Showing posts with label I didn't spend all those years in medical school to be called Miss. Show all posts
Showing posts with label I didn't spend all those years in medical school to be called Miss. Show all posts
Wednesday, April 21, 2010
Friday, December 19, 2008
It's 6:45am and I'm already cranky...
Attention patients/families of patients/people who leave me annoying voicemails because they want me to write them prescriptions:
My name is not Miss. Nor is it Kate, or Katherine, and it's really, really not Kathy. No, I am not a nurse. No, I am not a social worker, clinical therapist, or whatever else you've decided for which I went to school for four or five years. No, I do not need to "check with the doctor."
I am the doctor.
When people want to check with the doctor? They could check with me. See how that works?
If I were a nurse, then that'd be great, had I wanted to be a nurse. I'd be debt-free, making a lot more money currently, and working a much better schedule. I could defer and check with the doctor. But, I made a different choice. I did three undergraduate majors in four years. I spent four years in medical school working up to 120 hours per week while taking out ridiculous amounts of loans for the privilege to do so. I spent a year in hell doing an obstetric internship, and then committed another five years of my life to psychiatry residency and fellowship. I work 60-80 hours a week, have ruined my credit because I can't make the $1600/month payment the loan company thinks I should be able to make on a second year resident's salary, and lay awake at night wondering if I'm doing the right thing, if I'm serving my patients well, and if any of them are going to put a gun to their head tonight. It's a job I love, and a choice I made, but it's a freakin' lot of work and comes at a large cost.
The least you can do, here, is call me "Doctor."
My name is not Miss. Nor is it Kate, or Katherine, and it's really, really not Kathy. No, I am not a nurse. No, I am not a social worker, clinical therapist, or whatever else you've decided for which I went to school for four or five years. No, I do not need to "check with the doctor."
I am the doctor.
When people want to check with the doctor? They could check with me. See how that works?
If I were a nurse, then that'd be great, had I wanted to be a nurse. I'd be debt-free, making a lot more money currently, and working a much better schedule. I could defer and check with the doctor. But, I made a different choice. I did three undergraduate majors in four years. I spent four years in medical school working up to 120 hours per week while taking out ridiculous amounts of loans for the privilege to do so. I spent a year in hell doing an obstetric internship, and then committed another five years of my life to psychiatry residency and fellowship. I work 60-80 hours a week, have ruined my credit because I can't make the $1600/month payment the loan company thinks I should be able to make on a second year resident's salary, and lay awake at night wondering if I'm doing the right thing, if I'm serving my patients well, and if any of them are going to put a gun to their head tonight. It's a job I love, and a choice I made, but it's a freakin' lot of work and comes at a large cost.
The least you can do, here, is call me "Doctor."
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.
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.
Monday, July 07, 2008
Another one bites the dust
I am HOME. Call is OVER. Only 5 more intern calls to go.
Call was not bad. It was Mike and me tonight, and we're a good team. Which was so helpful, because I had some serious moments of "rhymes with Bluster Duck" tonight. People? People make me crazy. And it wasn't so much the patients tonight as much as it was, say, our NP who didn't bother to see the patient I'd asked her to and then left when her "shift" was over without actually telling anyone she hadn't seen the patient.
You know....I defended her for a long time, when she first started, and everyone else was all "she's horrible!" And there was a moment in there where she was starting to get better. And I said, oh, you know, there's a learning curve to this job, etc, etc, she's all anxious, we need to be empathetic, blah blah blah. You know what? She's just fucking incompetent. I'm so done. She needs to get her act together or just get the hell out of my way.
And then there was this whole fiasco on the child unit I can't even begin to describe. And I did my best to iron out the situation and get things taken care of, all the while speaking in soft, calm, soothing, dulcet tones. And I call downstairs at one point, and I say to Tyler, still in my low, syrupy, "fussy infant" voice, "Could you tube those papers up to me? Thank you, that'd be wonderful. Because I? I'm going to kick someone in the shins very, very soon."
Tyler. I do not know how we function in the 16 hours a day he's not there.
And he and Mike are a good combo. They play off each other and they're just funny together. Between the two of them, the evening ended up being downright enjoyable. And it was really nice, I have to say, because Mike? Totally understood the advantage of having me there, without actually taking advantage of having me there. Like, he saw two people in the ER, I did a direct admission and a clinic admit (also the ER patient the dumbass NP didn't see), we spent much of the last two hours of call trading pagers because one of ours would go off when we were on the phone so the other would answer it. It was just seamless, it was good teamwork, and it was wonderful. And then Benny came on at 10, and she's just generally delightful as well. All in all, not a bad night, and I got to leave at 10.
Maggie was excited that I came home. That's the best part of any call.
I'm on Saturday with Sparrow. Which is awesome, except, we have to actually find someone to take care of our dogs! But I think one of the interns has us covered.
Today was long, yo. I had nine new patients this morning when I walked on to the unit. And you know something? Nine acute psych patients? They're a lot to deal with. Really rather draining. But I actually have a reasonably pleasant bunch this go around. And possibly two ECT candidates.
I've got to go to bed. Because, I still have nine patients to deal with in the morning, it's 11:30, and oh, the new med students start tomorrow. Which could be awesome, but invariably adds work. I never really appreciated that in medical school, just how much more work med students create for the residents. Gosh, I thought we were so helpful...ah well. It was a useful delusion.
Call was not bad. It was Mike and me tonight, and we're a good team. Which was so helpful, because I had some serious moments of "rhymes with Bluster Duck" tonight. People? People make me crazy. And it wasn't so much the patients tonight as much as it was, say, our NP who didn't bother to see the patient I'd asked her to and then left when her "shift" was over without actually telling anyone she hadn't seen the patient.
You know....I defended her for a long time, when she first started, and everyone else was all "she's horrible!" And there was a moment in there where she was starting to get better. And I said, oh, you know, there's a learning curve to this job, etc, etc, she's all anxious, we need to be empathetic, blah blah blah. You know what? She's just fucking incompetent. I'm so done. She needs to get her act together or just get the hell out of my way.
And then there was this whole fiasco on the child unit I can't even begin to describe. And I did my best to iron out the situation and get things taken care of, all the while speaking in soft, calm, soothing, dulcet tones. And I call downstairs at one point, and I say to Tyler, still in my low, syrupy, "fussy infant" voice, "Could you tube those papers up to me? Thank you, that'd be wonderful. Because I? I'm going to kick someone in the shins very, very soon."
Tyler. I do not know how we function in the 16 hours a day he's not there.
