"Maybe God remembered how cute you were as a carrot."

A classic Olivia Benson line from this week's SVU (which I finally watched today after I got home from a ridiculously long flight on the tin can. At least it was a pretty day). Which...well....I liked it.

They really need a psychiatrist on the consulting team.

Now, maybe things are different in New York. But holy cow, Kathleen totally could've been committed in North Carolina. In fact, I think I've treated Kathleen a couple dozen times. And I can't believe Bernie only got sent to the hospital once. But on the whole, a well-ish done episode. Ellyn Bursten was good.

Hmm. I had more to say about this, but then I got distracted by the GIANT COCKROACH on my wall. Ew.

Ewewewewewewewewewewewewew.

I have to go call my landlord.

Sadness

Sometimes, I forget I'm allowed to feel stuff.

It's one of those therapist-y things, to some degree, You know, we're supposed to be all neutral and not have personal lives and know how to handle shit. Which, of course, "handling" things doesn't actually mean not having emotions, but rather, having them, knowing what to do with them, working through them, blah, blah, blah. But you get used to being all dispassionate and impartial and "what do you think about that?", that sometimes you forget the tempered side of things doesn't actually mean being detached from everything. That's just boring.

In some part it's one of those trauma survivor things. You get into this mindset of, you know, like, "victims" are controlled by their emotions and their trauma, but, "survivors" control theirs. Which, is, of course, crap. There are many things that differentiate the two; that is not one of them.

I've been running around for the past two days, very, "oh, no, I'm fine, thanks." And I *am* fine. But I often forget it's just fine (even for me) to be a little not fine. So, yeah, I'm fine. I'm also sad. And exhausted. And I think I'm coming down with something.

Thanks, everyone, by the way, for all the kind words and support.

::sigh::

But in better news, my cellmates officemates and I went to dinner after work tonight, at this new chain spot called Evos. It's all organic, healthy, eco-conscious fast food, blah, blah, blah. They "air bake" their fries. I was skeptical, but it was really good. The fries, well, taste like fries. The burger was free-range, hormone-free, antibiotic-free, and really tasty. And I had one of the best chocolate shakes I think I've ever had. Plus, the company couldn't be beat.

I only had one class tonight, which was nice, because I hadn't even done the reading for that one. And then Sparrow and Maxine came over (to retrieve Sparrow's laundry). And now I'm watching the premier of SVU, which, the only thing I can say about it thusfar is, dude, I think that kid's been on our unit....

Pizza Sunday

Ah, I really do love a whole weekend off.

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

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

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

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

2. Preheat oven to whatever the package says.

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

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

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

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

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


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


9. Wonder why dog never listens.

10. Stick the pizza in the oven.

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

12. Realize that you forgot to set the timer.

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

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

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

16. Open back door.

17. Cue smoke detector.

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

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

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


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

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


It's a good thing.

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

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

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

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

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

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

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

Hey, look, I'm late...

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.

Operant conditioning

So today, we started our Academic half day. Which means that we have lecture all Wednesday afternoon. My classmates don't have clinic scheduled in the afternoon. The time is supposed to be "protected" for all residents. Which means they sat in lecture and I got paged all frakking afternoon.

Blah.

Okay, I ignored most of the pages, mostly in the hope of beginning the process of conditioning the floor to not freakin' page me during the hours of 12 and 5:30 on Wednesday. It didn't go so well. Particularly when the medicine resident misordered the blood gas she didn't bother to tell me she was ordering in the first place. Argh.

My dog, though, has the concept of operant conditioning down cold. So, now, Maggie, is useful for keeping things clean around here. We have a good system. I drop something edible on the floor, I say, "Uh-oh, doggie!" (shortened from, "uh-oh doggie, you'd better come here!"), she immediately drops whatever important doggie task she's doing, and she gets a tasty tidbit for her troubles. When this becomes particularly amusing is, like, tonight, I'm making dinner, and I added way too much of something, and I say, "Oh, shit!"

Dog wakes up out of a dead sleep, leaps off the bed, scrambles into the kitchen, and gets all confused when she can't find anything on the floor. It was very cute.

