Friday, September 28, 2007
1. preventive med
5. aerospace med
7. physical med & rehabilitation
8. med oncology
12. general internal med
13. emergency med
15. orthopaedic surgery
18. plastic surgery
19. occupational med
20. allergy & immunology
21. radiation oncology
22. thoracic surgery
24. nuclear med
27. infectious disease
29. colon & rectal surgery
31. general surgery
35. family practice
Okay, first off, I can't think of anything I'd be more bored doing than preventive medicine. And for the number of times it asked me if I liked problem solving and challenges and I answered "most true", you'd think this would be at the bottom of the list. Secondly, NO WAY am I built for pediatrics. Kids scare the hell out of me. Remember how 80% of my intern class wants to go into Child and Adolescent, and I'm like, no way in hell, I'm going to go do Forensic Psychiatry? Then, nephrology? Yick. I hated that rotation. Pulmonology I might buy because I did like intensive care an awful lot, and ICU med tends to be a pumonology thing. But of all the things I thought about doing - Ortho, Urology, PM&R, ER - renal was never EVER one of those things. Neither was dermatology, ew. And shit, seriously - can you see me as a plastic surgeon?
Next year I have to do pre-op evaluations for patients undergoing bariatric surgery. A, can you imagine them sitting across from my fat white ass during this process? And 2, you know I'm going to be all diagnosing everyone with eating disorders or whatever and pointing out that surgery ain't going to fix that (those of you who know me IRL know how vehemently opposed I am to bariatric surgery in general. Because seriously, everyone, everyone has complications, they tend to be bad, and there's a high mortality rate from the surgery itself, much less the consequences thereof. Plus, not healthy, and, usually doesn't fix the real problem! Getting skinny is not an automatic remedy for your low self esteem or your traumatic childhood or your whatever. But, I digress). I imagine me as a plastic surgeon would be much the same scenario. "Look, you're gorgeous the way you are. And this nip and tuck business isn't really going to help, since I can't fix your neurosis with my scalpel. So why don't we rethink this plan, and you tell me what's really going on..."
Did you notice, by the way, that OB/G was, um, #23 on the list. Ah, well. It seemed like a good idea at the time....
Thursday, September 27, 2007
First, there was an article splashed across the front of the City and State section of the N&O yesterday (I guess it was a little too much to hope that this was front-page worthy news, being about crazy people and all, although they've done it before) about how the county is now fighting to keep State Hospital open. It was a very revealing article. For a few years now, according to folks in my program, the plan has been to close SH and move everyone to the new place they're building about 50 minutes north of here. Allegedly, or at least if you believe the website, it was going to be soooo much cheaper to build the new hospital and merge State Hospital and Other State Hospital than to revitalize either of the old ones.
But apparently, the reason it's so damn cheap is because, oh, the new hospital has waaaaaay too few beds to actually house the patients. Like, it's a couple hundred short. And that assumes that the system works as it is, and won't need to expand again. I.e., the new place has a mere 432 beds. State Hospital, at capacity and with all of its mojo working, can house three thousand (yeah, it's a huge place. There are several towns smaller than that in this state). We have more patients than that now, and our acute units are always on delay because we're full. And that doesn't even take into account the addition of all the patients over at Other State Hospital.
Oops. Dang it.
And then, last night, one of the local news stations set aside a whole half hour and aired their original documentary, Focal Point: State of Minds, about the general problems of mental health care in the state of NC. Which, frankly, generalizes reasonably well to the state of mental health care in America. If you've got 22 minutes to spare, I highly recommend clicking the link and watching it, even if you aren't in the business of crazy (go ahead, you can knit while you watch). It's actually very well done - we were all a little worried that it would have a tremendous political agenda, as the station that aired it usually has pretty heavy political leanings. But I think it's very fair, remarkable in its scope for being so short, and overall a good picture of the flaws in the system. I'm not sure it accurately represents the shit we deal with at the level of those providers left to pick up the pieces, but, again, only 20 minutes. I also liked that they left it on a reasonably optimistic note, but what I found particularly heartening is how they continually emphasized the point that mental patients, well, they're people, who want to live life like other people, who have families that love them, and really have a tremendous burden to deal with. They're people who are sick and often could be helped by relatively simple means, if they could actually get a few reasonable things that they need. Not automatically scary, weird, or needing to be shunned or forgotten or marginalized. Who are and can be productive members of society. Really, they're just people, people.
