Tuesday, September 29, 2009

Slipping

What a long day.

I meant to go to bed at 8 last night. I tried to go to bed at 8 last night. Things kept happening, the phone kept ringing, and I got to sleep around 1am. I then promptly woke up at 4 with a completely evil migraine. And subsequently cancelled with my trainer so that I did not vomit on her shoes at 5:30am.

But, I got my ass to work. The pain had more or less subsided (after a handful of Motrin), but I was still having weird visual things and was right queasy. It was a rough day. Crazy people, lots of yelling. One of my clinic patients needed to be admitted. I still made it out roughly at 5(ish) and got a bit of reading done before my class tonight.

Class, however, was late, but very enjoyable. It's on Freud, right, and Freud's models of the mind. Tonight's topic was his three lectures on parapraxis - more commonly known now as "Freudian slips." We had a good academic discussion, but we also had a good bit of storytelling and anecdotal humor. Not the least of which was this:

Monday, September 28, 2009

Rainy night

Mags and I are listening to one heck of a fall storm. I really do love a good thunderstorm. Maggie? Notsomuch.

Today was really long. I didn't sleep well (so what else is new?). My 7am therapy patient forgot we had a session. It was a long day on the unit. I had a migraine and a family meeting with lots of yelling.

But I also got to see the end of a Bones on TNT tonight that I'd apparently missed; where Zach tells Sweets that he didn't actually kill anyone. How did I miss that? That seems important...

My head still hurts.

Sunday, September 27, 2009

Bittersweet day

So, it's a day of good things, and one particularly sad thing.

First, the good. Today is both Claudia's birthday AND Annie's birthday.

Claudia, I'm reasonably certain is 29 (still).

Happy birthday to you both. Love you both, miss you both. Hope it was a great day.

In less happy news, my friend's 15 year-old completely awesome black Lab died. Barney was a good friend. He purred - no kidding! It was the darnedest little noise he'd make when you scratched his belly. And you could not leave a glass of beer unattended long, and especially not on the coffee table. Love you, too, Barnes. Have fun chasing squirrels in heaven.

Saturday, September 26, 2009

Not at all painless

I still just don't even know what to say.

Tuesday night, someone I care about very much tried very hard to take her own life.

Except, here's the thing - "she" didn't...my cousin, whom I love so very much, struggles with something called Dissociative Identity Disorder, or DID. It used to be called Multiple Personality Disorder. Very, very bad things happened to her when she was in her most formative early years. When significantly traumatic things happen during the development of one's personality, if the predisposition is there (and we're not really sure what that is), the personality structure can fracture. It's a complicated and confusing situation, and more than it's worth getting into here. But the thing is, while a few decades ago this was the diagnosis du jour, it's now one of the most hotly contested diagnoses in psychiatry.

I feel like people often try to diminish things they don't understand. Even the people who have this don't understand it. But bigotry and bias, as always, will not make it better.

I'm not going to argue the validity of the diagnosis. I think it's ridiculous that we even have controversy like this in a scientific pursuit. The "because it's weird and I don't get it" defense doesn't hold up, folks. And anyone who doubts the existence of this disorder needs to spend a couple of days with my cousin, or my ex, or my good friend in Florida. Herschel Walker, football great and Heisman Trophy winner, recently wrote a book about his struggle with DID. It's out there, folks. And no, it's not a "convenient excuse" that allows you to disavow responsibility for your actions ("It's not my fault, my alter did it"). Yes, it can be malingered for some sort of secondary gain, but so can every other psychiatric illness, or for that matter, most medical ones (factitious disorder, anyone?).

Imagine for a moment that you wake up tomorrow morning, and walk into the kitchen, and pour your coffee as usual. And on the counter you find a bag full of things you don't remember buying. Maybe they're clothes that are so totally not your style, or expensive electronic gizmos you really can't afford. You wonder who bought them, and look at the receipt, and the name on the credit card is yours. Except the signature doesn't look quite right. Imagine how confusing that would be. Did someone steal your card, break in, and leave the stuff there? Maybe one of your family members bought it with your card? You look at the time on the receipt and try to remember where you were at that time yesterday, and...strangely...for the life of you, you can't. And you wonder why this keeps happening...

Now imagine what you find is cocaine. Or cuts and bruises all over your body. Or you wake up in jail. Or in the ICU.

Imagine you wake up safe in your own bed with overwhelming feelings of guilt, shame, depression, worthlessness, and have no idea what you've done. Imagine people coming up to you on the street and seeming to know you, including details of your life, except you have no idea who they are and they're calling you by a different name. Imagine losing big chunks of time, finding yourself in places you don't remember getting to, or hearing voices running commentary on your life while you're trying to live it. Imagine feeling like the only way to end the chaos was suicide. Imagine not thinking that and waking up in a puddle of blood or with a tube down your throat.

Not every case is this extreme, or dramatic, of course; these disorders all exist on a continuum, like depression, or schizophrenia, or anything else. People with DID (or any disorder on the dissociative spectrum) can be very ill and still remarkably high-functioning. Remember that the whole point of the disorder is survival. It's a very primitive but powerful form of adaptation.

