30 August 2020

[Above photo:  The perfect swimming pool at the Governor’s Residence.]

There has been a Covid-19 count rapidly growing in Sittwe, the capitol of Rakhine State. A woman visiting in Yangon for three days returned to Sittwe and, puzzled because she couldn’t smell anything, visited an ENT Doc. He became the second case. It went to 5 and within a few days to 70. The State borders are locked, people are to stay inside, and we wait and hope. The genome of the virus is new to Myanmar, not like the 400+ cases that preceded it: much more contagious with rapid community spread. Rumors are that people rode buses to the Ayeyarwady State border, disembarked, got on minibuses with the locals and continued on.  Is it really true that the Military just want to lock up Rakhine State and sort it out again? At least no pedophiles, cannibals, and Satanists.

Because it seems likely to spread, my students convinced me to monitor clinic from home by Zoom. Clinic traffic, like all traffic, is down with the news of the virus, so the students will spell each other on rotation, 3 at a time, in the clinic itself, allowing for better social distancing. On Sunday Thi Thi was heading from her home in Magway to the bus station to return to our class in Yangon when the city was locked down and the trip cancelled.  At least she’s locked in with her family. I do worry, as Yangon is so dense in areas that it seems the virus could spread like a California wildfire.  And it’s not my time yet.

I mentioned over lunch Monday that I was looking for a less expensive apartment, closer to the original old Yangon downtown, with classic British buildings and lots of trees. My current apartment is $1500/month and while I can afford it, it seems silly to toss away so much, especially if I’ll be in the US for 4 months each year. The area where I want to move is much quieter and less crowded.  Su Su knew of a condo owned by a friend–$370 for a two bedroom, with a view of the river, near Botataung Pagoda. I could even take the Water Taxi from Botataung Jetty to the jetty at Lanmadaw Street and walk the few blocks to UM 1 on Thursdays.  I fantasied about it for a couple of days.

Thursday after class four of us drove there. It is in a huge complex of 3 apartment towers; they look like the beehives I saw on the Chinese mainland when Aillen and I took a boat tour around Macau. Su Su had gotten a key for the elevator from the owner, an orthopedic surgeon, when we stopped briefly at Yangon General Hospital on our way. We rode to the 5^th floor. The condo in question is leased until December by a Japanese family. They are stuck in Japan with Covid and they have the only door keys. Across the hall was an open door and a family of seven—-granny, husband and wife, sister of wife, and 3 young children. They allowed me to have a look. It was very small, very generic, with a wretched kitchen, and no view of the river, identical to the one becoming available. It also was sited in an industrial area about 20 blocks east of where I want to be. I could picture getting very depressed in a place like that.

However, it is next to V-Hangout where Kelly and I had a beer a week ago—-V is for Vintage, I learned, not female anatomy, BTW—-so we went for a cool drink on the shaded upper deck and chatted and laughed. The petite, most energetic of our group, Su Myat, was drinking Red Bull. What?!! “I don’t like anything else—coke or juice. I had it during my pregnancy—they all said it will damage the baby. She’s now 5yo and fluent in English, Myanmar and Mandarin.”  It is true. Her daughter left me a message on my phone, instructing me—“Dr George, my mother’s dress is Pink, not Shocking Pink.” Ha. Now Su Myat is determined to find me an apartment. “If you use an agent they will show you the most expensive. I know what you want. Bogalay Zay or Bo Aung Kyaw streets. Old buildings, quiet, lots of trees.” I said I’d give her the broker’s fee—1 month rent—if she found me the one I moved into. Her eyes sparkled as she laughed!

We see a boy in clinic who is so rigidly oppositional I wondered if he was on the Autism Spectrum. At 14yo he states he enjoys nothing but denies having a low mood. He easily gets bored with everything. Currently, he is not seeing his few friends because of the virus, all being homebound. He has been playing “Fortnite” a lot when he should be studying. “I can only study a couple of hours a day or I fall asleep.”  He is so quiet in the therapy hour that it is difficult to get a conversation going. I start a game of wastebasket ball with him using crumpled up paper for basketballs—he gets into it and, finally, smiles and engages. That’s the route, I think. He seems depressed but also, underneath, hurt and angry and rigidly tied up in knots.

There is nothing to mention about the RNC—lies, lies, and more lies. I could watch only a tiny bit.  If Kim Guilfoyle and Junior are the faces of the New GOP, god help them. She really was just bellowing; he was just selling cars. I prefer the lady doctor Mafia Don used as a Covid resource who talked about devil sperm when a woman has sex outside of marriage. She has a lively imagination, at least. Poor Junior, a chip off the old block, he lies so smoothly. Is there a conscience around here somewhere?

A few months ago a contest for best band name was initiated on Beach Island. I used my old standard, Rock Cod and the Fingerlings (as in fingerstyle guitar). But at 4AM today I awoke and had a creative burp. Consumer Warning: one is not PC.  “Ghengis and the Hordes: [Headbangers], “A Diet of Worms” [Reformation Punk], and “‘Dolph and the ‘Stapos” [Camp Songs]. How about “Don and the Lyin’ Trumplets”? [MegaChurch Choir]. Or “Mitch and the Chins” [Something with an accordion]. “The Rotters” [Sappy National Anthems]. “The Peloponesians” with Thucydides on vocals. [Spartan Chants]. “Hippocrates and the Oaths” [Medical Malpractice].  This could go on awhile. “Prufrock and the Ragged Claws” [Hesitant Hip-Hop]

The Main Event for me is that I’ll be 80yo on Tuesday. I’ve been invited away for the weekend by 3 friends. “Pack a bag with your swimming suit and we’ll leave from Kelly’s at one on Saturday.” Hm. I didn’t ask more but said, definitely, no female room service. I’m just not that kind of guy. One of them is a woman and I trust her kindness and good judgment will prevail. It makes me a little nervous but I’m certain we’ll have a memorable weekend. They are all 3 fun and lively and compatible. I would have let the date pass; I liked to count them when I was younger but now I feel it’s one more step towards the edge of this flat disk we inhabit. {Kidding, although there are those who believe that, despite the 3-D photos from space.]

I’ll pause writing now, Friday afternoon, and resume Sunday evening after the Event.

As I was instructed to do, I arrived at Kelly’s at 12:30PM Saturday, overnight bag with swimming trunks packed. Jose soon joined us and we cabbed to the street one short of Yangon Children Hospital where our clinic was last year and turned into an unpretentious entrance. However, after walking into the building we found acres of manicured grounds, a fabulous and immense crescent-shaped swimming pool, peacocks strutting through the outside dining areas, a pair of ornamental and aggressive geese on the croquet pitch, and, finally, ascended stairs to my elegant room of polished teak. It was a 1920’s palace for important ethnic Kayeh visitors, called the Governor’s Residence. Fabulous, 800 thread sheets, pillows as soft as any lover’s breast, on and on.  Irene greeted us there and had purchased an array of wonderful gifts—a lacquer-ware bowl, a self-contained tote bag, flowers, a sweet little water bottle, various munchies, dark chocolate of a variety I rarely afford, wine. We were served champagne in the room as we plotted our assault on this palace: how best to exploit its pleasures without feeling like we were on a mission, driven. Kelly assured me that “Koh Rah”, a gorgeous mystical girl was—in the wardrobe. No? She’ll join us later, for sure. We ate—Truly amazing croissants at breakfast! I am not a snob but I do get that way with croissants.— and swam and talked and drank and played vicious croquet. Vicious croquet is when you are so far behind that your only thought is to pursue and smack the leader to the nether reaches of the pitch. Forget going through the wickets! Irene, on her first croquet outing (It was the Brits, not the Scots, who invented it.), with a tiny assist, beat us all. Kelly and I were fractiously occupied, trying to do each other maximal damage, and Jose was perfecting his long shots.

