Darkness

Oh, for Pete's sake...

So I get home tonight....long day at work. Whiny patients. Lots of crap to deal with. Endless paperwork. 7am therapy patient.

Fortunately, I had my very first spinning class to look forward to tonight. And it was awesome. It wound up being a private lesson, because there were only two of us signed up and the other woman didn't show. And I LOVE it. She sent me home with a drop spindle and some roving, but I am so totally in love with the wheel. It's very....zen. I could just treadle for hours (and, in fact, did, for about an hour). I had lanolin all over my hands and left with about 11 yards of handspun from the wheel, and a huge ball of Blue Leicester Top roving to spindle. I am pleased. I have two more lessons, on the next two Tuesdays.

So I stop and grab some dinner on the way home, walk up to the door...and the dog is whining. And I notice it's awfully dark - usually the dog walker leaves the front room light on, and I always leave my porch light on. Hmm. So I go in, flip the switch, and....nothing.

Turns out, last week or so ago when I paid the bill that the power company finally sent me, the online bill payer never actually sent the payment. So they disconnected us. Also? My rent check "bounced" this month (more bank weirdness), and I came home at 7pm yesterday to a note telling me I was about to be evicted.

We have power again (when I started writing this, I was stealing my neighbor's wireless...). And are not being evicted. And I will get the bank straightened out eventually (because, you know, they're not open when I'm not at work...). But still....jeebus.....

In better news, only three more days until the weekend.....

A very embarrassing story...

One morning in high school (I think it was in the morning), we were running in gym class. Now, as I think I've mentioned before, I was in fat gym in high school. Which was actually way better than being in regular gym. We got to wear what we wanted, one day a week we had classes on stuff instead of dressing out and sweating, and not once did we have to spend weeks at a time playing Ultimate Frisbee. We did more actual working out than any regular gym class. And no one was the fat kid. In fact, not everyone was really fat. But, we won't single them out (even though some of them read this blog).

So anyway. We're running in gym class. I think this was my Junior year. I had on at least one sports bra (I eventually progressed to three before the jiggling was sufficiently contained). I'm running along, talking to whomever I was running with, and my friend says something behind me. And I made a very poorly timed look over my shoulder...

...and smacked myself in the face with my boobs.

Now, naturally, the four of us involved dissolved into giggles, and my gym teacher suggested moving up to two sports bras.

I'm a little afraid of a similar incident tonight, frankly.

I'm all vamped up and ready to go to Cleo and Tony's Halloween party. And I look like the prow of a ship.

A glittery, black-lipsticked, giant-hoop-earringed prow of a ship. Wearing jeans, because I never could find the skirt I wanted, and a name tag that says, "Hello, my name is Id. How can you serve me today?"

It's all very tawdry and...um...unconscious (that was a psychiatry joke, sorry. My anxiety's up a little, here).

::whimper::

The funniest thing, I think, is that this whole costume started with a ridiculous black and pink wig that Ruthie talked me into buying. Which annoyed me so much I'm not actually wearing it.

Okay. I'm going to stop babbling and go find my boxing gloves. Wish me luck, y'all.

It's like Lent

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Wednesday...which is almost Thursday...

...which is so close to Friday....

It's 9:35 and I've just finished my notes from today and yesterday. I can't come up with a coherent posting. So here's five random things about my day:

1. I officially have 89,000 miles on the Jeep.

2. I keep forgetting Easter is Sunday. My parents called, said they were going to Church tonight. I honestly have no idea what today is that requires church attendance. Next time this year, I might remember, but now? Too tired. No clue.

3. The patient who, last week, our fourth year "junior attending" resident pulled me abruptly out of the morning interview because he thought the patient was about to attack me? This morning, the patient was pleasant and polite and smiled and called me "hon." I think I fixed him, I think I fixed him! I also ordered an MRI on him and found weird "abnormal FLAIR attenuations". I have no idea what that means. So I called Neurology in. I don't think they know what that means, either.

4. I got solicited by some random asshole today looking for "fun with a BBW" (big beautiful woman). You know, whether men find my "deviant" body revolting or fetishitically appealing, I still really, really hate it. And for the obvious reasons, it just wigs me the hell out. I hate Match.com.

5. One of my current med students is trying to get a month's worth of med school credit for biking across the country. I think that's cool as shit. They do much cooler things here at Big Hospital Medical School than we ever did at Stritch. For credit!

Oy, I'm so tired.

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....).

"Safety is Always a Concern"

Oy. Read this.

On the homefront, still waiting for the crusties. Still itchy. Still feeling like crap. Still watching a lot of Law and Order (well, what did you expect, I've seen all the episodes of CSI by now!). Really hoping to go to work on Friday. Stupid pox.

