Thursday, January 31, 2008

Ding, dong....

We got a new senior resident on our team today.


Hall-e-freakin'-lujah.

So I wrote this whole post, which Blogger promptly ate. Argh. But really, the point is, Betsy is GONE! Yee-haw! Our new resident is very nice. She may prove to be a little useless, we can't tell yet, but useless and pleasant beats the heck out of useless and narcissistic and controlling.

The other point? Don't believe it when it says it saved....

Wednesday, January 30, 2008

Thanks for your patience

That's actually an Alanis Morrisette reference. When I originally titled this, I wrote, Thanks for your patients. And then went, hmm, that doesn't look right....why?,,,,,

Hmm.

I'm so tired. As Barb so astutely pointed out to me, this is the sort of tired sleep just won't fix. Although it doesn't help that I'm so sleep deprived. And like, today, I had all these great plans for when I came home. Actually, I had all these great plans when I went in. Betsy was going to be gone all morning for her academic stuff that the Family residents do on Wednesday, and we only had 6 patients between us, and I only had to see two this morning, so I came up with this great idea that I was going to be ready to sign out when she got back (she was on call today) at like noon or one or something and then I was going to make Mike go have lunch with me at the Cajun place we keep trying to get to (but they close for the afternoon at 2:30) and then I was going to go to sit and knit at the yarn shop which is right down the street from the Cajun place and then I was going to come home and write this great post I've been composing for two days in my head and then I was going to do a couple other things and then be in bed by nine and ahhh, what a good plan.

It didn't quite work that way. Mike and I made it out of the hospital around 2:15. And we did go to lunch, but we went to this New York style pizza place in downtown Chapel Hill. Not bad, interesting pizza, good beer. We stayed and chatted until about 4ish, I got home about an hour later, and was like, okay, gonna do this and this and this, but then I was like, I'll just lay down here on the couch for like a half hour....and I woke up twenty minutes ago. And I would've just gone back to sleep except I have a phone call I have to make at 8:10....

I'm just so tired....but on the plus side, I did get to stick a needle in some guy's belly today and drain off two liters of fluid. I haven't done that in about three years. That was pretty darn cool.

Tuesday, January 29, 2008

Begin at the beginning

A piece of advice from the episode of CSI that DSR'd last night. It's one of my favorites. It's all about being saved.

I really need to go to bed. More tomorrow, I really, really promise.

Monday, January 28, 2008

Postdates

(That's an OB joke)

Look! My first official post-dated post.

More when I get home. Call was a monster. Someone died, but at least it wasn't me.

Sunday, January 27, 2008

Post-Holiday Blues

So this afternoon was the psychiatry department Christmas party. Yes, I know it's January 27th. What we actually have is an annual Post-Holiday Blues party. Which, is funny, for a bunch of psychiatrists. Here's the rest of why it's funny.

The blurry guy on the right, with the guitar? That's my department chair. The woman on the drums (whom you can't really see in this picture, from the Treo) is his wife. This is Dr. R's blues band.

Post-holiday blues.

It was a fabulous party, at this funky little divey place in nearby Carrboro. A lot of my classmates were there. Some of the upperclassman came. A few of my favorite attendings, er, attended, and my program director was there. We drank. We danced. I finally met Fang's little blonde girlfriend (whom I like). Mike wore a leisure suit. Which led to me having a long discussion with another classmate's husband about what exactly was so leisurely about the leisure suit. I pulled out the FMBs - not that anyone could see them, because I was wearing long bootcut jeans, but they make me tall. They also hurt like hell, what with all the standing, and the dancing, which I'd sort of forgotten until I hobbled out of the bar at the end of the evening. But damn they look good. Even if I'm the only one who knows it.

Saturday, January 26, 2008

It wouldn't be so funny if it wasn't dead-on true....

I had dinner at PenguinShrink and Chef's tonight. The food was wonderful, the company was delightful, and I haven't had that much wine in a long time (but it paired so well, so what could I do?). Plus, Chef showed me this. Watch. Laugh. Enjoy. Perhaps forward on to all the anesthesiologists you work with (ahem, Mom).



There'll be a substantive post tomorrow, I promise.

Friday, January 25, 2008

Some nights I'd be better off as a real call girl

So, here's my call in a nutshell: At 3:30 this morning, I called my shrink and left her a message asking if she still had that noon appointment open.

One of the points we're "working on" in therapy is how I never call her between sessions if things are bad.

Oh, my God, last night was pure hell.

We had nine admissions. It was a busy night. And in fact, we got ten....except that the person I started admitting at 6:30 this morning...okay, that was a disaster. The psych resident saw this woman and said, well, gosh, I'd admit her, but we don't have any room, so, see if primary care will take her, sorry (um, how many people do we send out to other hospitals because we don't take their insurance or we're full or whatever?). She sees an FP, so they called me. I couldn't find the sheet that says which Family practices we admit for, but they have a copy in the ER, and the name sounded familiar, and he'd just woke me up from my five minutes of sleep I got last night, so okay fine. I was already pissed because this was a dump from psych - she came in because she was depressed and needed psychiatric help and when I got down there...ohh. She was this sweet, sweet sixty year old woman with a 20 year alcohol history who came in because she was depressed and drinking too much and she couldn't handle her life because she has lung cancer and her husband of almost 50 years is dying of brain cancer. I reassured her husband and her son. I held her hand. I did the most thorough psych intake exam she could possibly have gotten on a non-psych service, despite the fact that I had a large pile of patients to round on and a ton of work left and only like a half hour to do it. But how could I not admit her?

Well, apparently, I can't. Because we don't contract for that practice. So my on-call senior was going to call the ER and have her go to internal medicine and "take care of it."

I just spent how long reassuring the whole family I'd take care of her. That she'd be well tended and she'd have two psych residents on her team and her family trusted me enough to finally go home and now I wasn't even going to go down and tell them I couldn't admit her?

Thinking about it after I left today, I should've fought it. I'd already done all the work. I should've argued for her to come to our service.

But the real problem was the patient I admitted Wednesday before we left. She turned out to be a raging nightmare. She made me cry four times. I think I managed not to cry in front of her, but I cried in front of the nurses. In front of my attending at 11pm. In front of Mike and Betsy this morning. I've only had one other patient this whole year who made me cry and she was a crack whore sociopath.

The reasons she got to me so badly just go on and on (hence, the call to my shrink), but the root of it really was that she's someone I consider a friend. And I tried. I tried so hard to take good care of her. She sucked me dry last night. And to her credit, she called and apologized this afternoon. And, she's really sick. And she's got her own stuff going on psychologically. Which I understand - believe me, no one can relate to that kind of ingrained PTSD better than I can. But between spending my whole 30 hour shift wholly investing myself in her care, and, you know, the other ten patients we admitted, and oh, the twenty five or so I was cross-covering.

But this was really nice - My senior got to bed a good hour and a half before I did, at least. I finally got up to the call room at like 5, right? It's actually a call suite - there's a little bedroom with bunk beds and a common room with a computer and a TV and a futon. I always sleep ("sleep") on the futon. I usually leave it folded up, because I like to snuggle up against the back (I sleep with my bed against the wall at home). But anyway, I walked into the call room, and found the futon out and all made up with two pillows and a couple of warm blankets and the sheets turned down, waiting for me.

Betsy redeemed herself a little today, too. She was really supportive and did a good job trying to get me out today. She also tried to make it more about her and at one point outright called me fat, but, at least she said she'd want me on her side in a fight.

I'm really having trouble with how "out of control" I got last night. I can't believe I let anyone see me that upset. I can't believe I cried multiple times in front of people. Betsy and the Duke resident both made the comment, "I've never seen you like this!" Like they've known me for so long, you know? Still, I don't like it when the cracks in my carefully crafted facade are exposed. And I'm not sure Mike took my unhingement all that well.

And of course, me "unhinged" mostly involves crying while continuing my usual get-things-done shtick, and is still more way tightly bound than some people on a good day. But I don't much care how well they can hold themselves together.

My attending handled it well, actually...I think we were sort of in this together, which helped. He's normally one of the most unflappable people I've ever met, and this situation clearly had him...um...flapped. I mean, he needed to be the point person on this, and I kind of had to push that on him a couple of times (including a text page I sent him at about 9 or 10 pm that literally said "HELP. Sarah's out of control"), but he ultimately took the brunt of things this morning and was remarkably firm and really just did an excellent job this morning trying to lay down strong boundaries. I learned a lot from him over these two weeks, mostly in the behaviors he's modeled. The past 48 hours were obviously no exception to that.

Meanwhile...I'll call Sarah back tomorrow. We're going to be fine, at least from my end; I know this is beyond extenuating circumstance for her. And by the time I get back to work on Monday she'll be home recovering and all will be well.

Did I mention I have the whole weekend off? It's my "golden" weekend (postcall Friday, whole weekend off. So, um, sort of like the real world. Not sure what exactly is so golden about that, but, you know). I'm so excited about that, I can't hardly tell you. I think Maggie's a fan, too.

