Sunday stuff

Y'all, it's been a rough month.

I know I've been less than awesome about posting useful or interesting things, but there's been so much more going on than I could even start to tell about. The big stuff? My dad's been sick. Someone else who's really important to me was just diagnosed with cancer (I'm not trying to be cryptic, I'm just not sure it's my story to tell, here), and that's been a tough thing for the whole family. And I went to the sports medicine guy on Friday, who stuck a needle into my knee and added even more fluid (with steroids in it), and then gave me a string of diagnoses about what's wrong (patellar subluxation. Plica syndrome. Gigantamous, multi-loculated, huge-ass Baker's cyst. Meniscal tear. Patellofemoral syndrome. Osteochondral damage. Effusion).

And then there's a large pile of little things. For whatever reason, Matt and I ended up being the designated people to fuss over Eva while she was having kind of a difficult end to her pregnancy (which, of course, ended happily). Little Amelie has joined us, albeit a bit early, which of course involves a little worrying on Thea Kate's part. Dude, there's been a lot of baby-ness going on lately, which is kind of making my ovaries anxious. Being on the eating disorders unit is actually kind of fun, but really, really triggering - in ways both positive and negative, often at the same time, which is in itself exhausting. There are a number of things going on with my friends right now that are weighing on me. I'm leaving to go home in three days (which, yay), but my house is a mess, I'm completely exhausted, and haven't even figured out how I'm getting to the airport, much less even really thought about the fact that I'm going to be, you know, home. For the holidays. Oh, right, and it's the holidays, which are difficult for a lot of people, one of whom is me, and a lot of whom are patients of mine who are suddenly in crisis. And on and on and on.

Whine, whine, whine.

So, given the chance to be social yesterday or be seclusive...well, I was kind of hoping the predicted snowpocalypse would give me an excuse to go with seclusive, but since it didn't, I chose not to make up another excuse and went out and made like a butterfly. As I said, I spent the first part of the day trying frantically to finish that blanket, but then I actually made it to the shower for the newest member of the Ming psychiatric dynasty. We had fun. It was more of a party with gifts than a shower, really (i.e, no stupid shower games). What was decidedly weird about it, though, was about an hour or two into it, talking to my recently-married (like, this past week. Well, sort of) friend, I realized that Matt and I were the only two single people there. But, you know, that's okay, and that's part of what I like about my friends here.

Later in the evening Edie had a Yule party. Which was cool, actually; I like her a lot, of course, but also just find her kind of fascinating. She's a practicing witch, and is one of those people who's just really open and tolerant, which of course, also brings with it a good deal of endearing quirkiness. Edie and Peng were sort of the only people I knew there for most of the time, which was kind of interesting, but Edie's friends are of course also a quirky bunch, so it was entertaining as well. And from there, Peng and I went on to Wayne's overgrown frat party (seriously. There was beer pong). We met back up with Matt...and, Wayne's random neighbor, who was very awkward, and walked into the party with us even though he wasn't actually invited. Fortunately, he also didn't stay long (Did I mention? Weird guy). Wayne has a kind of hilarious conglomerate of friends (I told you about the random Australians, right?), which was very entertaining. Mike and his girlfriend were there, too, as was Tony, and Wayne's brother, and one of the girls from work, though, so we at least knew some people. It was also apparent early on that Peng and I were partially there to protect Matt from the scary cool people, which is sort of amusing, considering the coolness quotient that is me and Peng....

So, you know, some good stuff this weekend. I also made it back to the gym today, finally, after like a month. Slowly, but, it's progress. And, well, on we go, with another week. We'll see what happens. At least it isn't dull around here...but damn, I'm tired...

Randomness

Well, we haven't had a good Friday Fragments post in a while...and yes, I know it's Sunday...but nonetheless....
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I am now completely caught up on my discharge summaries. Which is helpful, because I was about to get suspended for delinquency. Which...I have to say...I think is completely ridiculous. I take good care of patients. And they're going to suspend me for paperwork. I mean really though....
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I still have two weeks' worth of clinic notes to do, however. All that damn patient care gets in the way, you know?
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Maggie and I went to the Cook Out for dinner tonight. I live right behind it and every now and then the smell gets the best of me and I cave. That's some good stuff, man. What was even funnier was that I put Maggie in the back seat of the car instead of in the way back, which is her spot. Because it was easier, and we were literally going like two blocks. I had to pick her up and put her in the back seat (she jumps readily into the cargo area), and she refused to walk up into the front seat to get out. Wouldn't budge, just kept standing there in the back seat looking at me through the window with this pleading, "don't leave me here!!!" kind of stare. One foot in front of the other, pup...
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There's a show coming up on National Geographic Channel called Search for the Amazon Headshrinkers. It claims to be about a tribe in the Amazon jungles who still practice the shrinking of their enemies' heads. I think, though, that if you based it purely on the title, this search could end in my office.
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I FINALLY unpacked the new vacuum cleaner I bought like two months ago to replace the one that died about then. I vacuumed up a whole new dog today. Not to mention about a jillion little dead bug carcases. I even pulled out the little tools and did the stairs. Meanwhile, my floors may be cleaner, but my allergies are through the roof...
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This was on my radio this morning. I cracked up.

(And ps, what horrible videography we had back then...)

Such a throwback. I love my satellite radio.
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I'm so completely appalled at what happened at Ft. Hood. And have so much to say about it. I'm hoping to finish that post later this week.
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I'm the ECT resident this month, right? So two weeks ago, I get really lost wandering around the second floor. They do ECT in the main OR procedure room, which is at the back of the PACU. Which I finally found, and had a panic attack walking through post-op. Which is when I realized I hadn't been back in an OR since the Emerald Palace.
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I got over it.

It turns out I really like doing ECT.
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Look! Here's a picture of my cute dog....

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Yeah, it's time for bed........

I'm all for free speech, but...

I think this is one of the more curious protests I've seen...



