Saturday, May 31, 2008

The best laid plans...

Maggie and I had such plans for today. We were going to sleep in (check). The movers were coming this morning to give us an estimate on packing, moving, and storing. They were very nice, and Maggie really liked the one guy. So I'm using this moving company, right, that's part of a comprehensive rehab program for substance abusers. So these two guys show up, all tattooed ex-badasses, in their ironed chinos and short hair, smelling pleasant and just as polite as can be. They were quick and efficient. And then I had all these great ideas about spending most of the day doing discharge summaries (I'm SOOOOOOO behind) and then starting to weed out stuff that's getting sent off to charity. Because, the house that I'm moving to is about half the square footage of the one I'm currently renting, so, lots has to go. And did I mention we're moving in LESS THAN TWO WEEKS, now?

Ahhhh, well.

I guess the working like 100 hours a week is finally catching up with me. Maggie and I spent the whole day watching Animal Planet and napping on the couch. Like, literally, it was suddenly 7pm and I had finished exactly one d/c summary.


We watched Animal Police, Houston. And Detroit. And, um, Miami (we love Animal Police. I really think Maggie just likes the barking. I like seeing the dogs in their new homes at the end. And Animal Police Miami always has alligators and horses and cool stuff like that). And we watched several episodes of this bizarre reality show, Groomer Has It.

Wow. Such ridiculous drama. But strangely addictive. And hosted by Jai, my absolute favorite Queer Eye guy. And next week they're going to the pound. We may have to watch.

So Jai is dealing with crazy dog groomers (at least he has a cute sidekick messenger dog), and Carson is telling fat girls they look good naked (of course they do). Ah, how the dynasty has...well...gone to the Crab People.


She really does get into some screwball poses to hang out and watch TV.

So now we're watching this very silly show called Showdog Moms and Dads. Which is another ridiculous reality show. Except it's not supposed to be so silly. But...ever see Best In Show? (If you haven't, you really need to.) It's exactly like that. Which...was supposed to be a parody. Oh, dear.

I guess we need to have a useless day every once in a while...

Friday, May 30, 2008

Oh so tired

Just finished today's notes. I need to go to bed. I promise a fascinating and insightfully witty post tomorrow. Or, you know, more of my usual rambling...

Thursday, May 29, 2008

Life, Love, and the thing about crazies

Oh, such a long, long, long day.

Today was another one of those days where I didn't have five minutes to sit down. Rounds, team, which went straight into a really tough family meeting. Which got interrupted by my next family meeting. Which I had to cut short at three minutes to lecture, and I still needed lunch. So I ran down to the coffee shop for a kind of disappointing salad (it's not so much that the salad is bad, it's actually decent, but that they didn't have the Mediterranean Vegan Platter that I like so much), and then I of course got interrupted several times for pages that actually had to be answered (I was reeeeeeeeeeeeeally bad about returning pages today, because I spent so much time in session). Then lecture, then phone calls, then the meeting that didn't happen, then upstairs to interview my sweet little 5 year old who said he gets "whupped with a belt" when his dad is mad. Which went long, and broke my heart. And then like three crises hit at once. Including Monkey's mom suddenly wanting to apparently act like his mother and take him home this weekend. Which turned out to be, well, not. And then there was problem, after problem, after problem. And then I came home, and then actually sat down and wrote my notes for the day.

::sigh::

You know what, though? I love my job.

I have to say, though, I kind of forgot, because I've been so busy, that tomorrow's my last day on Child and Adolescent. So I've done kind of a terrible job of terminating. I mean, Marlena knows I'm going off service, but I don't know that I've prepared her for it, because when she came in I was thinking it was going to be a short stay and that she might leave tomorrow. My other adolescent won't notice I'm gone. My one kid went home today, the one I admitted yesterday knew I was only going to be around until Friday (although they somehow think they're following up with me, which let me tell you, no). My third kid will notice that Penguin Shrink isn't me, but he'll be okay with it when I say goodbye tomorrow.

I'm really worried about Marlena and Monkey.

Like I said, Marlena knows I'm going, but I worry that she's not going to handle that all that well. I'm the first person she's been able to be safe with and talk frankly about what her uncle did. She totally outed me today, too, in her family meeting. She was yelling at her parents, after she was able to say that she didn't feel safe with her current therapist, and she says, "I have to see somebody who's been through what I've been through. I have to have someone to talk to that understands." I was like, I know, kiddo. That's totally what you need.

Monkey...I haven't told Monkey I'm going. I really don't think he's going to take it well. He's gotten pretty attached, particularly for a kid with attachment issues. Today, he had a toothache, and he comes up to me and holds my hand against his cheek to make it better. Aw, it was so sweet. His mom may not want to take him home, but I totally would. I think my attending would, too. He's really messed up, this poor kid, and a lot to deal with, but he's just so sweet. So broken. Such battered innocence.

Speaking of which, I sat down with my other little guy, the five year old, and tried to institute what the child abuse psychologist had given me yesterday. Let's talk about what you know about the body. What's this part? What's it for? Anything else? How about this one? Now let's talk about the parts under your clothes. The belt thing turned out to be nothing reportable, but then he draws me this bathtub, and tells me all about how his brother touched his winkie in the shower.

Okay, he didn't just tell me. It took a lot of giggling and patience and crayon wax.

His brother told him it would be fun. It really upset him, though, when this happened. My kid? Mad. Not fun.

Wasn't expecting to find that. Was looking for, honestly? Daddy spanks me. Which I got. And a little bit more. So it's not reportable, but, I had to sit down and tell his dad.

It was busy today. It was tumultuous today. But you know what? I was helpful today. I like being helpful.

I think it's settled. I mean, we'll see how the outpatient stuff goes next year, but I think I'm going to do a Child and Adolescent fellowship.

I think I have whiplash from the change in direction my life just took. Again.

Wednesday, May 28, 2008

Ewwwww, bleh.

So, of course, I was again on call tonight.

Today was a rough one to begin with. Like, I literally didn't have five minutes to sit down and think. I went from family meeting to family meeting. Had a meeting with the child abuse psychologist on how to interview my one kid about how his dad beats him. Remember my girl Marlena, the one with the uncle who raped her and then shot himself? She's back. She had a big crisis this morning. We worked through it, but wow, I felt so bad for her.

One of the things she's really mad about is how her uncle took away her ability to confront him. So I gave her the assignment today to write out a script, of what she would've said and what would've happened if she'd gotten the chance to confront him at trial.

I can't imagine.

So anyway, rushing, rushing, rushing around, and then I get to call, and there's like eight gazillion people in the ER. I took the job of tying up all the loose ends that the day shift had left, and let my upper level just start on the new people. And somewhere in the process of this I picked up this guy, who we were going to have to transfer out, right? Because he'd been sent to the ER...um...from the jail.

No, that didn't make any sense to us, either.

So, clearly this guy was going somewhere else. Because he was in jail on sexual battery charges. And part of the reason he was placed on commitment was because he'd been inappropriately touching the nurses at the prison (where he was sent "for safekeeping" from the jail. He was sent to the damn psych ward of the prison. But apparently it seemed like a better idea to send him to, uh, us?). So I started trying to figure out how to get him to a hospital where the might be able to appropriately manage an incarcerated sex offender. And then somewhere in there I got the bright idea that I probably ought to go actually interview the pervert.

Which is not the attitude I went in with. I went in, and sat next to him in a chair, and was doing fine...until he reaches over and touches my breast.

Um.

Not cool.

And it was weird. It was just his index finger, like, he pointed, and then poked. And I didn't react. Because, let's face it, he's some flavor of crazy. And I didn't want to reinforce the behavior by giving it any sort of positive or negative attention. So we keep talking (although I now want to hit him) and a few minutes later, he sticks out his index finger and acts like he's going to do it again.

