Intern, turn, turn

So I'm playing intern again today.

We sent our actual interns to the beach this weekend. Unfortunately, it's pretty cold here in NC. But I bet they're having fun anyway.

I, on the other hand, am not at the beach. I'm sitting in the Neurology call room waiting for the 8pm shift change. Which isn't so bad.

I mean, except for this, in the shower...

And the mousetraps in the call room itself.

What is it about me and roaches and vermin?

Although....look at the publisher of the bottom book. That, at least, cracks me up.

It's been interesting. I haven't actually been on a non-psychiatric service in, what, over two years? And I think my neuro month was about three years ago. I was really anxious about this morning. Turns out, of course, I needn't have been worried. It's like falling off a bike.

I forget sometimes, too, what a difference it makes to be a senior resident. I was thinking earlier about my first day on Neurology as an intern. As luck would have it, it was also my first day at Baby Blue. Ever. There was supposed to be someone replacing the anesthesia intern, so they told me, hey, don't worry about it. But of course, that person didn't show up until Tuesday. Suddenly? Oh. Hey. Could you cover his patients? Just go see them and write notes. Don't worry too much about it.

Yeah. Right. Not to mention, I had no idea how to use the computers here. I couldn't remember how to write orders. I'd totally forgotten my log in for the electronic medical record.

I sat in the workroom, right off the nurses station, trying not to cry. I was absolutely determined to figure this out. I called the help desk. I dove in. And, of course, I figured out enough to get by. They were happy.

Of course, that didn't actually address that I knew practically NOTHING about neurology. Recovering gynecologist, remember?

But it turned out to be a pretty good month. I had good attendings and reasonable residents and my co-intern was AWESOME. I had a nice white cloud for call. I caught some really interesting cases. And generally, I had a good time. Notably, I was the only one in my class who actually liked their neuro month...

So, today? Not so bad. And I get two days off in compensation for this, one of which I'm taking tomorrow.

Which is useful, because I could really use some sleep. Yesterday was loooong. I went for coffee, then did the headless chicken thing preparing for Cleo's not-a-baby-shower (nothing like doing it all in the last few hours before the party, you know?). Then, of course, was the actual not-a-shower. Which was a lot of fun. Fewer people actually showed up than had RSVP'd, but we had lots of fun, even if there was too much cake (is there such a thing?).

I ran home, showered, ran and picked Maggie from my folks', ran to drop her off at home, and then ran to Jen and Bill's. A bunch of us went to a not-so-local haunted house last night.

I'll be honest. I had significant reservations about this. We didn't leave until 7:30 pm, which I knew was not going to get me home at any reasonable hour. I was crabby and wanted to hide from the world before I even got to Jen and Bill's. And, let's be frank - PTSD girl in a Haunted House? Not necessarily the best idea. But I like my friends. And it's fall. And really, why be responsible?

It was okay. I enjoyed the time with my people. The Haunted House itself was pretty good. The headless horseman rode up on a real horse! I, however, spent too much time figuring out what was going to jump out at me from where, which figures were props and which ones were people. I don't really relish that feeling. I don't really like being scared - it brings up too much. I don't like people getting up in my face. It was reassuring knowing that they weren't allowed to touch me, but they came closer than a bratty younger brother in the backseat who's "not touching you! Not touching you!". On the whole, thought, it was fine. And I enjoyed the drive there and back and the silliness waiting in line (for-ev-er). And my friends were pretty amusing to watch going through the haunted house.

I did get insulted by a redneck zombie, though. He came up to me and said, "Looks like we could feed on this one for a couple of months." I was pretty pissed about that. In fact, I'm still kind of pissed about it. But, then again, he did invite me to stay for dinner....

Calling Dr. Kate...

Yeah, so I covered the first half of the intern psych call today, because it's Intern Retreat weekend. I was supposed to be done at 8. It's 11 and I'm still here. But hopefully leaving shortly...

Lots o' crazy out today....

Throwback

So I'm postcall.

I know, I know, I said I was never going to have to take call again, there may have been a happy dance involved, etc. But, to clarify, I believe what I actually said was more that after that, any time I was doing "call" it was going to be voluntary and heavily compensated. And this was.

I think we killed Veronica on Friday. She and I left Friday night about the same time, she'd had one beer, she was looking a little peaked, but well, she's an intern, they always look a little peaked. We left because she was on call yesterday and I was just freakin' tired and had shit to do over the weekend. So I came home, blogged, stretched out, fell asleep a little after 1. Woke up at 7:15, of course (after waking up at 5), and was sort of dozing, mostly refusing to get out of bed, and my phone rings. And it's one of our chiefs, and she's like, "The intern is sick and can't take call. I'll give you three comp days if you do it."

Once I actually woke up, I was like, hell yeah. I'm all over it.

