Long day

I kept trying to come up with a lyrical reference for the title. I had to Google, because the only songs I could come up with referenced "bad day", and, my day wasn't especially bad. And lo and behold, I came up with this song:



Which I cannot believe I didn't think of, especially since I've been on a Matchbox 20/Rob Thomas kick since I linked to the 3am song the other day. And particularly because I have long time fond attachments to two particular lyrical phrases in this song. Well, three. Because there's also this one:

"I'm surprised that you'd believe in anything that comes from me I didn't hear from you or from someone else."

Because I actually find that reasonably profound.

The two in question, however, are the following:

"I'm sorry 'bout the attitude I need to give when I'm with you 'cause no one else will take this shit from me."

I mean, that sums up my last four relationships, right there. Not to mention a large portion of my friendships. And, what I do professionally, because the point of therapy is often to transfer and express feelings you otherwise can't safely or appropriately emote. Which means we take a lot of vicarious crap from people. Which isn't as bad as it sounds; actually, it's usually pretty interesting.

"Reach down your hand in your pocket, pull out some hope for me."

Which....really....I think is a lot of what I do. For a living. I think, in a lot of ways, people pay me to give them hope. To find hope for them, or help them find it themselves.

So my day started and ended with therapy patients. My freakin' SEVEN AM patient is one I've been seeing for a little over a month now. Unfortunately, we decided that Tuesdays at 7am are a good time for a standing appointment every other week. Which...okay...it's not really that early. In my OB/G days, man, I'd have my first case in the OR by then. But for psychiatry? We complain when we have 8am patients. The more unfortunate piece of it is that my Tuesday nights are going to extend until 9:30, because the second course I'm taking at the Psychoanalytic Institute did not, in fact, get cancelled.

And let me tell ya. 15 hours? Long day.

So I had him at 7. And then our child clinic ended up being overbooked (which was totally ridiculous, because for the past three weeks we've been severely underbooked in that clinic) and down two members of the team. But Elspeth, the social worker, and I knocked it out. And then my afternoon clinic was full, but, two of my favorite patients came back. One of them brought me a present - art, and in that, art which he'd created, which is the coolest thing you can ever give me, particularly if you're my patient. And he's good, y'all.

So, and this is a total sidebar (shocking, right? Me, digressing?), we have this art gallery at the hospital, called Brushes with Life. It's all art that's been produced by artists with mental illness. We have so many pieces the whole Neurosciences hospital is lousy with them, and even at that there's a rotation, and some pieces only make it up once. But there's a big gallery up on the third floor, and every now and again we stage a real showing at a real gallery. It's amazing, some of the things that come out of that exhibit. And, two of the best featured artists are my personal patients. Who are also just really cool people in general. Anyhow, a year or so ago, some documentary filmmaker decided to a, uh, documentary film on the gallery. And several of my patients are in it, not the least of which is the patient I saw today. They're screening the film again next week. I think I'm going to go.

He also has a band, but I'm on call when they're playing next. Which is just as well, because I can't decide if that would be a boundary violation to go see him play. I mean, it's at one of the major local indie clubs. Where I've gone to see other bands perform. And he's just so tremendously talented, and frankly, he's not a therapy patient, I mostly just do med management with him. I kind of think a public venue like that, if I just went and didn't try to be all social with him, would be a non-issue. Which is the consensus of the people I polled today.

Thoughts from the crowd?

Anyhow, my last patient, who's my child therapy case, was at 5 (so, after clinic hours), was this kid I've seen in clinic, but this was our first therapy appointment. Man, he's driving his parents batshit crazy. Which, frankly, I think is a short trip. And honestly...I think he's a really good kid. Now, I'll also be honest and say that I'm glad he doesn't live with me. Mostly because I'm glad most any child doesn't live with me right now. And I'm not sure how I'd handle these issues if he were my kid.

But I think it's safe to say, if he were my kid, he'd have entirely different issues.

I feel for his folks. I do. It has to be hard. But shit, an hour with them makes *me* want to smoke pot. I can sorta figure out why he does it.

I know this child therapy gig is sort of along the lines of what I want to do, or, as it were, it's very along the lines of what I want to do in the short run. But wow, it's exhausting. Because with kids...well, with everyone, you end up having the whole family as your patient. I mean, no one exists in a vacuum. But with kids, you end up doing this whole-family thing more actively. Like, you actually treat the whole system instead of trying to do it as a theoretical and a little more by proxy.

It's a rough charge. That's a lot of stuff to tangle with. We have this saying, in psychiatry, about how the identified patient, the one who's coming to see you and actually branded with the "crazy" label, is usually the healthiest one in the system from which they come. Often, it's their job to bear the dysfunction of the whole family ("we're crazy because you make us crazy, so everything that's wrong is all because of you"), and because they're actually the healthiest of the bunch, they can't tolerate the dysfunction as well as the more dysfunctional (does that make sense?).

And kids? Don't come with a set of fully-formed coping mechanisms, adaptive or otherwise. It's hard to deal with badness and try to figure yourself out and mature into an independent functioning human all at the same time. And when you're in the middle of all that, and some random stranger tries to come "fix" you...it's hard to trust anyone. Particularly any adult. I mean, shit, I saw three different therapists when I was being actively molested, and I didn't tell any of them. It's going to be slow going with this kid. And, I respect that. His parents, like most families of "identified patients", want him "fixed." Like, yesterday.

It's a little bit exhausting all by itself.

And the real secret is? Adults? Really, psychologically speaking? Often just big, unresolved kids.

And, somehow it got to be 11pm (well, Sparrow came over, we got to chatting....). I meant to be asleep an hour ago. So I'm gonna go do that....