What that "MD" really means...

So, this morning, I'm driving to the Target (again) in the cold nasty raininess, and I was thinking, you know, my blog posts of late have so often been just a chronicle of my day. Nobody cares, dude. I should really have a topic today...

Uh, thanks, Dad, but that wasn't entirely what I was going for.

There are upsides and down sides that come with being a good doctor. Or being a doctor, period. One of them is that you become a nightmare for your family's doctors.

Okay, maybe I'm not a nightmare, but only because I work at being more reasonable. And I'm not sure how often I succeed...

So my father calls me this morning. No, wait, let me back this story up even further. I call home Thursday night, and my mother answers the phone, and the reception is terrible. I assume it's me, so I'm wandering all over the house, and it doesn't get better. Meanwhile, she's being all evasive. I finally get tired of piecing together words and phrases across the cell phones (it's cheaper to talk cell-to-cell under our family plan) and was like, forget it, I'll call you on the house phone.

There's a pause. She finally says, "Uh...we're not home."

Oh, okay, so they went out. On....Thanksgiving...but, okay....I ask where they are, and there's another pause, and she tells me they're at the little community hospital by their house. At which point my stomach curls up into a cold little leaden ball. Because my dad always goes back to the hospital where I went to medical school when he's sick. The little community place by them is actually pretty good, but all his doctors are at my med school, it's a tertiary care center, they know him well, etc, etc...the only time my dad goes to the local place is when he goes by ambulance.

Or, it turns out, when he does something dumb that doesn't actually require the hour-long drive to the tertiary care center.

So my father - older, on steroids for his COPD - is coming down the stairs on Thursday carrying something, and whacks his hand on the side post. Which tears a three-inch flap of skin off the back of his hand. What does my dad do? Smooths the flap BACK OVER THE EXPOSED TENDONS and goes about his day (Daddy, I love you, but these are the times I wish I still lived close enough to smack you upside the head). So, finally, at some point later (as the story was told to me....I suspect my mother's influence in this turn of events), he decides, you know, maybe someone who isn't me should look at that. Two hours, several stitches, and one bottle of PO antibiotics later, all is well, and my still-completely-nonplussed father can't understand why I'm all exasperated that it took him so long to go to the hospital.

So this morning, I get up early (all I was doing was lying around coughing anyway), and trek out into the cold and rainy with the goal of beating all the other people to the Target (and also of buying an area rug for the front room). I get out of the receptionless Big Box Dead Zone and I have this voicemail from my folks. At 8:00 my time. And I'm all, why on earth did they think it was a good idea to call me that early...and then I hear my father's tone of voice. And I get this far through the message - "Hi, Kate. It's us. I woke up this morning and my right knee's really sore-"

Which is when I hung up and called home to tell him to get his ass to the hospital. Right about the time the paramedics were arriving.

And so there's all this fuss which ends with my dad in a private ambulance on the way to my medical school and the Fire Department medics telling the contract service, "His daughter's a doctor in North Carolina, so if he gives you any trouble, call her and she'll yell at him."

I...um...if it weren't true....

So what do *I* do? I pick up the phone, call my med school hospital, and have the Ortho resident on call paged. Because that's the logical option, right? An gosh, it was just such a characteristic exchange.

I called the operator, right? Asked if she could page the ortho resident on call. I gave the story, the patient's name, date of birth. She asks for a callback number. Was I calling about a transfer? No. And the she asks what my name is.

I gave the usual last name, but I gave my first name as "Doctor."

Because I know if I see "Dr. Smith 888-555-1212" on my pager it means whole other things to me than some random name with an out of state number. So this little intern gets on the line, all full of attitude and already exhausted at 9am (don't worry, hon, I remember what it was like to be a surgical intern). I an hear the OR monitors beeping in the background. I had a small moment of, ohhh, maybe I shouldn't have called. But I held my ground.

I told her my name and that I was a physician out of state

(get it out there right up front. Both a demand and an apology)

and that my dad was a patient of Dr. H's who'd had bilateral TKAs in the past

(so, yeah, I speak your language)

and now has an open wound on his hand and woke up with severe pain in his knee this morning.

(which, I expect you to know what I'm angling at, here. You'd better be on your game)

I give her a little more, remind her that I'm out of state and haven't looked at the knee, but according to my mother there's a one-inch area of redness. So, should I send him to her or should I have him go to the nearest ER to get antibiotics started as quickly as possible?

She's like, well, I can't tell you over the phone what's wrong.

(No shit, kiddo.)

We fumble with this for a minute. I throw in things like, well, you know, I admit I haven't done any ortho

(although my advisor in medical school was an orthopedic. For four years. I did several dozen knee and hip replacements with him)

in like five years

(I've been a doctor longer than you have)
(For those of you playing along at home, this does not make me right, but it gives me seniority. Which is everything in the surgical world)

but my memory is that it's pretty imperative to start antibiotics as soon as possible if there's any question of infection at a prosthetic joint.