So I made a mad dash for the shower, found my scrubs, ran out the door, and despite my commute and the proximity of her calling me to the start of the shift, I made it by the end of checkout rounds. I was on with Scott, and we had a rockstar medical student (also named Kate). And two new ED evals waiting for us by the time I got there. So Scott went off to Second Year Consult Land, and the Kates headed down to the ER. Go team. Break!

It was a constant stream. We were essentially bedless, so there was a lot of referral action going on. It was a crazy shift. I didn't see my office after I dropped my stuff off in the morning, much less my bed. And for that level of chaos with two upper levels on, I can't even imagine how awful it would've been for a sick Veronica.

Crazy.

But interesting, and amusing in a lot of ways. We had some really good cases. Scott and I work well together, and Kate did a great job. We functioned as a remarkably good team, actually. And we had a couple of short lulls. One was like early evening, when Kate was still there, and we had a very good discussion of object relations and projective identification and a whole bunch of related nonsense that Scott and I are both pretty into, and she seemed to really enjoy. The second was sometime after midnight, when Scott and I finally got around to ordering dinner (one thing I did not manage to do during my AM Tasmanian devil impersonation was grab any sort of provisions for the day, because, well, yesterday was my day to go grocery shopping...). Of course, we hadn't had lunch until 3:30pm, so, midnight seemed pretty reasonable to us. Tarheel Takeout had already stopped delivering by the time things quieted down enough for us to think about food again, but we discovered this pita place nearby that delivered, and was pretty tasty. Good falafel. He and I also had a chance to decompress a little about some issues in the residency that we generally agree on, but on which we often have different outlooks.

One thing I found especially amusing yesterday was how shocked the medical student was that we all talked so openly about being in therapy. We both kind of shrugged and were like, well, how are you supposed to see things in other people's patterns if you don't know anything about yourself? I gave her my standard line of, I really think the key to being a good therapist is having a good therapist.

It also was remarkably helpful that I was on last night in that one of my patients had to come back in to the hospital, and I think it made it a lot safer and easier for her that I was there. She and I have a good therapeutic alliance, and wow, she really looked like hell when she came back in. We talked for a bit, she cried a lot, and by the time I'd gone back in to have her sign the paperwork, some outside influences had made things even worse. I hugged her before I left. We try to use physical contact very sparingly and with intention in this business, but sometimes, a simple pat on the shoulder or a careful and genuine hug can be the single most therapeutic intervention.

But while it was really good for her that I was there, it was really pretty upsetting to me that she came back, for reasons of my own neurosis. I, obviously, was so glad she was able to come back and to be safe and ask for help, but the transference in our interaction being what it is, and my own internal critic being as it is, and the fact that I was sleep deprived going in to the shift and had now been awake for like 21 hours made it really hard for me to see her looking as dysphoric as she was so soon after I'd last seen her. People who aren't in our profession really don't understand the depth of the internal tumult that goes on when you're surrounded by the sort of external chaos that we are.

The end result of that last night, unfortunately, was me yelling at a Neurology consultant who was trying to dump work on me in a pretty condescending manner. I actually hung up on him. Scott's commentary on that was somewhat pointed (see above re:sleep deprivation). He was like, "He's a good guy. I'm not saying he wasn't an ass to you right now." I ranted for a moment and then turned to him and said, "You can tell me if I'm being unreasonable." He thinks about this for a second and says, "Emotional, maybe. Logically, that was a reasonable request, but the emotions are out of proportion." I couldn't argue with that. Later, after the neurologist had actually done what I'd asked him, and I'd done what he'd wanted me to do, and I finally did agree with him that the neuro exam was pretty unrevealing in that patient, I paged him and apologized.

Interestingly, the apology was what Scott got kind of snarky about. I was driving home today and thinking that whole story arc of last night was a whole kitchen full of pots and kettles....

On the plus side, I did get a couple hours' worth of postcall nap in this afternoon. Oh, there is no greater bliss than a good postcall nap...

So now I'm actually going to go to bed, because I do have a 7am therapy patient tomorrow, and it's been a long damn weekend. But, really? I love my job.

Coverage

Not a lot of excitement...

I still really adore a day off. I also really like a productive day. Fortunately, today I had both.

I slept in until - are you ready for it? - eleven today. I never sleep that late! And I went to bed not all that late last night...again, around eleven.

Sparrow said that she spent much of her first month of second year kind of walking around in a fog, and spent a good portion of the first couple of weeks asleep. I've been gradually catching up on some of the things that have fallen to the side.