So, okay, first and foremost, the places to cut the budget are NOT where it will take from those who need it the most. It's a liberal way of looking at things, yes, but also rational and humane, really. And cutting HIV services helps no one.

But. A die-in? Not to mention - Stop killing queers?

First of all, everyone gets HIV now. It's no longer "gay plague," or GRID (Gay-related immunodeficiency, which was the original bigoted name for AIDS). Pink people, brown people, men, women, gay, straight, transgendered - everybody gets HIV. It's moved up the ranks as an equal-opportunity disease.

Add that to the protesters who seem to be bleeding from holes in their bodies and this leads me to conclude from this video that the budget cuts in California have not, in fact, targeted HIV services but instead opened a hunting season on gay people.

My first question is, how did the Religious Right manage THAT? And two, that's just mean. So, yeah, stop that right now!

Seriously, people. Condoms are cheap. Wrap it up. You're not invincible. Stop having sex on drugs. Stop hooking up unprotected. Get tested. Get informed. Stop being stupid.

Stop killing everyone.

I'm just saying...

"No. Really. Come back soon."

First of all, a very happy birthday to my cousin Danielle. She's a Baskin-Robbins this year (31). Many happy returns. Maybe I'll actually make it down to Texas to visit before we're 32. Or at least before Annalise is!!

Re, the title: I went up to the unit today to see one of my therapy patients who wound up on the inside, and ran into my friend John, whom I haven't seen in a while. The end of our conversation entailed a discussion of how I was going to be back working the inpatient units (also clinic. Eek) in two weeks. He was like, "good. It'll be good to have you back." I said, I'm sure you'd do just fine without me.

I tell you what. I had six patients scheduled today. My last one was at 2 and was the one that was admitted. I got in wretchedly early so I could leave by 4 at the very latest (nooooo problem, right? Ha) and make my rescheduled appointment with my trainer at 5.

I left the hospital at around 5:30 (which, incidentally, was a good hour or more before Peng got to leave. Catatonia slows everything down).

And oy, it was a long day. One of my patients didn't show. Another one cancelled (when I texted her ten minutes after her appointment time and said, are you coming?). I had THE LOUDEST HUMAN BEING ON EARTH's mother and case worker calling me to complain about each other (I'm not telling you whose side I'm on). I had a crapton of prescription refills, paperwork, and lab reports waiting for me. And of course I spent like two hours total up on the adolescent unit.

So my kid, who's getting closer to legal adulthood every day, got "in trouble" for talking to one of the younger patients about sex. I asked her about this, and she says, "well, the other patient had questions. I was honest with her. We talked about what it means to have that in your life. It wasn't like I was giving her advice on positions or anything."

I asked the staff, "what kind of 'talking about sex' was this?" They said, "well...it was about sex."

::sigh::

I'm sure the answer is somewhere between Little Miss Innocent and Little Miss Devil, but, come on, people.

Not to mention...here's the beginning of my conversation with John.

(John is standing in front of the nurses' station and, illustrating a point - although I can't imagine what point - has his hands up over his head and is reaching down his back. I happen to be walking behind him and poke at his fingers. You know, because we're 12.)

John: Hi, Kate.
Me: Hey, John.
John: I'd know those fingers anywhere!
Me: Shh! John! Don't tell them our business!
John: I meant anywhere geographically, not anywhere on my body! That's a whole other conversation we shouldn't have in front of the kids.

The nurses found this humorous (God only knows why). Now, I concede, John and I are both adults. My hands have never actually been lower than John's scapula (I think I've punched him in the shoulder a couple of times), and we're obviously friends, and obviously kidding. And the staff jokes at this level all the time (because? We're all secretly 12 when we walk on that unit). Which is fine, as long as everyone involved is okay with it (John and I know our limits, but part of the reason we get along so well is that he's as dirty as I am, and we both know this). But it does suggest an atmosphere of...casualness and permissiveness about these sorts of things.

There's a lot of ways to "talk about sex." Some of them are really inappropriate. Some of them are really beneficial. And the younger patient in question was a teenager. Hopefully, she's had some formal sex ed at this point. And you KNOW she's had some form of informal sex ed by that age. Plus, sex is kind of a basic human thing (anyone remember Maslow? Or Freud? Or Salt-n-Pepa?). You can make it something that can be discussed openly in a respectful and appropriate manner, or you can make it something that needs to be whispered about at night between bed checks.

I'm just saying.

(In a related story, my Aunt Aphrodite, earlier this week, was telling a story at our big family gathering about seeing this movie which referenced "BJs", and these two older women in the theater in front of her that were like, "What the heck's a BJ?" So she's telling this story, and several of my relatives were like...um...what IS a BJ? She says, think about what it stands for. And one of my uncles starts spelling. Seriously. "Is it b-l-o...?" I finally stuck my head out of the kitchen, and was like, "Oral sex. It's oral sex. Finish the story." Christ on a cracker, I'm THIRTY, people. And a doctor. As funny as it was, spelling things just ain't going to cut it...but back to my point.)

There are a lot of problems with assuming that kids don't talk/think/know about sex and making it a shameful or off-limits thing to discuss. You create a mysterious or rebellious drive to find out. You send them looking to other sources for information that can be unreliable or dangerous. You deprive them of learning what's appropriate to discuss when and how. Like I said, I don't know what the story really is, here, in this scenario, but I don't think it should automatically be a demerit just on principle.

And the thing that's most important to me in a group of kids like this who are at very high risk of abuse or exploitation, you make it impossible for them to talk to you about it. So, you've made it something bad and shameful, which you don't talk to adults about...how do you deal with it if someone's hurting you or making you do things or even just making you uncomfortable?

It's just sex, folks. Funny how it's important, but trying to make it seem unimportant makes it become just that much more important.

Fun with pictures

Call it Wordless Tuesday. Except with words. Lots of 'em.

So Sparrow and I are on together tonight. Which, so very rocks.

(PS - did I mention that Sparrow had a birthday last week? I think I forgot. She had her first 29th birthday this past week. We went out for "Asian Fusion" - if several days later - and it was yummy. The company was impeccable, of course, as well...)

