Sunday night

I'm up way too late on a school night again.

I had SUCH a productive day today (finally!). Mags and I got up this morning, bummed around for a bit, and then I went to Starbucks and spent more time on paperwork. Which I finished. Seriously!! I'm totally caught up!! You know, until tomorrow, when I get behind on my notes again... Anyway. Then I made it back to the gym for the first time in almost 2 weeks. I picked up some lunch, came home, and then....wait for it...I cleaned. No, like, I unpacked and stuff! You know, it's only been six months since I moved back here. And this morning, if you'd come to my house, I would've made you stand on the step, unless you already knew me well enough that you were at this point required to love me. Now? The first floor still isn't awesome, but it's clean enough that I'd let you in my house. I'd even invite you to sit down.

Crazy, I tell you, crazy.

This evening we had a dinner for the prospectives who are interviewing tomorrow (it's recruiting season again...). It was at a pretty nice place down the way from the hospital. We had six prospectives, two spouses, and four of us. It was a pretty good time actually. And I have leftovers easily for two days. I had a really interesting time talking to one of the gals and her husband, who's a high school teacher and had some great stories to tell about his students (his wife was like, "When I was on the Adolescent unit, we discovered that we do the same job"). Plus there was chocolate. And then I went to Whole Paycheck and picked up a couple of things I needed and spent the whole time being "that person" on the phone with Veronica, who has nearly convinced me that I need to write a book called Queen Nut in the Nuthouse. Don't steal that, it's mine.

Anyhow, y'all, it's been a good day. And now I'm hoping for a good night. Because I have an early patient tomorrow, and then? It's gonna be a long week....the only night this week I expect to be home at any reasonable hour is Friday. Oy...

Tired

Dudes. It was a crazy long day. Full of crazy people. And crazy shit. And my own craziness.

Crazy.

And this is kind of how I feel.

(I stole that from my Weekly Coyote email courtesy of The Daily Coyote. I have multiple pictures of Ms. Mags making that face, but this one is her long-lost cousin Charlie. I opened my email tonight, looked at this and was like, oh, exactly....)

Throwback

So I'm postcall.

I know, I know, I said I was never going to have to take call again, there may have been a happy dance involved, etc. But, to clarify, I believe what I actually said was more that after that, any time I was doing "call" it was going to be voluntary and heavily compensated. And this was.

I think we killed Veronica on Friday. She and I left Friday night about the same time, she'd had one beer, she was looking a little peaked, but well, she's an intern, they always look a little peaked. We left because she was on call yesterday and I was just freakin' tired and had shit to do over the weekend. So I came home, blogged, stretched out, fell asleep a little after 1. Woke up at 7:15, of course (after waking up at 5), and was sort of dozing, mostly refusing to get out of bed, and my phone rings. And it's one of our chiefs, and she's like, "The intern is sick and can't take call. I'll give you three comp days if you do it."

Once I actually woke up, I was like, hell yeah. I'm all over it.

So I made a mad dash for the shower, found my scrubs, ran out the door, and despite my commute and the proximity of her calling me to the start of the shift, I made it by the end of checkout rounds. I was on with Scott, and we had a rockstar medical student (also named Kate). And two new ED evals waiting for us by the time I got there. So Scott went off to Second Year Consult Land, and the Kates headed down to the ER. Go team. Break!

It was a constant stream. We were essentially bedless, so there was a lot of referral action going on. It was a crazy shift. I didn't see my office after I dropped my stuff off in the morning, much less my bed. And for that level of chaos with two upper levels on, I can't even imagine how awful it would've been for a sick Veronica.

Crazy.

But interesting, and amusing in a lot of ways. We had some really good cases. Scott and I work well together, and Kate did a great job. We functioned as a remarkably good team, actually. And we had a couple of short lulls. One was like early evening, when Kate was still there, and we had a very good discussion of object relations and projective identification and a whole bunch of related nonsense that Scott and I are both pretty into, and she seemed to really enjoy. The second was sometime after midnight, when Scott and I finally got around to ordering dinner (one thing I did not manage to do during my AM Tasmanian devil impersonation was grab any sort of provisions for the day, because, well, yesterday was my day to go grocery shopping...). Of course, we hadn't had lunch until 3:30pm, so, midnight seemed pretty reasonable to us. Tarheel Takeout had already stopped delivering by the time things quieted down enough for us to think about food again, but we discovered this pita place nearby that delivered, and was pretty tasty. Good falafel. He and I also had a chance to decompress a little about some issues in the residency that we generally agree on, but on which we often have different outlooks.

