E.D., not E.D.





Well, what can I tell you…

Most of my posts recently have been rather heavy, and personal. I thought I would trot out another attempt at medical humor that (actually!) happened to me on the job.

Everyday, before a Medical Assistant begins seeing patients, there’s a litany of things to take care of. Some mornings are busy, some run smooth; but, the ducks need to be in a medical row before showtime can begin and the first patient is seen. You’ve got to meet with your provider and pow-wow the day, make sure every room is stocked, make sure you’ve got equipment set aside for any special procedures that day, and gulp down about a gallon and a half of coffee.

Nearly every hospital or facility uses what’s called an EHR, or: electronic health record. This is essentially the operating system of the clinic. You can see all sorts of nifty PHI (patient health information) here, as well as the schedule for the day. Many facilities use an EHR known as Epic, although there are others. The days of paper system providers are practically an anachronism.

In February of 2009, President Barack Obama signed the HITECH act, or the: Health Information Technology for Economic and Clinical Health Act. The goal of this act was to compel ‘meaningful use’ of electronic health records; that is, to facilitate national healthcare information between different healthcare facilities, and to promote the safety of patients by digitally checking drug interactions, duplicate orders, unrecorded allergies, a current medication list, and a host of other measures.

There are, of course, drawbacks to this measure. Any electronic system of information can be hacked. If you’d rather not be discouraged, please do not read this:

https://www.healthcareitnews.com/news/biggest-healthcare-data-breaches-2021

To be fair, nearly all modern healthcare facilities use state-of-the-art electronic security systems for their internal network, with an army of techies constantly guarding it. The chances of someone cracking into a hospital’s system are extremely low. So please, do not follow this link:

But, by and large, your information is quite safe. Another criticism of the electronic health record system is the difficulty transmitting information from one facility to another. Within the same company, it’s not a problem. But if Epic goes to link a patient’s PHI from another healthcare company, the results can be quite variable. Sometimes, the information is linked immediately. Other times, the targeted EHR does not respond; or, in some cases, it does, but painfully slow. However, when it works, it’s a fantastic tool for healthcare practitioners.

Still another criticism is purely opinion, one I have heard from many in the industry, and not necessarily my own. The Department of Health contributed nearly $37 billion dollars to promote the adoption of EHRs. This was a worthwhile incentive for a worthy endeavor, but essentially, this all but rendered small, private practices extinct. It is extremely expensive for a small provider or a facility to convert from a paper records system to an electronic system, generally running over 6 figures per provider. Thus, the Amazon analogy applies.

Personally, I find the Epic EHR a great system, easy to use, very customizable, and a wealth of PHI. I could not imagine doing my work without it. In my opinion, the developers have done a fine job.

But, back to the matter at hand: the beginning of a Medical Assistant’s day. Within Epic, there is a schedule for the day feature, listing the patient, their pertinent information, the time and length of visit, and, at the click of a button, whatever else you need to know. Perhaps the most useful category on this list is: ‘reason for visit.’

It was early on in my healthcare career, while I was an extern at a primary care clinic, using Epic. My mentor, who had the grace and social skills of a rabid possum trying to do math, asked me what reasons patients were coming in for today. I glanced at the computer monitor showing Epic, looking under the reason for visit column. There is was.

At least 8 of the 14 or so patients coming in that day, for our provider, were listed as ‘ED follow up.’

My God, I thought. These poor patients. So many. One of them was only in his early 20’s…

Erectile dysfunction is no laughing matter. So go ahead, get it out of your system. Go ahead with your vienna sausage problem jokes. Yuck it up. But the truth is, erectile dysfunction can be a very debilitating, and alarmingly frequent condition. It affects over 30 million men in the United States. The causes can be quite varied: diets, medications, neurological disorders, psychological disorders, kidney disease, age, lifestyle habits, and many others.

https://www.mayoclinic.org/diseases-conditions/erectile-dysfunction/symptoms-causes/syc-20355776#:~:text=Erectile%20dysfunction%20(impotence)%20is%20the,necessarily%20a%20cause%20for%20concern.

Sadly, one of its main side effects, other than the ability for a male to perform during sex, is psychological. There are a myriad of of psychological reasons why this is important to men, a topic for another time. But erectile dysfunction can cause seriously debilitating psychological damage to a male. Self-esteem can take a massive hit, and depression can result. A male may feel woefully inadequate, a self-defeating thought which pervades other areas of the man’s life. It is an embarrassing condition, one which men don’t like to talk about, it sucks, it’s no fun, women laugh at you, you think you’re worthless, I hate myself, no one will ever love me again, I am only half a man, why does God hate me, I…. wait, who am I talking about, here? I wasn’t talking about me! WHAT?!? Anyway, I digress.

There are, of course, many treatments available for ED. Depending on the cause and severity, it may range from a simple medication or lifestyle change, all the way up to an unfortunate but life changing surgery. It can be fixed.

https://www.mayoclinic.org/diseases-conditions/erectile-dysfunction/diagnosis-treatment/drc-20355782

So, my mentor asked me the reasons for patient visiting that day. I really didn’t know what to say. I paused, turned to her, recalling that this is healthcare, and said to her: “It looks like we have a lot of patients coming in today for ED.”

