GOOD-BYE BROWN EYES; YOUR STORY IS NOT OVER

BROWN EYES – 1997

I first met in her in mid-May, both of us in a strange place in a strange state of mind. Neither of us could adequately explain what brought us to that place, but her company there in that isolated pocket of sadness was an unexpected source of happiness, of companionship, and, eventually, guilt. But for those two weeks, she was my rock, my angel, and above all, someone who understood.

She had the most beautiful brown eyes. In fact, that’s what I called her: ‘Brown Eyes.’ Peering into them was as if I were at the edge of deep pool of still, dark waters, both calming and dangerous at the same time. There were several of us there, about twenty, but Brown Eyes was the only one close to my age; myself, 23, Brown Eyes, 22. We hung close to each other those two weeks. Practically every hour of the day.

Soon, however, we understood that it was pain, a deep hurting, that brought us to that place. Sometimes, a mind will work against its own, the cause of which could be a host of things, and will damage that soul, driving them down, causing pain, causing despair, madness, and, all too often, death.

Brown Eyes was an incredibly gorgeous young woman, both to the eyes and to the mind. She was caring, compassionate, prone to giggling, and a devoted listener. She radiated a warmth that I was instantly drawn to, a solace in a world gone mad.

Yes, we stuck together. We loved each other’s company, yet we were both afraid, both hurting. No wonder, then, that we were drawn to each other. But though our time together was brief, the days we spent together were full of closeness, friendship, and a kinship that I will never forget. Brown eyes and I used to have wonderful times together. We played poker, told hilarious stories about ourselves while we smoked cigarettes on the patio, we watched (and mocked) the nightly film, we ate together, and sometimes we were just together. We were as close as two young people could be in a place such as there. We shared a bond. We shared everything.

I remember once, one of the older residents, at one of our sessions, noticed the spark between Brown Eyes and myself. She remarked: “You two are going to get together when you get out of here, aren’t you?”

We both blushed. Brown Eyes managed a: “Well….” I smiled broadly, in the hopeful affirmative.

But Brown Eyes was hurting. Deeply. I so wanted her to get better, to see that she had value, to myself and to the world. Once, when we were journaling together, she had written ‘I am hopeless’ repeatedly across her worksheet. That crushed me. No one is hopeless. All life is precious.

I never discovered what brought her to that place, but her pain, so evident when it manifested, was so profound, so powerful, I could not help but be wounded further myself. I would find herself alone, trying to sleep, but crying. The suffering Brown Eyes would be curled up into a ball, clutching a Roald Dahl book, no doubt a book from her childhood, from a happier time. I went to her then, and felt her pain, stronger than my own. I did not understand it wholly, but I knew what it was like. I would hold her. Our little world, however, was constantly monitored. Such is the nature, the precautions the physicians must take, when two young people find themselves in the psychiatric unit of an old hospital on Seattle’s First Hill.

I remember what brought me there. I had been diagnosed with clinical depression only a year before. The treatment was still new to me, and I was battling old demons at the same time. Note to self: certain medications and alcohol are a terrible mix. My physician saw the signs as I collapsed, the ideations. Thus, this was how I met Brown Eyes.

Her eyes. Those deep worlds of both pain and compassion; never will I forget them. I remember the day Brown Eyes was discharged. She had given me her phone number. I will always remember this moment, the last time Brown Eyes spoke to me: “Please,” she said, “Do call.” I promised I would.

I don’t know why, but I waited a day. Perhaps I wanted to give her time to reacclimate with her family. Perhaps I thought it too early, for whatever reason. This is a regret that haunted me, ate at me, damaged me for several years.

I eventually did call her, the next morning after breakfast. The phone just continued to ring. I called several times that day, but no answer, no machine. The phone would just continue its incessant ringing. Finally, that evening, someone picked up. “May I talk to Brown Eyes, please,” I asked. The voice replied: “Who’s calling?” There was a sense of disbelief, and also inconvenience in his voice. “This is Andrick,” I replied, “A friend of hers from the hospital.” There was a long pause, followed by deep sigh. Finally, the voice, an uncle, spoke: “Brown Eyes is dead.”