One thing I found especially amusing yesterday was how shocked the medical student was that we all talked so openly about being in therapy. We both kind of shrugged and were like, well, how are you supposed to see things in other people's patterns if you don't know anything about yourself? I gave her my standard line of, I really think the key to being a good therapist is having a good therapist.

It also was remarkably helpful that I was on last night in that one of my patients had to come back in to the hospital, and I think it made it a lot safer and easier for her that I was there. She and I have a good therapeutic alliance, and wow, she really looked like hell when she came back in. We talked for a bit, she cried a lot, and by the time I'd gone back in to have her sign the paperwork, some outside influences had made things even worse. I hugged her before I left. We try to use physical contact very sparingly and with intention in this business, but sometimes, a simple pat on the shoulder or a careful and genuine hug can be the single most therapeutic intervention.

But while it was really good for her that I was there, it was really pretty upsetting to me that she came back, for reasons of my own neurosis. I, obviously, was so glad she was able to come back and to be safe and ask for help, but the transference in our interaction being what it is, and my own internal critic being as it is, and the fact that I was sleep deprived going in to the shift and had now been awake for like 21 hours made it really hard for me to see her looking as dysphoric as she was so soon after I'd last seen her. People who aren't in our profession really don't understand the depth of the internal tumult that goes on when you're surrounded by the sort of external chaos that we are.

The end result of that last night, unfortunately, was me yelling at a Neurology consultant who was trying to dump work on me in a pretty condescending manner. I actually hung up on him. Scott's commentary on that was somewhat pointed (see above re:sleep deprivation). He was like, "He's a good guy. I'm not saying he wasn't an ass to you right now." I ranted for a moment and then turned to him and said, "You can tell me if I'm being unreasonable." He thinks about this for a second and says, "Emotional, maybe. Logically, that was a reasonable request, but the emotions are out of proportion." I couldn't argue with that. Later, after the neurologist had actually done what I'd asked him, and I'd done what he'd wanted me to do, and I finally did agree with him that the neuro exam was pretty unrevealing in that patient, I paged him and apologized.

Interestingly, the apology was what Scott got kind of snarky about. I was driving home today and thinking that whole story arc of last night was a whole kitchen full of pots and kettles....

On the plus side, I did get a couple hours' worth of postcall nap in this afternoon. Oh, there is no greater bliss than a good postcall nap...

So now I'm actually going to go to bed, because I do have a 7am therapy patient tomorrow, and it's been a long damn weekend. But, really? I love my job.

Breaking it down...

Thankfully it's Friday, because wow am I fragmented after this workday...

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I didn't leave work until 7:45 today. I would've left earlier, but I returned a call to one of my patients, who wasn't surprised that I was still at the hospital. She'd called for two reasons - one, she was having this persistent hallucination of smelling something rotting. I said, well, okay, it's possible we need to push up the dose of your antipsychotic, but first, why don't you go see your PCP and make sure this is actually an hallucination, and not, say, a sinus infection.

Two, she said, was that she'd seen her GYN, who has this knowledge of psych meds because of X, and she recommended we try Y, which would possibly fix both her pain problem and address a psych issue (it was a very reasonable and interesting suggestion, by the way). When she's telling me this, she laughed and said, "I told her, 'how interesting. My gynecologist knows psychiatry and my psychiatrist knows gynecology.'" I agree, that's pretty funny.
_______________
By the way? I'm really much happier to be back doing inpatient psychiatry. I think that should tell me something.

Of note, however, even though I love my job, I wouldn't mind doing it a couple less hours per day...I'm just sayin'...
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I'll admit it, I've become completely addicted to FarmTown on Facebook, which is a game where you create a little farm, and plant things, and sell things, and have livestock, and it's very cute.

