Mars

I made a skinny girl cry today.

So I'm on the eating disorders unit now. I'm covering for Mike this week and Sparrow next week. And then I'm back for a full month in June. It's an interesting thing, to be up there. It's a whole different planet, really. With very underweight, constipated little Martians.

When I decided to go into psychiatry, I'd originally planned on being an eating disorders doc. I haven't abandoned the idea, but I think that it might be more in the context of trauma. Which is an interesting thing at the moment, because our inpatient unit is really a weight stabilization unit. Which means we tend to get the severe anorexics, who tend to be more on the OCD spectrum. What we tend not to get up there are the bulimics, who tend to be more normal weight, and also have a higher correlation with a history of trauma. They're generally more borderline-y, less inflexible, and I tend to understand them a bit better (duh). The anxious, perfectionistic, rigid anorexics make no sense to me. And because they make no sense, I have a harder time figuring out how to work with them in any sort of useful way. Because the program is so structured, too, I have a hard time figuring out exactly where the therapeutic part of my job is and where I fit into the picture.

The staff is pleasant. My attending is awesome. There's an NP on the service now, too, whom I've known for a while and like very much. I actually really like about half my patients, and the others are tolerable.

But we had this family meeting this morning. And for whatever reason, I identify with this girl. Yes, she can be a pain in the ass, but I really do think she's working hard. And I listened to her parents sit there and give her all sorts of mixed messages about what she's worth to them. She regressed a lot. It stressed me out.

But the crying and yelling and throwing of non-injurious items didn't actually bother me. I have a high tolerance for that stuff. She called one of the staff members a bitch. I laughed. The staff member got huffy and walked out. I was like, really? This isn't about you. She's just being a brat because she doesn't have the ability to say what she's actually trying to express. And if that's the worst thing I'd get called by a patient, cool. But no, she wanted a response, she wanted to push the staff member away, she accomplished what she was trying to do. So the staff member walks out, I kept talking about how we believe she can do this, we know it's hard to tolerate, etc. I made a couple of extra interpretations. By the time I walked out of the room, the patient was able to give me a little humor.

So, you see the difference, there? I tolerated the affective storm without reinforcing it, and we connected in some small way. The other technique? Puts up walls. I agree with the idea that you need to set limits about the way people treat you, but come on.

So I'm back up on the unit later, and the staff member comes to me and is just like, oh my God, that girl, blah blah blah. And I was like, oh, dude, she's terrified, etc, etc, but the staffer couldn't see past the obnoxiousness. The staffer was also incensed that the mother (of this adult woman) didn't say anything about the name calling. I couldn't control the eye roll on that one.

And then I made some comment about the eating disorder being a life-long illness, that you can be in recovery but you're never recovered. And the staffer starts arguing with me about that. And finally ends with, "well, it's controversial."

Uh....no, it isn't.

This annoyed me more than anything up to this point. She says later, "I just think people need to have some hope. By this time, the unit nurse and my friend John had joined the conversation, and were both like, nah, we see people up here over and over. We've seen people relapse after 20 years. Which, I have, too. You can be in recovery, you can be really strong in recovery, but you can't ever take it for granted. Because the moment you aren't looking? It will kick your ass, just because it can.

Seriously, lady. Why are you working with this population if you have no desire to figure out what's really going on, here?

Argh.

Fortunately, John rescued me and made me leave the unit and then bought me a cup of coffee. I'm not sure he consciously recognized the intervention, but let me tell ya, it was so exactly what needed to happen right then.

Massive Dumbassery

I? Am the worst friend. Ever.

Well, okay, maybe not ever. But I lost some big points tonight.

Mike's dad passed this weekend, and Cleo, Sparrow, and one of our other coworkers drove down to GA for the funeral. And since I can't seem to get off the gero unit for more than a week anyway, I covered the Gero/ECT service today and tomorrow for Cleo. I'm covering the eating disorders unit next week for Mike, and then the following week (well, three days) for Sparrow. I don't mind the bouncing around, and I'm happy to help.

But it turned out to be this weird combination of a very strange day and a very slow day, for a bunch of reasons. So, okay, Mikaela wanders in to my office at the end of the day, and was like, can you leave a few minutes early? Want to grab coffee before my 5:30 appointment? I said, sure. Took my laptop so I could work at the Starbucks for a little while before I took care of something I had to do before I went back home. But then I get this call, and I've been really distractable all day anyway, and then I tried to get some work done and the software wouldn't cooperate, and I got all sorts of frustrated, and then I called back...and then I got upset...and so then I went home.

And I ate dinner, and snuggled my dog, and read Facebook, and continued to be upset, and then I get this text from Sparrow saying, hey, how's little Maxine?

And now I kind of hate myself.

Because you know that thing I was supposed to do after Starbucks? I was supposed to go let Maxinie out. Because her mom was two states away supporting a good friend of ours in a time of need. And then when I called and was like, oh my God, I totally flaked, I'll get back in the car right now and drive all the way back there and let her out, Sparrow was like, no way. If she poops on the floor, she poops on the floor, so be it. You leave your house, I'll smack you.

