What I Did In Another Life

One of the residents told me that our residency program director had asked him to ask me what I did before residency. I guess they’re both curious. Here’s a link to Dr. Amos in a previous life. OK, so it’s an old blog post but it’s really the best answer to their question.

WHKS

The blogger in another life

WHKS-Vision-Values-Purpose-PosterI actually was not cut out for land surveying because I have seasonal allergies. Despite that, I really liked being outside most of the time. Nowadays, measuring distances is done mostly by electronics. We used a chain back in the day, more probably called a steel tape in my era but actual chains were used a long time ago. The one pictured below is on a reel but we also used a loose tape without a reel and which you had to “throw” in order to wrap up for storing in the truck.

Surveyor reel steel tape

I wonder if many surveyors known how to throw a chain now. It’s actually a skill that took me a little while to learn how to do just right. It’s almost impossible to describe and I was lucky enough to find a YouTube video showing how it’s done. If you google this, you might find a video that shows a guy just throwing a chain for exercise–that’s not the one.

You have to wrap it by holding one end with your left hand (opposite if you’re left-handed) and the tape laid out behind you. Then you reach back behind you with your right hand about the length of your arm, grasp the tape and pull just enough to lay it on top of the end you have in the left hand. Keep doing that until the entire length of the tape is in your left hand. The tape then just naturally falls out in the shape of a figure eight.

The hardest part is grasping both ends and twisting it just right so that it falls more or less neatly into a single ring.  You see why it’s hard to explain. You have to do it to get the knack. The video shows the method. You can mute the volume because there are no instructions (naturally, since you really can’t tell somebody how to do it) and the background “music” is awful. Sorry, it’s the only video I could find and I was amazed to find one at all.

An old range rider surveyor taught me how to throw a chain and he taught me other practical things. His name was Lyle. I still think of him, sometimes.

There’s an analogy to assessing delirium. You have to do it enough times to get the knack. Although there are written instructions for using screening tools and bedside tasks to increase the sensitivity and specificity of the tool–you just have to practice.

CAM Mini Cog

There are many ideas and skills a doctor has to learn and some that must be unlearned. An internist called me today and asked for advice on assessing and managing delirium. She had responded to a consultation request from a surgeon who asked her if a psychiatric consultation request should also be made.

She told me that she said “No.” It’s the first time I’ve ever heard that from an internist. Around here and in many hospitals, the assumption has been for years that you have to call a psychiatrist to evaluate and manage delirium. It’s driven by the culture and has nothing to do with how intelligent or skilled an internist is. They just have to practice…and unlearn the learned helplessness driving dependence on psychiatrists.

"Relegating this work entirely to specialists is futile for it is doubtful whether there will ever be a sufficient number of psychiatrists to respond to all the requests for consultations. There is, therefore, no alternative to educating other physicians in the elements of psychiatric methods."--George W. Henry, MD, 1929

“Relegating this work entirely to specialists is futile for it is doubtful whether there will ever be a sufficient number of psychiatrists to respond to all the requests for consultations. There is, therefore, no alternative to educating other physicians in the elements of psychiatric methods.”–George W. Henry, MD, 1929

 

 

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