Locopup

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

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


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

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

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

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

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

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

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

So I brought her home a beef pop.


She was super excited.


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


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


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


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


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


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

A good time was had by all, this evening.

TGIF

Ohhhh, thank God. I made it. One week down.

I figure this is going to get a little easier every week.

Meanwhile....I'm exhausted....

Nearer my god to thee

Today was weird.

So I get out to the airfield this morning, and they're all waiting for me, and we pile into this tiny little anchovy can with wings. They let me sit up front. They encouraged me to sit up front. It was me, and two other doctors, and an ultrasound tech. And, obviously, the pilot. So I walked across the wing (!) and climbed in. We didn't shut the door until we were just about to take off (because, you know, there's no AC on the plane). And then away we went.

I was practically in the pilot's lap.

It does not help that little planes? Not so much made for big people.

Also, you know, I've never once gotten carsick, airsick, or seasick in my entire life. But I'll be honest, I was a little queasy for about the first 15 minutes or so. It was definitely bumpier than a commercial flight. On the way home, we flew through some rain (at about 5000 feet, which meant we were flying through a whole bunch of clouds) and there was a lot of this sort of slipping going on that felt like being in a car that was sliding on ice. I'm knitting away, being a little nervous about this (not to mention all of the bumping around we were doing)....and the pilot was reading a book.

I was just glad it wasn't Flying for Dummies.

AHEC was an interesting time, too. The staff psychiatrist and I tooled around digging up crazy people. No, really. It was actually kind of cool. He and I got in the car, and drove around doing home visits. Or, well, the closest we could get. One guy, who's homeless, apparently they usually meet him at the library. Today the shelter let them all stay in, because it was so hot out (SO hot), so we pulled up to the shelter, and he climbs into the back of the car, we check in with him, and then he gets out and we drive away. The first guy we saw, he answers the door, he's this young guy, cornrows, t-shirt, baggy jeans. We walk into the house...and it's full of these, like, 12" dolls with big, crocheted dresses.

We walked out, and I said to Dr. B... "Um...so I'm guessing that's his mom's house."

It was also immaculate. Smelled like apple-cinnamon oatmeal. There were adorable small people there (his nieces, for whom he babysits). I was ready to pull up a spot on the big overstuffed couch and watch Hannah Montana with them.

He also gave us a CD he made of two of the songs he wrote. He and Dr. B trade hip-hop CDs occasionally, apparently. But the patient is more East Coast, he tells me, and Doc is more West Coast (I actually disagree with him...he had a distinct Biggie Smalls thing going on the tracks he laid down). I said, well, that works out, because, frankly, I'm more Dirty South.

We also saw this older guy, whose family is totally taking advantage of him and so completely not taking care of him. Every morning he gets just enough money to walk down to the store to get a soda and cigarettes. And then he comes home and sits on the couch and watches TV in this dark, filthy house that reeks of cigarettes and cat urine, with all the curtains drawn tight. Which wasn't quite as bad as the rest home that was our last stop, where, apparently, a lot of our "consumers" (can't call them "patients" anymore, that's not PC) live. Each building we walked into smelled worse than the last. The conditions were awful. It was astonishing.

And then I got back on the plane.

::sigh:: I did get the heel turned on my toe-up Tolerance Sock. So named because I let my obnoxious Family Medicine upper-level knit a row and her tension was all wrong. And then because I missed a few rows of ribbing on the top of the foot. I kept convincing myself that it was NOT worth frogging the whole sock just because it had some quirks. Even though I'm wishing I had about 4 fewer stitches in it. Maybe 8. But then, today, I finished the heel and realized that something had gone horribly, terribly wrong.



I ripped out the heel flap, but you know....I think I'm just going to frog the whole thing and just start over. I love the yarn, and I love working it on the Addi Lace needles...screw tolerance, I want nice socks!

You'll poke your eye out

So tomorrow morning, I climb onto the big avion and...oh, no, wait.

Tomorrow I start my AHEC, which is short for Area Health Education Centers, which seems to have nothing at all to do with what I'm actually going to be doing (health education? What?). Basically, it's my community psychiatry rotation. As I think I mentioned, every Thursday this year, I'm going to be one of the psychiatrists on an Assertive Community Treatment Team in a coastal town. Which is something over two hours away, by car. Which means that every Thursday, rain or shine (!), the hospital is going to stick me in a tin can flying clown car small private plane and putt-putt-putt me out to the coast.