I suck.

And Maxine is getting one big ass Jumbone for Christmas....

Maybe tomorrow will be better. I'm about to write off this whole damn week.

How is it Monday again?

Seriously. And what a Monday it was.

People are so irritating. I spent a while in Mikaela's office today ranting about this. Particularly about how freaking annoying I find men who can't quite get the idea that sometimes, other people know better than they do, or see things differently than they do, or whatever, and just because that person's a woman doesn't mean you're any less awesome and manly and virile.

I hate that politicking nonsense. Go stroke your own ego. I have patients to take care of.

Get a therapist. Hell, get a hooker. Whatever works. I don't care, just get out of my way.

But in better news, I got some quality girl time with my aunt tonight since my uncle was out of town. We ate breakfast pizza for dinner (crescent roll crust, with scrambled eggs, potatoes, cheese, etc on top, made like a pizza) and looked at pictures online of Saturday's soiree and it was very very nice.

Meanwhile...I'm going to bed...maybe when I wake up, people will stop being stupid.

(It could happen. Don't crush my delusions. It's just mean.)

Worst. Consult. Ever.

So I get this page...

Me: Hi, this is Dr. Kate, I'm returning a page?
Her: Yeah, hi, this is so-and-so med student, I was hoping you'd do a consult on my patient.
Me: What's her story?
Her: Well, she has a history of Crohn's disease, and is on prednisone, and four years ago when she was on prednisone, she became psychotic.
Me: Okay.
Her: So will you see her?
Me: Is she psychotic now?
Her: No.
Me: ...um...then there's not really anything for us to do.
Her: Well, also, four years ago she was discharged on Abilify, which she hasn't taken in about three and a half years. Should we restart her on this?
Me: Is she psychotic?
Her: No.
Me: Well, then let's hold off on the anti-psychotics.
Her: So my attending would like you to see her because he's worried about keeping her on the prednisone.
Me: Well, she's tolerating it. And not psychotic. So I'd say, if she needs it, keep doing what you're doing and call us back if she gets psychotic.
Her: Yeah. Okay. Thanks.
Me: Anytime.

Apparently, this whole exchange actually started with her paging Scott, my intern. Who told her she was paging the wrong person. And then added, "So, I'd start out by telling her you're a medical student. Because, otherwise? I don't see this going well..."

If you give a Maggie a margarita...

No, I did not actually give my dog alcohol. But I commented on my FB status that Maggie was all freaked out by the thunderstorms, and my aunt in Texas suggested a margarita might be a good solution (a little hair of the dog, if you will). So then I started musing about what turned into the title (a reference to the If You Give A Mouse A Cookie and If You Give A Pig A Pancake books, which, are, like, a couple of my favorite children's books EVER). If you give a Maggie a margarita, she's going to want a wedge of lime. If you give her a lime, she's going to think it's been far too long since you dropped any food on the floor...hmm. If you give a Maggie a margarita, she's going to want some salt for the rim. If you give her some salt, she's going to think it's been far too long since you dropped any food on the floor...or, okay...If you give a Maggie a margarita, she's going to think it's been far too long since you dropped any food on the floor...

I do love that dog.

So I tried to wear the goofy ski boots last night. Remember how I said I couldn't even keep socks on my feet at night (by which, by the way, I meant that I take my socks off in my sleep if I can even stand to keep them on that long. I could totally wear socks with the boots if I wanted to)? I had 'em on for like an hour before I actually went to bed, and then managed to sleep about 45 minutes before I woke up because I was kicking myself trying to take them off in my sleep. And, honestly, my legs hurt a LOT more today. Which may have been all the walking of yesterday, or all the manipulating of my feet, but I think a big part of it was all the fussing with the boots.

So now I have a large, furry hot pack applied to my left shin and I'm NOT wearing the boots tonight. Because I'm on weekend call tomorrow, and as the second year, I get to walk all around the hospital seeing consults. Which is painful in so many ways.

Stupid defective feet.

Gomer, today? I said, "So the podiatrist said this and blah blah blah and then he gave me these stupid splints I'm supposed to wear and is going to make me special orthotics or something," and he gets this devious little grin on his face and says, "You're like Forrest Gump!"

So now we both have sore shins.

(No, I didn't really kick him in the shins. I said something really clever like "shut uuuuup!" and then let him kick my ass around the gym for half an hour...but, the story's always better with a little secondary revision.)

The podiatrist also told me, incidentally, that he'd "be remiss" if he didn't mention my weight. I was like....really? He then went on to tell me that, well, obviously he wasn't going to manage my weight loss but I needed to pay attention to my calories as well, not just my physical activity.

....?

I resisted the urge to say, "What? My weight....oh, my god! When did I get fat?! Why didn't anyone tell me this before you did?! Thank God you were here, I never would've known!" or "uh, yeah, jackass, I get it, because, see, I'm a real doctor, not a doctor of feet." And I resisted the urge to kick him, too (which was hard, because he was right at prime kicking height when he said this). And I said something like, "right, yeah, no, I know that, and part of the reason I came in now, since, you know, I've had pain like this pretty much for the last quarter century (I distinctly remember my pediatrician telling me, "Oh, you'll grow out of it." Oops), is because it's starting to impede my progress at the gym. And it's probably worse now because of all the time I'm spending there."