She looked even more annoyed than usual, looked at her screen (with the same schedule pulled up), and scowled. Turning back to me, and said, with the tone and temperment of a ferret with a flamethrower: “Some of these patients are female!” Huh? I looked back at Epic. I hovered the mouse cursor over the reason for visit column. (Epic has this neat feature… hover to discover… you pull up more detailed info when hovering the cursor over the subject…) Further information was displayed in an expansion of the display.

“Emergency Department follow up for dog bite.” “Emergency Department follow up for sore lower back.” “Emergency Department follow up for transient tachycardia.”

Ah. Emergency Department follow up. E.D., not E.D. Well, egg on my silly face! I learned that day something very important: in healthcare, what is colloquially known as the ’emergency room’ or ‘ER’ is actually called the ’emergency department.’ Well, that’s good to know. Would have been nice if that had been in the classroom curriculum. Back to you, Jaimers!

So, there you have it. If you need to go to the ER, it’s just fine to call it that. Let’s say you go in for a bad bee sting or something. Then, the staff there will advise you to follow up with your regular provider. When you schedule that follow up appointment, behind the scenes, Epic will list the reason for your visit as an ED follow up. But don’t worry. You don’t have ED. Especially those of you coming in for gynecological exams.

As an aside, my mentor turned out to be a very cool person. She and I keep in touch, years later, as she was very instrumental to my success. Although, I remember more than a few times, while I was turning an exam room (cleaning it and restocking it after a patient’s visit), I overheard her say: “Having an extern rules. He has to do whatever I tell him. I love that!” Heh. She was a great mentor, and a great Medical Assistant, and very much part of my education. Thank you again, KK at Wedgewood.

Well, there you have it! Take care of yourselves! Wash your hands! Get vaccinated! Be good to each other! Bye for now.

TY: KK, UWM – Wedgewood, JP

SUICIDE IS SERIOUS (but my cat is immortalized)

Well, I haven’t written anything in a while. I’ve been busy repairing myself, and working on another writing project. It was just published in the Seattle Times today!

https://www.seattletimes.com/seattle-news/mental-health/i-felt-disillusioned-abandoned-and-alone-a-medical-worker-on-why-mental-health-care-is-needed-in-the-field/

My mental health has greatly improved. And my cat is a life-saver.

I’ll write a post again soon. Take care of yourselves!

Suicide Prevention Hotline: 800-273-8255

Andrick

TY: HF, AP, PS, TS, CS, CP, Dr. LE, LMHC CL-K, Mia the Cat

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)

Additionally, there are professional organizations dedicated to the education, destigmatizing, and healing of mental health conditions. One of the best is The Boca Recovery Center, at:

bocarecoverycenter.com

Their information on depression and addiction is outstanding:

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….

FROM HELL’S HEART I STAB AT THEE

I work in healthcare. I am a Certified Medical Assistant. Children hate me. They can’t see my big, goofy smile through my surgical mask. That matters little. They know who I am. I am the man who keeps Mr. Pain in his pocket.

Millions and millions of Americans hate going to see the Doctor. There are a lot of valid reasons for this. One is primarily economic. American healthcare can be extremely expensive. We are the only industrialized nation that has not figured this out, and there is plenty of debate concerning this; however, that argument is for another time. Millions of Americans also hate going to see the Doctor because they refuse to believe they are sick or in need of treatment. That’s all well and good, you hardy lumberjack, you; but many diseases and illnesses have no symptoms, until the affliction decides to kill you. Millions of Americans hate going to the Doctor because they think that all Doctors are quacks, and are just going to take your money. Well, sorry you feel that way, but I’ll probably be the one taking your vitals when the cancer kicks in that could have been avoided had you seen the Doctor sooner to prevent your illness. Millions of Americans hate going to see the Doctor because they believe Western medicine is impure and inherently harmful. There is nothing wrong with yoga, meditation, or tai chi; in fact, Western medicine has embraced these practices. To a degree; I’m really not sure that chamomile tea and ginger root paste is going to cure your diabetes. Just sayin’. But I posit this: Millions of Americans are afraid to go to the Doctor for one simple reason: they are afraid of needles.

Trypanophobia is the fear of medical procedures, especially needles. This is distinguished from aichmophobia, the fear of sharp things. Also, this is not to be confused with iatrophobia, the fear of Doctors, the White Coat syndrome, why your blood pressure goes up in the exam room even though hypertension has never been a problem for you. But back to the fear of needles. There can be good reasons for this. With an injection or a blood draw, metal is entering your flesh, and you may see blood. On an instinctual level, that’s not supposed to happen; even though on a rational level, it may be necessary treatment for an illness. It’s really as simple as that. But please allow me to elaborate.

