A pox on my house

I was on call today.

I got sent home.

Why?

I have...........the pox.

Yep. I got the bloody stupid motherfucking chicken pox again. This is, I think, the fifth time I've had them. According to one of my cell bio profs in med school, I likely have an apparent T cell defect which is either too efficient at actually eliminating a virus that's supposed to lie dormant in your nerve roots forever (until you get shingles) or is too inefficient at turning this particular virus over to the B cells so that they can confer a longer-lasting immunity, so that when I get exposed to the virus again (say, from my AIDS patient with fulminent shingles, or the family practice resident who's just getting over the chicken pox she didn't have as a kid), my antibodies whallop the new invading virus instead of letting it manifest again. And no, it's not shingles, because it's everywhere.

At least I never get a very severe case. The worst I've ever had was I think 25 pox. So far I've counted 11 this time. And it could be worse. I could have smallpox. Or cowpox. Or I could get indolent, repetitive courses or leprosy or something. But I haven't had it since medical school and then I got the vaccine and I thought I was safe....

Stupid pox.

Good judgment is the product of bad experiences

My attending said this to me today in the process of our "debriefing" the past two weeks. It's so very true.

I wouldn't mind having just a little bit less good judgment, sometimes, you know?

I really liked him. Actually, I've liked the vast majority of the people I've worked with who weren't Betsy. In fact, Mags and I have a couple of doggie play dates set up and I've picked up a knitting "student" or two. But as I told them today, I will miss the people I've worked with. I will NOT miss their service.

I'm on call tomorrow, and then so Sunday, I'm finally done with Family Medicine. I'm so excited I can't even tell you. Mike had today off so yesterday was his last day. I'm generally not a jealous person, you know, but today I have to admit I hated him juuuuuust a little bit.

I'm so exhausted. I cannot wait for this to be over.

All my scut work should be like this

We were done with our work really early today - like two hours before teaching conference. So I sat around and worked on my sock and talked knitting with my senior (the one I'm on service with, not the weird one I take call with), who's a new knitter. And then after conference, she was like, wow, I'm on call tonight, and now I wish I'd brought my knitting. And then she looks at me, and is like, hey...can you go get me something?

Hmm. Can I go to the yarn shop on a mission with someone else's money. You freakin' betcha, baby.

My only rules were "brightly colored" and to get the right needles. So I got her a skein of Encore Chunky in something brightly colored, and Crystal Palace circulars, because the needle selection was really disappointing. Actually, their whole selection was sort of disappointing today. Except for this...you know, before I left a skein of sock yarn just happened to fall into my bag....

It's from a local spinner/dyer whose yarn I totally love. The color is called Science Fiction and frankly, this is going to be my second try at the obnoxiously bright on-call socks. We'll see.

Meanwhile....I'm still really tired. Which is sad, because I missed our intern night out tonight because I fell asleep on the couch and woke up too late. Oy.

A firm and unyielding stance...sometimes...

So several of you have brought up the point in reference to the last post about Maggie and people food. I know there are many people that feel very strongly that dogs shouldn't get anything but kibble. I disagree. I mean, there are limits (no chocolate, no raisins, that kind of stuff, obviously. She also isn't allowed to have rawhide, either, but then, neither am I). We have one hard and fast rule in this house and that's pretty much that anything that hits the floor is hers, and I really do think that's fair. Well, unless it's chocolate (I'll block her over that). Or vegetables, which she won't eat unless they have salad dressing on them. Or fruit of any kind. Oh, no, wait, she likes dried apricots. But that's pretty much it in the fruit department (I think that's my best friend's influence. Katie won't eat fruit, either. Except bananas).

She's not really a beg at the table sort, more just a sit closely and look pitiable type. If she begs or whines she gets sent away, but I don't especially object if she wants to sit there quietly and look cute. I mean, that's what she does best, after all.

As for table scraps, we actually have "pack rules" about how she doesn't get anything until I've had some, and usually she doesn't get much of what I'm having until I'm done with it. Like how in the "wild" the alpha lets the lesser dogs in the pack have their scraps. I mean, that's the order of things - the subordinates in the pack usually clean up after the pack leader's meal. The fact that I'm not gnawing on an antelope or a raw squirrel doesn't change that. And usually I handle anything I give her, which gets my scent on it (I confess...that's a Cesar Milan thing).

Anyhow...

Call was weird last night. We kept admitting people only to have them leave. I had one guy leave against medical advice because he had tickets to the Duke/UNC game tonight. One woman was a very cute schizophrenic with a cat named Tina who just didn't meet criteria for admission. Which was fine, except that my OCD senior resident couldn't handle that the patient was all disorganized and wasn't super consistent with her story. Where as I, for example, was like, dude, she's schizophrenic. They do that. Disorganized thinking is actually one of the diagnostic criteria.

I'm not sure exactly what that says about my thought patterns, frankly....particularly post call....

One guy I did admit...I asked him to roll on his side and take a deep breath so I can listen to his lungs. He does, takes one deep breath in, lurches over the side rail of the gurney (fortunately the opposite side rail from the one I was standing at), and wretches and vomits and spews bloody vomit everywhere. This was, of course, at 2am. Of course.

Just prior to that we had a Rapid Response on my Munchausen's patient who's somehow creating her allergic reaction to everything. Where the medicine team came in and totally undermined my attempt to retain a little sanity and order to the case. She's now in the stepdown and going to the ICU tomorrow for "desensitization." Whatever. If she goes to ICU, she's not our problem anymore.

I spent a lot of time chasing the cross-cover stuff last night, too. So it's not like a got a whole lot of rest, despite the fact that I "didn't have anything to do" (i.e., few admits). I also got in a big put-my-foot-down kind of argument with Medicine about who was going to take the stroke patient off of Neurology's hands. I won, ultimately. Despite my senior being all, "call them back and tell them we'll take her! We don't want them to think they're only taking her because we won't!" Um....except....we didn't want the patient who was circling the drain when she should've been neurology's responsibility to begin with. She sure would've been back when I was the Neuro intern...

I'm really tired. I have like seven dozen other things to say, but, I think they're going to have to wait....

Maggie-isms

How to speak Dog - a brief course in translation, by Maggie.


Scene: Sunday morning, and a Starbucks cinnamon roll.


Wow. Look at that cinnamon roll. Hmm. That looks like a tasty little pastry. Mmm. I, you know, I'd really like a bite of that. That, I mean, that looks like the tastiest cinnamon roll I've ever seen, in my whole life. And you know cinnamon rolls are my favorite food ever, right? I know last night my very favorite food was spaghetti. But no, really, it's cinnamon rolls. Mmmm, cinnamon rolls.

You want to give me the cinnamon roll.....you want to give me the cinnamon roll.....you WANT to give me the cinnamon roll....you want to give MEEEEE the cinnamon roll....I'm irresistable.....I'm sooooo cute.......I'm so cute you want to give me things....I'm so cute you want to feeeeeeeeed meeeeee......feed me cinnamon rolls......

Alright already. Look at me. I'm a good girl. I'm sitting, for Pete's sake. Look how good I sit. I'm cute, and I'm sitting, and I'm a good sitting cute dog. What more could you want?? How are you not going to give me the cinnamon roll? What are you, made of stone? Are you totally heartless that you'd let me starve and just eat kibble? Woe, woe is the puppy.

::huff:: Fine....but anything you drop is mine, and don't you forget it. It hits the floor, it belongs to the puppy. Unless of course you change your mind and want to just give me some. I'm gonna wait right here just in case. Right here, where I have a good view of the floor, but also close, if you want to rethink that decision to not share with your favorite best dog in the whole wide world.

For the record, the cinnamon roll wasn't all that good anyway....

What alternative did I have?

So I ended up not going to the Superbowl party last night. Partly because I was grumpy and tired and tired and also grumpy. But also partly because the dog made a very convincing argument that I should stay home:

I mean really though. How could I argue with that??

So we stayed in and ate takeout and alternated between the Law and Order marathon on USA and Puppy Bowl IV on Animal Planet. And I worked on some discharge summaries and did some dishes and we almost made it to bed early. And then this morning she leaps into bed with me the moment she decides I'm awake, and was all, yay! You're still home!! And I was like, do you need to make this so difficult every single day, pooch? Like it wasn't hard enough to get out of bed right now anyway....

Ultimately, I did once again fall prey to the snuggling. But I'm still going to work, just about ten minutes later than I'd planned....

Now back to today's regularly scheduled posting

I have today off. I love a good day off.

