Monday, March 31, 2008

The perfect ending....

....to a less than perfect day.

OH MY FREAKING GOD work was so hellish today it simultaneously sucked and blew. The Psychotic Disorders unit is a frakkin' war zone. I spent at least half the day dealing with crazy mothers of my crazy patients. I spent a good portion of the day getting told I was an ugly, fat, stupid, horrible bitch by my crazy pregnant patient. I spent, let's face it, the WHOLE day putting out various fires. And then I still had notes to write. The nurses were stressed out and understaffed and horrible today. My really crazy patient is now batshit crazy. My other really crazy patient has become crazy as a fucking bedbug. And my other other really crazy patient had electroshock this morning and though she calmed down for a moment, by late afternoon she was, to quote my medical student, "crazy as a shithouse rat." There's leftover Easter candy everywhere and I ate way too much sugar, which in some ways is sort of fortunate because I had to toss about half my uneaten lunch because it was getting to the point that if I kept trying to eat it between interruptions I was going to ruin my dinner. And I should have ran and hid except then one of my patients had a meltdown, so I pulled her into the rec room and we had a little therapy session.

But then, PenguinShrink and Chef (her boyfriend. Guess what he does for a living. Go on, guess) had me over for dinner. Chef cooked Indian food reportedly for the first time since culinary school. He made this fabulous curried chicken and saag and homemade paneer cheese, which is my favorite thing ever. I, quite seriously, could live on saag paneer and a little naan. We cooked and we laughed and we watched a cool movie. And I felt much better. Because by the time I left the unit, I was close to killing someone.

This poor patient with the meltdown today, right? Everyone thinks she's schizophrenic and apparently when she got admitted they told her that they were going to start her on clozaril, which is the big gun of antipsychotics, and it very, very carefully used, because while it's strong as hell, it has very serious and potentially life-threatening side effects. I almost fell off my chair when she told me this. Because neither my attending nor I thinks she's really schizophrenic. And so we had this long session in which, among other things, she recounted a past that was too much like mine. She told me that the first time she was molested was on this beautiful spring day, and that she kept thinking, this can't be right, because nothing so horrible could happen on such a really beautiful day. It may not have been the first time, but I remember a clear, cloudless night and a big, bright, early summer full moon. I remember that it was so surreal. Oh, I felt so bad for her today. Because I've been there. She's another one, you know...I always look at my patients, or my friends, and I wonder, what's different, you know? Why do some of us respond in some ways, some of us in such vastly different manners? Why can I manage to be higher functioning than those that I treat? I don't understand it. I don't know what makes us different when I know what makes us so similar.

Yeah...so that's a clear sign I need to go to bed.......

Sunday, March 30, 2008

Rainy Sunday Call

So, most of the time, when I talk about patients on this blog, I'm really obsessive about confidentiality. Identifying details are changed, or omitted, or outright confabulated. Because my patients deserve their rights and dignity, even the ones who commit phenomenal feats of jackassery.

But tonight I give you a verbatim quote directly from the patient record. Nope, nope, not a HIPPA violation. Why, you ask? Because there are no details in this thing that identify anything.

Part of being an efficient resident on call is cruising the ER census, a whiteboard-esque program called T-system. It gives the patient name, location, chief complaint (which all too often is "psych eval." Psych eval is not a chief complaint, people!! Who walks into the ER and says, "I'm here for a psych eval"? I mean really though), and a few other key pieces of data all at a glance, and then if you click on them, you can essentially read the patient's whole ER chart. From wherever else you may happen to be in the hospital. It's nice, actually. And so as a bonus you can surf T-system and keep on top of what patients they will probably be calling you about. Often, especially on kids, we'll just turn up before they even really call us if we can already tell they're going to. So, like, tonight, I see this patient listed as something psychiatric, so I click, and this is what the intake nurse has written, word for word:

Can not focus tried to get admitted several weeks ago but no bed admitted upstairs in November changes are quit aggression, if phone rings started Klonopin yesterday not SI yesterday said he did not want to liver.

Which is when I walked over to that part of the ER and said....um....what???

I've had notes from floridly psychotic patients that made more sense than this. Fortunately, the nurse who had written it thought it was almost as funny as I did.

Oy. It's time for bed, y'all. It was a long damn call day. But I still really like the going home at 10(ish) part.

Saturday, March 29, 2008

Things that make you go...ARGH!

So, you might notice that the amount of days on my timer at right has gone up...

Oh, I can't tell you how pissed I am.

So you might remember that little debacle with my licensure after the evil jackasses at the Emerald Palace tried to screw me up. For those of you who don't, well, the evil jackasses at the Emerald Palace continued their two year run of harassment in turn for my treachery of leaving by sending a libelous and distorted "verification" of my training there. Which resulted in my license being delayed by three weeks until I ultimately had to go meet with a board member who was like, why the hell not? It's just a training license.

Well.

Until this week everyone seemed to be conveniently forgetting that three week delay. Which seems fair, because I didn't get any credit at all for the time served up north. Until the new chiefs took over, and so I get this email. Telling me that not only is the start of my second year being delayed for a month because of this, I have to do another month of crisis, and take another month of intern call, AND my "intern" year is being extended ELEVEN DAYS LONGER THAN ANYONE ELSE'S.

Eleven days.

Eleven days longer. Than any of the other interns. This will come out of my last year experience, he says.

So now I've done 10 months of internship in OB/G. I'll have done a full internship in psychiatry. And then I get to take almost two weeks out of my fourth year, so I could do even MORE internship. And they won't make any sort of allowance. They won't let me do clinic part time in July. They won't let me be in the second year call pool instead of the intern call pool (oh, but there'll be 5 interns on that month, so we'll be on every fifth night instead of every fourth. Big conciliation).

And the man behind the curtain wins again.

That's really the issue. Not the extra month. I can do another month on crisis, whatever. I can do the extra call. But I reserve the right to feel jilted about it.

In other news, the pine pollen has arrived in North Carolina.

It runs in sulfuric rivulets with the rain and it coats everything, inside and out. It's like the worst dust you can imagine.

Pine pollen is my nemesis.


My nose is running. My eyes itch. My throat hurts. I'm wheezing and squeaking by the time I walk into the hospital from the parking lot in the morning. I'm not sleeping well. I'm tired, I'm sore, from these puddled masses yearning to be trees.

And apparently, I make terrible puns in response to the pollenosis.



Maggie's dealing with it okay, though.

Friday, March 28, 2008

Meme-meme-meme-meme-meeeeeme.....

Oh, such a long, long day. I have eight patients. I managed to write one note. Oy. So I still have seven to do, and I've got a migraine, and all I really want to do is nap, and whine.

So instead, I'll do this little meme from my cousin Danielle instead.

What I was doing 10 years ago:

Hmm. I'm not sure I remember 10 minutes ago just now. Um, what was that, 1998? I was a sophomore in college. So I was taking O-chem and thinking about joining a sorority I would shut down two years later and being told I shouldn't even apply to medical school by my advisor (Had I ever thought about podiatry?) and falling in love with the asshole I'd become involved with over the coming year, and generally, hating life.

Five things on my to-do list today:
1. Actually make it to work (done)
2. Go to C/L conference (done)
3. Go to department lunch (done)
4. Go to Grand Rounds (didn't make it)
5. Write all my notes (Yeah, so I went back and finished those)

Snacks I enjoy:
1. Clementines
2. Frosted mini wheats.
3. Most things chocolate
4. Nachos
5. Cookies

Things I would do if I were a billionaire:
1. Start a foundation for survivors of sexual abuse and assault
2. Open my own multi-disciplinary treatment center somewhere down the road (you know, like after I'm board certified)
3. Buy a house on a big lot with a fence and a fireplace and hardwood floors and a nice big kitchen
4. Adopt like eight other dogs
5. Pay off all my damn debt

Five of my bad habits:
1. Not taking the best care of myself.
2. My housekeeping skill (okay, not really the lack of skills, but the lack of priority)
3. Internalizing way too many things
4. Not checking my mail very often
5. Picking at my nails, which are already flaking and bad enough
6. Not actually tagging people for memes (Consider yourself tagged)

Five places I have lived:
1. LaGrange IL
2. Aurora IL
3. Valparaiso IN
4. Lebanon NH
5. Cary NC

Thursday, March 27, 2008

Love This

First of all, I appreciate no one commenting on how I misspelled the title of yesterday's post.