(my hackles are up. I'm not showing my teeth yet, but, don't fuck with me)

She says, is it swollen? An inch of redness doesn't make it a septic joint. But he's welcome to come to us if they want to drive out here.

(so, an equal display of, you don't scare me)

I say, they're headed to one ER or the other. In an ambulance.

(a low little growl)

She says something about not being able to judge it over the phone. I say, "okay, so the question is..."

(I haven't told her what specialty I practice yet, but "what is the question?" is something that consultants use a lot. Which actually doesn't narrow the field down much, but establishes that I'm someone that other doctors routinely ask for help. The fact that *I* posed that phrase to *her* - the actual consultant in this scenario - is a total display of power. Power that I don't have - 850 miles away. Family member, not a treating physician. Psychiatrist, not an orthopedist - but it works. She rolls over)

Well, she says, yeah, I mean, tell him to come in to our ER,

(as in, don't expect me to be down there waiting for him. She hasn't rolled over completely)

the ER doors are always open.

(but I've flustered her and established the upper hand)

And, then we can consult Dr. H's team as soon as we know what's wrong, and his records are here, and yeah, you know, it's just hard to know over the phone.

I say, tell me about it.

(I know I'm being a pain in the ass)

She says, yeah, and it's hard because it's your dad.

(I understand. I'm just as much of a pain in the ass when it's my family)

We hung up, I called my mom back and told her they were aware he was coming in.

Amazing how much goes on between the lines, though, isn't it? And that's the Cliffs Notes version.

At so many points in that exchange could I have gone off on her (Listen, newbie, my 77 year old father, who's on steroids, and has two prosthetic knees, and has now failed PO Keflex and likely has a festering infection in his joint, he's coming to you, so don't fuck it up, because if he loses his joint who do you think I'm going to come after?) but...that's just counterproductive. I'm not all that interested in the politics of it, and if he's going to lose the joint he's going to lose the joint. Plus, I actually was asking for her advice about whether or not delaying treatment by an hour would make enough of a difference to warrant going to an outside facility with fewer resources. This is not about my ego, my power trip, or my need to defend myself from narcissistic injury.

But so often, with medical family members, it is. Because they're worked up and scared and trying to fall back on their favorite defense mechanism - intellectualization - and it's failing them, because they're not in the driver's seat. And in general, doctors really like driving the bus. So some can get pretty nasty when you tell, say, an oncologist that the appropriate treatment for his psychotic daughter is not what he thinks it is.

And a lot of times, a little bit of knowledge is a dangerous thing. See above re: oncologist. If we're talking about a patient, and that rational distance is there, it can go very differently. Quite often, when my patients are getting what I think is not substandard care (or maybe just a little substandard) from another specialist, but not necessarily what I'd do, I'm willing to throw up my hands and say, well, if you don't tell me how to practice psychiatry, and I don't tell you how to practice nephrology, eh, the patient will probably be just fine on both fronts.

(I'm very protective of my patients, though, so while I may not challenge them directly, you can be damn sure I'm keeping an eye on things.)

However, when you lose that detachment, maintaining that same perspective becomes almost impossible. We make pains of ourselves at best; at worst, we get in the way.

What's a doctor to do except know that about themselves? I try hard to be nice, to listen and learn, to be respectful even when I'm getting attitude, and try to be really appreciative when my family's doctors take the time to speak my language. And when I'm on the other side of it, I try really, really hard to be thoughtful and accommodating and understanding and empathic.

So if you're wondering how this story ends, they admitted him, but so far everything looks okay. They tapped his knee (sounds better than "stuck a long needle in it and drew out fluid", doesn't it?) and found more inflammatory cells than they'd expect, but no frank bacteria. So right now we're on the watch-and-wait program. His ortho's going to see him in the morning. We'll see what the big boss thinks.

And, the resident I talked to swears to my parents that I didn't offend her at all when I called. So, maybe I'm doing a decent job of staying on my chain after all.

Or not.

Something stinks.

I really don't know what.

Maggie's been loose in the house the last couple of days. We're working on making use of that doggie door, right? So I figured, she's made a mess somewhere. Except I can't find one. So then I thought, well, maybe she's dragged something in and hidden it somewhere? Except, I can't find any evidence of that, either. So I'm washing her doggie bed. Except...I don't think it's that, either....

I'm thinking maybe something crawled up under the house and died.

Either way...ew.

Anyhow.

