Coronavirus – An Update

Posted Posted in Elder Care, Homestudy, Nutrition, Seminars, Webinars

By Mary O’Brien, M.D.

It’s progressing. We knew it would.

The novel coronavirus, just renamed CoVID 19, has surpassed SARS in the number of deaths caused.

The number of confirmed cases worldwide is 60,081 with 1363 deaths. Nearly 99% of cases are still in China and the mortality rate remains around 2‒3%. There are undoubtedly far more unconfirmed cases in China since large numbers of people are at home with mild to moderate symptoms, or even asymptomatic infection. Inadequate testing to confirm the virus or rapidly triage and admit patients to intensive care in Chinese hospitals appears to be a serious problem.

The Chinese physician who first recognized an outbreak of SARS-like illness was targeted and arrested for “rumor-mongering.” He was even forced to recant his story. Dr. Li Wenliang contracted the coronavirus and died last week. Even his death was denied by authorities for a day. Dr. Li joins a brave, dedicated, compassionate group of heroic physicians throughout history who succumbed to the very illness they were treating. His memory will be honored.

The only way to solve a serious problem is to address it in an open, straightforward manner. Secrecy rarely solves serious problems. We’ve all heard the old dictum, “Sunlight is the best disinfectant.” Fortunately, the President’s task force on the coronavirus has done an excellent job of educating the public, securing and screening ports of entry, coordinating distribution of viral test kits to U.S. labs, evacuating Americans from China, and quarantining appropriate people with possible exposure.

The CDC, NIH, and Department of Health and Human Services personnel are working nonstop to contain the virus and develop a vaccine and potential treatment. In the meantime, supply chain disruption is affecting car companies, tech firms, and even medical supply businesses. Many of our OTC and prescription medications, including antibiotics, are made in China. The FDA has evacuated our personnel who inspect these production plants. There may well be consequences in the coming weeks and months here in the U.S.

Meanwhile, we’re in peak cold and flu season. Fastidious hygiene remains key:

  • Wash your hands – frequently and with soap and hot water for at least 20 seconds.
  • Do not touch your mouth, nose, and eyes. Viral particles suspended in respiratory droplets can penetrate mucous membranes and conjunctiva very easily.
  • Maintain at least 6 feet between yourself and others (social distancing)
  • Avoid crowds and unessential travel
  • Get more sleep than you think you need
  • Stay home if you have cold or flu symptoms (and don’t lay a guilt trip on colleagues who are sick)
  • Disinfect hard surfaces frequently. This coronavirus can apparently survive on hard surfaces as long as 9 days. Phones, keyboards, bathroom fixtures, door handles, and steering wheels are just a few examples.

Seasonal epidemics triggered by a mutated virus can be devastating, but eventually they are contained. Until then, our job is to stay calm, stay informed, and practice the time-tested principles of good patient care and common sense.

How To Get Back To Civility

Posted Posted in Brain Science, Continuing Education, Homestudy, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

We all have blind spots about ourselves, but sometimes our self-image can border on delusional.  Seventy-eight percent of people polled believe that there has been a decline in civility during the past decade.  The other 22% were probably in a medically-induced coma.

The real shocker comes next.  Ninety-nine percent of people believe their own level of civility has remained constant.  So who are all those rude people out there?  Perhaps a brief self-assessment is in order.

Do you remember the last time you:

  • Sent a thank-you note (a real handwritten one)?
  • Let someone go ahead of you in a checkout line?
  • Waived another driver ahead of you in busy traffic?
  • Held a door open for someone else? (That’s called manners, not chauvinism.)
  • Offered to help someone struggling with boxes, bags, or packages?
  • Helped someone get his or her luggage in the overhead compartment of an airplane?
  • Helped an older patient in and out of a chair (as opposed to merely standing there and watching him or her struggle)?

There are countless other examples, especially in this age of narcissism.  Self-absorption is Cause No. 1 of the four major causes of rudeness.  This time of year, people talk about flu epidemics.  But “me, myself, and I syndrome” is a year-round epidemic.  Simply being unaware of other people or their needs is ubiquitous behavior these days.  It speaks to a failure of parenting and education.

