February 2014


Dr. Renato Guzman

Dr. Renato Guzman

On June 23, 1994, this man saved my mom’s life by performing emergency surgery. I got to meet him when my mom was in the hospital two weeks ago for a repeat of the same ailment. He was ready to save her life again, but it turned out that she didn’t need it this time. He didn’t strike me as a person who would enjoy this kind of accolade, but I feel compelled.

At the time of the surgery, I was 22 old and appropriately egocentric. I remember being scared that my mom was in the hospital, had a tube coming out of her nose, and seemed suddenly so helpless. (As far as I know, the only other time she’d been in the hospital was for my delivery.) It did not occur to me to seek out and thank Dr. Guzman. I never felt much gratitude towards him in the years since, either, possibly because of how long and arduous her recovery was.

This time around I was much more involved and met Dr. Guzman several times. This time it became very clear: This man allowed my mom to live twenty more years, and hopefully a lot more, than she otherwise would have. He allowed my mom to see my brothers grow up, meet their wives and children, meet my wife, and take part in all of our lives as fully as she has. He made it possible for my mom to do all the wonderful things she has done, with and for our family and community, for the last twenty years. I am grateful for him, his skill, and all the choices he made that brought him to be a surgeon in Joshua Tree. Thank you, Dr. Guzman!

(Read my mom’s account of her recent hospital stay here.)

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My wife Reanna was ambivalent about owning her first car, largely for reasons of environmental ethics. So when she got one she started reading about “hypermilers,” a group of people developing driving techniques to increase gas mileage in their vehicles.

I’ve been interested, of course–this is right up my alley–but have little time for reading these days. Here is the only hypermiling post I’ve read,which is quite good. Mr. Money Mustache, a financial blogger, monitors his miles per gallon, gallons per hour, and other information like engine temperature in real time while he drives. He uses a bunch of driving techniques, and averages 44 MPG in his Scion (rated at 27 MPG) in city driving. Some highlights from the article:

“‘If you have to brake, you’ve made a mistake’…. [P]retend [your brakes] are hooked up to a speaker on your dashboard which blares out my voice saying ‘MEEEEEEEHHHHHHHHHH!!!’ at you for the duration of your brake application….”

When you decide to drive 75 MPH, sing this song in your head: “I am Mister Fancy, I am in a hurry, my time is so valuable that I am wasting gas. Wasting gas, wasting gas, look out world I’m wasting gas. Tomorrow I will save some gas, but today I’m wasting gas”.

On the use of air conditioning: “Is it dollar-an-hour hot in here today, or not?”

Reanna started tracking her by-the-tank gas mileage right away, using Gas Cubby, so we have a record of the MPG for every tank of gas we’ve put in. Lately I’ve been driving it the most, so I decided on an experiment based on Saul Griffith’s (which I wrote a bit about and linked to here):  I drove a full tank with an self-imposed speed limit of 60 MPH and then a tank at 55 MPH max. There are 65 and 60 MPH speed limits posted for parts of my normal commutes, so these new limits affected a significant amount of my driving–maybe a third? So to be clear, I drove normally for me (which does not include hypermiling techniques, for the most part) unless the posted limit was above my imposed new limit, when I would drive at that speed.

Hack display of 29 tanks in our 2-door Toyota Yaris. The X axis is MPG.

Sorry about the hack display, but I think it gets the point across. Each dot is a tank and bigger dots mean more tanks at that MPG. The tank with a 55 MPH speed limit was the least efficient driving, at 32.5 MPG and the tank with a 60 MPH speed limit was the most efficient, at 40.8 MPG. I really did not expect this. I expected 55 to be more efficient than 60 and I did not expect a limit of 60 to make much of a difference.

Some complications to consider: 1) It is winter right now, and we are not using air conditioning, while many of these tanks supplied energy for significant AC use. And colder engines are less efficient. 2) I was not perfect and exceeded by self-imposed speed limits accidentally, off and on. Also, I drove 10-15 minutes of my 55 MPH tank at posted speed limits of 60 and 65 because I had something time-sensitive to deal with while my mom was in the hospital. 3) Reanna drove the Yaris 25-30% of these tanks, and she is a congenitally slow driver, rarely exceeding 55 MPH.

And a note about the psychology of driving slower than a posted speed limit: I was surprised at how embarrassed and defensive I felt while driving slowly on the highway. It breaks a social norm that I didn’t often notice: Driving slower than a posted speed limit is deviant. You will drive as fast as you are allowed, if not faster. It reminded me of when, because of a back injury while a student at the University of Oregon, I started standing in the back of the class during lectures. I realized that no one stands during lectures or meetings, and it really sticks out when someone does, regardless of how harmful sitting is.

You might argue that the amount of time community mental health therapists spend writing paperwork is unethical, and you would be right in at least two ways: (1) It is an unethical use of tax payer money, paper, and storage space, as much of it is redundant, and (2) it squanders a valuable resource, attention from therapists, on writing, which we are not particularly good or efficient at.

But the worst part for me is that I consider myself a writer of sorts and really care about the quality of my writing, but now spend a large part of my full time week practicing how to write badly. I groan inwardly each time I write something like, “Clinician used psychoeducation about anchoring and adjustment and introduced perspective taking exercises. Client showed understanding of psychoeducation and participated in perspective taking exercises.” And there is no time or economic incentive to make it better.

At least, I tell myself, I did not “utilize” psychoeducation like many of my dear colleagues, but that is small comfort.

It reminds me of why I got out of the small-time freelance record production business. There I was, a songwriter, and the grist for my creative mill was whatever songs someone who could afford my hourly rate brought to me. And those over, and over, and over. Don’t get me wrong–I loved the work and most of what my client’s brought me was good, I just needed to curate what went into my ears more carefully.

The analogy is not perfect, but close. Therapist paperwork writing is not only bad, but emphasizes the least important parts of therapy. A good document of therapy would be more like one of Irvin Yalom’s novels, narrative, interesting, a document of confusion, exploration, courage, inspiration, a document of the development of a mutually beneficial relationship. But this is not what gets you paid. “Clinician challenged cognitive distortions” gets you paid.

And the writing of notes does intrude into therapy occasionally. Occasionally, in session, I have the thought, “How am I going to write this up?” Not a therapeutic thought. Brush it aside, suppress shudder, return attention to client.

One of my supervisors likes to say, “You need to own your charts, you need to love your charts. Your documentation is the only record of what you do.” In an economic and bureaucratic sense, she is exactly right. And I am committed to this career, so I know what I need to do: Fully master the paperwork. Spend as much time as necessary now so that the future me will have perfect case notes, perfect assessments, perfect charts, with no more than the minimal time, stress, and effort spent.  And hope that the bad writing I am practicing makes the minimal impression on my creative brain.