Thursday, July 31, 2008

Loved Thursday

So tomorrow is my VERY LAST DAY AS AN INTERN.

Wow.

It's been a good year (and then some). Hard, but, good. I've learned so much...about psychiatry, about my patients, about myself, about life in general. And I've really enjoyed doing inpatient psychiatry. But I'm definitely looking forward to moving on to outpatient.

And I'm so tired.

This morning, though, the nurses on the Crisis unit really put a nice bit of punctuation on the year. We got in this morning, and they'd prepared quite a nice spread for my co-resident, the medical students, and me, to say thanks to all of us. There were muffins, sausage biscuits, hard boiled eggs, homemade quiche, bananas, juice, coffee....it was really sweet. And then they'd all signed cards for us. Mine said over and over how much they'd enjoyed working with me, what a good doctor I was, etc.

Awwwwww. I almost cried. It was so nice of them.

Tomorrow I have to present for our M&M conference (which, for those of you not in the biz, has nothing at all to do with chocolate candies. It stands for morbidity and mortality; every department has these conferences. You talk about cases where something went wrong, talk about why it went wrong, what you can learn from it, etc) about my patient who ran away. I'm a little nervous. Mostly because, well, speaking in front of the entire department, and two, the last time I was involved in an M&M at the Emerald Palace, all the shit rolled right downhill and on to me. I expect that tomorrow will go much differently.

What a contrast. It's been such a different experience here.

What a difference a year makes.

Wednesday, July 30, 2008

Not at all painless

So I've been thinking, today, and for a while, about suicide.

No, not my own (so put the commitment papers away, Peng). But, working inpatient psych, suicidal ideation is probably 60% what we deal with; probably 80% of those admitted to the Crisis service. And it always amazes me, the crazy amount of people that think about, or even attempt, suicide.

I don't understand. I don't understand the people that impulsively down a bottle of tylenol because their girlfriend broke up with them or cut their wrists because they had a fight with their boss. I can't comprehend this idea of, I'm having a bad day, I think I'll kill myself.

Death is so final. It's so....dead. We don't know what dead is. Nobody really knows what death is like. Maybe it's just nothingness. Maybe it's heaven. Maybe it's worse than anything we can possibly imagine in this existence.

And beyond that, it's an end. Which, is why I can understand the patients that are super depressed or really traumatized and think of suicide. I'll admit, I've been there. Not actively suicidal, but, in that place where you're just like, if I died, you know? That would probably be okay. At least this would be over. But it never seemed like a reasonable way out, and certainly never like a quick fix. And let me tell you, when I had - transient, brief, evanescent - thoughts like that, whew, I was in the lowest place I've ever been. It was so far down. I could not have been sitting in the dayroom laughing and watching TV the next day if anyone had locked me up. I understand the patients we have that have no hope, that see no possible light at the end of the tunnel; most of the time they barely see the tunnel. That's a black, black place, and I can understand the need for relief.

I had a friend once who told me that, when she was in high school and realized she was gay, she went to her pastor looking for guidance. And he told her that she was going to burn in hell because of who she was. And she left there, and what kept going through her mind was how she was going to continue to be persecuted while she was here on Earth - she lived in Hicksville, Nowhere and they didn't take too kindly to her sort. So she had a life of hell ahead of her, only to be followed by an eternity of hell afterwards.

So she contemplated suicide, because, why increase her suffering by staying alive? Why not bypass that and go straight to hell? That I get. I'm really mad so I'm going to take all of my klonopin? That's the grown up equivalent of, I'm going to hold my breath until I die and then you'll be sorry. Except, holding your breath until you turn blue? Low lethality attempt. By the time we grow up, we use much higher lethality options. Pills, guns, drugs, nooses...you stay blue.

And that doesn't even address the people you leave behind. Even if you have no family, no friends, nobody at all who loves you and would be distraught if you took your life, I guarantee, it'll matter to someone. It'll matter to your doctor. Losing a patient to suicide is something we all face at some point in our careers, but let me tell you, it shakes every one of us to our core. The very idea of it keeps us up at night. And chances are, there's someone out there - a friend, a neighbor, a family member, a pizza delivery guy - who's going to miss you. Who's going to be upset that you did what you did. Who's going to blame themselves for failing you. Who's going to be saddled with that for the rest of their own life. And suppose you do have a spouse, a parent, a child, a sibling left behind? Who does love you, who worries about you? How the hell are they ever going to deal with that?

I'm just sayin'. Think about it.

And for the love of all things holy, enough with the tylenol, people. If you need to kill yourself, there are ways to assure that you die. I'm not going to tell you what those are, obviously, but I can tell you one that WON'T work - a tylenol over dose. All it's going to do is kill your liver. And then you get to die a slow, awful, excruciatingly painful and uncomfortable death. I'm guessing not the quick fix you're looking for.

Seek help. Everyone has emotions that are intolerable; suicide is never the answer. Think about what suicide would really mean. Get to a hospital ER, call a crisis line, or better yet, seek psychiatric treatment before it gets to that point. Tell someone, tell anyone that you're in trouble.

Every state has a HopeLine. Ours, in NC, is 919-231-4525. The Teen TalkLine is 919-231-3626. You can find your state's by Googling "hope line" and your state. They often have toll free numbers as well. Or you can dial (800) SUICIDE. They're anonymous, they're supportive, and they'll let you talk as long as you need to. So if anyone out there finds themselves in that place, where suicide seems like the best - or only - next step, get help, and get it now.

You'll be glad you did.

Tuesday, July 29, 2008

Tagged! I'm it.

So, my cousin Danielle tagged me for her Top Five YouTube Videos meme. The directions of which are to, um, post your five favorite YouTube videos. So, in no particular order, here are five of my favorites (well, six, if you count the one I can't embed. Think of it as a bonus...).

1. My very favorite aria from Die Fledermaus (Mein Herr Marquis, or as it's usually billed in English, Adelle's Laughing Song), sung by the coloratura who does it best, Edita Gruberova. She's one of the best that ever graced the stage.



Some of you know this, but there was a brief point in my life when I thought about becoming an opera singer. Now, my preferred venues are pretty much the shower and speeding down the highway. But it's always a sellout crowd. You know, given that I don't sell tickets. Nevermind, that was a stupid joke...

2. Well, as long as we're talking about stupid things and videos in German...there's this one that my friend sent me yesterday. Which became even funnier given that I'd just spent my whole day trying to speak a whole other language that I don't speak well at all (I see a Rosetta Stone course in my future). It also amuses me because, let's face it, Americans are damn Anglocentric people. And, because it's David Hasselhoff. I mean, that's just funny no matter how you slice it.

Don't Hassle the Hoff, man.



Funny. Did you know he went to my high school? Has a little plaque on the wall and everything.

Okay, the next two, not safe for work. Well, it depends on where you work, I guess. But probably not kid-safe, and well, probably not safe for parents (sorry, Mom and Dad). So if you need to, skip ahead.

3. The funniest, lewd-ish-est, makes-no-sense SNL skit in recent history. With Spanish subtitles, but, I was going for video quality, here. That's the nature of YouTube...



See, I'm wise enough to know when a gift needs giving...gotta love a non-sequitor R. Kelly reference. I freakin' love that sketch. Even though I cannot figure out who they're supposed to be parodying, and it, as I said, makes no sense. But if you want, you can buy a t-shirt with those three-step instructions emblazoned on it, or if you surf Facebook long enough, you'll find waaaaaay too many men in their 20s dressed up as those guys for Halloween. Including my best friend's little brother, which is just about the funniest thing ever.

Oh, wait. The next one is kid-safe. Because it's bleeped. But they might ask you what a shank is, fyi. Tell 'em Iceberg hit a brother with a leg of lamb. They'll never know the difference.