Today was long. And I'm so tired. And I still have six notes to write, but, I came home to write them, and now the electronic medical record won't let me in.

::sigh::

I did get a lot of knitting done during our lectures, at least. And, since I was knitting, I was paying attention, and they were actually enjoyable.

Have I mentioned how excited I am about psychotherapy clinic this year?

Also with the being done with intern year. I'm definitely excited about that as well. 25 more days.

In my continuing efforts to live life on life's terms (to borrow an AA aphorism), I am taking this as a sign from above that I am supposed to snuggle with the dogs and go to bed early.

Oh, but I'll leave you with today's SVU quote of the day, courtesy of everyone's (okay, my) favorite TV psychiatrist, Dr. George Huang:

"Boys are socialized to express their anger. Girls are socialized to be nuts."

Ow.

Last time I saw my God daughter (she's six), she told me this exact story:

"This summer we went to Mexico and we flew in a big plane and we sat in the back and I sat near the window and I kept asking my mommy, 'Are we in Mexico yet? Are we in Mexico yet? Are we in Mexico yet?' And then my mommy got a headache."

My aunt and uncle came over today. And then I got a headache.

I don't think the two are more than coincidentally related, though, frankly.


(It's a random cartoon I found on the internet while doing an image search for "headache". It really amused me. The only credit I could find was that it was filed under "Ben is a dork." I don't know what that means. God, I love the internet.)

You know those days where you wake up and think, okay. I have a plan today. I'm going to do this and this and this, and it's going to be fabulous. And then the dog vomits on your bed and the light fixture explodes and you end up washing ranch dressing off the ranch dressing. You know those days? Today was one of those days.

Oh, it seemed like such a nice day when I woke up at 6:30. Which is a ridiculous hour to be up on a weekend day, but, whatever. Mags and I lounged in bed and watched an early morning prelude to the SVU Marathon on USA today (God, I love USA, aka the all-Law-And-Order network). And I thought, okay, up, shower, go to Starbucks to work, come back, unpack a little, have lunch with the fam, come back, make some espresso, unpack again, go to the new intern thing, come back again, go to bed. What a lovely day, right?

Ha.

I went into the bathroom, and the light made this weird hissing sound. And I thought, oh, the bulb's about to burn out, whatever. And then all of a sudden, the leftmost socket (the only one with a functional bulb in it) EXPLODES in a loud, popping, shower of sparks. I ducked. And then I made sure nothing was on fire (note to self: She who lives in an old house made entirely of wood should really buy a damn fire extinguisher! Anyhow...). And then I put new bulbs in it and flipped the switch. That socket's blown, but the other two still work. When I go back to Lowes to replace the blinds I bought that are an inch too short, I'll get a new fixture. Because if I wait for the handyman to fix it, it'll never get done. ::sigh::

And then I went to Starbucks, and managed to finish all the outstanding Child discharge summaries I had (I still have a couple from the adolescents, but I'm less worried about those because I really want my attending from Child to like me. Not that I don't want the other one to, but I really liked her, and so I want her to think I'm like the best resident ever, right, so she'll take me under her wing and turn me into a really good C&A psychiatrist and vote for me for a fellowship at Baby Blue. Okay, no, that's all secondary. I thought she was cool and so I want her to think I'm cool, too. It's so...well....adolescent....). And dropped my tea. But I only spilled a little. So then I went to Target and bought a $14 rice cooker (because my $40 one always burned the rice) and some groceries. And spent a lot of time standing in the aisles going, now...what the hell was it that I wanted here? And, um...where was I going again?

It was the first of many times I would ask myself today, what the hell is wrong with me??

I came home. I swore a lot and tried to find a place for the groceries (have we talked about my lack of cabinet/counter space?). I unpacked more of the kitchen. I had to stop several times and go into the other room before I started crying about not knowing where the hell to put the glass bowls or not being able to remember the word for "toaster oven" or being a big spaz and dropping things. So I went into my room and the dog hops on the bed and is all smooches and snuggles and rub my belly until, without warning, she yaks all over the blanket.

Oy.

Fortunately, I was able to locate the OxyClean with minimal swearing and fuss. And I rinsed the blanket out in the bathtub because my uncle hadn't actually come over to hook up the washer/dryer yet. Frack.