Second of all, read this.

He. He he he.

What's particularly amusing to me is that from this account of his behavior, I could petition and commit him in the state of North Carolina. I won't, because that would muck up the campaign. But the thought amuses me.

It was yet another looooooong day at work. We had a very anxiety-inducing lecture on anxiety. And then I had an even more anxiety-provoking, two hour long family meeting (which of course, started at 4) with the family of my really, really sick patient, which included the mother who yesterday told me I was killing her baby. And obviously the patient's dad. And the mother's sister (whom I would swear was related to the father, because she was so rational and level-headed). And the mother's brother, who's a psychologist, whom I was actually quite glad he was there, except that he kept posturing by pimping us about the medications. One of the differences between us (psychiatrists) and psychologists is that we deal in meds. PhDs can't prescribe. So he's all like "blah blah blah, what's the efficacy, can you speak about the side effect profile, blah blah blah". Which, wow, my attending was a rock star. He whipped out all this data and information and studies with big acronyms and I was like, wow, thank God you're here. After all was said and done, the meeting went amazingly well. The mom held it together and really tried to hear what we were saying. I stepped off my platform of "No. Seriously. This is quite possibly schizophrenia. You just need to accept it already."

It's Love Thursday. Today, I love my attending. And also, I love my medical student, who took such an active role in the family meeting and really in this patient's care altogether and she's just really good. And honestly, truly....even though I'm exhausted and drained and pissed off about a couple of things I'll elaborate at another time altogether....I love my job.

Wednesday, March 26, 2008

Weird Wenesday

Ohhh....here's seven reasons my day has been really stinkin' weird...

1. My patient who's still really crazy, whom I really, really want to transfer, we decided today that she's going to go for electroshock therapy. I posed this to her, and she acted like a kid at Christmas. She's SO excited about us running an electrical current through her brain and making her have a seizure. SO EXCITED. Now, I concede that she's manic, but, um, really now.

2. My other patient who's really sick told me this morning that God compelled her to put on an uncomfortable bra.

Later, her mother accused me of "killing her baby" and experimenting on her (with one of the OLDEST ANTIPSYCHOTIC MEDICATIONS we have. Uh, yeah, we're experimenting, for what, now?). ::sigh:: What can I say? I'm a bad doctor for letting my patient have a say in her medical care.

You know what? I'm ridiculously possessive and protective of my patients. As I've mentioned, I'm particularly attached to and invested in this one. So don't tell me I'm not taking care of your kid. I know she's your "baby" and I may not have "babies" of my own, but I wouldn't take care of my own kids any differently than I'm taking care of yours.

3. We got two new medical students this week, of course. One of them is fabulous, and I got her. The other one really annoys me. And today, I was commenting on a discussion that's been going on over at Shrink Rap and the comments I'd left, and he was like, "You're commenting with total strangers on a message board about prescription medications? Does legal know about this?"

Dude. I'm not advising any particular person on whether or not to take a med. It's all theoretical. And yeah, it's possible legal could have a problem with my comments, my blog, my general loudmouth assertions around the unit. But, I'm, I'm guessing not.

4. I still got stuck in traffic despite getting out of work an hour and a half later than I'd planned. So I diverted to the Whole Foods to buy cornbread to go with the chili I made for dinner. While I was there, I got super excited because I found these organic oranges in a bag that I've bought before and they were just so good. So I bought a bag (whee!) and when I got home, I cut into one while dinner was cooking....and it was a grapefruit. I just bought a whole big bag of grapefruit. Which is okay, but...

5. I got home from work (and buying grapefruit) and discovered three, probably 8-10-ish year old boys sitting on my back porch, in the chairs, drinking Capri Sun. So I opened the door, and was like, um, hi. Can you tell me why you're on my porch? And they were like, oh...well, we're sitting. Do you want us to go? Uh......yeah.

So then they stayed out in the backyard and played soccer. Maggie kept huffing and looking at me like, "boy, they're loud." Yes, sweetie, little boys are loud. One of them appeared to be named "OMAROMAROMAR!" and another one was "Clar-ence."

6. I had to stick my hand in another woman's vagina today. Which didn't used to be an unusual occurrence, but you know, not a lot of psychiatrists do that very often. I acquired that crazy pregnant patient today, and the OB wasn't going to be able to come see her and do the pelvic until tomorrow. So I said, do you mind if I check her cervix? And she was so nice, which really is kind of unusual from this OB department. She was like, great, actually, that'd be so helpful. And so I did. And she's probably remote from delivery. And we all feel better now. Because when I ordered that they send a delivery tray up to the unit to be sure that if something happened, we were prepared (if, IF, not when. I'm not planning on delivering her on the Psychotic unit, but you know, she had her last kid in a hotel room, and didn't call 911 for a good half hour afterwards), the whole staff freaked out.

7. When I got of the phone with the sick patient's crazy mother and had the other sick patient's crazy mother holding for me on the other line, I commented to my attending about how it was days like this that make me wish I drank more. He told me it was never too early to start.

I'm so tired.

Tomorrow we have a family meeting with the hysterical histrionic mother who accused me of killing her baby. Her baby who can legally drink and was wearing the uncomfortable bra that God smote upon her. ::sigh:: Send positive thoughts.

Tuesday, March 25, 2008

Crazy Tuesday

But then again, what day isn't crazy day in my world.

Such a long day at work. Ohhhh, dear.

My patients continue to be really, really, really sick. One of them is getting a little bit better, the college girl who had her first episode of schizophrenic psychosis...can you imagine how horrible that must be? For her, for her family...and, really, a little for her psychiatrist, who's like, wow, I didn't see this coming, but in retrospect, I so should have...which, no, he couldn't have until she actually had her psychotic break. Which, by the way, seems to be a very fitting word. She's done broke. And now she's broken. And hopefully we can fix her, at least a little. But, you know, two years ago she was a straight-A student. Now she's completely psychotic and trapped in the false reality of her own head. Her very sweet and loving and supportive parents are devastated, and I can't imagine how they could possibly be anything else. And in truth, I think the part of the girl that was that's still in there somewhere is struggling and fighting and really conflicted by what seems real. The meds are helping a little. It's heartbreaking.

My other really, really sick patient has gotten worse. She'd been doing better, and we were going to send her home at the end of last week. I said it, Thursday, that if we didn't discharge her, she was going to decompensate over the weekend. Sure enough, she's a whirling dervish now. Who's being rude and acting out and was caught with her hand in some other patient's lap this afternoon. Which is when she nearly found herself on a bus to the state hospital, but my attending told me not to be so impulsive. I hate to tell him this, but she's been walking that line for over a week, and I would've sent her a long time ago if he would have let me.

Tomorrow, I have a really crazy pregnant lady coming down to my service from the crisis unit. Seems appropriate, huh? She should be interesting...

But then again, it's always interesting on the psych ward.

Monday, March 24, 2008

Will someone please turn the crazy down?

Wow. It was bad on the psychotic unit today. Wow. Fortunately, the patients aren't quite as violent as they were two weeks ago when I started, but, they're just really, really sick.

Really, really sick.

It's so exhausting. I keep underestimating how exhausting this is.

Fortunately, at least, I'm not on call this week until Sunday. So at least there's that.

Sunday, March 23, 2008

Random Endorsement Sunday

You know, 'cause I missed Love Thursday this week.

Happy Easter to all of you for whom it is, in fact, Easter.

Orthodox Easter follows Passover, so our Lent just barely started. I remember when I was little, my mom used to refer to Roman Easter as "Pagan Easter", which I didn't realize was a dig. So I wandered around referring to it as such for years. Heaven only knows how many of my grade school teachers I offended with that one.

And for those of you who are actually Pagan, well, happy equinox and happy Spring.

