Saturday, September 29, 2007

aboard the Koo Koo train...

For the past couple of weeks, a representative from our main European office has been visiting at work, and this weekend, our department head is flying to Europe, all as part of an ongoing effort to make our day to day operations more global in nature. (Yeah, it sounds like so much hooey to me, too, but I’m wording it like that because I’ve been steeped in corporate jargon at the endless series of mandatory meetings that I’ve attended on this very topic in the past couple of weeks).

So yesterday there was a farewell department lunch at a Mexican restaurant, sometime after which, back at the office (“back on campus” in corporate jargon), we were ordered to assemble for a group photo. Shortly before the appointed time, I ambled downstairs with two colleagues, M and S, only to discover The Liar busily walking about with a tripod and an expensive SLR digital camera, because, Master Photographer that she is (this in addition to all her other achievements), she had volunteered to take the pic, which she didn’t actually do...but more on that in a minute.

While we were waiting, S commented wryly (and quietly) to M and me that she was missing her badge and hoped she hadn’t lost it. The Liar overheard this comment and immediately interjected herself into our conversation. “$35 to replace it!” she announced, briskly and loudly, as if we’d asked, “AND they’re going to fix it so we can’t use each other’s badges anymore”. The three of us looked at The Liar, which of course is what she wanted. “$35 to replace a lost badge? Are you kidding?” M asked. “No, no, I’m not kidding! $35!” The Liar said happily, enjoying the schadenfreude aspect of the moment even though I’d be willing to bet she doesn’t know the term. “AND they’re going to fix it so we can’t use each other’s badges anymore,” she repeated, like a parrot, in case we hadn’t heard her the first time.
The Liar inhabits a dramatic and strange universe that is apparently parallel to the one inhabited by the rest of us, in which things like fines, retribution and punishment loom large and appear frequently.

I rolled my eyes but took the bait: “So how would anyone know whether I’m using my badge or someone else’s?” I asked The Liar. “I mean, what are they going to do, scan our eyeballs? Or maybe take a thumbprint?” “Oh, for Pete’s sake!” M exclaimed, seeing where this was going. “That doesn’t make any sense. If they scanned a thumprint, for a machine to tell whether it’s mine or not, they’d have to have my prints on file, and no one has my prints on file!” The Liar began to beam, warming to her topic. “The government has MY prints on file,” she said, “and I bet they have Judi’s prints on file too, because I know Judi is a bad, bad girl...”

I smiled benignly at The Liar. “In fact, my prints are on file,” I said, “because as you know, I spent 5 years of my misspent youth working for the Feds...”

The Liar moved close to M. I used to think she had no sense of interpersonal space, but in fact this is not so. The Liar knows exactly what she is doing, and she enjoys doing it. “Wanna know why MY prints are on file?” she asked M, in her hoarsest, breathiest, most conspiratorial voice. “It’s because,” she continued without waiting for M to assent, “like Judi, I worked for the Feds, too. For several years, I was a photographer for the Feds...they sent me everywhere. I had Top Secret, wait, I take that back, I had TOP TOP Secret Clearance...” and with that she was off on another of her confabulations. S had slipped away to look for her badge, and I walked away in disgust, leaving M to deal with The Liar by herself.

In addition to being a Master Photographer with Top Top Secret Clearance for The Feds, The Liar is, by her own account: a certified clinical research study coordinator; a certified clinical research monitor; an accomplished jazz saxophonist who is regularly invited to jam with professional musicians; an ordained minister; a licensed helicopter name a few of the things for which she regularly takes credit...and then there are the things she could have been but chose not to pursue: professional stand up comic (this in spite of the fact that she’s not remotely funny); a Van Cliburn finalist (dunno whether she actually even plays piano...and in spite of dropping this tidbit at every opportunity, she’s never expressed an interest in, nor any knowledge of, classical music in my presence); a clinical psychologist (she’s told me she’s completed all of the necessary coursework on a PhD at an unnamed institution, but decided not to finish when a client committed suicide)...I could go on and on, but you get the idea.