Lying poolside, I had great talks with Irene and Jose, separately. Each has led such an interesting life. Irene, searching for her spot on this earth, covered a lot of ground, from business (not a fit) to dance to yoga to humanitarian work. Jose’s parents were both physicians in the Philippines and came to Mayo Clinic in the 60’s. His maternal grandfather was wealthy and was the Mayor of Manilla. Jose has degrees up, down and sideways.  I know Kelly better as we bachelors sup together with some frequency.

It was a wonderful weekend, a celebration unanticipated by me. I thought I’d let 80 slide by.  How joyful can I get as I am headed for the last exit in this Brooklyn?  I don’t have the Burmese [what seems to me] advantage of another life to anticipate, even as they are trying to escape the cycle of reincarnation. I’d rather be a dog or a frog than random molecules in the earth—I think.

I have, at last, forgiven my mother.  She was a mixed bag. Not a warm, cosy, steady, interested-in-your-thoughts kind of lady. Ambitious, bright, accomplished, competitive, easily stung, exquisitely reactive. But she was loyal, paid for my college, medical school, and assorted psychotherapy back then. She was a great raconteur and an adventuress, always up for a fun and exciting time. Thank god I got to 80. I’ve discovered and resolved so much in myself in the past 5 years, as well as having a hell of a good time. I feel much better forgiving her for her shortcomings. It’s a step towards forgiving myself for mine which is, of course, the rub for many of us.

23 August 2020

[Above photo:  My view. Two small ferries in the foreground, a small freighter carrying sand in the middle, and the recently-launched fishing fleet, perhaps 30 large boats, to the rear. The view always changes, always engages me.]

[NOTE: When you receive an alert for my post, click on the green emblem and it will bring you to the most recently edited version, complete with photo.]

My students decided we should meet for breakfast on Wednesday.  I went an hour before clinic opened and walked along the damp sidewalk across the busy street from the hospital.  I’d been given directions of sorts and a name, Tin Tin Aye, of the mohinga shop where we’d meet. After asking several people and receiving puzzled looks, one fellow brightened and pointed down the road. My accent isn’t so bad; I think people just aren’t expecting me to speak in Myanmar. I was the first to arrive and sat down on a plastic stool in the little shop, open on two sides and with a very low ceiling. It is part of a “chain” of 3 mohinga shops of the same name scattered about Yangon. Eventually 4 of the 6 students appeared and we removed the see-through plastic barriers set on each table, selected what fried delicacy we wanted in our mohinga, and slurped away as we chatted. It was a good way to start the morning.

This week’s Trump Truism. Upon the release of the Senate Intelligence Committee final report about Russian interference in the 2016 election, Mafia Don said, “This is just a continuation of the most hideous witch hunt in the history of our country.” I agree. He truly is the “most hideous witch.”

We’ve seen an 11yo girl in clinic who presented with psychosis and seizures. Her mother states she was normal, doing well in school and with a good cohort of friends until 6 months ago. She was seen by our pediatric neurologist who obtained an MRI of the head which showed diffuse calcifications in the brain, including the basal ganglia. She was being managed on low dose antipsychotics and antiepileptic medication.  They thought she might have Fahr Syndrome, a genetically-determined disorder with similar symptoms and basal ganglia calcification.

She seemed to be doing quite well until a week ago when she had 3 days of fever and a recurrence of her seizures. Because of the recurrence, I wondered about an underlying autoimmune encephalitis and sent her for a spinal tap to check for antibodies. The doctor who saw her at Yangon General Hospital obtained some blood work, as well, and her calcium was very low, her phosphorus very high, and a subsequent assay for parathyroid hormone was very low. Thus, she has hypoparathyroidism and has been referred to an endocrinologist. The cause may still be autoimmune and lab results for that are pending.

I’d never heard of Fahr Syndrome and have never seen, or heard about, a case of hypoparathyroidism.  Somehow, even with fumbling, we arrived at a correct diagnosis. Her treatment will be Vit D and calcium which can be very helpful for symptoms but also can lead to kidney stones. Newer treatment is available in wealthy countries; parathyroid hormone is now able to be synthesized but it isn’t available here.  Perhaps this is too much Medicine for this blog. But it was so interesting for this psychiatrist, seeing things now that I last thought about in medical school for the Pathology final exam (1963-64).

An 11 yo boy was brought to our clinic by an NGO worker. He has been awakening at night, screaming the equivalent of “Mom, Mom!” He sleeps in bed with his 18yo brother who he loves—the callow older youth doesn’t reciprocate. Our patient witnessed his mother being stabbed to death by her boy-friend 4 months ago. How to help?

He is HIV+ and has taken antiretrovirals without side effects for the past 3 years. His mother previously was a sex worker. He currently lives with his half-sister (same mother), her husband, their 4 children, the husband’s parents, and his brother. That’s ten people crowded into a dilapidated shack in a massive slum in South Dagon. And all that is keeping this leaky boat afloat is a singly betel nut stand operated by the half-sister and her husband. Each day after breakfast, the boy is turned loose to roam the slum all day, not allowed to return to the house until supper time. He did go to school and did quite well prior to Covid; it provided some structure to his day.

The boy was initially shy but quickly warmed to my student and clearly enjoyed himself. He appears of at least normal intelligence and can both read and write basic Myanmar (and Arabic numerals, as well).

Wanting to meet the half-sister and support whatever efforts she could muster on his behalf, we arranged to see her. The NGO worker drove me and my student followed in his car. We met her in a tea shop; it was not “high tea”, as you might guess. The area was a typical slum—it reminded me of the outskirts of the Limbe Market or of Ndirande in Blantyre—with falling-down shacks crushed together, large pools of standing water, and plastic and paper waste littering all. The dengue must be fierce, with all the mosquito-breeding ponds.

She was an attractive woman, well-groomed and simply dressed.  Initially she was wary, as would be expected. However, she met my eyes throughout. I brought her a shopping bag with a large bottle of cooking oil, a sack of rice, a packet of dried shrimp, and a large box of chocolate-covered cookies, for which she was appreciative. She helped us with the context of the child’s life. I wondered aloud about how difficult her mother’s death must be for her. After the mother was stabbed, she was carried to this woman’s house where she died. [I’m not sure why an ambulance wasn’t summoned but it probably was wise as she could die surrounded by her family, at least.] I offered that if she felt unhappy and wanted to talk about it, she was welcome at our clinic. I doubt we’ll see her; a visit to a psychiatrist here is freighted with ideas of madness, as in most countries. It also makes no sense to most people, who don’t recognize the possible benefits. She is 26yo and looked about 50yo. That she chews betel nut contributes to it, since betel stains your gums and teeth a dark red so they appear to be rotting away. But her life had worn her down.

The NGO worker will bring the boy in to see us weekly. I was reminded of Japhet, a 12yo boy in Malawi who’d been attacked by a neighbor with a panga knife (machete), nearly killing him until a bystander intervened. On our third visit, my “treatment” was to have him draw a picture of the attack, after which  he shrieked and ran out of the clinic. He was back the next week, however, and was no longer dissociated. I saw him weekly to chat for 3 months after that. He went on to do well in a local boarding school. After establishing a supportive relationship with the current boy, perhaps we’ll follow that example.