I gave a lecture on DID last year to the interns, and the take-home point I tried to make to them was this: the real myth is that we have one cohesive, integrated personality. Think about it; you're constantly altering what parts of yourself are most prominent. I think of myself as generally consistent within the circles of people who know me, but at work, I'm more reserved and professional. I don't drink at work, of course. I don't wear my pajamas. Even the difference in closing our office door reveals a much more sarcastic, silly, sassy version of me than my patients will ever see, but if you ask those same patients about my personality, many of them would cite sarcastic and sassy. Some of them wouldn't - some of them see the more overtly maternal traits that I have, and think of me as soft and supportive and positive. Some of them would call me a hard-ass bitch. None of the above things are not who I am, all the time. They're just not always who I am in the moment.

DID is an extension of this process, as I conceptualize it. Most personality-related pathology is just an exaggeration of normal traits, right? We all have our moments when we're particularly narcissistic, or borderline, or avoidant, especially in times of crisis when our defenses are strained. When it becomes the defining aspect of our interactions, when it severely impacts our ability to function in a healthy way, psychiatry calls this a personality disorder. DID is no different - it's an exaggerated expression of a normal structural phenomena, in response to an event or series of events that exceed the capacity of the existing defenses to protect the psyche from painful or destructive emotions.

And, in case you were curious, the above is a lovely example of the defense mechanism of "intellectualization."

My own painful and destructive emotions? Too numerous to count in this instance. The dominant one is, I'm so terrified for her.

The other point of this post? Again, I hearken back to suicide. It's never just you that you're trying to kill. Even though my cousin survived, and is expected to be medically fine, and is finally in a safe place (finally....well, that's another story for another day), a little bit of all of us who love her died on Wednesday. It sounds overdramatic, but it really isn't; any sensitive person who's been in this situation can tell you.

But, we all do what we can, you know? We try to help, we mobilize the resources we have, both internal and external. We hope that someday we can look down at the well-healed scar and appreciate it as a memory of damage overcome. We try to learn what we can and move forward. I deal with suicide every day at work, and know this provides me an invaluable perspective. I know it strengthens my own resolve not to ever go down that path, regardless of how bad my own internal chaos might get. I know it makes me all the more grateful for the time and interactions and moments I have with people interspersed within the minutia of my life. It fuels my academic interest and professional development. And it makes me hope that I never, ever, ever have to deal with a similar experience again.

Friday, September 25, 2009

Diatribe, interrupted.

Thanks for all the support, y'all. I was going to divert some mental energy to composing a post about all this today, but the day tried to kill me a little. I left the hospital about 13 hours after I got there, ran home to let the pup out (the dog walker makes a point of not being gone on holidays, but this means he takes his "holidays" at other random times during the year, so he's gone this weekend), and then backtracked about halfway to have dinner with Ruthie. Which was lovely and restorative and a very nice diversion. And now it's 11:30 and I'm ridiculously tired and I have a large mountain of clinic notes and discharge summaries to occupy my tomorrow, so, I think I'm going to go to bed. Will post actual explanation tomorrow and not loser-y "sorry, I have to go to bed now" post.

But...well........sorry, I have to go to bed now....

Thursday, September 24, 2009

Defenses.

Yeah, there's something going on. I'm fine, my folks are fine, Maggie's fine. I spent a long time tonight trying to compose a post, but I'm just so confused about the whole thing that I can't quite put it into words.

It's one of those occasions in which something is so unreal that I don't really know what to do with it. I keep saying, yeah, yeah, I'm fine, because, well, I am, but mostly because, there just aren't words. I keep trying not to tell people, because that's what I do, I just go on quietly when my life is falling apart. Actually, a number of bad things have happened to the people around me lately, and it's definitely taken its toll on me, but only a few close people know anything about it. I'm always "fine."

Truth is, I'm not sure I know how to let myself be not fine.

I got into a little tiff with Scott this morning. I walked in, ridiculously early, as always, and was bantering with him and Sonia for a while (they were the overnight call team). And we were talking about this patient we all know a little better than we'd like to, and he makes this sarcastic comment about a subject which is sort of a running thing between us. It was standard fare; we've debated this rather jocularly on multiple occasions. Unfortunately, this just happens to be the topic related to the recent badness in my life.

So today there was no joking or debating. Today there was me, sniping, which wasn't fair. He didn't know that today was not the day to confront that. But instead of "Not now, man," what came out was, "Oh, you can fucking bite me."

He dropped it, we moved on, things lightened. And I felt bad about this all day. So I texted him before I left work and was like, I'm sorry. Here's why I snapped at you this morning. In truth, it was maybe 10% of the reason I actually snapped at him, but that was the best explanation I could give. He was like, I didn't even think of it as a snap. Figured you were tired. Really sorry I went there, and about what happened.

