Well, I don't know how useful it is, but at least there are pictures

I'm feeling better. I did a little yoga. I haven't done good, real yoga in at least two years, or almost any in well over a year. It wasn't my best session ever, technically speaking, but oh, it was so cleansing. So need to do this for real.

I've got to join a real gym. Not the little treadmill room at my apartment. Not my silly hodge-podge collection of DVDs and a punching bag and a cheap-ass rowing machine in my apartment. I need a gym. With people and classes and without the Chicago gym attitude and I need a personal trainer.

To whom I'm likely going have to sell my body in order to afford any of it.

Hmm.

I did make it to the grocery store today. I even bought wine. Mostly because of the label.

You know, it's probably not what you think, though. Look more closely at the label, you perverts. It was the name of the winery that sucked me in, up there, in French, above the two dancing figures:

Folie a deux.

Literally, it means the misstep or derangement in a pair, but there's a much fuller meaning implied. In psychiatry, we define folie a deux as a shared psychosis. Like, I'm so crazy, I pull you into my craziness, so that you also exhibit features of my craziness.

If you think about it, this isn't as rare as it seems. It's more a question of extremes.

Also, yes, I'm a sucker for wine that makes references to psychoneurotic phenomena. And it turns out, the wine's pretty good. There will be more in my wine rack. I can find my (empty) wine rack.

What I can't find is my wine glasses. So, I made do with the cup that came with lunch.

Classy, eh?

Don't worry, I didn't even come close to filling it. But you want to see something even classier? I totally broke the cork trying to pull it out. So the fun wine is now being stored in this bottle instead...

Yeah, there used to be spaghetti sauce in that. Super classy.

I also bought fresh strawberries and fresh baked poundcake.

Mmmm, so good. So utterly good.

I think, ultimately, what's going on with the dynamic of our Family Med team is something of a folie a deux (quatre?). It's just a wine inspired thought, but I think it also might be quite a useful piece of insight. Tomorrow will be an interesting anthropological evaluation of that...

Speaking of which, I have six patients to round on in the am, according to the list. Before 7:30, so Betsy can interfere with my thought process and flow before formal rounds even occur.

Sat nam...sat nam.......om..........

Me siento en la necisitad por la velocidad

I'm watching Top Gun. On cable. In Spanish.

I don't so much speak Spanish.

That in and of itself isn't entirely peculiar - I occasionally watch some of my DVDs with the Spanish tracks on (and usually with the English subtitles). Because I do keep trying to learn Spanish. But this is cracking me the hell up. Like, things that aren't actually meant to be funny are making me cackle out loud. Part of it is the two hours of horrible, horrible sleep I got last night. Part of it is that I understand enough Spanish to understand how poorly some idioms translate on Telefutura (i.e., Goose says, when Charlie asks what they were doing un metre y medio from the MIG, "giving them the bird." Spanish Goose says something closer to "throwing a bird at them." How does one not crack up at that?). Part of it is how much I simultaneously love this movie and abhor Tom Cruise (no, I'm not entirely certain why that last piece contributes to all the giggling, but, it does). And he still looks like a rodent. Rick Rossovich looks equally delicious all oiled up with his shirt off in Spanish, though. And I never have been able to figure out why exactly Kelly McGillis is a "consultant" at Top Gun, in any language.

Does it surprise anyone else, as a total aside, that Katie Holmes has a new movie coming out? With Diane Keaton and Queen Latifah. It actually looks kind of funny in that over the top goofy, First Wives' Club kind of way. I'm just amazed he's letting her work. And all her hair seems to have grown back.

I'm so tired. Maybe I'll have something useful to say later...

Adding to the list of necks I'm going to break...

So I come up to the men's crisis unit to evaluate this poor sad sack who fell on his wrist. And this little Hispanic man in his early 20s with this innocent little bowl haircut comes up to me and says, "Do you remember me? I remember you!" And then he puts his hands out about two feet wider than I actually am and says "You're big, like this."

Do you want to get put in restraints? Because I'll do it. So help me God I'll do it. Learn how to talk to white girls, Paco.

I do remember him, though. The last time I admitted him he thought he was the Virgin of Guadalupe.

And at least he said it with adoration. Alright, I have to go assess the fourth person with an injured hand in two hours. What the hell is going on here tonight?

Winter in the Medical Unit

Wait....brace for it...I'm on call.

So I'm at State Hospital. On call for medicine. And it's like five degrees in here. I'm freezing. It's like winter or something.

It's been one of those days thusfar that's just sort of annoying in it's "hurry up and wait" -ness. Like, it's almost 1pm. I really have had nothing to do for the past couple of hours, because I've been waiting for my attending on call (Dr. Asshole. Great.) to come down and tell me what to do with this patient. I suspect? We will do nothing. Why? Because she needs nothing done. That would probably be the best thing for her. But we might give her some IV fluids, because her sodium's low. Except, she's totally asymptomatic, and I think she has too much volume on board. Does he remember that lecture he gave me about hypervolemic hyponatremia? Work with me, here, man.

I just called him to tell him her urine studies were normal, too. So guess what we're doing? We're giving her IV fluids. ::sigh::...fine....

It's like three hours later now. She's on her second liter of fluid. He says to me, "she has a history of heart failure and absolutely no edema (swelling of her legs). She must be dry." Um, well, okay. Didn't know not being in heart failure was a criterion for diagnosing dehydration, but, after all, he is a cardiologist.

So, yesterday was awful. I swear to God, I'm going to break someone's neck on that service. Soon. Something has got to give. I was there until 7:45 last night. And then I came home and worked via remote until right before I made that last post. We had a rough day...I don't even know where to start. My senior resident (let's call her Betsy) is...something else. She's a total drama queen. Everything's a catastrophe. Which feeds off my attending, whom I like very much but is currently stressed out and very high strung. Mike was not tolerating the pressure very well and looked like he was about to crack more than once. I, of course, responded to all of this by being all soothing and cooing and trying to maintain an air of overriding composure.

Except for the brief moment of Tourette's I had alone in the elevator, and the three seconds of foot-stomping and screaming "I swear to God I'm going to break someone's neck on that service!" while waiting with Fang and two of the second year residents (honestly? Whom I've met before and I like them both very much, and I don't even come close to remembering what the hell their names are) for the interviewees to show up for lunch.

Problem is, that isn't much of a relief valve, and I was under a LOT of stress yesterday.

Mike was on call, with one of the seniors whom I don't especially care for. Family call is rough. Any call is rough when you're on with difficult people. And my attending kept piling work onto us yesterday. And Betsy is really not helpful (in fact, I think she just compounds our work). She decides that I can't go to the recruitment lunch because she's got to go to clinic. Nope, sorry, I have a responsibility to my own department, here. My attendings had already given me the nod. And she freaks out, because, it's her first day, and we have to communicate or the service will fall apart, and, and, and. I'm sensing a real need for maintaining my boundaries around her, so I offer to come back early, but am very firm about going to this thing. And I leave, and she - literally - comes running down the hall after me and says that they changed her clinic time and she has to be there in 15 minutes and I can't go. So I said, okay, let's run the list. I offer her alternatives (do you want to page me when you're done?). She continues to freak out. Okay. So we run the list and I finally escape and extricate myself from her grasp and I try to put on a "I love my job (just not today)" attitude for the prospectives, and I get paged in the middle of lunch by my attending, who says, "You've got to call your patient's daughter, she's crazy."

Great.

So I excuse myself and go back and call the daughter - who is, in fact, crazy. But I think the crazy was inflamed by her interaction with my attending. So I soothe her. And calm her down. And convince her that it is indeed okay that we're discharging her mother that afternoon to a local rehab facility. And I've barely finished signing the note about this conversation when she calls me back, having a fit about some misinformation that the social worker gave her. Calm, calm, soothe, soothe, shhhhhh. And then I go talk to the patient. And then it's 4pm and I sit down with my attending again and still have way too much work to do and she gives me more and then Mike, who looks like he's about to pop an aneurysm, comes in and points out that Mr. C upstairs isn't breathing very well. So the attending says, "give him some lasix." Mike leaves, and then she looks at me and says, go with him. In essence, take care of him. Which, okay. I have more experience than Mike, I did a month of ICU back in the day, I can handle this. He, on the other hand, looks really upset. So I follow him upstairs and say, "what can I do?"

