I’d Do Anything If Only

Atina!  Stop shredding your bed!  Atina!  You can’t have chocolate!  You’re a dog!  Chocolate is NOT good for doggies!  Atina!  Get that goddam wet ball out of my face!  Atina!  SHUT THE FUCK UP!!!


Last night was a total wreck.  For some reason Atina spent her night growling, woofing, and outright barking, at something that I could not see. 

We are in a well-lit campground, so if there was, like, a bear strolling around, or a bull moose, or a hedgehog, I’m certain I would see it. 

Maybe it was some perv hiding behind a tree, whacking off.  All night.  Sheesh.

On this premise, I chalked Half #1 of the night up to Virtuous Vigilance on the part of the Pup.  But when Night Half #2 rolled wearily around, I got cranky.  I shushed.  I gave orders.  I YELLED.  I cursed. 

As grey dawn faded into a grey rainy morning, I felt worse and worse.  If there’s one thing that kicks me right out of orbit, mentally and physically, it’s sleep deprivation.

And of course my baby still needed her walkies, and breakfast, and more walkies, and playtime…And I needed large quantities of thick coffee, and something to force into my queasy stomach so I could take my pills, and I needed to use the bathroom, and brush my teeth, and put on clothes…And Atina, none the worse for her own sleepless night (who knows, maybe 🐶 s only take 😸 naps anyway…), was red hot and rarin’ to go, while I was dragging serious ass.

I got to feeling cross and cheated and just plain ill-tempered, and then I thought about something that happened, and my mind changed.

Here is what happened.

1989. I was pulling a two-week stint in the Pediatric Intensive Care Unit–the PICU. 

My residency program was working us like slaves because we were down four warm bodies.  One, my sweet ward partner, died in a car crash.  One got meningitis from a kid she was treating.  One got hepatitis from her dear boyfriend when he got back from India.  And one was on a sort of permanent leave, because he had miscalculated a chemotherapy dose and the child died.

So the house staff were stretched much thinner than usual.  Instead of every third or fourth night call, we were on every-other or every-every night.

In the PICU we usually did every-other-night, actually 24 hours on, 24 off.  But since we were so badly strapped for staff, the PICU director came up with a brilliant plan:  he would live in the PICU for two weeks, and I would live in the PICU for the next two weeks, and then we’d switch off again for another month.  That way we’d both get to see our families, for the two weeks we’d be off.  And of course if things were slow, our families could come and visit us in the call room, which was an 8 x10 ft luxurious affair made of beige-painted cinderblock, with a tiny bedside table to hold up the phone, and a worn metal chair.  

When you switched off the overhead fluorescent lights, you were instantly plunged into darkness.  Fortunately, every doctor carries a penlight, so at least you could find the bed, if you ever got a chance to actually lie down.

Hypervigilance is a common symptom of PTSD.  Therefore, since half of my consciousness was always scanning the PICU for problems, I never really got to sleep. 

One night when we had a truly puzzling and terribly critical case on the unit, I lay staring into the velvety black of the call room.  Everything had been taken care of, rounds, orders, and the nurses were wonderful and right on top of things; so there was no reason not to catch a few winks.

But I was in the grip of free-floating anxiety, so I felt my way along the wall until I found the light switch, and lacing up my Rockports, I sidled out into the unit.

We’d received a case that day that came in via the ER.  It was a little three year old boy, who presented with a high fever and blueberry muffin looking rash.  I mean really, he looked like a blueberry muffin.  But unlike muffins, which are good, he was not good.  He was in very bad shape.  Septic shock of some kind.  Our usual tests could not detect the pathogen, or anything that could have caused his condition.  This was 1989, remember.  We’ve learned a lot since then.

We ran through every possible infectious disease that we knew about, and every form of toxic ingestion or exposure, and every possible cause of bleeding and organ failure, but nothing came out positive.

So we did the only thing we could do: we put the little guy on life support, gave him fluids and antibiotics and steroids, and prayed that with supportive care, his body would come through whatever it was, and heal itself.

