Lunch at St. Kate

On a whim, my friend Jane and I decided to try something new. Instead of our usual trips to Milwaukee Art Museum or Museum of Wisconsin Art, we wanted to check out a new venue. We drove downtown and took Water Street past the Fiserv Forum, MSOE, Viets Field and the many new apartments and condos. Milwaukee is looking really good, I said. The Park East Corridor is no longer a vacant wasteland.

On the corner of Kilbourne and Water Street is the Marcus-owned St. Kate. It’s actually called St. Kate The Art Hotel, named after St. Catherine, the patron saint of artists. It advertises as a hotel by and for artists; in fact, the  interior design of some of its 219 hotel rooms were created by local artists.

We rode the elevator up to the lobby of the Wisconsin Center that consists of entrances to the Milwaukee Repertory Theater, Pabst Theater and the Stackner. That’s the same as its been for years. But we went down the hall, heading for what was once the Wyndham Hotel and instead turned left into a fantasy world.

The hotel lobby resembled a gallery. High ceilings, lots of light, conversation areas and a bar. Art was everywhere. On the walls. Hanging from the ceiling. All beautifully placed that added to the open-air feel of the room. A group was gathering for an “art tour.”

To get to the lobby desk we walked past a classroom-styled alcove, walls covered with a photography exhibit. Actually, we’d ridden in the elevator with the photographer whose work was on display. He’d explained that in the evening he’d be hosting a public discussion of his work.

The theater box office was on the other side of the hallway. Not only do they produce plays but the activity schedule was full of art events in the coming days. Every wall, hallway, stair well, nook and cranny featured a piece of art. There was even art in the elevator. Impeccably chosen and placed.

We went to the second floor to Aria, one of several restaurants in the hotel. This one has the most intricate tile floor I’d ever seen. A lovely room with comfortable chairs and booths. Small rugs placed under tables for a homey touch and curtains could be pulled around a table if privacy was needed. High ceilings, lots of light and again, art was everywhere. I felt like I was in New York City.

We were surprised to see on the menu the Marc’s Big Boy Burger. St. Kate is Marcus- owned and they ran the Big Boy restaurants throughout Wisconsin until the 1950s. A nice touch of nostalgia.

We had a great time and found this new venue to be more than we’d anticipated. We’ll be back for sure. We paid $15.00 for a Big Boy Burger. And it was worth it!

Teaching Behavioral Medicine

At the close of the Naseau Project, the medical director offered me a position teaching behavioral medicine at the family practice residency program located at St. Mary’s Hospital. Eighteen residents were completing a three-year residency in the out-patient clinic and as house staff at St. Mary’s Hospital.

Everything residents do was overseen by faculty physicians who rotate as attendings in the clinic and hospital. I was part of the faculty team along with six such physicians.

Behavioral medicine encompasses all aspects of patient care that doesn’t involve diagnosing and treating disease. I’d often described my job as teaching doctors how to talk to their patients. And more importantly, how to listen to them. Often, I felt like a patient advocate, making sure the resident was communicating in a way the patient understood.

Among the variety of activities that filled my day, I participated in quarterly resident evaluations, attended a weekly faculty meeting, did hospital rounds with residents once a week, did lectures and saw patients for therapy two half days a week.

In addition to the family practice residency, we also had a combination psychiatry/family practice program. It was a five-year residency and a double-boarded family practice and psychiatry doctor was the program’s director. He and I did a monthly lecture on “the difficult patient.” Each resident chose one of their patients, presented the case to the room, followed by a discussion and development of a plan of care.

It soon became apparent residents were choosing the typical non-compliant patient; that’s the patient who missed appointments until their condition was urgent or didn’t follow through with the recommended treatment.

So, the psychiatrist and I began “helping” the resident choose a patient who was more complex medically, psychosocially and psychologically. That ensured this exercise would help them understand what was really going on beyond the non-compliance.

Two half days a week I saw clinic patients for therapy. These cases were referred by residents or faculty. Residents were invited to sit-in on the sessions or to view it from a one-way mirror. Some residents expressed astonishment of what was really going on in their patient’s lives. All this was done with patient permission, of course.

