2009 is peeking around the corner!!

Let the games begin

So today was sort of my last (of two) day of calm, as it were. I hung out with the folks, my mom and I went shopping, we had my aunt and uncle and cousin over for dinner, whom I haven't seen since February. It was nice. We had Chicago pizza, good wine, and fabulous cookies. And Mai-Tais, with some wicked good pineapple in them. Ahh. Oh! And I bought my dad his first-ever iPod, a little silver Shuffle. I tried to get my mom one, too, but they didn't have blue, and she doesn't think she'd use it (I think she'd be surprised). All in all, a nice day.

Tomorrow, I'm out the door at a quarter past dark to have breakfast with one of my med school buddies. I have a few things I need to do whilst on the west side, and then have a phone appointment at 10:30, and then am heading over to the lovely Bianca's to hang out with her and my nephew, Basil (who's TWO AND A HALF OHMIFREAKINGAWD). After that, I'm going to head over to the equally lovely Robin's to score some time with her and meet my new (um, seven months ago) nephew, Luke. We're going to hang out around there for the evening, for a wonderful evening sans pantalon (NO PANTS!) (It's a long story....which I'll probably tell you tomorrow). We're doing a bring-your-favorite-takeout New Year's, which we've done before and was a raving success. I'm thinking I might order pizza, because, ohh...anyhow, Thursday I'm going to sleep in as long as little Luke will let me, and then am headed up north to hang with my college friend and her wife (take that, Prop 8 bitches) and their two adorable children. And with any luck, I might get to spend some quality time with my awesome Goddaughter on Thursday night.

I sense an impending onslaught of clock-ticking, after all of this baby/kid time in the next few days...

Fortunately, Friday I'm going in to the city for a fun-filled afternoon with Claudia, and then she and my cousins (the ones whose parents are my surrogate family in NC) and I are headed out for a night of single-gal debauchery. Even if my one cousin is married (I really like her hubby, so, I can't really hold that against her). I see fabulous martinis in our future...

Saturday is a smallish extended-family to-do at my cousin Paulie's restaurant, the best in the South Suburbs. It's a small, intimate thing, which in our circles means about 40 people (if I ever do have my own big fat Greek wedding, expect over 200 people. On my side. This is why I'm eloping). And then Sunday? Sunday I get back on the big avion and fly back to my real life. I'm guessing Peng will not be as late picking me up as the cabbie was dropping me off. And Maggie, I'm guessing, will still be happy to see me, even though she's spent all week with Maxine and Sparrow. And Monday's a full clinic, Tuesday I'm on call, and, away we go again.

Damn. I'd better get some rest...

Oh! But I do have a big decision to make in the next 48 hours or so - Blog 365 2008 is drawing to a close....do I sign up for Blog 365, 2009 edition? What do you think, folks?

::EDIT:: Oooh! Look! There's a poll! Go vote! (Be kind...)

I kind of hate to admit this, but...

It's 8:45 (Central). I've done pretty much nothing but nap all day, and eat home-cooked food, and knit about ten rows, and read four pages, and then nap some more. And y'all? I'm going to bed. My mother assures me I'm just catching up on my sleep debt from the past week/month/year and a half. I think I might've caught the narcolepsy, I hear that's been going around...hopefully, it's just the 24-hour narcolepsy...

Home again.

I'm back in the Windy City. It's sorta chilly here, but not bad, and, at current, not even that windy.

Thus begins another whirlwind week trying to spend quality time with as many people as humanly possible. I flew in this morning....all my friends were either out of town, on call, or (ahem) ignoring their text messages, so I reserved a cab to take me to the airport this morning. The cab was insanely late, and I had to call twice. The fare was close to $50, he said, just give me $30, we made you too late. So I gave him $30 and not a penny more. Tips are for good service. He was 40 minutes late, and went the wrong way down my one way street. Here's a tip - try being on time.

The flight itself was reasonably uneventful. And then my folks picked me up and we ran home and I grabbed my dad's keys and went to knitting.

You know how, with some people, you can not see them for, say, over a year, and you sit down and it's still like you come every week? That's totally what knitting group was today. God, I miss you people!!

Val even gave me a skein of sock yarn. It was from a yarn of the month thing, and really not her color, but you know whose color it totally was? Ruthie's. And the socks I'm currently making for Ruthie are turning out to be very nice (and I love the yarn) but less Ruthie-colored than I was hoping. But I think they're looking to be someone else's color. And then the socks that I was going to make for her can go back to being for the person I was originally making them for, and then...well, then...one of these days I'm going to knit something for myself again. But anyway, I'd forgotten how much I missed seeing what everyone else was making and fondling everyone's fancy yarns and swapping project ideas. I miss these knitting buddies, but I think I also miss having knitting buddies in general.

Okay, mostly I miss these knitting buddies.

See, this is why I don't come home more often. Okay, no it isn't. I don't come home more often because I work 60 to 80 hour weeks and have no disposable income. But coming home also invariably makes me homesick.

Funny, that....

Preparations

So I'm post call. I left the hospital around 11:30, came home, picked up the girls, ran some errands together (Maxine was excited about the bank). Then we came home, ate some lunch, and napped for a while. I dragged my sorry ass out of bed around 4 and made it over to A Southern Season, who was having a lovely after Christmas sale, made a panicked trip to Wal-Mart because I decided I didn't like the suitcases I had, and then came home and packed.

It would appear I have a stowaway....

Sadly, I don't think they'd let me take her in my carry on, either.

"What?"

Acronym of the night

VORB.

Taken as a word by itself, kinda makes me giggle. This was all over the ER charts tonight, I'd never seen it before. Anybody care to venture a guess what it means?

(Yeah, I'm on call again. Why do you ask?)

Merry Christmas to all!

So it's Christmas in North Carolina.

We've had a pretty uneventful day so far. I went to my aunt and uncle's last night for their traditional Christmas Eve homemade ravioli, which, mmm, mmm, mmm. So good! And we had such a good time. My cousin and I were coasting towards our traditional Trivial Pursuit victory, but my other cousin and her husband rallied late and overtook us. It was a good night, though. Good wine, good food, good company. I'm leaving in about ten minutes to go back for dinner tonight. We're confident we'll be triumphant at Christmas Trivia tonight.

So our day here at Chez Kate...Little Maxine is here, of course, while Sparrow is home visiting her family (Mags is going to hang with them next week when I'm in Chicago). The girls and I slept in, and then we made cinnamon rolls from a little tiny tube.

The girls had a little standoff over their food as well. Maggie stood around for a good ten minutes, clearly not wanting to finish her breakfast, but not wanting Little Maxine to eat it, either.

Maxine, meanwhile, stood at the ready. Finally, Maggie gave up, and just laid down near the food dish...

This, by the way, was what all the fuss was over...

We got it figured out eventually. And they we mostly napped (I never got any post-call sleep yesterday) and ignored the housework (oh, that my house would magically be neat and organized when I get back from Chicago! Oh, well...). We did a little laundry, I did some dishes, I answered an email from one of my patients who's having an awful Christmas, but mostly I stalled on the internet and we watched A Christmas Story (over and over and over on TBS) and I spent a good deal of time addressing Maxine's inability to make a decision about if she wanted to be on or off the bed (it's about two inches too high for her to jump up by herself). And Maggie tolerated my need to take festive holiday photos.