I tried to run errands today, but it turned out the only place I needed to go that was open was PetSmart. Where I needed to go because my dog walker left me a big note yesterday saying "NEED TREATS!!!"

So I went for treats. And here's what I got:



The treats are Maggie's very favorite. I suspect they're probably tasty, but I think the bigger point is that they're round, and they roll across the floor (you know, when I roll them across the floor), and then you can chase them, and pounce on them, and they're lots of fun. So I'm walking to the checkout counter, and I pass this display for something called the Furminator.

Wow. I so incredibly love this thing.

Mags was a little apprehensive at first, but afterwards was sort of like, ooooh. Yeah. Oh, brush a little more. And then after we spent about a half hour sitting outside brushing and brushing and brushing, she was like, okay, thanks, that's enough.

Holy Oh My Gosh, there was so much hair.

Sadly, I didn't get a picture of Maggie with all the undercoat hair all over her, but I can show you pictures of the fallout.
There were little Maggie hair tumbleweeds everywhere.

SO MUCH HAIR.
And a lucky cricket who just happened to be passing by.

Seriously. If you own a dog, who has fur that sheds, you need to go get one of these rightnow. (a Furminator, not a lucky cricket. Although...). PetSmart is open right now. Go, go.

Maggie says, get some treats while you're at it.

Meanwhile, we've gotten some random chores done and now we're watching Eight Below, which I taped off of Starz a long time ago. Maggie likes all the barking, I think. I always cry so hard at this movie. So hard. Maggie keeps trying to remind me that they're actor dogs and that me sobbing uncontrollably when Old Jack and Dewey die, or when Max gets lost, she says it's just silly.



She's probably right.

Saturday, March 22, 2008

Shit

Oh, in so many ways.

So....last night, was bad. I admitted four people. I did full evaluations and admissions on three more. I totally worked one kid up and sent him to Other State Hospital, which is an involved process to begin with, but he was mentally retarded, which then adds this whole long process of requesting an exemption from some Senate Bill or House Bill or dollar bill or something like that. I did four consults we didn't admit.

The last admission was this very sad woman who had been tossed out of another local hospital after a bizarre altercation with the staff psychiatrist, who was just highly inappropriate. But she'd originally been headed to the medicine service overnight, but you know, then she sort of woke up, and so it's 2am, and I finally get a minute to breathe, and I'm literally closing down my computer to go to bed, and my senior (who, in her defense, had also gotten slammed all day with inpatient consults) says, can you just go evaluate this woman in the ER? You don't need to admit her yet, but, you know, just go see her.

That was 2am. I finally called my attending at 6.

Now, admittedly, I had everything except the orders pretty much wrapped up by the time I called him. I mean, why wake him up in the middle of the night if I don't need to? And I had some calls to field in there, too. So shortly after 7am I wandered up to bed. I got a couple more pages, and then finally dozed off for about twenty minutes until the pager woke me up again. It was an outside call, and at least half of those are other institutions trying to transfer a patient. Which, on a weekend like this when we're full to the gills, is an easy denial.

Instead, I got the call we all dread.

There was a woman on the other line, obviously having consumed some substance, who told me that she had overdosed on her sleeping meds. She kept telling me that she didn't want to wake up, how nobody liked her, how she wanted to die. I tried to talk her into coming in, into letting me call some help for her. She was a little gamey with me, but I finally managed to get her to give me an address. She kept going on and on, and I'm stuck in this call room, by myself, trying to figure out what the hell to do with her. So I finally went through the little bathroom that connects my call room to the second year's, woke up my senior, and tried to ask her to call the local police. Which is hard to do in the dark when you wake somebody up, so asked the girl to hang on, and wasn't off the phone for more than fifteen seconds. When I got back, she'd hung up. I tried to call her back, but the number she'd given me was disconnected. So we called the hospital police, who sent us to the town police, who told us to call 911. So I finally end up talking to the county police, who called me back and said that they went to the address, which was a vacant house.

Shit. All I could say to the officer was, shit.

We get about three or four calls from the ledge per year, from what I understand. Sometimes we can help. Sometimes we can't. I don't know. I don't know if she was fucking with me, if she was high/drunk/stoned and decided this would be fun, if she was setting up the person who was listed at that vacant address and had a similar name and happened to be listed in our medical records system so they got a visit from the county PD. I don't know if she actually had overdosed and really wanted to die. Maybe she slept it off and felt better. Maybe she's just personality disordered and wasn't in trouble to begin with. Maybe she needs help and will come in, to us or some other institution, to get it.

Maybe she's dead.

All I know is, that sucked. And I ten minutes to signout after I got off the phone (again) with the police. The last thing I needed was caffeine, but I went down to the coffee shop anyway for my morning cup of English Breakfast tea with cream. And a scone, because they don't have bagels on the weekend. I wasn't especially hungry, and I was already shaky (you know that feeling where you feel like you're trembling uncontrollably but you aren't actually shaking? Is is just me?), but I needed the routine of it. And I was $.50 short. And they were so nice to me, and just let it go, and she got me started on a club card, because "well, you get a free drink for every 15 you buy, and you're here every morning (and about half the time I buy my med students coffee, too), so it's silly that you don't have one." I felt a little better. And then I felt a little better when the intern who relieved me was all like, "oh my God!" But the senior coming on, who, by the way, is my completely useless "big sibling," was like, "yeah. Oh well, what are you going to do? So what do I need to do today? How come there's all these consults left?"

I'm new at this, alright? And I'm not sure this kind of thing is ever going to get easy. It really shouldn't.

The clincher? The senior I was on call with comes in to report and says, "So...someone, during the course of last night, went into the bathroom by our offices and left a large pile of feces on the back of the toilet. Who does that?"

Friday, March 21, 2008

Know what sucks?

Call.

Man, the crazies are out in force tonight. Damn full moon.

Thursday, March 20, 2008

Match Day

Today, I'm going to break a hard and fast rule of my blog. For so many reasons, I never post pictures of myself on my blog. Not that it's really that hard to figure out it's me, here, if you know me, but nonetheless. While on the blog, as in life, most of my "rules" tend to be closer to "guidelines", this one's pretty much written in stone. Except today. Because, it just fits.

What's so special about today, you ask? Today is Match Day.

For those of you who don't know, the short explanation is that Match Day is this torture ritual cooked up by the Axis of Evil to add even more stress and drama to the life of a blossoming young doctor. See, what happens is, way back in August of your fourth year, you start submitting applications for places you want to train to do the specialty that you want to be in when you grow up. And the programs get all these hundreds of applications, and decide who they want to interview. So then, you interview at whatever programs, and they interview however many prospectives (i.e., we interviewed 90 for our 12 slots). Then after all that, which so far is not unlike getting a real job, in February you rank all the programs at which you interviewed in the order in which you would like to attend them. Meanwhile, the programs rank all the applicants they interviewed in the order in which they would like to have them. And then somewhere in Idaho or Texas or something some big computer puts all this together with a couple of complex mathematical algorithms and a hearty serving of voodoo and then spits out who goes where for what.

And that's the simplified version. We're not even going to talk about early match, the San Francisco Match, couples matching, or any of that shit.

Then comes Match Week. Match Day is always the third Thursday in March. But before that comes Black Monday, which is when you find out IF you matched, although not WHERE you match. The programs find out on Tuesday if they've filled all their slots, and then, the students who didn't match try to find open positions at programs that didn't fill, which may or may not be in their desired specialty and usually involves a lot of phone calls and faxing. This, appropriately enough, is called Scrambling. So then on Thursday, all the medical students in the whole country find out at 1pm Eastern where they're spending their next 1-8 years.

It's nerve-wracking. And a particularly sociopathic way to make people find jobs.

So last year the Match wasn't AS big a deal for me, because I was at home waiting for the results on my laptop in my parents' kitchen. Actually, last year Black Monday was the big day, because I only ended up ranking two programs (shhh) and the much bigger piece for me was if I had to scramble into a position. Once I knew I was in somewhere, I really had two options. I was a little surprised that I was going to Carolina, but, I'd waited so long for some stability and sense in my life and the ability to move forward by that point.