(Ruthie's birthday is today, also. I made an impromptu little banner on our door using Post-It notes.)

(But I digress.)

So Sparrow and I are here. And we had a lot of funny, funny stuff come across our paths last night. So we decided to take pictures (you'll notice that all the patient identifiers are conveniently missing...).

Shortly after I came on, a direct admission came from one of the community hospitals. I went down, signed her in, talked to her a bit, and then came back upstairs and looked through the thick envelope of material that the outside hospital sent with her.

I found about twenty pages of MARs (medication administration records), which was ridiculous because this woman is on exactly ONE medication. And of course, they sent a big stack of nursing notes.

Notably missing? A discharge summary. Or, say, a psych consult note. But in case you were worried, we got her post-endoscopy nursing notes, too.

Absolutely essential to good psychiatric care.

They also...seriously, I almost fell off my chair when I saw this. This is not a diagnosis.

The word is hypokalemia. I mean, really. They are just makin' shit up at this point.

You know you're in good hands when your doctors start making up diagnoses just for you. That's a sure sign that they really know what they're doing.

Also waiting for me when I came in was this hand-off note:

Oh, but, be sure to notice the patient's age.

It's the the Playskool Trenchcoat Mafia out there. They're just starting younger and younger these days. Sparrow tells me she got a report from a parent the other day that some three year old girl was "pole dancing". Really? A three year old taking off her clothes. Astonishing. That's highly unusual. Toddlers almost never like to run around naked.

And furthermore, pole dancing is not an innate talent, unless you're a surgeon (inside joke. Sorry...). So if you find your little one working the pole at Gymboree...you've got ask yourself where she could possibly have learned that behavior.

I'm just sayin'.

Why do we pay these transcriptionists?

So I spent a little time today editing my dictations for the last month or so. ::sigh:: Here's a direct quote from one of them:

"He has had multiple spontaneous pneumothoraces at about age 21, which required multiple tattoos and eventual surgery. "

What I dictated was, "which required multiple chest tubes."

Different.

Multiple tattoos? Really? Did that make any sense??

God as a psychotherapist

It's been a lovely day.

I slept in a bit this morning, but eventually, I dragged my ass out of the house because the colors were just past their peak and the light was...well, decent. But it was an absolutely beautiful day out. Sunny, in the high fifties/low sixties, a light breeze, just gorgeous. So I wandered over to the county...um...left of us (I still don't have my north and south figured out around here), and shot for a half hour or so.



There's this little community out there called Fearington Village, which is just an adorable, faux-bucolic, peaceful little place. They pride themselves on these white-belted cows, which is somehow their signature.

Oddly enough, they're called "Belties."


Apparently they come in a goat, too.

(I still can't look at a goat without thinking, "cashmere." And then, goat cheese. I still cling to this fantasy of living semi-rurally someday, of maybe having a small coop of chickens and possibly a sheep or an alpaca. This fantasy suddenly has been amended to include a goat. Named Cashmere.)

So then I went to the grocery and came home and chatted with my folks and then went to Starbucks and finally went in to work, where Cleo and Matt and Sparrow and I spent a good deal of time fussing around the new work space/rec room ("relaxation area") for the interns (the administration stole the intern office for clinic space, and we got all cranky and demanded that they give the interns a place to be. And, to their credit, they did. So now we're going about making it all nice and homey. Because, after all, one tends to live at the hospital intern year...).

I stayed because I had work to do, which I got done, but not before I spent an hour in Matt's office talking music and theology. Which is always interesting to me; I always enjoy talking philosophy with thoughtful people.

Matt also invited me to come check out the church he attends, which is a little start-up under the ministry of a friend of his from his seminary days. And he directed me to their website, where you can listen to podcasts of the sermons each week. Which I did, after I got home.

It's interesting.

Religion has always been a difficult thing for me. My faith, however, is not. Which makes the two even harder to reconcile.

I identify myself as an Orthodox Christian, which is in many ways more a cultural issue than anything else. The Greek culture and the Greek Orthodox church are impossible to tease apart. I have some issues with the Church, as I've mentioned before. Mostly, I think, because I've always found a lot of judgment and hypocrisy there. The congregation I grew up in was headed up by one of the most wonderful and pious men I think I'll ever meet, and yet the much of the parish was very see-and-be-seen, judgmental, elitist...hypocritical. The one thing that always constantly amazed me was how people who claimed to be following the Church rule of "You are entering the house of God. Please dress appropriately" (the most relevant piece of this is, women can't wear pants) but would show up on Sunday morning looking like cheap (or not-so-cheap) whores. Who showed up to find a husband or wife, and then, once they'd found one, would show up to show off their undisciplined and poorly behaved children. I love the Liturgy. I love the sounds and smells and splendor of the Liturgy, I love the rich tradition, I love the feeling of being nearer to God. But I can't take the people. I feel like a religion should be about community, inclusion, acceptance.

But then, I think my God is a lot more accepting than some people's.

I think organized religion, by its very nature, encourages exclusion. But I see God as this...very tolerant parent. One who understand our strengths and shortcomings and knows that to learn to walk, we're going to have to fall down a lot. And who just keeps picking us back up, no matter how many times that is. I see God as having created everything in the universe, which to my mind means that nothing can be without merit. I think "sin" is a human interpretation of something of which we can't yet comprehend, because we see things in black and white and a limited palate thereof - God? Sees infinite shades of grey. I think that there is nothing my child could do such that I would stop loving them. How can I expect less of God than I expect of myself? And therefor, I can envision no reason that God would deny us and cast any of us out of heaven. Jews, Pagans, Protestants...Hitler and Hussein and the child molesters of the world...I think we all go on to the same afterlife.

Maybe I'm wrong. I guess we'll find out soon enough.