My first thought about that was, great, I love that I'm even blowing this out of proportion, that I (as always) made the assumption it was as bad outside my head as it was inside, but apparently I can't even let that kind of stuff show very much. My second thought was, God, I so incredibly HATE that I told him. That I let him see even that tiny crack of vulnerable and crazy. Hate hate hate.

But, it is what it is. And what it is, is that I'm way too defended.

I know this about myself. I know why it's there, and I'm not sure how to make it not so.

So tomorrow, when I don't have to be up at 5am after another night of tossing and turning, I'll have more to say about this. Meanwhile, I have some unsettling dreams waiting for me...but that's pretty much the same as every night.

Tuesday, September 22, 2009

"Why do you think people would treat you worse if they knew the truth?"

I'm watching last night's episode of House.

(Don't worry, no spoilers.)

He's in the psych ward. Several of my patients today were really upset about this episode, and I'm trying to figure out why. My conclusion thusfar (I'm maybe halfway through) is that it's just the State Psych Hospital feel of the set. Which...I have a lot of trouble believing someone like House would be in a place like this. But, okay.

I really like the lead psychiatrist (or at least, I did until the boundary crossing). I identify with him, I'm not sure why. I wonder what it says about me (I'm kind of wondering why it's not House I identify with). Maybe it's the stubborn. Or the interpretations. I've had a lot of patient visits and family meetings over the past few days in which I've spent a lot of time being way more directive and interpretive than I normally tend to be. So far, it's worked out, although there's one case I'm a wee bit worried about.

Okay, that's not true. I'm worried about most of them. It's what I do.

I dunno, y'all. I'm tired. And my stomach hurts. And I don't feel so good in general. I'm unsettled, and I'm pensive, and...I...yeah, I dunno....

So, episode over, and my opinion of it is overall positive. Although I think the catatonia girl storyline was pushing dramatic license a bit.

And, there was one line in there (not the title line, which I also like) that I think very eloquently sums up my own ideas about therapy:

"You've got to make things better, you can't just keep talking and hope for the best."

Funny how many people don't get that.

Monday, September 21, 2009

Monday amusement

Here, check this out.

Read. Laugh. Enjoy. Meanwhile, I'm going to bed. Nothing like a 13 hour workday to kick off the week.

Sunday, September 20, 2009

How did the week go so slowly...

...and the weekend so fast?

Hmm.

Today was not as productive as I'd hoped, but wicked enjoyable. I went to the 'Bucks this morning and spent like three hours writing a ridiculously long letter for a patient of mine. I grabbed some lunch, and then I met up with my aunt and uncle for the Local Farm Tour. We only made it to two farms, actually, but they were pretty awesome. The first one had goats and sheep and ducks (ducks that eat fire ants, how cool is that?). I ate some goat cheese, picked up a lovely bar of goat's milk soap, and - of course, the real prize for me - procured four ounces of very pretty white Border Leicester roving. We also bought some yarn from her sheep for my cousin, who's a relatively new knitter. Seriously awesome yarn. One of the farm folks was knitting a thick wool sweater out of it, and wow, was it gorgeous.

On #6 straights. I was like, seriously? Who knits a sweater on straight needles anymore? But I digress.

The second farm we went to was just so beautiful. Unlike the first farm, which was still sort of being restored, the second was like four generations deep. It was so lovely. They had sheep and goats and a pair of llamas. They also had two really gorgeous horses and all these hilarious chickens. And, Guinea....um....are those chickens? Guinea fowl. They were hysterical. And apparently really like to eat ticks. Way to go, Guineas. There's also a lovely patch of gardens which grow things including cotton, which becomes more relevant in a minute.

On that farm, the woman had this whole building where she spins and weaves. The building itself was made from trees that were uprooted during hurricane Fran. It's a gorgeous little studio, and she has this antique wheel that's like taller than me. She also has a Schacht that's much more functional. I bought another half pound of roving from her - four ounces of something brown and soft that I don't remember what kind of sheep it came from (something that started with a T, I think), and four ounces of this unbelievably awesome Cotswold roving. It's pin drafted, so all you really need to do is just fire up the wheel (were that I had one...soon, soon. This lady also gave me some good ideas about where to find used wheels). And it's just totally...I'm so in love. I need to get me some Cotswold sheep some day.

I also really like Cotswold cheddar. Maybe what I need to do is just move to Cotswold. It sounds like a magical land...

We were going to go to a local vineyard as well, but spent way too much time talking to the spinner lady (and, really, North Carolina wines....), so we diverted and just went back to their house and made pizza. And I took my drop spindle over to illustrate what I'd been babbling about on the farm, and gave my uncle a brief lesson in spinning on the drop spindle. He did really well with it, actually (he's an engineer, and gets the physics of all of this). We had a very good time, as we always do.