I had to bribe the girls with Jumbones to get this picture. And take away the hat. And they STILL wouldn't sit together.

Merry Christmas, everybody. Or whatever holiday it is that you celebrate. May it be a happy one.

The Holiday Season

"Can you believe our humans do this to us?"

"What? I can't hear you over these stupid flashing antlers...."

Today, in emoticon.

>X-{

Blech.

So, Little Maxine is visiting while Sparrow is home for the holiday.

I guess, at some point today, she liberated a bag of Candy Cane Hershey Kisses off the table (where they're generally safe from Maggie, so I didn't even think about it) and ate them all. When I got home there were red and white foil wrappers all over the floor, and she'd barfed all over the couch. So I cleaned up the couch, called the vet (who said no problem because no actual chocolate in them) and put her up on my bed and was snuggling her because she clearly did NOT feel well, and all of a sudden she picks her head up and yaks all over the bed spread. I have never in all my days seen that much vomit come out of someone so small...my word.

But it helped. She seems to be feeling better. And Mags let her take over the queen's throne.

::sigh:: They're so cute..luckily...

I think the comforter is a lost cause. I tried to wash it three times, it's still covered in puke. I'm oddly sad about losing a ten year old comforter that I've had to stitch up three or four times and is all ragged and sad. Wonder what that's about...

Everybody keep your fingers crossed. I'm on call tomorrow, and am still terrified they're going to try to make a break for it again. Except...I think I've come to the conclusion that I might have had the order of things backwards during their last jailbreak. I think it may well have started with Maggie going over the wall - you know, after the cat or some such thing - and not being able to get back over, so Maxine dug her way out, and then they went on their grand adventure to Sparrow's house. Who knows, really, but the hole is blocked off, and the air conditioner Maggie used to jump over the fence is blocked off, and so...we'll, here's hoping, is all I'm sayin'...

Time for voice recognition software...

I...I hate people.

So I dictate my clinic notes, because it's marginally faster and is sort of the quickest way to get something into the patient's record. They get transcribed reasonably quickly, and then in theory we correct them and sign them, and all is well in the universe. Except...I'm not always the most conscientious about the correcting and signing step, because it often takes me almost as long to correct the damn dictation as it took me to dictate it.

The short version of this story is that I went into this weekend with sixty some dictations that needed attention, some from as far back as October. I've been neglecting them because, well, I have a crapton of other work to do, and it's in the medical record, so, is there really a time crunch on this? Apparently, there is, if we want to bill for it. So I've been getting all manner of nasty emails from my attendings that are like, sign your damn notes already, kid!

I'm down to 20. I've been doing them like five at a time because it takes so damn long and it pisses me off. Apparently we outsource our transcription to some little old ladies in India. Sometimes the syntax is off, in sort of the typical ways you'd expect from non-native speakers. That's fine. It amazes me, really, how many random typos are typically in these things - extra letters, too many spaces, line breaks where there shouldn't be, etc. But, fine. What actually gets to me is the crazy things that end up in the medical record that make no sense whatsoever, when, if whomever was transcribing took a minute to think about what they were typing, just a second, really, they'd figure out what they'd just said was ludicrous. I've been cutting and pasting some of the worst offenders...

"He is currently working on reading the Tail of Two Cities." (Hmm, I think I missed that one in high school...)

"He says he has been helping his dad with some construction projects, and supervising the construction of his grandmother's edition. " (Addition. Although...)

"He had begun calling her and taxing her incessantly." (Uh, that would be "texting". He is not a government official)

"The patient is handling this very well, and being very supportive of his friend, the deceased girlfriend." (That was supposed to be, "the deceased's girlfriend. It's different.)

"His family recently took a vacation to Cozumel, I believe, in the Caribbean." (They went to Cozumel, Belize, and the Caribbean. I know Cozumel is in Mexico, dammit!)

"He will go to the transplant percipient class, at which point he will go on the list for a kidney transplant." (From Merriam-Webster Online, the definition of "percipient" (n): a person on whose mind a telepathic impulse or message is held to fall. Um, please stop reinforcing my patient's psychotic delusions!!)

"She is concerned that this has gone largely and addressed." (Me, too)

"He presents today meeting a bridging prescription for his lithium." (Steve? Lithium. Lithium? Steve.)

"They have has no other complaints today." (That is was sure a good thing idea, there, hey.)

"She also has done two sits in rehab." (Hmm, maybe that's why it didn't work...)

"It was the first Thanksgiving without his grandmother, who recently passed out and that was a little difficult for the whole family." (Until grandma woke up, six feet underground because the rest of the family thought she'd passed ON.)

"He says that as long as he is alerting he is okay." (Well...then...carry on.)

"And that she particularly likes school because they are free, contained no clipart" (I have no idea what this means...)

"The idea of writing the letter but not sending it was discussed and she seemed to devaluate that." (Devaluate isn't even a word! It's like "ironical". And furthermore...I really just have no clue what the hell word I actually used there...)

"His property is routinely searched for code violaceous." (I hate it when that happens.)

"He is feeling like this man is 'how to get him'" (How is that, exactly?)

(In a continuing description of my patient's car accident, where he was driving on the straightaway with his dim headlights and missed the fact that the road was about to end, so he ended up in a ditch) "...and that it was very dark and his headlights particularly bright. He came to T in the road, coming on the strayed away, and crossed over the perpendicular road and went into a ditch. He severed only minor abrasions to his left hand."

"He also had surgery on his finger in 1992 after a crush." (Injury. Crush injury. That's an important distinction!)

"We will continue with Remeron 45 mg p.o. q.h.s. He is given a prescription for 50 mg tablets." (You've just got to shave 'em down a little, it's no big deal.)

"If her panic attach become more frequent, we will consider something like propranolol." (Or possibly a crowbar.)

"He says that he is not happy with his current physician, that he is a "kangaroo psychologist"." (Yep, that's exactly what he said. No, I still don't know what that's supposed to mean. But perhaps if he stopped going to veterinarians, he'd get better mental health care?)

"He states now that that was primarily over the mounting is fair." (I...um...huh?) (You know what I think that was, originally, actually? "Mounting despair". Yeah, different...)

"He notes that he is 'still measurable.'" (Well, thank God! No one likes an unmeasurable patient. Especially not one who's, say, MISERABLE!!! Really, people, this is not that hard!)

"There is heavy alcoholism on both sides, and his paternal uncle is a aeronautics." (Wow, he must be confused about why all those AA meetings are required for the space program.)


Idiots.

Um, but then there were the dumb things I actually did say...

"...and was initially initiated on amitriptyline..."

"The patient has a somewhat impulsive and minimally jerky kind of gait that his mother reports is at his baseline." (I...guess it gives you a picture of how this guy walks?)

"I will fax a copy of his lab report to Dr. X at [fax number], as well as the copy of his lab report." (Right before I fax him the lab report.)

"The patient denies any suicidal or homicidal ideation; however, she does note that she once considered throwing a plate of food at her father this week." (Hey, they say it, I just put it in the chart.)

"The patient was counseled that he should probably stop smoking marijuana." (Yeah, you know, sometime, when you get around to it...)

"She says that her symptoms have maintained at about the same level, although she does also state that her symptoms are significantly improved since starting the Celexa." (Honestly? I think she really did say both, but...)