Anyhow, so Matt's pastor was talking about anxiety last week. Which, apparently, is a sign of non-belief. I'm not so sure I can get behind that idea. Because I think conflict is the very point of our existence. But nonetheless, he was talking about Matthew 6, which I dug up and read, and it struck me that Jesus had some useful ideas on the issue. He brought up the parables of serving two masters (and why that doesn't work), about how God provides for all living things, and how it's useless to worry about distractors.

In Matthew 6:27, he says (this is obviously the NRSV translation), "Can all your worries add a single moment to your life? Of course not." He ends Matthew 6 with verse 34: "Therefore do not worry about tomorrow, for tomorrow will worry about itself. Each day has enough trouble of its own."

Jesus, it seems, was a mentalist.

I like those two passages. They're practical, pragmatic, and wise, without being berating, disparaging, or demoralizing. Much as I conceptualize Jesus.

Matt's pastor did make an interesting point, though - he said, "Our anxiety exposes that which we treasure...Worry exposes our focus." That, for some reason, I find especially salient. Because I do think that sometimes we get so wrapped up in our anxiety that we sometimes forget the significance of what we're even anxious about. What does it mean? What does it indicate? Is it really deflected from some other conflict? Last week in my PECC class we talked about Kernberg's idea that in the borderline personality construct, the affect that arises when conflict occurs is almost always not the real affect - it's the dyad, or relationship, that's employed to defend against the one that's really being threatened. How often do we get swept away worrying about something and don't ever stop to think about why we're worrying about it?

So I wonder why I get so anxious about religion?

It's a little like Christmas Eve...

First of all, how sad is it that Obama's grandmother died this morning?

My fellow 'mericans (as our current embarrassment of a Commander in Chief would say). Tomorrow is, I think, and I've said it before, probably the most historic presidential election since George Washington. When the dust settles, we're either going to have a black president, or a female vice-president, either of which sets a remarkable new precedent.

So, get out there and vote. Be part of it. Tell your kids about it, your grandkids, some random kids on the street.

Plus, if you don't exercise your right to vote, you lose any right to complain about the government for the next four years.

So, if you haven't voted already,

VOTE, ALREADY!!!

Babbling the midnight oil

Night float, day 2...

I've seen exactly one patient, who was here when I got here, but you know what? I feel good about that patient. It was an adolescent that I took a long time with and I think I managed to get the situation to work in her best interest. It helped that there was a Pedes ER attending on who was just incredibly helpful and interested and invested in this kid.

You know...I have this soft little place in my heart for adolescents that I didn't have any sort of awareness of until this year. Previously, I mostly found them annoying and juvenile and always felt like they were making fun of me. I forget, though, what a complicated and tumultuous time adolescence is by its very nature. Add in screwy social circumstances or caretakers with limited parenting skills, and gosh, these kids just have so much trying to coalesce on them. And, you know, maybe it's the population of kids that I deal with, but I see so much...I don't know what it is. Energy, color, potential, intensity...so much raw possibility, this sort of effervescence of conflict and recombination, this complexity that's simultaneously developing and concluding... It's fascinating. And when you're underneath it, it's overwhelming.

I just don't see it in a lot of my adults. I mean, sometimes I see vestiges of it. Sometimes I see outright mature correlates, these peculiar and disorganized qualities come to fruition. But honestly, a lot of adults seem to have just lost this ineffable, diaphanous quality. Sometimes it seems like it's been sublimated into the unconscious, sometimes it seems like it's been partitioned off and redirected...but sometimes...in others...it just seems like it's gone. Like they've gone flat.

I don't know what that is. I don't know what it means. I obviously can't even describe whatever this is that I'm talking about with any degree of significant eloquence, but, well, it's 3 in the morning.

Does this make sense to anyone who lives outside my head?

Anyhow.

So the other interesting thing about my night has been this - when I got here and read my email, I discovered that I'm being audited for inappropriately accessing a patient's confidential medical records without a release of information on file. Which, I wasn't too concerned about, because, I figured it was one I opened on accident who had the same name as my patient, or, a patient I treated a while ago whom I was checking up on for continuity of care and, you know, silly things like learning. Until...until I got to the patient's name.

It's my record.

From the email conversation that's ensued, apparently, I'm being brought up for disciplinary action for - wait for it - violating my own privacy. And when I explained why I went in, that I added my medications which are prescribed by an outside provider, she told me that was a grave misuse of my access to the system.

Oh, come on.

So...apparently...it's an abuse of power to "alter" my medical record in such a manner. Because, you know, if one day, whilst I'm walking home, I get run over by the Chapel Hill Transit system (God forbid), and I wind up in the ER, all unconscious and bleeding, it's really not important for those doctors to know what goes into my body on a daily basis. Because it won't affect my treatment at all. Thank heavens I was all "ethical" and didn't "alter" anything.

I'm really pissed off about this. I mean, forgetting the fact that my record contains exactly this: the medications I've entered and two test results (a rapid strep and a Flu A aspirate) from when I went to employee health with the flu last year. Oh, and now, it probably shows a pending appointment with a family doc next week (FINALLY I'm going to go get all of this exhaustion and falling down checked out). It has my address wrong. It doesn't have my insurance information. And until said employee health flu visit, it had my name spelled wrong. Forgetting that there's NOTHING THERE, it's my information. It can't tell me anything I don't already know!

So, one of the things I did tonight was fill out a release of information form - to release my own information to myself. For the love of Steve....

Disciplinary action, my fat white ass.

Again I say...anyway.

So, now, I'm hanging out. I finished some paperwork, I disinfected my desk (Ruthie seems to have the plague). I did some laps around the psych department. I read my newly-arrived copy of Franklin Habit's cute new book of knitting cartoons, "It Itches." (SO cute. So Franklin. I love it.) I'd pre-ordered it months ago, so I was excited when I found it on my stoop this evening when I left for work. Last night I watched House and 30 Rock and Doogie Howser reruns on Hulu.

I keep trying to read more important things (like my readings for class tonight), but damn if I can concentrate on anything like that. I concede that I slept well today and thus tonight hate night float a little less, but, considering it's taken me over two hours to write this blog (I keep wandering off to do other very random things and then suddenly thinking, oh! Was I done with my blog?), I don't know that I'm up for great feats of concentration...

