Seems appropriate for a Sunday....

Listen. This post got a little too long and wound up being all about religion and faith and the philosophy therein. This is my blog, my belief system, and my external processing. Please, if you feel the need to leave some comment about how I'm going to hell or have missed the point, just....leave. Now. Quietly.

Thanks, The Management
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It's been kind of a rough day for me today. I slept poorly, which isn't new. I couldn't quite get my shit together at any point today. In truth, this is a smaller representation of a larger truth for me.

It's been kind of rough lately, period.

And there are a million and twelve reasons why that is, but I struggle daily nonetheless with things I never thought would become this important. Or maybe still aren't important but feel like they should be.

One of our patients came into the ER a couple of years ago, high on who knows what (he said he'd been smoking phone books. Nobody believed that as the literal truth, but also, none of us knew of any common substance of abuse that got referred to as "phone book"), requesting detox from ghosts.

That is primarily how I feel today. I feel toxic, I was realizing, as I drove home from meeting Matt for lunch. Matt himself I do not find especially toxic (nor, say, breakfast, which was yummy today). But Matt and I get into these deep, personal debates about such trivial things and the purpose of life and the true place of scripture in religion, not to mention the place of religion in faith. I love having these conversations with Matt because we can; we're both well versed in many aspects of what we speak. We're respectful and polite but engaged and can disagree easily. And it's rarely true "disagreement" as much as exploration. Having come from a strong Orthodox Christian background, a militantly Lutheran undergrad, and a very Jesuit medical school - not to mention that I have an undergraduate degree in a theology-heavy view of Humanities. It was somewhat more polytheistic in its spectrum than his MDiv, but, see above, re: militant Lutherans. We both talked, and we both listened, and had useful discussion of things like the overlap between the Christian faith and Wicca, Judaism, Islam, etc. Given all of the name-calling and hell-sending and hypocrisy and righteous indignation and fear (above all, fear) in that my view of "religion" is so steeped...given all of that, it was absolutely fabulous today to sit at an outside cafe, surrounded by beatniks and people from all strata, basking in the newly arrived spring breeze, eating tasty organic hippie food, with a good friend who can have these discussions with me in a non-judgmental, non-secular, non-threatening way...it helps.

It also brings up a great deal of pain, which I realized about halfway through our lengthy discussion that in large part what I was doing was (if you'll pardon my digression into psychoanalytic babble) discharging a lot of my intolerable affect and painful energy around this stuff, giving it to him to contain, hold, detoxify, metabolize. In lay terms, one might use a word like "dumping." In realizing this, I also realized just how much pain, confusion, disappointment, conflict there is in this for me. I'd not been aware of the extent of this before today.

The interesting thing, to me, I was thinking on my way home, is that God is never the pain, confusion, disappointment, conflict. God and I are on solid terms. It's people that I can't seem to grasp.

Apparently my faith, which is a different entity than my religious affiliations, is something a bit more mystical than I'd realized until the past few months or so. I believe in the existence of God because I know God. I just do. I see God in the faces of my patients, the laughter of children, the brilliance of spring daffodils, the sweet and complete affective honesty of my dog. I see God in my life, and my family, and believe firmly that I was created in the image of God. Do I believe in the dual nature of Jesus and that He was the son of God? Of course I do. I think we're all children of God, and Jesus of Nazareth had a particular path, and investment of divine energy to understand and reclaim the bond to these creatures that had done exactly what God wanted them to do - develop autonomy. Truthfully? I believe Jesus saved us. All of us - not just the Christians. And in a way, I believe Jesus saved God. Jesus struggled, he was tempted and tortured, and did not always make what contemporary humans thought to be the right choice, but made the "mistakes" he did because they were so important to understanding humanity. This, I think, was his deity. He was the man he was to help us understand God, who through the passing of the Old Testament times had become less vengeful, more loving. Jesus not only told us what he saw as the desires and ideals of God, but showed them to us as well.

I bet Jesus was tired.

I align myself with the Greek Orthodox church, for reasons of culture more than reasons of doctrine, but that doesn't mean I ignore the dogmatic. But when it comes down to the truth of my relationship with God, I draw from countless traditions that are full of good ideas. Various inceptions of Christianity. Wicca. Islam. Buddhism. Hindu. Kabbalah. I've read the Q'uran, the Mahabharta, and the words of the Buddha. I know a lot about voudou and Santeria and Wicca. I get what we're all trying to do here - understand that which is incomprehensible. We don't all do it in as different ways as we might think, truly. I have my own interpretation of scriptures that at times may seem incompatible with things I endorse, but they aren't. Because it all makes sense in how I understand and relate to God.


But - and this is what struck me later, and is ostensibly why this rant has gone on so long - where we get ourselves into trouble is when we insist we've got it "right." This is why wars are fought over belief systems. I'm right, you aren't, and unless you see that you aren't, I'm going to have to annihilate you because I can't tolerate your dissent. And that can manifest itself in a lot of ways - torture, imprisonment, whatever means it takes to break your spirit; actual death; or, simply dismissing you as not being one of the chosen. I, having the one and only very correct answer to this, will spend my life in servitude to something greater (usually very apparent, loud, and obvious servitude, lest you should miss it) and be rewarded with the privilege of Heaven, because I am better and you are not. Poor you, condemned to fire, brimstone, and endless congressional filibusters.

You'll notice that the people who truly live their Christian (or whatever applies) faith rarely feel the need to rub your nose in it. They'll engage you about it if need be (or want be). They'll model it if you watch them closely. But they won't announce it every thirty seconds and smack you in the head with their well-worn religious tome. They will not condemn, they will not disdain. They will love, they will try to understand, they will do their best to accept.

Humanity....we all want to be special, chosen, elite. Christians...Muslims.....hell, have you met a Jungian lately? It's part of our inherent narcissism - the key to which is always poorly structured self identity and the inability of the ego (self) to defend itself from rejection, because it feels so inherently fragile that at any conflict, even relatively minor, it will be destroyed. The Buddha, though, who was self-identified as a philosopher and not a prophet, the Buddha makes all sorts of observations about self and non-self. About how we are nothing.

I've started to come around to this idea. Because it isn't as nihilistic as one might think. My interpretation of this is, we are nothing, precisely because we are everything. There is not one of us on this earth - future, past, and present - that is not connected. As parts, we are amazing, but the sum of those parts is something so big and all encompassing and important that it is simply unfathomable. It's like, consider the fibers of flax or cotton, cleaned and combed and laid just so...spun into a thread with a tensile strength well beyond that of an individual fiber. The thread is dyed a vibrant color, and delicately, painstakingly woven into its place. When you look at the great and impressive tapestry, the individual thread may not be noticeable, but it is of tantamount importance to the design, not to mention the structure - if you pull on that one scarlet thread, the whole tapestry will be altered and may well unravel.

I am special precisely because there is nothing special about me. This is the conclusion to which I've come today. There are many things about me which are good, many less good, many that are defining and I am as unique a creature as one could imagine. But I'm part of some greater whole, and that is truly the amazing thing about me. Life, humanity, the Holy Spirit, a Higher Power...the echoes are endless. I am but a scarlet thread.

And I, too, am tired. But also feeling better about getting that down. I might read it tomorrow and disagree with it some, but you know, if that happens, it is what it is.

This is the crap that goes on in my head all the time, ps. All. The. Damn. Time. This is part of my perpetual exhaustion...

Sunday! Sunday! Sunday!

Ahhh, I do like a weekend.

Yesterday I didn't do much, frankly, which is a nice change. My knee was still sore, so Gomer and I decided it was best to reschedule to today. So mostly I sat around not doing much for a while (okay, I was reading), and then Peng and I went to a wine tasting. Which was delightful. Peng's one of a cast of regulars who, as she's been telling me for a while now, are hysterical. Certainly the rowdiest bunch of oenophiles I've met, ever. It was a very good time. With some very good wine. And then she and I went down the way to this little Italian place that had surprisingly authentic Chicago-style deep dish. A little cornmeal would've made it just about perfect. Ohh, gosh, that was a delightful find. Made me a little bit homesick again when I had the leftovers for lunch today...

All in all, it was nice - I had dinner with Ruthie on Friday when Peng was on call, and dinner with Peng last night. I like my officemates.

Oh, and the Tarheels won. Yay.