This was not to be.

Even with maximal supportive care, his body deteriorated.  He had been unconscious when he came in, and never opened his eyes or gave any indication of awareness.  His kidneys stopped working, and fluid was backing up into his organs and tissues.  We tried our hardest to keep up with that too, but soon it was clear that this little boy was not going to make it.

I can’t remember who we were waiting for.  His mother had died, I remember that.  It was just his father alone who took care of him.  We must have been waiting for someone else…to be there…when we took him off the vent.

As I turned the corner from my call room to the unit, I saw the boy’s father sitting on a hard chair, his knees up against the bed, stroking his little boy’s swollen hand and weeping, his shoulders heaving.

I laid my hand gently on his shoulder and said nothing, waiting.

“Yesterday,” the father sobbed, “He was running around making so much noise, I told him to shut up…Oh, if he would only make that much noise again!”

Just Stop

Laura P. Schulman, MD, MA:

Josh has hit the nail on the head. He has put words to the thoughts that rage through my brain every time one of these horrible massacres occurs, and the press and its hand-picked interviewees start up the old saw: “Mentally ill..he must have been mentally ill…”

Originally posted on My Friday Blog:

Hello dear reader(s)!

Stop saying the shooter was mentally ill.  I would like to see your psychiatry credentials.  I would like to see your social work degree or your psychology degree.  I would also love to know how you feel you can diagnose someone after their death.

Mentally ill people are far more likely to be the victims of violence as opposed to the perpetrators.¹  These assumptions that any of these mass shooters was mentally ill is simply offensive.  People are attempting to justify the things they can’t understand by assuming the people must be mentally ill.  I have read posts today about depression being involved and how these shooters just “snapped”.  Snapping is not a symptom of the mentally ill.  It is a symptom of the mentally weak.  It is also hard to say that someone snapped, when they premeditated a murder.  If depression were the reason, how come…

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Over The Line

I like to think I’m a fairly patient person.  I try to give others the benefit of the doubt.  Everybody has their own set of experiences and insecurities–me too.  And when somebody rings my chimes, I try to look inside and find what hurt, what insecurity is in there, that got my back up when they said or did that.  Usually that defuses my defensive reaction, and I can forgive and forget and make the interaction a productive one.

So it is with more than a little frustration that I have finally reached my breaking point with someone who has been very helpful, yet in equal measure annoying: Atina’s veterinary resident, the one who has been shepherding us through the grueling process of finding out what is wrong with Atina.

It started with her insisting on calling herself Doctor, while calling me by my first name.  Maybe there is a different protocol in veterinary medicine, but in human medicine, to call a senior physician by her first name without being invited to do so, let alone insisting that she, a young doctor still in training, should be called Doctor rather than by her OWN first name, is not only rude, but a major insult.

I let that slide for a few weeks, then had a joking conversation with her about it that either made her blush, or perhaps flush with anger, I don’t know.  It didn’t seem to “take,” in any case, so I guess there’s something about it that I don’t get.

After hanging around Colorado for weeks spending money on campgrounds, I had to start East.  I have stuff I have to get done before I head back to the Southwest for the winter.  I waited five days after Atina’s surgery, to make sure she was OK and that her surgical wound was stable enough to travel, and then I began making my way slowly across Kansas, what a drag.

In the meantime biopsy results are slowly rolling in, and Dr. Vet is being kind enough to forward the reports to me.  Today came a preliminary pathology report, complete with photos of the microscopic sections.  Terrible.  Really terrible.  The results, I mean.  The quality of the pathology studies is excellent.  It shows the mostly non-functioning elements of Atina’s kidneys all too well.

In my thank-you email, I mentioned that because of the storms and flooding on the East Coast, I would likely be delayed past the 14 day timeframe for taking Atina’s stitches out, and if so, I would just remove them myself.  Her reply: she would rather have a veterinarian remove them.