4. I have no way to segue to this one, because, it's in English, and has nothing to do with Justin Timberlake...whatever. Ice-T. Love him. Always have.

So, aside from my adoration of opera, I also have a deep love of old-school gangsta rap, and no one is more OG than Ice. There's just brutal honesty in that old stuff, you know? It's poetry, it really is. No, stop that, I'm serious.

So the video I really wanted to post is Body Count's Cop Killa. History-making rap. I remember when that song came out, man...it was right around the same time as rival group NWA's Fuck Tha Police (which is, of course, sampled in this song, which is HUGE. Imagine Biggie sampling Tupac. I'm sayin'). And so I'm in white bread suburbia, and everyone was just up in arms about this song. Which is clearly a caricature, and addressing the larger issues of poverty, oppression, police brutality, and sanctioned abuse of power. The song wasn't about good cops - it was about rebellion, unrest, and an unwillingness to accept injustice. Plus, how can you argue with logic like "better you than me" and "fuck police brutality"?

But I can't embed it. And you know something else? You can't buy it on iTunes, although you can find other songs from that Body Count album. Anything that can be that inflammatory for that many decades? You know there's more truth in that than we want to admit.

But, since I can't embed that one, here's another groundbreaking song. Particularly notable because it was one of the very first rap songs to actively and openly condemn gay-bashing.



In case you were wondering, the other of the first tracks to condemn gay-bashing? Ice-T's Straight Up Nigga, which is off the same album (OG).

Love. Him.

A total, total aside - no discussion of my musical proclivities would be complete without mentioning how I occasionally make up songs. Usually they don't make it out of my head. Because we're not talking serious composing here. A good example is the melody that's been circulating regarding our recent infestation. Which would be? Straight Up Chigger.

Moving on....

5. As long as we're on political commentary, nobody did it smoother than Marvin Gaye. And this is one of my very favorite songs ever - it's a remake of What's Going On, by a bunch of bubble-gum pop stars who happened to be popular a few years ago and none of whom have the staying power of Marvin, but I really like the way it was adapted. It was a good homage in and of itself, and takes the political mission intended by the original song, updated it and kept it going. Plus, I just love the video.



So that's what I've got. Anyone else want to pick up this meme?

Monday, July 28, 2008

Mi vida es extraño

My life is weird.

So, today, I walked onto the unit and was immediately like...ohhhh....

Which, it turns out, was warranted. Five out of my nine patients were new. Two of them didn't speak any English (fortunately one of my rockstar medical students is reasonably fluent. And now I know how to write prescription directions in Spanish. Una pastilla antes de dormir...). So we rounded, and I started out with no discharges. And then as the day progressed, two of my patients' families convinced me to send them home. And one of them begged me not to discharge her tomorrow, as planned, because...well, honestly, because they really would prefer she were in the hospital forever. This happens a lot, actually, the, "Can't you just keep them until they're, you know, fixed? And thus no longer a bother/source of stress/imposition to me?" Sorry, no. But I feel your angst. Well, except for that "imposition" part.

You know how sometimes, you're reasonably sure you're doing the right thing, but there's that tiny little sliver of doubt that nags at you? It's always hard to know when people are really ready to leave the hospital. They tell you they're ready when they aren't, they swear that they aren't ready when they really are, and so often all you really have to go on is your clinical judgment. So, basically, your gut with a little more education. Sometimes you throw them out of the nest and they soar; but sometimes, you make a safety plan, you have a foolproof aftercare plan in place, you let them teeter on the edge of the nest for a moment and survey the land before you tap them gently...and they plummet to the ground and flop around for a while. If you're lucky, you, or some surrogate agent of you, are still there to shake your head and scoop them up and mumble things about bumblebees. If you're not...well...that's what keeps us all up at night.

I had a discharge like that today. I think she's okay. I think her family will take good care of her, and they really, really want to. She's not as stable as I would've liked, but I think that she'll fly better with her family around her instead of a bunch of crazy people who don't speak her language (not to mention the patients). Still...I worry. I had another discharge like that on Friday...called her today to check up and tell her that her labs were okay, and of course, she's doing great, and the weekend at home was just what she needed.

Still.

I mean, obviously, the attending backs us up, and it's ultimately his decision, but he more or less places his trust in my judgment. And some day, he's not going to be there, and it's going to be all me. It's a lot of responsibility. Particularly when you work with a population who, can say all the right things, tell you what you need them to say, convince you they're okay and look genuinely better....and then go out and kill themselves the next day. It happens. It happened to us last month. So you either become an administrator, or, you worry.

And sometimes, you just shake your head.

One of our patients, whom we discharged on Friday, came in Thursday night high as a damn kite and swearing he was going to kill himself, or maybe someone else, I don't really remember (he wasn't one I was responsible for). And we interview this guy in the morning, and he says, all fabulous, "No way would I kill myself. I'm too cute to kill myself. I mean, I know that sounds conceited or whatever, but, look at me."

Can't argue with that logic. Even from a scrawny little white-bread queen.

Then there's this other guy, shows up on our unit today (not sure who he was, could've been a visitor), with "PUMPKIN" tattooed on one forearm, and "NOODLEZ" on the other, such that when he puts his fists together, it reads, "PUMPKIN NOODLEZ". We spent a lot of time today speculating on that one. Kevin, my co-resident with the same last name as me (just to confuse all the staff), says, "Is that a gang tattoo, maybe? Like, 'Beware the harvest season!'?" I literally almost fell off my chair in the middle of treatment team. This came up again later, of course, with the girls in Admissions and my friend John, who says, totally deadpan, "I bet they gave it to him in prison. He was somebody's bitch, and they named him Pumpkin." And then he adds, all coy, "Come heeeeere, Pun-kinnnn". I, of course, had been busy noticing the detail work on it earlier, and was like (totally serious), "No...it didn't look like a prison tat..." He smirks and counters about how they have some seriously good artists in the joint these days. I, by then, had figured out he was kidding, and pointed out the lack of fine-tipped vibrating needles. And then ignored him when he asked me why I knew so much about tattoos...

The party, last night, by the way, was faboo. Doc G lives out in the woods, in this place that reminds me a whole lot of the area in which all my classmates lived in New Hampshire, except without the skiing. We had a hell of a good time. The food was awesome (catered from this Mediterranean place in town), the beer was cold, the company was excellent. Doc G is a funny, funny guy, and only slightly funnier than his wife, Doc D, who is a trauma surgeon. They have this massive house with two decks, two balconies, and floor to ceiling windows everywhere...and a can of Spam on their mantle. Outside, there's a koi pond, a hibiscus with flowers the size of hubcaps (so not kidding), and a six foot tin chicken. No, I don't know. Oh, and there's also...a Howitzer. I don't know why.


That's their cat. With the Howitzer. Click on it, you have got to see the expression on the cat's face. I don't remember the cat's name. But holy cow, it was a nice evening.

We spent some time talking about my patient I'd had who I spent an entire week fighting with Medicine to take her on their service because, let's face it, we're not equipped to provide that level of medical care, as sick as she was, on our unit. She was originally Doc D's patient when she came in (on account of her self inflicted stab wounds), and then she was Sparrow's, who handed her off to me when I came on service, and then she became Doc G's, when medicine finally took her (he was the consulting attending).

I got to work today and discovered she'd died this weekend.

You know, the last day she was on our service, when I finally just called them out on their bullshit, and she was full of crackles and her fingers were turning blue (ominous sign, ps) and she could barely get out the sentence, "I still want to die"...I said this to the medicine residents. I had said it outright to the ones with whom I'd been arguing all week, "You know, I know she wants to die, but I don't really want to help her, here." They made fun of me. That last day, I was like, "I'm not kidding. I'm not going to facilitate her exit." And then something along the lines of, come fucking do your job or I'm going to find out a way to do it for you. Which, it's not like I have ICU admitting privileges, which is where she needed to be, so that was an empty threat. But I told them. And now she's dead. And that just sucks.