Today, I got up, spent some quality time with Mags and then Little Maxine (Sparrow was on call last night), went to the Starbucks and the Walgreens and then to the gym. Gomer and I had rescheduled for today, right? He cancelled on my this morning (things were hectic at his real job last night), and then recanted (well, maybe he wasn't feeling all that bad) and then we agreed that maybe Tuesday was better anyway (when I pointed out that I wouldn't be at all offended if he wanted to take today off after all). Which made it even funnier when I went to the gym at the same time I'd planned to go anyway and ran into him. We had a nice little chat, I went back to the elliptical and he went back to his workout, which...you know, I always suspect there's a weekly meeting where all the trainers sit around and come up with more ways for us to look stupid (seriously. Two weeks ago, about twenty minutes before he made me do sideways squats with a big heavy disc thing and then toss a medicine ball against the wall, I watched Gomer pushing another of his clients across the gym in an office chair). It's nice to know they save a little of the looking ridiculous for themselves, too.

I spent five more minutes on the elliptical today than I usually do (I'm still getting into elliptical shape - that thing is hard - and am trying to slowly push up my time and resistance), and think I figured out how I jacked up my knee last week. Well, okay, it hurt when I left the gym Thursday night, after a hard go at the treadmill and elliptical and the lifting workout that involved those sideways squat things again, and then I stepped out of bed later, and it caught, and I twisted it. But I think that I'm hyperextending it too much on the elliptical. Which I think is causing some general inflammation, but also some patellar tendonitis. Or maybe infrapatellar bursitis. I don't know, I'm a psychiatrist. Knees are a little beyond my purview these days...

Anyhow.

That five extra minutes added a good deal more stinky, but I went to the grocery store anyway. I'm sure the grocery people were thrilled. I bought the wrong sour cream and forgot like eight things, including the chicken I'd planned on making for dinner. I came home and did a shitload of dishes, some of which had gotten unacceptably gross (strangely, those were relatively new. Turns out this Spirutein stuff I've been drinking ferments really fast and then starts to grow all manner of weird stuff). I realized about halfway through that my plan to scale this giant mountain of dishes, which I washed by hand in really hot water, and then take a shower was ill-conceived about halfway through when I started running out of hot water....

Planning was not my strong suit today.

But I did manage to do all the dishes, and the laundry, and eventually I did even manage to shower. With hot water and everything. I also washed all the pieces of my espresso machine and its little accessories today, in an effort to cut back on my Starbucks consumption (we'll see how that goes....). I'd intended to make chicken and potatoes for dinner, but, see above, re: stupid grocery shopping moment, so I had a big baked potato with cheese and broccoli. Which...somewhere in there, I realized I wanted to actually bake the potato. And...I hadn't really done that in a while, so I wasn't quite sure I remembered how. Like, I usually do them on the grill or in the microwave. So I texted Peng, who knows about these things, is marrying Chef, and can locate her Joy of Cooking faster than I can (it's in a box somewhere, still). She helped me out, but in the meantime I found this website. Which cracked me up a little.

It was a yummy potato. But next time I might microwave it a little first...

Interpretation

You know those therapy sessions where things just come together, and you get to the end, and you can look back on the content and the structure of the session, and like, everything just aligns, and is so profound, and you just kind of sit back all, like, whoa, and it's so about the alliance that you end up sort of vicariously raw and exhausted, and ultimately you look at your patient and you're just, like, wow. Good work. How cool that I was here for that.

I had one of those tonight.

Except I was the patient. And I left and was sort of like, ohhhh. So THAT's what that's like on the other side of the couch.

Cool.

Also, how many years have I been in therapy, and how many therapists have I seen in the recent past, that this is the first time that's really all come together like that? Which, okay, is not entirely true - this is the first time that it's come together like that in the way that I was able to have sort of that directed awareness of the process because I'm in residency and training in psychotherapy. Which makes me wonder why anyone would be in training and not be (or at least have been) in their own therapy.

I've said it before, and I'll say it again: I really think a large part of the key to being a good therapist is having a good therapist. Because some things you just can't learn by hearing about them.

This little PIGgy

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

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

Let me tell you how my day went...

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

"Dogs out."

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

Dog's out.

My dog.

Is out.

Shit!

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

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

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

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

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

::sigh::

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

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

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

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

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

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

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

A very embarrassing story...

One morning in high school (I think it was in the morning), we were running in gym class. Now, as I think I've mentioned before, I was in fat gym in high school. Which was actually way better than being in regular gym. We got to wear what we wanted, one day a week we had classes on stuff instead of dressing out and sweating, and not once did we have to spend weeks at a time playing Ultimate Frisbee. We did more actual working out than any regular gym class. And no one was the fat kid. In fact, not everyone was really fat. But, we won't single them out (even though some of them read this blog).

So anyway. We're running in gym class. I think this was my Junior year. I had on at least one sports bra (I eventually progressed to three before the jiggling was sufficiently contained). I'm running along, talking to whomever I was running with, and my friend says something behind me. And I made a very poorly timed look over my shoulder...

...and smacked myself in the face with my boobs.

Now, naturally, the four of us involved dissolved into giggles, and my gym teacher suggested moving up to two sports bras.

I'm a little afraid of a similar incident tonight, frankly.

I'm all vamped up and ready to go to Cleo and Tony's Halloween party. And I look like the prow of a ship.

A glittery, black-lipsticked, giant-hoop-earringed prow of a ship. Wearing jeans, because I never could find the skirt I wanted, and a name tag that says, "Hello, my name is Id. How can you serve me today?"

It's all very tawdry and...um...unconscious (that was a psychiatry joke, sorry. My anxiety's up a little, here).

::whimper::

The funniest thing, I think, is that this whole costume started with a ridiculous black and pink wig that Ruthie talked me into buying. Which annoyed me so much I'm not actually wearing it.

Okay. I'm going to stop babbling and go find my boxing gloves. Wish me luck, y'all.

A post about sex, and religion

One of my friends emailed me this article today.

I've always liked the Jesuits.

So, I, myself personally, am not Catholic. Or Lutheran. Or particularly religious, for that matter, although I identify myself as Orthodox Christian. But I tend to find my spirituality much more important than organized worship, and in my own faith have learned from a lot of different traditions. And yet I went to a very religious, conservative Lutheran college, and a very religious, more liberal Jesuit medical school. Maybe it was just that the Jesuits seemed so much more realistic than the crazy fringe Lutherans we went to undergrad with (okay, they weren't all crazy, but some of them were reasonably extreme. I once witnessed an LCMS Lutheran and an ELCA Lutheran get into a fistfight over who performed the baptism sacrament most according to God's plan or something like that. I thought this was especially ridiculous, because from the Orthodox Christian perspective, you're both doing it wrong!), but I really got comfortable in that environment. We had a ministry office in the commons of the medical school, replete with priests and nuns and other ministering types, and I tell you, that was the nicest place to be on a bad day. I sang in the Gospel Choir every year on Martin Luther King Day (it was really the only time we performed, but man, you should hear this crazy white girl belt out "We shall overcome"). We celebrated Ramadan, and the Jewish holidays, and Orthodox Easter. They were such a welcoming, accepting, inclusive bunch, and that really surprised me.

We also had 12 full time chaplains on staff at the hospital, and a bevy of part timers, and they all had pagers and specialties and assigned areas of the hospital. There was a chaplain in-house, on duty, 24 hours a day. They responded to traumas, codes, and plain old requests. The medical students had to do shifts with the chaplains. I cannot tell you the impact this had on patient care, and frankly, the whole mood and mode of the hospital was influenced by the Jesuit ideals. The way we practiced was more holistic, more inclusive of families, more centered on the patient as a person.

It definitely tied our hands sometimes - i.e., one of the most heartbreaking cases I had as a med student was this woman who had a baby with anencephaly - a baby in whom the brain had not, and would not, develop. This kid's head literally stopped at its ears. These babies, obviously, cannot survive long, if at all, when disconnected from their mothers. We were a Catholic hospital, so we couldn't offer her a genetic termination. She was Catholic, so she wouldn't have done it anyway (or so she said...who knows, if we'd been able to provide it, if that would've changed things). It was absolutely heart-wrenching, to watch her go through the pregnancy, feeling her baby move, having strangers come up to her and ask when she was due, if it was a boy or a girl, did she have a name...knowing her child would be born with no chance at life. It struck me as months and months of torture, and I couldn't fathom the idea that God wouldn't understand her decision to terminate.