We saw the girl in clinic Wednesday who had regressed and became mute when her mother, upon returning from the Thai border where she was working in her brother’s fruit stall, gave birth. She’s improving slowly but is still mute.  She is clearly very intelligent. We’ve attempted to decrease the secondary gain she gets from her mother and grandfather for her “illness”. She no longer breast feeds her mother or suckles on the nursing cat, happily!

After the family left the clinic, three of the students were sitting together and began to laugh. I asked what was going on. One of them, a very quiet, sweet woman who is the girl’s therapist, said, “I just want to slap her on the back of her head and tell her to snap out of it. Is that countertransference?”  I howled.

I was impressed with the DNC 2020. Decency, inclusion, kindness, science, optimism. And I suspect the platform will move us forward a big step, if it is enabled. Seeing the fires in California and reading the Covid, economic, and White House news makes it all seem like the End of Days.

An international cabal of Satanists, pedophiles, and cannibals, you say?  That has the makings of great costumes and a hilarious musical, like a combination of Guys and Dolls, Lord of the Flies, and The Producers, underpinned with shadenfreude.  Can they top “Springtime for Hitler”?  I am sure some clever librettist is already working on it. Sarah Cooper could star as Mafia Don. I think we need to honor both Kaleigh Mcenany and Sara Huckabee Sanders, as well, giving them each the “Distinguished Dissimulator Award”. “The Joy of Imprisonment” could catalogue those moral stalwarts, “the finest people”, before, during, and after their incarcerations. What, Nero fiddled while Rome burned?  Humor is serious work, I submit.

I’d best stop. This is compelling fun and I have a lot of work to do today.

16 August 2020

[Above photo: Black-backed jackals on the Skeleton Coast of Namibia, one of the most arid areas on the planet.  Some animals there don’t pee, they just expell pellets of urea, etc.]

“Oh, mairzy doats and dozy doats and liddle lambs ydivy, a kidel ydivy too, wouldn’t you?”  “NO!” we’d shout. Repeat. I recall puzzling over the meaning of this as a young child. Even when I understood it as:  “Mares eat oats, and does eat oats, and little lambs eat ivy, A kid will eat ivy, too, wouldn’t you?”  it still made no sense. One of those silly, “novelty” songs, trying to lighten the mood, I suppose, as our young died on the battlefields in Africa, Europe, and Asia and Jews and others in the camps. It was written in 1943 by 3 men (Three grown men wrote that!?).  The Merry Macs were the second group to record it and theirs hit #1 in the US in 1944. It was recorded by many performers over the years, including the Andrews Sisters (whose version I remember).  The “Mule Train” of an earlier era.  I have no idea why this came into my mind this week. It recalls the riddle of the Sphinx: Am I regressing back to childhood, as I approach 80? I am obsessed with not getting old—and guess how far that gets me! I look ancient in the constant photos my students like to take.

While she wasn’t an effective primary campaigner, struggling to settle on a consistent message, and while she was, in hindsight, way too fierce a DA at a time when some of the public wanted that, Kamala Harris is an inspiring person. I think when she is elected and doesn’t have to worry about pleasing her constituents to the same degree, she will feel free to demonstrate her fine character and intelligence more clearly.  The dramatic contrast between her and both Trump and Pence is so compelling. She is a real live person, an animated woman, and isn’t afraid to express her broad range of emotions.  Trump and Pence are so monochromatic, the first a massively dishonest and insecure hater/divider and the second so tightly wound I wouldn’t be surprised if he was exposed as a bot.  A Biden-Harris victory will be like resurfacing after 4 years at the bottom of the sea, amidst the slimy eels and toothy sharks. Hard to breathe down there.

I’ve just finished reading Wallace Stegner’s Crossing to Safety.  It was hard to put down. Like coming upon a muddy, marshy area when you are hiking in the woods. Going to the head of it you lift up a rock and there is the spring source: pure, cold, clear water burbling up. His honesty about the range of human emotions and our capacity to tolerate foibles in those we love was inspiring.  Reading the biographical notes at the end of the Kindle Edition made his voyage upward and his capacity as a truth-teller all the more amazing. Since the action is set in the world of writing and teaching, I thought about Stephen Arkin who just died. The best story-teller I’ve known, I suspect he was an amazing teacher at SF State University, where he led the English Department for many years.

I’ve read, and intentionally not read, David Brooks in the NY Times for some years. I used to be infuriated with his smug conservatism and avoid him altogether. He has evolved, according both to my reading of him and to himself. He wrote the following on 14 August:  “The veneer of civilization is thin and if you simply start breaking things you get nihilism, not progress.”  It’s why the most effective revolutionary leaders are not the best suited to run the shop after they win. Manela excepted. Everyone has a different skill set.

I recall an amazing film I saw as a senior in college. Eric Erikson had asked Margaret Mead to come to lecture one day. She showed a film which demonstrated the fragility of civilization. A hunter-gatherer tribe somewhere in East Africa was removed from their ancestral lands—-oil or minerals to be collected, I imagine—and resettled as an agrarian group on a bit of arid earth. The film showed the inside of a hut, with a starving, skeletal man sitting on the dirt. His wife came into the hut, concealing a root she had found and was nibbling on it clandestinely, trying not to show it to him. The group previously had crafts and rich traditions of working cooperatively that had served them for millenia. Within a few years, it all fell apart. Mothers nursed their babies for 3 years and then the latter had to forage for themselves. Nothing was crafted. No communal will or spirit. It was, suddenly, desperately, everyone for themselves. The collapse of a culture.

It was chilling to view. It also seems consistent with Mafia Don’s view of the world.  He certainly has worked to seed a dystopian society, a projection of his inner world, during his reign. It found fertile soil and has germinated.

If Biden is elected, and there is a good chance it seems, we can look at a bullet dodged. I do worry about what desperate surprises DT has in store. What war to start, what bomb to drop, what dramatic lies to spin. “Biden hates God”. Oh, please. “Harris is part of Pizzagate.” The film about the wonderful guy who owns the named pizza parlor dispels any concern, except for the time the heavily armed man entered, demanding to see the dungeon in the basement. Flour, mozzarella cheese. No defiled children. There is an entire book written about GHW Bush and cronies involved in a satanic-pedophile ring centered in Omaha, Nebraska. It is a familiar meme. We cannot disprove the existence of god or the possible validity of any conspiracy theory. Best to keep our eyes and ears open; if you hear hoofbeats, chances are strong that it is a horse, not a zebra or a kudu…. or a unicorn.  Be sensible.

I can guarantee there are no itsy bitsy spiders in our waterspouts. Down comes the rain, in torrents. I’m about to mount my elliptical for 40 minutes and then head uptown for poker and supper with friends. Are there Grab* boats?

*Grab is the Uber or Lyft service in Myanmar.

9 August 2020

[Above photo: Kelly in a trishaw, heading into busy traffic at night with no lights. ]

I am assembling my talk for the AACAP meeting. Photos will enhance it, give it context. This week I walked to, and circled, the Shwedagon Pagoda. It is currently closed because of Covid but I wanted to get a good photo of it. It is the most prominent and recognizable Buddhist site in the country. Note that Buddhism knows no bounds on numbers of images; certain caves will have thousands of tiny images stuck to the ceilings. There are stupas everywhere in this country, some in the most unlikely places, such as at the top of deserted, [nearly] inaccessible peaks.

