North Cack

Mom and I are back home in NC. Maggie is relieved. Dad is on his way by ambulance. He's feeling better, although not great.

I? Am tired. And have a thirteen-hour day tomorrow. Awesome.

Wrung

I am wiped. Out.

So, we're still in SC. My dad got himself admitted to the hospital this am (not near the ER that's five minutes away, but to the main hospital which is a half hour north).

He's feeling better - has stopped puking, is eating and getting some fluids IV, generally doing better - but my mom and I have had one hell of a long day.

I tried to take a nap this afternoon. I think it made things worse.

I think I need a few days off to recover from this "vacation," yo.....

We're not so good at this "vacation" thing.

So, day one of beach vacation wasn't a total failure.

We all made it up for the sunrise this morning. It was awesome. I took way too many pictures (duh).

Then the folks and I putzed a little, finally made it out the door, couldn't find the IHOP, finally found the IHOP, etc. I resisted the pull of the New York Cheesecake Pancakes. All was well, except my dad kept looking more and more pale. Which, okay, fluorescent lighting isn't flattering to anyone. But he finally says, somewhat nonchalantly, "I think my blood pressure must be low."

Which it was.

There was some calm, quiet arguing about whether or not to call EMS, but once I recruited the waitress onto my side (when she happened to walk up to the table, ask if things were okay, and agree with me), it was a done deal. So we got to meet the very nice people North Myrtle Beach Rescue Squad as well as the strapping young fellows from Horry County EMS. And as a bonus, the fine people of Seaside Medical Center (or Seafront? Seaview? No! Wait! Seacoast) were very pleasant as well, there in their giant 8-bed trauma center. Which was, also, pretty new, strangely high tech, and very charming. Or, at least quaint.

Dad got a liter of fluid, and his blood pressure came up a little. The doc suggested some med adjustments but released him into our care. He spent the afternoon being a little woozy, but, woozy in front of a picture window resplendent with panoramic ocean-front views. Dinner perked him up and he's actually looking quite chipper right now.

My mother and I are a little worn out, though.

But generally, the rest of the day was pretty uneventful. I cast on a new baby blanket (#5 of the season. Thanks to Carol for the pattern rec). Mom and I went to the BiLow. We overcooked a frozen pizza or two and I took a very long sunset walk on the beach.

I love the ocean. I think I've been ocean deficient since I got back from Hawaii. I think I must've been a mermaid in a previous life.

By the seashore

So the fam and I are in Myrtle Beach.

(Don't rob my house. The dog sitter's there. And Maggie will bite you.)

It was a long day. Picked up the folks at the airport, drove down south of the border.

But we have a great condo. And it's very pretty down here.

'Night, all.

I take a somewhat different approach.

I heart this so.

Wow, has it been a long-ass week. Maybe I should try blowing the dust out of my patient's ears...it makes about as much sense as many of the other things we do.

Did I mention it's been a long-ass week?

It just gets worse and worse.

Read this.

Huh.

In follow up to Tuesday's post, it seems that not only is there no such thing as safety online, but you're not even safe from the people who are trying to keep you safe.

Then again, I guess that's not a new truth, either. But this does rather take it to a whole new level.

You look tasty...

Scary out there

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

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

Things like this prove my point.

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

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

That, I recognize, is a tremendously idealistic view.

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


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


Yeesh.


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

Run under

So I'm back on the child unit for a month.

Kevin, who of course has the same last name as me, is my co-resident. Our attending's last name is two letters off from ours.

It's going to be a long month.

I'm exhausted.

Plus/minus

It's been a good weekend, in the balance. But there's been some darn annoying things as well.

I've been stood up no less than four times this weekend by four different friends. Two of my friends bailed, independently, for the movie last night (you know, after I'd bought the tickets, so like ten minutes prior to the start of the flick. Fortunately, the theater refunded me for the two unused tickets). Another friend was supposed to go with me to see tigers this am, another thing involving tickets, but I woke him up when I called to say I was ten minutes out, and he was...clearly not feeling so hot (ahem. I got in at 2, okay? I was moving. AND I had coffee waiting). So he bailed. I was a little annoyed when I hung up with him (not as much because of the ticket, not so much because of the last-minute-ness, but mostly because I had to drive 45 minutes out of my way to get him and didn't realize how far away CH is from Pittsboro, and I was already running a little late). I was pulling off the highway, so I gave his coffee to the guy panhandling at the exit. Who was very kind and grateful, and I think might have been a patient of mine at some point. So that made me feel better.

Today is the Chinese New Year, and it is, of course, the year of the tiger. In fact, it is also a metal year, the combination of which is associated with white tigers. And my friend happens to volunteer at the Carolina Tiger Rescue, where they just happen to have a white tiger. His name is Jellybean.

So she invited some of us to come take her tour this am and ring in the Year of the Tiger with...well...actual tigers. It was awesome. They have a bunch of different predatory cats in their sanctuary, most of whom have remarkable stories (i.e., the two that were found wandering down the street in a town in MO. Or the one chained to a lamp post. Or the one who turned up on the CTR doorstep one morning in a crate with a note, like an abandoned baby. Or the two that lived in a junkyard, and one of them is blind, which the owner didn't know. How does one miss something like? Anyhow...). Jenny's been a tour guide there for a number of years now, and the cats love her. It was a great tour; very informative, and a lot of fun. Not to mention, of course I took WAY too many pictures.

I was supposed to have lunch plans today as well, but, once again, got stood up. The friend I was supposed to have lunch with never called and didn't return my text, so, I decided to wander my way home and stopped to take some more pictures of the Haw River. Which was fortunate that I didn't just turn around and grumble my way home, because shortly after I stopped Jenny texted me and asked if I wanted to join them for lunch. Which I did, and had a wonderful time with her, her boyfriend, and a coupled set of their friends. It was also a really good time. Plus, it got me over by the Target, where I needed to go anyhow...

When I consider the things I got ditched for this weekend - the movie, the tigers, lunch - I really can only come to one conclusion, though: Wow. Four of my friends did a really good job of missing out on some seriously awesome stuff.

Like Pocahontas, but bluer

I had a lovely evening tonight. We went to an Indian restaurant in Durham to celebrate the February birthdays, which turned out to mean Tyler's (Mikaela has a bday this month, too, but she couldn't join us). The food was really good, the conversation and company were especially awesome, and we drew a good crowd. I think there were 17 of us, which was awesome.

In the course of dinner, we started talking about things and decided that we were going to the 10pm showing of Avatar in 3D. Six of us were going; two bailed at the last minute (like, after I'd already bought the tickets), so it ended up being me, Sonia, Bernie, and Liam. Which is a good bunch.

Ohh. It was awesome.

Wait, wait - who is this?

Right?? Totally looks like Sigourney Weaver (which it is. Well, sort of).

The effects were awesome. It was definitely worth seeing in 3D. But I'm kind of glad we opted for 3D and not IMAX 3D, because about halfway through I was so queasy I had to leave.

Seriously. I've never been carsick, airsick, seasick, ever, ever, ever in my entire life. I've been on some pretty rough flights and choppy seas. But, apparently, Pandora did me in.

I went back in after about 5 or so minutes, though, and watched the rest of the flick with my left eye closed. It was a great story, kinda predictable, but awesome. And the title is a criticism I've heard often, but frankly...I saw a lot of Hawaiian mythology in it, but it might be that I'm more familiar with that than the Amerind counterparts (and given that somehow the Na'vi speak English with a softly West African accent, there's probably some African allusion in there as well). It was visually stunning and outright epic; the attention to detail was incredible. But I really enjoyed the undercurrents of mysticism and various allegories that were woven subtly into the landscape of the story. I'm never sure if those are things I see or things that were actually intended, but I suppose it doesn't really matter. As someone whom I've since forgotten once said, what the reader sees in a novel is what matters, more than what the writer tells.