Today I started out back at the Starbucks (did I mention I finally, FINALLY finished all of my discharge summaries from intern year?). They closed the Starbucks in downtown Chapel Hill, so a few of the Baristas have come over to the Starbucks I like in Durham. One of them is this British guy who sounds exactly like Jack Sparrow (Pirates of the Caribbean, for those of you who live in a hole, who was actually Johnny Depp, who is actually not at all British). Rather looks a bit like him, too, come to think of it, if Jack Sparrow were an early 20-something, heavily tattooed coffee slinger, rather than, you know, a fictitious pirate. But I do so enjoy his accent.

And then I went to the Whole Foods, and for once, I actually made a list. I think I'm going to go back to my six small meals a day plan for a while. I've worked with a collection of dietitians in my day. One of them was awesome. One was okay. The others, I have to say, totally didn't get it. I'll let you in on a secret - most anyone with an eating disorder could be a dietitian. We all know the calories and amounts and ratios and portion sizes and blah, blah, blah. So, that's really not what we need help with. Marilyn, the world's best dietitian ever (who is sadly in Florida), spent all of our time working on normalized eating, mindfulness, triggers, and balance. Know the difference? She's recovering from an eating disorder. Anyway, Marilyn the Fabulous and I had this whole checklist thing figured out. And I've noticed (when I'm paying attention) that my blood sugar's tanking in the afternoons, especially with this walking to work and all that. So we'll see.

So, anyway, groceries. Came home, did laundry, did a bajillion and a half dishes. Played with the pups (Maxine is over). Made dinner eventually. Watched a lot of SVU (I love USA). Met the new neighbors. All in all, a nice little Sunday off.

Tomorrow, of course I have a jam-packed clinic schedule. As is the case on Tuesday. I'm hoping I've got the routine down a little better this time around. We'll see how it goes....

Locopup

Whew! I do love me a weekend off. I have...well...I guess I still just have two of them this month, which is the same number I used to get when I was taking intern call, except that I'm only on call three times this whole month. Cannot tell you how exciting that is.

I'm finally starting to deal with fixing some of the collateral damage of intern year exhaustion. For example, this morning I dragged my laptop and my tired ass over to the Durham Starbucks and sat there for four hours or so doing paperwork that was way, way, way overdue. Dude, I had a lot of work piled up from last month.


I did something like fifteen discharge summaries this morning. And learned a few things. I.e., did you know that Trampoline is an official Olympic sport? As is BMX biking, which is apparently new this year (that was the free drink question of the day - what three sports are new in the '08 Olympics? BMX and Steeplechase are the two that I heard, although people had some other amusing ideas. Lawn Darts was my favorite wrong answer). I still have two more to do (the really difficult ones), so I'll probably spend a bit more time there tomorrow morning. Who knows what I'll learn then.

I am happy to report, however, that my second year paperwork is completely up to date. Every clinic note has been dictated and edited. But don't worry. I'm sure to get behind again in short order...

And Ruthie officially moves in to our office on Monday! I'm very excited. Peng and I have managed to have some semblance of productivity this past month, but, I'm sure that's going straight out the window. Add Ruthie to the mix, and no one in that office will ever get any work done in there again.

So tomorrow is PenguinShrink's birthday (Happy birthday, Peng!). Ruthie bought her a bonsai tree, because, she says, Peng is a Bonsai Psychiatrist - wee, but hardy. I laughed really hard. I may just start calling her Bonsai.

We had a very nice night out in honor of her reaching double digits turning not actually that much younger than me (although I like to give her considerable shit about her youth. Mostly because when we're fifty, I'm going to look 55 and she's going to look 30). Strangely, a lot of our cohorts were out of town this weekend, but we rallied the remaining troops. It ended up being more or less the usual cast of characters - Ruthie, me, Peng, Sparrow, and Tyler, who had quite a harem going tonight, really - as well as another of our classmates (whom I know I've referenced on here before but can't remember the pseudonym I gave her! Martha, maybe?), one of the social workers from State Hospital, and our psych pharmacist from Big Hospital. We went to this very good Persian place in town. I had some sort of pomegranate chicken that was outstanding, as was the assortment of appetizers we ordered, not to mention the Iranian beer.

We then wandered across the street to this place called Locopops. Which, as you might imagine, has a selection of unusual popsicles made in a Mexican tradition called paletas. They have such flavors as Cherry Hibiscus, Mojito, Olive Oil and Lemon (dude, I don't know about that one), etc. Our group sampled the Cookies and Cream, Blueberry Peach, Green Tea and Jasmine, and Mexican Chocolate (that was mine. Very cinnamon-y. So good). And, know what else they had? Are you ready for it? Beef.

Okay, they had beef and chicken, which were on rawhide popsicle sticks. Now does it make more sense? So, naturally, I had to bring one home for Maggie. Because she was a very good girl today, and deserved a treat. Maggie stayed home by herself while I was at Starbucks, out of her crate, the whole time I was gone (we're working up to making good use of that doggie door). And she did well - didn't destroy anything, didn't get into trouble, and her human even remembered to put all the garbage cans out of reach this time.

