Maybe my crazy is showing

I'm sitting here importing a bunch of my old CDs into iTunes (this is no small feat, because I own well over 300 CDs). The title? Is a line from a very old Bryan White song (Between Now and Forever, if you were wondering), which I'd totally forgotten about and still think that line is just funny as hell. Now, perhaps more so than I did back when I was a freshman in college. Which was a disturbingly long time ago.

There are an awful lot of bad CDs I didn't even remember I owned. Still importing them, because every now and again you still get a craving for some really corny old song, knaamean?

So, today, this woman...well, let me start this story with a little neurology lesson. There are two types of things that sometimes get called seizures. The epileptic sort, where a group of neurons in the brain misfires, and then more and more neurons around them get electrically rerouted, and sometimes the whole brain gets involved. There are lots of different ways that epileptic, or electrical, seizures manifest, from "zoning out" or tapping your foot to the thing that most people think of classically as a seizure, the big, arms and legs jerking, thrashing around, foaming at the mouth, biting your tongue sort of event.

And then, there are non-electrical seizures, which are sometimes called psuedoseizures, or psychogenic seizures. Which are different from epileptic seizures because the brain actually still works fine, it's the mind that gets in the way. Now, unresolved emotional baggage can cause a lot of medical problems. And it has that stigma of being factitious - something you're intentionally doing for attention. Which, yes, there are people that do that. My patient that I FINALLY discharged last week after TWENTY FIVE FREAKIN' DAYS IN THE HOSPITAL? She did that. You could tell, because sometimes the phone ringing, or, like, threatening not to feed her dinner would miraculously bring her out of a four hour "seizure". Conversion disorder, pseudoseizures, that sort of stuff? Not voluntary. But it still carries that stigma of being "all in your head," which is really difficult for people to handle when you tell them their seizures aren't "real", because they are really, generally, they're just not an electrical storm in the brain.

Okay.

I have this patient, right, who came in while I was on call in "status epilepticus." Which, for those of you who've made the silly choice to pursue a career in something other than medicine, is a state where you have either one really long intractable seizure, or many in a row so fast that you don't have time to return back to normal. And we give drugs like valium to break this. But, she, clearly, clearly has non-electrical events. Even you non-medical types can figure this one out: she has seizures every month when she menstruates, which started after she had a miscarriage.

Um...as we sometimes like to say in psychiatry....duh.

And so when she has these things, her vital signs are normal, she's physically safe, whatever. Yet, they still gave her EIGHT MILLIGRAMS OF VERSED in the ER. Which, if you know what that means, dude! I know! And if you don't, well, if you walked over and injected that into me? I'd probably stop breathing. Dumb, dumb shit, for, clearly not status epilepticus, because, not epileptic! But, whatever. So this woman, right? Has clear axis II stuff going on, obviously having pseudoseizures, etc, comes in for EEG monitoring. And her epileptologist goes in yesterday and tells her, these aren't electrical. And then the psych consultants go in, and completely piss her off (and, off the record, left me one of the worst consult notes I've gotten from any service all month). So today, I tried to calm her down, and promised to come back and do a little therapy on this topic (which isn't quite how I pitched it to her, but, you know). And I do, and she keeps interrupting me, right, and asking me stuff about myself. Like, am I married, do I have kids, etc. And I basically answered her briefly and then redirected her back to her stuff, because it wasn't anything too personal, and she was saying a lot of other things to indicate that she was clearly identifying with me, which is a useful therapeutic tool. And then she says, "How old are you?" And I told her, and she was all, "Really? Really?? You're actually 29?" And then she says:

"I thought you were like, 40."

.........?

Forty?

I mean...what?

Now, if I were forty, then it would be okay (it's kind of like, if I were a nurse, it'd been cool when people ask me if I'm their nurse. Because it would be okay for me to be a nurse, but I'm not, so it irritates the crap out of me that people assume that because I'm female I'm the nurse, not the doctor, despite the fact that I'm wearing a long white coat and...well...doctoring them. Because if I were their nurse I'd have a lot less debt and wouldn't have had to work my ass off in medical school and right now would be making a lot more than $8/h and working a lot less than I do. But, I digress). But I have eleven years to go before I'm 40! And, she explained it away by saying that she thought I looked young, but, assumed that to be a doctor I had to be much older.

Not helping.

On a related note, I'm wondering if I made a big political faux pas this morning. My attending, who's kind of a cocky bastard, and is also a behavioral neurologist, went in this morning and gave her a very good talk about pseudoseizures and why that doesn't mean we think she's crazy (we think that for other, unrelated reasons), that these are very real events, etc. Now, I'd warned him that she was pissed at psych and offended that "we all thought she was making it up", and I'd talked to her a little already, but, he just did a very good job with it. And a lot of people don't, as my psych colleague clearly demonstrated. And so when we walked out, I said to him, I think very genuinely, "That was a good explanation." And he says, "Yeah? Well, I've given it a few times." And I couldn't quite tell if he was being, um, coy (for serious lack of a better term), or really sarcastic. And it occurred to me later that my comment could've come off as being sort of condescending and a little insubordinate. Because, well, I'm an intern. He was interviewed by the New York Times yesterday as an expert on dementia.

And back at the Emerald Palace I used to get criticized a lot for "not knowing my place." Which, I concede, I usually don't.

I dunno. I figure I'm probably okay, because I've also noticed that recently he assumes every patient is mine and has started wearing cologne to rounds.

Damn, this post got awfully long. Nice of you to still be reading it!

Oh, it's so naptime...

Yesterday's post? Was supposed to automatically post at 8:30am. It just showed up now. What the heck? Clearly, Blogger and I need to have a talk about being responsible...or maybe I just need to learn how to use the dumb thing...anyhow.

So, who watched Bones on Tuesday night? There was this great moment, where she's interrogating this Jeffersonian Institute professor guy who's all smug and better than everyone, whom they suspect of murdering his mistress. It goes like this:

Aldrich: Dr. Brennan, surely I merit someone higher up the food chain than an FBI consultant.
Brennan: Kyle. I know you get everything you want by flaunting your superior intellect. But that won't work with me.
Aldrich: Why is that?
Brennan: Because I'm smarter than you are.

I? Love that.

I think I had more to say, but I'm also really, really tired. I had an interesting, but exhausting call. And I have to be at the hospital really freaking early again tomorrow. So, maybe I'll just go to bed...

Gratuitous Cuteness

This? This is my niece, Lily. She's a giraffe.

I'm starting to love Halloween.

But even better? She just turned one. And of course, there was cake.

She's the daughter of one of my dear friends from medical school. I was in her parents' wedding. So, again, I take full credit for her brilliance and adorableness.

Enjoy. I'm on call again today. Here's hoping for a quiet night, and a couple of good stories.

Misty watercolored memories

For those of you who missed it, Otter made a very accurate comparison in the comments about my last post: Internship must be like childbirth, you forget how bad the pain really was.

Totally.

And the two years of limbo and sleeping in on weekdays and working in a yarn store didn't help. Plus, I think there's just some outright traumatic repression factored in - it was sort of hard to tell what badness was general intern crap and what was actually the result of the Reign of Terror that was my OB program. And I'll be the first one to admit, freely, that this time around is so much better. It's nice not being the whipping child. I don't miss being constantly berated and demoralized. SO MUCH BETTER.

Which, does not, however, make it good.

You do forget the peculiarities. The dull ache in your upper back from the thirty pounds of stuff you have crammed in the pockets of your white coat. The mania induced by not sleeping every fourth night (which has struck me a lot this month, when we routinely sleep deprive patients to make them have seizures. Um, does anyone else see a problem, here?). The constant, vague sense that you're doing something wrong. The sheer mass and speed with which shit rolls downhill (and you're the valley, baby). And the bone-deep, leaden fatigue that never quite goes away, even when you technically are getting "sleep".

There came a point in medical school, early in my third year or so, where I had to become a doctor because my loans were so huge that I couldn't afford not to. Which was fine, because I actually wanted to be a doctor, but it still was sort of intimidating, in that holy-crap-I-guess-I-can't-change-my-mind-now sort of way. That's sort of where I'm at again. I've had a couple of moments this year where I'm like, really? Do I really want to be a psychiatrist? Am I sure? And then some part of my brain comes in and squelches that and says, fuck that, kid. You picked it, you're stuck with it, because I am so not doing this intern year thing ever again.