And furthermore...why...well, I mean, don't assume, period. But why the comment about "watching my calories?" It's not like I was sitting in his office eating a donut. Do I have the best diet? Of course not. I'm a stressed-out, overworked resident. And in fact, I'm a stressed-out, overworked, PTSD-addled resident with an eating disorder. But that doesn't mean I live on chocolate cake, know what I mean? I generally do okay. Don't assume you know.

Which may not have stimulated much more than a big eye roll from me on a good day, but I also spent an hour on Wednesday getting criticized by one of my psychotherapy supervisors. Apparently she thinks I'm "too unsettled" and it's "interfering with my learning experience." A, how the hell does she have any idea what my "learning experience" is? That would be the very nature of an experience, in that, it's mine, and defined by how I, well, experience it. And 2...I mean...come on, lady. It's no great insight that I'm unsettled. I get the sense that she thinks I should be so grateful for these big interpretations she makes (because, remember, she's the one that told me they weren't admitting me to the institute - although they weren't not admitting me, either - because they were concerned that I didn't seem to have much reflective capacity), but in point of fact, I'm a big ball of reflective capacity. I reflect, ponder, analyze, debate, discuss, and ruminate on every morsel of my life until it's ground into a fine powder. I don't always see things right away, but sometimes that's because of the defenses in place, not because I'm shallow and not paying attention. Chances are, if she asked me what was going on instead of told me, I'd have plenty of ideas about it. And I don't mind feedback, because sometimes people who can see less detail have a better grasp on the big picture. I'm more than happy to listen to considered, measured insights - right or wrong - in the right context. But I think she's just trying to take my inventory without really knowing what's in stock, and as it stands, I don't feel like I can disagree with her, lest she decide I'm just being obstinate and defensive. So I shut up, stay defended, and take it. Which, let's face it, is not helpful.

And, let's face it, is a common response that I have, which has gotten me in a world of trouble before.

::sigh:: I just want to be normal, Spud.

Sex and Love Thursday

So yesterday we had this "sex therapist" come lecture to us. I don't know why I put that in quotes, she really is a sex therapist. Just...well, maybe she's a better therapist than lecturer.

She was really...awkward. Which seemed weird, given her profession. And disorganized. And seemed peculiarly uncomfortable with the men in the room (we only had two, relative to, what, three times that many women?). I dunno, it was weird.

So this woman's going on, and Sparrow (I love that she's representin' for me) points out that, wait, didn't *I* do this work for a while?

Which, I did. During my training hiatus, I sold yarn and worked as a sex therapist.

Seriously, my life is weird.

But nonetheless. So, Sparrow brings this up, and I said, yeah, and....I don't think I'm usually a name-dropper, but the woman I worked with is one of the top names in the business. She looks at me blankly, so I explained in a sentence or two the work that we did. Which she then, later, snarked at a little bit.

Um...really? First of all, was that necessary?

And second, I was a little offended. Sure, everyone takes a different approach, right, but, the clinic I worked in is world renowned. People come literally from the other side of the globe to do her program. She must be doing something right.

And so I was thinking about the clinic today during all of my driving back and forth from the coast. It was a seven week intensive program (recreated by my boss in this book) for married couples (we were a Jesuit hospital, after all). We worked as therapist pairs, and met with the couples for five hours a night one night a week for seven sessions, and it was, well, intense. We'd start with a check in, then split up and do individual, then come back together, then there was "symposium" (sex ed, really), where all the couples would come together for information sharing, and then we'd go back to our therapist-couple sets, dish out homework for the next week, and they'd go home. They spent five hours there per session, we spent about seven, not including the two weeks of introductory training we had. We did a lot of teaching, and lot of different types of therapy - dynamic, CBT, gestalt, relational...

It was a good time. I learned a lot about therapy and psychiatry and working with couples. And when you got right down to it, not much of what we did was really, strictly, about sex. We did a lot (lo-ot) of relationship work, which was the thing that I think this therapist yesterday really failed to communicate. We did a lot of work about attitudes, communication, ideas passed on by one's family of origin. We worked with religious beliefs, fetishes, gender role ideals. We worked on trauma, conflict, abuse. We rooted out anger, resentment, shame, blame, and guilt. And we changed people's lives. Some couples split as a result of the work that they did in the clinic, but many, many marriages were saved. Countless relationships were made stronger. My boss, in the decades she's been doing this, boasts close to 100 marriages that were consummated after years of marital celibacy because of the work that she's done (one of which was one of my couples. You know, once they stopped beating on each other). She's a pretty remarkable lady.

And what she did a good job of, which this woman yesterday really flubbed, was pointing out that sex is really just one form of communication in a relationship. It's actually a pretty potent, very intimate communication - even when it's casual. And it's often a crucible in which all the loaded issues of the past, all the passions and conflicts of the present, all the predictions and hopes for the future, hit a flash point.

Yeah, not a small issue. And really not about silly toys and "shocking" books.