And then...sometimes, maybe it's a little of both...

"The patient agrees that he probably needs to stop watching U-tube."


Oy. I still have 13 left, but, they're going to have to wait...

Best $14.99 I've spent in a while...

So, today, I'm out and about. I went to the Target, apparently to completely forget the list of things I needed and instead focus on trying to find a coffee maker, which I also didn't buy. Anyhow, on the way home, I stopped at the Chick-fil-a (a Southern-ish fast food chicken chain). It's not a place I eat often, but, it'd been a rough morning, and I just was not in the mood to cook when I got home, and I've recently discovered an affection for their wraps, which are also reasonably healthy (nevermind the waffle fries...). So, okay, I'm in the drive-through, and I see this little advert for their holiday gift basket. Which I've seen advertised a few times over the last month, and it looked really funny. But, you know, silly, and unnecessary, and I haven't been able to convince myself it was a worthwhile investment (because...okay, fine, it isn't). But, like I said, rough morning. So I finally gave in. And it made me giggle. And it continues to make me giggle. It's very frivolous, but, perhaps you might also think it worth a giggle.

I expected a little baggie full of stuff, right? And the woman at the register climbs up on her little step stool, and pulls this giant, intricate thing off a shelf. Quite the presentation!

It was huge! Here, a view without the cellophane...

Turns out the whole thing is worked into a drink carrier, and there's a lot of double stick tape involved.

So...okay. Anyone who's known me for a considerable amount of time knows that I used to collect cows. Not entirely on purpose - I liked cows, thought they were cute, and then suddenly every gift I got had a cow theme. I had towels, pictures, magnets, pillows, and more stuffed cows than I knew what to do with (Note to anyone who might be inclined to buy me a gift this year - no! No more cows! No!). But, I've retained a soft spot for the Chick-fil-a cows.

So there's a little stuffed cow, wearing a little sandwich board with the classic slogan, "Eat mor chikin." He's really, really cute. To that end, there's also an "eat more chikin" Pez dispenser (seriously. What could be better than a PEZ dispenser!!), and a cow-head-on-a-stick fan. There's a little cow tumbler. There's also coupons, little mints, and the 2009 "Bovines in Blue" calendar, which features such parodies as Grill Street Blues and BSI:Bovine Scene Investigators. Included in the calendar are monthly coupons for various Chick-fil-a products, of course, but the illustrations are by themselves just all manner of amusing.

I know, I'm a little pathetic...did I mention it's been a rough couple of weeks?

It's 6:45am and I'm already cranky...

Attention patients/families of patients/people who leave me annoying voicemails because they want me to write them prescriptions:

My name is not Miss. Nor is it Kate, or Katherine, and it's really, really not Kathy. No, I am not a nurse. No, I am not a social worker, clinical therapist, or whatever else you've decided for which I went to school for four or five years. No, I do not need to "check with the doctor."

I am the doctor.

When people want to check with the doctor? They could check with me. See how that works?

If I were a nurse, then that'd be great, had I wanted to be a nurse. I'd be debt-free, making a lot more money currently, and working a much better schedule. I could defer and check with the doctor. But, I made a different choice. I did three undergraduate majors in four years. I spent four years in medical school working up to 120 hours per week while taking out ridiculous amounts of loans for the privilege to do so. I spent a year in hell doing an obstetric internship, and then committed another five years of my life to psychiatry residency and fellowship. I work 60-80 hours a week, have ruined my credit because I can't make the $1600/month payment the loan company thinks I should be able to make on a second year resident's salary, and lay awake at night wondering if I'm doing the right thing, if I'm serving my patients well, and if any of them are going to put a gun to their head tonight. It's a job I love, and a choice I made, but it's a freakin' lot of work and comes at a large cost.

The least you can do, here, is call me "Doctor."

So totally love it Thursday

It was foggy in North Carolina today. Like, the kind of foggy where I kept missing my exits because I couldn't see the signs foggy. There was no way the flying tin can was going up in that, and if it was, there was abso-fucking-loutely no way I was going to go up in it. I get scared when the FTC flies through a solitary fluffy cloud. It's a ruddy tin can! The size of my car! That's somehow supposed to stay up in the damn air a mile above the earth! ACK!

So I drove to the coast. Because I was on walk-ins last week, so couldn't go, and then called in dead the previous two weeks when I had the plague, and then there was Thanksgiving in there somewhere...so, it's been a while. I figured it was worth making the trip, and when I finally got to the group room where we have morning team (I was a little late and then blustered past them "Hi-I'm-here-3-hours-in-the-car-gotta-pee!") they seemed happy to see me. I went out with the peer counselor, and we saw three patients clients consumers individuals people we serve (or whatever the hell we're supposed to call them now). The first one and the third one were relatively quick. The second woman we saw...wow, the whole thing broke my heart. So we walk up to this double-wide with six cats milling around our feet, gingerly step over the dead roach on the front porch, and have to knock four or five times before she actually answers. And she opens the door and is like, "I hurt myself." Which, in my world, usually means "I cut" or "I tried to kill myself." But, no, she'd fallen. Okay. And then she holds out her arm, and there's this giant bruise above the elbow...and, let's just say, from her elbow to her shoulder was not a straight line, as I imagine it was yesterday morning. So I look at this, as I'm walking through the door behind the PC, and said, "Hi, I'm Dr. Kate. You need to get to a hospital. How are we going to do that?"

We ended up calling an ambulance. We probably could've put her in our car and taken her, but I'll be damned if I was going to accept the liability of this otherwise medically fragile woman falling again or having any of her chronic issues kick up on the way there. Plus, they have things like pulse oxymeters and accuchecks and oxygen and arm splints on the bus. But while we waited, I sat and talked to her, got my exam in. We sat, in her filthy kitchen. With bugs crawling up the wall. And years of nicotine and tobacco smoke staining the ceiling tiles. Half the floor tiles were up, which gave her plenty to trip over. She herself was greasy-haired, dirt caked in the beds of her fingernails, in a stained t-shirt that was two sizes too small. She was dirtier than most homeless people I know. Poor sick old lady. And her husband shows up at one point, and says, "her damn arm ain't broke." The paramedic says, "Sir? Have you seen it?"

Alls I can say is...bless his heart....

But we were done by 2ish and so I hit the road, got some lunch, and before I truly pointed the wagons west, I stopped at my favorite not-so-local yarn store. And I made one of the coolest yarn finds to date.

Check this out.

I thought it was a scarf. But, no! It's basically sock yarn, knitted into a big ol' rectangle, with a provisional bind off. They call it Flat Feet. The idea is, you knit straight from the edge of the fabric, unraveling as you go. So no winding, no ball to mess with, no tangles, no problem! You can even cut it in the middle (there's another bit of provisional thread) and do two socks at once!

Here's a close-up of the hand-dyed-ness.

Seriously cool. I can't wait to see how they knit up. If, you know, I didn't already have three pair of gift socks on the needles...

Oh, but since we're talking about socks, check out this new and oddly addictive web-based game, Sock and Awe, in which you get to hurl shoes at George W. Bush's head.

Only in America, my friends. Only in America.

What's wrong with this picture?

A screen shot from our ER census last week...

So, see, there's this running thing in our group about the ER labeling our patients with a chief complaint of "psych" or "psych eval" (which invariably translates on the phone to, "I've got one for you!"). Check out the complaint three lines above my patient.