In the course of the next three hours I bounced between Mr. C, a guy we were cross covering in the stepdown unit with the DTs, and my attending. Periodically getting interrupted by the senior on call who's like, why are you still here? My attending alternates between giving me more work, wondering why I'm doing Mike's on-call cross cover stuff (because it needed to be done and he had way too much to do, that's why. She thought that was an acceptable answer), and needing reassurance that Mike's doing okay and that I'm okay with helping him out and not just going out to him and badmouthing her. Soothe, calm, soothe.

Mr. DTs guy was a touchy thing to handle, and of course I also had to soothe his very nice wife. So then I went back upstairs because the nurses said they couldn't draw the STAT labs on Mr. C. Who was crumping fast, and had actually been discharged earlier in the day but hadn't yet made it out of the hospital before things started going south. So I soothed his wife for a bit, called and harassed the respiratory therapist to come help me out with this guy's breathing, and then proceeded to try and draw the blood myself. Which, let me tell you, my skill with a butterfly needle could usually make Dracula jealous. Usually I can open up a vein without so much as a second thought.

I stuck him five or six times. Blew two veins and came up bone dry the other times. Fuck. So the RT took pity on me, I think because he thought I was cute (what is it with me and RTs?), and was like, I'll get the blood. And these guys do arterial draws all day long, which are harder then venous draws. HE couldn't get blood from this guy. So I paged the IV team and assured his wife he was doing fine, that we just couldn't get the blood, and he was much better on the breathing machine, and abandoned ship to go downstairs and tie up my loose ends because I wanted to go home, where I should've been hours ago.

I woke up at three am and heard my pager beeping downstairs. It had three 911 pages on it from radiology, from midnight or one-ish, so I called them back. They were like, oh, Mr. C was down here for a head CT and we thought he was on his way out so we called you, because you ordered it. But we got a hold of who we needed. I apologized for not having heard my pager go off in the first place, and they thanked me profusely for calling back at all. And I went back to bed.

The guy died last night.

He told me he was dying. As in, let me die. I'm dying, just let me die. I shushed him and held his hand and told him he was okay, he just needed to take slow deep breaths. And we knew the guy was on his way out, just, not quite yesterday.

You know, it's funny. As soon as I checked the electronic medical record this morning to see how he had done overnight and discovered this fact, I sent Mike an email saying, "are you okay? It always sucks when this happens on your watch." I understand. I was the angel of death during that aforementioned ICU month (because I was "so good with the families", so my team would leave withdrawals of care for my night on call. It seemed like every third night for the entire month of November, 2004, I was killing someone with their family's blessing). But I didn't realize until right this moment how much it upset me.

He was a nice old man. I held his hand. He'd been in the hospital since December 14th. He's been more or less Mike's patient all through WARS. I hadn't even met him before yesterday evening. And all day today I've been going back and forth about feeling like I should've done something different. Like I should've prepared his wife better. I wasn't even on call, I didn't really even need to be there. Both Mike and my attending were in house after I left. He was DNR and going to die shortly, regardless. I still feel like I should've done something else. Something different. Like in my full day of soothing and comforting and stroking and ameliorating, I failed to smooth out the biggest wrinkle of them all.

No, not logically. But if I were driven by logic, I would've let everyone be upset and stay ruffled and put out their own damn fires yesterday. And I probably would've left at 5 and been home to let my dog out and not have called my poor mother on the way home and sobbed for 40 minutes while unleashing all my pent-up angst onto her and my poor father.

I have a story I was going to tell about one of the first patients I withdrew support on back at the Emerald Palace. But this post has already gone on too long, so I'll save it for tomorrow. Maybe I'll even have a little more commentary on this, esoterically. But right now I'm going to go be upset and knit a little and hide for a few minutes, if the pager is willing.

Thanks for listening this long, though. It soothed me.

Now THIS is the Family Medicine I was warned about....

AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAHHHHHHHHHHHHHHHHHHHHHHHH!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Thank you, that is all.

What am I, a med student?

So, just this morning, I was thinking, wow. I'm exhausted. And it occurred to me that I used to have it much rougher, really. Like, when I was a third year on surgery. I worked such longer hours then. More things rolled downhill at me then. Well, maybe or maybe not...things rolled downhill, in spades, but I didn't have nearly the responsibility to deal with them as I do now.

Today was long. In an epic sense. I had too many patients. We had a new attending who is looking to impress the department chair, who's also rounding with us, of course. I actually went to my psych lecture. I had a very nice, very sick gal who got sicker and sicker and sicker and I finally appealed to the ICU team, who took her off our service before she crumped. We rounded three times today. And there's all this discussion about what the point of the team should be and what's expected of us and for us and yada yada. The attending hovered. Honestly, it was kind of fun, the whole, running around being a doctor part. But it was exhausting.

And then, I get home, right, finally, at a quarter to EIGHT tonight, and my pager goes off. And it's my upper level, who starts tomorrow, and she's all full of muss and fuss about about what the point of the team should be and what's expected of us and for us and yada yada. And oh, by the way, can you be ready a half hour earlier so you can round with me before you round with the attending?

Um....

Well....

Honestly, I approve of that logic. But it's a giant pain in the ass for me and Mike.

Not to mention, I have to give a presentation tomorrow. On Ranson's Criteria. I guess I'd better go figure out what those are, again....

2008, day 2

It's cold. In fact, do you know what happened today in NC? It snowed.

No, really.

The unit secretary was all like "it's snowing!" And of course everyone commenced to finding a window to see the snow. Which was barely a flurry, and lasted about three minutes. But in the south, I think that's considered a blizzard.

Much more exciting today was Wednesday afternoon knitting group at the LYS, which, you know, I discovered last week. There were a few more people there today including some very fun and lovely ladies, and...are you ready for it? A man. A man! With a dog! Who knits!

::sigh:: He should only be straight....

I also started reading Girl, Interrupted this evening, which I ordered as a reward for myself for getting through last month (I'm thinking about a monthly reward system to propel me through the end of the year. Something small, you know, when I finish a 4 week block). I've owned the movie for years, and I watched it last weekend, and wow, had a whole new perspective on it after all my time at State Hospital (i.e., I'm not sure she was really borderline, based on the movie). So I decided to snag the paperback and read the actual story, see how that compared.

For surviving this month? I earn Offender Profiling and Crime Analysis. Is that pathetic?

Tomorrow my co-intern Mike and I are cast back to reality. WARS ended today, so I have to drag my ass into the hospital way too early again tomorrow. Over the past week and a half, all three teams have sort of blended into one, and tomorrow we split them all up again and resume the usual state of chaos. Damn, I've really enjoyed the getting in at 8am thing (and more precisely, the not getting up at any time that has a 5 at the front, particularly at the beginning of that hour, blech).

Resolute

Happy 2008, y'all.

It's gonna be a good year. I just have a feeling.

Mags and I had a less boring night than we'd anticipated, but that doesn't imply that it was all that fun. I went to bed around 10:30 (shut up), thinking I'd read and watch the rest of the CSI marathon. And I started to doze off about an hour later, but fortunately, my neighbors had devised a couple of ways to keep me up. First of all, they had their music cranked up so loud my walls were vibrating with the bass (seriously. And it was that Chicano pop with the accordion in it, you know? I thought I was in the barrio for a minute, there). And then there were the firecrackers, which let me tell you, Maggie was none too pleased with. I, on the other hand, always like firecrackers and thunder, because it means the dog gets snuggly. However, for some reason she wouldn't actually get onto the bed (trying to stay out of the line of fire, maybe?), so she just sat at the foot of my bed and whimpered until I gave in and picked all 45 pounds of her up under the armpits and lugged her into bed with me. Apparently there were also a lot of "issues" in our humble little town last night, too, because the police and the fire department kept going by, sirens blaring. Made me a little homesick, really.