So I brought her home a beef pop.


She was super excited.


Started licking the bag, jumping up and down...in an effort to minimize the mess, I thought I'd give it to her in her food dish, but in her crate (since I figured it was going to end up in her crate anyway).


We played that game for a little while....I put it in the dish, she took it out. I put it back in the dish, she took it out again. Et cetera, until I just gave up and conceded that it was probably time to wash that stupid crate pillow anyway. (PS -see that maroon thing in the corner? You remember the shawl Peng gave me for Christmas? Maggie kept stealing it, so Peng made her one of her very own to curl up with. I know, awwwww...)


Maggie really liked the rawhide. She was pretty psyched about the beef part, too, but the rawhide seemed to be her favorite.


Okay, now we're just into gratuitous pictures. I'm sorry, I can't help it that I have the cutest dog in existence!


But then.....it was all gone....


She got over her momentary disappointment, though, and I got a lot of very cold, beef-scented puppy kisses. And she's currently sprawled out on my bed sleeping the sleep of the very contented.

A good time was had by all, this evening.

Exhaustion + Vodka

= Wow, am I drunk.

Ahh, I had so much planned today. Again, foiled by the post-call inertia.

Last night was long, and obnoxious, but, as always, never dull. I met some interesting people. I got some things thrown at me (because I made him act like that. No, I said, you had a choice. And your choice just bought you a ticket to the state hospital. Because I know how to duck, I have the pen that signs your commitment papers, and you're not going to act like a jackass on my unit). I sent a crazy old hippie to medicine who had tried to kill himself (and nearly succeeded) who gave me a great lecture about how back in the 60s marijuana "used to mean something" and PCP was a sacred ritual.

I did get one of the best quotes of my residency last night, though - this very unhappy crack addict said to me, "Girl, I got W-2s older than you, and that's legal money."

What?

So then I got about three hours of sleep on the floor of my office. I futzed around and did some paperwork, and then I went to Starbucks, came home, and played with the dog for a while. Eventually I fell asleep for a couple of hours. And then Sparrow finally convinced me to go out. She and I went to this local Japanese place that has these fabulous drinks called a Hibiscus Petal, which they make with crushed basil (of all things!) and this vodka that's infused with hibiscus flowers. Definitely different, really good. She and I had dinner and dessert, and then Mike joined us for a Dark & Stormy, and then the three of us wandered down the street to the bar at this posh hotel we've got in town. It was so nice, and I had two really awesome martinis.

Now, I am not a lightweight. But apparently when I've only slept 5 hours, on the heels of 13 of the most exhausting months of my life, it only takes about five or six ounces of various flavored vodkas (hibiscus, pomegranate, vanilla) to eradicate my sense of balance.

I fell down. At least it wasn't in the middle of the street this time.

Mike and I have concluded it's actually him, since, the last time I fell down and went boom this gloriously, I was with him. And I hadn't even started drinking yet. Although, tonight, I got home and still couldn't stand up especially straight.

And I am really, really tired. And wow, do I have a lot of work yet to do this weekend.

Guess I'd better go to bed...

Stick a fork in me...

'cuz I'm DONE!

Frak, I'm tired...

Yeah, that, really just says it all....

(so it's actually 5am when I'm writing this. I don't care what the date says. But, three and a half more hours until intern year is unequivocally, completely, officially OVER!)

Loved Thursday

So tomorrow is my VERY LAST DAY AS AN INTERN.

Wow.

It's been a good year (and then some). Hard, but, good. I've learned so much...about psychiatry, about my patients, about myself, about life in general. And I've really enjoyed doing inpatient psychiatry. But I'm definitely looking forward to moving on to outpatient.

And I'm so tired.

This morning, though, the nurses on the Crisis unit really put a nice bit of punctuation on the year. We got in this morning, and they'd prepared quite a nice spread for my co-resident, the medical students, and me, to say thanks to all of us. There were muffins, sausage biscuits, hard boiled eggs, homemade quiche, bananas, juice, coffee....it was really sweet. And then they'd all signed cards for us. Mine said over and over how much they'd enjoyed working with me, what a good doctor I was, etc.

Awwwwww. I almost cried. It was so nice of them.

Tomorrow I have to present for our M&M conference (which, for those of you not in the biz, has nothing at all to do with chocolate candies. It stands for morbidity and mortality; every department has these conferences. You talk about cases where something went wrong, talk about why it went wrong, what you can learn from it, etc) about my patient who ran away. I'm a little nervous. Mostly because, well, speaking in front of the entire department, and two, the last time I was involved in an M&M at the Emerald Palace, all the shit rolled right downhill and on to me. I expect that tomorrow will go much differently.