But that whole respect for life thing was, in general, a really positive influence on my education. I did a rotation in Child Advocacy my 4th year. I talked to my patients, their families. I did a sub-internship in the NICU, and watched the way those little lives were cared for as they walked that line between life and death, how they were respected as full human beings with resplendent potential. How they were held up in those final hours. One night, I stayed several hours after my shift was over because one of the 24 week twins I'd delivered a few days earlier (when I was doing an OB rotation) was dying. Her sister had passed the night before, and her parents were so distraught they couldn't bear to be up there once they'd made the decision to let her go. We took her off the ventilator, swaddled her tiny body in handknit cloth, and the nurses and I took turns holding her until her little heart finally stopped.

I know a lot about end of life care, and am comfortable with the inevitability of death, at least professionally. I can deliver bad news like no one's business. I think I've mentioned on here before how, at the Emerald Palace, I felt like the angel of death on my ICU month, because the team always waited until I was on call to withdraw support from our patients, because I was "so good with the families," and I was "just so much better at it." Likewise, when I was on the labor deck, I always, always took the genetic terminations. Because my cohorts would check in at the beginning of the shift, and then leave them alone until something happened. You know, "so they could have their privacy" (read: "we don't know how to deal with them, so we won't"). I, on the other hand, went in, introduced myself, asked how they were feeling, learned everybody's names in the room, asked if the baby had a name and referred to it as such if it did, and checked in every two hours like I did with my other laboring moms. Plus, delivering a significantly pre-term, dead, and often deformed fetus takes some skill - not so much technical skill, but skill at knowing how and when to do things. They're fragile, their skin is delicate, you can damage them easily. It's important to know how to collect and present the fetus so it looks like a real baby, so they can touch and hold and understand their child. It's important to understand the pain of malpresentation, even for someone so small, and how much it hurts to force an immature uterus to contract. It's important to respect the life ending and the ones being left behind. It was such a horrible, traumatic experience for most of these women anyway, that a cold, impersonal stranger rushing in awkwardly at the last minute to deliver their child was just unacceptable to me.

Interestingly, it was my Jesuit medical school at which I also did my sex therapy training. We only treated married couples in the clinic, and we would talk about God if the patients wanted to, but beyond that there was little to brand the therapy as "Catholic" or "faith-based". But there was something there that went unsaid, this undercurrent of respect and celebration of life, union, and effort that imbued the way we taught, and interacted with, our couples. So many of them came in with taboos, misconceptions, and shame that had been imparted under a guise of "religion"; we were open, accepting, unfazed. We touted sex as a good thing and an important piece of a good Christian marriage. We taught masturbation (yes, yes we did) as a means of exploring, accepting, and learning about one's God-given body. We "preached" love, tolerance, compromise, and connection. It was a nice view.

The article above reminded me of all this. I particularly like how she holds casual sex up not as "sinful" and in a punitive light, not as a "violation of sex", but rather, a disappointment, a failure to expect enough of themselves and their partners, that they are "not asking enough" of sex. That good sex is an expression of incarnation, a celebration of our physical nature, given to us by God. Who can argue with that?

Just an interesting read, and a nice foray into musing philosophical.

(PS - Comment with reckless abandon, but, I don't want to hear about the evils of abortion or how abstinence is the only way. Go blog about that on your own space.)

Closing a door

Hey, I'm 30.

No, for real. Not in the sense of how I've been answering "thirty" to casual queries about my age for the past two years. But in the sense of, thirty years ago today, at 8:06pm (Central), I was pulled screaming from a Pfannenstiel incision in my mother's abdomen at 35+3/7 weeks.

Hmm. I miss the days when I used to use phrases like "I was born."

Yeah, no I don't.

So the thing about it is...I'm surprisingly cool with turning 30. I feel like it's kind of a landmark, actually. And kind of analogous to pregnancy, in a weird, only-in-Kate's-head kind of way...life, I think, can more or less be divided into trimesters. For the first 30 years, you develop and change a lot. There's a lot of energy expended in this. You disrupt other peoples' lives a lot, and you're fairly demanding because you just need so much to pull off what you need to accomplish.

But then you cross into that second trimester. The transition itself is relatively subtle, but hitting that 12 week, er, 30 year mark is a pretty big milestone. Because if you've made it this far, you can't be too defective. You're reasonably well differentiated. The vomiting has usually stopped. Things calm down. Everyone relaxes a little. You refine your skills, you develop yourself, and you continue growing.

Eventually you hit the third trimester. At first, there's not a lot of difference. You still have quite a bit of growing to do, but, you've come a long, long way. But eventually, you just get more and more uncomfortable. You gradually become more burdensome to others again. And then one day, you hit a point when this state of being doesn't work anymore, and it's time to move on.

For the record, I may have come into this world preterm, but I fully intend on going postdates.

Yeah, I know, these things only seem profound to me...but, oh! It's my blog!

So, Tim McGraw may have said it better. That song's been in my head a lot over the past few days, for the obvious reasons, and I've been thinking a lot about my own Next Thirty Years...and, my previous thirty years.

And what a long, strange trip it's been.

I've been thinking a lot about myself on my previous "landmark" birthdays. Who I was at 16, at 18, at 21.

My mom called me in "sick" for my 16th birthday (actually, I think she called in and said, "I'm taking Kate for her driver's test today, she won't be in"). We went to the Sec State's office (the Illinois version of the DMV), and I dutifully turned on each blinker in succession, maintained a two-second space cushion between me and the car in front of me, and backed around a corner (I don't know why that's part of the road test). The examiner was looking for a reason to fail this clearly spoiled whippersnapper who had the audacity to skip school on her birthday. But, alas, I didn't give him one. I took an awkward picture on a red background and my mom and I went out to lunch.

Wow, what that guy didn't know.

I barely remember those years. I was so miserable. I was in this deep, obsidian abyss. That was the year I got sick - mono, EBV, somatization from a soul-sucking depression, we never did figure out what was wrong with me. I slept all the time and had a mildly elevated sed rate and some lymph nodes that lit up on a gadolinium scan. I missed a year and a half of high school before all was said and done. It was just as well. I hated being at school. I hated my life. I hated the very essence of myself. I was detached, chaotic, and fractured, and consumed with self-rejection and self-loathing. I was broken and distorted. I was floating somewhere between wanting to survive and being overwhelmed with the reality of being me, of who I was and what I'd been through. And it wasn't over yet. And I knew that.

Not exactly a high point in my existence.

The night before my 21st birthday, I went bowling with some of my sorority sisters (we were in a league. I had a three-digit handicap), and Lisa bought me my last illegal drink - a fuzzy navel - at, like, 11:55pm. Because I'd promised my dad he could buy me my first legal one. And he did - an amaretto stone sour at lunch the next day. Then I drove back to college and went out with my friends. We went to my favorite Mexican(-ish) place for dinner, then the over-21 among us went to a local bar I can't remember the name of. I had a margarita at dinner and three drinks at the bar. Robin was my designated driver that night. She had about an inch of her gin and tonic and was more buzzed than I was. Kate's roommate brought me a stick (to beat off the men in the bar, she said). It was a good night.

College was a rough time as well. There was a lot of internal conflict and a not insignificant bit of external conflict and I couldn't figure out for the life of me who I was or who I was supposed to be. I had three majors, and was president of five organizations my senior year. I fell in love with a really manipulative man and ended up in a bad relationship ("relationship") I couldn't quite extricate myself from. I wanted to be a doctor, but I got pulled into my advisors' offices on two separate occasions and got the "your GPA sucks ("sucks") and you're taking your MCATs too late (because I was having my gallbladder out the day I was supposed to take them the first time). You shouldn't even apply to medical school. Have you ever considered podiatry?"

I hate feet.

But then my MCAT scores came in, and they were all like, oh....huh. Well, that's okay then. And of course I got into medical school. But I distinctly remember driving home one night my senior year...it was a crisp, cold night and there was a full, bright moon over the cornfields and I had the sunroof open and the heat on...and thinking, God, I hate my life. But I knew the end was in sight. I don't think I'd been accepted to med school yet, but, I knew I was going to graduate at the end of the year, and then I'd be somewhere else, doing something else, away from the toxic, draining people I'd somehow accumulated. Not that everyone in my life was toxic - far from it. But it only takes a few. And I had a lot.