And he and Mike are a good combo. They play off each other and they're just funny together. Between the two of them, the evening ended up being downright enjoyable. And it was really nice, I have to say, because Mike? Totally understood the advantage of having me there, without actually taking advantage of having me there. Like, he saw two people in the ER, I did a direct admission and a clinic admit (also the ER patient the dumbass NP didn't see), we spent much of the last two hours of call trading pagers because one of ours would go off when we were on the phone so the other would answer it. It was just seamless, it was good teamwork, and it was wonderful. And then Benny came on at 10, and she's just generally delightful as well. All in all, not a bad night, and I got to leave at 10.
Maggie was excited that I came home. That's the best part of any call.
I'm on Saturday with Sparrow. Which is awesome, except, we have to actually find someone to take care of our dogs! But I think one of the interns has us covered.
Today was long, yo. I had nine new patients this morning when I walked on to the unit. And you know something? Nine acute psych patients? They're a lot to deal with. Really rather draining. But I actually have a reasonably pleasant bunch this go around. And possibly two ECT candidates.
I've got to go to bed. Because, I still have nine patients to deal with in the morning, it's 11:30, and oh, the new med students start tomorrow. Which could be awesome, but invariably adds work. I never really appreciated that in medical school, just how much more work med students create for the residents. Gosh, I thought we were so helpful...ah well. It was a useful delusion.
Monday, June 23, 2008
"Alright, and what else is new?"
I had a very long day at State Hospital. Although I was actually busy today, which was a nice change, although I concede a lot of it was busy work and fussing and logistical crap. Whatever. Hopefully tomorrow will be a reasonably early day, because Wednesday is my last full 30 hour call at SH. Possibly (I think it is) the last one ever in my life, actually. Hooray! I'm on call again on Sunday night, but that doesn't start until 8pm.
Anyway, I'm at the end of this long, long day and waaaay down at the other end of the hall (the women's unit is very loooooooong), one of Ruthie's patients is arguing with her. And she screams, "Fuck you!" and storms down the hallway to her room, loudly slamming the door behind her. I continue walking down the hall and grab Ruthie by the arm (she's one of my good friends and one of mycellmates office mates next year) and start harassing her about, dude, Ruthie, what kind of doctor are you, patients all slamming doors up in here? And she rolls her eyes and says, "Right. And I'm going to hell."
I said, "Haven't we already established this?" Ruthie and I have had multiple conversations about how, not only is she a heathen and a sinner, she has failed to accept Jesus Christ into her heart as her personal savior (as I think I've mentioned previously, Ruthie's Jewish).
She says, "Well that's what I told her! I said, 'alright, and what else is new'? Ugh!"
I assured her we'd have a good time.
Maybe she can be a third for Claudia and my standing Canasta game on Tuesdays in Hell. Or perhaps PenguinShrink and Chef will have us over, for pork, I assume, on a Friday during Lent. Peng has often commented on how they're already looking at a nice condo with a view of the River Styx.
Seriously, if we went to hell every time our patients told us we were going there, we'd already be in hell right now (or maybe that's the point of intern year. Nah, I think that's more like purgatory).
Oh, speaking of the afterlife, did everyone know that George Carlin died? I'm a little sad. And I wonder if Jesus will, in fact, serve him pork chops tonight.
Anyhow.
It was just a long damn day today. Mondays usually are, but today, man. My patients were extra cranky, two of the men got in a big, table flinging, chair throwing, drag-out of a fight up in the mall (we have this thing called the psychosocial rehab mall, which is just a wing where patients go to groups and classes and such. It isn't an actual like a shopping mall or anything. But it confuses a lot of new folks. The first time I heard this I was like, you're taking them where??). I stood there and looked puffed up and large and immobile. On the unit we call this "show of force." It's basically an intimidation tactic where we display our presence to the patient in hopes of getting them to back down and comply with what we want them to do, and usually involves several large black men and me standing there looking severe. Occasionally, it's just a numbers thing - i.e., we pack as many staff members as we can find into as large a posse as possible to overwhelm them with our sheer numbers. Most of the time it works, actually, and we avoid having to lay hands on the patients and physically restrain them or whatnot. But truth be told? If that guy had so much as blinked twice in my direction you would've been amazed at how fast my fat ass was across the room and diving behind the upended table for cover.
I had one patient who was trying to tell me that her mother had schizoaffective disorder, which is something we diagnose when someone has both schizophrenia and a mood (affective) disorder, like depression or bipolar. But she told me that her mother was schizodefective.
Um...I know she may have seemed that way to you, but...
But, when I came home, I had gas! And in a good way, not because we went for Indian food yesterday. It actually smells a little more strongly that I'd like by the fireplace, which is a gas log and has a pilot light, so I'm trying to air the place out a little and keep telling myself it's just because the gas hasn't been on in so long. We'll see. I'm going to go see my shrink in a few minutes. so we'll close up and see how bad the smell is when I get back.
Oh, and Maxine came over when I got home, because Sparrow's flown off to the mountains. She and Maggie are still being all jealous and competitive. But they occasionally unite forces to protect the house from errant squirrels or falling leaves and cars and such.
.JPG)
Aww.
PS, I'm back now, and it smells less like gas in here. I guess we'll see what it's like in the morning. Oh, and my shrink made what had to be one of the shrinky comments of all time. We were talking about how I get in my own way - everyone does. It's therapy, resistance is expected - and I was saying that part of the reason I think this is true for me is because of my intellect, and thus my ability to intellectualize the crap out of anything and everything. I framed this as, "On occasion I'm just too smart for my own well-being." And what I assume (hope) she was trying to say was, your intelligence is just fine the way it is.
What she said was, "Kate, you're not too smart."
I laughed really, really hard. Fortunately, so did she.
Anyway, I'm at the end of this long, long day and waaaay down at the other end of the hall (the women's unit is very loooooooong), one of Ruthie's patients is arguing with her. And she screams, "Fuck you!" and storms down the hallway to her room, loudly slamming the door behind her. I continue walking down the hall and grab Ruthie by the arm (she's one of my good friends and one of my
I said, "Haven't we already established this?" Ruthie and I have had multiple conversations about how, not only is she a heathen and a sinner, she has failed to accept Jesus Christ into her heart as her personal savior (as I think I've mentioned previously, Ruthie's Jewish).
She says, "Well that's what I told her! I said, 'alright, and what else is new'? Ugh!"
I assured her we'd have a good time.
