Sunday, November 30, 2008

What that "MD" really means...

So, this morning, I'm driving to the Target (again) in the cold nasty raininess, and I was thinking, you know, my blog posts of late have so often been just a chronicle of my day. Nobody cares, dude. I should really have a topic today...

Uh, thanks, Dad, but that wasn't entirely what I was going for.

There are upsides and down sides that come with being a good doctor. Or being a doctor, period. One of them is that you become a nightmare for your family's doctors.

Okay, maybe I'm not a nightmare, but only because I work at being more reasonable. And I'm not sure how often I succeed...

So my father calls me this morning. No, wait, let me back this story up even further. I call home Thursday night, and my mother answers the phone, and the reception is terrible. I assume it's me, so I'm wandering all over the house, and it doesn't get better. Meanwhile, she's being all evasive. I finally get tired of piecing together words and phrases across the cell phones (it's cheaper to talk cell-to-cell under our family plan) and was like, forget it, I'll call you on the house phone.

There's a pause. She finally says, "Uh...we're not home."

Oh, okay, so they went out. On....Thanksgiving...but, okay....I ask where they are, and there's another pause, and she tells me they're at the little community hospital by their house. At which point my stomach curls up into a cold little leaden ball. Because my dad always goes back to the hospital where I went to medical school when he's sick. The little community place by them is actually pretty good, but all his doctors are at my med school, it's a tertiary care center, they know him well, etc, etc...the only time my dad goes to the local place is when he goes by ambulance.

Or, it turns out, when he does something dumb that doesn't actually require the hour-long drive to the tertiary care center.

So my father - older, on steroids for his COPD - is coming down the stairs on Thursday carrying something, and whacks his hand on the side post. Which tears a three-inch flap of skin off the back of his hand. What does my dad do? Smooths the flap BACK OVER THE EXPOSED TENDONS and goes about his day (Daddy, I love you, but these are the times I wish I still lived close enough to smack you upside the head). So, finally, at some point later (as the story was told to me....I suspect my mother's influence in this turn of events), he decides, you know, maybe someone who isn't me should look at that. Two hours, several stitches, and one bottle of PO antibiotics later, all is well, and my still-completely-nonplussed father can't understand why I'm all exasperated that it took him so long to go to the hospital.

So this morning, I get up early (all I was doing was lying around coughing anyway), and trek out into the cold and rainy with the goal of beating all the other people to the Target (and also of buying an area rug for the front room). I get out of the receptionless Big Box Dead Zone and I have this voicemail from my folks. At 8:00 my time. And I'm all, why on earth did they think it was a good idea to call me that early...and then I hear my father's tone of voice. And I get this far through the message - "Hi, Kate. It's us. I woke up this morning and my right knee's really sore-"

Which is when I hung up and called home to tell him to get his ass to the hospital. Right about the time the paramedics were arriving.

And so there's all this fuss which ends with my dad in a private ambulance on the way to my medical school and the Fire Department medics telling the contract service, "His daughter's a doctor in North Carolina, so if he gives you any trouble, call her and she'll yell at him."

I...um...if it weren't true....

So what do *I* do? I pick up the phone, call my med school hospital, and have the Ortho resident on call paged. Because that's the logical option, right? An gosh, it was just such a characteristic exchange.

I called the operator, right? Asked if she could page the ortho resident on call. I gave the story, the patient's name, date of birth. She asks for a callback number. Was I calling about a transfer? No. And the she asks what my name is.

I gave the usual last name, but I gave my first name as "Doctor."

Because I know if I see "Dr. Smith 888-555-1212" on my pager it means whole other things to me than some random name with an out of state number. So this little intern gets on the line, all full of attitude and already exhausted at 9am (don't worry, hon, I remember what it was like to be a surgical intern). I an hear the OR monitors beeping in the background. I had a small moment of, ohhh, maybe I shouldn't have called. But I held my ground.

I told her my name and that I was a physician out of state

(get it out there right up front. Both a demand and an apology)

and that my dad was a patient of Dr. H's who'd had bilateral TKAs in the past

(so, yeah, I speak your language)

and now has an open wound on his hand and woke up with severe pain in his knee this morning.

(which, I expect you to know what I'm angling at, here. You'd better be on your game)

I give her a little more, remind her that I'm out of state and haven't looked at the knee, but according to my mother there's a one-inch area of redness. So, should I send him to her or should I have him go to the nearest ER to get antibiotics started as quickly as possible?

She's like, well, I can't tell you over the phone what's wrong.

(No shit, kiddo.)

We fumble with this for a minute. I throw in things like, well, you know, I admit I haven't done any ortho

(although my advisor in medical school was an orthopedic. For four years. I did several dozen knee and hip replacements with him)

in like five years

(I've been a doctor longer than you have)
(For those of you playing along at home, this does not make me right, but it gives me seniority. Which is everything in the surgical world)

but my memory is that it's pretty imperative to start antibiotics as soon as possible if there's any question of infection at a prosthetic joint.

(my hackles are up. I'm not showing my teeth yet, but, don't fuck with me)

She says, is it swollen? An inch of redness doesn't make it a septic joint. But he's welcome to come to us if they want to drive out here.

(so, an equal display of, you don't scare me)

I say, they're headed to one ER or the other. In an ambulance.

(a low little growl)

She says something about not being able to judge it over the phone. I say, "okay, so the question is..."

(I haven't told her what specialty I practice yet, but "what is the question?" is something that consultants use a lot. Which actually doesn't narrow the field down much, but establishes that I'm someone that other doctors routinely ask for help. The fact that *I* posed that phrase to *her* - the actual consultant in this scenario - is a total display of power. Power that I don't have - 850 miles away. Family member, not a treating physician. Psychiatrist, not an orthopedist - but it works. She rolls over)

Well, she says, yeah, I mean, tell him to come in to our ER,

(as in, don't expect me to be down there waiting for him. She hasn't rolled over completely)

the ER doors are always open.

(but I've flustered her and established the upper hand)

And, then we can consult Dr. H's team as soon as we know what's wrong, and his records are here, and yeah, you know, it's just hard to know over the phone.

I say, tell me about it.

(I know I'm being a pain in the ass)

She says, yeah, and it's hard because it's your dad.

(I understand. I'm just as much of a pain in the ass when it's my family)

We hung up, I called my mom back and told her they were aware he was coming in.

Amazing how much goes on between the lines, though, isn't it? And that's the Cliffs Notes version.

At so many points in that exchange could I have gone off on her (Listen, newbie, my 77 year old father, who's on steroids, and has two prosthetic knees, and has now failed PO Keflex and likely has a festering infection in his joint, he's coming to you, so don't fuck it up, because if he loses his joint who do you think I'm going to come after?) but...that's just counterproductive. I'm not all that interested in the politics of it, and if he's going to lose the joint he's going to lose the joint. Plus, I actually was asking for her advice about whether or not delaying treatment by an hour would make enough of a difference to warrant going to an outside facility with fewer resources. This is not about my ego, my power trip, or my need to defend myself from narcissistic injury.

But so often, with medical family members, it is. Because they're worked up and scared and trying to fall back on their favorite defense mechanism - intellectualization - and it's failing them, because they're not in the driver's seat. And in general, doctors really like driving the bus. So some can get pretty nasty when you tell, say, an oncologist that the appropriate treatment for his psychotic daughter is not what he thinks it is.

And a lot of times, a little bit of knowledge is a dangerous thing. See above re: oncologist. If we're talking about a patient, and that rational distance is there, it can go very differently. Quite often, when my patients are getting what I think is not substandard care (or maybe just a little substandard) from another specialist, but not necessarily what I'd do, I'm willing to throw up my hands and say, well, if you don't tell me how to practice psychiatry, and I don't tell you how to practice nephrology, eh, the patient will probably be just fine on both fronts.

(I'm very protective of my patients, though, so while I may not challenge them directly, you can be damn sure I'm keeping an eye on things.)

However, when you lose that detachment, maintaining that same perspective becomes almost impossible. We make pains of ourselves at best; at worst, we get in the way.

What's a doctor to do except know that about themselves? I try hard to be nice, to listen and learn, to be respectful even when I'm getting attitude, and try to be really appreciative when my family's doctors take the time to speak my language. And when I'm on the other side of it, I try really, really hard to be thoughtful and accommodating and understanding and empathic.

So if you're wondering how this story ends, they admitted him, but so far everything looks okay. They tapped his knee (sounds better than "stuck a long needle in it and drew out fluid", doesn't it?) and found more inflammatory cells than they'd expect, but no frank bacteria. So right now we're on the watch-and-wait program. His ortho's going to see him in the morning. We'll see what the big boss thinks.