That leads to Cause No. 2 of rudeness:  ignorance.  Manners and civility need to be taught, and no participation trophies are not awarded.  Civility is its own reward.

Cause No. 3 of rudeness is lack of character.  We don’t speak much about someone’s character these days.  It’s a serious flaw in our culture.  Character determines how any one of us behaves when no one is watching.  It’s our default mode of behavior.  Eric Hoffer said, “Rudeness is the weak man’s imitation of strength.”  It takes a strong person to be kind, gentle, patient, or polite.

Cause No. 4 of rudeness is simply being in a hurry.  It’s curious, but can you even imagine the spiritual giants of the ages being in a rush?  Granted, people like Moses, Jesus, and Buddha lived a long time ago, but no one could possibly picture their being frantic and frenetic.  As Emerson wrote, “Manners require time, as nothing is more vulgar than haste.”

Self-absorption, ignorance, lack of character, and haste.  These are the major causes of rudeness.  Maybe we could start to “reverse engineer” our way back to civility.  It would surely be worth the effort.

All the Little Warning Signs

Posted Posted in Brain Science, Continuing Education, Elder Care, Homestudy, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

A friend of mine died last week from cancer. She was 52 years old.  Few people knew how seriously ill she was.  She didn’t want pity.  She didn’t even want sympathy.  The only thing she wanted was exuberance in life and dignity in death.  She successfully achieved both.

Sitting in the back of the church and listening to her eulogy, I wondered how many people struggle silently with serious illness and stress.  I suspect every one of us knows people who, despite their poise and polish, suffer tremendous personal anguish that remains hidden from the world.  They function day to day scarcely skipping a beat.  They’re the first ones to lend a hand when someone else is in a jam and they hardly ever grumble or gripe.  Other folks tend to dump extra work in their laps because they’re so good-natured and conscientious.

Then one day, overwhelmed by stress, illness, depression, or exhaustion, these selfless stoics collapse.  Nearly everyone in their sphere of influence is shocked because they failed to notice all the little warning signs.  Somehow it was so easy to overlook the growing fatigue, the waning enthusiasm, or the uncharacteristic irritability.  I’d like to say that doctors are usually expert at recognizing the subtle signs of serious illness and stress.  But the truth is, most of us are not.  Doctors, by and large, are so accustomed to chronic exhaustion in their own lives, they often overlook it completely in others.  There is no laboratory test for stress and no scan will screen for exhaustion.  It takes time and concern and insight to detect the subtle signs of serious stress.  And while many of us may be interested in the well-being of others, few of us take the time to develop true insight into other people’s problems.

Maybe if we all slowed down long enough to notice a friend’s fatigue or a colleague’s quiet mood, we could do something helpful before it is too late.  Maybe if we stopped placing so many unreasonable demands on one another, we wouldn’t be plagued by chronic fatigue and burnout.  Maybe if we made an effort to be more friendly and flexible in our daily encounters, folks would feel free to ask for help when they need it.

It would be wonderful if teachers and preachers and bosses and bureaucrats would promote empathy and compassion as much as they promote rules and regulations.  But until patience and kindness work their way into the culture’s curricula, we’ll have to rely on the insight of individuals.

Do you know someone who’s overwhelmed, worn out, dejected, or depressed?  Be gentle with him or her.  Cut such people some slack.  They may be up against serious stress or illness.  Be kind to them and to everyone you encounter today.  You may not have the chance to be kind to them tomorrow.

Some Timeless Advice

Posted Posted in Brain Science, Continuing Education, Homestudy, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

How’s your bank balance doing these days?  More importantly, how’s your emotional balance doing?  Incessant political nastiness, market swoons, natural disasters, urban decline, violent crime, geo-political tensions, ever-expanding congestion, traffic, and professional pressures are weighing on all of us.  And we haven’t even mentioned the personal stresses of illness, family strife, teenage traumas, aging parents, and relationship struggles.  At least there doesn’t seem to be a massive asteroid threatening our existence.  That was a joke.