Maybe she can be a third for Claudia and my standing Canasta game on Tuesdays in Hell. Or perhaps PenguinShrink and Chef will have us over, for pork, I assume, on a Friday during Lent. Peng has often commented on how they're already looking at a nice condo with a view of the River Styx.
Seriously, if we went to hell every time our patients told us we were going there, we'd already be in hell right now (or maybe that's the point of intern year. Nah, I think that's more like purgatory).
Oh, speaking of the afterlife, did everyone know that George Carlin died? I'm a little sad. And I wonder if Jesus will, in fact, serve him pork chops tonight.
Anyhow.
It was just a long damn day today. Mondays usually are, but today, man. My patients were extra cranky, two of the men got in a big, table flinging, chair throwing, drag-out of a fight up in the mall (we have this thing called the psychosocial rehab mall, which is just a wing where patients go to groups and classes and such. It isn't an actual like a shopping mall or anything. But it confuses a lot of new folks. The first time I heard this I was like, you're taking them where??). I stood there and looked puffed up and large and immobile. On the unit we call this "show of force." It's basically an intimidation tactic where we display our presence to the patient in hopes of getting them to back down and comply with what we want them to do, and usually involves several large black men and me standing there looking severe. Occasionally, it's just a numbers thing - i.e., we pack as many staff members as we can find into as large a posse as possible to overwhelm them with our sheer numbers. Most of the time it works, actually, and we avoid having to lay hands on the patients and physically restrain them or whatnot. But truth be told? If that guy had so much as blinked twice in my direction you would've been amazed at how fast my fat ass was across the room and diving behind the upended table for cover.
I had one patient who was trying to tell me that her mother had schizoaffective disorder, which is something we diagnose when someone has both schizophrenia and a mood (affective) disorder, like depression or bipolar. But she told me that her mother was schizodefective.
Um...I know she may have seemed that way to you, but...
But, when I came home, I had gas! And in a good way, not because we went for Indian food yesterday. It actually smells a little more strongly that I'd like by the fireplace, which is a gas log and has a pilot light, so I'm trying to air the place out a little and keep telling myself it's just because the gas hasn't been on in so long. We'll see. I'm going to go see my shrink in a few minutes. so we'll close up and see how bad the smell is when I get back.
Oh, and Maxine came over when I got home, because Sparrow's flown off to the mountains. She and Maggie are still being all jealous and competitive. But they occasionally unite forces to protect the house from errant squirrels or falling leaves and cars and such.
.JPG)
Aww.
PS, I'm back now, and it smells less like gas in here. I guess we'll see what it's like in the morning. Oh, and my shrink made what had to be one of the shrinky comments of all time. We were talking about how I get in my own way - everyone does. It's therapy, resistance is expected - and I was saying that part of the reason I think this is true for me is because of my intellect, and thus my ability to intellectualize the crap out of anything and everything. I framed this as, "On occasion I'm just too smart for my own well-being." And what I assume (hope) she was trying to say was, your intelligence is just fine the way it is.
What she said was, "Kate, you're not too smart."
I laughed really, really hard. Fortunately, so did she.
Tuesday, May 13, 2008
One for the archives
First of all, I want to just say that two days of back to back call, even short call, is a bad idea. Don't let me do that again.
I don't know what's wrong with me, really. Lots of people work two jobs and 16 hour days all the time. Now, it's somewhat possible that they have less stressful jobs than I do. But, nonetheless.
Anyhow.
Before I go collapse into my bed, I have to share this. I got the absolute best crisis call of all crisis calls, ever.
So the pager goes off, and it's an outside call routed through our call center, so whomever is calling has called the operator, asked for the psychiatrist on call, and is still holding. They in turn page me with a name and callback number, as well as an internal extension I can call to connect as long as they stay on the phone. I look at the pager, and recognize the name as the call I missed earlier (which is weird, because I'm usually obsessive about the crisis pages. But I was really inefficient and distractable tonight, because, alas, second night in a row on call). So I call the extension, and I start with my usual opening line...
Me: Hello, this is Dr. J, I'm the emergency psychiatrist on call. How can I help you?
Her: Hi, this is Jane. I have a question.
Me: Okay.
Her: About a word.
Me: ...okay?
Her: I'm not sure if it's a medical word or not.
Me: Um, okay.
Her: The word is "impulsive."
Me: .....in what context did they use that word?
Her: What?
Me: How did they use that word?
Her: Well...I had a psych evaluation today. And they said that I was 'calm, laid back, easy going, and impulsive'.
Me: Ah. So what do you think that word means?
Her: Well, I think, like, calm, laid back, easy going.
Me: ....um....well...."impulsive" means that, like, when you think of something, you just do it, you don't think about it a whole lot before you do it.
Her: Oh, that's totally me.
Me: Oh?
Her: Yeah, I always think about things a lot before I do them.
Me: Uh....okay....
Her: So is it a good word or a bad word?
Me: Well, it's not really a good word or a bad word. It's just a description. That's all.
Her (sounding very satisfied with that answer): Oh! Okay. Well, thank you.
Me: Er...glad I could help.
You know how, when you found a word in your report that you didn't understand, and instead of googling it, or going to the dictionary, or asking, I don't know, pretty much ANYONE else, you decided it seemed like a good idea to call the hospital and ask to speak to the psychiatrist on call? Yeah, that's what it means.
I don't know what's wrong with me, really. Lots of people work two jobs and 16 hour days all the time. Now, it's somewhat possible that they have less stressful jobs than I do. But, nonetheless.
Anyhow.
Before I go collapse into my bed, I have to share this. I got the absolute best crisis call of all crisis calls, ever.
So the pager goes off, and it's an outside call routed through our call center, so whomever is calling has called the operator, asked for the psychiatrist on call, and is still holding. They in turn page me with a name and callback number, as well as an internal extension I can call to connect as long as they stay on the phone. I look at the pager, and recognize the name as the call I missed earlier (which is weird, because I'm usually obsessive about the crisis pages. But I was really inefficient and distractable tonight, because, alas, second night in a row on call). So I call the extension, and I start with my usual opening line...
Me: Hello, this is Dr. J, I'm the emergency psychiatrist on call. How can I help you?
Her: Hi, this is Jane. I have a question.
Me: Okay.
Her: About a word.
Me: ...okay?
Her: I'm not sure if it's a medical word or not.
Me: Um, okay.
Her: The word is "impulsive."
Me: .....in what context did they use that word?
Her: What?
Me: How did they use that word?
Her: Well...I had a psych evaluation today. And they said that I was 'calm, laid back, easy going, and impulsive'.