Call on Friday was rough, but not nearly as brutal as the last one. We actually managed to evade four admissions, which was handy, because we had six. My new call senior is weird. Very nice. Very knowledgeable. Very religious. Like, Evangelical Catholic, doesn't swear, won't prescribe birth control, can't say "God damn" in front of her. She got very excited when I told her I was Greek Orthodox. I'm not really sure why, because the Orthodox church is, um, old and stoic, but nowhere near Evangelical. And I certainly neglected to mention that I've read the Quran and the Mahabharata and I think Wicca has some good ideas and if the Church wasn't so ingrained in my family and my culture and my damn DNA I'd probably be a Buddhist (but then again, I have this theory that Jesus would be, too). She's also very slow, and overly thorough, and insisted at the beginning of call that I should do all the admissions, even the Green team ones, but that not only did I have to do all the work, she would come in with me to do the interview, like I was some damn medical student that couldn't tie my own medical shoes. Which, I think she's more motivated by her OCD than her mistrust of my abilities, but it still is annoying. And she's really nice. And she did do the 2:30 admission by herself even though it was a Blue Team patient, and I went to bed. Which was lucky because I was about to fall over.

And then in the morning I tried to put an IUD in this patient of mine who needs one for host of reasons that have nothing to do with contraception (she has her tubes tied already). And so we wheeled her allllllllll the way over to the Women's hospital so we could use their procedure room (not a short drive), and tried and tried, but her os was stenotic and it just wouldn't work. I tried. My attending tried. We couldn't get her to dilate enough to get the tiny little uterine sound in (it's about the size of a US3 knitting needle), much less the Mirena introducer. It was very painful for her, and I felt really, really bad. Really bad. So I called gynecology, to see if they had any ideas. Here's an excerpt from our conversation:

Me: So, I have this patient that I'm trying to put a Mirena into because [long, technical description of patient's medical history]. And I couldn't insert it because her os is stenotic

Him (before I could really tell him why I was calling the consult in the first place): Okay, first of all, [long, technical description of why my thinking is wrong. A conversation ensues about why I want to do this in the first place involving a lot of circular logic and me repeating myself].

Me (finally): Okay, whatever, anyway we thought maybe you could offer some ideas about the next step here.

Him: Well, she's bleeding, right?

Me: She is.

Him (chuckling): Well, her os has to be patent, because stuff's getting out. Otherwise she'd have metrometria.

Me: Duh, you dumbass. I said stenotic, I never said it wasn't patent. Okay, fine. Clearly her os is still open, but it's smaller than a uterine sound, which means I can't get an IUD in.

Him: Well, something you could do to make this really easy is to ripen her cervix with some -

Me: I did that. Last night. She got 400mg of vaginal misoprostol.

Him: Oh. Well. Did you sound the uterus?

Me: Of course.

Him: Well what did you use?

Me: Um...a uterine sound?

Him: Oh. Well I always sound the uterus with an endometrial sampling pipelle. It's easier on the patients and you know, you can't create a false passage through the cervix. (My attending's response to that comment when I told him later: "What's he on? You can do that any time you start poking around the cervix. You can do that with a speculum." Not really, but, the point is it's crap)

Me: Okay, whatever. I used a sound.

Him: Well, did you have good visualization of the cervix?

Me: No, I started poking blindly in her vagina with a sharp object. Of course.

Him: Well, did you use a tenaculum?

Me: Of course.

Him: Well, did you pull traction on the -

Me: Of course I did. I used to be a gyne resident. I know how to do this.

(Long pause)

Him: Well, if you know how to do this, do you really need a consult?

Touche.

In other news, I've started knitting up the yarn I got in my yarn swap with Tiny Tyrant.


It's a local (to her) yarn company called Royal Hare, handpainted superwash merino, dk weight (appropriate, no?). The color is Mt. Tam Moss. It's lovely. I'm knitting it on size threes (in the picture, it's on my little tiny Addi dps, but I started it doing magic loop on my Addi Lace that's a little too long - I think it's a 40" cable - and the sock went back on the Lace about ten minutes after this picture. The dps lasted about three rows. They were just too poke-y). I'm using Sarah's basic toe-up pattern, with a broken (moss-stitch) rib on the instep/leg.

I'm debating whether or not I should take my sock to the department Super Bowl party I'm going to this afternoon. That's a lot of prime knitting time. But I'm not sure they know me well enough yet for me to pull out the knitting at this sort of function...

Ooh, do you know what I'm doing tomorrow, though? I'm going to Duke Law school to be a fake expert witness for their trial practice class. Should be a fun time.

Songs in the Key of Meme

For those inquiring minds who want to know, or for those of you who simply think the meme was unfair because I listen to crap (shut up, Katie, I do not. I'm eclectic), here's the answer key to the previous post. And frankly, if any of you steal the meme from me, which I strongly encourage you to do, I think it's reasonable to put the song title in with the lyrics in the first place. If nothing else, it keeps you from having to do this and searching through iTunes thinking, "What the hell song was THAT?" (I especially liked when I Googled #20 - which I at least had a clue who sang it and what the title might be, as opposed to a couple of the others - and the only hit I got was my own blog.)

1. I Will, But... She'Daisy
2. Maybe, Kelly Clarkson
3. Catch Me When I Fall, Ashlee Simpson
4. Gone, Kelly Clarkson
5. Hold On, Sarah MacLaughlin
6. Wake Up, Alicia Keys
7. Independant Woman Part 2, Destiny's Child
8. Judas, The Flying Hamsters of Doom
9. How Come, D-12
10. Because of You, Ne-Yo
11. Power of Two, Indigo Girls
12. Rendezvous, Craig David
13. Mile in These Shoes, Jennifer Lopez
14. Fallen, Sarah MacLaughlin
15. Count Me In, Deana Carter
16. Didn't It Rain, Mahalia Jackson
17. Love Song, Pink
18. Both Hands, Ani DiFranco
19. Never There, Hoobastank
20. Where the Blues Were Born in New Orleans, Louis Armstrong
21. Still Dirrty, Christina Aguilera
22. Subdivision, Ani DiFranco
23. Forgiven, Alanis Morrisette
24. You Look Good in My Shirt, Keith Urban
25. No, No, Raja, Moxy Fruvous
26. Concrete Angel, Martina McBride
27. Guess Things Happen That Way, Johnny Cash
28. Starts With Goodbye, Carrie Underwood
29. Cowboy, Take Me Away (Live), Dixie Chicks
30. Reunion, Indigo Girls
31. Tortured, Tangled Hearts, Dixie Chicks
32. What About Us?, Brandy
33. Sad, Sad Situation, Bowling for Soup
34. Perfect Day, Hoku
35. Hey Mama, Black Eyed Peas
36. Falling is Like This, Ani DiFranco
37. Favorite Year, Dixie Chicks
38. Get Rhythm, Johnny Cash
39. Stay, Ney-Yo
40. When the Roll Is Called Up Yonder, Johnny Cash
41. Slow Turning, Keith Urban
42. Make It Work, Ne-Yo
43. That Ain't a Crime, Julie Roberts
44. Freek-a-Leek, Petey Pablo
45. When You're Mad, Ne-Yo
46. Right Hand Man, Joan Osborne
47. Delicious Surprise, JoDee Messina
48. My Cinderella, Li'l Romeo
49. You'll Always Be My Baby, Sara Evans
50. With You, Leann Rimes

Yeah, you know, I don't think iTunes' shuffle is as random as it likes to think it is....

Mindless post-call memery

Oh, such a long night last night. At least no one died this time. More later. In the meme-time, I offer up this fun little meme that I'm stealing from my friend Matthew's blog. Apparently the idea is that you hit shuffle on your iPod (mine's in the car, so I cheated and used the "Party Shuffle" function on iTunes) and write the first line of the first fifty songs that turn up. Amusing, and doesn't involve calling a consultant who will just piss you off.

Bonus points if you tell me how many you could identify.