In 1995, Dr. J. G. Hamilton, a smart man with a no-nonsense name, published a paper on this topic: (https://pubmed.ncbi.nlm.nih.gov/7636457/). He suggested that the fear of needles has an ancient genetic basis in evolution. Our pre-history ancestors were well aware that sharp cuts or bites could very well be a death sentence. There were no antibiotics; if the wound were to become badly infected, it could kill the injured. There was no healthcare to speak of, save the shaman or medicine man who may try to perform rituals to appease the deity the tribe believed in, as the injured had angered this god, bringing the affliction upon the wounded.

Another evolutionary theory by Stefan Bracha, MD, suggests that one might faint from an injury to demonstrate that a fallen combatant is no threat, and is taken out of the violent melee over the hunting grounds of contention at hand. (https://www.sciencedirect.com/science/article/abs/pii/S0278584606000091?via%3Dihub) You know, I’m still not really sure if possums actually do that. But I digress. Possums are cool.

The truth is, however, you really don’t need to go that far back in our evolutionary history to paint a simple picture of a grown adult’s fear of needles. All of us, when we were toddlers, received several vaccines. The Centers for Disease Control and Prevention has a schedule that healthcare providers follow:

This itinerary is only to 6 years. There are several vaccinations and inoculations after that, and many into adulthood. Many of the diseases listed in this chart have been all but eradicated due to immunizations. However, healthcare deeply respects patient autonomy. There are many parents out there who, for whatever reason, distrust vaccines (anti-vaxxers is the pejorative term) and refuse to get their children vaccinated, because there is a 0.000007% chance the vaccine will cause their child to grow a second head. On a serious note, this philosophy is why measles and mumps have not been completely eradicated, and, sadly, it is often the children who suffer and die.

But regarding a young child getting their shots: I posit a train of thought, a somewhat obvious one, that if one follows, it is quite easy to see why many of us hate needles. You are probably familiar with psychologist Erik Erikson’s eight stages of human development. Of course, unless you are a Scientologist, there is no perfect model for human psychology. Nevertheless, Erikson’s model has been studied and reworked by various schools of human development and psychology. Marysville Universtiy has a great article on this model, as well as others: (https://online.maryville.edu/online-bachelors-degrees/human-development-and-family-studies/stages-of-human-development/). In a healthy environment, trust and autonomy will foster in the growing human in the formative years. These healthy traits are directly opposed at the Doctor’s office.

When we are infants, toddlers, we are coddled, fussed over, and, in a healthy and nurturing environment, we are loved. Our needs are met. We have no responsibilities. Or course, there is discipline and punishment when we don’t get our way, but; again, in a healthy environment, this is for our protection. But. eventually, we are taken to the Doctor. Toddlers in particular, at some level, understand these visits, as much as they are places of potential pain.

When we are administered the vaccinations above, we certainly do not have the mental capacity to understand why we are being hurt by the scary man in scrubs. We are restrained, which is terror enough. Then, a sharp blast of pain appears on the body, usually, in the case of a toddler, on the thigh. This can be quite the traumatic experience for the youngster. I was holding down the legs of a 3 year-old once, while another Medical Assistant was giving him his shot. The young man was quite vocal in his opposition to all this. He really filled the room. And I tell you, a tiny human like that can really summon precocious strength. I didn’t like it, but I really had to hold him down. Generally, the parents are off to the side, although some assist in restraining the child, and all of them usually say things like: “It’s okay sweetie. You’re doing fine.” In the child’s head, nothing is okay, and nothing is fine. These are our formative years. We remember these events, at some level of consciousness. It is quite easy to see, then, why we carry this fear of Doctors, and specifically needles, well into adulthood.

There is a physiological process behind all of this. Most of us are familiar with the concept of fight or flight. This human (and animal) phenomenon is older than the theories of ancient man outlined above. It is ingrained into the very survival instinct off all human beings. It has been with us since we first banged the rocks together, and it continues today, when we go to the Doctor to get poked with a needle.

You have a nervous system, commanded by your brain. The nervous system carries out commands to different parts of your body to tell them what to go do with themselves. The main nervous system, the central nervous system, is divided into several sub-systems. The parasympathetic nervous system is responsible for resting the body when you are relaxed, resting, or feeding. The sympathetic nervous system, on the other hand, ramps your body up when danger is perceived, kicking in the fight or flight reflex. Our ancient ancestors had to do things like run from bears (this would the ‘flight’ portion of fight or flight). When this system kicks in, blood and oxygen and sent to the lungs, and the body is filled with adrenalin, to prepare ourselves to get the hell out of there. This reflex is with us today, although it can be associated with actual, physical danger (car crash, mean dog, airplane turbulence) or societal danger (the boss wants to see you, the principal called, collections just sent you a letter). When this happens, and one is expected to hold still, sitting in the phlebotomist’s chair, blood and oxygen leave the brain, our thinking becomes clouded, and many people either have an intense reaction of fear, or, even the big tough guys, experience vasovagal syncope, a fancy term for passing out. I’ve seen it happen.