And then...we're lying there watching South Park, bundled up and Maggie staying low to avoid stray bullets, and we hear this very distinct whine. Maggie pops her head up, ears at the ready, looks at the window, looks at me, looks at the window, looks at me, all, "Someone's in trouble! Kate! We have to rescue him!" And the dog outside whimpers again, this very wrenching, oh, help, I'm stuck! kind of whimper. So I look out the window, and I see nothing, but I hear him, and I whistle, and he whines in response, and I whistle again, thinking he'll come closer, but he only whines harder. And Maggie's freaking out, and I said, okay, okay, we'll go look. So I go out in the back yard, in my flannel pants and my hoodie sweatshirt, all bed-headed and in my flip-flops, armed with Maggie's leash and a pocket full of treats, while she eagerly kept guard in the dining room behind the screen door. And I whistle, and I follow the whimpering....

My neighbors - the ones in the barrio - have apparently gotten themselves a puppy. Whom they tied outside last night. Woe is him. I watched him for a minute through the little divider fence thingie that separates my patio from theirs, to make sure he wasn't stuck or caught or anything, told him he was okay, and a good boy, and went back inside to reassure my dog.

Boy, he was cute, though. I'd say he's some sort of bully breed, maybe 6 or 8 weeks old? Sooo cute. I almost slipped him a treat under the fence just for being so cute.

And then midnight came, and there were more firecrackers, and the music got louder, and I wished Maggie a happy new year and went to find some cotton to shove in my ears. The music persisted until about 4. My friends from Chicago (with whom I usually spend NYE) called around 1, though, that was nice.

So now it's 2008. And the day of resolutions is upon us. TLC is airing a full day marathon about the grotesquely fat and the so fat they've been institutionalized and bariatric surgery and the Half Ton Man and "I eat 33,000 calories a day" and, and, and. I guess this is supposed to be motivational? Great. Reinforce how scary and horrible and disgusting it is to be fat. So we all keep our resolutions to lose weight. Turn these poor people into sideshow freaks. ::sigh::

What's disgusting is how they're mass-marketing our insecurities and reinforcing one of the last acceptable social biases. Can you imagine a day-long marathon of "Why it's bad to be black"? Or "How it's grotesque to be gay"? Wow, people would be up in arms, and rightfully so. But this is "motivational".

I will admit to watching several episodes of Inside Brookhaven Obesity Clinic, which I actually liked. The director of this place in NYC was very realistic, stressing diet and exercise and positive motivation over long periods of time, focusing on health and well-being, and was quite accommodating to the different and individual needs of "75 of the fattest people in America". He was very reasonable about, you know, these are people with eating disorders, there's no quick fix here that's going to work. He was quite realistic about the addiction component of it and how "food" wasn't really the issue, that the psychological drama motivating it was what needed to be addressed. He was very against bariatric surgery, for all the reasons I am as well, but understood that his clients were adults and would facilitate appointments with a competent surgeon if that's what they insisted they wanted. Despite the sensationalism of the program and the overriding melodramatics in the production of it, he came off as a very stable guy who genuinely cared, and didn't make his patients into villains or deviants. Which was rather refreshing.

And then the show about the bypass surgeons came on. And I rolled my eyes and changed the channel to something more humane. Like, "When Animals Attack."

Why is it that our resolutions are always about our perceived faults? We belittle ourselves and typically set ourselves up for failure, every January 1st, perpetuating a cycle of self-deprecation and insecurity and defeat every time we get a symbolic new start. How clean is that slate, really? And why don't we ever resolve to retain and strengthen the traits we like? Why isn't it ever, "I was a very generous and compassionate person this year when I did _______. In the coming year I resolve to continue that behavior and perpetuate it by doing ______."?

I think that should be our MO this year. Find strength instead of fault in your new year's resolutions. Accentuate what you've been doing right. And couch even your assertions of change in a positive manner ("I resolve to continue eating vegetables this year and to encourage myself every time I make a healthy choice"). You're more likely to be successful, and I bet they'll be even that much more satisfying when you are.

Stripey Brown Socks!

FINALLY.

I started these stupid lovely and wonderful socks in May, I think. My dad was supposed to get one for his birthday (July) and one for Christmas. But the first one went so fast, I got excited and gave him the first one around Father's Day, and thought, oh, hey, no problem, I'll have this done by July!

I finished them yesterday.

They're cute, though, huh? And very comfy. They're Austerman Step, so, with the jojoba and aloe right in the yarn.And of course what did I do, except cast on the next sock.

And, okay, I hate this yarn. I have many skeins of lovely sock yarn which I like very much. So why do I keep reaching for this one?

And that's not totally fair. Love the yarn (Jitterbug, which of course gets that Wham! song going in my head). It's the color I hate. It looks so good in the ball. Okay, that's not true. It looks so whimsical in the ball. As a sock, it just looks....obnoxious.

I'm knitting this on the Addi Lace needles I bought when I bought the yarn. They're like 40", which, for the record, is way too long, even for magic loop. And they stink. Stink. But I do like the pointiness a lot.

Maggie and I are ringing in the new year in style tonight. That style being, um, super casual. I'm hanging out with my dog tonight. Hopefully at least one of us will still be awake at midnight. We ordered pizza (it was very NY style, which, fine, but it was just okay) and will have hot chocolate (well, just me) and I'll do some reading and some knitting and Mags will nap and snuggle and we'll watch a lot of CSI. Maybe next year I'll do something out and fun and enjoy my wild single life, but this year....besides, who's more fun than my pup?


Incidentally, I'm now completely addicted to The Daily Coyote (see the link in the sidebar at right). I cannot get over how much Charlie looks like Maggie. In build, attitude, deportment. And his love of cats. Plus he's just so darn cute.


Happy new year, everyone!!

Rainy Sunday

It's a rainy, rainy Sunday afternoon here in NC. Little Miss Delicate Puppy Dog is not pleased, neither by the giant puddle that is our back patio nor by the thunder that's rumbling around. I think maybe she's forgotten about her dislike for snow, though.

I'm feeling better. I'm not willing to go to "great" yet, still a little dizzy and nauseated but I'm significantly less achy and slept a little better last night. And my temp is down. I think the staying home yesterday was good for me (regardless of the fact that I would've been useless at the hospital). I even managed to go run some errands this morning. I was going to run to the Super Target, where, in theory, I could get everything I needed. But, of course, I totally forgot something that I didn't remember until after I'd left, which is my habit with Target. So I stopped at the Whole Foods to pick up milk. Which was better, anyway, because they always have local goods, and I'm always much happier to buy local. And while I was in the dairy section, I bought this:
Partly because I was running low on feta cheese (it's a staple around here). Partly because it cracked me up. Apparently this spelling is because the Greek government is cracking down on their proprietary right to call only cheese made in Greece "feta".

Pheta...

And as long as we're taking pictures of ridiculous things in my fridge, I also happen to think this is really funny. I have this package of polenta, right? And in the preparation instructions, is this:

Nine sixteenths? Really? They couldn't have just said half an inch?

Anyway. As I was saying.

Maggie and I spent pretty much the whole day hanging outdoing nothing yesterday (which, incidentally, is also my plan for this afternoon). Pretty much any time I got up, Mags stole my place on the couch.

We spent most of the time that we were awake watching movies on Lifetime. I got sucked in to the end of this really, really awful one called Criminal Intent. Wow, holy cow was it terrible. The acting was terrible. The plot was ludicrous. I'd watched about ten minutes of it and turned on something else, but then decided to turn it back on to catch the last fifteen minutes. Wow, it was so bad.