The Shwedagon is surrounded by beautifully manicured gardens where families can rest from the bustle of the city. Across the road on the eastern side is a small lake with a park around it. The day I walked was the Full Moon of Waso holiday, the beginning of three months of Buddhist Lent, so the parks were accommodating families. The women here, as in Malawi, always are dressed beautifully; the men are less attentive to this. Children were playing on the grass—this isn’t France where grass is treated like flowers and you don’t play on it.  It was wonderful for me to walk among the greenery and I realize how divorced most city dwellers, myself included currently, are from the soil.  Just as I completed my cirque, and I had been able to snap some nice images, le deluge. I immediately hailed a cab for Junction City, where I bought a few groceries. Seeing the rain continue to flow, I had a cappuccino and brownie at Gloria Jean’s. Thus fortified, I entered the stream and walked home, soaked and pleased.

A 15yo boy was sent to see us from a city 11 hours away by bus. He had written a love letter to a girl in his class and his teacher intercepted it. The teacher then made him read it aloud in front of the class and, after completion, beat him with a stick. This happened 5 months ago; the boy was teased mercilessly by his classmates and he transferred schools. Then Covid struck and schools closed. He continued to feel bad. He is a star student, has had good friends, and likes playing soccer (“football” here). I’m not sure why his parents made this lengthy trip to see us.

The boy refused to come into the clinic, so we went to him. We left the hospital and crossed a busy highway in the rain to enter a dark tea shop where the youth was sitting with his father. A sturdy, handsome fellow with excellent eye contact, his nervousness subsided as Lin Htet and I spoke with him. I volunteered that what the teacher had done was wrong, terribly wrong. That Lin Htet and I had each written love letters when we were his age and that the world would be a better place if more people wrote love letters. He smiled and relaxed. I wondered if he thought that seeing a psychiatrist meant you were cuckoo? Yes. Far from it, although psychiatrists do help people who have lost contact with reality, as well. We understand he wants to be a doctor? [Medical school is the most difficult university to enter in Myanmar so many of the star students apply, even if they end up being politicians, as in Latin America.]  Perhaps he would consider becoming a psychiatrist. Myanmar needs smart, compassionate psychiatrists and we think he’d make an excellent one. Not your usual consultation but I think a fruitful one.

Last night Kelly and I met for a beer. Irene was out of town at a yoga retreat and Jose was alternately cleaning their home and writing a paper due Monday. I selected a bar, V Hangout—you can imagine we bachelors had some fun with the name—-and I walked there from home. It was about two miles from my apartment and in the middle of the port, surrounded by shipping containers stacked 5 high. The approach passed the Botataung Pagoda, which is a golden, glistening miracle in the late afternoon sun following a rain. I often trick myself into thinking that if the sky has been emptying for two hours, when it stops that’s it for the day. So I take my tiny portable umbrella as insurance and 5 minutes from home it resumes in earnest. Even clouds need a little rest at times. Oh, well, it’s warm and kind of like a shower with your clothes on.

V Hangout has a ground-level bar/restaurant area and another nearby that is thirty feet in the air. Both are on the Yangon River bank, next to the V Hotel. The latter is a megayacht, probably 250 feet long, permanently moored and used as a hotel and dining facility. It is pretty spectacular, along the lines of an Aristotle Onassis or Larry Ellison toy. For $70/night you can have a stateroom on the river side; for $50 on the land side.

Anyway, Kelly and I got into the spirit and chatted away, sitting in the elevated portion, while the sun set and the river breeze cooled us. After a couple of beers we set off to meet Jose at Green Gallery, a hole in the wall Thai restaurant with the absolutely best food. Passing a group of trishaws, Kelly said he’d never taken one. I said, “Let’s.” and soon we were in two, being biked down the wrong side of streets, cutting across busy traffic, and hoping that this wasn’t our last ride, since it was also our first. We arrived safely and I must say it is a lot nicer riding in a trishaw, danger aside, than a cab. Smooth, quiet, comfortable, constant fresh air.

Jose was waiting for us at the restaurant and, after chiding him for choosing house cleaning and writing over a beer with us, we feasted on green tomato salad, Pad Thai, a green coconut chicken curry, and a seafood salad. With mango and sticky rice for dessert. You know how in the US they bring you a bowl of sticky rice and a few slices of mango? We each had a large complete mango, beautifully sliced. It was all over the top and made me want to run to the kitchen and embrace the cook, a middle-aged Burmese woman who lived in Thailand for several years. I resisted the impulse. It would have scared her.

The Beirut tragedy could happen to the world on a larger scale.  He is vengeful, impulsive, and determined to be uninformed. He is the Commander-in-Chief, god help us, and controls the most powerful weapons on Earth. And distraction is his central ploy.

I don’t have the heart to rehash the mess that is Mafia Don. Happily, he has pissed off Sheldon Adelson, a strange, greedy 87yo zillionaire and one of The Don’s major donors. Has there ever been an election with this much at stake? With this much tension and apprehension? Not in my lifetime. The most exciting two were JFK and Obama, both with their faults but both smart, decent men. Now we may get a woman of color, we may get a dictator. It will be a long 3 months.

26 July 2020

[Above photo:  A few of us discussing a Zoom therapy session. ]

It was so moving to hear AOC’s considered reply to Rep. Yoho’s raving insults, as she  instructed the Congressional Cromagnons who secretly smiled when they heard he’d called her a “fucking bitch”.  Of course, he denied it; it hardly mattered since he had already called her “disgusting”. And then he’d defended his “passion” as coming from his “love for God” etc. I’m old enough to be her grandfather.  I find her brave and articulate and fair.  She can breathe a fire hot enough to scare the shit out of the Old Boys Clubs.

See this strut: https://twitter.com/i/status/1285692799812341760

Of course, she won’t always be right. Of course, she is human and fallible. But what a smart and right-minded messenger. We have waited so long for her, it is hard not to freight her with unreasonable hopes.

Kelly and I had another memorable meal/chat. On my ½ hour walk to the bar, Father’s Office, a dark, dingy, smokey affair from out of the Burmese past, I saw a trishaw driver—-a trishaw is a three-wheeled bicycle with a sidecar, so perhaps he’s more a trishaw engine—who had affixed a vase in which he had orchids to his handlebars. I almost jumped on except that I needed the exercise. Then, ascending the pedestrian overpass I saw three large umbrellas on the concrete walkway with young couples concealed underneath them, smooching and talking. This is common around Inya Lake, a more romantic scene than above the noisy, gaseous intersection of Maha Bandula and Shwedagon Pagoda roads, but these city dwellers have no other place to be romantic. Each member of a couple lives with their entire extended family in a room or two. At first I felt sad for them but quickly I realized they were as activated and happy as could be.  If for anyone, my twinge should be for myself, matelessly off to dine with my buddy, no hormones activated.