Yeah, don't think I'm going to class tonight.

Oh, in related news, I had my last interview for the psychoanalytic society this morning. It was much more pleasant than the one with the intrusive old guy who lived in the country. And I'm relieved that it's all wrapped up and done with.

Alright, I think I'm going to go knit. If anyone's still reading at this point...wow, you're awfully tolerant...

Closing a door

Hey, I'm 30.

No, for real. Not in the sense of how I've been answering "thirty" to casual queries about my age for the past two years. But in the sense of, thirty years ago today, at 8:06pm (Central), I was pulled screaming from a Pfannenstiel incision in my mother's abdomen at 35+3/7 weeks.

Hmm. I miss the days when I used to use phrases like "I was born."

Yeah, no I don't.

So the thing about it is...I'm surprisingly cool with turning 30. I feel like it's kind of a landmark, actually. And kind of analogous to pregnancy, in a weird, only-in-Kate's-head kind of way...life, I think, can more or less be divided into trimesters. For the first 30 years, you develop and change a lot. There's a lot of energy expended in this. You disrupt other peoples' lives a lot, and you're fairly demanding because you just need so much to pull off what you need to accomplish.

But then you cross into that second trimester. The transition itself is relatively subtle, but hitting that 12 week, er, 30 year mark is a pretty big milestone. Because if you've made it this far, you can't be too defective. You're reasonably well differentiated. The vomiting has usually stopped. Things calm down. Everyone relaxes a little. You refine your skills, you develop yourself, and you continue growing.

Eventually you hit the third trimester. At first, there's not a lot of difference. You still have quite a bit of growing to do, but, you've come a long, long way. But eventually, you just get more and more uncomfortable. You gradually become more burdensome to others again. And then one day, you hit a point when this state of being doesn't work anymore, and it's time to move on.

For the record, I may have come into this world preterm, but I fully intend on going postdates.

Yeah, I know, these things only seem profound to me...but, oh! It's my blog!

So, Tim McGraw may have said it better. That song's been in my head a lot over the past few days, for the obvious reasons, and I've been thinking a lot about my own Next Thirty Years...and, my previous thirty years.

And what a long, strange trip it's been.

I've been thinking a lot about myself on my previous "landmark" birthdays. Who I was at 16, at 18, at 21.

My mom called me in "sick" for my 16th birthday (actually, I think she called in and said, "I'm taking Kate for her driver's test today, she won't be in"). We went to the Sec State's office (the Illinois version of the DMV), and I dutifully turned on each blinker in succession, maintained a two-second space cushion between me and the car in front of me, and backed around a corner (I don't know why that's part of the road test). The examiner was looking for a reason to fail this clearly spoiled whippersnapper who had the audacity to skip school on her birthday. But, alas, I didn't give him one. I took an awkward picture on a red background and my mom and I went out to lunch.

Wow, what that guy didn't know.

I barely remember those years. I was so miserable. I was in this deep, obsidian abyss. That was the year I got sick - mono, EBV, somatization from a soul-sucking depression, we never did figure out what was wrong with me. I slept all the time and had a mildly elevated sed rate and some lymph nodes that lit up on a gadolinium scan. I missed a year and a half of high school before all was said and done. It was just as well. I hated being at school. I hated my life. I hated the very essence of myself. I was detached, chaotic, and fractured, and consumed with self-rejection and self-loathing. I was broken and distorted. I was floating somewhere between wanting to survive and being overwhelmed with the reality of being me, of who I was and what I'd been through. And it wasn't over yet. And I knew that.

Not exactly a high point in my existence.

The night before my 21st birthday, I went bowling with some of my sorority sisters (we were in a league. I had a three-digit handicap), and Lisa bought me my last illegal drink - a fuzzy navel - at, like, 11:55pm. Because I'd promised my dad he could buy me my first legal one. And he did - an amaretto stone sour at lunch the next day. Then I drove back to college and went out with my friends. We went to my favorite Mexican(-ish) place for dinner, then the over-21 among us went to a local bar I can't remember the name of. I had a margarita at dinner and three drinks at the bar. Robin was my designated driver that night. She had about an inch of her gin and tonic and was more buzzed than I was. Kate's roommate brought me a stick (to beat off the men in the bar, she said). It was a good night.

College was a rough time as well. There was a lot of internal conflict and a not insignificant bit of external conflict and I couldn't figure out for the life of me who I was or who I was supposed to be. I had three majors, and was president of five organizations my senior year. I fell in love with a really manipulative man and ended up in a bad relationship ("relationship") I couldn't quite extricate myself from. I wanted to be a doctor, but I got pulled into my advisors' offices on two separate occasions and got the "your GPA sucks ("sucks") and you're taking your MCATs too late (because I was having my gallbladder out the day I was supposed to take them the first time). You shouldn't even apply to medical school. Have you ever considered podiatry?"

I hate feet.

But then my MCAT scores came in, and they were all like, oh....huh. Well, that's okay then. And of course I got into medical school. But I distinctly remember driving home one night my senior year...it was a crisp, cold night and there was a full, bright moon over the cornfields and I had the sunroof open and the heat on...and thinking, God, I hate my life. But I knew the end was in sight. I don't think I'd been accepted to med school yet, but, I knew I was going to graduate at the end of the year, and then I'd be somewhere else, doing something else, away from the toxic, draining people I'd somehow accumulated. Not that everyone in my life was toxic - far from it. But it only takes a few. And I had a lot.

Medical school was better. I liked my life, I still hated myself. As it turned out, I had a lot of work left to do. I still hadn't figured out who I was. I had no idea what I wanted. Things shifted; some gave. My sense of self finally started to coalesce. I started to solidify.

And then I headed off to New Hampshire. Where they pushed me until I broke completely apart.

I spent the next two years underwater, fighting a number of currents that threatened to suck me back down, but, you know...sometimes you have to fall apart in order to put the pieces back together in the right order. And so I started this process, piece by piece.