But by then I was sucked into the Lifetime vortex, and I ended up watching this movie about some Mormon woman in one of those extremist polygamist sects that escaped with her kids. It was formulaic, but entertaining. And then there was this movie called "Girl, posi+ive" with Kelly from 90210 (why can't I think of her name? Oh, Jennie Garth) about a girl that got HIV in high school. That one was actually fairly creative. And then I watched "The Waitress" on On Demand. I'd kind of wanted to see it back when it was in the little art film theaters, but never got around to it, and then yesterday they were advertising it and I discovered that it had Nathan Fillion in it, and well, I was sold (I adore him, even if he does have that weird hypertelorism thing going on). It was decent. Not as good as I was expecting after all the hype, and I didn't really like the relationship between Fillion's character and Keri Russell's (I think it's because I'm a doctor. There was a whole, medical ethics, makes-me-feel-kind-of-icky-inside thing to it that I probably wouldn't have responded to if I was, say, an accountant). But on the whole, worth the cheap rental.

So this afternoon I'm planning to do some knitting (I'm thisclose to having my sock finished. You know, the one I started in June) and nap through a marathon of Law and Order: SVU, which is one of my new favorite shows. Not because of the show itself all that much. I mean, it's well acted in general. The plotlines are usually fairly well written (although I occasionally find myself rolling my eyes when they blow right past the obvious solution and thinking, don't you people ever watch CSI??). And who doesn't love the irony of "Body Count" Ice-T as a cop? But really, what I love most is their liberal use of forensic psychiatrists, particularly the later episodes with B.D. Wong. That? Is the job I want. Right there. Profiling. Consulting to law enforcement. Doing actual criminology and forensics work, not prison psychiatry. Except maybe for the FBI. Really, I want to be Gordon Gordon.

Shut up, Katie, I do not watch too much TV.....

Sick Day

This morning, I did the unthinkable.

I called in sick.

I was supposed to be on call at State Hospital today, right? No big deal. And I'm on with an attending I like very much (possibly my favorite of the State Hospital medicine attendings), and I've got a decent moonlighter, it really shouldn't have been much of a deal at all. It's overcast and damp here today (even if it is 68 degrees out), so it's not like I really even could resent not having the day off.

And then...well, I was not feeling well when I got up this am.

You cannot believe the arguments I had with myself. I could probably manage. But I had a fever. But things aren't often very hectic at State Hospital, it was entirely possible I could spend part of the day hiding in the call room and possibly even get a nap in this afternoon. But I didn't feel good. But I've gone to work sicker - in fact, I went to work sicker than this last week. But my co-intern when I was on Medicine came in to work when she'd had food poisoning all weekend and had barely stopped throwing up. But I've covered for my sick colleagues on at least three occasions. But I was being irresponsible. But I was being responsible to myself - I was sick all last week, and this past week I've come home and crashed pretty much every single day. I've gotten nothing done despite the fact that I haven't been working very many hours. The only thing I think I've accomplished was passing my flu bug to my current co-intern, unless it was our senior resident who did that, because she was sick, or our attending, who was also sick, or any of the other sick residents (you know, or patients). And it's entirely possible that I wasn't quite better to begin with and either just got sicker, or I got reinfected from him (or her or him or them). But maybe I was just being neurotic. Maybe I really didn't feel all that bad.

Well, but maybe I did. I'd had a rough night. I'd been hoping to feel better all night, but still felt crummy. I had a little fever. I was sore and hot and congested and shaky going to work was not going to make me any better.

So I called the doc in charge of the medicine group, and said, I'm sick. I'll come in if I have to, but, I'm sick.

She basically said, wow. This is inconvenient. I don't have my phone list at home. I can't make the attending take call, he's on (home) call all weekend, that would be "humanly impossible" (what?) and also illegal (no it wouldn't. There are no work hours restrictions for attendings. Mostly because they don't need them). I really wish you'd called me yesterday.

Yeah. Can you imagine? "Hi, this is Kate. I'm going to be sick tomorrow. Could you rearrange the schedule now so we can accommodate that? Thanks."

Makes perfect sense.

And, I can't quite figure out why this was such a crisis. Usually, the attending is there until 5pm, when the moonlighter shows up. Who sometimes leaves at 11, or sometimes stays all night. Why they couldn't just carry the first call pager is a little bit beyond me.

I mean, what exactly is it that the intern can handle that's too overwhelming for the board-certified and experienced senior physician?

Anyway. So she fusses and frets and says, well, I'll try to make some calls...but you might need to come in anyway. I don't know who I can get to cover (because, it's not like that department employs a whole pool of physician extenders and moonlighters and locum tenens docs). You might need to come in at least this afternoon, for the night. So I got up, and showered - just in case she decided I needed to come in - and at some point remembered that I was probably supposed to call the chief resident and let them know. So I got dressed, and looked up which chief was taking those "emergency" calls this month, and paged him, bracing for the same kind of reaction from him, or worse (you know, like the couple of times I had to call in sick in my old program).

He says, "don't worry about it. We'll get the shift covered. These things happen. Now, what do we need to do for you? Are you okay? Do you need anything?"


I almost cried.

But no, I don't need anything. I have the TV remote, a pillow, a blanket, my couch, lots of fluids, and my dog to take care of me. Honestly, what more could I want?

::sigh:: Once again, though, I'm forced to ask myself, what the hell's wrong with the medical profession? We don't take care of ourselves. We work ridiculous amounts of hours, we expect perfection where it cannot be had, we expect our bodies, psyches, and spirits to be more than (less than?) human. Which is very different than what we expect from our patients. Or anyone else, for that matter. Stupid.

The THING

Maggie has a thing on her foot.

The groomer noticed it this weekend. I'd noticed she'd been licking her feet an awful lot. I looked at it, I was like, huh, that looks like a wart. The groomer said, I think that's a wart (what she actually said was, "my boyfriend has a wart like that on his foot. It gets all spongy when it gets wet, too, just like hers does." Umm...).

But then I slowly turned from overeducated pack leader into a pet parent.

What if it's something terrible?

What if the dog's foot falls off?

What if Maggie has toe cancer? (Now, that one's actually justifiable, because Kedzie, my old roommate's dog, had toe cancer. And they cut off his toe! And he missed it, I think, poor old fellow. And he's also, like, six hundred years older than Maggie. And cancer of the toe is sort of a fluke thing. But still!)

So I kept fussing at her and looking at her foot. And fretting. And worrying. I think this is what Maggie thought of my whole "toe cancer" idea.

I knew she was right.

But I took her to the vet anyway. Who said, "well, what that looks like is a papilloma."

And I thought, oh, God! A papilloma??!! Like, papillary toe cancer? A papilloma! Oh, God! Not a papilloma! Oh, my poor baby, not a pap-

And then I stopped. And I looked at the vet. And I said, "So....she's got a wart?"

Maggie has a wart. On her foot. A foot wart, if you will.

So glad I took her to the vet all freaked out about a wart. So is she. Because she ended up getting four shots while we were there. And has to go back for her lyme, giardia, and bordatella boosters in three weeks. Plus, now she has to get her teeth cleaned one of these days. But on the plus side, she did get a new toy.

And she now has vet insurance. Which I've been meaning to get for three years, but, seriously, the only thing my dog has ever had wrong with her are some seasonal allergies (Maggie having a sneezing fit is about the funniest thing you've ever seen in your whole life), and apparently a case of plantar warts that she probably picked up at that filthy horrible boarding facility. Which she really loves, and will probably be going back to stay at next weekend when I'm on call. However, not having vet insurance totally bit me in the ass with my last dog. Poor Wolfie was a sick little puppy (he was, like, eight), and his final three days in the doggie ICU alone almost cost me $2K. This cheap little Banfield-only plan is definitely a better idea.

What I think is especially funny, though, is that her health insurance costs more than mine. Now, admittedly, mine is subsidized. But I don't know why Blue Cross/Blue Shield won't let me claim her as a dependant. I mean really.

::sigh::

Oh, and you remember how like a year ago the groomer back in Illinois looked at Maggie was like, "Wow, she looks like she's got some coyote in her." And I thought, huh, she kind of does. Well, if I'd had any doubts, they were squelched by the photos of Charlie, a coyote who's been domesticated by a lady out in Wyoming after he was orphaned as a tiny little pup. Check out the pictures, he's way cute. And could well be Maggie's littermate, if she wasn't like four years older than him.

