Sunday, July 29, 2007
Allow me to expound in my usual circumferential, verbose, allegorical manner.
Once upon a time, in the long, long ago, there was an OB/GYN intern at a program in the Middle of Effing Nowhere. Now, of course, this intern is not me, and this program is not the one I started out at, this is entirely a yarn spun for comparison (an allegory, if you will, used to fulfil the "allegorical" mannerism of which I just spoke), because to allege that this were true in such a public and finite forum would be to take on more liability than I would want just right now. So, anyhow, in the long, long ago, this intern, two weeks or so into her residency, on her third call, with the ink not even dry yet on her medical degree, is left alone, by herself, all to her lonesome, on the labor and delivery floor, with four laboring patients. Three of these are high risk and complex. One of them is a nice, normal woman having a nice, normal pregnancy that has suddenly (as in, within the time that she walked on to the floor) become very emotionally complicated. And the intern has been left alone why? Because there is a crisis somewhere? A mass casualty incident, perhaps? No. Because someone marginally famous brought his wife into the ER with a very rare gynecologic emergency (you know, the kind that perhaps an intern should be exposed to), and her attending, who, incidentally, does not practice gynecology, but solely obstetrics, has left to go gawk at the young wife of the marginally famous person with the fascinating emergency.
Well, as you might have guessed, chaos ensues. Fortunately, the fictional patient for whom chaos has ensued was the medically healthy woman with the emotional complications, and the fictional intern just happened to have followed her instincts and hovered around that patient to, among other things, take the excuse to tend to her psychological well-being (which should have been her first clue, were the intern at all real, that she was in fact in the WRONG SPECIALTY), so that when chaos did in fact ensue, the intern was there to handle things. She did the very best job she could with the knowledge she had. No one was hurt. The family was grateful. Her attending, however, ripped her several new assholes in front of the entire staff, and as time went on, black-balled her for the rest of her time at the program. And in retrospect, she would look back and decide that this very night set off a chain of events that, coupled with the fact that this intern really did not fit in with this group of people and the program was dysfunctional and disastrous anyway, led this intern into ten of the worst, most abusive months of her life. Which actually says quite a lot, if you know anything about this intern's life.
You know, if she were real.
Now. Back to present-day reality. So, Friday, I had short call, right? Which means that one of my elder residents shows up at 8pm to relieve me. In practice, they often show up around 5 or 5:30, because the earlier they clock in, the earlier they start earning the $45-60/hour one can make as a moonlighting physician (beats the hell out of the $9/hour one makes as an intern, let me tell you). Yee-haw. So I had all sorts of plans for Friday evening. Well, pick up dog food and dinner and watch CSI and do laundry, but well, they were my plans, and besides, Petsmart's only open until 9.
But, alas, as is reasonably typical for my life, things started out weird Friday and just turned left. I got called for an admission at 2:30; I'm not supposed to get called until 5, I think. I then got slammed with a few subsequent admissions, to the detriment of the assessment I was supposed to be doing up on my own patient upstairs. Eh, my attending did it. He paged me later and said, don't worry, I did that, and I discharged some other patient, and I transferred the guy who needed to go to long-term. And I apologized profusely. And he said, really, don't worry about it, I know you're swamped down there, and I could take care of it. Enjoy your weekend, page me if you need me.
My initial admission, as an aside, turned out to be a deaf person who was hearing voices. If you've been deaf from birth, how do you know you're hearing voices? I didn't ask the patient that in the interview, but I almost asked the sign language interpreter.
I later discovered that the reason I got so swamped down there was that the attending who was supposed to be doing admissions was nowhere to be found. And the staff - who, really, is just fabulous - finally did track her down, and she'd forgotten she had to work. Which is funny enough, but wait, it gets funnier. And not because she then got stuck in traffic. Okay. She finally gets there, things calm down, it's 7:30, I'm tying up some loose ends, all happy and ready to go home...and then it's 8...and then, it's 8:10...and then it's 8:15...and I'm still there. And this is weird, because you remember the $60/h? Hmm. But, my attending did get stuck in traffic, so maybe my moonlighter did too...but I finally broke down at 8:25 and called my chief resident, and said, "what do I do?" And she asks (over the din of the party she was at) who was supposed to be on, and I told her, and there was a pause, and she finally says,
"Are you absolutely certain? Because she's standing right next to me."
The moonlighter, also, had forgotten she was working Friday night.
See? I told you that would become even funnier.