But you know, the bottom line is this: it could be a lot worse. Depending on the skill of the healthcare provider, and the type of injection, getting a shot in the shoulder or getting a needle in the arm for a blood draw is pretty low on the pain scale. Needles today are designed to cause as little pain and discomfort as possible.

This is a fantastic article: (https://medicine.uq.edu.au/blog/2018/12/history-syringes-and-needles) The first needles were used in the second century, CE, with disastrous results, and by that I mean fatal. It wasn’t until the mid-19th century that modern needles began to take shape. But I don’t imagine those needles were all that easy to take, let alone sanitary.

Let me wrap it up this way: Have you ever been stung by a bee? That hurts! That’s because it’s designed to hurt. All of us have jabbed one our fingers with a staple before. That hurts! Those are things that are piercing our flesh. Modern needle design, with the hypodermic wielded by a skilled healthcare practitioner, really: Does. Not. Hurt. Sure, it stings a little, but it’s over in a few seconds, your arm may be a little sore afterwards, but trust me, you are probably going to be okay. When I am practicing in a clinic, I am forbidden from giving any kind of assurances, but here on this blog, I’m pretty sure you’re going to survive your shot.

Most of the injections I give are either in the shoulder, the thigh, or, rarely, the back of the upper arm. I occasionally give small injections on the inside of your forearm. Once in a while, the buttocks. I know what I’m doing. There are tips are tricks that I paid a lot of tuition money to learn. I’ll make it east on you. But, not to scare you, there is the occasional injection, rarely given, that are handled by Registered Nurses or Doctors: intraosseous, into the bone. Intrathecal: into the spine. Intracerebral: into the brain. These all sound fun, right? But these are rare, and are administered carefully and with anesthesia by a highly skilled practitioner. There is also, of course, an amniocentesis, which expectant mothers may be familiar with. But there is also cardiocentesis, when a needle punctures the heart. These are just a bit above my paygrade.

So the bottom line is: it’s perfectly okay to be afraid of needles, but it really doesn’t hurt too bad. On the second day of my externship, I have to give a vaccine to a 7 year-old child. She was frightened, scared, and crying. I did not patronize her; I told her it would hurt a tiny bit for just a few seconds, that it was okay to be scared, it was okay to cry, and it would be over quickly. She relaxed a bit. As soon as I injected her, she immediately perked up. “Oh!” she said. “That really doesn’t hurt too bad!” I happily affirmed her, was done in a couple seconds, and withdrew the needle. My mentor said she had never seen a reaction like that from a child. So, I know that needles are scary, and that’s perfectly okay to feel that way, but just remember that 7 year-old girl.

I’ve gotten very good at assessing what kind of patient I have, very quickly. Sometimes, if someone has a healthy outlook on life, but, I can tell, is afraid of injections, I usually try to lighten the mood with a few jokes:

“Well, let’s give this a shot.” “It’s okay not to look; I don’t either.” “I promise you, this won’t hurt me a bit.” “Present: arms!” “Oh… no wonder… that’s the wrong end of the needle…” I’ve got pages of these!

There is one final note to end on, something I neglected to mention. The Dentist. The Dentist uses needles, too. Your gums are much thicker than skin, so the Dentist uses a larger needle. The nonvaccine is very thick, so the needle must remain in gum for a longer time. The Dentist enjoys this. The Dentist is evil. The Dentist enjoys hurting you. The next time you go to the Dentist, bring your holy water, and banish the Dentist back to which they came. I kid! I’ve had some great dentists.

Remember: it doesn’t hurt that bad. Be like that 7 year-old girl! I’ll see you at the clinic!

Peacock Surgery

DISCLAIMER: I HAD NOTHING TO DO, AT ALL, WITH THE FOLLOWING STORY. I AM LICENSED TO PRACTICE ON HUMAN BEINGS. THIS STORY AND PICTURES WERE RELATED TO ME BY… A FRIEND OF MINE. AGAIN, I DID NOT DO THIS.

Peafowl are common birds of the phasianidae family, related to the pheasant. They are found in warm, tropical regions of the world. The male of the species, the peacock, is known for its resplendent display of tail feathers, the peacock train. They are some of the most beautiful birds on Earth.

My friend, who told this story to me, has a friend who owns a no-kill farm out in the country. The place is fantastic; friendly goats, peafowl, war-like geese, chickens, and even the last remnant of the dinosaur, the emu.

Though they may be vastly different than human beings, the peafowl can succumb to very similar ailments and conditions. This story, related to me and not done by me, is the story of a peacock with a very bad cyst.

My friend’s farmer friend had purchased a peacock. At first, he paid no mind to the cyst on the side of the animal’s face. But the cyst grew quite large, and was causing the poor bird problems with its vision and breathing. As you can see, its left eye was nearly useless, as the pressure of the cyst was pushing it out of its socket. It also had a rasp to its breathing, as the cyst was putting pressure on throat. This animal needed help.