Thursday, January 24, 2008

I cannot go to work today....

A little classic poetry from my youth, by Shel Silverstein. It just sort of sums up how I'm feeling this morning....


"I cannot go to school today"
Said little Peggy Ann McKay.
"I have the measles and the mumps,
A gash, a rash and purple bumps.
My mouth is wet, my throat is dry.

I'm going blind in my right eye.
My tonsils are as big as rocks,
I've counted sixteen chicken pox!
And there's one more - that's seventeen,

And don't you think my face looks green?
My leg is cut, my eyes are blue,
It might be the instamatic flu.
I cough and sneeze and gasp and choke,

I'm sure that my left leg is broke.
My hip hurts when I move my chin,
My belly button's caving in.
My back is wrenched, my ankle's sprained,

My 'pendix pains each time it rains.
My toes are cold, my toes are numb,
I have a sliver in my thumb.
My neck is stiff, my voice is weak,

I hardly whisper when I speak.
My tongue is filling up my mouth,
I think my hair is falling out.
My elbow's bent, my spine ain't straight,

My temperature is one-o-eight.
My brain is shrunk, I cannot hear,
There's a hole inside my ear.
I have a hangnail, and my heart is ...

What? What's that? What's that you say?
You say today is .............. Saturday?
G'bye, I'm going out to play!"

Wednesday, January 23, 2008

Somebody's gettin' on my nerves...

(Missed the reference? Click here. Before I forget that I'm a lady and give 'em what they deserve.)

People are driving me crazy tonight.

Today was a weird ass day. It was Wednesday, so all the Family residents scampered off to their academic stuff all morning. Which meant it was pretty much just me and Mike and a bunch of attendings. We rounded, I got my notes done, and was more or less ready to leave at noon. It was a nice morning, actually. Mike and I got stuff done, Betsy was gone...and then the attendings started talking about how Sarah, my attending from two weeks ago (remember her?) was in the ER and coming on to the Family Medicine service as a patient.

I like Sarah. She's kind of a lot sometimes, but she's a really good person. And we'd already agreed that we needed to stay friends after she relinquished her position of authority over me. So I went down to the ER to make sure she was okay, offer to take care of her dogs, whatever. We got to chatting and I said, Red Team's admitting, but you know they're going to let you decide whatever team you want to be on, so I'm sure you're just as good to go on Green. And she says, can I come to the your team? I said, of course. And promptly called the covering attending and told her that Sarah wanted to come to the blue team and I was already down there, I'd do the H&P and take her on as my patient. Even though, you know, I'm on call and thus the admitting resident tomorrow.

The attendings appreciated it. Sarah appreciated it. I'm not sure the on call residents were as thrilled, but, should they really care? It's an admission they didn't have to do.

And then I discovered my really manipulative patient we discharged last Friday was back. The one who was so freakin' personality disordered and like ate my whole day and then frakkin' Betsy comes in and plays right into the manipulation and triangulation and the next day we discharge her and she wants Betsy to be her real doctor (a-ok with me, sister, even though someone in my line of work is so much more what she needs. But, please, go play dueling Borderlines, with my blessing) and Betsy sends her out the door with pain meds. Wait, let me rephrase: Betsy sent a known narcotic dealer and abuser out of the hospital with prescriptions for oxycodone, oxycontin, and ambien.

My mind boggles at the street value alone of this little hospital stay...

So she's back. First, the on-call resident tries to get me to do that H&P too, even though, um, I'm NOT ON CALL TODAY. And then Mike and I decide that she clearly needs to be Betsy's to follow, because the patient and I do not get along (because I'm a hardass that sets limits), and because she's technically Betsy's primary care patient, Betsy should see her anyway. So I gave B the courtesy of text messaging her this info - she's yours to follow in the am, and oh by the way, we picked up Sarah on our service. The flurry of texting that ensued just pissed me off on so many, many ways. Suffice it to say, I'm seeing the sociopathic patient in the morning, along with my other four patients. Despite the fact that I'm on call tomorrow and thus admitting. Know why I have to see her? Because Betsy has afternoon clinic, and so she can't possibly see ONE FUCKING PATIENT tomorrow.

I'm so ready to be done with her. Which will be Monday. And I have the whole weekend off. Thank God.

And just to add injury to insult to this day, Mike and I escaped the hospital about 3 and went to this cute place in Carrborro for lunch. I fell down. On the way in, before I'd even had anything to drink. In the middle of the street. Tripped over my shoe. In the middle of the street. Boom. Scraped my elbow. Felt like a moron. Mike, fortunately, picked me back up, hugged me, and then plied me with really good alcohol. It was an excellent response to the situation. I still feel like a moron. But at least lunch was good.

Tuesday, January 22, 2008

Cowgirl and Pumpkin

When we were in medical school, my friend Karen had this propensity for making up little songs. They were usually impromptu, funny, and endearing, although rarely Grammy material. There's one in particular that's stuck with me over the years. She made it up when she was on call one night, I think on surgery. I often find myself singing it in my head in the wee hours of my calls, and every now and then on nights like tonight, when I'm just freakin' tired. It goes like this:

I'm a tired cowgirl and I wanna go to bed
That's what the tired cowgirl said.

Simple. Succinct. Capable of being stuck in one's exhausted brain like a sing-song little mantra.

I am a very tired little cowgirl.

Pumpkin the Wonder Mutt over here just buried my cell phone in the blankets on the couch. I think that may be a subtle attempt at telling me that I need to stay home more. She's been getting very upset in the mornings when it starts becoming obvious that I'm not going to be staying home that day. I feel bad, but she deals with it okay. Soon enough, puppy, soon enough.

And in case you're wondering, yes, that's still Maggie I'm talking about. She has many nicknames. Her full name is actually Margaret Mae (and then we have the same last name), but she's also known as Maggie, Mags, Mutt, Muffin, Pooch, Spoochie, Baby, Pumpkin, Dog, Goofball, Nutbutter (which is an extension of "Nut"), Punkin Head Doggie, Crazy, Magpie, Skilimou (which means "my dog" in Greek), and Best Girl Ever, to name a few. My old roommate used to call her Magglio, after the White Sox player (knowing full well that Maggie is a Cubs fan). What's amazing is that, a, at this point she answers to any and all of them (as well as things like "Donde esta mi perro?"), and b, they're still better than her original name when I got her at the shelter, which was Sweet Pea. Which, she's so not a Sweet Pea. I mean, it still pops up occasionally as a term of endearment, but, as her actual name? No way. She never answered to it, and I refused to use it the first few days she was mine, which meant that she didn't actually have a name. And then about three days after I got her we were sitting on the back patio under the stairs that led to the second floor mother-in-law apartment, and we were playing and I looked at her and I said, "Your name is Margaret, isn't it?" And she licked my face, and so it was.

And it's quite possible that was the last time I called her by her given name that she wasn't in trouble for something or about to get into trouble for something.

Have I mentioned that I'm exhausted? I think he q4 thing is already getting to me, but I also was thinking in the car on the way home tonight that I've really been dealing with a lot of the more concrete manifestations of illness than I'm used to. Like, today Mike and I googled one of the patients we discharged home late last week (to hospice) and discovered that she'd died on Sunday. She was such a sweet little old woman, and oh my God, she was so miserable. She was in so much pain there at the end (she's the one, for those of you who've heard this story, who GI came in and did a somewhat urgent colonoscopy on her at midnight during my first call). And I as thinking about her on the way home and how horribly swollen her legs were, to the point that they were disfigured and the skin was all translucent and they looked almost unreal. And then I thought about how many times I've seen that in the past month. How many diseased and distorted variations I've seen on the physical human body this month. Not that I'm not sort of used to that, it's just so much more in your face, so much more concrete, than what I've become "used" to dealing with. Which, it strikes me, is a reason so many people don't like doing psychiatry, because it's so abstract and kind of existential and so rarely concrete. I think that's actually a little bit easier for me, a little more congruent with my way of thinking. I wonder what that says about me....

Well, whatever. Snugglepuppy and I are going to bed.

Monday, January 21, 2008

Nap, interrupted

Oh, I was having such a nice nap until Mike called and woke me up. But, whatever, if he wants to be all "responsible" and find out about the patients he has to see in the morning, fine. And then he starts telling me...he had his first medicine call at State Hospital this weekend. He hasn't done the medicine service yet, so this was a little bit of a trial by fire thing anyway. But I assured him, dude, so not anything to stress about. Saturdays are slow at SH, oh my gosh I got so much knitting done last month, really, you'll be fine. So he tells me that he ran all day. First thing when he gets there, he has to transfer someone out to a real hospital. Then he has an admission. They paged him all day long for all manner of things. And - are you ready for this? He had a code.

PenguinShrink and I had a multitude of Medical Stats, which are a step down from calling a real code. We still ran to them. They still brought the crash cart. And usually it meant that someone had DFO'd (done fell out. They do that in the South). And occasionally we had to call an ambulance. But I don't think they've had a real Code Blue called at State Hospital in at least a year.