And again, it helps that I really do think I want to be a psychiatrist. But after this year? Never doing q4 in-house call, ever, ever again. Never going to be a scut monkey for a service I don't even belong to (ahem, family practice) again.

So ready for this to be done, and I'm not even crowning yet. Can I at least get an epidural?

So, okay, maybe it's not quite as bad as all that. I mean, it does have its moments. Like, I got to do a nerve block on a headache patient today, which was pretty cool. And the psych stuff can be very frustrating, but it's certainly never boring. Plus, I do like my cohorts. And I'm meeting interesting people, especially now that I'm off-service and in a big hospital where we can call in consultants. And it's only one year.

At least I've stopped swearing every single time my pager goes off.

Only 237 days to go...

So, two years ago, when I left my OB program, I remember having this conversation with this guy I was soon to fall madly in love with (which turned out to be a terrible mistake - when isn't it? - but nevertheless) about what the hell to do with the rest of my life. And we went back and forth about finding a new residency and staying in gynecology and blahdy blah blah blah. And so I made the memorable comment, "I don't mind having to repeat my intern year. I mean, the intern shit, I can handle. Being an intern? That I can do."

You know what? I do sort of mind. I'm tired.

Today was long. We had a family meeting with the sons of a patient of mine who had something close to a catastrophic stroke, who's doing really poorly, and who, incidentally, I've taken a lot of flack on for doing things that were very reasonable (like calling the hospice people to see if she was eligible after my attending said, "Let's get hospice involved." And then this morning everyone was all, what?! You called HOSPICE?! I...um...yeah. Remember when you told me to?). It was heartbreaking. She was, by all reports, a vibrant and wonderful woman. She, now, can't eat, can't move half her body, can't stay awake, can't really communicate. And her son -when we were discussing whether or not to put in a feeding tube - says, "You know, as long as she can swallow" (which she currently can't) "that's fine. I mean, I don't care if someone has to feed her, or, you know, if she doesn't know what day or month it is, whatever."

I wanted to cry. I have a feeling that would matter to her.

Talk to your families, folks. Be explicit in your advance directives. Tell the people you love how you would want to be treated if you can't make those decisions. Talk to your family about what they want. It sucks to think about these things, and you don't ever want to think they'll happen to you or to anyone you love, but, it does. And you'll be glad you had those conversations in a calm, rational moment when things aren't so calm and no one is feeling very rational.

Well, it was a nice idea...

So I agree to do this daily posting thing, right? Only to discover last night that I can't sign in to Blogger from the hospital. Don't know why, just can't. Seriously, I tried like six different computers.

Argh.

So I could, technically, cheat and backdate my post so it looked like I wrote it yesterday, but I, I am not a cheaty-head, and so I'm going to just go forward and try to plan better for the days when I'm on call.

Call was actually quite nice last night. I spent most of my evening fretting about my patient in the stroke unit and chasing her blood pressures and freaking out at her heart rhythm on the monitor (only to call the Cardiology fellow and have him say, "Pah, PVCs. That wouldn't worry me at all." Which he said in a rather friendly sort of way, or I'd have muttered something nasty under my breath about Cardiologists. But this one is fairly nice, and has endeared himself to me in the past, and I'm pretty sure he was just trying to reassure me that she wasn't going to flip into v-tach and DIE in the next five minutes). But then I got to bed around 10 or 10:30, woke up a couple of times to roll over, call the stroke unit and pester the nurse about how my patient was, and then go back to sleep until 6:30, when I finally got up and was like, wow, what a great call that was.

And then we got a new attending today.

Now, I've mentioned that I'm not overly crazy about my new team. But our attendings over the past two weeks have been really pretty cool, which I've greatly appreciated. This one? This one is a strange, strange little man.

He came on all blustery and puffed up like a surgeon this morning. And then he calmed down a little, and got a little bit more comfortable with us, and then he started doing things like taking extensive psychiatric histories on our patients for no good reason (sometimes it's warranted. Sometimes it's just annoying). I was like, you do remember that you're a neurologist, right?

Bleh.

So we'll see how it goes. If nothing else, it's twelve days, and three calls, to go. And, the strange little man could turn out to be amusing when I'm better rested and less likely to feel threatened by his insinuations that I'm a moron because I can't read an EEG or I lump MRIs into the categories of either "that's probably fine" and "this one looks funny."

I'm a psychiatrist, dude. And the real point of this month? Learning when to call a neurologist.

But in the meantime, to make up for my lack of posting yesterday, here is a gratuitous cute picture of my niece, Annalise:

She's a banana. Ha! And five months old this week. And one of the cutest children in existence, all of whom seem to be somehow related to me. And by "related" I mean she's my cousin's kid, who isn't actually my cousin but we grew up together and I always called her parents Aunt and Uncle, and you know how Greek relatives don't actually have share genes with you. In the coming month I also have other gratuitous cuteness planned featuring probably more of her as well as my other friends' children, all of whom have been claimed as my nieces and nephews and can expect to be spoiled accordingly. That's just how it works.

NaBloPoMo.

No, it isn't screwed up pig Latin. It stands for National Blog Posting Month and is apparently this online community thing where bloggers agree to post every day for the month of November. I was reading about it on Jen's blog and thought, what the hell is that? And then I clicked on the little link and was like yeah, yeah, whatever, until the point where they said:

"The Groups tab will help you find other likeminded individuals. I'm looking at you, knitting bloggers."

Now, it's not that I actually consider myself a knitting blogger (because we all know how much knitting is going on around here these days), so for no real good reason, that cracked me up. And I said, okay. I'll toss in my two cents. I've been bad about posting lately, and it's been bugging me, so maybe this will be good motivation (not sure how well this will work with my call schedule, either, but hey). And there's a cool button. I don't think I'm eligible for fun prizes or whatnot, because I didn't actually figure this out until November third, but, you know, whatever. We'll see how it goes...

Confessions of a Cranky Call Girl

So, week two of Neurology, down. For a while there, I was actually really enjoying it. But then the month changed and so the team changed, and now? Now I'm just crabby.

On the whole it hasn't been a bad month. Initially, there were two of us off-service types - me, the psych intern, and a Physical Med and Rehab intern I'll call Liz - as well as three second year Neuro residents and one senior, about to graduate in July-type Neurology resident. The six of us got along well. Our chief was laid-back and practical. Our attending for the first week was very cool and also really liked me, which was a plus. Our attending this week (they change weekly) is a very nice guy, quiet, soft-spoken, very easy going, but with this very disarming razor-sharp dry wit. Prior to Wednesday, I'd had two very easy calls. Ahhh.

And the system, as it is, is very nicely set up. Whenever the second year takes call, they're on by themselves. So they do consults, admissions from the ER, stuff on the patients already admitted, whatever. And they wind up being on a little bit less than q4, although not much. When Liz or I - who are strict q4, on every 4th night - are on, there's an upper level resident with us. So we take care of the patients already on service, up on the floor, and we do any direct admissions (transfers, clinic patients, whatever). The upper level, who theoretically knows something about Neurology, handles consults and makes decisions about admitting people down in the ER. Plus, they're available for any point at which the off-service intern finds themselves in a situation where they need guidance. It's actually quite pragmatic and useful, plus, we both have an easier night than we would've alone.

Oh, and did I mention how much better it is that being the only medical doctor overnight in a state psych hospital that has over 500 patients? And isn't always staffed by the most competent medical providers during the day?

But then November first came along. And we lost four residents, and only gained three. Liz and I are still there, and I'm so glad, because holy cow do I like her. She's a good egg and a very good co-intern. But we now only have a chief and two second year neuro residents. Our chief is high strung and intense and micromanaging and, while very nice, is kind of a lot to handle. And, AND, she does things like decide we need to round at freakin' 8am (we'd been rounding at 9:30 prior to this), which means I have to leave my house by 6 to get there in time to preround on all my patients, which totally bloody sucks. And then yesterday she made the whole team stay until after she was done with clinic, so we didn't leave until way too late, despite the fact that the two of us who could leave (Liz was on call) had been done for some time. And while one of the new 2nd years is actually a really nice guy whom Liz and I both really like, the other one is a condescending jackass. Which, we all know how well I take to condescension. Arrrrrrrrgh.