We seem very well-met, Kelly and I. He described spiritual pilgrimages to Palenque, those fabled Mayan ruins in the jungles of Yucatan. I loved travels with my wife in the Yucatan and in northern Guatemala. We talked about the guilty pleasure, truly low-hanging fruit, of being foreigners with needed skills in a developing country. I used to look down on friends for wanting to be “unique” in such an effortless way. Now I think it is great! I do the work here because I love it and it is desperately needed; the “specialness” is just a side benefit, and who am I to reject that? It is always being corrected anyway; I am regularly being jerked back into reality by my awareness of my cultural gaffes. I’m never in danger of believing how extraordinary I may seem to others here. “In the land of the blind……”

We’re thinking about in-country travel, since it is beginning to open up here and there never has been much covid.   I mentioned visiting Kawthaung, at the southern tip of lower Myanmar. It is the primary gateway to the Myeik Archipelago, 804 largely uninhabited islands with great diving and snorkelling. We both also want to go to Putao, the northern-most town in the country, 1200 miles away, tucked into the tail of the Himalayas. He has been to Hakha in northern Chin State; he says it looks like Tibet, all tilted shale and quite barren. On a steep hillside and prone to slides, in 2015 a team of German geologists determined the town, the capital of Chin State, was “too dangerous to live in”, given the likelihood it would all slide away someday soon. And it is very cold, being at 6100 feet.  I suppose we’ll await holiday weekends after the monsoon passes. I’m also eager to trek again, but further than previously, from Hsi Paw into the hills of Shan State with my guide, Omaung.

The Myanmar Mental Health [read “Psychiatric”] Society gave a lovely dinner in appreciation of Dr. Khin Maung Zaw, the Burmese-UK child psychiatrist who is helping with my course, and myself. Requisite speeches. I was concerned I’d be under-dressed, since I decided to wear my beige taikpon (jacket), rather than my black one. I needn’t have worried. None of the men wore one, coming from work in longyis and rumpled shirts. The women, of course, were dressed to the 9’s and all looked magnificent. They always do. Students and graduates of last year’s program were at one table, the old-timers at another. The Sedona Hotel put on an elegant feed.  I always want to bring zip-lock bags to these affairs to take home the left-overs but I am sure they go to the kitchen staff for their families.

KMZ and I were each given large blue bags. In the top of mine was a brown leather purse—“pleather”, I later discovered—and another sack of stuff below. When I got home I looked and found a small bag with a beautiful jade bracelet and a paper bag stuffed with bundles of money, fresh from the bank. Thousands of dollars! Since it was heavy, I had imagined it was pickled quince from Lashio or another ethnic treat.

I know how difficult it is for doctors to earn money here. I think my gift represents gratitude—Prof. Tin Oo’s or MMHS’s, I don’t know—for my efforts. Also, it is perhaps a response to the fact that my request for a salary from the government was turned down. In any case, I am very grateful and have used the money to open a separate account at CB Bank earmarked for Child Psychiatry needs in the future. I tried to open it where I have my first account, at Aya Bank, but was told foreigners could only have one account at a given bank. Also, I tried to put Prof. Tin Oo on as a co-signatory for the CB account but was told that if I did it couldn’t be atm-accessible. Trying to head off what? Corruption? Confusion? Complications?

We’ll continue with our webinars today with one on Assessment. How does one manage a full assessment in a clinic bursting with clients? One of my students has clinic in the morning and appointments for her assessments in the afternoon. You cannot rush a child, nor parents. Yet we need to know as much as we can before determining a management plan. As is said, “Driving faster won’t get you there any sooner if you don’t know where you are going.”

I read a wonderful opinion piece in the NY Times today about re-opening the schools. The ravages of the coronavirus have seemed like a horror film here, scary and heartbreaking but distant. Somehow the Times piece brought home to me the incredible worry and suffering this illness, and its mismanagement, has wrought. How many lives lost, businesses ruined, families shattered? What is the combined weight of the anxiety of the parents, unable to provide stable food and shelter for their children? How many small primary care medical practices will go under? Rural hospitals will close? How many children have been beaten by stressed, decompensated parents? With what will we as a nation be left? I hope, given the stress, that we can think smart and clearly and consensually. And, at last, we can elect thoughtful, inclusive leadership. The path out and upward is obvious; we just must choose it.

19 July 2020

[Above photo: Twilight on the Yangon River.]

Last Sunday I needed some groceries so I set out with my umbrella and day pack under a light-appearing sky. Within one short block and one long block (equal to 4 short blocks), the sky emptied on downtown Yangon in the fiercest downpour of the season. It continued while I trudged to the market, 9 short and another long block away. I shopped for ¾ of an hour and it continued. I had a cappuccino and a brownie at Gloria Jean’s and it continued. Resigned,  I trudged home, getting soaked. Preferring to head south into oncoming traffic, I turned down 19^th Street instead of Sint Oh Tan. Soon I was sloshing through water 8-10 inches deep for a long time. I arrived home damp in body but I hadn’t melted or gotten hypothermic and my groceries were all ok so nothing lost. I could have taxi’d but I actually enjoy the wildness of getting soaked, as I did when I was a kid in Seattle.

On Monday the 9yo boy from the Defense Services Academy Pediatric Hospital who had severe recurrent vomiting returned to our clinic.  His EEG showed temporal lobe epileptiform discharges! A stretch of a diagnosis but it may well be. He’s on carbamazepine and vomiting/seizure-free for 10 days. His older sister has a history of severe headaches; migraine is common in families of children with Cyclic Vomiting Syndrome and anti-migraine medication is effective 60% of the time with those cases. We’ll see if the carbamazepine stops the vomiting; if not, he may have temporal lobe seizures and CVS. I’m sure the pediatricians think we are geniuses (just kidding).

A 15yo girl, the younger twin and the third of 4 sisters, was brought to us today. 3 months ago, on the occasion of her baby sister’s birth, she became mute, was episodically aggressive, slapping her twin sister, and destructive, and acted like a baby. She wanted to suckle her mother, who let her when her breasts were engorged and the newborn was full and sleeping. She also suckled a pregnant cat in the home. She developed an “imaginary playmate” who looks “just like” her. Because of her aggression and the confusing picture, she was admitted overnight to the Yangon Mental Health Hospital but Professor Tin Oo saw her in the morning and diagnosed her as having a Conversion Disorder. I think she has an Adjustment Disorder with striking regression in reaction to the birth of her baby sister. Of note is that her mother left her with her grandmother at 7 months of age and has been working in Bangkok since, not returning home.  She returned to Yangon 6 months ago with a new husband and bread in the oven. For about 3 months our patient was able to be the baby of the family (by 3 minutes) and to have her mother’s attention but, suddenly, it has been jerked away. Meeting with her she is mute, bright, infantile, engaging, and clearly not psychotic. When I ask her how old she is, she holds up 1 finger. “I am a baby”, she silently protests.

We saw a 10yo boy who has been talking a lot about sex for 2 months.  He touched his teacher’s breast once. He lives in a 7 story dwelling with 24 other adopted orphans and 10 single adults, two generations of one family. Each adult has adopted 2 or 3 of the children. There clearly is too much sex too early in his life. Perhaps a lack of adult supervision, perhaps a lack of incest taboo since none of the kids are blood relatives, perhaps he is engaging in “scientific researches” as Freud called the sexual explorations of younger children, or maybe there is a pedophile in the mix. We don’t have Child Protection Services here so we’ll form a positive relationship with him and try to tease out what is happening. If his “uncle” doesn’t bring him back to see us next week, I guess we may have to call the police after contacting him. I talked with the students about the dangers of overreacting or underreacting, the fact of our having to live with uncertainty and lack of definitive knowledge, the disorienting nature of the living arrangements, even for here, and the importance of fostering a supportive relationship with the adult(s) and child involved.