My friend, who told this story to me, is quite familiar with cysts. However, he is not a veterinarian. Be that as it may, this appeared to be a sebaceous cyst, a very common growth. They are non-cancerous, and generally filled with semi-liquid or dead tissue. They are formed when the sebaceous gland, which produces sebum to coat skin and hair (or feathers) becomes damaged or blocked. They are typically not a problem, unless they are in a troublesome part of the body, such as this poor bird. Cysts grow slowly, and this beautiful animal would have continued to suffer.

Well, my friend, who is not me, has removed cysts before. It’s really quite simple. A shot of lidocaine, an incision, and then you scoop the gunk out. A course of antibiotics is then in order.

But, my friend had no lidocaine. This would have to be done Viet Nam style. He did, however, have two brilliant surgical assistants who were invaluable in this surgical procedure.

So, in my friend went. My friend did not know this, but a scalpel designed to cut human flesh barely works on a peacock. It took a little slicing. My friend was concerned that the animal would recoil in terror and pain, but it was quite cooperative throughout the entire procedure. More so than any human, actually, and without any lidocaine. Cysts are full of material that has no nerve endings; once you cut through the skin, you’re working with dead tissue. Also, my friend’s farmer friend told me that an animal will frequently settle down in a mixture of calmness and fear once it realizes it has no choice.

After just a few cuts, there it was: a disgusting mass of dead, crumbling, moist material. I will spare that picture. My friend scooped a lot of it out. It was… rather repulsive.

Withing minutes, the peacock’s left eye began to descend into its proper place, and the milky material in the lens all but disappeared. It’s breathing became less labored. Amazing what can happen when you release a little pressure.

Unfortunately, my friend got a little too ambitious when digging out the core of the cyst, and severed an artery. Again, my friend is no veterinarian, but he was confident that there was no major artery in that part of the animal. With some constant pressure applied with sterile gauze, the bleeding stopped.

My friend cleaned out the wound with saline, and applied some animal antibiotics. Every farmer has a bottle lying around: Tylan 200.

The bird looked much better after the surgery, but a little rough. It’s eye had returned to a normal state, and its breathing became better. My friend’s farmer friend kept up with the antibiotics, and I’m happy to say that the bird is doing just fine.

The cyst had been with the animal for quite some time, so it was unused to using its left eye. However, the little peacock brain has returned to normal use of its vision as its vision neurology has healed as well.

So, a happy ending. Again, I had nothing to do with this. It was related to me by a friend. The peacock has returned to his ostentation, and is living a happy life. This is what healthcare is all about. All life is precious.

Update: He’s looking pretty good!

Caffeine and Anxiety – Not Always the Best of Friends

 

Caffeine and Anxiety Disorders – Not always the best of friends

Well, who doesn’t like a good cup of coffee. I sure as heck do! What a great way to start the day! You have that first cup, you feel that pick-me-up, and you’re ready to go. You shake off the morning grogginess, and you feel great! At least that’s what your brain is telling you.

Caffeine is the most widely used psychoactive substance in the world. I’m from Seattle, the coffee capital of the world, (even though you can’t grow coffee beans here) and the birthplace of Starbucks. They’ve pumped the brakes a little as the world changes with the pandemic, but basically you can find a Starbucks anywhere in the world. Just turn around. But shoot, I tell you. I remember when it was just a cup of coffee. To each their own, but I do get a little annoyed when I get in line behind someone who wants a double-pump, almond, half-steamed, skim-milk, peppermint Karenchino. It’s just mud! We drink it for the caffeine!

I don’t keep it a secret, and I’m not ashamed of it, but I have an anxiety disorder. How society judges the mentally ill is for another post. My disorder has been largely held in check for a long time now, and I’m functioning very well, despite the recent loss of my father. But let’s take a look at how caffeine and anxiety work together, or, more properly put, don’t work together.

Most folks get their caffeine from coffee, a brewed drink prepared from roasted coffee beans, the seeds of berries from certain Coffea species. This makes caffeine an alkaloid, a naturally occurring organic compound, usually derived from plants. When coffee berries turn from green to bright red in color – indicating ripeness – they are picked, processed, and dried. Dried coffee seeds (referred to as “beans”) are roasted to varying degrees, depending on the desired flavor. Roasted beans are ground and then brewed with near-boiling water to produce the beverage that we all love.

I’m speaking generally of caffeine, but there are plenty of other ways to get the substance in your body: tea, soft drinks, chocolate, and, if you’re feeling like trashing yourself, No-Doz.

How caffeine works, and why it makes you feel good

Your brain does a lot of neat tricks, and it accomplishes them in clever ways. When your neurons, or brain cells, are firing, they are doing exactly that; sending jolts of electricity to one part of the body or the other, telling it what to go do with itself. To aid in this, your brain uses what are called neurotransmitters, nifty little chemicals. There are quite a few different types, and each of them plays either a few roles or many, depending on the need. There is one neurotransmitter in particular called adenosine, a natural central nervous system depressant, which keeps you mellow and composed. Caffeine blocks the actions of adenosine. So you wake up! At the same time, this blockage of adenosine results in the brain releasing other neurotransmitters, namely dopamine, which makes you feel great, and glutamate, which helps ramp up the body. But of course, the caffeine wears off after a while, your neurotransmitters try to return to normal, and you get tired. So time for more mud!