So I get a forward today, one of those mass emails with the cute pictures and catchy phrases and the guilt clause of, you know, "if you don't send this back to me I'll know you don't love me." And it led off with this phrase:

"There comes a point in your life when you realize who matters, who never did, who won't anymore, and who always will. So don't worry about people from your past, there's a reason why they didn't make it to your future."

And I got to thinking about that.

I disagree.

I think that I've lost a lot of good people along the way, you know? I've certainly kept a bunch, too, like I mentioned at the end of my last post. But I think occasionally about the people who aren't in my life any longer, for whatever reason, mine or theirs. And sometimes it makes me a little sad.

Sometimes, though, I will concede, I spend more time thinking, "Wow. Glad I dodged that bullet."

An ex of mine told me once, people come into your life, when they come into your life, for a reason. But sometimes, once they've fulfilled that, they no longer have a place there.

He gave me a lot of sound bites, that one. And to some degree, I agree with him. I'm not sure I agreed that it was a good reason to break up with me, but, nonetheless. Sometimes I agree with the logic of the above statement. Sometimes, I don't. I guess it's a case by case thing.

Ruthie and I, while rearranging our office on her whim this afternoon, decided that the gestalt of pretty much all of psychiatry comes down to the title phrase - "Or not." You could treat the patient with meds....or not. You could hospitalize them....or not. This patient has reasonably good defensive mechanisms so she must have been traumatized at the post-Oedipal stage...or, perhaps, not. One of the great things about psychiatry, which is also one of the most frustrating, is the propensity for which things are always the way they are...except when they're not.

Yeah, I don't know where I'm going with this, really. Just sort of waxing philosophic. Then again, maybe there's a point...

...or, not.

Now back to our regularly scheduled blogging...

So, I'm at Starbucks. Big shocker, right? I know, it's unusual. But the power's out, and there's internet here. Free, now, for registered Starbucks Card holders.

I'll confess, it's not my first trip of the day. The mutts and I headed out early this morning for the one in Durham that has a drive-through. Obviously, Maxine needed her coffee...



Sparrow was on call yesterday, so Maxine spent the day (and night) with us. She was terrified during the storm last night and stuck to me like velcro. After she tried to burrow far enough under the blankets to maybe hide under the mattress, I'm thinking. Poor thing. Maggie was our valiant protector, but if Maxine hadn't been there, I suspect she would've been holding nearly as tight.

Maxine felt better this morning when we went out to get coffee. She'd never been in my car before, and it was exciting. My car is, of course, a mess, so there was lots to explore.



Poor girls, they had a rough night. Mine was more along the lines of amusing. Like, I own something like six flashlights (don't ask) but could only find one, which would of course be the one with the dying batteries. And when I moved, I threw out all but one of my candles. Which, I finally found, but then couldn't find a match to save my damn life. On the bright side, though, I did solve a problem that I've been trying to figure out since they turned the gas on, which is how to shut off the pilot light for my gas log. Unfortunately, I figured this out while I was trying to light a birthday candle with it (as a spillikin for the bigger candle).

Crap.

Ultimately, though I did find the fancy Zippo candle lighter (it's just a lighter, but it's long and thin). In a suitcase. Where else would one keep it?

Last night was one of the few times that I'm sorry I don't smoke...anyway, though, I got the candle lit, and then promptly found myself sitting on my bed with the dogs thinking, it's 10pm. What exactly am I going to do, now? Why don't I just go to bed, already?

Ah well. Apparently there's a 70% chance of storms tonight, too, so it still might come in handy.

Like I said, things were fine this morning. I was going to get the girls up a little earlier but I figured it was best to just let sleeping dogs lie (aren't I funny?).



We tried to go for a walk this morning and canvass the neighborhood, but, it ended up being a giant disaster of knotted leashes. Which is particularly funny, considering they started out on the double leash. Maybe some other time, when there isn't as much chaos to sniff at.

So we went to Starbucks instead.

Maggie was not pleased when I decided to go back after Sparrow came home and Little Bit went with her. I actually closed the door to her crate on her feet before she'd move them.



She does this in the mornings sometimes, too. Or at the old place, she'd stay in bed and refuse to come downstairs if she knew I was getting ready for work.

I did get a lot done yesterday, though, which was nice. Because I'm not sure how productive today's going to be.

So to catch y'all up...this week has been weird. Wednesday was my last day at State Hospital. I was there for the morning so I could disorient the heck out of my poor intern (Oh! And here's this. Oh! And don't forget that. Oh! And then there's this. And this patient's crazy. And this one's a pain in the ass. And this one, well, don't get within striking distance of her. Oh, and...). The staff did a good job of scaring them for me ("Think of our patients as a female prison population." No....), so I could cross that off my to-do list.

And then I dashed back to the big house for the first half of Second Year orientation. Which was less disorienting and just total information overload than last year was. But then, it was also four days shorter.