On a related note, I'm worried that these 12- and 14-hour days are cutting into my Facebook time.
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I'm a little worried about my proclivity for unavailable men. Not, like, married unavailable, just emotionally so. I have theories about this. Somehow, that doesn't seem to keep me from collecting them.
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I picked up a patient this morning whose H&P said she was drinking "between 6-121 beers per day." We had fun with that. And it was clearly a typo, but we learn not to assume in this business. We have another guy on the unit who was taking roughly the equivalent of 120 tablets (not milligrams - tablets) of valium per day. For reals. We think.
_______________
I got all excited when I came home and checked my email, because I had a message offering me a "free gift" from Filatura Di Crossi yarns, which are Italian and typically lovely, or at least interesting. It turned out to be a pattern.

I think it's overpriced.
_______________
I have this clinic patient who's being extremely difficult right now. So I was in Mikaela and Scott's office today, generally ranting about how it was already 3:30 and I still hadn't eaten lunch and I had this patient to deal with and these three very borderline-y patients on my service and blah, blah, blah, and Scott says to me, "Well, now, some people think that you attract and collect specific things for a reason. And we do know what your professional interests are, now, don't we?" (This conversation, of course, followed one about dissociative disorders, which are totally my cup of tea and also very highly comorbid with borderline personality organization/disorder.)

I kinda hate it when he calls me out on stuff like that. I'm also typically really impressed by it.
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Spinning class starts Tuesday!! Not the kind with the bike, the kind with the wheel. And wool. And happiness.
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I'm working this weekend. With Peng, although we won't be covering the same units. And also with Dr. Jabba, who'll be my attending (I'm pleased with that). It's both Peng and my first weekend of coverage. It should be interesting.
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My neighbor is outside revving his engine incessantly. I'm a little annoyed by this, because I'm going to want to be asleep soon. In related news, the new people in apartment D, with whom I share a common wall, are REALLY FREAKIN' LOUD. And I blame them for the roaches.
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On the roach-y front, I found like a dozen of them in the kitchen tonight. Mostly these teeny-tiny little ones who are barely bigger than a fruit fly. A couple were bigger. I also found a really big cricket. I squished them all, and then found a collection of roaches hiding in the corner of my counter under the cutting boards, which I promptly stamped out. The exterminator came today, and is allegedly coming every week for the next few weeks. In the interim, you can call me Dr. Kate, Slayer of Roaches.
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I didn't make it to the gym this morning, and am a little disappointed with myself, although, it's fine. Instead I laid in the dark for 30 minutes and ruminated and made myself anxious. But I'll go tomorrow. In the afternoon, because I'm going to still get up at 5:30 tomorrow to go in and round.
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I'm really, really, really tired...

Whoosh...

Year three, day two. Went better. Still hectic.

On Thursday, I have to present a Journal Club article to the group. Something about postpartumness. Some idiot, who might have been me, decided a 17-page Cochran Review on the use of estrogen and progesterone in post-partum depression sounded like a good idea. Problem is, *I* actually have to read it!!

So that's what I'm going to go do. Because, it's not like I can move. My quads are SO SORE from SUNDAY's workout, I can still barely get up out of a chair. But gonna gym tomorrow AM, so have to get up wicked early. And more punishment on Thursday, but this time she's meeting me at 5:30am.

Oy, the masochism....

Growing up...

First of all, a happy third birthday (holy cow...) to my adorable little nephew, Basil, who was pictured in yesterday's post (I have a very similar picture to that one from about a year and a half ago. Such a little ham).

Bazie is 3. Annalise is 2. Luke is 1. When did these kids start getting so old? And what does that imply about us?!

Alas, time continues to march on, with or without us, and I prefer "with."

I spent a good portion of this weekend watching ridiculous reality shows on MTV. I spent Saturday watching "16 and Pregnant," which is pretty much what it sounds like. I spent yesterday watching "The World's Strictest Parents," which is actually not an accurate moniker, from what I saw. It was more like, "People who actually do a good job of parenting." Most of them were not actually all that strict, there was a lot of respect for the kids, and there was a lot of teamwork and give and take. They put a lot of emphasis on the punishments, but there was a lot of positive reinforcement that went on as well. And that makes such a difference. If all you do is yell and criticize, of course your kids are going to get out of control. But the other thing that really struck me was that these parents all had their own shit reasonably well under control, at least in that they knew what of their own experiences and feelings had a place in their parenting and what didn't.