1. I won't be bored, I won't be ignored
2. I'm strong, but I break
3. Is anybody out there? Does anybody see that when the lights are off, something's killing me
4. What you see's not what you get with you
5. Hold on, hold on to yourself. This is gonna hurt like hell.
6. You used to be my closest ally.
7. Question: tell me what you think about me
8. Give me a part that I can play
9. How come we don't even talk no more
10. Want to but I can't help it, I love the way you feel
11. Now the parking lot is empty, everyone's gone some place
12. 6:00 in the morning, wipe the sleep from my eyes
13. Strangers always got some mess to spread but I have learned to flick them off
14. Heaven bent to take my hand, lead me through the fire
15. Could there be a different ending to the same old story?
16. Didn't it rain, children, talkin' bout rain on my Lord
17. I've never written a love song that didn't end in tears
18. I am walking out in the rain and I am listening to the low moan of the dial tone again
19. I'm filling up inside like I need to open wide and pour my heart out to you
20. Folks, come gather round my stand and hear Satchmo's happy Dixie band
21. If you see me walking down the street or in the pages of your magazine lookin' just a little differently, showin' off the softer side of me
22. White people are so scared of black people
23. You know how us Catholic girls can be
24. When you walked up behind me and covered my eyes, and whispered in my ear "guess who"
25. I wanna taste it, give me a little taste, I wanna taste it again
26. She walks to school with the lunch she packed, nobody knows what she's holding back
27. Well you asked me if I'll forget my baby, I guess I will someday
28. I was sittin' on my doorstep, I hung up the phone and it fell out of my hand
29. I said, I want to touch the earth, I want to break it in my hands
30. I had Gods like watchdogs, dogs in a manger, I could feel the protection, possession, and anger
31. Well, there was a little falter at the altar of confession
32. Why don't you return my calls? Why you trip out where I be?
33. Hitched a ride, I was so messed up but I sure was glad to meet ya
34. Sun's up, it's a little after twelve
35. Hey mama, this that shit that make you groove
36. You give me that look that's like laughing with liquid in your mouth
37. We were young and so inspired
38. Hey, get rhythm when you get the blues
39. The room is spinning and I can't breathe and ooh, my head is just achin'
40. When the trumpet of the Lord shall sound and time shall be no more
41. When I was a boy, I thought it just came to ya
42. You understand me, at least you say you do, lately that's enough for me
43. I could go on out tonight and do anything I want
44. 24-34-46, good and thick and what you give her she'll work with it
45. It's just the cutest thing when you get to fussin', cussin', yellin' and throwing things
46. Let me use your toothbrush, have you got a clean shirt
47. If I won me the lottery, I'd dance naked in the street with a top hat full of money
48. Yeah, it's young Romie, looking for a homie, a little Juliet
49. There I was, 10 years old, waiting in my room for him to come home
50. A little stretch of river on a big green field, the kind you see from airplanes, baby, that's the deal, that's the deal

36 was the only one that actually made me stop and listen to the whole thing. So here's the full set of lyrics to that song. I'm also open to interpretation of what that might mean.

You give me that look that's like laughing with liquid in your mouth
Like you're choosing between choking and spitting it all out
Like you're trying to fight gravity on a planet that insists
The love is like falling, and falling is like this

It feels like reckless driving when we're talking
It's fun while it lasts, and it's faster than walking
But no one's going to sympathize when we crash
They'll say you hit what you head for, you get what you ask
And we'll say, we didn't know, no we didn't even try
One minute there was road beneath us, and the next just sky

I'm sorry I can't help you, I cannot keep you safe
I'm sorry I can't help myself, so don't look at me that way
We can't fight gravity on a planet that insists
That love is like falling and falling is like this

Happy February!

Yesterday, when I went to see my patient with the DTs, I asked him what day it was and he said, "Saturday, January 30th, 2008." And I said, "Close. It's Thursday, February 1st, 2008."

Oops.

Oh well. He won't remember it anyway.

On a whole 'nother note, how am I supposed to go to work - especially when I'm on call and won't be home for a whole 30 hours or better - when confronted with this?

Ding, dong....

We got a new senior resident on our team today.

Hall-e-freakin'-lujah.

So I wrote this whole post, which Blogger promptly ate. Argh. But really, the point is, Betsy is GONE! Yee-haw! Our new resident is very nice. She may prove to be a little useless, we can't tell yet, but useless and pleasant beats the heck out of useless and narcissistic and controlling.

The other point? Don't believe it when it says it saved....

Thanks for your patience

That's actually an Alanis Morrisette reference. When I originally titled this, I wrote, Thanks for your patients. And then went, hmm, that doesn't look right....why?,,,,,

Hmm.

I'm so tired. As Barb so astutely pointed out to me, this is the sort of tired sleep just won't fix. Although it doesn't help that I'm so sleep deprived. And like, today, I had all these great plans for when I came home. Actually, I had all these great plans when I went in. Betsy was going to be gone all morning for her academic stuff that the Family residents do on Wednesday, and we only had 6 patients between us, and I only had to see two this morning, so I came up with this great idea that I was going to be ready to sign out when she got back (she was on call today) at like noon or one or something and then I was going to make Mike go have lunch with me at the Cajun place we keep trying to get to (but they close for the afternoon at 2:30) and then I was going to go to sit and knit at the yarn shop which is right down the street from the Cajun place and then I was going to come home and write this great post I've been composing for two days in my head and then I was going to do a couple other things and then be in bed by nine and ahhh, what a good plan.

It didn't quite work that way. Mike and I made it out of the hospital around 2:15. And we did go to lunch, but we went to this New York style pizza place in downtown Chapel Hill. Not bad, interesting pizza, good beer. We stayed and chatted until about 4ish, I got home about an hour later, and was like, okay, gonna do this and this and this, but then I was like, I'll just lay down here on the couch for like a half hour....and I woke up twenty minutes ago. And I would've just gone back to sleep except I have a phone call I have to make at 8:10....

I'm just so tired....but on the plus side, I did get to stick a needle in some guy's belly today and drain off two liters of fluid. I haven't done that in about three years. That was pretty darn cool.

Begin at the beginning

A piece of advice from the episode of CSI that DSR'd last night. It's one of my favorites. It's all about being saved.

I really need to go to bed. More tomorrow, I really, really promise.

Postdates

(That's an OB joke)

Look! My first official post-dated post.

More when I get home. Call was a monster. Someone died, but at least it wasn't me.

Post-Holiday Blues

So this afternoon was the psychiatry department Christmas party. Yes, I know it's January 27th. What we actually have is an annual Post-Holiday Blues party. Which, is funny, for a bunch of psychiatrists. Here's the rest of why it's funny.

The blurry guy on the right, with the guitar? That's my department chair. The woman on the drums (whom you can't really see in this picture, from the Treo) is his wife. This is Dr. R's blues band.

Post-holiday blues.

It was a fabulous party, at this funky little divey place in nearby Carrboro. A lot of my classmates were there. Some of the upperclassman came. A few of my favorite attendings, er, attended, and my program director was there. We drank. We danced. I finally met Fang's little blonde girlfriend (whom I like). Mike wore a leisure suit. Which led to me having a long discussion with another classmate's husband about what exactly was so leisurely about the leisure suit. I pulled out the FMBs - not that anyone could see them, because I was wearing long bootcut jeans, but they make me tall. They also hurt like hell, what with all the standing, and the dancing, which I'd sort of forgotten until I hobbled out of the bar at the end of the evening. But damn they look good. Even if I'm the only one who knows it.

It wouldn't be so funny if it wasn't dead-on true....

I had dinner at PenguinShrink and Chef's tonight. The food was wonderful, the company was delightful, and I haven't had that much wine in a long time (but it paired so well, so what could I do?). Plus, Chef showed me this. Watch. Laugh. Enjoy. Perhaps forward on to all the anesthesiologists you work with (ahem, Mom).



There'll be a substantive post tomorrow, I promise.

Some nights I'd be better off as a real call girl

So, here's my call in a nutshell: At 3:30 this morning, I called my shrink and left her a message asking if she still had that noon appointment open.

One of the points we're "working on" in therapy is how I never call her between sessions if things are bad.

Oh, my God, last night was pure hell.

We had nine admissions. It was a busy night. And in fact, we got ten....except that the person I started admitting at 6:30 this morning...okay, that was a disaster. The psych resident saw this woman and said, well, gosh, I'd admit her, but we don't have any room, so, see if primary care will take her, sorry (um, how many people do we send out to other hospitals because we don't take their insurance or we're full or whatever?). She sees an FP, so they called me. I couldn't find the sheet that says which Family practices we admit for, but they have a copy in the ER, and the name sounded familiar, and he'd just woke me up from my five minutes of sleep I got last night, so okay fine. I was already pissed because this was a dump from psych - she came in because she was depressed and needed psychiatric help and when I got down there...ohh. She was this sweet, sweet sixty year old woman with a 20 year alcohol history who came in because she was depressed and drinking too much and she couldn't handle her life because she has lung cancer and her husband of almost 50 years is dying of brain cancer. I reassured her husband and her son. I held her hand. I did the most thorough psych intake exam she could possibly have gotten on a non-psych service, despite the fact that I had a large pile of patients to round on and a ton of work left and only like a half hour to do it. But how could I not admit her?

Well, apparently, I can't. Because we don't contract for that practice. So my on-call senior was going to call the ER and have her go to internal medicine and "take care of it."

I just spent how long reassuring the whole family I'd take care of her. That she'd be well tended and she'd have two psych residents on her team and her family trusted me enough to finally go home and now I wasn't even going to go down and tell them I couldn't admit her?

Thinking about it after I left today, I should've fought it. I'd already done all the work. I should've argued for her to come to our service.

But the real problem was the patient I admitted Wednesday before we left. She turned out to be a raging nightmare. She made me cry four times. I think I managed not to cry in front of her, but I cried in front of the nurses. In front of my attending at 11pm. In front of Mike and Betsy this morning. I've only had one other patient this whole year who made me cry and she was a crack whore sociopath.