And, the resident I talked to swears to my parents that I didn't offend her at all when I called. So, maybe I'm doing a decent job of staying on my chain after all.

Saturday, November 29, 2008

Have a couple of drinks and quit discriminating

This has been a Luda Service Announcement.

(The new Ludacris album dropped on Tuesday, I picked it up this morning. It's ridiculous how much I love this song.)

Today was slightly more productive. I actually got a fair amount of stuff done around the house today, even if I didn't get everything done I wanted to, or didn't wake up until 10:30. Sparrow and Peng helped me move some stuff into the attic, so the house looks a little less cluttered. I still haven't figured out the best use of the space yet. But I really need to get this stuff organized and freakin' move in. I mean, I've only lived here five months...

It's rough being neurotic sometimes.

I understand why I never really unpacked in at the old place - I never actually believed that they weren't going to fire me. Not because anything at the program indicated that they were going to fire me, but, because life at the Emerald Palace was so tenuous, and they clearly never intended to let me get to second year.

But now, here I am, in a whole new year, and a whole new house, and I really don't think I'm going to get fired. Yet, I'm still surrounded by boxes, have no seating, and can't get my shit together to actually unpack and find places for my stuff in the new house. Now, though, now I think it's just because I'm crazy. Not to mention perpetually exhausted.

Urg.

Friday, November 28, 2008

Lazy Sunday

I keep forgetting it isn't actually Sunday....and I still have two whole days off! I think every weekend should be a four day weekend...

Maybe I don't, actually. Because even though it was only three days long, this work week stunk for almost everyone I know.

Today I did next to nothing, which is very different from what I had planned, which was far from nothing. I slept until noon, then finally got out of bed at 1 (well, I was postcall yesterday, and had only slept two hours on Wednesday night, and then was up all day yesterday, and let's face it, I haven't slept well all week...). Maggie and I went to the Petsmart, went for some dog food and a new retractable leash (the old one died. I mean, I've only had it for five years...), and a PediPaws. I think this may be in the same league as the Furminator, y'all. It's a little rotating drum of sandpaper and so it files your dog's nails down, rather than cutting them. Maggie actually tolerated it really well, and she NEVER lets me cut her nails, so they're always like a mile and a half long and she keeps going clickity-clickity-clickity on the wood floors.

We also got a few "wow am I tired oh look isn't that cute!!" purchases....

One was a puppy Kong. Maggie's never been a fan of the Kong, but so many of our friends' dogs swear by them, that I keep trying. And Maggie's been doing some weird things lately when I'm gone, digging through the trash, chewing up non-food things, that kind of stuff, which tells me that she might be getting a little anxious and/or bored. And we already know how guilty I feel leaving her at home at all, much less as much as I do these days. So we're looking at Kongs in the store today, and they have new ones for puppies that have teething rubber. Which, I've long thought that the regular Kongs hurt her teeth, so, I thought, hmm...let me tell you, she loved it. I threw some treats in there, she spent hours playing with that thing. We may have success after all...

We also got...I'm such a bad owner....matching little reindeer coats for her and Little Maxine. With antlers that light up. Ohmigosh if it isn't the cutest thing ever.

We went over to Sparrow's for dinner tonight, and oh, look at the cuteness...



I'm hoping for Christmas card cuteness before the month is out, but neither of them was exactly thrilled with the outfits, so, we didn't quite get the photo op I was hoping for. But, we'll keep trying.

Meanwhile, Little Maxine got back at Maggie for stealing her bed on election night...

Oh, the cuteness...

Anyway. That's about the extent of my productivity today.

I stopped at the Panera on the way home from Petsmart for soup (they were out of bread bowls, I was sad), and then did a whole lot of nothing until we went to Sparrow's. Well, that's not true. Look what I started:


It's two toes. At the same time. On one big ol' Addi Lace. And so far I haven't even knitted them together once. The yarn is this Koigu KPPPM that Jenn sent me for surviving my intern year. Mmm, it's yummy. And I really like the way it's knitting up. I just have to pick a stitch for it - I've gotten really bored with plain old stockinette socks, but, I can't do anything too complicated if I'm going to knit in lecture, which is really my prime knitting time all week...

Thursday, November 27, 2008

Good girl

Barb's old girl Sydney passed away yesterday. Mags and I are sad for the Coopers. Syd was one of those outstandingly wonderful packmates that really make you remember just what pure and sincere goodness dogs are.

She loved well and she was well loved. That's about all that any of us can ask for.

OMG, what-ever!

Ahhh...it's nice to not be the only nation with a bumbling, idiotic leader who spends so much time with his foot in his mouth he has Athlete's Tongue...

But then, also on CNN.com today, the same world power proves that there are some areas in which same-sex couples cannot ever expect total equality - or rather, it cannot be expected of them.

(The last line of the above article also makes me wonder a little what kind of snake charmer is selling the Japanese their polar bears.)

The US for so long has been the world's petulant adolescent, Japan one of the wise elders. Sometimes the generations really do have a lot in common. Next thing you know they're going to be text messaging all night and...wait, I think they're already responsible for the Wii...

Happy Turkey Day, y'all.

I'm finishing up the end of my call night and so looking forward to the four day weekend. There's a big fat nap in my future (assuming I can stop coughing long enough) and then I'm off to my aunt and uncle's for a lovely evening of tryptophan and that silly jellied cranberry sauce (love that stuff). Hopefully I'll have something more productive to say for today after I've slept...

Tuesday, November 25, 2008

Life on Life's terms

It's an old AA mantra. I'm trying to hang on to it today. Not that I've ever been in AA, but, I think it's useful.

Here's my day.

I woke up at 4:45 this morning, after a restless night of coughing and choking and fussing. I putz for a bit, decide I'm going to go to the Starbucks for breakfast, because I have a little time and a distinct absence of clean dishes, and it's not that far. And so I'm headed down the road, at like 6 am, and I pull off of one highway to another, and there's this woman, standing in the road, in a dress and a coat and heels. She looks a little wobbly. I can't tell if she's trying to summon help or hitchhike. In an uncharacteristic display of good judgment, I resist my urge to save the whole world and do not stop. Instead, like a responsible citizen, I call 911 from my cell phone. And talk to the world's stupidest dispatcher.

I say, there's a woman standing in the road where Road X N pulls on to Road Y E. He asks me six questions about if she's "in" the road, or off to the side of the road, or near the road. I tell him she's in the outside part of the lane. He says, is this the on ramp or the off ramp? I tell him - for the fifth time (no kidding) - that it's coming OFF of Road X and ON to Road Y, so, well, whatever that means to you. He asks for a description. I tell her she's a tall, slender Hispanic woman in a green dress and a brown coat, and heels. He - I could not make this up if I wanted to - asks me what color her heels are. I said red. I honestly have no idea, but it seemed like the quickest solution, and, well, I doubt the officers were going to get out there and be like, oh, sorry, we were looking for someone in red heels, couldn't be you! He asks me if she looks intoxicated. I said she looks unsteady, but it's 40 degrees out and she's standing in the roadway in heels, that could make a girl wobble. He finally dispatched a car. I hung up and rolled my eyes extra hard.

(Angie, you think maybe we could trade him into your department, you could come here? Clearly we need some competence...)

So I get to work, and I have an early therapy patient on Tuesdays. Who asked me if he was losing his mind because he pulled kind of a bonehead move the other day. I told him no (45 minutes later. 'Cause at that point in the day I was still a good therapist), and neglected to mention the three times in the past two weeks I have walked up to other silver Jeeps and wondered why my key won't work in the door.

We had one patient in the child clinic, who didn't show. I tried to dictate all my notes from yesterday, made it through two before the coughing fits rendered that a bad idea. My afternoon clinic was fine, everyone was doing well.

For the first time in my recorded history, I batted 1.000 this week - every patient I had scheduled showed up except one who cancelled well in advance. I guess we're not truly there yet, until the two therapy patients I have tomorrow afternoon come, but I think they will. And wow, let me tell you, I was hoping for some no-shows yesterday...although, good for them.

So, I'm getting my afternoon clinic squared away, and....within ten minutes of each other, both of my therapy kids crashed. Boom. One of them did so in the office (fortunately, he was seeing his med doc today, not me). I know with these kids an hour a week is like giving them a bucket on the Titanic, but, still. In my self-indulgent, PMS-y (yes, still), immune compromised, underslept moments of self-pity, I feel like just the worst therapist ever. Cognitively, I know this to not be true, but, as one of Sparrow's patient's pointed out recently, thinking and feeling are not the same thing.