You know that Indigo Girls song, Airplane?

Up on the airplane nearer my god to thee
I start making a deal inspired by gravity
If I did wrong I won't do it again
I can be sweet and good and nice
And if I had enemies they're friends
I hold onto my life with the grip of a vice

Up on the airplane nearer my god to thee
I start making a deal inspired by gravity
That little spot on the ground is my hometown
I like to call it my home and it's sweet
I'd rather take a seat down there than a throne up here
Up above 30,000 feet
And I'm up on the airplane

I never should've read my horoscope
Or the fortune on the bubble gum strip
Saying what you think won't happen will
Great thing to read before a trip on an airplane

Pilot says the big blue sky's like a swimming pool
Big fluffy clouds like a feather bed
But I'd rather have a real pillow underneath my head
Lying in my bed
Which is in my hometown
Which is on the ground
Far from an airplane far from an airplane

I have a feeling that's going to be going through my head on a regular basis...

I called Monday to confirm my reservation for this Thursday, and talked to a very nice woman. She told me to come up to the airport (the tiny, municipal airport) around 7:15. There's a gate, she says, and you have to punch a code to get in. And then she just keeps talking. So I was like, wait, what's the code? She says, "oh, I don't know, it's like, 1-1-1-1 or something." I joked about the tight security, and she said, "Well, the code's printed on a sign on the gate."

Uh-huh.

The gate, really, is more to keep the critters out at night, she explained. So we talked a little longer, and I said, "You know, I understand that this isn't a commercial flight, but, are there things that I can or can't bring?" She says, "Well, bring gum. And the plane isn't air conditioned, but once you're in the air, the pilot can open the vents. And if you bring a beverage, we'd prefer it was water, or well, things that won't be sticky if they spill. Basically, anything with a lid."

I'm guessing there won't be beverage service...

So then I asked about my knitting needles. Were those okay to bring? She says, "just don't poke your eye out."

I assured her I had been knitting for many years now with absolutely no knitting-related eye injuries.

I'm not super fond of flying as it is. And, she asked me, had I ever flown on a little crop duster like this? I said, hmm, maybe when I was, like, seven. She says, "ohhh. Well, I'll let the pilot know this is your first time on a little plane."

Gulp.

It should be interesting.

Meanwhile, today was really productive. I got my application done for the Psychoanalytic Institute of the Carolinas, which was, of course, due today (I dropped the application off at 7pm). I got all my paperwork together for the AHEC site. I got all my stuff coordinated and filled out and filed from clinic yesterday. And I went to Walgreens. Where I found the coolest thing this side of Jumbones, if you ask Maggie.

These are three of her very favorite toys.




Pheasant is a longtime buddy who we bought when we moved in with my folks off Pheasant Lake. The tiny pink sheep, which was her previous veryfavoritetoy (which she routinely protects from Maxine, not that Maxine is all that interested), fits in the palm of my hand, and she loves to toss it wildly about. The one in the middle is a four foot long Loofah Dog. For $10. I tried, I did, but I could not resist. Maggie loves Loofah Dogs. As hard as I tried to talk myself out of it, I had to get it. And I'm so glad I did, because she looooooooooooooved it. She dragged it all over the house and even tried to take it outside with her (it got stuck in the doggie door. I laughed so hard I almost fell over. Again).

Here's a handy size-gauging device:

Too funny.

Tell me this isn't just the cutest thing ever...

They're so sweet.

Okay, I'm off to supervision and lecture...more later.....

Year 2, Day 2

Whew.

I'm tired. And my feet hurt. And I'm itchy.

No, no, I said itchy.

So I've been walking to work. Because I live a mile from the hospital. And it's all eco-friendly and more economical and good for me and shit. It's also uphill both ways (and, well, there's some downhill both ways, as it were) on some really uneven pavement. It's not really the distance that's uncomfortable, it's the wobbliness. Remember how I like to turn my ankles in and fall down a lot? Yeah. Haven't gone boom on the trail, yet, but my ankles aren't the best swivel joints, is alls I'm sayin'.

And it's also humid as hell and in the 90s out there.