But at least I have today off. Which is nice, because I need the chance to catch up on my sleep, because of course I'm on call again tomorrow. Such a good time. I'm on with one of the second years from our old team, who's a great guy, but always admitted a ton of people on call. We'll see how it goes.

Incidentally, the title of today's post comes from my habit of answering the question, "Are you on call tonight?" with something along the lines of, "Yep, I'm your Call Girl this evening." I said that on Wednesday, and the nurse and the RT I was talking to (both men), were all shocked and scandalized and giggly. I, on the other hand, was like, it's kind of a corny joke, y'all, calm down.

There are many ways in which I whore myself out for this job. That? Is not one of them.

In other news, in what spare time I do have I've been reading a lot, which has gotten in the way of me knitting a lot, which I hope to remedy soon. And all the people who told me my wool stash was useless down here? Oh, you lied. Lied like a hand-crocheted rug (you know, like the one in my bathroom). I may not need quite the same level of woollen insulation that I did in the Chi, but, it's gotten sort of chilly down here. You can tell because Maggie, who usually looks like this when she naps:

has started sleeping like this:

And the leaves are starting to change for real, which is very pretty. I'm told the Carolina springs are even more gorgeous. I have to say, I have yet to meet a season which isn't lovely in this part of the country (even if the summer was sort of steamy). We'll see how I feel about winter.

Meme a little meme with me

I was tagged, sort of indirectly, by Barb for this. And since I have the WHOLE DAY OFF tomorrow (in the middle of the week! Not even post call! A whole day!), I thought I'd indulge. (For those of you unfamiliar with the concept of a meme, click here, or if you want to know the actual sociological definition of meme, click here).

Things I'm Passionate About:
1. The people who are close to me
2. My dog
(and the rest, in no particular order)
3. Music
4. Justness and fairness
5. Language, words, and communication
6. Beauty, meaning, and analogy
7. Knitting
8. Access to quality mental health care (and being able to provide same)

Things I Want To Do Before I Die:
1. Get through my intern year and manage the lingering effects of the last one
2. Develop actual self esteem
3. Learn to paint for real
4. Have a healthy, useful relationship with a good man
5. Communicate to those close to me exactly how much they mean to me (never gonna happen. There aren't words for this. But I'd like to come close)
6. Become a really, really good psychiatrist and have a productive career
7. Be able to give voice to those who had theirs taken in those ways I lost mine
8. Live long, and well

Things That I Say Often:
1. Is alls I'm saying
2. This is Dr. Kate, returning a page? (Okay, I use my last name)
3. Dude (typically a conjugate - as in "Dude, whatever" or "Dude, seriously!!")
4. Shhhhhhhhit!
5. You know what I'm saying.
6. Are you fucking kidding me? (Hey, my vocabulary is a capacious lexicon. Which is why it's okay that I swear like a sailor)
7. Are we there yet?
8. Hmm. And when have you felt like that before?

Books I've Read Recently (Or Am Reading):
Currently have my nose in...
1. Travels With Charley In Search of America, John Steinbeck (So far, a good read)
2. Bones to Ashes, Kathy Reichs (Ditto, although I've been told it isn't quite up to par with her older stuff. Which, considering how much Break No Bones annoyed me the first time I read it, dude. Fatal Voyage and Bare Bones are still my favorite Temperance Brennan novels)
3. Clinical Neurology for Psychiatrists, David Kaufman (yawn)
Recently finished...
4. The Book of Lost Things, John Connelly (A good read. The ending's kind of predictable, but the language, imagery, and allegory are fantastic)
5. Walking in Circles Before Lying Down, Merrill Markoe (Cute. Fluffy. Quick)
6. Big Big Love, Hanne Blank (Excellent. Purports to be about sex although it really isn't, and a wonderful book for anyone with body image issues)
7. Bitter is the New Black, Jennifer Lancaster (Funny, if kind of shallow. And made me homesick)
8. Bright Lights, Big Ass, Jennifer Lancaster (Hysterical. Funnier than Bitter. Jen's blog is also an amusing read)

Songs I Can Listen To Over and Over:
(in no particular order, and not especially my eight favorite songs of all time)
1. Get Back!, Ludacris (LOVE him. It's inexplicable)
2. Watch Me Shine, Joanna Pacitti
3. As Cool As I Am, Dar Williams
4. One Girl Revolution, Superchick
5. Blood in the Boardroom, Ani DiFranco
6. Break Away, Rascal Flatts (There are several RF songs that fit here, actually)
7. Time, Sarah McLachlan (Ditto. And this one, oddly enough, a song that will always remind me of Baltimore)
8. Judas, FHOD (The Flying Hamsters of Doom. Seriously. Coolest band ever. Why? Because my cousin plays bass, and they're actually really good, not like most people's bands-their-cousin-is-in)

What Attracts Me To My Friends:
1. Sense of humor
2. Common interests
3. Disparate interest
4. Compassion
5. Honesty
6. Genuineness
7. Common neuroses (let's be honest, here)
8. Something more diaphanous and ineffable

Things That I Learned (in the) Last Year:
(Okay, I'm taking a liberty and expanding this to the past three years)
1. I can teach knitting. Who knew?
2. Stability is fleeting and unreliable
3. Denial is a crappy defense mechanism
4. People will declare themselves, if you give them the chance
5. Who the "mentally ill" really are
6. The only way out is through
7. Where the cafeteria is at the hospital (Hey, the can't all be life lessons, can they?)
8. Exactly what I'm made of (okay, maybe I'm still learning this...)

Consider yourself tagged. Go!

Uhhhhhgh....

I? Am so, so tired.

I started Neurology today. It's okay. My team seems nice enough. We had a really busy day.

So I was supposed to have this nice, get-acquainted sort of day, right? We didn't have a psych intern on the Neurology service last month. I'm on call tomorrow, which makes me pre-call today, which, when combined with the fact that I'm not following someone else should have meant that I didn't have any patients to see. Right?

Err, maybe not...

Allegedly, there's pretty much always an anesthesia intern on the service as well. And the one who left was supposed to sign out his patients to the one who was incoming. All good, right?

Except.

No anesthesia intern showed up today.

Oops.

It turns out there is no anesthesia intern this month, but there's a Physical Med and Rehab guy, who isn't showing up until tomorrow. So suddenly I went from this nice, casual day of having no patients to follow, helping out, getting oriented and maybe even leaving a little early so I could go replace the tuning fork and reflex hammer I can't find (at least I bought a penlight yesterday), to suddenly having six patients I knew nothing about to round on. Using a computer system I don't know. In a hospital system I don't know. On a service about which I know nothing (although, as my best friend points out, who really does know anything useful about neurology?).

I made it through, got things done, even discharged one. And spent an inordinate amount of time on the phone with the help desk. And although I didn't exactly get out early, I made it home in time to take Maggie to the boarder (I have to take her tonight, because I have to leave home tomorrow about an hour before they open. And she'll be there until 5 on Wednesday because I won't get home in time to pick her up during the morning pickup hours. I'm working on a dog sitter...).

Stressed. Me. OUT, today did.

I guess we'll see how call goes tomorrow. I'm told their call isn't too bad. I'll believe it when I see it...

...only 252 more days, 4 hours, and 5 minutes....

Coolest. Friends. Ever.

So, as per usual, I was on call last night. Shocking, I know (this every fourth night thing is getting a little weary, and I still have 257 days to go, according to the little countermajig. Which translates into roughly 65-70 more calls, and oh my GOD, that was a number I never should've crunched). And it wasn't too bad a night - the lady who was in the unit with DTs and detoxing off of methadone, street opiates, cocaine, xanax, and who knows what else did not actually have a seizure, nor did she achieve her goals of chewing through her restraints or biting her nurse. The kid who keeps sticking foreign objects in his dialysis port (he now has a staple - like, you know, the kind that holds paper together - in his lung, permanently) managed to not stick anything else in there last night. I was on with one of my favorite moonlighters. And I even got my flu shot yesterday. Why people needed to call me at 2am to clarify orders that weren't going to be carried out for another 6 or 7 hours is totally beyond me, but, all in all, it wasn't a bad night. And I only have one more State Hospital medicine call left (Saturday) until January. Huzzah.