So they showed up, with tools and a milk pitcher and air filters for the furnace (because my aunt says to me yesterday, "Have you checked the air filter? If you tell me what size it is, we can pick one up for you on our way" And then I sent her a long email saying EW EW EW EW THAT'S THE GROSSEST THING IN EXISTENCE, EW! No WONDER the place still smelled like cats!). We changed the gross filter of disgustingness and went to lunch at an Indian place in Durham. And then we came back, and my uncle and I spent WAY too much time trying to figure out my new espresso machine.

The Starbucks here had a tent sale last weekend, to clear out their old model coffee makers and make room for the new ones. My $50 Target espresso maker didn't survive the move, so I thought, you know what? This is going to be my congrats-on-surviving-intern-year-AGAIN present to myself. So I bought the Sirena, which was originally $600, marked down to $199, and then got the 20% tent sale discount PLUS the manager's additional 10% employee discount (because he knows me. Because I went to that Starbucks every single morning that I lived down the street). Wow, what a deal! And it's so nifty! And it's made by BMW! WOW! I have the BMW of espresso machines, cool!

Leave it to BMW to turn espresso into a ridiculously complicated process.

Now, part of it was, again, I kept dropping things, and I was just generally like, "what?", and my aunt kept coming in and saying "Where do you want this? Where do you want this? Where do you want this?" and I kept getting all overwhelmed and confused trying to make espresso AND arrange the kitchen. And after we finally figured it out and made some damn good espresso (what do you know? The $600 machine really DOES make a better cup of coffee than the $50 one!), then we hung pictures and moved the TV (because the one in my bedroom chose today to die, ps. Not that I didn't buy it, oh, my first year of medical school, and not like I didn't buy it off the clearance rack, but, nevertheless...) and then my neighbor came over to complain that my empty water bottles outside waiting to be picked up were over the property line (no, really! Way to meet the new neighbor, huh? She didn't even bring cookies!). And then my aunt and uncle left and Maxine came over and she and Maggie sniped at each other a lot (jealous, jealous puppies over here). And I tried to do the dishes and make a salad for tomorrow and discovered one of the neat little single-serving cups of ranch dressing I'd bought this morning had mysteriously exploded all over the refrigerator and the other little cups of ranch dressing (which then became part of the dishwashing extravaganza) and nearly wound up in tears again and for the five hundred eighty fourth time thought, Jesus, Mary, and Steve, what the hell is WRONG WITH ME?!

And then I went...

Wait....what's today's date?

Oh.

Nevermind.

And somewhere in that mess of dropping things and verging on tears and stuff exploding, my catamenial migraine hit. That's what all the clumsiness was about (I have no idea why things kept exploding).

You know, most days out of the month I really like being a woman. And most of the time I don't even mind the monthly ritual of sloughing and end up humming Ani DiFranco's well-stated and empowering Blood in the Boardroom, with it's lines like "I bleed to renew life every time it's cut down" and "Men have all the money, they have the implements of death, but I can make life you know. I can make breath". But every now and then I revert back to the real meaning of what I'm commonly heard to say, "I think God took all the souls that couldn't handle being women and made them men."

Which really means, sometimes? Being a woman totally sucks. Bleh.

Chillin' out, maxin', relaxin', all cool and all...

(If you missed that reference, and you are roughly my age, you should be very ashamed. What, did you live under a rock?)

I spent, like, the whole evening on the phone. Today was better, but I'm so tired...I'll give you the update tomorrow. Meanwhile, here's some gratuitous pictures of my girl, hanging out, watching a little SVU.

Ohh! It's the mid-episode plot twist!

::sigh:: Funny, that used to be my spot for laying on the couch watching tv...

I dream of angels but I live with demons

Today's SVU quote. From a schizophrenic suspect who refuses his medication. Which, incidentally, drove me crazy about this episode because, seriously, we force meds on people who aren't sane enough to want them all the damn time.

But I do feel like this is a nice summation of the struggle that is mental illness, regardless of whether it's schizophrenia, bipolar, depression, trauma, eating disorders...no matter if you actually hear voices, or just deal with the voices in your head.

I feel like this a lot myself, actually.