So yesterday, I'm dragging my ass home, walking with Sparrow (who's my neighbor for another ten days, still), and we discussed the Great Falling Down Incident of Saturday Night. She says, "All of a sudden Mike and I were like, what are you doing on the ground? How did you get there?"

Too funny.

We got stopped by our landlord (who lives behind us. I mean, we were cutting through her yard) and her two dogs, and Maxine, and then of course I had to go get Maggie. And then, there had to be a rousing game of fetch (or, rather...Rags fetches, Maggie runs after Rags, James Brown runs after Maggie, and Maxine tries to herd everyone while barking a lot). And since Rags and Jimmy are little dogs, I of course had to sit down on the ground to play with them. And then I stood around in the backyard for a while. You know, at dusk. Around all the foliage and standing water. The mosquitoes sucked out so much blood I got dizzy. Then again, it's probably the West Nile.

Oy.

So, today, I had child clinic, and schizophrenia clinic. Child clinic was fun. I had two really cute kids. One (the one that wasn't 16) was this kid who, the last time she was seen, threw toys at the resident. Today, she drew me pictures of me and her together. Frankly, I think it's the ritalin.

My afternoon clinic was great, actually. I squeezed my bipolar lady who's a completely amazing artist in for an appointment just before that clinic, and she's doing great. All of my schizophrenics showed up, on time, being polite, and pleasant, and doing well. Two of them brought their moms. It was sweet.

I then dictated notes like a dervish (still with this "I, uh, I mean, the patient was, er, um..." all over the place), tried to dart home (ow, ow, ow, ow) and dashed to my shrink's office a mere five minutes late. And then I came home, and picked up Maxine ('cause Sparrow's on call), and am immediately accosted by my landlord for this month's rent (which I would've sent her a while ago, except the property I live in is about to change hands, so they told me not to send it until we figured out who to send it to). I still haven't located my checkbook (it's in a box, um, somewhere), which is normally okay, because I do all my banking online. But no, no, suddenly she wants a check, and she wants it rightnow. Fine, fine.

What a day.

Dude, I'm tired. Tomorrow should be easier, though....well, in theory....

Like the first day of school all over again

So today, I did something I've never, ever done before.

I was a second year resident.

I'm pretty excited about that.

So the way things work in our program, you spend your whole first year doing inpatient stuff - medicine, neurology, and of course, psychiatry. Then you spend your whole second year doing outpatient (clinic) work. Your third year is a hybrid of the two, and your fourth year, if you do one (because if you do a child fellowship, you get to skip your fourth year), is just a bunch of electives and free time.

So here's how my week is going to go these days: Monday morning I have Bipolar clinic, then adult diagnostic and treatment clinic in the afternoons. Tuesdays I have child clinic in the morning (until January, when I have intake clinic) and psychotic disorders clinic in the afternoon. Wednesday mornings I have psychotherapy supervision, Wednesday afternoons I have lectures. Thursday, I - get this - climb on a tiny little two prop crop duster plane and fly to the coast, where I spend my day presumably wandering around after the beachside crazies as part of an ACT team before I fly back. Fridays, I have nothing scheduled after our 8 am lectures. Sounds like a lot of free time, right? Except that I have to fit two hours of CBT, four hours of dynamic psychotherapy, an hour of child therapy, and between two and four additional hours of supervision (child and CBT and maybe DBT) in there, too. Plus, you know, all the other shit I have to fit in.

And I'm still on call, but, instead of every 4 nights, I'm on about every 12-14. Now, we don't have short call anymore, so all our calls are 24 hours. But the great thing about that? I'm done by 9am, and have the whole post-call day to be, well, all post-call. And I love me a good, full post-call day.

Today was my very first day of clinic. Also the very first day I walked to work. I wore my grubbies to walk through the mile through the nasty humid grossness, and put my work clothes in my backpack, and then changed at work. I spent a good deal of time picking out today's outfit, because I wanted to look just right. You know, professional, put together, not too intimidating. I popped the decoy ring onto my left hand. And I sallied forth into the world of clinic.

Now, of course, one of the things I liked most about OB/GYN was, of course, my outpatient clinic. So I'm not too worried about this.

It is quite the balancing act, though. They told us, at orientation, "this year is going to tax your organizational skills." They weren't kidding. Fortunately, I'm surprisingly anal-retentive and a bit of an organization freak (not that you could tell that from looking at my house...). Still, it was exhausting, trying to get the new routine down when everyone else had been in clinic for a while, you know? I felt slow and clunky. I dictated notes for the first time in eons (seriously. I think the last thing I dictated was an operative note on a C-section), which involved a lot of "ummmm"s "err"s, and "oh, no, wait, I meant...".