But, now it's 2am, and I'm getting up to go see tigers in the morning (more about that later), so maybe I'd best get to bed.....

Gratuitous cuteness

It was a long day. And a rough day. And I've spent way too much time looking at online knitting patterns (because I refuse to knit ANOTHER color-block baby blanket. Four in three months is my limit). And I found this, which is not a blanket, nor is it knit, but I think is really quite cute...

You betcha

One of my med students pulled this up at the end of team rounds yesterday. If you haven't seen it yet, I think it's one of the very funniest most fucking retarded things I've seen in a long time....

The Colbert Report	Mon - Thurs 11:30pm / 10:30c
Sarah Palin Uses a Hand-O-Prompter
www.colbertnation.com
Colbert Report Full Episodes Political Humor Economy

From the Windy City, South

(It's windy, windy, windy in NC today.)

Headache

Ow.

But in related news, it got me out of my god-awful meeting tonight. Which probably wouldn't actually have been that awful if I wasn't headachy and crabby. But still.

Margarita therapy

Today was, I think, one of the worst days on record. Oyyyyyyyy.....

But, fortunately, I had dinner with friends, and that helped a LOT. It's amazing what can be healed with chips and salsa and raucous laughter.

It reminds me how grateful I am to have the kind of people in my life that I have in such abundance.

Super Sunday

Wow! What a game!

Yeah, I gave in and watched the Super Bowl. (And flipped between that, SVU, and the Puppy Bowl. Which was equally awesome)

It still wasn't as good as this one:

Rainy Saturday

Today was not super productive...I'm cool with that.

This is our Second Look weekend. Now, see, in the cluster of ridiculousness that is the Match, you interview at a program, and you get the interview day experience, so often people go back for a second look to get a more informal view of what the program is like. We here at Baby Blue started my intern year trying to consolidate that experience, so that the kids that did come back could get the best bang for their buck. So we have this weekend when we try to get everyone to come back at the same time, and try to organize things like tours of the state hospital, a real estate tour, case conference, and lots of face time with the residents and faculty. This year, it started Thursday night with a dessert for the applicants and some members of the PGY1-3 classes (not including me, because I have class on Thursday nights now).

Yesterday was, like, holy cow. I started the day...well, I started the day by realizing it was 57 degrees in the apartment and that the heat was out. It took some fussing, but I figured out it was the circuit breaker and fixed it, but needless to say between the getting home ridiculously late Thursday and the cold apartment, I didn't sleep so well. So there was a triple-shot mocha involved in my morning as well. I co-led one of the small groups ("small" being something of a relative term here, I'm noticing. They're, like, 30 students. Mine were 10. But there were still pterodactyls around when I went to med school, so...) for the second year medical students, ran back to the unit, got to rounds late (which was planned), did a discharge, scarfed some lunch, saw my therapy kid, and then went and was part of the panel discussion for the applicants. I had another patient at 3 who took until about 4:30 (I anticipate this about her), then I tried to get as much of my shit together and paperwork done, etc, as I could tolerate before heading off to the dinner party at the chair's house.

At which point it was a monsoon. I mean, really, the standing water was amazing. And of course the chair lives out in a more rural area where "only part of our road is paved" (we estimated about 10 feet of it). So Scott rode over with me, preferring to let me and Joe the Jeep traverse the rivers of mud instead of his decidedly non-4WD car with bald tires. Shortly after we got there, Annie's husband showed up and got his car very stuck in the mud in front of the house. I offered to make an attempt, but, no, no, we've got it, burly men, blah blah blah. So, okay. I wandered off, talked to people, schmoozed a bit. And when they came back in, having failed with all of their manly brute force, I offered again. You know, before they called AAA.

I? Am from Chicago. Where we get stuck in the snow all the time. I got behind the wheel and had their car out in under two minutes.

The party itself was a very good time. I had a lot of fun, both with some of the applicants as well as with my friends. It was a nice excuse for us to hang out in a fairly informal way on the department's dime. Scott and I cut out around 10, which was of course some 16 hours or so after I'd left my house that morning.

Today was much more laid back. We had a brunch for the applicants at one of the fancy hotels near the hospital (so, you know, 30 miles from where I live) and it was really quite lovely. After that I ran a couple of errands and wandered over to Starbucks, where I met up with Matt and we were so very productive that I'm not sure he ever opened the textbook he brought with him. I did manage to get a little bit of work done after he left to go hang out with another friend of his, but decided my table by the door of the 'Bucks was too cold and I left and wandered back to my house.

After that...hmm...I know Maggie and I must've done *something*...in fact, I did accomplish a couple of things, although not as much as I would've liked and nothing work related, but got some important stuff done nonetheless.

Tomorrow is all mine. I have no particular Super Bowl plans (I'm not much of a football fan, but, I do sometimes go to these things and socialize). I'm foreseeing some grocery shopping, a little note writing at Starbucks, and some reading for my class....

...probably along with a nap and some catching up on my DVR, because next week's going to be chaos again.

Quirky

Okay...so....included in this video are (I think):




1. My old roommate
2. A handful of my childhood friends
3. Several of my old teachers.

Oy....

Brr

It's been a long ass day. But not a bad one.

Work was long. And chaotic. But I only have six more days on the crisis unit.

We went out for dinner after work - it was Mikaela's birthday today, so she and I and Scott and Wren (the small but motley crew we could cobble together at the last minute) went out, and Peng joined us later. It was lovely. There was a lot of laughing. Then I had class #2 of my mindfulness course, which was...I dunno. I'm finding it to be kind of disappointing, but I'm sure it will perk up soon. And one of my previous classmates has joined our group, which is pleasant. After class, though, in a remarkable joint display of poor judgment, I ended up standing in the parking lot talking with a classmate of mine for two hours in the 38 degree weather. At one point he looks down and says, "My toes are frozen." I said, "Yeah, we should go." So we walked ten feet down the parking lot and then talked for probably another 45 minutes.

Y'all, I'm cold.

And I need to go to bed. Because morning does come awfully early around these parts....

Hip hop hooray...ho....hey....ho......

Please turn the crazy down.

So I'm at work today, and I'm at the nurses station, amidst the cacophony of the unit, simultaneously on the phone with an outside therapist, text paging my attending, trying to keep one of my freakinawesomeintern's more irritating patients at bay, and trying to keep my black-belted freakinawesomeintern from slugging said patient...when one of freakinawesomeintern's other more annoying patients jumps up so he is leaning onto the counter, pushed up on his forearms, feet off the ground, and leaning so far forward he's about six inches from freakinawesomeintern's face. He said something to her, and I didn't hear what, but I quickly interrupted Outside Therapist with a, "hang on." And I covered the mouthpiece of the phone and I gave him what my friend Robin would describe as a "teacher look." You know - the very pointed, you know you're not supposed to be doing that, you'd better stop it now or there's going to be hell to pay, every schoolchild fears this look, that teacher look.

And I said - again, very directly - "You need to get down off that counter. Right. Now."

He backs about halfway off (this is when I knew I was going to win), and says, "Why?" I said, "Do you want to go into seclusion?" And then he was like, yeah, seclusion would be fun, blah, blah, blah.

That was a gaffe. What I should've said was something more along the lines of, "If you don't get down, we will put you in seclusion." Or, even better, said nothing. But I recovered with my best alpha dog staredown (in which you look fixedly and directly into one eye - normally we look back and forth between someone's eyes. Only looking into one produces a much more unwavering stare and thus confers much more dominance). He mouthed off to me a bit, but backed off, and walked away.

Later, I walked on to the unit, and he gives me this shadowboxing bob-and-weave kind of maneuver. I gave him the teacher look again, and pulled out my best Dog Whisperer calm assertive energy. He backed down immediately.