Me: Ah. So what do you think that word means?
Her: Well, I think, like, calm, laid back, easy going.
Me: ....um....well...."impulsive" means that, like, when you think of something, you just do it, you don't think about it a whole lot before you do it.
Her: Oh, that's totally me.
Me: Oh?
Her: Yeah, I always think about things a lot before I do them.
Me: Uh....okay....
Her: So is it a good word or a bad word?
Me: Well, it's not really a good word or a bad word. It's just a description. That's all.
Her (sounding very satisfied with that answer): Oh! Okay. Well, thank you.
Me: Er...glad I could help.
You know how, when you found a word in your report that you didn't understand, and instead of googling it, or going to the dictionary, or asking, I don't know, pretty much ANYONE else, you decided it seemed like a good idea to call the hospital and ask to speak to the psychiatrist on call? Yeah, that's what it means.
Sunday, May 04, 2008
.....*whimper*.....
Tomorrow morning, I start Child and Adolescent Psychiatry.
Just for a month. I keep telling myself it's just for a month.
Half my class wants to go into Child and Adolescent. We take five fellows every year. Everybody's doing it these days.
Which is why nobody seems to understand why I want to crawl into a corner and hide.
I don't want to do this. I'm just not ready for this. I....oh, my freaking GOD. Stupid frakking American Board of Psychiatry and Neurology who thinks I need to learn how to treat kids for "well rounded" training and damn my stupid program who thinks it's a good idea to get exposure in the first year because, you know, if you want to do a child fellowship you have to start applying in your second year. Not like that makes any sense or anything. Damn it.
It really is going to be fine. It's 10pm, and I just got off the phone with Mike - who, by the way, is likely going to do Child and Adolescent and was just like totally in his element this past month - and I don't have either of the sexual predators on my service. So that's something. But I have all manner of horribly abused kids. I have one girl whose uncle was abusing her, and he got caught, and then he shot himself. Not to leave that on a kid.
I've often wished my abuser dead, but, holy shit, I can't even imagine that girl's guilt.
Mike's all, I'm glad you're taking over, because I keep making that girl cry. He's like, there's two really abused girls on the service who'll just do so much better with a woman. I'm thinking, yeah, I get that. And they'll probably do better with someone who's been there. Not that he knows that. Because the last guy I told about that, well, that didn't work out so well.
Ahhhh, the panic. The neurotic, neurotic panic.
It's going to be fine. I'll be fine. And I need to go to bed.
Just for a month. I keep telling myself it's just for a month.
Half my class wants to go into Child and Adolescent. We take five fellows every year. Everybody's doing it these days.
Which is why nobody seems to understand why I want to crawl into a corner and hide.
I don't want to do this. I'm just not ready for this. I....oh, my freaking GOD. Stupid frakking American Board of Psychiatry and Neurology who thinks I need to learn how to treat kids for "well rounded" training and damn my stupid program who thinks it's a good idea to get exposure in the first year because, you know, if you want to do a child fellowship you have to start applying in your second year. Not like that makes any sense or anything. Damn it.
It really is going to be fine. It's 10pm, and I just got off the phone with Mike - who, by the way, is likely going to do Child and Adolescent and was just like totally in his element this past month - and I don't have either of the sexual predators on my service. So that's something. But I have all manner of horribly abused kids. I have one girl whose uncle was abusing her, and he got caught, and then he shot himself. Not to leave that on a kid.
I've often wished my abuser dead, but, holy shit, I can't even imagine that girl's guilt.
Mike's all, I'm glad you're taking over, because I keep making that girl cry. He's like, there's two really abused girls on the service who'll just do so much better with a woman. I'm thinking, yeah, I get that. And they'll probably do better with someone who's been there. Not that he knows that. Because the last guy I told about that, well, that didn't work out so well.
Ahhhh, the panic. The neurotic, neurotic panic.
It's going to be fine. I'll be fine. And I need to go to bed.
Thursday, April 24, 2008
It's Thursday!
Isn't it?
So tired. And just home from call. So very, very tired.
So, I don't know what y'all think about this, right, but this morning I mentioned to our "junior attending" (Have I given him a pseudonym yet? I don't think I have. We'll call him...Bif) that I had gone to see crazy pregnant lady's baby. And he was like...hmm. Clearly, clearly didn't approve. So, you know, because I don't play the political game well, I asked him outright, why is that weird, that I would go visit the kid? And he's all, well, you know, it's such a unique relationship, and she could become jealous that you got to see the baby and she can't, blah, blah, something else, by then I'd stopped really listening but that was the gist.
Okay...so...before I say anything about what I think...was I wrong?
I mean, I don't think so. I like that I'm the kind of doctor that would go visit my patient's baby. I like that I'm the kind of person that would go snuggle her because I wanted to make a difference, even a tiny one, in her ability to relate and attach later in life. Because I wanted her to feel safe and loved. And selfishly, because I wanted to touch even a little bit of that newness and purity again, to glimpse that sweet innocence. I rarely get even remotely close to that anymore.
Plus, you know, that patient hates me anyway. And it's not like I went back to her and said, "Wow, your baby's cute. Her skin was satin and she smelled like innocence and sunshine." I mean, I'll freely admit (to you) that I'm totally in love with that baby. But I'm sure not going to rub that in her face. Instead, I brought her a picture - which I got to her via a back-handed maneuver so she didn't know it came from me - and her nurse and I gave her a teddy bear today.
I've been thinking a lot lately about the "kind" of psychiatrist I am, the "type" of therapist I'm going to be. I think I'm going to be different from Bif. I mean, he's very smart, he's very pragmatic; he'll do well in consult psychiatry, which is where he's going. We have different strengths, different shortcomings. But I think...you know....I'm not going to be everybody's best psychiatrist. No one is. But I think I'm going to be okay.
So tired. And just home from call. So very, very tired.
So, I don't know what y'all think about this, right, but this morning I mentioned to our "junior attending" (Have I given him a pseudonym yet? I don't think I have. We'll call him...Bif) that I had gone to see crazy pregnant lady's baby. And he was like...hmm. Clearly, clearly didn't approve. So, you know, because I don't play the political game well, I asked him outright, why is that weird, that I would go visit the kid? And he's all, well, you know, it's such a unique relationship, and she could become jealous that you got to see the baby and she can't, blah, blah, something else, by then I'd stopped really listening but that was the gist.
Okay...so...before I say anything about what I think...was I wrong?