No, really. Piece of cake. I got so much knitting done last month.....

My call yesterday was not nearly so bad. We had four admissions, no one was super sick. I spent a lot of time coordinating stuff and had a couple of weird outside calls. But on the whole, it was a fairly chilled out day. Two down, five to go.

I talked to my friend Bianca back home today. You remember her as the mother of my nephew Basil. She just started repping for a line of really wonderful children's books called Barefoot Books. It's a grassroots company started by two women from Texas who abandoned the corporate life and started up something they hoped would make a difference. They've got stories from all over the world and they're just beautifully illustrated. So all of you folks-with-kids type people, or you other people who might know some kids who like presents, should go check it out.

And then my best friend emailed me this. This is a cute puppy.




Also gives me a better perspective on our half an inch of snow. Although it's freakin' cold down here in NC. It was 17 degrees today when I left the hospital! Brr-rrr! I mean, okay, back home that'd be pretty warm right now, but we're not set up for the cold down here like they are up north!

Alright, I think it's time for me to meander towards my bed. Because I have to go back to the hospital in the morning. As always. Wow, I'm really tired. Kind of in general.

And don't worry, Paige, I'll post about my tat by the end of the week.

Sunday, January 20, 2008

Blues in the night

So, I'm on call. And my team (although, on call, we cover all three teams) is the blue team. Hence the title.

It's been a slow day, which almost guarantees us a bad night. I guess we need something to look forward to, right?

I'm on call with one of the third year Family residents as well as the Duke resident, who's also a third year. It's been a fine day. We ate well. My senior's husband came by with her ten month old little girl, who's just the cutest little thing ever. I ran into my med student from State Hospital, who's on Surgery now. And we even took care of some patients. Not a bad deal, really.

Guess we'll see how the rest of this night goes.....

I have more to say, but I think I'll say it later. Keep your fingers crossed for me that we maintain our smooth sailing.

Saturday, January 19, 2008

Snow and Ink

So I'm driving around doing errands this morning, and I hear this story on the radio. Apparently the chief surgery resident at the Mayo Clinic in Scottsdale just got fired because he took a picture of a patient's penis with his cellphone during a cholecystectomy and then showed it to his friends. Horrible, right?

I'm having a little bit of trouble feeling sorry for this guy.

Yes, that was really unprofessional behavior. Yes, that was a violation of his trust and the doctor-patient relationship. Yes, the surgeon really should've known better than to create evidence. And it was jocular and silly. But...the guy had "Hot Rod" tattooed on his penis.

Not for nothin', but...hmm. Did you not think that would attract some attention? I mean, I have an unusual tattoo, too (different from a ta-tutu), and I knew when I got it that people would comment. And mine's nothing like that. So, come on, bud. What that resident did was wrong, but, really, the way he's carrying on and being all outraged and horrified is a bit...dude, you let a total stranger with a needle tattoo the words Hot Rod on your penis. Not to mention that now everyone in the literate universe knows about your, um, little secret. I? When that doc had called me, would've been like, fine, sir, whatever, let's just never mention this again.

We're not even going to talk about the number of times I photographed women's genitalia during surgery when I was a GYN resident because they had some clinically interesting or relevant finding. A couple of those pictures even got published, I think, in a journal article, of one woman's vulvar cancer. Not the same thing, I know, but, I'm not sure we told very many of those people we'd taken pictures of their cooch. Our ability to take photographs during surgery is in the standard release form. Now, I concede that the "clinical utility" of these Mayo photographs is questionable, and I was either taking them with the hospital's digital camera or a laparoscope, not a cell phone...but anyway...

In other news, it's snowing in North Carolina.

I think it's sort of funny. In the few hours since I started this post we've actually had some accumulation. We're supposed to get more tomorrow. Maybe it will keep people home and make for an easier call night? A call girl can only hope.

And in still other news, Tiny Tyrant sent me some very cool sock yarn in a yarn swap. Which I promptly tied into a great big knot (with the help of my ball winder) that took me two episodes of Bones to untangle today.

It's very cool. I'll post more about it later now that it's in actual balls and I have a tiny bit of it knit up. Maybe I'll have some time to write tomorrow (keep your fingers crossed for me), but right now, I've got to get to bed....

Friday, January 18, 2008

Something worthwhile

I rarely endorse those click-for-a-cause sites, but, I'm a little partial to shelter dogs, you know....so click here, and feed them. I'm thinking about putting this link in the sidebar, even.

So much to say. And so very tired, so, going to say it tomorrow....

Thursday, January 17, 2008

1 down, 6 to go

So, my first Family call has been survived. My upper level said he felt useless.

It was a moderately busy night, and things kept coming in a steady stream. But it was an emotionally draining night. And even more so today. I'm so freaking tired I can't even really see straight. Maybe I'll write more later. I'm hoping to, but I would really like to sleep a little and there's a recruitment shin dig I really want to go to tonight...we'll see how it goes.

Wednesday, January 16, 2008

Testing, 1, 2, 3...

Okay, apparently I can blog from the hospital, or at least here in the FP call room (remember how I could never actually log in when I was on call for Neuro?). We'll see if I have time and/or privacy enough to actually write anything of substance later. As for now...wish me luck tonight!

Tuesday, January 15, 2008

On the runway

I have the cutest dog ever. No, really. I have photographic evidence this time.

My dear, dear friend and fellow fiberworker, Penguinshrink, was kind enough to make me a Christmas present (hers? Unfortunately....ugh, still a ball of yarn....maybe for her birthday...). You'll remember her as my partner in crime from the mass crocheting of the Intern Retreat gifts. She's a fabulous crocheter and in fact, on said intern retreat, helped me figure out a problem with my technique which has made my crocheting a whole lot easier. And she's also a darn good doc and a kickass co-intern. Girl, you rock!!!!

She made me a very lovely shawl and hat combo. Just perfect for the climate down here. The color is fabulous, the yarn is soft, it's quite wonderful.

And you know I have this policy about not putting pictures of myself on the blog. But it didn't seem quite right to just do the standard laid-out-flat-on-the-couch picture.

Fortunately, I was able to find a model.

Now, Maggie has those big coyote ears, right? And she really doesn't tolerate having anything on her head for very long. But she did okay with the hat.



Actually, she was kind of a ham.



Come on, come on, give me attitude....



Work it, girl. Yeah, yeah, good girl, goooooood, good girl.



Seriously. This dog cracks me up.

Oh, and PS, she clearly approves, because as soon as our photo shoot was over, she promptly stole the shawl and buried it in the couch cushions. You know, for safekeeping. She does this...

Monday, January 14, 2008

Theoretically possibly potentially

So you remember my patient who had the stroke and had to shave her head and then I knit her that hat?

I'm in our 11am teaching conference today, right? And I get this page. And it's the research nurse from Neurology. She's like, hey, do you remember me? I said, of course I do. And then she tells me my patient with the stroke is in clinic for her 60 day follow up (wow, has it really been that long?) and would really love to see me if I could get away.

Of course I could.

She looks fantastic. Amazing. I think she talks better than I do right now. She has no motor deficits. And holy cow, is she rocking out the short hair.

She was so excited to see me. She hugged me twice. Her fiancee was also thrilled to see me. Wow, I can't believe how good she looks. And I can't believe how happy she was to see me again. Or how impressed with me the research nurse was. I....what did I do, really?

You know, I think maybe I'm a good doctor.

And I don't mean that sarcastically. It was sort of an interesting day in that regard...Betsy spent a lot of time undercutting me today. She laughed at me when I suggested on rounds that nebulizers were equal in efficacy to metered dose inhalers (they are. There's data). She acted like I was being ridiculous when I went to give my pneumonia patient a flu shot (it's protocol) and then called me five minutes later to tell me to give her a flu shot. She kept telling me that I needed to present in a problem-based format. I finally said, "um, I thought I was." She pointed out that if I'd really been organized, the attending wouldn't have had to go back over the systems after I was done. Not that it was his first time meeting our seven fairly complicated patients or anything like that. Not that he needed to get a lot of information organized in his own head.

This all, of course, after she called me last night to tell me Mike was off today and so I then had to round on all seven patients. Because she was on call today (they don't really start admitting until noon. There was no way Betsy was going to be holding the call pager. And in her spot in the rotation, there are three residents, not two like every other night, because the Duke resident takes call, along with her and an intern). So she couldn't possibly write any notes.

For Pete's sake.

My shrink and I had an interesting conversation the other day about what it meant for me, symbolically and fundamentally, to be sequestered with an actual bad resident. In the context of my old life where I was just told over and over again that I was a bad resident, when in all likelihood, I really wasn't. I mean, I'm not a different doctor here. And my patients loved me there. I won a teaching award from the medical students. Several patients complained bitterly when I left. But if you'd asked me then....if you'd asked me a lot more recently than then...I would've agreed that I was a worthless human being and a dangerously bad physician. They had me convinced for a brief while that I shouldn't be allowed near actual patients because I was bound to do something harmful. Not that there was evidence of this, but, they had me convinced.

