Hoarders

Lots of patients and friends have been talking about these reality shows featuring various hoarders. Intrigued about how hoarders are portrayed in these shows, I sat down with Hubby and watched an episode.

I have been to homes like that. I have had patients who lived like that. As an intern, there was a severely depressed woman who came to the hospital nearly mute. Initially, she only said yes and no. As she improved, more social issues came about. While she was hospitalized, her neighbors called Code Enforcement and her dwelling was pronounced uninhabitable. They found over a dozen cats, and rats, and gerbils, and of course, the usual feces and garbage. My co-intern and I were incredulous. When we asked her, "So, um, how many cats do you own?" She thought she had two. She also thought she had about half a dozen of rats and gerbils in cages. Well, according to the authority, they were DOZENS and these animals roaming. To this day, I have no idea how there were cats and rats running around the same property?! A lot of times, these homes are made aware to authorities because of fire hazards (can you imagine an apartment full of papers burning?) and of course, health hazards.

I also completed this rotation where I went to people's homes to evaluate competency. Basically, is there anyone upstairs to manage the estate/health of the said person, and if there is no one upstairs, and if it is a 'psychiatric reason' (generally, it was all psychiatric reasons,) I then filed paperwork and requested a judge to pronounce the said person to be incompetent. Once that is in place, then a conservator gets involved and theoretically, things will get better. As you can imagine, people really don't want to be conserved. There was a woman in a fancy neighborhood who refused to let us in, we called the cops and she still refused. Without a warrant, one could not go in. (Perhaps she was really with it?!)

There was another lady who lived in this neighborhood that I would love to live in, and apparently, according to the social worker who had been there previously, had no electricity, no water, no heat, and was full of garbage. This elderly woman was never home when we stopped by- we thought she was just sitting in the dark behind the door.

Then there was this family with a very strong psychotic gene, that resided in this very, very, very fancy neighborhood, where a home easily could fetch 5 million bucks. Yet it was so incredibly dilapidated.

Of course, on the other spectrum of the socioeconomic range, a man and his three adult sons lived in this trailer along the coast. It was absolutely disgusting. The toilet had not worked in a very, very, long time and was, well, brown. There was food, of all ages, everywhere. Surprisingly, there was a computer, albeit surrounded by lots of empty boxes from Amazon. The poor elderly man was taking a nap with his CPAP for his sleep apnea, and man, that CPAP was loud! Anyway, turned out, he was competent and he was aware of the mess.

Then things can get freaky at these home visits. Thankfully, a social worker typically already made a connection so I never had to go in 'blind.' There was a lady who 'collected' tarantulas. Her house had floor to ceiling full of stuff: mailings, circulars, letters, newspapers, crap. She did manage to form aisles through it, so one could get from the front of her residence to the back.

It is my opinion that there are two types of hoarders: ego syntonic hoarders and ego dystonic hoarders. Whereas ego syntonic hoarders like it, and must keep up with it, ego dystonic hoarders tend to also suffer from depression, anxiety, psychotic disorders, and do not like how they are hoarding. In general, ego dystonic hoarders are more easily 'treated.'

I was struck by several things for the episode I watched. First of all, these psychologists sound really, well, dumb. They keep saying the obvious. "Let's encourage her. It is ok, I am here to help you." Definitely not a useful portrayal for what a psychologist can do in these situations.

Secondly, some of these people really need to be medically treated for their underlying disorders. Surprisingly, that was not an intervention used in the episode I saw.

Thirdly, I think hoarding really speaks to how isolated people can be in our modern society. So often, people start hoarding behaviors after life circumstances change: after kids move out, after a spouse dies. Sometimes, I think, the prevalence of our psychiatric illnesses would decrease if people lived in more secure communities, where people got in on each others' business, with care and kindness.

Anyway, I think TLC and A&E ought to hire me as an 'expert.'

Kids

I do have two kids, although one may not be able to readily come to that conclusion based on my recent posts.

They are well.

Aidan's reading has improved so tremendously over the summer, and I am thrilled. He is doing well in first grade, making friends, doing homework, being self motivated. While he no longer chews on his finger nails, something we worked on over his year in kindergarten, he now has this weird throat clearing thing going on. I think, it started with his bad allergies, and turned into a bad habit. I have seen no improvement on antihistamines or nasal steroids, perhaps I should try him on Singulair, or send him to see a behavior modification therapist. On one hand, I think he will grow out of it, but on the other hand, man, it is annoying. The old adage in parenting is true, "If it is not one thing than it is the other."

Zoe is becoming quite a young lady. She clearly has an opinion of her own, saying things like, "Good idea!" "I told you so!" It is amusing to see her so determined to 'write.' She is independent, and just loves routine. She is just so eager to grow up and be like her brother. I am, however, not looking forward to her growing up. I can already see the wild hormones that will come our way again, in full force, in about a decade, probably less. She can be so passionate! Why sugar coat it? She can be emotional. I just need to show her how to be emotional appropriately, not an easy task, for sure. (Not that I have mastered it myself...)