Not "neuro eval"?

::sigh:: Somehow I think this may be a commentary on how our patients are treated...

Grumble...

I know it's not Wordless Wednesday, and I actually have a post all set up for tomorrow, but I've had a very long and tired day and I just spent the last hour of my class doodling "I don't care. Don't care, don't care, don't care. So very don't care. Could I care less? Ohh! Nope! Couldn't!! Don't care!" in the margins of my notes (covertly. It's a small class), and y'all, I want to go to bed. Not to mention, I think this sums up the situation in Illinois right now just perfectly...so, I spare you my cranky-pants ranting and I give you this:

Urine Ecstasy

(I am?)

This was the title of a fax I got today about one of my patients. Which followed a call I got about the same patient, saying that she'd shown up in this outside ER all threatening to kill herself and oh by the way, her urine had popped for MDMA (commonly known as? You got it. Ecstasy). Which is really out of character for her. So I called their tox lab (after calling our tox lab, who said they couldn't tell me anything without knowing what assay the other lab used), and said, what cross-reacts with the MDMA reagent? Turns out, a whole lot.

It was a helpful giggle in what turned out to be a long, long day.

Man, I'll be glad when the holidays are over...

Sunday night again

I'm not sure where the weekend went...

Today was lazy. I slept until 9, didn't get out of bed until noon, got my car inspected (FINALLY. I had to wait for the new registration to come. Tomorrow, ps, would be the day they start fining me for my past-due inspection). Went to the Whole Foods, where everyone and their third cousin was out shopping, and of course they're redoing the store so everything was somewhere else. Which, combined with my lack of sleep and general crankiness...let's just say I got out of there as fast as humanly possible. I had all manner of plans for things to do when I got home. So far I've run a load of laundry and dinner is cooking...

Yesterday was busy, but a blast. The Housestaff Council (Housestaff = residents and fellows. My friend the pathologist says her department kids her about being on Student Council. Kinda true...) had its first annual Breakfast With Santa, and it was so nice. There was hot breakfast, the kids got to take pictures with Santa (one of our psych nurses. Shhh!), do crafts, a good time was had by all. The cash proceeds went to the Ronald McDonald House, and we collected canned goods for the local food bank and toys for Toys for Tots. The psych department had an excellent showing (made me so proud), in part because I'm on the council and Tina - whose idea this whole event was, and she did such an amazing job pulling it together - is an officer. But it was awesome, really.

Peter, the nurse who played Santa, is an amusing guy who was a State Hospital nurse for yeeeeears. He spent most of the morning trying to convince me to sit on his lap. So eventually I sent him Mike. I decapitated this picture on purpose (the no people on the blog rule - Peter doesn't count because he looks like every other Santa you'd see at the mall), but you get the idea.

Later, Mike had us all over for a "tree trimming" party (although the tree was already very nicely done up). Once again, a good time was had by all. Renee made peppermint martinis, Sparrow made sangria, and Mike makes a good cosmo. Peng made fudge, which was quite of interest to Mike's littlest furball, Clementine.

We hung out there for a while, gathered around the fire pit he'd borrowed from Cleo, roasted marshmallows (which were frozen from staying outside so long - funny!), we had a good time. And then a few of us went out to this middle eastern place in town, which is a restaurant by day and a dance club by night. It was about 12:30 by the time we got there, so, no mezes for us. It was, um, smelly. Sweaty. Smoky. But, we hung out, we drank a little more, we danced (Mike so got served by this guy who was like a foot shorter than him). We then took Mike home and then Renee, and Tyler and Sparrow and I went out for Mexican. At 3 am.

Love it.

Also? Still really tired....

Late Night

Had a busy day. But I just got in, and, yeah, I need to take a cue from Mike's cat, Madeline...

Did I mention it's 4am? Sparrow and I have concluded that Mike and Tyler are a bad influence on us...

Kate and the terrible, horrible, no good, very bad day

(With apologies to Alexander)

Oy.

So, I started out today thinking, great. I've been on walk-ins all week, today should be shorter, I get to see my own patients, it should be a nice time. Here is how I expected my day to go...

-Starbucks
-Get to work around 7:30
-Lecture
-Patient 1 - difficult, probably fragile, teetering
-Patient 2 - fine but cranky
-Interview
-Conference
-Patient 3 - casual, placid, pleasant
-Patient 4 - annoying but manageable, quick
-Patient 5 - ten minutes late, enjoyable, stable

Leave by 4:30-ish. Easy, low-key, early day - woo-hoo!

Here's how my actual day turned out....

-Starbucks
-Get to work at 7:30
-Lecture
-Patient 1 - remarkably stable, doing pretty well. Yay.
-Patient 2 - sobbing, messy, suicidal. Spent half the session trying to coerce her to be admitted. Finally won...well, sort of.
-Interview - nice enough kids today.
-Conference -again, pleasant enough.
-Patient 3 - Like friggin' pulling teeth. Come on, man, you've got to work with me a little. Give me SOMEthing (I nearly fell asleep in this session. It was bad, y'all).
-Patient 4 - Oh, my freakin'...trying to break things. Needs to be admitted. Starts having chest pain. Gets a personal Dr. Kate escort to the emergency room...who, um, realized while alone in the elevator with him that she probably should've called security to do that...
-Patient 5 - fifteen minutes late, enjoyable, a little nutty
-Go back, check voice mail, hear this: "Doc, my husband left me last night, I'm completely distraught, I just don't want to live anymore!!"
-Leave at 6:45 pm. With three notes left to write when I got home.

Bleh.

In good news, though, Peng and Chef have set a date. And - I get to be in the wedding! Whee!! I'm so honored. I almost cried. Differently than all the other times I almost cried today.

Ohhhh, so glad it's finally the weekend. And it should be a nice one - busy, but nice. Tomorrow I've got a charity thing I'm working in the morning, and then Mike is having a tree trimming party in the evening. Hopefully next week will be a little calmer (but...you know....it won't).

Happy Holidays, folks. Ho freakin' ho ho.

Interpretation

You know those therapy sessions where things just come together, and you get to the end, and you can look back on the content and the structure of the session, and like, everything just aligns, and is so profound, and you just kind of sit back all, like, whoa, and it's so about the alliance that you end up sort of vicariously raw and exhausted, and ultimately you look at your patient and you're just, like, wow. Good work. How cool that I was here for that.

I had one of those tonight.

Except I was the patient. And I left and was sort of like, ohhhh. So THAT's what that's like on the other side of the couch.

Cool.

Also, how many years have I been in therapy, and how many therapists have I seen in the recent past, that this is the first time that's really all come together like that? Which, okay, is not entirely true - this is the first time that it's come together like that in the way that I was able to have sort of that directed awareness of the process because I'm in residency and training in psychotherapy. Which makes me wonder why anyone would be in training and not be (or at least have been) in their own therapy.

I've said it before, and I'll say it again: I really think a large part of the key to being a good therapist is having a good therapist. Because some things you just can't learn by hearing about them.

There's only one word for this....

It's bliss.

Guess it rained today....

This was my first clue...

Okay, that's not true. My first clue was when I walked in (having been at the hospital well over 12 hours, grrr) and the whole house smelled like wet dog.

(There was some paper shredding that went on today, too, as you can tell from the picture...)