But I stayed roughly on schedule. I compensated for my clunkiness as best I could. And generally, it went well. Which, okay, it helped that two of my patients didn't show.

I did have one frustrating moment, though. My morning clinic is technically Adult Diagnostic and Treatment clinic, except that my supervisor is, like, the preeminent bipolar researcher on the East Coast. So he only wants bipolar patients. Which, let me tell you, I'm not real thrilled with the idea of a whole clinic full of "bipolars" (someday, I'll rant about the overdiagnosis of bipolar disorder and the pathologies that get written off as bipolar). And so, my very first patient in the entirety of my career is this kid who, two months ago, was found by police naked and muddy. And he has these "manic" episodes consistently after he's made himself stay up for three or four days straight. And there's usually substances involved. So...yeah. Not bipolar. Four days without sleep would make anyone psychotic. Which I said to my attending, and he was like, no. No way. Lack of sleep will not make someone manic (um, really? Aside from the fact that this is a well-documented phenomenon, has he actually met any of us when we're postcall? Okay, that's just hypomania, but it's also just 30 hours up, not, like 90). He says this guy is CLEARLY bipolar.

Uh, whatever. Okay.

I know that when all you have is a hammer, everything looks like a nail, and that's even more true when you are a hammer. But it's not always a nail, you know? Sometimes it's a screw. Sometimes it's a thumbtack. And sometimes? It's a grapefruit. Is alls I'm sayin'.

Know what, though? Still really, really tired.

What was especially funny, though, was all the residents walking around looking snazzy. This weekend, of course, was the Tax Free Holiday in NC. Which is an effort to give lower-income families a break with the back-to-school expenses. And also apparently works well for lower-income residents. I think we all went out and got new clothes this weekend.

Exhaustion + Vodka

= Wow, am I drunk.

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

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

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

What?

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

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

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

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

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

Guess I'd better go to bed...

Stick a fork in me...

'cuz I'm DONE!

Frak, I'm tired...

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

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

Loved Thursday

So tomorrow is my VERY LAST DAY AS AN INTERN.

Wow.

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

And I'm so tired.

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

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

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

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

What a difference a year makes.

Not at all painless

So I've been thinking, today, and for a while, about suicide.

No, not my own (so put the commitment papers away, Peng). But, working inpatient psych, suicidal ideation is probably 60% what we deal with; probably 80% of those admitted to the Crisis service. And it always amazes me, the crazy amount of people that think about, or even attempt, suicide.

I don't understand. I don't understand the people that impulsively down a bottle of tylenol because their girlfriend broke up with them or cut their wrists because they had a fight with their boss. I can't comprehend this idea of, I'm having a bad day, I think I'll kill myself.

Death is so final. It's so....dead. We don't know what dead is. Nobody really knows what death is like. Maybe it's just nothingness. Maybe it's heaven. Maybe it's worse than anything we can possibly imagine in this existence.

And beyond that, it's an end. Which, is why I can understand the patients that are super depressed or really traumatized and think of suicide. I'll admit, I've been there. Not actively suicidal, but, in that place where you're just like, if I died, you know? That would probably be okay. At least this would be over. But it never seemed like a reasonable way out, and certainly never like a quick fix. And let me tell you, when I had - transient, brief, evanescent - thoughts like that, whew, I was in the lowest place I've ever been. It was so far down. I could not have been sitting in the dayroom laughing and watching TV the next day if anyone had locked me up. I understand the patients we have that have no hope, that see no possible light at the end of the tunnel; most of the time they barely see the tunnel. That's a black, black place, and I can understand the need for relief.

I had a friend once who told me that, when she was in high school and realized she was gay, she went to her pastor looking for guidance. And he told her that she was going to burn in hell because of who she was. And she left there, and what kept going through her mind was how she was going to continue to be persecuted while she was here on Earth - she lived in Hicksville, Nowhere and they didn't take too kindly to her sort. So she had a life of hell ahead of her, only to be followed by an eternity of hell afterwards.