Tonight's bit of folksy, on-call wisdom

Growing pot in your closet does NOT constitute "working in a greenhouse." I don't care how many grow-lights you've got in there...

Time for voice recognition software...

I...I hate people.

So I dictate my clinic notes, because it's marginally faster and is sort of the quickest way to get something into the patient's record. They get transcribed reasonably quickly, and then in theory we correct them and sign them, and all is well in the universe. Except...I'm not always the most conscientious about the correcting and signing step, because it often takes me almost as long to correct the damn dictation as it took me to dictate it.

The short version of this story is that I went into this weekend with sixty some dictations that needed attention, some from as far back as October. I've been neglecting them because, well, I have a crapton of other work to do, and it's in the medical record, so, is there really a time crunch on this? Apparently, there is, if we want to bill for it. So I've been getting all manner of nasty emails from my attendings that are like, sign your damn notes already, kid!

I'm down to 20. I've been doing them like five at a time because it takes so damn long and it pisses me off. Apparently we outsource our transcription to some little old ladies in India. Sometimes the syntax is off, in sort of the typical ways you'd expect from non-native speakers. That's fine. It amazes me, really, how many random typos are typically in these things - extra letters, too many spaces, line breaks where there shouldn't be, etc. But, fine. What actually gets to me is the crazy things that end up in the medical record that make no sense whatsoever, when, if whomever was transcribing took a minute to think about what they were typing, just a second, really, they'd figure out what they'd just said was ludicrous. I've been cutting and pasting some of the worst offenders...

"He is currently working on reading the Tail of Two Cities." (Hmm, I think I missed that one in high school...)

"He says he has been helping his dad with some construction projects, and supervising the construction of his grandmother's edition. " (Addition. Although...)

"He had begun calling her and taxing her incessantly." (Uh, that would be "texting". He is not a government official)

"The patient is handling this very well, and being very supportive of his friend, the deceased girlfriend." (That was supposed to be, "the deceased's girlfriend. It's different.)

"His family recently took a vacation to Cozumel, I believe, in the Caribbean." (They went to Cozumel, Belize, and the Caribbean. I know Cozumel is in Mexico, dammit!)

"He will go to the transplant percipient class, at which point he will go on the list for a kidney transplant." (From Merriam-Webster Online, the definition of "percipient" (n): a person on whose mind a telepathic impulse or message is held to fall. Um, please stop reinforcing my patient's psychotic delusions!!)

"She is concerned that this has gone largely and addressed." (Me, too)

"He presents today meeting a bridging prescription for his lithium." (Steve? Lithium. Lithium? Steve.)

"They have has no other complaints today." (That is was sure a good thing idea, there, hey.)

"She also has done two sits in rehab." (Hmm, maybe that's why it didn't work...)

"It was the first Thanksgiving without his grandmother, who recently passed out and that was a little difficult for the whole family." (Until grandma woke up, six feet underground because the rest of the family thought she'd passed ON.)

"He says that as long as he is alerting he is okay." (Well...then...carry on.)

"And that she particularly likes school because they are free, contained no clipart" (I have no idea what this means...)

"The idea of writing the letter but not sending it was discussed and she seemed to devaluate that." (Devaluate isn't even a word! It's like "ironical". And furthermore...I really just have no clue what the hell word I actually used there...)

"His property is routinely searched for code violaceous." (I hate it when that happens.)

"He is feeling like this man is 'how to get him'" (How is that, exactly?)

(In a continuing description of my patient's car accident, where he was driving on the straightaway with his dim headlights and missed the fact that the road was about to end, so he ended up in a ditch) "...and that it was very dark and his headlights particularly bright. He came to T in the road, coming on the strayed away, and crossed over the perpendicular road and went into a ditch. He severed only minor abrasions to his left hand."

"He also had surgery on his finger in 1992 after a crush." (Injury. Crush injury. That's an important distinction!)

"We will continue with Remeron 45 mg p.o. q.h.s. He is given a prescription for 50 mg tablets." (You've just got to shave 'em down a little, it's no big deal.)

"If her panic attach become more frequent, we will consider something like propranolol." (Or possibly a crowbar.)

"He says that he is not happy with his current physician, that he is a "kangaroo psychologist"." (Yep, that's exactly what he said. No, I still don't know what that's supposed to mean. But perhaps if he stopped going to veterinarians, he'd get better mental health care?)

"He states now that that was primarily over the mounting is fair." (I...um...huh?) (You know what I think that was, originally, actually? "Mounting despair". Yeah, different...)

"He notes that he is 'still measurable.'" (Well, thank God! No one likes an unmeasurable patient. Especially not one who's, say, MISERABLE!!! Really, people, this is not that hard!)

"There is heavy alcoholism on both sides, and his paternal uncle is a aeronautics." (Wow, he must be confused about why all those AA meetings are required for the space program.)


Idiots.

Um, but then there were the dumb things I actually did say...

"...and was initially initiated on amitriptyline..."

"The patient has a somewhat impulsive and minimally jerky kind of gait that his mother reports is at his baseline." (I...guess it gives you a picture of how this guy walks?)