I mean, I don't think so. I like that I'm the kind of doctor that would go visit my patient's baby. I like that I'm the kind of person that would go snuggle her because I wanted to make a difference, even a tiny one, in her ability to relate and attach later in life. Because I wanted her to feel safe and loved. And selfishly, because I wanted to touch even a little bit of that newness and purity again, to glimpse that sweet innocence. I rarely get even remotely close to that anymore.
Plus, you know, that patient hates me anyway. And it's not like I went back to her and said, "Wow, your baby's cute. Her skin was satin and she smelled like innocence and sunshine." I mean, I'll freely admit (to you) that I'm totally in love with that baby. But I'm sure not going to rub that in her face. Instead, I brought her a picture - which I got to her via a back-handed maneuver so she didn't know it came from me - and her nurse and I gave her a teddy bear today.
I've been thinking a lot lately about the "kind" of psychiatrist I am, the "type" of therapist I'm going to be. I think I'm going to be different from Bif. I mean, he's very smart, he's very pragmatic; he'll do well in consult psychiatry, which is where he's going. We have different strengths, different shortcomings. But I think...you know....I'm not going to be everybody's best psychiatrist. No one is. But I think I'm going to be okay.
Monday, April 07, 2008
Reflections on a new beginning
You'll forgive me if the next week or so I spend a lot of time waxing philosophical.
Know what I'm doing right now? I'm sitting in a Barnes and Noble in Durham, in the Cafe, drinking a Cinnamon Dolce White Mocha and blogging. I was planning on coming in and working on my many delinquent discharge summaries, but, alas, I'm on vacation. Sort of (I mean, I'm going in to work at quarter past early tomorrow for a meeting with the OB/G dept about my crazy pregnant patient, and then I have my review later in the morning, and then I'm probably going to stay for intern support group so I can kibbutz. And Saturday I'm spending at a conference here in town - which is really, really ironic, for reasons that will become apparent soon - and I'm probably taking call on Sunday. But, you know, vacation).
Know what I was doing right now (well, it may have been about an hour from now) three years ago?
I was getting in SO MUCH TROUBLE. Why? Because I was going to a conference on the 9th and 10th.
Also, I had just delivered my very last baby. But we'll talk about that some other time.
So there was this conference I wanted to go to in '05. In February, I pulled the flier out of my mailbox and went to toss it in the recycle bin like all the other solicitations I got, but for some reason it caught my eye. It was a conference for residents to improve their laparoscopic skills. Of which mine we very limited, because I was the bad intern and no one would ever let me play with the toys except for Ben, who liked having me operate with him alone (i.e., no upper level resident) on his laparoscopic or hysteroscopic cases. And it was in Chicago, so, bonus, no lodging costs. Plus I would be on my Anesthesia rotation, who made it abundantly clear (as in, they said it outright) that they didn't care if we came in at all for the whole month, this was clearly for our learning. Lots of the upper levels told me they went in one or two days a week while on Anesthesia (since you still had OB/G call and clinic responsibilities). Cool. So I emailed our program coordinator and said, can I go to this conference two whole months from now? And she said, this is how much you have left in your educational account, tell me if you want to use it on registration fees. And then I got my department chair to write them a letter saying that yes, I was a resident in our department, thus making me eligible for the resident rate and membership in the organization. I was excited. It looked really interesting. And maybe it would help me to improve my skills enough that someone would actually let me operate once in a while. I was trying to be better, despite the fact that I knew I was never going to be good enough.
So, the Wednesday before this conference, I send my duty hours in, and say, oh, by the way, don't forget that I'm going to this thing this weekend. At which point my program director was like, "What? What conference? Interns aren't allowed to go to conferences." I said, remember how I emailed y'all about this in February? And then by today, which was Thursday, she had concluded that I was totally abusing the system by taking Friday and Monday off to travel. I said, but Anesthesia's okay with me being gone, and Dr. A - the anesthetist in charge of me - and I have already worked out a plan to make up the hours I'm going to miss.
She said, "I see no reason to involve the Anesthesia department in this."
Um...other than the fact that I was responsible to them that month?
And it wasn't like I was going to the coast for a four day weekend, or skiing, or to Martha's Vineyard, like so many of my cohorts had done on that rotation. I was going to a conference. To learn surgical techniques they wouldn't teach me. Oh, my gosh, though, I was in so much trouble.
I was "allowed" to go to the conference, because I'd already made plane reservations but we were going to have to "talk about this when I got back."
I should've said it right then. I should've said it months before. I should've pulled out the "oh, fuck you." I should've told them I wasn't coming back from Chicago. I should've told her that if she were doing her damn job, instead of abusing and scapegoating me for everything that went wrong, instead of throwing me to the wolves when she wanted to avoid confrontation, if she would've acknowledged my strengths and been constructive instead of abusive, I wouldn't have been so miserable, confused, and demoralized that I was clinging to the last jagged shards of my sanity. I should've told her precisely what was wrong with this picture. I should've told her exactly how much more and how much better I was than she was portraying me to be.
But I didn't. Because at that point, I was so broken down I didn't know any better.
I did, however, go to the conference.
And the conference changed my life. In fact, I think it's not at all an exaggeration to say that it saved my life. You'll hear about that in a couple of days, I'm sure.
I doubt Saturday's conference is going to as life altering. But let me just say that not only am I going with the department's blessing, they're paying my $200 registration fee. I mean, it probably helps that we're hosting the conference, but, still.
I'm so grateful for my life right now. I'm so grateful for where I am, so grateful for what it, and I, are becoming. So grateful for what the last four years have taught me. So grateful that I'm even alive, and have a career ahead of me to speak of. So I guess there's really only one thing left to say, today.
Fuck you, Karen George.
Know what I'm doing right now? I'm sitting in a Barnes and Noble in Durham, in the Cafe, drinking a Cinnamon Dolce White Mocha and blogging. I was planning on coming in and working on my many delinquent discharge summaries, but, alas, I'm on vacation. Sort of (I mean, I'm going in to work at quarter past early tomorrow for a meeting with the OB/G dept about my crazy pregnant patient, and then I have my review later in the morning, and then I'm probably going to stay for intern support group so I can kibbutz. And Saturday I'm spending at a conference here in town - which is really, really ironic, for reasons that will become apparent soon - and I'm probably taking call on Sunday. But, you know, vacation).
Know what I was doing right now (well, it may have been about an hour from now) three years ago?
I was getting in SO MUCH TROUBLE. Why? Because I was going to a conference on the 9th and 10th.
Also, I had just delivered my very last baby. But we'll talk about that some other time.