It never fails to amaze me how much people are like dogs.

And how unlike dogs they are. Because dogs let go of things, run back and play, tails wagging.

And that was just one of our patients.

People are crazy.

My head hurts.

Proxy

So, I read this today on Paulo Coelho's blog. And I really liked it. So I thought I'd share...

On the importance of “No”
Published on February 1, 2010

Paulo Coelho

“Hitler may have lost the war on the battlefield, but he ended up winning something,” says M. Halter. “Because in the 20th century, men created the concentration camp, resuscitated torture, and taught their fellow men that it is possible to close one’s eyes to the misfortunes of others.”

The most important words in any language are small words. “Yes,” for example. Love. God. These are words that are easy to utter, and they fill in empty spaces in our world.
However, there is one word – also a small one – that we find difficult to say:
“No”.

And we see ourselves as generous, understanding, and polite. Because “no” is considered to be cursed, egoistic, not at all spiritual.

We have to be careful here. There are moments when we say “yes” to others and in fact are saying “no” to ourselves.

All the great men and women in the world have been people who, rather than say “yes”, said a very big NO to everything that did not fit their ideal of solidarity and growth.

We may often be called intolerant, but it is important to open up and fight against everything and all circumstances if we see injustice, manipulation or cruelty. No-one can admit that, after all is said and done, Hitler set a pattern that can be repeated because people are incapable of protesting. And to reinforce this fight, let us not forget the words of John Bunyan:

“For all that I have suffered, I do not regret the problems that I have faced – because they are what brought me to where I wanted to arrive. Now that I am close to death, all that I have is this sword, and I hand it over to whoever wants to follow their pilgrimage.
“I carry with me all the marks and scars of the combats – they are the witnesses of what I have lived through, and the rewards for what I have conquered. It is these cherished marks and scars that will open for me the gates of Heaven.
“There was a time when I was always hearing stories of bravery. There was a time when I lived only because I needed to live. But now I live because I am a warrior, and because one day I want to be in the company of Him in whose name I have fought so hard.”

So scars are necessary when we fight against Absolute Evil, or when we have to say “no” to all those who, sometimes with the best of intentions, try to impede our journey towards dreams.

It's interesting, to me, as someone who has difficulties saying "no," to think about this. Particularly the idea that every time you say yes to something, you're saying no to something else, and what it means what that something else is you.

Hmm.

In other news, Mags and I are back home. She got to spend the day with May's (whom I think I called June the other day. Damn pseudonyms! June is engaged, though, BTW) wife (we're going to call her Juliet. Like July, but girlier. She needs a pseudonym, because I hope to be spending more time with them as life moves forward). Apparently they had fun. Work was fine, although not especially "fun".

Still snowed in

Well....-ish.

We stayed in the hotel one more night. It's not really snowed in, but apparently the ice is going to be brutal tonight. So, we're here again.

I'm almost finished with the knitting project I've been working on. There's nothing good on TV. I'm going to have to wear scrubs to work again tomorrow b/c I didn't bring actual work clothes.

Yeah, I'm ready to go home. But, we'll do the best we can with this giant king sized bed with the down comforter and fifty million pillows. It's rough, but we'll get through.

Chilly dog

Mags and I are hanging out at the hotel. I got up wicked early and went in to work, did speed rounds, and then checked in with my boss and left. I came back here and wrote notes...until I dozed off... So after I woke up a few minutes later, I finished them for real (and prepped all of tomorrow's), and then took a wonderful, fabulous, rockstar, 4-hour nap. It was awesome. Woke up when radiology paged me with a not-so-awesome finding on one of my patient's images, but, the nap was still fantastic.

I had some of the oddest dreams. And one where I woke up convinced I'd had this conversation with my co-worker in real life for about five minutes or so, until I figured out, no, no, that was part of that dream I had...

May and her wife, it turns out, life right across the street from here. So they invited me over for dinner. I was trending towards being seclusive and just ordering room service, but decided to make the concerted effort to go be social. They invited Maggie, too. We had a wonderful time. Good conversation, good food, lots of fun watching Ricky the cat try to decide if he wanted to be friends with Maggie (he did. He really, really did. Except then he wasn't sure...)

Typical ambivalent male.

But now we're back, and cozied in for the night. I'm hoping to get some actual sleep tonight despite the marathon nap.

Call it a working vacation....

So, here we are, in NC, with all sources indicating we are heading into the SNOWPOCALYPSE this weekend.

Today was k-r-a-z-y at work, to begin with. And then everyone's all freaking out about the snow. I'm doing coverage this weekend, which means that, barring an actual apocalypse, I have to be at the hospital tomorrow (and Sunday, when we're supposed to have considerably more snow). And did I mention that the entire state is FREAKING OUT?

So, I gave in. Mags and I are staying at a Residence Inn a few miles from the hospital (instead of, you know, 30, like my house). It's nice - it's a studio. They have this weird, small, two-burner, flat-top range that might as well be a hotplate. I tried making spaghetti on it tonight, with limited success. But, beyond that, it's actually laid out pretty well.

There's real, actual, SNOW out there tonight. Mags and I romped in it for a little while. It was falling really, really fast for a time, but now has slowed down. We have a couple of inches! Raleigh is supposed to get over a foot this weekend! We'll see.

Faye is on with me this weekend. She's two floors up.

I somehow feel like this might be the start of one of those really momentous residency stories....

A little less....something

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

The class? Is and will be awesome.

And includes a 15 minute mindfulness practice at each class.

That? Tonight? For me? SUCKED.

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

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

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

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

Which will, undoubtedly, suck.

Cherub

Best intentions

So, the following is something I received in an email today. It's a forwarded email from a physician who went down to Haiti to provide care. I know I thought of going. Yes, I'm a shrink, but I am an MD, which means I can provide basic medical care. I used to be a surgeon, so while I couldn't necessarily operate on my own, I'm an excellent first assist. I pick things up quickly, so can provide a versatile range of services. Not the least of which is, you know, I'm a shrink. Ultimately, though, I concluded I had neither the flexibility of schedule nor the funds to do so.

What I wasn't expecting to hear from those on the front line was how unbelievably primitive the medical conditions were before the quake. I....find this unfathomable, that we, the major powers of the world, allow this to happen in less developed nations. This email, I think, does an excellent job of pointing out why the "a little here, a little there" approach to aid to Haiti pre-earthquake just doesn't cut it in any sort of humanitarian sense. What little I personally can do about this, I think, is give them a venue to disseminate this message.
************************
I believe we went in with a reasonably comprehensive service we wanted to provide acute trauma care in an orthopedic disaster.  Our plan was to be at a hospital where we could utilize our abilities as trauma surgeons treat the acute injuries involved in an orthopaedic disaster.  We expected many amputations however came with a philosophy that would reasonably start limb salvage in what we thought was a salvageable limb.

We put a team together which  included:
2 orthopaedic trauma surgeons
3 orthopaedic trauma fellows
2 highly skilled anesthiologists
1 general surgery trauma surgeon
2 synthes reps who were also scrub techs
1 trauma nurse practitioner to do triage
2 OR nurses

Our equipment including a huge amount of anesth medications and equipment, ability to construct 150 ex fix both small and large, OR equipment including scalpels etc, OR soft goods, splint material, OR prep material. We also had a plan of physician and equipment replacement that was dynamic where w/i 24hrs we could bring in what was necessary on the Synthes private jet.

We thought the plan was a good one.

We were incredibly naïve.

Disaster management on the ground was nonexistent.  The difficulties in getting in despite the intelligence we had from people on the ground and david helfet's high political connections with Partner's in Health as well as the Clintons only portended the difficulties we would have once we arrived.

