Blah, blah, blah

It was a big day for some reasons I can't yet divulge (don't you love it when I do that?) but also because I started on the child unit today. Whew. I forgot how exhausting the little ones can be, especially when they suddenly have to be discharged.

My day actually started much earlier than that. My adolescent therapy patient who comes at 7am (voluntarily. Of her own choosing)....um...well, she came at 7am. We're doing some transition work now, so she only comes every other week. We had a good session today, about some pretty heavy stuff. And then, later, after the whirlwind discharge and while I was on my way to supervision (handy), she sent me a text telling me that what we had talked about this morning ended poorly.

Can I be totally honest with you? It broke my heart a little.

I know we're all trained to come off as being somewhat aloof and all "blank slate" and whatnot, but here's a dirty little secret of psychotherapy: we get emotionally invested. At least, the good ones do. And this is a kid I've been seeing for three years now, which is not an insignificant chunk of her life (or mine, for that matter). I've seen her grow in a lot of really profound ways. And even if my response was something close to the cliche "that must be so hard for you," I really hurt for her. To really get the emotional content, blank slate or not, you have to make an emotional connection. That's why this work is so exhausting. I see it in my colleagues' exuberance about college acceptance or dismay at an abrupt and clumsy termination. We may sometimes give the impression that you may only exist to us for a fifty minute hour, but in truth, as much as we hope our patients internalize us, we internalize them to some degree too.

It's kind of cool, when you get right down to it.

Oh - and, I went to the gym after work and supervision and therapy and the, um, whatnot, and I did my little proscribed treadmill workout at 1.8 miles per hour in the middle of the crowded, post-work-rush gym. Yeah, I was still self-conscious about it (especially because that 7% grade was kicking my ass today), but I did it.

Baby steps, you know?

Juju

My life is exceedingly strange.

I'm generally okay with that - it's never boring. But it does sort of beg a question or two.

Last night, Jen and Bill were kind enough to help me move my bed from the old apartment to the new one. The movers are coming in a week, but since I can't sleep in the old place without having some sort of allergic catastrophe, I really appreciate being able to stay in the new one without having to sleep on the floor (although, as I told my mother this morning, I almost think the little nest I've been sleeping on at their place is more comfortable than my bed...). So we get everything into the trailer, and are about ready to leave, and we're all sort of standing around the trailer when a woman I've never seen before comes out of my neighbor's doorway. She backs out, and is trying to shut the door when she falls back and bonks her head on the concrete. It was one of those moments where you see the inevitability of what's about to happen and are completely powerless to stem the flow of events. So, okay, down she goes, smacks her head, and starts SCREAMING, "I need 911! I need 911!!" I, of course, being as snark-tastic as I am, was like (in my head), relax, lady, you didn't hit your head that hard. But then she starts yelling, "my finger is off!!!"

Your...I...what?

She sits up, and is clasping her right hand in her left, and there's blood running down her hand because she's severed the tip of her finger. I ran in and got her some paper towels. She didn't want those. Bill sends me back in for a cold, wet rag, which I got, as well as a bag of ice and a couple of plastic bags (tip - never, ever put an amputated part in a bag of ice. Put it in a bag, insulate the bag with a towel or something, waterproof that - i.e., put that in a bag - and then put that whole mess in a bag of ice. Otherwise the digit in question will get frostbitten or macerated or something equally unacceptable). Jen called 911. Bill sat with her, held pressure, and tried to keep her calm. Jen and I had the enviable task, then, of looking for the finger amidst the bushes and pine straw mulch. We saw a piece of jagged glass on the ground, figured that was what had severed her finger, and so we looked and looked and searched and fussed in that general vicinity. No luck.

Finally, a little exasperated as to how the finger had come off anyway, I asked, "How in the world did you do that?" And it turns out she'd shut the door on her finger, which had sliced off the tip of it, down to the base of the nail.

First? Ouch. Second? I worked out the physics of that in my head. Severed while shutting the door. The tip of her finger wasn't in the bushes, it was in the house.

I looked at the door, and thought, aw, shit. My neighbor has these two horribly-behaved little dust mop dogs, who were at that very minute undoubtedly sitting on the other side of the doorway licking their little rat-dog chops.

Crap.