"I will fax a copy of his lab report to Dr. X at [fax number], as well as the copy of his lab report." (Right before I fax him the lab report.)

"The patient denies any suicidal or homicidal ideation; however, she does note that she once considered throwing a plate of food at her father this week." (Hey, they say it, I just put it in the chart.)

"The patient was counseled that he should probably stop smoking marijuana." (Yeah, you know, sometime, when you get around to it...)

"She says that her symptoms have maintained at about the same level, although she does also state that her symptoms are significantly improved since starting the Celexa." (Honestly? I think she really did say both, but...)


And then...sometimes, maybe it's a little of both...

"The patient agrees that he probably needs to stop watching U-tube."


Oy. I still have 13 left, but, they're going to have to wait...

Life on Life's terms

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

Here's my day.

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

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

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

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

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

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

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

And I feel pretty bad about it.

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

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

Two ex-wives away from being a country song.

Seriously. Here's my day...

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

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

10:33 - wonder what Freud would say.

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

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

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

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

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

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

11:27 - Call AAA.

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

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

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

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

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

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

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

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

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

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

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

12:09:10 - car starts right up.

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

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

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

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

12:40 - tea. Scone. Better.

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

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

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

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

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

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

Why do we pay these transcriptionists?

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

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

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

Different.

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

Night moves

So, here I am again. Floating.

It's 4:30am and I'm waiting for the ER to call me about some dimwit who cut herself because she got into a fight with her boyfriend. She's saying (according to the ER notes) that it was impulsive and silly and she's not suicidal, so I don't really need to see her but $20 says they call me anyway. Technically, they're supposed to consult us on potential admissions; stuff like this they're supposed to be able to handle. And who knows, maybe they will. But they stole all her clothes and dressed her out in those silly blue paper scrubs we give to potentially suicidal people, and that's a very strong indicator that there's going to be a psychiatrist sometime in her near future.

Meanwhile, I blog.

It amazes me sometimes how much people don't want me around. I think I went from the one profession people really don't want to go see to the only one they want to see less. When I was a gyn, I had a woman tell me she'd rather get a root canal than have to see a gynecologist. As the shrink, I think most people would rather have a gynecologic exam. Some, I think, would rather have a gynecologic exam in Times Square than have to talk to me. People get so resentful that their "real" doctor called a psychiatrist to see them. Because my presence clearly indicates the other doctor thinks either, a, they're crazy, or 2, they're making it up. Not so, folks, not so. You wouldn't believe the reasons we get consulted (earlier tonight, Fang fielded a consult on a burn patient because she was crying. What?! Someone who's burned badly enough to end up in the ICU is - gasp! - crying?! Holy cow! Fire up the ECT machine, STAT! Seriously, though, I think "crying patient" is probably #4 or so on the list of reasons we get called by other inpatient services). What always makes me a little nuts, though, is the people who do things like, you know, try to kill themselves, and then get all pissy when someone calls a psychiatrist. Because, you know, they're not crazy.

Please. Like crazy is such a bad thing.

Is it bedtime yet?

So I've actually spent the evening seeing patients (and writing up long-ass interviews with same) and haven't gotten any knitting done. Which is a shame, because all I have left on my one project is the duplicate stitching and then I can felt it, but, I would've SWORN I had yarn needles in my desk, and alas, I do not. So sad. That's about all I can tell you about the projects I'm working on right now, though, because they're super top secret. Because I'm knitting for the CIA. No, okay, because they're gifts. But I promise pictures just as soon as I can post them.

I'm trying to decide what to put on the needles next. More simple socks? A throw for the new intern work area? An afghan? A new scarf? I'd really like to knit a nice thick sweater coat thing, but that seems like a fairly big undertaking, and I might not finish it until it's warm out...

Aaaand there goes my pager. Because they want a full consult on the dimwit. I got news for you, kids, it's not a committable offense to be stupid....

Babbling the midnight oil

Night float, day 2...

I've seen exactly one patient, who was here when I got here, but you know what? I feel good about that patient. It was an adolescent that I took a long time with and I think I managed to get the situation to work in her best interest. It helped that there was a Pedes ER attending on who was just incredibly helpful and interested and invested in this kid.

You know...I have this soft little place in my heart for adolescents that I didn't have any sort of awareness of until this year. Previously, I mostly found them annoying and juvenile and always felt like they were making fun of me. I forget, though, what a complicated and tumultuous time adolescence is by its very nature. Add in screwy social circumstances or caretakers with limited parenting skills, and gosh, these kids just have so much trying to coalesce on them. And, you know, maybe it's the population of kids that I deal with, but I see so much...I don't know what it is. Energy, color, potential, intensity...so much raw possibility, this sort of effervescence of conflict and recombination, this complexity that's simultaneously developing and concluding... It's fascinating. And when you're underneath it, it's overwhelming.

I just don't see it in a lot of my adults. I mean, sometimes I see vestiges of it. Sometimes I see outright mature correlates, these peculiar and disorganized qualities come to fruition. But honestly, a lot of adults seem to have just lost this ineffable, diaphanous quality. Sometimes it seems like it's been sublimated into the unconscious, sometimes it seems like it's been partitioned off and redirected...but sometimes...in others...it just seems like it's gone. Like they've gone flat.