So she contemplated suicide, because, why increase her suffering by staying alive? Why not bypass that and go straight to hell? That I get. I'm really mad so I'm going to take all of my klonopin? That's the grown up equivalent of, I'm going to hold my breath until I die and then you'll be sorry. Except, holding your breath until you turn blue? Low lethality attempt. By the time we grow up, we use much higher lethality options. Pills, guns, drugs, nooses...you stay blue.

And that doesn't even address the people you leave behind. Even if you have no family, no friends, nobody at all who loves you and would be distraught if you took your life, I guarantee, it'll matter to someone. It'll matter to your doctor. Losing a patient to suicide is something we all face at some point in our careers, but let me tell you, it shakes every one of us to our core. The very idea of it keeps us up at night. And chances are, there's someone out there - a friend, a neighbor, a family member, a pizza delivery guy - who's going to miss you. Who's going to be upset that you did what you did. Who's going to blame themselves for failing you. Who's going to be saddled with that for the rest of their own life. And suppose you do have a spouse, a parent, a child, a sibling left behind? Who does love you, who worries about you? How the hell are they ever going to deal with that?

I'm just sayin'. Think about it.

And for the love of all things holy, enough with the tylenol, people. If you need to kill yourself, there are ways to assure that you die. I'm not going to tell you what those are, obviously, but I can tell you one that WON'T work - a tylenol over dose. All it's going to do is kill your liver. And then you get to die a slow, awful, excruciatingly painful and uncomfortable death. I'm guessing not the quick fix you're looking for.

Seek help. Everyone has emotions that are intolerable; suicide is never the answer. Think about what suicide would really mean. Get to a hospital ER, call a crisis line, or better yet, seek psychiatric treatment before it gets to that point. Tell someone, tell anyone that you're in trouble.

Every state has a HopeLine. Ours, in NC, is 919-231-4525. The Teen TalkLine is 919-231-3626. You can find your state's by Googling "hope line" and your state. They often have toll free numbers as well. Or you can dial (800) SUICIDE. They're anonymous, they're supportive, and they'll let you talk as long as you need to. So if anyone out there finds themselves in that place, where suicide seems like the best - or only - next step, get help, and get it now.

You'll be glad you did.

Tagged! I'm it.

So, my cousin Danielle tagged me for her Top Five YouTube Videos meme. The directions of which are to, um, post your five favorite YouTube videos. So, in no particular order, here are five of my favorites (well, six, if you count the one I can't embed. Think of it as a bonus...).

1. My very favorite aria from Die Fledermaus (Mein Herr Marquis, or as it's usually billed in English, Adelle's Laughing Song), sung by the coloratura who does it best, Edita Gruberova. She's one of the best that ever graced the stage.



Some of you know this, but there was a brief point in my life when I thought about becoming an opera singer. Now, my preferred venues are pretty much the shower and speeding down the highway. But it's always a sellout crowd. You know, given that I don't sell tickets. Nevermind, that was a stupid joke...

2. Well, as long as we're talking about stupid things and videos in German...there's this one that my friend sent me yesterday. Which became even funnier given that I'd just spent my whole day trying to speak a whole other language that I don't speak well at all (I see a Rosetta Stone course in my future). It also amuses me because, let's face it, Americans are damn Anglocentric people. And, because it's David Hasselhoff. I mean, that's just funny no matter how you slice it.

Don't Hassle the Hoff, man.



Funny. Did you know he went to my high school? Has a little plaque on the wall and everything.

Okay, the next two, not safe for work. Well, it depends on where you work, I guess. But probably not kid-safe, and well, probably not safe for parents (sorry, Mom and Dad). So if you need to, skip ahead.

3. The funniest, lewd-ish-est, makes-no-sense SNL skit in recent history. With Spanish subtitles, but, I was going for video quality, here. That's the nature of YouTube...



See, I'm wise enough to know when a gift needs giving...gotta love a non-sequitor R. Kelly reference. I freakin' love that sketch. Even though I cannot figure out who they're supposed to be parodying, and it, as I said, makes no sense. But if you want, you can buy a t-shirt with those three-step instructions emblazoned on it, or if you surf Facebook long enough, you'll find waaaaaay too many men in their 20s dressed up as those guys for Halloween. Including my best friend's little brother, which is just about the funniest thing ever.