My shrink had a term for that, too. It was, "brainwashed." She's a good psychiatrist.

It's really hard for me to admit this, but I think maybe I am, too.

Sunday, January 13, 2008

Why I do what I do

I also got this yesterday. One of my patients from back when I was on the Women's unit at State Hospital is down in rehab in Florida right now, and she sent me a Christmas card. It took a little while to reach me, because technically I'm not on staff at State Hospital, but it finally got to someone who knew who I was and passed it on.


Truly, that's everything I can ever hope for.

Wired

I have had way too much caffeine today.

But at least I've been productive. I left the hospital, went and picked up the Maggie, and then we stopped at Starbucks. I came home, loaded the dishwasher, swore at the Treo for a while, and then gave up and went to Circuit City, where I hemmed and hawed and was very indecisive for a very long time about what navigator to get. Then I went to the grocery store, stopped and got lunch, came home, took the trash out, swore at the Treo some more, and now, I'm babbling on here. Good times.

Someone said to me, back when I got the VZNavigator on my phone, if you get the navigator, you'll never learn your way around. I said, nonsense. I'll just not get as lost when I do get lost. But I'll know the town just as quickly. It'll be fine.

Now I say, alright, fine, shut up.

I lasted three days, and one of those days I was on call. I got so rip-roaring lost on Friday coming back from lunch downtown that it was ridiculous. Especially considering there was another physician with me, who also works there, who didn't know where the hell we were, either. And "downtown" is neither that big nor that far from the hospital. For all the IQ points in that car on Friday, I'm just sayin'. But alas, no. The only reason we didn't get lost on the way to lunch was because I was following Mike, who, a, gets out more than I do so he knows his way around "out" better than I, and 2, lives four blocks from the restaurant, so, he really ought to know where it is.

So, adding to the gadgetopolous in which I live, came the TomTom.

There was much wailing and gnashing of teeth over this vs the Magellan. Because I can talk to the Magellan. And the sales guy thought it was easier to use overall. But I couldn't get into the interface, and I really like the look of the TomTom maps. And I got the stripped down version, because I concluded that was really all I needed. But, like, it couldn't find the grocery store. So I ended up googling the Fresh Market on my Treo and then entering the address into the TomTom and feeling a little like the bionic woman. Especially now that I've taken to wearing both my phone and my pager on my hip (because I'm not leaving anything as expensive as the Treo in the pocket of my labcoat). I'm wired for sound, baby.

And I had immediate buyer's remorse as soon as I took the TomTom out of the package. D'oh, I should've gotten the Magellan! Except that this was all triggered by my inability to find the Fresh Market, and who's to say that that Magellan would've been able to find it, either?

Once I gave it the address, though, it did find it. And I fulfilled what's become my Sunday routine...go to the Fresh Market when it opens, buy produce and yogurt and other random (usually impulsive) things, then go to the Char-Grill next door, and get a very yummy burger for me with mustard and onions and a plain cheeseburger for the pup. Today's burger was especially good, and they have the best fries in town. I also made three particularly good finds at the FM. One was vanilla chai, which has become my new addiction at the hospital coffee shop. I also discovered that my new favorite wine also comes in a red, and the other...oh my gosh....I was in the cheese section, getting shredded Parmesan to go with the salad fixin's, and I saw this little half-pint deli container with a really white, softer looking shredded cheese, and I thought, huh, I wonder what kind of Parmesan that is....but it wasn't. It was...are you ready for it? Mizithra! Which is this dry, salty Greek cheese that I could live on. No, really, a little butter and some Mizithra on pasta is the best thing going. It's the food of the gods, I'm telling you, Athena herself invented that dish. It has to be new this week, because I look for it pretty much every time I go past their cheese counter. And there it was! I let out an audible gasp in the middle of the cheese section this morning when I discovered it. There may even have been a Mizithra dance. I'm telling you, this is exciting news. Especially after having conquered the TomTom to get there in the first place.

If I could figure out how to sync the effing Treo, by the way, I'd show you a picture of the TomTom taken with the Treo. Because I thought that was funny. But, alas, I still can't get the laptop to talk to the phone. It was a fluke, one-time deal, apparently. At least it worked long enough for me to load a couple good pictures of my dog onto the phone, so I could show her off at lunch Friday.

Technology is my friend...

Lunch, as an aside, was very nice though. Sarah took Mike and me (Betsy was post-call) out for Thai food to celebrate our surviving the past two weeks (the attendings rotate off service after two weeks, so we'll have a new attending tomorrow. I'm hoping this mellows Betsy out, but, none of us are optimistic). It was very pleasant. The food was excellent, we had a very good time, it was very laid back, and I still left early. Very nice. Plus, Sarah and I have intentions for a doggie play date shortly. She has two dogs, one who she picked up at the roadside after he got hit by a car - a German Shepherd who's probably about twice Maggie's size - and a Leonberger she rescued from the shelter who was so little when she brought him home that he used to sleep in the cats' bed...he's now close to 200 lbs, and he's not done growing. He gets his head stuck in the cat bed now because he doesn't realize he doesn't fit there anymore. He barely fits in her car. I can't wait to meet this big furry mountain.

Those two are going to terrify Maggie, though. She likes cats and little dogs. Unlike my old dog, Wolfie, who was this ninety pound Husky-Akita mix and had a heartbreaking, pining crush on the 125-lb older-than-God German Shepherd next door, Bob. Wolf would run over to the fence when Bob was out and just watch him, awed, tail wagging like crazy. And then he'd look over his shoulder at me all excited, like, "It's Bob! Do you see? Do you see?? Oh, Kate, it's Bob, it's Bob!!" But he'd never bark, and he never dared actually approach Bob, who, incidentally, was this very sweet, toothless, grumpy-old-man kind of dog. No, my dog was a groupie.

Bob died shortly after Wolfie did. And then the big mean old Rottie they had got stomach cancer or something (I told my neighbor, it was probably someone he ate), and he was put down. So shortly after Mags arrived, they got this very obnoxious pit bull puppy. Maggie and Kedzie, my roommate's dog (who's like 13 now or something and is a TOTAL grumpy old man) were both sort of like, what the hell did you bring him here for?

The best Wolf story, ever, though, was when one day we were out for a walk. And these six little rat dogs come tearing out of the house down the block, like, in formation, barking and snapping and squealing and they start circling Wolf, nipping at him, barking, huffing, growling. And Wolfie, bless his little poochy heart, stops, and looks down at these little knee-high (to him) annoyances with this quizzical look on his face. And then he calmly looks up at me, completely baffled, like, "Dude. Really. What the hell are these things?" And he kind of watches them for a minute (in contrast to his owner, who's flailing about yelling "Get out of here! Go! Go! Stupid little shit dogs, get!") and then looks at me again like, "These things are stupid, and noisy. Can I eat one?" Fortunately, their owner happened to notice about then that they were missing and called them back into the house. And he - I'm so not kidding - watched them go back into the house, looked at me, shook his head, and then started back down the road towards our house. I totally would've let him eat one.
That's my Wolfie. He was such a good boy.

Well, Mags and I are going to go spend some quality time napping, and then there more dishes to be done and laundry as well and I still have two discharge summaries to write up. Mi vida loca...

Saturday, January 12, 2008

My rockin' Saturday night

I'm on call at State Hospital again.

My life is so special.

At least Maggie's having a social life. She managed to get to the doggie day care. She hasn't been there in a while, because they don't open early enough for me to take her there when I'm working at Big Hospital. So we have a dog walker. He's very nice, she likes him an awful lot, and he never says a word about the horrendous mess that is my house (I'm so not exaggerating). But I still think she'd prefer to be with all her puppy friends at the day care. I'm hoping next year she can actually go there as a day care pup once or twice a week.

Only 170 days until "next year".

Tonight is my very last call at State Hospital. Possibly ever, because in theory, they're closing the place before I rotate back here in June. But the way things are going, I'm going to be able to get an attending job here after I graduate (seriously. They have a great loan repayment plan). I'm ready to be done, frankly.

So I think I mentioned that Mike and I switch next week and he starts taking Saturday call here and I start taking Family Medicine call at Big Hospital. FM call is brutal, generally speaking. Mike's gotten 10 admissions or more each time he's been on. Plus the floor pager goes off all the time. You're up all night. It's hectic. It's crazy. And I'm thinking I might actually do better with that.

I was thinking about this today. Psych call here is just about as bad as that. I never sleep. I admit between 10 and 20 people a night, although the "admission" is usually more of a cut and dry process here (basic diagnosis, basic admission orders, rarely anything to follow up, labs are followed up by medicine, etc. Interview 'em, write their orders, get 'em to the floor, you're done). I'm usually here until 11 or noon. And I actually enjoy those calls a heck of a lot more than these medicine calls, where they perpetually call me for stupid things, and these Saturdays have an awful lot of down time. And I'm sure that's also partly because I like doing psychiatry, too. I don't know. Maybe I'm making this up so I'll feel better about starting FM call. I liked Neuro call, too, though, that was actually my favorite - I was usually fairly busy until 11 or 1 or so, and then I went to bed, and usually got some sleep.