This year, it's a big deal because as of today the light at the end of the tunnel is finally confirmed to not be a train. There are people, with names and identities and pictures, who are coming to take my place in July. Fresh, new, impressionable minds that we can watch be progressively beat down and jaded next year and think fondly, well, at least it's not my turn anymore. Hmm, think I'll give myself the afternoon off from clinic next Tuesday.

Nah, actually, the interns are well supported around here. Intern year is just hard, even without the chaos and pathology and malevolence that made up my OB/G experience.

Four years ago (holy shit, it really was that long ago, wasn't it?) was a HUGE deal. My whole class, and all our families and friends, got together in this bar in Forest Park. And back then, you know, it was NOON Eastern, so 11 central that we found out. And Black Monday was so, like, whatever, because I knew then I wasn't going to NOT match, because my home program was going to rank me, but oddly, when I logged on that Monday to find out, and I looked at the little message that said, "Congratulations! You have matched." I got this weird sinking feeling in my stomach. So by the time Thursday rolled around, I was a nervous wreck. The Emerald Palace had once been at the top of my rank list, but after I went back for a second look, and after I did the same elsewhere, it dwindled down to #3. And my #1 rank had been heavily recruiting me. And please, my #2 should be so lucky to have me (although, I'm not sure why I thought I would match there, because I didn't like them, and they didn't really seem to like me, but, whatever). So I'd come up with two scenarios in my head: either I got my top rank, went home, put the house on the market, and moved to Baltimore, or I got my #2, went home, messed up the house again, and stayed in Chicago.

For some very bizarre reason, I had no contingency plan for #3.

And that year they'd made a rule that the bar wouldn't open until 11, when we all had our letters, because there'd been some embarrassing behavior in the past. And wow, I was a mess. I don't actually drink much, but let me tell you, I've never in my life been SO INCREDIBLY PISSED that no one would give me a drink as I was at 10:55 that morning.

So 11am finally comes. I go up to get my sealed letter telling me that (not that I knew this yet) I was being sent to hell. And I dawdled a little on the way back. And finally the friend who's standing on my right in the picture was like, "Well???" And then he dragged me to the back of the bar where my parents and my close circle of friends were waiting. And we all opened our letters. And I read mine. And fortunately, my friend Martha captured the moment on film:


Yeah, I wasn't so pleased.

Not that I could actually tell you why. I was more stunned than anything else. I kind of wandered around in a fog for a little while while the afore-mentioned friend and my other friend's husband kept feeding me drinks. And then a little while later we wandered over to the neighborhood Borders, where I again wandered aimlessly until I found myself in the Travel section. And then I thought, huh. I probably ought to get some books on New Hampshire.

So I loaded myself down with just about every book I could find, and then went back to the Cafe, where I encountered my friend Phil's wife, who had expected that they would match in Detroit but ended up matching in Cleveland, poring over an equally tall stack of books about the state of Ohio.

Last I heard, his mismatch turned out better than mine.

Whatever, I'm here now, and better days are in sight. Sometime I'll tell you about the night before Match Day 2004, which is a whole other story in and of itself (and involves a tattoo parlor). But pardon me while I escape to go drinking with my co-interns. We have a lot to celebrate...some of us even more than others.

Wednesday, March 19, 2008

Is it too much to demand...

...I want a full house and a rock 'n' roll band.

You know that Mary Chapin Carpenter song?

Here's what I want, at least tonight.

I want a rice cooker that doesn't burn my damn dinner.

I want my dog to understand that, just because it's raining doesn't mean you can't pee.

I want actual red hair, as in, roots that don't show when I get too busy to keep it up.

I want a couple more hours in the day to get stuff done.

I want someone else to pack up my house before I move in a couple of months.

I want to calm down and enjoy the rest of my intern year.

I want my patients to actually get better, and not just better enough.

I want cool quiet, and time to think.

I want more hours to sleep tonight.

I want you all to go download FHOD's new album, My Great Escape. My cousin wrote four of the songs on their new album. I don't actually know which ones yet. But I'll find out. I'm excited because I have new music to listen to on the way to work tomorrow.

Oh, and of course, I want world peace.

Tuesday, March 18, 2008

A tail of two puppies

Today, Maggie is six. You know, probably.

So in honor of same, she got a Jumbone, and her very own blog post. Here's the story of how I got Mags (with a lot of gratuitous pictures).

Once upon a time, I moved into a big house all by myself. Well, okay, that's not true. I moved in and my sorority sister from college moved in for the first semester. But then, she finished her internship at the engineering firm she was working at and went back to college. And I was a first year medical student, single, alone, in a big empty house that backed up to a trailer park.

So I got onto the Internet and started looking for a dog. And I found Wolfie.




Wolf was a Husky/Akita mix who was supposed to be 4. Well, they said later, maybe 6. The vet thinks he was somewhere closer to twice that old. He was a good, good boy, though. Oh, gosh, such a good dog. 90 lbs of snuggly, devoted, good, good dog. But what he wasn't was a well dog. The vet and I theorized later that he probably had metastatic cancer when I got him. I drove almost to Iowa and picked him up two days after Christmas, and he started having seizures about two days after that. He lasted almost a year, and it was a rough year. Once, when having a seizure, he bit me and I ended up in the hospital for three days. We had to clean his ears out twice a day because he had this horrible chronic infection. He had to take pills every day. Ultimately his liver failed and he got so sick he couldn't stand up and I had to euthanize him probably hours to days before he died a worse death. Aw, but he was just the best dog.

By then I was a second year medical student and was like, wow, this would be stupid for me to get another dog.

But then, my third year, my third roommate moved in, and he brought his dog, Kedzie.



Kedz? Also a good boy. Now such an old man. And I'd been longing for another pooch, so I thought, okay, this is good. I can get a vicarious puppy fix. And Kedz spent a lot of time down in my part of the house. But, although he liked me a lot, he was clearly Jeremy's dog.

I held out all the way to September of my fourth year. I started looking around and toying with the idea and even "interviewed" at this shelter in Naperville, who decided I was an unfit parent because I worked too much and denied me. And then one day, this woman my dad worked with said, hey, you know anyone who's looking for a dog? We've got a good one down at the shelter.

Well, that did it. I went down to see her. And I actually walked past her cage, because she was so timid and quiet, and all the other dogs were barking and making themselves known. But I stopped, and I said, oh. She's smaller than I was expecting. I want a big dog. And I was kind of thinking I wanted a male. But....she's awfully cute. And her tail started to wag.



And I said, well, is there a place I can take her for a walk or something? And the volunteer said, sure, and she picked up a leash. And wow, all the dogs went nuts. Barking, jumping...there was this big St. Bernard in the next cage who was banging on the cage door and just slobbering everywhere.

Maggie wagged her tail harder.



So we went outside. And she was so shy, and so timid, and so beaten down. And I scratched her head and played with her big velvety ears and she wouldn't look me in the eye. And Mags is part Greyhound, right, so she's a skinny gal as it is, but she was so thin you could see her ribs through her full fluffy Husky winter coat. She was clearly a damaged little soul. I rubbed her back, crouched down to pet her. And she leaned. You know how they do that. Knocked me over, actually. I laughed really hard. She hid behind my dad. And I was in love. This little girl? Was my dog.



So she couldn't come home with me that day because she wasn't done healing from her TAH/BSO (sometimes known in the non-former-OB/GYN community as being spayed). And it turned out that they adopted on a first come, first served basis. Which was a PROBLEM. Because she needed to be my dog, and I? Was taking step 2 of my medical boards on the day she was available for adoption. Crap.



So I gave my dad a letter, saying how much I wanted this dog, and that I had a nice house, with a big yard, and a dog run (that both my Husky Houdinis have had no problems getting out of, so it wasn't very useful, but I didn't mention that), and wow, I really wanted this dog. But you know, first come, first served. And when they opened the doors, three people were waiting for MY dog.