I'd better go to bed. I can only guess at what's in store for me tomorrow...

Sunday, July 27, 2008

Pizza Sunday

Ah, I really do love a whole weekend off.

I've gotten some of the things done today that I wanted to. I slept until 9, and then went to Starbucks, Target, the New Balance store, and the gas station. I got some of what I needed at Target (cannot get out of there without forgetting something), although I was disappointed in their selection of bedrolls. I've decided, as I think I mentioned a while ago, to start sleeping in my office when I'm on call. So I've been looking for something to sleep on. I don't want an air mattress, I really am fine on the floor. I'm thinking maybe a sleeping bag would be nice. Possibly a mat, or one of those egg crate things. Target was heavy on air mattresses. I tried to stop at Great Outdoor Provisions, but they were closed. I also struck out at the New Balance store (my shoes, in my size, are on backorder).

So then I came home, and realized that the party tonight is catered, so if I want something to take to work tomorrow, lunch was going to have to involve cooking. So I looked in the fridge (haven't made it to the grocery yet), and decided to make White Pizza.

White pizza is merely pizza without a tomato-based sauce. Some places replace it with alfredo, some with just olive oil, but there's this place in Chicago that uses a garlic butter base that is worth lusting after. So that's sort of the idea I use. In case you were feeling inspired, here's a step-by-step guide you can follow at home.

1. Dig around in fridge and find premade pizza crust. Using premade dough, or actually making your own, is an acceptable - if crazy - alternative.

2. Preheat oven to whatever the package says.

3. Melt some butter in the microwave. You know, enough. Like, a domino-sized chunk. It depends a little on how big your pizza crust is. Then crush two cloves (or so) of garlic and add to the butter. Mush. Add some Parmesan cheese. You know, the Kraft sort. Add enough until it's a fairly thickish paste.

4. Set the crust out on the counter. Grumble about how you have no counter space.

5. Smear the garlic-butter-cheese paste on the crust in a pretty fine layer. You don't want to dump this on like you would with Marinara.

6. Add whatever sort of cheese is on hand. I like a good layer of mozzarella, and then some goat cheese, and this Whole Pantry shredded three cheese blend. But I had no goat cheese today, which is sad.

7. Be sure to drop some cheese on the floor for the dog.


8. Smooth everything over and wait for oven to finish preheating. Remind dog that no matter how cute she looks, you're not giving her anything else.


9. Wonder why dog never listens.

10. Stick the pizza in the oven.

11. Go back and rewind the same 10 minutes of SVU you've been trying to watch for about an hour.

12. Realize that you forgot to set the timer.

13. Make a vague guess about how much longer the pizza should cook.

14. Play with the dog and attempt to watch those 10 minutes of SVU.

15. Walk into the kitchen when the timer goes off and wonder why the damn smoke detector, which goes off at the feeblest hint of smoke, is silent and the kitchen is full of smoke.

16. Open back door.

17. Cue smoke detector.

18. Remove pizza from oven. Begin to stick head into oven, noting that there seems to be no obvious source for all the smoke.

19. Realize that you're about to stick your head into the oven. Stop that.

20. Lay pizza out on non-existent counter to cool.


21. Cut pizza into some pieces. Eat them. Makes two to three to four servings, depending on how hungry you are.

22. Remind dog that no matter how cute she is, no matter how hard she tries her Jedi-dog mind tricks on you, you're not going to give her the pizza.


It's a good thing.

I did manage to make a few non-pizza acquisitions today. One was this:

Known in the business as a decoy ring. Deliberately chosen for its maybe-it-is-a-wedding-band-maybe-it-isn't ambiguity (not to mention its $12 price tag, as this is, after all, an experiment). Because I'm not married. But if my patients should choose to think I am, well, that's up to them. And one more subtle boundary between me and them. And maybe my patients will stop hitting on me, grabbing my ass, and asking me out.

You'd think a thick layer of blubber would be enough. Apparently that's just enough to attract wayward Aleutians (if anybody asks, this harpoon is just a new piercing).

I also found a couple of new additions for the Blogroll. One is Day by Day, which is penned by Allison, one of my friends from college who married another one of my friends from college and then they had an unbelievably cute little guy. Who looks really adorable in a laundry basket.

My favorite Allison story? She stole a stop sign for me for my eighteenth birthday. No, now, no lectures about how that's illegal or heartwrenching tales of how your cousin was killed because of a missing stop sign. It was one of those rural, middle of a dead end dirt road, nobody pays attention to them anyway stop signs. I still have it. It hung over my treadmill for a while in college, and then in my office in Chicago, then over my bar in New Hampshire. Now it's hiding under a bunch of boxes in the den here. Cracks me up every time I remember her coming in to Chemistry lecture all mischievous and like, "Happy birthday. I stole you a stop sign."

Heh. Ah, back in our impetuous youth...

I also discovered Mariska Hargitay's blog. Whom you all know is one of my personal heroes, partly for her passion in her continuing role as Detective Benson on Law and Order:SVU (I was recently watching this interview with Christopher Meloni, who plays her partner, talking about a letter he'd gotten from a man who was molested throughout his childhood. He told Meloni that once he started watching the show, he often thought about how it would've been different if Benson and Stabler had been real and fantasized about them swooping in to save him as a little kid. And I thought, wow, you know, what victim wouldn't want someone like them on their side? What survivor hasn't thought about someone dashing in to save them? And how much do we all cling to the hope that those out there still being victimized have someone like Benson and Stabler to protect them? And they do...there just aren't enough of the real-life Bensons and Stablers to go around). But mostly for her real-life efforts to raise awareness and rally support for the victims and survivors that still exist after the credits roll. She speaks out, fundraises for charities, and does great work. Way to go, Mariska.

Hey, look, I'm late...

Saturday, July 26, 2008

Ahhh, Saturday...

Every now and then you need one of these days of absolute nothingness. Even though I had really high hopes for productivity today.

I slept in. Then I watched some TV. Caught up on everyone's blogs. Napped a little. Sent some emails. Didn't actually get out of bed until, oh, say, three-ish, and then it was only to drag myself next door to Sparrow's and lie on her couch for a while.

Maggie was happy to help me with my mission of snoozing...



...although I think she was getting annoyed with all of the photo ops....



Eventually I did manage to shower and put myself together and went out to dinner with some of the girls from work. It was me and Sparrow and Faye and Ruthie and three of the interns - whom we'll call Chandra, Sonia, and Rene. A little single girls' Saturday night out. It was a lot of fun. I really like them. We went to this "Mexican-by-numbers" place (as Rene put it) that actually turned out to be fairly authentic and actually pretty tasty. And had really good margaritas. Huge, really good margaritas. The intern-y types (of which I am so close to not technically still being one of, anymore, by the way. One. More. Week.) were very cute, and all, like, thanks for letting us come along! I was like, well, actually, we invited you because we like you people, but, um, you're welcome?

Wow, what a damn week it's been.

Hectic, busy, oy. And the patients have been particularly wacky this week. I mean, I don't know what's up, but someone's cranked up the crazy about three notches in our whole hospital. I don't think the moon's full. But wow, it's been nutty.

I have too many stories from the last three days to even begin to tell y'all.

In better news, my feet are looking better....



I can't quite figure out what happened here, either. Somehow, standing out in front of Sparrow's house a few days ago, this happened. I assumed they were wayward mosquitoes, but Sparrow thinks they look like fire ant bites. I don't know, but they itch like the dickens.

Hopefully I can get some things accomplished tomorrow. One of our attendings is also having an end-of-intern-year party for us tomorrow afternoon. Which I'm definitely looking forward to...both the party and the end of intern year...

Friday, July 25, 2008

Wednesday, July 23, 2008

Not a good combination...