And as an aside, are any of you other Blogger users finding that NONE of the little buttons at the tops work anymore? Not the spell check, the hyperlink, the image tool, none of it. Argh!!

Now back to today's regularly scheduled posting

I have today off. I love a good day off.

Call on Friday was rough, but not nearly as brutal as the last one. We actually managed to evade four admissions, which was handy, because we had six. My new call senior is weird. Very nice. Very knowledgeable. Very religious. Like, Evangelical Catholic, doesn't swear, won't prescribe birth control, can't say "God damn" in front of her. She got very excited when I told her I was Greek Orthodox. I'm not really sure why, because the Orthodox church is, um, old and stoic, but nowhere near Evangelical. And I certainly neglected to mention that I've read the Quran and the Mahabharata and I think Wicca has some good ideas and if the Church wasn't so ingrained in my family and my culture and my damn DNA I'd probably be a Buddhist (but then again, I have this theory that Jesus would be, too). She's also very slow, and overly thorough, and insisted at the beginning of call that I should do all the admissions, even the Green team ones, but that not only did I have to do all the work, she would come in with me to do the interview, like I was some damn medical student that couldn't tie my own medical shoes. Which, I think she's more motivated by her OCD than her mistrust of my abilities, but it still is annoying. And she's really nice. And she did do the 2:30 admission by herself even though it was a Blue Team patient, and I went to bed. Which was lucky because I was about to fall over.

And then in the morning I tried to put an IUD in this patient of mine who needs one for host of reasons that have nothing to do with contraception (she has her tubes tied already). And so we wheeled her allllllllll the way over to the Women's hospital so we could use their procedure room (not a short drive), and tried and tried, but her os was stenotic and it just wouldn't work. I tried. My attending tried. We couldn't get her to dilate enough to get the tiny little uterine sound in (it's about the size of a US3 knitting needle), much less the Mirena introducer. It was very painful for her, and I felt really, really bad. Really bad. So I called gynecology, to see if they had any ideas. Here's an excerpt from our conversation:

Me: So, I have this patient that I'm trying to put a Mirena into because [long, technical description of patient's medical history]. And I couldn't insert it because her os is stenotic

Him (before I could really tell him why I was calling the consult in the first place): Okay, first of all, [long, technical description of why my thinking is wrong. A conversation ensues about why I want to do this in the first place involving a lot of circular logic and me repeating myself].

Me (finally): Okay, whatever, anyway we thought maybe you could offer some ideas about the next step here.

Him: Well, she's bleeding, right?

Me: She is.

Him (chuckling): Well, her os has to be patent, because stuff's getting out. Otherwise she'd have metrometria.

Me: Duh, you dumbass. I said stenotic, I never said it wasn't patent. Okay, fine. Clearly her os is still open, but it's smaller than a uterine sound, which means I can't get an IUD in.

Him: Well, something you could do to make this really easy is to ripen her cervix with some -

Me: I did that. Last night. She got 400mg of vaginal misoprostol.

Him: Oh. Well. Did you sound the uterus?

Me: Of course.

Him: Well what did you use?

Me: Um...a uterine sound?

Him: Oh. Well I always sound the uterus with an endometrial sampling pipelle. It's easier on the patients and you know, you can't create a false passage through the cervix. (My attending's response to that comment when I told him later: "What's he on? You can do that any time you start poking around the cervix. You can do that with a speculum." Not really, but, the point is it's crap)

Me: Okay, whatever. I used a sound.

Him: Well, did you have good visualization of the cervix?

Me: No, I started poking blindly in her vagina with a sharp object. Of course.

Him: Well, did you use a tenaculum?

Me: Of course.

Him: Well, did you pull traction on the -

Me: Of course I did. I used to be a gyne resident. I know how to do this.

(Long pause)

Him: Well, if you know how to do this, do you really need a consult?

Touche.

In other news, I've started knitting up the yarn I got in my yarn swap with Tiny Tyrant.


It's a local (to her) yarn company called Royal Hare, handpainted superwash merino, dk weight (appropriate, no?). The color is Mt. Tam Moss. It's lovely. I'm knitting it on size threes (in the picture, it's on my little tiny Addi dps, but I started it doing magic loop on my Addi Lace that's a little too long - I think it's a 40" cable - and the sock went back on the Lace about ten minutes after this picture. The dps lasted about three rows. They were just too poke-y). I'm using Sarah's basic toe-up pattern, with a broken (moss-stitch) rib on the instep/leg.

