Thursday, August 30, 2007
In other words, nobody cares about you if you're crazy and have no health insurance.
But the fact is, it's not just that mental care is failing the poor, it's that medicine seems to be failing the poor mental patient (as in, the psychiatric patient who also has no money, not necessarily "poor" in the pitiful sense). The medical unit, where I'm stationed now, of course, has become a hotbed of this all week. I threatened to safety pin this headline to one of my patients today when I sent him off to finally get his surgery, except that, well, he didn't.
My one patient, well, he's not exactly Gandhi. I know that. In fact, he can be kind of scary. But this kid, he's now been waiting ten days to get his broken bone surgically fixed. TEN! Because they "can't fit him on the schedule." You know, over at my hospital, which, let me tell you how much I want to own up to that right now! And now it's a holiday weekend, of course, so it's going to be at least another three. In spite of the fact that everyone at State Hospital has been pestering the crap out of them. Which, okay, has in a very big way been primarily me, but only because I pester like nobody's business (I pulled such ex-surgeon-like tricks as calling the OR directly and then calling the service back and saying "Okay, so I called the OR and they told me he isn't actually on the schedule. Can you explain this?"). And meanwhile, the whole thing (and the events leading up to it) has generated so much QA and Risk Management and damage control and legal CYA drama that one of the staff designated our unit today as "CSI:State Hospital."
We had another patient bounce from, again, my hospital, after she - completely psychotic, since her psych meds unmasked another medical condition and she had to be taken off of them, and then, of course, got all crazy again - "refused" a particular treatment. No discussion of capacity, just, okay, ick, get her out of my hospital. And a third one, today, whom we bounced to a private hospital yesterday because he came to us looking on the verge of death. They called this morning saying, he's fine now, you can take the scary psych patient back already. We said, um, no. Just because he has a psych history, doesn't mean he doesn't need medical care more. Now knock it off.
You know what? This pisses me the hell off.
This used to happen when I was an OB/G, too. I'd get called to take over care on pregnant women - or worse, just, women. You know, people who dared have a uterus - before they'd even been examined. They didn't need an obstetrician to manage their asthma attack when they were six weeks pregnant, or sew up their cut on their finger when they were thirty weeks.
Likewise, people with psychiatric illnesses get sick, too. Yeah, fine, some of them are a little "weird." Or "different". Or "straaaaaange."
You know what? So are some surgeons.
Now everybody play nice and quit labeling my patients.
Sunday, August 26, 2007
Poor girl. To quote Ron White, you can't fix stupid.
But it also, for some reason, reminded me of this:
Not for any other reason than I think this was the last time I saw Mario Lopez in anything other than a Saved by the Bell rerun. It's a Carlos Mencia skit. You know my love of Carlos Mencia and his deeply inappropriate humor. Let it also be known that I think Brokeback Mountain, though it may only be 64 pages, is one of the best books I've ever read, and I do think the movie more or less did it justice. This, however, this is just funny. And not in the ridiculously dumb, Trapped in the Closet kind of way.
In other news, I spent part of yesterday getting way too sunburned at the 31st Annual Lazy Daze Festival, which they describe as "one of the South's premier festivals" and I think the best one I've ever been to (and remember, I'm from Chicago). It's billed as an arts and crafts festival, but that doesn't especially fit. You hear "arts and crafts", you think plastic beaded jewelry on elastic string and woven potholders. This was, like, an artisan fair. There was tons of remarkable pottery, art, wood carving, jewelry (that didn't involve elastic), not to mention cool local arts stuff (the American Turkish Association of NC had belly dancers walking the streets, and the Cary Players had five people dressed up as pirates in the town square. I was really jealous of the pirate wench's costume, it was wicked cool). There was live music, local food, it was really great. And the whole thing ran like clockwork, they were so well organized (you should've seen the way they ran us through the shuttle buses).
If it hadn't been A HUNDRED AND FIVE DEGREES OUT it would've been a very enjoyable time.