Today definitely fueled my little pipe dream of being farm people. I come from farm stock, after all (I got very nostalgic today, as the second farm smelled a lot like my great-aunt's). I frequently have this bucolic little fantasy about living out in the country with my alpacas and a few sheep and a couple of goats. Not as any real sort of means of self-sustenance, but I imagine we'd make a little extra money from the alpacas and whatnot. And chickens. I'd also like a little coop of laying hens. And maybe a cow. And a husband who really liked to garden, and we could grow all of our own produce and maybe we could trade stuff with our little farmer neighbors (maybe I'd let them have the cow) and grow berries and have those freakin' hilarious little Guineas running around. And dogs. We'd need a couple of really huge dogs and then a couple of indoor mutts. And definitely some cats in the barn (although, no cats in the house). Ooh, and a horse. A really nice old mare that I could ride around the farm on. I don't think it would have to be that big; maybe 15 or 20 acres would more than suit us just fine.

And then I remember that this little agrarian utopia conflicts with my pipe dream of living on the beach. And also that there aren't a lot of Starbucks near farmland.

Meanwhile, I stayed out way too late on a school night. And, I still smell like farm.

Saturday, September 19, 2009

How is half my weekend gone?

I wanted to be in bed over an hour ago. ::sigh::...

I slept in this morning (until 8). Went to Starbucks and did some work. Spent an hour there before I actually DID any work. Stopped for lunch, came home, and sorted through the nearly 800 photos that I took last weekend. Copied, sorted, filed, uploaded, annotated. I was pleased. Then Peng and I went to wine tasting (always a good time) and had dinner at this new Italian place which was overwhelmingly mediocre. Home, a bit of futzing....and a lot of wondering where the heck today went.....so how is it 11 pm?

Could I have a bit more weekend, please?

Friday, September 18, 2009

Friday!

We made it.

I'm not yet sure what the weekend looks like, because I'm just too tired to even try to plan for tomorrow. I have things I need to do, things I want to do...and mostly, I just need sleep.

It's been a long week.

Today, though, I spent two hours trying to teach my peripartum patients to knit. Either I've lost my touch or the crappy plastic circular needles the OT gave me to teach them with sucked. But we had fun. And then my one patient (who's just doing so much better)'s kids came and we had fun with them. I really like having kids and babies on the unit.

I have one more week as the peripartum resident. I'm going to miss it.

Thursday, September 17, 2009

Is it Friday yet?

So I didn't leave the hospital until 7:30 tonight. I got there at 6:30 this morning. It was a long ass day. So long in fact that this afternoon I was talking to my boss about an email I'd sent her when I got up this morning and referred to it as "that email I sent you last night."

I'm in dire need of a weekend.

And a good night's sleep, since I have to meet my trainer in the morning at quarter past dark.

Did I mention that it was a long-ass day?

Tuesday, September 15, 2009

Fatigue

It was such a long day. Crazy, lots of running around, lots of fighting with the neurology service, of all things. Actually made it out right around 5 and had a little time to do most of the reading for my class tonight. Class was a lot of fun; good discussions, rousing debate, wonderful collegiality, and a little bonus girl talk with Mikhela afterwards. My trainer kicked my ass this morning. My sunburn is blistering, and Peng has been kind enough to help me keep my back slathered in this fancy yogurt after-sun lotion that is essentially tzatziki sauce in a Korres bottle.

But I'm still not quite caught up with my sleep from the weekend. And I was sleep deprived before that. So, in the absence of any significant or substantive posting, I will instead give you another gratuitous beach photo. This one is from sunrise on Sunday.

Tomorrow's Wordless Wednesday? My very favorite picture of the whole set.

G'night.

Monday, September 14, 2009

Coolness

Check this out:

"Unashamed" music video

My cousin's band made a video.

It's a good song, although not especially one of my favorites. The video is clearly low-budget and fairly unimaginative. But, still, really pretty cool.

My cousin is the bassist.

They really do rock.

Sunday, September 13, 2009

Spent

So we're home. We had an AWESOME weekend. Julius and Scott and I got there midafternoon on Friday, had a very amusing grocery shopping trip (Scott was postcall and had been awake like 34 hours at that point. Scott is usually pretty loose and sarcastic, so you take away what filter he has...), at the end of which we found Faye.

The house was amazing. 5 bedrooms, the master suite of which had a bathroom big enough to be another bedroom. Two queens, two rooms with 4 bunkbeds each. I got one of the queen rooms, not that I slept much (the mattresses, incidentally? Not awesome). It had a nice living area, a big kitchen (with ridiculously dull knives), a table that most of us could fit around at the same time, a little breakfast bar at the island for those that couldn't. Two decks, oceanfront, beach access, totally stellar views. I took 760 pictures, most of which were of sand or waves or birds or some such nonsense (I got some totally great shots, though). Fortunately, Mike often had my camera when it was out of my hands, and he got some good shots of people.

Friday night everyone started to trickle in between 7 and midnight, and it was nice to watch the progression as people kind of came together. Julius, Scott, Mary and I took a beach walk around 11, which was totally gorgeous. I got bitten by a crab (and still have the mark to prove it - he got me good!), which was mostly amusing. Apparently it was a big drunkapalooza after I went to bed at 2, though. The boys went through a bottle of tequila and like three cases of beer (I kept finding empties the next morning as I was cleaning up, like, are you kidding me?). Which explains why I ended up poking my head upstairs at 4am to tell my dear loved ones to shut the fuck up.

