Monday, October 24, 2011

Snapshots: The a.m. and the p.m. hug

(1) I understand that New York therapists take off the entire month of August.

But my habit, being a Chicagoan (as opposed to a New Yorker) is to take off Jewish holidays and an occasional mental health day.  Or week. 

This is Jewish holiday season, which includes: (a) the Jewish New Year (Rosh HaShana) contemplations, regrets, mainly, about the old year; (b) the Day of Atonement (Yom Kippur), that fast we'll talk about later, and (c) a couple of lesser known chaggim (hard "ch", festival in Hebrew),  Succot and Shemini Atzeret, or Simchas Torah.  So I haven't been to work all that much this October.  Anyone trying to reach me at the office heard a variant of this:
Hi, it's Dr. ____. I'll be out of the office until __(date)___.  You'll hear from me then if you leave a message.

If this is a life threatening emergency, call 911 or go to an emergency room. Have someone contact your primary care physician.

If you feel it's urgent, but it is not an emergency, you can call
_(first name) (last name)__ and ask him to call you back. (First name)__ is on call for non-emergencies.  Thanks so much.
In other words, See ya'.

As a younger therapy doc, the only way not to make a mistake in this recitation would be to read the message from a scrap of paper, not unlike scripting a phone conversation with a patient suffering from social anxiety waiting to hear about a job or a date. 

Reading from a script only empowers a person so far.  In my case, the wrong inflection requires re-recording the message as many times as it takes to get it right. The tone of the voice-mail can't sound too happy or too glib, and certainly not self-satisfied.  The only humane way to get it right is to try to empathize with callers, to guess how they'll respond.  My hunch is many respond like this:

Uh, duh! Like I don't know about 911?


No freaking way I'm calling someone I've never met just because it's "urgent".


What's a primary care physician?


She never told me she was going on vacation!  The chutzpah!  (Chutzpah rhymes with puts-the, hard "ch", Hebrew for gall, or nerve).

(2)  If you know me, then you know I never take real vacations, not the kind where you go whitewater rafting or see monkeys in rain forests; not kicking back vacations, drinking margaritas or whatever the cool drinks are these days, or sight-seeing in Peru or Italy.

Having successfully launched most of our children, FD and I think of a vacation as seeing family, feeding them or being fed, and taking the little ones off on urban adventures.  Or just playing cards. The cards are tossed in the trash after the kids visit because we find them everywhere.  Without the kids around, there's no point in trying to make decks.  And my father left me an entire duffel bag of unopened decks, anyway.  No fool. 

Combine the family vacay or in this case, stay-cay with a Jewish holiday or five, and you have many, many people, most of them first or second degrees, under one modest roof, with visitors.

The toughest decision I generally have to make is this: Do I go to services? (Meaning the synagogue).  Or would it be better to whip up batches of pancakes and french toast?  This decision all depends upon the seriousness of the particular holiday. The pancakes are blueberry, the french toast pan fried with the brown sugar, butter and maple syrup.  

This year the kids visited us, meaning that cooking, sweeping, straightening up, and throwing an occasional baseball or tennis ball occupied most of my time.  If you do this with a  future major league pitcher, wear gloves.

(3)  Just to switch gears, before I started writing this post I glanced at AOL news to find that experts are okay with patients taking a break from ADHD meds (we call this a med-vacation).  

That the online expert is only okay with the med-vacay is disheartening.  The thinking, never mess with what is kind of working, paired with a long list of possible physical, social, and emotional consequences for messing with it, essentially marries the patient to medication.  And it makes a baseline comparisons impossible.  Over the years, who knows what normal is anymore?

That said, if you are considering going off medication, of course discuss it with your doctor first.  But keep in mind that how you feel at any given moment depends upon a host of variables, like maturation, events (history), things that may have nothing whatsoever to do with whether or not you're taking medication.

And that laundry list of warnings (in the AOL article), the dire consequences that might transpire should you go off prescription medication, is bloated.  Anything can happen and probably will, but it may have nothing to do with missing doses, although it is possible, which is why you first talk to your doctor. Find out what anything is, if you can.  Maybe it's not so bad, and maybe it is something you need to work on.  And talk to your doc.

My most memorable adult patient with Attention Deficit  Disorder was a middle-aged male who had been on ADD meds his whole life.  He had no life, not one after work.  First visit he fell asleep on my sofa, didn't budge for 45 minutes, a 5:30 pm appointment.  When at last he woke, he complained to me that he usually falls asleep on a sofa at home by 7 pm, literally waits out the night until morning when he can dose up again to face the next day.

More than one med-vacay might have served him well. 

There was no keeping me quiet forever.

(4) We do love our drugs, and that can be a good thing.  Most of the time it is.  Here's a Facebook status* I posted before taking off for the holidays.

Today, at noon, it seemed like such a good idea to make that pot of coffee (5 cups, half caf, choc milk for creamer) and drink it all.   Now I'm not so sure.
At 2 a.m., if anyone read that, the third batch of vegetarian gumbo tasted just right, much better than it looked.  We would need it for the coming onslaught of eaters.