We started out friday morning, got a slot to get in friday that was eventually canceled when we were on the runway to be rescheduled the next day.  We diverted to the DR and planned on arriving in POP saturday. Once on the ground we had intelligence that the hospital was up and running with 2 OR's General Hospital was included severely in the earthquake and not capable of running functioning OR's as there was no running water and only a limited electrical supply on generator.

We quickly took our second option

Community Hospital of Haiti.  We found approx 750 pt in the hospital upon our initial eval, the hospital had running water, electricity and 2 functional OR's. Our naivette did not expect that the 2 anesth machines would not work, there would be 1 cautery for the hospital, autoclave that fit instruments the size of a cigar box, no sterile saline, no functioning fluoro and no local staff only a ragtag group of voluntary health providers who like us had made it there on there own.

To summarize, we had no clue the medical infrastructure of the country was so poor.

As we got up and running in the OR and organized the patients for surgery we communicated our new needs back to Synthes and more supplies were loaded for a second trip - these included battery operated pulse lavage, a huge supply of saline, soft goods in the OR.  This plane landed as planned sunday pm, equipment was loaded on a truck and subsequent hijacked between the airport and the hospital. At the hospital we had zero security despite promises form NYPD and NYFD to provide that to us.

Our philosophy was to work like this was a marathon: run the OR's around the clock with the idea that we would have a defined extraction time of 11pm tues.  The plane that extracted us would come in with a new medical staff compliment to replace us. Equipment included urgent things to maximize issues that were nonexistent in the hospital that would enable us to provide better and more efficient care:
2 portable anesth machines
2electrocautery
2 portable monitors for the pacu
2autoclaves
Replacement exfix
Things that didn't arive with the previous flight

That plane's slot was cancelled by the military at 6am tues.

We also previously had seen daylight in the remaining patients monday night having completed approx 100 surgeries.  However on tues morning we found a huge # of new patients.  The hospital was forced to undergo lockdown closing its gates to the outside and outside crowd becoming angry. We also noted tues morning that many of the patients we were operating on were becoming septic.
We finished operating at noon tues, the last surgery our group assisting an obstetrician on a caesarian and resuscitating a baby that was not breathing.

We decided as a group the situation for us at the hospital was untenable supplies were running out, team was exhauted, safety a huge concern, and no extraction plan with resupply.  We decided to make our way to airport thru the help of a hospital benefactor.  Jamaican soldiers with M-16 were necessary to escort us out with our luggage as the crowd outside saw us abandoning the hospital. We made it to airport on back of a pickup track, got onto the tarmac, hailed a commercial plane that carried cargo to montreal and had private jet pick us up there.

The issues we were unprepared for and witnessed were
1.  The amount of human devastation
2.  The complete lack of a medical infrastructure in the country
3.  The lack of support of the haitian medical community
4.  The complete lack of any organization on the ground.  No one was in charge, we had the first functional up and running hospital in the POP area yet no one and I mean NO ONE came to the hospital to assess what we were doing, what we were capable of doing and what we would need, to be more efficient.  The fact that the military could not or would not protect the resupply equipment on sunday or let the tues flight come in says it all.
5.  Lack of any security at all at the hospital

I would take away that disasters like this need organization on a much higher level than we had with the clear involvement and approval of the military from the beginning. Currently there is no one obviously running the show and care is in chaotic at best.  MD's are coming in country with no plan of what the are going to do.  Surgeons that expect to just show up and operate are delusional as to what their role would be as without a complement of support staff and supplies they would be of limited or no value.

For all that are thinking of going, I hope this helps.  We all felt as though we abandoned these patients and that country and feel terrible.  Our role now being back in NY is to expose the inadequacies of the system to the media in the hopes of effecting a change in this system immediatly.  We feel that the only way to really help now is an urgent programtic change and organization in the support of the medical staff on the ground and what is critically needed to expeditiosly bring in.

Cherrios on the tarmac are not getting it done on these patients which clearly would be savable if good care could urgently be provided.

Please share this email with everyone and anyone you find might help.

We interrupt this blog....

 Blogger's having some technical difficulties tonight...so...I love you people, but I'm not going to re-write that whole post I just penned. It wasn't very interesting, I promise...

And now for something completely different.

It seems like maybe we needed something a little lighter on here today. So I give you this - a lesson of which I've been trying to convince my patients for two and a half years now...

Sorrow

So, tonight, it's 10:15, and I'm sitting on my bed, being anxious, knitting, reading, and watching TV (yes, all at the same time). And I decided to go move things around in the still-isn't-unpacked office/spare room/whatever it is, with the idea of channeling some of that anxious energy so that maybe I could get to bed at a halfway decent hour (or, as it stands, not). And I came across a box. It was small, and unassuming, and taped up with that blue painter's tape. In it is the tiny little foot-high Christmas tree that my friend's mom sent to me when I was in college.

And then, I wept.

She died this past Wednesday. Patti was my friend Brett's mom, and of course my friend Robin's mother-in-law (as, Robin is married to Brett). I'd known her since I was 15, maybe 14. And over the past, gosh, I think 8 or 10 years, she battled with thyroid cancer, lymphoma, and melanoma. It was weird. It was horrible. And she was so incredibly strong through the whole thing.

When I was home last month, I really, really had wanted to go see her. But, it was looking like the end was upon us, and I didn't want to take away from their family time. I didn't want to intrude, you know? In retrospect, I so regret not asking for a ten-minute drop in. I thought about writing her a letter. But, in the end...I guess the week got away from me, and then I was back at work, being scattered and being wrapped up in my own life...until my cell phone rang at 9:30 Wednesday night. And when I saw Robin's number, at that time of night, I knew it could only mean one thing.

It's my personal belief that, in death, in what lies beyond this life, she knows what she meant to me. So tonight I decided that maybe it's still worthwhile to write that letter. Here it is.

Dear Patti,

I can't even begin to tell you how glad I am that I was able to have you in my life.

It's funny now to think about the first few times I visited the old house in Brookfield. I remember how festive the house always looked. I remember Brett's battleship grey room in such stark contrast to the rest of the house, the one splash of color in it being the stuffed Grumpy Bear on his dresser (a gift from Robin, before they were even officially dating, I think, because she thought it looked like him. She...well...she wasn't wrong). I think time I was over at the house was, of all things, for Reformation Day - we watched a black and white movie about Martin Luther. I still don't remember why I was invited to that, but I still remember the movie. And I remember sitting in the living room, with you, and Mr. P, and Brett, Robin, Amandah, and Kyle, and thinking...this is really nice. I'm Orthodox, of course, so I had no idea why this was a holiday, but I was just so grateful for the inclusion and the hospitality.

I have such great memories of the lake house. I remember the red white and blue room, covert discussions of unexpected visitors, and lying in bed in the loft at night and listening to Mr. P and Bianca snore in (dis)harmony. I have vivid memories of the thick green algae in the water and of jumping off the pier, of girl talk in the front of the pontoon boat while Brett and Mr. P manned the helm, of watching everyone tubing off the back of it, laughing hysterically even though we were chugging along in a pontoon boat while those show-offs zipped past us pulling waterskiers behind their speedboats. My very favorite were the nighttime cruises on the lake, looking at the fancy houses all aglow, the fireflies that twinkled on the banks like a million stars, and the whole universe that seemed to open up in the expanse of the night sky. I remember being in the kitchen, baking muffins for breakfast, and talking about the first cancer, the thyroid tumor, and being so impressed with your strength and optimism, although this would hardly be the first or last time that would happen.

I loved the day that I showed up at the school where you taught as part of an outreach program we did in medical school, and you hugged me in front of all your kids and told them what a special friend I was of yours. I know how much you loved to teach, and I credit you (at least in part) with inspiring your daughter in law (before she was). I've seen her in action and I can only hope my kids have such great educators. I know you taught long after you could've stopped, after the illness had started to become a significant burden on you...and I kind of understood it. Now, being older, being in a place where my work means a lot to me and the people whose lives I touch mean even more, I get it. I get the not wanting to give in, to let it win; not wanting to let it steal something that meant so much to you (and to the students you taught).