Today was...not a good day. Got some bad news. My dog ran away when I opened the door to clip her out (she's back, but not before she got about a hundred feet from the big major street by our complex, which is on the other side of an on ramp for the highway. I was already getting a little screechy, I was a hair's breadth from hysterics when she finally turned and came back over to me). It turns out we lost in not-court, despite the fact that the plaintiff has NO EFFING CASE. I tried to redo my nails and got smeary goop all over everywhere. Blogger freakin' refuses to upload my pictures.

I'm not pleased with today.

I did go to the yarn store, though, and got replacement yarn for a new shawl. I spent about twenty minutes picking up the same three balls of Encore and being displeased with my choice of the same three balls of Encore when I finally spotted this hand painted yarn called Elaine by Schaefer Yarns. I'd show you a picture, but.... I also got more Lamb's Pride for my friend's baby blanket. I'm going to be doing an awful lot of garter stitch in the next few weeks...

Hot blooded (check it and see)

(Miss the reference? First of all, shame on you. But, if so, click here.)

Technically, my temp's only 102. And, I told you it wasn't the flu.


Which is fortunate. What's unforunate is that they had to suck stuff out of my nose to find out. That was a little uncomfortable. I also don't have strep, in case you were wondering. But they sent me home from work today regardless.

I really felt like shit this morning when I went in, and then I started having shaking chills during rounds. Which is when I decided I probably shouldn't take call tomorrow night. And I was talking to my cohort and we got to discussing the fact that there've been several lab-diagnosed cases of flu on our unit. And I said, hmm, maybe I should go get a flu swab. And then if I do have the flu, I'll just do my work with a mask on tomorrow, and...my co-intern was like, dude, they're not going to let you work if you've got the flu.

So what did I say?

"Oh. Then I'd better not go get swabbed."

So what did she say?

"Don't be an idiot."

She was right, of course. So I go down to Employee Health, and ask for a flu swab. The nurse was like, hmm, yeah, we don't typically do that. I said, we've got all these patients upstairs with flu upstairs. She said, welllll, I'd have to talk to the epidemiologist. I said, okay. She sighs, says, fine, come in, we'll at least take your temperature and whatnot. And, lo and behold, it was 102.

She goes out of the room. She comes back in wearing a mask. Umm....

So they did a nasal aspirate for flu and a rapid strep test and they sent me home. And I spent a good 45 minutes fussing and working and trying to rearrange the call schedule so my call was covered and figuring out the work for tomorrow and finally my chief resident threw me out and as I turned to leave I saw him reaching for a bottle of Purell. And it cracked me up a little. Which of course sent me into a coughing fit.

Employee Health paged me about a half hour later and said, everything was negative. So if it's flu, it's not Flu A. Which means it could be Flu not-A, of course. Or just some random upper respiratory virus. But I'm banished from the hospital until I've managed to not run a fever for 24 hours. Which means I'm missing work again.

I really don't know what else I can take this month.

The final irony of it? The call switches they worked out put me on call on Roman Good Friday. Which, um, not a very big deal to me, because Orthodox Easter is like a month and a half later than Roman Easter this year. But it's a holiday. And being on call on a holiday earns me a comp day. Which is an extra day off, scheduled at my discretion.

I....really though....

So it's Thursday. Let me start with some things I don't love. Don't love the not-A Flu or whatever this is. Don't love Afrin (it really makes my throat burn and I'm not sure it's worth the decongesting). Don't love missing work AGAIN. But here are five things that I do love today:

5. Kleenex.
4. Getting comp days for being sick (okay, not that I don't have to actually work the holiday, too, but still)
3. Nurse Maggie
2. Hot liquids
1. My DVR, which I've been lying on the couch watching all afternoon. So here's today's quotable SVU.

Tutuola: What's all this?
Stabler: Asbestos testing.
Benson: It's in every building constructed before 1970.
Tutuola: I'm not stayin' in here with all those tiny cancer-causing particles flying around!
Munch: Stop worrying. As an African-American you're statistically far more likely to die of diabetes, high blood pressure, or heart disease.
Tutuola (defensively): Or a bullet!

It's possible I'm a little delirious, but that made me giggle.