I told him - in that calm, stern, low tone that these moments require - that if he touched me again I'd break his wrist.

Okay, not my most professional moment. But the place that came out of, that wasn't the professional part of me.

I would've done it, too.

It's weird. I've treated a couple big handfuls of known sexual predators. I've had other patients (or, say, surgery attendings in the OR in medical school) feel me up before, or touch my ass, but rarely have they been able to actually get to me this badly. This guy? I don't know if it was the way he did it, or his general deportment, or what the hell it was but, let me tell you, after I left that room, it was all I could do to keep from vomiting up my lunch (because I sure as hell didn't have time to eat dinner tonight). I. feel. so. gross. Still. Oh, ick, it was horrible.

That's the particularly horrible thing about trauma. One finger, this guy touches me with one lousy finger, and I feel like I've been raped outright. That's the sick thing about the damage that it leaves. It doesn't take much at all to reactivate a whole lot. Once you know how it feels....you know?

Sweet mother of God, I have to keep Marlena from this life.

The night float resident had come on by the time I actually disclosed this to the people in the office. She said I ought to press charges. I...a, that would've turned into a much bigger nightmare than it currently will, and b, I just didn't think it was a charge-worthy offense, in the empirics of it. But I appreciated that she really took it seriously. It was...well....validating.

So I'm going to go try and get some sleep now. Tomorrow will be better.

Tuesday, May 27, 2008

Oh, the longness of days....

Okay, that's one thing I'm definitely looking forward to about going back to State Hospital on Monday. Shorter days. No coming home and finishing notes for three hours. Rahoo.

::sigh:: I'm on call again tomorrow. At least it's only until 10. And it's my last call with the current second years. Next month I'm on alone, at State Hospital, and then when I come back in July I'm...ready for it?...on with my classmates.

I'm so tired...and there's a dog that needs snuggling, because she was kind of pukey before I left this morning. Although she did steal half my biscuit when I got home. Let her back in the house - I was totally going to share! - and the next thing I know, I turn around from locking the door, and she's hiding in her crate with the rest of my dinner.


It's a darn good thing she's so cute.

Monday, May 26, 2008

Post-call, take two.

Ahhhh, the weekend is finally over.

I got home today in a surprisingly really good mood for someone who'd been on call for 48 of the previous 80 hours. Last night wasn't awful. I saw four, sent two home, sent two to medicine, and accepted two direct admissions. Which I directed towards the second year resident. Because, ehhh, you know, she was sort of the direct opposite of June's extreme helpfulness the other night. And she was really passive-aggressive about trying to get me to not accept the the transfers which, we can't do that anymore without a legitimate reason (as opposed to our old reason, that we sort of like to keep the beds available for our own patients who come in, which apparently is not a legal practice. Somehow. Whatever).

I did have a rather unfortunate discourse with an ER doc at our affiliate hospital. Whose patient I accepted. But, so when I accepted the patient, the ER social worker said, "I don't know if this makes a difference to you, but he has no insurance". So I told her, of course not, we'll certainly accept him (let me repeat that - we WILL accept him), but you need to let the patient know that he is likely going to get a bill for his admission and he does have the option of going to the state hospital, where it will be substantially less. I told her it was approximately $1100/day here but we do have financial counselors who would be willing to work with the patient.

So there were a couple of little medical things I wanted cleaned up, and when I called her back to officially accept (ACCEPT) the patient, the ER doctor gets on the phone and is like, are you the one that told the social worker to tell the patient he'd be getting a bill? I said, yes. He says, wow. Well, you might want to watch that in the future, because that's a huge EMTALA violation. I said, no, it isn't actually, because we're certainly not going to refuse him because he has no insurance, but we tell our patients these things up front. And he says, all incredulous, but to give them a dollar amount? Don't you think that's some questionable ethics? I said, no, I think the patient has a right to know what he's getting into. And then the ER guy told me I had some "interesting" philosophies and refused to place the PPD I'd asked for.

Okay, first of all, it can't be an EMTALA violation because I took the patient (EMTALA, for those of you not in the know - and how lucky for you - is the anti-dumping law. What it really says is, you can't deny a patient emergency stabilization because they have no insurance. Somehow this has come to mean, at least in our fun and fabulous world of mental health, that you apparently can't reject a patient for any particular reason, either). Second of all, I think it's his ethics that are questionable. I guarantee you the reason this narcissist got mad at me was because State Hospital was on male delay and if the scary psych patient chose to go there, he'd stay in this guy's ED for another day or two. And beyond that, I'd want to know if I had that choice, wouldn't you? Say, a $5k-8k bill, vs almost no bill, in a facility that's not as nice and the patients are crazier but it's roughly the same doctors treating you (honestly? Having spent as much time as I have at both facilities, I'd take the bill. But at least it'd be my choice). It's part of empowering the patient in their own care, which I concede, is decidedly contrary to the old patriarchal model of medicine. The, I'm going to decide what's best for you (and for me) and you, patient, can just deal with that. Which is why it's old. And outmoded. And stupid.

I think he's stupid. Yelling at me at two o'clock in the morning over something about which he clearly knows nothing. And dude, I have degree in Humanities. Don't even start arguing philosophy or ethics with me unless you're prepared to bring your A game. I'm all about the Kantian bodyslam and the infamous Nietszche elbow to the ribs, baby.

Big stupid stupidhead.

Wow, maybe I've been hanging around with the kids too long.

But nonetheless. Because actually? Left in a really good mood, still in a pretty good mood. So here are five things, in no particular order, that contributed to my really good day.

1. The napping. Particularly the napping with my puppy. And then the lying in bed watching CSI and watching my puppy sleeping all hidden out underneath the chair in my bedroom, on which she used to sleep until I put something in the chair and made her sleep with me instead. (I might give her the chair back tonight. She clearly misses it). But seriously, there is no better feeling than the post-call nap.

2. Between leaving the hospital and my appointment with my shrink this morning, I went to the Borders to wander. And I found the best book ever. This book:

It's a parody of the Dangerous Book for Boys and the Daring Book for Girls, which are these cute and interesting compendia of random knowledge that everyone boy or girl should know (how to ride a skateboard...how to tie sailor's knots....how to properly set up a lemonade stand....etc). I actually looked at those on the way into the store today. They were clever. This one? So much better. Seriously, quite possibly the best book I own. Makes me giggle a really, really lot.

3. So one of the second years, we'll call her Maria, had a barbecue yesterday. Because, a, cookouts are what you do on holiday weekends, and b, in North Carolina we don't so much have "cookouts", we have barbecues. Which are different, because I tend to think of cookouts as general grilled meat, burgers, brats, whatever, whereas a barbecue involves pork and barbecue sauce around here (don't even get me started on the type of barbecue sauce, because that argument is apparently is a cause for justifiable homicide in NC). Anyway, Maria and husband had this barbecue yesterday, and I was very sad because I was not able to go. And then Mike randomly shows up with a plate of leftovers. He came in to the hospital to do some work while waiting to pick up another of our friends at the airport (I'm not entirely sure why, exactly, because Mike lives less than ten minutes from the hospital, and we can all access our charting system at home, and he was actually a lot closer to the airport at Maria's, but, nonetheless, who am I to question his motives when he's bringing us real food?), so he brought some leftovers in for the call team. Which was awesome. And then he hung around for a while and did some work and distracted me with silly YouTube videos of old 80s music. Which, how does Culture Club just not make your night better?

(Okay, no one tell Mike that I don't actually really eat barbecue. I'm working on it. It's the smoke flavor I can't quite deal with. And I have a thing about texture and lots of sauce and also pork. But I did have a little, last night, and it was quite good, as barbecue goes. Apparently Maria and her husband make their own sauce, and that's cool.)

