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.