Robin told me a couple of years ago, when I was sitting on a tiny chair in her first grade classroom sorting misplaced puzzle pieces, that my dislike of puzzles surprised her, because I was such a problem solver, and besides, the smart kids always like puzzles. I have no patience for anything with more than, like, 5o pieces. I think it's because I spend so much time examining my own patterns, trying to find what fits where. I have enough almosts and not-quites; I just can't handle tiny little pieces of die-cut cardboard that somehow become a picture of kittens.

They're still not all back together. There are still a number of shards that don't seem to fit right and sometimes they slip or have to be re-broken and sometimes I get just so frustrated. But sometimes they set right in. More often, I have glue all over my fingers and slice myself open trying to put things in order. Either way, I keep working. And every day, I get a little closer to wholeness.

So, in my next thirty years...I'm going to keep going. I'm going to strive for authenticity, for excellence, for integration, balance, acceptance, and temperance. I'm going to let the pieces fit where they may and receive whatever form that turns out to be. I'm going to pay more attention to where I am instead of where I'm trying to go. I'm going to conclude that first trimester, acknowledge everything I accomplished - which is a lot -and move forward to what has yet to be.

Acceptance. That's going to be a big task, I think. Accepting myself. Accepting what comes. Accepting what is, whatever that is.

And I think I might get another tattoo...

Vote, dammit!

I stumbled across this yesterday:



I freaking love it.

And, while, yes, some states closed their registration Friday, most others just stated that you needed to be living the place you plan to vote by Friday. So, if you're not registered, do it now (DO IT NOW!!!!!). And freakin' vote, already.

Seriously, though, folks. Regardless of how it turns out, this is the single most historic presidential election since Washington. No, really. We're either going to have a black president or a female veep. That's huge.

Huge.

Plus, there all sort of pertinent congressional issues, referenda, local people...it's important, people!!!!!! (!!!!!!!!!!!!!!!!!!!!) Hundreds of thousands of men and women died for your ability to stand in line, poke a hole in a card, and get a sticker that says "I voted!". It's your patriotic duty. It's a basic, but amazingly precarious, human right. It's one of the most valuable things we as Americans can do.

SO DO IT!

Lockjaw would make it worse, come to think of it

So, my day.

It started badly.

And then it just kept getting worse.

Here's the most photogenic manifestation. This was about the third bad event of the morning.


I did this in the shower (toe vs faucet). While bleeding all down the other leg from a giant razor nick. Note the flap of skin on the medial surface of my big toe that's just been tacked down with a little purple band-aid all day. It probably could've handled a little stitch or two. And I probably could use an update on my tetanus shot, frankly (I'm right at the cusp). But no, I slapped on said little purple band-aid and just went the hell to work. Screw my lucrative career as a foot model!

Needless to say, between this and all of the falling off of my new bike that I did yesterday (21 gears and I can't find the one that will get me up a fucking hill), I did not walk to work today.

I had two clinics today (morning and afternoon). They were both full. Everyone showed up. The first patient in each clinic needed to be admitted. My very first patient of the day, whom, again, I had to admit, had to be escorted down to the ER by the police because he was scaring the attending. And then his mother yelled at me for lacking "human kindness" (he's in his 50s). After I bent over backwards being all soothing and empathetic and nice.

You want to see bitch? Because I can pull out bitch at any moment, old lady, just keep pushing.

Yes, yes, I totally understand she was stressed and upset. Which is why I just smiled and ignored the comment and kept up the soothing-empathetic-nice routine.

See? This is why I sometimes forget I'm allowed to feel stuff.

Because I already wasn't doing so hot when I got to work.

So, he gets escorted off by a man with a gun. I apologized profusely to my 9am patient. Thank GOD my 10am called and cancelled because he was stuck at the beach with his roommate. My 11? Came late and then took until 12:45.

Which meant I got to my 12pm committee meeting at 12:50. By when, thankfully, it was over, because I still had to eat.

I inhaled my lunch between 12:59 and 1:02.

No really, I looked at the clock.

My 1:00 comes in, looks like crap, is all depressed, I say, "do you think you need to be in the hospital?" She comes all unglued and is like, "yes, but I didn't think I could tell you." So, in comes #2. And while I'm admitting her (which is not a short process, but, on a full clinic day, it gets broken up a lot), my pager goes off.

One of my therapy patients is in the ER, having unintentionally overdosed on meds he stole from his mother. I went down to talk to him, and he didn't even respond to a sternal rub (for those of you who don't know what that means, drag your knuckles up and down your breastbone a couple of times. Now imagine me doing that like I mean it. Yeah, ouch). This later involved two...no, wait, four conversations with the ER resident and one with the on-call intern tonight about why this kid needed to be admitted. Now. And we'll put him in a bed when we have one. No, I don't care if he's all calm and awake now, he's coming in. COMING IN. BECAUSE I SAID SO, STOP ARGUING.

Damn passive-aggressive pediatricians. Say they'll admit him and then try to discharge him behind my back....

I'm just sayin'.

And, in case you were wondering, I JUST finished writing his H&P. At, like 10:15 pm.

I also had just a difficult couple of patients this afternoon. None of whom compared to the rest of the company, but, nonetheless.

And I don't like my socks that I just knitted. Or the other ones.

And I'm not even going to go into the biggest cranky-pants-inducing stuff that was making my day so bad. Because that lives in my head and needs to not be unleashed on the outside world.

Oh, my word, I'm so cranky....

At least? Tomorrow will be better. Because there aren't a lot of other directions in which it can go....

Long day

I kept trying to come up with a lyrical reference for the title. I had to Google, because the only songs I could come up with referenced "bad day", and, my day wasn't especially bad. And lo and behold, I came up with this song:



Which I cannot believe I didn't think of, especially since I've been on a Matchbox 20/Rob Thomas kick since I linked to the 3am song the other day. And particularly because I have long time fond attachments to two particular lyrical phrases in this song. Well, three. Because there's also this one:

"I'm surprised that you'd believe in anything that comes from me I didn't hear from you or from someone else."