4. I also picked up Jen's new book today. Haven't started it yet, because I got way too distracted, what with the dog book and the napping. But I'll let you know how it is. I expect great things, because Bright Lights, Big Ass was just so damn funny.

5. It was such an incredibly beautiful day here in NC. And I was finally out and awake enough for a while to enjoy it. It's been a remarkably beautiful weekend.

All in all, today, I'm really happy with my life.

Sunday, May 25, 2008

And, the floodgates open...

::sigh:: So I'm on call. Again.

At one point around 11:30 this morning, I gave up screwing around on the computer and went up to the call room to take a nap. And in the hallway were two of my 11 year old patients, on these little scooter majigs (like the ones you used to scoot around on in gym class, but with handles. It's kind of hard to explain...) racing up and down the hallway. I stopped and talked to them and the nurse and was like, wow, how cool! And my one patient, Monkey, he tried to follow me into the call room. And he says, "what's that? Why's there a bed in it? Is this your room?" I said, no, it's a work room, but we have a bed here because sometimes we have to stay overnight. He says, "Do you live here?"

Ahh, Monkey. If you only knew the irony of that statement.

I said, well, sometimes.

So today, unlike Friday, has been suspiciously q-u-i-e-t. I've been surfing the ER census (T-system) all day, and until my last check about ten minutes ago, there was nary a psych patient in sight. I tried to do some real work this morning but just ended up goofing off (well, I did get one discharge summary done. Which only leaves, um, like eight). And then I went upstairs and tried to take a nap. Which is when the pager started going off a lot, of course. But I managed to drift in and out until about 2ish, by which time I was so hungry that I gave up and went and got lunch. And then I came down here, and ate, and read blogs, and was kind of excited about the possibility of no-hitter (we have a day or two like that every year), when I saw two suicidal patients on the T. One is very drunk and wants detox and has a blood pressure that's like 230/140. Um, nope, medicine, thank you very much! The other one is complaining of suicidal thinking and chest pain. Although not right now. You know, apparently he was when the officers tried to arrest him. For what I don't know, because he hadn't been worked up that far yet. And dude, he's 61. Shouldn't you stop getting in trouble by 61? I know 50 is the new 30, but still.

Anyway, now the seal is broken. We'll see how big the leak gets before the night is over.

Saturday, May 24, 2008

Wow. That sucked.

Last night was kind of evil.

We got slammed last night. Slammed. We had so many patients. Oyyyy.

I was on call with June, which was at least a good thing. Sometime around 4am, she turns and looks at me and is like, I'm going to the cafeteria, you want anything? I said, well....you know, I'm dying over here, so maybe a Coke, but I'd kind of like something more substantial... She says, you want eggs? Pancakes? French toast? Breakfast starts at 3:30 around here. I told her to surprise me. She brought me French Toast. It was okay. Well, for hospital French Toast at 3:30 in the morning, it so totally rocked.

And at least it was an equally divided rough night, which I really appreciate about June. Usually, the division of labor is that the intern covers the ER, the crisis pager, and on the weekends, the floor calls, while the second year does inpatient consults and direct admissions, and helps out the intern if there are too many people in the ER. But last night, there were so many people to see that the status quo sort of went out the window. June saw five people in the ER, I saw six, I did a direct admission, whatever. I also had a woman crumping on the floor, who had a Rapid Response called on her this morning when I was about to leave. Oyyy.

This was June and my workstation by the time we were getting ready to give signout this morning.
Count the caffeinated beverages...

Oh, and speaking of things that suck, check out this article from the local newspaper. It's the latest in a series of front-page articles about how ridiculous this whole New State Hospital thing is about to become. It's slated to open in three weeks...incidentally, that's in the middle of my State Hospital month. They're supposed to move the same weekend I am. I have a bad feeling this is going to be a giant disaster...

Meanwhile, I'm going to go back to bed. Because I get to get up and do it all over again tomorrow.

Friday, May 23, 2008

I'm a jackass

Okay, who besides Claudia noticed that in the last post, that while I was going off on the mother of my homeschooled patient for misusing her words, I suggested that her daughter "go to the principle."

Principal.

I could've just gone back and fixed it, but, you know, it just seemed like it needed to stay. Because even though I was totally just blowing off steam and this woman's been very labor intensive to me and is so completely overinvolved in this case...sometimes I am, in fact, just a moron like that.

Thursday, May 22, 2008

Such a weird day

So today, I come around the corner, after my daily tennis ball routine (that's the joy of covering both units - back and forth, back and forth), and there's one of the care management guys - we'll call him John - standing in the doorway to where the elevators are, drinking a cup of coffee. And he sees me, and he says, "Kate. I've been waiting all morning for you, where ya been?" I'm actually not sure why, particularly, he was, well, loitering, but I'm reasonably sure he wasn't waiting for me. Nevertheless, I sassed him back a little, told him I'd spent the morning avoiding him (John and my interactions are usually feisty and border on gratuitously flirtatious, but we're not quite at the point of "Honey, you've been waiting for me a lot longer than that." Give us a week). But in case he actually had been looking for me I said, what's up, man? And he looks at me, cocks his head a little, and says, "You know, it's been a weird, weird day."

He really wasn't kidding.

There was a lot of parental weirdness going on today. No, not my parents. The parents of our patients. The other resident's parents are heavy duty. My kids' parents are mostly well-intentioned if a little neurotic (oh, the foreshadowing of that statement!!). Well, except for Monkey's mom, who doesn't really seem to care (Monkey, by the way, I adore that kid. I inherited him from Mike, who thought he was scary. But then again...I was relating to Mike the other day how Monkey had a tantrum and all I did was sit down next to him and he scooted over on the floor next to me and snuggled up, and then, tantrum over. He stopped crying, he went back to group, all was well. Mike shakes his head, says, "Yeah, well, he threw a piece of hard plastic moulding at me, so..." Honestly? Mike's a little less maternal. Which means, really, he lacks the soft snugly boobs. Nurse Ana and I think that's really what the story is).

I do have this one newly acquired mother, on the Adol unit, who is a little past neurotic. Now, let me state before I say anything else, I am not an opponent of homeschooling. I think you have to be like the smartest person in the world to home school your kids well. I know a lot of very bright, well socialized, well adjusted home schooled kids, and I think it's easier these days than ever before to be well supported in that endeavor. Truth be told? I have a little piece of me that really, really wishes that, were I to have any children, I could have the opportunity to home school them. But let's face it. High school geometry and I didn't get along so well the first time around. Plus, you know, that whole "doctoring" thing gets in the way, and I think that's an important example to set, too. But, I digress. The point is, I'm so not against home schooling your kids. What I am against is neurotic - wholly well-intentioned - MORONS home schooling their kids (this mom, and I know she's under stress, misused no less than six words in our half-hour conversation. And she be teaching the vocab?). I have this girl, on my service now, and okay, so she's fat. She's also apparently funny and very smart and a sweet kid, not to mention actually quite a pretty girl when she's not caterwauling. Anyway, when they moved here two years ago from Colorado, she went to her first day of school, and the kid who had the locker next to her kept kicking her between periods and telling her to move her fat ass. So what do her parents do? Withdraw her from school. Right away.

Great message to send.

Um, news flash, folks. High school, on the majority of occasions, sucks. There is not enough money in the world to get me to go back to being that age. Blech. But maybe there were other alternatives. Like, talking to her about it. Going to the principle. Et cetera (I told her today she should've kicked him back. Not the most shrink-y advice, maybe, but, well, then maybe he'd learn not to kick the fat girl!). Oh, but she's so sensitive. Um, maybe because you've never let her face a problem and win and her self-esteem is in the toilet. Maybe.