So then after dinner I walked into my bedroom and found a matching set of paw prints on the sheets. So, we had to change the sheets. Which meant I had to shoo the dog off the bed...the dog who wasn't happy about that. And then decided she was in trouble. So she couldn't quite understand why I was upset when she leaped back on the bed before I'd even finished tucking all the corners in.

Then, because I'm as silly as my dog is, I threw the comforter on top of her. This is about two minutes later...

Goofball.

Man, she's lucky she's so cute.

In other news, what the hell is going on in Illinois?! I mean, we all knew Blago was corrupt as hell (even by Chicago standards), but...what sort of narcissist do you have to be to sell a senate seat when you know that the phone is tapped?? Dude.

Walk in clinic kind of kicked my ass today. But two down, two to go....

Sibling Rivalry

Uh-oh. Guess I'm going to have to make sure we have enough treats to go around. Read this, from Today's Chicago Tribune.

Maybe it's good we got them matching Chritsmas outfits after all.

Walk ins, day one, is done. Three more to go this week. It wasn't awful, but, I can think of happier ways to spend my time.

Oh...

Dudes, I'm tired. I have things to say, but, we've got to go to bed.

Cycles

Ohh, I'm so glad this week is over. Actually, the week itself wasn't so dramatic (I was home sick Wednesday and Thursday, after all), but, I'm just so glad it's the weekend.

I need some vacation time. Fortunately, I have a week coming up, but I'm not anticipating that to be very relaxing, since I'm going back to Chicago (the week of New Years, for those who might have a vested interest in that). Good, of course, just kind of frenetic.

The coming week is going to be...um, let's go with...interesting. I'm on Walk-Ins Monday through Thursday (there's a long involved story about why Ed and I switched Fridays...so I have four days this week and one day next week, and then I'm on call twice the week of Christmas...). Walk-Ins refers to the Walk-In clinic, which is just what it sounds like - ideally, an urgent care clinic (I need my meds today because I'm about to run out. I'm going to kill myself. I'm going to kill someone, possibly me, if we don't get this depression treated quickly. You get the idea). You also cover the ER during the day. So it's like daytime call. Or as I tend to refer to it, Day Float.

What's nice is that it's 8:30-5. You plan accordingly and you sign out to the incoming call team at 4:30. Done. What's...um, let's go with...interesting about it is that we have this group of social workers and psych NPs and such that's supposed to be doing all this with us. They're part of the "crisis team" and are salaried to do Day Float things. This sounds great in theory, right, because in theory it would free up the physician (there's only one) to do doctor-y kinds of things. You know, stuff clinical social workers can't do (meds) or aren't really trained to deal with (complicating/complicated medical issues, physicals, orders, etc). Problem is, our crisis team tends to be...um, let's go with...inefficient. They're nice people, just sort of...unmotivated. With a different work ethic than residents tend to have. And rather than firing their asses encouraging efficiency (it doesn't have to be the threat of unemployment that's used to motivate them. How about praise? Incentives? A higher standard and expectation?), they're coddled and stroked because we don't want them to leave.

The residents this year have all been like, so let them leave. They either need to get moving, or get out of the way. We...you know, we're a hard-working bunch. We'll get in there shoulder to shoulder and fight through the roughest of shifts. And, fine, so residents in general are more used to hard work and long hours, we're sort of a masochistic group anyway, etc, but, damn it, if we're in there hip-deep, we expect the people who are paid a heck of a lot more than us to do this very job to be in there with us.

We'll see how it goes. There's a new guy, Charlie, who seems promising. We hired him away from one of the community hospitals, and every time I've worked with him on call he seems to be busting his ass. He's been doing this for a number of years, so I don't think he's going to burn out, and he doesn't seem like the type to be lazy just because everyone else is and he can get away with it, so, maybe the rest of the crew will have to step up to keep from looking bad.

A girl can hope...

I went to this talk this morning for the PECC (more about that in a minute), and the speaker was talking about what he referred to as The Lead Rule - do unto others as others have done unto you. It's so simple and obvious (and sardonic), but damn if that doesn't sum up a lot of issues in medical education. We get into these ruts of "this is how it's been" and "if I had to do it, so do you." This is particularly rampant in the surgical disciplines, but, I think it's pervasive. And I think it occasionally translates into, if no one else has to do it, why should I?

Sometimes? Life kind of stinks. Sometimes you have to do things because it's the right thing to do, or they have to get done, or whatever, even if they're unpleasant or tedious or not what you'd rather be doing. But, if we ALL do this, then it tends to mean less unpleasantness for everyone.

Amazing how many people look at that and say, well, too bad. You can take my share of the unpleasantness. I'm going to go over here...

Also at this talk this morning, I met up with one of my colleagues who told me some disappointing things about our current chief class and how unhelpful and minimally mediocre they've been for the intern class. This upsets me. Because, last year? Our chiefs rocked. They weren't always perfect, but, they always made an effort. And we were all interns once. And it sucked, but we got through it, and that support made it so much easier. This year? You know, I think the thing that bothers me most is that their attitude is contagious. Like, I've always jumped in when someone was sick. I took on May's work when she was ill when we were on together at State Hospital. I took calls for Cleo and Fang on less than 12 hours' notice (about three hours, in Fang's case). I dug in and took on some of Mike's work when he was overwhelmed or had a bad night on Family. I was q2 for a week when Peng had dental surgery. You get the idea. We help each other out, you know? Two weeks ago, when I had a 102 temp and needed my call covered? It was next to impossible to find someone to step up (Sparrow = goddess. Have I mentioned that? JD also rocks) and Ruthie said there was a lot of "fighting" about who was going to take it. I just sort of shook my head at this, because I think it's spilled over from the "I don't want to do more than I have to" attitude that's at the top of our pyramid right now. I think the next three chief classes look promising, though. And you know...as much as I rant about things sometimes....

Holy freakin' cow am I glad I'm here.

Yesterday was an interview day. We had I think seven candidates, all in their smart black suits, all on their best behavior. It's cute. They seemed like a nice bunch (one of them reads my blog! How cool is that?!! Hi, D!!). In general, this year, I've been so pleased with the candidates. Anyway, they'd assembled in Corrina's office and got escorted off to lunch, leaving Peng and me and a couple of the other residents to talk about them, er, discuss recruitment. And we were like, I hope they realize we're all pretty much as we seem, here. We get along. We're a quirky but genuine group of overall good people. The interns lost their tiny little office space? A bunch of us stepped up and procured for them what I now like to call the Intern Rec Room. The Child/Adolescent month was too scattered, we got it changed to being just Adolescent. The faculty supports us, the chair is very interested in how we think things are running, and overwhelmingly people are interested in teaching, learning, and being colleagues. We like each other. We respect each other. I can't even express how important that is.