And I feel pretty bad about it.

And then, of course, I made another trip to the Starbucks (it was coffee or dinner, as it often is. And as always happens, coffee won. At least it wasn't the same Starbucks as this morning) and ran off to class. Which was long. And, um...I couldn't actually remember anything I'd read in my febrile delirium over the weekend. Lovely.

I just need to go hide in my bed....

Monday, November 24, 2008

Presents.

I came home tonight, and had a padded mailer in my mailbox, and a big Express Mail box on my doorstep. I was excited. The mailer, it turns out, was....odd. It was a book of "poetry" from the Center for the Advancement of Psychotherapy (sketch). They, of course, included a handy postcard telling me where I could mail a donation for the lovely gift they had just sent (even more sketch). The other, however, was from my aunt and uncle (the biological ones) in Chicago, and it was awesome. They sent me the 32-page Commemorative Edition of the Sun-Times Sunday magazine from November 9, entitled, "Obama: A Walk Through History."

Sometimes....my family makes me so proud....

It's funny, actually. My aunt and uncle (my mother's brother) have always been staunch Democrats. My cousins are both ardent Republicans (this makes no sense to me...my older cousin plays bass in a metal band....how can he possibly be a Republican? I think those two are mutually exclusive...). My parents are vehement Republicans (my daddy was not allowed to play with Democrats when he was little, because they were not nice people, according to my grandfather). And you ALL know what a flaming liberal tree-hugger I am. So I think my aunt and uncle are just glad one of us kids turned out to have some political sense.

They also sent me a Target gift card and a very nice card regarding the fellowship I was recently awarded through the PECC (it's a scholarship, really. They call it a fellowship because it sounds snootier). And you know how I always love me an excuse to go to Target.

The appearance of gifts made me slightly anxious, though, because I thought one of them might be from my Secret Santa - my knitting buddies back home are doing a holiday gift exchange, and I got to play along, too. Which was all well and good until this morning, when I realized that the socks I'm knitting for said exchange...um...don't match. And, okay, they're supposed to not match, but not in the way that they currently don't match. And apparently they're due next Friday, i.e., they have to be in Illinois by next Friday. Crap.

Also, a few days ago, my cousin (different cousin. Obama supporter) gave me the Aloha Award on her blog. Here are the rules:

"First, answer this question...If you were stuck on an island, what 5 things would you want to have with you? Then, spread the Aloha! Send this award to 5 other people and let them know they've been given The Aloha Award! That's it, easy peasy! Keep the chain going and spread the aloha all over the blogospshere! (be sure to link to the person that sent you the award...so we can keep the linky love going!)"

(Not Danielle's words, I'm guessing)

(PS - there will be no linky love allowed on my island of stuckness. Stop that! Stop that right now!)

Ahem.

Alright, if I were stuck on an island and given my choice of five things, I would take...

1. My dog. Not only would she be an wonderful companion, and enjoy running off leash (I'm assuming it's a relatively small island. Where's she gonna go?), but if I can learn to spin between now and the time I get stuck on this island, she could be an excellent source of yarn fiber.

2. A laptop with a solid satellite wireless connection (hey, it's my island, back off!)

3. Sunscreen. A lot of sunscreen. Don't make me tell you the story of the last sunburn I sustained in Hawaii.

4. A really good set of knives.

5. Phosphorus matches. Because, I am not patient enough to do the whole flint and steel crap.

And I tag....

Barb
Peng
Angie
Jenn
Allison

Pomaika`i, hoapili.
(Good luck, friends)
(I hope that's what it means...)

Sunday, November 23, 2008

Two ex-wives away from being a country song.

Seriously. Here's my day...

10:30am - wake up, for real, after waking up every 90 minutes to cough self into a fit of gagging, hacking, kak-kak-kak-ness, and probably a few times in between.

10:31 - wonder what the heck was wrong with my head last night, because entire night was categorized by epic, disorganized, really bizarre dreams. When I woke up, I'd been dreaming about (I'm so not kidding) flesh-eating bacteria that wrote boy-band lyrics through these kids in a cult that burned down my church (the cult, not the kids specifically). The kids were coming to my clinic, which seemed to be some sort of OB-Psych-ER hybrid, and one of them was living with me. Possibly in the hospital. Along with four dogs from the cult. I could not make this up if I tried.

10:33 - wonder what Freud would say.

10:35 - shower. Sometimes known as steam cleaning. This allows for penetration of the thick layer of concrete-like goo firmly sealing my eyelids shut and a small amount of air to pass through my sinuses for maybe 45 seconds, until they clog up again.

11:00 - execute decision that, while I can still see and possible even breathe a little, I'm going to go to Starbucks and the grocery. And then play it from there...

11:02 - turn key in ignition. Car makes odd clicking sound that is remarkably similar to above-mentioned kak-kak-kak-ing.

11:03 - wonder if I should call Sparrow for a jump. Notice that Juan's truck is parked in the driveway; wonder how to say "jump start" in Spanish.

11:23 - note that when I let the key rest, the radio, blowers, and interior lights come on. Note the presence of 3/4 tank of gas. Decide it can't possibly be the battery.

11:24 - call my dad (because, really, what do you do in these situations, except call your dad who is 850 miles away and say, "No, here, listen to this," and hold up the phone while you try to turn the engine over). Dad says it's probably the battery. Make him listen to the engine again and tell him it isn't the battery, because the lights work (will later tell him that dying batteries make a progressively slowing "ruh-ruh-ruh" sound, not a "click-click-click" sound). Become frustrated that my father - who's an engineer, not a mechanic - can't diagnose and/or fix the problem over the phone, from 850 miles away.

11:27 - Call AAA.

11:28 - sit down on the ladder that we've lain behind the gate of the fence because Little Maxine was trying to dig out there. Pet Maggie, who's outside all like, "what's wrong with the big noisy silver thing?"

11:34 - finally get through to AAA. Because circumvented the "if you aren't in the state of Illinois, press 2", and called the Illinois operator. She is very helpful. She transfers me to the NC operator, who, not so much helpful. She asks what service I need, and I say, probably a tow, because the woman in IL said I'm probably going to need a tow. She yells at me when I don't know where I want it towed (how is "wherever's closest" not an answer?). Does not understand how the name of the cross street is "like the holiday" (i.e., "it's the corner of Main and Christmas." "Christmas with a K or a C?" "C. You know, like the holiday." "What??" "The holiday. In December." "Ma'am, is that with a K or a C?"). Cannot comprehend how I don't yet want to commit to wanting a rental car until I find out what's wrong with mine. Get very annoyed, which is not helped by

11:34:30 - Maggie decides to make a break for it (chase me! It'll be fun! You'll feel better! Wheee! It's an adventure!!).

11:46 - devil dogs across the street scare Maggie. She darts back to hide behind me. I smack her on the tucas (so very hard I'm not sure she knew it was a smack) and stick her back in the house.

11:48 - start making eggs, because, obviously not going to get breakfast at Starbucks. Call parents to whine report in.

12:03 pm - yell at poor unsuspecting mother when she suggests I call someone local for advice on where to tow my car. Because I can't yell at the AAA lady, she's not required to love me. And I'm sick, and stuck, and my dog ran away, and my car died, and I forgot to put cheese on my eggs. And I woke up dreaming about pop-song-composing flesh-eating bacteria.

12:06 - tow guy comes. Tells me he can't service my car through AAA because my tags are expired.

12:07 - remind myself not to cry in front of the tow guy.

12:07:15 - tow guy says, "Well, let me see what's wrong with it first..."

12:07:45 - tow guy turns key in ignition. Car goes, "click click click".

12:09 - tow guy hooks this thing called a "power pak" up to my battery.

12:09:10 - car starts right up.

12:09:11 - resist urge to hug the tow guy.

12:10 - tow guy suggests it's time for a new battery. Ask tow guy where good place is to get battery. Tow guy suggests his service station.

12:15 - lock house, lock dog in crate, head to Starbucks with stated intention of charging alternator.

12:22 - make jubilant phone call to parents. Give dad satisfaction of being right, over the phone, 850 miles away. Apologize to mom.

12:40 - tea. Scone. Better.

1:05 - pull in to tow guy's service station. Walk in and announce I need a battery. Get blank looks from guys behind the desk. Weird but seemingly nice black guy who always offers to help my inflate my tires despite me crouched in front of the tire with the air hose in one hand and a tire gauge in the other and obviously knowing how to inflate my own tires (turns out I go to tow guy's service station a lot) pulls out $7000 voltmeter (I told him they were like $12 at Radio Shack). Confirms that I need a new battery.

