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.