So there was this conference I wanted to go to in '05. In February, I pulled the flier out of my mailbox and went to toss it in the recycle bin like all the other solicitations I got, but for some reason it caught my eye. It was a conference for residents to improve their laparoscopic skills. Of which mine we very limited, because I was the bad intern and no one would ever let me play with the toys except for Ben, who liked having me operate with him alone (i.e., no upper level resident) on his laparoscopic or hysteroscopic cases. And it was in Chicago, so, bonus, no lodging costs. Plus I would be on my Anesthesia rotation, who made it abundantly clear (as in, they said it outright) that they didn't care if we came in at all for the whole month, this was clearly for our learning. Lots of the upper levels told me they went in one or two days a week while on Anesthesia (since you still had OB/G call and clinic responsibilities). Cool. So I emailed our program coordinator and said, can I go to this conference two whole months from now? And she said, this is how much you have left in your educational account, tell me if you want to use it on registration fees. And then I got my department chair to write them a letter saying that yes, I was a resident in our department, thus making me eligible for the resident rate and membership in the organization. I was excited. It looked really interesting. And maybe it would help me to improve my skills enough that someone would actually let me operate once in a while. I was trying to be better, despite the fact that I knew I was never going to be good enough.
So, the Wednesday before this conference, I send my duty hours in, and say, oh, by the way, don't forget that I'm going to this thing this weekend. At which point my program director was like, "What? What conference? Interns aren't allowed to go to conferences." I said, remember how I emailed y'all about this in February? And then by today, which was Thursday, she had concluded that I was totally abusing the system by taking Friday and Monday off to travel. I said, but Anesthesia's okay with me being gone, and Dr. A - the anesthetist in charge of me - and I have already worked out a plan to make up the hours I'm going to miss.
She said, "I see no reason to involve the Anesthesia department in this."
Um...other than the fact that I was responsible to them that month?
And it wasn't like I was going to the coast for a four day weekend, or skiing, or to Martha's Vineyard, like so many of my cohorts had done on that rotation. I was going to a conference. To learn surgical techniques they wouldn't teach me. Oh, my gosh, though, I was in so much trouble.
I was "allowed" to go to the conference, because I'd already made plane reservations but we were going to have to "talk about this when I got back."
I should've said it right then. I should've said it months before. I should've pulled out the "oh, fuck you." I should've told them I wasn't coming back from Chicago. I should've told her that if she were doing her damn job, instead of abusing and scapegoating me for everything that went wrong, instead of throwing me to the wolves when she wanted to avoid confrontation, if she would've acknowledged my strengths and been constructive instead of abusive, I wouldn't have been so miserable, confused, and demoralized that I was clinging to the last jagged shards of my sanity. I should've told her precisely what was wrong with this picture. I should've told her exactly how much more and how much better I was than she was portraying me to be.
But I didn't. Because at that point, I was so broken down I didn't know any better.
I did, however, go to the conference.
And the conference changed my life. In fact, I think it's not at all an exaggeration to say that it saved my life. You'll hear about that in a couple of days, I'm sure.
I doubt Saturday's conference is going to as life altering. But let me just say that not only am I going with the department's blessing, they're paying my $200 registration fee. I mean, it probably helps that we're hosting the conference, but, still.
I'm so grateful for my life right now. I'm so grateful for where I am, so grateful for what it, and I, are becoming. So grateful for what the last four years have taught me. So grateful that I'm even alive, and have a career ahead of me to speak of. So I guess there's really only one thing left to say, today.
Fuck you, Karen George.
Saturday, March 29, 2008
Things that make you go...ARGH!
So, you might notice that the amount of days on my timer at right has gone up...
Oh, I can't tell you how pissed I am.
So you might remember that little debacle with my licensure after the evil jackasses at the Emerald Palace tried to screw me up. For those of you who don't, well, the evil jackasses at the Emerald Palace continued their two year run of harassment in turn for my treachery of leaving by sending a libelous and distorted "verification" of my training there. Which resulted in my license being delayed by three weeks until I ultimately had to go meet with a board member who was like, why the hell not? It's just a training license.
Well.
Until this week everyone seemed to be conveniently forgetting that three week delay. Which seems fair, because I didn't get any credit at all for the time served up north. Until the new chiefs took over, and so I get this email. Telling me that not only is the start of my second year being delayed for a month because of this, I have to do another month of crisis, and take another month of intern call, AND my "intern" year is being extended ELEVEN DAYS LONGER THAN ANYONE ELSE'S.
Eleven days.
Eleven days longer. Than any of the other interns. This will come out of my last year experience, he says.
So now I've done 10 months of internship in OB/G. I'll have done a full internship in psychiatry. And then I get to take almost two weeks out of my fourth year, so I could do even MORE internship. And they won't make any sort of allowance. They won't let me do clinic part time in July. They won't let me be in the second year call pool instead of the intern call pool (oh, but there'll be 5 interns on that month, so we'll be on every fifth night instead of every fourth. Big conciliation).
And the man behind the curtain wins again.
That's really the issue. Not the extra month. I can do another month on crisis, whatever. I can do the extra call. But I reserve the right to feel jilted about it.
In other news, the pine pollen has arrived in North Carolina.
.JPG)
It runs in sulfuric rivulets with the rain and it coats everything, inside and out. It's like the worst dust you can imagine.
Pine pollen is my nemesis.
.JPG)
My nose is running. My eyes itch. My throat hurts. I'm wheezing and squeaking by the time I walk into the hospital from the parking lot in the morning. I'm not sleeping well. I'm tired, I'm sore, from these puddled masses yearning to be trees.
And apparently, I make terrible puns in response to the pollenosis.
.JPG)
Maggie's dealing with it okay, though.
Oh, I can't tell you how pissed I am.
So you might remember that little debacle with my licensure after the evil jackasses at the Emerald Palace tried to screw me up. For those of you who don't, well, the evil jackasses at the Emerald Palace continued their two year run of harassment in turn for my treachery of leaving by sending a libelous and distorted "verification" of my training there. Which resulted in my license being delayed by three weeks until I ultimately had to go meet with a board member who was like, why the hell not? It's just a training license.
Well.
Until this week everyone seemed to be conveniently forgetting that three week delay. Which seems fair, because I didn't get any credit at all for the time served up north. Until the new chiefs took over, and so I get this email. Telling me that not only is the start of my second year being delayed for a month because of this, I have to do another month of crisis, and take another month of intern call, AND my "intern" year is being extended ELEVEN DAYS LONGER THAN ANYONE ELSE'S.