The reasons she got to me so badly just go on and on (hence, the call to my shrink), but the root of it really was that she's someone I consider a friend. And I tried. I tried so hard to take good care of her. She sucked me dry last night. And to her credit, she called and apologized this afternoon. And, she's really sick. And she's got her own stuff going on psychologically. Which I understand - believe me, no one can relate to that kind of ingrained PTSD better than I can. But between spending my whole 30 hour shift wholly investing myself in her care, and, you know, the other ten patients we admitted, and oh, the twenty five or so I was cross-covering.

But this was really nice - My senior got to bed a good hour and a half before I did, at least. I finally got up to the call room at like 5, right? It's actually a call suite - there's a little bedroom with bunk beds and a common room with a computer and a TV and a futon. I always sleep ("sleep") on the futon. I usually leave it folded up, because I like to snuggle up against the back (I sleep with my bed against the wall at home). But anyway, I walked into the call room, and found the futon out and all made up with two pillows and a couple of warm blankets and the sheets turned down, waiting for me.

Betsy redeemed herself a little today, too. She was really supportive and did a good job trying to get me out today. She also tried to make it more about her and at one point outright called me fat, but, at least she said she'd want me on her side in a fight.

I'm really having trouble with how "out of control" I got last night. I can't believe I let anyone see me that upset. I can't believe I cried multiple times in front of people. Betsy and the Duke resident both made the comment, "I've never seen you like this!" Like they've known me for so long, you know? Still, I don't like it when the cracks in my carefully crafted facade are exposed. And I'm not sure Mike took my unhingement all that well.

And of course, me "unhinged" mostly involves crying while continuing my usual get-things-done shtick, and is still more way tightly bound than some people on a good day. But I don't much care how well they can hold themselves together.

My attending handled it well, actually...I think we were sort of in this together, which helped. He's normally one of the most unflappable people I've ever met, and this situation clearly had him...um...flapped. I mean, he needed to be the point person on this, and I kind of had to push that on him a couple of times (including a text page I sent him at about 9 or 10 pm that literally said "HELP. Sarah's out of control"), but he ultimately took the brunt of things this morning and was remarkably firm and really just did an excellent job this morning trying to lay down strong boundaries. I learned a lot from him over these two weeks, mostly in the behaviors he's modeled. The past 48 hours were obviously no exception to that.

Meanwhile...I'll call Sarah back tomorrow. We're going to be fine, at least from my end; I know this is beyond extenuating circumstance for her. And by the time I get back to work on Monday she'll be home recovering and all will be well.

Did I mention I have the whole weekend off? It's my "golden" weekend (postcall Friday, whole weekend off. So, um, sort of like the real world. Not sure what exactly is so golden about that, but, you know). I'm so excited about that, I can't hardly tell you. I think Maggie's a fan, too.

I cannot go to work today....

A little classic poetry from my youth, by Shel Silverstein. It just sort of sums up how I'm feeling this morning....


"I cannot go to school today"
Said little Peggy Ann McKay.
"I have the measles and the mumps,
A gash, a rash and purple bumps.
My mouth is wet, my throat is dry.
I'm going blind in my right eye.
My tonsils are as big as rocks,
I've counted sixteen chicken pox!
And there's one more - that's seventeen,
And don't you think my face looks green?
My leg is cut, my eyes are blue,
It might be the instamatic flu.
I cough and sneeze and gasp and choke,
I'm sure that my left leg is broke.
My hip hurts when I move my chin,
My belly button's caving in.
My back is wrenched, my ankle's sprained,
My 'pendix pains each time it rains.
My toes are cold, my toes are numb,
I have a sliver in my thumb.
My neck is stiff, my voice is weak,
I hardly whisper when I speak.
My tongue is filling up my mouth,
I think my hair is falling out.
My elbow's bent, my spine ain't straight,
My temperature is one-o-eight.
My brain is shrunk, I cannot hear,
There's a hole inside my ear.
I have a hangnail, and my heart is ...
What? What's that? What's that you say?
You say today is .............. Saturday?
G'bye, I'm going out to play!"

Somebody's gettin' on my nerves...

(Missed the reference? Click here. Before I forget that I'm a lady and give 'em what they deserve.)

People are driving me crazy tonight.

Today was a weird ass day. It was Wednesday, so all the Family residents scampered off to their academic stuff all morning. Which meant it was pretty much just me and Mike and a bunch of attendings. We rounded, I got my notes done, and was more or less ready to leave at noon. It was a nice morning, actually. Mike and I got stuff done, Betsy was gone...and then the attendings started talking about how Sarah, my attending from two weeks ago (remember her?) was in the ER and coming on to the Family Medicine service as a patient.

I like Sarah. She's kind of a lot sometimes, but she's a really good person. And we'd already agreed that we needed to stay friends after she relinquished her position of authority over me. So I went down to the ER to make sure she was okay, offer to take care of her dogs, whatever. We got to chatting and I said, Red Team's admitting, but you know they're going to let you decide whatever team you want to be on, so I'm sure you're just as good to go on Green. And she says, can I come to the your team? I said, of course. And promptly called the covering attending and told her that Sarah wanted to come to the blue team and I was already down there, I'd do the H&P and take her on as my patient. Even though, you know, I'm on call and thus the admitting resident tomorrow.

The attendings appreciated it. Sarah appreciated it. I'm not sure the on call residents were as thrilled, but, should they really care? It's an admission they didn't have to do.

And then I discovered my really manipulative patient we discharged last Friday was back. The one who was so freakin' personality disordered and like ate my whole day and then frakkin' Betsy comes in and plays right into the manipulation and triangulation and the next day we discharge her and she wants Betsy to be her real doctor (a-ok with me, sister, even though someone in my line of work is so much more what she needs. But, please, go play dueling Borderlines, with my blessing) and Betsy sends her out the door with pain meds. Wait, let me rephrase: Betsy sent a known narcotic dealer and abuser out of the hospital with prescriptions for oxycodone, oxycontin, and ambien.

My mind boggles at the street value alone of this little hospital stay...

So she's back. First, the on-call resident tries to get me to do that H&P too, even though, um, I'm NOT ON CALL TODAY. And then Mike and I decide that she clearly needs to be Betsy's to follow, because the patient and I do not get along (because I'm a hardass that sets limits), and because she's technically Betsy's primary care patient, Betsy should see her anyway. So I gave B the courtesy of text messaging her this info - she's yours to follow in the am, and oh by the way, we picked up Sarah on our service. The flurry of texting that ensued just pissed me off on so many, many ways. Suffice it to say, I'm seeing the sociopathic patient in the morning, along with my other four patients. Despite the fact that I'm on call tomorrow and thus admitting. Know why I have to see her? Because Betsy has afternoon clinic, and so she can't possibly see ONE FUCKING PATIENT tomorrow.

I'm so ready to be done with her. Which will be Monday. And I have the whole weekend off. Thank God.

And just to add injury to insult to this day, Mike and I escaped the hospital about 3 and went to this cute place in Carrborro for lunch. I fell down. On the way in, before I'd even had anything to drink. In the middle of the street. Tripped over my shoe. In the middle of the street. Boom. Scraped my elbow. Felt like a moron. Mike, fortunately, picked me back up, hugged me, and then plied me with really good alcohol. It was an excellent response to the situation. I still feel like a moron. But at least lunch was good.

Cowgirl and Pumpkin

When we were in medical school, my friend Karen had this propensity for making up little songs. They were usually impromptu, funny, and endearing, although rarely Grammy material. There's one in particular that's stuck with me over the years. She made it up when she was on call one night, I think on surgery. I often find myself singing it in my head in the wee hours of my calls, and every now and then on nights like tonight, when I'm just freakin' tired. It goes like this:

I'm a tired cowgirl and I wanna go to bed
That's what the tired cowgirl said.

Simple. Succinct. Capable of being stuck in one's exhausted brain like a sing-song little mantra.

I am a very tired little cowgirl.

Pumpkin the Wonder Mutt over here just buried my cell phone in the blankets on the couch. I think that may be a subtle attempt at telling me that I need to stay home more. She's been getting very upset in the mornings when it starts becoming obvious that I'm not going to be staying home that day. I feel bad, but she deals with it okay. Soon enough, puppy, soon enough.

And in case you're wondering, yes, that's still Maggie I'm talking about. She has many nicknames. Her full name is actually Margaret Mae (and then we have the same last name), but she's also known as Maggie, Mags, Mutt, Muffin, Pooch, Spoochie, Baby, Pumpkin, Dog, Goofball, Nutbutter (which is an extension of "Nut"), Punkin Head Doggie, Crazy, Magpie, Skilimou (which means "my dog" in Greek), and Best Girl Ever, to name a few. My old roommate used to call her Magglio, after the White Sox player (knowing full well that Maggie is a Cubs fan). What's amazing is that, a, at this point she answers to any and all of them (as well as things like "Donde esta mi perro?"), and b, they're still better than her original name when I got her at the shelter, which was Sweet Pea. Which, she's so not a Sweet Pea. I mean, it still pops up occasionally as a term of endearment, but, as her actual name? No way. She never answered to it, and I refused to use it the first few days she was mine, which meant that she didn't actually have a name. And then about three days after I got her we were sitting on the back patio under the stairs that led to the second floor mother-in-law apartment, and we were playing and I looked at her and I said, "Your name is Margaret, isn't it?" And she licked my face, and so it was.