But it was WAAAAY TOO HOT. Kool and the Gang, Cole Porter kind of hot. Because it was 105, crazy humid, and there were 60, 000 people crammed into a couple blocks of downtown Cary, which is roughly half the population of the whole sprawling town. It was hot. And we were packed in like little sardines in a toaster oven. Which was sad, because I could've easily spent another 2 hours there. Which probably would've resulted in me getting a worse sunburn and spending a lot more money, so maybe it was fortunate after all. As it is, all I bought was lemonade (as a sidebar, I'm loving the abundance of fresh-squeezed lemonade down here) and a birthday gift for my friend in Long Island, but I'm regretting passing up several purchases that would've been really good, unique Christmas gifts. I would've had to stop moving, though, and ugh, that would've been awful. The heat was bad.
Oh! But! Guess who else I found there? The local Knitter's Guild! I still have yet to locate an SNB, but there were actual knitters! And they were knitting, right there, in the wild! They also told me that essentially my entire stash was worthless down here, given, you know, how it's almost entirely wool and alpaca, and I now live where you wear wool sweaters, like, once a year.....owwwww.......thank God for my recent sock yarn addiction...
Friday, August 24, 2007
Not to mention my personal favorite piece of practical advice, "don't lead her on and think that's enough." A-hem.
So, go check it out. It won't take long.
And as long as we're offering up good quotes, I'm adding this one from last night's CSI (which is on the DVR. Have I mentioned how much I like the DVR?): We're all carrying prehistoric genes in a postmodern world.
I like that.
Thursday, August 23, 2007
I composed this little poem in the hour I spent lying in bed this morning, which, admittedly, is an hour more than I usually get. And note how that's different from sleeping, because sleeping involves not having to answer your pager every ten seconds for things like "Hi, this is the nurse on the unit, and I was reading the patient's chart, and I saw that it says he once had tuberculosis when he was in prison, and I know you did a chest xray and cleared him before he came to the floor and all, but I was wondering, should he still be wearing a mask?"
No. That's what we meant by "cleared."
And I'll admit that the first draft went a little more like this:
Wait, how many syllables are supposed to be in the second line of a stupid haiku?
Where is my pillow?
And I'm on call again tomorrow night. Yee-haa. It's short call, though, so hopefully I'll be out at a reasonable hour tomorrow night. And then we switch services on Monday, which, I have to say, I'm a little sad about. I'm going to medicine (again), for real this time, in theory. At least my co-intern will be cool, but I'm not super excited about the medicine piece. Difficult, anti-social, and crazy though they may be, I've enjoyed my patients over the past month, and I've enjoyed the people I work with. And you know? I think I've really enjoyed the psychiatry. Imagine that.
But meanwhile, the weather's finally letting up a little, here. I'm going to try and enjoy it this weekend as much as I can before, oh wait, I'm on call again on Monday for Medicine. I'm so ready to be done with this call thing...and, oh, it's not even September yet....
Saturday, August 18, 2007
1. You know everyone who works at your local store, and all the drama in their life.
2. You pull up to the drive thru in the morning, and they interrupt you in the middle of your order and say, "Yeah, Kate, come on through."
2a. The whole place gets messed up when you deviate from your regular order (and feels the need to come to the window and comment on it to you).
3. This arrives in the mail -
In the mail this week, Starbucks sent me a CD. Totally unsolicited, and with a little card inside the mailer saying "Thank you for being one of our most loyal and dedicated customers."
Now, it's an old CD, and it's a compilation of "up and comers," which makes me think they probably had a bunch laying around and someone at corporate looked at them and thought, "What the hell are we going to do with all of these things? I know, let's send them to our cardholders who are actual regulars!" But it's also good. Very eclectic, has a couple of songs I really, really like...all in all, not bad for something that mysteriously appeared on my doorstep!