I'm exhausted. And overworked. And cranky. And premenstrual. And frustrated. And did I mention overworked?

All in all...I'm really ready for it to be the weekend. But, alas...only Wednesday.

Sparrow and I had a raucous and chaotic call last night. And of course, one of my patients ended up in restraints 30 minutes before I was going to go to checkout (to start call). Which is not a short event, nor a small pile of paperwork. Had another one go into seclusion today. Oh, my God, it's like a state hospital milieu up there.

Speaking of which, New State Hospital opened, and Other State Hospital closed its doors and moved all its patients over. But State Hospital hasn't moved their patients in yet. Which somehow means they have no beds and are delaying everyone for three to four days. What??

In better news, I've gotten quite a lot done on my scarf in the round, which is my Wednesday-afternoon-full-of-lectures mindless knitting project. And I'm thinking of starting another one when I'm done. It's pretty nifty.

Ohh, cranky. Need a day to sleep in and drink margaritas.

Maybe I'll just go to bed.

Tuesday, July 22, 2008

Picture it: Sicily, 1922....

Sad, sad news. Riposi in pace, Sophia.

Now, excuse me while I go back to the chaos of my day...

Monday, July 21, 2008

Happy Monday

Hey, it's Monday.

OY, today was so freakin' long. I discharged half my service today, though. Which, well, they're getting better, so that's nice. Including my guy who doesn't have TB (we're ruling him out over a bullshit call by a radiologist and my dumb ass getting the film in the first place. But...he had a cough...and a history of TB...and schmutz on his lung...honestly, we didn't have much of a choice. So the poor guy's been locked in the negative pressure room since last Tuesday).

Today was a taxing day. I have this bunch of really needy patients. Some of them, genuinely have needs. One of them may well be the most anti-social woman I've ever treated. And that? Says a lot. A lot.

I always have this desire to crack those big old personality disordered folks like an Easter egg, see what's inside of them.

But I think it's probably just a big void.

I had a nice, extraordinarily random conversation with my friend John this afternoon. Did you know that Bull Shannon's first name was Nostradamus? I did not. But then, I'm apparently not nearly as up on my Night Court trivia as he.

I had some really nice things happen today, though. My patient with the asshole husband? Wants me to see her and her husband in couples' therapy. And Dr. Jabba might actually let me. And then I checked my voicemail, and I had a message from this mother whose son I saw in the ER back at the end of April. I made a passing comment about my clinic starting in August when I saw them (I think as in, no, I'm sorry, you can't follow up with me, I won't have a clinic until August). But I also made a suggestion about a change in her son's medications. And so today, I got this message telling me that they'd made the medication change and he was doing so well and his academics were solidly on the right track (actually, above and beyond), and could they come see me in my clinic now that August was upon us?

I'm kind of excited. I think maybe I'm a good doctor.

Sunday, July 20, 2008

Annoying things, amusing things, and just, things

Before I head down my ranting rantiness...Happy Birthday to my adorable and wonderful nephew, Basil. No, he's not 30. But he is 2. Which, frankly, I'm not opposed to 30, but I think 2 might just be a better age.

So I'm on call. When am I not, first of all (14 days...). But secondly...today? I hate people.

I've been fighting with morons all day (the latest of which is the medicine service. Damn them! Take the patient! Take the patient!) about the disposition of the, like, three psych patients that have come into our ER.

One of whom, interestingly, is insisting on going to Other State Hospital. Which is, of course, MOVING TOMORROW! So he's gonna sit in the ER for three days. Which is probably better, because I think he might be going into the DTs. But what do I know about substance withdrawal, anyway? I'm just a psychiatrist. It's not like our patients do this ALL THE DAMN TIME. Or that they might, say LIE TO US about their alcohol use. Nahhh, our patients always tell us the complete truth.

Bastard coated bastards. With creamy bastard filling.

Anyway.

So yesterday, I sign into Facebook, right, because a couple of people I went to college with had friended me. And what do I see? This:

Are you kidding me?

What are they, Greek? 29?? Since when is that overdue for a man? I mean, except in my cultural circles, where of course I've been past my expiration date for yeeeears now...

Seriously. Hate. People.

Also want to back my car over my pager.

In other news...I finally went to the Petsmart yesterday, which was timely, because my poor dog had been eating bowls full of treats for the prior two days, since we ran out of food and all (she thinks we should run out of food every day, I think. She thought this was a FABULOUS idea. I? Also enjoyed it, because for Maggie, eating a bowl full of treats means that she has to sneak up, all wiggly with excitement, steal one out of the bowl, dash back to her crate, happily devour it, and then repeat the whole process. Because this is what you do with treats). So whilst at the Petsmart, I was walking past the big display of cheap toys, and wouldn't you know it, there were two she just had to have...okay, honestly? There was one I thought she'd really like, and one that I just thought was too damn hilarious not to buy.


Maggie was initially very excited about the prospect of new toys. The first one, which I bought more for her (because I think it looks sort of stupid) is this one.


The cool thing about it is, even though it's pretending to be a container of organic juice (what? What dog wants to play with one of those? What owner wants their dog playing with juice? Just sounds sticky to me, frankly), is that it makes a very crinkly noise when you play with it. Maggie likes a good deviation from "squeaky" once in a while. This one? Has crinklies AND a squeaker. WOW.

This one? This one I bought for me. Not so much to play with, as to periodically giggle at and say, "what the hell?"


Dudes. It's a chicken. A whole chicken. On a barbecue fork. WTF?

When Maggie was but a wee pup (okay, when I got her, and she was 18 mos old), she used to tear her toys up in nothing flat. Like, fifteen minutes to a half an hour, done. And then one day, the magical Stuffed Hippo showed up. She still has that hippo. In fact, it's still her favorite toy. You know, to nap on and things like that. I don't know what it was about Hippo, but suddenly all the destroyage stopped.

Now, now Maggie and her toys look more like this....


She's a good girl....

Saturday, July 19, 2008

Transference + sleep

First of all, Happy Birthday to Kate! Holy shit, you're 30!

There's a lot of that going around these days....

Meanwhile...I had more to say around my post yesterday, actually, but was just so damn tired. I'm looking forward to not being quite so exhausted all the time. Although, I have this feeling, I'm probably going to find ways to be just as busy next year. But with less call, and less commuting than I did this past year, so, that'll definitely help.

So, transference. We've been talking about this a lot lately at work, and will talk more about it as we spend much of our second year learning the ins and outs of psychodynamics and analysis. And transference is sort of the primary concept in analysis. Plus, I'm thinking of entering the NC Psychoanalytic Institute if I can make it fiscally feasible (see? Plenty to do next year), which means I'll be up to my id in transference.

Transference, though, is an integral part of what we do. Not that it isn't present in every patient-physician interaction, but we're the only ones who really pay attention to it and even encourage it. Truth is, it's central to most human interaction. And, apologies to Dr. Freud, but it's not that dramatic a concept - we all view our lives through the filter of our past experiences. We make judgments about people based on cues that are familiar, that we've seen before. Thus, we're conditioned to respond to a stimulus we've seen and responded to before, and when we see that stimulus in someone else, we'll of course respond in kind. At least at the automatic level; at a more conscious level, we can modulate this response. Often, for us, our own transference is a useful tool - i.e., feelings that are evoked in our interactions with patients are in response to something about them. If we can use those responses to identify what that something is, it can tell us a lot about people. Problem is, you have to know a lot about yourself, and possess a certain humility about that, to do this well.

And once you start to be able to recognize this, it becomes problematic sometimes to be able to dissect these responses from what's just a genuine response to the person in front of you. My woman's husband, who I did the couples' session with yesterday, I think he's genuinely a jackass. So it was a lot to sort through, you know? What of my dislike of him was due to my own transference, my own response to other malignant narcissists and sexual sadists I've encountered in my personal and professional life? What was my protective, maternalistic feathers being ruffled over what I knew he'd done to my patient? What was the fact that he was just an asshole in our session?