And it's quite possible that was the last time I called her by her given name that she wasn't in trouble for something or about to get into trouble for something.

Have I mentioned that I'm exhausted? I think he q4 thing is already getting to me, but I also was thinking in the car on the way home tonight that I've really been dealing with a lot of the more concrete manifestations of illness than I'm used to. Like, today Mike and I googled one of the patients we discharged home late last week (to hospice) and discovered that she'd died on Sunday. She was such a sweet little old woman, and oh my God, she was so miserable. She was in so much pain there at the end (she's the one, for those of you who've heard this story, who GI came in and did a somewhat urgent colonoscopy on her at midnight during my first call). And I as thinking about her on the way home and how horribly swollen her legs were, to the point that they were disfigured and the skin was all translucent and they looked almost unreal. And then I thought about how many times I've seen that in the past month. How many diseased and distorted variations I've seen on the physical human body this month. Not that I'm not sort of used to that, it's just so much more in your face, so much more concrete, than what I've become "used" to dealing with. Which, it strikes me, is a reason so many people don't like doing psychiatry, because it's so abstract and kind of existential and so rarely concrete. I think that's actually a little bit easier for me, a little more congruent with my way of thinking. I wonder what that says about me....

Well, whatever. Snugglepuppy and I are going to bed.

Nap, interrupted

Oh, I was having such a nice nap until Mike called and woke me up. But, whatever, if he wants to be all "responsible" and find out about the patients he has to see in the morning, fine. And then he starts telling me...he had his first medicine call at State Hospital this weekend. He hasn't done the medicine service yet, so this was a little bit of a trial by fire thing anyway. But I assured him, dude, so not anything to stress about. Saturdays are slow at SH, oh my gosh I got so much knitting done last month, really, you'll be fine. So he tells me that he ran all day. First thing when he gets there, he has to transfer someone out to a real hospital. Then he has an admission. They paged him all day long for all manner of things. And - are you ready for this? He had a code.

PenguinShrink and I had a multitude of Medical Stats, which are a step down from calling a real code. We still ran to them. They still brought the crash cart. And usually it meant that someone had DFO'd (done fell out. They do that in the South). And occasionally we had to call an ambulance. But I don't think they've had a real Code Blue called at State Hospital in at least a year.

No, really. Piece of cake. I got so much knitting done last month.....

My call yesterday was not nearly so bad. We had four admissions, no one was super sick. I spent a lot of time coordinating stuff and had a couple of weird outside calls. But on the whole, it was a fairly chilled out day. Two down, five to go.

I talked to my friend Bianca back home today. You remember her as the mother of my nephew Basil. She just started repping for a line of really wonderful children's books called Barefoot Books. It's a grassroots company started by two women from Texas who abandoned the corporate life and started up something they hoped would make a difference. They've got stories from all over the world and they're just beautifully illustrated. So all of you folks-with-kids type people, or you other people who might know some kids who like presents, should go check it out.

And then my best friend emailed me this. This is a cute puppy.



Also gives me a better perspective on our half an inch of snow. Although it's freakin' cold down here in NC. It was 17 degrees today when I left the hospital! Brr-rrr! I mean, okay, back home that'd be pretty warm right now, but we're not set up for the cold down here like they are up north!

Alright, I think it's time for me to meander towards my bed. Because I have to go back to the hospital in the morning. As always. Wow, I'm really tired. Kind of in general.

And don't worry, Paige, I'll post about my tat by the end of the week.

Blues in the night

So, I'm on call. And my team (although, on call, we cover all three teams) is the blue team. Hence the title.

It's been a slow day, which almost guarantees us a bad night. I guess we need something to look forward to, right?

I'm on call with one of the third year Family residents as well as the Duke resident, who's also a third year. It's been a fine day. We ate well. My senior's husband came by with her ten month old little girl, who's just the cutest little thing ever. I ran into my med student from State Hospital, who's on Surgery now. And we even took care of some patients. Not a bad deal, really.

Guess we'll see how the rest of this night goes.....

I have more to say, but I think I'll say it later. Keep your fingers crossed for me that we maintain our smooth sailing.

Snow and Ink

So I'm driving around doing errands this morning, and I hear this story on the radio. Apparently the chief surgery resident at the Mayo Clinic in Scottsdale just got fired because he took a picture of a patient's penis with his cellphone during a cholecystectomy and then showed it to his friends. Horrible, right?

I'm having a little bit of trouble feeling sorry for this guy.

Yes, that was really unprofessional behavior. Yes, that was a violation of his trust and the doctor-patient relationship. Yes, the surgeon really should've known better than to create evidence. And it was jocular and silly. But...the guy had "Hot Rod" tattooed on his penis.

Not for nothin', but...hmm. Did you not think that would attract some attention? I mean, I have an unusual tattoo, too (different from a ta-tutu), and I knew when I got it that people would comment. And mine's nothing like that. So, come on, bud. What that resident did was wrong, but, really, the way he's carrying on and being all outraged and horrified is a bit...dude, you let a total stranger with a needle tattoo the words Hot Rod on your penis. Not to mention that now everyone in the literate universe knows about your, um, little secret. I? When that doc had called me, would've been like, fine, sir, whatever, let's just never mention this again.

We're not even going to talk about the number of times I photographed women's genitalia during surgery when I was a GYN resident because they had some clinically interesting or relevant finding. A couple of those pictures even got published, I think, in a journal article, of one woman's vulvar cancer. Not the same thing, I know, but, I'm not sure we told very many of those people we'd taken pictures of their cooch. Our ability to take photographs during surgery is in the standard release form. Now, I concede that the "clinical utility" of these Mayo photographs is questionable, and I was either taking them with the hospital's digital camera or a laparoscope, not a cell phone...but anyway...

In other news, it's snowing in North Carolina.

I think it's sort of funny. In the few hours since I started this post we've actually had some accumulation. We're supposed to get more tomorrow. Maybe it will keep people home and make for an easier call night? A call girl can only hope.

And in still other news, Tiny Tyrant sent me some very cool sock yarn in a yarn swap. Which I promptly tied into a great big knot (with the help of my ball winder) that took me two episodes of Bones to untangle today.

It's very cool. I'll post more about it later now that it's in actual balls and I have a tiny bit of it knit up. Maybe I'll have some time to write tomorrow (keep your fingers crossed for me), but right now, I've got to get to bed....

Something worthwhile

I rarely endorse those click-for-a-cause sites, but, I'm a little partial to shelter dogs, you know....so click here, and feed them. I'm thinking about putting this link in the sidebar, even.

So much to say. And so very tired, so, going to say it tomorrow....

1 down, 6 to go

So, my first Family call has been survived. My upper level said he felt useless.

It was a moderately busy night, and things kept coming in a steady stream. But it was an emotionally draining night. And even more so today. I'm so freaking tired I can't even really see straight. Maybe I'll write more later. I'm hoping to, but I would really like to sleep a little and there's a recruitment shin dig I really want to go to tonight...we'll see how it goes.

Testing, 1, 2, 3...

Okay, apparently I can blog from the hospital, or at least here in the FP call room (remember how I could never actually log in when I was on call for Neuro?). We'll see if I have time and/or privacy enough to actually write anything of substance later. As for now...wish me luck tonight!

On the runway

I have the cutest dog ever. No, really. I have photographic evidence this time.

My dear, dear friend and fellow fiberworker, Penguinshrink, was kind enough to make me a Christmas present (hers? Unfortunately....ugh, still a ball of yarn....maybe for her birthday...). You'll remember her as my partner in crime from the mass crocheting of the Intern Retreat gifts. She's a fabulous crocheter and in fact, on said intern retreat, helped me figure out a problem with my technique which has made my crocheting a whole lot easier. And she's also a darn good doc and a kickass co-intern. Girl, you rock!!!!

She made me a very lovely shawl and hat combo. Just perfect for the climate down here. The color is fabulous, the yarn is soft, it's quite wonderful.

And you know I have this policy about not putting pictures of myself on the blog. But it didn't seem quite right to just do the standard laid-out-flat-on-the-couch picture.

Fortunately, I was able to find a model.

Now, Maggie has those big coyote ears, right? And she really doesn't tolerate having anything on her head for very long. But she did okay with the hat.



Actually, she was kind of a ham.



Come on, come on, give me attitude....



Work it, girl. Yeah, yeah, good girl, goooooood, good girl.



Seriously. This dog cracks me up.