In other news...I did finish my Bones Hat the other day. I even wore it to work yesterday and got compliments on it. Now, you'll remember that this is Take Two of the Tapestry hat. I'd made one to go with the set that I'm making, and it was really boring, and I was busy coveting the hat that Emily Deschanel had been wearing on a recent episode of Bones. So this was my template And this is what I ended up with.

Not bad. The cables are a little different, and the brim isn't designed to be flipped up like that, but all in all, I'm quite pleased with it. And it's far more interesting than the original. It's made out of Tapestry and Cascade Superwash.

What is wrong with me?

Seriously.

So...from the creators of NaBloPoMo comes Blog 365. Like NaBloPoMo, you commit to posting every day. Except, for the entire year of 2008.

Well, February 29th, it turns out, is a free day.

And, the rules are a little bit more flexible. Like, they allow for post-dating your postings (on the assumption, of course, that if you can't get to a computer that day you'll do some "old school blogging" - i.e., with a piece of paper and one of those writey-type things that we so rarely use anymore...which, you know, given my doctor's handwriting and general inability to spell on a consistent basis, may not be such a bad advancement - and then transfer your content to your blog). And if you maintain more than one blog, as long as you put a post up every day, you're golden, even if it's not always on the same blog. Not that I have more than just this one, but, I'm sayin'.

I, of course, read the email and went, hmm, sure, sign me up.

Why did that seem like a good idea?

I'm genuinely stumped by this. And, I don't really know why, I mean, it's not a bad idea (although, honestly, I'm not sure I really understand why anybody at all reads this thing), but, what's the point? As my best friend so eloquently pointed out in November, it's not like blogging is endangered or something. It's not like I actually get paid to blog, although there are some people who do. And I'm not like "blogging for the cure" or whatever. I'm not even a theme blogger, so, it's not like I'm trying to get my message out or anything - most of the time I just write whatever drivel dribbles out of my head. So, what's the point of doing Blog 365? Some competitive and/or compulsive tendency of mine? Some form of narcissism or self-importance? Maybe a reach for connection? An attempt at stability or control? Or possibly a need to be heard? Which, considering how much I censor myself on here...

And don't get me wrong, I ask this out of genuine curiosity, not self-critical scrutiny. It's possibly a query about what blogging really represents to me. I just wonder.

And no, I don't expect you to have the answer.

WARS (WARS!!!!!)

I heart Family Medicine. At least for the next ten days.

So, every year at the holidays, they do this thing called WARS, which my co-intern insists you have to sort of growl, all loud and baritone, sort of like, WARRRRRRRRRRRRS! It allegedly stands for Work At Reduced Staff, or Wives Against Resident Slavery, or We Are Really Short, or We Are Really Screwed, or Work's Always Really Shitty, depending on whom you talk to. What it amounts to is that half the staff gets the whole week of Christmas off, and the other half has the whole week of New Year's off. But on the alternate week, they're on call like every other night and work their butts off.

But we don't. Because we're not really part of WARS, so, we're just gravy for them. Pretty much every morning, my cohort Mike and I go in at 8 am, which is an hour and half or so later than we usually get there, and see whatever patients are assigned to us, and then whenever we're ready we round with the attending. And then as soon as whatever work we have to do to take care of those patients is done, we go home. And while I still have Saturday State Hospital call duty, Mike takes no call at all until after the first and has both weekends off. It's a sweet deal.

I had a lovely day today. I actually had to pick Mike up on my way in this morning because he was having car trouble. We were both woefully unprepared today - we both forgot our ID badges (which of course give us access to the unit we're on) and he forgot his pager. Which, no matter, we still wandered in at 8 and managed to get onto the ward and all was well. I had three patients to see, chatted with the attending, called a consultant or two, and was done before 11. Mike finished around 11:30, and offered to buy me lunch if I drove him to Borders to pick up the rest of his girlfriend's Christmas gift. And you know how much I simply hate going to bookstores. I wandered around and read a few pages of a few different books and got a little giddy off the book fumes while he picked out a travel guide for her upcoming trip out of the country. And then we went to this nearby Indian place and I had very wet daal and vegetable curry and we had a leisurely conversation about our program and our coworkers and I clued him in on medicine at State Hospital, which he's doing after we're finished with Family, and we had a very nice time.

As a sidebar, he also told me that he's doing State Hospital Medicine with another of our classmates (obviously), one of the two other male full-time residents in our class, whom we'll call Fang (for reasons that have nothing to do either with his dentition or, say, a preponderance of tattoos. Just trust me, it makes sense). Mike can be pretty laid back, generally, but I think he still may not take especially well to all the power jockeying. He's also very tall, which will make Dr. Asshole feel even shorter than, say, I did (Mike's probably close to a foot taller than I am). And Fang...is a bit more hot blooded and occasionally lacks a filter between his brain and his mouth. And both of them are pretty smart guys, seem to have a pretty good sense of people. Which, can be very difficult when Dr. Asshole starts pretending to know anything at all about psychiatry. But then again, they both have Y chromosomes, which our infamous Med Unit attending tends to equate with intelligence (or rather, he tends to equate the lack thereof with a lack thereof). I think that's going to be an interesting little bit of behavioral sociology, right there.

Anyhow. It also happens that Mike lives about three blocks from the good yarn store. So, darn it all, I just had to stop in. I bought a book of very cool baby blanket patterns and another one about dyeing yarn with plants. Because really, I wanted to sit and knit for a while, and none of what I'm knitting with currently could possibly have been purchased at their store. So I had to buy something. And then I did sit and knit. It turns out that they have a Wednesday afternoon knitting group. Ohhh, which was so nice. I mean, not my group from back home (you guys are irreplaceable), but it was just so very lovely to be among knitters. And to sit and knit in the presence of strangers without anyone looking at me like I was doing witchcraft. Ah, it was wonderful.

AND, it turns out that many of these very nice people I met today are part of a knitting group that meets every Tuesday night at 7pm at a bookstore near the hospital. I think...I think I might have found a knitting circle! Do you know how exciting that is?! Knitters! And a social group of non-hospital folks (not that I don't love my fellow doctor types, but, you know how sometimes stay at home moms need to have conversations with adults? It's kind of like that. Sometimes it's nice to be able to talk about something totally unrelated in, you know, English. Instead of Latin and/or acronyms). I'm all a-twitter. And, almost done with my revised Tapestry hat.

My Christmas was wonderful, by the way. I spent both Christmas Eve and Christmas evening with our family friends that live here in town. Their eldest daughter, who's a few months older than me and with whom I veritably grew up, was in for the holiday, which, it was so nice to see her, too. And, she and I kicked some serious ass at Trivial Pursuit. It was just such a nice time.

Oh, and for those who are worried, fear not, I won't let Maggie get cold, even if she is naked. I actually didn't have her clipped all that close, so she still has SOME fur. And also a nifty red coat. And a little sweater, if absolutely necessary. But really, the fur was so out of control. She's on really top-shelf food and has really soft, healthy fur, but, it's that husky undercoat. No amount of brushing has seemed to curtail it, either. I normally have her clipped in the spring and then in like, August, not this time of year, but she was miserably itchy, and the loose hair was getting in her ears and making them itch. And, I'm allergic to dog hair. Plus, there were like five other dogs getting clipped at the groomer that day...it's not like winter in Chicago.

Merry Christmas, y'all

Happy Christmasolistikwanzakah.

And in the Christmas spirit, I give you two things. My very favorite Christmas song, a Dar Williams classic...



...and a bit of holiday amusement, via Penguinshrink.

Christmas Carols for the Mentally Ill

* 1. Schizophrenia --- Do You Hear What I Hear?