They ended up disqualifying one lady because she didn't have a fenced in yard or something. She had a little girl with her. So they put the other two names in a bowl and let the little girl pick. And because God, Allah, Vishnu, the Fates, and all the other ethereal powers knew that this was MY DOG, my name was on the paper she pulled out. I left the test, and there was a puppy waiting for me at home.



Oh, and ew, did I mention her name was Sweet Pea? Now, my girl, even before she recovered from her past life, even before she was the smart, funny, happy dog she is today, was so very not a Sweet Pea. So for the first three days of her new life she was named "Dog." And then one day, we were out in the back yard with Kedzie (whom she initially wounded but grew to love with reckless abandon), and I looked at her and I said, "Your name is Margaret, isn't it?" And she licked my face. And so it was. From then on she was Margaret Mae (like Maggie May, the Rod Stewart song).



They figured she was about eighteen months old when I got her. So I designated her birthday as six months for the day she came to live with me. Which is today. I've had Maggie for four and half years, and she really is the best puppy ever. We still don't really know what she is (except for the best puppy ever). She definitely has some Husky. She probably has some Greyhound. She may have some Shepherd. And the more I find out about them, she really seems to have a lot of Coyote (and they're rampant in the suburbs of Chicago). So my working theory right now is that her mom was probably something of a Husky/Greyhound mutt, and I'm guessing Dad was a Coyote who was passing by. I base this parental designation on, she had some training when I got her, so she was probably born to a domestic dog. Who was less likely to be a Coyote, because people generally don't have those at home bellying up to the water dish. Although I did try to pick one up on the side of the road once and take it to a vet. Because it looked like my dog, so it took me a second to realize, um, no, not somebody's errant pet.

But regardless of her roots, or whomever treated her poorly in the past, Maggie's been the best pal a girl could want. She went to New Hampshire with me. She came back to Chicago. She went on vacation to Florida. She went on interview trips with me. She even went to work at the yarn store with me and became our shop dog.



And now we're here. People criticize me often for being a "single mom" who works so much, and I'm not going to pretend that Mags wouldn't prefer I gave up my job and stayed home all day (actually, I think her Nirvana would be us both moving in to Daycare). But she's a very happy little pup, and she knows she's loved, and I like to think she wouldn't ask for a different life (with the exception of the afore mentioned Daycare clause). And I couldn't ask for a better companion through these last crazy years. To anyone who says money can't buy love, I would say, go down to your local shelter with $75. You'll get devotion, adoration, dedication, plus a leash and probably a bag of food. Spring the extra $3.50 on a Jumbone, add a little walk and a belly rub and you're guaranteed a friend for life. Shelter dogs are the BEST EVER. I have yet to meet a purebred who was as good a dog as my Wolfie and my Mags.


Love you baby. Happy 6th birthday.

Monday, March 17, 2008

So. Very. Tired.

What a long damn day. Holy cow.



It was a long day. It was a long call. I just finished all my notes at home. Which means it's time to go to bed, and maybe when I wake up, it'll be a good day. Because today, really, really not so much a good day. Stupid frakkin' really dumbass day.

I hate people.

GDR.

Sunday, March 16, 2008

Lazy Sunday

Mags and I had a very useless weekend. I got pretty much nothing done.


This is how she spent most of her time.

I, on the other hand....well, I spent a lot a time doing kind of the same thing. But last night I went over to my pseudo-aunt and uncle's to watch Gone With the Wind. Which I had never seen, and they were appalled that I could consider living in the South and not have seen the most quintessentially Southern movie ever made. Fair enough. Definitely epic. Although I have to say, Scarlett...oy. I really have so many things to say about Miss Katie Scarlett. But I'll stick to a rough tally of the times I rolled my eyes and moaned, "Oh, my God." Which I'm estimating at about fifteen. Hey, it was a four hour movie.

Today I had lunch with a med student I worked with on Neuro. It was nice. We spent like three hours chatting. Mostly talking psych. At which she's very adept. I was more than a little disappointed when she told me she was thinking of doing OB/Gyn. I kind of wanted to shake her a little and give her some speech to the effect of "don't make the same mistake I did!" Except that she's precisely the kind of person who needs to be in OB/G. ::sigh:: Kind of like I was. Good with patients, empathetic, has a good appreciation of the psychological things that influence women's health. You know, that whole biopsychosociocultural model of health care that's the new buzzword of psychiatric care. But I did tell her a little more about what went down at the Emerald Palace so she can properly warn her colleagues to stay far, far, far away.

And I got some laundry done. And some dishes. But nowhere near the amount of work I wanted to get done. Ah, well.

I did take some gratuitous cute pictures of my dog, though. This one's my favorite.


I'm on call tomorrow night again. Ahhhh, good times.

Saturday, March 15, 2008

Considering myself tagged

So my cousin Danielle "created" this meme based on some questions from this book, which she notes was written by a psychologist in order to get yourself thinking. I thought it was interesting. I added a couple (from the first few pages, which are on Amazon). And I echo her terms - if you are reading this, and you like memes, then feel free, you are already tagged.

Do you believe in ghosts or evil spirits? Would you be willing to spend a night alone in a remote house that is supposedly haunted?

I do, which is to say, I believe that we don't really understand the world we live in, the nature and/or physics of consciousness or what happens in the afterlife. I think there are spirits, not necessarily "evil" or "good". And, yeah, probably. Could be fun.

If you were to die this evening with no opportunity to communicate with anyone, what would you most regret not having told someone? Why haven't you told them yet?

Generally, I try to let people know what they mean to me. I've come close to dying a couple of times, and I've been around death a lot. I know how tenuous life is. I try to keep that in mind. I hope the people I love know that I love them.

If a new medicine were developed that would cure arthritis but cause a fatal reaction in 1% of those who took it, would you want it to be released to the public?

Absolutely not. That would never get past the FDA. And the class action lawyers would be salivating, regardless of how much time you spent on informed consent. Plus, you know, arthritis is debilitating, but not fatal. We can do better.

Do you think the world will be a better or worse place 100 years from now?

Yes. Also no. I think it depends on your perspective.

Would you accept a million dollars to leave the country and never set foot in it again?

Sure. I get to pick where I'm going, right?

Which sex has it easier in our culture? Have you ever wished you were a member of the opposite sex?

I think men definitely have it easier in our culture, and, really, in most cultures. Please, who hasn't wished that? You know, at least for a day or two. Generally I'm rather happy being a woman, but you've got to wonder what it's like on the other side.

If at birth you could select the future profession of your child, would you do so?

Nah. I mean, on the whole I'd prefer it wasn't a criminal endeavor, but beyond that, anything they want to do that makes them happy and through which they can support themselves is fine with me.

Would you be willing to become extremely ugly physically if it meant you would live for 1,000 years at the age that you choose?

Wait, I get to live for a thousand years?! How come nobody told me before?

If you could wake up tomorrow having gained one ability or quality, what would it be?

Teleportation. I'd never be late again, and I'd save so much on gas.

For an all-expense paid, one week vacation to anywhere in the world you choose, would you be willing to kill a beautiful butterfly by pulling on its wings? What about stepping on a roach?

Oh, I'll step on a bunch of roaches for, like, a Target gift card. The butterfly, well, probably not. It wasn't doing anything to me, and pulling its wings off is just sort of cruel. So it's a double standard. It's a double standard based on pestilence. I mean, really though.

If God appeared to you in a series of vivid and moving dreams and told you to leave everything behind, travel alone to the Red Sea and become a fisherman, what would you do?

I'd probably think about adding some Risperdal to my current medications.

You discover your wonderful one year old child is, because of a mix-up at the hospital, not yours. Would you want to exchange the child or try to correct the mistake?

No way. Although I'd want to have a relationship with the other family, for the sake of both kids. You need to know about your genetics, you know?

If you could spend one year in perfect happiness but afterward remember nothing of the experience, would you do so? If not, why not?

Absolutely. Because I think you remember in other ways beyond what this question implies.

Friday, March 14, 2008

Ohhhhhh, it's FRIDAY

Thank. God.

AND it's the last full weekend I have until MAY. 107 more days, yo.