But wait, there’s more! Caffeine also inhibits the release of a neurotransmitter called GABA. GABA’s role is to calm the mind and decrease feelings of fear, stress and anxiety. So when you have a lot of caffeine in your system, GABA cannot do it’s job.

Anxiety Disorders

Anxiety disorder is an umbrella term for several conditions characterized by worry and fear. It is the most common mental illness in the United States; over 40 million people have some form of it. In these challenging times, the disorder has become more prevalent.

At the risk of WAY oversimplifying things, the physiology behind an anxiety disorder is as follows. (Yes, these is a physiologic mechanism behind it; so the next time someone tells you to just calm down and deal with life, tell them to take a good look in the mirror, worry about themselves, and don’t offer unsolicited advice. Or feel free to use stronger language, if you like.) There is a part of your brain called the amygdala. Like most parts of the brain, it plays several different roles. One of the hats that it wears is playing a primary role in fear and anxiety. Studies have shown that people with increased activity in their amygdala are at a much higher rate for depression and anxiety. In the case of an anxiety disorder, the amygdala will overreact to the illusion of fear, if you will, and signal another part of your brain called the hypothalamus. This then will activate your sympathetic nervous system, responsible for the phenomenon known as fight or flight. In doing so, this floods your body with chemicals called cortisol and adrenaline. This action increases blood pressure and pulse, increases muscle tension, and the acceleration of the breathing process. These are well-known symptoms of anxiety. In the meantime, the same mechanism floods your brain with a neurotransmitter call noreprinephine, which mobilizes the brain for action and alertness, at the cost of rational thinking. This is also a well-known symptom of anxiety.

One of the main neurotransmitters that calms the amygdala is GABA. Many psychiatric medications are used to treat anxiety, but some of the most common are a class of drugs called benzodiazepines (Klonopin, Xanax, etc.).

There are, undoubtedly, psychological factors that contribute to an anxiety disorder, but that’s for another time.

When caffeine and anxiety collide

Well then, it is clear that the physiological mechanism of action of caffeine and the physiological mechanism of action of an anxiety disorder can be disharmonious. Excessive caffeine can greatly exacerbate an anxiety disorder. Tremors, difficulty breathing, cognition problems; these can all result when an anxious mind has too much caffeine.

As an aside, I was on benzodiazepines for a time, and I thought I could drink all the coffee I wanted to. I could, for a while. But the chemical storm was raging in my head, and, as strong as benzodiazepines are, caffeine can be much stronger.

My anxiety disorder is well-managed these days, so I keep my coffee to 1 or 2 cups per day. Some individuals with an anxiety disorder find that tea or matcha works well for them, while others may use supplements. Some people with an anxiety disorder are better off avoiding caffeine in their lives altogether. I cannot diagnose, and I cannot give medical advice, but for those of us with an anxiety disorder, the role that caffeine plays in our lives must be considered.

Thanks for reading! Wear the mask, social distance, wash your hands, stay safe!

 

 

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

Cute Animal Stories and Physiology

cat nursing puppies

The link above is a very cutesy video, but it had me reaching for my textbook.

According to this video, the mother cat had recently lost her kindle (I love collective nouns) and was, quite naturally, profoundly depressed. This animal foster family took the cat in, and found the cat to be needy, sad and distressed. It was only after the introduction of a litter of puppies that had lost their mother (what is this, a Disney movie?) that the cat came around.

There is an endocrine gland (that means it makes hormones) in the middle of your brain called the pituitary gland, answering to your CNS by way of the hypothalamus, a bridge between the CNS and the endocrine system. The pituitary gland is often called the master gland, because it does a lot of stuff, probably gets paid more. One of the hormones it secretes is called oxytocin. In mammalian females, oxytocin plays a major role in commanding the body for pregnancy, birth, and nursing. However, in both genders, oxytocin, by the very nature of its primary function, also engenders feelings of attachment, belonging, and intimacy. This cat was flooded with oxytocin, was depressed, and needed attention. When the puppies were introduced, the oxytocin returned to its primary role, and the cat became a surrogate mother. At this time, the cat’s pituitary gland produced another hormone called prolactin, and enabled the animal to nurse the puppies.

I’m not trying to reduce the powerful emotions this cat felt, emotions that would also easily occur in a human being, by explaining it away in technical terms. I’m not trying to take the ‘awww’ out of it. Just two things:

1: It is profoundly interesting that external, emotional events have a direct, physiological impact on how your body functions. Your emotions are very real, can be very strong, and, if you need proof, take a look inside and see the physiological process. If someone tells you to suck it up, if someone shames you for mental illness, if someone tells you to stop feeling a certain way, then they are A) ignorant of how the body works, and B) an asshole. “It’s all in your head!” Well, of course. Everything is. But that’s ontology, for another time.