Her mother says, let's look in the house. The bleeding woman on the ground is insistent that her finger isn't in the house. Don't go in the house! she says. I say, "Okay, well, can *I* go in the house?" But the dogs are going to get out! they say.

Lady, that's the least of your problems.

And of course, no one is considering that the neighbor routinely lets the dogs out, off leash, to poop all over the neighborhood and they always come back. Unless they come in my house, but that only happened a handful of times, I mean really.

Bill assured them that he and Jen have a dog who LOVES to get out and run around and terrorize the neighbors, that they can handle it. I, meanwhile, have headed into the house with the woman's mother. There is, of course, no finger in sight. Nor is there even a spattering of blood on the floor. Which, of course, you would expect if the finger was severed in the door.

I looked at the dogs. They...well, were just being dogs....

So then the paramedics show up. They go to bandage her finger, and the medic looks at me and says, "Ma'am? You might want to turn your head before I take this towel off."

I managed not to laugh at him.

So they get her all put together, send her to the ER in her own car, and the other paramedic and Jen and I are cleaning up, and the paramedic sighs and says, "Well, if you see a little dog running around with a finger in its mouth..."

Jen and I had already had the opportunity to look at each other and mutter under our breath, "Dog? Yeah, dog." So were both like, "well, yeah, they have two dogs, so..."

The poor paramedic looked at us and went, "Oh. Ohhhh...."

But, on the plus side, here are five things I learned from this adventure:

1. The bad mojo in the apartment that I've been feeling for the past year and am feeling even more acutely now is definitely not just mine. Which makes me feel better about leaving, that I'm not the source of the bad juju (and thus the wheel of fortune may be turning for me. Here's hoping).

2. My friends are awesome. (Okay, I knew this.)

3. My life is weird. (Yeah, I knew this, too.) As is Ms. Stumpy's, or at least it is now that she collided with my weird life and the Evil Apartment Building.

4. I consistently keep getting reminded that the universe is conspiring around us. Five minutes earlier, Jen, Bill, and I were all inside the house. Five minutes later we would've been gone. There were reasons we got there later than we wanted to. But we were definitely supposed to be there right then. Call it fate, karma, synchronicity, whatever you'd like, there are most certainly forces at work here greater than ourselves.

5. It turns out that when you freakishly slice off your finger in a door frame, there's no one better to have around than a doctor, a social worker, and a convicted felon.

Remembering

No fancy allegories or verbose soliloquies today, just a few scattered thoughts: Freedom comes at a very high cost. None of us are free while others are oppressed. And to those who gave everything or anything to make humanity a little more humane, I say simply this -

Thank you. 

Barred

So I have this friend.

No, no, an actual friend. A friend who started as a friend of a friend but now I consider him a friend in his own right (I think that if they broke up, his girlfriend - my original friend - would ultimately get custody of me, but we could still be friendly). This friend has had some really awful shit happen to him, not the least of which (ahem) was getting sentenced to life in prison at the tender, formative age of 15 while taking the fall for a crime he was only involved in as an accessory.

That's the short version of the story. The long version, actually, is the subject of an indie documentary.

It's a good story, ultimately, because even if it was nearly three decades later, this was rectified. Tomorrow there's a celebration to commemorate his one year anniversary of his release. And I have to say, it's been a pretty remarkable year. He's done an amazing job of reintegrating, keeping his nose clean, and being a functioning member of my social circle.

There are times, of course, this gets downright comical, like when he got a ticket because he'd never seen a parking meter before and didn't know you had to feed it ("There was a bike chained to it. I thought it was a pay-per-use bike rack."). And there's times when it just completely sucks that his previously rough life led up to that at such an important time in his life and development.

We were having coffee this morning (it's what we do, since he's part of the coffee-related circle of friends), and he was like, "You know, I think about all of my experiences, and realize now, I generally don't have troubles." We, of course, were all like, what? And he went on to explain that, although he does sometimes get worked up about things, when he really takes a moment to stop and look at what's happening, it never really seems to be that bad. What's the worst that could happen?

Remarkable, really. I think there aren't many people who could walk away from this experience or even the things that preceded it and not think the world was a heinous, awful, dangerous place.

I told him this morning, it's absolutely amazing, that he got a second chance. A whole new life. Full of new discoveries and good people and humor ("This is my friend from school. We went to Penn State. No, wait, that was the State Pen") and the little everyday triumphs and tragedies that make life what it is.