It was interesting, really. His wife, my patient, afterwards, was like, wow, I can't believe how well you handled him, how you got him to talk about things. I've kind of discovered that, in my professional dealings, I actually deal pretty well with controlling, narcissistic men. It's a power play, and if you operate on their level, they win. So instead, I tap into what they're evoking in me to give me cues about what sort of traits they might possess, and this where their weak points might be. And I think that in itself is a cue to pull back, which allows me the detachment to institute a number of techniques to gain the upper hand. In the words of everyone's (okay, my) favorite TV psychiatrist, "One of the ways to beat a psych defense is a psych offense."

Sometimes I don't like that about myself. Sometimes I feel that it's very useful. It is what it is, I guess.

And regardless, I still have to honor the fact that I left there wanting to kick him in the shins.

Oy.

My other patient, well, it's awkward. And I had much the same thought as PenguinShrink's, in her comment to the last post, but frankly, I think it may actually be a reason I should do therapy with him. He's an interesting patient, particularly from a biological perspective (he's got this old brain injury). I think he's reasonably innocuous, and I think identifying a strong woman who can set and maintain good boundaries with him is going to be a positive step towards dealing with a few of his issues. Plus, it wasn't a predatory kind of thing, I think it was more of an impulsive kind of slip, from someone who has fairly poor impulse control (see above re:old brain injury).

But don't think for a second that I'll hesitate to discharge him from my practice if he can't respect the boundaries of the therapeutic setting. And I'm definitely getting a left-hand ring before I start doing outpatient (I've been debating this for a while. This did sort of clinch it).

It's such a complex landscape, the human psyche.

Friday, July 18, 2008

Transference

Two more weeks of being an intern.

I've been working my ass off (see previous post re: size of ass).

I had a rough day. My patient that eloped, her stepfather is now paging me directly (damn it, I knew I shouldn't have given out my number, even if it was an emergency). I had a tremendously intense family session with this woman and her husband that both her primary therapist and I want to kick him in the shins (okay, her therapist's phrase was "shiv to the back"). And the patient that I discharged today, who's going to become my outpatient and probably my therapy patient? Asked me out. Dude. So against the rules. Plus, you know, b, he's crazy.

Oy.

And of course, I didn't write a single note before 6pm.

Fortunately, about an hour later Sparrow came along and was like, "Wine on the patio?"

Yes.

Still had those damn notes to write, though.

I'm really tired...

Thursday, July 17, 2008

One for the money, two for the show...

I know, "three to go" isn't the next item in that set. But, that's where we're at.

Happy birthday, by the way, to my cousin Danielle. Welcome to mid-life. I'm right behind ya...

So, call #4 down. I saw one patient, admitted same, and still left 40 minutes late. But he was a kid (they always take longer), whose mom didn't speak English (our Spanish interpreter down there rocks), and then I wrote the longest HPI (history of present illness) in the history of HPIs (you think I'm kidding). He was adorable. And possibly psychotic. Although I think there's something wrong with his brain. Neurology's going to love this consult tomorrow.

And then I came home, called my folks, and had a distracting little IM conversation. And now there's an ant crawling across the screen of my laptop.

Lost little bug, there's nothing to eat there!

I think that's about all of this day that I can handle.....

Wednesday, July 16, 2008

Bad day

Bad, bad day. Bad, bad, bad, bad day.

One of my patients eloped this morning. Which, no, doesn't mean she ran off to get married. It means she escaped the hospital. We found her. She's fine. Ultimately, I am too, but wowie.

And then I get home and there's ants all over my office. Because I left my yogurt bowl in there this morning. I hate ants. Whatever, I sprayed, and they're all currently curling into little tiny dead-ant balls.

Really glad they're the ones dying and not my patient. Despite her threats of suicide.

Wow, did that scare me.

I somehow ended up in charge, sort of (hello, intern, 'member?). I did fine while this was all going down, of course. That's what I do. But afterwards, after she was back, and safe, and I was walking off the unit, I was just like...oh....my....God.....

Oh, bad day.

Weirdly? Still love my job. It's inexplicable.

Tuesday, July 15, 2008

Erm...

I have too much to say. To the point that I cannot figure out what to write about tonight. And I have to go read a chapter about "the nuts and bolts of psychotherapy." Which - ha! Let me tell you, I could write a book on already (and am planning a blog post, when I have time to sit down and write it).

So instead, I go to my default pathway....here's a funny picture of my dog.

The old apartment

(missed the reference? Click here)

So it's 1:20 AM, and I just sent the following email to my landlord...


Dear Landlord,


Attached is a picture of the second roach-like thing I've killed in my bedroom in as many nights. This one had the untimely misfortune of CRAWLING ACROSS
MY HAND AT ONE IN THE MORNING WHILE I WAS ASLEEP, which brought about its expedient end. Last night there was a smaller roachie-looking thing crawling on the wall, again in my bedroom, which was also summarily dispatched.

Oh. And did I mention, EW, OHMIGOD, EW, EW, EW, EWWWWWWWWW!! In my sleep. In my BED. Across my HAND. EW, ICK, UGH, BLEH, EW!!

There are ants in the kitchen as well. I keep spraying, but, to no avail.

Please send your favorite exterminator at once. And perhaps on a bi-monthly basis. Which may be about the time it takes me to get back to sleep.

Ew.




Oh, did I mention...EW!!! And just a little too reminiscent of this....

Ewwwwww, ick, yuck, bleh, nasty, ew.....

And then, while I'm typing this post, I killed a tiny little albino-y looking cricket-type thing that was sitting on my other hand. Mags and I are one more tiny little bug away from a stint at the Residence Inn.

Ewwwwwwwwwwwwwwww..............

Monday, July 14, 2008

Circadian...um...what was that again?

I. Am. So. Tired.

I slept all yesterday afternoon, of course. Which meant that when it came time for me to actually go to bed? Wide awake. And then I talked to Faye at 11. And then an hour later a different friend called (in a whole other time zone, so it wasn't late where he was). And then I laid awake until 3:30. And then I got up at 6.

So I'm gonna go to bed...try this whole thing again....

Sunday, July 13, 2008

Four to go

One more overnight intern call left. Three short calls. 31 in-house calls left in my career. 21 more days of intern year left.

But who's counting?

Yesterday wasn't too bad. I admitted one patient that was left over, and then spent a large portion of the day cleaning up paperwork. I got ALL of my discharge summaries done (boo-ya!), including two that were left over from MAY. And pre-wrote one for tomorrow. Of course, not the one I really needed to pre-write, but, whatever. And then, of course, as is typical, the day picked up around 5pm. I did a pretty thorough consult on a woman who tried pretty hard to kill herself, and then sent her to Medicine. She's undoubtedly back, and will be on my service tomorrow. I sent another woman from my service to Medicine.

Medicine looooooved me last night, let me tell you.

I slept in my office last night instead of the call room. Peng (who's, of course, my officemate), thinks that's weird. But I slept so much better. I think it was a combination of things...the most obnoxious of which is that the concrete floor with the thin industrial carpeting over it is actually more comfortable than the call room beds. But I think it was also a bit of being in more comfortable surroundings (i.e., it was my space). And I think it also helped to be behind a locked door that not everyone has the key or the code to get into. And it was so much quieter. I think I'm going to get a sleeping bag or a camping pad and make a habit of this for the next 28 overnights.

I used to do that in medical school, when I was taking call on the NICU. I was on the Nurse Practitioner team, as opposed to the resident team. And I was pleased about that. My co-sub-I was a future pediatrician, so it made more sense that he would be on their team anyway. And, let's face it, I'm more suited to the touchy-feely NP team. It was a good experience. They gave me my own desk. It was comfortably decorated and less stark than the physician workroom. And we had these little white Christmas lights in the office (because it was December). It was a cozy, cozy place to sleep.