But it got worked out, and she was there by ten, and it was just fine. And I got home, and Maggie got another dinner of dog treats, and I called my folks, and my dad pointed out that being left alone on a very early call when I wasn't supposed to be has now become a trend (because it only takes two points to make a line, after all). And I hung up, and I kept thinking, but what a huge difference. I mean, a, here, it wasn't all that big a deal, because there comes a point in the evening where we're supposed to be the only physician in the hospital (at the state mental hospital, obviously, not the big university hospital). Like, at 10 pm on weeknights, the Medicine doc on call and I are the only two people in the entire hospital with MDs after their names, and that person is a psych intern, unless it isn't, in which case it's a moonlighter or a PA.
But b, I couldn't quite grasp - especially since it wasn't all that big a deal - how grateful everyone was that I'd just jumped in and started admitting people (although, in my head, what the heck else was there to do?), how glad they were that I had, well, done the best job I could with the knowledge that I had. And I know it's because that's at this point not the response I'm conditioned to expect. But, still. It strikes me as one more example of how bloody different things are here than in The Time Before. Which is not to say that things are perfect; no way. But every place has its problems and idiosyncrasies. But problematic and idiosyncratic are a far cry from destructive and abusive. Still...it takes a little getting used to, when you're used to something else, you know?
One of the questions we ask as part of the standard intake, to test your abstract thinking, is "What's the same about apples and oranges?" If you're psychotic and concrete, you say, they're both round. If you're abstract, you say, they're both fruit, they grow on trees, whatever. If your thinking is bizarre, you say, "Ohio". If you're paranoid, you say, the government is poisoning both of them. Whatever, you get the picture. Anyway, I've been thinking about that question a lot this weekend in analogy to my residency experience (along with the one that follows it on the questionnaire, "If I said to you, 'it's no use crying over spilled milk', what would that mean?"). But I'm starting to feel like comparing the two is a little like comparing apples to lug nuts.
We actually had a resident leave the program this week. Which, at this point, I think says more about said resident (not in a bad way, just about what they need for themselves and their life at this juncture) than the program, but it does make me sad, because I considered the one that left a friend. And I'm sure we'll fill the post without too much trouble. It does mean my schedule is going to get rearranged, but the upside of that is that I'm staying on the Men's Acute unit for another month, and this makes me happy. Partly because I'm grateful for the stability, but mostly because I just really like the people I'm with, the work that I'm doing, and where I am. It's a good time.
Okay. I'll try to post a little more often - and consequently with a little less verbosity! - this week....honest...
Monday, July 23, 2007
But before I explain the subject line, yet another CSI quote, that just happened to be from the episode I'm watching as I type this:
Someone asked the Buddha, how do we escape the heat of a summer's day? And the Buddha said, why not leap into a blazing furnace?
- From, Felonious Monk. And, I happen to know that's an actual Buddhist proverb.
So. Today. Day Two on the medical unit. Going along fine. Having a reasonably slow day, actually. And then. My Chief resident comes down, looks at the resident who'd been filling in for me whilst we all awaited my license, and then at me, and says, "I need to talk to you two."
After I reestablished a normal cardiac rhythm...because, I turned white, swallowed my tongue, and said, "wait, just...I still have a license, right?" and she assured me that I did...she then pulled me off the medical unit and reassigned me to the Men's Acute Stabilization (read: psychiatric intake and crisis) unit.
So now I'm on psych.
And now I'm on call tomorrow.
And there's like 27 patients on that unit. There were 3 when I left Medicine.
Plus, as I told them like eight times, I haven't actually done any psychiatry - any real doctor-in-charge, sanctioned psychiatry - in like four years. Since I was a medical student. By training? Gynecologist. Freakin' awesome to have around if any of these guys go into labor. But...that's really unlikely to happen. And I thought I had three more months to read and acclimate and learn something so that when I said "I don't know anything about psychiatry, you know" I wouldn't really mean it.
Plus, the reason I went over is unsettling (in a more personal manner). And I don't know many of the details, actually, which makes it even more upsetting, because the details I fill in are undoubtedly worse than what's probably happened. What I suspect is actually closer to the truth will probably just make me sad.
I guess we'll see.............really, I guess we'll see how much crazier this ride gets....
Sunday, July 22, 2007
Every day we meet people on the worst day of their lives.
-Grissom to Sarah, in one of the seventy thousand episodes of CSI I've watched over the past three weeks. According to a Google search, and subsequently, this site, the episode is called Too Tough to Die. So there you have it.