This is in stark contrast to how I spent my day today.

My first patient of the day was...probably delirious. Possibly psychotic, or catatonic, or something, but something was most definitely wrong with her, so I took her to the ER. My other two clinic patients went better, but in between all of this I spent way too much time on the adolescent unit. We had one of the most chaotic family meetings I've ever been in (my ears were ringing when I left), which ran over and I had to go see a clinic patient. So then I went back up to the unit and processed with my kiddo for a while. And I talked to the intern on the service, who was wonderfully validating of my observations in the meeting.

Peng says to me, later, in our office, "You know, all I'm saying is, nobody else's therapists go to the family meetings." I, of course, because I do this, started defending my decision to be part of this (although running it was not what I'd had in mind, but the intern is like two weeks old. I kind of wish the social worker had chimed in a bit more, but...). She puts up her hand and says, "no, no, I'm not saying you should or shouldn't have gone. I'm just saying, other kids who've been on that unit have therapists here and they never go to the family meetings."

And with that simple statement, she really makes so many really good points.

I think it was important for me to be there today - if nothing else, my kiddo needed someone who was solidly on her side, but who could be a little more objective and was a good referee - but this stuff always takes a toll on you, you know? It's hard work being the therapist. But it's also really rewarding sometimes.

See? I'm not a dominatrix. I'm a masochist. I'm not sure those two can really go together...

Bleh

So I woke up this morning just feeling like crap. Crap-tastic, even. I had a weird migraine-y thing going on. So I snoozed for half an hour whining in my aching head about how awful I felt and how my tummy was unhappy and how I got kind of dizzy whenever I picked my head up...but I got up, and I got dressed, and I slumped down the stairs...and then had a conversation with my mom, who was like, are you nuts? Be a real person. Take care of yourself and go back to bed.

Wise, my mom.

And wouldn't you know it, a couple hours' sleep in a dark room helped a heck of a lot more than six hours of distracted therapy and two lectures would have. And as guilty as I felt about cancelling, my mom also pointed out that for the hourly rate they charge for me (which is, what, about $180 an hour more than I make), my patients deserved to have a doctor who was actually paying attention and not trying not to throw up on them.

I did get paged twice, though, out of my quiet, dark little den. One was Magical Corrina the All-Knowing, who needed my parking application (why do they create all this paperwork? I had parking. I'm still employed here. I want to keep my parking. Done. Is that so hard? Magical Corrina and I have other things we could be doing with our time), which was fine, because Peng was already on it and forging my signature on the paperwork I left on my desk and forgot to sign. The second page was this woman from the medicine service. It went something like this...

Medicine: Hey, I just had a few questions about this guy.
Me: Um, yeah, so, I think I only saw him, like, once. Remind me who he is?
Her: He's the guy with CF.
Me (amazed that that description actually did the trick, because, you know, like there's only one patient in the whole world with cystic fibrosis): Oh, yeah. What's up?
Her: Well, he's in the hospital.
Me: Okay.
Her: (silence)
Me: ...with a CF exacerbation?
Her: Yeah.
Me: Okay. So...
Her: Well, you know, there's a significant psychological component to it, too.
Me: Um...can he breathe?
Her: Oh, it's getting better.
Me: Uh-huh.
Her: Right.
Me: So...um...how can I help you?
Her: Well, I was wondering if you wanted to do anything.
Me: Uh, you know, I only saw him once, in the intake clinic, like a week ago.
Her: Right. And he's been taking the medication you prescribed, and went up to the full dose about two days ago, and seems to be doing pretty well on it.
Me: So, psychologically, he's doing better?
Her: Yeah.
Me: And...um...he can breathe?
Her: Yeah.
Me: (pause) Okay.
Her: So we were just wondering if you wanted to do anything else, you know, while he was in.
Me (trying to think of a way to put this tactfully): I...um...no.
Her: Oh.
Me: I mean, I guess if you feel like his medicine needs to be increased, you could go up another 5mg, but I think the thing he really needs is therapy. And we've discussed that, but if you could reiterate that, it'd be great.
Her (clearly frustrated that I just prescribed "therapy" for a "psychological problem"): Yeah, okay, whatever. Thanks.
Me: Well, glad I could help.