Mmm.

One of my friends, who's a year ahead of me, can't say enough about how good third year is. I'm just looking to get to second year.

I love my job. I can't actually say that enough, because it always sort of amazes me. Maybe I'm just not used to it, to being able to do my job, to love my work, and not constantly be fighting with the people who are supposed to be supporting me. Maybe it surprises me that I'm as happy as I am in psychiatry. Because, honestly? Back in the day, I never thought of psychiatrists as "real doctors."

Which of course, is crap. We play dumb a lot ("You've got take this patient onto your service. I mean, we're just psychiatrists, here"). In a lot of ways a good psychiatrist is more a doctor than others. Good psych nurses are the same way. We have to watch all the medical stuff, have enough of a knowledge base in general medicine, endocrinology, etc, etc, to manage the biological part of our patients' illnesses. And we need to know when we're in over our head. Like, my patient who's been going into renal failure for a week; I've been pestering Medicine to take her for about as long). And then we have to have several whole other skill sets - therapy, management of various disorders, psychopharmacology. And then we have to be able to deal with ourselves, you know? Our responses to the patients, our own issues, our sympathies for them or anger at them. Or the pieces of ourselves that they represent for us.

That gets hard some days, you know?

Nah, I don't know where I'm going with this, either.

I'm tired...

Saturday, July 12, 2008

If I'm always working my ass off, then why is it still so big?

A girl has to wonder, you know?

Today has been a busy call.

Meanwhile, my friend out in Cali sent me this. It's catchy.

Friday, July 11, 2008

One week down...

...three to go. Soon, soon.

And I'm on call tomorrow. With any luck, I'll have time to chip away at the mountain of paperwork I still have outstanding before the patients start showing up.

I just finished my last note. Now, admittedly, there was a three hour break in there because I went out for dinner and drinks with Mike, Peng, Faye, Ruthie, Sparrow, and new intern Sonia. It was a very good time. But it didn't help that I didn't even start my first note until after 5, and then got back to them about 9:15.

I'm so tired...

Maybe I'll even have time to write a nice long post that has some substance to it...

Thursday, July 10, 2008

Love Thurzzzzz.....

Holy shit, I'm so tired.

And Sparrow and I had better have an easy call on Saturday, because I'm literally swimming in paperwork that has GOT to get done this weekend.

I'm so....overwhelmed is the wrong word. Overworked is a better one. Overextended is actually the perfect one. Oy.

So, anyhow, let's go straight to the five things I love today...

1. Apples and peanut butter with cinnamon and a little drizzle of honey. Which is what I had for dinner.

2. My goofy ass dog when she gets a case of the wiggles. There is seriously nothing funnier. She wags her whole body. It's awesome. Especially when it's for you.

3. My three medical students this block. They're friendly, intelligent, hard working, and surprisingly good for people who've done exactly three days of clinical medicine. I enjoy them a lot.

4. My friend John, who just came back from a slightly extended leave (not that I knew this, because I was at State Hospital) after bad things happened (that ended up being okay). I hugged him this morning after he told me all this, and got back one of the nicest and most genuine hugs I've gotten in a long time. He's a good man, and I dislike it when bad things happen to people I like.

5. My really, very, oh-so-cozy bed.

Wednesday, July 09, 2008

Oh - and!

We got our psychotherapy supervisor assignments today. Dr. Jabba leaves this letter in our box, saying, I've assigned your supervisors through an intricate and complex process known as Dr. Jabba's personal instincts about who you'd fit well with. We were assigned two - one per two therapy patients.

The first name on my list? My shrink.

Once I stopped laughing (that took a while), I emailed him faster than you can say "conflict of interest" and suggested that he reassign me. But I complemented him on his instincts - she and I do, indeed, work well together.

Meanwhile, I'm totally taking that letter with me to therapy on Friday. Because it will amuse her, too.

Operant conditioning

So today, we started our Academic half day. Which means that we have lecture all Wednesday afternoon. My classmates don't have clinic scheduled in the afternoon. The time is supposed to be "protected" for all residents. Which means they sat in lecture and I got paged all frakking afternoon.

Blah.

Okay, I ignored most of the pages, mostly in the hope of beginning the process of conditioning the floor to not freakin' page me during the hours of 12 and 5:30 on Wednesday. It didn't go so well. Particularly when the medicine resident misordered the blood gas she didn't bother to tell me she was ordering in the first place. Argh.

My dog, though, has the concept of operant conditioning down cold. So, now, Maggie, is useful for keeping things clean around here. We have a good system. I drop something edible on the floor, I say, "Uh-oh, doggie!" (shortened from, "uh-oh doggie, you'd better come here!"), she immediately drops whatever important doggie task she's doing, and she gets a tasty tidbit for her troubles. When this becomes particularly amusing is, like, tonight, I'm making dinner, and I added way too much of something, and I say, "Oh, shit!"

Dog wakes up out of a dead sleep, leaps off the bed, scrambles into the kitchen, and gets all confused when she can't find anything on the floor. It was very cute.

Today was long. And I'm so tired. And I still have six notes to write, but, I came home to write them, and now the electronic medical record won't let me in.

::sigh::

I did get a lot of knitting done during our lectures, at least. And, since I was knitting, I was paying attention, and they were actually enjoyable.

Have I mentioned how excited I am about psychotherapy clinic this year?

Also with the being done with intern year. I'm definitely excited about that as well. 25 more days.

In my continuing efforts to live life on life's terms (to borrow an AA aphorism), I am taking this as a sign from above that I am supposed to snuggle with the dogs and go to bed early.

Oh, but I'll leave you with today's SVU quote of the day, courtesy of everyone's (okay, my) favorite TV psychiatrist, Dr. George Huang:

"Boys are socialized to express their anger. Girls are socialized to be nuts."

Tuesday, July 08, 2008

Oyyy, I'm still an intern....

Fuck. Somewhere over the holiday weekend I forgot how much work this was.

The new med students are cute, though. They're all super-eager and green. One of them, today, was like, "Can I watch you put in that order?" Aww.

Today was loooooooooong. Which wasn't helped by the fact that I was running on 5 1/2 hours of sleep. Oh, holy shit, was I cranky when I left.

Looooooooooong.

Yesterday, when everyone else was running around being all jittery and anxious and whatnot about their first day, I'll confess, I was sort of glad to be up to my old routine. Today? Today I was a little jealous. *I* wanna be in clinic, too...

I will be soon enough. I cherry picked my first patient today. She's this woman I inherited on the unit who has all of this totally amazing art in our gallery (the coolest thing ever). It was like meeting a celebrity. I saw her name on my patient roster and was like, oh! Oh my God! I can't afford her stuff! And wouldn't you know she needs a new outpatient psychiatrist. So, I flipped open my appointment book and called our scheduler and ta-da! She's my patient now. I'm so excited.

Oy. But I was there a solid 12 hours today, and only left when I did because I had an appointment with my shrink. Tomorrow, we start this "academic half day" thing, where we're in lecture all afternoon. So I have to get all my orders done and patients seen and notes written (HA!) by noon. Yeah, it's going to be another late night. But I'll probably come home and work, at least. My goal is to be OTD at 5 on the nose.

And now, of course, I'm still totally wiped and it's 11:15 because, you know, I came home, and had to talk to my folks (Happy Birthday, Dad!!), and then to my friend who called from California, and then I had to go next door and have a glass of high-quality Riesling with Sparrow and bitch about work (I'm mostly through this post, and she calls and is like "Oh, I see out the window that you're still up. Want wine?" Of course I do). So I foresee that tomorrow's also going to be a highly caffeinated day...

Monday, July 07, 2008

Another one bites the dust

I am HOME. Call is OVER. Only 5 more intern calls to go.