Yesterday I woke up at 5, watched the sunrise (of which I took a crapton of pictures until my damn battery died right before the actual sun came up over the horizon), and spent like three hours on the beach before I went back and woke Mike up, who was sleeping on the couch (I can respect not waking him at 5, but by 8am, if you're sleeping in the common area, it's fair game). Gradually the rest of the crew trickled up, we made breakfast, hung out for a bit, and then spent more or less the rest of the day on the beach. We bodysurfed, we laid out, we swam, we walked and walked. Scott has apparently been trying to get into kiteboarding, the first part of which is learning how to use the kite, so he brought it along and we all made lots of disastrous flights with it. The boys (and Faye, who incidentally throws like a girl) tossed a football around for a while. Peng and I beachcombed a bit (okay, she beachcombed, I went along and was neurotic).

Tyler and Scott rented surfboards and these paddleboard things, which you stand on what looks like a large surfboard and paddle around with these very long, thankfully buoyant paddles. I took lots of pictures of them falling off the paddleboard things. I went out for a while and was trying to get a shot of both of them standing up at the same time, but, um, that just wasn't happening. It was actually pretty amusing to watch - Tyler would get up and wobble for a minute before falling, but Scott would be straight upright and looking like he was totally fine and then just suddenly be in the water. So I got bored (not board! Ah, I crack me up...) and started shooting more environmentals. There's a bunch of really great houses around where we were which produced some great photographs (and also some crappy ones. Part of the 800+ photos I actually shot - I deleted a bunch - was about learning how to actually use the new dSLR like a real camera, not like a very overpriced snapshot camera). I chased this bird around a sand dune for a while. And then I looked over and there they both were, standing up, paddling along. I actually managed to catch the moment on film before they both promptly fell off again.

I also spent a good 45 minutes that evening upside down on a sand dune. It seemed like a darn good place to do a yoga inversion, so I plopped myself down into a good pose, listened to the waves, watched the horizon, watched the clouds, and was finally laying there just sort of breathing and listening and being still when I suddenly found Scott and Tyler standing over me, back in from surfing, being very amused that I was upside down. I convinced Tyler to join me for a few minutes, but he doesn't get the "still, quiet" piece of it very well and so we chatted for a while and then wandered back up to the house, completely coated in sand. It was amusing.

Mike made his famous Low Country Boil last night (shrimp and sausage and scallops and corn and...I don't remember, other things, all thrown in a pot and boiled), which always goes over well and when combined with some scrambled eggs made excellent leftovers for breakfast. I, of course, don't eat seafood, but we had enough leftover whatever that I did just fine. I also made Painkillers, which are a rum-based drink I learned from my Aunt and Uncle, and are also apparently the national drink of the Dominican Republic. They were very tasty, and I now believe are best ingested on the deck with a cool ocean breeze and a brewing storm.

I was also not feeling super well at this point, because by then I'd developed what's turned out to be the single most painful sunburn I've ever had in my life. It's predominantly on my back, and does not pair well either with long hair or wearing of a bra. So I was cranky, and decided another evening beach walk would maybe fix some of the cranky (and not make me crabby again. Ha! I'm just so punny...). Meanwhile, Scott had wandered off down the beach several hours previous, and didn't take his cell phone, and although he's totally the type of person who would just wander off, go farther than he'd intended, and find his way back eventually, he's also not above falling and breaking his leg, getting mugged, or perhaps being attacked by a giant octopus or something (they have those at the beach, right?). So the general consensus was that I'd point my own walk in the general direction of his last known location and if I happened to stumble across his cold, limp body, would alert someone to that.

As it was, we somehow passed each other in the dark and Peng called me when I was less than a half mile away to say he'd turned up (tangentially - because THAT's unusual for me - he was the second member of our party we'd lost that day. Mike went off for a run or a bike ride or a something earlier in the day and was gone for like 6 hours, and was of course not checking his cell phone. But he eventually came home, too). So I continued to wander along the beach a little longer, until it suddenly occurred to me....wait...I'm a woman, alone on a beach, at night, having gone out (in part) to look for a friend who'd been out, on a beach, alone, at night, and disappeared....I've seen this slasher movie...

So I turned around and headed back to the house. We watched "Old School," which I'd never seen in its entirety (funny), and SNL, and made microwave S'mores (because we'd also discovered at lunch that we had charcoal but no actual grill). I finished another baby blanket square. Peng crocheted on her afghan. There was...I hate to admit this....beer pong (Tyler had texted me Friday to ask if there was a table big enough for beer pong. I said, "No. We're grown ups." I got vetoed. And on top of that, Faye and I lost to Mike and Tyler). We all went to bed earlier (and some of them significantly more sober) than the night before. It was nice.