My world collapsed. My time in the hospital was extended. I recall very little of the first few days afterwards. And yet, even in those dark days, I strongly disagreed with Brown Eyes: There is always hope. With the skill of the mental health providers at the hospital, and the daily visits from my psychiatrist, I improved. I wanted to improve. My father, whom I recently lost, would visit me everyday. Friends would call me, offering support. This is crucial to a recovery from a mental illness: a strong social support system and a team of dedicated professionals. And recover I did, more determined than ever to live. This was the first gift that Brown Eyes left me with: the will to push on, to live, to change the lens and see the world, and myself, as a wonderful place to be. This was her second gift to me: suicide will destroy those left behind.

RECOVERY

I was not in the hospital much longer. Though I had learned painful lessons, this is often how one learns and grows, especially in the assessment of those lessons. Pain is there to teach.

My psychiatrist was very skilled. He was both a physician of the brain, and a psychologist of human behavior. My Doctor was a rare breed then, and now, practically, an anachronism.

I have written on this before:

Now, these days, an unfortunate schism has happened: the divorce of psychiatry and psychology. But in 1997, I was very fortunate to have my physician and my confidant in the same office. Our visits were for an hour, several days a week after my discharge, as I began the healing process. We would discuss medication, but we would also discuss the illness, and the guilt.

Though I had only known Brown Eyes for two weeks, the bond we shared, in that environment, with someone my age who suffered a similar illness, was strong. My Doctor and I spoke of her extensively, and the choice she had made.

For that is what her suicide was: her choice. But the nagging guilt still gnawed at me; why didn’t I call sooner? What if I had said something different in our time together? What could I have done?

My recovery was strong. I returned to acting. The local theater community in Seattle was a strong source of support. I loved to perform for an audience, an emotional release you might not be able to tap offstage. I worked in hospitality, and rose to the position of Operations Manager. I switched to banking, where I eventually filled the same roll, with Chase Bank for fifteen years. I tried my hand at writing, and had a couple of books published (they were not very good, nor well received…. it turns out I am better at writing essays than I am at writing novels). At the tender age of 47, I made another choice, one of the best I have ever made. And so now I find myself in healthcare. Ironic, perhaps, but a profession I love nonetheless.

But those early years after the hospital were a steep climb. And yet, recover I did. Those who have recovered from a mental illness are aware that this is an affliction that may forever be a part of them. But, along the way, you learn skills, and ways to cope, so that each time the affliction attempts to return, you know what to do. Oftentimes, this involves one the hardest things there is to do: ask for help.

But there was always that little demon in the back of my mind, worming its way into my consciousness: that feeling of guilt. Eventually, as part of the healing process, you must accept that certain things are not your fault. There was nothing I could have done. Brown Eyes had made her decision. I understood her pain; I understand why she did it. Sometimes, the dark night of the soul is so powerful, one sees the only relief as oblivion. It was a decision I myself could never make. This was her choice. It was not my fault.

SUICIDE IN AMERICA

Suicide is the most destructive act one can do to those that love them. Survivors of those who have lost loved ones are often adrift emotionally and mentally, sometimes for years, or for the rest of their lives.

It is a difficult subject to broach, as it always stirs feelings of confusion, sadness, resentment, depression. Those who have lost loved ones to suicide oftentimes find themselves alone and misunderstood. Conversations can be awkward. The guilt can be overpowering.

Survivor’s guilt can lead to complicated grief, a kind of post-traumatic stress disorder than can degenerate into depression. Most of us have faced death, and we feel the hole it leaves within us. But to lose a loved one to suicide is a wound that is very difficult to heal.

Yet talk about suicide we must. Here in America, though we have faced profound problems for the last year and a half (to put it rather lightly), we have the resources and intelligence to address this problem. And a problem it is:

https://afsp.org/suicide-statistics/

In 2020, over 48,000 Americans died by suicide, making it the 10th leading cause of death in the country. On average, 132 Americans died by suicide every day.

Suicide is to succumb to the darkness, but it is also a desperate cry for help: a staggering 1.4 million Americans attempted suicide.

Suicide is the 4th leading cause of death of those aged 35-54.

A statistic that is absolutely heartbreaking: suicide is the 2nd leading cause of death of those between the ages of 10 and 34.

Every day, 22 American military veterans take their own lives. That is 1 suicide every 65 minutes. This number is appalling and unacceptable. No matter what your stripes, these men and women put their lives on the line every day, for very little money and insufficient appreciation.