Here's a tip, for all of you consultants of psychiatry or future consultants of psychiatry or people upon whom others may consult psychiatry... Corrina aside, we're not magic. As our chairman is fond of saying, "We heal minds, we don't read them."

I still have no idea what she wanted me to do. The real reason they sent the guy to me was because they want him to stop coming into the hospital. I failed to do that with one 30 minute visit (he was 30 minutes late for his intake appointment) and ten days worth of homeopathic doses of an adjunct medication.

Uh....NO KIDDING.

I got a consult this weekend to come "talk" to a kid in the ICU who drank himself into alcohol poisoning because the team was too busy to find out "what was really going on." Yeah, like this kid's going to tell me. Surely they must realize that "Hi, I'm Dr. Kate, I'm one of the psychiatrists on call" translates, in the patient's head, into "Hi, I'm another random doctor. Clearly the team thinks you're crazy, which is why they called psych to come talk to your crazy ass." And when I balked a little at the consult, the resident call it in was like, "okay, and, so this is the second kid in two weeks we've had from his peer group with the same problem. We need to you to find out what's going on with them, see if there's like some abuse issues or something."

I? Am neither Colombo, Kreskin, nor DSS. And I do not speak the mythical language that makes teenagers give polysyllabic answers (I, too, still get "fine," "yeah," and "stuff"). But I couldn't actually seem to get out of doing the consult, and I figured (like so many of the ones that we do) it would actually be better for the patient to talk to me about it than the crazy Pedes lady who was overestimating my ESP, so I went and saw the kid. And discovered that, a, he'd already figured out this alcohol poisoning nonsense was a stupid thing to do, and 2, the other person from his peer group who'd had the "same problem"? Was a kid on our unit who tried to overdose to kill himself, not one with a raging case of bad judgment.

Sometimes I really have to wonder...what is it that everyone else in the hospital thinks we do?

Nosh safely

There's a patient in the ER with a chief complaint listed as "snack bite."

Looking at the actual note, it's possible this could be a typo, as the story involves a snake, not a hamster covered in steak sauce or perhaps a rogue potato chip.

Still. Be careful out there tonight, people.

I knew it!

So, my nephew Luke's birthday was actually Saturday. Which is what I had written on my calendar, but, as we all know, I'm easily confused. So, happy 367th day of life, little guy. I promise you'll get that baby blanket sometime before you have your own kids.

(PS - here's how that cake thing went Saturday...



Don't worry. It got better.



Is he not just the cutest thing or what?)

Today was long and irritating. I had three patients show up all day, out of eight scheduled (I think it was originally nine, but one disappeared before last night, so they don't count). Only one cancelled. So I spent the day doing disability paperwork and making lists for the clinic people and talking on the phone to my "No really, I'm gonna do it, I will!" chronically suicidal patient who always makes me a little sad.

I went to the Staples, though, between work and my shrink, which always makes me a little giddy. What is it about office supplies? I'm such a junkie. I think it's all the possibility that exists in blank reams of paper and brightly colored pens. The sheer potential of an unsharpened pencil. It's quite heady. Anyway, today I bought new pens, a giant box of forks (you heard me), and a brand new July-August planner for my third year clinic. That's exciting in its own right.

It struck me today - isn't it interesting that "academic year" planners go by a residency year? I think it's probably coincidence, but, well, it's the sort of dumb thing I find "interesting." It's helpful, for me, at least.

Yeah, that's probably a sign I need to go to bed...I only got half the dishes done, but I think the others can wait until tomorrow.

Patience

So one of my patients dropped out of therapy today. It happens - it's not always the right time for the work that we do, you know? You've got to be in the right place, the timing has to be good, or you're working uphill. In the wind. It just is what it is. Kind of a shame, because I liked working with her, but, c'est la vie. See above, re: uphill in the wind.

But, in parting, in discussing the work that we'd done, she reminded me of a stanza from this song:



I was locked into being my mother's daughter
I was just eating bread and water, thinking nothing ever changes
And I was shocked to see the mistakes of each generation
Would just fade like a radio station
When you drive out of range.

I think it's a good point. Never fully the answer, but...a good point nonetheless.

And now stuck in my head.