This morning I got up and shot the sunrise for real, which was obliging and completely awesome. I was back in the house dozing in a comfy chair when Tony got up, and we chatted for a while before we gave up and started making noise and coffee. We had the latter brewed and the kitchen mostly cleaned when the rest of the house started trickling upward. Tony and Mike pulled out a little "ghetto breakfast" (we made do with what leftovers we had, and had things like hamburger buns as toast). Tony and Scott got a little more surfing in, Julius wandered around on the beach a bit longer, Mary and Cleo caught a wee bit more sun. I avoided the sun like the damn plague and Peng rubbed cocoa butter on my back while I swore at the numbers for the weekend and could not make the accounting add up. But we all pulled it together, and left by the time we were supposed to be out, and did all the stuff we were supposed to have done, and the boys and I made great time (as in, two hours, which is almost an hour less that it's supposed to take. Which is not because I was speeding, but apparently my GPS actually DOES know where it's going on occasion). We were all pretty worn out and had far less spirited discussions on the way back (Scott and I have a tendency to debate almost anything pretty hard).

It was a really good weekend.

So that's sort of the journalistic report of Beach Weekend. I have a lot of more interpretive things to say, but I also really need to go to bed, so I'll save them. The moral of the story, though, is that we had a hell of a good time. I really like my friends. And I totally love the beach. This was such a fun time, and as those things often are, it was both completely exhausting and tremendously restorative. What else can you ask for?

Saturday, September 12, 2009

Oops.

I didn't actually manage to get a post up for Saturday. Partly because a bunch of people were using my computer. Partly because we were having a LOT of fun. Partly because I was getting the single most painful sunburn of my entire damn life.

Part II tomorrow.

(PS - Sunburn? Ouch. But totally worth it.)

Thursday, September 10, 2009

Packing


It's what I'm doing.

Beach tomorrow!!! Beach! Beach! Beach!! We finally reserved a house. It's going to be a little more expensive than the one I'd initially planned on, but it's a lot nicer as well. And still not exorbitant.

I am feeling a wee bit guilty, because I was going to take Maggie with, and now am leaving her at home. But the dog sitter will spoil her rotten, so...still. She would've enjoyed it. And I'm going to miss her.

Scott and Julius and I are hitting the road midday tomorrow, which means I have to be at work super early to make sure I'm done by noon with absolutely anything that needs doing (we're planning to leave at 1, so I'm aiming for noon). Peng is a goddess and said she'd cover anything that had to be done in the hospital (i.e., orders written), since she has late afternoon patients and has to be there anyway. So the boys and I will get to the coast, get to the house, get things settled, and most of the rest of the crew will come after work.

It's going to be lovely.

Beach! Beach! Beach!

Tuesday, September 08, 2009

Oyyyy.....

So, four people, maybe 5, have now backed out of our beach trip this weekend, leaving us at potentially 12-13. Which means it's going to be somewhat more expensive, since, after all, we're paying for it ourselves this time. I have yet to determine how much more, though, because, of course, we still haven't picked a house.

I'm completely amazed at how many people involved have said something along the lines of, "you should just not even go." Seriously? First of all, it's like you people don't even know me. Finding solutions at the last minute is one of the things I do best. And beyond that, there's still 12 or 13 people going. Why shouldn't we still go and have fun? I'm just sayin'.

Scott's pissed. I? Am strangely less worried.

Wow, I wish that made sense...

It was really the icing on a very long, very stressful day. I can't even begin to tell you....

Monday, September 07, 2009

Still life

(Hardly.)

I do love a good holiday weekend. I got next to nothing of what I actually wanted to accomplish accomplished, save for like nine hours worth of clinic notes and discharge summaries (I still have one left of each, plus like eighty three bajillion therapy notes, but those are quick, because they say nothing). And I bought new pants and a vacuum cleaner, but the latter is still in my car (I bought it this afternoon). I unpacked exactly one box, although I did rearrange the furniture in my bedroom into a fashion I think will actually be better.

So, the to-do list may not be much shorter, but really, looking back at the weekend, I actually did get quite a bit accomplished.

Not the least of which was having a very lovely time with friends and family. Saturday night Peng and I went to wine tasting, and then I skipped over to Cleo's, where I met a very fabulous friend of hers from the Chi and we all ate way too much pork (Mike had cooked literally half a pig. There were 10 of us. Needless to say, lots of leftovers). And then tonight I went over to my aunt and uncle's, where we made Margherita pizza from scratch and my aunt and I finally fixed the hem on my pants (for no apparent reason, the hem on the right leg of all of my pants keeps falling out. I do not know what this is about. I'm thinking my left hip must be higher than my right or something....). I also finished square #1 (of 16) of the four baby blankets I have to knit in the next 20 weeks (why are they all due at the same time?!?!!).