I kept thinking of this line on Friday. Which is not to say that I saw a whole hell of a lot of patients, or even that I'm doing psychiatry yet, really, mind you. I am, for these three months (well, now, nine weeks) working on the Internal Medicine service at the state psychiatric hospital with which my institution is affiliated (there are actually two in the area, which are going to conglomerate into one big new one, allegedly last spring, oops). So it's general medicine, except, on psychiatric inpatients. And as far as I can tell, usually ones who've been committed against their will, or they'd be at one of the "nicer" hospitals (although, this one is pretty decent). It's an interesting idea, and actually, I think the fact that we get to do our general medicine in this setting is a serious strength of the program. Because, really, whose general medical problems am I most likely to be treating in my career, except, psychiatric patients, with all of the comorbidities and special issues that label evokes?
But I digress.
My first day went fine, and thank you all for being so eager to hear about it (I actually tried to leave a blurb on here Friday night, but Blogger was having an off day or something, it wouldn't take....anywho...). It actually was fairly uneventful. I sort of picked up one decidedly now-stable patient, took a very disorganized history on her, took bloody FOREVER to write my note on her (because, seriously, the last time I wrote a gen med note was, what, four years ago when I was a third year medical student?), and then my cohort discharged her back to the psych service at the end of the day. I got orientation-ed to within an inch of my life again. I got very lost and confused on a couple of occasions. And we had a nice talk about acid-base disturbances and another about benzodiazepine withdrawal. All in all, a good time.
On the whole, no one was mean to me, I like my co-residents, and one of these days I'll be able to find everything. And my attending seems cool, and he teaches a lot, which I really appreciate, rather than being demoralized for my lack of telepathy. But I couldn't quite shake the feeling of being a fish out of water, still, which was a very weird thing for me in a setting where I used to feel quite, well, wet and fishy. I think part of it was coming in late when the rest of the team already knows their way around and gets the routine. I think a lot of it is still feeling like I'm supposed to be the gynecologist, and where does a gynecologist fit in the medical unit of a psych hospital? And part of it, certainly, is still that feeling of not being worthy of being on any unit, left over from my last experience (my therapist once referred to this component of said last experience as "brainwashing"...).
Those last two are going to be pervasive themes this year, I think.
The latter, well, it's just something I've got to work on. But I do miss that feeling of...not even of knowing what I was doing, because I still do, but of knowing that I did. Of course I didn't have all the answers; we never do. But there was a time when I knew that I could find them, or the people who knew them, that I was intelligent and well-trained and facile enough to do what I was doing. There was a time when I felt worthy of what authority I carried and confident that I could manage what I was given. There was a place when I questioned my decisions a reasonable amount - and I do think that's wise, it keeps information fresher and perspective sharper - but I did not question myself to this unreasonable degree. I miss that. I feel like that's been forcibly taken from me, like so many other things have. And I'm sure, with time, it'll return, but you know something? It really does suck.
As for the former...I'm certainly not the only one in my program who's coming from a non-traditional background - two of my colleagues were out in practice elsewhere. So, they didn't just come out of their fourth year of medical school having done a boatload of psych electives, either. And no one here seems to expect me to be a font of psychiatric knowledge right out of the gate, especially since my first four blocks are primary care. It's going to be fine.
But it's also definitely an adjustment, and that's where that quote kept popping up on Friday. When I was a gyn, I saw a lot of people on the best day of their lives. Or, the first day, for that matter. I saw them on some anxious days and some complicated days, but, like...I had this very simple case, medically speaking, on Friday. Yet, for my patient, there was absolutely nothing simple about that day. It was scary as hell. She ended up in my care through almost no fault of her own. She ended up needing psychiatric care because something unthinkable had been done to her by someone she trusted. She didn't have nine months to plan, even poorly, for what happened. There was no pre-op visit, no explanation of risks and informed consent to sign when her life was shattered. I'm sure the sheriff was occasionally involved in my old practice, but rarely if ever did my patients come to me as a direct next step after meeting him, and I don't remember anyone waking up in handcuffs. If I were ever to go to court and sit opposite my patient (which, let's face it, as an OB, I would have eventually), it would've been by their charge, not by some third party's, not by mine, and I certainly wouldn't have wandered across the street to some little stone house (which is where the magistrate's court or whatever it's called is located at our state hospital) to do so. The day you come in to the hospital to have a baby or to have an ovarian cyst removed or, really, even to have your cancerous tumor removed, it's probably a remarkable day. But not in the way it the day you come to the psych ward, especially if you don't come of your own accord. I'm not really qualifying that as better or worse than the OB/G populace; it's just...different. And going to take some adjusting.