(I'm also a little partial because this is one of my favorite Ani songs. I've long thought that this was a good point. Good choice, patient.)

All I need is a couple (more) days off...

(A la Huey Lewis)

So I'm at Starbucks. It's my last day of "vacation" and I'm debating how much more I want to be productive vs being a bum. Bum might be winning, especially given that my first patient tomorrow is at 7am and then I'm there all night. Bleh.

So, to answer Danielle's question from the comments the other day, here's how you become a subspecialist physician in two short decades: you start with four years of college, heavy on the sciences. Somewhere in there, you take the MCAT, do the first scary application process, and then you go to med school for four years. At the end of that, you're an MD, but you can't do a whole lot with it. So during your fourth year you go through the match, which is insane, and roughly this: You apply to residency programs, they can then offer you an interview, and after all the interviewing is done, you rank all the places you want to go in the order of preference, and they rank all the candidates in the order of their preference, and then some big computer in Texas matches everybody up. Sometimes this works well, sometimes they send you to Hell. Anyway, assuming this works out, you do between three and eight years of additional training (residency) in your chosen specialty. And when you're all done with THAT, if you're really insane, you do sub-specialty training, Fellowship, which is typically between one to three extra years. And if you're completely crazy, you might do more than one fellowship. Some of these fellowships are "accredited," i.e., recognized and regulated by the governing bodies that, um, govern these things. Some aren't, but can be equally valuable because they provide additional training in some area that just hasn't been approved by the big folks yet.

So, let's recap/project my career as an example, not including the false start between med school and psych residency. College (4 years), medical school (4 years), psychiatry residency (4 years - I'm currently in Year 2), child and adolescent psychiatry fellowship, which is an accredited fellowship (2 years, but your first year of fellowship can overlap with your fourth year of residency, so it only adds one year total to your training), and possibly an unaccredited fellowship in Traumatology (1 year). And then, THEN - 14 years of training after high school, not including my year of OB/G - I get paid like a real doctor and get to start paying back my loans in earnest.

Fun, right? Well, okay, actually it is, a lot of the time....

So, of course, every step of this process is full of applications, personal statements, references, interviews, and uncomfortable shoes (although - yes, Allison, Dansko does make dress shoes! They weren't bad, actually, just new). And my interview for THIS particular step in the process was Wednesday. It went....well, I'm never a good judge of these things. I'm sure it actually went fine. I mean, these people know me, right?

The problematic thing, for me, was that I felt like I spent the whole day talking about the Emerald Palace. All five of my interviewers asked about it. One pointed out that it "raised concern." Three of them asked me if I'd had any problems with anyone here, and then agreed they hadn't heard that I'd been trouble here (so why ask??). It was probably fine, but on my side of the couch, it's really frustrating. Haven't I done enough penance? My life fell completely apart. I'm still dealing with the financial and logistic aftershocks (which says nothing of the psychological fallout). I mean, I got out of an abusive situation. How long am I going to have to apologize for that?

My program director up North threatened me when I left, that they were going to haunt me for the rest of my career, that this was going to "follow me" and they'd make it so I had to "explain myself" every time I applied for a license, a job, or a training position. Turns out, she was right.

Fuck. What the hell was I supposed to do? It was bad. I got pulled into their enactment. My job, my personal life, my well being were in peril. So I left. I wasn't the first one. I wasn't the last. It's completely amazing they still have accreditation with their rate of attrition alone. But fortunately for them, those of us who have left are either so glad to be out or so traumatized that no one's taken formal action. So they just keep going.

Look, we all make bad choices. We all stay in situations we shouldn't because we want to hold onto hope, or we're scared of the consequences, or we think we're the primary problem.

And I suppose if I were divorced, my prospective new spouses would want to know what happened. I guess this isn't a whole lot different. Except, in this analogy, I've been dating this program for a year and a half. If it's thinking of proposing, shouldn't it look at our time together instead of worrying about my tarnished past? We've had a pretty darn good relationship, I think. I like it here. I like the people here. It's why I want to stay. I've worked hard, I've taken good care of patients, I've done some interesting stuff. Why not focus on that?