Most of us have learned that taking only withdrawals from a bank account does not work well.  Sooner or later we need to make some deposits.  The same principle applies to our emotional balance.  The stresses we face in everyday life represent withdrawals from our emotional reserve.  We need to balance those withdrawals with some regular deposits.  And that, unfortunately, is not always so easy or obvious.

Emotional depletion has consequences.  Eventually it can compromise our immune, neuroendocrine, and cardiovascular systems.  Since millions of us are experiencing emotional depletion, we need to be intentional about restoring our emotional account balance.  Here are a few ideas:

  • Take a deep breath and slow down long enough to realize you’re running on empty.
  • Disconnect from your devices, social media, and TV for several hours. If this causes undue stress, you know you’re emotionally depleted.
  • Spend at least 15-20 minutes each day in a natural setting. Remember nature?
  • Let go of anger, resentment, and criticism. No one can experience love, joy, or peace when he or she is consumed with negative thoughts and emotions.
  • Do something physical and useful. Clean out a closet, spruce up the yard, bake cookies, wash the car.  As long as it gets you up and moving and has tangible results (not staring at a screen), it will help.
  • Call or visit with a sympathetic person who will truly listen and encourage you. Texting doesn’t count.
  • Do something thoughtful and unexpected for another person.
  • Forgive everyone.

If all else fails, remember some timeless advice from Abraham Lincoln, “This too shall pass.”  It always does.

Patriot Day

Posted Posted in Brain Science, Continuing Education, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

It’s hard to believe, but it happened 18 years ago.  The horrific events of Sept. 11, 2001 (9/11), shocked the nation and the rest of the civilized world.  We now have an entire generation of young people who know of 9/11 only through video images.  They have no actual memories of that day.  Those of us who do will never be the same.

This coming Wednesday, 9/11, is Patriot Day. Many people across the nation are honoring those who sacrificed themselves for others by performing an act of kindness.  Wouldn’t it be great if kindness became our second nature, our default mode?  We would wake up thinking, “Whom could I help today?”  Sadly, we do not think this way.

Instead, we are focused on getting “likes” on Facebook and/or other forms of social media.  As a result, far too many people are literally addicted to attention.  Getting “likes” on Facebook actually stimulate dopamine release in the reward pathways of the brain.   However, did you know performing or witnessing an act of kindness also stimulates release of serotonin and boosts “Immunoglobulin A” (IgA) production?  IgA is our first line of defense against infection.  It is most concentrated in tears, nasal secretions, and saliva.  This could be helpful as we head into cold and flu season.  And, heaven knows, millions of us are worried sick about horrible headlines and hurricanes.

Given this reality, performing acts of kindness truly becomes therapeutic.  Maybe this year on 9/11 we could:

  • Take the time and interest to compliment someone — especially someone who probably hasn’t received a compliment lately.
  • Pay for the driver in the car behind us at a toll booth or drive-thru.
  • Donate clothes or household items in good condition to Goodwill, the Salvation Army, or a shelter.
  • Take a box of donuts, muffins, or chocolates to the people at the bank, pharmacy, fire station, or police station.
  • Leave a basket of treats on the doorstep of a single mother or elderly neighbor.
  • Send a greeting card (a real one) to someone who has had a rough year.
  • Donate blood.
  • Send flowers anonymously to someone in a nursing home.
  • Give a donation to the American Red Cross for disaster relief.

There has been a battle between good and evil since the beginning of time.  Two thousand years ago someone told us to overcome evil with good.  So far, no one has come up with a better plan.

A Precious, Healing Balm

Posted Posted in Brain Science, Continuing Education, Homestudy, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

It’s not on Amazon.com.  None of the brick and mortar stores have it.  You won’t find it in a catalogue.  It’s not available at a bank or hospital.  This elixir is so rare and valuable you couldn’t even talk your doctor into giving you a prescription for it.  That’s just as well because no pharmacist would know how to fill it.  This vanishing and precious healing balm is silence.