Oh, and PS, she clearly approves, because as soon as our photo shoot was over, she promptly stole the shawl and buried it in the couch cushions. You know, for safekeeping. She does this...

Theoretically possibly potentially

So you remember my patient who had the stroke and had to shave her head and then I knit her that hat?

I'm in our 11am teaching conference today, right? And I get this page. And it's the research nurse from Neurology. She's like, hey, do you remember me? I said, of course I do. And then she tells me my patient with the stroke is in clinic for her 60 day follow up (wow, has it really been that long?) and would really love to see me if I could get away.

Of course I could.

She looks fantastic. Amazing. I think she talks better than I do right now. She has no motor deficits. And holy cow, is she rocking out the short hair.

She was so excited to see me. She hugged me twice. Her fiancee was also thrilled to see me. Wow, I can't believe how good she looks. And I can't believe how happy she was to see me again. Or how impressed with me the research nurse was. I....what did I do, really?

You know, I think maybe I'm a good doctor.

And I don't mean that sarcastically. It was sort of an interesting day in that regard...Betsy spent a lot of time undercutting me today. She laughed at me when I suggested on rounds that nebulizers were equal in efficacy to metered dose inhalers (they are. There's data). She acted like I was being ridiculous when I went to give my pneumonia patient a flu shot (it's protocol) and then called me five minutes later to tell me to give her a flu shot. She kept telling me that I needed to present in a problem-based format. I finally said, "um, I thought I was." She pointed out that if I'd really been organized, the attending wouldn't have had to go back over the systems after I was done. Not that it was his first time meeting our seven fairly complicated patients or anything like that. Not that he needed to get a lot of information organized in his own head.

This all, of course, after she called me last night to tell me Mike was off today and so I then had to round on all seven patients. Because she was on call today (they don't really start admitting until noon. There was no way Betsy was going to be holding the call pager. And in her spot in the rotation, there are three residents, not two like every other night, because the Duke resident takes call, along with her and an intern). So she couldn't possibly write any notes.

For Pete's sake.

My shrink and I had an interesting conversation the other day about what it meant for me, symbolically and fundamentally, to be sequestered with an actual bad resident. In the context of my old life where I was just told over and over again that I was a bad resident, when in all likelihood, I really wasn't. I mean, I'm not a different doctor here. And my patients loved me there. I won a teaching award from the medical students. Several patients complained bitterly when I left. But if you'd asked me then....if you'd asked me a lot more recently than then...I would've agreed that I was a worthless human being and a dangerously bad physician. They had me convinced for a brief while that I shouldn't be allowed near actual patients because I was bound to do something harmful. Not that there was evidence of this, but, they had me convinced.

My shrink had a term for that, too. It was, "brainwashed." She's a good psychiatrist.

It's really hard for me to admit this, but I think maybe I am, too.

Why I do what I do

I also got this yesterday. One of my patients from back when I was on the Women's unit at State Hospital is down in rehab in Florida right now, and she sent me a Christmas card. It took a little while to reach me, because technically I'm not on staff at State Hospital, but it finally got to someone who knew who I was and passed it on.


Truly, that's everything I can ever hope for.

Wired

I have had way too much caffeine today.

But at least I've been productive. I left the hospital, went and picked up the Maggie, and then we stopped at Starbucks. I came home, loaded the dishwasher, swore at the Treo for a while, and then gave up and went to Circuit City, where I hemmed and hawed and was very indecisive for a very long time about what navigator to get. Then I went to the grocery store, stopped and got lunch, came home, took the trash out, swore at the Treo some more, and now, I'm babbling on here. Good times.

Someone said to me, back when I got the VZNavigator on my phone, if you get the navigator, you'll never learn your way around. I said, nonsense. I'll just not get as lost when I do get lost. But I'll know the town just as quickly. It'll be fine.

Now I say, alright, fine, shut up.

I lasted three days, and one of those days I was on call. I got so rip-roaring lost on Friday coming back from lunch downtown that it was ridiculous. Especially considering there was another physician with me, who also works there, who didn't know where the hell we were, either. And "downtown" is neither that big nor that far from the hospital. For all the IQ points in that car on Friday, I'm just sayin'. But alas, no. The only reason we didn't get lost on the way to lunch was because I was following Mike, who, a, gets out more than I do so he knows his way around "out" better than I, and 2, lives four blocks from the restaurant, so, he really ought to know where it is.

So, adding to the gadgetopolous in which I live, came the TomTom.

There was much wailing and gnashing of teeth over this vs the Magellan. Because I can talk to the Magellan. And the sales guy thought it was easier to use overall. But I couldn't get into the interface, and I really like the look of the TomTom maps. And I got the stripped down version, because I concluded that was really all I needed. But, like, it couldn't find the grocery store. So I ended up googling the Fresh Market on my Treo and then entering the address into the TomTom and feeling a little like the bionic woman. Especially now that I've taken to wearing both my phone and my pager on my hip (because I'm not leaving anything as expensive as the Treo in the pocket of my labcoat). I'm wired for sound, baby.

And I had immediate buyer's remorse as soon as I took the TomTom out of the package. D'oh, I should've gotten the Magellan! Except that this was all triggered by my inability to find the Fresh Market, and who's to say that that Magellan would've been able to find it, either?

Once I gave it the address, though, it did find it. And I fulfilled what's become my Sunday routine...go to the Fresh Market when it opens, buy produce and yogurt and other random (usually impulsive) things, then go to the Char-Grill next door, and get a very yummy burger for me with mustard and onions and a plain cheeseburger for the pup. Today's burger was especially good, and they have the best fries in town. I also made three particularly good finds at the FM. One was vanilla chai, which has become my new addiction at the hospital coffee shop. I also discovered that my new favorite wine also comes in a red, and the other...oh my gosh....I was in the cheese section, getting shredded Parmesan to go with the salad fixin's, and I saw this little half-pint deli container with a really white, softer looking shredded cheese, and I thought, huh, I wonder what kind of Parmesan that is....but it wasn't. It was...are you ready for it? Mizithra! Which is this dry, salty Greek cheese that I could live on. No, really, a little butter and some Mizithra on pasta is the best thing going. It's the food of the gods, I'm telling you, Athena herself invented that dish. It has to be new this week, because I look for it pretty much every time I go past their cheese counter. And there it was! I let out an audible gasp in the middle of the cheese section this morning when I discovered it. There may even have been a Mizithra dance. I'm telling you, this is exciting news. Especially after having conquered the TomTom to get there in the first place.

If I could figure out how to sync the effing Treo, by the way, I'd show you a picture of the TomTom taken with the Treo. Because I thought that was funny. But, alas, I still can't get the laptop to talk to the phone. It was a fluke, one-time deal, apparently. At least it worked long enough for me to load a couple good pictures of my dog onto the phone, so I could show her off at lunch Friday.

Technology is my friend...

Lunch, as an aside, was very nice though. Sarah took Mike and me (Betsy was post-call) out for Thai food to celebrate our surviving the past two weeks (the attendings rotate off service after two weeks, so we'll have a new attending tomorrow. I'm hoping this mellows Betsy out, but, none of us are optimistic). It was very pleasant. The food was excellent, we had a very good time, it was very laid back, and I still left early. Very nice. Plus, Sarah and I have intentions for a doggie play date shortly. She has two dogs, one who she picked up at the roadside after he got hit by a car - a German Shepherd who's probably about twice Maggie's size - and a Leonberger she rescued from the shelter who was so little when she brought him home that he used to sleep in the cats' bed...he's now close to 200 lbs, and he's not done growing. He gets his head stuck in the cat bed now because he doesn't realize he doesn't fit there anymore. He barely fits in her car. I can't wait to meet this big furry mountain.

Those two are going to terrify Maggie, though. She likes cats and little dogs. Unlike my old dog, Wolfie, who was this ninety pound Husky-Akita mix and had a heartbreaking, pining crush on the 125-lb older-than-God German Shepherd next door, Bob. Wolf would run over to the fence when Bob was out and just watch him, awed, tail wagging like crazy. And then he'd look over his shoulder at me all excited, like, "It's Bob! Do you see? Do you see?? Oh, Kate, it's Bob, it's Bob!!" But he'd never bark, and he never dared actually approach Bob, who, incidentally, was this very sweet, toothless, grumpy-old-man kind of dog. No, my dog was a groupie.

Bob died shortly after Wolfie did. And then the big mean old Rottie they had got stomach cancer or something (I told my neighbor, it was probably someone he ate), and he was put down. So shortly after Mags arrived, they got this very obnoxious pit bull puppy. Maggie and Kedzie, my roommate's dog (who's like 13 now or something and is a TOTAL grumpy old man) were both sort of like, what the hell did you bring him here for?