During one of my nighttime awakenings, of which there are usually two, I was pondering the future of our country. In areas where there is massive inequality—I’m thinking of parts of South America, Asia, and Africa, as well as our own country—-we often see social instability, as well as the inevitable suffering. The rulers also tend to become more and more totalitarian to ensure that they can hold on to what they have. The obvious struck me; money/material wealth is like a battery. It is stored energy which can be used to buy work or work’s products, if desired.  Some people have massive lakes with dams including electricity-generating turbines built into the dams.  Other people may have only a single triple A or even one of those tiny batteries that power a wristwatche. It is dangerous to freedom “of the people” that some have so much more power.

It also seems cruel, ridiculous, and stupid for some to have so much more than they’ll ever need while some never have enough to adequately feed their children to avoid stunting. It puts too much power in the hands of too few. In the US, together with Citizens United, the rich can direct the flow of work/energy to maintain the status quo or even widen the gap, as has been happening there for 3 or 4 decades. I don’t need a massive palace or an immense yacht and if someone wants one, I do begrudge them their greed and their contribution to Earth’s destruction. It seems crazy when a medium-size yacht will do and the poor could then feed and educate their children. A smaller house has less surfaces to dust, as well.

There will always be wealth inequality. The only way a democracy can survive is if there is a governor on the system—-anathema to Americans and their Dream— and if those who are more wealthy understand, or at least are forced to respond helpfully to, the plight of the poor. I suddenly don’t get a warm feeling from the word “democracy”, knowing that, like electricity, it can be manipulated to light our way or to torture and kill others. As we’ve learned with Mafia Don, a rich sociopath in the White House can get away with murder—-even multiple murders—while a poor man can be, and often is, killed for stealing a loaf a bread to feed his starving family.  We must address the tears in our federal fabric that allow a crook to repeatedly degrade it to save and enrich himself. And we must help to educate and support his benighted base, many of whom have been kicked to the curb. Also, we should eliminate the Electoral College, get private money out of political campaigns, and lessen the inequality by progressive taxation. It is strange to me that tax attorneys don’t think they are chiselers when they cleverly manipulate the tax code to save their employers from having to pay their fair share. So frail are we, such short memories, such limited compassion.

Kelly and I had supper last night with a couple he knows from the American Club; Kelly is a fiercely competitive and skilled tennis player and often wins the tournaments there. The wife runs one of the major art galleries here. Her husband is an entrepreneur who got his start after college when he played club lacrosse in Australia. They live a colonial life style in a gorgeous mansion on Inya Lake, in a  lush setting and facing the peninsula at the top of the lake where the late dictator, Ne Win, had his palace. They have a large staff to keep the enterprise running and the grounds manicured.  The air was soft on the candle-lit terrace. I felt strange being cared for by “staff”.  It was not an unpleasant evening and there was good conversation but I left feeling how behind the times it all was.  At least for me.

Mafia Don’s magic seems to be fading for most. Instead of a rabbit, his top hat is filled with a grey, slimy substance. I hope Tony Fauci will break character and bite their hand if they attempt to muzzle him. Such a wild debacle! Our death toll is heading toward the numbers of Iraqi civilians killed as a result of our invasion. The US acts like a rabid dog at times, snapping at others, then snapping at its own paws and tail. Just as the depth of the market’s plunge is the time to buy, now is the time for hope.  “Diseases desperate grown are by desperate appliance relieved, or not at all.”

12 July 2020

[Above photo: A hot pot lunch in the UniMed1 cafeteria. Dr. Thi Thi Aye, in yellow, ordered it.]

I’m certain that I am not the first to label DT (addicted and delirious) as “Mafia Don”.   His consistent gangsterism occasions it. Veiled threats, predictable vengeance, us vs. them, and “favors”. That he bought the concrete for his buildings in NYC from Tony Salerno, the head of the Genovese Crime Family, and was cozy with others in that sphere isn’t a surprise, given how many of his “associates” have gone to jail in the past 3 years. There is method to his chaotic, dishonest, and conflicting style: keeping everyone constantly off balance and reactive to him. The only defense is to make sober, accurate, and direct comments occasionally, enunciate good policy plans, and not to be reactive. I think Joe is doing that nicely.

And I must say, Tammy Duckworth certainly looks good to me. She has the smarts, the courage, the mouth, and the credentials, if anyone does. How fabulous for our country to have a real war hero, an honest patriot, someone who in fact puts America first.  His attacks on her patriotism are risible; she lost her legs and soldiers on, he has bone spurs (maybe) and cheats at golf. Mary Trump’s book would ordinarily allow me to feel some empathy, except that he has occasioned such immense damage, destruction, and death. And pardoned Roger Stone, his slimy buddy.

Our new clinic is such fun! This Wednesday at one moment there were two individual psychotherapies being conducted in the front of the auditorium, as well as a third via Zoom. In the back were two child evaluations and a family behavior management session. I am so thrilled with my students. One said, “I haven’t ever, for one minute, regretted taking this course.” The course is taken, for her, with considerable effort as she must return to Dawei (12 hours by bus) every two weeks to run her clinic and is on 24 hour call by telephone all the time when here as she is the only psychiatrist in her district hospital.

Another student approached me during a quiet moment in clinic to say: “There are 5 principles a student must follow with her professor. We learn these in Standard 1 (First grade). Number one: Be obedient. Number 2: Study hard. Number 3: Care for your professor. Um, I don’t recall the other two.” We both dissolved into laughter when she couldn’t remember these other “principles”. I later sent her a WhatsApp: “Number 4, Iron his longis. Number 5, Prepare a different musical welcome for him each day”.  She is very soft-spoken and incredibly competent and intuitive. She grasps psychodynamic principles in a way I could only envy if I were at her stage of training. In addition, she is one of Professor Tin Oo’s proteges and is constantly having to do massive amounts of work to assist him. She finished her Journal Club presentation today at 4AM, for example. “I often don’t get too much sleep.”

Yet another of my fabulous students told us not to bring lunch on Thursday. She had ordered a take-out hot pot to be delivered. We traipsed down to the student cafeteria to find it nearly empty since the medical students have not yet returned to school.  A Myanmar celebrity, Maung Maung Aye, who runs a very popular Myanmar TV game show, “Dreamboat”, saw the coronavirus closing of all the restaurants in March as a business opportunity. He quickly arranged for large hot pots—with central charcoal-filled chimneys—to be manufactured and has a thriving business.

Our hot pot came with plenty of fresh vegetables, fish, chicken, lotus root, shrimp, etc. and two large containers of broth. We got it all going and in 20 minutes we were eating like kings and queens, complimenting it with spicy and savory dipping sauces. The people in the cafeteria looked on in amusement, if not amazement or envy. We laughed and slurped and had a great time. At one point, the student who ordered it, Dr. Thi Thi Aye, said, “ I am always with people in my family who don’t want to take risks. Life is so boring without adventures. My father was always saying, ‘Please, my daughter, don’t do it. It is too complex.’ I would always do it.” She is smart as a whip. She said the other day, “I have really learned something valuable from this training. I have learned how to contain myself, how not to just react.”

I love them all. I pointed out the difference between content and process in our meal. We were preparing and eating lunch from the hot pot, the content.  The process was we were laughing and totally enjoying ourselves. They really fill a deep need for connection for me, although I don’t socialize with them individually.

I had a remarkable stroke of luck. A Burmese psychiatry resident in California saw my blog and contacted me. He left Myanmar for the US after high school, went to college, worked at the NIH, went to medical school and now is doing his psychiatry and child psychiatry training at UC Davis. It’s where I trained 45 years ago.