We are addicted to noise.  It’s nearly impossible to escape.  Incessant noise bombards us in the workplace, the grocery store, the drug store, airports, waiting rooms, and neighborhoods.  People bring their own noise with them everywhere they go — just in case there might not be enough ambient noise.  People can’t even go for a walk without portable noise.  Years ago, Max Picard wrote, “Nothing has changed the nature of man so much as the loss of silence.”

He was right.  Silence gives rise to the very rhythm and harmony of life.  Without silence, there is no calm, comforting stability.  Chaos is, by its very nature, noisy.  Consider the floor of any stock exchange.  Everything is noisy and chaotic, and yet markets crave stability.  Most people crave stability whether they recognize it or not.  Perhaps we use noise to avoid facing the deepest truths about ourselves.

Many of us are familiar with Henry David Thoreau’s quote, “Most men lead lives of quiet desperation.”  The American writer James Thurber tweaked that sentiment in 1956, writing, “Most men lead lives of noisy desperation.”  Given our current culture, that’s probably more accurate.  Anyone who has lost electrical power for even 20 minutes knows that feeling of desperate frustration.  We want our gadgets to function.  We want our noise.

Oddly enough, when we’re sick or in pain, we usually want peace and quiet.  Could it be that silence is therapeutic?  That concept seems foreign to many people today, but it’s worth considering.  Silence is indeed a precious, healing balm.  It lies at both the center of the universe and the human heart.  Maybe, one day we’ll catch on.

You Never Know Who Might Be Listening

Posted Posted in Brain Science, Continuing Education, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

Are you well-spoken?  Would other people agree?  There are many aspects of professional behavior, and speaking is one of the most important. Unfortunately, as a culture, our speech patterns, vocabulary, and grammar are deteriorating badly.

Incessant use of e-mail and texting has had a negative impact on speaking skills and vocal quality.  Parents, teachers, and bosses seem reluctant to correct anyone.  Someone might get upset.  People often confuse correction with criticism.  That’s misguided and it can undermine success.  Part of being an effective health-care professional involves conveying knowledge and inspiring confidence among patients and colleagues.  Bearing that in mind, here’s a little checklist to help polish your speaking skills:

  • Watch out for verbal crutches (um, uh, well, like, you know). Better yet, eliminate them.
  • Don’t start or end a sentence with the word “so.” So, we’ve had a lot of turnover lately, so.
  • Learn the correct use of the words “fewer” and “less.” Skim milk has fewer calories than whole milk.
  • Try not to begin or end a sentence with a preposition (to, of, with, for, on).
    • Incorrect: He doesn’t have any place to go to.
    • Correct: He doesn’t have any place to go.
    • Incorrect: We have many medications to choose from.
    • Correct: We have many medications from which to choose.
  • Learn when to use the subjunctive case.
    • Incorrect: I wish it was true.
    • Correct: I wish it were true.
  • Review the proper use of pronouns: Attention, Southerners.
    • Incorrect: Her and her husband went to the seminar.
    • Correct: She and her husband went to the seminar.
  • Recall the use of past perfect tense: Attention, Midwesterners.
    • Incorrect: Ordinarily I would have went home.
    • Correct: Ordinarily I would have gone home.
  • Eliminate redundant adjectives: Attention entire country.
    • Incorrect: The patient had a small, little bruise.
    • Correct: The patient had a small bruise.
  • Pay attention to singular or plural agreement between nouns and verbs.
    • Incorrect: There’s lots of options.
    • Correct: There is a lot of options.
  • Avoid constant self-reference.
    • “For me, this is not helpful.”  It’s not about you, but this phrase is ubiquitous.
  • Check your vocal quality. Is your voice loud, shrill, strident, or frenetic?
  • Watch out for bad habits in the cadence of your speech. Refrain from “sing-song” phrasing and “up-talking” at the end of a sentence.  It makes anyone sound like a silly school girl.
  • Slow down. Smart people often speak quickly, but you don’t want to sound like a toy machine gun or a cartoon character on amphetamines.
  • Diction is a crucial part of effective speaking.  It requires effort.
  • Guard against “whiny girl” or “lazy girl” voice. Irritating sound emanates from the posterior pharynx with inadequate volume.  The speaker comes across as bored and boring.  Modulate your voice to sound like a competent, knowledgeable adult.
  • Be careful with gestures. Many people overuse hand gestures.  It’s distracting and undermines the real message.  Excessive gestures can make someone look desperate.  Politicians take note.