I haven't dealt well with my time today. I've been so tired, and I have no idea why. I keep trying to read, I nod off, but can't even get a good nap in because the pager is either going off or I keep worrying about the pager going off. My knitting is going too slowly. I'm just grouchy.

Ooh, but my pager finally went off to say that dinner is here. Maybe that'll make me less grouchy.....

Friday, January 11, 2008

Don't believe everything you think

I saw a car with that bumper sticker today. He he. I love it.

I can't stay awake right now, yo. I'll write more later.

Thursday, January 10, 2008

New toys I can't afford anyway

Sunday morning, while I was on call....there was a death.

My palm pilot is no more.

Notice me not saying "death of a loved one." Maybe I could go with "a dear one." A frequently used one. One I depended on that aggravated my by crapping out frequently and at the worst possible times.

Oh, but how I miss thee.

Understand, I bought this dumbass thing in July. It barely survived until January. My dad still has my old palm, which I bought, what, in '03? '04? I don't know that he actually uses it, but, it still works.

Whatever. So today was my day off. I had all sorts of plans. Ahhh, such plans had I. I was going to clean. I was going to go to the grocery store, to Target, to Walgreens, to see my shrink, an to buy me a new palm. And then to maybe nap on the couch and watch a movie with the doggie. Ahh, a nice idea, huh?

Yeah, well....

I was up really late last night after all the work I had left to do, and then just the agitation of it all, and then I slept pretty badly. Sometime this morning I had this very weird, epic sort of dream (I've been having a lot of those lately, where they just go on and on and on. I'm about two more shy of scheduling a sleep study to figure out what's wrong with my REM sleep) about my ex, who was just snide and indifferent to me in the dream, and his business partner, who looked nothing like what he actually looks like and kept trying to recruit me into their GYN practice even though I wasn't in the same specialty anymore. Oh, and it went on and on and on, seemingly for days (at least it wasn't as nightmarish as the one I had Sunday). Then I woke up and spent about an hour poking myself in the eye, because I lost a contact and would've sworn to you that it was still in there, but I don't think it was, because I ended up putting a new lens in, thinking at least they might stick together and then I could get it out, and it doesn't hurt as much and nothing else has emerged, so...

Then I did manage to make it to my therapy appointment, and then to Walgreens, and then I spent an inordinate amount of time discovering the fact that no one sells PDAs anymore. So it occurred to me that since I hate my KRAZR, which isn't working very well anyway, maybe there was a phone option that would solve both of my dilemmas. So I went to the Verizon store. Where a very nice woman told me that she wouldn't be able to give me any sort of discount and the most compatible phone she had that would fit my needs was over $600.

Yeahhhhh, no.

So I went to Circuit City, where I actually talked to someone, who told me they haven't sold PDAs in almost a year. She isn't sure why, because they always sold well, but no one in town sells them anymore. Argh. So, I stopped at the Verizon kiosk there and posed sort of the same question. And she's like, well, we have this option and this option, and hey, where do you work? Are you a state employee? Of course you are. So she xeroxed my State Hospital ID and I got a substantial discount off everything I bought (phone, charger, etc) as well as 20% off my monthly bill. Plus she gave me the new contract phone price (which I wasn't really eligible for yet). So I paid less than half of the original quote for the pretty new phone.


Isn't it pretty?

I still haven't really figured out how to use it yet. Although I did get Epocrates on it, which is what's most critical to my life. And I can call out, especially to people already in my contacts, and text message without too much pain.

The one thing I really will miss about the other phone, though, is my GPS navigator. Although for the price I paid for the service, I've discovered I can easily get a TomTom, now (wow, have they come down in price, PS). So I stand a chance of still not getting lost.

The camera's better, too. If I could figure out how to get the dumb thing to sync again, I'd show you a cute picture of my dog....

Wednesday, January 09, 2008

Of course, of course

First, though - what the hell is wrong with New Hampshire??!?!!!?! I mean, you'd think that a year of living there would be more than enough for me to stop asking this question, but, I mean...at least Obama took Iowa.

I voted in NH in the last presidential election. They gave me a legal-sized sheet of paper, and a pen. It's the only time in my very lengthy voting history (ahem) that I've voted straight ticket...because all six people I happened to want to vote for were democrats, and, um, there were only about six races on the ballot.

With a pen. Did I mention the pen? No hanging chads in New Hampshire. Freakin' ass-backwards state. I should've known to turn and run right then.

Then again....here's the end of my day today. I walked out of the hospital, called my folks, and when my dad picked up and asked me how I was, said very loudly "I AM SO FRIGGIN' GLAD TO BE OUT OF THIS GODDAM HOSPITAL." Then I sat in [long string of expletives] basketball traffic. Because, of course, the hospital sits in the middle of the college campus, literally. You know that scene in Renaissance Man where Danny Devito gets awakened by the Army boot camp recruits doing loud morning calisthenics at 5am, and runs around the grounds yelling "GO NAVY!"

I was thisclose to opening all my windows and yelling "Go Duke! Go Duke!"

But I did take advantage of the down time by texting my co-intern with the following message:

You're going to need to commit me soon for homicidality. Also, Betsy wants you to round on seven patients tomorrow morning because she can't write that many notes. (Maybe if we share a room on the inpatient unit, they'll give us a group rate?)

This was followed by a forty minute conversation with Mike and then an hour and a half phone conversation with my attending.

Today....I....oh my God.

Today was the first day of this new curriculum on the part of the Family Medicine department where they corral all their residents for learning on Wednesday mornings. Which meant the only residents left were me, Mike, and the Duke resident. Mike was postcall, and he'd had a rough night. So I made him sign all his work out to me and took his pager and then my attending (have I given her a pseudonym yet? I don't remember. Let's call her Sarah) and I sent him to go sleep for a while. And then we went off and tried to take care of some patients and get some stuff done and had some very manic and wacky walk rounds.

In the midst of this, by the way, we were awfully punchy, and I don't remember for the life of me what prompted this, but she started walking down the hall singing the Mr. Ed theme song. And she gets to the "famous Mr. Ed! Wil-bur!!" part, and...I'm so not kidding...someone in one of the patient room whinnied. Right on cue. It was the funniest damn thing I've heard in a long time.

We've conferred - we both heard it.

So then Betsy, our upper level, pages me. We'd both thought she was in clinic. Know why? Because this morning she told us that she had clinic. So she pages me, and is like, where are you? She's back from lecture (an hour and a half later than everyone else, by the way) and is all pissed off because you know, if I don't keep her informed she will never be able to run the service. And then we meet up with her (after we do some actual, you know, work), she sits us down and has this, like, 30 minute intervention. Which means basically she, a second year resident, berated Sarah, my attending physician, for a full half hour in front me, an intern from another department. About how Sarah was not respecting her and undermining her ability to do her job by - more or less - helping too much.

I....just....I...for.....what the fuck, woman?

What it boils down to, frankly, is she's making all of this all about her. It isn't about her. You know what? It's not about her at all. It's about taking care of patients. Something that needs to be done as a team. And you know what else? If she was doing her fucking job, Sarah and her co-attending, the, um, department chair, wouldn't need to interfere so much.

I really wanted to smack her. What I did, after about twenty minutes, was interrupt. And she says, "you're interrupting me."

I said, "Yes." And then I pointed out that I wasn't really involved, here, so, um, could I go take care of the page-long list of jobs I had to do?

She says, "No. This involves you."

How it involved me in any manner other than making me an audience to her histrionic, self-indulgent unprofessional behavior is totally beyond me.

Part of what she brought up was how poorly it reflected on her when the resident coming on call walked into the call room and found Mike asleep. Neither Mike, nor Sara, nor I can figure out why. It had nothing to do with her. It wasn't about her. It was a benevolent thing for us to do. And at one point she brought up the duty hours issue. I was like, oh, honey, don't even start. Because let me tell you, no one knows the ACGME duty hour rules better than I do. Not after life at the Emerald Palace.

Sarah slipped me her phone number on the way out and mouthed "call me." She felt really bad about me having to be involved in all this, she says. I was like, um, it wasn't you. Betsy wouldn't have let it go down any other way. ::sigh:: I don't understand people sometimes. I've really hit my limit with Betsy's behavior. I'm really not sure how I'm going to handle three more weeks of her without any hair-pulling. And of course next week Mike and I switch places and I stop taking Saturday call at State Hospital and start taking call with the Family Medicine team every fourth night. I'm a little concerned about this, because Mike's mantra over the past few weeks has become "I hate my life."

Fortunately, I have tomorrow off. Because, you know, I get one day off a week, and I'm on call on the weekends. Thank God. I think Maggie's excited about it, too.