Some of my very favorite memories of my adolescence were from Senior Year. Robin and I made a decision that year to go to all of the away football games. We would stop for hot chocolate on the way, we would bundle up, and by the end of the first half I was usually sitting on Robin's feet to keep her toes warm. After the first couple of games, we started sitting with you and Amandah-with-an-h ("Hamanda?" I asked Robin), watching #64 on the field with his neatly tucked-in orange towel. I was a little nervous at first, but by the end of the season I found myself being really sorry it was ending. I had no idea back then just how much Robin and Brett - or you - would come to mean to me.

You were always festive, creative, crafty, but mostly I remember you as maternal. In kind of a different way than my own mother, neither better nor worse, a difference I could never quite verbalize. In the end, I carry some of that ineffable difference with me (You? Would have totally LOVED the Christmas wreath I made for our office door this year). And I have to tell you this - when, Freshman Year, you sent me that little Christmas tree, I cried. I felt so loved, and was so grateful that you would think of me. You might not have known it, but it was a time at which I really, really needed that.

I remember one night, when I was back in Illinois after my first attempt at residency, your family was in town, and you invited me over for dinner. They were hilarious, and they were good people. I had a really long conversation with your brother that evening, which you later joined, and I still hold that as being one of the formative experiences of my decision to go into Psychiatry. I remember, that evening, at a time when I was feeling pretty worn down and worthless, you telling me I would be back on my feet in no time and how proud you had always been of me. I can't quite remember why I'd been at your house the day before and managed to garner that invitation, but I remember feeling over those two days like I really got to know a part of you that I (albeit appropriately) never got to see as a kid - who you were as an adult, as a woman. (I'd always suspected that sassy sense of humor...)

Ultimately, I see you so strongly in Brett, in Robin, and in Baby Luke, who are so dear to me. Your children, your daughter-in-law, and your grandson are a powerful legacy - through them your light will continue to shine, your grace, kindness, compassion and generosity will continue to bloom. And I see your influence in myself, in Bianca, in Katie, in Alison, an influence that goes far beyond festive holiday plates and Katie's delight at being successfully crafty.

I wish, and I will never be able to express how much, that you hadn't left us so soon. This is one of those times that I find myself angry at the unfairness of having such a good person taken from us, at the suffering and trials that you had to endure to leave us prematurely. My relationship to God is such that I don't question His judgment or direct my anger at Him. Instead, I find myself holding it out to Him; I entrust to Him my sorrow, and pray that in time, He will lift it from all of us left behind.

We'll miss you, but I trust in the belief that you are in a place of lightness and relief. I hope that what comes next is extravagant in the joy and peace you find there. Keep an eye out for my Yiayia and my Aunt Eugenia - I think they're people you'd enjoy (and give my old dog Wolf a scratch behind the ears). Meanwhile, we'll do our best to honor your memory in the kindness, humor, and comfort we offer to others.

I love you, Patti Pumpkin.

The best medicine

Laugh. Go on, it's okay.

Lindsay Lohan's eHarmony Profile from Lindsay Lohan

You know...I actually give her a lot of credit for this. You have to know when to laugh at yourself.

Stopgap.

So, yesterday, I lost someone very special to me. And I sat down to write about what I was feeling, and discovered - I have simultaneously nothing, and too much, to say. What I did write was primarily a jumble of thoughts, memories, and sorrow.

So I'm going to wait, until this weekend, until I can say what it is that I really want to.

I'm really, really, really sad.

Wonder how you'd spin this?

Oh, my, my, my....

Today crashed in with a vengeance.

So I'm on the Crisis unit, which is the shortened form of Adult Crisis and Stabilization, its full name. It's known for being a land of borderlines and substance abusers, at least at Baby Blue (because remember, we have seven subspecialized units. So things get sort of boiled down to their essence). It's also known for it's high drama and high turnover.

We had both today.

Now, as the third year resident, because I still have clinic responsibilities (we're supposed to be 75/25% inpatient/clinic, but it really ends up being more like 50/50), I only carry 6 patients, whereas the intern, who has no clinic, carries 9. So I was like, oh, okay, I can handle this. I had 6 on my Gero service. No big deal.

Except there's a LOT more drama, of course. And a lot more gaminess. And, oh, did I mention, I discharged 4 of those people today. Which ends up being a freakin' lot of paperwork, if nothing else.

Whew.

Well, one day down.

At least (okay, it's rather a lot), my intern is the bomb-diggety. She's hard working and efficient, and also funny and smart and good to work with. That is always a huge, huge factor.

But at the very least, I don't have the pox this go round...

Better laid plans...

....still didn't happen.

So, I've been thinking a lot about the life of Dr. King, lately. As I've said every MLK day for a few years now, I respect the work that he did. I admire that he died for the cause. And I think he changed the world, for which I'm grateful.

And I've been pondering over the past couple of days, what to say in today's post. And, once again, I had big plans for today. Mags and I slept in, then got up and got breakfast and went to PetSmart. After that I Furminated her, and by the time Mags decided she'd had enough I had over half a plastic grocery bag full of undercoat (which I saved, and will continue to add to it, and intend to someday spin). I was contemplating meals and groceries (I am determined to get back on my meal plan...you know, eventually...), did a bit of other stuff, showered, and then Faye was like, "Hey, want to get lunch?" So we did, and it was lovely, and then I stopped by my friends' house on the way home. Just to drop in. For, you know, not more than a half an hour. No, seriously, I was going to leave by 3:30 - 4 at the very latest - because I wanted to hit the grocery store and then come home and finish the laundry and clean the kitchen and get the Christmas tree put up and make dinner and...

So, I left around nine.

We had a lovely time. It was a good end to the weekend. We talked and laughed and told stories, messed with the Wii, ate dip. I knit, and actually got quite a lot done on my current project. And I finally was like, no really, I have to get home (because as I type this, it's 11pm, and I start on the Crisis unit in the morning). And so I got home, and made some dinner, and was fussing with the laundry, and I thought, you know, well, this was probably a much better course of action for the day. My house may still be a disaster, but my soul feels better. And that's really the point, right?

And then I was thinking about the blog, and what I was going to write before I went to bed, and then, it suddenly dawned on me that the friends with whom I was hanging out were black.

And I thought....you know...I'm not sure I could think of a better way to honor Dr. King's vision than to spend 6 hours on an impromptu social call, having discussions of various family members' skin tones and assorted cultural mores of both "my people" (the Greeks) and "their people," and generally enjoying the company of good friends, without it ever really occurring to me to question that they were any more different from me than anybody else who was raised in a different cultural subset of Americans.

Thank God Almighty...is this "free at last?"

Best laid plans

Ohhh, I had such big plans for this weekend.

I...um...haven't really accomplished much.

Okay, so maybe that's not entirely true.

Yesterday I spent with my aunt, uncle, and cousin - we hit like seven different places in CH, including the yarn shop. My cousin is a new-ish knitter, and just this week made the breakthrough to non-square knitting. She made a kickass hat, and, much like what happened after my first hat, I think she might never knit on straights again. We had a lot of fun yesterday, but something I ate didn't quite agree with me. Mike had a party last night, which, his parties are always a good time, but in the end I stayed home and was queasy.

I feel a little better today, but still not awesome. But I had all these great ideas about cleaning my house this weekend - one room per day, really really get it straightened and cleaned and upacked...

...um...yeah...notsomuch.