I'm debating whether or not I should take my sock to the department Super Bowl party I'm going to this afternoon. That's a lot of prime knitting time. But I'm not sure they know me well enough yet for me to pull out the knitting at this sort of function...

Ooh, do you know what I'm doing tomorrow, though? I'm going to Duke Law school to be a fake expert witness for their trial practice class. Should be a fun time.

Some nights I'd be better off as a real call girl

So, here's my call in a nutshell: At 3:30 this morning, I called my shrink and left her a message asking if she still had that noon appointment open.

One of the points we're "working on" in therapy is how I never call her between sessions if things are bad.

Oh, my God, last night was pure hell.

We had nine admissions. It was a busy night. And in fact, we got ten....except that the person I started admitting at 6:30 this morning...okay, that was a disaster. The psych resident saw this woman and said, well, gosh, I'd admit her, but we don't have any room, so, see if primary care will take her, sorry (um, how many people do we send out to other hospitals because we don't take their insurance or we're full or whatever?). She sees an FP, so they called me. I couldn't find the sheet that says which Family practices we admit for, but they have a copy in the ER, and the name sounded familiar, and he'd just woke me up from my five minutes of sleep I got last night, so okay fine. I was already pissed because this was a dump from psych - she came in because she was depressed and needed psychiatric help and when I got down there...ohh. She was this sweet, sweet sixty year old woman with a 20 year alcohol history who came in because she was depressed and drinking too much and she couldn't handle her life because she has lung cancer and her husband of almost 50 years is dying of brain cancer. I reassured her husband and her son. I held her hand. I did the most thorough psych intake exam she could possibly have gotten on a non-psych service, despite the fact that I had a large pile of patients to round on and a ton of work left and only like a half hour to do it. But how could I not admit her?

Well, apparently, I can't. Because we don't contract for that practice. So my on-call senior was going to call the ER and have her go to internal medicine and "take care of it."

I just spent how long reassuring the whole family I'd take care of her. That she'd be well tended and she'd have two psych residents on her team and her family trusted me enough to finally go home and now I wasn't even going to go down and tell them I couldn't admit her?

Thinking about it after I left today, I should've fought it. I'd already done all the work. I should've argued for her to come to our service.

But the real problem was the patient I admitted Wednesday before we left. She turned out to be a raging nightmare. She made me cry four times. I think I managed not to cry in front of her, but I cried in front of the nurses. In front of my attending at 11pm. In front of Mike and Betsy this morning. I've only had one other patient this whole year who made me cry and she was a crack whore sociopath.

The reasons she got to me so badly just go on and on (hence, the call to my shrink), but the root of it really was that she's someone I consider a friend. And I tried. I tried so hard to take good care of her. She sucked me dry last night. And to her credit, she called and apologized this afternoon. And, she's really sick. And she's got her own stuff going on psychologically. Which I understand - believe me, no one can relate to that kind of ingrained PTSD better than I can. But between spending my whole 30 hour shift wholly investing myself in her care, and, you know, the other ten patients we admitted, and oh, the twenty five or so I was cross-covering.

But this was really nice - My senior got to bed a good hour and a half before I did, at least. I finally got up to the call room at like 5, right? It's actually a call suite - there's a little bedroom with bunk beds and a common room with a computer and a TV and a futon. I always sleep ("sleep") on the futon. I usually leave it folded up, because I like to snuggle up against the back (I sleep with my bed against the wall at home). But anyway, I walked into the call room, and found the futon out and all made up with two pillows and a couple of warm blankets and the sheets turned down, waiting for me.

Betsy redeemed herself a little today, too. She was really supportive and did a good job trying to get me out today. She also tried to make it more about her and at one point outright called me fat, but, at least she said she'd want me on her side in a fight.

I'm really having trouble with how "out of control" I got last night. I can't believe I let anyone see me that upset. I can't believe I cried multiple times in front of people. Betsy and the Duke resident both made the comment, "I've never seen you like this!" Like they've known me for so long, you know? Still, I don't like it when the cracks in my carefully crafted facade are exposed. And I'm not sure Mike took my unhingement all that well.

And of course, me "unhinged" mostly involves crying while continuing my usual get-things-done shtick, and is still more way tightly bound than some people on a good day. But I don't much care how well they can hold themselves together.

My attending handled it well, actually...I think we were sort of in this together, which helped. He's normally one of the most unflappable people I've ever met, and this situation clearly had him...um...flapped. I mean, he needed to be the point person on this, and I kind of had to push that on him a couple of times (including a text page I sent him at about 9 or 10 pm that literally said "HELP. Sarah's out of control"), but he ultimately took the brunt of things this morning and was remarkably firm and really just did an excellent job this morning trying to lay down strong boundaries. I learned a lot from him over these two weeks, mostly in the behaviors he's modeled. The past 48 hours were obviously no exception to that.