Today...oh, my gosh, I'm just so glad this week is over. I finally made it to a Grand Rounds today. I was so disappointed. My attending was all excited about this guy. My shrink, last night, warned me that she was coming to GR because she was trying to get this guy to come speak somewhere else (and technically she's part of our department). And then I went to the "lunch with the speaker" thing, and wow, I thought he was just so cool. He was a profiler for the CIA. Oh, my word, talk about my dream job! I mean, okay, it's a little backwards; he used to profile actual people - political leaders, which, actually, isn't where my interest lies either. But still, wow. And he had such great stories. And I was like, how cool.

And then I went to his talk, which was about terrorism.

I was so disappointed. And then I asked him a question, which I thought was a really good question. I asked him, how does that line get crossed between activism and terrorism? And then he interrupted me and then he gave a very tangential answer about how we have to work against radical Islam, not just terrorists.

What?

I sat there with this bewildered look on my face, which usually prompts the speaker to ask, "does that answer your question?" Which typically gives me the opportunity to say, well, no, what I was really getting at was.... He didn't bite. But what I was really getting at was, you know, Rosa Parks met a lot of the criteria he mentioned for who becomes a terrorist.

Rosa Parks? Really, really, really not a terrorist. Just a tired black woman on a bus. Just an activist.

You know, a lot of people protest, and fight, and argue. A lot of people play the media. There's a pathology in there somewhere that makes protesters into terrorists. I think that's where it becomes fascinating.

Oh well. Whatever.

I had to more to tell you, but, dudes....we're tired....

Thursday, March 13, 2008

How can you not love this?

Dude. It's a big, cuddly giant neuron.

Reminds me of the time my best friend gave me syphilis and the clap for Christmas.

That was a big year.

I'm very tired. Maybe I'll muster a meaningful post tomorrow.

Wednesday, March 12, 2008

Lip vs Goat

Was listed as the chief complaint for a patient in the ER tonight.

And that wasn't even a psych patient. Ah, the glamor and excitement that is my job. My life is so weird.

Well, not as weird as the person who got impaled in the face by a goat tonight...

Another very weird story. Also weirder than my life. I think even weirder than the goat. But this patient would definitely be one of ours.

109 days left. 26 more calls. Yeehaw.

Tuesday, March 11, 2008

Echoes

Well, I think it's good news.

You know how Pedigree has been running these pro-adoption commercials? You know how awesome I think that is. And you know I think shelter mutts are the best. dogs. EVER. Doesn't get any better. So, a while ago, they aired this commercial. Broke my heart. I almost went out and adopted a second dog every single time I saw it. Possibly made me cry once when I was postcall.



But then today? I saw this:



Yay, Echo! He looks so darn cute and happy, doesn't he? Look at that tail! And that big puppy grin.

Shelter dogs really are the coolest.

Monday, March 10, 2008

A Post-post post

Oh my GOD I'm so tired. It's weird - the post- post-call day is often worse than the post-call day in terms the exhaustion. And today was my first day on the Psychotic Disorders Unit (like, schizophrenia, psychotic mania, etc). Which....wow. I have some really sick patients. Whew. It would've been an exhausting day in its own right, but when you factor in the preexisting exhaustion, I actually nodded off in the work room. Oy.

It's chaos up there. Even logistically. Like, there's no space for us to work in, really. I have no where to put my lunch, even, much less work and type notes and make phone calls. And the unit is a lot dingier and more disorganized than the Crisis unit. In a weird way it sort of embodies the difference in the patients that are housed there.

I have, like I said, some really sick people. Fortunately for me, my co-intern and I have two very different services, and it's weird the way they're split. She has all the really aggressive and just batshit crazy ones; mine are more psychotic in that personality disordered way. Which is nice, because they're quieter, spend less time attacking people, and don't end up in seclusion as often, and I have a real interest in personality structure and disorders and formation and whatnot, so it's good in that way. But, it also means they're a lot harder to treat. Some of them are also sort of interesting - I've got a former nurse who keeps trying to escape in the laundry bin. I've also got a very sweet, soft-spoken, very intellegent African man who was so despondent he tried to immolate himself, which, his burns are pretty bad, but he took the whole house down with him and caused significant damage to both neighbors' houses (how he got out with just the burns he has beats the hell out of me). I have a couple of people who just don't know where the hell reality is. I've got one who had all manner of delusions about bringing a referendum to legalize marijuana - and curiously, he has a roommate who is a baker and thinks the panacea for everything is marijuana cookies. One woman had a big crying fit today because she wanted a room with a roommate and threw all her stuff across the dayroom. But seriously, kids. It's a weird place.

My co-intern, we'll call her Ruthie, is also crazy. I mean, I knew she was a little nuts, but she's crazy. Which, not in a bad way, and I really do like her a lot. But I think she's a bit nutser than I thought. We also have two medical students who started today. I got the one who is very small and cute but doesn't look like a Barbie doll. Which is good, because she's the one I wanted. Barbie...well, I hate to admit I'm making such a judgement on her looks when I get so annoyed when people do that to me...and maybe it's more her demeanor and carriage...she just seems a little too self-important for my tastes. At first blush. We'll see how it goes.

Anyway, now that I'm finally up from my nap, I'm going to bed. Thanks, also, for all the supportive comments on the last entry. You guys rule.

Sunday, March 09, 2008

Not a post to read if you can't handle profanity

But then, if that's the case, you should probably be avoiding my blog altogether.

So, call. I'll tell you something....while I'm not a huge fan of the sleep deprivation, and don't get me wrong, I'm SO VERY READY for this year to be over and can't believe I still have FOUR MONTHS of it left....I kind of enjoy call at Big Hospital.

I mean, on the whole I'd rather be lounging at the beach with a tropical drink and a handsome traveling companion. But I kind of enjoy the work. I thought I'd hate it, right? The responsibility for the decision of whether someone stays or goes, all the damn paperwork, calling insurance companies and talking to other hospitals about bed availability - unlike at State Hospital, where you know they're staying, insurance isn't an issue, and the paperwork is less. And I'm not crazy about any of those things, but...I don't know. I like the diversity of it. I like the process of it. I mean, I guess what I'm saying is, I like psychiatry.

And yesterday was kind of nice, because I get along well with the second year I was paired with, and he gave me all sorts of tips for next year (primarily about what to do with my office and how to organize my clinic stuff). And I'm really starting to get excited about second year. Which is nice, considering how long it took me to even acknowledge that there was going to be a second year here (it's leftover from the Emerald Palace, where they tried to screw me about second year. One of the many, many ways they tried, and occasionally succeeded, to screw me). And he was supportive, but let me kind of do my own thing, which is a good balance.

But the unfortunate part of this job is that part of what makes me good at it is also sort of my Achilles' heel. And that's part of why training is four years or more. That's part of why I stay in therapy. That's part of why I dutifully take my Effexor every morning. And honestly, I've always been one who's in favor of pushing my own buttons and provoking things, because that's how you work through them.

That doesn't make it suck any less.

And let me say right now, the rest of this post isn't my usual lighthearted babbling. I won't be offended if you stop reading here.

Yesterday, I get called to evaluate this kid. This kid, who isn't in our system himself but whose father's therapist is one of ours and told them to bring him in, I get called to see this kid because he was caught molesting his younger brother.

Externally, I said, "yeah, okay, I'll get there as soon as I can." Internally, there was a maelstrom going on.

I totally had this kid sent up the river the moment I heard about this. I was pissed. How dare he do this, and then come to me for help, you know? Why did *I* have to deal with this? Call fucking law enforcement, nail his ass to the wall for taking advantage of a younger kid like that, slimy asshole predatory motherfucker. And of course I had warning that he was coming in before he actually got there, because of the dad's therapist, so I had plenty of time to anticipate and convict and work up a good froth. I thought about making my second year (whom we'll call Matt) go see him, which I could've done. I probably could've asked him to do it, you know, because it was sensitive and complicated, without even divulging my history, because he's good like that. And I thought about asking him outright, could you do this eval, because I was molested and the acuity of this, and him being the perp, is all just too much for me right now. I think Matt would've handled that well, and although I rarely offer up the info, in general I'm reasonably open about what's happened to me (obviously), because I don't think it's anything I should be ashamed of anymore. But I didn't. I just said, okay, I'll see him. We didn't even wait for the ER to call us, we just kept watching for his name on the ER board. And then, there it was, sooner than I'd expected. I wanted to throw up. Instead, I emailed a friend, took half an Ativan (they're prescribed. I don't usually take them with me on call, but for some reason I threw the whole bottle in my bag yesterday morning), and steeled myself against this rat bastard.