We work hard to develop our careers.  Don’t allow poor speaking habits to sabotage your future.  You never know who might be listening.

We Can Do Better

Posted Posted in Brain Science, Continuing Education, Homestudy, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

The pendulum has swung too far.  Fifty years ago there were psychiatric hospitals full of mentally ill patients who were poorly treated and even abused.  “One Flew Over the Cuckoo’s Nest” was required reading.  National outrage peaked and psychiatric hospitals closed leaving thousands of patients unequipped to face the outside world.  Alcoholism, drug addiction, and homelessness began to spiral out of control.

Today major cities like New York, Seattle, Portland, Los Angeles, San Francisco, and others have homeless populations overwhelming local resources.  Los Angeles County now has over 60,000 homeless people, and San Francisco publishes a map to help visitors avoid piles of human feces and used syringes.  Police officers are becoming ill as a result of contact with infected people.  Tuberculosis, Typhus, Typhoid fever, Hepatitis A, and scabies are only a few of the conditions smoldering on the streets.  Rape and violent assault are routine.  California now accounts for one-fifth of the homeless population of the entire country.

The two largest contributors to homelessness are mental illness and addiction.  Most cities have laws against sleeping on the streets, but often those laws are not enforced.  Decriminalizing bad or problematic behavior does not make it go away, and permitting squalor is not compassionate.  Homeless people do not represent a big voting block, but government officials have a responsibility to protect public health and safety.  Experience over the last 40 years has taught me something about caring for homeless patients and starting free clinics, so here are a few thoughts:

  • Commit to addressing the problem. If inaction, complacency, and blame solved problems, we wouldn’t have any problems left.
  • Enforce existing laws and give the police the support and back up they need. That is not being “mean.”
  • Triage people in tent cities. Most need help from social services, many need treatment for addiction and mental illness, some may respond to help from church organizations, and some probably need to be arrested.
  • Organize a volunteer force (the local equivalent of the Peace Corps or the Job Corps). Those not in need of acute treatment for mental illness or addiction might be salvaged with a program that teaches basic living skills.  Such programs already exist in some areas.  College and graduate students could volunteer and earn “credits” toward paying off some school loans.  Colleges and universities would need to cooperate, but at some point you have to put your money where your mouth is.  Tax credits could be given to non-student volunteers.
  • Organize mobile free clinics to vaccinate, screen for infectious diseases, and begin basic treatment. Invite nursing and medical students as well as retired professionals to help.  Sometimes people simply need to be asked.  They would need legal protection from malpractice.  Non-controlled drug samples and old medical equipment could be donated.  I know whereof I speak here.
  • Create transitional housing facilities (like senior life care in reverse). Old warehouses and military style barracks could be refitted. California has the largest percentage of billionaires in the country.  Ask them for help.  No one becomes massively successful because he or she has a dearth of ideas.

Fifty years ago some people were abused in mental hospitals.  Now we allow them to abuse themselves and one another on the streets.  This is a massive, complex, and expensive problem.  But failing to address it will have catastrophic consequences for everyone.  We can do better.

An Idea Whose Time Has Come

Posted Posted in Brain Science, Continuing Education, Homestudy, Seminars, Webinars

By Mary O’Brien, M.D.

Are you an adult?  Are you sure?  Young people today are taking longer and longer to grow up.  Throughout history people worked hard and started families in their teens.  Only a privileged few could afford the time or money for an education.  Even a mere century ago, finishing high school was a relative luxury.

A few weeks ago, during the 75th anniversary of D-Day, we heard remarkable stories of 18- and 19-year-old boys fighting for freedom and civilization.  These boys grew up very fast.  They had no choice.  Mommy and Daddy could not indulge every whim of their sons.