What a contrast. It's been such a different experience here.

What a difference a year makes.

Mi vida es extraño

My life is weird.

So, today, I walked onto the unit and was immediately like...ohhhh....

Which, it turns out, was warranted. Five out of my nine patients were new. Two of them didn't speak any English (fortunately one of my rockstar medical students is reasonably fluent. And now I know how to write prescription directions in Spanish. Una pastilla antes de dormir...). So we rounded, and I started out with no discharges. And then as the day progressed, two of my patients' families convinced me to send them home. And one of them begged me not to discharge her tomorrow, as planned, because...well, honestly, because they really would prefer she were in the hospital forever. This happens a lot, actually, the, "Can't you just keep them until they're, you know, fixed? And thus no longer a bother/source of stress/imposition to me?" Sorry, no. But I feel your angst. Well, except for that "imposition" part.

You know how sometimes, you're reasonably sure you're doing the right thing, but there's that tiny little sliver of doubt that nags at you? It's always hard to know when people are really ready to leave the hospital. They tell you they're ready when they aren't, they swear that they aren't ready when they really are, and so often all you really have to go on is your clinical judgment. So, basically, your gut with a little more education. Sometimes you throw them out of the nest and they soar; but sometimes, you make a safety plan, you have a foolproof aftercare plan in place, you let them teeter on the edge of the nest for a moment and survey the land before you tap them gently...and they plummet to the ground and flop around for a while. If you're lucky, you, or some surrogate agent of you, are still there to shake your head and scoop them up and mumble things about bumblebees. If you're not...well...that's what keeps us all up at night.

I had a discharge like that today. I think she's okay. I think her family will take good care of her, and they really, really want to. She's not as stable as I would've liked, but I think that she'll fly better with her family around her instead of a bunch of crazy people who don't speak her language (not to mention the patients). Still...I worry. I had another discharge like that on Friday...called her today to check up and tell her that her labs were okay, and of course, she's doing great, and the weekend at home was just what she needed.

Still.

I mean, obviously, the attending backs us up, and it's ultimately his decision, but he more or less places his trust in my judgment. And some day, he's not going to be there, and it's going to be all me. It's a lot of responsibility. Particularly when you work with a population who, can say all the right things, tell you what you need them to say, convince you they're okay and look genuinely better....and then go out and kill themselves the next day. It happens. It happened to us last month. So you either become an administrator, or, you worry.

And sometimes, you just shake your head.

One of our patients, whom we discharged on Friday, came in Thursday night high as a damn kite and swearing he was going to kill himself, or maybe someone else, I don't really remember (he wasn't one I was responsible for). And we interview this guy in the morning, and he says, all fabulous, "No way would I kill myself. I'm too cute to kill myself. I mean, I know that sounds conceited or whatever, but, look at me."

Can't argue with that logic. Even from a scrawny little white-bread queen.

Then there's this other guy, shows up on our unit today (not sure who he was, could've been a visitor), with "PUMPKIN" tattooed on one forearm, and "NOODLEZ" on the other, such that when he puts his fists together, it reads, "PUMPKIN NOODLEZ". We spent a lot of time today speculating on that one. Kevin, my co-resident with the same last name as me (just to confuse all the staff), says, "Is that a gang tattoo, maybe? Like, 'Beware the harvest season!'?" I literally almost fell off my chair in the middle of treatment team. This came up again later, of course, with the girls in Admissions and my friend John, who says, totally deadpan, "I bet they gave it to him in prison. He was somebody's bitch, and they named him Pumpkin." And then he adds, all coy, "Come heeeeere, Pun-kinnnn". I, of course, had been busy noticing the detail work on it earlier, and was like (totally serious), "No...it didn't look like a prison tat..." He smirks and counters about how they have some seriously good artists in the joint these days. I, by then, had figured out he was kidding, and pointed out the lack of fine-tipped vibrating needles. And then ignored him when he asked me why I knew so much about tattoos...

The party, last night, by the way, was faboo. Doc G lives out in the woods, in this place that reminds me a whole lot of the area in which all my classmates lived in New Hampshire, except without the skiing. We had a hell of a good time. The food was awesome (catered from this Mediterranean place in town), the beer was cold, the company was excellent. Doc G is a funny, funny guy, and only slightly funnier than his wife, Doc D, who is a trauma surgeon. They have this massive house with two decks, two balconies, and floor to ceiling windows everywhere...and a can of Spam on their mantle. Outside, there's a koi pond, a hibiscus with flowers the size of hubcaps (so not kidding), and a six foot tin chicken. No, I don't know. Oh, and there's also...a Howitzer. I don't know why.


That's their cat. With the Howitzer. Click on it, you have got to see the expression on the cat's face. I don't remember the cat's name. But holy cow, it was a nice evening.

