Happy 4th and whatnot

Back from Rene's wedding at the Biltmore in Asheville.

The wedding itself was a-ma-zing.

 The Estate is phenomenal.

She looked incredible, the scenery was breathtaking...

A good time was had by all. In fact, um, a few had a little too good of a time. Which led to some significant badness after the wedding.

But, in the end, I think all will be well. And fortunately, I have an appointment with my shrink tomorrow...what a night.

Grindstone

Back to work today. It was one crazy, busy-ass day. And of course I had to run out in the middle to get my mom to the hematologist, who was also, of course, running late. I ended up bringing several hours of work home, which I finally just finished.

Whew. What a day.

And oddly enough (and believe me, there was plenty of "weird" that I can't talk about on the blog), the weirdest thing, I thought, about today was when the hematologist asked me if I was in a relationship where children were imminent.

I...what? A, um, no I'm not (hello, IUD. And, you know, crappy taste in men). And two...what? What does that have to do with anything? If you think genetic testing is relevant, let's do it. If not, then, why ask me weird questions like that? Especially when I'm like the only one in my world who isn't pregnant right now...

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
_______________________________________________

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...

Scary out there

So, I've always said, you can't shelter your kids from the world. To protect them, you have to stay with them, know where they're going, teach them how to protect themselves when they're not there. No child-safe internet blocker is ever going to work, because kids will find ways around everything.

They're kids. They're adaptive, and creative, and sneaky. It's what they do.

Things like this prove my point.

So, a friend commented on Facebook that she had to look up this thing she'd heard about called Chat Roulette. I, of course, tend to be curious about everything, and also, I have two adolescents therapy kids with whom I work closely (and, as I've discovered lately, I have to keep up with my 66 year old patient as well. But, I don't worry as much about her being preyed on. She's pretty sharp). Plus, I'm on the child unit, and headed into a child fellowship. I like to keep an eye on the landscape, know what's out there for them to get into.

The concept of this is kinda cool, right? You log on...well, not even that, because it's completely anonymous. You click a button, and you get matched up with a random stranger anywhere in the world. In one respect, this is awesome. I spent about 20 minutes wandering around, chatted briefly with some very nice people in France, and Australia, and elsewhere in the US. I talked for a bit with a nice man in China who's trying to improve his English. I got to use a little of my terrible French. The worst thing any of them said to me was that the one of the people in France told me I was old. I guess when you're 18... But in that aspect, it makes the world a little smaller, allows you to interact with people in other cultures, etc.

That, I recognize, is a tremendously idealistic view.

So, many of the people on this thing have webcams. I saw a lot of high school and college kids, who, yeah, kind of a vulnerable group. Especially considering some of the other things I managed to see on there. Wow. Not enough eye bleach in the world.


::sigh:: It's amazing. I'm guessing that wouldn't even be blocked at the hospital (whereas, you know, everything else is). The anonymity is superficially protective, but also disinhibiting. It perpetuates this idea that you can say or do or be anything you want, and not worry about it, when in fact you should worry about it quite a bit. Especially if your judgment isn't very good because, say, your frontal lobes aren't fully formed yet. There's no guarantee that the people on the site are over 16 (by clicking the button you agree that you're over 16. There isn't even a checky-box. Oh, yeah, that's gonna work...). Or aren't, say, serial killers and pedophiles. In fact, I'm guessing this would be a deviant Mecca in a way that Facebook or MySpace or any of the other sites we worry so much about never could.


Yeesh.


Now, admittedly, I'm a hypervigilant, socially suspicious psychiatrist with a trauma history. But, seriously, folks. The shit that's out there is scary. 

A little less....something

Today was a very long day, starting with co-leading a med student small group about substance abuse, which was a good time, but necessitated me missing rounds. The workday was chaotic; I then went to the Bucks and read for a while before class. Tonight was my first Mindfulness and Psychoanalysis class.

The class? Is and will be awesome.

And includes a 15 minute mindfulness practice at each class.

That? Tonight? For me? SUCKED.

It somehow ended up feeling really unsafe, and turned in to one long pre-verbal flashback that extended through most of my drive home.