After that, my day got better. I sat in the service station for a while, wishing I'd brought my knitting, sending long rambling texts to Claudia and watching this thing on MTV about the top ten over-the-top Sweet 16 parties of the rich and overprivileged. Which I then spent a good deal of time discussing with the mechanics. Tow guy showed up with subs from Jersey Mike's (a local chain, which is allegedly very good) and offered me part of his sandwich. Twice (I love North Carolina...). They hooked me up with a shiny new battery and a new little bulb for my license plate light (which is what actually got me pulled over the other night, and needs to be fixed anyway before I can pass my state inspection). I then motored over to Whole Foods, where I spent a ridiculous amount of money on...well, what, I'm not certain. I got small little tokens of affection for Sparrow, JD, and Cleo for their help in not making me take yesterday's call (I also bought a little bundle of flowers for JD's wife, whose tolerance was key to this operation). I got wine and chocolate to take to my aunt and uncle's for Thanksgiving (I'm also charged with getting the crescent rolls that come in a tube). I got a lot of random other things, which, frankly...I'm no longer allowed to shop post-call (except I still do), and so now I'm not allowed to shop when I'm sick...maybe I should just never be allowed to shop again...

After that I ran some things over to my office, and then stopped by Sparrow's and had a very nice cup of tea. She also gave me some leftover rock star garlic chicken that Rene had left for me, because she also rocks (she called earlier and was like, hey, I'm stopping by with leftover chicken, because I know you don't want to cook...I, unfortunately, was in search of a battery...) Little Maxine was all snuggled up parrot-style on my shoulder, so Sparrow was like, do you want to take her home? I'm going to be out all evening, I can pick her up on the way home...so now there's a teeny-weeny Maxine-y (Maxinie?) sitting at my feet and whimpering to be played with. Maggie's tossing around her stuffed alligator in the living room.

Is it weird that I can identify dog toys by their squeak at this point?

I'm feeling a little better today. Don't seem to have a fever, or at least much of one. I'm still doubting my ability to get a good night's sleep tonight, but, we'll see. And then...it's funny, I've been all stressed out about next week, right, because my Monday and Tuesday clinics are just packed to the gill....except...um...then that's it. If I wasn't on call Wednesday night (and hadn't thus scheduled a patient for the afternoon), I'd pretty much have a five day weekend, because I don't typically see patients on Wednesdays, and our lectures are cancelled. Uh, I think I'll be fine.

Guess I'd better go throw an alligator, snuggle the little one, and think about dinner....

Saturday, November 22, 2008

Admitting defeat

Damn stupid virus.

So, last night, right, Sparrow and I had left it that I would go in for call this morning, insisting of course that I was fine, and then Cleo (who was on call last night) would assess me, and if she felt I lacked capacity to make the decision about taking call (sorry, shrink joke), she'd send me home and Sparrow would pinch hit, at least for the day shift. But, of course, I would be fine.

Ah, it was a good plan...

So I got all, like, I'm going to bed. I'm going to be well-rested and fine tomorrow. Ahh, bed. Except...once I laid down...I couldn't breathe. No, really. My nose was dripping, my sinuses were full of concrete, and every time I relaxed enough to get to sleep I'd shut my mouth and then start suffocating. Which was between the times I started choking and coughing as I kept drowning in my own secretions. Ugh, it was awful.

So I finally gave up around 12:30 and decided to do something about it. I put on some passable clothing, climbed into my car, and headed for the Walgreens.

::sigh:: I hadn't even made it past the hospital before I got pulled over.

Okay, fine, so my tags are expired. Because in Illinois, they send you a letter reminding you that your plates are about to expire. In North Carolina, they send you a letter reminding you that, hey darlin', your tags expired two months ago and you should really get that fixed.

How was I supposed to know?

Fortunately, Officer Friendly was "feelin' the holidays" and took pity on my snotty, pathetic, transplanted self. So I went to Walgreens, bought cough syrup, and Afrin, and nose strips, and saline spray. And wound up continuing to cough and drip and drown all night. Except I couldn't swallow, because my throat was so sore from the Afrin. And I was sweating and tossing and turning and, oh, yech, it was a terrible night.

This morning, when my alarm went off at 6:30, there was just no way I was going to be of use to anybody today. And, my temp was still 102. So Sparrow took the first half of my shift (did I mention she was a goddess?) and JD took the overnight (he is also fabulous, although - to his relief, I'm sure - not a goddess). Ohh, thank God.

Although...I can't even begin to tell you how guilty I feel. I know, I know, stupid, unwarranted (ahem, 102) - and not that I won't pay back the time - but there nonetheless.

So, Maggie and I sat around most of the day trying to nap (she was a lot more successful at that than I) and watching TV. The unfortunate part of that is, while Thursday and yesterday I had a lot of good stuff accumulated on the DVR...today, the TV was crappy.

Which did not stop me from watching it. Despite all the interspersed commercials about how part of a healthy lifestyle is limiting TV to two hours per day or less (ha!). And my increasing guilt about what a disaster the house is (because I haven't really moved in. For a whole bunch of ridiculous neurotic reasons and a couple of moderately reasonable ones - like I have too much stuff and a significant paucity of time). But I'm siiiiiiiiiiick....

I watched a documentary on the Jonestown tragedy (which was 30 years ago this week) on the History Channel. I watched a terrible Lifetime movie. I watched a couple of episodes of Scrubs, and M*A*S*H, and the Cosby Show. I forgot how much I used to want to be Claire Huxtable...

I watched a show on Freebirthing on Discovery Health that was...well, interesting. My cousin blogged about this (and the show I watched after it) earlier in the week, and I was intrigued. Hmm. As a former deliverer of babies, I cannot in any way condone what they're doing. Cannot condone no prenatal care (a drug store BP cuff and a fetoscope? Come on). Cannot condone knowing that you may have something wrong that could easily kill you and your baby in minutes and not getting it checked out. Cannot condone such over the top disregard of what we've learned over the past several thousand years.

There was this one woman I just wanted to slap (the one with the drugstore prenatal care and the possible low-lying placenta. Minutes). She was going on and on about how horrible her first birth was and, you know, if she'd only known how risky the interventions were that they were doing (minutes!! Bloody! Horrible! Traumatic! Well before your husband would even call EMS!). Please. Because a shoulder dystocia or a cord accident without the benefit of a trained attendant, yeah, that's not risky. She also ranted about how, at her first delivery, the doctors kept yelling at her that she wasn't pushing right. And she didn't know "what the big deal was, because, you know, it only took like ten minutes."

That's when I started yelling (well, rasping) at the TV.

Okay, now, I concede that I haven't delivered as many babies as she - oh, no, wait, I probably have a couple hundred on her. And I can tell you, when we start saying things like that in a situation like she described, it's because the baby's in trouble.

Which is the PERFECT indication to have a baby far away from any medical care. Idiot. Shouldn't be allowed to breed.

Ahem.

But on the other side of it...you know, I don't support unattended births. I don't even really support home births, because they scare me. I concede that women have been doing this for thousands of years. I absolutely concede that more births around the world occur outside of the Western medical setting than not. But I also would point out how many fewer moms and/or babies die in childbirth or have poor delivery outcomes in the Western world than in the third word or developing nations. But by the same token, I don't either entirely support the medical, institutionalized birth. I've said this before on here, that I dislike the assembly line, everyone gets an epidural at 4 cm, everyone delivers in lithotomy kind of birth, which we do because it makes us feel as practitioners like we're more in control of a chaotic process. But the truth is, I think it often leaves us less in control. I got in so much trouble for deviating from that standardized delivery, but I really felt like everyone was better for it, including me. As I told my patients time after time, my philosophy was this: look, it's your birth, your body, and your baby; I'm just here to keep everybody safe. So, within reason, we'll do this however you want it. Which involved any number of things, even in my short career - backrubs, perineal massage, mineral oil, olive oil, music, Wiccan sand circles, I delivered babies with their moms in pretty much any position they could come up with, and once or twice I was more or less on my back.

Interesting, isn't it, that as much as they complained about my "avoiding" the OR, the only time they commented on how I jumped in on the labor deck was to tell me I was somehow doing it wrong...

Anyhow. The bigger point is, I loved labor and delivery.