Because I actually find that reasonably profound.

The two in question, however, are the following:

"I'm sorry 'bout the attitude I need to give when I'm with you 'cause no one else will take this shit from me."

I mean, that sums up my last four relationships, right there. Not to mention a large portion of my friendships. And, what I do professionally, because the point of therapy is often to transfer and express feelings you otherwise can't safely or appropriately emote. Which means we take a lot of vicarious crap from people. Which isn't as bad as it sounds; actually, it's usually pretty interesting.

"Reach down your hand in your pocket, pull out some hope for me."

Which....really....I think is a lot of what I do. For a living. I think, in a lot of ways, people pay me to give them hope. To find hope for them, or help them find it themselves.

So my day started and ended with therapy patients. My freakin' SEVEN AM patient is one I've been seeing for a little over a month now. Unfortunately, we decided that Tuesdays at 7am are a good time for a standing appointment every other week. Which...okay...it's not really that early. In my OB/G days, man, I'd have my first case in the OR by then. But for psychiatry? We complain when we have 8am patients. The more unfortunate piece of it is that my Tuesday nights are going to extend until 9:30, because the second course I'm taking at the Psychoanalytic Institute did not, in fact, get cancelled.

And let me tell ya. 15 hours? Long day.

So I had him at 7. And then our child clinic ended up being overbooked (which was totally ridiculous, because for the past three weeks we've been severely underbooked in that clinic) and down two members of the team. But Elspeth, the social worker, and I knocked it out. And then my afternoon clinic was full, but, two of my favorite patients came back. One of them brought me a present - art, and in that, art which he'd created, which is the coolest thing you can ever give me, particularly if you're my patient. And he's good, y'all.

So, and this is a total sidebar (shocking, right? Me, digressing?), we have this art gallery at the hospital, called Brushes with Life. It's all art that's been produced by artists with mental illness. We have so many pieces the whole Neurosciences hospital is lousy with them, and even at that there's a rotation, and some pieces only make it up once. But there's a big gallery up on the third floor, and every now and again we stage a real showing at a real gallery. It's amazing, some of the things that come out of that exhibit. And, two of the best featured artists are my personal patients. Who are also just really cool people in general. Anyhow, a year or so ago, some documentary filmmaker decided to a, uh, documentary film on the gallery. And several of my patients are in it, not the least of which is the patient I saw today. They're screening the film again next week. I think I'm going to go.

He also has a band, but I'm on call when they're playing next. Which is just as well, because I can't decide if that would be a boundary violation to go see him play. I mean, it's at one of the major local indie clubs. Where I've gone to see other bands perform. And he's just so tremendously talented, and frankly, he's not a therapy patient, I mostly just do med management with him. I kind of think a public venue like that, if I just went and didn't try to be all social with him, would be a non-issue. Which is the consensus of the people I polled today.

Thoughts from the crowd?

Anyhow, my last patient, who's my child therapy case, was at 5 (so, after clinic hours), was this kid I've seen in clinic, but this was our first therapy appointment. Man, he's driving his parents batshit crazy. Which, frankly, I think is a short trip. And honestly...I think he's a really good kid. Now, I'll also be honest and say that I'm glad he doesn't live with me. Mostly because I'm glad most any child doesn't live with me right now. And I'm not sure how I'd handle these issues if he were my kid.

But I think it's safe to say, if he were my kid, he'd have entirely different issues.

I feel for his folks. I do. It has to be hard. But shit, an hour with them makes *me* want to smoke pot. I can sorta figure out why he does it.

I know this child therapy gig is sort of along the lines of what I want to do, or, as it were, it's very along the lines of what I want to do in the short run. But wow, it's exhausting. Because with kids...well, with everyone, you end up having the whole family as your patient. I mean, no one exists in a vacuum. But with kids, you end up doing this whole-family thing more actively. Like, you actually treat the whole system instead of trying to do it as a theoretical and a little more by proxy.

It's a rough charge. That's a lot of stuff to tangle with. We have this saying, in psychiatry, about how the identified patient, the one who's coming to see you and actually branded with the "crazy" label, is usually the healthiest one in the system from which they come. Often, it's their job to bear the dysfunction of the whole family ("we're crazy because you make us crazy, so everything that's wrong is all because of you"), and because they're actually the healthiest of the bunch, they can't tolerate the dysfunction as well as the more dysfunctional (does that make sense?).

And kids? Don't come with a set of fully-formed coping mechanisms, adaptive or otherwise. It's hard to deal with badness and try to figure yourself out and mature into an independent functioning human all at the same time. And when you're in the middle of all that, and some random stranger tries to come "fix" you...it's hard to trust anyone. Particularly any adult. I mean, shit, I saw three different therapists when I was being actively molested, and I didn't tell any of them. It's going to be slow going with this kid. And, I respect that. His parents, like most families of "identified patients", want him "fixed." Like, yesterday.

It's a little bit exhausting all by itself.

And the real secret is? Adults? Really, psychologically speaking? Often just big, unresolved kids.

And, somehow it got to be 11pm (well, Sparrow came over, we got to chatting....). I meant to be asleep an hour ago. So I'm gonna go do that....

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.

Annoying things, amusing things, and just, things

Before I head down my ranting rantiness...Happy Birthday to my adorable and wonderful nephew, Basil. No, he's not 30. But he is 2. Which, frankly, I'm not opposed to 30, but I think 2 might just be a better age.

So I'm on call. When am I not, first of all (14 days...). But secondly...today? I hate people.

I've been fighting with morons all day (the latest of which is the medicine service. Damn them! Take the patient! Take the patient!) about the disposition of the, like, three psych patients that have come into our ER.

One of whom, interestingly, is insisting on going to Other State Hospital. Which is, of course, MOVING TOMORROW! So he's gonna sit in the ER for three days. Which is probably better, because I think he might be going into the DTs. But what do I know about substance withdrawal, anyway? I'm just a psychiatrist. It's not like our patients do this ALL THE DAMN TIME. Or that they might, say LIE TO US about their alcohol use. Nahhh, our patients always tell us the complete truth.