The Liar also happens to be gay, and although she claims to be in a long-term, committed relationship, she never misses an opportunity to hit on K while at work. K, a friend with whom I previously worked in child and adult psychiatry, straight, married, and 25 years younger than The Liar, has made it abundantly clear to The Liar that she does not welcome her advances. Nevertheless, The Liar, apparently believing herself to be, in addition to everything else, irresistible, continues to hit on K with amazing regularity and a complete lack of discretion. To paraphrase Leonard Cohen, her lust is a secret all over the block...

Yesterday, after leaving M to deal with The Liar on her own, I spotted K, and walked over to join her in walking to the appointed place for the photograph. “What’s the story today?” K asked, looking at The Liar, who was still talking animatedly to M, clearly a reluctant audience. “She’s telling her all about how she had top top secret clearance working as a professional photographer for the Feds,” I said. K snorted. “There is something SERIOUSLY wrong with her,” she said. I nodded my head in agreement.

When we were assembled outside on the steps for the group photograph, The Liar produced a minion, someone who doesn’t work in our department, to take the actual pic. I would have thought, being a Master Photographer and all and having set up the shot with the camera on a tripod, The Liar would have simply used the timer or a remote to snap a series of pics. But what do I know? No, instead, after spending some time looking through the lens and making much of her ability to focus, like that was some amazing talent, etc., etc., she turned the camera over to her “assistant” and ran to join us on the steps. A total of 3 pics were taken with The Liar in the photograph with the rest of us, then she dismissed her minion, removed the camera from the tripod, and proceeded to snap some more shots of the group.

At least, that’s what she said she was doing.
I looked over at K. Smiling into the lens, she said quietly through gritted teeth, “This damn well better not be a series of close ups of my face!” while two coworkers, aware of The Liar's passion for K, chanted softly, “K’s gonna end up on the ‘net tonight” ...

Oh yeah. Another day at the office...or, as K so aptly put it...aaaaaaaaallllllllllllll aaaaaaaabbbbbbbbbooooooarrrdddddddddd the Koo Koo train...

Monday, September 24, 2007

Brunch with my Posse, or I Get By With A Little Help From My Friends...

Main Entry: pos·se
Pronunciation: 'pä-sE
Function: noun
Etymology: Medieval Latin posse comitatus, literally, power or authority of the county
1 : a large group often with a common interest
2 : a body of persons summoned by a sheriff to assist in preserving the public peace usually in an emergency
3 : a group of people temporarily organized to make a search (as for a lost child)

I haven't been blogging much lately. I've been reading (more about that in another post), working on my house, and trying to figure out whether I want to keep doing what I'm doing, which pays well but is boring me silly, plus there's that formidable commute. In the meantime, on Saturday morning I had a happy respite from all this mulling: I met with my posse for brunch. These are friends with whom I share laughter and tears, successes and failures, dreams and regrets...knowing I won't be judged. (And I know that I'm lucky, because I have a couple of additional friends who don't live in Texas, with whom I also share those things...)

Anyway, here we are, from left to right: Chandini, Sherri, moi, Maryse, and Melissa. The five of us worked together a couple of light years ago in an outpatient pediatric psychiatry program at Children's Medical Center in Dallas. There, we became fast friends, and though all of us have left that program, thanks to modern technology we stay in touch, and last Saturday morning, for the first time in two years, we got together again, to play catch up in person. As you can see by the photo, we are a diverse group, ranging in age from 28 (Chandini and Melissa) to 58 (which I became on September 11). Chandini and Maryse are married; Melissa is engaged; Sherri is single; I'm divorced. Chandini and Melissa were just out of college when they started working at Children's; since then, both have completed Master's degrees, and Chandini now administers grants for a large foundation in Dallas, while Melissa is completing her last year of medical school before beginning a residency in child psychiatry. Sherri worked briefly as pharmaceutical rep before starting her own business; she now has 9 employees and twice a year takes fabulous adventure vacations that leave all of us envious (think white water rafting on the Nile) - oh, and her hair is in braids because she ran a 10K before meeting us for brunch. Maryse, a clinical psychologist, has just returned from two years living in Paris. Chandini is pregnant with twins; Maryse is currently a stay-at-home mom of two preschoolers; my 4 are grown and one has a child of her own...and Joni Mitchell's song, The Circle Game, comes to mind...