We spent some time talking about my patient I'd had who I spent an entire week fighting with Medicine to take her on their service because, let's face it, we're not equipped to provide that level of medical care, as sick as she was, on our unit. She was originally Doc D's patient when she came in (on account of her self inflicted stab wounds), and then she was Sparrow's, who handed her off to me when I came on service, and then she became Doc G's, when medicine finally took her (he was the consulting attending).

I got to work today and discovered she'd died this weekend.

You know, the last day she was on our service, when I finally just called them out on their bullshit, and she was full of crackles and her fingers were turning blue (ominous sign, ps) and she could barely get out the sentence, "I still want to die"...I said this to the medicine residents. I had said it outright to the ones with whom I'd been arguing all week, "You know, I know she wants to die, but I don't really want to help her, here." They made fun of me. That last day, I was like, "I'm not kidding. I'm not going to facilitate her exit." And then something along the lines of, come fucking do your job or I'm going to find out a way to do it for you. Which, it's not like I have ICU admitting privileges, which is where she needed to be, so that was an empty threat. But I told them. And now she's dead. And that just sucks.

I'd better go to bed. I can only guess at what's in store for me tomorrow...

Ahhh, Saturday...

Every now and then you need one of these days of absolute nothingness. Even though I had really high hopes for productivity today.

I slept in. Then I watched some TV. Caught up on everyone's blogs. Napped a little. Sent some emails. Didn't actually get out of bed until, oh, say, three-ish, and then it was only to drag myself next door to Sparrow's and lie on her couch for a while.

Maggie was happy to help me with my mission of snoozing...



...although I think she was getting annoyed with all of the photo ops....



Eventually I did manage to shower and put myself together and went out to dinner with some of the girls from work. It was me and Sparrow and Faye and Ruthie and three of the interns - whom we'll call Chandra, Sonia, and Rene. A little single girls' Saturday night out. It was a lot of fun. I really like them. We went to this "Mexican-by-numbers" place (as Rene put it) that actually turned out to be fairly authentic and actually pretty tasty. And had really good margaritas. Huge, really good margaritas. The intern-y types (of which I am so close to not technically still being one of, anymore, by the way. One. More. Week.) were very cute, and all, like, thanks for letting us come along! I was like, well, actually, we invited you because we like you people, but, um, you're welcome?

Wow, what a damn week it's been.

Hectic, busy, oy. And the patients have been particularly wacky this week. I mean, I don't know what's up, but someone's cranked up the crazy about three notches in our whole hospital. I don't think the moon's full. But wow, it's been nutty.

I have too many stories from the last three days to even begin to tell y'all.

In better news, my feet are looking better....



I can't quite figure out what happened here, either. Somehow, standing out in front of Sparrow's house a few days ago, this happened. I assumed they were wayward mosquitoes, but Sparrow thinks they look like fire ant bites. I don't know, but they itch like the dickens.

Hopefully I can get some things accomplished tomorrow. One of our attendings is also having an end-of-intern-year party for us tomorrow afternoon. Which I'm definitely looking forward to...both the party and the end of intern year...

Oh, wait, *I* do...

Hate to keep y'all in suspense, but damn, I'm goin' to bed...

Love Thursday.

Sleep.

I love it.

I miss it.

Who needs it?

Not a good combination...

I'm exhausted. And overworked. And cranky. And premenstrual. And frustrated. And did I mention overworked?

All in all...I'm really ready for it to be the weekend. But, alas...only Wednesday.

Sparrow and I had a raucous and chaotic call last night. And of course, one of my patients ended up in restraints 30 minutes before I was going to go to checkout (to start call). Which is not a short event, nor a small pile of paperwork. Had another one go into seclusion today. Oh, my God, it's like a state hospital milieu up there.

Speaking of which, New State Hospital opened, and Other State Hospital closed its doors and moved all its patients over. But State Hospital hasn't moved their patients in yet. Which somehow means they have no beds and are delaying everyone for three to four days. What??

In better news, I've gotten quite a lot done on my scarf in the round, which is my Wednesday-afternoon-full-of-lectures mindless knitting project. And I'm thinking of starting another one when I'm done. It's pretty nifty.

Ohh, cranky. Need a day to sleep in and drink margaritas.

Maybe I'll just go to bed.

Happy Monday

Hey, it's Monday.

OY, today was so freakin' long. I discharged half my service today, though. Which, well, they're getting better, so that's nice. Including my guy who doesn't have TB (we're ruling him out over a bullshit call by a radiologist and my dumb ass getting the film in the first place. But...he had a cough...and a history of TB...and schmutz on his lung...honestly, we didn't have much of a choice. So the poor guy's been locked in the negative pressure room since last Tuesday).