I wanted to blow my stack!  Here is a very junior clinician, who knows that I have many years of practice under my belt, almost all of them in the emergency department, telling me that I should not remove my dog’s stitches.  I’m sure she means well.  Maybe she is concerned that I might get bitten, doing it myself without a tech.  Who knows.

It rang my chimes.

In addition to six months of surgical training in a veterans’ hospital, where they were so short handed that I was first assistant, I did four excruciating months of facial plastics.  Excruciating, because my attending was a total asshole who sexually harassed me, at a time in history when such practices were routine and not reportable.

But the training came in handy when I worked in rural ERa where the nearest plastic surgeon might be 50 miles away, so rather than send somebody off in the middle of the night, I had the skills to repair the delicate layers over an eyelid, or fix a busted lip, reimplant a torn out tooth, pick iron filings out of a cornea using a microscope….

And also castrate my goats, fix plugged udders, sew up my horses when they ran into fence posts, perform reconstructive surgery on my Corgi when she picked a fight with my German Shepherd over ownership of a stick and got her throat badly torn (duct tape makes a fine muzzle in a pinch.  Always have some duct tape around). Of course it happened on a Sunday, and I couldn’t get a vet.  Even the large animal mobile vet wouldn’t come.  He knew me, and suggested I take care of it myself. 😠 My son, who was 14 at the time, held the thrashing Corgi down while I irrigated the wound, identified the tissue layers, and made a decent job of it despite the moving target. 

So of course I bridled at this junior physician’s opposition to my performance of this very minor procedure.  Even if there were a sign of poor healing of the deep abdominal sutures, that is first of all something very easy to detect, and secondly something that would have to wait until I could see my “home vet.”  Clearly, if it were anything major, like wound dehiscence (the wound not healing at all and instead falling apart), I would seek out an emergency veterinary hospital.

So now I’m writing this, as a way to lick my wounds.  I miss my practice.  I miss my active medical life.  I want to go home to the ER and sew people up.  I don’t want to battle death.  I just want to sew people up and pick hair beads out of ears, noses, vaginas, and any other orifices hair beads can get stuck in.  I want to lance boils and pack them with Betadine gauze.  I want to set broken bones and put dislocated shoulders back in place.

I want to rise from the dead.

Paralyzed Patient Uses Brain-Computer Interface to Walk


Let’s hope we see spine-injured people leaving their hospital beds, learning to walk in a new way…But maybe not exactly like this…


A Broken Justice System – Cases in Point – Part 2 – The Case of Courtney Bisbee

Laura P. Schulman, MD, MA:

This case makes me shudder for more than one reason.

In 2005 I was living in a religious community in Seattle. Because I was an older woman, and a pediatrician, I was presumed to be the “grandmother type,” although I am the opposite. I am not in the least “touchy-feely.” I enjoy children, but as patients, not as anything else. There was this one lady in the community who kept after me to babysit during services, and I kept saying no, and she kept badgering me, so finally one day I said fine, I’ll play the banjo for the kids but I won’t take care of them. Somebody else has to be there to take care of the little beasts. So that’s what I did.

Wouldn’t you know, a few days later there’s a knock on my door, and who is there but one of the religious leaders and a woman, a mother of one of the children, and she’s accusing me of molesting her kid. I about died, and told them that I had had nothing to do with her brat, that she just wanted money because she thinks I’m a rich doctor, that I did nothing but play the banjo for the kids, and there were three older teenagers there to prove it. Very fortunately, the religious leader was embarrassed by this woman’s clearly false accusation and lead her away in disgrace. I shut the door shaking, realizing things could have gone a very different way and it could have been the police at the door instead. I never, never, never have agreed to play babysitter in any capacity again. It’s too easy for predators to descend like vultures on someone they think they can squeeze money out of. The case below is tragic. Courtney’s big mistake is that she went to someone’s house. Whether or not there was anything improper going on, and I know I will be smacked for saying this–in this day and time, anyone who takes their professional calling into a setting where there are no other responsible adults on site is at risk for being accused of wrongdoing. Regardless of the altruistic intentions a person may have, going to a place where the only other people are children, even if invited by the children’s parents, is no longer a safe thing to do. Very sad, but very true, and very dangerous. Don’t do it. I lived in fear of another kind of knock on my door for years, just because I gave in to another adult’s nagging and played the banjo for some toddlers for half an hour.