So I got home around noon, picked up a disappointing burger at the Cook Out down the street, and came home and tried to nap. But there was banging outside. My damn pager went off (not it, people, not it!). And then the doorbell rang, at like, 2:30. And I thought, who the hell...?

And I thought about just ignoring it, but then I decided that it might be maintenance and they might be coming in if I didn't answer, and I was not in the mood to have my apartment invaded, so I got up, threw on my bathrobe, and trudged downstairs to say, no thank you, whatever you're selling, I don't want to buy any.

But I opened the door, and I found this package. And I opened it, and it was one of the best pieces of mail I've ever, ever, ever received. Look what was inside:

These, along with a card from my knitting buddies back in Chicago (Sarah and Lorna, and Joy, Valerie, Cindy, and Heather, who don't have blogs for me to link to). There are six of them, and six pieces, so I'm guessing that everybody made one. The patterns are apparently from a Leisure Arts book of bath and spa sets, and the yarn is Lily Sugar and Cream, in a colorway that will go very nicely with my upstairs bathroom. So awesome!!

What's also amusing is that in my drowsy stupor, the first things I saw when I opened the tissue were the bath mitt and the two hand towels, which looked like one really long piece of cloth, and the gathered up top of the soap bag. And I thought, huh. This is really cool, but why did they make me a hat, mittens, and scarf set out of cotton?

And then I got it.

And then I got a little sniffly.

So now I'm all ready for a day of fabulous spa-like self pampering (all I need is, um, a day). I love them! And I really like the little lace detail. So cool! THANKS SO MUCH, Y'ALL!!!

Plus, if you saw the comments from the last post, I also got notification today from Amanda that Sarah had entered me in her contest, and I won! It's an embarrassment of riches today, really...and I appreciate each and every bit more than I can ever tell any of you.

It's my birthday (and I'll rant if I want to)

So, following in Sarah's lead (although sadly, I don't have the tiara), happy birthday to me.

It's my very first 29th birthday, in case you were wondering.

And thanks to all for the lovely cards and phone calls and emails. I miss each and every one of you (and a few who didn't even bother to acknowledge the day, a-HEM. See what you get for your birthdays...).

My one aunt sent me a card wishing me a man this year. I think she was kidding (although, as long as I get to pick him out - or there's a gift receipt so I can return him - I'm actually cool with that. Frankly, could be the best gift yet).

So how am I celebrating? Well, I've spent an awful lot of time on the phone. And I may order pizza for dinner (there was some talk of going out, but, well, I haven't heard anything, and it's after 6, and I slept through lunch, so...). Oh, and I was on call last night. Which was fan-freaking-tastic. And I slept for two hours. And lost the ability to use my typical line, "oh, and it's not even my birthday!" when people called me up and said they had a patient for me to see.

Eh, it's a corny line. It's not such a big loss.

But I did come home and take a big fat post-call nap (seriously, there's nothing better than the post-call nap, when you're really tired and your bed is so comfy and ohh...) with the dog. Who was so glad to see me this morning, even if she did cry all the way home from the day care/kennel place. Aww.

Actually, the birthday part of being on call last night wasn't so bad. The people in Screening and Admissions (intake, basically) had dinner for me, which was so incredibly nice that I almost cried (but, I'm a big girl). The woman who runs the place and who actually coordinated dinner was all upset that she didn't get to actually cook, but wow, that Stouffer's makes a darn good lasagna. And then there was apple pie, with ice cream.

Which I ate out of a styrofoam cup. Apparently, pie-in-a-cup is "such a hospital thing", or at least this is what I'm told. I say, ??? Seemed like a darn good (and darn portable) idea to me.

It was very nice. And I took some back for the med unit nurses (and the RT, whom I dragged in on his day off), and they were all very excited. I mean, there was pie in a cup, for Pete's sake! And that particular group tends to take pretty good care of me. It was nice, in spite of the scary episode with the kid that ensued and the train wreck admission at 3am.

I have to say, as much as I miss everyone back home (which is a LOT), I do rather like it here.

So, just prior to this dinner episode, though, Dr. Asshole struck again. One of our nurses is pregnant - the one I made the hat for - like, seven-ish months. So, she has a fair amount of baby hanging off the front of her, right? So, right before he leaves, she was giving him crap about how he was going to be a nerd and go home and read journal articles instead of going out to dinner with the group from work that was going out last night. It was totally jovial, not, like, an actual attack on his character or anything. And he points to himself and says, "Um, let's see...cardiologist...and, what are you again?" Which he then recanted (given our reaction) to "Well, not a cardiologist." And we all were a little incredulous, and she gives him a little lip back, and so he points to his scrawny-ass, never eats anything (well, okay, he only eats carbs, and meat, on Fridays. Like he's some sort of Atkins Anti-Catholic or something. And this is all rumor because it's not like we ever see him actually eat), not-especially-attractive abdomen and says, "Or, okay, um, six pack and what? One pack?"

We were all just a bit floored that he'd actually just said that to, well, anyone (asshole), but particularly to a. pregnant. woman. I mean, really though. I was a little dumbfounded.

He's actually pretty lucky he didn't say that to me, to be quite honest.

So then we spent the next half hour or better talking about what an asshole he was. And I spent the rest of the evening saying "Well, but if you were a cardiologist..." every time something went a little bit awry down there.

Oh, and PS, um, you're not a cardiologist any more than I am right now, buddy. Being accepted for a fellowship does not equate to actually having completed that fellowship. And what's so special about cardiology, anyway? It's not particularly elite, and to invoke a bit of a cliche, it's not exactly neurosurgery.

Jackass.

This really bothers me, in case you haven't figured that out yet.

One. More. Week. And fortunately, my two remaining calls are with two of the attendings I actually sort of like. Although, one of the nurses told me a really disappointing story about one of them last night, which involved a guy dying because of her poor management.

Not that we don't all make judgement calls that turn out to be less than ideal through the retrospectoscope, but, like he said, there's safety in the mediocrity there. And, you know, it's just sort of disheartening to hear that someone you thought was one of the only really competent docs around there made such a bonehead move.

And, I still don't really know where I'm going after next weekend, because, natch, I'm the swing resident again. So if our colleague comes back from sick leave, or if our second new resident gets approved by the state medical board (ha), before next Monday, I'll be on Neurology. And if not, I'll be on (shudder) Child Psychiatry. Um, you know, I know that I'm actually quite flexible, but, I'd sort of like to know WHAT THE HELL IS GOING ON. Sometimes I actually sort of like a little structure. It's, you know, kind of comforting....

Ah, whatever. The bigger point is, one more freakin' week on the medical unit.

Oh, and, it's my birthday! I should get me something....

Proof of actual knitting (and crochet)

Did you all really think I'd given up the yarn? Now, come on.

In truth, I haven't had all that much time to knit. And I diverged a little into crochet...because, you know, it's fast...

Some time ago my classmate and partner in crime PenguinShrink (or as I am sometimes wont to call her, Wet Armadillo Girl, given her propensity to say things like "50 lashes with a wet armadillo." She's from Texas, what can you say) and I made the very silly commitment to hand craft thank you gifts for all of the donors who gave money for the intern retreat. We were told there are usually about 7 or 8 donors, and that this year they'd had more trouble recruiting people to donate because the retreat, um, wasn't well attended last year (again, I tell you, it's a weekend off, at a beach house, all expenses paid. What's the conflict??).

There were 15 donors.

We had a lot of fiber work to do...

Penguin's a much more accomplished crocheter than I (you should see the blanket on their bed!), so she tackled the more complicated items, for the higher-amount donors - i.e., a moebius scarf and shawl, a very cool ribbed newsboy hat, etc. This is my contribution:

What you see here, from left to right, are three scarves at the top - in Encore (from my stash), Red Heart (I know, but, dude, it was cheap) and Malabrigo Chunky (also from the stash, and, for the program director). The left two are just some combination or another of sc-dc rows; the one on the right is the infamous Potato Chip Scarf, or at least my crocheted version.