I think we as a society tend to forget that sometimes.
Anyhow, it'll be interesting to see what comes of this. A lot of the staff seemed to breathe a collective, if premature, sigh of relief yesterday. No one really wants the hospital to close, I'm coming to understand. And not because everyone's afraid of losing their jobs, because they aren't, and not because it's so far away, and not because it's going to be a giant pain in the ass to actually institute this whole move. But because a lot of people at State Hospital actually have a lot of pride in what they do, and because of the very long and rather important history of what's been done there.
And that's nice. And reassuring, especially when Asshole Attending is constantly discharging people early from the medical unit because they're disruptive and weird, or when he and I, um, don't see eye to eye about psychiatric issues (I'll tell you the what happened today in another post, some other time. Right now I'm still busy being appalled at his cruelty).
As an aside, the person who's been feeding me much of this information (with great enthusiasm and ardor) is our respiratory therapist, who turns out to be a wealth of knowledge. Case in point, I'm sitting at the nurses' station a couple weeks ago, writing a note, chatting with said RT, when he looks at me sort of quizzically and says, "Hey, isn't there a line of sex toys named after you?"
Happy first 29th birthday, Katie and Annie!
Oh, and by the way, Katie - you'll always be 16 days OLDER than me! Ha ha! (Just teasing. You know I love you more'n my luggage....)
Monday, September 24, 2007
Scene: Thursday, 8am-ish, morning report. A room full of medicine attendings, two psych residents, and a bunch of nurse practitioners and physicians assistants (NPs and PAs, aka "physician extenders"). The medical director comes in and starts the conference (which is supposedly meant to let everyone know about the patients the on-call person saw overnight and make announcements) with a discussion about the forms for the new hospital. She makes the point that the forms need to be very directive - pick one of the following options sort of thing. I agree with this. However, her reasoning was distinctly offensive: "there are going to be psych residents filling this out, and nurses interpreting it". Damn, bitch, did you not look around the room before you walked in?
Today I had this one patient who ATE MY WHOLE DAY (and, you know, not like my other patients suddenly disappeared). Whole damn day! He came in right after we got out of morning report, and when I left at 5:30 they were actively trying to transfer him to another hospital where he could get, you know, real medical care (I felt like he should be in short proximity to an ICU; I think they just didn't want to deal with the paperwork of him crashing in the middle of the night). The respiratory therapist and I spent about half the day begging and pleading and cajoling and bargaining with him to get his blood gas drawn, and listening to - I kid you not - a nearly 40-year-old, grown man cry, whine, and whimper like a six year old. I was about ready to smack him upside the head for behaving like a moron, but I remained pleasant and persuasive and kept telling him what a good boy he was. Aaaaand then I drugged him, which helped the most. But somebody in this scenario owes me a beer for all of the sweet-talking I did with this guy, I just can't quite figure out who. Which makes collecting on that whole thing problematic...
Sunday, September 23, 2007
Saturday, September 22, 2007
But then, heck, I was awake, so I came down to check my email, and in the comments Lorna had made the brilliant suggestion of a countdown clock. Dude. Why didn't I think of that earlier? So, note the new addition to the sidebar. I think it's technically wrong, since, because of my license debacle earlier in the year I'll probably still be pulling intern duty the first month of my second year (what salty irony that is - instead of getting credit for the internship time I've already done in OB, I'm going to end up with an extended intern year. Oy...), and it aims for July 1. But whatever. I installed it, and then I sat there for a full twenty seconds or so and watched it count down to one less minute. It was so satisfying.
Friday, September 21, 2007
That's all I have to say right now.
Oh, and a patient finally made me cry today. Which I did in the back, in the office, in the safe realm of PenguinShrink's company (and good hugs). She may have been a crack whore, but even a crack whore can get under my skin if she calls me a fat white bitch and a bad doctor enough times and with enough venom (I'm sure the probable PMS doesn't help, either).
Oy, some nights I really hate this place. Only nine more hours until I can go the fuck home...and only ten more months until I'm not an intern anymore.....