Eleven days.
Eleven days longer. Than any of the other interns. This will come out of my last year experience, he says.
So now I've done 10 months of internship in OB/G. I'll have done a full internship in psychiatry. And then I get to take almost two weeks out of my fourth year, so I could do even MORE internship. And they won't make any sort of allowance. They won't let me do clinic part time in July. They won't let me be in the second year call pool instead of the intern call pool (oh, but there'll be 5 interns on that month, so we'll be on every fifth night instead of every fourth. Big conciliation).
And the man behind the curtain wins again.
That's really the issue. Not the extra month. I can do another month on crisis, whatever. I can do the extra call. But I reserve the right to feel jilted about it.
In other news, the pine pollen has arrived in North Carolina.
.JPG)
It runs in sulfuric rivulets with the rain and it coats everything, inside and out. It's like the worst dust you can imagine.Pine pollen is my nemesis.
.JPG)
My nose is running. My eyes itch. My throat hurts. I'm wheezing and squeaking by the time I walk into the hospital from the parking lot in the morning. I'm not sleeping well. I'm tired, I'm sore, from these puddled masses yearning to be trees.
And apparently, I make terrible puns in response to the pollenosis.
.JPG)
Maggie's dealing with it okay, though.
Tuesday, March 04, 2008
So I'm dull. It's not such a bad life
Apparently Mr. (Ms?) Anonymous hasn't been too thrilled with my opinions in the comments over on the Shrink Rap blog and felt the need to come over here and make a couple of snide remarks. He/she seems to be someone who feels like psychiatrists are misanthropic snake oil peddlers (which seems like a strange sort to be lurking around a blog written by three psychiatrists, about mental health issues).
It's not a unique viewpoint. And you know, in a way, we are. Well, maybe not misanthropes, but a lot of our treatments are based on anecdotal evidence of what works instead of hard biological data. I mean, you can say that about a lot of things in medicine, but it's even more prominent in psychiatry, I think. Each patient is such a unique mixture of chemicals, experiences, conditioning, and genetics, that one size fits all treatments are usually inappropriate. Now, I concede, that doesn't mean there aren't shrinks out there that think the answer to everything is higher and higher doses of Seroquel or that dole out SSRIs like candy. I quite often get patients who are followed by providers outside our system whose med lists leave me scratching my head (or occasionally outraged). I got into quite a battle last week about a patient who has a diagnosis that not everyone believes in, and how everyone then blamed her therapist for destabilizing her with this voodoo instead of admitting they didn't know much about or understand her diagnosis. I had a doctor send me a patient yesterday -on whom he hadn't come close to exhausting all her medication options, who wasn't catatonic, who wasn't suicidal - and more or less tell me that if I wasn't going to give her electroshock therapy, I might as well send her home, because that's the only reason he was involving us.
Which is not to say I'm the best doctor ever. Far from it. I have a lot to learn, but at least my knowledge is sound on one point: these are the lessons I'm going to learn from my patients.
And let me say this...you know, I'm actually relatively slow to medicate people, but I do think drugs are an important adjunct. Otherwise it's kind of like withholding insulin from a diabetic - you can monitor their labs and check their retinas and take meticulous care of their feet and watch their kidney function and they can do everything else right, but if they don't have the chemical that makes things work, things are going to go wrong. And like diabetes, brain chemistry comes in a spectrum of qualitative and quantitative deficits. Also like diabetes, if you supply the chemical but the patient does all the wrong things, then you're still aiming for disaster. Mental hygiene is exactly the same - balance the chemicals to provide relief and remove any biological impairments, and then find the therapy to move things forward. But where mental health veers from the diabetes analogy is in that afore mentioned idiosyncrasy of being human. Despite our best efforts to diagnostically lump patients, each one is a singular event. The choice of which chemical or combination of chemicals to alter, the utility of what kind of therapy is appropriate or potentially harmful....it's as different as a fingerprint. The DSM is useless as anything but a guidebook.
And since I've beaten that to death...I will concede that even I think my posting of late has sometimes been lackluster. I think it's mostly exhaustion and a touch of being compelled to daily blogging by this Blog 365 business (i.e., you get more verbiage, but it's less profound). Blame the pox. Or the not-court. Or the Flu not-A. Or life as an intern. Or maybe I'm just boring. You know, there's something to be said for leading a life that isn't overrun with drama. A life of contentment with what is and little complication.
.JPG)
I wish I felt like I was living such a life right now....
It's not a unique viewpoint. And you know, in a way, we are. Well, maybe not misanthropes, but a lot of our treatments are based on anecdotal evidence of what works instead of hard biological data. I mean, you can say that about a lot of things in medicine, but it's even more prominent in psychiatry, I think. Each patient is such a unique mixture of chemicals, experiences, conditioning, and genetics, that one size fits all treatments are usually inappropriate. Now, I concede, that doesn't mean there aren't shrinks out there that think the answer to everything is higher and higher doses of Seroquel or that dole out SSRIs like candy. I quite often get patients who are followed by providers outside our system whose med lists leave me scratching my head (or occasionally outraged). I got into quite a battle last week about a patient who has a diagnosis that not everyone believes in, and how everyone then blamed her therapist for destabilizing her with this voodoo instead of admitting they didn't know much about or understand her diagnosis. I had a doctor send me a patient yesterday -on whom he hadn't come close to exhausting all her medication options, who wasn't catatonic, who wasn't suicidal - and more or less tell me that if I wasn't going to give her electroshock therapy, I might as well send her home, because that's the only reason he was involving us.
Which is not to say I'm the best doctor ever. Far from it. I have a lot to learn, but at least my knowledge is sound on one point: these are the lessons I'm going to learn from my patients.
And let me say this...you know, I'm actually relatively slow to medicate people, but I do think drugs are an important adjunct. Otherwise it's kind of like withholding insulin from a diabetic - you can monitor their labs and check their retinas and take meticulous care of their feet and watch their kidney function and they can do everything else right, but if they don't have the chemical that makes things work, things are going to go wrong. And like diabetes, brain chemistry comes in a spectrum of qualitative and quantitative deficits. Also like diabetes, if you supply the chemical but the patient does all the wrong things, then you're still aiming for disaster. Mental hygiene is exactly the same - balance the chemicals to provide relief and remove any biological impairments, and then find the therapy to move things forward. But where mental health veers from the diabetes analogy is in that afore mentioned idiosyncrasy of being human. Despite our best efforts to diagnostically lump patients, each one is a singular event. The choice of which chemical or combination of chemicals to alter, the utility of what kind of therapy is appropriate or potentially harmful....it's as different as a fingerprint. The DSM is useless as anything but a guidebook.