Tuesday, January 08, 2008

"For someone who hates psychology, she sure has a lot of it."

It's one of my favorite quotes from the pilot episode of Bones, which is on tonight. And it's so true. I'd forgotten what a grumpy, cocky "cop" Booth was in the pilot. I'm glad he got over it. And I really like that Booth is all angsty, thoughtful, pining for a woman he can't have, again, except he has so much more depth in his thoughtful pining angst than Angel ever did. And Boreanaz is even cuter in the daylight.

Today was long again. Not quite as stressful, partly because I'd planned on going to SNB tonight at the local Borders, and the dog sitter came during the day. Needless to say, I didn't make it to knitting. I only left two patients of mine on our service, but, we're admitting tonight. I, truly, was done with my work at 2pm. But I left after 7. Because there was rounding and then this and then that and oyyy. And then one of my patients got sicker. So I stuck around for another hour fussing so Mike wouldn't have to. And I tied up his patient into a neat little package for discharge. It was a favor but you survive this life on favors-both the ones you get, and the ones you give. And no, I don't expect him to stay nearly this late when, starting next week, I'm the call girl du jour. Although....okay, maybe I will expect him to reciprocate on the post-call coffee I'm bringing him in the morning....

Because there is simply nothing better than a hot post-call beverage of choice from outside the hospital. It's that warm, little comforting cup of hope that the free world still exists somewhere outside the sterile and stagnant confines. Okay...there is one thing better...the post-call nap. Preferably a post-call nap with a warm dog or some other snuggly warm mammal.

I'm babbling again. I have a really sick patient I spent of a lot of today fussing over. I'm still really tired. Oy....I'm going to turn off House, which is now on because Bones got all solved and done with, and go to bed. But, after this:

"Treating illness is why we became doctors. Treating people is what makes most doctors miserable." It's a quite from tonight's House which more or less illustrates why I don't usually watch House. But....I will give him a tremendous amount of credit for this one:

"It's five o'clock. I'm going home."

Monday, January 07, 2008

Taken out of context I must seem so strange

That's a line from an Ani DiFranco song, Fire Door. It's one of my favorites, and that's one of my favorite lines. I'm not quite sure what it's doing in my head right now, but, there it is.

Today was, once again, long. One of the first things I said this morning was "I absolutely have to get out of the hospital by 5:30 tonight because I have an appointment at 6." Okay? Okay. Except that I ended up calling my shrink at 5:58 saying "Okay, I'm almost to my car so I'm going to be about 10 minutes late..." Fortunately she is both understanding and very near to the hospital.

Many many things annoyed me today, but one that really impressed me was that we talked about the patient who died on Friday at our midday teaching conference. And not in the M&M, dissect out the case and point out where everyone went wrong sense, but to discuss how we all sort of felt about it and how those involved had dealt with it. It was reassuringly touchy-feely. Being a group therapy veteran myself - on both sides of the notebook - I thought this was a fantastic idea. It also helped that I did this death thing a lot in my past life, and that my training surrounding end of life issues in medical school was really good. One of the things I've always pushed for was sort of the CISD model of intervention (critical incident stress debriefing - a model used often "in the field": paramedics, fire, law enforcement, etc - to get everyone together and go though the issues involved in big traumatic events. It's been shown to be a great predictor of who doesn't end up with bad long-term sequellae after badness -PTSD, etc.). But as often as I groaned and moaned and coaxed, I never got this to really happen in the ICU, or the OB floor, etc. Mostly they were devotees of either the "no, really, I'm just going to go on, because this doesn't affect me" school (located near that river in Egypt), or the far worse "I'm not going to deal with it because if I do I'll be admitting fault, and I can't handle that" camp. This really impressed me today. I wished I'd said more, because I almost guarantee I have more experience handling death than anyone else in that room who isn't full faculty. I wished we'd gotten into it a little deeper, but then one of my patients was seizing and I ran off, and having lost the person in the crowd who was likely to keep instigating the discussion, it fizzled. They did use the segue well to go into a useful discussion on the death paperwork as it applies to our institution though, and a little discussion about guidelines for talking to families. It was nice. I need to point that out tomorrow to the powers that be. It's really a shame that the guy died. But I'm glad they handled it well on the group level. And I think both our attendings talked to Mike when it happened. So good.

I'm not sure Mike agrees with that.

We're having an interesting experience of parallels, he and I, right now. I, really like my attending, quirky and neurotic though she may be, and am about ready to strangle Betsy. Mike? Doesn't seem too bothered by Betsy but may have commitment papers filled out on the attending, because he's convinced she's nuts and she's driving him there with her. I obviously loved this little group huddle today; he (and possibly because he was sort of put at the center of it) didn't seem really very comfortable with the idea, or of divulging how he'd handled any aspect of it except the paperwork.

But then, I'm guessing he hasn't spent nearly as much time in therapy - or for that matter, at this point, doing therapy - as I have.

Whatever. Anyway.

As an aside for those of you not in the biz, M&M stands in our world for morbidity and mortality, a conference held regularly to go over cases that had poor or unexpected outcomes. The idea is that it's an open forum to address the inevitable errors that happen and sort out systems errors and improve patient care by learning from our mistakes. The proceedings are protected and even inadmissible in court, in an effort to make it as open and honest as possible. However, people are in fact human and often, particularly in the surgical specialties where the afflicting neuroses are somewhat more prominent, it often becomes a farce of finger pointing and puffed-up armchair quarterbacks with the benefit of hindsight. They an be very illuminating, or horribly painful. I have particularly traumatic memories of one from about this time of year three years ago, where we were discussing this woman who bled at her trochar site after surgery. This woman with a known clotting problem. Who had to take special drugs from hematology to clot her up. Whose bleed clearly must have been caused by the tiny baby dose of an anti-inflammatory pain killer that the intern gave her in post-op, since her hematoma cropped up seconds after she got that injection (read: it had been building for long before the shot, and was likely the reason she needed pain meds; the intern's actions - which were initially supported by the senior resident, unless you'd hear him tell the story at M&M - had nothing to do with it). Bad intern, bad! What was really demoralizing is that they kept referring to me as "the intern." Like I didn't even have a name. Everyone knew it was Ben and Wass and my case, our department wasn't that big. Plus, if you name the other people involved, and just call me "the intern", you know it conveys a message.

Unless you do it correctly. Like "Ben and Wass didn't address the problem staring them straight in the face very much at all, whereas, the intern came up with a very sensible and practical course of action to resolve this problem."

Right. That was going to happen the day we actually had flying monkeys at the Emerald Palace...

Sunday, January 06, 2008

Well, I don't know how useful it is, but at least there are pictures

I'm feeling better. I did a little yoga. I haven't done good, real yoga in at least two years, or almost any in well over a year. It wasn't my best session ever, technically speaking, but oh, it was so cleansing. So need to do this for real.

I've got to join a real gym. Not the little treadmill room at my apartment. Not my silly hodge-podge collection of DVDs and a punching bag and a cheap-ass rowing machine in my apartment. I need a gym. With people and classes and without the Chicago gym attitude and I need a personal trainer.

To whom I'm likely going have to sell my body in order to afford any of it.

Hmm.

I did make it to the grocery store today. I even bought wine. Mostly because of the label.

You know, it's probably not what you think, though. Look more closely at the label, you perverts. It was the name of the winery that sucked me in, up there, in French, above the two dancing figures:

Folie a deux.

Literally, it means the misstep or derangement in a pair, but there's a much fuller meaning implied. In psychiatry, we define folie a deux as a shared psychosis. Like, I'm so crazy, I pull you into my craziness, so that you also exhibit features of my craziness.

If you think about it, this isn't as rare as it seems. It's more a question of extremes.

Also, yes, I'm a sucker for wine that makes references to psychoneurotic phenomena. And it turns out, the wine's pretty good. There will be more in my wine rack. I can find my (empty) wine rack.

What I can't find is my wine glasses. So, I made do with the cup that came with lunch.

Classy, eh?

Don't worry, I didn't even come close to filling it. But you want to see something even classier? I totally broke the cork trying to pull it out. So the fun wine is now being stored in this bottle instead...

Yeah, there used to be spaghetti sauce in that. Super classy.

I also bought fresh strawberries and fresh baked poundcake.


Mmmm, so good. So utterly good.

I think, ultimately, what's going on with the dynamic of our Family Med team is something of a folie a deux (quatre?). It's just a wine inspired thought, but I think it also might be quite a useful piece of insight. Tomorrow will be an interesting anthropological evaluation of that...

Speaking of which, I have six patients to round on in the am, according to the list. Before 7:30, so Betsy can interfere with my thought process and flow before formal rounds even occur.

Sat nam...sat nam.......om..........

Me siento en la necisitad por la velocidad

I'm watching Top Gun. On cable. In Spanish.

I don't so much speak Spanish.