In a few short hours it'll be back to the grindstone, but at least it's a short week. And then there's beach this weekend!! I'm so excited I can hardly stand it. I think I mentioned that we're recreating our intern retreat, except this time we have to pay for it ourselves and we're taking the second years with us. And also one of the fourth years, and a couple of other people we like. Scott, who's the other half of the Planning Committee, is being extraordinarily male about the whole thing and driving me absolutely crazy (I recognize, that's a short trip), particularly in that we're leaving Friday and we still haven't settled on what house we're going to rent. I picked one, he suddenly developed an opinion, he may have then finagled us a whole better deal, but we're not sure yet...I totally heart Scott, and we generally work very well together, but he's kinda making me nuts, here. And honestly? I'm not entirely sure why. We're going to have a place; if his falls through, mine won't. So I don't know why I'm so worked up about this. Because either way, it's the BEACH. Beach! Beach! Beach!!

Have I mentioned how excited I am about the beach?

Sunday, September 06, 2009

Lazy Sunday

In response to the question apparently raised by yesterday's post, no, I don't have anyone specific in mind with that reference. It resonated, though, for reasons I'm not sure I can verbalize, except to say that I've always felt like we have a path in life. That we're given the challenges we are, put in the situations we are, encounter the people we do, for reasons beyond our understanding. Our job, then, is to learn what we can from each one, take whatever data we can gather from each interaction, observe and synthesize that information into what informs us as we move through the rest of our lives.

It's not an uncommon philosophy. It's fairly fatalist, I suppose. But, it's the way I make sense of my life, you know?

Today was a relatively low-key, minimally productive kind of day. I went to the Starbucks, got some actual work done. Then I went to the gym, where I spent a little too long, I think (but, there was an SVU marathon on and the episode wasn't over, so I just kind of kept going on the treadmill.....), after which I came home for a little puppy lovin'. Little Maxine was visiting us overnight, and I got such a good double dose of snuggles, that I put my head down...you know, just for a moment...I didn't actually get any real restorative sleep, but it was good for the soul. But I finally got myself motivated enough to get up and get in the shower, with lofty goals of taking Little Maxine back to Sparrow's, then going to Ulta (I need sunscreen and hair dye), Lane Bryant (I need pants), and Target (I need stuff. Not the least of which is groceries). And I feel like there was somewhere else I was going to go, too. But then I get out of the shower and find my dog happily devouring the end of my bottle of melatonin.

I thought...hmm...

So I Googled, and it seemed to be fine. And, just to be sure, I called the vet. Who couldn't really say definitively, so they gave me two phone numbers to call. One turned out to be Carolina Poison Control, whom I talk to not infrequently and was most certainly NOT going to call and be all "so, about my dog..." The other one was the ASPCA poison control line, which seemed appropriate. And, apparently, charges $60 per consultation. Which...you know what? Fine. It was worth the peace of mind to hear that it would probably just make her sleepy.

Which...well....duh.

So, I aborted the errands mission to keep an eye on the pooch. Rene came and picked up the small one, and I got to meet the future Mr. Rene, who was very nice. And then I spent a few hours scouring over the photography books I bought a couple of weeks ago, one of which is specifically about my camera. I took some pictures on the various settings, and made some notes, and then flipped through the other one, which is "for teens, by teens." I'm thinking the teens had some help, because it was the most useful and accessible book I found when I was sitting on the floor at the Border's sifting through every book I saw that looked mildly useful in the photography section. And had the best pictures. Which is kind of the point, isn't it?

I didn't take anything super exciting (I pointed and shot at whatever was sitting next to me on the bed), but I got a couple that were kind of cool. One was of yarn.

But for the shots in which I was fiddling with the shutter speed, yarn just wouldn't cut it. Fortunately, I had a willing subject....

Saturday, September 05, 2009

Friday, September 04, 2009

Mufasa and Darth Vader agree...

Since it is, of course, National Suicide Prevention month, I thought I'd share this great new PSA by James Earl Jones, supporting Hopeline, as well as two other organizations I love, PostSecret and To Write Love On Her Arms.



We've spent the past week on the unit talking in the groups I run about secrets, and the way secrets will fester and become shameful and toxic when, had you just let the information see the light of day in the first place, it would've been just fine. Secrets become like monsters in the closet; when you turn on the light, you realize it's only the vacuum cleaner. Privacy is one thing; but secrets destroy.

Start talking, people. Everyone thinks they're the only one, but they're not. If we talked openly about things like depression, self-injury, sexual abuse and assault, and suicide, if we splayed them out to the light of day, we'd probably end up with a lot less to talk about in the long run.

Thursday, September 03, 2009

Love Thursday

I haven't done a good Love Thursday post in a long while, so, I thought maybe tonight I'd do 10 things I love...in no particular order whatsoever.

1. My job. No, really, despite the long-ass hours (left at 7pm tonight. Awesome), the endless paperwork, and the emotional tumult, I love what I do. I love that I get to do it. And I love where I do it. There's always room for improvement, obviously, but I'm really glad I'm where I am.

2. Babies. There's a sudden abundance of them. And somehow, the ones who require blankets are ALL due in about 20 weeks. I'm not sure I have the time to knit four blankets between now and then...