This time of year always leaves me a little retraumatized nostalgic about life at the Emerald Palace. I remember talking to one of the candidates that would eventually become one of the interns in the class after mine, whom I liked a great deal. I remember thinking I should tell her to run screaming (RUN. RIGHT NOW. AS FAST AS YOU BLOODY CAN. RIGHT. NOW), but what I told her was, intern year is a hard year. The dynamics here are difficult sometimes, and you have to watch out for yourself, but if you know that coming in, I suppose it's easier to handle ("But, gosh, the program has so many positives, too." Like...uh...the way our labor deck is set up. And the cool robotic system in the OR. And, uh, the scrubs are free. And working at Student Health (not here). And the off service months (not here). And the ER attendings (not ours)...). Yesterday, I'm interviewing this guy (I got to interview! It was fun), and I was like, you know...intern year is a hard year. Harder here that most places, but gosh, you learn so much. You come out of it so much stronger in your professional sense of self. And the faculty is supportive, and the upper classes are supportive, and people are genuinely interested in you here. And we're social, and we have fun, and we work hard but we're encouraged to get the hell out of here and be well rounded people. And yeah, not everything works perfectly, or even as well as we'd like it to. But even when there's nothing that can be done about that, they hear us.

He asked me if I was happy. I said, without a second thought, "I love it here." And I meant it. And then he commented on what a good research program we are, and I thought about that for a little while, and he said, all nervous, "Well, you may not agree with that, I guess." And I said, no...actually, I do agree with that. But don't think we're just about research...and then we had a nice discussion of how we're very patient centered and we emphasize psychotherapy and how many opportunities we have here.

The Emerald Palace taught me a lot. In my time there, and in the subsequent cleanup, I've learned a lot about myself. I learned a lot about interpersonal dynamics and group psychopathology and systems errors. I learned a lot from them about what I don't want, and a little about what I do. I learned what it means to be "the doctor" - the program might have rarely let me be that person, but my patients did in spades. I even learned how to do a colposcopy and run the cool robotic system in the OR and do a wicked good circumcision. But the best thing they did for me? They got me here.

I wish I was the kind of person that could thank them for that. I'm still going to go with, "Fuck you."

Ho ho ho!!

Yay, presents!!

So, my knitters back home set up a Secret Santa gift exchange. My package arrived in Chicago today (pictures after my designee gets her gifts tomorrow). Even better, the package for me was waiting on my doorstep when I got home!!

It started with a funny card...

And there was sooooo much good stuff inside....yarn. Chocolate. Dog treats. What could be better??


There's sock yarn from Lorna's Laces that's a cheery red and white. There's hot cocoa mix (with marshmallows!!), M&Ms, a Lindt chocolate reindeer (or, at least, I swear there was one of those around here a minute ago...), and a candy shot glass (he he!). There's also a box of peanut butter Jump and Sit Bits for my girl (those are going to be such good stuffin' in the Puppy Kong!!).

This is awesome!! Thanks, Sarah!!

NPH saves the day. Again.

I came across this today posted at Just Like Doogie Howser...Only Different, a blog I discovered from the NaBloPoMo '08 Blogroll.

Prop 8 - The Musical.

See more Jack Black videos at Funny or Die

(Click here if it won't load.)

I so incredibly love it. It's got Jesus! Shrimp cocktail! Jazz hands! And Neil Patrick Harris! What's NOT to love?!

Not to mention, an outpouring of support for equality and justice from the members of Hollywood's upper eschelon. How many stars can you name?

(Still pissed that Prop 8 passed? You should be. Click here to sign the Petition to Protect Children and Prohibit Divorce.)

(No, no one really wants to ban divorce. It makes a point. Here, watch this.)

Pink is the new red...er, green...er...blue and silver...er...

Christmas has come to the Pink Office...

Dear little white cells of mine -

Listen, if you could step it up in there, that'd be great. Because frankly, I've had enough of this.

I'm so done with being sick.

I think I have bronchitis. I made Peng listen to my lungs today at work. And then emailed my doctor, "Peng says my lungs are clear. She's a real doctor and everything."

And then Peng declared that I need to quit dying, dammit. And, as she noted, since she said "dammit" I have to obey.

Then again, as Matt was quick to point out (helpful man that he is), physical exam alone will miss a pneumonia 50% 0f the time.

Matt also looked through my clinic files today and declared that he does think I'm more anal than he is. And let me tell you, my friends, that is a high-set bar. He then mocked my lung-hocking cough. So I punched him in the arm. So then he pulled my pigtails.

No, wait, that was second grade...that was something else entirely...

Meanwhile, Ruthie was running around the office today in a tizzy. She was behind in clinic, she was on call tonight, it was a day of chaos for her. I felt bad. Apparently not bad enough, though, to not point out her inefficient habits when she complained about clinic running late (I wasn't as blunt as all that, and in fact, was pointing out that she needs to hold her boundaries and respect her own needs over those of the clinic, the patients who show up forty minutes late and are super demanding, our supervisors who are also making demands, her office mates who label her compulsive need for completeness as "inefficiency"....). But then, I always was a bitch.

Heh. I love how our patients think we're all "normal" and shit...

So I rescheduled my day tomorrow and am staying in bed and mainlining orange juice and trying for the life of me to stop being sick (dammit). So maybe I'll have something less stream of consciousness and more insightful to say then. Meanwhile, I'm going to bed.

Oh, but, my dad's knee culture didn't grow anything, so they're probably throwing him out tomorrow after PT. No surgery, no antibiotics, but with closer ortho follow up. So that's a good thing.

Weird things over email.

First of all, happy December. Or to those who survived NaBloPoMo, way to make it through the whole month!

I had a couple of bizarre things in my email today when I got home. And I feel crappy and am borderline grouchy and, well, I needed a post today without a lot of thinking involved (if you think I'm kidding, it took me four attempts to properly spell "involved" just now). I think I may have honked my brain right out my nose and it's now been replaced with mucous.

Anyhow.

Item one, from CNN Breaking News. Let me say that again - BREAKING News.

-- The U.S. entered a recession in December 2007, according to the National Bureau of Economic Research.

Um...yeah, thanks, I kinda noticed that already.

They get that it's December 2008, right? As in, almost 2009. As in, you're just getting around to deciding this NOW?

And further more...breaking news? Really?? Really. You're sure? They didn't send me an email about Mumbai, but, deciding we've been in a recession FOR A YEAR somehow qualifies as an emergency. Come on, folks. It's a developing story like the Grand Canyon was a riverbed.

Item two - today's Merriam-Webster's word of the day: alienist.

Who knows what it means? Want to venture a guess? And no, neither Scully nor Mulder was one.

It's a psychiatrist.

No, really! Or at least that's what they claim. Here's their explanation:

Did you know?

"Alienist" looks and sounds like it should mean "someone who studies aliens," and in fact "alienist" and "alien" are related — both are ultimately derived from the Latin word “alius,” meaning "other." In the case of "alienist," the etymological trail leads from Latin to French, where the adjective “aliéné” ("insane") gave rise to the noun “alieniste,” referring to a doctor who treats the insane. "Alienist" first appeared in print in English in 1864. It was preceded by the other “alius” descendants, "alien" (14th century) and "alienate" (used as a verb since the early 16th century). "Alienist" is much rarer than "psychiatrist" these days, but at one time it was the preferred term.

Makes me glad I didn't practice in the 1860s. As do many other things....

See? Don't you feel wiser now?

I'm perhaps more ill today than I have been. My working theory is that while I was down with the plague I caught a nice hefty rhinovirus, and the two progressed more or less seamlessly in a continuous blog of grossness. I miss breathing, I do... It could just be a continuation of the Pink Office Plague, though, because both Peng and Ruthie have remnants of their respective bouts some three or four weeks later. Apparently, also, down South this sort of thing is referred to as "the crud," or when particularly epidemic, "the creeping crud." So I'm attempting to fight the crud with its known natural enemy - soup in a bread bowl.