This was certainly not unrelated to part of today's chaos having to do with difficult discussions with patients with bad abuse histories. It also has to do, I think, with all of the hard work I've been doing in therapy over the last couple of years, and all of that somatic memory is more accessible now more than it probably ever has been in my entire adult life.

Which, frankly, sucks. In case I didn't mention the suckage.

But, it does tell me, this meditation thing is something I need to do more of.

Which will, undoubtedly, suck.

This makes me want to vomit....

Read this.

OH.....my freakin' GOD....

Sometimes? The cruelty of people completely astounds me.

Fortunately, though, the kindness of people frequently does, as well. It's a shame that it rarely makes the news.

Not at all painless

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Diatribe, interrupted.

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

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

Needed

Mufasa and Darth Vader agree...

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



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

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

May we all see many more.

Welcome to September.

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

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

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

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

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

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

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

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

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

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

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

Queasy

This...makes me a little bit sick.

(Click here if the video won't load.)



Some days, it still amazes me, the degree of fucked up depravity that can go on in our world.

And yet...18 years later, what a blessing for this family, to have their daughter returned, alive, long after reasonable hope had faded.

Maybe, maybe, with some good intensive therapy, this poor woman and those young children can have something that resembles a somewhat normal life. But I can't even imagine how one would even start to get over that....

"No. Really. Come back soon."

First of all, a very happy birthday to my cousin Danielle. She's a Baskin-Robbins this year (31). Many happy returns. Maybe I'll actually make it down to Texas to visit before we're 32. Or at least before Annalise is!!

Re, the title: I went up to the unit today to see one of my therapy patients who wound up on the inside, and ran into my friend John, whom I haven't seen in a while. The end of our conversation entailed a discussion of how I was going to be back working the inpatient units (also clinic. Eek) in two weeks. He was like, "good. It'll be good to have you back." I said, I'm sure you'd do just fine without me.

I tell you what. I had six patients scheduled today. My last one was at 2 and was the one that was admitted. I got in wretchedly early so I could leave by 4 at the very latest (nooooo problem, right? Ha) and make my rescheduled appointment with my trainer at 5.

I left the hospital at around 5:30 (which, incidentally, was a good hour or more before Peng got to leave. Catatonia slows everything down).

And oy, it was a long day. One of my patients didn't show. Another one cancelled (when I texted her ten minutes after her appointment time and said, are you coming?). I had THE LOUDEST HUMAN BEING ON EARTH's mother and case worker calling me to complain about each other (I'm not telling you whose side I'm on). I had a crapton of prescription refills, paperwork, and lab reports waiting for me. And of course I spent like two hours total up on the adolescent unit.

So my kid, who's getting closer to legal adulthood every day, got "in trouble" for talking to one of the younger patients about sex. I asked her about this, and she says, "well, the other patient had questions. I was honest with her. We talked about what it means to have that in your life. It wasn't like I was giving her advice on positions or anything."

I asked the staff, "what kind of 'talking about sex' was this?" They said, "well...it was about sex."

::sigh::

I'm sure the answer is somewhere between Little Miss Innocent and Little Miss Devil, but, come on, people.

Not to mention...here's the beginning of my conversation with John.

(John is standing in front of the nurses' station and, illustrating a point - although I can't imagine what point - has his hands up over his head and is reaching down his back. I happen to be walking behind him and poke at his fingers. You know, because we're 12.)

John: Hi, Kate.
Me: Hey, John.
John: I'd know those fingers anywhere!
Me: Shh! John! Don't tell them our business!
John: I meant anywhere geographically, not anywhere on my body! That's a whole other conversation we shouldn't have in front of the kids.

The nurses found this humorous (God only knows why). Now, I concede, John and I are both adults. My hands have never actually been lower than John's scapula (I think I've punched him in the shoulder a couple of times), and we're obviously friends, and obviously kidding. And the staff jokes at this level all the time (because? We're all secretly 12 when we walk on that unit). Which is fine, as long as everyone involved is okay with it (John and I know our limits, but part of the reason we get along so well is that he's as dirty as I am, and we both know this). But it does suggest an atmosphere of...casualness and permissiveness about these sorts of things.