Oh, wait. The next one is kid-safe. Because it's bleeped. But they might ask you what a shank is, fyi. Tell 'em Iceberg hit a brother with a leg of lamb. They'll never know the difference.

4. I have no way to segue to this one, because, it's in English, and has nothing to do with Justin Timberlake...whatever. Ice-T. Love him. Always have.

So, aside from my adoration of opera, I also have a deep love of old-school gangsta rap, and no one is more OG than Ice. There's just brutal honesty in that old stuff, you know? It's poetry, it really is. No, stop that, I'm serious.

So the video I really wanted to post is Body Count's Cop Killa. History-making rap. I remember when that song came out, man...it was right around the same time as rival group NWA's Fuck Tha Police (which is, of course, sampled in this song, which is HUGE. Imagine Biggie sampling Tupac. I'm sayin'). And so I'm in white bread suburbia, and everyone was just up in arms about this song. Which is clearly a caricature, and addressing the larger issues of poverty, oppression, police brutality, and sanctioned abuse of power. The song wasn't about good cops - it was about rebellion, unrest, and an unwillingness to accept injustice. Plus, how can you argue with logic like "better you than me" and "fuck police brutality"?

But I can't embed it. And you know something else? You can't buy it on iTunes, although you can find other songs from that Body Count album. Anything that can be that inflammatory for that many decades? You know there's more truth in that than we want to admit.

But, since I can't embed that one, here's another groundbreaking song. Particularly notable because it was one of the very first rap songs to actively and openly condemn gay-bashing.



In case you were wondering, the other of the first tracks to condemn gay-bashing? Ice-T's Straight Up Nigga, which is off the same album (OG).

Love. Him.

A total, total aside - no discussion of my musical proclivities would be complete without mentioning how I occasionally make up songs. Usually they don't make it out of my head. Because we're not talking serious composing here. A good example is the melody that's been circulating regarding our recent infestation. Which would be? Straight Up Chigger.

Moving on....

5. As long as we're on political commentary, nobody did it smoother than Marvin Gaye. And this is one of my very favorite songs ever - it's a remake of What's Going On, by a bunch of bubble-gum pop stars who happened to be popular a few years ago and none of whom have the staying power of Marvin, but I really like the way it was adapted. It was a good homage in and of itself, and takes the political mission intended by the original song, updated it and kept it going. Plus, I just love the video.



So that's what I've got. Anyone else want to pick up this meme?

Mi vida es extraño

My life is weird.

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

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

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

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

Still.

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

And sometimes, you just shake your head.

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

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

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

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


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

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

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

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

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

Pizza Sunday

Ah, I really do love a whole weekend off.

I've gotten some of the things done today that I wanted to. I slept until 9, and then went to Starbucks, Target, the New Balance store, and the gas station. I got some of what I needed at Target (cannot get out of there without forgetting something), although I was disappointed in their selection of bedrolls. I've decided, as I think I mentioned a while ago, to start sleeping in my office when I'm on call. So I've been looking for something to sleep on. I don't want an air mattress, I really am fine on the floor. I'm thinking maybe a sleeping bag would be nice. Possibly a mat, or one of those egg crate things. Target was heavy on air mattresses. I tried to stop at Great Outdoor Provisions, but they were closed. I also struck out at the New Balance store (my shoes, in my size, are on backorder).

So then I came home, and realized that the party tonight is catered, so if I want something to take to work tomorrow, lunch was going to have to involve cooking. So I looked in the fridge (haven't made it to the grocery yet), and decided to make White Pizza.

White pizza is merely pizza without a tomato-based sauce. Some places replace it with alfredo, some with just olive oil, but there's this place in Chicago that uses a garlic butter base that is worth lusting after. So that's sort of the idea I use. In case you were feeling inspired, here's a step-by-step guide you can follow at home.

1. Dig around in fridge and find premade pizza crust. Using premade dough, or actually making your own, is an acceptable - if crazy - alternative.

2. Preheat oven to whatever the package says.

3. Melt some butter in the microwave. You know, enough. Like, a domino-sized chunk. It depends a little on how big your pizza crust is. Then crush two cloves (or so) of garlic and add to the butter. Mush. Add some Parmesan cheese. You know, the Kraft sort. Add enough until it's a fairly thickish paste.

4. Set the crust out on the counter. Grumble about how you have no counter space.

5. Smear the garlic-butter-cheese paste on the crust in a pretty fine layer. You don't want to dump this on like you would with Marinara.