The medical director had arranged clinical supervision for me with the chief resident of the psychiatry program. A win-win for both of us since I got supervision and he got experience in supervising.

I also oversaw a community medicine rotation for residents in their second year. Residents visited various community sites and this was less than successful. I found this out when the director of the addiction program at Milwaukee Psychiatric Hospital called and said residents could no longer come there. Seems they weren’t treating it seriously by coming late, leaving early and generally blowing it off. I made arrangements for them to go to Rogers Hospital and the same thing happened.

I got resident’s attention by refusing to give the entire second year class a completion of the rotation. Instead they were given a small research project then had to meet with me to explain themselves. This is a perfect example of what is really thought of anything that isn’t “real medicine.”

But the most satisfying and time-consuming portion of my time involved videotaping residents while they were seeing patients in clinic. All of the exam rooms had video equipment and I’d videotape the opening and closing of the visit.

We did not tape the physical exam and I assured patients to watch the light on the camera turn from red to green that signaled when we were taping. After a full explanation of the process and how much they were contributing to resident education, most patients agreed. I videotaped a full clinic session for each resident every quarter.

Then, I’d schedule a session with the resident. I’d have looked over the tapes ahead of time and chosen those where there were concerns. We watched the tapes together, then I got their impressions and gave them mine.

I came away from this experience believing empathy skills or sensibilities can’t be taught. They either have it or they don’t. My goal became to simply raise their awareness.

Behavioral medicine is only taught in family practice residency programs; and that tells it all in how important the industrial medical complex thinks it is for doctors to achieve these skills.

I could see reality coming down the road. First Columbia Hospital and St. Mary’s Hospital merged. Each had a residency program. Next, the residencies merged with the Columbia Hospital medical director in charge of the new program. The Columbia residency had a behavioral scientist who’d been there for fifteen years. And he had a PhD, which I didn’t. So, at the end of the academic year my position was eliminated.

 

Soccer Field of Dreams

It begins slowly. One car parks across the street. Then the ritual begins.  First, out comes the cooler. Then the lawn chairs. Often an umbrella. Followed by various and sundry balls, blankets, toys. Then slowly the parking places along one side of the street are filled as each family performs the same routine.

 

Out the window of my residence, I take in the activity across the street at the soccer field. It’s a grassy plain with trees along the edges in this Midwestern urban village that I call my home. The field is cared for by the city and I’ve become accustomed to a man coming early, riding a large and noisy machine to cut the grass and trim the edges of the field. Then a big, noisy truck arrives to maintain the porta-john. The field is set for another day.

Families pick their spots under the trees around the edges and sides of the field. I should say fields since there are four of them and sometimes, they’re all in use at the same time. Each day, I watch to see what will happen.

Weekends are filled with teams that filter in and out throughout the day. Some are kids and some are adults. I notice two tall and slender adults who try to get things organized and gain some control. The children know each other evidenced by the talking, laughing and constant movement. They’re like a cackle of birds in flight.

Other teams look like middle and high school kids. The coaches or referees are adults with loud voices. There’s a lot of cheering and yelling going on. Off to the side I might see a father hitting the ball with his son. Or a small group of children playing and running or sitting quietly on a blanket in the shade.

As the families with children are leaving, the men arrive. This group of men play the most loud and frantic games. They play on weekends and sometimes into the night. I can hear the shouts and cheers above the evening news. It’s nice to see so many families and groups enjoying time together.

One particular Saturday was a cloudy day and teams of adults were playing a game in the far field when the deluge began. Though it was pouring, they kept on. Their shouts were audible and clear. Aren’t they afraid of lightening, I had to wondered.

But one day I noticed something different. This was a Monday and it looked like a soccer camp was being held. The dozens of players were all dressed the same in their green or yellow tee shirts and shorts. Their nervousness was apparent as they clung together in small groups.

But what’s really different was that these were very tiny people. My guess was they were three-year-old’s, exuberant and excited as they lined up. The team leaders appeared to be high school age.