In totally unrelated news, though, I have spent a good portion of my weekend reading the seventh Harry Potter book, and I have to say, I was pleased. I liked the ending. I even liked the epilogue. I really liked Chapter 33 (partly because I also really like being right, and I called that, like, three books ago). I have some minor complaints about it, and things I really appreciated, neither of which I'll air here just yet for fear of being stoned for spoiling the plot, but I will say, I thought it a fitting end to the series. Which, as much as I enjoy them, I agree that they need to conclude. But I look forward to whatever else Jo Rowling decides to write now.
Thursday, July 19, 2007
Monday, July 16, 2007
Actually, this time, I think it's the GME (Graduate Medical Education) office at my institution...so the NCMB comes down from on high and *ding!* grants me my license, right? So I get to start being a psychiatry resident, right? Oh, except, for, I need this thing called an NPI, which I believe stands for National Provider ID Number, which, I don't know, this is new, I always only had a DEA number before. But, okay, because this is usually one of those things that requires filing a form and a 24 hour turnaround, and hey, it might even come through by the end of business on Friday. If not, no worries, it'd be there Monday morning.
So, I continue to play this game wherein I wait for the phone to ring, to tell me if I'm going to work the next day. At least, at least, this time it's a function of red tape and paperwork. But, still.
Oh, and have I mentioned that I'm not getting paid at the moment? Nor do I have health insurance coverage? Ay yi yi....
Some day, something in my life is going to go smoothly, and according to plan, and I'm just not going to know what the fuck to do with that.
Friday, July 13, 2007
I met with a member of the board this morning; we chatted, he says, yeah, I don't really see a reason not to give you a license. I was like, me neither!! And by the time I got home from said meeting, it was done. A few more papers to shuffle locally, and I will be set to start Monday or Tuesday. Hooray!
Maybe some day I'll say more about the rat bastards at my old program and how and why they so consummately suck for putting my in this position after everything else they've put me through. Hell, maybe some day I'll figure out what makes me so damn special that the feel the need to continue to harass me two years later. But for now, I think I'll just keep movin' on and be a psychiatrist, and a damn good one, secure in the knowledge that they didn't win.
Thursday, July 12, 2007
So, instead, I've been focusing on the small amusements of my week. And, well, still watching a lot of CSI.
Sunday, comrade in arms pict-shrink and I went to Market - the NC State Flea Market, and the NC State Farmers' Market. The flea market was a sight to be seen, for sure. As one friend so aptly stated it, you think flea market, you think crap nobody wants and stolen things. And, there was definitely some crap, and probably some stuff that was hot. But there was also a lot of really cool stuff - lots of the requisite hand made furniture, refinished antiques, collectibles, homemade fudge, jewelry, tea, spices. Also some weirdness; like, aside from the army surplus place, there was the random booth that sold "weapons" - including what purported to be a "vampire slaying sword" (which, we concluded...wouldn't one of those have to be made out of wood?). But it was cool. And the farmers' market was an equally good time. They have a restaurant there. With disappointingly mediocre food, it turns out, and bad service. But the market itself has a lot of very neat stuff.
Neither of us bought any fleas or any farmers. Although I did come home with some very tasty peaches.
And, I also give you, some gratuitous pictures of my dog. She just got a new crate a couple of weeks ago, which she almost refuses to come out of.
She also is very excited to be allowed on the couch again, now that we've got our old furniture back from New Hampshire.
Yesterday, I'm sitting on the floor, the dog's on the couch, which she barfs all over with no warning. Which, first off, ewww, puppy. But, fortunately, I still had that blue comforter on the couch. So, I just tossed it in the washing machine. Which, I LOVE my new washing machine. Love it!
It really is a beautiful thing. I've been waiting three weeks to blog about this stupid washing machine. It's a Frigidaire Gallery...something....something....stacked he. I mean, it's no Sir Washie, but come on, what is? And I got it at Sears for less than $1000. For he! It's deceptively huge capacity, very quiet, fun to watch the front loader (you think I'm kidding). And, you can easily fit a queen sized comforter in that tiny little washer. Easily. Pop it right in. I've washed that blue comforter like three times already (out of necessity, not sport, unfortunately) as well as the one on my bed.
And as a side note, the thing on the left is a chest freezer I bought back in NH. See the shelf above it? Custom made, expertly crafted by my friend Carl. It's a beautiful thing.
So, that's the frivolity for today. I have to go to lecture shortly, and there's also a lunch to help us identify mentors. Yee-haw. And then I have to go pick up my overpriced suit that's being altered and still won't fit right anyway. Good times...