6. Add whatever sort of cheese is on hand. I like a good layer of mozzarella, and then some goat cheese, and this Whole Pantry shredded three cheese blend. But I had no goat cheese today, which is sad.

7. Be sure to drop some cheese on the floor for the dog.


8. Smooth everything over and wait for oven to finish preheating. Remind dog that no matter how cute she looks, you're not giving her anything else.


9. Wonder why dog never listens.

10. Stick the pizza in the oven.

11. Go back and rewind the same 10 minutes of SVU you've been trying to watch for about an hour.

12. Realize that you forgot to set the timer.

13. Make a vague guess about how much longer the pizza should cook.

14. Play with the dog and attempt to watch those 10 minutes of SVU.

15. Walk into the kitchen when the timer goes off and wonder why the damn smoke detector, which goes off at the feeblest hint of smoke, is silent and the kitchen is full of smoke.

16. Open back door.

17. Cue smoke detector.

18. Remove pizza from oven. Begin to stick head into oven, noting that there seems to be no obvious source for all the smoke.

19. Realize that you're about to stick your head into the oven. Stop that.

20. Lay pizza out on non-existent counter to cool.


21. Cut pizza into some pieces. Eat them. Makes two to three to four servings, depending on how hungry you are.

22. Remind dog that no matter how cute she is, no matter how hard she tries her Jedi-dog mind tricks on you, you're not going to give her the pizza.


It's a good thing.

I did manage to make a few non-pizza acquisitions today. One was this:

Known in the business as a decoy ring. Deliberately chosen for its maybe-it-is-a-wedding-band-maybe-it-isn't ambiguity (not to mention its $12 price tag, as this is, after all, an experiment). Because I'm not married. But if my patients should choose to think I am, well, that's up to them. And one more subtle boundary between me and them. And maybe my patients will stop hitting on me, grabbing my ass, and asking me out.

You'd think a thick layer of blubber would be enough. Apparently that's just enough to attract wayward Aleutians (if anybody asks, this harpoon is just a new piercing).

I also found a couple of new additions for the Blogroll. One is Day by Day, which is penned by Allison, one of my friends from college who married another one of my friends from college and then they had an unbelievably cute little guy. Who looks really adorable in a laundry basket.

My favorite Allison story? She stole a stop sign for me for my eighteenth birthday. No, now, no lectures about how that's illegal or heartwrenching tales of how your cousin was killed because of a missing stop sign. It was one of those rural, middle of a dead end dirt road, nobody pays attention to them anyway stop signs. I still have it. It hung over my treadmill for a while in college, and then in my office in Chicago, then over my bar in New Hampshire. Now it's hiding under a bunch of boxes in the den here. Cracks me up every time I remember her coming in to Chemistry lecture all mischievous and like, "Happy birthday. I stole you a stop sign."

Heh. Ah, back in our impetuous youth...

I also discovered Mariska Hargitay's blog. Whom you all know is one of my personal heroes, partly for her passion in her continuing role as Detective Benson on Law and Order:SVU (I was recently watching this interview with Christopher Meloni, who plays her partner, talking about a letter he'd gotten from a man who was molested throughout his childhood. He told Meloni that once he started watching the show, he often thought about how it would've been different if Benson and Stabler had been real and fantasized about them swooping in to save him as a little kid. And I thought, wow, you know, what victim wouldn't want someone like them on their side? What survivor hasn't thought about someone dashing in to save them? And how much do we all cling to the hope that those out there still being victimized have someone like Benson and Stabler to protect them? And they do...there just aren't enough of the real-life Bensons and Stablers to go around). But mostly for her real-life efforts to raise awareness and rally support for the victims and survivors that still exist after the credits roll. She speaks out, fundraises for charities, and does great work. Way to go, Mariska.

Hey, look, I'm late...

Ahhh, Saturday...

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

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

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



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



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

Wow, what a damn week it's been.

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

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

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



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

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

Oh, wait, *I* do...

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

Love Thursday.

Sleep.

I love it.

I miss it.

Who needs it?

Not a good combination...

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

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

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

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

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

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

Maybe I'll just go to bed.

Picture it: Sicily, 1922....

Sad, sad news. Riposi in pace, Sophia.

Now, excuse me while I go back to the chaos of my day...