He is interested in returning to Myanmar after his student loans are repaid. His large family all lives here.  I liked him instantly. He is kind and smart and courageous, qualities we so need in our leaders. We’ll keep in touch. He’s currently working in an early psychosis detection and intervention program, an evidence-based model that is operational, and very effective, in many parts of the world.  I’ve asked him to consider doing a webinar on it for us.

The rising number of infections and deaths in the US is sobering for most but not apparently for the one person who, more than any other, could make a huge difference in the outcome.  The Lincoln Project (George Conway and other disaffected Republicans) videos are short and sharp. The Opposition (Jason Klepper et al) videos are witty and hilarious. Mafia Don’s leaky boat is drifting farther and farther from shore and help does not appear to be on the way.  His buddies are leaving the beach and packing their cars to head home. Helios’ chariot is dipping into the sea. No cement slippers needed for The Don, I think.  And, of course, Ms. Maxwell’s testimony may punch another hole in the side of his skiff. Perhaps his financial records will show why he is so fawning over and conciliatory to Mr. KGB, in addition to the fact that The Don admires his style and envies his power.

5 July 2020

[Above photo: Another amazing temple from 12th century Bagan.]

I’m not sure why it took me so long to notice the similarity. I suppose it’s because I haven’t watched South Park for decades but isn’t DT represented perfectly by Cartman? An ignorant, vengeful, foul-mouthed, impulsive bully, a school failure who enjoys torturing others? My god, he’s ruined another, if minor, pleasure—laughing at Cartman’s antics.

Our new clinic works amazingly well. We are in a large conference room with an open stage and a 30’x40’ open area in the back. The conference seating in between is on numerous immense matching overstuffed leather couches and chairs, obviously from an earlier era, as half of the metal upholstery button caps have fallen off.

It is a pop-up clinic. On Monday and Wednesday at 9AM we unlock the double doors and set up two portable child tables, two portable regular-sized tables and chairs, two cloth-on-metal -frame screens, two large blue foam pads in front of the child tables, a grouping of chairs on the stage for psychotherapy, and our box on wheels. In the latter are charts and charting materials, toys, art supplies, etc. Because the entire conference room has a green felt floor covering (no shoes allowed), the sound-proofing is pretty good.

Today, however, there is a conference in the conference room so we have moved to the cardiology clinic wing of the hospital. We were given only one small room with a table and three chairs so we have imported several other tables and are using the large waiting area to see our patients. Built with economy and ease of maintenance in mind, it is all hard, flat surfaces, maximally reflective of sound. We have our box on wheels and at the moment a psychotherapy session is happening with a 15yo teen in the one private room and two intakes are happening in the waiting area. I was prepared to do a Zoom therapy session with my one patient, sitting in a corner of the waiting area, but it is much too noisy, so I have rescheduled.

Since people’s lives are so precarious, interpersonal boundaries seem very porous, and most people live packed closely together, our clinic environment doesn’t seem to faze anyone. In addition, or perhaps primarily, people who come to us are so desperate for help that they overlook the material deficiencies. We learn and do good work.

We saw a fascinating 9yo boy with episodic vomiting that has put him in the hospital 11 times. He was brought to us from the Defense Academy hospital. He is intellectually disabled and cannot attend school. He was presumptively treated for tuberculosis on the basis of enlarged abdominal periaortic lymph nodes, so common is tb in his area. His mother beats him sometimes. He has become dangerously dehydrated at times, with a serum sodium of 150meq/L. Curiously, he has an apprehension before he begins to vomit, his body stiffens, his toes curl, and his feet dorsiflex tonically, and he has an outburst of aggression each time immediately after the vomiting ceases. While it may be that this is Cyclic Vomiting Syndrome, it also could be a Temporal Lobe Seizure disorder so we are working him up for both. And seeing if we can get the mother to stop beating him.

After clinic on Wednesday, my students drove me to Wake ‘n Bake, a durian shop. By that, I mean to say that is all they sell. Durian puffs, durian pillows, iced durian in coconut milk, and so forth. Year round. There is an adjacent storage room with racks full of durian. You either love it or are disgusted by it. We all love it and the groans of satisfaction from our packed booth would have suggested an orgy to a blind observer. Of course, we had to take off our masks to eat it.  One student called her husband, who was nearby, to join us. The sign—”No firearms. No durian.”—in hotels is pretty ubiquitous. More people globally are killed by falling durian in a year than by sharks, a fact.

I have seen more rats—both dead and alive—this week than ever before. Fresh roadkill, ancient flattened roadkill, and alive and scurrying across the road or the sidewalk immediately in front of me. One consistent fact, they are all huge. No timid little hickory-dickory-dock rodents; they are hefty, dark gray, solid beasts. I wonder if they are out more often in daylight now because they became accustomed to fewer cars and people, given our self-isolation for the past few months.  We need more cats.

We continue to have very few cases of Covid-19 here—about 300 confirmed for the country. Myanmar has been very conservative, strictly limiting international and local air traffic, as well as travel within the country.  Mingaladon International Airport is essentially closed and has been since late March. Many townships don’t allow people from adjacent townships to enter. People still wear masks in public, although more variably in Chinatown than in other areas. I cannot explain the lack of spread.  The hospitals have seen very few cases and there have only been a handful of deaths. With the crowding and poverty, I’d expect to see higher numbers; perhaps they will come soon. I have gradually relaxed my guard, although I still wear a mask in public and wash my hands frequently.  I don’t wear a mask when doing psychotherapy or at lunch with my students, however. Or with close friends at their homes. The latter have been very careful, mostly working from home.

I am enviously imagining my sister, her daughter, and the latter’s son all enjoying the beauty and tranquility of Beach Island for two months.  Next year for me, although who can tell? Maybe there will be a tsunami or a storm of durian. Perhaps the US borders will be closed to travelers from Myanmar. It is all such a strange time.

I have accepted another patient.  It is difficult not to, as it was in Malawi, since there is no one as qualified to see him. He is 15yo and was adopted by a single mother at 4 months of age after his mother and father abandoned him in the hospital. At first he was quite anxious about seeing me; by the end of the hour he was asking if he could come 2x/week! I think we’ll make progress with motivation like that. I’ll not take on any more, although I could clearly have a thriving practice here to support myself. At my age, I don’t think I should take on new, long-term cases.  The situation is somewhat different than in the US. There is an abundance, at least in the Bay Area, of good, younger people to see them.

The California Medical Board sends out a quarterly report. I often glance through to see if any of my acquaintances are in trouble. Usually it is “acts of negligence” and “failure to maintain accurate and adequate medical records”. There are few flagrant sexual violations, surprisingly, given how riven the analytic community has been with them at times. A fair number of “excessive prescribing of narcotics” and “prescribing without prior examination” or “prescribing with intent to divert”. Then there are the curious ones: “driving while intoxicated and performing an act forbidden by law”. Obscene stand-up comedy? Oral sex? Bestiality (which is, curiously, legal in Russia and Angola)? Or this doozy: “No admissions but convicted of three felony counts of obtaining and unlawfully using the personal identifying information of another; and charged with having a condition affecting his ability to practice medicine safely, dishonest acts, prescribing with intent to divert for self-use, and false representation.” How can you not admit to these things when caught red-handed? Or this: “No admissions but convicted of one misdemeanor count of inflicting a corporal injury resulting in a traumatic condition upon a person; one misdemeanor count of using force and violence upon the person of another; and two misdemeanor counts of violating a protective order.”  He sounds more like a Mafia enforcer than a physician. How did he get through medical school? Why did he want to? Why not just go directly to your local capo and enlist, saving the repayment of all those educational loans? I do, always, think of the cascade of problems that lands on their families.