That in and of itself isn't entirely peculiar - I occasionally watch some of my DVDs with the Spanish tracks on (and usually with the English subtitles). Because I do keep trying to learn Spanish. But this is cracking me the hell up. Like, things that aren't actually meant to be funny are making me cackle out loud. Part of it is the two hours of horrible, horrible sleep I got last night. Part of it is that I understand enough Spanish to understand how poorly some idioms translate on Telefutura (i.e., Goose says, when Charlie asks what they were doing un metre y medio from the MIG, "giving them the bird." Spanish Goose says something closer to "throwing a bird at them." How does one not crack up at that?). Part of it is how much I simultaneously love this movie and abhor Tom Cruise (no, I'm not entirely certain why that last piece contributes to all the giggling, but, it does). And he still looks like a rodent. Rick Rossovich looks equally delicious all oiled up with his shirt off in Spanish, though. And I never have been able to figure out why exactly Kelly McGillis is a "consultant" at Top Gun, in any language.

Does it surprise anyone else, as a total aside, that Katie Holmes has a new movie coming out? With Diane Keaton and Queen Latifah. It actually looks kind of funny in that over the top goofy, First Wives' Club kind of way. I'm just amazed he's letting her work. And all her hair seems to have grown back.

I'm so tired. Maybe I'll have something useful to say later...

Saturday, January 05, 2008

Adding to the list of necks I'm going to break...

So I come up to the men's crisis unit to evaluate this poor sad sack who fell on his wrist. And this little Hispanic man in his early 20s with this innocent little bowl haircut comes up to me and says, "Do you remember me? I remember you!" And then he puts his hands out about two feet wider than I actually am and says "You're big, like this."

Do you want to get put in restraints? Because I'll do it. So help me God I'll do it. Learn how to talk to white girls, Paco.

I do remember him, though. The last time I admitted him he thought he was the Virgin of Guadalupe.

And at least he said it with adoration. Alright, I have to go assess the fourth person with an injured hand in two hours. What the hell is going on here tonight?

Winter in the Medical Unit

Wait....brace for it...I'm on call.

So I'm at State Hospital. On call for medicine. And it's like five degrees in here. I'm freezing. It's like winter or something.

It's been one of those days thusfar that's just sort of annoying in it's "hurry up and wait" -ness. Like, it's almost 1pm. I really have had nothing to do for the past couple of hours, because I've been waiting for my attending on call (Dr. Asshole. Great.) to come down and tell me what to do with this patient. I suspect? We will do nothing. Why? Because she needs nothing done. That would probably be the best thing for her. But we might give her some IV fluids, because her sodium's low. Except, she's totally asymptomatic, and I think she has too much volume on board. Does he remember that lecture he gave me about hypervolemic hyponatremia? Work with me, here, man.

I just called him to tell him her urine studies were normal, too. So guess what we're doing? We're giving her IV fluids. ::sigh::...fine....

It's like three hours later now. She's on her second liter of fluid. He says to me, "she has a history of heart failure and absolutely no edema (swelling of her legs). She must be dry." Um, well, okay. Didn't know not being in heart failure was a criterion for diagnosing dehydration, but, after all, he is a cardiologist.

So, yesterday was awful. I swear to God, I'm going to break someone's neck on that service. Soon. Something has got to give. I was there until 7:45 last night. And then I came home and worked via remote until right before I made that last post. We had a rough day...I don't even know where to start. My senior resident (let's call her Betsy) is...something else. She's a total drama queen. Everything's a catastrophe. Which feeds off my attending, whom I like very much but is currently stressed out and very high strung. Mike was not tolerating the pressure very well and looked like he was about to crack more than once. I, of course, responded to all of this by being all soothing and cooing and trying to maintain an air of overriding composure.

Except for the brief moment of Tourette's I had alone in the elevator, and the three seconds of foot-stomping and screaming "I swear to God I'm going to break someone's neck on that service!" while waiting with Fang and two of the second year residents (honestly? Whom I've met before and I like them both very much, and I don't even come close to remembering what the hell their names are) for the interviewees to show up for lunch.

Problem is, that isn't much of a relief valve, and I was under a LOT of stress yesterday.

Mike was on call, with one of the seniors whom I don't especially care for. Family call is rough. Any call is rough when you're on with difficult people. And my attending kept piling work onto us yesterday. And Betsy is really not helpful (in fact, I think she just compounds our work). She decides that I can't go to the recruitment lunch because she's got to go to clinic. Nope, sorry, I have a responsibility to my own department, here. My attendings had already given me the nod. And she freaks out, because, it's her first day, and we have to communicate or the service will fall apart, and, and, and. I'm sensing a real need for maintaining my boundaries around her, so I offer to come back early, but am very firm about going to this thing. And I leave, and she - literally - comes running down the hall after me and says that they changed her clinic time and she has to be there in 15 minutes and I can't go. So I said, okay, let's run the list. I offer her alternatives (do you want to page me when you're done?). She continues to freak out. Okay. So we run the list and I finally escape and extricate myself from her grasp and I try to put on a "I love my job (just not today)" attitude for the prospectives, and I get paged in the middle of lunch by my attending, who says, "You've got to call your patient's daughter, she's crazy."

Great.

So I excuse myself and go back and call the daughter - who is, in fact, crazy. But I think the crazy was inflamed by her interaction with my attending. So I soothe her. And calm her down. And convince her that it is indeed okay that we're discharging her mother that afternoon to a local rehab facility. And I've barely finished signing the note about this conversation when she calls me back, having a fit about some misinformation that the social worker gave her. Calm, calm, soothe, soothe, shhhhhh. And then I go talk to the patient. And then it's 4pm and I sit down with my attending again and still have way too much work to do and she gives me more and then Mike, who looks like he's about to pop an aneurysm, comes in and points out that Mr. C upstairs isn't breathing very well. So the attending says, "give him some lasix." Mike leaves, and then she looks at me and says, go with him. In essence, take care of him. Which, okay. I have more experience than Mike, I did a month of ICU back in the day, I can handle this. He, on the other hand, looks really upset. So I follow him upstairs and say, "what can I do?"

In the course of the next three hours I bounced between Mr. C, a guy we were cross covering in the stepdown unit with the DTs, and my attending. Periodically getting interrupted by the senior on call who's like, why are you still here? My attending alternates between giving me more work, wondering why I'm doing Mike's on-call cross cover stuff (because it needed to be done and he had way too much to do, that's why. She thought that was an acceptable answer), and needing reassurance that Mike's doing okay and that I'm okay with helping him out and not just going out to him and badmouthing her. Soothe, calm, soothe.

Mr. DTs guy was a touchy thing to handle, and of course I also had to soothe his very nice wife. So then I went back upstairs because the nurses said they couldn't draw the STAT labs on Mr. C. Who was crumping fast, and had actually been discharged earlier in the day but hadn't yet made it out of the hospital before things started going south. So I soothed his wife for a bit, called and harassed the respiratory therapist to come help me out with this guy's breathing, and then proceeded to try and draw the blood myself. Which, let me tell you, my skill with a butterfly needle could usually make Dracula jealous. Usually I can open up a vein without so much as a second thought.

I stuck him five or six times. Blew two veins and came up bone dry the other times. Fuck. So the RT took pity on me, I think because he thought I was cute (what is it with me and RTs?), and was like, I'll get the blood. And these guys do arterial draws all day long, which are harder then venous draws. HE couldn't get blood from this guy. So I paged the IV team and assured his wife he was doing fine, that we just couldn't get the blood, and he was much better on the breathing machine, and abandoned ship to go downstairs and tie up my loose ends because I wanted to go home, where I should've been hours ago.

I woke up at three am and heard my pager beeping downstairs. It had three 911 pages on it from radiology, from midnight or one-ish, so I called them back. They were like, oh, Mr. C was down here for a head CT and we thought he was on his way out so we called you, because you ordered it. But we got a hold of who we needed. I apologized for not having heard my pager go off in the first place, and they thanked me profusely for calling back at all. And I went back to bed.

The guy died last night.

He told me he was dying. As in, let me die. I'm dying, just let me die. I shushed him and held his hand and told him he was okay, he just needed to take slow deep breaths. And we knew the guy was on his way out, just, not quite yesterday.

You know, it's funny. As soon as I checked the electronic medical record this morning to see how he had done overnight and discovered this fact, I sent Mike an email saying, "are you okay? It always sucks when this happens on your watch." I understand. I was the angel of death during that aforementioned ICU month (because I was "so good with the families", so my team would leave withdrawals of care for my night on call. It seemed like every third night for the entire month of November, 2004, I was killing someone with their family's blessing). But I didn't realize until right this moment how much it upset me.

He was a nice old man. I held his hand. He'd been in the hospital since December 14th. He's been more or less Mike's patient all through WARS. I hadn't even met him before yesterday evening. And all day today I've been going back and forth about feeling like I should've done something different. Like I should've prepared his wife better. I wasn't even on call, I didn't really even need to be there. Both Mike and my attending were in house after I left. He was DNR and going to die shortly, regardless. I still feel like I should've done something else. Something different. Like in my full day of soothing and comforting and stroking and ameliorating, I failed to smooth out the biggest wrinkle of them all.