And the seasons they go round and round
The painted ponies go up and down
We're captive on the carousel of time
We can't return, we can only look behind
From where we came
And go round and round and round
In the circle game

Friday, September 14, 2007

Master Bedroom, redux...

Of course, I needed adequate supervision to complete this project, and Leo, one of my two ladder-climbing cats, was more than happy to oblige....

I love the brown, don't you?

Friday, September 07, 2007

CDC: Suicide rate among U.S. girls soars

I find this incredibly depressing. The thing is, antidepressants WORK, and they work on kids as well as on adults.

A few facts about suicide that I lifted from the Dallas Suicide & Crisis Center (where I volunteered for 3 years):
• Here in America, the overall suicide rate is higher than the overall homicide rate. Hard to believe but true: Suicide is the eleventh leading cause of death; homicide the fourteenth.
• Suicide among young people has nearly tripled since the 1950's. Today it is the third leading
cause of death among teens; accidents are #1 and homicide (for teens) #2.
Most suicidal people communicate their intent to kill themselves before they attempt to do
so. (Keep this in mind; it's pertinent to my rant).

Prior to the 1950's, if you got depressed, there wasn’t much that could be done for you. People suffered and “toughed it out”, or they were institutionalized, or they committed suicide. Then, in the early 1950's, Monoamine oxidase inhibitors or MAO inhibitors were discovered and prescribed to fight depression. MAOI's are powerful drugs, but not without problems. Many patients using these drugs experience weight gain, a feeling of being drugged, headaches and, if the person taking them eats certain foods or drinks wine, it's possible to have a stroke. Another class of early antidepressants is tricyclics, named for their atomic structure. These also have lots of side effects, for example, they can cause dry mouth, blurred vision, constipation, confusion, drowsiness, irregular heart beat and...they’re quite lethal if taken in larger quantities than intended. Clearly, it was best to not get depressed in the first place when these were the only drugs available...

Then in 1987, the Eli Lilly Company released a new drug called Prozac, an SSRI (selective seratonin reuptake inhibitor) antidepressant. SSRI’s help the brain to do what it should be doing on its own, and have been compared to insulin for diabetics. The release of Prozac was quickly followed by the release of a variety of other SSRI antidepressants by many other drug companies. Doctors loved SSRI’s and readily prescribed them, not only because they tended to work well, but because they had the added benefit of being incredibly safe compared to MAO inhibitors and tricyclic antidepressants.

By 1990, lots of SSRI’s were being widely prescribed, and not just by psychiatrists, and not just for adults. With almost no danger of overdose, general practitioners were writing a huge volume of prescriptions for SSRI’s, many of those prescriptions “off-label”, meaning, doctors were prescribing drugs for something or someone other than the FDA indication for that drug, including for a lot of depressed adolescents.

Then the research began. Yep, it’s backward, I know, but it’s pretty much always like that. After widespread, off-label use, studies are designed to test the safety and efficacy of drugs in new populations or for treatment of additional conditions. So beginning in the mid-1990's, a lot of studies were designed and run all over America to test the safety and efficacy of SSRI antidepressants used to treat depression in children and adolescents. And eventually, some of that research revealed that kids on antidepressants admitted to thinking about suicide more than kids not taking antidepressants admitted to thinking about suicide.