THE LACK OF MENTAL HEALTH RESOURCES

Though suicide is obviously a profound problem in the United States, there is an unfortunate lack of resources for the mentally ill. At every clinic I’ve worked at, nearly every provider has decried the lack of options and availability for those who are on the edge. But, these physicians do their best. If one is depressed, and contemplating suicide, it is better to seek help from any Doctor than none at all. Every Doctor you will meet, every Nurse, every Medical Assistant; all of them will do their absolute best they can for you. I have worked among some of the best. They are dedicated to their craft, and to helping you heal as best as they possibly can.

Though we have come a very long way in understanding and accepting the existence of mental illness, we still have quite a ways to go. The social stigma still exists. The lack of awareness, though decreasing, is still present. There are often limited options and long waits to see a mental health professional. And, though I realize this is a subject of debate, healthcare in America can be egregiously expensive, and oftentimes, recovering from a mental illness takes in-depth and lengthy care.

WHAT YOU CAN DO

First and foremost, if you are having thoughts of suicide, and have made plans: CALL 911.

If you are depressed, or feel that life is not worth living: reach out for help. See a Doctor. See your religious counselor. Talk to a friend or family member you can trust.

If you are a survivor of losing someone to suicide, take care of yourself. It will take time to heal. As so above: reach out for help, wherever you can find it. Someone out there knows what you are going through. You are not alone.

In fact: Anyone suffering from depression or thinking of hurting themselves; please realize, you have value, you have a future, and you are not alone.

National Suicide Prevention Lifeline: 800-273-8255

Veterans Help Line, for those currently serving: 800-342-9647

Disaster Distress Helpline: 1-800-985-5990

suicidepreventionlifeline.org

https://afsp.org/ (American Foundation for Suicide Prevention)

https://www.nimh.nih.gov/health/topics/suicide-prevention/ (National Institute of Mental Health)

https://www.mentalhealth.va.gov/suicide_prevention/data.asp (for veterans)

https://www.militaryveteranproject.org/22aday-movement.html (for veterans)

https://youth.gov/youth-topics/youth-suicide-prevention (for teens and young adults)

As the saying goes: I would rather listen to your story than attend your funeral.

PROJECT SEMICOLON

Project Semicolon, stylized as ‘Project;’ is an American nonprofit organization known for its advocacy of mental health wellness and its focus as an anti-suicide initiative. It was founded in 2013 by Amy Bleuel of Wisconsin, who lost her father to suicide in 2003. Tragically, Bleuel herself committed suicide in 2017.

Project Semicolon defines itself as “dedicated to presenting hope and love for those who are struggling with mental illness, suicide, addiction and self-injury”, and “exists to encourage, love, and inspire.” A semicolon ( ; ) is used as a metaphor: the author could have ended the sentence, but chose not to. “The author is you and the sentence is your life.”

Today, one might see or notice people with the semicolon tattoo. Many celebrities have been seen with such a tattoo. I dislike it when entertainers use their positions of prominence to talk about politics, but if they are bringing awareness to mental illness, more power to them.

My heritage is far too Teutonic for a tattoo; hence, my necklace. I swear I’ve got a little Bigfoot in the family tree, somewhere…

https://projectsemicolon.com/

IGY6

IGY6, or: I’ve got your six (I’ve got your back) was inspired by project semicolon, created by military combat veterans to advocate for suicide prevention and awareness. One may occasionally see a veteran or first responder emblazoned with “IGY6;22.” The number 22 represents the number of combat veterans who commit suicide every day.

https://www.theigy6.com/

BROWN EYES, 2021

It was not until earlier this year that I accomplished something that I had neglected to do, perhaps unconsciously. I have lead an exciting and successful life; setbacks, here and there, to be sure, but with my new education and my new love of healthcare, I have a great future to look forward to, full of potential. But it occurred to me, 24 years later, that I never officially said goodbye.

It took a little digging on the internet, but I found it. I drove across town, and visited Brown Eyes’ grave.

There was an outpouring of emotion, to be sure, as memories came back. But there was also a sense of relief, of closure that I was not aware I needed. Her grave is on a beautiful, gentle hill, overlooking Seattle. It sits underneath a Japanese Holly tree, surrounded by trinkets and memories of those who had come by.