Medical school was better. I liked my life, I still hated myself. As it turned out, I had a lot of work left to do. I still hadn't figured out who I was. I had no idea what I wanted. Things shifted; some gave. My sense of self finally started to coalesce. I started to solidify.

And then I headed off to New Hampshire. Where they pushed me until I broke completely apart.

I spent the next two years underwater, fighting a number of currents that threatened to suck me back down, but, you know...sometimes you have to fall apart in order to put the pieces back together in the right order. And so I started this process, piece by piece.

Robin told me a couple of years ago, when I was sitting on a tiny chair in her first grade classroom sorting misplaced puzzle pieces, that my dislike of puzzles surprised her, because I was such a problem solver, and besides, the smart kids always like puzzles. I have no patience for anything with more than, like, 5o pieces. I think it's because I spend so much time examining my own patterns, trying to find what fits where. I have enough almosts and not-quites; I just can't handle tiny little pieces of die-cut cardboard that somehow become a picture of kittens.

They're still not all back together. There are still a number of shards that don't seem to fit right and sometimes they slip or have to be re-broken and sometimes I get just so frustrated. But sometimes they set right in. More often, I have glue all over my fingers and slice myself open trying to put things in order. Either way, I keep working. And every day, I get a little closer to wholeness.

So, in my next thirty years...I'm going to keep going. I'm going to strive for authenticity, for excellence, for integration, balance, acceptance, and temperance. I'm going to let the pieces fit where they may and receive whatever form that turns out to be. I'm going to pay more attention to where I am instead of where I'm trying to go. I'm going to conclude that first trimester, acknowledge everything I accomplished - which is a lot -and move forward to what has yet to be.

Acceptance. That's going to be a big task, I think. Accepting myself. Accepting what comes. Accepting what is, whatever that is.

And I think I might get another tattoo...

Plutocrat

You ever get a word just stuck in your head? This is the one wedged in mine today. No, I don't know why. A plutocrat is a member of a ruling class that's determined by wealth. A plutocracy, as it were. So, I have no idea why that's rattling around in my cranium.

Seriously. I'm not the only one that has this problem, right?

I remember having a conversation with Kate when we were in college, about how she always had a song playing in her brain, and every now and then it would just revert back to a "default" song, which at the time, was that tinny little circus melody that you would know if you heard it but I can't sing it to you on a blog (and "de de de-de-de-de deet de deee de" isn't very helpful).

I was so relieved to hear that someone else did that, too.

There's always a song in my head. Always. I have this weird sort of multi-channel brain...and apparently one is a music channel. Sometimes a particular song is there for obvious reasons. Sometimes I have no earthly idea why it's there. Sometimes I don't even know what the hell song it is - I occasionally just have a phrase or a vague melodic idea. Mostly, though, it's a verse or a stanza.

I know. It's weird up in my head. You don't have to tell me that, I live here.

At the moment I have this line playing in my head:

My day's filled with mistakes, some that I didn't make, I carry them around.

It's from a song called 10,000 Stones by a woman named Adrianne, apparently. This one at least makes sense - it was playing in the background of the episode of One Tree Hill I was just watching. The first line - that line - caught my attention. You know how I'm a sucker for really good lyrics. I also like the chorus:

10,000 stones hanging deep in my heart
No, I don't know how they don't tear me apart
How could I ever believe
10,000 stones would build the best of me?

I identify with that. I think it's kind of profound.

(Claudia's out there rolling her eyes at me. She may not be the only one. Hey, profound is an individual thing, you know?)

Anyway.

I also feel the need to point out that I don't actually watch One Tree Hill very often. Or, okay, this is the first time I've watched it. Because I was reminded last week that it's filmed in the coastal town where I spend my Thursdays. Which, dude, it really is! That's kind of cool.

Is it wrong of me, by the way, that I'm kind of hoping TS Fay will spin up this way before Thursday morning and ground my plane? I like going coastal, and I think I'm not going for something like the next three weeks because of the call schedule, but I also could just really use a real day off.

I'm so very post-call, by the way. In case you missed that. Not that I didn't sleep last night (Peng rocks). But, well, I did sleep on the floor of our office. While trying not to sleep through any pages this time. And then there was Ed the Drunk Guy who's been calling the crisis pager all weekend, who somehow also got through to me, who wept and told me how much he trusted all of us and told me at least six times that his dad had cancer and his sister had a double mastectomy or that his sister had cancer and his dad had a double mastectomy or something, I wasn't really listening. Not that I didn't feel bad for the guy, but you know what? You can only listen to some old drunk guy for so long before he just totally stops making sense.

Today was a day with so much potential...see above re: full night of sleep. I left the hospital, ignored the parking ticket I got for leaving my car in a lot that's open on the weekends but apparently wasn't this morning, got gas, went to Starbucks, went to the Whole Foods, spent a ridiculous amount of money, had a little moment of "What the hell did I buy, diamond crusted strawberries???", came home, and was thinking about getting a move on my day when Mike called wanting to park in my driveway (he, also, gave up his parking privileges this year. He has scooter plans; I have walk/bike plans. Sparrow never has paid to park at the hospital). So I had to chat with him, and then I had to rescue Maxine (who, later, dug her way under the gate and escaped from our yard, a-HEM), and then...well...then I just kind of ran out of oomph. I spent most of the rest of the day lying on my bed reading. Or watching TV. Or out retrieving Maxine. I did manage to get the groceries put away, at least, and get the fruit washed. And I made pasta for dinner, which I promptly dumped into the sink when I was trying to strain it. So then I went out and got some dinner....

Anyway.

I should really go to bed....

Looseness of association

The windows of my soul
Are made of one-way glass
Don't bother looking into my eyes
If there's something you want to know, just ask

I have this verse stuck in my head. Which is better than what I had in my head previously, which was the theme song from the Stanley Steamer commercial. Anyway, it's from an Ani DiFranco song called Willing to Fight, which, I think has some of the best lyrics ever penned. In fact, here they are:

The windows of my soul
Are made of one-way glass
Don't bother looking into my eyes
If there's something you want to know, just ask

I got a dead bold stroll
Where I'm going is clear
I'm not gonna wait for you to wonder
I'll just tell you why I'm here
'Cause I know the biggest crime
Is just to throw up your hands
Say, "This has nothing to do with me
I just want to live as comfortably as I can."
You gotta look outside your eyes
You gotta think outside your brain
You gotta walk outside your life
To where the neighborhood changes

Tell me, who is your boogeyman
That's who I will be
You don't have to like me for who I am
But we'll see what you're made of by what you make of me

I think it's absurd
That you think I am the derelict daughter
I fight fire with words
Words are hotter than flames
Words are wetter than water

I got friends all over this country
I got friends in other countries, too
I got friends I haven't met yet
I got friends I never knew
I got lovers whose eyes I've only seen at a glance
I got strangers for great grandchildren
I got strangers for ancestors

I was a long time coming
I'll be a long time gone
You've got your whole life to do something
And that's not very long
Why don't you give me a call
When you are willing to fight
For what you think is real
For what you think is right

I don't know why this is so firmly lodged in my psyche right now, but it seems significant (certainly more so than the carpet cleaning jingle). It started because I was thinking about Facebook, and that little "status" line at the top. I was doing the dishes and thinking of things I could change my status to.

Kate...

....inexplicably has the Stanley Steamer jingle stuck in her head.

....thinks that's particularly weird because she has no carpet in her house.

....wishes the damn oven would preheat.

....is hungry.

....wonders if it's bad that she was so grateful that three of her patients didn't show up today.

....thinks it's funny that no one else in her residency is named Kate, but about half of her female patients are.

....wonders why she always seems to be doing dishes.

....is hyperventilating a little at the thought of, if she's forever doing dishes (and laundry!) now, and she's just one person, what the hell is going to happen if she finds some man crazy enough to marry her and/or knock her up?

....is making pizza.

....wonders if she remembers how to give a shot in the deltoid.

....thinks her dog is really funny.

....hasn't been on a bike in a really long time, but figures it's like riding a bike...