Thursday, September 20, 2007
Also, I made garlic spaghetti for dinner (ahh, the life of the single girl) and Maggie has been licking the bowl for ten minutes now. She literally is lying on the floor with one paw cradling the bowl and one paw on the rim. Guess she likes it. I thought it needed more garlic. Either way, I think we're both going to have stinky breath tonight. Not that anyone minds, really.
So I'm stalling and she's "cleaning" and of course there's CSI on in the background. Mi vida loca, people.
My last call, on Monday, was completely wretched. I got thirty minutes of sleep. Here's a brief overview. I get this call to go to the adolescent building, right? "Doctor, come quick, this girl we just admitted today is having a seizure!!" And so I page my moonlighter and leave word for her to come meet me, jump in my car, race over to the adolescent building, go flying up the stairs, and...am met by one of my favorite nurses, we'll call her Miss Luci, who starts shaking her head at me. So, apparently, this girl throws herself of the floor and starts flailing about, and it looks pretty real until Miss Luci goes over and touches her arm. And, miracle of miracle, the "seizure" stops. So Miss Luci looks at this girl, pointedly, and says, "Are you finished?" And the patient stops, looks up at her, and says, "....yeah.....I'm sorry....."
Have I mentioned my so very not wanting to do adolescent psychiatry?
So, fine. I write a note, and then I get paged down the street to the long-term adolescent building, for a sprained ankle. Okay. Then one of the forensics patients faints, a couple of other things happen, and I get to bed around 1:30. At two (so, not asleep yet), my pager goes off, and it's Miss Luci. Who says, "well, now we have a kid having an actual seizure."
So the short version of that is, I try to admit him to medical, the nurses have a fit (one of the nurses on the med unit tells the nurse from Adolescent, "She's just fussing." Um, hello? Does anyone realize how I have absolutely no power around here and really can only do what the attending tells me to do?), and the Adol nurses convince me that he'll be fine with them (and probably get more supervision) until morning - you know, when the regular practitioner gets there - and I shuffle off to bed, where I toss and turn and fret and worry because maybe I should have admitted him (I think he was actually better off where he was) and because the on-call attending wouldn't let me give him any Valium (it's a great acute anti-seizure drug, it's not just for calming down suburban housewives), and finally, finally start to drift fitfully off to sleep when the pager goes off again, and Miss Luci tells me, "He's seizing again."
So I race over, again, and Miss Luci and two of the techs and I bring him back to Medical, and I load him with IV stuff per the attending, and, and, and, and then finally, right around 6, my head hits the pillow again. And I think, okay. I usually get up at 7 and round when I'm on call, but, I can delay that and sleep all the way until morning report at 8, right?
Because at 6:30, the pager goes off again. And once again, it's Miss Luci. She slipped and fell and screwed up her knee. And since Medical On-Call covers employee health after hours....
I really like Miss Luci. But if I ever see that much of her again in one night, there'd better be margaritas involved, and we'd better be far, far away from State Hospital.
This rotation continues to drive me crazy, and I still have another month of it. Like, I almost stroked out this morning watching my attending trying to do an I&D (incision and drainage of a pus-filled infected thing), and I swear, his surgical technique could've been worse pretty much only if he'd dropped the forceps on the ground and stepped on them before using them. And then, there's things like...this morning, my attending called one of the moonlighters a "prostate." I swear to God, this is the story I got from the nurse, with the attending sitting next to her. Now, I know he's foreign, and I'm quite certain he must have meant "prostitute" (because said moonlighter often buys food for the people he's on with. Um, no honey, that's not prostitution, that's how you get people in hospitals to like you. Well, that, and not being a condescending jackass to them), but...dude....and then he couldn't quite grasp why I couldn't stop laughing at him...
In totally unrelated, and much better, news, both Bones and CSI premier this week! And then? The week after that? South Park is back! Squee! I'm going to fall in love with my DVR all over again....
Wednesday, September 19, 2007
I've never really been a person who gets actual "food" on the occasions she's at Dairy Queen (after all, doesn't that miss the point of DQ? Is it called Chicken Queen? Come on, now), but now I might actually have to try their chicken strips one day. Goooood advertisers...good! Good job! ::Scratches them behind the ears...::
Friday, September 14, 2007
Is my current career path healing, or just punishing?