I also suspect it's related to the fact that I have a Duetto card, one of those fancy-schmancy things that is both a regular Visa and a Starbucks card (at the same time! It's like magic). Which brings me to the point that, if you are in any way a frequenter of the crack house that is Starbucks, totally get you one of those. Not only do I earn solid rewards in Starbucks bucks, but they're forever sending me cards telling me they've added $5 or $10 to my balance (on the Starbucks card side, which is just like the reloadable gift cards you get in the store, not to the Visa balance!) because it's the holidays or their anniversary or my birthday or the second Tuesday of a month that has an R in it. And apparently, they also send you random free things. Killer.
Friday, August 17, 2007
So, one of the guys on the ward - not my patient - was admitted after a manic episode that included, as many manic episodes do, a spending binge. Except that this guy spent over $300 at - are you ready for it? The dollar store. We had a good bit of theorizing at morning report about how one even comes close to spending that amount at a dollar store, and why the employees there didn't call us. That should be a commitable offense, right there, by itself. But you have to applaud his frugality.
My first patient of the day, got mad and walked out on the interview. That's how you know my day has officially started, fyi. My patients do this to me frequently. I don't know what it is about my style that makes them get all pissed off and storm out. I guess I'm just glad they aren't hitting me.
Later, my drama llama patient shoved a pay phone in my hand while I was walking down the hall for the second time in two days to demand that I talk to his girlfriend and break the news that he was not coming home yet again, despite the fact said girlfriend had already made reservations for tomorrow evening. Yes, sorry, I'm a bitch. And then he threatened to have my job. Again. Fine, take it.
Prior to this, I did an assessment on an old man who was demented and, really, had no business being on our unit, but should've been on the gero side. He starts out by looking me up and down, smirking delightedly and saying, "oooh, the big lady's come for me!" Which, I ignored, because he also thought we were in a furniture showroom (man, who'd want to buy that furniture?) and at one point accused me of being from the rival Thomasville store. He then, later, after I'd pointed out that, no, we were in a hospital, and I was the doctor, said, "well, I don't know about this place. And," (he looks very pointedly at the top of my head) "I really don't know about that hair."
Dude. Do not. Insult. Your psychiatrist.
The interview did not get any better.
And then I walked out, and this very big, tall, buff, bald, black man is walking down the hall, and he looks at me, and he gives me the once over, and he starts singing - in a big, tall, buff, bald, black man sort of baritone - the chorus from Beautiful Girls (Sean Kingston). And for once, instead of ignoring it and walking away faster (my usual response to these sorts of commentary, which are usually somewhat more lecherous), I looked at him (okay, as I was walking away, I admit) and said, "thank you." And he grins this big, tall, buff, bald, black man sort of grin, and says, all Southern boy, "Yes, ma'am." And I just sighed.
So here are the morals of today's very laid back, slow kind of day:
1. I'm very sorry to tell you this, but, if you do something goofy on your way to the psychiatric hospital, the staff, well, we're going to laugh at you. Please don't take it personally. Because we're not really laughing at you, you're providing a much-needed respite from the severity of our jobs. If we didn't develop a certain sort of inappropriate and gallows-esque humor about what we do, it would be far too heartbreaking to come to work. So, actually, before the next time you end up on a psych ward, try to do something a little silly on the way in. Help us out.
2. Dinner plans are not a valid reason for discharge. That argument never swayed me into inducing labor when I was an OB/GYN, either.
3. Never. Insult. Your. Psychiatrist. It's a good way to get a solid 30 day commitment.
4. All the good ones are married or psychotic.
And for dessert, you know how my shift ended? I walked out of the hospital, and slipped on an acorn. Fell down. Went boom. Splendidly, and with flourish. I fell on an acorn, dude. My life is weird.
My best friend asked me, if a Kate slips and falls on an acorn, does she make a sound? The answer, my friends, is, most definitely. And that sound is a lot like, "SHIT!"