Mags and I went to Starbucks this am; we got the Sunday paper, and came home and cut coupons. I messed around online. We found the dog park in the town where we live, finally, but then discovered you have to pay a membership fee and need a keycard to get in. I did some knitting. I cleaned the kitchen a bit and I did the dishes. I finally lined the shelves and started putting stuff back in the cabinets (I'd cleared them out a month or so ago so they could do a "deep spray" for the roaches. They've sprayed in there a couple of times now, but thusfar the things that seem to have actually helped the most are the cold weather and the baits that I bought). Mags and I ordered pizza for dinner. I knitted a little bit more. There was a nap in there somewhere, too...

So, a slow day, but maybe a needed one.

I have to wonder....

...think this'd work?

"True" story

See? I'm not the only one who thinks Pat Robertson is the devil.



I couldn't have said it better myself, Mr. Olbermann.

Love-ly Thursday

So, today....I had zero patients scheduled, and zero actual inpatient responsibilities (I'm on Neurology this week, so technically I should be shadowing in clinics, but...). Fortunately, in a rare moment of foresight, I noticed this last week, and continued to not schedule patients for today.

I'm trying very hard these days to take advantage of opportunities when they come along.

So I worked remotely today. I did actual work, and frankly got done in three hours more than I probably would've accomplished at the big house all day. And then, you know, I went to the gym, I gave my cousin a knitting lesson (her very first hat - and very first excursion away from scarf knitting - turned out SUPER cute). I went and did the recruitment dinner with Peng and Rene. I hung out with my dog and watched an hour of SVU. All in all, a sunny, balmy, lovely, productive, enjoyable day.

Except I think I ate too much at dinner, and now my tummy hurts. Which adds to the headache that I think I got from the wine.

I'll get over it.

A Yukon metaphor

Continuing the profane streak of the past few days...

(....and then we're back to our baseline level of profanity, I promise...)

This is my sentiment for the day:

No, no, I don't have cancer (that I'm aware of). And I did not make this hat. But I'm rather thinking of making one for someone who does, except I really can't decide if she'd actually wear it...

Monday mirth

So Lila walks into my office today (first time I've seen her in like, two months!! They've been keeping her hidden out at the community clinic. Bastards). And we start talking about...well, important things and unimportant things, cerebral stuff and general trash...because, frankly, that's what goes on in my world. And she shows me these two videos. Which I think are hih-freakin'-LARIOUS. But, do contain some minor strong language. So, make sure you know who's listening if you've got your speakers up.

First, this one, which is a little commentary on the (very disappointing, I think) Snuggie. And gives it a more accurate name:


And, secondly, I think I just had a status update the other day about this....

Calm

There's a storm brewing this week. It's a metaphoric one, but nonetheless. This week is going to be particularly psychologically challenging for me. Well, it could be.

Not to be cryptic or anything. Mostly what I'm saying here is, I'm a little stressed. I don't do anticipation particularly well, but I'm always well-prepared. Details will follow when I feel it's okay to tell them.

(I'm fine, btw. So are my parents. So don't waste time worrying.)

But here's what it makes me think of.

There was this guy, a few years ago, with whom I was involved. It was probably the single most vulnerable point in my adult life, and in as many ways as he was toxic, he was also one of the most helpful and supportive people in my life for a time. Peter (I'm sure I've mentioned him on here before) had a lot (LOT) of his own issues, and I still occasionally hope to hear from him some day down the road when he's had a lot of therapy or is on his Eighth Step or something. But nonetheless, Peter and I had this really interesting way of interacting, wherein, when he was most revealing of himself, he always spoke in these big metaphors. I really don't think he actually knew he was doing it, but it was still somehow always my job to listen to the story about remodeling his home or rounds at the hospital and at the end, say, "So what you're really trying to say is..." He spoke of his home as a metaphor for himself, frequently, often talked about our ways of relating in stories about how he related to his patients. He'd tell me a story about a woman in his office enduring a procedure without anesthetic, how he felt really worried about how much pain his ministrations were causing, but she told him to keep going. I said, "So, what I think you're really saying is, you're afraid that you're hurting me by trying to help, and worried I won't tell you when the pain is too much."

His answer was always the same: "What? No. I mean, I'm saying, I mean, no, I mean....yeah, okay."

At his core he was a good man (possibly several); I still believe this. But there was just so much that got in the way. Not to mention, I was not at my most stable right at that juncture, and my shrink at the time was encouraging me to be a lot more engaged with Peter than I ever should, for reasons that were probably not all that altruistic on the shrink's part. Ah, it was a mess.

So, at one point, he and I are fighting (because we did that about 60% of the time), and there had been a blowup, and we weren't speaking (because he knew that I HATED it when he stopped talking to me). And I was in northern Florida for some other reason, and he was refusing to acknowledge me being in the same state.

And then, there was this little storm that blew through.

I remember being caught in the outer bands of Katrina; I have never seen it rain that hard in my life. I was soaked straight through to the bone from running from my car to my hotel. They had to give me towels in the lobby because I was just so drenched I was leaving puddles on the floor. I knew the eye was passing over southern Florida, where he was, but well, it was only a Category 1 storm at the time. And I'd gotten quite an education from him already about Cane-Proof windows and storm readiness and blah, blah, blah.

But I got up the next morning, and opened my browser, and the first thing that popped on to my screen was "KATRINA BALLOONS INTO CATEGORY 5 HURRICANE." I looked out my window at the glorious sunny day that had appeared, and tried to figure out what to do with the ball of lead in my stomach. And after much internet reading, caffeine, and contemplation, the answer seemed irrefutable to me: I was headed south.

An hour or so down I-95 (far enough that I wasn't likely to change my mind but not so far that it would cost me much time if he was like, fuck you, stay the hell away from me), I decided I should probably warn him that I was in town (my friends in north Florida had all been like, just show up in the south. Call and be like, hey, I'm at the Starbucks down the block, come meet me for coffee). But that felt a little too stalker-ish to me, and I wanted to give him the chance to tell me not to come. So I called.

He answered, of course, because no matter how mad he was at me, he never seemed to figure out how to screen my calls. I could hear people talking in the background, recognized a couple of the voices as those of his family members. And I was like, hey, I'm heading your way. He balked a little - never told me not to come, said he wasn't sure he'd have time to see me, wasn't sure what kind of disaster their clinic schedule was going to be the next day, wasn't sure of much of anything. How long was I going to be down there? Because maybe he could see me the day after. I was like, look, I'm coming down because I'm so much closer than I usually am, and because there was just this big natural disaster, and that tells me it's time for you and me to work this the hell out. Once and for all (although it wasn't).

And somewhere in all the discussion of semantics and scheduling, I finally realized the one thing I hadn't asked that I really needed to: "You guys are okay, right?"

He says, "What? Oh, yeah, fine, of course."

I guess I'd known from the tone of his voice, the stories (metaphors) he'd told me about the day's activities, the laughter in the background. But I still needed to hear it stated.

As it turned out, I drove down, we had a very long phone conversation while I was stuck in traffic on 95 and he was sitting in the hospital parking lot. We never did get into the same space, but we parted on much more amicable terms (that time). I was able to drive for a while around sunny south Florida, in a town I absolutely adore (with or without him in it), and see for myself that Katrina, there, had been little more than a thunderstorm in their view - a far, far cry from the devastation it was unleashing on the Gulf coast.

Somehow, Katrina, from my vantage point, seemed as equally metaphoric as any story that had passed between us, any words spoken or unspoken, in so many ways. It was, indeed, a harbinger of things to come with us; it was also a perspective on how each person individually perceives and experiences a storm, how that storm may vary in lethality and intensity from moment to moment, and how none of these things have any bearing on what has been forecast.