I'm a little bit jealous, actually. He got to leave his prison. So many of us - myself included - can't ever seem to get out of our metaphoric ones, to free ourselves from the past. His imprisonment meant something much more literal, of course, his liberties curtailed in a way mine have never been. But what I'd give to not be shackled to those years of abuse and pain and terror. I recognize it as a hell of my own creation (well, maybe not exclusively mine), but apparently, like Persephone, I can't ever really leave.

So, in short, Bill, if you're reading this (or if Jen is telling you about it. Hi, Jen!), good work. Keep it up. We're all really proud of who you're becoming and the transition you've made. And don't ever let the rest of us forget how lucky we are to take our freedom for granted.

An open letter to Monday

Dear Monday:

Shoo. Shoo!! Go on, get!


I need more weekend. 

Please try to be kind, okay?

Begrudgingly yours,

Kate

Wordless Tuesday

I've been thinking a lot today about how people communicate. Okay, fine - I think about it a lot, in general.

So much of what we say to each other, we don't say at all. It's remarkable, really. There's a huge amount of nonverbal cues that go back and forth in even the smallest, most casual exchange. There are these things called meta-messages, right? They're about context. They're what we're really saying, or what we're hearing others say. Note, though - the meta-message that's sent and the one that's received are often not the same. And then you factor in pheromonal signals and other subconscious cues, and it's amazing that we ever communicate anything correctly.

I was thinking about this today after a conversation this morning with a friend of mine. He reminds me a lot of an ex I have, who always seemed to speak in metaphor. He'd tell me stories about his house, his work, his family, which would always be code for how he was feeling and what he was thinking about me, himself, us. It was a lot of effort for me to decipher that, but validating and satisfying when I did, which is part of what kept me there. I was always on my toes with him, which, let's face it, wasn't always where I wanted or needed to be.

My friend at work is much the same way (which is, let's face it, why our friendship is a little complicated). The difference, here, though, is that I've evolved a bit, and I spend less time worrying about if I got it right with him and more time looking at what's going on. I spend more time thinking about what I'm telling him. I pay a lot of attention to this stuff, and I still think I only have a minute inkling of what's actually transpiring.

It really is a miracle we ever communicate anything, ever.

Oh for Pete's sake

Apparently I'm now officially a day behind in my posting of things. Which is not because anything is going wrong - just that I keep coming home exhausted. I'd actually started a post yesterday that got interrupted, but I came home last night at midnight (from meeting Claudia for dinner, not from the hospital) and promptly fell the hell asleep.

I also haven't been sleeping super well. I sense some espresso in my future today.

I'm also on the phone with some pharmacy tech at Walgreen's, because of course I've extended my tour of duty and have now run out of my asthma meds. She's really being snarky and condescending. I forgot how rude Midwesterners can be, relative to the South. I mean, Southerners might be sweet as pie and then talk about you behind your back, but who cares if the pharmacy girl does that. I'll take pie, thanks.

I'll write something actual and meaningful today, I promise.

Working pretty well, actually.

I was thinking this morning on my way in to work (aka the only hospital in the area that provides indigent care, fyi) about Sarah Palin's comment in a recent speech: "Hey America - how's that whole hope-y change-y thing working out for you?"

(And then, of course, Will Ferrell's George W. Bush on SNL saying, "Gosh, Sarah, you're just so darn folksy. I tried to be folksy, but it just came off douchey.")

I'm so glad the HCR bill passed. It isn't sufficient, in its current inception, to really fix the system, but it's a step in the right direction. And we need to take some serious steps. The system, as it stands, cannot sustain much longer. It is going to fall apart, soon, and dramatically. Medicare and Medicaid are imploding (Medicare reimbursement was supposed to be cut this month by more than a quarter, independent of any such reform measures, because old and disabled people are just so gosh darn expensive! Yeah, that's the solution. Cut their access to care even more...). And folks, don't think you aren't already paying for the uninsured and the illegal immigrants - we got ourselves in this mess because everyone who IS insured is paying more because the uninsured are sucking down resources. And they're using expensive ER visits instead of primary care offices, long medical and psychiatric hospital stays that could have been avoided with early intervention. People are sucking the system dry - not because they refuse to work and want to be taken care of. The irony is, THOSE people have coverage. Instead, the vast majority are doing so because they have no other choice. They need care, they are sick. As a kind and ethical people, we cannot just throw our hands up and say, oh, sorry, you're just not important enough to society. Which - news flash - in a pure, orthodox, strictly Capitalist model? That's exactly what would happen.