* 2. Multiple Personality Disorder --- We Three Kings Disoriented Are

* 3. Dementia --- I Think I'll be Home for Christmas

* 4. Narcissistic --- Hark the Herald Angels Sing About Me

* 5. Manic --- Deck the Halls and Walls and House and Lawn and Streets and Stores and Office and Town and Cars and Buses and Trucks and Trees and.....

* 6. Paranoid --- Santa Claus is Coming to Get Me

* 7. Borderline Personality Disorder --- Thoughts of Roasting on an Open Fire

* 8. Personality Disorder NOS --- You Better Watch Out, I' m Gonna Cry, I'm Gonna Pout, Maybe I'll Tell You Why

* 9. Attention Deficit Disorder --- Silent night, Holy oooh look at the Froggy - can I have a chocolate, why is France so far away?

* 10. Obsessive Compulsive Disorder - - - Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle,Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells


Wishing you the happiest of holidays - whichever ones you celebrate - and good mental health.

Fur and fun things

Maggie finally got her haircut today. She's so naked!!

And this would be why Maggie got a haircut.....

Seriously. The hair was out of control.

Maggie has a slightly different take on the day's events...

(Is that not the cutest picture, ever, of my dog? And look, now you can see her supercool Tarheels collar!)

So anyhow. When we got home from Petsmart, there was a mysterious box on our front step. It rattled! You know how I love presents, so I was very excited. Maggie also thought the present was very exciting, which made me think it must contain food and/or dog treats. Turns out, I think it just smelled like cats. Because when I opened it, it contained this:

Exciting, right? Well, look what happens when you open it:


It's yarn! And a pattern! And lavender-scented shea butter! And not just any yarn and pattern and lavender-scented shea butter. Hand-dyed sock yarn from Jen of Knitting Like Crazy. Sarah's December Nights sock pattern. And the shea butter is from Mother Earth and You, which is local to the yarn store. Yes, folks, it's one of the December Nights Sock Club Kits from Peggy's Strands of Heaven in Plainfield, IL. Sarah, of course, designed the December Nights sock. It's this very cool toe-up pattern that starts with a little knitted rectangle instead of the goofy figure-eight cast-ons everyone is always arguing about that never quite get tight enough and etc, etc, etc. So, so cool. And now I have one of my very own! Thanks, Sarah!! You totally made my holiday (sniff, sniff)!!

And as long as we're frequenting YouTube

A couple of my other favorites...

Take away the snow, make the moose a farmhouse, and change the wreath to a bag of beach stuff, and this is more or less me, on the way to the Intern Retreat on Topsail Island, shortly after my GPS navigator dropped me in the middle of a cornfield somewhere in Deliverance Back Woods, NC.



And then add a lot of hysterical screaming into the phone as my parents tried to Mapquest me from Chicago and I just kept getting more and more lost. I'm not especially proud of that moment, but did I mention the burning crosses?

(Yes, of course there were no actual burning crosses. Much like there was absolutely no chance whatsoever of me hitting the seventeen year old renal failure kid in the last post. It's called dramatic license, people, calm down.)

And, as long as we're talking holiday commercials, this one just cracks me up.



Heh...

Admixture

I'm post-call. Which means my brain is a little more disorganized than usual. Which...is...frankly, a little frightening, all things considered. So anyway, today I bring you a mish-mosh, a melange, if you will, a random assortment of....stuff....

First off, I'm a little worried that there's something wrong with my dog. I mean, look at this irrefutable photographic evidence:


See the dog? And the hamburger? Laying, mere inches, uneaten, from the dog?

She eventually ate the meat. And some of the bun. And it's possible she may have been a little carsick, still. We went out to the Petsmart this morning. Maggie was supposed to get a haircut this morning, but, alas, somehow the Banfield here still hasn't gotten her rabies info from the Banfield back in Chicago. Who, of course, is closed today. So maybe she'll get one tomorrow, if we can coordinate all the paperwork. Anyway, so we wandered around the Petsmart for a while, bought some food, bought some of the treats she really, really likes (they're from Authority, some sort of organic carrot-y things, I think, but the point is, they're round, and so if you roll them across the floor, she gets to chase them. Which is apparently very exciting. Last week, I handed her one, and she took it....and then promptly tossed it into the air and swiped it with her paw and then chased it and pounced on it), and then we wandered over to Raleigh for post-call hamburgers from the Char-Grill. Maggie occasionally gets her own - no toppings - when I go for post-call hamburgers. And she's usually quite pleased with the arrangement. But maybe today there was just too much excitement and driving involved.

Second of all, click here. Scroll all the way down to the bottom. Click on the link under "Dating Application" and download the form. It's freakin' hilarious.

Third, watch this:



Sara Bareilles. Her first big single, Love Song, is on that Rhapsody/TiVo commercial, and it kind of caught my attention. So I poked around, and ended up downloading her new album, Little Voice, off of iTunes, which, it's cheaper than most, which is an even bigger cause for excitement, because wow. Its fantastic. Bluesy, jazzy, with solid vocals and clever lyrics. Go to iTunes. Buy it, buy it, buy it now.

This is actually my favorite song off the album, Vegas:



I love finding new music I like. And I really get excited when you take a chance on somebody and buy an album having only heard a song or two, and the whole thing turns out to be good.

And finally, a tiny little blurb about call last night. Okay, first, the setup...on call, I get to wear scrubs. Which, I usually only wear scrub pants, and a regular shirt. The nice thing about this is that scrub pants? Have a pocket. Which, you'll notice that most women's pants aren't so good on the pocket-ness. And this is especially nice because I can toss a pen and my palm pilot into my pocket, throw my stethoscope around my neck, and not have to wear my whole labcoat. But, this leaves me with an unfortunately palm-pilot-shaped lump on my ass. So...I got a call, to one of the men's long-term units. And I went up, and I'm unlocking the door to the nurses' station, and there's this guy sitting in a chair next to the door, who reaches over and TOUCHES MY ASS. Now, my impression was that he saw the unusual shape of whatever was in my pocket, and reached over to touch that, i.e., to figure out what it was, rather than actually just fondling me (like certain other patients have, a-hem. Although if they're going to feel me up, they usually go for the boobs). And you know, these psychotic folks, not so good at the impulse control.

Which is why I merely turned and gave him a very warning glare instead of decking him.

Although I'm getting better at controlling my impulse to hit the patients when they come after me. I.e., last week, when I was on psych, I went over to see the renal failure kid on the adolescent unit, because he was acting out. And he's all screwing around, and being all aggressive, and he starts faking punches at the staff (who, by the way, were two gigantic muscular black dudes). And I speak very menacingly to him. So then he starts trying to punch me.

At which point he went into restraints.

Now, technically, we're not supposed to put patients into restraints if they're in danger of hurting someone else, only if they're in danger of hurting themselves. But, you know, he's all flailing around, he easily could've smacked into the wall, cut himself....and let me tell you...he took one more swing at me, that boy was going to be hurting.

There's only one word for this...

It's bliss.

(Missed the reference? Click here.)

And, try not to notice that the hot chocolate is in a Duke mug. It's the only one I have clean. And, it was a gift from the PA student I worked with back in August, so I actually use it quite frequently.

The sock is the second of my dad's pair of Birthday/Christmas socks, which, okay, still probably not going to finish by Christmas, considering I'm on call this weekend. And there's no way humanly possible that my mom's gift will be finished. And my best friend's? A pipe dream, involving lots of yarn that may or may not already be in balls and a pattern I'm not at all sure I can find.

Yeah, I'm not sending out Christmas Cards this year, either. I'd been hopeful, at one point, but...no.

So the chocolate in the mug is actually kind of exciting. It's Starbucks drinking chocolate. Which has been gone from their menu for a while, and I wasn't that excited about in the first place, but now it comes in chunks in bag at Target. You microwave a little milk with a couple spoonfuls of chocolate chunks, stir it up into a mocha syrup (you know, what you add to coffee to make a mocha), basically, then add more milk, and zapp-o, kickass hot chocolate. So good.

Although....you know, I think I kind of like my Ghirardelli double cocoa powder a little better. And it's lower maintenance. Mmmm, what a sweet dilemma.