I don't know what that is. I don't know what it means. I obviously can't even describe whatever this is that I'm talking about with any degree of significant eloquence, but, well, it's 3 in the morning.

Does this make sense to anyone who lives outside my head?

Anyhow.

So the other interesting thing about my night has been this - when I got here and read my email, I discovered that I'm being audited for inappropriately accessing a patient's confidential medical records without a release of information on file. Which, I wasn't too concerned about, because, I figured it was one I opened on accident who had the same name as my patient, or, a patient I treated a while ago whom I was checking up on for continuity of care and, you know, silly things like learning. Until...until I got to the patient's name.

It's my record.

From the email conversation that's ensued, apparently, I'm being brought up for disciplinary action for - wait for it - violating my own privacy. And when I explained why I went in, that I added my medications which are prescribed by an outside provider, she told me that was a grave misuse of my access to the system.

Oh, come on.

So...apparently...it's an abuse of power to "alter" my medical record in such a manner. Because, you know, if one day, whilst I'm walking home, I get run over by the Chapel Hill Transit system (God forbid), and I wind up in the ER, all unconscious and bleeding, it's really not important for those doctors to know what goes into my body on a daily basis. Because it won't affect my treatment at all. Thank heavens I was all "ethical" and didn't "alter" anything.

I'm really pissed off about this. I mean, forgetting the fact that my record contains exactly this: the medications I've entered and two test results (a rapid strep and a Flu A aspirate) from when I went to employee health with the flu last year. Oh, and now, it probably shows a pending appointment with a family doc next week (FINALLY I'm going to go get all of this exhaustion and falling down checked out). It has my address wrong. It doesn't have my insurance information. And until said employee health flu visit, it had my name spelled wrong. Forgetting that there's NOTHING THERE, it's my information. It can't tell me anything I don't already know!

So, one of the things I did tonight was fill out a release of information form - to release my own information to myself. For the love of Steve....

Disciplinary action, my fat white ass.

Again I say...anyway.

So, now, I'm hanging out. I finished some paperwork, I disinfected my desk (Ruthie seems to have the plague). I did some laps around the psych department. I read my newly-arrived copy of Franklin Habit's cute new book of knitting cartoons, "It Itches." (SO cute. So Franklin. I love it.) I'd pre-ordered it months ago, so I was excited when I found it on my stoop this evening when I left for work. Last night I watched House and 30 Rock and Doogie Howser reruns on Hulu.

I keep trying to read more important things (like my readings for class tonight), but damn if I can concentrate on anything like that. I concede that I slept well today and thus tonight hate night float a little less, but, considering it's taken me over two hours to write this blog (I keep wandering off to do other very random things and then suddenly thinking, oh! Was I done with my blog?), I don't know that I'm up for great feats of concentration...

Yeah, don't think I'm going to class tonight.

Oh, in related news, I had my last interview for the psychoanalytic society this morning. It was much more pleasant than the one with the intrusive old guy who lived in the country. And I'm relieved that it's all wrapped up and done with.

Alright, I think I'm going to go knit. If anyone's still reading at this point...wow, you're awfully tolerant...

Love (my photogenic pooch, and my photogenerative parents) Thursday

I had a long day, as per usual, really. We had Treatment Team this morning, which is something new and different on the Psychotic Unit. Treatment team is essentially this - one scared patient pulled into a room full of everyone involved in their care: doctors (4 people, including the med students), nursing (1), social work (2), pharmacy (1), occupational therapy (1), and rec therapy (1). So, 10:1. We put them in the hot seat and say, "how do you think things are going?" and assess where we are relative to our goals for treatment and their goals for treatment.

On the whole, this isn't as awful as it sounds, and actually tends to be very empowering to the patients (well, after the first one). Most of my patients did fine. One of them called me fat after I told him I was changing his medications and felt that he was not ready for discharge ("If we're going to get personal, you could stand to lose some weight." Hmm, yeah, thanks for the advice. Thank God you were here, I never would've known) and then railed on both me and my attending for eating meat. And...then said he'd have to just wait for his UFO to take him away.

Um...yeah.

Yesterday, he almost had me convinced that he was ready for discharge, had made a genuinely logical and somewhat reasonable argument....until he said..."Don't make me get the weather involved."

Uh-huh.

He continues.

"Fine, okay, two thousand years ago I was Jesus Christ, but..."

::sigh: You give a crazy guy enough rope, eventually...ah well.

So, long day. But then we had cake for Faye's birthday (we went out last night, but today was her actual birthday, and she was on call - ew - so Cleo brought her a cake and we sang and it was nice), and then Ruthie offered to drive me home. And then we decided while sitting in traffic that neither of us wanted to cook, so we went to this little diner for dinner. It was nice.

And when I got home, I discovered that my new camera came today! Thanks, Mom and Dad!

Fortunately, I had a willing and photogenic model.

Here's the shot from the old camera:


And the new:


So...um...bluer...better definition...well, I'm still learning how to use it...