Sibling rivalry is also ever present with us. Because they are at different schools, one child always gets picked up first. It does not matter which child I get first, within 2 minutes of the two of them being together, whining and attention grabbing take center stage. Whenever I have just one of them with me, whether we run errands, read a book, hang out quietly at home, it is a breeze. Whenever I have both of them, they bicker over why so and so has two crackers and "I must have the same, or more." Truly. Delightful.

Yet they can also be so sweet together. When they play "I am a dog" game, the dog so docilely follows the owner around, and the owner always so lovingly feeds the dog. Aidan chose to write Zoe a letter for a school project, and he wrote, "I love you" at least five times. (Possibly because he really knows how to spell all those words.) Zoe will save something special for Aidan too.

I hear sibling rivalry continues, forever. Dear God, have mercy on me.

Soliliquy #4

Since I started talking about decreasing health care costs, here are some more ideas.

I don't understand why MediCare and MediCal programs are so expensive and inefficient. Well, I do know why, at least partially.

Part of the problem is that they are government-run programs, and let's face it, people get government jobs for pensions and security. Perhaps this will make me hugely unpopular with my colleagues of yore, but I really think that if physicians who work for the government actually worked, they won't need so many physicians. The problem is that the physicians are salaried, and when people are salaried, in a secure position, with pensions, they are just not motivated to do work. If those doctors actually got paid for the work they do, I would say, they really only need 1/2 to 2/3 of the staff. Seriously.

For instance, when I worked at my old job, we fought tooth and nail to not see more than one new patient a week. These days, I regularly meet 2-3 patients a day. Yup, your tax dollars, hard at work.

Fortunately, or unfortunately, people are more motivated when given the right incentives.

I think, we should do away with county health services. Instead, there should be a loan forgiveness program for people who work exclusively with MediCare and MediCal patients. There are currently programs like that for serving Native Americans on preservations, or with the military. Why not expand it? I would have gladly worked in such a place if my education loans could be forgiven, even partially!

It would also help tremendously if we do away with existing pension programs. I know, it is not a popular thought, but the truth is, we can't fund them anyway, and to go on pretending is really foolish.

I think people should have options, to go into Social Security or to private programs, such as 401(k)s. For those people who just don't want to think about investing, they can opt to go into Social Security, while taking the biggest risk of "It belongs to the government and let's face it, the government is broke." Or, "Let me take this seriously, that the market can fluctuate, and I need to be responsible."

President Obama made a speech about how social security shouldn't be privatized and that Social Security, as a government program, is much safer and people need that kind of safety. I think he made the speech about 2 weeks ago- I saw it while walking on the treadmill on my cruise trip. I mean, does he really think Social Security is secure?!

I have a patient, who retired as a school teacher and saved responsibly during his career. As he neared retirement, he followed the rules and pulled out his money from stocks and bonds, and bought CDs instead. He did this in 2006, when the market was still going up and up. He locked in rates of 6% on CDs! So he is laughing on the golf course while his closest friends, who are still working as physicians slave away fighting for reimbursements.

I do think people should be made to save, just like money is sucked out from each pay check for social security, we should be able to choose where that money goes but no choice in the fact that money has to be saved somewhere.

Perhaps we can learn from China, where entitlement programs don't exist, and people save at a rate of about 40%. Is it surprising that they hold most of our debt?

Soliliquy #3

I think becoming tough can be very good for all of us.

For starters, to be physically tough will decrease the rates of obesity, hypertension, cancer, diabetes, and lots of other diseases. With decreased morbidity, the health care cost will be less, and well, that is good for everybody.

I understand that obesity can be genetic, and of course we shouldn't punish people for what nature has dealt them. On the other hand, people can be rewarded for making changes! Why not have actuaries figure out how much it does cost to insure an person with a BMI of 40 versus a BMI of 30, and each step in between? I am sure actuaries can tell us that, even with more factors thrown in, such as smoking habits and all. Then, based on the facts, we can get money back for making good choices. I really do think people want to change, they just need the right motivation and help.

I can probably count on my fingers the number of obese patients who are not interested in losing weight, that I have encountered thus far. People are very open to discussing meal plans, exercise routines, emotional eating habits...with me. And most of them do lose weight!

I don't know if talking about helping people lose weight and then rewarding them with better insurance rates makes me ultra conservative or what, but that is good for them! Why not?!

Soliliquy #2

People who live in my house are a bunch of softies.

That is my conclusion after reading two books about WWII recently. The first one I read was The Longest Winter about the Battle of Bulge, and the second one was The Ghost Soldiers. It described the POWs held by the Japanese in the Phillipines for over THREE years. (This book has some hilariously awesome writing, such as "The antiquated diseases came out of the latrines for an encore performance.")