I'm excited about this year, in general. Because y'all know what a therapy junkie I am. And I'm looking forward to clinic. And I'm glad I got to go to orientation with the rest of my class, even though I'm not starting for a month. We've been so scattered, that it was nice to be together for a while. Ruthie, who's starting in September, and Faye, who starts in November, unfortunately weren't able to join us, because they get their own little orientation later.

One thing that's going to be anxiety-provoking about this year, though is that we start applying for Child and Adolescent fellowships. And there's only 5 spots. And I think there's more than 5 of us who are interested. I'm considering one, maybe two other programs (the only one I'm likely to seriously look into is University of Maryland, because it's possible I would LOVE to go work at Sheppard-Pratt, where they have a whole unit devoted to trauma patients). But I'd rather just rotate up there for a month, because when you get right down to it, I really want to stay here for fellowship. I like the people. I could keep my therapy patients. I like where I'm living (a LOT). But I'm really unhappy to be competing against my classmates, primarily because a few of those going into child happen to also be a few of my closest friends. That's uncomfortable, unless we suddenly pare ourselves down to five or less. But, that's my own neurosis to manage.

Call, this week, was also weird. So, the way weekday call works here, there's a second year on overnight who has worked all day, an intern on until 10 who has worked all day, and another second year who comes in at 10 to relieve the intern who's on Night Float, which means they work 10p-8:30a Sunday night through Thursday night. So it's like shift work. But typically, after the intern leaves, it's you and one of your classmates.

But I'm still in the intern call pool. Which means I was on with Curly until 10, who was doing her very fist second year call (the typical division of labor is that the intern/NF resident covers the ER and the crisis pager, the second year covers direct admissions to the floor and consults. So it's different, although, sometimes when it's busy you just get shit done no matter what you're assigned to). Which, was nice for her, because she didn't have to train her intern. And then Fang came on at 10, which was also nice for him, because I'd seen five people and had one patient left to be seen in the ER and a minor task to sign out to him. And they were both fine, but it's weird to be the "underling", and you know...and I know they'll get this the next time they're on call and have one of the real interns...but I don't think some of our classmates get what it means to have Faye and me - who, you know, generally know what we're doing - in the intern call pool in July. I'm just sayin'. I'm on call Monday with Mike, with Benny as my relief. We'll see how it goes. I'm thinking it should be better - I've worked with both of them a lot.

But, I do love me a three day weekend. I think I'm going to blow this pop stand and maybe go get some new tires and a bag of dog food before I go home and see if the power's back on. Here's hoping I'm posting from home tomorrow!!

TGIF

Oy, what a day.

It was a very long, very frustrating, but strangely, very good day over here. Kind of a weird combination.

And there were several notable events.

My four year old Jeep Liberty hit 100,000 miles just as I got to work this morning.


I had, I think, 118K on my last Jeep when I traded it. I'm hoping for a few more years out of this one. I finally pay it off in May. Go, Jeep, go!

Have I mentioned that my Jeep's name is Kate? I usually name my cars after the patron saint of the day that I buy them (which resulted in my Geo being named Phanourios, and the old Jeep being named Vasili. I don't actually remember the Aztek's given name...which didn't really matter, because we called it many other names...). My whole family does it that way. But I didn't name the Jeep. My best friend did, during its inaugural voyage to Red Robin. Because, well, there's a lot of Kates in my world besides me. She thought it was funny. I agreed. And so she's Kate.

Anyhow....

I met the new interns today!! We had lunch with them during their orientation at State Hospital. They had the same good ol' Southern food they had last year, which, wow, was so good. They looked like a great herd of deer in some very large headlights, much as I imagine we did last year around this time. And of course, we're still talking with immediacy about "when we move to the new state hospital", much like we did last year around this time. I'm sayin'...but regardless, they seem like a nice bunch.

I'd commented to Ruthie the other day, when we were looking over their face sheets, about how several of them seemed to be somewhat analogous to residents already in program. There was a girl much like Sparrow and a guy a lot like Fang, who were friends of theirs, respectively, from medical school. There's one guy who had a major in divinity and one of our almost-third years actually went to seminary for a while before choosing medicine. There's a girl who strongly resembles Benny in conduct, appearance, and background. Ruthie and I couldn't find ourselves, though.

Today, I met me.

She's only an analogue, of course, there are several notable differences. Like her husband and four year old child. Like the fact that she's older than I am and was a practicing specialist for a while. Like the fact that she's tiny and I'm rather the opposite of tiny. In fact, she's probably one of the latter ones on the list that I would've identified to be my analogue. But listening to her talk today? Oh, so totally. Last year, I was the one going on and on about what it was like to be on call and how you changed throughout the first year and trying to be helpful but worrying that I just sounded like a know-it-all. Trying to adapt my thinking from a very different specialty. Feeling really, really out of place with a bunch of recent med school grads. Being so anxious about that I was borderline manic.