Believe me, it's a question I've asked myself many, many times before heading down this road, and on a nearly daily basis since. And the answer is absolutely the former. But only because I make it so, and that takes a lot of work, and I get that.
This is a complicated issue, on a couple of levels. One, there's a good lot of psychiatrists who pick this field more or less for the free therapy. They come in with all manner of insidious, unresolved issues, looking to fix themselves on a usually less-than-conscious level, and what ends up happening is that they leave a lot of poor decisions and bad patient care in their wake. They give the rest of us a black eye, because if you lack the insight to know what's pushing your own buttons, you probably aren't going to be insightful about anyone else's issues.
But then there's another group of us, the wounded warriors (and no, it's not an either/or thing. Some people just like psychiatry, so they pick it for their job). We tend to work in fields like trauma or addiction or eating disorders, because to really be good at those types of issues, you have to have a certain level of inside knowledge. Why? Because...nobody "normal" gets it. Because it's like being in Holland (Chernobyl). And unless you've actually been there, all the guidebooks in the world can't tell you what it's like. And, because all of these issues are defined by isolation and secrecy...well...when you think you're alone, the best person to tell you that you aren't, is someone who really means it.
The thing about it is, I can do good work here. I'm good at what I do, I have a good instinct about people's psyches, and I possess a valuable perspective. Plus, there aren't many people who want to do what I want to do in the first place. And look at the statistics, folks: one in three women and one in twelve men worldwide will be sexually abused or assaulted in their lifetime - in the US, the official statistics (I suspect they may actually be worse) are one in six women and one in 33 men. That averages to one assault every two and a half minutes in our country alone. The typical pedophile has 150 victims; that number drops to a mere 72 if he's caught and charged. If you've never been a victim, think of your two (or three, as the case may be) closest female friends. Think of your daughters, sisters, grandmothers. And begin to understand the scope of the problem. Nothing fractures your psyche like being sexually violated, especially at a young age.
For comparison, one in nine American women will be diagnosed with breast cancer. Be diagnosed with, not die from. And you can't swing a pink cat without knocking over a dozen products to raise money or awareness. Which is not to say it isn't a worthy cause. But where's my 5K? Who can even tell me the correct ribbon color or awareness month? (Teal, and April, in case you were wondering.)
And as for what it activates, well, the thing about trauma is that avoiding it doesn't make it go away. I live with the repercussions and little earthquakes every day. That's nothing new, and it hasn't been fixed by my neuroses and unhealthy coping mechanisms that will undoubtedly be another post for another day, silence, trying to avoid the triggers, or, say, going into a field where I can completely avoid treating men (that wasn't my only motivation for going into gyne, honest). The way to fix it, is to get up in its face and deal with it, to push those buttons until the response is manageable. It sucks to get through it, but it's got to happen. The only way out, is through.
So yeah, going into psychiatry has actually been - and I expect it will continue to be - quite healing. As has finally finding a really good psychotherapist. Which, I hope to someday perpetuate. See, it's all cyclical.
So I leave you with three things before we go back to our regularly scheduled rants and anecdotes and yarn-related commentary. 1, for anyone who is, knows, or loves a survivor of rape or incest, RAINN is a tremendous resource. No matter what your stage of recovery, The Courage to Heal and The Survivor's Guide to Sex (this is the best book out there, as far as I'm concerned) are amazingly useful, and for those of you who are partners in the process, I highly recommend both of those books as well as Allies in Healing.
2. I submit to you a verse from Dar William's fantastic therapy theme song, which I think really does justice to the process:
I say, well, I'm lucky, 'cause I am like East Berlin
I had this wall, and what I knew of the free world was
That I could see their fireworks, and I could hear their radio
And I thought that if we met, I'd only start confessing
And they'd know that I was scared
They would know that I was guessing
But the wall came down, and there they stood before me
With their stumbling and their mumbling
And they're calling out just like me
The stories that nobody hears
I collect these sounds in my ears
And, 3, finally, a gratuitous cute picture of my dog. Because we've had enough heavy seriousness.
Thursday, September 13, 2007
Tonight, I'm sitting here listening to an Alanis Morissette song that I always thought summed up my college relationship pretty damn well (the rest of the lyrics also fit quite solidly).