Bastard coated bastards. With creamy bastard filling.

Anyway.

So yesterday, I sign into Facebook, right, because a couple of people I went to college with had friended me. And what do I see? This:

Are you kidding me?

What are they, Greek? 29?? Since when is that overdue for a man? I mean, except in my cultural circles, where of course I've been past my expiration date for yeeeears now...

Seriously. Hate. People.

Also want to back my car over my pager.

In other news...I finally went to the Petsmart yesterday, which was timely, because my poor dog had been eating bowls full of treats for the prior two days, since we ran out of food and all (she thinks we should run out of food every day, I think. She thought this was a FABULOUS idea. I? Also enjoyed it, because for Maggie, eating a bowl full of treats means that she has to sneak up, all wiggly with excitement, steal one out of the bowl, dash back to her crate, happily devour it, and then repeat the whole process. Because this is what you do with treats). So whilst at the Petsmart, I was walking past the big display of cheap toys, and wouldn't you know it, there were two she just had to have...okay, honestly? There was one I thought she'd really like, and one that I just thought was too damn hilarious not to buy.


Maggie was initially very excited about the prospect of new toys. The first one, which I bought more for her (because I think it looks sort of stupid) is this one.


The cool thing about it is, even though it's pretending to be a container of organic juice (what? What dog wants to play with one of those? What owner wants their dog playing with juice? Just sounds sticky to me, frankly), is that it makes a very crinkly noise when you play with it. Maggie likes a good deviation from "squeaky" once in a while. This one? Has crinklies AND a squeaker. WOW.

This one? This one I bought for me. Not so much to play with, as to periodically giggle at and say, "what the hell?"


Dudes. It's a chicken. A whole chicken. On a barbecue fork. WTF?

When Maggie was but a wee pup (okay, when I got her, and she was 18 mos old), she used to tear her toys up in nothing flat. Like, fifteen minutes to a half an hour, done. And then one day, the magical Stuffed Hippo showed up. She still has that hippo. In fact, it's still her favorite toy. You know, to nap on and things like that. I don't know what it was about Hippo, but suddenly all the destroyage stopped.

Now, now Maggie and her toys look more like this....


She's a good girl....

Transference + sleep

First of all, Happy Birthday to Kate! Holy shit, you're 30!

There's a lot of that going around these days....

Meanwhile...I had more to say around my post yesterday, actually, but was just so damn tired. I'm looking forward to not being quite so exhausted all the time. Although, I have this feeling, I'm probably going to find ways to be just as busy next year. But with less call, and less commuting than I did this past year, so, that'll definitely help.

So, transference. We've been talking about this a lot lately at work, and will talk more about it as we spend much of our second year learning the ins and outs of psychodynamics and analysis. And transference is sort of the primary concept in analysis. Plus, I'm thinking of entering the NC Psychoanalytic Institute if I can make it fiscally feasible (see? Plenty to do next year), which means I'll be up to my id in transference.

Transference, though, is an integral part of what we do. Not that it isn't present in every patient-physician interaction, but we're the only ones who really pay attention to it and even encourage it. Truth is, it's central to most human interaction. And, apologies to Dr. Freud, but it's not that dramatic a concept - we all view our lives through the filter of our past experiences. We make judgments about people based on cues that are familiar, that we've seen before. Thus, we're conditioned to respond to a stimulus we've seen and responded to before, and when we see that stimulus in someone else, we'll of course respond in kind. At least at the automatic level; at a more conscious level, we can modulate this response. Often, for us, our own transference is a useful tool - i.e., feelings that are evoked in our interactions with patients are in response to something about them. If we can use those responses to identify what that something is, it can tell us a lot about people. Problem is, you have to know a lot about yourself, and possess a certain humility about that, to do this well.

And once you start to be able to recognize this, it becomes problematic sometimes to be able to dissect these responses from what's just a genuine response to the person in front of you. My woman's husband, who I did the couples' session with yesterday, I think he's genuinely a jackass. So it was a lot to sort through, you know? What of my dislike of him was due to my own transference, my own response to other malignant narcissists and sexual sadists I've encountered in my personal and professional life? What was my protective, maternalistic feathers being ruffled over what I knew he'd done to my patient? What was the fact that he was just an asshole in our session?

It was interesting, really. His wife, my patient, afterwards, was like, wow, I can't believe how well you handled him, how you got him to talk about things. I've kind of discovered that, in my professional dealings, I actually deal pretty well with controlling, narcissistic men. It's a power play, and if you operate on their level, they win. So instead, I tap into what they're evoking in me to give me cues about what sort of traits they might possess, and this where their weak points might be. And I think that in itself is a cue to pull back, which allows me the detachment to institute a number of techniques to gain the upper hand. In the words of everyone's (okay, my) favorite TV psychiatrist, "One of the ways to beat a psych defense is a psych offense."

Sometimes I don't like that about myself. Sometimes I feel that it's very useful. It is what it is, I guess.

And regardless, I still have to honor the fact that I left there wanting to kick him in the shins.

Oy.

My other patient, well, it's awkward. And I had much the same thought as PenguinShrink's, in her comment to the last post, but frankly, I think it may actually be a reason I should do therapy with him. He's an interesting patient, particularly from a biological perspective (he's got this old brain injury). I think he's reasonably innocuous, and I think identifying a strong woman who can set and maintain good boundaries with him is going to be a positive step towards dealing with a few of his issues. Plus, it wasn't a predatory kind of thing, I think it was more of an impulsive kind of slip, from someone who has fairly poor impulse control (see above re:old brain injury).

But don't think for a second that I'll hesitate to discharge him from my practice if he can't respect the boundaries of the therapeutic setting. And I'm definitely getting a left-hand ring before I start doing outpatient (I've been debating this for a while. This did sort of clinch it).

It's such a complex landscape, the human psyche.

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.