Thursday, August 16, 2007
Ohhh. Sorry. Here, let me just hand you the keys to the unit. My mistake.
Then again, think maybe he'd take some of my call next week?
Tuesday, August 14, 2007
I do not know what happened in my hospital last night, but for some reason, the whole place went nuts. Er, nuts-er. I got called to come write orders to put someone in seclusion or restraints eleven times (I think the sum total of all my other call nights put together was four S/R calls). I had to do emergency forced medications on two patients. I got five whole minutes of sleep (I think). I got called twice for Miss "Please Don't Make Me Stay Here, I Don't Want To Kill My Mama No More" (whom I admitted on a previous call), whom, the first time I got called, I could hear here screaming and pounding on the windows of the adolescent unit two or so blocks away when I left the Maximum Security unit (also a separate building). I spent a good portion of my night bouncing between said maximum security forensics unit (so, too crazy to be in prison, to dangerous for free society) and the adolescent unit (which, if you ask me, is the more frightening unit - man, adolescents scare the hell out of me!). I got one call about a woman who, they told me, "went to the quiet room." Now, there is an option where patients can essentially take a voluntary time out, so I assumed this is what they meant (especially because I was calling this nurse from the squalling din of the adolescent unit). Until they called me back 45 minutes later to make sure I was coming to sign the seclusion order (which has to be signed within 1 hour of initiation) - turns out she'd needed to be carried to seclusion by four people and had in fact assaulted one rather large male nurse. Oops. And then this morning I got called because a rather young gentleman I'd admitted to the Gerontology unit, who when I admitted him was so sedated and stuporous I couldn't get him to stay awake through a whole sentence, had just threatened to beat a nurse with his cane. What else could I say, except, "Oh, good. He woke up"?
Sunday, August 12, 2007
So tomorrow, I have to be an adult again and go back to the real world (or, at least, as real as it gets in my world). I'm highly ambivalent about this. I hate not knowing what I'm walking into tomorrow morning, especially on a call day. But at least I'm only on call once this week, as opposed to the three call days I have next week. Oy.
Well, I guess we'll see how it goes. My service will have changed completely in my absence - that's one of the things about the short term unit that is both a plus and a minus. Like, I have no idea who these people will be that I'm seeing in the morning. I could have two patients on my service or I could have, like, nine. And who knows what they'll have been admitted for. But on the plus side, maybe they'll be a little less criminal than the group I left. Or maybe not. I dunno. But to pull a quote from my current favorite episode of CSI (which is so because it takes place at a state forensic mental facility, and which also just happens to be on Spike right at this very moment):
"Crazy or not, here we come."
Saturday, August 11, 2007
First, it brought me this unexpected present:
A necklace, from my friend (who was my best friend in kindergarten and whom I went to school with all the way through college) and her husband (who was my housemate for two years, thanks to her), all the way from Maui. Well, they may have mailed it from Chicago, actually. But it was hand-imported! It's gorgeous. The picture doesn't do justice to the shimmery Mother-of-Pearl-ness about it. I love it. That came Saturday morning.
And then later Saturday, I got this:
Okay, true, technically this did not come in the mail, it came on an airplane, along with my friends who were visiting for the weekend. It was hand-imported all the way from Rome (unless I'm making that up and it came from Florence, but I'm reasonably sure it's from Rome. Either way, Italy). It's fabulous. I love it, too.
And THEN, today, I'm sitting on the couch, and the doorbell rings, and it's this!
So how cool is that?? Thanks, everybody!!!