If it weren't for your maturity, none of this would've happened
If you weren't so wise beyond your years, I would've been able to control myself
If it weren't for my attention, you wouldn't have been successful
If it weren't for me you would never have amounted to very much.
The problem with that is how much it extends beyond just him. How many men, in how many settings, have told me that lie precisely, or a slim variation on any of those four lines in particular.
And maybe it's time for a response.
Don't blame me for your lack of impulse control. If it weren't for my maturity and its concomitant pathologic sense of hyper-responsibility, this could've gone down a lot worse for you. Meanwhile, I just internalize it in the interest of conflict avoidance. This is very fucking useful for my mental health.
If you had been able to control yourselves - ever - I might have had a shot at a normal life and growing up whole and less neurotic and dodged a whole lotta crazy.
Don't think for a minute that I've gotten to anywhere I am or become anything I am because you gave me those skills. I may well have used what bits you left me with to reassemble into the best skill set I could. If that produces any measure of success, it's mine, not yours. All you gave me was miles of barriers to overcome.
And those barriers, those hot buttons, those neurotic sore spots, that's what I have to fight with every day. This is life in my skewed reality. It makes me better at what I do, and particularly what I want to do professionally in the long run, but it also kicks my ass. Again. Every single day. With every single breath. Because aside from just the running negativity and awfulness that goes on in my own head, I run into the scary would-be stalker patients, the acting out and inappropriate ones, and even the ones that just try to mentally manipulate and screw with my head and make me feel inconsequential, unworthy, and inept. Not to mention non-patients who should be patients I have to work with and the general personality dysfunction in people I meet in the day-to-day.
Usually, my concentrated time among those who most activate me isn't quite so bad, and hell, I want to go into Forensics, which is, frankly, the belly of the beast...but last night, into this morning...was just fraught with this sort of shit. It was a hard, hard day.
But I survived. I didn't actually take anyone out (I'll be honest...I've never come so close to stepping over that professional line and physically defending myself from a person instead of diverting a patient) I didn't fall apart. I got through. And I'll get through again. It's all part of the work (and this time, I don't mean the work I get paid for). That work is in large part why I chose my professional path.
But that work? It's a grueling, draining, exhausting, on planes so much more than physical. It's difficult to fight with yourself all the time. It's difficult to want to be something that more closely approximates "normal" and realize that your "normal", your "reality," is way too far away for it to happen. And not because, like I, and so many like me, are tempted to think, because we, ourselves are intrinsically flawed. But because someone set us up for this. Someone else imposed this on us; all we could do was ride it out and learn how to deal.
It reminds me a little of that "Welcome to Holland" poem for mothers of disabled children. Except somehow I landed in Chernobyl. There are no windmills or pretty tulips here. And what's worse, there are no 10K walks to show support, no pride parades, no mass-merchandising covered in pink for months at a time. Maybe, maybe, if someone rapes you, once, at knifepoint in an alley, someone will knit you a scarf.
But when it happens over and over and over again, when the people involved are people you're supposed to trust, when unspeakable things go on, they just aren't spoken of. You don't get a parade or a T-shirt or a bag of colorful M&Ms. There's no TV show on TLC documenting your ability to adapt and survive. You don't even get a guidebook. Hell, there isn't even really a psych diagnosis that covers it (one of my complaints with PTSD is that it applies so much more to single critical event trauma than to repeated trauma). You just get a lot of pain and confusion and you think you're completely alone and you hope to God that there's a way out. You, and only you, can find the path you need to take from "victim" to "survivor."
So my name's Kate, and I'm a sexual abuse and assault survivor.
I'm on that path, yo. But it's long and it's fraught with new and inventive ways to test me. Like the groping, disgusting patient and the one who pointedly says my first name when he asks why I'm leaving. Like the patient who fired me this morning (you know, after I saved his life yesterday) after saying hideous, horrible things to me. But also problematic? The (non-patient) guy at work who seems to have taken at least a mild interest in me. The people around me who seem to genuinely like me and find me interesting. The fact that everyone, wherever I go, doesn't actually seem to hate me the way expect them to or judge me as harshly as I judge myself.