Now, obviously, this is a sensitive case (unlike, say, my patient who thought he was a bear) and I'm not going to post the details. But suffice it to say that what I discovered when I got down to the ER was more complicated than I could possibly have imagined. I expected, he was molested when he was little, now he was molesting his little brother, whatever, cry me a river. I seriously walked into that ER ready to nail his pig-fucker ass to the wall, commit him to the worst place I could find, and, to be perfectly frank, use him as a surrogate for confronting my own abuser. Two hours later I was arguing with my program director (the call attending) about why he should be allowed to go home with his family instead of admitted to the hospital. Two hours after that I was so physically angry with the people who were insisting I admit this kid without actually evaluating him, I was close to kicking something in the workroom. Two hours after that I chewed out a nurse who called me because she didn't have a private room and they usually put those kids in a private room.

Twenty-two hours after that, I still want to throw up.

Okay, "chewed out" is an extremely exaggerated view of what I said to her. But the point is, "he molested his brother" is not the whole story and is probably kind of inaccurate. And can I just say, the mom in this situation, wow. Every mom who gets a disclosure - much less whose husband catches her sons in the act like this - should be as amazing as this woman was. It was everything I could possibly do to keep from hugging the stuffing out of her.

I felt so bad for this kid. In the end I was so mad that I got forced into admitting him. I think he felt like I was punishing him for telling the truth, and even if I knew it wasn't true, and even if admitting him may well have been the best thing for him, I kind of felt like that, too, to be honest. I think he was likely the most victimized person in this whole story, when you get right down to it. And even if I wasn't necessarily successful, I tried like hell to advocate for him.

And frankly, I had a lot of trouble with that.

My shrink and I have been working a lot lately on the sort of Stockholm Syndrome piece of my symptom complex. Any my abuse was nothing like what was going on in this house. My abuser didn't just try to badger and convince and get me to consent. He coerced and threatened and manipulated and if that didn't work (and often when it did), he raped me. He beat me. He tortured me. He completely fucked with my head and left psychological scars so deep I won't ever fully know the depths of them. He took things away from me I didn't know I had, and I'll never get those back. He's tainted and soiled pretty much every piece of my life. He was a sadist, and a monster, and I can't believe he's still out there in free society. And I still have this very conflicting piece of me that feels bad for him. Because sometimes in those nights I learned part of what made him so evil. And because I am who I am, I can't help but have compassion for that. He was innocent once, too. He didn't just become a monster - someone helped make him that way.

It's not an excuse for what he did to me. Notice that compassion and forgiveness are two very different things.

This kid yesterday really activated that part of me. Like, I was sitting there looking at my patient, thinking about him when he was this kid's age and what might have happened if someone had intervened then. Would he have been different? Would I have been spared? Maybe not. I mean, it's not all about perpetuating what's been done to you. I clearly had a different reaction to his evil that he did to his abuser's. He clearly had tendencies towards violence and sadism. He became a monster. I became neurotic. He perpetuated the cycle. I push men away. I learned to subjugate my own needs. I learned to read people and preemptively meet theirs. I still fight with the negative self-esteem, the constant self-criticism, the worthlessness he left behind. He turned outward; I waged a war against my body, myself, everything I am. I still fight every damn minute with PTSD and bulimia (we'll talk about that someday, too). But while my life may often be hell, and it's in large part his fault, his life hasn't been what it should've been, either. And ultimately, I'm a survivor. He'll never be anything but a victim of his abuse.

There's something innately pitiful about that.

Saturday, March 08, 2008

Look! I figured out how to post!

I'm on call. For some reason, the computers here at Big Hospital don't let me click on the little banner buttons that say things like "log in" and "new post." So I had to be a little subversive...I logged in to leave a comment on Barb's blog. And then I clicked on my profile. And then I clicked on Edit My Profile, then on the Dashboard link, and then I had a real link to "Add Post". I felt just like James Bond.

You know, if James Bond was really bored and on call at a psych hospital instead of an international spy. I'm currently fielding a lot of calls for sleep meds. Ahh, the glamorous life I lead.

It's actually been a really rough call. I'm on with a good second year, though, we're having about as much fun as you can have being as busy as I've been, but he's been really helpful with things like paperwork and such. During the week, we have this coordinator, whom we're going to call Tyler. So during the week I usually see the patient, decide to admit the patient, and then come upstairs and say, "Tyler, what do I do now?" and he hands me things and says "Sign here." It's a good system, really.

It doesn't hurt that he's 24, devilishly good looking, and offered to marry me last week.

No, really.

As it turns out, there's another resident here, a second year, who has the same last name as me. And the same first initial. This confuses people to no end around here, and next year - when we both have clinics, etc - it's going to get a lot worse. Apparently Kyle's been dreading me becoming a second year for just that reason. So last week, when I was on call and he was on night float (the night I lent him my ID badge because he'd forgotten his, and you know, everyone thinks we're the same person anyway) we were discussing ways to preemptively troubleshoot this. What I finally concluded to be the best plan was me finding some guy who does NOT have the same last name as Kyle and me and running off to Vegas sometime in the next four months (113 days and counting....). All I need is to find a suitable groom, and this plan is golden, right? So Kyle recommends that if I can't actually find the love of my life, I could just find some guy with a good last name, marry him, get it annulled, and keep the name. At which point Tyler promptly pointed out that he was free this weekend and his surname was legally available.

Which was when Kyle pointed out his girlfriend. She? May not be so thrilled with the plan.

Ah well. He does have a pretty good last name, though. Short, easy to spell...but I'd have to rework my whole signature, and I've finally got that "K-scrawled line" thing down so well...

I really should go lay down while I can. Because it really has been an very rough day, partially because I've been crazy busy (no pun intended). Partially because I had one really rough case. Maybe I'll tell you about it tomorrow....maybe not.

Friday, March 07, 2008

Love Friday

Ohhh, so not feelin' the love today.

I wish I had the energy to tell you about the wackiness that's gone on this week on the unit. But I don't. So I tell you what I do love.


5. It's spring in North Carolina.

4. That Snoop Dogg is on Monk tonight.

3. That the new meat next year's intern class is identified in less than two weeks (it's like a light at the end of the tunnel, you know?)

2. I'm done (DONE!) with Crisis.

1. I'm on call tomorrow. Not normally a cause for joy, BUT, Daylight Savings Time starts Sunday morning. We spring forward! For the first three years that I was doing clinical medicine, I was on call for the fall back. Every year. This year, not only was I not on for that, I'm on call for the call that's a whole hour shorter! And, it turns out I'm on call with a resident I really like, instead of the one I thought I was on with, whom I don't really know but haven't really cared much for the limited times I've met her.

In less lovely news, ANOTHER ONE of our interns announced that he's leaving today. He's got good reasoning - he can't get his research funded here, and he's the one that's part time and spends the rest of his time doing research. But it's sad, because I really like him, and his partner.

Thursday, March 06, 2008

Something is wrong with today...

Today was wacko. I had this massively psychotic patient on the unit today. The whole milieu was worked up. My patients were pulling on me and hanging on me and swearing at me and...oy.
Plus, we made CNN. It's completely tragic.

And...dude, what the hell is going on here?

And, not to mention, I'm really glad this story didn't run two weeks ago, considering where I was then.

Oy.

I was on call tonight, so I'm going to bed. It was a loooooooooooooooooooong freakin day. Stay tuned for Love Friday.

Wednesday, March 05, 2008

Devil dog

Taken shortly after her little walk-about.

Cracks me up.

Ohhhh, today was such a long day....