Originally posted on Wrongful Convictions Blog:


From time to time, I become aware of cases that are particularly good examples of the flaws, the problems, the shortcomings, the failures, and the actual injustices of our so-called justice system (that I have been writing about here for the last 3 1/2 years). This is Part 2 of what is intended to be a continuing series highlighting these cases. These cases have been selected as representative and demonstrative examples, but be aware they are just the “tip of the iceberg.” This kind of stuff is happening every day in every state. You can see Part 1 here.

[Note: To the best of my knowledge, everything in this article is a matter of public record. If it can be shown that there are any misstatements, I will immediately post a retraction and an apology. This article has been reviewed and approved for posting by…

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Laura P. Schulman, MD, MA:

Ouch….Been there, didn’t do such a good job with that…

Originally posted on Depression Comix:


Read at depression comix at http://wp.me/s3zYhM-258

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Bad News


Atina in her post-op coat, checking for mice

My readers already know that Atina’s kidneys are bad, that I knew that within 24 hours of her purchase, and proved it by taking her to the vet and having blood and urine tests done immediately.  We knew that the broker I bought her from, along with her trainer, and along with their veterinarian, cooked up a cockamaimie story that I was somehow responsible for Atina’s kidney failure because she sniffed some of my arnica oil.

Over $5,000 later, just in vet bills, not including travel, camping, food, and other strictly Atina-related expenses, we finally have an answer.  And as we might have guessed, it has nothing to do with arnica.

The initial biopsy report came in today.  More will trickle in over the week.  But the news is not good.  Really, really not good.

Kidneys are made up of a lot of different structures.  The ones that have to do with filtering out bad stuff and keeping good stuff in the blood are called nephrons.  The biopsy consisted of a wedge shaped chunk of kidney.  This chunk was divided up into several smaller chunks, each destined to be tested in a different way.

The first test is simply to look at the architecture of the kidney.  This is the result we got today, and it’s shocking, and horrifying.

The chunk of kidney tested contained 27 nephrons.  Of those, only two were normal.  The majority of the rest were fetal nephrons.  The rest were basically dead, having been worked to death from trying to compensate for the undeveloped ones.

The pathologist wrote that this was likely due to something that happened to Atina’s mother, either while she was pregnant or nursing, that affected Atina’s kidneys and stopped them from going ahead and developing.  These fetal nephrons will never develop.  They will calcify, or just turn into scar tissue.  There is already scarring.

My poor girl is somehow continuing to chug along on 7% of normal kidney function.  It shows.

She doesn’t have much energy.  Her appetite waxes and wanes.  But show her a frisbee and boy, she will chase that thing two or three times, before she tuckers out and I make her stop.  I learned the hard way, though.  One day I let her play all she wanted, and she tried to die on me.

Today we’re camped at a State Park.  Two young adolescent boys came along, bearing a toy football.  Atina went up to them, and they froze in their tracks.  She looks so scary!  But she went ahead and took what she wanted: she stuck her head under each boy’s hand and demanded that they pet her!  First one boy, then the other.  They were petrified.

I wanted to say, You’d better pet her, or she’ll bite you!  But I didn’t.

Then we had to part ways, because Atina realized that there was a ball involved…And I said to the boys, don’t throw that ball till I get her out of here, ’cause she will pop it if she gets hold of it!

Tomorrow another part of the biopsy will be in.  At this point it’s purely academic, since we know most of the story from today’s result.  Her vet at the University gives her several months to live, maybe a year or two if we’re lucky.

The Power of Unconditional Love

Listen, I don’t pretend to be a perfect practitioner of unconditional love. I wish I was. My loved ones would have had such better lives, had I had any notion of what unconditional love could do.