Down in front (here's a close-up):

are two washcloths in Bernat Organic Cotton (the pink - and can I say, $3 for 84 y and AMAZING. Seriously, I'm in love) and the old standby Sugar 'n' Cream, which is also what that square thing is made of (it's a washcloth-bag thing that you put your soap right into, whatever the hell that's called, and it has a bar of soap in it, in a box, which is why it's square). Then that little thing next to the washcloths is a coffee cup cozy in the custom-dyed Lorna's Laces that Sarah sent, for one of the State Hospital attendings who, well, drinks a lot of coffee. In truth, it started out as a sock, but, I didn't like the way it was turning out, decided I needed to do a slip-stitch pattern of some sort, blah, blah, but I didn't frog it, so I just ribbed a few rows, bound off, and *poof*, instant java cozy (incidentally, I made one of those for my uncle, for Christmas, and he raved about the silly thing). Anyway, next to that are two gift bags, one knit, one crocheted, out of the Encore again (which were going to be filled with chocolates), and then finally, also for chocolate-filling, is a little bowl on the end there made out of some icky Paton's Canadiana that was in the stash, don't ask me why (the color actually turns out sort of cool, but blech, it feels so..acrylic). And there you have it.

Then, the past few days, I've been working on a little baby beanie (not to be confused with a Beanie Baby) for one of the nurses at work, who's having a shower tomorrow.

Here's Maggie, modeling the hat with all the enthusiasm Sarah's Worfy (PS - happy birthday, Sarah!) usually shows as well....

And, perhaps a better view, on the couch:

It's made out of RYC Cashsoft, a machine-washable merino-cashmere-microfiber blend, and possibly my all-time-favorite baby yarn.

So that's what's off the needles/hook these days. I need to start something else...I've got a couple of socks going that just aren't calling to me these days....any suggestions?

Succinct

So, I came home this morning, after a wretched, wretched call, and found this in my inbox, again from Barb.

I cannot tell you how well this sums up my call. And currently, my job. Or how much this song will be in my head over the next two weeks (okay, year).

Plus, I, just, I howled.



I think this is going to replace my old on-call song in my head from back in my OB days (although, how can you possibly replace the lyrics, "It's like hey, l'il stupid, don't make me lose it!" Although....I admit....it's the second bridge that was usually running through my head...)

Another must-see

Barb sent me this today. It's a Dove ad, part of their Campaign for Real Beauty. It speaks volumes....and frankly, that overwhelming torrent of judgemental messages they portray so well, is kind of how I feel most days....



The next post will include fiberwork, I swear it. But this seemed important enough to preempt that, so...

At least it wasn't the couch

So I'm on call again. As always. What else is new?

Sunday was my last call, and OH. MY. GOD. did it suck. Sucked like a Hoover in a hurricane. Tonight, tonight's going a little better. It helps that my "moonlighter" (we typically have a moonlighter on from 5-11 with us, who is usually a medicine fellow of some sort - mostly GI - or sometimes one of the Locum Tenens types. They're useful to us, but really, their moonlighting function is for the attending, so they can go home at 5 and only come in if there's a serious crisis) is one of the most competent attendings we have and also one of the more delightful people in the department. She's very cool about just handling whatever needs to be handled. It's nice.

And, guess what. I got to sew. I did! On a person again. Ohhhhh, it was wicked cool.

It actually started our evening with quite a bang. Shortly after 5 (when everything switches over to the "on call" folk and everyone else goes home), they called a medical stat (think of a code blue, but a little less dire than that) on the medium-security forensics unit. And, much like a code, when you hear that, you move. And if you aren't one of the ones moving, you get out of the way. So I take off running (I do run pretty fast for a fat girl) and when I get up to F-Med (and someone finally lets us in behind all the security doors) there's just blood everywhere. I mean, everywhere. Apparently one of the patients got out of control, decked a staff member so badly we had to send him to the real hospital, and knocked this other patient across the back of the head with a chair, opening up about a 6 cm-long gash. And between the two of them, they bled all over everything like a couple of stuck pigs (the assailant, by the way, had nary a scratch on him, ended up in four-point hard leathers and bought himself a ticket over to the maximum security side).

I have mentioned that forensics is my specialty of choice, right?

So I got to sew his head up. Ohhhh, I do miss the sewing. It took me the first suture or two to get my groove back (it has been over two years, you know), but it's like falling off a bike. I was telling him, as I was stitching, about the last head I sewed up, which was on Halloween 2004. The guy was very intoxicated and both his girlfriends happened to show up to his costume party, and in the process of trying to keep them separated, he cracked his head on the bar lamp and wound up in my ER, dressed like Paris Hilton, with two big gashes and me sewing on his head. This guy, tonight? Apparently tried to murder his mother, was found incompetent to stand trial, and then just wound up on the wrong side of that chair. He was so much more pleasant and cooperative than the last fellow whose head I stitched.

After I dressed his wound, I sent him back up to his floor with an order for tylenol, and told him that next time, he really should duck.

Um, yeah, but what about the part where kids scare me?

So, way back when dinosaurs roamed the earth and I was in medical school, someone in our class found this aptitude test online for figuring out your specialty. I was stressed out about choosing a specialty at that point and couldn't figure out what I really wanted to do and was so very hopeful that this would tell me what I was supposed to be doing with my life and then my sense of identity that was in such flux would be all set and life would be better. I remember taking it at the time, and I think it said that I should go into either preventive medicine or PM&R, I don't remember which, and then aerospace medicine, and then something else (ER?), and then I thin OB was 4th or 6th or something. So I happened to come across it on someone else's blog today, and thought, oh, isn't that fun, I should take it again and see what it thinks I should be doing now (you know, having just switched careers and all that). So this is the list that it gave me:

1. preventive med
2. pediatrics
3. pulmonology
4. nephrology
5. aerospace med
6. psychiatry
7. physical med & rehabilitation
8. med oncology
9. neurosurgery
10. rheumatology
11. hematology
12. general internal med
13. emergency med
14. dermatology
15. orthopaedic surgery
16. radiology
17. urology
18. plastic surgery
19. occupational med
20. allergy & immunology
21. radiation oncology
22. thoracic surgery
23. obstetrics/gynecology
24. nuclear med
25. ophthalmology
26. endocrinology
27. infectious disease
28. anesthesiology
29. colon & rectal surgery
30. otolaryngology
31. general surgery
32. gastroenterology
33. cardiology
34. neurology
35. family practice
36. pathology

Huh?

Okay, first off, I can't think of anything I'd be more bored doing than preventive medicine. And for the number of times it asked me if I liked problem solving and challenges and I answered "most true", you'd think this would be at the bottom of the list. Secondly, NO WAY am I built for pediatrics. Kids scare the hell out of me. Remember how 80% of my intern class wants to go into Child and Adolescent, and I'm like, no way in hell, I'm going to go do Forensic Psychiatry? Then, nephrology? Yick. I hated that rotation. Pulmonology I might buy because I did like intensive care an awful lot, and ICU med tends to be a pumonology thing. But of all the things I thought about doing - Ortho, Urology, PM&R, ER - renal was never EVER one of those things. Neither was dermatology, ew. And shit, seriously - can you see me as a plastic surgeon?

Next year I have to do pre-op evaluations for patients undergoing bariatric surgery. A, can you imagine them sitting across from my fat white ass during this process? And 2, you know I'm going to be all diagnosing everyone with eating disorders or whatever and pointing out that surgery ain't going to fix that (those of you who know me IRL know how vehemently opposed I am to bariatric surgery in general. Because seriously, everyone, everyone has complications, they tend to be bad, and there's a high mortality rate from the surgery itself, much less the consequences thereof. Plus, not healthy, and, usually doesn't fix the real problem! Getting skinny is not an automatic remedy for your low self esteem or your traumatic childhood or your whatever. But, I digress). I imagine me as a plastic surgeon would be much the same scenario. "Look, you're gorgeous the way you are. And this nip and tuck business isn't really going to help, since I can't fix your neurosis with my scalpel. So why don't we rethink this plan, and you tell me what's really going on..."

Did you notice, by the way, that OB/G was, um, #23 on the list. Ah, well. It seemed like a good idea at the time....

My new local news source

So State Hospital has been a flurry of local interest over the past few days.

