Like the first day of school all over again

So today, I did something I've never, ever done before.

I was a second year resident.

I'm pretty excited about that.

So the way things work in our program, you spend your whole first year doing inpatient stuff - medicine, neurology, and of course, psychiatry. Then you spend your whole second year doing outpatient (clinic) work. Your third year is a hybrid of the two, and your fourth year, if you do one (because if you do a child fellowship, you get to skip your fourth year), is just a bunch of electives and free time.

So here's how my week is going to go these days: Monday morning I have Bipolar clinic, then adult diagnostic and treatment clinic in the afternoons. Tuesdays I have child clinic in the morning (until January, when I have intake clinic) and psychotic disorders clinic in the afternoon. Wednesday mornings I have psychotherapy supervision, Wednesday afternoons I have lectures. Thursday, I - get this - climb on a tiny little two prop crop duster plane and fly to the coast, where I spend my day presumably wandering around after the beachside crazies as part of an ACT team before I fly back. Fridays, I have nothing scheduled after our 8 am lectures. Sounds like a lot of free time, right? Except that I have to fit two hours of CBT, four hours of dynamic psychotherapy, an hour of child therapy, and between two and four additional hours of supervision (child and CBT and maybe DBT) in there, too. Plus, you know, all the other shit I have to fit in.

And I'm still on call, but, instead of every 4 nights, I'm on about every 12-14. Now, we don't have short call anymore, so all our calls are 24 hours. But the great thing about that? I'm done by 9am, and have the whole post-call day to be, well, all post-call. And I love me a good, full post-call day.

Today was my very first day of clinic. Also the very first day I walked to work. I wore my grubbies to walk through the mile through the nasty humid grossness, and put my work clothes in my backpack, and then changed at work. I spent a good deal of time picking out today's outfit, because I wanted to look just right. You know, professional, put together, not too intimidating. I popped the decoy ring onto my left hand. And I sallied forth into the world of clinic.

Now, of course, one of the things I liked most about OB/GYN was, of course, my outpatient clinic. So I'm not too worried about this.

It is quite the balancing act, though. They told us, at orientation, "this year is going to tax your organizational skills." They weren't kidding. Fortunately, I'm surprisingly anal-retentive and a bit of an organization freak (not that you could tell that from looking at my house...). Still, it was exhausting, trying to get the new routine down when everyone else had been in clinic for a while, you know? I felt slow and clunky. I dictated notes for the first time in eons (seriously. I think the last thing I dictated was an operative note on a C-section), which involved a lot of "ummmm"s "err"s, and "oh, no, wait, I meant...".

But I stayed roughly on schedule. I compensated for my clunkiness as best I could. And generally, it went well. Which, okay, it helped that two of my patients didn't show.

I did have one frustrating moment, though. My morning clinic is technically Adult Diagnostic and Treatment clinic, except that my supervisor is, like, the preeminent bipolar researcher on the East Coast. So he only wants bipolar patients. Which, let me tell you, I'm not real thrilled with the idea of a whole clinic full of "bipolars" (someday, I'll rant about the overdiagnosis of bipolar disorder and the pathologies that get written off as bipolar). And so, my very first patient in the entirety of my career is this kid who, two months ago, was found by police naked and muddy. And he has these "manic" episodes consistently after he's made himself stay up for three or four days straight. And there's usually substances involved. So...yeah. Not bipolar. Four days without sleep would make anyone psychotic. Which I said to my attending, and he was like, no. No way. Lack of sleep will not make someone manic (um, really? Aside from the fact that this is a well-documented phenomenon, has he actually met any of us when we're postcall? Okay, that's just hypomania, but it's also just 30 hours up, not, like 90). He says this guy is CLEARLY bipolar.

Uh, whatever. Okay.

I know that when all you have is a hammer, everything looks like a nail, and that's even more true when you are a hammer. But it's not always a nail, you know? Sometimes it's a screw. Sometimes it's a thumbtack. And sometimes? It's a grapefruit. Is alls I'm sayin'.

Know what, though? Still really, really tired.

What was especially funny, though, was all the residents walking around looking snazzy. This weekend, of course, was the Tax Free Holiday in NC. Which is an effort to give lower-income families a break with the back-to-school expenses. And also apparently works well for lower-income residents. I think we all went out and got new clothes this weekend.