Call was not bad. It was Mike and me tonight, and we're a good team. Which was so helpful, because I had some serious moments of "rhymes with Bluster Duck" tonight. People? People make me crazy. And it wasn't so much the patients tonight as much as it was, say, our NP who didn't bother to see the patient I'd asked her to and then left when her "shift" was over without actually telling anyone she hadn't seen the patient.

You know....I defended her for a long time, when she first started, and everyone else was all "she's horrible!" And there was a moment in there where she was starting to get better. And I said, oh, you know, there's a learning curve to this job, etc, etc, she's all anxious, we need to be empathetic, blah blah blah. You know what? She's just fucking incompetent. I'm so done. She needs to get her act together or just get the hell out of my way.

And then there was this whole fiasco on the child unit I can't even begin to describe. And I did my best to iron out the situation and get things taken care of, all the while speaking in soft, calm, soothing, dulcet tones. And I call downstairs at one point, and I say to Tyler, still in my low, syrupy, "fussy infant" voice, "Could you tube those papers up to me? Thank you, that'd be wonderful. Because I? I'm going to kick someone in the shins very, very soon."

Tyler. I do not know how we function in the 16 hours a day he's not there.

And he and Mike are a good combo. They play off each other and they're just funny together. Between the two of them, the evening ended up being downright enjoyable. And it was really nice, I have to say, because Mike? Totally understood the advantage of having me there, without actually taking advantage of having me there. Like, he saw two people in the ER, I did a direct admission and a clinic admit (also the ER patient the dumbass NP didn't see), we spent much of the last two hours of call trading pagers because one of ours would go off when we were on the phone so the other would answer it. It was just seamless, it was good teamwork, and it was wonderful. And then Benny came on at 10, and she's just generally delightful as well. All in all, not a bad night, and I got to leave at 10.

Maggie was excited that I came home. That's the best part of any call.

I'm on Saturday with Sparrow. Which is awesome, except, we have to actually find someone to take care of our dogs! But I think one of the interns has us covered.

Today was long, yo. I had nine new patients this morning when I walked on to the unit. And you know something? Nine acute psych patients? They're a lot to deal with. Really rather draining. But I actually have a reasonably pleasant bunch this go around. And possibly two ECT candidates.

I've got to go to bed. Because, I still have nine patients to deal with in the morning, it's 11:30, and oh, the new med students start tomorrow. Which could be awesome, but invariably adds work. I never really appreciated that in medical school, just how much more work med students create for the residents. Gosh, I thought we were so helpful...ah well. It was a useful delusion.

Sunday, July 06, 2008

Day of rest...

PFFT! Can't even type that with a straight face....

I was productive today. Actually, this weekend.

My hair is red again.



My roots were frighteningly long...

I went to no less than four grocery stores today and spent about 3/4 of the monthly grocery budget (like I have a budget... "recommendation"). Now, admittedly, the last two trips were minimally costly efforts to pick up things I forgot the first two (three) times.

But when I left, my refrigerator contained exactly this: a bag of onions, mustard, lemon juice (actually, I probably ought to throw that out), toasted flaxseeds, an as-yet unopened container of protein powder, and one can of Starbucks Doubleshot. Oh, and that little single-serving contain of salad dressing.

After my hours of grocery shopping, the fridge looked like this (isn't this just the classic Cribs shot?):


Hmm. You'd expect more for the amount of money I shelled out today...there's a few things in the pantry, too, obviously. And I finally found Pyrex tupperware. And I bought a cactus for our office. It's very cute.

I did two loads of laundry and a crapload of dishes and tried to fix the coffeemaker, but I think it's shot. Every time I run water through it, it does this:


Ew, frankly.

I got a little work done on my Tolerance Socks yesterday while at the tire store (wouldn't you know it? My car doesn't pull to the right anymore!). Unfortunately, I'm not sure there's enough yarn left...and I realized that oh, right, I'm knitting these toe-up, which is why the ribbing I did on the top of the foot...probably should've continued through the gusset shaping....argh. I want to frog them and just start the heck over again (because, among other things, I think they're too big) but I can't find my yarn winder. Again I say, argh.


Maggie still hasn't rendered an opinion...


Peng and I also loaded up the kickass $20 fridge she found on Craigslist and took it to our office. And then I came home and helped Sparrow pick out her outfit for the first day of second year. And then I made homemade mac and cheese for dinner, with enough left over to take for the call crew tomorrow (of which I am part).

I got a ton of other things done this weekend, too, despite the 24 hours without power. I swapped out the screens so now I can actually open a window in my bedroom. I got my calendar all laid out (hey - this is exciting in my world). I at least have a list of all my patients (hopefully I can get in early enough to print out all their stuff and organize it before rounds). Sparrow and I went out for dinner last night (since we, um, had no power) and spent some time exploring downtown. I tied up a lot of little stuff.

It was a good weekend.

Saturday, July 05, 2008

Let there be light!

Our power's back on! Our power's back on!

It was out for about 24 hours...in other words...just long enough for everything in my fridge and freezer to spoil. Oh well.

And just in time for a new wave of storms. Here's hoping it stays on...

Now back to our regularly scheduled blogging...

So, I'm at Starbucks. Big shocker, right? I know, it's unusual. But the power's out, and there's internet here. Free, now, for registered Starbucks Card holders.

I'll confess, it's not my first trip of the day. The mutts and I headed out early this morning for the one in Durham that has a drive-through. Obviously, Maxine needed her coffee...



Sparrow was on call yesterday, so Maxine spent the day (and night) with us. She was terrified during the storm last night and stuck to me like velcro. After she tried to burrow far enough under the blankets to maybe hide under the mattress, I'm thinking. Poor thing. Maggie was our valiant protector, but if Maxine hadn't been there, I suspect she would've been holding nearly as tight.

Maxine felt better this morning when we went out to get coffee. She'd never been in my car before, and it was exciting. My car is, of course, a mess, so there was lots to explore.



Poor girls, they had a rough night. Mine was more along the lines of amusing. Like, I own something like six flashlights (don't ask) but could only find one, which would of course be the one with the dying batteries. And when I moved, I threw out all but one of my candles. Which, I finally found, but then couldn't find a match to save my damn life. On the bright side, though, I did solve a problem that I've been trying to figure out since they turned the gas on, which is how to shut off the pilot light for my gas log. Unfortunately, I figured this out while I was trying to light a birthday candle with it (as a spillikin for the bigger candle).

Crap.

Ultimately, though I did find the fancy Zippo candle lighter (it's just a lighter, but it's long and thin). In a suitcase. Where else would one keep it?

Last night was one of the few times that I'm sorry I don't smoke...anyway, though, I got the candle lit, and then promptly found myself sitting on my bed with the dogs thinking, it's 10pm. What exactly am I going to do, now? Why don't I just go to bed, already?

Ah well. Apparently there's a 70% chance of storms tonight, too, so it still might come in handy.

Like I said, things were fine this morning. I was going to get the girls up a little earlier but I figured it was best to just let sleeping dogs lie (aren't I funny?).



We tried to go for a walk this morning and canvass the neighborhood, but, it ended up being a giant disaster of knotted leashes. Which is particularly funny, considering they started out on the double leash. Maybe some other time, when there isn't as much chaos to sniff at.

So we went to Starbucks instead.

Maggie was not pleased when I decided to go back after Sparrow came home and Little Bit went with her. I actually closed the door to her crate on her feet before she'd move them.



She does this in the mornings sometimes, too. Or at the old place, she'd stay in bed and refuse to come downstairs if she knew I was getting ready for work.

I did get a lot done yesterday, though, which was nice. Because I'm not sure how productive today's going to be.