So there was this woman on the Freebirthing show who had this completely amazing delivery. It was a water birth (one thing I haven't done, partly because we didn't have the facilities, partly because it yicks me out), and wow, it was so peaceful. There was no screaming and raving and wailing. She just let things happen, accepted them as they came. She claimed it was more or less pain-free, which, I think that depends on your definition of "pain-free" (i.e., I've seen plenty of women control a reasonable level of labor pain with meditation and self-hypnosis). But it was just entrancing to watch. She was nearly silent through the whole thing. And her baby came out, sweet, beautiful, and didn't cry. I, of course, got worried, and apparently she did too, but the kid was breathing just fine. I guess he just didn't have a lot to say. She interpreted this as him being "relaxed", and I'm not sure I disagree with that. The whole thing was completely beautiful. The only thing I would've done differently (aside from being somewhere less than 500 feet from a functional OR) is that her husband didn't touch her the whole time, apparently to protect himself from some British law regarding unlicensed attendants at a birth. Which is sort of sad.

Still. Would it kill you to have a midwife on hand?

The other program I watched was on the "pregnant man." That was a lot more productive. I still don't consider him a pregnant man (uterus = not a pregnant man), but I really support what they did, and I can see his point. I had a lot more respect for them after I saw the program. They seemed like a sweet family. I really appreciated the wife's efforts to breastfeed. I did think it was sort of interesting how quickly they seemed to fall into traditional gender roles. They seem like they have been (the wife has two daughters from a previous marriage) and will be good parents (which is fortunate, because there's another one on the way), and really, can you ask for anything more than that? Everybody's family is different. Everybody's parents screw them up. And the show was an interesting and compassionate commentary on the issues that transgendered couples face. Plus, that kid's adorable. And, I do not envy any boy who comes sniffing around her in 15 years or so - she is so going to be daddy's little girl!

I did get two very amusing quotes out of today's TV watching extravaganza, though. The first, from the stupid Lifetime movie:

"Your son is looking at porn on the internet!"
"That's nice, honey. G'night."
(which, incidentally, was the correct response, at least initially. You know, before he developed his big porn addiction and started lying and stealing and the whole world came catastrophically crashing down...in typical Lifetime fashion...)
And, care of Dr. Huxtable...

"Regional forecast...warm, and no babies."

If I was an OB, I'd so totally steal that (hmm...maybe I can still make it work...)

Okay, yeah, I'm done babbling...

Friday, November 21, 2008

Gratuitous Cuteness

So I've now spent a good deal of time arguing with Sparrow over whether or not she's going to take part of my call tomorrow. Because she's the only one available. And she was on call last night. Which...because I'm a stubborn masochist and Sparrow just rocks, I'm betting you can guess how this conversation has gone...

Me: I'm fine!

Sparrow: No, you're not!

Me: Of course I am.

Sparrow: You're being ridiculous.

Me: Probably.

Sparrow: Let me do it!

Me: No!

Sparrow: Yes!

Me: I'm fine!

(repeat)


She's awesome. She and Cleo spent a lot of time today trying to find someone to cover for me. In the end, I just don't think it's worth the drama (you know, I won't think it's worth the drama until I end up with pneumonia...). And I'm on with Dr. Itchy tomorrow, as my intern (it's a long story how he gave himself that pseudonym), who is also fabulous. I'm sure it'll be fine. I'm sure I'll be fine. And Maggie and Little Maxine will have a good time over at Sparrow's.

I actually have a lot-ish to say, including my worthless trip to the doctor today (Larry wasn't in the office, so I saw Kelly, another attending, who didn't remember me despite the fact that I worked with her for two months straight less than a year ago. She asked me, "do you work around sick people?" ::sigh::), but I really need to go to bed. So instead, I give you gratuitous adorable pictures of the pooches.

Little Maxine came in all muddy this morning, so I scooped her up in this big towel, and she was all like, "ahhhh...." So I had to take pictures. The ones of Maggie in her chair are apparently her attempt at claiming the Cutest Puppy Ever title.

("Hey, everybody!")







("Ha! Maggie's funny!")

This has been most of what I've seen of Mags over the past few days. She's been dutifully stationed at the foot of my bed.



So sweet.

Such good girls...

Thursday, November 20, 2008

Ugh.

I'm sick. Also tired. Fortunately, I have two fantastic if fuzzy nurses to take care of me (Sparrow's on call, so Little Maxine's over).

It was sweet tonight...I couldn't get the dogs to stop licking me. Both were over-the-top cuddly. And I was like, okay, you two! But they kept being all persistent, and finally...it occurred to me that I was really hot.

Smokin', baby! Right?

No, really, my temp had gone up two degrees. To 104.

So I popped 800mg of motrin, sent my classmates an email looking for someone to cover my call on Saturday, and called all my patients to cancel tomorrow's appointments.

Everyone calmed down after that. In fact...we ordered Indian food for dinner. I was lying on my bed, Little Maxine snuggled up beside me, Maggie napping in her chair...and I heard this tapping sound. The delivery guy? I looked at the dogs...no. They were still sound asleep. Must've been something else. Until I heard it again a minute or so later. That was a definite knock. Still, the girls did nothing until I actually got up and started towards the door. Then suddenly they thought it was the invasion at Normandy. The driver was really amused, fortunately.

Goofy dogs. It's fortunate for them they're both adorable and sweet and cuddly.

I think I may have to get a tiny little nurses' hat for Little Maxine....

Wednesday, November 19, 2008

Well, I always wanted a pony...

I'm a little hoarse.

Between my office mates, my patients, and my ACT team - ALL of whom have been trying very hard to infect me with things - someone finally succeeded. Currently it's mostly in my chest, although...it's been sort of interesting, actually, to watch this develop over the course of the day. Usually I wake up with these things, and the only real warning I have is that I went to bed feeling "not quite right", or, on the best of occasions, I have a prodromal day or so of scratchy throat or mild stuffiness. But this has been coming on all day...when I left supervision this morning, I could still chalk my tight chest and scratchy throat up to the cold air. I was a little cough-ful in the LYS, but, well, the yarn fumes were soothing (oh...my...God, they have this cashmerino silk stuff...I wanted to knit myself a cocoon out of it....but that would be more money than I make in a month, I think. I settled for a little cuddle before I put it back on the shelf). I started coughing for real and producing mucous in earnest towards the end of lecture. And by the time I left my housestaff meeting, I was all scratchy and wheezy and febrile (but the chocolate cake was SO worth sitting through the meeting).

I stopped on the way home and bought Airborne and a thermometer. And am now going to take my dog and go curl up under the electric blanket. Maybe I'll wake up all fixed. It could happen!

Tuesday, November 18, 2008

I...um...oy.

My Facebook status reads, currently:

Kate is concomitantly over-caffeinated and deliriously tired.

I'm so bloody tired right now. And a little bedraggled. Last night was not awful, and Mike was on night float and took good care of me overnight (he didn't even make me see anybody after 1am. I wandered in to the workroom sometime around 3:30, and he was sitting at the computer, piles of paper surrounding him on the floor, each referencing a patient that somebody or another wanted to send us. I was like, "You need help?" He sort of looks around, looks back at me, and says, "Nope." Who am I to argue? I went back to bed. Well, I went back to my office. I dictated two clinic notes, checked my email, putzed and fussed, and then finally went to sleep around 5. I actually slept pretty darn well from 5-8, but from 1:30-3:30, I tossed and turned in this restless, shallow, inexplicably anxious sort of sleep, which I find is almost worse than just staying up.

There's cable in the intern lounge now. And a recliner. I should've just gone in there and dozed...

Sparrow's always reminding me that it's perfectly reasonable to be useless on your post-call day. Maybe if I would just quit fussing and lay in bed and watch House on these days, I wouldn't end up doing that on the weekends. But, nooo, I'm always trying to be "productive." Pah.

(Sparrow, by the way, so totally rocks. It was, to quote Peng, "ass-bitingly cold" this morning. So Sparrow calls me up and is like, I don't have to be at work until 10, and it's way too cold for you to walk, do you want me to give you a ride home? I almost cried. She also picked up dinner for us last night - which, apparently, Little Maxine got to come along for the trip, and thought the food was for her, and couldn't understand why Sparrow wouldn't let her eat it. Tyler - who met her downstairs - was very amused by Little Maxine. They - Maxine and Sparrow - also took good care of Ms. Mags overnight. Sparrow's so totally my hero today.)

I caught a little nap today. I tried to read. I saw my shrink and waxed philosophic about work for an hour. And I joined the gym. I liked the gym. They were very friendly. I have my complementary assessment and workout (read: sales pitch) with this large, bald, black wall of muscle named Joe on Friday night (I'm on call Saturday. Here's hoping I can still walk). There were old people working out (apparently they have three members over 90) and I got high-fived by the staff a lot. I also got a wicked (WICKED) deal because the manager was in a good mood and thought I was cute.