It's better that we've parted ways. But I still worry about him. I have moments where I still miss him (or, at least, parts of who he was). I know how different I am from then; I wonder what he'd think about that, what he'd say, how he's changed. And I can't get through one of our southern squalls without thinking of him, of Katrina and what she meant, and smiling a little at those few fond memories I still hold.

Day of Lazy Rest

In truth, I wasn't actually lazy today.

Mags and I had a low-key day today. We slept in, we got a slow start on the morning, which was nice. I read some. I ordered the books for my upcoming course on Mindfulness and Psychoanalysis. I did a lot of price-comparison, which left me about $30 ahead. And, ps, I love E-bates.

Last night was quite lovely. A bunch of folks from our group have birthdays in January, so we went to this new Thai-Japanese place in Durham. The food was actually pretty awesome. As it turns out, I still don't like tofu (I keep trying), but if I could've gotten the spicy basil with chicken instead (next time I'll ask for that) it would've been awesome. Sonia came prepared with a cake for the birthday kids, and the restaurant gave us a random scoop of ice cream (that was...well...random) and a piece of coconut cake (that was pretty awesome). We talked a lot about work (which is what happens when you get a bunch of shrinks together). We laughed a lot and generally had a good time. I was really tired yesterday, and almost didn't go, but I'm really glad I did.

Still, it was nice to chill out with the pup today. It's been a stressful week, and tomorrow, I think, is going to be kind of busy. So we cuddled and watched a lot of SVU today. It was nice to have a moment to breathe..

Turred

(Apparently that's how you say "tired" in Southern)

Y'all, it's been a hellish week. I'll have more to say about it tomorrow. But tonight I went out with a bunch of folks from work. There are a bunch of January birthdays in the second year class, and so we went to this Thai/Japanese spot to celebrate. It was lovely.

And I'm so unbelieveably ready for bed....

Tigers and Cougars and Crazies - oh my!!

There's a newbie in the Blogosphere.

One of my good friends from Baby Blue has started a blog. Well, actually, two. Jenny, who on occasion is known on this blog as Tiger, or previously, Edie (I think) speaks of the tales and tails that allow us a glimpse into the crazy and wonderful that is her life at A Life I Never Expected. Additionally, she opens to us her spiritual journeys, and those of her coven, at Which Way Apothecary.

Welcome, Jenny.

Incidentally, it's also Jenny's birthday. She says she's slipping over the hill. I say she's my favorite Cougar. Either way, I hope this is a wonderful year.

It's actually quite a time of year for birthdays. Brad's was yesterday as well - happy birthday, Brad! Rene's was this past weekend - happy birthday, Rene! And there are enough impending that there's a group birthday outing tomorrow night for all the January birthdays. Should be a good time!

How do you say "mocha" in Arabic, I wonder?

(No, I didn't take this. The photo is courtesy of Starbucks, via Twitter)

Sex on CNN

So, I'm trolling for something interesting to post tonight (with my exhausted mush-for-brains dribbling out my ear), and two linked articles on CNN.com caught my eye.

Let me preface this by saying, I debated for several minutes whether or not it was appropriate to post this. Because, you know, "old" people read my blog. And then I came to the conclusion that, look, if it's safe for work, it's safe for people over the age of 60.

Isn't it funny how we spend so much time as parents (or parental-y figures) trying to protect our kids from smut, and then eventually, as kids we spend so much time trying - in a very similar fashion, honestly - to protect our parents from smut.

I'm also reminded of this story from when I was home in July. Really, people. I was 30 years old. And, um, I can spell.

Anyhow. So the article that originally caught my eye was this one. Which did so because, back during my year working in yarn sales and sex therapy, the existence of the G-spot was a HUGELY contested issue in the Sex Clinic. Like, I'm not sure I can think of an issue we collectively argued about more. I'm in the "of course it exists" camp, my supervisor was in the "of course it doesn't exist" camp. I think this study CNN references is poorly constructed and the results are useless. But it continues to amaze me that we as clinicians and as women argue so hotly the very existence of this. Like unicorns. Or Dissociative Identity Disorder.

Sheesh.

But then, that article was linked to this one. Which just upset me. Because I'm perpetually amazed at how often my adolescent patients, or their friends, or whomever, have "pregnancy scares" these days. Or get knocked up. I brought this up to one of my patients one day, after reading that they were teaching abstinence-only sex ed in our public schools, and she was like, "No, not really. Mostly what we talk about in Health class is what to do with your baby while you're in school." Which kind of made me want to bang my head on my desk for a while.

Not to mention, uh, pregnancy cures itself. AIDS is forever.

It's just sex, people. Humankind will not shatter if we discuss anatomy and sexual health. Your children will not burst into flames if you teach them how to use a condom.

(But I was brought by a stork. And I refuse to believe otherwise, so don't even argue.)

Oof-ta.

Oyyyy, what a Monday.

I'm on the gero unit - AGAIN - covering ECT for Fang today, tomorrow, and Wednesday. I can't seem to leave the gero unit. And painfully (for them; this was much easier for me) I had the same three patients I had the last time I was on ECT. Sent one of 'em home. Oy.

Had to call social services today. Spent an hour on the phone with them. Meanwhile, my schizophrenic patient showed up on the wrong day for his shot. And I had to reschedule my entire afternoon clinic because they scheduled me for my physical therapy intake tomorrow, and I had a clinic full of patients, but the soonest I could reschedule was the FOURTEENTH. So, okay, fine, I'll move people around... And then I had to run to the off-site gero clinic this afternoon. It was a full and emotionally taxing day.

I...I have this whole post in my head about the real meaning of independence, as I spent the whole day working with people whose independence we're trying to take...for their own safety, obviously, but it still feels horrible. But, it's already 10:15, so that's going to have to stew until another day.

Fortunately, I had dinner with my aunt and uncle tonight (my Southern family, after a week with my Northern family, as it were). And that was a lot of fun. And some seriousness. But definitely pleasant, and very tasty. It was a nice way to wrap up the day.

Oops, there goes gravity

So, it's back to reality in NC tomorrow.

(My apologies both for the ridiculous title of this post as well as the Eminem reference from whence it came.)

I had a pretty un-busy Sunday, which was completely delightful. Mags and I slept in a LOT (I woke up at 9:30, dozed and refused to get out of bed for another hour). We went to Starbucks and then stopped at the Teeter to get a Sunday paper, with the goal of attacking the coupon circulars. Now, hear me when I say that cutting coupons is NOT my idea of a good time, frankly, but one of my goals for this year is to be more fiscally responsible (because, in trying to work out out a budget over break, I somehow can't afford my life, which is honestly not all that fancy. Electricity, heat, basic cable, no landline... I make way too much to be this poor). And then I looked at the ads, and the online specials, and plotted, and planned (and played on the internet), and then somehow it was 3pm. So I headed out. I went to the gym. I went to Staples. I went to Trader Joe's. I went to Walgreens. I saved a very not-insignificant amount of money, but most of that was at Staples, which I'll explain in a minute. But, between the ads and the coupons, and not including Staples (or the $.50 notebook I got there on clearance), I estimate I saved about $12. Not bad.

So, running a bit counter (although not entirely) to the fiscal initiative...I haven't been able to find the power cord to my old (in the tech world) and often cranky printer. I've looked in every box, crevice, and usual hiding spot I could possibly think of. And it's becoming more and more irritating to only be able to print things at work. So I got stuck in the middle of something today and was finally like, screw it. I'm going to look around, and if I can find a justifiable deal, I'll suck it up and buy a new printer. So I research it, and this week, at Staples, I find a very nice Canon 3-in-1, reasonably priced to begin with, that has a $50 instant rebate. And duplex printing, and wireless capability (thank heavens, because I already have enough things tethered to my laptop), and it prints photos straight from the card - or the internet - and, you know, some other fancy-dancy things. All for the same price that I paid for my old 3-in-1 a hundred years ago (well...2002 or 2003, probably). Cool.