There's a lot of ways to "talk about sex." Some of them are really inappropriate. Some of them are really beneficial. And the younger patient in question was a teenager. Hopefully, she's had some formal sex ed at this point. And you KNOW she's had some form of informal sex ed by that age. Plus, sex is kind of a basic human thing (anyone remember Maslow? Or Freud? Or Salt-n-Pepa?). You can make it something that can be discussed openly in a respectful and appropriate manner, or you can make it something that needs to be whispered about at night between bed checks.

I'm just saying.

(In a related story, my Aunt Aphrodite, earlier this week, was telling a story at our big family gathering about seeing this movie which referenced "BJs", and these two older women in the theater in front of her that were like, "What the heck's a BJ?" So she's telling this story, and several of my relatives were like...um...what IS a BJ? She says, think about what it stands for. And one of my uncles starts spelling. Seriously. "Is it b-l-o...?" I finally stuck my head out of the kitchen, and was like, "Oral sex. It's oral sex. Finish the story." Christ on a cracker, I'm THIRTY, people. And a doctor. As funny as it was, spelling things just ain't going to cut it...but back to my point.)

There are a lot of problems with assuming that kids don't talk/think/know about sex and making it a shameful or off-limits thing to discuss. You create a mysterious or rebellious drive to find out. You send them looking to other sources for information that can be unreliable or dangerous. You deprive them of learning what's appropriate to discuss when and how. Like I said, I don't know what the story really is, here, in this scenario, but I don't think it should automatically be a demerit just on principle.

And the thing that's most important to me in a group of kids like this who are at very high risk of abuse or exploitation, you make it impossible for them to talk to you about it. So, you've made it something bad and shameful, which you don't talk to adults about...how do you deal with it if someone's hurting you or making you do things or even just making you uncomfortable?

It's just sex, folks. Funny how it's important, but trying to make it seem unimportant makes it become just that much more important.

Sunday Secrets

So, every Sunday morning at midnight, the new crop of secret postcards go up at PostSecret. They're often poignant, typically interesting, and frequently amusing. And feed that voyeuristic thing we all have but don't like to admit to. I look forward to them all week.

I love, love, love this one, from this week's secrets:

Love.

(And no, really, I'm going to bed now.)

Where's my day of rest?

It was a busy day. It's gonna be a busy day tomorrow. Oy.

The dogs woke me up at 6:30 (on a Saturday!! Need to get those girls a calendar) by dive-bombing me. So I finally agreed and got up, Mags and I went to Starbucks (Maxine got to stay home in Maggie's crate, which she just loved. It was adorable. She thought she was queen of the world), and then I came home and worked on a knitting project that's due next Saturday. I spent two hours at the gym. I picked up my bridesmaid's dress - which, blissfully, is the right length and doesn't need to be altered - and my shoes, and a new skin for my phone (the old one fell apart today). I went to work for three or four hours and moved most of my stuff to my new desk in our new office (the Pink Office is going prime time, folks. We're a little worried, given the nature of the conversations that go on in there on a daily basis). I also cleared out all my files and my big stack of papers and my drawer of, as Ruthie calls it, Nuclear Holocaust food (I had a lot of microwave-in-the-pouch rice stuff in there). The dogs are fed and walked...and I'm really, really tired.

I met my new trainer at 9. She's nice. She's a she. That's a little weird. Gomer she ain't, but, maybe the change is good. We're going to call her Kelly. She's blonde and thin (she has a very athletic build, though, she's not a twig) and younger than me, but easy to talk to and, as she says, "probably a little more gentle and sensitive that your last trainer." So far I like her, which is more than I could say for Gomer after our first session. He grew on me, though, obviously.

But one thing she definitely has on him was that she seemed to take me seriously today. We did our little assessment, which was way more involved than the one Gomer and I did (his was all weights and measures. She tested my balance, my heart rate recovery, my lifting endurance), and she was consistently just like, alright, here it is. And she seemed reasonably impressed (I maxed out on the 40lb chest press at 40 reps. Our new goal is 50 reps of 55 lbs in the next 8 months. I don't know why 8 months, but, okay). Now, she also has the benefit of getting me after six months of Gomer, which Gomer obviously did not. But he was sort of like, "Yeah, whatever" in the beginning, until I actually did what he told me to between sessions and didn't drop out and was like, "bring it on." She also did a really good job of being like, "Okay, you're a doctor, I don't need to explain things like BMI to you or why it's useless." She also was like, "great," when I said I didn't want weight to be a goal. Gomer, our first day, was like, "Let's try to get you to lose 10 lbs this month." I said, "Well, let's just do what we do and see where I end up." He didn't seem to know what to do with that answer. He got over it. Gomer really did do an awesome job of "getting over it," in a lot of different ways.