BUT. This morning, I got some classic Maggie pics.

I found this new Whipped Cottage Cheese made by this company called Friendship Dairies. It's really good. Really good. This morning I finished the container, and Mags just looked so pathetic and forlorn and wanted something to eat...so I gave her the empty container to clean it up.


It was yummy.

So then she really went in for it.


Which didn't work out so well for Maggie, but I thought it was funny as hell.


Fortunately, she figured it out.




Mmmmmmm, tasty.

No one believes you

We had a patient in the ER tonight report that he was "self-medicating" with - ready for it? - 40 lbs of chocolate. A day.

Dude, whatever.

Besides, I think it was the vicoden with which you were self-medicating, actually.

I keep thinking about the magnitude of that. 40 lbs. So, the average Hershey bar is 0.095 lbs (according to Hershey.com. It's not like I randomly know this). Let's round up to a tenth of a pound for the sake of middle-of-the-night math. So, at ten per pound, that's 400 Hershey's bars per day. And roughly 84,000 calories.

Not even a champion chocolate chomper such as myself could do that. Not a chance, buddy.

But seriously, folks

No, really. There are few things funnier than a group of drunken psychiatrists. Unless those things would be, a, a group of drunken psychiatrists square dancing, or, b, barely legal very drunk white dudes trying to crash the drunken psychiatrist square dancing party.

But we'll get to that.

So I am, of course, still in Asheville. The conference is winding down and we're having a hell of a good time.

Yesterday I whored myself out to the drug reps for some funny accoutrements. Sadly, I think the tables have all gone down and they will not let me pilfer in the morning. So I'll have to be satisfied with my current mind-warping booty.

Yes, that's a big orange clothespin. It's for the office. I don't know what we're going to do with it, but I thought we needed one. I already threw out the Risperdal highlighter set, it was crappy (it's good for them I already like their drug, because, if I were to be easily swayed by drug company trinkets...). Incidentally, for those of you worried that I'm being unduly influenced, I actually don't remember what psych drugs Lilly makes, I find Invega useless, I'm so not a fan of Seroquel, and I don't actually know who Ridgeville and QTCM are.

Yesterday morning had a couple of really good lectures, and one very boring lawyer who was not very informative. I spent most of that hour texting Peng and Claudia. And then I came back to my hotel and took a nap. Last night there was a nice little reception, and then, THEN we went on the Ghost Trolley Tour. I went with Ed and his wife Georgia, whom I had not previously met but now totally adore.

I love ghost tours, btw. Have I mentioned that? It's such a great way to get a flavor for the real history of a city. Last night's did not disappoint for spooky moments and awesome stories. And it had beer.


Our tour guide, who is actually an engineering student at UNC-A. Yes, yes, that is a Ghostbusters costume he's wearing.

We saw a lot of cool sites and heard a lot of good stories, including several about the Biltmore (apparently George Vanderbilt thinks he's very funny) and the Grove Park Inn, about destitute bankers who plummeted to their deaths on Black Tuesday and now walk around and give investment advice, and how two of the local high schools were built on mass paupers' graves. We had a slightly spooky moment at this place called Helen's Bridge, where this woman apparently hung herself after her young daughter died in a fire. Apparently, if you park under the bridge after dark and say "Helen, come forth" three times, Biggie Smalls will appear and bust a cap in your ass. Oh, no, wait, that was South Park. Here, she will either appear to you, stall out your car, or leave handprints on your car. Last night she did none of the above (can you blame her? A busload of shrinks?). But even the most stoic skeptic among us had to admit it ended up feeling a little spooky.

My very favorite spot on the tour, though, was one relevant to us:


This is the Insane Asylum (I don't know what it is these days) where F. Scott Fitzgerald's wife, Zelda, spent the last ten years of her life, until she died in a fire. First of all, is this not just a beautiful building for an asylum? Anyhow, apparently back in those days they used to chain the patients to their beds at night. One night, a fire broke out, and she and eight other women were immolated because they couldn't leave. Awful, what they used to do to the crazies.

I also learned that Big Blue still has a parapsychology program. It's one of two left in the country. Matthew, Veronica, how could you have not shared this with me?? We often joke about our patients needing exorcisms instead of drugs, but, I wonder if they'd actually do that. Can you call them for a consult?

We definitely saw some awesome places. Asheville is a gorgeous town. Sadly, though, because I was shooting at night without the flash on a bumpy trolley, most of my pictures came out looking a lot like this...


On the way home, though, I did manage to get a picture of the neon monstrosity of a hotel down the street:


On the other side or the marquis it says "With a touch of modern." I don't know what that means. Maybe it's the wireless.

That sign is just large and gaudy and amused me. But I have to wonder, what is he supposed to be doing in this little rendition in electrified vapor?


Fishing. I'm going to tell myself it's fishing.