I remember exactly when these results were released, because at the time, I was working as a clinician in child psychiatry at a site where a great deal of research had been done on using SSRI antidepressants to treat child and adolescent depression. In fact, some of the research done at our site was key to the FDA’s granting of an indication for Prozac to be prescribed for depression in children.

All of us who worked with depressed kids had seen drugs make a difference, and it wasn’t just us. According to the Centers for Disease Control, in the 13-year period from 1990 to 2003, the suicide rate among 10 to 24 year olds fell by 28.5 percent. I didn’t know that statistic at the time the statement was released, but I knew what I knew, and I found the statement about suicidal thoughts misleading and dangerous.

Read it again and think about it. It’s ambiguous. The research didn’t show whether kids taking antidepressants actually think about suicide more than other kids, it only showed that they admit to thinking about suicide more than other kids. And I can say with some authority, as a parent, as a former clinician in child psychiatry who saw hundreds of kids with serious psychiatric disorders, and as a volunteer for 3 years on a suicide crisis line, no one ever wants to hear that anyone he or she cares about is thinking about suicide, and especially not if the person thinking about suicide is your child.

The FDA was apparently as spooked by the finding as any parent would be. In 2003, the FDA issued a warning that the use of antidepressant drugs could increase the chances of suicidal thoughts or actions in children and teenagers, and in October 2004, a “black box” statement to that effect was added to most antidepressants. Not surprisingly, there was a decrease of 22% in the number of antidepressant prescriptions written for children aged 0 to 19 in both the US and the Netherlands following the FDA warning statement.

So what happened next? Well, maybe fewer kids were admitting to having suicidal thoughts, but more kids were acting on those thoughts than had happened in a long time. The youth suicide rate in the U.S. rose 14% between 2003 and 2004; in the Netherlands it rose 49%. As if that weren’t depressing enough, the suicide rate for U.S. girls ages 10-14 increased by 76% in that same time period(!!!), with 94 suicides in that age group in 2004, compared to 56 in 2003.

Here’s the thing...and I admit this is sort of’s better, always, if a person who is thinking about suicide can bring him or herself to talk with someone about those thoughts. Because if they can tell you they’re having those thoughts, you have the opportunity to intervene, to get them some help. In child psychiatry and on the crisis line, we always asked about suicide. With kids, barring evidence to the contrary, I’d usually start off a little oblique: "Do you ever feel so bad that you think about hurting yourself? Would you dare to tell me if you did have thoughts like that?" However, if a kid had made an attempt of any sort, or even a threat to attempt, I never danced around with those kids. I'd confront: “You told your Mom that you’d like to kill yourself. How would you do it?” Kids without a plan were handled differently from kids with a plan, but all of them were taken seriously, and assessed at length as to how best to keep them safe from harming themselves.

So yeah, there’s a lot of talking about suicide when dealing with depression, whether you’re talking with kids or with adults. People have this idea: you’ll plant the idea in their head. Not so. People who are depressed, whether young or old, come round to the idea of ending the pain on their own. There is no “What a great idea” moment when someone finally has the cajones to ask them if they’re thinking about suicide.

So if you're worried about someone...anyone...harming themselves...ASK. It can't hurt and it might help. There's more information about suicide HERE

Sunday, September 02, 2007

this 'n that...

I'm painting my bedroom, a nice rich sort of ginger brown, a variation on the theme of the rest of the downstairs in my house. I like earthtones; I do best with drab colors, as strange as that may sound...nevermind, I'll post pics when I've finished. In the meantime...

I went to a great party this evening; friends had a party to celebrate their empty nest, and that was fun; I had a good time. On the homefront...I'm reading Faulkner, a first for me, and I'm really loving him, the king of long run-on sentences that he is. I'm reading Absalom, Absalom...and it's wonderful.

What else? Xander is here this weekend, and I'd forgotten how wonderful 5 can be. And I've been in regular contact with Mike, at UA, who is a reminder of how terrific 22 can be. More later...