I said goodbye to Brown Eyes. I said I loved her, that I was not angry with her, and that it was her choice, but I wish she had made a different one. I imagined the conversation we might have had then, had she survived her illness, so long ago, as if we were two old friends, catching up on old times. I have absolutely no idea what happens in the world to come, but if we persist, in whatever form, after death, she will be the first person I hug.

Good bye, Brown Eyes! I remember your spirit, and our memories, both of which I will carry; your story is not over.

Dedicated to Hannah Elaine Harvey, 1974 – 1997

HIATUS

This will be my last blog post for the foreseeable future. Though I have loved writing my observations and thoughts on healthcare, it is time-consuming, and there are things I must move on to. All of you who enjoyed reading my posts, I can’t thank you enough. My website will still be there, and, somewhere down the road, I may post again. Thank you all, and do feel free to contact me.

Thank you all! Wash your hands! Get vaccinated! Take care of yourselves! Take care of each other! Bye for now….

THE FAILURE OF MENTAL HEALTH TREATMENT: THE DIVORCE OF PSYCHIATRY AND PSYCHOTHERAPY

There is a massive problem with the practice of psychiatry in today’s modern healthcare industry. There are several reasons for this, which I will address in a moment, but first, let’s get a few things out of the way.

Many people have a very reactionary, negative opinion of the field of psychiatry. They feel that it does more harm than good. In today’s healthcare environment, they may have a point, but I am speaking in general terms. Psychiatry, to many, is a dangerous science that can damage your brain. Of course; many medical procedures can damage you if administered improperly. That’s why I went to school. Many people feel that psychiatrists have very little clue as to what they are doing. While it is true that the study of the brain, which has remained a difficult and emerging science for a very long time, and will continue to be so, there are millions of Americans who have benefited from what psychiatry does know, and what treatments it can provide. And still others feel as though psychiatry, and indeed, any treatment of the mind or emotions, should be out of the realm of medicine, and kept in either the family or church. While it is very true, and studies have confirmed this, that those of faith, or at least some level of healthy optimism about life, tend to heal much quicker from whatever affliction they may have, that does not mean that medical intervention is sometimes required. Nor does it mean that atheists do not heal.

Plenty of people have a negative opinion of healthcare in general. That is unfortunate. Many millions of people have benefited from the proper treatment of an affliction, and go on to live healthy and productive lives, despite an illness that would have been a death sentence one hundred years ago. The human body is a machine, an amazing construction, the triumph of life on Earth (although the debate about that is for another time). Whether by evolution or design, you and I, and everyone else on Earth, are amazing creatures, composed of practically countless processes, organs, chemical and electrical reactions, and things still yet to be discovered. However, just like any other form of life, like any artificial machine, like any magnificent creation of geology, things can, quite simply put, break down. Sooner or later, it happens to all of us. Have you ever thrown your back out? Well, so have 65 million other Americans. We are wondrous creations, but not entirely perfect. Healthcare plays a role in our repair, and improving our quality of life.

But back to psychiatry. The negative connotations I mentioned above are not entirely unfounded. The history of psychiatry is replete with practices that today seem barbaric, and would never be considered as an option for treatment. What is worse, in modern history, authoritarian regimes have tortured and killed untold numbers under the guise of psychiatry: Nazi Germany, The Soviet Union; even the CIA is guilty of using psychiatry for nefarious purposes.

However, like all healthcare, psychiatry is an evolving field. Healthcare, in essence, is an applied science. That is, it is a scientific endeavor, used for practical means. Many constructive gains have been made. However, the application of these discoveries, when applied to the practice of modern American healthcare, has been severely misappropriated.

I can’t get into the tired debate of whether or not mental illness exists. Believe what you will. Many people, intelligent people, will claim that there is no definitive diagnostic test to prove whether or not a mental illness exists. It is true that nearly all mental illnesses, particularly the behavioral ones, are diagnosed by interview and observation, or that form you occasionally fill out at your annual exam where you check the corresponding box as to whether you are happy or sad. However, you can get out the fancy medical equipment and see it for yourself. In people with anxiety, a part of the brain called the amygdala is overactive. In cases of depression, insufficient monoamines are developed in the neurons of the brain. One could utilize these ludicrously expensive machines if you want to see the proof, but good luck getting insurance to pay for this.