For example, on July 20 I bought a skinny, sick, fearful dog, for a ridiculous sum of money. I was in a terrifically needy state, having lost my beloved dog Aress to a freak accident. I looked into this pitiful sick doggie’s soft brown eyes, paid the sum, and took her home.

It was clear that she had never been in a real house before. OK, I don’t really live in a “real house,” since I make my home in a fancy van. But it is undeniably a home, and it was clear that she had never been in one. She lived in a kennel outdoors, was taken out to train, and put back in her kennel. From her lamentable condition, it was also clear that nobody had ever paid much attention to her.

In the six or so weeks that I’ve had her, she’s become a sleek, happy pup who loves almost everybody except people she deems untrustworthy. This is her job, and she does it well. She’s affectionate to the point of occasional annoyance, since there are things that must be done (according to me), like writing, doing chores, paying bills…but to Atina, these are annoyances to her, for damn the torpedoes, the play must go on!

An old buddy of mine stopped by to camp for a few days (hi, pal, in case you’re reading this!). I showed him the picture of Atina when I first got her. You could count her ribs and all her vertebrae, and the bones of her pelvis stood out like a sick cow’s. Her coat was dull and ratty: so much so that I had her tested for mange.

My friend asked me how I had managed to rehabilitate her into the sleek, happy girl she is today. I shrugged.

“Love,” he said quietly. I nodded, tears stinging.

Although he gets furious when I bring up the topic and vigorously denies it, my son is a very high functioning autistic. He learned to speak before the age of one, and before that, he developed his own version of sign language. By 19 months he could count to 19, and by three he could tell you the names of every dinosaur known to man, where they had been discovered, and what they did, their diets, their habitats, and what era they lived in. By four he had taught himself to read and do basic arithmetic via “Reader Rabbit” and “Math Blaster” on our desktop Mac.

On the other hand, he hated anything to do with other children, refused to participate in preschool, and whenever possible isolated himself in corners, absorbed in a book or playing with his plastic dinosaurs or action figures. At three, he was already seeing a child psychologist. We managed to get through private kindergarten in five-minute segments. If he cooperated and sat in the circle with the rest of the children for five minutes, he got to go to his corner and be alone for fifteen minutes. Later in the year he discovered the school office and became enamored with the laminating machine, so he became more motivated to sit for five minutes so that he could run to the office and laminate for fifteen.

First grade was a bust, as far as the teacher was concerned. We enrolled him in a progressive Quaker school: small class size, emphasis on art and music, compassionate teachers–what could be better? Nothing, I guess. Literally nothing. My son staidly refused to cooperate with anything whatsoever. His teacher, a caring and earnest young man, could not get him to do anything. He retreated to a corner and refused to come out. Somehow he managed to ace all the tests, though. But he would not come out of his corner, nor would he speak a word. The teacher called me on a weekly basis.

“He refuses to participate. What shall I do?”

I was busy, harried, frustrated and sleep deprived, so my stock answer was, “You’re his teacher. YOU find a way.”

This did not work.

Finally I had a brainstorm: “Make him the class scribe. Give him a tape recorder, and have him sit just outside the class circle and record everything. This way he’ll feel like he’s got an important job and is not simply one of the (muggles, but that word had not yet been coined by Rowling).”

It worked. We managed to make it through first grade without any further conflict.

In later years, I experienced what happened when I tried to force my son into anxiety-producing behaviors using negative consequences. He either withdrew, or else he simply sat down on the floor and crossed his arms, earning him the nickname “Sitting Bull”. When he got older, he became threatening and intimidating. I was not about to knuckle under, so I upped the ante, and so did he. Soon a full-blown war was in progress.

Now, I don’t believe in accepting bad behavior, not even from a “special” child. But there are ways, and then there are ways.

