Pink Elephants on the Wall

I was reminiscing this morning about medical school and some of my psychiatric training.

I clearly remember the first day of my psychiatric rotation in medical school. It was my last rotation in my final 4th year. and knew by that time that psychiatry was the field for me. I felt anxious and excited when I walked into the hospital that morning. I met the attending psychiatrist who was assigned to me. Without further ado, we immediately went onto the locked ward to make morning rounds. He said, “Don’t worry. You’ll be fine. You’re training starts now. You’ve learned a lot of theory in the books, but this is where it’ll start for you.” I never had been on a locked psychiatric unit before. I felt apprehensive but not totally frightened. Short of 5 minutes on the unit, we discovered one of his patients sitting in a wheelchair in the middle of the hall. She looked to be in her 70s. Well made up. Hair curled. And pretty. She was energetic and animated given my internal concept of what “old” people were supposed to be like.

The Dr. began to speak with her. She smiled warmly and it appeared that she totally understood him. Then she spontaneously looked over at the right side of her to the wall and stated, “Oh, yes. I totally understand what you mean. Aren’t those pink elephants up there on the wall pretty? I think they are playing. Let’s go over and look at them.”

I began to feel up with tears not knowing exactly what I was feeling. Being an astute man, the Dr. took me into a side staff room and sat down with me. He said, “I can already tell that you are going to be an excellent psychiatrist just by your reaction. But, I need to remind you of something. You’re going to see, hear, feel and experience more things in this field than you ever imagined—more than most people could ever dream or think of during their entire life. So, you can either laugh or cry. One of the two. For your own insanity during your career, you must learn to laugh. Otherwise, you’ll burnout and never last. It’ll take some time to learn to laugh but it will protect you in the long run. (And, yes. Humor is the 2nd best defense mechanisms out of over 30 of them. I don’t think we use it enough with patients with dementia and their caregivers.)

As I ponder this now, I would be highly convinced that she suffered from Lewy Body Dementia (LBD) since seeing non-existing animals and people can be a pleasant experience. This is one of the features that is different than Alzheimer’s disease.

Just think. Few people know about Lewy Body disease now in 2009. Imagine the little information that even neurologists knew back in 1977!

As I type this, I am reminded of how I saw pleasant flying peace doves, my dog, and other playing animals at the bottom of my bed last at the end of 2007 while in the hospital being evaluated for LBD.

So let’s use some humor. I laughed a lot when I tried to answer these questions…………I hope you do too!

Take the test presented here to determine if you’re losing it or not. The spaces below are so you don’t see the answers until you’ve made your answer. OK, relax, clear your mind and begin.

1. What do you put in a toaster?
Answer: “bread.” If you said “toast,” give up now and do something else. Try not to hurt yourself.. If you said, bread, go to Question 2.

2. Say “silk ” five times. Now spell “silk.” What do cows drink?

Answer: Cows drink water. If you said “milk,” don’t attempt the next question. Your brain is over-stressed and may even overheat. Content yourself with reading a more appropriate literature such as Auto World. However, if you said “water”, proceed to question 3.

3. If a red house is made from red bricks and a blue house is made from blue bricks and a pink house is made from pink bricks and a black house is made from black bricks, what is a green house made from?

Answer: Greenhouses are made from glass. If you said “green bricks,” why are you still reading these??? If you said “glass,” go on to Question 4.

4. It’s twenty years ago, and a plane is flying at 20,000 feet over Germany (If you will recall, Germany at the time was politically divided into West Germany and East Germany). Anyway, during the flight, two engines fail. The pilot, realizing that the last remaining engine is also failing, decides on a crash landing procedure. Unfortunately the engine fails before he can do so and the plane fatally crashes smack in the middle of “no man’s land” between East Germany and West Germany . Where would you bury the survivors? East Germany, West Germany, or no man’s land”?

Answer: You don’t bury survivors. If you said ANYTHING else, you’re a dunce and you must stop. If you said, “You don’t bury survivors”, proceed to the next question

5. Without using a calculator – You are driving a bus from London to Milford Haven in Wales . In London, 17 people get on the bus. In Reading, six people get off the bus and nine people get on. In Swindon, two people get off and four get on. In Cardiff, 11 people get off and 16 people get on. In Swansea, three people get off and five people get on. In Carmathen, six people get off and three get on. You then arrive at Milford Haven.What was the name of the bus driver?

Answer: Oh, for crying out loud! Don ‘t you remember your own name? It was YOU driving the bus.

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Depression, Dementia and Aging


 Depression is Not a Normal Part of Aging




Depression can occur in persons already diagnosed with Alzheimer’s disease or other types of dementia. Dementia and depression can cause increased intellectual decline. Depression is a treatable illness. If the depression responds to treatment, the person with dementia will have a better quality of life and will be better able to cope with losses caused by dementia. The diagnosis of depression needs to be made by a medical doctor, advanced practice nurse, or a mental health professional such as a psychiatrist or clinical psychologist.


Using mnemonic devices was the way I got through medical school. The mnemonic which I use to remember the symptoms of depression is SIG E CAP.  Just think of someone by that name. Here’s how it works.



S     sleep changes, sad, suicidal, self-esteem changes, restless

I       loss of interest, ignoring responsibilities, irritable

G      increased guilt (real or imagined)


E      decreased energy, feeling empty



C     crying, concentration changes

A     appetite & appearance changes, aches, anxiety, agitation

P     decreased pleasure, hopeless, helpless


Interestingly, many of the symptoms of depression and dementia are overlapping. Always consider depressive symptoms first. Then dementia. In private practice, I treated a middle-aged female who periodically became depressed. But she would never feel depressed. At the peak of her depression, she appeared to be severely demented and confused. With antidepressant treatment, her dementia-like symptoms totally disappeared. It was almost magical to see the pseudo-dementia disappear. If the dementia-like symptoms don’t disappear with antidepressant treatment, then dementia is more likely the diagnosis. However, an individual can be demented and depressed at the same time. Their dementia can actually improve if one looks for depression and adequately treats it. Many physicians and caregivers are quick to attribute dementia as the culprit.


A new fact I learned today. There is a free service called 411 Service.  Simply dial 800-373-3411 (800-FREE-411). You’ll get free directory assistance from your cell or land line. The catch is, however, that you do have to listen to a short (only 20 seconds) ad before you can ask your question, but really, that’s a small price to pay for a free service.  I haven’t tried it het, but will be curious as to what people think of it. 


And a new vocabulary word today.   Codicil [kod-uh-suh] 


  1. a supplement to a will, containing an addition, explanation, modification, etc., of something in the will.
  2. any supplement; appendix
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