As my friend, Jeff, once said to me, in the wake of 3 members of the Boston Psychoanalytic Institute having had sexual relationships with their patients: “We are so fragile.” Such strong feelings, ghosts from our past, are activated in therapy, it is amazing that it doesn’t happen more. I have certainly had my Id stirred many times in the course of a long career. Happily, I could always step back and be curious about it. In all humility, I’m lucky that the stars weren’t in alignment for such a transgression. We are fragile, men more than women, it seems.

Knowing how exercised, how filled with adrenaline I can quickly become in an argument about our Dear Leader, it was a good and sobering lesson to see an interview yesterday with Bob Woodward from 1 ½ years ago at the occasion of the publication of his book about DT, Fear.  I watch stuff when on my elliptical trainer; it allows me to run much further, distracting me from my fatigue. In the Q & A period at the end, an impassioned woman with a trembling voice implored him to say something about Trump; he quickly said, “I don’t want to respond to that kind of question.” He talked about the need to de-polarize our country and that calm, thoughtful discourse was more likely to succeed at that than strident confrontation.  We must calmly stick with the logical, the critical thinking part of dialogue to avoid polarization. We need to talk with each other and listen to each other based on facts, not scream at each other fueled by feelings. Women pulling pistols in parking lots and women calling police to report attacks by birdwatchers are based on hysteria, which only will go badly. The same with shouts, accompanied by fists, of “White Power” by old men in golf carts. Cars driving into protestors. Police killing black people has a more sinister, if similar, irrationally fearful basis.

DT’s Mt. Rushmore antics are true to form. Fear and division are all he knows, since he seems incapable of the character, discipline, or motivation to study and learn otherwise. He is, like Mike Mulligan and Mary Ann (his steam-shovel) in my favorite book from childhood, digging a nice deep pit with 4 square sides and 4 square corners for himself. Maybe, like Mike, he can set up house there. It may match his capabilities better than Trump Tower or Mar-a-Lago.  They could be re-purposed for low-income housing for the poor, including blacks and immigrants.

28 June 2020

[Above photo: One of my students, Dr. Su Myat Yadanar, on the beach at Dawei, taking a break from her clinic last weekend.]

There is so much good news here. The webinar we did for >500 physicians across Myanmar was such a success that I’ve volunteered myself and my students to do a series of 13 more. We’ll use the same format—a lecture-discussion followed by two detailed case presentations. Not surprisingly, one of the cases presented then, who had a near-miraculous turnaround of very aggressive and disturbing behaviors, reverted to his old ways the day after the presentation. But my intrepid student (see photo above) has continued to work with him and the family and he is doing well again. Success in this work is rarely a straight line, especially with intellectually disabled patients whose un-learning may be as impaired as their learning.

A follow-up on the 11yo boy who is cared for by his elderly grandfather and three elderly, spinster great-aunts. After his brief hospital stay and twice per week visits to clinic, he is sleeping at regular hours and only had a single, brief, daytime aggressive outburst when his great-aunt scolded him for something. The adults have been taking him outside to a park daily. He looks happier. He is mutable, I think; I fear the adults are much less so. The primary great aunt repeats that all she wants is a pill for his aggressive behavior and a pill to make him go to sleep at night. Whew!

Professor Tin Oo sent me an email from Nay Pyi Taw, the capitol, where he had just met with the Union Minister of Health and Sports. The latter agreed to build a child and adolescent psychiatry training center and clinic facility, presumably on the grounds of Yankin Children Hospital where we now hold our clinic. This is thrilling to me. If they will also fund a professorship in Child and Adolescent Psychiatry at University of Medicine 1, which the Rector mentioned to me, I’ll feel I have really gotten something going here.

Our Facebook page, Caring For Our Children, is off to a stumbling start. Never having done this sort of thing on Facebook before—I really don’t know how to navigate it well.—-I should have been much more clear about my idea and plan. One of my students suggested that we start again, with a different title. The student who has been administering it has used it like a regular Facebook page—-a self-advertisement with photos, etc. I want a simple informative newsletter, in Myanmar and English, with weekly entries and, eventually, a Q&A appendage. No photos, no advertisements for ourselves or our services. We’ll start again, after thinking it out together more carefully.

The pharma marketing CEO did follow-up with a lunch invitation. I asked that all my students could be included, which he seemed happy about. We had the best Thai meal yesterday, with lots of laughter. I was so full I came home and promptly fell asleep on the couch for 2+ hours. The soft-shell crab and the sautéed razor clams were outstanding, as was the chicken curry in coconut milk and the baked fish with ginger and lemon grass. Dish after dish. The CEO, whose name I don’t even know, was a friendly Indian from a small village outside of Lucknow. A handsome devil, he’s surrounded himself with a couple of lovely women assistants. The piece de resistance of the meal was frozen durian in coconut cream. Heaven!

My left shoulder was a bit painful in early April when I  lifted weights, small 5# dumbbells. My routine was 50 repeats of 9 different exercises, added to 45 minutes on the elliptical trainer. I stopped doing the exercises which caused pain and, finally, all exercise of my upper body but the pain has increased. For the past 3 weeks I cannot sleep well, every position hurts my shoulder. I often must nap in the afternoon, as a result. I cannot take non-steroidal anti-inflammatory medication, since I whacked my kidneys with chemotherapy 10 years ago and NSAIDs don’t agree with them. I’ll see a doc next week but it is definitely irritating, physically and emotionally. I had a frozen right shoulder some years ago as a result of doing competitive yoga (I, of course, was the only one in the class competing!). That was a terrifying experience. I couldn’t move my upper arm at all, could hardly sleep, etc. Two steroid injections later and I was fine and it hasn’t returned. It felt like a paralysis or an amputation, however; I couldn’t button my own shirts, let alone put them on or remove them. This shall pass, I am sure, but probably needs a little medical care.

It is awful to see the testing numbers rising in the US again, even as I feel a certain shadenfreude—“You deserve it, dummies.”—that it is hitting Texas and Florida especially hard, given their governors’ arrogant, dismissive stances. As if we can get the economy going without careful attention to the virus. But my niece lives in Austin and is at risk if she were to contract the disease, which helps me contain my splenic joy.

Why is scientific opinion so reviled by so many? Is it that, no matter how hard I wish for something to be otherwise, science always is right?  Is it that those guys who stayed in school and got advanced degrees actually do know more than me about some important things that affect me? Scientific opinion generally emanates from universities and government agencies with a mantle of authority, which infuriates people, like DT, who want their opinion to best all others. It’s a kind of group narcissism. “The world works the way I feel it does.”, critical thinking be damned. Many preachers, people with a direct phone line to God, feel it is their imperative to tell their flocks how the world is. Science, including evolution, can interfere with their power.  Often their power derives, in part at least, from opposing a rational viewpoint, which resonates with their flocks. I note that I am talking about his base.

It is chastening to reflect on how tidied-up my sense of history is. In 1862 The Great Emancipator, stated, “If I could save the union without freeing any slaves I would do it; and if I could save it by freeing all the slaves I would do it; and if I could save it by freeing some and leaving others alone I would also do that.” Sigh.  I had no idea. Just as was Freud, we are (mostly) all creatures of our time and place, imperfect.