Et cetera.

And this got me to thinking about this Marmaduke comic my dad emailed me today, that centered around text messaging. Now, I think of Marmaduke as a seriously old-school comic. You know, back in the Leave it to Beaver days of big doghouses and Norman Rockwell families. Which got me to thinking about how pervasive pop culture and all these new innovations are in our lives. Like, who doesn't know what OMG or LOL means? Every grandparent has email. One of our more senior attendings sent me a message from his iPhone the other day. Little kids and homeless people have cell phones.

Not bad things. But, I keep thinking, like, if my great-grandmother suddenly woke up in the middle of all of this, what would she think about it?

So this gets me to thinking about the internet, and this blog, and Facebook and email and how I have really wonderful connections going right now with people I haven't seen in ten or fifteen years, or people I've never seen at all. Which I think is what got me to the line about "I got friends I haven't met yet/I got friends I never knew." And then I got stuck on the opening verse, because I think that one (and the one about the boogeyman, and the two lines about words are hotter than flame/words are wetter than water) has just so much interpretation and philosophy attached to it...

...yeah, there's no explaining how things work in my head.

Boxes, Pork, and other double entendres

And so I'm back at Starbucks. I got home from PorkFest at about 3am, drugged the heck out of my recently-sobered-up ass around 4 when I went to bed (because I'm on overnight call tonight, so sleeping in would actually be a huge plus), still woke up at 8:30. Damn it. And honestly? A little hungover this morning. I never get hungover. I'm also never nearly as much of a lightweight as I was last night, although, let me tell you, I was apparently quite amusing...I think it was a combination of not having really eaten all day and being pretty dehydrated from a day of fussing around the house. Oh, and possibly the shot of moonshine (no chaser - Claud, you would've been so proud).

So earlier in the day. my Aunt and I hit the place pretty hard. What we unfortunately didn't do was unpack a single damn box. But we restored a necessary order and organization. You remember the wall to wall boxes in the living room and the inaccessible office? It's better.

The front room actually has furniture in it.


You can make it all the way into the office now. Like, if you need to hook up the cable, or perhaps install a dog door.


I think I neglected to upload the corner that's piled three deep and six high with boxes of books, but, whatever....

We piled all the kitchen stuff on the dining room table, because there's no room for it to happen in the kitchen, but at least you can find the dining room furniture.


The dog continues to find places to hide, though. Can you find Waldo Maggie?


(PS - how much do I love that fireplace?)

Oh my gosh, we went over and Maggie met Sparrow's dog this morning, too. Maxine (the dog) is this tiny little bundle of adorableness. And I'm not an overwhelming fan of tiny dogs, but she's just awesome, and wow, the portability of her is a lot of fun. She and Mags seemed to do okay. Maggie might stay with them tonight while I'm on call, we'll see.


Bedroom's still tiny, but, nicely functional. Still needs screens so I can open the damn windows at night.

The Gardenias are in bloom, though. Aren't they lovely? Notice how I'm not showing you the fancy vase they're in, which is...um...a Starbucks cup...

So after a long day of rearranging what the movers left, I finally showered and put on whatever clothes I could actually locate without looking too grungy, and headed off to Mike's for PorkFest 2008.

Which was a big hit.

Around 40 people showed up, I think, and there was a wide assortment of pork-related dishes.


(Note the centerpiece. He.)

Everyone brought some take on cooked pig. There were pigs in a blanket, pigs' feet, pork tenderloin, collards with fatback, several salad-with-bacon variations, Mike's (in)famous South Georgia Super Bowl dip (still not sure what's in the stuff, but I could mainline it), Mac and Cheese with bacon (i.e., "Fancy Mac 'n' Cheese"), prosciutto with melon, some sort of potato casserole, etc, etc, etc, and a LOT of high quality barbecue.


The overflowing table.


And of course, there were the desserts. I picked up some chocolate bars with bacon in them (actually not bad), and these local cupcakes that still use lard frosting (orgasmic), and the absolute best was Mike's take on the classic Elvis sandwich, which was peanut butter, bananas, Nutella, and...well...bacon, then pan-fried like a grilled cheese. Actually quite, quite good. One of the third years and his girlfriend (who I adore, but hey, she's a chemist) made this awesome cake for one of the fourth years who just graduated and part of the point of this party was to bid him farewell.

It was red velvet cake inside.


Very reminiscent of Steel Magnolias and the scene with Tom Skerrit and Shirley MacLaine and the groom's cake. Ain't nothin' like a good piece of ass.

Hmm. That was an unintentional segue...


I don't know exactly how Mike's window got broken, but we have several very amusing pictures of him trying to fix it...

Overall a good time was had by all. Or at least by most. Sometime after all the kids went home, the moonshine (S'cuse me, corn whiskey) came out, and wow, I haven't been that drunk in a while. Which was a collective problem. Mostly for PenguinShrink, who was on call last night, when we got the brilliant idea to prank call the Crisis Pager.

Oh, poor thing. I'm not sure how exactly I got to be the one doing the calling, but we identified ourselves to the operator as Lola Manlove (which is a surprisingly common last name around here, which we'd been talking about earlier). And she gets on the line and we're all screaming - at one point Mike had the phone and was talking about how his wife wouldn't have sex with him anymore and was she commitable - no, really, folks, we get calls like this - and the whole crowd is yelling, and my pre-assigned part at this point was to stay in the background and yell "Hell, no, I ain't touchin' that itty-bitty thing anymore, you bastard!" Until Mike couldn't keep his composure any longer and handed me the phone, and of course I'm in hysterics and poor Peng was like, "Ma'am, you have to slow down, I can't understand you. You're going to have to calm down, ma'am." Which was when I finally caught my breath and was like "no, no, it's Kate." And there was this pause....and she was like...."Kate, are you drunk?" To which I could only answer..."Yes. A lot." There was another pause, and she says, "Mike has a couch, right?"

I assured her that I could contract for safety for the evening. Meanwhile Mike's in the background yelling "go ahead, try it, commit me!!"

Oh, my God, I can't even tell you how funny we thought we were.

We eventually passed around the phone and hopefully amused both her (note to self...need to call her today....) and the second year she was on call with.

This is the sort of debauchery that happens when you get a bunch of drunken psychiatrists together, my friends.

And fret not, I stayed put until I was good and sobered up, which turned out to be interesting in whole other ways, because I ended up meeting a very different set of Mike's friends (er, his friends' friends?) including one who promises he can do wonders for my hair. I'm so going after this guy because, a, he was such a gentleman and didn't even comment on the length of my roots, and two, Matthew, you know I've always got your back and am looking to find more of the Gays for you. Plus, what sane straight woman passes up a good gay hairdresser? Anyway.

So I'm caffeinated and fed now and feeling a little better. Planning on more or less taking the day off, since I have to be at State Hospital at 8 tonight for overnight call. Maybe there will be a more successful nap involved in my day. And possibly another trip to Target. Back to my routine...I love it.

Joy Sunday

No, I don't plan to make it a regular feature, but I missed Love Thursday this week, and Barb started this Rush of Joy meme, so I thought that since I finally had a few moments to sit and write (not that I shouldn't be packing/going to the grocery store/writing discharge summaries/etc/etc/etc), I'd throw in my two cents.

As you all know, it's been a particularly rough patch of late. So I thought this was a good challenge to take up. I went with Barb's original number of 15 because I wasn't sure I could think of 10, so, me being me, I decided that was a reason to aim higher. Because there are a lot of sources of joy in my life. Because I can certainly stand these days to concentrate more on the positive aspects. So...

Fifteen things that bring me joy (in no particular order):

1. Maggie's ears. They're incredibly expressive, very funny, and feel like velvet. I also adore her soft little muzzle, her curious little eyebrows, and her gentle, sweet (and surprisingly slobber-free) puppy kisses. Okay, fine, so generally, my dog melts my guarded little heart.


2. A really good, up-tempo, anthemic-y song, played loudly in my car. You know the ones. Full of energy and hope and you can't help but sing along at the top of your lungs. Or actually, even a song that may not be as adrenaline-inducing, but has really good lyrics that make me ache. And then, like, the songs of my youth (as utterly ridiculous as some of them are. I can't believe I still know all the lyrics to "Ice, Ice, Baby"). So really, lots of songs.

3. The ocean. And it sounds silly, but I'm more partial to the Atlantic than the Pacific. I love the rhythm of waves on the beach, the saline breeze, the ebb and flow of energy that comes with the tides. There's a peaceful fluidity and an expansiveness to life that you can't get anywhere else.


4. That ah-hah! moment when you finally "get it." Kind of regardless of what "it" is, whether the answer to a puzzle, the solution to a problem, or what someone is really saying to you. There's a particular rush in that moment when things click into place and suddenly make sense. You know?

5. Rain. Particularly, a good thunderstorm. I used to be terrified of thunderstorms for a while when I was an adolescent, because I lived in Chicago and thunderstorms occasionally mean tornadoes, and for a while I had this really bad phobia of the unpredictability of tornadoes. I've gotten over it, though, and a good thunderstorm is now one of my favorite things. Rain has a sort of cleansing feeling to me, and I totally love lying in bed all bundled up when there's a little chill in the air and listening to it rain. But I also love the force and tumult of a good thunderstorm. When I'm at home, they also mean that Maggie (who is still not a fan) gets extra cuddly. But, like, the last night we were at the beach for the intern retreat, and there was a tropical storm rolling in, and we sat on the deck and watched just the most impressive light show, and it was one of those storms where the thunder resonates and vibrates your very soul...it was magnificent.


6. That giddy intoxicated feeling you get when you're with good people and can be totally disinhibited and just giggle like a moron at the silliest things.

7. Getting totally engrossed in a good book, to the point that I lose all track of time or my surroundings and it's like the language of the page becomes my very way of thinking, when you're so voracious and can't hardly stand to turn the page for what happens next.

8. Birth. Wow, it's amazing. The whole process is like seeing God. But there's this particular moment when the mother's flesh yields and the baby (who's probably been on the perineum for some time, as long as everyone's tolerating it - including the doctor/midwife - just waiting, stretching, holding, almost there) slides into the world and a new life officially begins. To be witness to that is to touch a small piece of heaven, and is an incredible privilege.

9. Oh, speaking of which...my new nephew.


(Can you just smell that little baby head smell? Oh, I love that.)

And my "old" one.


And the myriad of other small people my friends have brought into the world.

10. The blatant innocence of children. You know those moments, when they're just so pure of heart. There's a reason the word is "unadulterated."

11. The heady intoxication of good yarn fumes. Wool, or alpaca in particular. Oh, man. The smell of baking bread, all warm and yeasty and comforting, is a different high than yarn fumes, but comparable.

12. Being with comfortable people. The ones you can totally be yourself with and know they'll still like you. The ones that you can just let it all hang out and let them see your really good qualities as well as the ones you're not as fond of.

13. Seeing "New Comment on your post..." in the subject line of an email. I seriously live for comments.

14. Dancing. Alone, or particularly with a group of friends at a club or a wedding or something. Where you're not trying to impress anyone, and you can just be free and open and dance like a fat white girl and it's okay.

15. The Chicago skyline at night. It's breathtaking. Why don't I have a picture of that?

All right, your turn. Click on the link above for the meme rules.

Raining on Sunday

(It's a Keith Urban song that was playing on Pandora this morning. It's one of my favorites, and seems amusingly appropriate today...)

I'm guessing that the drought in NC is over, people. Call it a hunch.

Happy Mother's day to all. Particularly to my mom (hi, Mom). And also to my "aunt" down here, who my actual mother likes to refer to as my "Southern Mom" (although I'm not sure she reads my blog). And also to Barb, Jenn (yes, you), Bei, Robin, Danielle, Gia, Lorna, Lorna's Mom, Lorna's MIL, Kate (not me), Mattie (here's hoping!), and anyone else I've forgotten to name individually. Blame my chronic sleep deprivation. You know how that goes. Also, to anyone who has a mother that they will actually admit to.

I have a whole 'nother post that I'm working on about mothers, so I'll try to keep this one short. Assuming that one turns out to be something better than more incoherent rambling.

So it's Sunday here (as I imagine it is there). Which is, as usual, far from a day of rest for Mags and me. I spent a chunk of the morning at Starbucks again, inside this time (because it's cold and rainy) trying to get some discharge summaries done, but alas, trying to summarize the hospital course on the longer-term patients I inherited from Mike is proving to be problematic, as you can expect. And apparently the d/c summaries I was writing on Psychotic (which consisted of cutting and pasting all the Daily Hospital Course notes into the Hospital Course section of the summary) aren't acceptable on child. What do you want, people? You want it fast or you want it meaningful? I guess the difference is that the outside providers actually read the ones we do on Child and Adolescent. So I still have three to do.

I then went to the grocery store, where they didn't have nearly anything I wanted but I still spent $90. You know, it's going to be one of those weeks, though. I'm on call Monday and Tuesday, Wednesday night I have some Neurology Interest group dinner to go to, and Friday I have an appointment with my shrink at 6, which usually means I'll grab something on the way home or eat at the hospital. And then I'm on overnight call Saturday. So mostly I'm not eating at home this week, without a lot of time to prepare stuff (seriously. Who wants to make tomorrow's lunch when you get home at 11pm?) which tends to mean a lot of hospital food. I'm going to try and bypass that by making chili and oatmeal or something today (not together). And I'm going to attempt to make some Paneer cheese, which I learned from PenguinShrink's boyfriend Chef, and is super easy and can be used much like tofu, except it's not tofu (which I'm finally giving up and conceding I don't especially care for). So we'll see.

Actually, I probably ought to go back out and go to Target and Whole Foods now. We'll see how much motivation I can muster, here....there's still dishes and laundry and reading to be done, too...not to mention the packing I haven't managed to start yet...

Fine, fine

So, to address the comments from the last post...

Okay, I didn't get details about the potato masher (although, Claud, I love your judicious use of legal terminology, and hey, by the way, are you EVER going to tell me about the car?? Is this my punishment for accidentally texting you in the really early of the morning?). Which is fortunate, because I got way more details than I ever wanted to know about many other things. What I do know is that she borrowed said masher from her neighbor, then returned it, and told her neighbor that she'd found "explicit ways" to use it. I mean...I just....EW! Right?! Ew! Fortunately, she was relatively certain that her neighbor was too, um, dumb to understand what she meant. Thank heavens.

And no, killing a man's cows is just way over the line. What did the cows ever do to her?

I had a very long and obnoxious day today. I barely made it out of the hospital in time to make it to my shrink, and I'm postcall, and I've been to bed late every single night this week, and so when a bunch of the crew was going out for dinner and drinks at this cute place near the hospital, I was like, welllllll..........

But oh, my God, I'm so glad I went.

So there's this great little place in Carrboro that's right on the train tracks, and it's made out of old train cars. We went in honor of the fact that Mike's mom is in town. So I met up with Mike, and his mom (who's awesome), and New Robin, and Newer Stephanie, and one of the 3rd years. And oh, we had such a good time. It was rejuvenating.

And, AND, I was supposed to be on call this weekend, but there was this whole rearrangement of the schedule, and now I'm not. Which means I can go to Ike's going-away party on Saturday now, yay! And Mags and I are going to Duke Gardens with my aunt and uncle on Sunday. The wisteria is supposed to be in bloom now. So excited.

And still really, really tired....

I don't own emotion, I rent

Ah, if only that were true.

Feeling a little better, on all fronts. Actually a little bummed that I missed the conference at this point, but less guilty that I missed it because I couldn't move without thinking my head was about to explode than if I had just chickened out and not gone. Not that this migraine wasn't in large part caused by stress, anxiety and general battiness (plus, a little pollen, I think. The crazy doesn't get all the credit), but, seriously, the wandering around in the dark this morning saying "Nono, doggie, shhh, shhhhhhhhh!" whenever the pooch made a sound, it does sort of legitimize and validate things.

Monday. Monday's going to be the really bad day, I can already tell you.

I'm for some reason very sensitive to anniversaries (probably because I don't do anticipatory anxiety very well). But this year is by far the worst, for the obvious reasons. Next year, when I'm actually a second year, and I actually got through my intern year okay, it's going to be so much better.