(5) As long as we're talking about eating.

Let's talk about Yom Kippur, the Jewish fasting holiday, 25 hours, no food or drink

Parse out the word, holi-day, and you get it.

It can be annoying, especially not drinking any water, but by the end of the fast, the following evening, the light-headed, feint feeling, the emotion, the chorus of hundreds of voices, one of them is yours, everyone is singing, everyone in tennis shoes**, light on their feet, voices rising, rousing the most serious cynic to return to the fold, this has to be the most powerful moment of the year, certainly for some of us.  Sheer soul.

Probably all religions have this, some kind of parish sing along, but on the Jewish high holy days, the greatest hits, for us, are second to none.  There's healing in the community choir, and of course an incredible rendition of a song you only sing in the church, or the synagogue once a year, has to make you happy.

A cancer survivor told me she can't even go to the synagogue, it's so emotional. (Jewish kids grow up on  Barbra, *** who does a nice job with Max Janowski's Avinu Malkeinu, Our Father our King.)  Not as powerful as hundreds of voices live, but it will do.

On the way home from the airport on Sunday morning, the first run, alone in the car, I flipped on the radio to hear a mass.  Mr. Bach understood the power.  

Oh.  And FD reminds me, every year, that the day proves that we all eat way too much every other day.  We really don't need it.   And he's a doctor.

(6) Accountability

The whole thing about the serious holidays, the Jewish New Year and  that crazy fast day, is that we're supposed to introspect, retrospect, and consider our flaws.  We're supposed to think, Hey, I'm really NOT that good of a person, not nearly the person I should be.  I should change! 

Not a bad concept, truly, unless you already have low self-esteem.  And even then, doing things to raise your self-esteem, consciously making an attempt to do better deeds, be a bigger person, a better person, can't be bad.

A few days after those high holidays, at an early morning circumcision (a new baby, he'll pay dues!), I was yenty-ing (rhymes with gently-ing, Yiddish for chatting) with another friend when she noticed a piece of paper on the floor.  She picked it up and we studied a list of things someone actually considered changing about himself in the coming new year.

We were blown away.  People do this! They even write it down, they don't just give it a passing thought, change. So if you lost it, take heart that you inspired at least two people, which has to be a good thing.

(7) Apropos of Hugging: The a.m. and the p.m. hug

Cooking the gumbo, on the Adelle station Pandora blasts a song by Christina Perri, Arms. Here are some of the words.
You put your arms around me
And I believe that it's easier for you to let me go
You put your arms around me and I'm home . . .

I hope that you see right through my walls
I hope that you catch me, 'cause I'm already falling
I'll never let a love get so close
You put your arms around me and I'm home

You put your arms around me and I'm home
It's another one of those walls song! But that's not why we're talking about it today.  The song made me think of an intervention we use (okay, I use) in couples therapy.

It is a common complaint in therapy that our culture focuses way too much on sex in relationships, and that simple touch, affection, is interpreted as a prelude to sex.  And it shouldn't be that way.

Sex isn't what everyone wants.  Some, maybe most people prefer pure, unadulterated affection.  Not that sex isn't nice.  But it shouldn't be the only thing, and maybe shouldn't even take precedence over physical affection.  Not all of us learn it at home, and many of us are afraid of rejection, afraid of looking wimpy, even. But as an added relationship seasoning it can make everything feel better. Kiss the proverbial emotional boo-boo, we all have at least one by the end of the day, surely.

But the intervention isn't a kiss, it's the twice a day hug, morning-time and evening-time, if at all possible. This is a standing, full-frontal, full body hug with a main squeeze, partner, lover, or mate. If you have no partner, hug yourself, and keep the intervention, or relationship-skill, if you will, in mind for when you do.

(8) Fall in Chicago 

It's here. And I'm back to work, crazy as that feels.

See ya'.


*I don't use Facebook for anything but communicating with family.  If you're a TherapyDoc facebook friend, it's because I never got around to deleting that account.  When I remember the password, I'll get to it.

**We don't wear leather on this holiday, or gold and silver, either.  Why some people lost that part of the observance is a mystery to me.

***I'm not obsessed with Barbara Streisand, but acquired every song, every album, as a kid, and for some reason, I learned every word.  On Sunday, visiting my mother at Independent Living (for lack of a better word, we need a  contest on this) heard someone belting it out, Don't Rain on My Parade.  I went to the common room to hear a cabaret singer who did a really nice job.   The whole place was hopping.


Sidney said...

I hope you had a great round of holidays, Doc. And your Autumn photos make me pine for cold weather.

Liz said...

thank you for all the richness in your post. and i also prescribe the 2/day hugs to so well.

Anonymous said...

Yes, what a wonderful post about a wonderful life! Mazel tov, TD, for understanding what is important (unlike many Manhattan-August-vacation-taking therapists).

Laura said...

pernicious amnesia? or anemia? thanks for this great chunky stew of a post.