So to catch y'all up...this week has been weird. Wednesday was my last day at State Hospital. I was there for the morning so I could disorient the heck out of my poor intern (Oh! And here's this. Oh! And don't forget that. Oh! And then there's this. And this patient's crazy. And this one's a pain in the ass. And this one, well, don't get within striking distance of her. Oh, and...). The staff did a good job of scaring them for me ("Think of our patients as a female prison population." No....), so I could cross that off my to-do list.

And then I dashed back to the big house for the first half of Second Year orientation. Which was less disorienting and just total information overload than last year was. But then, it was also four days shorter.

I'm excited about this year, in general. Because y'all know what a therapy junkie I am. And I'm looking forward to clinic. And I'm glad I got to go to orientation with the rest of my class, even though I'm not starting for a month. We've been so scattered, that it was nice to be together for a while. Ruthie, who's starting in September, and Faye, who starts in November, unfortunately weren't able to join us, because they get their own little orientation later.

One thing that's going to be anxiety-provoking about this year, though is that we start applying for Child and Adolescent fellowships. And there's only 5 spots. And I think there's more than 5 of us who are interested. I'm considering one, maybe two other programs (the only one I'm likely to seriously look into is University of Maryland, because it's possible I would LOVE to go work at Sheppard-Pratt, where they have a whole unit devoted to trauma patients). But I'd rather just rotate up there for a month, because when you get right down to it, I really want to stay here for fellowship. I like the people. I could keep my therapy patients. I like where I'm living (a LOT). But I'm really unhappy to be competing against my classmates, primarily because a few of those going into child happen to also be a few of my closest friends. That's uncomfortable, unless we suddenly pare ourselves down to five or less. But, that's my own neurosis to manage.

Call, this week, was also weird. So, the way weekday call works here, there's a second year on overnight who has worked all day, an intern on until 10 who has worked all day, and another second year who comes in at 10 to relieve the intern who's on Night Float, which means they work 10p-8:30a Sunday night through Thursday night. So it's like shift work. But typically, after the intern leaves, it's you and one of your classmates.

But I'm still in the intern call pool. Which means I was on with Curly until 10, who was doing her very fist second year call (the typical division of labor is that the intern/NF resident covers the ER and the crisis pager, the second year covers direct admissions to the floor and consults. So it's different, although, sometimes when it's busy you just get shit done no matter what you're assigned to). Which, was nice for her, because she didn't have to train her intern. And then Fang came on at 10, which was also nice for him, because I'd seen five people and had one patient left to be seen in the ER and a minor task to sign out to him. And they were both fine, but it's weird to be the "underling", and you know...and I know they'll get this the next time they're on call and have one of the real interns...but I don't think some of our classmates get what it means to have Faye and me - who, you know, generally know what we're doing - in the intern call pool in July. I'm just sayin'. I'm on call Monday with Mike, with Benny as my relief. We'll see how it goes. I'm thinking it should be better - I've worked with both of them a lot.

But, I do love me a three day weekend. I think I'm going to blow this pop stand and maybe go get some new tires and a bag of dog food before I go home and see if the power's back on. Here's hoping I'm posting from home tomorrow!!

Friday, July 04, 2008

Blackout

So I'm in the middle of this big Fourth of July post last night, when this huge thunderstorm broke - thunder, lightning, high winds, hail, the whole nine yards - and just as it was starting to abate, the wind kicked up again, and *boom* - the power went out.

It's still out this morning. I think this could be why:


(Sorry about the crappy Treo photography there. Fortunately, when I went back to take a picture of it with the real camera, there was a crew there replacing the utility pole that you may or may not be able to see is cracked in half. Egh.)

Or, it could have something to do with this:


That's about a block behind our house. Fortunately, Sparrow and I did a full survey when she got home (she was on call last night), and both our houses and the landlord's seem to be fine. Can't say as much for the house down the street:


Of course, it could be worse. This is left over from one of the last big storms....


Yeah, that sucks....

Thursday, July 03, 2008

Morpheus

Turns out he and I have a date tonight...I think I fell asleep at 7:45...and am going back to bed...more tomorrow, honest.

Wednesday, July 02, 2008

Distraction

I'm home. I just finished my last note from call. And oh holy shit am I cranky.

So, here, here's a funny picture of my dog...because you know what they say about, if you can't say anything positive....


See? Isn't that better?

Tuesday, July 01, 2008

Oh - and!

Did y'all see this, about the psych patient in New York who DFO'd and died in the admissions office and everyone ignored her?

First let me say...this is disgusting. Horribly upsetting, and a complete disgrace to the public mental health system. In some ways it's understandable - note the difference between that and excusable - because psych patients can often be, um, overdramatic and eventually you get a little desensitized to that (except that it stopped being understandable when they falsified records). But it really is a terrible, terrible tragedy, and provides just another obstacle for those of us who work very hard to provide high quality mental health care to the indigent and under-resourced.

But then, let me also say this: I get into work at State Hospital this morning (my very last day!), and my new patient that came in last night is rolling on the floor, wailing, "You're just like those people in the TV! You're just like those people in the TV!! I'm gonna diiiiiiiiiiiiiiie!!!"

Not that I don't want my patients to be informed, but maybe we could turn on SpongeBob instead of Good Morning America once in a while, huh?

Biting the apple


::sigh:: Knowledge has always come at a high price.

I've concluded that Adam and Eve did not encounter a serpent in Eden, but in fact a representative from my student loan company (I know, sometimes it's hard to tell). They caught up with me today (I say that like I've been hiding from them instead of answering the phone and saying, oh, right, is it that time of year again? Which form do I send in this time?). Apparently, I've "used up" all my residency deferment, despite the fact that I've only been in residency two years, but technically, since I graduated in '04 and should be making attending money by now, I should be able to pay the ridiculously insane amount they think is "reasonable". I laughed outright when he suggested this number. I said, look, I'm barely scraping by on what I make. I have rent, and a car payment, and I'm rather fond of heat and electricity and eating, too. And once in a while I like to do or acquire things that bring a little pleasure into my life. Because I need a little to counteract all the ready-made stress. And I don't think I ask very much. Do you see me buying a big ol' flat screen? No. But I'm rather attached to my Starbucks runs. I think this is reasonable.

And let's be honest - even if I gave stayed out of Target for the rest of my residency, I wouldn't be saving enough to make the payments they want.

Argh.

So apparently I can get a reduced sentence rate for six months, but then it'll go up. In reality, I'll pull more credit card debt for six months, and then argue with them again about how I can't afford the payments. Sorry, folks, but I'm on a fixed income here until moonlighting options open up (and honestly, that's when I was going to start paying them back. Can't they be a little more patient?). I don't know what they want me to do about it.

I'll figure something out. It'll be fine. But, still, I'm working a bajillion hours a week, I'm exhausted, and I've had a shitty past four years. I've been an intern twice. Shouldn't that by itself qualify me for some sort of insanity deferment?

Argh. Did I mention that already? I'm just not in the mood for this.

I've been thinking that in August I'm going to go back to the LYS and see if I can't get some teaching hours there. Which is not going to approach making a dent even in the reduced loan payment, obviously, but maybe it can keep me in yarn money. I was thinking more along the lines of, it'll get me out of the hospital a little more and maybe broaden my social base. And maybe I can get a discount on spinning classes (yarn spinning, not the kind on a bicycle) and fiber and spindles and things.

I've also been thinking about getting my MBA. Probably through Walden or UoP or some other ridiculous online institution, so I can work around my clinic schedule. And I just want the knowledge, it's not like I need to be a graduate of Kellogg. I was thinking this year might be the time to start that, because I have more time, except, what? I can't afford it. But maybe if I'm accruing more loans, the other ones will go back into non-repayment status, so maybe this is the time to do that. Wait, but then I end up with more loans...

Whatever. Truth be told, I'm just excited to have health insurance and not be getting paid in yarn anymore...or to be condemned to wearing fig leaves, for that matter.