And, ultimately, maybe they won't. I'm sure it was fine, and it'll work out the way it's supposed to. And as Corrina (the program coordinator. Her full name is, of course, Magical Corrina The All-Knowing) pointed out, my odds were less than 1 in 10 when I matched here in the first place, and they're currently 5 in 6. I just really, really want to be one of the 5 (see above, re: really liking it here). And I think it's a great training program. And I like to think that maybe some day, they'll be like, oh, Dr. Kate? Yeah, she was one of ours, back before she was one of the most prominent names in trauma/wrote that New York Times Bestseller/opened that cool yarn store (you know, whatever).

And maybe then I'll be able to say, well, that false start just was what it was - a chance to learn a whole lot about myself.

Sushi

Way later than I need to be up right now. Here's the gist of my day - got to bed late last night, woke up early to meet Gomer, who cancelled at the last second. Grumbled for a while, went to Starbucks, Target (even made a list this time and I still forgot half of what I needed! Argh), then the gym. Grabbed lunch, came home, took a wonderful nap. Then I somehow let myself get talked into going for sushi (part of the discussion over the last few days of where we were going to go tonight was Ruthie saying, "But Kate hates fish!" Which is true. But, alas, we were going out for Tyler's birthday, not mine, and so I make do...). Peng and I tried to be all accomodating and pick Tyler up but he now lives in the middle of nowhere and we got very, very lost. But we made it eventually, I got a minute to play with his roommate's dog (sooooooooooo sweet), and we weren't even the last ones there. It actually wasn't bad and my veggie roll was even quite good. And we had fun. We ended up back at Mike's and now it's far too late for me to still be awake but I'm texting with my patient who's in crisis, and wow, I really need to go to bed, because I'm (of course) on call tomorrow...

Am I on something, or does she actually sound smart??

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Paris Hilton Responds to McCain Ad from Paris Hilton

Loves it.

Today was loooooooooooooo(ooooooooooooooooo)ng, yo. My 7am therapy patient didn't show, but that didn't mean that *I* wasn't already there. And then I had lecture at 8, a conference at noon, and the rest of the day was booked solid with therapy patients until 5:30. Seriously, my day was packed so tightly it was like therapizing sardines. And then tonight we had a party at Doc G's for all of the candidates back for the second-look weekend (part of the whole new resident recruitment thing). And tomorrow morning I have to meet Gomer at 8:30, then be at Cleo's at 10 for brunch, and then there's a tailgaiting thing at 4 or 5 I might go to....and then, Sunday night....I start week #3 of night float.

Right now? I'm tired, bitches.

Dear little white cells of mine -

Listen, if you could step it up in there, that'd be great. Because frankly, I've had enough of this.

I'm so done with being sick.

I think I have bronchitis. I made Peng listen to my lungs today at work. And then emailed my doctor, "Peng says my lungs are clear. She's a real doctor and everything."

And then Peng declared that I need to quit dying, dammit. And, as she noted, since she said "dammit" I have to obey.

Then again, as Matt was quick to point out (helpful man that he is), physical exam alone will miss a pneumonia 50% 0f the time.

Matt also looked through my clinic files today and declared that he does think I'm more anal than he is. And let me tell you, my friends, that is a high-set bar. He then mocked my lung-hocking cough. So I punched him in the arm. So then he pulled my pigtails.

No, wait, that was second grade...that was something else entirely...

Meanwhile, Ruthie was running around the office today in a tizzy. She was behind in clinic, she was on call tonight, it was a day of chaos for her. I felt bad. Apparently not bad enough, though, to not point out her inefficient habits when she complained about clinic running late (I wasn't as blunt as all that, and in fact, was pointing out that she needs to hold her boundaries and respect her own needs over those of the clinic, the patients who show up forty minutes late and are super demanding, our supervisors who are also making demands, her office mates who label her compulsive need for completeness as "inefficiency"....). But then, I always was a bitch.

Heh. I love how our patients think we're all "normal" and shit...

So I rescheduled my day tomorrow and am staying in bed and mainlining orange juice and trying for the life of me to stop being sick (dammit). So maybe I'll have something less stream of consciousness and more insightful to say then. Meanwhile, I'm going to bed.

Oh, but, my dad's knee culture didn't grow anything, so they're probably throwing him out tomorrow after PT. No surgery, no antibiotics, but with closer ortho follow up. So that's a good thing.