First, there was an article splashed across the front of the City and State section of the N&O yesterday (I guess it was a little too much to hope that this was front-page worthy news, being about crazy people and all, although they've done it before) about how the county is now fighting to keep State Hospital open. It was a very revealing article. For a few years now, according to folks in my program, the plan has been to close SH and move everyone to the new place they're building about 50 minutes north of here. Allegedly, or at least if you believe the website, it was going to be soooo much cheaper to build the new hospital and merge State Hospital and Other State Hospital than to revitalize either of the old ones.

But apparently, the reason it's so damn cheap is because, oh, the new hospital has waaaaaay too few beds to actually house the patients. Like, it's a couple hundred short. And that assumes that the system works as it is, and won't need to expand again. I.e., the new place has a mere 432 beds. State Hospital, at capacity and with all of its mojo working, can house three thousand (yeah, it's a huge place. There are several towns smaller than that in this state). We have more patients than that now, and our acute units are always on delay because we're full. And that doesn't even take into account the addition of all the patients over at Other State Hospital.

Oops. Dang it.

And then, last night, one of the local news stations set aside a whole half hour and aired their original documentary, Focal Point: State of Minds, about the general problems of mental health care in the state of NC. Which, frankly, generalizes reasonably well to the state of mental health care in America. If you've got 22 minutes to spare, I highly recommend clicking the link and watching it, even if you aren't in the business of crazy (go ahead, you can knit while you watch). It's actually very well done - we were all a little worried that it would have a tremendous political agenda, as the station that aired it usually has pretty heavy political leanings. But I think it's very fair, remarkable in its scope for being so short, and overall a good picture of the flaws in the system. I'm not sure it accurately represents the shit we deal with at the level of those providers left to pick up the pieces, but, again, only 20 minutes. I also liked that they left it on a reasonably optimistic note, but what I found particularly heartening is how they continually emphasized the point that mental patients, well, they're people, who want to live life like other people, who have families that love them, and really have a tremendous burden to deal with. They're people who are sick and often could be helped by relatively simple means, if they could actually get a few reasonable things that they need. Not automatically scary, weird, or needing to be shunned or forgotten or marginalized. Who are and can be productive members of society. Really, they're just people, people.

I think we as a society tend to forget that sometimes.

Anyhow, it'll be interesting to see what comes of this. A lot of the staff seemed to breathe a collective, if premature, sigh of relief yesterday. No one really wants the hospital to close, I'm coming to understand. And not because everyone's afraid of losing their jobs, because they aren't, and not because it's so far away, and not because it's going to be a giant pain in the ass to actually institute this whole move. But because a lot of people at State Hospital actually have a lot of pride in what they do, and because of the very long and rather important history of what's been done there.

And that's nice. And reassuring, especially when Asshole Attending is constantly discharging people early from the medical unit because they're disruptive and weird, or when he and I, um, don't see eye to eye about psychiatric issues (I'll tell you the what happened today in another post, some other time. Right now I'm still busy being appalled at his cruelty).

As an aside, the person who's been feeding me much of this information (with great enthusiasm and ardor) is our respiratory therapist, who turns out to be a wealth of knowledge. Case in point, I'm sitting at the nurses' station a couple weeks ago, writing a note, chatting with said RT, when he looks at me sort of quizzically and says, "Hey, isn't there a line of sex toys named after you?"

Who knew?

It's a good day to be born a Libra

So today was apparently a good day to be born, 29 years ago, because it's the birthday of my best friend, who's back home, and my other good friend, up the coast in Long Island.

Happy first 29th birthday, Katie and Annie!

Oh, and by the way, Katie - you'll always be 16 days OLDER than me! Ha ha! (Just teasing. You know I love you more'n my luggage....)

Sums it up, in a nutshell

So, I'm now frankly plagiarizing this from PenguinShrink's blog, because I've been trying to succintly recount this story, and I'm always too verbose, and she just sums it up so very well:

Scene: Thursday, 8am-ish, morning report. A room full of medicine attendings, two psych residents, and a bunch of nurse practitioners and physicians assistants (NPs and PAs, aka "physician extenders"). The medical director comes in and starts the conference (which is supposedly meant to let everyone know about the patients the on-call person saw overnight and make announcements) with a discussion about the forms for the new hospital. She makes the point that the forms need to be very directive - pick one of the following options sort of thing. I agree with this. However, her reasoning was distinctly offensive: "there are going to be psych residents filling this out, and nurses interpreting it". Damn, bitch, did you not look around the room before you walked in?

Yeah...just, yeah....

Today I had this one patient who ATE MY WHOLE DAY (and, you know, not like my other patients suddenly disappeared). Whole damn day! He came in right after we got out of morning report, and when I left at 5:30 they were actively trying to transfer him to another hospital where he could get, you know, real medical care (I felt like he should be in short proximity to an ICU; I think they just didn't want to deal with the paperwork of him crashing in the middle of the night). The respiratory therapist and I spent about half the day begging and pleading and cajoling and bargaining with him to get his blood gas drawn, and listening to - I kid you not - a nearly 40-year-old, grown man cry, whine, and whimper like a six year old. I was about ready to smack him upside the head for behaving like a moron, but I remained pleasant and persuasive and kept telling him what a good boy he was. Aaaaand then I drugged him, which helped the most. But somebody in this scenario owes me a beer for all of the sweet-talking I did with this guy, I just can't quite figure out who. Which makes collecting on that whole thing problematic...

Under the table and dreaming

(The reference? Click here. It's pretty literal this time.)

So my folks are in visiting. Maggie was very happy to see them. I couldn't resist these pictures of her curled up under my dad's chair this aftenoon...

She's just so damn cute, my dog....

What a good idea that was

So, I'm still at State Hospital, but feeling a little better this morning. I got woken up to go see one of my old Crisis Unit patients who got himself punched in the jaw during the morning med line up. I answered the page, and the nurse was like, "So I need you to come see this patient," etc, etc, and I said "Who is it?" And he told me, and all there was to say was "Of course he did." And then I went to see him, and for some reason the whole thing just amused the heck out of me (probably because so many of the staff members on Crisis had wished we could haul off and slug him).

But then, heck, I was awake, so I came down to check my email, and in the comments Lorna had made the brilliant suggestion of a countdown clock. Dude. Why didn't I think of that earlier? So, note the new addition to the sidebar. I think it's technically wrong, since, because of my license debacle earlier in the year I'll probably still be pulling intern duty the first month of my second year (what salty irony that is - instead of getting credit for the internship time I've already done in OB, I'm going to end up with an extended intern year. Oy...), and it aims for July 1. But whatever. I installed it, and then I sat there for a full twenty seconds or so and watched it count down to one less minute. It was so satisfying.

On Call

AAAAAAAAAAAAAHHHHHHHHHHHHHH!

Thank you.

That's all I have to say right now.

Oh, and a patient finally made me cry today. Which I did in the back, in the office, in the safe realm of PenguinShrink's company (and good hugs). She may have been a crack whore, but even a crack whore can get under my skin if she calls me a fat white bitch and a bad doctor enough times and with enough venom (I'm sure the probable PMS doesn't help, either).

Oy, some nights I really hate this place. Only nine more hours until I can go the fuck home...and only ten more months until I'm not an intern anymore.....

Ugh.

So I'm sitting here procrastinating because I really just want to go to bed and what I actually have to do is get all my shit together and pack because I'm on call again tomorrow night.

Also, I made garlic spaghetti for dinner (ahh, the life of the single girl) and Maggie has been licking the bowl for ten minutes now. She literally is lying on the floor with one paw cradling the bowl and one paw on the rim. Guess she likes it. I thought it needed more garlic. Either way, I think we're both going to have stinky breath tonight. Not that anyone minds, really.

So I'm stalling and she's "cleaning" and of course there's CSI on in the background. Mi vida loca, people.

My last call, on Monday, was completely wretched. I got thirty minutes of sleep. Here's a brief overview. I get this call to go to the adolescent building, right? "Doctor, come quick, this girl we just admitted today is having a seizure!!" And so I page my moonlighter and leave word for her to come meet me, jump in my car, race over to the adolescent building, go flying up the stairs, and...am met by one of my favorite nurses, we'll call her Miss Luci, who starts shaking her head at me. So, apparently, this girl throws herself of the floor and starts flailing about, and it looks pretty real until Miss Luci goes over and touches her arm. And, miracle of miracle, the "seizure" stops. So Miss Luci looks at this girl, pointedly, and says, "Are you finished?" And the patient stops, looks up at her, and says, "....yeah.....I'm sorry....."