Friday, August 10, 2007
Yesterday, I purchased a new laptop. My old bare-bones cheap Toshiba had hit that geriatric computer age of three and has, of late, been rapidly decompensating. It's sad to watch, Mr. Gates. My once spry and youthful companion is showing signs of advanced computer dementia. It crashes all the time, randomly turns itself off, has some sort of weird Outlook impotence, and, dude, it really can't handle all the iTunes upgrades...and it's constantly tethered to the external hard drive, so it can't go anywhere anymore...so heartbreaking... Um, tell me again why three years has somehow rendered my laptop arcane and decrepit? No, wait, that wasn't the purpose of this letter. The point was, I replaced it yesterday with a shiny, new, slightly meatier although still cheap Toshiba laptop (I have to say, the cheap-ass Toshiba held up better and with stronger constitution than any prior computer I've had, including - yes - the IBM), and it came with this New! Improved! Windows Vista Home Ultimate. It's new! It's improved! And, sir, I have simply this to say regarding the updates to your operating system:
If I wanted a goddam Macintosh, I would've bought a goddam Macintosh.
KNOCK IT OFF!
Or if you insist on trying that hard to emulate Apple, could you at least include some software that's as useful as iPhoto and iTunes?
Seriously though. This is crazy. There are still some things that identify it as a PC, fortunately, but had I known Windows was coming this close to assimilating the Mac interface, I would've at least gone to the Apple store and thought about buying a Powerbook. And it's not just Microsoft's fault. This past year, when I was putting my MD to good use selling yarn, the shop at which I worked was run by some of them (you know. Mac fanatics). So our shop computer and in fact also our cash register was an iMac. I hated that stupid computer, and it hated me. And part of the reason we didn't get along was because it had all of these "PC" programs on it that were not, in point of fact, right. Like, it claimed to be Excel, and it looked like Excel, but it didn't do the things Excel was supposed to do. The macros weren't there. You couldn't enter the same commands. The menus were all different and it was lacking a lot of functions. Which would've been fine if it claimed to be "Sort Of Excel." But it didn't. It said it was the real thing. It lied. It lied and then it crashed when you tried to make it act like the genuine article.
Do you think Bill Gates and Steve Jobs dress up as each other for Halloween?
And, and, I had no shortcut or icon ANYWHERE to Internet Explorer (what?!), and, my computer did not come with Outlook. I'm hoping my copy of Office 2007, when it comes (it's on backorder), has it, but for now I'm using Windows Mail. Which, admittedly, is virtually indistinguishable from Outlook, which means undoubtedly that it will be just close enough that nothing will transfer over. Ack!
But at least I have Solitaire again. I somehow erased it off my old computer.
In slightly related news, my old bosses have just today announced that the iMac-run yarn store is officially up for sale. Anybody want to buy a knitting shop? It's a nice place. Good location, excellent space, terrific employees (current and former), solid reputation. Lots of untapped potential to be explored if you're not trying to concurrently juggle a high quality hand-dyed yarn business at the same time (it's time for them to sell the shop and just focus on the yarn business. Ever since the Harlot got a hold of the stuff, demand has gone through the roof. And hey, it's good yarn). Get it now while the gettin' is good...
Wednesday, August 08, 2007
First some background.
So we've all seen the episode of South Park - Trapped in the Closet - where Stan joins Scientology and is "recognized" as the reincarnation of L. Ron Hubbard and then Tom Cruise comes to seek his approval and, not getting it, locks himself in Stan's closet. And then John Travolta locks himself in Stan's closet. And then R. Kelly - who, to my knowledge, isn't a Scientologist - locks himself in Stan's closet with John and Tom. You know, this episode:
South Park - trapped in the closet
Add to My Profile More Videos
If you haven't seen it, take the 22:20 and do so. 'Cause it's some funny shit. And it was a huge scandal. Nominated for an Emmy, but Tom Cruise and his people made such a fuss that it got banned from being aired in reruns, it's the episode that led to Isaac Hayes leaving because all of a sudden he objected to them making fun of religion (dude, did he not see the episode All About Mormons?), it was a big deal. But what I couldn't figure out was what the heck R. Kelly was doing there, narrating. And then I found this:
and rapper with increasingly poor fashion sense,
(there is just no excuse for this)
R. Kelly, has a series on IFC.com. Entitled, Trapped in the Closet. So far, there are 12 chapters totalling about 35-ish minutes (without the credits in Ch. 12). Apparently - are you sitting? Are you ready for this? It's a hip hop opera. And holy freakin' cow, it's the funniest thing I've seen in a good long damn while. I howled. Howled. Now, don't watch it in front of the young 'uns, because there's a lot of language you'd expect in a rap opera, but not as much as you might think. And only one person gets shot, despite a lot of brandishing of weapons by everyone from the crooked cop to the trailer trash white girl, but he's fine, he just needs to wash up a little. The midget just keeps passing out and pulling on his inhaler. Seriously, you can't make this stuff up. Go. Watch. Howl.