And since I've beaten that to death...I will concede that even I think my posting of late has sometimes been lackluster. I think it's mostly exhaustion and a touch of being compelled to daily blogging by this Blog 365 business (i.e., you get more verbiage, but it's less profound). Blame the pox. Or the not-court. Or the Flu not-A. Or life as an intern. Or maybe I'm just boring. You know, there's something to be said for leading a life that isn't overrun with drama. A life of contentment with what is and little complication.
I wish I felt like I was living such a life right now....
Monday, February 25, 2008
Pumpkin Whore
So I'm on call tonight, right? And at Big Hospital, one of the things this involves is everybody meeting a 4:30 so the person covering walk-in clinic and the ER during the day can sign out all the patients still in a holding pattern to the overnight call person (not me. Ha!) and the short call person (me. And not just because I'm 5'5" on a good day. Because I get to leave at 10pm when I'm short call, and sign out to the night float person. No, not a complicated system at all. But still way the hell better than having to stay all night. I heart short call. At least until I have to get up at 6 tomorrow and still put in a full day's work. But anyhow, I digress...). So there's one patient in the ER, and this other one who's floating in the "going to come in later" ether.
This is the signout I got on the ether patient: he's a chronic schizophrenic in his early 20s, on meds, but has had an increase in the voices lately. They're not commanding him to do anything, but they are calling him names, like "pumpkin whore."
I......um........really?
So like two hours later the ER calls me and says, hey, this guy is down here. He's a chronic schizophrenic in his early 20s, generally well controlled on meds but he's been hearing more voices lately. They aren't command hallucinations; they're just calling him names, like "punk" and "whore."
At which point I just started cracking up. And then I had to explain to the poor ER resident why I was laughing so hard. Who, to her credit, also thought it was hysterical.
Another random thought from today: we have this family in town who is, like, the local psychiatry dynasty. We'll call them the doctors Ming. So, many, many years ago, the eldest Dr. Ming decided to become a psychiatrist. And he was a good one. He was even the head (the Emperor, if you will) of State Hospital at one point. And so then he had three sons, and all three of his sons became psychiatrists, and then all three of the newly minted Ming psychiatrists decided to practice in the Raleigh-Durham area. And then one of them had a son, or maybe they all had a nephew, I'm really not certain (was there a fourth Ming brother who went another direction with his life? I actually don't know), but anyway, there was a third generation Ming who also decided to become a psychiatrist and is a year ahead of me in my program. Which is very cool. But also makes it hell for difficult when a patient comes in and tells you, "I see Dr. Ming." Uh, thanks, that narrows it down to what, half the psychiatrists in the Triangle area?
Anyway, I called one of the many Mings today to tell him I was sending his patient home tomorrow. And we had this conversation about her, and he says something to the effect of, you know, some people really shouldn't be in therapy. For some people, the goal is just to maintain, not to search and explore and conquer. Some people can't handle that.
This flies in the face of my entire practice philosophy. My whole idea of mental health is confronting and fixing mismatches, and getting in touch with what lies beneath. So my first instinct was to be all, what?! And then I started thinking, what if there's some merit to that?
Thoughts from the peanut gallery?
::sigh:: Incidentally, no phrase has ever gotten me (and possibly all of mankind) in more conundrums than, "what if".
Certainly no phrase like "pumpkin whore."
I still think that's hilarious. I should've told that to the voices. Maybe they'd start calling him that for real. I think that would've been less demoralizing.
Well, anyhow, given my obvious mental state, Mags and I are going to go to bed. In my very own bed. At home. Even if I am only there for 6 hours or so and don't get to leave early tomorrow. So diggin' this short call thing.
This is the signout I got on the ether patient: he's a chronic schizophrenic in his early 20s, on meds, but has had an increase in the voices lately. They're not commanding him to do anything, but they are calling him names, like "pumpkin whore."
I......um........really?
So like two hours later the ER calls me and says, hey, this guy is down here. He's a chronic schizophrenic in his early 20s, generally well controlled on meds but he's been hearing more voices lately. They aren't command hallucinations; they're just calling him names, like "punk" and "whore."
At which point I just started cracking up. And then I had to explain to the poor ER resident why I was laughing so hard. Who, to her credit, also thought it was hysterical.
Another random thought from today: we have this family in town who is, like, the local psychiatry dynasty. We'll call them the doctors Ming. So, many, many years ago, the eldest Dr. Ming decided to become a psychiatrist. And he was a good one. He was even the head (the Emperor, if you will) of State Hospital at one point. And so then he had three sons, and all three of his sons became psychiatrists, and then all three of the newly minted Ming psychiatrists decided to practice in the Raleigh-Durham area. And then one of them had a son, or maybe they all had a nephew, I'm really not certain (was there a fourth Ming brother who went another direction with his life? I actually don't know), but anyway, there was a third generation Ming who also decided to become a psychiatrist and is a year ahead of me in my program. Which is very cool. But also makes it hell for difficult when a patient comes in and tells you, "I see Dr. Ming." Uh, thanks, that narrows it down to what, half the psychiatrists in the Triangle area?
Anyway, I called one of the many Mings today to tell him I was sending his patient home tomorrow. And we had this conversation about her, and he says something to the effect of, you know, some people really shouldn't be in therapy. For some people, the goal is just to maintain, not to search and explore and conquer. Some people can't handle that.
This flies in the face of my entire practice philosophy. My whole idea of mental health is confronting and fixing mismatches, and getting in touch with what lies beneath. So my first instinct was to be all, what?! And then I started thinking, what if there's some merit to that?
Thoughts from the peanut gallery?
::sigh:: Incidentally, no phrase has ever gotten me (and possibly all of mankind) in more conundrums than, "what if".
Certainly no phrase like "pumpkin whore."
I still think that's hilarious. I should've told that to the voices. Maybe they'd start calling him that for real. I think that would've been less demoralizing.
Well, anyhow, given my obvious mental state, Mags and I are going to go to bed. In my very own bed. At home. Even if I am only there for 6 hours or so and don't get to leave early tomorrow. So diggin' this short call thing.
Friday, February 15, 2008
Oh-and!!
WTF is this? Why do nurses get their own cheesy-ass theme song? Where's the crappy "doctors make the world go 'round" song?
Dude. Stupid Johnson and Johnson....
Dude. Stupid Johnson and Johnson....
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