It is amazing how these men survived. The constant hunger- having so little to eat, and over time, even less as their captors also had less to eat. The unknown- will the captors be ruthlessly inhumane, or sympathetic? What will the captors do as they face the inevitable defeat? Will they kill all the POWs or let them be? The fear- has the American military forgotten about the POWs, will they ever come back?

I imagine that the toughness of these young men, most of them were in their 20's, stayed with them. There has to be correlation between the greatness of these soldiers who went on to shape the growth of this country, and the world.

In comparison, how did I spend my 20's? I studied, ate whatever I wanted, and became entitled. It is my right to be happy, darn it! I must have my gadgets so that I am constantly distracted! I need to be entertained! What does that mean for my generation? What will we do? How will we help those who are in need?

It is not a secret that I am not President Obama's biggest fan. (Yes, really.) And I think, part of the reason I am not so impressed is because he really hasn't been through tough times.

I think about the presidents we have had since WWII, and most of them have been through something hard. They have been through the Korean War, Vietnam War, and all the financial bubbles in between. Professionally, they governed states, and really made tough choices: If I choose to fund this program, that will have to go. I do think President Clinton was a good president, and I think he picked up a lot of his skills as a governor.

My generation is now encountering something difficult- has the US actually accomplished anything in Iraq? Will we ever have enough jobs to go around? Will our children actually be educated in the schools? I think we need tough people. We need to become tough ourselves!

I don't actually know how to do that. Suggestions?

Soliliquy #1

It seems to me, that somehow, what happens to us very much depends on what kind of judge a case gets in court.

With the case of Prop 8 here in California and how the voters decided one way, and they took the case to the court and a judge decided another way, it just seems to me that it is all so arbitrary. I am not going to focus on the merits of Prop 8 at all, but the process is alarming.

First of all, I don't understand how California has this proposition system for voters to vote in the law. Not that I am saying I want politicians to make laws either (do remember, that I don't actually have any solutions, I am only writing as the peanut gallery.) So people voted. The people have spoken, for better or for worse. And the case goes to a judge? And that one person decides?

Not too long ago, the people in Utah voted against raising taxes. The case got taken through the court system, and the judges there decided that actually, the State really needs more money, whatever, they are going to raise taxes.

Then this week, the case about stem cells went to see a judge, and that judge decided that new grants shall all be frozen.

What?! It seems to me that issues are being decided whether a 'conservative' or a 'liberal' judge hears the case? Is that really how it is going to be?!

I read The Sister Wife: Brides of Gabriel Book One by Diane Noble while on vacation. It is a story about Mary Rose, who converts to Mormonism, marries the love of her life, becomes a missionary to Illinois, and then is informed of plural marriages. The story explores the ambivalence within her, about how her ideas are in conflict with the teachings by the Prophets, yet she is utterly powerless to leave her marriage or to stop her husband from marrying her very best friend. Instead, she chooses to encourage her husband to take on more wives, because if she can't have her husband's love exclusively, she does not want him to love any other woman, definitely not the second wife, not the third...and imagine, all the rest. To find out for sure though, I am going to have to read Book Two.

The story got me thinking about these judges, we disagree with them, yet they alone make the rules, in the end.

Bummer.

Disclaimer: I am not an attorney, and does not understand the judiciary process at all. I am just a mostly-law-abiding, tax-paying citizen, who is paying the salary of the law makers and the judges.

Back from Vacation

Sorry to have been so wordless here- we just came home from a week cruising the inside passage of Alaska. I didn't want to broadcast to all that our house was going to be void of humans, besides, there was no reliable and inexpensive internet connection on the boat.

Precisely because there would be cell phone reception and internet access, it was very restful. I signed out my case load to a dear colleague, I even wrote out sign out notes to her and EVERYTHING, except I left it on our mail box and because I had asked the post office to not deliver mail for a week, the letter sat here for a whole week. Anyway, poor J, she took quite a few calls. I need to figure out a better way to do this next time.

The best part of the vacation was that after the children were in bed, Hubby and I simply sat, read, hung out and went to bed. The other awesome parts included never cleaning anything, no planning meals, no cooking meals... There was, however, a lot of disciplining of children. It was highly probable, that our expectation of behaviors was entirely unrealistic. I think, in retrospect, it is to be expected, that vacation is really behavior boot camp. Whereas on non-vacation days, we are so busy with tasks that A&Z have no time to misbehave. On vacation, we are with them nearly 24-7 (they did go to the kids' camp for a few hours here and there), and thorns became planks and we simply had to act responsibly. Interestingly, Aidan still gave thanks each nigh in his prayer, "Thank you God, for a great day."

Hubby and I had done the same cruise just as Aidan was gestating in me, and boy! 7 years make a huge difference! The glaciers are definitely melting away, the ports are still very, very small, and I am glad we don't live in Alaska.

I read a few books over the week, and because there were few distractions, I had a lot of thoughts about them. Be forewarned, long soliloquies are coming...