My moment of epiphany dawned upon reading Karen Pryor’s amazing book, Don’t Shoot the Dog. Pryor was the head porpoise and Killer Whale trainer at Sea World for many years. Now, you can’t make a large sea mammal do anything it doesn’t want to do. You have to make doing the desired behavior so attractive, that said mammal would rather do it than just swim around and play, like porpoises like to do. You have to make it fun to do what you want them to do.

Pryor’s book, as its title implies, carries this philosophy over to dog training. At the time her book was published, most dog training was based on negative reinforcement: You don’t do what I want, you get your neck jerked, you get yelled at, you might even get hit with a rolled-up newspaper for doing your business where you’re not supposed to.

Pryor applied what she had learned as a sea-mammal trainer to dog training. Thus, lucky dogs found out that doing the desired behavior resulted in treats and praise, while negative behaviors got them…nothing. Ignored. Exactly what a social mammal desperately does not want.

Of course, psychology students already knew this from getting rats to do things that humans had a hard time with, by simply having a tasty treat at the end of the maze. But applying methods that worked with “lower life forms” to humans? How insulting. Humans ought to just know that what they were doing was good or bad. Adam and Eve, right? Tree of knowledge of Good and Evil, and stuff like that.

The Behaviorist School of Psychology, pioneered by B.F. Skinner, showed that positive behaviors rewarded with positive reinforcement produced more positive behaviors, while negative reinforcement inhibited negative behaviors. A third strategy was called “extinguishment.” You do what I want, you get left alone to do what you want. You don’t do what I want…nothing. The behavior “extinguishes,” for want of reaction. In many cases this worked better than negative consequences such as electric shocks. (N.B.: a rumor somehow began that Skinner experimented on his own child by placing her in a “sensory deprivation” cage. This is not true.)

Pryor capitalized on Skinner’s Behaviorist School of psychology and its “behavior shaping” model in her sea mammal training program. She then morphed it over to dog training…and concluded her book with a chapter on shaping the behavior of humans.

I can’t say that I ever mastered behavior shaping, either in dogs or in humans, but I have tried to incorporate it, when I remember.

What I’ve learned through the years, though, is to assimilate and practice the art of “Love the person, even if you hate the behavior.”

I have always loved my son, completely and passionately, even when I was dodging head-butts when bear-hugging him through an autistic melt-down, or once again leaving a cart full of groceries in the checkout line when all those people were just too much for him, or agonizing through the time he was in and out of countless outpatient and inpatient addiction programs as a teenager, or sitting up nights worrying when his stepmother threw him out and he lived in a drug house, on the street, in a homeless shelter, in a psychiatric ward zombied out on legal drugs.

Finally he got arrested, and this was my chance to save his life. I called the judge, whom I knew from my work with the court system (yes, this was taking advantage of my position), and begged him to remand my son to long-term inpatient care. The judge reprimanded me for calling him, but honored my request.

After a long period of searching, we found the perfect place. The students were held to a strict policy of personal accountability. Positive behaviors were rewarded with increased privileges; breaches of the rules resulted in suspension of free time, which was instead spent writing a paper examining the undesirable behavior, why the kid did it, what the internal meaning of the behavior was, and why this was counterproductive to the kid’s development as a productive, independent, successful individual. The student then presented the paper to a mentor, who helped process the ideas and helped the kid internalize them. There was still a consequence in terms of loss of privileges for a finite period, and a defined way to regain the lost privileges.

In this way the teens learned that self-determined productive behaviors resulted in more freedoms. In addition to these interventions, the kids had daily group therapy, thrice-weekly individual therapy, a staff mentor who was always available for processing issues, family therapy monthly, and many other interventions. It turned many lives around. It gave my son tools that he is still using, ten years later.

For me, it reinforced that the power of unconditional love moves mountains and saves lives.


And You Think You Know What Weird Looks Like?

Guffaw, guffaw

Just get a load of Quasi, Anita, and vRollo, and don’t forget to check your weird meters. 😨

“Max Fleischer- The Cobweb Hotel”

My favorite carton of all time….Well, my SECOND favorite.  Just wait till I find #1!


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