2: It’s also profoundly interesting that we’re looking at two completely different species here. That’s incredible. That speaks to the strength of the survival instinct, but that’s for another time.

Well, I’m procrastinating again. Gotta hit the books. Wash your hands!

Fight or Flight in America as a Sociological Phenomenon

Crisis Fatigue

The link above is an interesting article. The physiological phenomenon known as ‘fight or flight’ exists in most living creatures, and is deeply ingrained into every human being. It’s a crucial component of the survival instinct, and has been for hundreds of thousands of years, existing as well as in our progenitor ancestors.

As simply as I can put it: Your 5 senses and your intuition will perceive a threat. This gets crunched in your consciousness, a poorly understood concept. This threat then gets sent to your amygdala, a part of your brain, for verification. This triggers a response in another part of your brain, the hypothalamus. The hypothalamus wears many hats (and we really don’t know how), but it kind of serves as a command center for a lot of things. In this sense, it triggers the fight or flight mechanism. Admiral Hypothalamus will activate your sympathetic nervous system, a part of your electrical wiring, which fires up your adrenal glands, which generally have about 8 cups of coffee in them already. Your adrenal glands will freak out and push the panic button, and secrete a number of hormones, mainly adrenaline, cortisol and norepinephrine. The adrenaline will ramp up your blood pressure and your pulse, and accelerate the actions of your lungs and muscles. The cortisol will adjust your glucose (stuff you get from food) to provide a burst of energy. The norepinephrine will flood your brain, increasing alertness and response times. Every other system takes a back seat, including rational thought. At this point, you’re ready to kick some ass. This goes back to the time when our ancestors had to face off grizzly bears. We don’t have to do that anymore (except for those idiots in Yellowstone who want a better picture), but fight or flight is very much with us today, in response to both physical (a mugger, a mean dog, road rage) or emotional (fight with your spouse, boss wants to see you, the principal called) experiences. Eventually, the response will abate, and you are left exhausted and weak.

Problems happen when people are under constant fight or flight, and the response does not get a chance to wear off. This will result in anxiety, depression, PTSD, heart problems, or all of the above.

I know nothing of sociology. However, this article posits the idea that American society has been living under a steady, constant fight or flight response ever since 2020 started. We are now suffering from the effects of 3 social phenomenons that are causing Americans a huge amount of stress. It started with the emergence of a virus we thought we may be able to control, but we were very wrong. Then, racism reared its ugly head once again, when George Floyd (and, let’s face it, he’s not the only one) was murdered by a police officer. This has triggered a massive social disruption of anger and violence. Perhaps worst of all, the federal leadership (dammit, GOP, I hate to say I told you so… I take no glee in his failures) has been fully exposed as incompetent, dysfunctional, and unwilling or unable to rise to these challenges. In fact, our President’s behavior has gotten worse, and it is clear that he is in way over his head. In the meantime, the violence continues, and the pandemic has now killed 111k Americans. At this point, things do not show any signs of significant improvement or healing. As with an individual, problems will arise when the fight or flight response does not get a chance to settle down. We are seeing that now, in the hatred, anger, depression, isolation, anxiety and general “I’m pissed off today” attitude in nearly every American. If things do not settle down, the damage to society, as with an individual, will be massive, and will take longer to heal than we can imagine.

Well, I’m just babbling instead of doing my homework. Sorry for the long post. I better hit the books. Wash your hands!

The Seattle Freeze

I thought I would muse on the cultural phenomenon known as The Seattle Freeze, and the internet community’s hatred of my hometown. You see it pop up now and then. I am a native of the Emerald City (that are not very many of us left), and I have spent most of my life here. Just thought I’d weigh in.

Evidently, my beloved Seattle is not well received by the rest of the nation. Just do a google for ‘I hate Seattle’ and you will come up with tons of results. Most of the time, the criticism focuses on the weather, the traffic, the homeless and drug problems, and, more to the point, the people of Seattle themselves. You read about the Seattle Freeze, and how people are so unfriendly here. People also bitch about the Seahawks. Well, as a native, bleeding rain, let me address the concerns of the world:

First, the weather. Yeah, I get this. I completely understand. The weather here kind of sucks. We get many, many days of little to no sunshine, and, in the winter, the sun goes down around 2PM. The lack of light really can really mess with your head. However, it’s worth noting that most places in America get far more rain than Seattle, annually; they just get it all at once. Our annual precipitation is spread out over half of the year, in that perpetual, gray mist, obscuring the sunlight. I call it living in the cave. Don’t like it? Well, hang in there until March! Another way to look at it is that the atmosphere is simply an extension of the Pacific Ocean’s sprawl. As in, the tide is really in today. Maybe it’s because I’m a native, but the weather here has never really bothered me. We rarely have any kind of winter, and we rarely have inhospitably hot summers. It’s 40-70 degrees here, year round.  The weather is rarely a problem. No heatwaves, no droughts, no massive snowstorms. We do, however, have to deal with an occasional earthquake or volcano, but those are few and far between, thankfully. Our weather, though perhaps not always sunshiny, is generally cool and comfortable. Air-conditioned outdoors. I kind of like it. Ultimately, however, I have to ask: Does anybody wonder why it’s called the Emerald City? Everything is freaking green here! This is a great place to be a plant! You look at the rest of the country; in fact, just drive over Snoqualmie Pass, and you will notice that the rest of the world is kind of dirt-brown. I love the green and gray of Seattle.