Oh, and PS - tomorrow is the Blog 365 "Day of Rest", so I'm not compelled to blog tomorrow under the rules of the...um...game, arrangement, whatever it is. We'll see if I have anything to say tomorrow. I might just hide from the end of February (before something ELSE tries to follow up the pox/court/high fever trifecta....).

Yet another perspective

So I'm watching some Law and Order:SVU rerun tonight, right? Because I've got a couple dozen of them DVR'd and waiting for me at this point. And in this one, which probably has an episode title but I don't know it, Mary Stuart Masterson guest stars as a cop-turned-psychiatrist. And Olivia is yelling at her because their victim, a very disorganized and psychotic schizophrenic, has just checked herself out of Bellevue after her 24 h hold expired.

First off, yeah, right. Like that patient wouldn't have been petitioned so fast she'd have had paper cuts. Second of all, maybe it is different in New York, but most states have a 48 or 72 hour hold.

But nonetheless. So Olivia says to her,

That's the problem with the mental health profession. You medicate them, just enough so you can cut 'em loose, and then nobody monitors them. They go off their meds and the next thing you know, they either become the victim of a crime or they commit one. Either way, we have to clean up your mess.

Some days, you know, I feel kind of the same way.

I got into a thing with our social worker today when I refused to discharge a patient because he lied to me about having a place to stay. It's possible his family lied to him. I think everyone was lying in this scenario, frankly. And so I made the decision that he was going to stay another day so we can make sure that the new place he's told us he can go is valid. And the social worker was like, why are we so concerned about where this guy is going? We toss people out on the street all the time. You know, homeless people, we just send them out to be homeless again.

And she's right. Last week I discharged a guy to the TTA bus. He was going to take it to Durham and "figure something out." I kept arguing with him that he needed to identify someplace safer that "figuring something out", but he said he was sick of stability. He gave me no reason I could commit him. He was voluntary, and he wanted to leave. My 72 hour hold expired. I had no choice but to discharge him to the streets.

At least with this guy, I had a choice.

Most of the time, if we send them to a shelter, is that really any better? Is it really any different? Some of them are only open at night. They're all overcrowded. There's just no good answer.

Which is part of why it sucks to be really crazy.

Sometimes this job is really hard (you know, like math, right PS?).

I spent the better part of an hour telling my one patient's parents they need to back the hell off and let him be a grown up. He's 18, wickedly neurotic, and very enmeshed with his family. And when I got in this morning and found that his mother had camped out in the waiting room all night and was planning to more or less be there until we discharged him so she could come in at every visiting period, I gained a much better understanding of why. So I went out, gave some really basic advice. A little bit of logic. A few reminders about how hard it is to establish your own individuality. He's a good kid. He has a lot of potential. They want to know every detail but at the same time they validate nothing (his four years of being chronically suicidal was "teenage moodiness"). His mother told him that because she never felt suicidal when she was depressed that he wasn't really depressed. Oy.

I have another woman who was supposed to be discharged today. She was doing fine, and then last night started seeing little brown monsters jumping on her bed. So, I kept her today, too. She, incidentally, was the patient of Dr. Ming's of yesterday's post. I think she legitimately has multiple personality disorder. Like my cousin. Like my good friend down south. Like my ex. And there is a lot of division in the profession about whether or not this diagnosis even exists, right? I think it does. I think it's the end of a spectrum of something that happens to all trauma victims, particularly those who are traumatized at an early stage of development. However...not everyone thinks the way I do. And now I'm starting to understand why my friend in Florida never wants to go into the hospital when she needs to. When she's unsafe, it feels safer for her to sit home in mortal peril than to go to a "safe place" where people can help her.

Some days, this job also makes my head hurt. Or it could be that I'm getting a cold.

Whatever. It's time for bed. And so with that thought, I leave you with another SVU line, from a subsequent episode. Everyone's favorite Cop Killa turned TV detective, Fin Tutuola (Ice-T), busts in and goes all undercover narco on this shifty lawyer, and the lawyer looks at Fin's partner , who's sitting in the back of the office, asks, "Who the hell is that guy?" Fin says,

Him? That's my Jew.

That one made me giggle.