The best Wolf story, ever, though, was when one day we were out for a walk. And these six little rat dogs come tearing out of the house down the block, like, in formation, barking and snapping and squealing and they start circling Wolf, nipping at him, barking, huffing, growling. And Wolfie, bless his little poochy heart, stops, and looks down at these little knee-high (to him) annoyances with this quizzical look on his face. And then he calmly looks up at me, completely baffled, like, "Dude. Really. What the hell are these things?" And he kind of watches them for a minute (in contrast to his owner, who's flailing about yelling "Get out of here! Go! Go! Stupid little shit dogs, get!") and then looks at me again like, "These things are stupid, and noisy. Can I eat one?" Fortunately, their owner happened to notice about then that they were missing and called them back into the house. And he - I'm so not kidding - watched them go back into the house, looked at me, shook his head, and then started back down the road towards our house. I totally would've let him eat one.
That's my Wolfie. He was such a good boy.

Well, Mags and I are going to go spend some quality time napping, and then there more dishes to be done and laundry as well and I still have two discharge summaries to write up. Mi vida loca...

My rockin' Saturday night

I'm on call at State Hospital again.

My life is so special.

At least Maggie's having a social life. She managed to get to the doggie day care. She hasn't been there in a while, because they don't open early enough for me to take her there when I'm working at Big Hospital. So we have a dog walker. He's very nice, she likes him an awful lot, and he never says a word about the horrendous mess that is my house (I'm so not exaggerating). But I still think she'd prefer to be with all her puppy friends at the day care. I'm hoping next year she can actually go there as a day care pup once or twice a week.

Only 170 days until "next year".

Tonight is my very last call at State Hospital. Possibly ever, because in theory, they're closing the place before I rotate back here in June. But the way things are going, I'm going to be able to get an attending job here after I graduate (seriously. They have a great loan repayment plan). I'm ready to be done, frankly.

So I think I mentioned that Mike and I switch next week and he starts taking Saturday call here and I start taking Family Medicine call at Big Hospital. FM call is brutal, generally speaking. Mike's gotten 10 admissions or more each time he's been on. Plus the floor pager goes off all the time. You're up all night. It's hectic. It's crazy. And I'm thinking I might actually do better with that.

I was thinking about this today. Psych call here is just about as bad as that. I never sleep. I admit between 10 and 20 people a night, although the "admission" is usually more of a cut and dry process here (basic diagnosis, basic admission orders, rarely anything to follow up, labs are followed up by medicine, etc. Interview 'em, write their orders, get 'em to the floor, you're done). I'm usually here until 11 or noon. And I actually enjoy those calls a heck of a lot more than these medicine calls, where they perpetually call me for stupid things, and these Saturdays have an awful lot of down time. And I'm sure that's also partly because I like doing psychiatry, too. I don't know. Maybe I'm making this up so I'll feel better about starting FM call. I liked Neuro call, too, though, that was actually my favorite - I was usually fairly busy until 11 or 1 or so, and then I went to bed, and usually got some sleep.

I haven't dealt well with my time today. I've been so tired, and I have no idea why. I keep trying to read, I nod off, but can't even get a good nap in because the pager is either going off or I keep worrying about the pager going off. My knitting is going too slowly. I'm just grouchy.

Ooh, but my pager finally went off to say that dinner is here. Maybe that'll make me less grouchy.....

Don't believe everything you think

I saw a car with that bumper sticker today. He he. I love it.

I can't stay awake right now, yo. I'll write more later.

New toys I can't afford anyway

Sunday morning, while I was on call....there was a death.

My palm pilot is no more.

Notice me not saying "death of a loved one." Maybe I could go with "a dear one." A frequently used one. One I depended on that aggravated my by crapping out frequently and at the worst possible times.

Oh, but how I miss thee.

Understand, I bought this dumbass thing in July. It barely survived until January. My dad still has my old palm, which I bought, what, in '03? '04? I don't know that he actually uses it, but, it still works.

Whatever. So today was my day off. I had all sorts of plans. Ahhh, such plans had I. I was going to clean. I was going to go to the grocery store, to Target, to Walgreens, to see my shrink, an to buy me a new palm. And then to maybe nap on the couch and watch a movie with the doggie. Ahh, a nice idea, huh?

Yeah, well....

I was up really late last night after all the work I had left to do, and then just the agitation of it all, and then I slept pretty badly. Sometime this morning I had this very weird, epic sort of dream (I've been having a lot of those lately, where they just go on and on and on. I'm about two more shy of scheduling a sleep study to figure out what's wrong with my REM sleep) about my ex, who was just snide and indifferent to me in the dream, and his business partner, who looked nothing like what he actually looks like and kept trying to recruit me into their GYN practice even though I wasn't in the same specialty anymore. Oh, and it went on and on and on, seemingly for days (at least it wasn't as nightmarish as the one I had Sunday). Then I woke up and spent about an hour poking myself in the eye, because I lost a contact and would've sworn to you that it was still in there, but I don't think it was, because I ended up putting a new lens in, thinking at least they might stick together and then I could get it out, and it doesn't hurt as much and nothing else has emerged, so...

Then I did manage to make it to my therapy appointment, and then to Walgreens, and then I spent an inordinate amount of time discovering the fact that no one sells PDAs anymore. So it occurred to me that since I hate my KRAZR, which isn't working very well anyway, maybe there was a phone option that would solve both of my dilemmas. So I went to the Verizon store. Where a very nice woman told me that she wouldn't be able to give me any sort of discount and the most compatible phone she had that would fit my needs was over $600.

Yeahhhhh, no.

So I went to Circuit City, where I actually talked to someone, who told me they haven't sold PDAs in almost a year. She isn't sure why, because they always sold well, but no one in town sells them anymore. Argh. So, I stopped at the Verizon kiosk there and posed sort of the same question. And she's like, well, we have this option and this option, and hey, where do you work? Are you a state employee? Of course you are. So she xeroxed my State Hospital ID and I got a substantial discount off everything I bought (phone, charger, etc) as well as 20% off my monthly bill. Plus she gave me the new contract phone price (which I wasn't really eligible for yet). So I paid less than half of the original quote for the pretty new phone.

Isn't it pretty?

I still haven't really figured out how to use it yet. Although I did get Epocrates on it, which is what's most critical to my life. And I can call out, especially to people already in my contacts, and text message without too much pain.

The one thing I really will miss about the other phone, though, is my GPS navigator. Although for the price I paid for the service, I've discovered I can easily get a TomTom, now (wow, have they come down in price, PS). So I stand a chance of still not getting lost.

The camera's better, too. If I could figure out how to get the dumb thing to sync again, I'd show you a cute picture of my dog....

Of course, of course

First, though - what the hell is wrong with New Hampshire??!?!!!?! I mean, you'd think that a year of living there would be more than enough for me to stop asking this question, but, I mean...at least Obama took Iowa.

I voted in NH in the last presidential election. They gave me a legal-sized sheet of paper, and a pen. It's the only time in my very lengthy voting history (ahem) that I've voted straight ticket...because all six people I happened to want to vote for were democrats, and, um, there were only about six races on the ballot.

With a pen. Did I mention the pen? No hanging chads in New Hampshire. Freakin' ass-backwards state. I should've known to turn and run right then.

Then again....here's the end of my day today. I walked out of the hospital, called my folks, and when my dad picked up and asked me how I was, said very loudly "I AM SO FRIGGIN' GLAD TO BE OUT OF THIS GODDAM HOSPITAL." Then I sat in [long string of expletives] basketball traffic. Because, of course, the hospital sits in the middle of the college campus, literally. You know that scene in Renaissance Man where Danny Devito gets awakened by the Army boot camp recruits doing loud morning calisthenics at 5am, and runs around the grounds yelling "GO NAVY!"

I was thisclose to opening all my windows and yelling "Go Duke! Go Duke!"

But I did take advantage of the down time by texting my co-intern with the following message:

You're going to need to commit me soon for homicidality. Also, Betsy wants you to round on seven patients tomorrow morning because she can't write that many notes. (Maybe if we share a room on the inpatient unit, they'll give us a group rate?)

This was followed by a forty minute conversation with Mike and then an hour and a half phone conversation with my attending.

Today....I....oh my God.

Today was the first day of this new curriculum on the part of the Family Medicine department where they corral all their residents for learning on Wednesday mornings. Which meant the only residents left were me, Mike, and the Duke resident. Mike was postcall, and he'd had a rough night. So I made him sign all his work out to me and took his pager and then my attending (have I given her a pseudonym yet? I don't remember. Let's call her Sarah) and I sent him to go sleep for a while. And then we went off and tried to take care of some patients and get some stuff done and had some very manic and wacky walk rounds.

In the midst of this, by the way, we were awfully punchy, and I don't remember for the life of me what prompted this, but she started walking down the hall singing the Mr. Ed theme song. And she gets to the "famous Mr. Ed! Wil-bur!!" part, and...I'm so not kidding...someone in one of the patient room whinnied. Right on cue. It was the funniest damn thing I've heard in a long time.

We've conferred - we both heard it.