Okay, the traffic. I have absolutely no rebuttal here. I am in complete agreement. The traffic in Seattle F*CKING SUCKS. This is an axiomatic truth. Again, I say this as a native, people in this town do NOT know how to freaking drive. This is the only one that really gets to me. This city is not big enough to have New York or Los Angeles level traffic problems. And, traffic or not, people here drive like they are on the Fury Road, on a bunch of crack. Seriously, people. My hometown has GOT to learn how to drive. We are, finally, developing a great light-rail system, but it’s about thirty years too late, and will eventually be finished right about the same time my 16-year-old niece is collecting social security. I took the Link light-rail the other day; it’s great, it makes you feel like you’re in a big city. But yeah, the traffic here is awful, and people drive poorly. I own this; Seattle is a terrible place to drive a car.

Okay, the homeless and drug problems. I can not make any snide or humorous comments here. These are serious, societal problems. It is more than obvious, when you peruse Seattle, any neighborhood, that we have a major homeless problem. There is a lot to unpack here. Drug addiction, mental illness and the lack of affordable housing are plaguing Seattle. However, this does not stop at Seattle’s borders. This is becoming a nationwide problem and should be addressed at the national, federal level. Sadly, with our current federal government, I don’t see that happening anytime soon. All we can do is put a few bandaids on the problem, but until we change how American society addresses mental illness and affordable housing, it’s probably not going to get better in the near future. I wish that the Congressional delegates we hire to send to D.C. would at least attempt to get some federal dollars to come our way to address these issues, as the problem is acute, and people are dying on the sidewalks. Again, we have a homeless problem that is only getting worse, but this is not a Seattle problem, it is an American problem. I don’t have any quick answers, but, last I checked, I am not an expert at anything and I don’t make decisions on how we spend our tax dollars. It is pathetic that the richest and most powerful nation on Earth can’t take care of its most vulnerable citizens. But hey, it’s nothing that some massive corporate tax cuts and a needless war with Iran won’t solve, right?

Alright, the Seattle Freeze. It’s real, I’ve seen it. But on this issue, I can only speak for myself. I am very shy and introverted. I get bad social phobia. I don’t like to go out; I would rather spend time at home, writing, reading, or watching bad movies while I cuddle with my girlfriend. Or I like to get out of the city altogether, which is a great perk of living in Seattle; mother nature is always a quick drive away. Anyway, I don’t drink and I don’t dance. That’s just me; I have absolutely no problem with people who enjoy recreation in a different manner than I do. I am told that I am very pleasant and easy to get along with, which I suppose is true. I like people, I’d just rather spend my free time in a quiet, peaceful atmosphere. I’m no misanthrope, I’m simply just not the outgoing type. Sadly, however, Seattle has a reputation of being full of people like myself, only they take it a few ugly degrees further, and are publically rude, intentionally isolated, and don’t return your phone calls. Well, that does suck. It can be extremely hard for someone new to Seattle to make friends. Seattlites come across as aloof, distrusting, and better than everybody else. Well, I may be aloof, but I usually trust people, and I sure as sugar know that I’m no better than anybody else. I can’t really speak for the city, but we need to fix this. I suppose a good place to start would be by just being nicer to strangers in public. This is easy enough, and I enjoy doing it. You never know what troubles another person may be having that particular day, so it’s a good thing to go out of your way to be pleasant to someone you don’t know. I will at least start there. I would encourage my fellow Seattleites to smile a bit more, and actually say hello to people. You still won’t catch me at the dance club, but we could all stand to be nicer to the people around us.

Lastly, the Seahawks. Richard Sherman is gone! He’s gone! Marshawn Lynch is gone! Sure, Russell Wilson can be a bit too boy-scouty, but he’s not talking trash. Get over it, people! But hey, if the Seahawks are considered one of the NFL’s most hated teams, I’m kind of okay with that. But, whatever, New England. You go right ahead and keep thinking the Patriots are great, even though they cheat their asses off. Whatever.

So, that’s just my two cents. I love Seattle, and it’s too bad that the rest of the country has such a poor opinion of my hometown. Which brings me to my final question: If you know the weather is bad (which it is), if you know the traffic is bad (it definitely is), if you know that the homeless problem is not being properly addressed (we have a lot of work to do), if you hate the Seahawks (12!), then why do people keep coming here?!? Don’t get me wrong; I love that I have watched my small hometown grow into an international city, and the influx of new people, from all over the world, has really created a great cultural scene, but is the rest of the country really that bad? Well, feel free to set me straight, and I’ll post again soon. Take it easy, everybody!

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