Meanwhile...I'll call Sarah back tomorrow. We're going to be fine, at least from my end; I know this is beyond extenuating circumstance for her. And by the time I get back to work on Monday she'll be home recovering and all will be well.

Did I mention I have the whole weekend off? It's my "golden" weekend (postcall Friday, whole weekend off. So, um, sort of like the real world. Not sure what exactly is so golden about that, but, you know). I'm so excited about that, I can't hardly tell you. I think Maggie's a fan, too.

Somebody's gettin' on my nerves...

(Missed the reference? Click here. Before I forget that I'm a lady and give 'em what they deserve.)

People are driving me crazy tonight.

Today was a weird ass day. It was Wednesday, so all the Family residents scampered off to their academic stuff all morning. Which meant it was pretty much just me and Mike and a bunch of attendings. We rounded, I got my notes done, and was more or less ready to leave at noon. It was a nice morning, actually. Mike and I got stuff done, Betsy was gone...and then the attendings started talking about how Sarah, my attending from two weeks ago (remember her?) was in the ER and coming on to the Family Medicine service as a patient.

I like Sarah. She's kind of a lot sometimes, but she's a really good person. And we'd already agreed that we needed to stay friends after she relinquished her position of authority over me. So I went down to the ER to make sure she was okay, offer to take care of her dogs, whatever. We got to chatting and I said, Red Team's admitting, but you know they're going to let you decide whatever team you want to be on, so I'm sure you're just as good to go on Green. And she says, can I come to the your team? I said, of course. And promptly called the covering attending and told her that Sarah wanted to come to the blue team and I was already down there, I'd do the H&P and take her on as my patient. Even though, you know, I'm on call and thus the admitting resident tomorrow.

The attendings appreciated it. Sarah appreciated it. I'm not sure the on call residents were as thrilled, but, should they really care? It's an admission they didn't have to do.

And then I discovered my really manipulative patient we discharged last Friday was back. The one who was so freakin' personality disordered and like ate my whole day and then frakkin' Betsy comes in and plays right into the manipulation and triangulation and the next day we discharge her and she wants Betsy to be her real doctor (a-ok with me, sister, even though someone in my line of work is so much more what she needs. But, please, go play dueling Borderlines, with my blessing) and Betsy sends her out the door with pain meds. Wait, let me rephrase: Betsy sent a known narcotic dealer and abuser out of the hospital with prescriptions for oxycodone, oxycontin, and ambien.

My mind boggles at the street value alone of this little hospital stay...

So she's back. First, the on-call resident tries to get me to do that H&P too, even though, um, I'm NOT ON CALL TODAY. And then Mike and I decide that she clearly needs to be Betsy's to follow, because the patient and I do not get along (because I'm a hardass that sets limits), and because she's technically Betsy's primary care patient, Betsy should see her anyway. So I gave B the courtesy of text messaging her this info - she's yours to follow in the am, and oh by the way, we picked up Sarah on our service. The flurry of texting that ensued just pissed me off on so many, many ways. Suffice it to say, I'm seeing the sociopathic patient in the morning, along with my other four patients. Despite the fact that I'm on call tomorrow and thus admitting. Know why I have to see her? Because Betsy has afternoon clinic, and so she can't possibly see ONE FUCKING PATIENT tomorrow.

I'm so ready to be done with her. Which will be Monday. And I have the whole weekend off. Thank God.

And just to add injury to insult to this day, Mike and I escaped the hospital about 3 and went to this cute place in Carrborro for lunch. I fell down. On the way in, before I'd even had anything to drink. In the middle of the street. Tripped over my shoe. In the middle of the street. Boom. Scraped my elbow. Felt like a moron. Mike, fortunately, picked me back up, hugged me, and then plied me with really good alcohol. It was an excellent response to the situation. I still feel like a moron. But at least lunch was good.

Adding to the list of necks I'm going to break...

So I come up to the men's crisis unit to evaluate this poor sad sack who fell on his wrist. And this little Hispanic man in his early 20s with this innocent little bowl haircut comes up to me and says, "Do you remember me? I remember you!" And then he puts his hands out about two feet wider than I actually am and says "You're big, like this."

Do you want to get put in restraints? Because I'll do it. So help me God I'll do it. Learn how to talk to white girls, Paco.

I do remember him, though. The last time I admitted him he thought he was the Virgin of Guadalupe.

And at least he said it with adoration. Alright, I have to go assess the fourth person with an injured hand in two hours. What the hell is going on here tonight?