My dad is doing okay, and thanks everyone for their concern and good wishes. So far, there's nothing super informative to report. He's apparently in a room that makes the Hilton look dingy (internet! cable! fold-out couch!), and they haven't decided what, if anything, they're going to do yet. He's on the OR schedule for Wednesday morning, but, uh, no one's really certain what surgery - if any - he's going to have. Which is fair - they're waiting for the culture results to decide the next course of action, but, you've got to claim the room before another surgeon does, else you might not have it if you need it. So we're waiting. And he's well-vicodenized.

Maybe I should tell my mom to bring him some soup in a bread bowl...

What that "MD" really means...

So, this morning, I'm driving to the Target (again) in the cold nasty raininess, and I was thinking, you know, my blog posts of late have so often been just a chronicle of my day. Nobody cares, dude. I should really have a topic today...

Uh, thanks, Dad, but that wasn't entirely what I was going for.

There are upsides and down sides that come with being a good doctor. Or being a doctor, period. One of them is that you become a nightmare for your family's doctors.

Okay, maybe I'm not a nightmare, but only because I work at being more reasonable. And I'm not sure how often I succeed...

So my father calls me this morning. No, wait, let me back this story up even further. I call home Thursday night, and my mother answers the phone, and the reception is terrible. I assume it's me, so I'm wandering all over the house, and it doesn't get better. Meanwhile, she's being all evasive. I finally get tired of piecing together words and phrases across the cell phones (it's cheaper to talk cell-to-cell under our family plan) and was like, forget it, I'll call you on the house phone.

There's a pause. She finally says, "Uh...we're not home."

Oh, okay, so they went out. On....Thanksgiving...but, okay....I ask where they are, and there's another pause, and she tells me they're at the little community hospital by their house. At which point my stomach curls up into a cold little leaden ball. Because my dad always goes back to the hospital where I went to medical school when he's sick. The little community place by them is actually pretty good, but all his doctors are at my med school, it's a tertiary care center, they know him well, etc, etc...the only time my dad goes to the local place is when he goes by ambulance.

Or, it turns out, when he does something dumb that doesn't actually require the hour-long drive to the tertiary care center.

So my father - older, on steroids for his COPD - is coming down the stairs on Thursday carrying something, and whacks his hand on the side post. Which tears a three-inch flap of skin off the back of his hand. What does my dad do? Smooths the flap BACK OVER THE EXPOSED TENDONS and goes about his day (Daddy, I love you, but these are the times I wish I still lived close enough to smack you upside the head). So, finally, at some point later (as the story was told to me....I suspect my mother's influence in this turn of events), he decides, you know, maybe someone who isn't me should look at that. Two hours, several stitches, and one bottle of PO antibiotics later, all is well, and my still-completely-nonplussed father can't understand why I'm all exasperated that it took him so long to go to the hospital.

So this morning, I get up early (all I was doing was lying around coughing anyway), and trek out into the cold and rainy with the goal of beating all the other people to the Target (and also of buying an area rug for the front room). I get out of the receptionless Big Box Dead Zone and I have this voicemail from my folks. At 8:00 my time. And I'm all, why on earth did they think it was a good idea to call me that early...and then I hear my father's tone of voice. And I get this far through the message - "Hi, Kate. It's us. I woke up this morning and my right knee's really sore-"

Which is when I hung up and called home to tell him to get his ass to the hospital. Right about the time the paramedics were arriving.

And so there's all this fuss which ends with my dad in a private ambulance on the way to my medical school and the Fire Department medics telling the contract service, "His daughter's a doctor in North Carolina, so if he gives you any trouble, call her and she'll yell at him."

I...um...if it weren't true....

So what do *I* do? I pick up the phone, call my med school hospital, and have the Ortho resident on call paged. Because that's the logical option, right? An gosh, it was just such a characteristic exchange.

I called the operator, right? Asked if she could page the ortho resident on call. I gave the story, the patient's name, date of birth. She asks for a callback number. Was I calling about a transfer? No. And the she asks what my name is.

I gave the usual last name, but I gave my first name as "Doctor."

Because I know if I see "Dr. Smith 888-555-1212" on my pager it means whole other things to me than some random name with an out of state number. So this little intern gets on the line, all full of attitude and already exhausted at 9am (don't worry, hon, I remember what it was like to be a surgical intern). I an hear the OR monitors beeping in the background. I had a small moment of, ohhh, maybe I shouldn't have called. But I held my ground.

I told her my name and that I was a physician out of state

(get it out there right up front. Both a demand and an apology)

and that my dad was a patient of Dr. H's who'd had bilateral TKAs in the past

(so, yeah, I speak your language)

and now has an open wound on his hand and woke up with severe pain in his knee this morning.

(which, I expect you to know what I'm angling at, here. You'd better be on your game)

I give her a little more, remind her that I'm out of state and haven't looked at the knee, but according to my mother there's a one-inch area of redness. So, should I send him to her or should I have him go to the nearest ER to get antibiotics started as quickly as possible?

She's like, well, I can't tell you over the phone what's wrong.

(No shit, kiddo.)

We fumble with this for a minute. I throw in things like, well, you know, I admit I haven't done any ortho

(although my advisor in medical school was an orthopedic. For four years. I did several dozen knee and hip replacements with him)

in like five years

(I've been a doctor longer than you have)
(For those of you playing along at home, this does not make me right, but it gives me seniority. Which is everything in the surgical world)

but my memory is that it's pretty imperative to start antibiotics as soon as possible if there's any question of infection at a prosthetic joint.

(my hackles are up. I'm not showing my teeth yet, but, don't fuck with me)

She says, is it swollen? An inch of redness doesn't make it a septic joint. But he's welcome to come to us if they want to drive out here.

(so, an equal display of, you don't scare me)

I say, they're headed to one ER or the other. In an ambulance.

(a low little growl)

She says something about not being able to judge it over the phone. I say, "okay, so the question is..."

(I haven't told her what specialty I practice yet, but "what is the question?" is something that consultants use a lot. Which actually doesn't narrow the field down much, but establishes that I'm someone that other doctors routinely ask for help. The fact that *I* posed that phrase to *her* - the actual consultant in this scenario - is a total display of power. Power that I don't have - 850 miles away. Family member, not a treating physician. Psychiatrist, not an orthopedist - but it works. She rolls over)

Well, she says, yeah, I mean, tell him to come in to our ER,

(as in, don't expect me to be down there waiting for him. She hasn't rolled over completely)

the ER doors are always open.

(but I've flustered her and established the upper hand)

And, then we can consult Dr. H's team as soon as we know what's wrong, and his records are here, and yeah, you know, it's just hard to know over the phone.

I say, tell me about it.

(I know I'm being a pain in the ass)

She says, yeah, and it's hard because it's your dad.

(I understand. I'm just as much of a pain in the ass when it's my family)

We hung up, I called my mom back and told her they were aware he was coming in.

Amazing how much goes on between the lines, though, isn't it? And that's the Cliffs Notes version.