This is also the mother who brought Cold Stone for her daughter at visiting hours, and then turned around and asked me if our hospital had a weight loss program for children. And I kept trying to say, you know, maybe some of the somatizing she's doing is about her body hatred, how about we just teach her to make healthy decisions and love the body she has? And her mom, like, didn't even acknowledge that I'd said anything. Instead, she started talking (through her own bowl of ice cream) about her own gastric bypass surgery and how she's put on weight with the stress of the last couple of months, but it's going to be gone soon, mark her words.

Ah. I'm starting to see more of the problem.

Then, I go back into the workroom, and I run into Suzie (one of the nurses) and John, who are debating what to do with this letter Suzie received from an ex-patient. Who says she still wants to kill herself and goes on for two pages about how she's obsessively in love with this other patient on our unit, who, incidentally, is catatonic. We'll call him....Tomato. Now, Tomato seems like he's a nice kid in there somewhere, but right now he's still not speaking. And she's been trying and trying to get readmitted so she can be near him and with Suzie, who's the only one who understands her. Attending doc had suggested that maybe we call the therapist, but, well, she wasn't going to be upstairs for a while, she was busy. John and Suzie thought a doctor really should call. So, I did. And talked to her psych, and faxed him a copy of the letter, and felt a little bad about breaking her confidentiality (although it's totally allowed in cases like this, particularly when she's threatening to harm herself, or say, stalk other people, and I called her doc, which is sort of generally permitted anyway). It was so one of those letters you write to get all the crazy out and then never send them, except, she did send it. And not directly to the recipient, but instead, she addressed it to the social worker. So she clearly wanted it read. Oy, kiddo...so messed up. I only knew her briefly, but, I ache for her a little bit.

You know, the longer I'm here, the more I'm discovering, I actually sort of like the little people. I'm actually sort of good at this. And it would be great training to have, given that I want to work with trauma victims. I wouldn't have to restrict my practice to kids, but having that board certification in Child and Adolescent (not to mention the stuff I'd learn in those two years) would be really helpful. It's unfortunate, because everyone in my damn class wants to do C&A, and we only have five spots. And the people I'd be competing against are, generally, my really good friends in the class. And that sort of sucks. And I'd really want to stay, if I did a fellowship. Because I like it here. I don't know...it's just a preliminary thought right now...I'll be back to wanting to do forensics before you know it...

Wednesday, May 21, 2008

Tuesday, May 20, 2008

Why life sucks

Tonight, I admitted the nicest man. He was a cop, 18 years on the force, when this asshole he was trying to apprehend got the drop on him and clobbered him with a pipe. Now he has a traumatic brain injury and one of the worst cases of PTSD I've ever seen. He's done all the right things. He still has nightmares every single night. He still sleeps with his gun. He relives the attack every single day. For the past two years. Every. Single. Day.

My med student kept referring to it as "the accident." UM. Not an accident. A criminal. Who had been maced. More appropriate words? Assault. Attack. Offense. Horrible, evil, life-altering disaster. And this guy totally blames himself for what happened.

Anger turned inward equals depression. And this guy's got his anger aimed in the wrong place.

That's the thing about trauma, you know? It's like a car wreck. One moment you're driving along, everything's right as rain (or, you know, the daily life version of that), and then, BAM, you're in the ICU with tubes hanging out of orifices that didn't exist two hours ago and you have to spend the next year learning to walk again and spend five years regaining your ability to speak correctly. And you never are quite the same. You have scars, your body's changed, the healing itself took a toll. Everyone understands that, conceptually.

Psychological trauma is exactly the same way. You're going along. Life's generally okay. And then someone assaults you. Someone puts their hands on you. Someone takes away - in the blink of an eye, in the space of a heartbeat, in less than an instant - your control. Suddenly you're surrounded by darkness and chaos and the screeching of twisted metal. Suddenly you're learning how to walk - live, breathe, dance, walk, work, function - all over again. In a whole new way. And you never quite recover. The healing itself takes a toll.

Sometimes, life just really makes no sense.

Monday, May 19, 2008

Angst Monday

I'm watching this week's Bones. I'm really sad that it's the season finale.

There's much other angst going on. But we'll discuss that some other time.


::EDIT:: Wow. Didn't see that coming. Him? Really??

Wow.

And I think Hodgins knew when he traced the water. I think that's what the scene with the morphine button was really about, even though you were supposed to think otherwise.

I'm a little mad a Sweets for profiling the obvious one and missing the real killer.

Oh, and PS, I'm now officially in love with Booth.

Sunday, May 18, 2008

Joy Sunday

No, I don't plan to make it a regular feature, but I missed Love Thursday this week, and Barb started this Rush of Joy meme, so I thought that since I finally had a few moments to sit and write (not that I shouldn't be packing/going to the grocery store/writing discharge summaries/etc/etc/etc), I'd throw in my two cents.

As you all know, it's been a particularly rough patch of late. So I thought this was a good challenge to take up. I went with Barb's original number of 15 because I wasn't sure I could think of 10, so, me being me, I decided that was a reason to aim higher. Because there are a lot of sources of joy in my life. Because I can certainly stand these days to concentrate more on the positive aspects. So...

Fifteen things that bring me joy (in no particular order):

1. Maggie's ears. They're incredibly expressive, very funny, and feel like velvet. I also adore her soft little muzzle, her curious little eyebrows, and her gentle, sweet (and surprisingly slobber-free) puppy kisses. Okay, fine, so generally, my dog melts my guarded little heart.


2. A really good, up-tempo, anthemic-y song, played loudly in my car. You know the ones. Full of energy and hope and you can't help but sing along at the top of your lungs. Or actually, even a song that may not be as adrenaline-inducing, but has really good lyrics that make me ache. And then, like, the songs of my youth (as utterly ridiculous as some of them are. I can't believe I still know all the lyrics to "Ice, Ice, Baby"). So really, lots of songs.

3. The ocean. And it sounds silly, but I'm more partial to the Atlantic than the Pacific. I love the rhythm of waves on the beach, the saline breeze, the ebb and flow of energy that comes with the tides. There's a peaceful fluidity and an expansiveness to life that you can't get anywhere else.


4. That ah-hah! moment when you finally "get it." Kind of regardless of what "it" is, whether the answer to a puzzle, the solution to a problem, or what someone is really saying to you. There's a particular rush in that moment when things click into place and suddenly make sense. You know?

5. Rain. Particularly, a good thunderstorm. I used to be terrified of thunderstorms for a while when I was an adolescent, because I lived in Chicago and thunderstorms occasionally mean tornadoes, and for a while I had this really bad phobia of the unpredictability of tornadoes. I've gotten over it, though, and a good thunderstorm is now one of my favorite things. Rain has a sort of cleansing feeling to me, and I totally love lying in bed all bundled up when there's a little chill in the air and listening to it rain. But I also love the force and tumult of a good thunderstorm. When I'm at home, they also mean that Maggie (who is still not a fan) gets extra cuddly. But, like, the last night we were at the beach for the intern retreat, and there was a tropical storm rolling in, and we sat on the deck and watched just the most impressive light show, and it was one of those storms where the thunder resonates and vibrates your very soul...it was magnificent.


6. That giddy intoxicated feeling you get when you're with good people and can be totally disinhibited and just giggle like a moron at the silliest things.

7. Getting totally engrossed in a good book, to the point that I lose all track of time or my surroundings and it's like the language of the page becomes my very way of thinking, when you're so voracious and can't hardly stand to turn the page for what happens next.

8. Birth. Wow, it's amazing. The whole process is like seeing God. But there's this particular moment when the mother's flesh yields and the baby (who's probably been on the perineum for some time, as long as everyone's tolerating it - including the doctor/midwife - just waiting, stretching, holding, almost there) slides into the world and a new life officially begins. To be witness to that is to touch a small piece of heaven, and is an incredible privilege.