Have a couple of drinks and quit discriminating

This has been a Luda Service Announcement.

(The new Ludacris album dropped on Tuesday, I picked it up this morning. It's ridiculous how much I love this song.)

Today was slightly more productive. I actually got a fair amount of stuff done around the house today, even if I didn't get everything done I wanted to, or didn't wake up until 10:30. Sparrow and Peng helped me move some stuff into the attic, so the house looks a little less cluttered. I still haven't figured out the best use of the space yet. But I really need to get this stuff organized and freakin' move in. I mean, I've only lived here five months...

It's rough being neurotic sometimes.

I understand why I never really unpacked in at the old place - I never actually believed that they weren't going to fire me. Not because anything at the program indicated that they were going to fire me, but, because life at the Emerald Palace was so tenuous, and they clearly never intended to let me get to second year.

But now, here I am, in a whole new year, and a whole new house, and I really don't think I'm going to get fired. Yet, I'm still surrounded by boxes, have no seating, and can't get my shit together to actually unpack and find places for my stuff in the new house. Now, though, now I think it's just because I'm crazy. Not to mention perpetually exhausted.

Urg.

I hope you kept the reciept...

I had a really long, really obnoxious day. Now, the long part is (partly) my fault - I'm the one that decided it was okay to do these 15-hour+ Tuesdays (although, usually, I at least like to have time to get dinner before class....notsomuch today). The obnoxious, well....

Fortunately, I had the two cutest dogs in existence waiting for me at home.



I watch the two of them, and I've come to decide that Mags and Max tend to act somewhat less like competing pack members and more like young siblings. Partly because pack members don't tend to get jealous and pouty when the pack leader shows attention to other members of the pack. Not favoritism, mind you. There's some significant sibling rivalry going on, here.

I think Maggie is ready to take her little sister back to the store.

Ah, wait, let me show you the time lapse on this one....here's Maggie, who FINALLY calmed down about twenty minutes after I walked in the door (literally. I get out of my car, and I hear rustling leaves, which tends to indicate she's gone dashing into the house to meet me. I walk in...and...no dog. So I say, tentatively, "Maggie?" at about the same time that she comes bursting through the dog door, all like,
"KAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAATE!!"
I felt loved).

Here's what happened when Maggie got up to get a drink of water...

They're such characters. I think I mentioned that Maggie got to go over to election night at Sparrow's.

Mags and Maxine both tried to score food off of everyone (there are two extreme cute pictures I can't show you, one of Chef lying on the floor with two dogs all like, "HI!! You're Chef! You smell yummy! You're on the floor! And you smell like bacon! We like you!", and one Maggie with her head resting on Matt's knee while he taunts her with a cupcake). Here, Mike battles the tandem "But... I'm so cute... and so hungry" stares.

And of course, Sparrow got new couches which are supposed to be a dog-free zone (okay, really, a dog-hair-free zone). So Little Maxine got a little new bed. Which Maggie then tried to take over.

Love the "Is this okay? Are you paying attention? Am I going to get in trouble?" look on her face...

::sigh:: It's time for bed, y'all....

The woman's a lunatic...

...and that's why I love her.

So I'm having this day, right? I'm tired and cranky and still not feeling super, and I have a full schedule except for that chunk in the middle where I have to leave the hospital and run down the street to my friend Larry's clinic, because he's going to be my new primary care doc. Which of course takes us a LOT longer than the 20 minute time slot that's allotted, and so I'm late for my 3:30, which turns out to be complicated (the actual appointment, not the lateness of me), and then there's my 4:30, and I'm all kerfluffled and then I get back to my office and I have this text message from Ruthie, who of course has been on night float all week and is a little delirious. So I call her, and she says, "Where are you?" And I say, well, I'm still at work, just finished my last therapy session, blah, blah, blah, where are you? And she says...

"Oh. I'm in your driveway."

....?

She continues.

"Yeah, you weren't here. So I cruised down by Larry's office" (which, incidentally, is like a half mile or so from the hospital and thus a mile and a half from my house. So, not far) "but I couldn't find your car anywhere. So now I'm in your driveway again and your dog is barking at me. Do you want to get dinner?"

Of course I did.