I hope she has as good a year as I've had.

I also came to an appreciation of the NC Mental Health system today, after spending five hours on the phone trying to transfer my New York manic to a hospital (any hospital that seemed appropriate) in the empire state. Got rejected by every one of them that I called, except of course for the state hospital, who wouldn't answer their phones!! Not even the admissions office! Oy, what a pain in the ass. Although I did speak with some very nice people up north, who gave me a good briefing in the differences between our system and theirs. Still, frustrating. But the BEST part was that I got to talk to my very good friend Buie, who like never ever answers the phone when I call her (AHEM).

I was sitting there, right, thinking, what the hell do I do with this woman? We'd all kind of decided that she'd probably do better if we got her home. Her psychiatrist apparently doesn't work on Fridays. And I'm like, come on, Kate. You transfer people all the time. How do I make this happen? And it suddenly occurs to me, I know someone in the NY Mental Health system! I mean, someone who works there (I also know a couple of people who don't, but still qualify for the earlier statement). So I call Buie up at work, and she actually answers! And then I called her again, and she answered AGAIN! Wow, it was great to talk to her. And she had really helpful suggestions. Even if they didn't actually pan out. But, helpful nonetheless.

So then, I'm on my way out, and my patient who's been really psychotic stops me to chat. And we did just that - had a very nice chat. I mean, it was about sort of psychotic stuff, but, she was enthusiastic and buoyant and just very pleasant to talk to. It was nice.

And THEN I stopped at the State Farmers Market, which is right next door (literally) to State Hospital. I went in with my $20 in box money, and walked out with all of the following for $15:


I spent the last five on a fresh-squeezed lemonade (so good down here) and the ensuant tip for the lemonade squeezer.

I made a salad to go with my dinner of leftover garlic pasta:


Wow. There is nothing like a fresh-ripe tomato, straight off the vine and still warm and heavy from the summer heat. So good. For dessert I had fresh strawberries (bought at the Whole Foods earlier in the week) and those blueberries on poundcake (also from WF). Them's some good blueberries, right there. He told me they were picked this morning, which I'm not sure I believe, because there was a moldy one in the container, but wow, so tasty.

I then sat down for my daily blog perusal and just laughed my ass off at today's Daily Coyote picture:


which is of course plagiarized directly from Shreve's blog right exactly here, and is titled, aptly, "Why Ranchers Hate Coyotes."

This amused me primarily because Maggie also has a little sheep toy which I bought for her when she started working at the yarn shop with me, because, you know, wool. I never thought about it like that, though. She does love her sheeps (she has two - one is tiny and hot pink).


AND she used the dog door all by herself today, without prompting. Now, admittedly, it was thundering outside and she used it to come in, but, whatever. Progress is progress.

It's like Lent

Dudes! I'm down to the last 40 days of internship. I'm thinking of giving something up for the occasion. Except, I've already given up free time and sleep...

I'm on call at State Hospital tonight. I was lamenting earlier that I didn't have my camera when I drove over to the adolescent building to put some kid in restraints. The grounds are quite lovely this time of year, and everything is in full bloom. This really is an amazing place, full of history and stories and lives and souls. Although, as I commented to the PA on our unit earlier, when the patient we just started on clozaril (clozaril = big gun antipsychotic) was lying on the floor naked in the middle of the hall and wailing at the top of her lungs in Spanish, this place feels more and more like a "state hospital" every day.

I've got this one patient I admitted yesterday, she's driving me crazy. She apparently was manic and decided it would be a good idea to drive from Manhattan to Florida. And as always happens (you'd be surprised at how many crazy people decide this is a good idea), she broke down in North Carolina. I don't know why they all crash land here. Apparently it's a good halfway point - they can make it through Virginia, but not quite to South Carolina. So she gets lost, starts feeling physically ill, and so what is the logical conclusion to this? She gets out of her car and lays down on the side of the highway.

.....really? That seemed like the best thing to do?

So now she's my problem. Because she got taken to a crappy private hospital where they made five medication switches in seven days, and then her insurance ran out, so they sent her here. And she of course has started refusing to take medications because they're "too strong, too strong!" So I pull her to the side today, and I was like, what gives? And she goes on and on, in full Fran Drescher voice, about how I'm too inexperienced and I don't know my medications and I'm trying to kill her and I'm trying to drug her out I asked very private things about her yesterday and now I'm going to do her like this and she won't take the medication I tried to start because she read about that and it's poison - POISON - and she has a medical background too, you know.