Warm milk and garlic

No, not together.

I'm still sick. Or, sick again. Or something. I was feeling better yesterday, but, alas, I spent most of rounds this morning trying not to pass out. Which I didn't.

But I came home, I took a little nap, I felt a little better. I did some work, I made some pasta with copious amounts of garlic. Which, I mean, garlic makes everything better. And it's well known for its antibacterial properties. So maybe it'll help. And then later I had some hot chocolate. Which, again, chocolate makes everything better. Plus, there's, like, flavenoids. And it was skim milk, so, lots of calcium, and warm tryptophan to help me sleep. And cinnamon is known for its restorative qualities. So, tomorrow, I should be a-ok. But just in case, I have tomorrow off.

I was kind of a bitch about it today. My senior resident was trying to be like, no, you get four days off a month, blah, blah, blah, something about call falling on the weekend, and I was like, no way. I'm on call every Saturday. Every Saturday for the next four weeks. Which means I get a day off during the week. Because I'm legally obligated to get one day off in seven. And I'm on call every stinking weekend this month. Don't fuck with my day off, man, I get cranky. And technically, since I get two days off for the holiday next week, they could probably make me not take a day off tomorrow. But damn it, one day off in seven is not an unreasonable thing. And Mike gets, like the next three weekends off, AND the holidays, and doesn't have to take call from the 22nd through the 4th of January, because of the holiday coverage. So, friggin', leave me alone.

In totally unrelated news, Barb's poor dog Scout had a little puppy surgery, and is now stuck in a cone collar. Poor, sweet, really cute pooch. And then, because he can scratch the one incision with his hind leg, the vet suggested that Barb put a t-shirt on him. And that cracked me up. Because Maggie? HATES wearing clothes, the little nudist. She gets really annoyed any time I try to put her in them. As evidence, I present the following picture:

This was her Halloween costume last year when we worked at the yarn shop. Boo.

And then there was Christmas.

My poor dog...

Family Medicne

When the last intern who'd been on the Family Medicine service signed out to me on Friday, he said, "Look for the list (on the computerized medical record). You're the blue team. You want the list where "blue" is spelled right but "medicine" is spelled wrong. There's also a list where "blue" is misspelled but "medicine" is spelled right - that's the wrong list."

Uhhhhhh-huh.

Today was my first day on the "blu" team. I'm there for two months. It was an interesting first day. Primarily because I've been dreading this rotation. The interns that have done it already this year had a really rough time of it. Typically, there are two interns assigned to family medicine - one who takes call every fourth night with the family service (which, incidentally, is the busiest group in the whole hospital. They admit more patients than the general medicine service. I think that's weird, but probably because I came from a hospital where family practice didn't admit at all), while the other works at Big Hospital during the week and takes Medicine call every Saturday at State Hospital. But, you know, for the past few months we've been a bit short staffed, so there's only been one psych intern on the Family team. So they essentially did the work of two people. While being up for 30+ hours ever fourth night. Good times. Needless to say, the four interns who've been on over the past six months have had some frightening stories to report. You know, stuff that was kind of like the intrinsic problems at my old residency - uneven responsibilities, work hours violations, a lot of dumping on people (the systematic issues, not the let's-beat-on-Kate type problems).

But, I've got a co-intern. Whom we'll call Mike. So, Mike and I split the patients. Which makes it a whole lot better. Especially considering that I've already got to get up at 5 just to get to the hospital in time to round on 4 or 5 patients, so if I had to round on 9 or 10, I might as well just move in.

I don't think it's going to be as bad as I was anticipating. Nonetheless, it was an interesting day. I'm...okay, I admit it, I hold what's probably an unfair bias against family practitioners. It's not a particularly competitive specialty. There are a lot of foreign medical grads that tend to fill up the residency spots, and a lot of US medical grads who don't match or can't get into more competitive residencies. And while the ideal is that they have a broad base of knowledge to treat patients from birth to death and at every stage in between. But the stigma is, they're a jack of all trades and a master of none, who have a shallow knowledge base and have to refer all the interesting stuff out. Which....you know, there are also a lot of family practitioners who fit the ideal. I have several very good friends who went into family because they had altruistic notions of life-long patient rapport, who have a wide-ranging base of knowledge, who enjoy the diversity of care. But I also have one or two classmates who are FPs now to whom I wouldn't send my neighbor's cat. And one in particular who admitted he was going into Family because he was - his word - lazy. Anyway, the point being....I need to get over that. We've got some really sick patients on the service. And like I said, they're the busiest service in the hospital. So they've got to know something. And they can't all be the wacky, scattered granola people of their reputation.

Although, my senior resident did hug me as I was leaving today....::sigh:: It's gonna be a weird month.

Blehhhh....

I'm sick.

Which is so annoying.

I think it's the flu or some other viral thingamajig. I'm running a temp, I've got chills, my throat's all patchy, my joints are weirdly achy, my stomach's all grumbly. I've been fighting it for a few days, and really, it was just a matter of time. My attending was out sick a few days this month, the social worker on my team was out sick for a while, the psychologist we worked with was out sick for a good long while...it's been going around. And while I'm tempted to say "Hmm, glad I got that flu shot, that clearly worked out well for me," it's probably why I made it this long without getting sick.

So I've dedicated the rest of the day to lying on the couch hiding under blankets trying to actually warm up (and because, dude, I start Family Medicine tomorrow, I need to be all recovered and ready). And in flipping the channels I came across the CMT Crossroads episode with Joss Stone and Leann Rimes.



On the whole, I'm not a huge Joss Stone fan. But the two of them really had great chemistry. And say what you will about Leann Rimes and her corny, twangy old stuff, the girl has pipes. I did spend most of the episode really distracted by her shoes, though. What were those about? (I loved that Stone was barefoot, too.)

I think I had more to say about that. But I don't know, I'm going back under the blankets. Enjoy the video.

What in the world.....?

I'm at State Hospital right now (I'm technically on call again, but it's short call, and my moonlighter should be here by 5, which is good, despite the fact that this makes me on call every-other-day and the students AND the other intern AND the social worker all got to work a half day today on this totally gorgeous sunny day not that I'm bitter why no not at all). And I'm walking down the hall, and I see this patient. Who is not my patient, so I don't really know what the heck her story is.

And she's standing in a doorway, braced against the door frame. With a sheet of paper on her head. And on top of that is a paper cup of water, which she's holding in place. And she's deeply engrossed in a conversation with someone who doesn't actually appear to be there.

Even by psych ward standards, that's weird.

Night at State Hospital

So.....I'm on call.

Thusfar things have been running at an absolutely breakneck pace. My medical student is also on call tonight (he? Leaves at 10. I'm telling you, Big Hospital coddles their students way too much. Yes, I admit, it was not always the most useful thing for me to sit around at 2am and watch my resident write orders, but at least we got the idea of how things work in the hospital in the middle of the night and what goes on and the difference between the big, open, during-working-hours hospital and the things that go bump in the night, if you know what I mean. I'm a little worried about how these kids are going to do when they have to be actual interns themselves. But, shocking though it may be, I digress....), and until I dropped him off with the attending doing intake, we'd spent our evening having a deep philosophical discussion on the meaning of life while I knit a sock. Which was interrupted a couple of times by the pager, sure, and once by dinner, but needless to say, it's not been one of those evenings of chaos.

So far.

I really think this cannot bode well for the rest of the night.

It's likely my very last psych call at State Hospital. Next month I'll be on call here on Saturdays for medicine, but by the time I rotate back to do either of the state mental hospital psychiatric services (i.e., men's unit or women's unit), we'll likely be far, far away at New State Hospital, to which patient transfer is slated for February. And which is like an hour away from my house, instead of ten minutes, like State Hospital. Unless I move. Which I might. But probably not by then. I dunno. Anyway, that's kind of...well, maybe it's sad. But I'm not sure sad is really the right word. It seems like a momentous sort of thing.