Mental illness exists. I was once speaking to a friend of mine, who had a negative opinion of psychiatry, and said to just get that person with depression some dancing lessons, a cat, and an exercise program. Okay, Tom Cruise. You tell the guy with the gashes in his wrists who’s hanging from a noose to get some dancing lessons, B-vitamins, and some duct tape, and I’m sure he’ll be fine. Sheesh. But I needn’t be snide. Annually, roughly 49,000 Americans take their lives each year. Suicide is the 10th leading cause of death in the United States; however, it is the second leading cause of death for those between the ages of 15 to 34. There are, on average, 132 suicides per day. Perhaps worst of all, according to the Department of Veterans Affairs, 20 veterans die from suicide every day.

To be fair, engaging in activities that one enjoys that are healthy, socializing with others, becoming involved in a community art or political program; these are great ways to alleviate the symptoms of depression. So too with the natural remedies; regular exercise, a healthy lifestyle, artistic expression, prayer and faith, whatever you might like. But many people are too depressed to even get out of bed.

Besides depression, anxiety disorders are the most common psychiatric disorder in the United States. They affect 40 million people. Untreated, this illness will damage those around the afflicted, cost industry labor, and overburden the healthcare industry. People having panic attacks often end up in the emergency room. The number of those with anxiety disorders is no doubt growing, considering the trauma of the last year and a half.

And we’re not even talking about schizophrenia, ADHD, PTSD, bipolar disorder, panic disorder, and a host of others. Intelligent people with fancy degrees will argue that the DSM, the Diagnostic and Statistic Manual of Mental Disorders, is cluttered with debatable mental disorders. It contains nearly 300 diagnostic entries. It should be noted that the ICD, the International Classification of Diseases, contains about 80,000 entries.

But I am severely digressing. The main point I am getting at with this article is the unfortunate practice of psychiatry that one will often encounter when they visit their regular clinic or provider.

Somewhere along the way, a great disservice was done to the field of mental health. Psychiatry and psychology were divorced. This is profoundly wrong, and does not do nearly enough to heal the mentally and emotionally afflicted.

These two sciences, psychiatry and behavioral psychology, go hand in hand. They are deeply intertwined. You cannot simply address psychiatric needs while at the same time giving little consideration, or even downright ignoring, the psychology that goes along with psychiatric suffering. It is analogous to a physician simply giving a person with diabetes insulin, and telling them to monitor their blood sugar at home, while not counseling them on their dietary habits. So with psychiatry. You cannot simply throw pills at them, without addressing the psychology, usually damaged, that accompanies it. This makes no sense.

Unfortunately, that is the solution of much of modern healthcare: throw a pill at it. Also, due to the profit motive, patients are generally allotted 15 to 20 minutes for a visit with a healthcare provider. That is not enough time. The psychiatrist, or MD with a specialty in psychiatry, may ask them how they’re feeling, how’s the job, etc, but that is insufficient time to dig deep enough to treat the illness.

Psychotherapists exist, of course. However, they are harder to find, as insurance will still balk at their treatment, or they are booked far in advance due to the dire need, owing to the stressful times we live in.

Some clinics will not even have a dedicated psychiatrist. Your primary care physician will treat you. I’m sure that person cares about their patients, and has studied, at whatever length, both psychiatry and psychology, but they are much more likely to just throw pills at you, tell you to keep a journal or do some art or something, and come back and see them in a month.

I was diagnosed with a mental illness in my early 20’s. It should be noted that there is no ‘cure’ per se, but there are treatments to alleviate the symptoms, mental exercises to retrain your thinking, so to go on and live a healthy and happy life. I was able to do so. Despite a crippling depression, in a way, I was very fortunate. I was first treated by a seasoned psychiatrist, whom I called Dr. Dispensapill, who knew that psychiatry and psychology cannot be separated. He would see me for an hour. We would talk briefly about medications. Then we spend the bulk of the visit speaking about psychological challenges I might be facing. Then we would wrap it up with any medication or lifestyle changes to consider.

His is a disappearing style. You can still find psychiatrists like him, but they are rarely covered by insurance, and they are frequently booked far out.