And I'm like, lady, if I wanted to drug you out, you'd be unconscious right now. But now that you mention it, maybe we should give that a try. And two, there's a big difference between being a nurses' aide and being, I don't know, a DOCTOR. What I said out loud was, okay, well, here's the deal. I'm willing to work with you, but, if you continue to refuse your medications, well, the difference between us and ol' Bipolar Hill Hospital (it's an inside joke) is that I can make you take them. WITH A NEEDLE. Don't think I won't. We finally came to an agreement but I so just wanted to duct tape her mouth shut. We'll see if she actually takes anything tonight...

Ohhhh. If she starts with me tomorrow I'm going to kick her in the shins.

I did, however, admit an amazing lady today. She's faced so much adversity I can't even stand it. And she's been working her Twelve Steps for ten years now. She's articulate and insightful and is here because she just got overwhelmed by a life that would overwhelm the strongest of people. She's a breath of fresh air in this place, let me tell you. She's going to be an amazing sponsor some day. I think she's really going to do great things.

She appreciated that I knew about the steps and "the rooms" and could understand phrases like "life on life's terms" and "let go and let God". I didn't tell her that I think the Twelve Steps are...well...I think they're kind of crap.

Okay, that's a giant overstatement - I fully and wholeheartedly support AA and NA and encourage my patients to go and to keep going until they find the right home group. I think it has a lot of solid concepts and the community support from others who've been where you are is invaluable.

I'll tell you one group I can't stand, though, is Overeaters Anonymous. Every OA meeting I've ever been to was like a setup for a hard core eating disorder. Food, weight, numbers, food, weight, numbers. Restrict, banish, eliminate. Seriously, no, that only makes it worse.

I'll tell you a secret. When I hit the end of my rope in NH and had to just let go, my own eating disorder was totally out of control (I've mentioned on here before that I have bulimia). That's the thing about addiction, and eating disorders (bulimia more so than anorexia), and the like - they're not healthy, but they're wicked strong coping mechanisms, and that's why we keep them. The eating disorder is a HUGE repository for anxiety, stress, trauma issues, self-loathing, all of those things. It's a vast, vast hole you can keep pouring your angst into. It was the strongest coping mechanism I had, and I was under so much stress then that even it was starting to fail to compensate. I don't want to know what comes next.

But by the time I got back to Chicago, I was so off-kilter, and I knew that I couldn't just dive back into another residency without making some serious changes in myself. So the program in which I sought help was Twelve Step based, because they treated addiction as well (honestly? Lots of people like to lump addiction and eating disorders together. But when you get right down to it, it's like apples and lug nuts). That's where I learned about the Steps, and that's where I started to feel like they had some serious flaws.

A, so not helpful for eating disorders, let me just say that. The Eight Steps to ANAD? Much better. Particularly Step Two - "Recognize that 'food' and 'weight' are not the real issues, but that other underlying problems in our lives have led to our obsessions with food, eating, and weight."

I cannot tell you the number of times that I scrawled "FOOD AND WEIGHT ARE NOT THE REAL ISSUES!" across the white board when we got off track in our ANAD meetings. Because it really is the whole point.

But B, I think the Steps and the Program are sort of flawed in general. Which, nothing's perfect. But I dislike how, the moment you slip, even a little, you're back to square one. It's a nice idea, but relapse is a part of recovery. You have to accept that and anticipate it, not pretend that it doesn't exist. Because it's going to happen, and the point is to have mechanisms in place to pull out of that nosedive faster every time. To get the point, not to just avoid.

The other thing I couldn't handle was the concept of powerlessness. I had SO much trouble with my First Step (which is the only one I had to do, thankfully), because I couldn't give over to that idea that I was powerless over my disease (some would say that's sort of the point, but, nonetheless). Because wasn't that the very point of being where I was? To gain power over it?

The bulimia, for me, came out of being powerless. It's such a complex entity I can't even begin to explain all the layers to it, but the original point was to distort myself, to become unappealing, in the hopes that it would stop my molester. I was 11 when it began (even though I wasn't diagnosed until my third year of medical school), just starting into puberty, my body was changing, becoming more womanly. This heralded a number of potential disasters. So I fell into this thing, this disease, that accomplished so many of my goals. I was fat and thus disgusting and unattractive, so even if I couldn't keep my perp at bay, at least I could keep other men at a distance to avoid retraumatizing myself (that's about half the reason I'm not a puker, because my other compensatory mechanisms aren't nearly as efficient). It made me look as bad on the outside (or closer to it, at least) as I felt on the inside. It reinforced my negative self image. It was a self-mutilating behavior, in essence. And it helped me strengthen my superpowers of dissociation, it functioned as a place to store all my anxiety, it did all the right things, even if it wasn't so healthy for me. The whole point was taking back some semblance of control over my own body and my own psyche.