(One thing I've noticed about North Carolina, both today at the gym and in the context of various people I've met thusfar, is that personal trainers tend to be large black walls of muscle. Who tend to think ass-ful white girls are hot. A girl could get used to that.)

So I sign all the papers and pay - cash, since I don't want to be paying credit card interest on it and specifically took this out of my bonus money. But they had to ask the manager if they accepted cash for membership payments. I thought that was hysterical - and as she's handing me my change she says, "oh, by the way, about our cancellation policy..." And it took a good deal of restraint in my shriveled-up post-call brain to keep from laughing at her and saying, "I want to quit the gym!"

(Which, if you missed the reference, is not actually the case. Rather, it reiterates that there is a Friends analogy for every situation in life. Exhibit A:

)

So then I went to Starbucks and pretended to read for a while, and then I went to class. My first class was good, as it always is, but the second...I'm discovering I don't especially enjoy it, although I find the material interesting. And tonight, right, we get to talking about attachment, and this concept, which I think is huge giganamous gargantuan - the infantile attachment bond determines what "safety" feels like for a given individual. So if you're a baby surrounded by chaos, or inconsistent reinforcement, or a detached and unresponsive parent, this becomes your view of "normal" and "safe."

It's a simple, very reasonable statement. But the implications of that are just HUUUUUUGE.

I've really been pondering that hard. What I found disheartening, though, is that my leader/teacher/whatever I'm supposed to call him eventually pointed out that this gets strongly internalized and likely doesn't change, you know, ever.

Which, well, made me want to curl up in a corner and rock a little. Because if that's true (which, it is, to a degree, I think, but that degree, and the factors that modulate it, are important), then what I do is futile. Which is daunting, particularly for someone who wants to work with people repeatedly traumatized at an early age.

Anyhow....I have to be slept and dressed and showered and in my supervisor's office in 10 hours to learn how to practice my futile craft better, so I guess I'd better get to bed....

Monday, November 17, 2008

Sunday, November 16, 2008

This little PIGgy

Tonight marks the beginning of the 2009 recruitment season. Tomorrow is our first set of interviews for next year's intern class, and so tonight is the traditional pre-interview gathering, affectionately known in our department as a PIG. It's pretty standard - the night before interviews at pretty much every program in every discipline, there's a meet-and-greet with the current residents at a local bar or restaurant, or when I was interviewing here, at one of the residents' houses. It's a nice, supposedly informal way to kind of get to know the people in the program, it gives you a feel for what people are like outside the hospital, and if you're particularly astute, it gives you a excellent way to gauge the dynamics of the people involved - are they snooty and distant? Generally relaxed and happy? Do they talk about work with each other or just when they're giving you their sales pitch (for those playing along at home, remember that we spend roughly twice as much of our awake time at work than not, so, if they're not talking about work at all, something's awry)? Are they snippy about it? Jovial? Excited? Dry? That can tell you an awful lot about peoples' attitudes toward their work and their patients. Do they generally avoid each other, or do they have inside jokes, ask about kids, family, hobbies? Do they volunteer positive information about each other ("Oh! Martha's really interested in community psychiatry, you should talk to her about our AHEC stuff," or, "Kate knit her own socks!" or, "Mike just ran a half marathon two weeks ago, you should talk to him about the running clubs around here")? Now, of course we're all on our best behavior, but, there's still a lot to be learned. And the residents - who often have a say in the rankings - can gather useful information as well. Generally, I like these things, and am hoping to go to as many of them (and the lunches during the interview day) as possible.

You'll notice, however, that tonight, this little piggy is blogging and making pizza.

Let me tell you how my day went...

I got a late start this morning. Way, way later than I wanted to. And I finally get out the door, and I get a table at the Starbucks, and read through some stuff....and then I get this text message from Sparrow:

"Dogs out."

I looked at that a moment...thought, huh? Is she just making a pop culture reference? Does she want to go take the pups somewhere? Is she...and then, it clicked.

Dog's out.

My dog.

Is out.

Shit!

I immediately started packing my stuff up and making a beeline for the door as I called her. Juan, our lawn guy/man Viernes had called her and said that Maggie had made a break for it. They were off to go corral her. I said something along the lines of "i'llberightthere!" Fortunately, Mags was standing right in front of the house (although Juan said she had started off towards Sparrow's house), and was easily redirected into my house, where the dog door was subsequently slammed shut. Sparrow called, and I stopped driving like a felon with a two-second headstart. By the time I got back home, Maggie was like, "Guess what happened! Guess what happened! Guess what...ohhhhhh, wait, I'm in trouble, aren't I? Ohhhhhhhhhh......"

It was cute. I hugged her. Sparrow'd already told her she was crazy.

Near as we can tell she did indeed go over the fence from on top of the air conditioner. Which is a dilemma I hopefully have solved, at least for the moment, as I took one of my old plastic shelving units and set the shelves upside down on top of the air conditioner. And there's a ladder in front of it. Maggie seems disappointed. For the record, I did NOT think she would go over that fence, certainly not more than once. It's a five foot drop, for Pete's sake! But then, Maggie is nothing if not spry and resilient...

I also discovered that there's been a large grey housecat living under my house. The entrance to which is right on the other side of the fence from the air conditioner (and which has again been sealed off). Dollars to donuts Maggie saw her and was all, "KITTY!!!" And, boop, over the fence she went.

(It was particularly amusing watching me try to explain this theory to Juan, I'm sure, given my pathetic command of Spanish and his limited English. It was a lot of me going, "Perro...con gatto..." and making leaping and scampering motions with my hands. The best part of that whole exchange, though, was when he picked up the recycle bin that's sitting next to the fence covering the hole that Maxine dug during their last jailbreak. He looked down and saw the hole, and all I said was, "Perrita Maxine." And he said "Ohhhhhhhh" in that knowing way, and laughed, and put it back down...)

::sigh::

So then I met up with Sparrow and Martha at this little deli in town, and we chatted and hung out and I had really good falafel. I then went to the Lowes Foods, where I suddenly discovered I was not feeling so well. Which perplexed me. Until two things happened: a, I finally got to the point where I felt so awful I was like, crap, I just need to go home, and 2, it finally occurred to me where we were in the month. So I attempted to finish shopping, checked out, and drove home, not yet realizing that I'd forgotten about half of what I'd gone for, including most of the components of tonight's dinner. Like, you know, cheese, and, say, pizza crust.

I curled up into a ball for a while, thinking some nasty things about Eve and bemoaning the five weeks I have left until Larry (my doc) puts in a shiny new progestin-eluting IUD and hopefully remedies a lot of this (have I mentioned that my insurance company is giving me a Mirena for Christmas? I'm so excited. Soexcited. In fact, never have I been so excited about a sharp poke in the cervix. I am hoping, however, this goes better than the last Mirena that Larry and I tried to put in together). But eventually I got up and realized that it was 4:30 and I'd forgotten about half the things on my list. And that this little piggy was going to have to go back to market.

So I got up. Went to Target. Went to Whole Foods. Came home, went to start dinner...and realized I still hadn't remembered to buy mozzarella cheese.

There was a long string of expletives, but fortunately the six cheese Italian blend I'd bought a month ago had a little mozzarella in it, so we converted from Greek pizza (because it turns out I didn't have any non-moldy feta, either) to fancy six cheese pizza (which I forgot to put seasonings on. I just remembered that. The leftovers have been in the fridge for over a half hour). I then started a load of laundry, and started doing the dishes. And promptly ended up looking at the clock, covered in dog hair and dishwater and swearing at anything in sight, and deciding that this? Was NOT the image I wanted to project to prospective interns.

I'm all for realism, and being up front, but, there is a limit to how much crazy I let people see. Even y'all.

I'm giving up and writing this whole weekend off. Tomorrow will be better. Even if I am on call twice this week. And then again next week.

Never mind. I'm going to go hide under my covers and snuggle with my jailbird dog...

Saturday, November 15, 2008

Funky

I? Am in a funk.

Not sure why. Maybe it's the rainy greyness and the increasing obviousness that Fall done fell in NC. Maybe it's the general stress and annoyance that starts to hit all of us at work about this time of year (I find it gets worse until about February or March, then starts to pick up. Perfect overlap with recruiting season...). Maybe it's the amount of work I haven't managed to do.