Dr. Dispensapill, north of 80 years old, recently ceased being able to practice. It was difficult to find help for my mental health afterwards, but I have found a combination that works. I see, for 15 minutes at a time every few weeks, Dr. Deer In The Headlights, who knows little of psychotherapy, it seems, but knows all about the different medications and how they work. She got a 4.0 in advanced chemistry, I guess. I have also been able to find a very skilled psychotherapist, Dr. How Many PhD’s Does One Actually Need. She has been fantastic.

More than one of the providers that I work with have complained to their superiors that there is a woefully insufficient staff of human resources to refer psychiatric and deeply troubled psychological patients to. They will help the best they can, but they are there to treat skin rashes and broken bones.

This is a great problem in American healthcare. We have made a damaging mistake. The mentally ill are not getting the proper treatment that they so often need. The separation of psychiatry and psychology is, in my low-level practitioner opinion, the biggest systemic mistake modern American healthcare has made. You can’t treat one without treating the other, and vice versa.

Until we fix this problem, and there are other, massive problems with American healthcare, the treatment of the mentally ill will remain insufficient. Many more will take their lives. Millions will continue to be crippled with anxiety, living tortuous lives. And the dangerously mentally ill, with no options for treatment, will continue to commit violence.

I’m not sure why this happened. It shouldn’t have. Just my opinion.

Be good to each other.

National suicide hot-line: 800-273-8255

ARE YOU BROKEN? PROBABLY. DON’T WORRY, THERE’S A CODE FOR THAT!

Well, let’s take another look under the hood of healthcare.

Healthcare, the practice thereof, confuses many people. That’s understandable. I wish that I had more time to explain to my patients what I was doing, because it’s incredible stuff. Another thing that confuses many people is health insurance. In fact, it makes them quite angry. Understandably. But that leads to my next topic. Let’s confuse things even more with the riddle of modern healthcare that is billing and coding.

In a moment, we’ll take a look at the ICD. But first, some context. Just about everything that happens in healthcare has a number attached to it. It’s really more simple than it sounds, but here we go: HCPCS (Healthcare Common Procedural Coding System) was established by the Centers for Medicare and Medicaid Services in 1978. Though it is in the purview of the CMS, it applies to all healthcare coding. There are three levels to it, but the first level is the most common, and it contains what are called CPT codes, or Current Procedure Terminology codes. These are the codes for what the physician does to you: evaluation, surgery, lab work, prescriptions, tells you to lay of the bacon cheeseburgers, etc. Pretty straight forward.

Then there are the ICD codes, or International Classification of Diseases. These are the codes for what exactly is wrong with you, and why you came to see the Doctor in the first place. A broken arm has a code. A flu has a code. A dog bite has a code.

Ostensibly, the ICD codes were implemented to track diseases across a population. Since illness has no respect for political boundaries, these codes are also used to communicate to physicians across the planet. Researchers and physicians who may not speak English can at least decipher the ICD code.

This concept has been around for a long time. Some medical historians place the origin of the ICD codes as far back as 1763, when a French physician named François Bossier de Sauvages de Lacroix developed a classification of 2400 diseases. (https://pubmed.ncbi.nlm.nih.gov/20978452/) The list continued to grow and develop, and by 1898, the United States was using the International List of Causes of Death. (https://pubmed.ncbi.nlm.nih.gov/9082128/). More twists and turns of the list followed, until the establishment of the United Nations and its subsequent organizations.

In 1948, the World Health Organization took over the ICD listing. The various lists used across the world were compiled, and the first official list, number 6, was published in 1949.

Again, these codes are used to track illnesses across populations and for better communication between the healthcare infrastructure of nations. However, these codes have taken on another role. These are the codes that are sent to insurance companies when a facility needs authorization for treatment, along with the CPT code mentioned above. The insurance company will plunk these codes into their computer, mull in over, and respond with how much they will cover, which 11 times out of 10 is slightly south of zero.

In my training, I was taught to look up ICD codes the old fashioned way. Our instructor handed us each a large book, the latest ICD code book, with more pages than War and Peace in large print, and we were to track down a patient’s ailment. These days, the code is simply generated when I enter it into the computer. If I enter ‘back pain,’ the code is automatically generated, with the option for further detail, should the physician think it warranted. My instructor loved to make us work for it.

Bear in mind, the ICD code book is not to be confused with the Diagnostic and Statistical Manual of Mental Disorders. That’s a whole different list of problems. I’ve got about half of them. Work is underway to integrate the DSM with the ICD, but that will probably take some time.