Now, of course, where it got me was almost two decades (so far) of being at war with my body and self-loathing and self-punishment and etc, etc. Although, you know, it wasn't the ED that did that. The ED was a symptom of that. But it certainly reinforced things.

So this concept of powerlessness was lost on me. And truthfully, it still is. I'm not powerless over my disease. Neither is my patient. She was telling me about how she found a bottle of gin in her daughter's room last week. She picked it up, she was tempted, but she walked away from it. Because she knew it wasn't the answer, that giving up her ten years of sobriety wasn't worth seconds, minutes, or even hours of gratification. That's a powerful woman, right there. There's nothing powerless about that act. I mean, I understand the concept, you know, but I think the application's all wrong.

And how do you get anywhere if you can't take the first step?

Was that more than you all wanted to know about me?

Timing is everything

Maybe Karma isn't as mad at me as I thought (or, maybe my Karma is finally catching up with me?). So I'm sitting here in the Starbucks in the town where I now live (yay!) and it occurs to me how well the timing of the things around this move have been pretty fortuitous, on the whole. Like, Maggie breaks her foot two days before we move to a house with no stairs. Starbucks introduces free wireless internet as a perk of registering your Starbucks card three days before the big long break in my internet access.

The move went...well, in the end, I'm in my new place, and I love it. Well, I think I do. Because I'm pretty sure it's there somewhere under all the boxes.

Things started out...inauspiciously. I was the second move of the day, which the guy who did the estimate assured me meant that they six man crew and large truck would show up between 12 and 1. Which was veryimportant, because I was supposed to present the Distinguished Teacher Award from the PGY-1 Class (or something like that) at Graduation last night, which started at 7. I told him I had to be there by 6. He said it might be a close shave for 6, but, it'd be fine.

They came at 5.

But, after a semi-frantic phone call and an afternoon of "Shit, they're still not here!" text messages, Mike (who's so my hero right now) stepped up and fixed it (he either took my place or found another intern to do it). Which is really lucky, because the movers didn't leave the new place until after 9.

But they were a good bunch of guys and man, they were hard workers. And because they came so late, they actually brought a crew of nine people, and three more came to the old place and picked up the three things that went to storage. The were a little disorganized...i.e., I KNOW I have way too much stuff for my new place, but, um, here's what the doorway to the office (which is actually the larger bedroom) looked like when they left:

Yeah, not getting in there. The whole front room was also a wall of boxes. With one little gimpy puppy trapped on the couch. Can you find her?


Here's a close up.


Don't worry, that big stain is from the water glass she knocked over.

But on the whole, I'd definitely recommend them, although I'd suggest being the first move of the day if you can. But they were very nice, very good, quite professional (also rather fun guys)and generally good to work with. Oh, not to mention cheap. So if you live in the Triangle, TROSA's the way to go. I would definitely use them again, except, I'M NEVER, EVER MOVING AGAIN. They also do lawn care, contracting, framing, eBay sales, have a furniture thrift shop, and sell Christmas trees seasonally. If I find the front room before December, we'll have a TROSA Christmas tree this year.

Unfortunately, after they left we had sort of a rough time. I couldn't find my bedsheets. Or my pillows. Or my sanity Maggie's food dishes. Or a bath towel with which to take a shower. Plus, there were no screens in my bedroom, the landlord didn't actually manage to get the place cleaned before we moved in, the washer/dryer hookup is wrong, Kyle (the old tenant) took all the light bulbs when he left (such a prick) and I couldn't find more than two bulbs of my own, the shower drain was full of hair, etc, etc, etc.

So Mags and I got in the car, went for a drive, purchased some bottled water from McDonald's (I drank 2 liters of water in about 30 minutes. I did a lot of sweating yesterday, y'all), and called my parents and had a little meltdown.

My poor mother. I hung up on her. I was hysterical and sobbing and tired and she kept saying exactly the wrong thing because there was no right thing to say, which I finally told her, I just needed to have my little temper tantrum and then I'd be fine.

Which I was. It was okay. I came home. I found some sheets, if not the ones I was looking for. I found a pillow, if not the ones I was looking for. I threw it at my dog, who was lying on the bed looking forlorn. Here's what she did with it:

She's so cute.

And ultimately I cleared a path into the office, and found soap and a towel to take the best shower of my whole life, and put a light bulb up in the kitchen, and finally went to bed. And then I decided (since I'd turned the air on, because I have no screens in the bedroom) that I wanted my comforter, which I knew was in the cedar chest. And I had trouble opening it...couldn't figure out why, until I finally got the latch to pop, and poof! There were my pillows, crammed in on top and smelling sweetly of cedar.