Today was also very nice. The morning talks were decent, although the one I'd been so looking forward to, the talk I actually came to the conference for in the first place (on complex PTSD, which, well, it's what I want to do with my life), was quite disappointing. Oh well. We also had a talk on so-called "cosmetic psychopharmacology", however, discussing things related to prescribing for people who don't actually have an illness, i.e., ritalin to make you better in school if you don't have ADHD. It degenerated a little into a discussion of drug marketing in the Q&A, which also incurred a lot of self-righteous pontificating, but, nonetheless, the talk was good.

This afternoon was our resident-specific stuff, which was mostly only attended by the Baby Blue contingent and a couple of ECU fellows. It was awesome, though (of course, because Ed arranged it). Probably the most helpful thing all weekend.

We also went out for lunch today with Eva's 91 year old grandfather, who is a retired Child and Adolescent psychiatrist. I liked him. We had a very nice lunch at this little bistro place downtown, and Eva bought me lunch (a wicked good burger, although I must confess that I was a little jealous of Papa's fried peanut butter and banana sammich. I loved that it was even on the menu, and I totally loved that he ordered it). He came to the resident programming with us, too. He joked that the panel discussion was so helpful for career advice, he wished he'd seen it 65 years earlier.

Tonight was the awards presentation and dinner. We were all going to ditch it, but somehow got guilted into staying and so we sat in the back and heckled (quietly). And then we skipped out to the lobby because they were about to start the bluegrass music. Where we sat and laughed loudly and were obnoxious and generally had a good time cracking jokes and telling stories (best line of the evening - Tina, who's black, and her husband, also black, were discussing Ed and my lineage: Ed's Armenian and things, I'm Greek (and things). It's a long story how we got to that, but then Tina told us that her grandfather was Greek. And her husband turns to her and says, "Wait...we're Greek??!"), until these three, very drunk, probably-of-age hicks come by from a wedding reception down the hall and start telling us how they crashed the party in the ballroom and tried to square dance with a bunch of crazy psychiatrists. Apparently the one was very sad that they wouldn't let him cut in. So he asked one of the guys, "If I lie down on the couch in the lobby, will you tell me what's wrong with me?" And whomever he was talking to told him that he couldn't afford their rates.

We laughed about that whole episode for a good ten minutes after they'd stumbled upstairs. And then we snuck back over to see our square-dancin' colleagues in action.

Wow, y'all. I....really.....shit, if I'd ever doubted that I was in the South....let's just say I don't see that happening at the Illinois Psychiatric Association meetings...

Good times.

So now I'm back at the hotel, and I have to pack and get to bed so I don't oversleep for the bright-and-early lecture on insomnia. The conference ends about 12:30, and then I'm going to try and go to the LYS that's about 6 minutes away (according to the TomTom). And then I have a four hour drive back, and then I'm meeting Crazy Friend Rachel for dinner, because she's moving on Monday, and because she had to have Mazel euthanized this week. Poor old boy had lymphoma, no one even suspected. Poor baby kept up a good front (yes, I know he's the dog that bit both me AND Maggie, but still, he was, at heart, a good boy). Shalom, sweet boy.

Best chief complaint of the night

A trauma that rolled into the ER while I was down seeing the SEVEN MILLION CRAZY PEOPLE who came in tonight:

"20 y/o female. Resident of X Dorm. Heavily intoxicated, fell off bunk bed. Trauma Code Yellow. Arrived via EMS in stiff collar and secured to long hard spine board."

Welcome back to college, kids.

What the bloody fuck, people?

(*This post contains strong language and may not be suitable for all viewers. As if you couldn't tell that from the title.*)


Okay, so, I was having a pretty good day, and I get home, and I have a comment on a post from March 3rd in my inbox. Which was, what, five months ago? And I thought, huh, that's weird. Because I remember someone making a stupid anonymous comment on that post around the time I posted it. It was a post about how I'd been having a particularly bad day, and among the things that had happened, Maggie had taken off running that day (Maggie, who thinks it's a game when I chase her, and who thinks it's fun, and who comes home the moment she thinks I'm going to just let her run). So I open it up, and this is what some, again, "anonymous" cowardly pig-fucker had to say:

"It is bad news. It's bad news that your dog came back. And now has to suffer living with miserable old you."

I....I didn't know what to think about that.

It occurred to me that it could've been a particular friend of mine who'd just been reading back that far (you know who you are, and if it is, email me and identify yourself RIGHTNOW so I can stop being all pissed off). Because it's kind of congruent with his very sarcastic sense of humor, in which case, knowing the source, it would actually be quite funny. But then I thought, why the anonymity?

And that's when I got mad.

First of all, why a five month old post? I've said many inflammatory things and made several dumbass remarks since then. Second, put your name on it. I don't care who you are, but saying something like that anonymously just makes you a punk-ass, chicken shit little bitch.

Third of all, if you don't like my blog? Go somewhere else. And while you're at it? Fuck off.

But most importantly, and so listen up, do not fuck with my dog.

That dog would take a bullet for me. And honestly? I'd take one for her. We may not have the "perfect" life, but it's a damn good one for us. She was in bad shape when she came to live with me. And now she's a happy, healthy, pretty darn well-adjusted pooch. I love that dog more than anything.

Get bit, you dumbass motherfucker.

And, by the way? Here's what Maggie thinks of you: