Counting...

I can count two posts yesterday as covering my post for today, right?

Sweet Mary Jane, am I tired.

Drove to the coast today. I have one more week of doing that, then I'm done with AHEC. Potentially forever - there's an AHEC requirement in fellowship, but I'm hoping to be at the county child abuse and maltreatment clinic, which isn't technically part of AHEC but (I'm told) should still count for my requirement.

I like my ACTT people. And they just got a new substance abuse counselor, who seems nice. Fritz is going to be their guy next year, and I think he'll do well there. They'll like him. He'll be too tall for the plane, but he's probably used to that. Fritz is a nice guy, I hope it goes well for him.

I feel like the free-range crazy chasing has fallen, for me, into a greater pattern of unrest. As my supervisor so eagerly pointed out, I've been very unsettled this year. I really, really liked the people I worked with at the ACT team (I would've switched sites mid-year if I didn't. In a heartbeat), and I really liked the work we did, but I really wish I'd had a little more consistency. And with all of the not going because of call, because I was on day float or night float, because I was sick, because the weather sucked, because I was on vacation...it made it hard to settle in. Some of that would've been better if my location were closer - i.e., there were several days I could probably made it through a day locally, but I was feeling way too sick to drive five hours or have my eardrums explode on an unpressurized plane. The weather, obviously, would've been a trivial influence instead of what turned out to be a huge one. The rest, well...that's part of the scatteredness of second year. Which, in general, I'm happy to leave behind. Because it's funny how, even though I'm scattered to all sorts of places, I'm still plenty responsible to the places I've left behind.

It's exhausting.

Monday.

So I'm at work.

After weeks and weeks and weeks of filled-to-the-rafters clinic days, I'm finally having a light day at work. I saw two patients this morning, the other two cancelled. I wrote some overdue clinic notes, and did all my little "learning modules" for next year that were due like two weeks ago. I read CNN.com. I walked to the cafeteria with Sparrow. I've been harassing Tyler over text message. I talked to my folks, who are on the road in West Virginia, currently. I've been emailing with Peng (who's at her AHEC), and just text-paged Ruthie to let her know that Dr. Jabba (who is one of my favorite attendings and mentors and who is currently on-service on the Crisis unit, where Ruthie is doing coverage this week) dropped by our office looking for her, and referred to her as "his minion." This made me giggle.

Currently my 1:00 patient, whom I talked to last week and assured me he was coming, is a half hour late (I just checked my voicemail. He cancelled like an hour ago. Just glad he didn't kill himself. That's a weird occupational hazard, to think like that...). I don't expect my 2:00 to come, my 3:00 cancelled, and my 4:00 is new to me, but was apparently fired by her old provider for missing appointments. So here's hoping. I mean, um, so we'll see if she comes. I still have a big bunch of paperwork to do, but I decided to take a break and play on the internet.

I've been trying to catch up on some of my blog reading, about which I've been very bad lately. I cracked up at Barb's post about Alternate Rating Systems. And I've been reading up on Megan's blog, on which I was really far behind. She's stuck in the hospital after a cornual ectopic pregnancy on Clomid. Which sucks.

She also, though, has been doing this x365 thing, which I find very, very cool. And as I said in her comments, if it wasn't hard enough for me to come up with one blog post a day as it is, I'd probably co-opt it myself. But I clicked on the link to the friend she referenced, and then tried to click on the "x365.org" link, and I got the big "BLOCKED SITE" error with this message:

Please discuss any blocked sites in the Global category with your Vice President or Department Chair.

Uh, yeah. I'll get right on that (although, now that I'm vice president of the Housestaff Council, I'm wondering if I can start a campaign to unblock Facebook at work). But I wondered - why the vice president, not the president?

And furthermore, apparently it blocks x365.org and Facebook, but not things like PostSecret or Dickipedia (which, is a website referencing people who are jerks, not actual penises. But it sounds a little like a porn site, doesn't it?). Because that makes sense.

Alright. More note writing. Because it's going to be a long-ass day, even if I am doing nothing, currently (left home at 7. Work. Gym. Store. Shrink at 7:15. Drive back home. Shower. Bed. Repeat). Although my commute this morning? From 25 miles away? Took me less time than my drive to Starbucks and then to work program I'd been on when I lived a mile from the hospital. I love it).

Ouch.

Everybody think encouraging thoughts for Chef. He and Peng headed out for a nice weekend in the mountains and ended up having his appendix yanked. I told him (well, I told Peng to tell him) I haven't missed mine for a minute. Still, yeowch. So, send good mojo his way.

Today was long, as Tuesdays always are. I had a much better show rate today (7/8). Two of my intake patients today were actually very enjoyable, even if one was 30 minutes late. One was a big ol' help-rejecting complainer (Fix me! Nothing you do will work!), although, I understand his frustration (I was still annoyed). My Tuesday afternoon is my psychotic disorders clinic, which is always interesting. I said goodbye to two of my patients today, as they will be following up with new residents (the current interns) the next time they come in, because next year we're only half time clinic (half time inpatient), so we have to pare down our clinics. Both are doing fine, will be delightful patients for whomever gets them, but one of them is one of my very favorite patients. He, unfortunately, may need more care than I can make available to him (I'm keeping 9 psychotic patients; they suggested we keep two or three) if circumstances advance as they might, so I'm passing him on, but, it was sort of sad. He was one of the patients that was in the NIMH trials back in the day when they decided to try psychoanalysis for psychosis. It doesn't work. But it gave him some really interesting perspectives on things, and he's a really smart guy, so he's always so interesting to talk to.

I've told a couple of my patients already that they probably won't be seeing me again. But, our psychotic clinics are smaller, and we tend to know the patients better, so this is the first time I've really been sort of sad about it. But it's the first of many of these goodbyes, since I'm only keeping 30 patients or so (ehhh...or so) next year, and then am giving those up the following year when I start fellowship.

Something about closing doors and opening windows, blah, blah, blah.

But I made it out almost in time, and headed to the gym, because I had my weekly ass-kicking scheduled. Gomer and I had rearranged this appointment, and we happened to be texting about this shortly after some annoying stuff had happened. We've been talking about pulling out the boxing equipment for a while, so I was like, "Can we hit things tonight?" And so we did. And it was good. He wiped the floor with me (actually, he made me stop after about 20 minutes when I couldn't especially breathe...), but I loved every damn minute of it. And I didn't even barf on him. And I did another 30 minutes on the treadmill afterwards.

I'm always the girl who fixes things, you know? Keeps her shit together and takes care of everyone else. I never get mad. I get incensed, but mostly about things that happen to people I care about, you know? And so even in this small, controlled, removed sort of way, being able to be a bit more forceful was really cathartic. And believe me, I've got plenty of untapped latent aggression yet to be liberated...

But then again, I'm a shrink. It's always either about sex or aggression with us, isn't it?

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.

Hungry

So here's my call story for the evening...it's been a rough day, actually; we've been crazy busy and I got a whole pile of bullshit consults, including one on OB to evaluate a woman for postpartum psychosis, which it turned out she did not have an in fact her only problem was that she was KOREAN and thus spoke KOREAN. Not English. So, you know, they didn't explain anything to her and then decided she was freaking out and psychotic when she was running around with blood on her arm (she pulled out her IV) babbling in...wait for it...Korean. I also had a patient try to leave the hospital (he almost made it) when I came by to tell him that I was trying NOT to commit him.

But anyway.

So, Guido, my intern, and I decide we're hungry and we're going to order dinner. And there's this great service around here that, you order online from one of like twenty restaurants in the area, and they pick it up and bring it to you. For a fee, of course, but you can pay with your hospital meal credit that we get for taking call and let me tell you, it rocks. Okay. So Guido and I order around 7. Usually it takes around an hour, so when dinner wasn't here by 8:30 I called them. And the kid that answered was like, wow, yeah, sorry, we're really backed up tonight, some stuff happened, lemme call the driver, blah, blah, blah. So she shows up about half an hour later, looking frazzled, and we tip her in quarters (neither of us had real cash, but, college kids like quarters, right?) and get our dinner and we are happy campers. Well, at least we've stopped being hungry.

But shortly after that, I get called to evaluate this college kid in the ER, right, who's complaining of "confusion" (as I was telling the kids story to my attending, he stops me and says, "Wait. She's a pothead, right? She sounds like a pothead." That...well, really says it all). And it turns out that what prompted this kid to come in was, she went to work tonight - guess where - and "kind of forgot I was supposed to be at work." Which ultimately translated into this: she went to pick up an order, then promptly went home and ate it. Her boyfriend walks into the kitchen and is like, wait, why are you home, and what are you eating?

Fortunately, it turns out that it wasn't, in fact, our dinner that she was eating.

Sweet kid. Really delightful family. Needs to cut back on the weed.....

Patience

So one of my patients dropped out of therapy today. It happens - it's not always the right time for the work that we do, you know? You've got to be in the right place, the timing has to be good, or you're working uphill. In the wind. It just is what it is. Kind of a shame, because I liked working with her, but, c'est la vie. See above, re: uphill in the wind.

But, in parting, in discussing the work that we'd done, she reminded me of a stanza from this song:



I was locked into being my mother's daughter
I was just eating bread and water, thinking nothing ever changes
And I was shocked to see the mistakes of each generation
Would just fade like a radio station
When you drive out of range.

I think it's a good point. Never fully the answer, but...a good point nonetheless.

And now stuck in my head.

(I'm also a little partial because this is one of my favorite Ani songs. I've long thought that this was a good point. Good choice, patient.)

Luck o' the Irish

Ohhh, it was a day full of angst, badness, and stress. Which was made infinitely better when Sparrow handed me a glass full of homemade Sangria tonight (it's not very Irish, but she makes the BEST).

So in honor of everyone being Irish today, I give you the following. Enjoy.



(And PS - xronia polla, Mom!)
(PPS - No, Danielle, it isn't really my Mom's name day - I address this to you because I'm guessing you're the only one who's going to get that the above phrase wasn't a typo... - my great-Aunt, however, declared that it must be, and so used to send her a card every year on St. Patty's. We miss her...)

Anxiety

So Claudia's back in the Chi, but we had a very nice visit (thanks, hon!). We spent her last day here making one more essential stop on the Culinary Tour of the Triangle - it was the abbreviated version, but, it was a good tour. We ate at Top of the Hill, Town Hall Grill, Weathervane, Spartacus, PF Changs (it was in a pinch, but we were able to maintain our streak of dining al fresco), my aunt and uncle's (the best place around, IMHO), and today? Bojangles. A Southern institution.

I met with Gomer this morning, came home, showered, and Claud and I headed out to the Boj. We then went into Chapel Hill to try and find this cupcake bakery my aunt had raved about, which was? Of course? Closed. So we ended up at the Cold Stone (mmm), but still got to sit outside on some picnic benches and enjoy the completely gorgeous day. We came home, and she packed, and then we decided we did indeed have enough time to move the furniture from my room into the other bedroom and vice versa, or at least get a good start on it, which we did. And then I dropped her at the airport, and headed about an hour west to pick up the suit jacket in my size at the store that had it. Because, y'all, I have my fellowship interview tomorrow.

I know, I know. I just found out about it Friday. The whole damn thing makes me even more anxious than I can say, and in fact, I'm making the conscious decision to stop discussing why (which, I've been whining to Peng and Claudia and my mom for a week) until after the interview is over tomorrow. So, Thursday. It's my last day of this abbreviated vacation, and the only scheduled thing I have is a 10:30 with Gomer. So, Thursday? Good post. Promise.

Meanwhile...I have a fabulous new suit. Great new heels (Danskos. Doesn't it figure?). Pretty new jewelry, including a watch, which is something I almost never wear. And a kickass new pocketbook. I have hose. I have makeup. I have...um...chutzpa. And I'll have a mocha in the morning. This interview day will go just fine, of course.

Still.....::whimper::.....

Revision

Okay, let me start today's post by saying, the sink was NOT Maggie's fault. I just thought the look on her face sort of said it all...

So yesterday, I got a few things done, I dyed my hair (ahhh, I'm a redhead again...), got out of the shower, set something very dramatic like my hairbrush on the sink, and it fell off the wall again. Which, it's done before, but I caught it, put it back up. This time, I noticed that the U-bend had cracked, but, I put it back up on the wall and it seemed to align very nicely. So, okay, I thought, I'll call the landlord later, and I wandered off to the kitchen (where the laundry is).

Maggie, for the record, was snoozing in her chair in the living room.

Shortly thereafter, there was a giant crash. And Maggie rocketed from the living room to my room, to hide on my bed. I, on the other hand, commenced to swearing. Because, of course, now there was nasty, moldy, sulfur-y water coming out of the drain and leaking all over my bathroom floor. And the sink was on the floor. Oh, here - a recreation, since I had to take the sink out of the bathtub so I could shower tonight...

And then last night - it snowed in North Carolina. Again. All over my daffodils.

Ohhh, but it was beautiful this morning. I wish I'd thought to take my camera. Mike may have gotten some (he thought to bring his, and he has a much better camera than I do), which I'll attempt to steal from him. I did manage to snap this one of my car, with my phone:

That was some 9 or 10 hours after I parked in the garage...it was cold in NC today, yo!

Only one of my patients showed up (out of 9 I had scheduled). And, after getting there at 6:45, I discovered around 8:30 that we were on a 2 hour delay. So, I didn't have to be there until 10. Fab.

Sparrow gave me the wonderful idea of calling all my afternoon patients to see if they were planning to come, and of course, only the 1pm was. So I managed to leave around 3:30 (after a conversation with Sparrow in which she was like, go! Go to the gym! Which was exactly what I'd wanted her to say when I walked in there and was like, but they said they might close early, and it's already 3:30, and my tummy still kind of hurts, and, and, and....) and went to the gym, and as I was dumping stuff in my locker to go work out, I realized...I'd just shut my locker - locked, of course - with both the keys to my lock inside.

Damn it.

So I went and worked out, and then went and got the bolt cutters from the guys at the desk and cut my lock off. And then discovered that the locker wouldn't open anyway. So then I went and got a screwdriver, and that eventually opened it.

Thanks, Sparrow. Going to the gym was a great idea.

(No, not blaming her any more than I am Maggie. I actually did have a good workout...and, after all, I went in there with the express purpose of getting her to tell me to go...)

And then, of course, I came home, and found both garbage strewn all over (I DO blame Maggie for that one) and my sink still sitting in the bathtub. My landlord's response? With the snow and all? He forgot. Meanwhile, I have a SINK IN MY BATHTUB. He swears he'll get it fixed tomorrow, and I believe him.

Oh, but, the best part of today? Tomorrow, clinic's not opening until 10.

And Maggie's wagging her tail in her sleep, which I think is about the sweetest thing I've ever seen...

Little Red Choo-choo

Hawkeye: Tell me something, Sydney, has my little red choo-choo gone chugging around the bend?
Sydney: You just can't resist tossing around that psychoanalytical jargon, can you?

Have I mentioned that my absolute favorite psychiatrist ever isn't Freud, Klein, Jung, or Kernberg, but in fact Dr. Sydney Freedman from M*A*S*H? (I'm not quite sure what that says about me, but...) And I think one of my favorite episodes is one entitled Dear Sigmund, in which Dr. Freedman makes a visit and ultimately divulges that he lost a patient and is needing some reinforcement from the 4077 crew.

I don't think I ever realized just how hard it is to be the therapist. Y'all, it's exhausting.

Yesterday was a rough, rough day. In fact, it's been a bad week. I haven't been feeling well, and I've had some really difficult patient stuff going on. Which got acutely worse yesterday, really bad, really fast. I'm going to leave it at that for now, because I'm not sure how much I can safely discuss without breaching, well, something (ethics, confidentiality, etc, etc, etc), but, well, no, I'll leave it at this, actually: we often joke about how what most of our kids (and some of our adults) really need is a "parent-ectomy." But when that actually happens, it's never a good thing.

Oy.

Today, however, has been better. Because she's a goddess, Cleo both noticed I was circling the drain yesterday and offered to swap today's call. And I feel somewhat better than I did this morning. Still a little achey and bleh, but dinner is sitting fairly well. And I tried to be reasonably productive, which, I managed - I got all of my notes up to date some of which were (I'm ashamed to admit this) four months delinquent. Which, my therapy notes always end up being low priority because they don't actually say anything, because anyone in the hospital can access them, and frankly I don't think it's any of Cardiology's business what goes on in our therapy sessions. Anyhow, I'm totally up to date now. And I did a little bit of laundry, and flipped my mattress, and got caught up on some of the blogs I read. And, like I said, I'm less queasy than I started the day, so...we'll see how tomorrow goes. More laundry, some reading, a little grocery shopping, and hopefully a nice nap. I might even try to get to the gym, which I haven't been able to do since Monday...

The end of today

Seriously. Is today over? Because I am so. very. DONE.

It started out poorly. I'd originally decided today was my very first day to get up at 5am and go to the gym. But, I went Saturday and Sunday, and my calves were just so sore (yet another part of the ankle-shin-calf-back issues I've been having all year. You know, I remember my friend in med school telling me that once he turned 29 - he was 29 at the time - his whole body fell apart. I...um...no, please) that I was like, well, maybe I'll actually LISTEN to my body and take today to recover. So then I decided to get up at 6. Which...5 would not have gone well at all, but 6 didn't go so hot, either. I didn't want to be awake. I didn't want to get out of my nice warm bed. Silly Naked Puppy was all snuggly and puppy-eyed and sad that I was getting up to go to work this morning. I was cranky. I was sore. I was not wanting to be cold. The alarm on the Treo was going off in the living room.

I would've given a king's ransom to cancel my clinic today, stay under my covers, and nap with my doggie. But, no, like a responsible adult, I dragged my ass out of bed, and showered, and bundled up, and went to work. And sometime overnight it got COLD in NC, y'all (I knew, the minute I shaved the dog...). So by the time I walked my asthmatic self from the parking garage I was squeaking. And then....you know...

Oh, what I would've given for one no-show today. But no. All eight showed up. All eight were crazy. Ohhhh, man, it was a rough, rough day. Which ended with my last patient (who started on time, of course, because I'm obsessive like that), with whom I finished a good forty minutes after his appointment was over (oy...), and then I blusteredly threw all my papers down on my desk (you know, the one I just managed to get cleaned off today on my lunch break) and got the hell out of Dodge.

It was an awful, awful, stressful day.

But I got home. I made veggie pizza (have I mentioned my idea about going vegan? I'm pretty sure cheese isn't on the vegan plan, but gosh it's good. I'm figuring something more along the line of increasing my veggies and decreasing my meat and dairy most of the time, but not all the way...i.e., I have plans for a nice burger tomorrow between the gym and class...ooh, and if I go to Evos - the organic healthy fast food place? Maybe a milkshake...) and had a long chat with my mom, and now I feel better. Although, tired. And I have a 7am therapy patient, AND I have to dig out my desk before that, because, dude, my morning is jam-packed and likely to suck. Fortunately, my afternoon looks hopeful for an early escape (hence gym and dinner...).

Oh, and, for the record, Maggie has been nonplussed by the cold, but she does have a coat if need be. She's very stunning in her smart red flannel coat (there'll be pictures, I promise).

TGIF

Wow. I can't even tell you how glad I am that this week is over...

My agenda for this weekend looks mostly like this: sleep in. Brunch tomorrow with one of my med student friends. Go in to work and spend several hours getting caught up on notes. Nap. Snuggle the dog. Maybe go to my social worker friend's Booty-Shakin' 40th Bday part tomorrow night. Sleep in. Do stuff. Snuggle the dog. Nap.

It's my favorite kind of weekend, frankly...

Call Girl

(Notice that I don't yet make anywhere near enough to refer to myself as a high-priced call girl...)

So I'm on call. Again. So far it's been busy, and Mikaela and I were hopping. But Cleo just came on - she's night float - and she's all fresh and perky and pleasant, and well, hell - I'm still pretty travel weary. She can handle things for a while whilst I nap...

Apparently, though, I've got quite the mojo working for me today. My lone afternoon clinic patient (I got SLAMMED this morning in intake clinic, but only one of my psychotic folks decided to show up this afternoon) told me I was pretty and asked if I was married. Well, no, he asked, "You're married, right?" I gave a non-committal "uhh", which, you know, he could interpret as he wished. He then asked me what my husband's name was.

I told him "Mister."

This evening, I got called to evaluate this 89 year old woman, whom I talked to for some time, and then as I was getting ready to leave, she remarked, "Wow, you've got really great boobs." I promptly then ordered a CT of her head (the two weren't related).

I also admitted a kid, who - 5 years old - intentionally broke her baby brother's arm. I went up to do the physical, she looks like just the sweetest little cherub. Later tonight I got called for an order to lock her bathroom door because she kept sticking her head in the toilet.

It's weird out there, y'all....

(PS - only 16 second year calls left to go...)

Kate and the terrible, horrible, no good, very bad day

(With apologies to Alexander)

Oy.

So, I started out today thinking, great. I've been on walk-ins all week, today should be shorter, I get to see my own patients, it should be a nice time. Here is how I expected my day to go...

-Starbucks
-Get to work around 7:30
-Lecture
-Patient 1 - difficult, probably fragile, teetering
-Patient 2 - fine but cranky
-Interview
-Conference
-Patient 3 - casual, placid, pleasant
-Patient 4 - annoying but manageable, quick
-Patient 5 - ten minutes late, enjoyable, stable

Leave by 4:30-ish. Easy, low-key, early day - woo-hoo!

Here's how my actual day turned out....

-Starbucks
-Get to work at 7:30
-Lecture
-Patient 1 - remarkably stable, doing pretty well. Yay.
-Patient 2 - sobbing, messy, suicidal. Spent half the session trying to coerce her to be admitted. Finally won...well, sort of.
-Interview - nice enough kids today.
-Conference -again, pleasant enough.
-Patient 3 - Like friggin' pulling teeth. Come on, man, you've got to work with me a little. Give me SOMEthing (I nearly fell asleep in this session. It was bad, y'all).
-Patient 4 - Oh, my freakin'...trying to break things. Needs to be admitted. Starts having chest pain. Gets a personal Dr. Kate escort to the emergency room...who, um, realized while alone in the elevator with him that she probably should've called security to do that...
-Patient 5 - fifteen minutes late, enjoyable, a little nutty
-Go back, check voice mail, hear this: "Doc, my husband left me last night, I'm completely distraught, I just don't want to live anymore!!"
-Leave at 6:45 pm. With three notes left to write when I got home.

Bleh.

In good news, though, Peng and Chef have set a date. And - I get to be in the wedding! Whee!! I'm so honored. I almost cried. Differently than all the other times I almost cried today.

Ohhhh, so glad it's finally the weekend. And it should be a nice one - busy, but nice. Tomorrow I've got a charity thing I'm working in the morning, and then Mike is having a tree trimming party in the evening. Hopefully next week will be a little calmer (but...you know....it won't).

Happy Holidays, folks. Ho freakin' ho ho.

Guess it rained today....

This was my first clue...

Okay, that's not true. My first clue was when I walked in (having been at the hospital well over 12 hours, grrr) and the whole house smelled like wet dog.

(There was some paper shredding that went on today, too, as you can tell from the picture...)

So then after dinner I walked into my bedroom and found a matching set of paw prints on the sheets. So, we had to change the sheets. Which meant I had to shoo the dog off the bed...the dog who wasn't happy about that. And then decided she was in trouble. So she couldn't quite understand why I was upset when she leaped back on the bed before I'd even finished tucking all the corners in.

Then, because I'm as silly as my dog is, I threw the comforter on top of her. This is about two minutes later...

Goofball.

Man, she's lucky she's so cute.

In other news, what the hell is going on in Illinois?! I mean, we all knew Blago was corrupt as hell (even by Chicago standards), but...what sort of narcissist do you have to be to sell a senate seat when you know that the phone is tapped?? Dude.

Walk in clinic kind of kicked my ass today. But two down, two to go....

Cycles

Ohh, I'm so glad this week is over. Actually, the week itself wasn't so dramatic (I was home sick Wednesday and Thursday, after all), but, I'm just so glad it's the weekend.

I need some vacation time. Fortunately, I have a week coming up, but I'm not anticipating that to be very relaxing, since I'm going back to Chicago (the week of New Years, for those who might have a vested interest in that). Good, of course, just kind of frenetic.

The coming week is going to be...um, let's go with...interesting. I'm on Walk-Ins Monday through Thursday (there's a long involved story about why Ed and I switched Fridays...so I have four days this week and one day next week, and then I'm on call twice the week of Christmas...). Walk-Ins refers to the Walk-In clinic, which is just what it sounds like - ideally, an urgent care clinic (I need my meds today because I'm about to run out. I'm going to kill myself. I'm going to kill someone, possibly me, if we don't get this depression treated quickly. You get the idea). You also cover the ER during the day. So it's like daytime call. Or as I tend to refer to it, Day Float.

What's nice is that it's 8:30-5. You plan accordingly and you sign out to the incoming call team at 4:30. Done. What's...um, let's go with...interesting about it is that we have this group of social workers and psych NPs and such that's supposed to be doing all this with us. They're part of the "crisis team" and are salaried to do Day Float things. This sounds great in theory, right, because in theory it would free up the physician (there's only one) to do doctor-y kinds of things. You know, stuff clinical social workers can't do (meds) or aren't really trained to deal with (complicating/complicated medical issues, physicals, orders, etc). Problem is, our crisis team tends to be...um, let's go with...inefficient. They're nice people, just sort of...unmotivated. With a different work ethic than residents tend to have. And rather than firing their asses encouraging efficiency (it doesn't have to be the threat of unemployment that's used to motivate them. How about praise? Incentives? A higher standard and expectation?), they're coddled and stroked because we don't want them to leave.

The residents this year have all been like, so let them leave. They either need to get moving, or get out of the way. We...you know, we're a hard-working bunch. We'll get in there shoulder to shoulder and fight through the roughest of shifts. And, fine, so residents in general are more used to hard work and long hours, we're sort of a masochistic group anyway, etc, but, damn it, if we're in there hip-deep, we expect the people who are paid a heck of a lot more than us to do this very job to be in there with us.

We'll see how it goes. There's a new guy, Charlie, who seems promising. We hired him away from one of the community hospitals, and every time I've worked with him on call he seems to be busting his ass. He's been doing this for a number of years, so I don't think he's going to burn out, and he doesn't seem like the type to be lazy just because everyone else is and he can get away with it, so, maybe the rest of the crew will have to step up to keep from looking bad.

A girl can hope...

I went to this talk this morning for the PECC (more about that in a minute), and the speaker was talking about what he referred to as The Lead Rule - do unto others as others have done unto you. It's so simple and obvious (and sardonic), but damn if that doesn't sum up a lot of issues in medical education. We get into these ruts of "this is how it's been" and "if I had to do it, so do you." This is particularly rampant in the surgical disciplines, but, I think it's pervasive. And I think it occasionally translates into, if no one else has to do it, why should I?

Sometimes? Life kind of stinks. Sometimes you have to do things because it's the right thing to do, or they have to get done, or whatever, even if they're unpleasant or tedious or not what you'd rather be doing. But, if we ALL do this, then it tends to mean less unpleasantness for everyone.

Amazing how many people look at that and say, well, too bad. You can take my share of the unpleasantness. I'm going to go over here...

Also at this talk this morning, I met up with one of my colleagues who told me some disappointing things about our current chief class and how unhelpful and minimally mediocre they've been for the intern class. This upsets me. Because, last year? Our chiefs rocked. They weren't always perfect, but, they always made an effort. And we were all interns once. And it sucked, but we got through it, and that support made it so much easier. This year? You know, I think the thing that bothers me most is that their attitude is contagious. Like, I've always jumped in when someone was sick. I took on May's work when she was ill when we were on together at State Hospital. I took calls for Cleo and Fang on less than 12 hours' notice (about three hours, in Fang's case). I dug in and took on some of Mike's work when he was overwhelmed or had a bad night on Family. I was q2 for a week when Peng had dental surgery. You get the idea. We help each other out, you know? Two weeks ago, when I had a 102 temp and needed my call covered? It was next to impossible to find someone to step up (Sparrow = goddess. Have I mentioned that? JD also rocks) and Ruthie said there was a lot of "fighting" about who was going to take it. I just sort of shook my head at this, because I think it's spilled over from the "I don't want to do more than I have to" attitude that's at the top of our pyramid right now. I think the next three chief classes look promising, though. And you know...as much as I rant about things sometimes....

Holy freakin' cow am I glad I'm here.

Yesterday was an interview day. We had I think seven candidates, all in their smart black suits, all on their best behavior. It's cute. They seemed like a nice bunch (one of them reads my blog! How cool is that?!! Hi, D!!). In general, this year, I've been so pleased with the candidates. Anyway, they'd assembled in Corrina's office and got escorted off to lunch, leaving Peng and me and a couple of the other residents to talk about them, er, discuss recruitment. And we were like, I hope they realize we're all pretty much as we seem, here. We get along. We're a quirky but genuine group of overall good people. The interns lost their tiny little office space? A bunch of us stepped up and procured for them what I now like to call the Intern Rec Room. The Child/Adolescent month was too scattered, we got it changed to being just Adolescent. The faculty supports us, the chair is very interested in how we think things are running, and overwhelmingly people are interested in teaching, learning, and being colleagues. We like each other. We respect each other. I can't even express how important that is.

This time of year always leaves me a little retraumatized nostalgic about life at the Emerald Palace. I remember talking to one of the candidates that would eventually become one of the interns in the class after mine, whom I liked a great deal. I remember thinking I should tell her to run screaming (RUN. RIGHT NOW. AS FAST AS YOU BLOODY CAN. RIGHT. NOW), but what I told her was, intern year is a hard year. The dynamics here are difficult sometimes, and you have to watch out for yourself, but if you know that coming in, I suppose it's easier to handle ("But, gosh, the program has so many positives, too." Like...uh...the way our labor deck is set up. And the cool robotic system in the OR. And, uh, the scrubs are free. And working at Student Health (not here). And the off service months (not here). And the ER attendings (not ours)...). Yesterday, I'm interviewing this guy (I got to interview! It was fun), and I was like, you know...intern year is a hard year. Harder here that most places, but gosh, you learn so much. You come out of it so much stronger in your professional sense of self. And the faculty is supportive, and the upper classes are supportive, and people are genuinely interested in you here. And we're social, and we have fun, and we work hard but we're encouraged to get the hell out of here and be well rounded people. And yeah, not everything works perfectly, or even as well as we'd like it to. But even when there's nothing that can be done about that, they hear us.

He asked me if I was happy. I said, without a second thought, "I love it here." And I meant it. And then he commented on what a good research program we are, and I thought about that for a little while, and he said, all nervous, "Well, you may not agree with that, I guess." And I said, no...actually, I do agree with that. But don't think we're just about research...and then we had a nice discussion of how we're very patient centered and we emphasize psychotherapy and how many opportunities we have here.

The Emerald Palace taught me a lot. In my time there, and in the subsequent cleanup, I've learned a lot about myself. I learned a lot about interpersonal dynamics and group psychopathology and systems errors. I learned a lot from them about what I don't want, and a little about what I do. I learned what it means to be "the doctor" - the program might have rarely let me be that person, but my patients did in spades. I even learned how to do a colposcopy and run the cool robotic system in the OR and do a wicked good circumcision. But the best thing they did for me? They got me here.

I wish I was the kind of person that could thank them for that. I'm still going to go with, "Fuck you."

Dear little white cells of mine -

Listen, if you could step it up in there, that'd be great. Because frankly, I've had enough of this.

I'm so done with being sick.

I think I have bronchitis. I made Peng listen to my lungs today at work. And then emailed my doctor, "Peng says my lungs are clear. She's a real doctor and everything."

And then Peng declared that I need to quit dying, dammit. And, as she noted, since she said "dammit" I have to obey.

Then again, as Matt was quick to point out (helpful man that he is), physical exam alone will miss a pneumonia 50% 0f the time.

Matt also looked through my clinic files today and declared that he does think I'm more anal than he is. And let me tell you, my friends, that is a high-set bar. He then mocked my lung-hocking cough. So I punched him in the arm. So then he pulled my pigtails.

No, wait, that was second grade...that was something else entirely...

Meanwhile, Ruthie was running around the office today in a tizzy. She was behind in clinic, she was on call tonight, it was a day of chaos for her. I felt bad. Apparently not bad enough, though, to not point out her inefficient habits when she complained about clinic running late (I wasn't as blunt as all that, and in fact, was pointing out that she needs to hold her boundaries and respect her own needs over those of the clinic, the patients who show up forty minutes late and are super demanding, our supervisors who are also making demands, her office mates who label her compulsive need for completeness as "inefficiency"....). But then, I always was a bitch.

Heh. I love how our patients think we're all "normal" and shit...

So I rescheduled my day tomorrow and am staying in bed and mainlining orange juice and trying for the life of me to stop being sick (dammit). So maybe I'll have something less stream of consciousness and more insightful to say then. Meanwhile, I'm going to bed.

Oh, but, my dad's knee culture didn't grow anything, so they're probably throwing him out tomorrow after PT. No surgery, no antibiotics, but with closer ortho follow up. So that's a good thing.

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....

Admitting defeat

Damn stupid virus.

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

Ah, it was a good plan...

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

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

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

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

How was I supposed to know?

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

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

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

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

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

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

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

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

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

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

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

Ahem.

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

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

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

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

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

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

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

"Your son is looking at porn on the internet!"

"That's nice, honey. G'night."

(which, incidentally, was the correct response, at least initially. You know, before he developed his big porn addiction and started lying and stealing and the whole world came catastrophically crashing down...in typical Lifetime fashion...)

And, care of Dr. Huxtable...

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

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

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

Gratuitous Cuteness

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

Me: I'm fine!

Sparrow: No, you're not!

Me: Of course I am.

Sparrow: You're being ridiculous.

Me: Probably.

Sparrow: Let me do it!

Me: No!

Sparrow: Yes!

Me: I'm fine!

(repeat)

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

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

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

("Hey, everybody!")







("Ha! Maggie's funny!")

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



So sweet.

Such good girls...