Today was a taxing day. I have this bunch of really needy patients. Some of them, genuinely have needs. One of them may well be the most anti-social woman I've ever treated. And that? Says a lot. A lot.

I always have this desire to crack those big old personality disordered folks like an Easter egg, see what's inside of them.

But I think it's probably just a big void.

I had a nice, extraordinarily random conversation with my friend John this afternoon. Did you know that Bull Shannon's first name was Nostradamus? I did not. But then, I'm apparently not nearly as up on my Night Court trivia as he.

I had some really nice things happen today, though. My patient with the asshole husband? Wants me to see her and her husband in couples' therapy. And Dr. Jabba might actually let me. And then I checked my voicemail, and I had a message from this mother whose son I saw in the ER back at the end of April. I made a passing comment about my clinic starting in August when I saw them (I think as in, no, I'm sorry, you can't follow up with me, I won't have a clinic until August). But I also made a suggestion about a change in her son's medications. And so today, I got this message telling me that they'd made the medication change and he was doing so well and his academics were solidly on the right track (actually, above and beyond), and could they come see me in my clinic now that August was upon us?

I'm kind of excited. I think maybe I'm a good doctor.

Annoying things, amusing things, and just, things

Before I head down my ranting rantiness...Happy Birthday to my adorable and wonderful nephew, Basil. No, he's not 30. But he is 2. Which, frankly, I'm not opposed to 30, but I think 2 might just be a better age.

So I'm on call. When am I not, first of all (14 days...). But secondly...today? I hate people.

I've been fighting with morons all day (the latest of which is the medicine service. Damn them! Take the patient! Take the patient!) about the disposition of the, like, three psych patients that have come into our ER.

One of whom, interestingly, is insisting on going to Other State Hospital. Which is, of course, MOVING TOMORROW! So he's gonna sit in the ER for three days. Which is probably better, because I think he might be going into the DTs. But what do I know about substance withdrawal, anyway? I'm just a psychiatrist. It's not like our patients do this ALL THE DAMN TIME. Or that they might, say LIE TO US about their alcohol use. Nahhh, our patients always tell us the complete truth.

Bastard coated bastards. With creamy bastard filling.

Anyway.

So yesterday, I sign into Facebook, right, because a couple of people I went to college with had friended me. And what do I see? This:

Are you kidding me?

What are they, Greek? 29?? Since when is that overdue for a man? I mean, except in my cultural circles, where of course I've been past my expiration date for yeeeears now...

Seriously. Hate. People.

Also want to back my car over my pager.

In other news...I finally went to the Petsmart yesterday, which was timely, because my poor dog had been eating bowls full of treats for the prior two days, since we ran out of food and all (she thinks we should run out of food every day, I think. She thought this was a FABULOUS idea. I? Also enjoyed it, because for Maggie, eating a bowl full of treats means that she has to sneak up, all wiggly with excitement, steal one out of the bowl, dash back to her crate, happily devour it, and then repeat the whole process. Because this is what you do with treats). So whilst at the Petsmart, I was walking past the big display of cheap toys, and wouldn't you know it, there were two she just had to have...okay, honestly? There was one I thought she'd really like, and one that I just thought was too damn hilarious not to buy.


Maggie was initially very excited about the prospect of new toys. The first one, which I bought more for her (because I think it looks sort of stupid) is this one.


The cool thing about it is, even though it's pretending to be a container of organic juice (what? What dog wants to play with one of those? What owner wants their dog playing with juice? Just sounds sticky to me, frankly), is that it makes a very crinkly noise when you play with it. Maggie likes a good deviation from "squeaky" once in a while. This one? Has crinklies AND a squeaker. WOW.

This one? This one I bought for me. Not so much to play with, as to periodically giggle at and say, "what the hell?"


Dudes. It's a chicken. A whole chicken. On a barbecue fork. WTF?

When Maggie was but a wee pup (okay, when I got her, and she was 18 mos old), she used to tear her toys up in nothing flat. Like, fifteen minutes to a half an hour, done. And then one day, the magical Stuffed Hippo showed up. She still has that hippo. In fact, it's still her favorite toy. You know, to nap on and things like that. I don't know what it was about Hippo, but suddenly all the destroyage stopped.

Now, now Maggie and her toys look more like this....


She's a good girl....

Transference + sleep

First of all, Happy Birthday to Kate! Holy shit, you're 30!

There's a lot of that going around these days....

Meanwhile...I had more to say around my post yesterday, actually, but was just so damn tired. I'm looking forward to not being quite so exhausted all the time. Although, I have this feeling, I'm probably going to find ways to be just as busy next year. But with less call, and less commuting than I did this past year, so, that'll definitely help.