The kids took tentative turns at handling the ball. First, they each kicked the ball toward the goal post. Many shrieks when they were successful. Then they all needed to master the art of moving the ball down the field. Push. Nudge.

Suddenly the group ran off the field in the direction of their parents who were camped out under the trees. The coaches have sent them for a drink of water. They sat with mom for a moment, then returned to their post when the whistle was blown.

I opened the window as wide as I could and spent the entire afternoon watching and listening.  Not a sports person, I must wonder if a child that young can really play such a high energy game. Soccer is intense.

In the six years I’ve lived here, I’ve spent many days watching this marvelous parade of humanity outside my window or just listening as the sounds come in through the open air. As the day winds down and the sun passes behind the bank of trees on the west end of the field, families pack up to go home. There will be another day and another montage of competition and fun. I can’t wait!

 

Working at Child and Family Services

I’d heard a rumor of a job at Child and Family Services of Upper Michigan who ran grant-funded programming.  They had cobbled together a thirty-hour a week job in Gogebic County working in two grant funded programs.

It was good to be back in my home territory where I worked alongside former colleagues. My office was at the Social Services office and that’s where I got my referrals though Child and Family Services was my boss.

Here’s where it gets a little funny. My supervisor was in Houghton-Hancock, 100 miles northwest of Bessemer. Child and Family’s home office was in Marquette, 140 miles northeast of Bessemer. This was before skype or facetime and even e-mails. I was literally on my own. Let’s just say, I learned to be self-sufficient.

I’d spend half my time doing in-home family therapy with clients referred from juvenile court and county child protective services. These were families too chaotic or unorganized to come to a therapist’s office. My job was to meet them in their home and try to prepare them for traditional therapy.

Since my grant was for short-term intervention, I could only be involved with each family for six months. My work seemed to be mostly putting out fires and trying to help them avoid further contact with child protection or juvenile court.

The other half of my time was spent recruiting and supervising volunteer parent aides. Following the WAR (World of Abnormal Rearing) cycle developed by professors at the University of Michigan, the goal was to inject a positive role model into a young parent’s life and break the cycle of future unplanned pregnancy.

The parent aide program had a comprehensive training program that had to be completed before a match was made. Then regular meetings were held to reinforce that learning. I found out soon that this was only the beginning.  I’d spend a considerable amount of time doing phone consultation.

The major challenge was to not squelch their enthusiasm but yet have them be realistic. This was my first experience with para-professionals. I was pleased with how hard they worked to form relationships with their clients and we had some positive results.

Soon after starting, my job was expanded to forty hours a week. A six-year-old was set to return to our county after his admission to a psychiatric hospital downstate, in Traverse City. My agency was asked to recruit and manage a special needs foster home that would ease this child’s way back into his family.

Soon, I’d realize I’d worked at every job this area had to offer, had learned a great deal and knew it was time to move on. I looked forward to my planned move and going to graduate school, ready for the next phase of my career.

Thank you, Mr. Occupant

I have learned silence from the talkative; tolerance from the intolerant and kindness from the unkind. I should not be ungrateful to those teachers.
                                                                                    —-Kahlil Gibran                                           

Mr. Occupant (of the White House)
You’ve taught me so much:

From breaking the record of telling the most lies ever,
I’ve learned the importance of truth.

From your use of bullying, mafia talk and cruel nick names,
I’ve learned the value of an all-inclusive environment.

From incessant twitter mis-spelling, made up words, normalization of ALL CAPS;
I’ve learned the importance of acting presidential.

From your penchant to throw supporters and foes alike under the bus,
I’ve learned the dynamics of building an effective team.

From your insistence to keep digging a hole deeper though that makes things worse,
I’ve learned the wisdom of saving face and moving on when an error has been made.

From your dance of diplomacy in North Korea, China and the middle east,
I’ve learned the complexity of world affairs and the need for strategy.

From your treatment of government work as a business transaction
I’ve learned that government and business can’t be co-mingled.

From your flagrant abuse of power and denigration of the political process
I’ve gained an awe of the Constitution, the separation of powers and rule of law.

Thank you, Mr. Occupant.
Your work is done.

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