9. Oh, speaking of which...my new nephew.


(Can you just smell that little baby head smell? Oh, I love that.)

And my "old" one.


And the myriad of other small people my friends have brought into the world.

10. The blatant innocence of children. You know those moments, when they're just so pure of heart. There's a reason the word is "unadulterated."

11. The heady intoxication of good yarn fumes. Wool, or alpaca in particular. Oh, man. The smell of baking bread, all warm and yeasty and comforting, is a different high than yarn fumes, but comparable.

12. Being with comfortable people. The ones you can totally be yourself with and know they'll still like you. The ones that you can just let it all hang out and let them see your really good qualities as well as the ones you're not as fond of.

13. Seeing "New Comment on your post..." in the subject line of an email. I seriously live for comments.

14. Dancing. Alone, or particularly with a group of friends at a club or a wedding or something. Where you're not trying to impress anyone, and you can just be free and open and dance like a fat white girl and it's okay.

15. The Chicago skyline at night. It's breathtaking. Why don't I have a picture of that?

All right, your turn. Click on the link above for the meme rules.

Saturday, May 17, 2008

Hell's Pass Mental Hospital

(Double bonus points for anyone who gets that. Triple bonus points for anyone who gets that before reading the rest of the post).

I had something to say earlier.......although now I can't remember what. I was...somewhere, here, in the hospital (I'm on call again, big shocker)...and I thought, oh, that's so going on the blog....and now....no clue.

::sigh:: It sucks to be old and sleep deprived.

Oh. It was the EMTALA thing. Yeah, now that I'm not totally mad about it, it doesn't seem so interesting anymore.

Call's been frustrating, but not yet awful. We had a good medical student here during the day. I like my senior a lot, and I've not been on call with her before, but I'm enjoying it. We ordered Mexican food for dinner, and Mike was able to come join us (he's on for Neuro call tonight). He always has good stories. And this woman on the ED unit is having poop issues, which I keep getting paged about (She threw up! She can't poop! She pooped a little! It hurts to poop! She pooped three little hard rock things! Now the poop's like golf balls! Poop! Poop! Poop!), and so we made many inappropriate jokes and Mike whipped out this poop rating scale (no, it's a real diagnostic scale. Honest to God) that one of the medical students had put on a little card for him.

We've giggled way too much about poop tonight. It's like an episode of South Park over here...

Friday, May 16, 2008

Good news!

I'm an aunt again!! My new nephew Luke made his grand entrance at 2:30 this morning. A little 6lb 12oz peanut. And two whole days before his due date. Welcome to the world, baby boy!!

His baby blanket? Still under construction. Honest, kiddo, I'm working on it!

Thursday, May 15, 2008

Who knew?

May is mental health awareness month.

I didn't know this until Tuesday. I went to our weekly intern thingie with the drug company lunch and found ribbons on the table. They're grey ribbons. They say, "Keep mental health in mind."


The Mental Health Awareness ribbon is green. Lime green, apparently, to be precise.

And it's halfway through the month.

Ah well.

Mind your mental hygiene this month, and always.

I'm going to model this behavior right now. Going to bed now. Good night.

Wednesday, May 14, 2008

I...it...um....

I'm deliriously exhausted. So very tired. Have things to say, no longer the verbal capacity to say them.

Oh - except this. TWO AND A HALF HOUR FAMILY MEETING. Started at 4pm. Very exhausting. Already delrious before that started. Another one at EIGHT AM TOMORROW.

To quote Barb...buster duck.

Tuesday, May 13, 2008

One for the archives

First of all, I want to just say that two days of back to back call, even short call, is a bad idea. Don't let me do that again.

I don't know what's wrong with me, really. Lots of people work two jobs and 16 hour days all the time. Now, it's somewhat possible that they have less stressful jobs than I do. But, nonetheless.

Anyhow.

Before I go collapse into my bed, I have to share this. I got the absolute best crisis call of all crisis calls, ever.

So the pager goes off, and it's an outside call routed through our call center, so whomever is calling has called the operator, asked for the psychiatrist on call, and is still holding. They in turn page me with a name and callback number, as well as an internal extension I can call to connect as long as they stay on the phone. I look at the pager, and recognize the name as the call I missed earlier (which is weird, because I'm usually obsessive about the crisis pages. But I was really inefficient and distractable tonight, because, alas, second night in a row on call). So I call the extension, and I start with my usual opening line...

Me: Hello, this is Dr. J, I'm the emergency psychiatrist on call. How can I help you?
Her: Hi, this is Jane. I have a question.
Me: Okay.
Her: About a word.
Me: ...okay?
Her: I'm not sure if it's a medical word or not.
Me: Um, okay.
Her: The word is "impulsive."
Me: .....in what context did they use that word?
Her: What?
Me: How did they use that word?
Her: Well...I had a psych evaluation today. And they said that I was 'calm, laid back, easy going, and impulsive'.
Me: Ah. So what do you think that word means?
Her: Well, I think, like, calm, laid back, easy going.
Me: ....um....well...."impulsive" means that, like, when you think of something, you just do it, you don't think about it a whole lot before you do it.
Her: Oh, that's totally me.
Me: Oh?
Her: Yeah, I always think about things a lot before I do them.

Me: Uh....okay....
Her: So is it a good word or a bad word?
Me: Well, it's not really a good word or a bad word. It's just a description. That's all.
Her (sounding very satisfied with that answer): Oh! Okay. Well, thank you.
Me: Er...glad I could help.

You know how, when you found a word in your report that you didn't understand, and instead of googling it, or going to the dictionary, or asking, I don't know, pretty much ANYONE else, you decided it seemed like a good idea to call the hospital and ask to speak to the psychiatrist on call? Yeah, that's what it means.

Monday, May 12, 2008

My call - a haiku (or, linguistic decompensation)

Fuck, fuck, fuck, fuck, fuck.
Fuck fuckity fuck-fuck-fuck
Fucking fucker fuck

That's really all there is to say.

The whole day was like this, actually. From the time I got harassed by the stupid rent-a-cop for coming in the wrong door this morning to the pager that wouldn't die to the electronic chart that just crapped out on me with two notes left to write.

It's just one of those days you have to hand it over to the FUBAR gods. And write a little haiku with all the eloquence and verbal prowess I have left in me.

Om....

Sunday, May 11, 2008

It's just what I think

"I asked my mom if I was gifted, and she said they certainly wouldn't have paid for me..."



I've been thinking a lot this week, for reasons that I'm sure are implicitly obvious, about what it means to be a mother. Or, I guess, a parent, in the broader sense. But for all the theories and fuss about equality and co-parenting and all of that, there's something different about being a mother and being a father. It goes beyond, I think, what still are staunchly defined gender roles in our society. I think it's something biological. And it's not that being a dad is any less important, or any less of a biological drive; it's just different.

I do think it's important that children have strong parental figures in both roles. As one of my favorite LMHCs once said, "You learn your role as a woman from your mother; you learn your worth as a woman from your father." I think that's really true. And I think that you learn so many other lessons in kind - how to treat members of the opposite gender, what it means to be someone of your own gender, what your role in society is, what your worth is as a person, a man or woman, an individual, a member of society. I also think you get so much from watching your parents (or surrogate parents) interact.


I was sitting with one of my patients this week, an adolescent who has a horrible father and a stepfather who's just as bad, and I asked him, "what does it mean to be a man?" He had a hard time answering me, and gave me a lot of negative answers - i.e., "It means not treating women badly," "it means not abandoning your family." I praised his insight as far as noticing what seemed wrong that was going on around him. I also had a feeling that he probably couldn't give me a good answer for the questions, "What does it mean to treat a woman well?" or "what are the ways a woman shows you her worth?" because that had never been modeled to him, either. I don't know that I have the answers to those questions myself, at least not in the superlative sense (actually, I totally stumped myself with the last one, but that's my own neurosis). Nevertheless. This kid's at such a disadvantage at the stage he's at now, trying to figure out how to be an adult, what that is. God help him when he tries to become a meaningful parent. It's a rocky, uphill transition regardless, but this kid has a lot holding him back.