Today started out with good intentions. Yesterday was good. I had four therapy cases (I should top off in a couple of weeks at six on Fridays, when my CBT patient returns and after my DBT case starts next week. I also have a Tuesday morning therapy patient and one more who's gone off to Texas. I'm holding his spot, but I don't think he'll be coming back to therapy. I'm hoping, though, that I can leave his slot open until my college student is fixed - I think she's going to be brief - and then maybe finagle in a spot on Wednesdays and take in someone who will go to twice-weekly. Then I'll be at my quota for therapy patients. Actually, I'll be well over it - I'm supposed to have four hours a week of Adult, one of CBT, and one of DBT. I also have two adolescents at an hour a piece. They're optional as far as the requirements are concerned). My two kids went especially well...my one who was spiraling down seems to have reached a reasonable plateau, and the other one is just doing great work. I really like my kids. I went up to the unit yesterday and met my new DBT patient (although I'm still not totally sure what my role is in the whole DBT thing). And we had a really great consult/liaison conference, about ethical issues in sterilizing those deemed mentally incompetent, which is near and dear to my ex-OB/GYN heart.

We went out last night for Cleo's birthday (which is actually Monday). It was funny, how her work friends and non work friends all segregated out, but, we had a good time down at our end of the table. Ruthie and Peng and I carpooled. Ruthie drove. Peng and I feared for our lives. It was amusing.

Today...I got up, I went to Borders...I went with the intention of using this coupon I have, and getting two specific books. I found neither book and left the coupon in the car. But I still got some great finds, including a book on doing two socks at once with magic loop, what seems to be a useful DBT manual, and Stephanie Pearl-McPhee's new book, Free Range Knitter. I'd planned to go from there to Starbucks and work for about three or four hours, but I was feeling sort of grungy and like I needed a shower, so I came home. And showered. And then...was just sort of overtaken by inertia. I watched House and South Park and whatever else had started building up on the DVR this week, although I still haven't seen any of this week's episodes (except South Park), because I kept doing the, well, I'll just snuggle up here in my blankets for another twenty minutes, and then I'll pause this, and go do some reading...

It's not that I didn't try to overcome the inertia. I tried to convince Sparrow and Little Maxine to go to Starbucks with me and Mags, but Sparrow's fresh off night float and all sleepy. I tried to corral a group to go get Greek food tonight, but Ruthie's cranky, Mike was watching football, Matt had other plans, Tyler got sucked into something else, Peng went shopping for purple things...you get the idea. And then I got into this little thing with Faye, because she and some of the other gals had made plans tonight, and by the time she called I was cranky and a little dejected and didn't want to go. But I caved, because I was feeling all guilty, and knew I'd have a good time in spite of myself...and she just called and was like, oh, you know, our plans tonight actually sort of fell apart...which, well, I wish I could say I was upset about. I like that crew, and would've had fun, but damned if I don't want to just crawl back onto the couch and watch this week's SVU.

Meanwhile, have I mentioned that my house still looks like I just moved in? Or that I have like thirty million pages to read for Tuesday? Or that I still haven't figured out what to do about at least six different decisions I have to make?

Speaking of which... We got a little bonus at work. It's meager, less than half of what they got last year, but, it's money. Most of it is going towards the never-ending avalanche of bills, but I kind of want to take part of it and join the gym. They have a stellar deal for residents, I don't have workout space at the new apartment, I kind of would like to have access to classes and weight machines and a pool again, etc. But I think the only time I could make a feasible commitment to going would be at 5am. Which is okay - I did that for a time in medical school, and I think I can convince Ruthie to start going at the same time (although currently she says she'll go but she won't talk to me at the gym...something about not being social and trying to do actual work there...I tried to point out that this was the very point of having a gym buddy, but, well, we're still working on it). I'd have to be better about my sleep hygiene, but, I can suck it up and do that. Not sure I can feel good about forking over gym money when I couldn't afford to pay my shrink if she weren't giving me a reduced rate for a few months, but, the gym will cost less than two sessions of therapy at the real price. And it's an investment in my health, yada, yada. My doc will be happy. Plus, the membership deal comes with two sessions with one of their trainers, which, between them and my friend the Rehab doc, I could probably figure out the right things to do in terms of all the issues I've had recently with my back and ankles and whatnot (apparently I have very tight heel cords and possibly shin splints. Or so I'm told).

Okay. The other thing I think I'm going to do is start paying for parking. I don't want to, and I can't get into the deck until something opens up, which means I'll have to park in the lot that's almost as far away as my house, except it has a shuttle bus that runs from 5 am to 11:45 pm. Plus, part of my plan for moving here was that it would save me the expense of gas and parking and whatnot. Which, okay, the gas really won't be noticeable. And the parking is pre-tax income, which is sort of helpful. But the thing about it is, these days, especially with Daylight Savings Time ending, I never get out of work until it's well past dark out. And I have to walk home through some very poorly lit and wooded areas. And a couple of weeks ago, some woman got run over by a bus and died at the big intersection I have to cross, which, according to the local paper, she's like the third person to get killed by a bus around our area in like two years. I'm having a harder time with this decision, but ultimately, maybe it does make some sense to get parking, even if I still walk a couple of times a week. Ruthie and I calculated it out, that getting employee parking costs less per month than parking in the pay deck - which I'm not supposed to do anyway - twice a week. And if I start going to the gym in the mornings, I'm so not going to want to/have time to come home, park, and walk a mile to work. Plus, a full workout and walking two miles is probably pushing it physically right now, what with above recent back/ankle issues.

The thing I can't get around, though, is....can I really justify paying to park when I live within walking distance and paying to join a gym for the exercise I'm no longer getting because I'm not walking to work?

I know it's not that simple. And both things probably make good sense overall. But it feels stupid.

Then again, that could just be the funk talking...

Friday, November 14, 2008

I don't get it.

Two ads on Facebook tonight that make little to no sense to me....

This one just seems weird. Why would you pay for something like this?

This one reminds me of that old Dan Akroyd sketch on SNL...


Really? All the kids want one for Christmas this year? Really?

Thursday, November 13, 2008

Wow.

Am I tired.

Here's the short version.

Mags went over the wall last night, but only made it as far as Sparrow's old house next door. I think she may very literally have hopped over the fence where it's shorter, by the air conditioner, and went over to look for Little Maxine (who's been staying overnight with us this week while Sparrow's on night float, but yesterday she stayed with Rene). But she came running right back as soon as I opened the front door to see why she hadn't come back in the dog door.

Crazy mutt. It's a good thing I dye my hair, or she'd be giving me grays.

Today I drove to the coast. Which...may actually have some benefits. Even if it is 300 miles roundtrip. I listened to the first part of the audiobook I downloaded last week, Barack Obama's Dreams of my Father, read by the author. Wow. I was really sad I'd only managed to burn an hour of it to CD before I left. He's only really discussed his life up to age 8 or 9 so far, but the living in the Spice Islands for a good part of his childhood already tops Gov. "I can see Russia from my house." And it's so far just a good story, with some interesting points. Looking forward to the rest of it.

I spent my day out with the Vocational Rehab counselor. We ran all over town and hunted down some people. We had a nice lunch at this Greek-ish place by the river. I gave one lady her Haldol shot. A good time was had by all.

Well, Sparrow just dropped off the little one, and it's been a long ass day. I think we're going to have some ice cream (well, that might just be me) and watch a little TV and fall asleep in the middle of the same episode of House I've been trying to watch for the past three nights...

Wednesday, November 12, 2008

Good news

Peng and Chef got engaged last night!!

He designed the ring. Isn't it gorgeous? I mean, we knew he had good taste, but, he outdid himself here. It's a family diamond, too, from what I understand.

Apparently he cooked her a lovely and lavish three-course meal (which is not an uncommon occurrence in their house), and presented the ring on a plate, as dessert. He then got down on one knee and asked her if he could cook for her for the rest of his life.

(Obviously, she said yes. Because she's a smart monkey.)

That's a good line. It even made the quote board in our office.

Congratulations!! Yay!!!!

Tuesday, November 11, 2008

I hope you kept the reciept...

I had a really long, really obnoxious day. Now, the long part is (partly) my fault - I'm the one that decided it was okay to do these 15-hour+ Tuesdays (although, usually, I at least like to have time to get dinner before class....notsomuch today). The obnoxious, well....

Fortunately, I had the two cutest dogs in existence waiting for me at home.



I watch the two of them, and I've come to decide that Mags and Max tend to act somewhat less like competing pack members and more like young siblings. Partly because pack members don't tend to get jealous and pouty when the pack leader shows attention to other members of the pack. Not favoritism, mind you. There's some significant sibling rivalry going on, here.

I think Maggie is ready to take her little sister back to the store.

Ah, wait, let me show you the time lapse on this one....here's Maggie, who FINALLY calmed down about twenty minutes after I walked in the door (literally. I get out of my car, and I hear rustling leaves, which tends to indicate she's gone dashing into the house to meet me. I walk in...and...no dog. So I say, tentatively, "Maggie?" at about the same time that she comes bursting through the dog door, all like,
"KAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATE!!"
I felt loved).