I had to pick a goal for our training work, either "lean," "healthy," or "strong." Now, as she pointed out, you head for one, the others will follow, but, they have different schemas depending on what you pick. I thought about it for a minute, and picked lean.

This was kind of huge for me (no pun intended). Because I'm never going to be skinny. Ever. My calculated lean body mass alone (so, none of the fat, just muscle and bone and organs and whatnot) rests right at the lower cusp of "obese" on the BMI range (because BMI is USELESS. Ahem). And I don't intend to stop building lean body mass just yet. But my frame is too big, and my genes too curvy, for me to ever be skinny. So I spend so much time trying to accept that fact that it feels a little like I might be setting myself up for failure by making this choice. But, the goal, really, isn't "skinny." It's "change my body" - not, primarily, my cardiovascular health or my endurance or my muscle strength - which is more reasonable, and more healthy, but also just a huge-huge-hugely-huge step out of the "safe" zone for me. "Fat" is an easy thing to blame when things go wrong. "Fat" is a useful device for internalizing my anger and self-deprecation and all those other things that go along with a history like mine. "Fat" is also protective against having to relive that history. It gives me a wall to put up when I need one ("He'd never be interested. I'm too fat. Good reason not to take the risk"). I don't know what I'd look like any other way, what I'd feel like, what it would be like to be me. This is frustrating and annoying (and, in a lot of ways - mostly influenced by my underactive thyroid and my polycystic ovaries - not as within my control as I might like to think), but it's also....safe.

So it's really interesting, this (we're going to go with "interesting"). Most of that minute I was thinking about it, I was thinking, is this something I'm ready to do? To focus on? To say, I accept this, but I want something different? To let go of all that it means, symbolizes, and provides?

I think I am.

And, you know, my real goal is still to accept who I am, whatever size, whatever else it means, no matter what. To feel better in my body and in my skin, to live here and live fully. So it fits that I'm not really working towards a weight goal (although I have a safe body fat percentage as a target) and not really working in a rigid time frame. It just is what it is, it comes as it comes, it moves forward and backward as it needs to. And we'll see where it goes.

Look, y'all, no one said it was normal inside my head...

Get mad. Get involved.

I'm so with Garfield on this hating Mondays thing.

Clinic was rough today. My first patient needed to be admitted (she knew this. She showed up with a suitcase). It's a long and fairly arduous thing to admit someone, and generally takes longer than a clinic appointment. Fortunately, someone who saw her last time dictated a fabulous H&P (it was me) so I could just cut and paste all of the history. I made it just under the wire so it was done before my next patient.

Meanwhile, the patient sat in the waiting room until - I'm not kidding - 5 pm waiting to be sent to the floor. There's got to be a better system than this.

I had a little bean bowl lunch with Ruthie, which is always enjoyable (she's insane. And I love her for it). And then my afternoon ensued. I had three really difficult cases and one poor lady who's quarantined in her house with MRSA. But one of those afternoon four was especially hard.

One of my patients was raped last week.

It was awful. It was an awful situation. There are details I'm obviously not going to share that made it especially heinous. I felt so bad. She's one of these abused kids who sort of ended up with "VICTIMIZE ME" stamped on her forehead, I think. She was already having a rough time of things (that's why she sees me), and then she gets slammed with this. It's a damn shame (it's always a damn shame). She's a little histrionic, but generally just sort of sweet and funny when she lets her guard down. And it never fails to amaze me the moments in which someone so otherwise worldly can end up being profoundly naive. But she's stronger than she knows, and she's going to come out of this okay. She'll never be the same, don't get me wrong - this is a particularly loud bell that cannot be un-rung - but I think she'll persevere.