So, transference. We've been talking about this a lot lately at work, and will talk more about it as we spend much of our second year learning the ins and outs of psychodynamics and analysis. And transference is sort of the primary concept in analysis. Plus, I'm thinking of entering the NC Psychoanalytic Institute if I can make it fiscally feasible (see? Plenty to do next year), which means I'll be up to my id in transference.

Transference, though, is an integral part of what we do. Not that it isn't present in every patient-physician interaction, but we're the only ones who really pay attention to it and even encourage it. Truth is, it's central to most human interaction. And, apologies to Dr. Freud, but it's not that dramatic a concept - we all view our lives through the filter of our past experiences. We make judgments about people based on cues that are familiar, that we've seen before. Thus, we're conditioned to respond to a stimulus we've seen and responded to before, and when we see that stimulus in someone else, we'll of course respond in kind. At least at the automatic level; at a more conscious level, we can modulate this response. Often, for us, our own transference is a useful tool - i.e., feelings that are evoked in our interactions with patients are in response to something about them. If we can use those responses to identify what that something is, it can tell us a lot about people. Problem is, you have to know a lot about yourself, and possess a certain humility about that, to do this well.

And once you start to be able to recognize this, it becomes problematic sometimes to be able to dissect these responses from what's just a genuine response to the person in front of you. My woman's husband, who I did the couples' session with yesterday, I think he's genuinely a jackass. So it was a lot to sort through, you know? What of my dislike of him was due to my own transference, my own response to other malignant narcissists and sexual sadists I've encountered in my personal and professional life? What was my protective, maternalistic feathers being ruffled over what I knew he'd done to my patient? What was the fact that he was just an asshole in our session?

It was interesting, really. His wife, my patient, afterwards, was like, wow, I can't believe how well you handled him, how you got him to talk about things. I've kind of discovered that, in my professional dealings, I actually deal pretty well with controlling, narcissistic men. It's a power play, and if you operate on their level, they win. So instead, I tap into what they're evoking in me to give me cues about what sort of traits they might possess, and this where their weak points might be. And I think that in itself is a cue to pull back, which allows me the detachment to institute a number of techniques to gain the upper hand. In the words of everyone's (okay, my) favorite TV psychiatrist, "One of the ways to beat a psych defense is a psych offense."

Sometimes I don't like that about myself. Sometimes I feel that it's very useful. It is what it is, I guess.

And regardless, I still have to honor the fact that I left there wanting to kick him in the shins.

Oy.

My other patient, well, it's awkward. And I had much the same thought as PenguinShrink's, in her comment to the last post, but frankly, I think it may actually be a reason I should do therapy with him. He's an interesting patient, particularly from a biological perspective (he's got this old brain injury). I think he's reasonably innocuous, and I think identifying a strong woman who can set and maintain good boundaries with him is going to be a positive step towards dealing with a few of his issues. Plus, it wasn't a predatory kind of thing, I think it was more of an impulsive kind of slip, from someone who has fairly poor impulse control (see above re:old brain injury).

But don't think for a second that I'll hesitate to discharge him from my practice if he can't respect the boundaries of the therapeutic setting. And I'm definitely getting a left-hand ring before I start doing outpatient (I've been debating this for a while. This did sort of clinch it).

It's such a complex landscape, the human psyche.

Transference

Two more weeks of being an intern.

I've been working my ass off (see previous post re: size of ass).

I had a rough day. My patient that eloped, her stepfather is now paging me directly (damn it, I knew I shouldn't have given out my number, even if it was an emergency). I had a tremendously intense family session with this woman and her husband that both her primary therapist and I want to kick him in the shins (okay, her therapist's phrase was "shiv to the back"). And the patient that I discharged today, who's going to become my outpatient and probably my therapy patient? Asked me out. Dude. So against the rules. Plus, you know, b, he's crazy.

Oy.

And of course, I didn't write a single note before 6pm.

Fortunately, about an hour later Sparrow came along and was like, "Wine on the patio?"

Yes.

Still had those damn notes to write, though.

I'm really tired...

One for the money, two for the show...

I know, "three to go" isn't the next item in that set. But, that's where we're at.

Happy birthday, by the way, to my cousin Danielle. Welcome to mid-life. I'm right behind ya...

So, call #4 down. I saw one patient, admitted same, and still left 40 minutes late. But he was a kid (they always take longer), whose mom didn't speak English (our Spanish interpreter down there rocks), and then I wrote the longest HPI (history of present illness) in the history of HPIs (you think I'm kidding). He was adorable. And possibly psychotic. Although I think there's something wrong with his brain. Neurology's going to love this consult tomorrow.

And then I came home, called my folks, and had a distracting little IM conversation. And now there's an ant crawling across the screen of my laptop.

Lost little bug, there's nothing to eat there!

I think that's about all of this day that I can handle.....