And then if you're really up for it, Google the video for Weird Al Yankovic's Trapped in the Drive Thru. I'm just sayin'.
Tuesday, August 07, 2007
The Simpsons Movie - Spider Pig
Add to My Profile More Videos
Cracks. Me. Up.
All in all, not a bad flick. Definitely worth the matinee price. I think it could've been better - I mean, they've been working up to this for, what, 17 years now? - but it's little stuff, and let's face it, I'm a South Park girl (one of my main complaints is that they should've killed Kenny at the end instead of Random Useless Character. SP gives the Simpsons nods all the time, it would've been a nice tip of the cap, is alls I'm saying. And no, that's not especially a spoiler). And dude, the Spider Pig song just rocks. Rocks.
More tomorrow, honest. For those of you who (ahem) think I'm slacking. Did I mention that I worked 68 hours last week in five days? I'm not sure I even had time to slack, yo.
Friday, August 03, 2007
But the good news is, after two very strenuous weeks of work, I am now on vacation for a week. It was scheduled a while ago, before the attack of the NCMB and its Licensing Gremlins. And it was so scheduled because I have friends coming in from back home. YAY! They're just here until Tuesday, but it's going to be a good time. We're going to bum around locally this weekend and then spend Monday at the coast. And probably see the Simpsons movie, which I need to see with them, because as you all know, I am a South Park girl myself, they are my Simpsons fans friends. It'll be a good time. Did I mention that already? Hmm. Chalk it up to the fact that I've had 3 hours of sleep in the past 38, and/or, that it'll be a good time.
In other good news, my usual dog sitter is, of all things, in Guatemala this week, so Maggie had to go to the doggie day care/boarding place whilst I was holding down the state mental fort (does it strike anyone else as weird that I get less sleep on call as a psychiatrist than I often used to as an obstetrician? I concede I was an OB in the middle of nowhere, but, still, it was a major medical center). I was a little worried she'd think she was back at the pound. But Tuesday, I picked her up early (usual pick up is at 5pm), at 2. And she was sooooo glad to see me. Until we got to the car, and she figured out that I wasn't there to join her, but that we were leaving. And we got in the car, and she literally cried all the way home (ask my dad. I called him and made him earwitness it). So today, I napped from 3 to 4:30 and then schlepped my dragging bipedal ass back over to the where my pooch was enjoying her full stay. And I walked in, and they knew right away who I was (they have over 40 dogs there for day care), and the guy brings her out and she's soaking wet. And he says, yeah, she just got out of the pool.
My dog. Who won't go out to pee if it's been raining and the grass is wet. Who glares disdainfully at any puddle she can't jump over or drink out of existence and which forces her to get her dainty little feet wet (she's part greyhound, and in her defense, they're very particular about their feet). The dog who I once took to the ocean and she ran trembling from it. The same dog who mopes at me like I'm committing a corporal crime when I give her a bath. This is the dog who "just got out of the pool."
Gotta be peer pressure.
Anyhow, we left, amid many cheerful calls from the staff of "'Bye, Maggie!", and there today there was a little less crying. Meanwhile, this is what she's done since she got home:
I guess they really wore her out!
So, I think both of us tired little gals are going to go to bed now...