After I slept through most of the day, I finally watched Rent, which had been on my DVR since September. I was a little disappointed. I mean, it doesn't help that I can recite the score of the musical pretty much from "December 24th, 9pm, Eastern Standard Time" straight through to the last "No day but today." And it also doesn't help that the first time I saw it on stage the cast was phenomenal. Oh, my gosh, they were so good. I think the movie did it justice, but, eh, they broke up a lot of songs that needed to be sort of all over the place, they left out one of my favorite songs (Happy New Year), and their Maureen was a little disappointing. Now, no one could be as good as the Angel I saw on stage, so it's probably not his fault that this one wasn't quite as charismatic and engaging. And they left out some really good lines. But I do think they cleaned up the second half well. It's always been a little...mmm...floppy and not quite as together as the first half. The movie did a much better job with the second half.

Anyhow.

I'm on call tomorrow, so I should get to bed. So much for vacation.

Freaking Out Friday

So, in roughly twelve hours I'm supposed to be at this conference, right? Gosh, it seemed like such a good idea at the time. It's right down the street from the hospital, sponsored by our department, four or five nice little talks, a good lunch. And the department offered to pay for the first ten residents who wanted to go. End of my vacation. Nice idea.

Except, I didn't realize the weekend when I asked to go.

And now I'm having a relatively big panic attack at the prospect of going to this thing tomorrow.

Oh, it's totally irrational. Although it was totally escalated when I just looked at the flier and realized that it's not being held where I thought it was and I actually have no earthly idea where this place is on campus.

So, three years ago, I spent the second weekend in April at this conference. It's the one I mentioned as being the event that changed my life and ultimately led to me not taking any more shit from the man behind the curtain and leaving the Emerald Palace. I was in all sorts of trouble for going to the AAGL class, right? But I went anyway. I thought maybe I could learn something. I thought maybe I could prove myself, you know? But I just ended up in trouble. So, anyway, I went to this thing, and all morning, I'm listening to these talks, you know, and that's fine, but in the breaks I start talking to talk to the other residents who are there. And they're listening to my stories - which I'm telling because I think they're normal - and they're all like, wow, that's...that's not good. I was like....um....okay....

And then we had lunch. There were these roundtable discussions, and I had, like, my top six choices all ranked in the program, and so I was headed to, table number 3 or whatever, for, like, Pearls for Reducing Your Rate of Complications in Hysteroscopy or something like that, when, suddenly, I didn't. For reasons I still can't explain I veered to what I think was my fifth choice, named something along the lines of Teaching Yourself Laparoscopy in Residency. Where I ended up sitting at a table full of residents, with one other intern who was SOOOOOOOOOO excited about her program, and the speaker, we'll call him Tony, who used to be a program director. I spent most of the lunch with my head down trying not to cry. These people were in a whole other world than I was. Tony was all "my residents" this and "my residents" that, so protective of them, and he had been in private practice for a couple of years by then.

Later that afternoon, we had labs. I spent the first half mostly with equipment reps, using the virtual reality trainer, picking seeds out of a pepper with a hysteroscope, plucking potato and toothpick "tumors" out of a pig bladder, that sort of thing. And then I went to the other room, to work on the older trainers and the foam rubber uteri with the real doctors and the real instruments.

And I was really good.

So here I am, right, on the trainer, and Tony comes up to me, watches me for a while, corrects my posture. He's like, you're really good. What are you, third year? I said, no, remember, I'm the intern who's in trouble for being here. I was running circles around my training partner, who actually was a third year. He's like, you have great dexterity. You're a really quick learner. Wow, you've got great strategy. And then I rotated on, and the next thing I know I'm doing moderately complex maneuvers with three of the best endoscopic surgeons in the country when back home, I couldn't tie a open field square knot without getting yelled at. It was surreal.

At one point, this black woman, who was like a fourth year resident somewhere else, she and I were talking, and I said something about things getting better when I got to second year. And she says, "Well, or you'll realize that your program just sucks." Um. Well...or there's that...

And then that night, I met up with my friends from home. I was still a little stunned from the day's events. And they were all like, good God, you look like hell, what are they doing to you up there?

It was a good question.

I went back the next morning (because it was a two-day conference), and talked to this other woman, this Greek girl who was doing her residency in Boston somewhere. I talked to Tony a little more, because it turned out that he and this Greek girl had gone to the same medical school. I listened to his lecture, which was essentially the same thing he'd told us at the roundtable the day before, but, it was, again, there was that undertone of "this is what you're entitled to as a resident. Someone's required to teach you, you're entitled to learn."

It was like someone had flipped a switch that first day. It was like some of the color had come back into my grey life. I went back, and within four hours of getting home my world started collapsing. My life, my career, my sanity, it imploded four days later. I can't even begin to explain the magnitude of that decision. How far-reaching the fallout would be. I still don't even comprehend the full scope of what happened. That sounds overdramatic, but trust me, it's not even close.

And Tony, well, Tony's a whole other post. Hell, Tony's a whole other blog.

Everything changed that weekend. Because I went to some random conference.

I know it's a whole different situation now. I know that what happened needed to happen. I know I'm in a very different place living a very different life now than I was then. I know I was skidding towards that catastrophe long before I even signed up for the AAGL class, that it was just a catalyst for things that had to happen. That this is so different. Different time, different people, different situation.

But that's not how PTSD works.

I don't know if I can go tomorrow. I don't know if I can do this. I don't know that it's the worst thing ever that I don't, and if I had shelled out for the registration myself I wouldn't think twice about not going. But I didn't pay for it. Now, honestly, I don't really know that the department did, either - I mean it's their conference.

It's totally irrational and superstitious, but you know, things are going well right now. I don't know if I can run the risk of everything changing again. I'm just completely terrified of it.

Okay, you know what? I never said I wasn't crazy.

More nostalgia

Three years ago today, I was on a plane to Chicago. My aunt, my uncle, my cousin came over for dinner. I remember feeling so wiped out, and, like, not even there. I felt grey. Colorless. Numb. I pulled out the two variations on black that I'd brought for the conference and picked one. And then I lay in my bed and stared at the ceiling fan and wished I could feel something other than blackness.

Three years ago today, I still wasn't thinking of leaving my program.

Today, I woke up at half past dark and pulled on my work clothes (still, variations on black, I admit) and went to a meeting about crazy pregnant lady with the OB/G department. I discovered that I was "famous" over there as the psych resident who can check a cervix. They love me. They? Seem to think I know OB. I find this really ironic. And they gave me a cookie for coming in at quarter to early on my vacation.

I'm a sucker for a cookie and some validation.

So then I went and checked in on the unit. Talked to one of my patients, who was like "You've been gone one day and they already changed my medication for no good reason and they're screwing it up." Then I did some paperwork, and then I had my annual review with my program director.

They like me. They really like me.

It was nice. I mean, I kinda knew that, since my attending gave me a review last week and said things like "I really think you were born to do this." But it was really nice to hear. And she asked if this experience was different from the last one. She says, "I hope it's like night and day." I laughed.

It's like night and penguins.

So then I spent a while on a conference call with crazy pregnant lady's guardian and her boss. Then I went to the noon lecture/conference/support group/free lunch thingie. Then I'm finally walking out of the hospital, and the woman whose house I'm trying to rent in June calls me. So I pop on over, chat with her, meet the dog, discuss the specifics. Somewhere in there my crazy friend Rachel calls me, and she's sick, and could I pick up her antibiotics? Of course I can. And then I had to get her car out of the muddy ditch at the end of her driveway, because I'm from Chicago, and we know how to do those things.

Then I came home and decided to brush out the dog for like a half hour. Which took almost two hours, because the little girls across the way decided they wanted to help. Still got a lot of fur off, though, eventually. And then I came in, changed out of the clothes covered in dog hair, and took leftover chili over to my aunt's. We ate chili. we watched a really sweet movie (The Jane Austen Book Club. I could've sworn I'd read the book, but, maybe I never got around to it. I know I own it, because my friend Sue gave it to me). I was instantly in love with the adorable male lead. So adorable.

It was a nice day.

Meme-meme-meme-meme-meeeeeme.....

Oh, such a long, long day. I have eight patients. I managed to write one note. Oy. So I still have seven to do, and I've got a migraine, and all I really want to do is nap, and whine.

So instead, I'll do this little meme from my cousin Danielle instead.