So I rationalize the hell out of this purchase. I go, I buy it, I come home to set it up. And....okay. I open the box, I fuss with all the cords and cartridges, etc. I go to clear off a part of the table in my bedroom which is currently acting as a temporary home for a bunch of different things, not the least of which is the old printer. And....I'm moving some things....and what do I find?

The power cord for the other printer.

Of course.

In a spot where - I'm so not kidding - I've looked AT LEAST 30 separate times.

::sigh::

But, it does print a lot better. And the duplex printing thing seems valuable. Tree-saving and whatnot. So, okay....

Friday Fragments, inspired by gravity

So I'm sitting in the airport in Chicago. My flight, previously scheduled to leave at 7:40, is now scheduled to leave at 8.

Yeah, I got here three hours early.

Part of that was kind of unintentional. I had an awesome, awesome lunch with my folks and my cousins (who just got back from Mexico last night, and were very tan and still on South of the Border time). We met at 2, ate freakin' awesome stuffed pizza, and chatted and visited, and then, you know, it was a little earlier than I'd planned on getting here (I usually aim for 90 to 120 minutes before departure time. After the Christmas day loveliness, I thought I'd shoot for 2-2.5h), but, fine, whatever. So I got here around 4:40. I cleared security at 4:56. Aaaaand....so.....now.....here I am.

I bought a couple of books. I browsed in a bunch of kiosk stores. Starbucks got my drink wrong. I finally succumbed and let myself be robbed at gunpoint bought in to the ridiculous expensive airport wireless. So, while I'm at it, let's do a little Friday Fragments. Quickly, before my battery dies.
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I'm sitting on the floor against the window. It's 14 degrees outside. I finally put my coat on just now. But during this visit, I also acquired a lap blanket that my grandmother knitted. When I checked in my bag, it was 1 pound overweight, so I took the blanket out and put it in my backpack. I'm thinking about whipping that thing out...
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I've been watching a lot of men and women (mostly men) in fatigues in the airport today. And to them I'd like to say two things. 1. Thanks for serving. We feel safer with you around. And 2, couldn't you have worn your dress uniforms today? I know they're uncomfortable, but they're just so scenic...
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This guy sitting next to me at the gate doesn't know it, but I've been watching the movie on his laptop for the past 30 minutes. I'm thinking of asking him for an earbud.
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I struggle with the question every time I come home of whether to move back here or to stay in NC when I'm done with residency. I don't have to make this decision for at LEAST two years. I think, more than anything, it represents me being homesick.
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I really like the internet. It amazes me that I've been able to meet people all over the world, can share pictures and words, thoughts and experiences, philosophies, observations, and amusement. I can feel close to people who are nowhere near me, to some whom I've never met in person. The world is getting smaller by the second.
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My good friends introduced me to Skype this week. I've always been sort of like, yeah, yeah, Skype, I have a phone, whatever, but they regularly eat dinner with their parents/in-laws over Skype. I think this is very cool.
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Have I mentioned the adorableness of my friends' kids? I'd tell you more, but I'd hate to have to shout over that loud, infernal ticking...
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The title of today's post is a reference to an Indigo Girls song, "Airplane." Which is one of my all-time favorites and is quite likely my favorite travel song. You know, when I'm flying.
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In other lyrics-related news, Barb mentioned on FB the other day that her daughter was cracking up at her misinterpretation of the lyrics to Jay-Zs "Empire State of Mind." Google says the chorus starts with "Concrete jungles that dreams are made of." But I was listening to this on the radio today, and I'll be damned if it doesn't actually sound like Alicia Keys is talking about "wintry tomatoes."
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That story also reminds me of this SNL sketch, which I find hilarious.

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Alright. I think I'm going to go read something now....

Holy cow, it's 2010.

So, it's a whole new year.

I had a wonderful time last night. Hung out with the old crew (it was, after all No Pants New Year, season 8), stayed up until 5am, laughed, talked, remembered why I adore these people so much.

I thought a lot yesterday about the changing year. It's sort of arbitrary, like a birthday - nothing is really different about the day to day, but in a way, that's also not true. Because for whatever reasons, we associate these things culturally with new beginnings, taking stock, and moving forward.

2009? Wasn't all bad. It wasn't generally all that good, mind you. The last few weeks in particular were amazingly stressful. But some very wonderful things happened in 2009. Life keeps going; it's blissful, horrible, awesome and terrifying all at the same time. You can resist the flow if you like, but in the end you have no real choice but to keep moving with it.

I frequently can't believe I'm a third year resident. Partly in the sense of, whoa, where the hell did the last two and a half years go? But also, you'll remember that my entire first year I couldn't convince myself that they weren't going to turn around one day and fire me. I couldn't conceive of the possibility of being promoted to second year. And yet, time goes forward. I'm still employed. I'm halfway through my tenure at Baby Blue, exactly, and somehow two and a half years seems both like a heartbeat and an eternity. I love my job. I know psychiatry. I know what psychiatrists *do*. Three years ago, I couldn't have said any of these things.

And I'm continually amazed at the caliber of the people around me. I'm perpetually marveling at all the good people in my life, frankly, local or otherwise. I have wonderful people close to me - the family I've created in my life and the family created for me. I have amazing friends, colleagues, and people that touch my life everyday. I also have somehow acquired better skills for dealing with the toxic people or interactions that sometimes lurk in my life like depth charges (although, let's be honest, I still have a good deal of skill to obtain in that arena).

We were waxing nostalgic last night on how it's been a decade since the Y2K scare. None of us could believe it'd been 10 years. I was thinking, later, as I lay on my friends' couch in the dark, about what a decade it's been. Thinking about where we all were ten years ago, how much has changed in these years that have just flown the hell by...it makes me think I can't even imagine what we'll be talking about on the eve of 2020.

I've been thinking this week how my life at times feels almost unrecognizable from what it was 10, 15 years ago. One of my relatives posted an old picture of me on Facebook a while back; one of my friends came into my office the next day and was like, wow, I almost didn't recognize you. And I said, yeah, well, those were different times. He asked if I had the same personality then that I have now, and I honestly wasn't sure of the answer. Similarly, I had coffee this week with a very dear friend whom I haven't seen since we graduated from medical school, and she commented that I seemed very different from then. I asked her to elaborate, and she said she noticed how "anxious and tired" I seemed.

I can't argue with that.

She reminded me that the girl she knew in medical school was confident, put together, always on top of things. What she didn't know about that was two things: A, it was a ruse. I'm still the woman who keeps her shit together in a crisis, still the one who puts out fires, still the girl who gets it done. Those things are true about me, and they're part of who I am. But I've been able to get much more in touch, for better or worse, with the side of me that is, frankly, a mess. Who isn't so good at being a grown-up some days. Who drops the ball occasionally, can't find the floor of her closet, and has learned how to live with (shudder) a low census of roaches in her apartment. Who sometimes is too passive, who often gets her feelings hurt, who internalizes everything that goes on around her. Who's funny and neurotic and is sometimes a spaz. Who is uncoordinated and imperfect. Who tries not to throw stones in her glass houses and who sometimes finds the storms of her own emotions to be completely overwhelming. Who attaches fiercely and faithfully to people, even though she thinks she rarely lets them see that. Who finally believes that happiness is an attainable reality.

The other thing my friend doesn't know about this, this has been a very significant source of angst for the past year or so, feeling like I don't maintain that facade of Ms. "Everything's under control, here." I feel like it makes me seem weak. In truth, I feel like it makes me weak. But the reality of it is, it's only because I've started allowing that shell to weaken that I've started to understand the many layers of who I am. And, that those components of myself are from where I draw my strength.

And so, we move on into 2010. A new year, a new chapter, and (arguably) a new decade. I have great things in mind for it.