Have I mentioned my so very not wanting to do adolescent psychiatry?

So, fine. I write a note, and then I get paged down the street to the long-term adolescent building, for a sprained ankle. Okay. Then one of the forensics patients faints, a couple of other things happen, and I get to bed around 1:30. At two (so, not asleep yet), my pager goes off, and it's Miss Luci. Who says, "well, now we have a kid having an actual seizure."

So the short version of that is, I try to admit him to medical, the nurses have a fit (one of the nurses on the med unit tells the nurse from Adolescent, "She's just fussing." Um, hello? Does anyone realize how I have absolutely no power around here and really can only do what the attending tells me to do?), and the Adol nurses convince me that he'll be fine with them (and probably get more supervision) until morning - you know, when the regular practitioner gets there - and I shuffle off to bed, where I toss and turn and fret and worry because maybe I should have admitted him (I think he was actually better off where he was) and because the on-call attending wouldn't let me give him any Valium (it's a great acute anti-seizure drug, it's not just for calming down suburban housewives), and finally, finally start to drift fitfully off to sleep when the pager goes off again, and Miss Luci tells me, "He's seizing again."

Shit.

So I race over, again, and Miss Luci and two of the techs and I bring him back to Medical, and I load him with IV stuff per the attending, and, and, and, and then finally, right around 6, my head hits the pillow again. And I think, okay. I usually get up at 7 and round when I'm on call, but, I can delay that and sleep all the way until morning report at 8, right?

Sure.

Because at 6:30, the pager goes off again. And once again, it's Miss Luci. She slipped and fell and screwed up her knee. And since Medical On-Call covers employee health after hours....

Yeah....

I really like Miss Luci. But if I ever see that much of her again in one night, there'd better be margaritas involved, and we'd better be far, far away from State Hospital.

This rotation continues to drive me crazy, and I still have another month of it. Like, I almost stroked out this morning watching my attending trying to do an I&D (incision and drainage of a pus-filled infected thing), and I swear, his surgical technique could've been worse pretty much only if he'd dropped the forceps on the ground and stepped on them before using them. And then, there's things like...this morning, my attending called one of the moonlighters a "prostate." I swear to God, this is the story I got from the nurse, with the attending sitting next to her. Now, I know he's foreign, and I'm quite certain he must have meant "prostitute" (because said moonlighter often buys food for the people he's on with. Um, no honey, that's not prostitution, that's how you get people in hospitals to like you. Well, that, and not being a condescending jackass to them), but...dude....and then he couldn't quite grasp why I couldn't stop laughing at him...

In totally unrelated, and much better, news, both Bones and CSI premier this week! And then? The week after that? South Park is back! Squee! I'm going to fall in love with my DVR all over again....

If Maggie weren't so impatient....

....this might be her. I love this commercial, and have been waiting for someone to put it on YouTube already. It's about time, people!



I've never really been a person who gets actual "food" on the occasions she's at Dairy Queen (after all, doesn't that miss the point of DQ? Is it called Chicken Queen? Come on, now), but now I might actually have to try their chicken strips one day. Goooood advertisers...good! Good job! ::Scratches them behind the ears...::

A Darned Good Question

So, in the Comments on the last post, Suburban Correspondent posed a terribly good question:

Is my current career path healing, or just punishing?

Believe me, it's a question I've asked myself many, many times before heading down this road, and on a nearly daily basis since. And the answer is absolutely the former. But only because I make it so, and that takes a lot of work, and I get that.

This is a complicated issue, on a couple of levels. One, there's a good lot of psychiatrists who pick this field more or less for the free therapy. They come in with all manner of insidious, unresolved issues, looking to fix themselves on a usually less-than-conscious level, and what ends up happening is that they leave a lot of poor decisions and bad patient care in their wake. They give the rest of us a black eye, because if you lack the insight to know what's pushing your own buttons, you probably aren't going to be insightful about anyone else's issues.

But then there's another group of us, the wounded warriors (and no, it's not an either/or thing. Some people just like psychiatry, so they pick it for their job). We tend to work in fields like trauma or addiction or eating disorders, because to really be good at those types of issues, you have to have a certain level of inside knowledge. Why? Because...nobody "normal" gets it. Because it's like being in Holland (Chernobyl). And unless you've actually been there, all the guidebooks in the world can't tell you what it's like. And, because all of these issues are defined by isolation and secrecy...well...when you think you're alone, the best person to tell you that you aren't, is someone who really means it.

The thing about it is, I can do good work here. I'm good at what I do, I have a good instinct about people's psyches, and I possess a valuable perspective. Plus, there aren't many people who want to do what I want to do in the first place. And look at the statistics, folks: one in three women and one in twelve men worldwide will be sexually abused or assaulted in their lifetime - in the US, the official statistics (I suspect they may actually be worse) are one in six women and one in 33 men. That averages to one assault every two and a half minutes in our country alone. The typical pedophile has 150 victims; that number drops to a mere 72 if he's caught and charged. If you've never been a victim, think of your two (or three, as the case may be) closest female friends. Think of your daughters, sisters, grandmothers. And begin to understand the scope of the problem. Nothing fractures your psyche like being sexually violated, especially at a young age.

For comparison, one in nine American women will be diagnosed with breast cancer. Be diagnosed with, not die from. And you can't swing a pink cat without knocking over a dozen products to raise money or awareness. Which is not to say it isn't a worthy cause. But where's my 5K? Who can even tell me the correct ribbon color or awareness month? (Teal, and April, in case you were wondering.)

And as for what it activates, well, the thing about trauma is that avoiding it doesn't make it go away. I live with the repercussions and little earthquakes every day. That's nothing new, and it hasn't been fixed by my neuroses and unhealthy coping mechanisms that will undoubtedly be another post for another day, silence, trying to avoid the triggers, or, say, going into a field where I can completely avoid treating men (that wasn't my only motivation for going into gyne, honest). The way to fix it, is to get up in its face and deal with it, to push those buttons until the response is manageable. It sucks to get through it, but it's got to happen. The only way out, is through.

So yeah, going into psychiatry has actually been - and I expect it will continue to be - quite healing. As has finally finding a really good psychotherapist. Which, I hope to someday perpetuate. See, it's all cyclical.

So I leave you with three things before we go back to our regularly scheduled rants and anecdotes and yarn-related commentary. 1, for anyone who is, knows, or loves a survivor of rape or incest, RAINN is a tremendous resource. No matter what your stage of recovery, The Courage to Heal and The Survivor's Guide to Sex (this is the best book out there, as far as I'm concerned) are amazingly useful, and for those of you who are partners in the process, I highly recommend both of those books as well as Allies in Healing.

2. I submit to you a verse from Dar William's fantastic therapy theme song, which I think really does justice to the process:

I say, well, I'm lucky, 'cause I am like East Berlin
I had this wall, and what I knew of the free world was
That I could see their fireworks, and I could hear their radio
And I thought that if we met, I'd only start confessing
And they'd know that I was scared
They would know that I was guessing
But the wall came down, and there they stood before me
With their stumbling and their mumbling
And they're calling out just like me
The stories that nobody hears
I collect these sounds in my ears


And, 3, finally, a gratuitous cute picture of my dog. Because we've had enough heavy seriousness.

Be forewarned...this one's darker than usual

Call sucked last night. And not for the usual reasons. The workload itself wasn't so bad, but, it was a series of interactions with a series of different patients (read: men) that just kept pushing, pushing, pushing on my own stuff.

Tonight, I'm sitting here listening to an Alanis Morissette song that I always thought summed up my college relationship pretty damn well (the rest of the lyrics also fit quite solidly).

If it weren't for your maturity, none of this would've happened
If you weren't so wise beyond your years, I would've been able to control myself
If it weren't for my attention, you wouldn't have been successful
If it weren't for me you would never have amounted to very much.

The problem with that is how much it extends beyond just him. How many men, in how many settings, have told me that lie precisely, or a slim variation on any of those four lines in particular.

And maybe it's time for a response.

Don't blame me for your lack of impulse control. If it weren't for my maturity and its concomitant pathologic sense of hyper-responsibility, this could've gone down a lot worse for you. Meanwhile, I just internalize it in the interest of conflict avoidance. This is very fucking useful for my mental health.

