Sunday, July 29, 2007

One of these things is not like the other...

So, I've been a psychiatrist for a week now. It's been quite terrifying, but I like it a whole lot. In fact, it rocks. I've even survived two calls, although one was a "short call", which meant I was supposed to have been relieved at 8pm. Note the use of the phrase "supposed to".

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. 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...


Barb said...

A long time ago, there was this cute, fictional woman from Austin and she eloped with this really mean accountant (allegedly) and he proceeded to verbally and emotionally abuse her for three years until the night he locked her out of the house when she (I hear) threw a large brick through a sliding glass door and got seriously, wondrously angry. Flash forward a bit and this nice young woman met another guy and ended up marrying him. This boy had some issues, too, like he was congenitally messy (possibly.) And at one point, our heroine, who had really compared this apple marriage to the orange marriage, thought to herself, "You know, I prefer a little messiness and chaos to sadistic mind games." Word.

Sarah said...

What if your response is, "They're both rather overrated as fruit?"
I hope life settles down soon. I hear dogs also like turkey and rice. Because after the pet food scare, my parents' dogs got spoiled and started eating that, warm please.

Valerie said...

You have come through brilliantly as always. You have good instincts and are using them. It sounds like things are starting to settle a bit....