Things definitely looked better in the light of day. So I cleared a spot big enough in the front room for Maggie's crate,

(Such a good girl, my girl.)

and headed off here. And now I'm going to the Home Depot and Whole Foods and Target. And my aunt's coming back over and we're going to try to make a dent before I take my pork-themed desserts over to Mike's for his Porkfest blowout tonight (Kate - sure you can't make it??). And I have a little time to work tomorrow before I'm on call tomorrow night. So we'll see how it goes. But regardless, we're home!

I really should just go to bed.

I know it's only 7:45. But I'm on call at State Hospital, and I'm a little bit nervous about what the night will bring. And while it's q-u-i-e-t, I should nap, so I can go home and pack (ack!) tomorrow before I go pick Mags up from the day care.

But in new and exciting news, my friend Robin (commonly referred to here as Original Robin) has a new blog all her own, Another Lesson Learned. Check it out. Urge her to post pictures (my nephew is CUTE).

Anyhow.

So it's my mom's birthday, I mentioned that already. It's days like this, things like when Luke was born, stuff like Ali's 30th birthday party, that I get a little more homesick than usual. Especially when I'm all stressed out, because, I don't know, the movers called me like 10 times in 30 minutes today to verify and change things (that was Ruthie's approximation. We spent a lot of time screwing around today, because it was a lazy sort of day. I seriously would've been out of here before noon if it weren't for me being on call. Which is part of why I'm bracing for the deluge to hit). So now I'm moving next Friday, not Saturday (my idea, because of changes Ruthie and I made in the call schedule so I would be able to take the 12th and 13th off), but the movers are coming at 1pm instead of 8am, and I'm confined to one smaller truck (their ideas. Or rather, availability). Although they might be able to get the larger truck with the later move time, because sometimes they go out on short jobs in the morning. And they've officially cancelled packing me. But still with the storage, just one unit instead of two.

Okay, next topic, I'm starting to get a little lightheaded again...

My attending, Dr. Chevy, this morning gave me this whole reminiscent story about how he moved like 11 times in 9 years between college, getting married, med school, having two kids, residency, etc, etc, etc. That was a long time ago, too, dude, the man is old. Okay, I don't really think he's old. But his grandchildren wear him out and he doesn't hear me very well most of the time and he kind of plays up the grandfatherly thing. He's a nice guy. With every intention of getting me out the door ASAP for the next week so I can go home and pack. I appreciate that he's understanding and supportive of these things, you know?

As for the moving company...they run a really tight ship over there, but when you get right down to it, ex-addicts are still not the most organized people, typically. So the fact that the plan is changing so much a week ahead of time is not especially surprising to me, and I think it's positive that at least it's today and not next Wednesday. And I think the coordinator I'm working with just really wants to keep me informed. So I'm not particularly concerned about it.

Okay, that's a lie.

The rational half of my brain isn't worried. Unfortunately, it isn't the dominant hemisphere right now...

This anxiety is of course compounded by the fact that everyone here (at SH) is in a tizzy about what's going to happen and are we really going to close at all and there's all sorts of rallies going on and the attending in Admissions this afternoon gave me a copy of a letter (there's a link on the sidebar of the article) that the physician staff here had written to the head honchos of this whole thing expressing their concern ("pass it around", he says. Dude, whatever, they already conceded to push back the move).

Can I be completely honest? (Of course I can, it's my blog.) I think we should just move in two weeks, when we were slated to go. Maybe the Baby Blue residents should get things up and running, and the Big Blues should come a week later. Not because we're better doctors than them, or whatever, but because Johnny Dix is going to run a lot like our state hospital. And I think, frankly, that another six weeks isn't going to solve the systems issues that are going to be the core problem. And a lot of staff just jumped ship again because of the uncertainty of when they're going to start work. Who can blame them? I say, work like gangbusters between now and then, get the physical plant in the patient-related areas finished, make sure the fire and duress alarms work, etc. I don't actually care if the policy manuals are sufficiently merged or not. We can handle that stuff on the fly for now, and defer to the clinical director if big policy issues arise. I don't actually care if we don't have a credentialing plan in place. I mean, soon, yes, but that's not at the heart of the problem. I don't actually care if all the form paperwork is perfect. Do we have progress notes? Order sheets? What else do we need? Come on, I can write admission orders all by myself, without a little checky-box sheet. I have been known to whip out the ADC VANDISSML in the past. Let's just get on with it already. Let's take care of some patients and let them show us where the problems are. 'Cause they're gonna, whether it's now, or in August when all the paint is dry in the School that they have to convert into offices (I DO NOT CARE if I don't have a "real" office), and the forms are all neat and agreed upon, and they've decided just exactly where to put the lockers in the call room.

Is alls I'm saying. Do it already, people. Do something.