Here's what happened when Maggie got up to get a drink of water...

They're such characters. I think I mentioned that Maggie got to go over to election night at Sparrow's.

Mags and Maxine both tried to score food off of everyone (there are two extreme cute pictures I can't show you, one of Chef lying on the floor with two dogs all like, "HI!! You're Chef! You smell yummy! You're on the floor! And you smell like bacon! We like you!", and one Maggie with her head resting on Matt's knee while he taunts her with a cupcake). Here, Mike battles the tandem "But... I'm so cute... and so hungry" stares.

And of course, Sparrow got new couches which are supposed to be a dog-free zone (okay, really, a dog-hair-free zone). So Little Maxine got a little new bed. Which Maggie then tried to take over.

Love the "Is this okay? Are you paying attention? Am I going to get in trouble?" look on her face...

::sigh:: It's time for bed, y'all....

Monday, November 10, 2008

Why do we pay these transcriptionists?

So I spent a little time today editing my dictations for the last month or so. ::sigh:: Here's a direct quote from one of them:

"He has had multiple spontaneous pneumothoraces at about age 21, which required multiple tattoos and eventual surgery. "

What I dictated was, "which required multiple chest tubes."

Different.

Multiple tattoos? Really? Did that make any sense??

Sunday, November 09, 2008

God as a psychotherapist

It's been a lovely day.

I slept in a bit this morning, but eventually, I dragged my ass out of the house because the colors were just past their peak and the light was...well, decent. But it was an absolutely beautiful day out. Sunny, in the high fifties/low sixties, a light breeze, just gorgeous. So I wandered over to the county...um...left of us (I still don't have my north and south figured out around here), and shot for a half hour or so.



There's this little community out there called Fearington Village, which is just an adorable, faux-bucolic, peaceful little place. They pride themselves on these white-belted cows, which is somehow their signature.

Oddly enough, they're called "Belties."


Apparently they come in a goat, too.

(I still can't look at a goat without thinking, "cashmere." And then, goat cheese. I still cling to this fantasy of living semi-rurally someday, of maybe having a small coop of chickens and possibly a sheep or an alpaca. This fantasy suddenly has been amended to include a goat. Named Cashmere.)

So then I went to the grocery and came home and chatted with my folks and then went to Starbucks and finally went in to work, where Cleo and Matt and Sparrow and I spent a good deal of time fussing around the new work space/rec room ("relaxation area") for the interns (the administration stole the intern office for clinic space, and we got all cranky and demanded that they give the interns a place to be. And, to their credit, they did. So now we're going about making it all nice and homey. Because, after all, one tends to live at the hospital intern year...).

I stayed because I had work to do, which I got done, but not before I spent an hour in Matt's office talking music and theology. Which is always interesting to me; I always enjoy talking philosophy with thoughtful people.

Matt also invited me to come check out the church he attends, which is a little start-up under the ministry of a friend of his from his seminary days. And he directed me to their website, where you can listen to podcasts of the sermons each week. Which I did, after I got home.

It's interesting.

Religion has always been a difficult thing for me. My faith, however, is not. Which makes the two even harder to reconcile.

I identify myself as an Orthodox Christian, which is in many ways more a cultural issue than anything else. The Greek culture and the Greek Orthodox church are impossible to tease apart. I have some issues with the Church, as I've mentioned before. Mostly, I think, because I've always found a lot of judgment and hypocrisy there. The congregation I grew up in was headed up by one of the most wonderful and pious men I think I'll ever meet, and yet the much of the parish was very see-and-be-seen, judgmental, elitist...hypocritical. The one thing that always constantly amazed me was how people who claimed to be following the Church rule of "You are entering the house of God. Please dress appropriately" (the most relevant piece of this is, women can't wear pants) but would show up on Sunday morning looking like cheap (or not-so-cheap) whores. Who showed up to find a husband or wife, and then, once they'd found one, would show up to show off their undisciplined and poorly behaved children. I love the Liturgy. I love the sounds and smells and splendor of the Liturgy, I love the rich tradition, I love the feeling of being nearer to God. But I can't take the people. I feel like a religion should be about community, inclusion, acceptance.

But then, I think my God is a lot more accepting than some people's.

I think organized religion, by its very nature, encourages exclusion. But I see God as this...very tolerant parent. One who understand our strengths and shortcomings and knows that to learn to walk, we're going to have to fall down a lot. And who just keeps picking us back up, no matter how many times that is. I see God as having created everything in the universe, which to my mind means that nothing can be without merit. I think "sin" is a human interpretation of something of which we can't yet comprehend, because we see things in black and white and a limited palate thereof - God? Sees infinite shades of grey. I think that there is nothing my child could do such that I would stop loving them. How can I expect less of God than I expect of myself? And therefor, I can envision no reason that God would deny us and cast any of us out of heaven. Jews, Pagans, Protestants...Hitler and Hussein and the child molesters of the world...I think we all go on to the same afterlife.

Maybe I'm wrong. I guess we'll find out soon enough.

Anyhow, so Matt's pastor was talking about anxiety last week. Which, apparently, is a sign of non-belief. I'm not so sure I can get behind that idea. Because I think conflict is the very point of our existence. But nonetheless, he was talking about Matthew 6, which I dug up and read, and it struck me that Jesus had some useful ideas on the issue. He brought up the parables of serving two masters (and why that doesn't work), about how God provides for all living things, and how it's useless to worry about distractors.

In Matthew 6:27, he says (this is obviously the NRSV translation), "Can all your worries add a single moment to your life? Of course not." He ends Matthew 6 with verse 34: "Therefore do not worry about tomorrow, for tomorrow will worry about itself. Each day has enough trouble of its own."

Jesus, it seems, was a mentalist.

I like those two passages. They're practical, pragmatic, and wise, without being berating, disparaging, or demoralizing. Much as I conceptualize Jesus.

Matt's pastor did make an interesting point, though - he said, "Our anxiety exposes that which we treasure...Worry exposes our focus." That, for some reason, I find especially salient. Because I do think that sometimes we get so wrapped up in our anxiety that we sometimes forget the significance of what we're even anxious about. What does it mean? What does it indicate? Is it really deflected from some other conflict? Last week in my PECC class we talked about Kernberg's idea that in the borderline personality construct, the affect that arises when conflict occurs is almost always not the real affect - it's the dyad, or relationship, that's employed to defend against the one that's really being threatened. How often do we get swept away worrying about something and don't ever stop to think about why we're worrying about it?

So I wonder why I get so anxious about religion?

Saturday, November 08, 2008

They call her out by her name

(Here's the reference, if you missed it. Love that song.)

So it's 1:30 in the morning and I'm just getting home from a lovely night out. Tyler texted us last night, and so Sparrow and I took their two extra tickets for the Black Crowes show in Raleigh tonight. It was us, Tyler, Mike, and two of their friends.

Wow, it was a great show. They had this group open for them, the Buffalo Killers (or, as I kept referring to them all night, the Buffalo Soldiers, the Buffalo Wings, the Buffalo Chickens...), who was decent enough. But man, the Crowes rocked it out, baby! I was sort of like, eh, okay, whatever when Tyler invited us, but wow. Chris Robinson does this silly little dance that's just way funnier in person. And they just jammed it the hell up, with these awesome guitar riffs and all this sort of call-and-answer guitar work, and dude, the drummer did this like, ten minute solo that just flat-out rocked (the rest of the band's all standin' around, drinking water, handed off their guitars to the roadies, the keyboard guy lit a cigarette and put his feet up...). There was one song that just seemed like it was NEVER GOING TO END, but it eventually evolved from this flowing freestyle guitar work into a different song (like, twenty minutes later. No exaggeration). They played like a two hour set with one encore. It was a "street show" at the Lincoln, so it was an outside stage. We stood around for five and a half hours (my feet are killing me) and drank overpriced beer and got a little clambaked from the incense (or maybe it was from the pot they were burning the incense to cover up). A good time was had by all.

I then got to drive Tyler's friend's big-ass Expedition home (ohh, it was sweet, that thing's a freakin' bus) because I was the sober one. And then we hit a bar downtown CH, and went to this fabulous burger place, and by then, all of us oldsters were ready to pack it in. It was a heck of a fun night, though. And Maggie gave me a good nasal frisking when I walked back in the door (I mean. really. I smelled like pot, Little Maxine, and hamburgers. She must think I had the most interesting night, ever).

And with that, y'all...it is way past my bedtime...