I'm not sure I'm going to miss it, exactly. I guess we'll see what the final setup is at New State Hospital. I'm not going to miss the bug bites I seem to acquire in the middle of the night every time I'm on call (I think there are ants in the call room, but I can't prove it. The whole hospital has an ant problem). Or the 100+ years of smelly funk that sort of permeates this place. Frankly, some of the units are sort of dumpy. But it's also old and full of history, here. There's a unique quality to this place that makes it feel like an entity all unto itself. I don't know quite how to describe it...maybe the place really is haunted, as the lore would have you believe. But it feels like that old person you see on the street, you know, the one you look at who, maybe they look a little roughed up by life, maybe their clothes don't quite match, maybe they seem a little whethered, but you look at them, and you just see a sort of ineffable wisdom, you know the stories they could tell would fill volumes and not be complete. That's sort of how I feel about this place. If these walls could talk they would pour out stories of such breathtaking depth, of joy and pain and madness and unreality and sorrow and fear, in such savage complexity, that it could overtake you. It's absolutely staggering, to think of the number of people who've passed through this place, patients and staff alike. To think of what occurred that now lays silent in these confines, happenings both earth shaking and nearly insignificant, both glorious and horrific. This place has seen so many turns of what defines "mental health", what makes up "normal", and conversely, what qualifies a person's value and worth (or lack there of). This hospital is the stuff legend is made of, and an infinite collection of things that seem tiny but are the whole world to someone. New State Hospital may be shiny and fresh and (at least for the moment) free of roaches, but what echoes in this place really needs to be honored.

Is alls I'm saying.

Hmm. Perhaps my excessively florid verbiage is a really good sign that I need to go to bed while I still can...

Blackout.

I'm sitting here writing this in the dark. Because this morning, Maggie and I were sitting in the living room of my little townhouse apartment, and I heard this funny buzzing. And I traced it to the breaker box that's on the wall between the kitchen and the living room. And I thought, ew, there must be a bug trapped in there or something. So I very cautiously opened it up, and no, no bug, but the circuit breaker for my bedroom was sparking. So, I flipped the breaker, called and left a message for maintenance, got a very long extension cord for my modem and router (which were on an outlet attached to the sparking breaker), and didn't worry about it.

But then I got home, flipped the switch for the lights in my living room....and nothing happened.

Except that Maggie was like, "AHHHHHHHHHHH! PEOPLE INVADED OUR HOUSE TODAY!!! LET ME OUT OH MY GOD LET ME OUT OF THIS CRATE AND PROTECT ME FROM THE SCARINESS! AHHHHHHHHHHHHHHHHHHHH!"

You know, but in dog.

So, okay, I find the little maintenance form that says "replaced breaker". And I think, alright, well, he probably knocked the living room breaker out when he did this. So I went to flip the living room breaker. Except, there is no breaker marked "living room." Plus, it's still making that buzzing noise. So I could just start randomly flipping them all, but alas....

The maintenance guy just came. And he flipped the breaker on the bottom right of the panel which was clearly marked "living room" and was obviously tripped.

Okay. Either I'm an idiot, or it was dark in here.

And he says the sparking was because the breaker stands a little bit out from the post, and so it occasionally grounds out to the box and sparks. Or at least that's my interpretation of what he said. He's going to come replace something else tomorrow, because, still sparking. But he swears it won't burn the house down.

I mean, come on. I have renter's insurance, but I don't really want to use it.

Also, I haven't had a man run out of my apartment so fast in a long time. I think he was afraid of Maggie. She did a very good job of barking intimidatingly when he came. She heard him and barked before he even knocked. Good puppy.

Oyyyyy, it was a long day today. I have a couple of the most....draining, suck-all-the-life-out-of-you kind of patients on my team. Which I'm trying very hard to keep from influencing the amount of care and time that I'm giving my more stable patients. Which is a hard thing to balance, when the squeaky wheels are coming up to you every five minutes because they're having some sort of issue. I have this one chronic schizophrenic who's just a big ol' leech, and wants to tell me something every time I walk by her, and yesterday asked to see me and when I asked her what was up (a half hour after I was supposed to have left, with another half hour of work left to do), she said, "Oh, I just wanted to get a feel for your personality."

Mmmm, right then? No, you really don't.

I have another patient who's convinced she's going to jail forever, despite the fact that we cannot dig up any current charges on her, anywhere. Today she informed me that she's absolutely certain that she's going to get the death penalty. For fraud. Because she passed just so many bad checks (which she didn't). And when I tried to point this out to her, and reiterated that we couldn't find any charges at the federal, state, or local level, she told me it was because the government was still watching her, taking their time to make a move. We even got the special counsel (lawyer who handles the commitment stuff, as the patient's lawyer, as opposed to the AG, who's our counsel) to talk to her, and she still will not budge in this delusion. She's also the woman who slit her own throat and stabbed herself in the abdomen multiple times, necessitating surgery. I have another patient who's 30 and has this very fixed and rigid delusion that her 82 year old ex-boyfriend (who doesn't exist) has a contract out on her and her family and that her neighbors (who, according to her dad, don't know who she is) are spying on her for him.

And then I have one whom I think has multiple personality disorder (no, for real), and who is just so damaged and has such trauma stuff going on, and oh, I could just sink my teeth into her case for months. She's totally right up my alley. But I've got her for such a short time, and she managed to cut herself twice in the ER before she came to State Hospital, so we're always worried about her sneaking off and doing something. Plus she's been cheeking her meds, etc, etc, etc.

And that's only, like, half my service. I also have Eeyore, and this new-onset dementia lady who's independence I'm having to curtail (that sucks), and, and, and. It's tiring. Plus then I basically gave my medical student a free therapy session today (he's been bugging me to diagnose him for two weeks now). And, I was supposed to have lunch with my assigned mentor, right? Who thought I was a third year resident - i.e., someone who was applying to the forensics fellowship next year - and showed up with the director of the program in tow. You know, for kicks. So the whole thing ended up being very formal and intimidating. Although I did find a good new restaurant in Raleigh.

Whew. No wonder I'm so tired...

Ravelry

So I'm on Ravelry now. I'm not entirely certain what that means, but everyone's been telling me I need to join. It's an online knitting community. They finally "approved" me. So, wahoo. I'm there as "doctorkate".

I'm also really tired. It was a long, long day....

Pomegranate, a haiku

Jubilant jewels

Except when wearing white shirts

Pomegranates, oy.

So this is December in the south...

I had to turn the heat off yesterday. Today, I'm sitting around in a tank top with the patio door open. It's 72 degrees out right now. Although, earlier in the week it was in the high 20s.

And I kind of miss snow. Although on Friday we had something like 70 accidents during morning rush hour because - allegedly. I mean, I sure didn't see any of it, but I guess I believe it happened - there was a little freezing rain. Our treatment team nurse got stuck in it for three hours. Yuck.

I made it to the Fresh Market today, finally. And got interesting things, like a pomegranate. I'm not quite sure what to do with a pomegranate, frankly, but I'm pretty sure I flipped through at least three recipes yesterday that discussed pomegranate.

In knitting news, I finished the Black Cherry Bag. Sort of.



Except it won't felt.

Well, it'll felt a little.

It felts enough that the mohair pops out and makes it nice and fuzzy and soft. But, you can clearly still see the stitch definition. And it shrunk more heightwise than lengthwise - like, a lot - so it's really rectangular if you don't fold in the sides, which is how I'd planned to leave it. And I'm out of ideas for making it felt any harder. I ran it through my washer, which didn't work very well. But okay, it's a front loader, I've heard they may not work very well for felting. So I wandered over to the laundry room and ran it through the entire cycle of the complex's commercial Speed Queen. And even that didn't work. So I tried the thing of putting it wet in the dryer with a big wet bath towel and running it on high heat. Which I did for a total of 30 minutes. And I got nothin'. So, I guess it's felted as much as it's going to. I'm a little disappointed. And I'm not super thrilled with how it turned out in general. It's shorter than I'd hoped. And it sheds more than Maggie right now. Ah, well....