In 1979, the ICD-9 was published. The codes are alphanumeric, five -seven digits long, and have the option for modifiers. There were over 13,000 different codes.

In 2015, the United States adopted the ICD-10. It was greatly expanded: there are over 70,000 different codes.

The theory was, the massive increase in entries allowed for greater specificity of the ailment, and did away with the need for modifiers. You ask me, someone had a little too much time on their hands, and probably started the day a great big bowl of amphetamine flakes. Nom nom!

Yeah, the ICD-10 may have taken it a little too far. The following are actual entries from the massive list:

W61.33: Pecked by a chicken

W5921: Bitten by turtle

R46.1: Bizarre personal appearance (Oh, I got that one, for sure…)

Z63.1: Problems in relationship with in-laws (What? When does that ever happen?)

V97.33: Sucked into jet engine

R15.2: Fecal urgency

Y92.253: Injured at Opera House (Hey, it happens…. Over 6 people a year succumb to this tragedy)

Y92.241: Hurt at the library

Y92.146: Swimming-pool of prison as the place of occurrence of the external cause of injury

Y93.D1: Stabbed while crocheting

V9107XA : Burn due to water-skis on fire, subsequent encounter (I really don’t know what to say…)

V9542XA: Spacecraft collision injuring occupant (Eyes front, Major Tom!)

And my personal favorite: Y.34: Unspecified event, undetermined intent (Well, sure! That works!)

I’m making none of these up. The ICD-11 is set to published in 2022. It is said to be almost five times as large as the ICD-10.

To end on a serious note: occasionally, the ICD will need to be quickly amended. In April of 2020, a new code was added. U07.1: Covid-19.

Wash your hands! Social distance! Wear a mask! Get vaccinated! Avoid Florida! We’re not through this yet!

Medical Terminology (and the ancient Romans were kind of jerks)

Well, the third quarter is underway, and so far it’s going great! I’m taking 2 courses; one is Pharmacology and Medication Administration (this is what the chemical is, this is how I will inject you with it) and Administrative/Clinical review (this class is a lot of fun –  the instructor basically sets up exam rooms, and we practice on-boarding patients; the instructor, playing the MD, then gives us a procedure to carry out with the patient), which ties together everything I’ve learned so far. We are also studying medical terminology, and where it comes from. Not sure why that wasn’t covered in the first quarter; perhaps they just wanted us to get familiar with the jargon before we closely studied the etymology.

Everything in healthcare seems to have a needlessly fancy name, but there’s a good reason for that. Just about every bit of terminology a practitioner uses is either Greek or Latin in origin. There is also the occasional eponymous term, a word named after the person who discovered/invented it (Pap test, Alzheimer’s, Tommy John surgery). I’m oversimplifying the history a bit, but a long time ago, when Hippocrates and his colleagues figured out that illnesses and diseases were actually environmental and not divine punishment (although that unfortunate concept still exists today), and began to actually study the human body, the ‘English’ of the day was either Greek or Roman. Many people in the known world (which was much smaller then, than our own) spoke one of these two languages; much like a good portion of the known world speaks English today. This way, a physician in Rome could correspond with a physician in Roman occupied England, who perhaps spoke a local dialect, and they would know what they were talking about. The practice continues today.

The word ‘doctor’ comes from the Latin ‘docere,’ which means: to teach. It also shares its roots with the word ‘docile.’ The thinking here is that one cannot properly learn and absorb information if one’s mind is not calm and focused on the matter at hand.

But, as it turns out, the ancient Romans could be a little flippant. The word ‘hyster’ comes from the Latin ‘hystera,’ the word they used for uterus (think: hysterectomy). The Romans believed that women got moody and emotional because of their menstrual cycle; therefore, the word ”hystera’ shares a root with the word ‘hysteria.’ Well, that’s charming. Sure, some women do occasionally get a bit out of sorts on their menstrual cycle, but that is not a character flaw or an indication of a psychological or psychiatric disorder. A woman’s endocrine system is simply in overdrive, if you will, forcing an ovum into the uterus. So there you have it. The etymology of medical terminology is fascinating, but glib, dismissive opinions are nothing new.

Wash your hands!

3rd qtr so far