Growing numbers of people now realize we have a problem.  Young people are graduating from high school and even college with minimal practical skills.  Changing a tire, cooking a real meal, or opening a bank account can overwhelm them.  This is not good.  Many of us were required to take shop class or home economics in high school.  Then, the “geniuses” in education had their way.  The results speak for themselves.

Happily, there is hope.  A young teacher at Fern Creek High School in Kentucky has begun three-day workshops called “Adulting 101.”  Sarah Wilson Abell has been instructing students in real-life skills:  how to handle basic food preparation and cooking; how to change a tire; how acquire the fundamentals of money management; how to read a map (in case Siri is sick); how to behave on a job interview; how to have basic table manners and etiquette; and how to tie a tie.

Parents used to teach these skills, but the days of June and Ward Cleaver and Ben Cartwright are long gone.  This timely idea is spreading.  More and more people in their thirties and forties realize they need these skills.  I recently encountered a 31-year-old woman who didn’t know how to sign her full name because, “We didn’t learn cursive.”  You can’t make up things like this.

Someone reading this is probably not a high school teacher, but many of our readers teach students in the health-care professions.  Starting your own “Adulting 101” class could be tremendously helpful.  In addition to the topics listed above, a few more are worth considering:

  • Good, old-fashioned people skills. Professional etiquette when dealing with patients and colleagues must be taught.  Translation:  Put down your cell phone and look up from your computer.
  • Principles of personal hygiene and dress. Don’t act outraged.  Most of us realize standards couldn’t have sunk much lower.  Our failure to teach and maintain such professional standards has compromised patient care and the career advancement of many students and trainees.
  • Essentials of appropriate speech and behavior in the workplace. As is the case with appearance and manners, there are boundaries that separate work, play, and personal life.  This comes as a shock to many young people.  We do them a great disservice when we fail to correct the situation.

“Adulting 101:” It’s an idea whose time has come.  It should have never gone away in the first place.

Memorial Day, D-Day and Cicero

Posted Posted in Brain Science, Continuing Education, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

Traffic Delays.  Slow Wi-Fi.  Dead phone batteries.  Forgetting a password.  Insufficient “likes.”  These are among the top stressors listed by millennials in a recent survey.  Contrast this with the real stresses endured by similarly aged men storming the beaches of Normandy in World War II and the absurdity of current culture becomes painful.

I’ve always been baffled by the number of people who confuse Memorial Day and Labor Day.  They’re not even embarrassed.  Ask nearly anyone much under the age of 50 what he knows about June 6, 1944, and prepare for a blank stare.  Twenty- and thirty-somethings may well scrunch up their faces in annoyed perplexity as only they can do.  People today lead frenetic, cluttered lives that leave little room for history.  But as Cicero wrote in 46 B.C., “To be ignorant of what occurred before you were born is to remain always a child.”

Memorial Day commemorates those who died in active military service.  Originally, it was called Decoration Day and was observed on May 30th.  Eventually, it was changed to the last Monday in May mostly as an excuse for another three-day holiday weekend.  This year Memorial Day falls on May 27th.  People will have barbecues, picnics, and parades. They will open neighborhood swimming pools and proclaim the unofficial start of summer.  A few thoughtful people will attend memorial services and place flowers on the graves of those who sacrificed all.  But millions will remain clueless as they consume hot dogs and beer.

This year, on June 6th, those of us fortunate enough to live in the free world will observe the 75th anniversary of D-Day (June 6, 1944).  The planning, hope, courage, determination, perseverance, and sacrifice of the Allied Forces on that momentous day cannot be overstated.  The unwavering commitment of thousands of men to stopping the onslaught of the Nazis despite the terror, horror, and agony of it all is beyond our grasp.  What those men endured makes our worries laughable.

The next time you find yourself upset by traffic delays, slow Wi-Fi, or a dead phone battery, remember Memorial Day, D-Day, and Cicero.  Some of us need to stop thinking like children.