If you had been able to control yourselves - ever - I might have had a shot at a normal life and growing up whole and less neurotic and dodged a whole lotta crazy.

Don't think for a minute that I've gotten to anywhere I am or become anything I am because you gave me those skills. I may well have used what bits you left me with to reassemble into the best skill set I could. If that produces any measure of success, it's mine, not yours. All you gave me was miles of barriers to overcome.

And those barriers, those hot buttons, those neurotic sore spots, that's what I have to fight with every day. This is life in my skewed reality. It makes me better at what I do, and particularly what I want to do professionally in the long run, but it also kicks my ass. Again. Every single day. With every single breath. Because aside from just the running negativity and awfulness that goes on in my own head, I run into the scary would-be stalker patients, the acting out and inappropriate ones, and even the ones that just try to mentally manipulate and screw with my head and make me feel inconsequential, unworthy, and inept. Not to mention non-patients who should be patients I have to work with and the general personality dysfunction in people I meet in the day-to-day.

Usually, my concentrated time among those who most activate me isn't quite so bad, and hell, I want to go into Forensics, which is, frankly, the belly of the beast...but last night, into this morning...was just fraught with this sort of shit. It was a hard, hard day.

But I survived. I didn't actually take anyone out (I'll be honest...I've never come so close to stepping over that professional line and physically defending myself from a person instead of diverting a patient) I didn't fall apart. I got through. And I'll get through again. It's all part of the work (and this time, I don't mean the work I get paid for). That work is in large part why I chose my professional path.

But that work? It's a grueling, draining, exhausting, on planes so much more than physical. It's difficult to fight with yourself all the time. It's difficult to want to be something that more closely approximates "normal" and realize that your "normal", your "reality," is way too far away for it to happen. And not because, like I, and so many like me, are tempted to think, because we, ourselves are intrinsically flawed. But because someone set us up for this. Someone else imposed this on us; all we could do was ride it out and learn how to deal.

It reminds me a little of that "Welcome to Holland" poem for mothers of disabled children. Except somehow I landed in Chernobyl. There are no windmills or pretty tulips here. And what's worse, there are no 10K walks to show support, no pride parades, no mass-merchandising covered in pink for months at a time. Maybe, maybe, if someone rapes you, once, at knifepoint in an alley, someone will knit you a scarf.

But when it happens over and over and over again, when the people involved are people you're supposed to trust, when unspeakable things go on, they just aren't spoken of. You don't get a parade or a T-shirt or a bag of colorful M&Ms. There's no TV show on TLC documenting your ability to adapt and survive. You don't even get a guidebook. Hell, there isn't even really a psych diagnosis that covers it (one of my complaints with PTSD is that it applies so much more to single critical event trauma than to repeated trauma). You just get a lot of pain and confusion and you think you're completely alone and you hope to God that there's a way out. You, and only you, can find the path you need to take from "victim" to "survivor."

So my name's Kate, and I'm a sexual abuse and assault survivor.

I'm on that path, yo. But it's long and it's fraught with new and inventive ways to test me. Like the groping, disgusting patient and the one who pointedly says my first name when he asks why I'm leaving. Like the patient who fired me this morning (you know, after I saved his life yesterday) after saying hideous, horrible things to me. But also problematic? The (non-patient) guy at work who seems to have taken at least a mild interest in me. The people around me who seem to genuinely like me and find me interesting. The fact that everyone, wherever I go, doesn't actually seem to hate me the way expect them to or judge me as harshly as I judge myself.

It sucks. And it's not fair. And I hate, hate, hate that this is my reality. Because I've finally figured out that it just isn't my fault. Nothing about me, my precociousness, my early mature coping abilities (including the one that isn't so healthy, but, it works), nothing about that led me down the path I ended up on. In fact, it ultimately led me out. But, dude. It still really, really sucks.

I think I'm done. But it's my blog, so, occasionally you have to wade through crap like this. Sorry.

Ummm, how about today?

So, I'm on call, and writing this from State Hospital (shh!). Which means that this may be abbreviated if the pagers go off, or the patient down the hall tries to grope me again (it's been a bad night. The theme of the entire evening has more or less been, "Men Are Gross"). But since I already reloaded the pictures into Blogger this morning before I left, I'll try to write what I can.

So the Interns went to the beach this weekend!


It was SO MUCH FUN. I cannot even tell you the fun that was had.

Now I know you sometimes hear "retreat" and you think "designated time hidden away to work on something specific." Or possibly "forced bonding awkwardness." But, no. Our retreat was more or less this: the faculty donated money, and the upper levels covered our call (don't feel too bad for them, they were handsomely compensated), and they rented us a house on the beach and gave us money for food and alcohol and said, "Go. Go to the beach."

And so we did. The place was on Topsail Island, NC, which is on the coast just south of the Outer Banks.

Here's where we stayed. Literally ten feet from the water at high tide. It's a duplex, so, six bedrooms, and two kitchens. Amazing views. Fantastic.

And we just went to the beach. We didn't have an agenda, we didn't have anything we were supposed to accomplish, we just were supposed to go, and bond, and have a good time. And relax, and be far away from the hospital, our pagers, crazy patients, all of it.

When I came back Sunday night for call (I came on at 8pm. So, not a totally call-free weekend, but, darn good), my attending was asking me about the weekend, and he for some reason couldn't get his head around this. He was like, who went, besides your class? I said, two spouses came. He says, what about faculty? I said, no, no faculty. He said, how about upper levels? I said, no, it was just for interns. And he thought about that, and he was like, but, what did you do? I said, well, we played on the beach. We played board games. We cooked good food in big group efforts. We drank a lot. We made sand castles.

Dude, we hung out. We laughed. We talked. We vented. We kvetched. We enjoyed being up until the wee hours of the morning because we were having fun and we wanted to be, not because our pagers were going off. We enjoyed each others' company. We kicked back, and we had a really freakin' good time.

And we were in a gorgeous place to do it.


And for me, it really was a weekend about hope. It sounds silly, and I'll have more to say about this later, I suspect, but our class fits together really well. We support each other and from what I've seen thusfar we're good about having each others' backs. Now, my three actual classmates back at the Emerald Palace were pretty good to me, it was a lot of the other residents who were awful, but this level of alliance is really something pretty remarkable, and I think it's really going to serve us in good stead, all of us. And I have to say, it was nice to hear that while we're all a little miserable, it's a uniform sort of misery. Everyone gets worked to death - it's not like my bad old days where all blame, misfortune, and scapegoatery got heaped onto roughly three people (and unevenly distributed, even at that). It's just nice to not be alone, you know? And it's particularly nice to not be alone with a group of really fun, generally awesome people. Who can make deadly margartias and teach me about scrimps.

Feels Like Today...well, it did for a minute, there...

(Missed the reference? Yeah, I don't blame you. Click here.) So this weekend was our Intern Retreat. HOLY COW, SO MUCH FUN.

And then blogger ate the nice, eloquent post I'd stayed up an extra hour post-call to work on. Evil thing.

Shit, I'll tell you about it tomorrow......there's lots and lots of pictures and everything!

Gratuitous Funny

Just, because.



It's from one of the local auto conglomerates down here. They have a whole series of them. This one's my favorite.

I'm on call again tomorrow night. Last time I got such excellent calls as:

1. Scabies in prisoner row

2. Mr. X was having "chest pain." When I got upstairs, Mr. X was sound asleep in the dayroom, and as it turned out, he was just afraid of his roommate and more likely wanted his room changed.

3. A kid in long-term adolescent had a zit (it's not actually quite as ridiculous as it sounds, but, for the purposes of this blog, oh, it totally is).

4. "The patient has an upset stomach and she wants Pepto-Bismol, but I don't want to give her any because I know she's just trying to manipulate meds out of the doctors." Well, that may be the case, but, I'm sure as hell not going to fight her over Pepto.

5. "Hurry, the patient is unresponsive!" So I get on my sweater, I put on my pagers...and I get paged again: "Never mind. She was just asleep. She's cussing me out now. She's okay."

6, and my personal favorite. "It's 2:30 in the morning, and the patient just got to the floor, and he doesn't want to take his stool softener. Is that okay, doc?"

Yeah, yeah, that's really fine with me.