But I'm listening to her story, and what really overwhelms me is this sense I get all the time when listening to these stories - I do not understand what motivates people to do things like this to others. I mean, I get the whole forensic ideas of, this happened when they were small, so this and this and this shows up in their personality, combined with this temperament and this inciting event and this is how the whole complex plays out, blah, blah, blah. But what I can never wrap my little brain around is...when does this feel okay? When, as a human being, does it seem like something acceptable to hold a woman down and rape her? To molest a child? To beat an elderly woman? To defile and humilate another life? Does that really feel like a normal path to sex/love/power/whatever delusion they hold? When does this seem like "something you do," like reading the paper on Sundays or going to the grocery store?

I just don't get it.

But it happens. It happens over and over and over again. Sexual assault happens to one in three women and one in nine men. To prostitutes and beggars, college kids and working moms, to doctors and lawyers and socialites. It happens to handicapped people and to the mentally ill. It creates handicaps and mental illness, and it perpetuates itself. But in that, some will flounder and drift downward, some will find strength they didn't know they had, and some will even find enough to lend that strength to others.

April is Sexual Abuse and Assault Awareness Month. Support your local Rape Crisis Center - give money, give time, give provisions, give prayers. Get involved with Threads of Compassion or another group that supports survivors. Get involved with a SANE program if you're in the medical field. Get involved in advocacy and victim's rights. Or just listen to a friend that needs to tell a terrifying story. Let people know they aren't alone. Be proud that you survived, or that your sister, your husband, your grandmother did.

Let no one stand alone who has fallen victim. Be aware, be involved, let this be out in the light of day.

Bang bang

Love Thursday, in bullets. Er, bullet points...

bI have the world's best dog.
bAlso a rockstar shrink.
bAnd a very comforting mom.
bAnd I'm done driving to the coast for another week.
bAnd it was an amazingly beautiful day at the coast today. BEAUTIFUL.
bI got to go out with our social worker today. I like her. She feeds me lunch.
bI went to the gym despite my really not wanting to and it was a good idea.
bI met nice people at the gym.
bI actually cooked dinner. Pasta primavera (with broccoli, peppers, and then corn and edamame, which don't quite seem to fit, but, whatever). Yummy.
bMy dog is all cuddly and cute. Love her.
bBones is on. Well, via the DVR.
bI finished one sock yesterday. Except...well...does anyone have a suggestion for a stretchy bind-off to use at the top of the sock??
bIt's time for bed. That's the best news yet.
bYep. Those are tiny little bicycles. They amuse me.

I know it's not Groundhog Day yet...

...but after the day I had today, I'm a little afraid of coming out of my cozy, warm burrow tomorrow and seeing my shadow.

Perhaps I'll just hide....


Yeesh.

Black Ice

Didn't go to the coast today - ice on the planes, ice on the roads, no WAY I'm driving five hours round trip in that. So I ran errands and went to the gym and processed and ruminated...and it always strikes me...on days I don't work, it always seems like I end up working so much harder on the stuff in my own head....

Meanwhile. I have a day booked solid from 7am to 4pm, and then I'm on call. It's going to be a long, long, long-ass day tomorrow. And it's been a long, long, long-ass day today. So, y'all, I'm going to bed...

Therapy, in various forms

Stolen directly from ihasahotdog.com. Just because I think it's funny. And because I have two very therapeutic dogs snuggled up with me right now...

He he.

So it was a full day today, even if I didn't get a whole lot done. Peng and I went wedding dress shopping, and found some really gorgeous stuff. We have an appointment at the local David's Bridal in the morning, but I expect we've already found her dress. It's exciting. She's going to look fabulous. This is going to be a fun affair. Squee!

Did I mention being excited about this?

Before we went, I had my first session with my assigned trainer this morning. So, Gomer...I'm not so sure about Gomer. A, he keeps throwing all sorts of numbers at me. Dude, I'm a bulimic, we don't do numbers in recovery because, well, we're too into numbers. I nearly smacked him when he suggested a goal weight for me in a month. It's just ten pounds, he says, just two and a half pounds a week. Literally, I growled something at him about wanting to think in terms of "healthy" and "fit" and "just end up wherever I end up." Because if I lose ten pounds this month? Cool. But if I don't, and we set his little goal, then I've failed. And I do. not. like. failing. So suppose in a month I've lost 12 pounds of fat and gained 4 or 6 pounds of muscle. Despite that I've actually accomplished my aims, I'll either go into overdrive trying to meet that goal if I anticipate in the week before that I'm not going to make it, or, I'll go into overdrive with the self-criticism if I wait until the 18th of February and discover that I'm not, in fact, ten pounds lighter. Either way, I'm likely to hurt myself trying. It's not normal. It's not rational. But it's what I do, and I know this about myself. Which is why I signed up for a trainer.