Saturday, July 07, 2007
So, I do not yet have a NC medical license. Why? No idea. They've had my paperwork for a week. It's administrative, the delay, we think, not that they've decided I'm a crappy doctor. And these delays happen not infrequently, it seems. So, I wait. And, I wait. And I wait.
Did I mention the waiting?
I'm thisclose to calling shenanigans on the NCMB.
It's frustrating. Especially because I've been getting somewhat mixed messages about if I'm going to wait until the next rotation to start or the next day after my license comes through. Now, I know whose message is going to win, and it's the next day. Which in many aspects I prefer. Because, damn it, I want to get to work already!!!!!!!! (!!!!!!!!!!!!!!!!!!!!!!!!!!!) And, every day I'm "off" is another day tacked on to the end of my residency, which interferes with when I start my fellowship, which is of course doable, especially if I stay put, but regardless, I've waited two years to get back to this, let's get moving already! However, it's also the much more stressful option, waiting for the phone to ring every day to tell me if I can start my life yet. I can't make plans in advance. I can't make decisions about major undertakings. I can just wait. And, watch a lot of CSI.
I still love the DVR.
So I've been trying to be a little more productive than just improving my knowledge of the history between Grissom and Sidle. I got my NC tags for my car. I had a very fun Fourth - one of my fellow interns and her husband had some of us over, along with a few of his (single, male, attractive, amusing, employed) coworkers. We went and saw Transformers, which, well, it was not good, but I freaking loved it. LOVED it. Not sure why, because, not actually all that good (and why on earth was Tom Lenk in that movie?). But it was a good time. The seven of us that went ended up sitting in four separate locations in the theater, which worked out well for me - I wound up with single male attractive amusing employed coworker #2, who happened to be from back home (of all the things), and we had really good seats. Anyhow, there was later the inevitable cookout, and much fun with the Nintendo Wii. It was a fun way to spend the day.
Also this week, my chief resident has been after me to go the beach. Because, this time is a gift, she keeps telling me (if I keep the receipt, can I get a refund?). So finally, yesterday morning, I decided to take her up on it. So I look at the map, and discover that if I more or less just drive east for two hours, I'll hit the coast, roughly in Wilmington, and there will be beach. All right! So off I went. And I drove. And I started following the signs that said "Carolina Beach". Because, that had to be the beach in question, right? Well...
Carolina Beach is a town, not an actual beach.
Nevertheless. I started then following the signs (you'd think I'd have learned by now, wouldn't you??) for Carolina Beach State Park. Because that would have beach, right? Like, a state beach. I've seen those in Florida. That makes sense. So I get to the state park, and I see....trees. And, campgrounds. A picnic area. And then finally, I'm looking at the sky, and it has that peculiar blue about it that only occurs over water, you know? So I think, there, that must be beach!! And so I follow, and, well, mostly it was marina. But, lo and behold, there was actual beach!!!
All five feet or so of it.
Never the less. I took a picture of my feet in the sand and the Atlantic, which I then emailed to the aforementioned chief as positive proof that I had, indeed, gone to the beach.
I also took some nice environmental shots, although it was like 11:30 at this point, and the light was less than ideal. Maybe I can tweak some of that with some editing.
That's some little cool cactus growing in the sand. We have those here.
And, I acquired a mediocre sunburn. In, like, ten minutes. Because I am the whitest girl alive. It was also about seven million degrees yesterday. Or so.
Now, as luck would have it, I then wandered around town a little more, and about five or six miles down the road, I found the actual beach.
This is a town called Kure beach, which strangely enough reminds me of the crappier parts of Miami (and by that I mean the cheaper, not-flashy, touristy parts where you can still safely wander around as a white girl by yourself).
And, I found some other interesting things nearby. Take for example, the Myrtle Grove Volunteer Fire Dept. Which seems to offer a flavor of the day.
Fantastic. Tiny, overstuffed, great selection. I bought a little needlepoint present for my mom (who does that sort of thing), a pair of the Addi Lace in #2 reallyfreakinlong (I've heard mixed reviews; I figure they're worth a try, and hell, at the moment, I've got the time!), and some wacky-colored Jitterbug sock yarn to go with the new needles. 'Cause I only have two socks on the needles right now, and a crochet project going. Even with all this time on my hands, I mean, really though....
Anyhow. That's been my week. Well, actually that hasn't even been the half of it. Tomorrow I'll tell you how they tried to evict me today....