Our parents always do. That's part of being what we are; they prepare us the best they can with the tools they have, but it's up to the next generation to come up with a better set of tools. Whether that means updating and adapting for the changing times, or turning maladaptive skills into beneficial ones, or dumping out the toolbox and starting over, it's the way of progress and of the progression of humanity.


It's an endless effort and a huge responsibility to be a parent. No, to be a good parent. There are so many jobs you take on. At the most basic level, you have to keep them nourished, clothed, sheltered. You have to keep them safe, which if you ask me, is both the most taxing and the most important job. And then, you have to nurture and encourage them. Contain them but give them room to grow. You have set limits, hold absolutely steadfast to those, and know when to break them. You have to know, when presented with two absolutely essential needs that have to be met, which one trumps the other. You have to pass on what's important but keep your own stuff in check. You walk a delicate balance.

The hardest thing, I think, is knowing you have to let them screw up sometimes, even when you see them heading straight for the cliff. Because it's important for all of us to fail miserably sometimes. You have to be willing to bite your tongue, and then offer nothing but a hand and a hug when they're sitting in the middle of a royal mess. Because they have to learn how to fix it.

And you know what? You're going to screw up, too. You have to know how to do that with acceptance, humility, and grace.

Kids learn so much through modeling. It's not the latest theory of parenting or the hippest new toy or the most traditional nuclear family arrangement that makes a difference for a kid - it's you showing them what kind of person to be. We joke about the inevitability of turning into our mothers, or opening our mouths and hearing our fathers' words come out, but it's the honest truth.

I do think it's different to be a mother. I've been thinking a lot about my crazy pregnant patient's baby, what biological drive sent me over to the Women's Hospital to hold her, to physically touch her. I think it stems from the fact that we're set up to carry those little lives for their first nine months. Which isn't to say you have to birth a child from your own womb to be a good mother, or that every woman who delivers a child will parent it well (that one gets the big old duh). But I think it's relevant that we're chemically set up to do that. I think it's relevant that, evolutionarily, we've got better sensory perception and processing than men do. That we multi-task better. That the sound of a crying baby will make a nursing woman let down. Chemically, neurologically, hormonally, biologically, we have a different set of parenting skills.

Which, again, isn't to say you have to be a woman to be the nurturing parent (double kudos to the stay at home dad for defying gender conventions both socially and parentally). And it certainly isn't to say you can only parent your biological children well. And while I'd prefer she didn't take the presidency, I have to give Hilary her due for the fact that it does, indeed, take a village to raise a child. Aunts, grandparents, siblings, good friends - have all been some of the best "parents" I know. And it never hurts to have multiple people to learn from, particularly if your primary parents model well taking the positive from every person you encounter.

Mothering is a tough job. And with much respect intended to all those out their raising their own kids, no one has it harder, I think, than the foster parents. Again, I correct that to, the good foster parents. Because there are so damn many who aren't. And why anyone would take on that job if they didn't intend to be damn good at it is beyond me. Because that must be the most difficult thing going. You get these kids who already come to you damaged in one way or another. They already have attachment issues. And you welcome them in, and you have to attach to them and love them and encourage and nurture them just like any other parent, to deal with their problems and genetic setups and poor coping, knowing that all you may have with them is a brief moment before they get taken from you and whisked to someplace else. It's an awesome prospect and it deserves equally awesome respect.

Ultimately, I think being a mother isn't for everyone, at least not in the "direct," having actual offspring of their own, sense. Some people excel at indirect parenting (i.e., being a positive influence on others' kids or taking a strong surrogate role when the main parental figure is lacking), but for some it just isn't in the cards at all. And that's okay. The key is knowing it, I think, before you actually have kids.

What it boils down to, for me, is giving it your best effort and working in good faith for the welfare of your kids. To listening to them and to your own instincts. To understanding that it won't always be perfect. To remembering that the best thing you can do for your children's development into solid adults is to show them how to be one. Whether they're actually "your" children or not.

And knowing that one day, they'll get it.



(PS - thanks, Jenn!)

Raining on Sunday

(It's a Keith Urban song that was playing on Pandora this morning. It's one of my favorites, and seems amusingly appropriate today...)

I'm guessing that the drought in NC is over, people. Call it a hunch.

Happy Mother's day to all. Particularly to my mom (hi, Mom). And also to my "aunt" down here, who my actual mother likes to refer to as my "Southern Mom" (although I'm not sure she reads my blog). And also to Barb, Jenn (yes, you), Bei, Robin, Danielle, Gia, Lorna, Lorna's Mom, Lorna's MIL, Kate (not me), Mattie (here's hoping!), and anyone else I've forgotten to name individually. Blame my chronic sleep deprivation. You know how that goes. Also, to anyone who has a mother that they will actually admit to.

I have a whole 'nother post that I'm working on about mothers, so I'll try to keep this one short. Assuming that one turns out to be something better than more incoherent rambling.

So it's Sunday here (as I imagine it is there). Which is, as usual, far from a day of rest for Mags and me. I spent a chunk of the morning at Starbucks again, inside this time (because it's cold and rainy) trying to get some discharge summaries done, but alas, trying to summarize the hospital course on the longer-term patients I inherited from Mike is proving to be problematic, as you can expect. And apparently the d/c summaries I was writing on Psychotic (which consisted of cutting and pasting all the Daily Hospital Course notes into the Hospital Course section of the summary) aren't acceptable on child. What do you want, people? You want it fast or you want it meaningful? I guess the difference is that the outside providers actually read the ones we do on Child and Adolescent. So I still have three to do.

I then went to the grocery store, where they didn't have nearly anything I wanted but I still spent $90. You know, it's going to be one of those weeks, though. I'm on call Monday and Tuesday, Wednesday night I have some Neurology Interest group dinner to go to, and Friday I have an appointment with my shrink at 6, which usually means I'll grab something on the way home or eat at the hospital. And then I'm on overnight call Saturday. So mostly I'm not eating at home this week, without a lot of time to prepare stuff (seriously. Who wants to make tomorrow's lunch when you get home at 11pm?) which tends to mean a lot of hospital food. I'm going to try and bypass that by making chili and oatmeal or something today (not together). And I'm going to attempt to make some Paneer cheese, which I learned from PenguinShrink's boyfriend Chef, and is super easy and can be used much like tofu, except it's not tofu (which I'm finally giving up and conceding I don't especially care for). So we'll see.

Actually, I probably ought to go back out and go to Target and Whole Foods now. We'll see how much motivation I can muster, here....there's still dishes and laundry and reading to be done, too...not to mention the packing I haven't managed to start yet...

Saturday, May 10, 2008

Dogs, Drugs, and Dissociation

So, I made it through the week.

Hooray!

Today I haven't done much. Mags and I went to Starbucks this morning to read, but met some other people with a dog and talked to them for a while. Their dog was named Ally and she was this German Shepherd that was a little bit bigger than Mags. She wasn't well socialized, so we all stayed sort of wary, but she did pretty well with Mags. They were well socialized, though, and we had a very nice chat. After they left to go take Ally to the lake (apparently she likes the lake. Aww), they were replaced by a weird middle aged swarthy gentleman who was rattling along on is cell phone in what I can only guess was Lebanese. He was a little leery, and kind of creepy, so we left shortly after that. And I really haven't done a whole lot since we got home except nap, and read a little, and nap some more.