What I was doing 10 years ago:

Hmm. I'm not sure I remember 10 minutes ago just now. Um, what was that, 1998? I was a sophomore in college. So I was taking O-chem and thinking about joining a sorority I would shut down two years later and being told I shouldn't even apply to medical school by my advisor (Had I ever thought about podiatry?) and falling in love with the asshole I'd become involved with over the coming year, and generally, hating life.

Five things on my to-do list today:
1. Actually make it to work (done)
2. Go to C/L conference (done)
3. Go to department lunch (done)
4. Go to Grand Rounds (didn't make it)
5. Write all my notes (Yeah, so I went back and finished those)

Snacks I enjoy:
1. Clementines
2. Frosted mini wheats.
3. Most things chocolate
4. Nachos
5. Cookies

Things I would do if I were a billionaire:
1. Start a foundation for survivors of sexual abuse and assault
2. Open my own multi-disciplinary treatment center somewhere down the road (you know, like after I'm board certified)
3. Buy a house on a big lot with a fence and a fireplace and hardwood floors and a nice big kitchen
4. Adopt like eight other dogs
5. Pay off all my damn debt

Five of my bad habits:
1. Not taking the best care of myself.
2. My housekeeping skill (okay, not really the lack of skills, but the lack of priority)
3. Internalizing way too many things
4. Not checking my mail very often
5. Picking at my nails, which are already flaking and bad enough
6. Not actually tagging people for memes (Consider yourself tagged)

Five places I have lived:
1. LaGrange IL
2. Aurora IL
3. Valparaiso IN
4. Lebanon NH
5. Cary NC

Not a post to read if you can't handle profanity

But then, if that's the case, you should probably be avoiding my blog altogether.

So, call. I'll tell you something....while I'm not a huge fan of the sleep deprivation, and don't get me wrong, I'm SO VERY READY for this year to be over and can't believe I still have FOUR MONTHS of it left....I kind of enjoy call at Big Hospital.

I mean, on the whole I'd rather be lounging at the beach with a tropical drink and a handsome traveling companion. But I kind of enjoy the work. I thought I'd hate it, right? The responsibility for the decision of whether someone stays or goes, all the damn paperwork, calling insurance companies and talking to other hospitals about bed availability - unlike at State Hospital, where you know they're staying, insurance isn't an issue, and the paperwork is less. And I'm not crazy about any of those things, but...I don't know. I like the diversity of it. I like the process of it. I mean, I guess what I'm saying is, I like psychiatry.

And yesterday was kind of nice, because I get along well with the second year I was paired with, and he gave me all sorts of tips for next year (primarily about what to do with my office and how to organize my clinic stuff). And I'm really starting to get excited about second year. Which is nice, considering how long it took me to even acknowledge that there was going to be a second year here (it's leftover from the Emerald Palace, where they tried to screw me about second year. One of the many, many ways they tried, and occasionally succeeded, to screw me). And he was supportive, but let me kind of do my own thing, which is a good balance.

But the unfortunate part of this job is that part of what makes me good at it is also sort of my Achilles' heel. And that's part of why training is four years or more. That's part of why I stay in therapy. That's part of why I dutifully take my Effexor every morning. And honestly, I've always been one who's in favor of pushing my own buttons and provoking things, because that's how you work through them.

That doesn't make it suck any less.

And let me say right now, the rest of this post isn't my usual lighthearted babbling. I won't be offended if you stop reading here.

Yesterday, I get called to evaluate this kid. This kid, who isn't in our system himself but whose father's therapist is one of ours and told them to bring him in, I get called to see this kid because he was caught molesting his younger brother.

Externally, I said, "yeah, okay, I'll get there as soon as I can." Internally, there was a maelstrom going on.

I totally had this kid sent up the river the moment I heard about this. I was pissed. How dare he do this, and then come to me for help, you know? Why did *I* have to deal with this? Call fucking law enforcement, nail his ass to the wall for taking advantage of a younger kid like that, slimy asshole predatory motherfucker. And of course I had warning that he was coming in before he actually got there, because of the dad's therapist, so I had plenty of time to anticipate and convict and work up a good froth. I thought about making my second year (whom we'll call Matt) go see him, which I could've done. I probably could've asked him to do it, you know, because it was sensitive and complicated, without even divulging my history, because he's good like that. And I thought about asking him outright, could you do this eval, because I was molested and the acuity of this, and him being the perp, is all just too much for me right now. I think Matt would've handled that well, and although I rarely offer up the info, in general I'm reasonably open about what's happened to me (obviously), because I don't think it's anything I should be ashamed of anymore. But I didn't. I just said, okay, I'll see him. We didn't even wait for the ER to call us, we just kept watching for his name on the ER board. And then, there it was, sooner than I'd expected. I wanted to throw up. Instead, I emailed a friend, took half an Ativan (they're prescribed. I don't usually take them with me on call, but for some reason I threw the whole bottle in my bag yesterday morning), and steeled myself against this rat bastard.

Now, obviously, this is a sensitive case (unlike, say, my patient who thought he was a bear) and I'm not going to post the details. But suffice it to say that what I discovered when I got down to the ER was more complicated than I could possibly have imagined. I expected, he was molested when he was little, now he was molesting his little brother, whatever, cry me a river. I seriously walked into that ER ready to nail his pig-fucker ass to the wall, commit him to the worst place I could find, and, to be perfectly frank, use him as a surrogate for confronting my own abuser. Two hours later I was arguing with my program director (the call attending) about why he should be allowed to go home with his family instead of admitted to the hospital. Two hours after that I was so physically angry with the people who were insisting I admit this kid without actually evaluating him, I was close to kicking something in the workroom. Two hours after that I chewed out a nurse who called me because she didn't have a private room and they usually put those kids in a private room.

Twenty-two hours after that, I still want to throw up.

Okay, "chewed out" is an extremely exaggerated view of what I said to her. But the point is, "he molested his brother" is not the whole story and is probably kind of inaccurate. And can I just say, the mom in this situation, wow. Every mom who gets a disclosure - much less whose husband catches her sons in the act like this - should be as amazing as this woman was. It was everything I could possibly do to keep from hugging the stuffing out of her.

I felt so bad for this kid. In the end I was so mad that I got forced into admitting him. I think he felt like I was punishing him for telling the truth, and even if I knew it wasn't true, and even if admitting him may well have been the best thing for him, I kind of felt like that, too, to be honest. I think he was likely the most victimized person in this whole story, when you get right down to it. And even if I wasn't necessarily successful, I tried like hell to advocate for him.

And frankly, I had a lot of trouble with that.

My shrink and I have been working a lot lately on the sort of Stockholm Syndrome piece of my symptom complex. Any my abuse was nothing like what was going on in this house. My abuser didn't just try to badger and convince and get me to consent. He coerced and threatened and manipulated and if that didn't work (and often when it did), he raped me. He beat me. He tortured me. He completely fucked with my head and left psychological scars so deep I won't ever fully know the depths of them. He took things away from me I didn't know I had, and I'll never get those back. He's tainted and soiled pretty much every piece of my life. He was a sadist, and a monster, and I can't believe he's still out there in free society. And I still have this very conflicting piece of me that feels bad for him. Because sometimes in those nights I learned part of what made him so evil. And because I am who I am, I can't help but have compassion for that. He was innocent once, too. He didn't just become a monster - someone helped make him that way.

It's not an excuse for what he did to me. Notice that compassion and forgiveness are two very different things.

This kid yesterday really activated that part of me. Like, I was sitting there looking at my patient, thinking about him when he was this kid's age and what might have happened if someone had intervened then. Would he have been different? Would I have been spared? Maybe not. I mean, it's not all about perpetuating what's been done to you. I clearly had a different reaction to his evil that he did to his abuser's. He clearly had tendencies towards violence and sadism. He became a monster. I became neurotic. He perpetuated the cycle. I push men away. I learned to subjugate my own needs. I learned to read people and preemptively meet theirs. I still fight with the negative self-esteem, the constant self-criticism, the worthlessness he left behind. He turned outward; I waged a war against my body, myself, everything I am. I still fight every damn minute with PTSD and bulimia (we'll talk about that someday, too). But while my life may often be hell, and it's in large part his fault, his life hasn't been what it should've been, either. And ultimately, I'm a survivor. He'll never be anything but a victim of his abuse.

There's something innately pitiful about that.