So then Betsy, our upper level, pages me. We'd both thought she was in clinic. Know why? Because this morning she told us that she had clinic. So she pages me, and is like, where are you? She's back from lecture (an hour and a half later than everyone else, by the way) and is all pissed off because you know, if I don't keep her informed she will never be able to run the service. And then we meet up with her (after we do some actual, you know, work), she sits us down and has this, like, 30 minute intervention. Which means basically she, a second year resident, berated Sarah, my attending physician, for a full half hour in front me, an intern from another department. About how Sarah was not respecting her and undermining her ability to do her job by - more or less - helping too much.

I....just....I...for.....what the fuck, woman?

What it boils down to, frankly, is she's making all of this all about her. It isn't about her. You know what? It's not about her at all. It's about taking care of patients. Something that needs to be done as a team. And you know what else? If she was doing her fucking job, Sarah and her co-attending, the, um, department chair, wouldn't need to interfere so much.

I really wanted to smack her. What I did, after about twenty minutes, was interrupt. And she says, "you're interrupting me."

I said, "Yes." And then I pointed out that I wasn't really involved, here, so, um, could I go take care of the page-long list of jobs I had to do?

She says, "No. This involves you."

How it involved me in any manner other than making me an audience to her histrionic, self-indulgent unprofessional behavior is totally beyond me.

Part of what she brought up was how poorly it reflected on her when the resident coming on call walked into the call room and found Mike asleep. Neither Mike, nor Sara, nor I can figure out why. It had nothing to do with her. It wasn't about her. It was a benevolent thing for us to do. And at one point she brought up the duty hours issue. I was like, oh, honey, don't even start. Because let me tell you, no one knows the ACGME duty hour rules better than I do. Not after life at the Emerald Palace.

Sarah slipped me her phone number on the way out and mouthed "call me." She felt really bad about me having to be involved in all this, she says. I was like, um, it wasn't you. Betsy wouldn't have let it go down any other way. ::sigh:: I don't understand people sometimes. I've really hit my limit with Betsy's behavior. I'm really not sure how I'm going to handle three more weeks of her without any hair-pulling. And of course next week Mike and I switch places and I stop taking Saturday call at State Hospital and start taking call with the Family Medicine team every fourth night. I'm a little concerned about this, because Mike's mantra over the past few weeks has become "I hate my life."

Fortunately, I have tomorrow off. Because, you know, I get one day off a week, and I'm on call on the weekends. Thank God. I think Maggie's excited about it, too.

"For someone who hates psychology, she sure has a lot of it."

It's one of my favorite quotes from the pilot episode of Bones, which is on tonight. And it's so true. I'd forgotten what a grumpy, cocky "cop" Booth was in the pilot. I'm glad he got over it. And I really like that Booth is all angsty, thoughtful, pining for a woman he can't have, again, except he has so much more depth in his thoughtful pining angst than Angel ever did. And Boreanaz is even cuter in the daylight.

Today was long again. Not quite as stressful, partly because I'd planned on going to SNB tonight at the local Borders, and the dog sitter came during the day. Needless to say, I didn't make it to knitting. I only left two patients of mine on our service, but, we're admitting tonight. I, truly, was done with my work at 2pm. But I left after 7. Because there was rounding and then this and then that and oyyy. And then one of my patients got sicker. So I stuck around for another hour fussing so Mike wouldn't have to. And I tied up his patient into a neat little package for discharge. It was a favor but you survive this life on favors-both the ones you get, and the ones you give. And no, I don't expect him to stay nearly this late when, starting next week, I'm the call girl du jour. Although....okay, maybe I will expect him to reciprocate on the post-call coffee I'm bringing him in the morning....

Because there is simply nothing better than a hot post-call beverage of choice from outside the hospital. It's that warm, little comforting cup of hope that the free world still exists somewhere outside the sterile and stagnant confines. Okay...there is one thing better...the post-call nap. Preferably a post-call nap with a warm dog or some other snuggly warm mammal.

I'm babbling again. I have a really sick patient I spent of a lot of today fussing over. I'm still really tired. Oy....I'm going to turn off House, which is now on because Bones got all solved and done with, and go to bed. But, after this:

"Treating illness is why we became doctors. Treating people is what makes most doctors miserable." It's a quite from tonight's House which more or less illustrates why I don't usually watch House. But....I will give him a tremendous amount of credit for this one:

"It's five o'clock. I'm going home."

Taken out of context I must seem so strange

That's a line from an Ani DiFranco song, Fire Door. It's one of my favorites, and that's one of my favorite lines. I'm not quite sure what it's doing in my head right now, but, there it is.

Today was, once again, long. One of the first things I said this morning was "I absolutely have to get out of the hospital by 5:30 tonight because I have an appointment at 6." Okay? Okay. Except that I ended up calling my shrink at 5:58 saying "Okay, I'm almost to my car so I'm going to be about 10 minutes late..." Fortunately she is both understanding and very near to the hospital.

Many many things annoyed me today, but one that really impressed me was that we talked about the patient who died on Friday at our midday teaching conference. And not in the M&M, dissect out the case and point out where everyone went wrong sense, but to discuss how we all sort of felt about it and how those involved had dealt with it. It was reassuringly touchy-feely. Being a group therapy veteran myself - on both sides of the notebook - I thought this was a fantastic idea. It also helped that I did this death thing a lot in my past life, and that my training surrounding end of life issues in medical school was really good. One of the things I've always pushed for was sort of the CISD model of intervention (critical incident stress debriefing - a model used often "in the field": paramedics, fire, law enforcement, etc - to get everyone together and go though the issues involved in big traumatic events. It's been shown to be a great predictor of who doesn't end up with bad long-term sequellae after badness -PTSD, etc.). But as often as I groaned and moaned and coaxed, I never got this to really happen in the ICU, or the OB floor, etc. Mostly they were devotees of either the "no, really, I'm just going to go on, because this doesn't affect me" school (located near that river in Egypt), or the far worse "I'm not going to deal with it because if I do I'll be admitting fault, and I can't handle that" camp. This really impressed me today. I wished I'd said more, because I almost guarantee I have more experience handling death than anyone else in that room who isn't full faculty. I wished we'd gotten into it a little deeper, but then one of my patients was seizing and I ran off, and having lost the person in the crowd who was likely to keep instigating the discussion, it fizzled. They did use the segue well to go into a useful discussion on the death paperwork as it applies to our institution though, and a little discussion about guidelines for talking to families. It was nice. I need to point that out tomorrow to the powers that be. It's really a shame that the guy died. But I'm glad they handled it well on the group level. And I think both our attendings talked to Mike when it happened. So good.

I'm not sure Mike agrees with that.

We're having an interesting experience of parallels, he and I, right now. I, really like my attending, quirky and neurotic though she may be, and am about ready to strangle Betsy. Mike? Doesn't seem too bothered by Betsy but may have commitment papers filled out on the attending, because he's convinced she's nuts and she's driving him there with her. I obviously loved this little group huddle today; he (and possibly because he was sort of put at the center of it) didn't seem really very comfortable with the idea, or of divulging how he'd handled any aspect of it except the paperwork.

But then, I'm guessing he hasn't spent nearly as much time in therapy - or for that matter, at this point, doing therapy - as I have.

Whatever. Anyway.

As an aside for those of you not in the biz, M&M stands in our world for morbidity and mortality, a conference held regularly to go over cases that had poor or unexpected outcomes. The idea is that it's an open forum to address the inevitable errors that happen and sort out systems errors and improve patient care by learning from our mistakes. The proceedings are protected and even inadmissible in court, in an effort to make it as open and honest as possible. However, people are in fact human and often, particularly in the surgical specialties where the afflicting neuroses are somewhat more prominent, it often becomes a farce of finger pointing and puffed-up armchair quarterbacks with the benefit of hindsight. They an be very illuminating, or horribly painful. I have particularly traumatic memories of one from about this time of year three years ago, where we were discussing this woman who bled at her trochar site after surgery. This woman with a known clotting problem. Who had to take special drugs from hematology to clot her up. Whose bleed clearly must have been caused by the tiny baby dose of an anti-inflammatory pain killer that the intern gave her in post-op, since her hematoma cropped up seconds after she got that injection (read: it had been building for long before the shot, and was likely the reason she needed pain meds; the intern's actions - which were initially supported by the senior resident, unless you'd hear him tell the story at M&M - had nothing to do with it). Bad intern, bad! What was really demoralizing is that they kept referring to me as "the intern." Like I didn't even have a name. Everyone knew it was Ben and Wass and my case, our department wasn't that big. Plus, if you name the other people involved, and just call me "the intern", you know it conveys a message.

Unless you do it correctly. Like "Ben and Wass didn't address the problem staring them straight in the face very much at all, whereas, the intern came up with a very sensible and practical course of action to resolve this problem."

Right. That was going to happen the day we actually had flying monkeys at the Emerald Palace...