It sucks. And it's not fair. And I hate, hate, hate that this is my reality. Because I've finally figured out that it just isn't my fault. Nothing about me, my precociousness, my early mature coping abilities (including the one that isn't so healthy, but, it works), nothing about that led me down the path I ended up on. In fact, it ultimately led me out. But, dude. It still really, really sucks.
I think I'm done. But it's my blog, so, occasionally you have to wade through crap like this. Sorry.
Wednesday, September 12, 2007
So the Interns went to the beach this weekend!
It was SO MUCH FUN. I cannot even tell you the fun that was had.
Now I know you sometimes hear "retreat" and you think "designated time hidden away to work on something specific." Or possibly "forced bonding awkwardness." But, no. Our retreat was more or less this: the faculty donated money, and the upper levels covered our call (don't feel too bad for them, they were handsomely compensated), and they rented us a house on the beach and gave us money for food and alcohol and said, "Go. Go to the beach."
Here's where we stayed. Literally ten feet from the water at high tide. It's a duplex, so, six bedrooms, and two kitchens. Amazing views. Fantastic.
And we just went to the beach. We didn't have an agenda, we didn't have anything we were supposed to accomplish, we just were supposed to go, and bond, and have a good time. And relax, and be far away from the hospital, our pagers, crazy patients, all of it.When I came back Sunday night for call (I came on at 8pm. So, not a totally call-free weekend, but, darn good), my attending was asking me about the weekend, and he for some reason couldn't get his head around this. He was like, who went, besides your class? I said, two spouses came. He says, what about faculty? I said, no, no faculty. He said, how about upper levels? I said, no, it was just for interns. And he thought about that, and he was like, but, what did you do? I said, well, we played on the beach. We played board games. We cooked good food in big group efforts. We drank a lot. We made sand castles.
Dude, we hung out. We laughed. We talked. We vented. We kvetched. We enjoyed being up until the wee hours of the morning because we were having fun and we wanted to be, not because our pagers were going off. We enjoyed each others' company. We kicked back, and we had a really freakin' good time.
And we were in a gorgeous place to do it.
And for me, it really was a weekend about hope. It sounds silly, and I'll have more to say about this later, I suspect, but our class fits together really well. We support each other and from what I've seen thusfar we're good about having each others' backs. Now, my three actual classmates back at the Emerald Palace were pretty good to me, it was a lot of the other residents who were awful, but this level of alliance is really something pretty remarkable, and I think it's really going to serve us in good stead, all of us. And I have to say, it was nice to hear that while we're all a little miserable, it's a uniform sort of misery. Everyone gets worked to death - it's not like my bad old days where all blame, misfortune, and scapegoatery got heaped onto roughly three people (and unevenly distributed, even at that). It's just nice to not be alone, you know? And it's particularly nice to not be alone with a group of really fun, generally awesome people. Who can make deadly margartias and teach me about scrimps.
Monday, September 10, 2007
And then blogger ate the nice, eloquent post I'd stayed up an extra hour post-call to work on. Evil thing.
Shit, I'll tell you about it tomorrow......there's lots and lots of pictures and everything!
Tuesday, September 04, 2007
It's from one of the local auto conglomerates down here. They have a whole series of them. This one's my favorite.
I'm on call again tomorrow night. Last time I got such excellent calls as:
1. Scabies in prisoner row
2. Mr. X was having "chest pain." When I got upstairs, Mr. X was sound asleep in the dayroom, and as it turned out, he was just afraid of his roommate and more likely wanted his room changed.
3. A kid in long-term adolescent had a zit (it's not actually quite as ridiculous as it sounds, but, for the purposes of this blog, oh, it totally is).
4. "The patient has an upset stomach and she wants Pepto-Bismol, but I don't want to give her any because I know she's just trying to manipulate meds out of the doctors." Well, that may be the case, but, I'm sure as hell not going to fight her over Pepto.
5. "Hurry, the patient is unresponsive!" So I get on my sweater, I put on my pagers...and I get paged again: "Never mind. She was just asleep. She's cussing me out now. She's okay."
6, and my personal favorite. "It's 2:30 in the morning, and the patient just got to the floor, and he doesn't want to take his stool softener. Is that okay, doc?"
Yeah, yeah, that's really fine with me.