At so many points in that exchange could I have gone off on her (Listen, newbie, my 77 year old father, who's on steroids, and has two prosthetic knees, and has now failed PO Keflex and likely has a festering infection in his joint, he's coming to you, so don't fuck it up, because if he loses his joint who do you think I'm going to come after?) but...that's just counterproductive. I'm not all that interested in the politics of it, and if he's going to lose the joint he's going to lose the joint. Plus, I actually was asking for her advice about whether or not delaying treatment by an hour would make enough of a difference to warrant going to an outside facility with fewer resources. This is not about my ego, my power trip, or my need to defend myself from narcissistic injury.

But so often, with medical family members, it is. Because they're worked up and scared and trying to fall back on their favorite defense mechanism - intellectualization - and it's failing them, because they're not in the driver's seat. And in general, doctors really like driving the bus. So some can get pretty nasty when you tell, say, an oncologist that the appropriate treatment for his psychotic daughter is not what he thinks it is.

And a lot of times, a little bit of knowledge is a dangerous thing. See above re: oncologist. If we're talking about a patient, and that rational distance is there, it can go very differently. Quite often, when my patients are getting what I think is not substandard care (or maybe just a little substandard) from another specialist, but not necessarily what I'd do, I'm willing to throw up my hands and say, well, if you don't tell me how to practice psychiatry, and I don't tell you how to practice nephrology, eh, the patient will probably be just fine on both fronts.

(I'm very protective of my patients, though, so while I may not challenge them directly, you can be damn sure I'm keeping an eye on things.)

However, when you lose that detachment, maintaining that same perspective becomes almost impossible. We make pains of ourselves at best; at worst, we get in the way.

What's a doctor to do except know that about themselves? I try hard to be nice, to listen and learn, to be respectful even when I'm getting attitude, and try to be really appreciative when my family's doctors take the time to speak my language. And when I'm on the other side of it, I try really, really hard to be thoughtful and accommodating and understanding and empathic.

So if you're wondering how this story ends, they admitted him, but so far everything looks okay. They tapped his knee (sounds better than "stuck a long needle in it and drew out fluid", doesn't it?) and found more inflammatory cells than they'd expect, but no frank bacteria. So right now we're on the watch-and-wait program. His ortho's going to see him in the morning. We'll see what the big boss thinks.

And, the resident I talked to swears to my parents that I didn't offend her at all when I called. So, maybe I'm doing a decent job of staying on my chain after all.

Have a couple of drinks and quit discriminating

This has been a Luda Service Announcement.

(The new Ludacris album dropped on Tuesday, I picked it up this morning. It's ridiculous how much I love this song.)

Today was slightly more productive. I actually got a fair amount of stuff done around the house today, even if I didn't get everything done I wanted to, or didn't wake up until 10:30. Sparrow and Peng helped me move some stuff into the attic, so the house looks a little less cluttered. I still haven't figured out the best use of the space yet. But I really need to get this stuff organized and freakin' move in. I mean, I've only lived here five months...

It's rough being neurotic sometimes.

I understand why I never really unpacked in at the old place - I never actually believed that they weren't going to fire me. Not because anything at the program indicated that they were going to fire me, but, because life at the Emerald Palace was so tenuous, and they clearly never intended to let me get to second year.

But now, here I am, in a whole new year, and a whole new house, and I really don't think I'm going to get fired. Yet, I'm still surrounded by boxes, have no seating, and can't get my shit together to actually unpack and find places for my stuff in the new house. Now, though, now I think it's just because I'm crazy. Not to mention perpetually exhausted.

Urg.

Lazy Sunday

I keep forgetting it isn't actually Sunday....and I still have two whole days off! I think every weekend should be a four day weekend...

Maybe I don't, actually. Because even though it was only three days long, this work week stunk for almost everyone I know.

Today I did next to nothing, which is very different from what I had planned, which was far from nothing. I slept until noon, then finally got out of bed at 1 (well, I was postcall yesterday, and had only slept two hours on Wednesday night, and then was up all day yesterday, and let's face it, I haven't slept well all week...). Maggie and I went to the Petsmart, went for some dog food and a new retractable leash (the old one died. I mean, I've only had it for five years...), and a PediPaws. I think this may be in the same league as the Furminator, y'all. It's a little rotating drum of sandpaper and so it files your dog's nails down, rather than cutting them. Maggie actually tolerated it really well, and she NEVER lets me cut her nails, so they're always like a mile and a half long and she keeps going clickity-clickity-clickity on the wood floors.

We also got a few "wow am I tired oh look isn't that cute!!" purchases....

One was a puppy Kong. Maggie's never been a fan of the Kong, but so many of our friends' dogs swear by them, that I keep trying. And Maggie's been doing some weird things lately when I'm gone, digging through the trash, chewing up non-food things, that kind of stuff, which tells me that she might be getting a little anxious and/or bored. And we already know how guilty I feel leaving her at home at all, much less as much as I do these days. So we're looking at Kongs in the store today, and they have new ones for puppies that have teething rubber. Which, I've long thought that the regular Kongs hurt her teeth, so, I thought, hmm...let me tell you, she loved it. I threw some treats in there, she spent hours playing with that thing. We may have success after all...

We also got...I'm such a bad owner....matching little reindeer coats for her and Little Maxine. With antlers that light up. Ohmigosh if it isn't the cutest thing ever.

We went over to Sparrow's for dinner tonight, and oh, look at the cuteness...



I'm hoping for Christmas card cuteness before the month is out, but neither of them was exactly thrilled with the outfits, so, we didn't quite get the photo op I was hoping for. But, we'll keep trying.

Meanwhile, Little Maxine got back at Maggie for stealing her bed on election night...

Oh, the cuteness...

Anyway. That's about the extent of my productivity today.

I stopped at the Panera on the way home from Petsmart for soup (they were out of bread bowls, I was sad), and then did a whole lot of nothing until we went to Sparrow's. Well, that's not true. Look what I started:


It's two toes. At the same time. On one big ol' Addi Lace. And so far I haven't even knitted them together once. The yarn is this Koigu KPPPM that Jenn sent me for surviving my intern year. Mmm, it's yummy. And I really like the way it's knitting up. I just have to pick a stitch for it - I've gotten really bored with plain old stockinette socks, but, I can't do anything too complicated if I'm going to knit in lecture, which is really my prime knitting time all week...

Good girl

Barb's old girl Sydney passed away yesterday. Mags and I are sad for the Coopers. Syd was one of those outstandingly wonderful packmates that really make you remember just what pure and sincere goodness dogs are.

She loved well and she was well loved. That's about all that any of us can ask for.

OMG, what-ever!

Ahhh...it's nice to not be the only nation with a bumbling, idiotic leader who spends so much time with his foot in his mouth he has Athlete's Tongue...

But then, also on CNN.com today, the same world power proves that there are some areas in which same-sex couples cannot ever expect total equality - or rather, it cannot be expected of them.

(The last line of the above article also makes me wonder a little what kind of snake charmer is selling the Japanese their polar bears.)

The US for so long has been the world's petulant adolescent, Japan one of the wise elders. Sometimes the generations really do have a lot in common. Next thing you know they're going to be text messaging all night and...wait, I think they're already responsible for the Wii...

Happy Turkey Day, y'all.

I'm finishing up the end of my call night and so looking forward to the four day weekend. There's a big fat nap in my future (assuming I can stop coughing long enough) and then I'm off to my aunt and uncle's for a lovely evening of tryptophan and that silly jellied cranberry sauce (love that stuff). Hopefully I'll have something more productive to say for today after I've slept...