family.

But then, sometimes they are just pretty. So I like to see them, and see them frequently. They bring happiness, sometimes good news and at least signify that the Sun is coming out to nourish the plants and help life thrive on the Earth. So I have a crystal hanging from my rear view mirror. My own little piece of civil disobedience to bring light into my life. A minor traffic regulation is not enough of a reason for me to take it down from my rear view mirror. They will have to catch me speeding first.

*Gentlemen, DO NOT take this to mean that a woman who has majored in chemistry is not going to show interest in "bling" as it were. Very few women, regardless of their level of scientific training is going to be able to resist the deep sparkle of a perfectly cut flawless diamond, especially when they are really clean and under the lights at a jeweler's case. The same goes for rubies, emeralds and a whole array of colors of sparkly stones that look good adorned on a woman's body somewhere. Dating a scientist will not get you off easy. Sorry.