No, not logically. But if I were driven by logic, I would've let everyone be upset and stay ruffled and put out their own damn fires yesterday. And I probably would've left at 5 and been home to let my dog out and not have called my poor mother on the way home and sobbed for 40 minutes while unleashing all my pent-up angst onto her and my poor father.

I have a story I was going to tell about one of the first patients I withdrew support on back at the Emerald Palace. But this post has already gone on too long, so I'll save it for tomorrow. Maybe I'll even have a little more commentary on this, esoterically. But right now I'm going to go be upset and knit a little and hide for a few minutes, if the pager is willing.

Thanks for listening this long, though. It soothed me.

Friday, January 04, 2008

Now THIS is the Family Medicine I was warned about....

AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAHHHHHHHHHHHHHHHHHHHHHHHH!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Thank you, that is all.

Thursday, January 03, 2008

What am I, a med student?

So, just this morning, I was thinking, wow. I'm exhausted. And it occurred to me that I used to have it much rougher, really. Like, when I was a third year on surgery. I worked such longer hours then. More things rolled downhill at me then. Well, maybe or maybe not...things rolled downhill, in spades, but I didn't have nearly the responsibility to deal with them as I do now.

Today was long. In an epic sense. I had too many patients. We had a new attending who is looking to impress the department chair, who's also rounding with us, of course. I actually went to my psych lecture. I had a very nice, very sick gal who got sicker and sicker and sicker and I finally appealed to the ICU team, who took her off our service before she crumped. We rounded three times today. And there's all this discussion about what the point of the team should be and what's expected of us and for us and yada yada. The attending hovered. Honestly, it was kind of fun, the whole, running around being a doctor part. But it was exhausting.

And then, I get home, right, finally, at a quarter to EIGHT tonight, and my pager goes off. And it's my upper level, who starts tomorrow, and she's all full of muss and fuss about about what the point of the team should be and what's expected of us and for us and yada yada. And oh, by the way, can you be ready a half hour earlier so you can round with me before you round with the attending?

Um....

Well....

Honestly, I approve of that logic. But it's a giant pain in the ass for me and Mike.

Not to mention, I have to give a presentation tomorrow. On Ranson's Criteria. I guess I'd better go figure out what those are, again....

Wednesday, January 02, 2008

2008, day 2

It's cold. In fact, do you know what happened today in NC? It snowed.

No, really.

The unit secretary was all like "it's snowing!" And of course everyone commenced to finding a window to see the snow. Which was barely a flurry, and lasted about three minutes. But in the south, I think that's considered a blizzard.

Much more exciting today was Wednesday afternoon knitting group at the LYS, which, you know, I discovered last week. There were a few more people there today including some very fun and lovely ladies, and...are you ready for it? A man. A man! With a dog! Who knits!

::sigh:: He should only be straight....

I also started reading Girl, Interrupted this evening, which I ordered as a reward for myself for getting through last month (I'm thinking about a monthly reward system to propel me through the end of the year. Something small, you know, when I finish a 4 week block). I've owned the movie for years, and I watched it last weekend, and wow, had a whole new perspective on it after all my time at State Hospital (i.e., I'm not sure she was really borderline, based on the movie). So I decided to snag the paperback and read the actual story, see how that compared.

For surviving this month? I earn Offender Profiling and Crime Analysis. Is that pathetic?

Tomorrow my co-intern Mike and I are cast back to reality. WARS ended today, so I have to drag my ass into the hospital way too early again tomorrow. Over the past week and a half, all three teams have sort of blended into one, and tomorrow we split them all up again and resume the usual state of chaos. Damn, I've really enjoyed the getting in at 8am thing (and more precisely, the not getting up at any time that has a 5 at the front, particularly at the beginning of that hour, blech).

Tuesday, January 01, 2008

Resolute

Happy 2008, y'all.

It's gonna be a good year. I just have a feeling.

Mags and I had a less boring night than we'd anticipated, but that doesn't imply that it was all that fun. I went to bed around 10:30 (shut up), thinking I'd read and watch the rest of the CSI marathon. And I started to doze off about an hour later, but fortunately, my neighbors had devised a couple of ways to keep me up. First of all, they had their music cranked up so loud my walls were vibrating with the bass (seriously. And it was that Chicano pop with the accordion in it, you know? I thought I was in the barrio for a minute, there). And then there were the firecrackers, which let me tell you, Maggie was none too pleased with. I, on the other hand, always like firecrackers and thunder, because it means the dog gets snuggly. However, for some reason she wouldn't actually get onto the bed (trying to stay out of the line of fire, maybe?), so she just sat at the foot of my bed and whimpered until I gave in and picked all 45 pounds of her up under the armpits and lugged her into bed with me. Apparently there were also a lot of "issues" in our humble little town last night, too, because the police and the fire department kept going by, sirens blaring. Made me a little homesick, really.

And then...we're lying there watching South Park, bundled up and Maggie staying low to avoid stray bullets, and we hear this very distinct whine. Maggie pops her head up, ears at the ready, looks at the window, looks at me, looks at the window, looks at me, all, "Someone's in trouble! Kate! We have to rescue him!" And the dog outside whimpers again, this very wrenching, oh, help, I'm stuck! kind of whimper. So I look out the window, and I see nothing, but I hear him, and I whistle, and he whines in response, and I whistle again, thinking he'll come closer, but he only whines harder. And Maggie's freaking out, and I said, okay, okay, we'll go look. So I go out in the back yard, in my flannel pants and my hoodie sweatshirt, all bed-headed and in my flip-flops, armed with Maggie's leash and a pocket full of treats, while she eagerly kept guard in the dining room behind the screen door. And I whistle, and I follow the whimpering....

My neighbors - the ones in the barrio - have apparently gotten themselves a puppy. Whom they tied outside last night. Woe is him. I watched him for a minute through the little divider fence thingie that separates my patio from theirs, to make sure he wasn't stuck or caught or anything, told him he was okay, and a good boy, and went back inside to reassure my dog.

Boy, he was cute, though. I'd say he's some sort of bully breed, maybe 6 or 8 weeks old? Sooo cute. I almost slipped him a treat under the fence just for being so cute.

And then midnight came, and there were more firecrackers, and the music got louder, and I wished Maggie a happy new year and went to find some cotton to shove in my ears. The music persisted until about 4. My friends from Chicago (with whom I usually spend NYE) called around 1, though, that was nice.

So now it's 2008. And the day of resolutions is upon us. TLC is airing a full day marathon about the grotesquely fat and the so fat they've been institutionalized and bariatric surgery and the Half Ton Man and "I eat 33,000 calories a day" and, and, and. I guess this is supposed to be motivational? Great. Reinforce how scary and horrible and disgusting it is to be fat. So we all keep our resolutions to lose weight. Turn these poor people into sideshow freaks. ::sigh::

What's disgusting is how they're mass-marketing our insecurities and reinforcing one of the last acceptable social biases. Can you imagine a day-long marathon of "Why it's bad to be black"? Or "How it's grotesque to be gay"? Wow, people would be up in arms, and rightfully so. But this is "motivational".

I will admit to watching several episodes of Inside Brookhaven Obesity Clinic, which I actually liked. The director of this place in NYC was very realistic, stressing diet and exercise and positive motivation over long periods of time, focusing on health and well-being, and was quite accommodating to the different and individual needs of "75 of the fattest people in America". He was very reasonable about, you know, these are people with eating disorders, there's no quick fix here that's going to work. He was quite realistic about the addiction component of it and how "food" wasn't really the issue, that the psychological drama motivating it was what needed to be addressed. He was very against bariatric surgery, for all the reasons I am as well, but understood that his clients were adults and would facilitate appointments with a competent surgeon if that's what they insisted they wanted. Despite the sensationalism of the program and the overriding melodramatics in the production of it, he came off as a very stable guy who genuinely cared, and didn't make his patients into villains or deviants. Which was rather refreshing.

And then the show about the bypass surgeons came on. And I rolled my eyes and changed the channel to something more humane. Like, "When Animals Attack."

Why is it that our resolutions are always about our perceived faults? We belittle ourselves and typically set ourselves up for failure, every January 1st, perpetuating a cycle of self-deprecation and insecurity and defeat every time we get a symbolic new start. How clean is that slate, really? And why don't we ever resolve to retain and strengthen the traits we like? Why isn't it ever, "I was a very generous and compassionate person this year when I did _______. In the coming year I resolve to continue that behavior and perpetuate it by doing ______."?

I think that should be our MO this year. Find strength instead of fault in your new year's resolutions. Accentuate what you've been doing right. And couch even your assertions of change in a positive manner ("I resolve to continue eating vegetables this year and to encourage myself every time I make a healthy choice"). You're more likely to be successful, and I bet they'll be even that much more satisfying when you are.