I still haven't started packing, although I think I did hire a mover. They haven't actually looked at the house yet, and we've mostly been playing phone tag, but they have availability the day I want to move, and I decided a few weeks ago that I wanted to use them. They're allegedly quite good and really cheap, but the more important thing (I think) is that they're an offshoot company of a treatment center for substance abusers. It's at least a two year commitment, I think, and you have to be clean - really clean - for the first year you're in residence before they'll let you work at any of their businesses. And the moment you slip up, you're out. But it's a fantastic second (or third, or eighth, or fiftieth) chance, a good honest living, and a great opportunity. For all parties involved.

Maybe if they're really as cheap as their rates on the website, I'll even let them pack me up. Because, let me tell you how quickly that's going over here.

I'm so tired. Physically, mentally, emotionally, metaphorically.

At least, as the week came to a close, I actually started to enjoy work a little bit. Like, I can at least appreciate how interesting this all is and think about how it might connect into adult pathology. The stuff that I find so fascinating in adulthood, it starts right here. The kids are interesting. Also still scary. But I've been able to separate the fact that I'm living in hell from the patients and the units. Not that the hell has really abated, just, it's not their fault. It's activating, what I'm doing, but it's activating my stuff. My stuff that's got to get dealt with eventually. So maybe the stimulation is good.

Which is unfortunate, because it feels like shit.

It's a hard feeling to articulate. It feels like I'm walking in one reality, and living in another. Another that no one else can see. It's very weird...and a little Joss Whedon, frankly.

Friday, May 09, 2008

Chillin' out, maxin', relaxin', all cool and all...

(If you missed that reference, and you are roughly my age, you should be very ashamed. What, did you live under a rock?)

I spent, like, the whole evening on the phone. Today was better, but I'm so tired...I'll give you the update tomorrow. Meanwhile, here's some gratuitous pictures of my girl, hanging out, watching a little SVU.

Ohh! It's the mid-episode plot twist!


::sigh:: Funny, that used to be my spot for laying on the couch watching tv...

Thursday, May 08, 2008

Love Thursday

Ohhh, today was so tiring. So, I inherited five patients from Mike, then acquired another one on Tuesday, to reach my cap of two adolescents and four kids. Today, I discharged two kids, another one's going tomorrow morning, and both my adolescents tomorrow afternoon. I'm a little worried about who's coming in their place.

One of my kids, I've been calling his mom for two days telling her we were discharging him today. I called her again today, she says, "I had no idea this was happening! I can't! I have to go to work!" Blah, blah, blah. I didn't tell her I also had to call Child and Family Services on her this afternoon because he told me about a whole bunch of violence going on in their home. I'm sending him home with her tomorrow morning. Sometimes, I hate my job....

...so, in honor of it being Thursday and all, here's five things I love.

5. That Thursday is really close to Friday. And I have the whole weekend off.

4. My med student. I have this great med student on adolescent right now. I rarely actually remember what his name is, so we're going to call him Blake. He's interesting. He's actually older than me, has sort of an interesting history. I always appreciate people who've taken circuitous paths to medicine, for the obvious reasons. His really heinous ties amuse me (he's trying to stick to the "kid friendly" or least intimidating ones, I think. But they're just ugly). He's also just very good. Like, he's not super adept at psychiatry yet (the poor misguided thing thought he was going to be a cancer surgeon. And then he discovered what that actually meant), but he's very good at those sort of intangible things. Like, he's really good with the kids. He's very unassuming, quiet, kind of a straight man but he's really quite funny. He tolerates me really well, which means he can probably but up with anyone. I'm trying to subtly convince him he wants to go into psychiatry, because I think he'd be good at it.

3. Now, you all know my affection for the Daily Coyote blog, and Maggie's long-lost cousin Charlie. I'm so pleased Shreve has become a Furminator convert. The following is plagiarized directly from her blog, right exactly here.

"In the past few weeks, I have gotten emails from many of you touting the wonder that is the "Furminator". I looked at this pet-grooming brush online, but even after your testimonials, I could not bring myself to spend $50 on a dog brush. Then, yet another person emailed me about this brush, and noted that it could be found for a discounted price online if one searched. I did, found a deal, and ordered it. The Furminator came today and WOW. It truly is amazing. I brushed out SO MUCH FUR it was shocking, and it was so much fun! Charlie loves it, too; he can't get enough. I then moved on to Eli, and filled A SHOEBOX with Eli's fur. I will be extra warm this winter - I'm going to knit myself a bodysuit from Charlie's wool and a pair of kitten mittens."

I will admit to being one of those emails. And I totally love that, a, Shreve is a knitter (who knew? But we should've figured), and b, that is completely and exactly what I plan to do with what I Furminate off of Maggie. One of the things I plan to do during all this free time they promise I'll have next year is take a spinning class, so I can make a Maggie scarf and nice Maggie socks.

2. My dog.


1. Y'all. Thanks for all the support and kind words over the last few days. You guys so totally rock.

Wednesday, May 07, 2008

Faking it

So yesterday, I'm sitting across from my patient, we'll call her Marlena (although I don't know why, because that's not even close to her name). You remember Marlena, she's the one who's uncle raped her for two years straight, threatened to kill her mother if she told anyone, and then shot himself when he got found out. Poor kid. So, I finally sit down with her yesterday. And she opens her mouth, and the floodgates open. She answers everything I ask - what he did, does she remember the first time, how she feels about him killing himself, how she felt about the way her family responded, etc, etc, etc.

I was telling Mike about this later in the evening, and he gets all excited. He's all, "I knew you could do it! I knew you could get her talking. I knew she'd do just so much better with a woman, and I knew you'd be good for her."

I just kept talking over him. Not because I didn't appreciate the compliment, but because I couldn't stop and talk about it. I was 15 minutes from going on call. I couldn't tell him that what she needed was, indeed, me, that what she needed was someone who knew what a flashback felt like and how pervasively this takes over your life. I couldn't tell him that I was sitting across the table from this sweet little girl, thinking, ohhh, God. How do I keep you from turning into me?

I'm so afraid for her. I'm so afraid of the life she has ahead of her. She's going to do fine, she's tough, she'll be a survivor. But it's going to be such a tough road.

Today, before we met with her family, she tells me that she was all sad and anxious in morning meeting because she'd just had a flashback. She won't tell me what the flashback was. And that's fine, I didn't push, I just encouraged her to think about who she could safely talk to about these things when she was ready.

Which was something I directly plagiarized from my therapist, when I sat on her couch Monday night talking about a particularly vicious memory that percolated through on Sunday. I hate that, when they're all sharp and jagged and newly recovered, how it takes over your whole body, your whole self, how the day even tastes different, how you feel caught in a rip in the fabric of time and you can't quite dislodge yourself from being back in that place. Everything seems out of phase. And I was telling this to my shrink, but I was totally holding back on the details. Because that's what I do. I'm always so afraid of traumatizing whomever I'm talking to that I temper the facts. Not that I want Marlena to do this - in fact, I could totally handle what she had to say. Not that I want any of my patients to do this with me (remember, I want to make a career out of Marlenas. A great number of years from now). Not that I really feel like my therapist will be too disgusted to listen or suddenly take on my nightmares. But it all feels too graphic, too abnormal, too hideous. Too shocking. I know I've got to pull out the gory details and show them to someone safe if I ever really hope to process them for real. My psychiatrist? She's very safe. She's quite wonderful, actually. And I sat in her office Monday getting the very same speech from her that I gave to my patient today.

I felt like such a fraud.

We had such a good session today. She totally knows. I don't have a poker face, and I keep saying things like, "You can't know what a flashback feels like unless you've had them," and then proceed to describe the feeling in detail. I'm completely transparent in this arena. We had a family meeting this afternoon. I'm certain her parents probably know I'm a trauma survivor. I've never said it outright, but, given all of my "you have to try and understand that you don't understand her experience", I clearly do understand. And I pulled out a page long list of resources - websites, books for victims, partners, and parents - that I'd read and could recommend personally. I've been there. I get it. And I left today feeling such conflicting awfulness...I knew it was helpful. I knew I made a difference.