3. Babies on the unit. This is quite possibly my favorite part of being the peripartum resident.

4. And since we're on baby-related topics, I miss obstetrics, and endoscopic surgery, and I think I'll always mourn the loss of the nice little life plan I had mapped out, but in truth? I love that I left OB/G. For so many reasons, not the least of which is that I finally stood the hell up for myself.

5. I totally love that I don't have to fight like that anymore for my very survival.

6. I love my dog. So much. I know this sort of goes without saying, but I was talking to my friend Paulie today about her, and the story of how I got her and whatnot, and I was just sitting there thinking, wow, I'm just really so blessed to have her as my furry little sidekick.

7. The beach. I really, really, really love the beach. And we're going next weekend!! I'm starting to get really excited about this trip (even if the planning committee still can't quite get its shit together). There's going to be about 17 of us, I think. 13 doctors, two spouses (well, one spouse, one spouse-ish), one pharmacist, and a Tyler. Friday night to Sunday. I just hope the weather cooperates...although, honestly? I'm not sure I even care. Rain at the beach is still at the beach.

8. Something that's brewing that I can't quite tell you about yet. Not sure it really qualifies as "love" as much as "scared shitless," but, I love that I'm even entertaining the idea of it. Not to be cryptic or anything.

9. I love that you people still read this drivel I write.

10. I so totally love that there's a three day weekend in my immediate future. It may well be filled with unpacking and note writing and cleaning and gym time (and SLEEP!), but, that sounds like a good three days to me.

Tuesday, September 01, 2009

May we all see many more.

Welcome to September.

In case you weren't aware (as I wasn't, until recently), September is National Suicide Prevention Awareness Month.

I've talked on here several times about suicide, and the devastating effects it has on families, friends, and society at large. Because it really does. No matter how inconsequential you think you are, someone is going to know that you're gone. Someone is going to miss you. Someone is going to wish with all their heart that you hadn't taken your own life.

Suicide is an everyday thing in my job. Now, actual completed suicides are fairly rare, as the statistics go, but every last one of us knows a patient who's died by their own hand. And it touches us all. I wish people could see how the sadness ripples through our department when this happens. But every single day, we deal with people (usually multiple people) who express some wish to take their own life.

On my inpatient service right now is probably the single most suicidal patient I've ever worked with who hasn't actually killed themselves. And what we're holding on to right now is that ambivalence she has, that there is a part of her that desperately wants to live. I've really learned so much from her. We were talking one day about how she views her life and herself, and I sat back, and made this interpretation: I said to her, it seems to me that you're coming to the table with all of these messages that you're useless and worthless and horrible, gathered from childhood experiences and projections of other people's pathology. And then, now, you're in this situation you desperately don't want to be in, but you don't see a way to change it. It's like you're standing in a corner and see no other way to go. She nodded, suddenly awash with tears. I thought about this for a minute and said, "I can see why you want to kill yourself."

This caught her a little off guard. Which, honestly, it shouldn't, because how many times had we made lists of ways to cope with a situation, and I always told her "Well, cutting or killing yourself is a way to deal with it, we'll put it on the list. And then let's come up with some better ways." But that always catches her a little off guard, too, it seems. So I say this, and she looks up at me, and I shrugged. I said, I get it. You genuinely feel like there is just nowhere to go from here. The only thing you can control in this churning sea of misery is whether you live or die. So why wouldn't you cling to that like a life preserver?

The thing is, I told her, that there are other ways to go that you just can't see, because you're facing that corner. My goal for you is to get you to turn around, see the rest of the room. Look at what's here, because you have a lot to work with. She argued that last statement with me, because she, of course, thinks she brings nothing to the table. But I'm awfully stubborn, and kept insisting she's got a lot of potential.

I actually discharged her a bit ago. I knew she wasn't safe, I felt it in every cell of my body. But she insisted that she felt safe, and wasn't thinking those thoughts anymore. She made it 36 hours, and then downed a bottle of sleeping pills. I saw her in the ER afterwards. I walked into her room, and she looks at me and started to cry and said, "I lied." And all I could say was, "I know." Later I hugged her and told her I was so grateful she'd come back in, that she was safe again. It totally broke my heart that she'd fallen so hard when she left, but I slept better after that, honestly.

I have another patient who comes in to my clinic and constantly insists that he has the right to take his own life. We've gone back and forth about this, and on a logical level, honestly? I can't argue. His claim is that he is in so much emotional pain it's unbearable, and that he's tried meds, and more meds, and ECT, and none of it has relieved this pain. So, he says, it's his right to end that suffering. I don't argue that point with him. What I argue is that he has not, in fact, failed everything.

And I find it interesting that the one thing he refuses to try is therapy.

Recovery is a program of brutal honesty. To yourself, to those who are helping you, to the people around you. If you are really honest with yourself, you will always find hope. And if you can't find hope, borrow some from someone else.

If you're thinking that ending your life is the only option, tell someone. Talk about it. Hold it up to the light of day. Seek help. I promise you, suicide is only one option, and it's the most destructive one of all.