He did write up a good workout for me. Well, no, that's not true. He wrote up a good workout. He didn't watch my form, failed to notice when I was failing midway through my second set of curl-thingies (he would've noticed that the weight was too heavy towards the end of my first set of curl-thingies, if he'd been WATCHING, because my control in my left arm was terrible), and sent me running up and down the stairs, which does NOT mix with my asthma, or my bad ankles, for that matter.

And, you know....I dunno. A training staff full of big black men and they give me the white guy. Which doesn't actually say anything about his abilities as a trainer, and it's a little stereotypical, but let's face it - it's a well known cultural phenomenon that black men have a better appreciation for big bootied white women. Gomer, on the other hand...I'd rather suspect he has a "No Fat Chicks" sticker on the back of his truck. You know, right under the gun rack. If he hadn't told me that he just bought a used BMW. Oh, no, wait, he didn't tell me that, he told the woman on the machine next to me. Because he didn't actually talk to me, or even look at me much (see above, re: not watching my form). And then he's like, "the more cardio you can do, the better." Nah, dude, don't friggin' tell me that, because seriously, I'll end up doing eight hours a week of cardio. And I WILL hurt myself. See above re: reasons for getting a personal trainer. Damn it.

I'm probably being too hard on him. I'll give him a couple more sessions before I request someone who can meet with me on Thursday nights. And interestingly, Steve seems to be keeping a pretty good eye on me. I stopped by to talk to him on the way out (about this incessant shaking that keeps happening by the end of my workouts), and he had all sorts of comments on the stuff I'd been doing independantly, which we hadn't discussed (but he's always there when I'm there). So I think he's kind of got my back. Which, he should, he's the guy in charge...

Training is hard, y'all. And painful. And not in the way you might be thinking. I've left pretty much every session at the gym thusfar and cried. There's a lot tied up in this for me - a lot of negative body stuff, traumatic memories...I've literally been at odds with my body for, what, the past 26 years? For the last 19 we've been outright at war, and for well over 20 I've been living more or less outside my body, for all intents and purposes. I'm just now, through a lot of hard work and therapy, figuring out what it means to live in this body. And I'll be perfectly honest (because that's what I try to do here) - I do not like it right now. My body feels contaminated, defiled, and disgusting, and that's why I've spent the past two decades in various states of dissociation. This is a lot to get over, and it's hard to do, and I'm doing the best that I can, here...and it still never feels like enough. There's so much badness to sift through. There's always something awful and torturous and unresolved batting about in my belfry. Is it any wonder I don't sleep? Larry, who's now my primary care doc, right, I told him I had complex PTSD, and he asked if I had flashbacks on a day to day basis. I said to him, this is a moment to moment issue (at one point I was literally having between 60 and 100 flashbacks a day, and thought that was normal). This is a nonstop battle, and getting healthier and doing the work is a jagged, rough, uphill climb. Combine that with my 70 hour a week job, plus my analytic classes, two hours of my own therapy every week, and now at least four hours a week at the gym (not including the times I plan to go in after work and hit things when I've had a bad day. I always keep my boxing gloves in my bag, but I haven't had the chutzpa to actually pull them out yet...but soon...). Not to mention time I need to read for work/class, the paltry social life I have, and time for things I find restorative, like blogging and keeping up with email and Facebook and whatnot. And then there's silly things like housekeeping (ha!) and grocery shopping and maintaining some facade of normalcy and functionality about my life...it's hard. It's a lot to do with a monkey like that on your back, especially once you're healthy enough to start fighting with the monkey and trying to get him off of you instead of just plodding along with him weighing you down.

But it has to get harder before it can get easier, right? And I actually have been enjoying my time at the gym this past week, even if it's been a little internally overstimulating at times (and even if I could barely walk Friday, s/p Wednesday's training session...). So for now I keep fighting, and I keep plodding. It'll all get better if I just keep moving...