Tuesday, March 04, 2008

So I'm dull. It's not such a bad life

Apparently Mr. (Ms?) Anonymous hasn't been too thrilled with my opinions in the comments over on the Shrink Rap blog and felt the need to come over here and make a couple of snide remarks. He/she seems to be someone who feels like psychiatrists are misanthropic snake oil peddlers (which seems like a strange sort to be lurking around a blog written by three psychiatrists, about mental health issues).

It's not a unique viewpoint. And you know, in a way, we are. Well, maybe not misanthropes, but a lot of our treatments are based on anecdotal evidence of what works instead of hard biological data. I mean, you can say that about a lot of things in medicine, but it's even more prominent in psychiatry, I think. Each patient is such a unique mixture of chemicals, experiences, conditioning, and genetics, that one size fits all treatments are usually inappropriate. Now, I concede, that doesn't mean there aren't shrinks out there that think the answer to everything is higher and higher doses of Seroquel or that dole out SSRIs like candy. I quite often get patients who are followed by providers outside our system whose med lists leave me scratching my head (or occasionally outraged). I got into quite a battle last week about a patient who has a diagnosis that not everyone believes in, and how everyone then blamed her therapist for destabilizing her with this voodoo instead of admitting they didn't know much about or understand her diagnosis. I had a doctor send me a patient yesterday -on whom he hadn't come close to exhausting all her medication options, who wasn't catatonic, who wasn't suicidal - and more or less tell me that if I wasn't going to give her electroshock therapy, I might as well send her home, because that's the only reason he was involving us.

Which is not to say I'm the best doctor ever. Far from it. I have a lot to learn, but at least my knowledge is sound on one point: these are the lessons I'm going to learn from my patients.

And let me say this...you know, I'm actually relatively slow to medicate people, but I do think drugs are an important adjunct. Otherwise it's kind of like withholding insulin from a diabetic - you can monitor their labs and check their retinas and take meticulous care of their feet and watch their kidney function and they can do everything else right, but if they don't have the chemical that makes things work, things are going to go wrong. And like diabetes, brain chemistry comes in a spectrum of qualitative and quantitative deficits. Also like diabetes, if you supply the chemical but the patient does all the wrong things, then you're still aiming for disaster. Mental hygiene is exactly the same - balance the chemicals to provide relief and remove any biological impairments, and then find the therapy to move things forward. But where mental health veers from the diabetes analogy is in that afore mentioned idiosyncrasy of being human. Despite our best efforts to diagnostically lump patients, each one is a singular event. The choice of which chemical or combination of chemicals to alter, the utility of what kind of therapy is appropriate or potentially harmful....it's as different as a fingerprint. The DSM is useless as anything but a guidebook.

And since I've beaten that to death...I will concede that even I think my posting of late has sometimes been lackluster. I think it's mostly exhaustion and a touch of being compelled to daily blogging by this Blog 365 business (i.e., you get more verbiage, but it's less profound). Blame the pox. Or the not-court. Or the Flu not-A. Or life as an intern. Or maybe I'm just boring. You know, there's something to be said for leading a life that isn't overrun with drama. A life of contentment with what is and little complication.



I wish I felt like I was living such a life right now....

Monday, March 03, 2008

I dream of angels but I live with demons

Today's SVU quote. From a schizophrenic suspect who refuses his medication. Which, incidentally, drove me crazy about this episode because, seriously, we force meds on people who aren't sane enough to want them all the damn time.

But I do feel like this is a nice summation of the struggle that is mental illness, regardless of whether it's schizophrenia, bipolar, depression, trauma, eating disorders...no matter if you actually hear voices, or just deal with the voices in your head.

I feel like this a lot myself, actually.

Today was...not a good day. Got some bad news. My dog ran away when I opened the door to clip her out (she's back, but not before she got about a hundred feet from the big major street by our complex, which is on the other side of an on ramp for the highway. I was already getting a little screechy, I was a hair's breadth from hysterics when she finally turned and came back over to me). It turns out we lost in not-court, despite the fact that the plaintiff has NO EFFING CASE. I tried to redo my nails and got smeary goop all over everywhere. Blogger freakin' refuses to upload my pictures.

I'm not pleased with today.

I did go to the yarn store, though, and got replacement yarn for a new shawl. I spent about twenty minutes picking up the same three balls of Encore and being displeased with my choice of the same three balls of Encore when I finally spotted this hand painted yarn called Elaine by Schaefer Yarns. I'd show you a picture, but.... I also got more Lamb's Pride for my friend's baby blanket. I'm going to be doing an awful lot of garter stitch in the next few weeks...

Sunday, March 02, 2008

And this is why I rarely mess around with gauge swatches...

So you'll remember how a couple of weeks ago I learned that my friends' mom was diagnosed with metastatic amelanotic melanoma.

(By the way, if you can say that five times fast without massively flubbing it, I think you automatically get admitted to an Oncology fellowship. If you say it in front of a mirror Biggie Smalls appears and gives you skin cancer.)

(Yes, that whole joke was in very poor taste. We doctors love our gallows humor defense mechanisms...)

(Anyway.)

So, since I can't actually cure cancer and am in fact pretty much powerless to help in any way at all (see above gallows humor), I picked up my needles. And began knitting a shawl. Because interferon doesn't make your hair fall out, and besides, she's been part of our social "family" for nearly fifteen years now, and very dear to me for at least the last twelve of those (I don't think I knew her very well until my friends actually started dating). She's a good lady. She deserves something warm and cuddly. So I had this Cherry Tree Hill marl in my stash. It was like 500 y and I thought, ah, this will work.

So I cast on 220 stitches, and worked and worked and knit and knit and knit and even put a little design in on the bottom.

And I started worrying that it was going to be a little short. Which I kind of figured, which is why I'd cast it on width-wise instead of height-wise. And so as the yarn began to run out, I started worrying that it was going to be too short and too narrow.

Well, it is a little short (I stole Barb's cork-for-size-perspective device, here). It's about 14 inches, top to bottom.
And close to eight feet long.

Frack.

I even did a damn gauge swatch. It was supposed to be about 5, 5 1/2 feet. Comfortable to wrap up in, but, you know, not actually long enough to TRIP OVER.
Here's another size-perspective device.
If it were symmetrical, it'd be a dandy table runner.

But, alas....I wasn't trying to knit a table runner. And as a shawl...well...

So I can't decide what to do with this. I might just keep it as a scarf. I might rip it out and start over again. I started knitting a new one, but I pulled this green mohair out of my stash to use and I'm a little worried. I was thinking "frothy" and I have a bad feeling it might come out looking more along the lines of "Muppet pelt". And it's sure not washable. I may just stop and pick up a couple skeins of Homespun on my way home tomorrow. Every prayer shawl ministry on Earth seems to make that stuff work.

Saturday, March 01, 2008

Lost Day

I've done absolutely nothing today. I'm not sure how that happened. No, I mean it. I don't know where today went. I don't think I actually left the house (and it was a beautiful day in NC). I don't think I had a real meal. I did knit a little, and actually, I ended up finishing the project I was working on (but...eh, it came up way short, and way too wide). I took a nap, sort of. I watched a lot of DVR'd TV. There's seriously like six hours of today I can't account for, though. And now my dog is being all cute and I can't even find my camera.

::sigh:: Maybe I'll just give up and go to bed, start all over again tomorrow.

Still sick. Feeling a little better, but I woke up this morning SO sore from coughing I could barely move, and it hasn't really gotten any better. Frakkin' stupid virus.

Tomorrow, tomorrow will be more productive.

And I think I'm pretty much out of SVU to watch on the DVR, so that'll probably help. Which means I'll probably also stop having an SVU quote of the day, soon, too...

Tutuola: Of all the detectives to have had this case before us, why'd it have to be Fiorella?
Stabler: Marty's a good guy, what's your problem with him?
Tutuola: I can't understand his handwriting.

That guy*: It's like a serial killer.
Tutuola: Worse, it's like a doctor.


*Tutola's random fill-in partner who's name I don't actually know. Nor do I know what happened to Munch.