And I also felt like I should sitting in jeans and a sweatshirt working at one of those Rape Crisis centers, not that I should be a psychiatrist. In fact, I felt very much at that moment that I should not be a psychiatrist.

No, I don't know what that means. I think it means that somehow possessing this knowledge firsthand makes me less worthy of being a doctor.

Yes, I recognize that it makes no rational sense whatsoever. I get that. Can anybody explain this? I have truly no idea what that feeling is about. And I don't particularly like it, frankly.

I'm so in Hell right now. It's really not the unit that's so awful, or the patients that are so bad. It's the me that feels inept and horrible. It's totally me that keeps getting assailed by my own childhood. It's all me who feels like I can't deal with kids very well (my attending today told me that she thinks I have a lovely rapport with children) and like I'm a big fat fraud who can't even move through her own trauma. Not that I've made miles of progress over the past few years or anything. Not that it's really helpful to patients when their therapist gets it.

I just don't get it.

Tuesday, May 06, 2008

Make like a tree

I'm so tired. I'm so, so tired. I was on call tonight. I admitted a very nice lady with a nasty H habit. I also acquired a new adolescent today, this very nice, respectful kid who runs with a gang and sells weed and lobbed a gas grill at his brother. In addition, I gained a new medical student on Adolescent, whom I like very much.

He says to me, the med student (whose name I haven't actually learned yet), he says, "How do you deal with this every day?" He says that after we interviewed the gang banger. I was like, oh, honey, you ain't seen nothing yet.

So I'm leaving from call tonight, and Tyler says, "Make like a tree." I looked at him quizzically, said, "And...?" He finishes it, "And get da fuck out of here!"

I think it was supposed to be "make like a tree and leave (leaf)." Yeah, somehow I missed that. Think it's the tired coming out. Also because his answer made me giggle ridiculously.

But Obama took NC! I like to think it was my vote that did it.

Monday, May 05, 2008

I'm in Hell

And I so don't want to talk about it.

Meanwhile, I love Bones. I'm so glad it's back.

I wish I had more to say. I'm just...way too drained.

Sunday, May 04, 2008

.....*whimper*.....

Tomorrow morning, I start Child and Adolescent Psychiatry.

Just for a month. I keep telling myself it's just for a month.

Half my class wants to go into Child and Adolescent. We take five fellows every year. Everybody's doing it these days.

Which is why nobody seems to understand why I want to crawl into a corner and hide.

I don't want to do this. I'm just not ready for this. I....oh, my freaking GOD. Stupid frakking American Board of Psychiatry and Neurology who thinks I need to learn how to treat kids for "well rounded" training and damn my stupid program who thinks it's a good idea to get exposure in the first year because, you know, if you want to do a child fellowship you have to start applying in your second year. Not like that makes any sense or anything. Damn it.

It really is going to be fine. It's 10pm, and I just got off the phone with Mike - who, by the way, is likely going to do Child and Adolescent and was just like totally in his element this past month - and I don't have either of the sexual predators on my service. So that's something. But I have all manner of horribly abused kids. I have one girl whose uncle was abusing her, and he got caught, and then he shot himself. Not to leave that on a kid.

I've often wished my abuser dead, but, holy shit, I can't even imagine that girl's guilt.

Mike's all, I'm glad you're taking over, because I keep making that girl cry. He's like, there's two really abused girls on the service who'll just do so much better with a woman. I'm thinking, yeah, I get that. And they'll probably do better with someone who's been there. Not that he knows that. Because the last guy I told about that, well, that didn't work out so well.

Ahhhh, the panic. The neurotic, neurotic panic.

It's going to be fine. I'll be fine. And I need to go to bed.

Saturday, May 03, 2008

"What kind of bomb can you make out of pudding?"

Apparently they confiscated Rachel's vanilla pudding pack at the Newark airport. Which is why she posed the above question to me. So I Googled it tonight. There was an interesting suggestion, but no actual bombs made of pudding. Although apparently this is a somewhat common problem.

So Mags and I are home. HOME. There's one dog and our own brand of messy and not nearly as many bugs. It's good to be home. You know, so we can start packing, because we move in six weeks (guess I ought to book some movers...).

Call itself wasn't too bad. But then I get home. And I notice that Mazel's ear looked weird, so I start fussing with it, and he's growling, and he nips me. On the hand, didn't break the skin, and you know, I take full responsibility for that one. He growled, I kept fussing, okay, fine.

And then I noticed a puncture wound on Maggie's foot. They must've gotten into it while I was on call last night. So I tried to avoid his ears, fine, whatever. But then I'm lying on the bed petting him, his tail's wagging, all's well, and he goes all Cujo all of a sudden and nips me in the face.

Great view of the bags under my eyes, too, huh? And that was after my nap. It's not bad. And Maggie's paw isn't too horrible, either.

She took a good chunk out of Mazel, though, according to Rachel, who actually managed to look at his ear without a muzzle.

Mags and I are similar in a lot of ways. One of which being, we're both relatively laissez-faire, both generally adaptable and clever and will try to find a sneaky creative solution to a problem rather than being confrontational. And both of us will take a lot of shit, but, if you back us into a corner, if you force it, we'll take a piece of you. And my girl's a shelter pup. She's from the streets, man. She's from the south side (of the suburbs, but, nonetheless).

Lesson? Don't fuck with us.

Or at least, don't fuck with us past a point. And we'll usually growl at you and give you ample warning. We don't just go for the jugular when you're being nice to us.

Anyway.

So then after doing the dishes and packing and feeding everyone and messing with a bunch of other stuff (I got three hours of call room quality sleep last night, so of course I would be running around fussing instead of, you know, napping), we Furminated.

We Furminated the crap out of Jake. Leos apparently molt once a year, and he had a lot of winter undercoat that needed to come out.

Jake, before:

Jake, after.



Wow, that was satisfying.

Anyway. We went and picked Rachel up at the airport, got her tucked in, and then it was way too late by then to go home and drop Maggie off and still make it back to my shrink's office which is five minutes from Rachel's. So Maggie got to come to therapy with me today! I offered to reschedule, but, what can I say? I have the best shrink ever.

I think Maggie feels better, too.

Friday, May 02, 2008

Thursday, May 01, 2008

The elusive kit-tays

So, like I said, CFR has four cats. Which is a lie, actually. She kind of has five. Interestingly, they all showed up last night.

So, first, I found Jasper, whom I hadn't seen all week and was a little worried that she might be dead under the bed or trapped in a closet somewhere. But then I walked into Rach's bedroom last night, and poof, there she is.

I also managed to get a snapshot of the elusive Chloe. She's a bit of a scaredy cat...

And then, wonder of wonders, I let Simon and Garfunkel out, and sitting there is Rachel's friend Nancy's cat. Nancy stayed here for a while while she got on her feet, and this cat, whose name I've totally forgotten, decided she liked it here better, so when Nancy left, kitty stayed. She's exclusively an outdoor cat, but has food and water and a cat condo out on the front porch.

So not only did I get pictures of all the cats who were greatly theoretical to this point, I also got a couple of really rather funny pictures.

First, Jabba the Cat...

...and a curious Garfunkel kitteh....

He he.

Today was nice. My favorite attending is back for my last two days on Psychotic. Hooray. Poor PenguinShrink has the plague, though. We keep dousing her in Purell, but somehow she's still sick...

Alright. Time to go let the puppies in and go to bed, as very, very sad as that is at this early hour. But Mags and I have already been snoozing on the bed for a while "watching" CSI, so I think I'm just going to give it up, since I'm on call tomorrow anyway...