Remember this?

"Give me your tired, your poor,

Your huddled masses yearning to breathe free,

The wretched refuse of your teeming shore.

Send these, the homeless, tempest-tost to me,

I lift my lamp beside the golden door!"

I'm so proud to be an American today. And so ashamed of those in my country who would rail against what ultimately amount to basic human rights, who stoop to violence and slinging harsh and hateful epithets, who would deny and exploit the vulnerable in our society. I invite them to spend a day in my ward, or better yet, the state psych hospital. I invite them to sit with any one of our social workers, struggling to find placement, housing, affordable medication, or even just follow up for some of the people that are in the most dire need of good care. I invite them to spend an hour at the homeless shelter on Rosemary Street, or at the Spanish-speaking mental health clinic down the road. I urge them to spend a morning in our Geropsychiatry clinic for a full-on view of how the current Medicare system works. And if they possess a soul, if they retain even a glimmer of compassion and humanity, I challenge them not to want to change the system.

And if that makes me a Socialist...well, so be it.

Happy St. Pat's from Scenic Butner, NC

You can't fix stupid

So I'm in Starbucks yesterday.

And there's this guy.

Who, incidentally, appears to be the LOUDEST PERSON ON EARTH.

And he's talking to the barista, who is a fairly recent immigrant, but works at Starbucks, so has good health care (they have GREAT benefits). And the LPOE is going on and on about what crap it is that the government wants to take ALL OF OUR HARD EARNED MONEY and give it to people who refuse to work. I roll my eyes a little...and he of course keeps going. Damn those Democrats. All they want to do is take money from working people and give people health care. He's totally against this, as someone who works. And, you know, health care is just fine.

I so wished I'd brought my iPod and could turn it up right then.

Listen, people. Health care is fine for many. Health care is NOT fine for the people that ACTUALLY need it. Medicare and Medicaid are disastrous. Private third-party payers are exploitative. Nobody gives a damn about the people that can't afford their medications or can't get the care they need because they're not people who matter anyway - you know, like old people, poor people, sick people, actual disabled people, etc.

And let me tell you, people don't even want to talk about the mentally ill.

Really, some people in this country would be just so much happier if the above demographics would simply go away. But they won't. These are the people that need support. These are the people that suck the money out of our system, yes - because we set it up in such a wasteful way, not because they themselves set out to do so. These are the people that no one wants to consider until it's a member of their own families - or worse, they themselves - who become part of that demographic. Then, then they're outraged. And suddenly find themselves shouting at the bottom of a deep, dark well.

And then they get why those of us in the trenches are constantly looking worn down, haggard, and jaded.

Health care reform isn't an option. The system must change, it will change, and we'd damn well better step it up to figure out how to change it into something that works before it implodes.

Over the past year or two, I've been completely bewildered by the "controversy" about health care reform. Really? Is this a question? What the hell is wrong with Capitol Hill?

And then, today, I read this.

And became a little more outraged, and a little more jaded...

Fat chicks rule.

So, I don't know who's heard about this, but Kevin Smith - director of such fabulous films as Dogma (my all-time favorite movie), was told by Southwest Airlines that he was too fat to fly on their plane and removed from a flight last month.

And, he's pissed.

I, frankly? I'm with him. I'll be completely honest. I really hate flying Southwest. I've seen them be not nice to several people, fat or otherwise. They've been shitty to me a couple of times. They once told me I was too fat to sit in the exit row, but never that I couldn't be on the plane.

I did have a different issue with them this weekend, when they refused to let my dad on the plane with his oxygen concentrator. I had to go back to the airport and sign some form (as an MD, not as his kid. I was in very doctor-y sweatpants), despite the fact that they let him fly with it many times before - most notably, on the flight down.

Morons.

And, beyond that, there was another fat girl on the plane. She tells her story on Kevin's podcast here. It's heartbreaking.

One of the things he said really stood out to me. He says, "You spend so much time, when you're fat, just trying to be out of everybody's way."

God, that's just so true.

Mr. Smith has called for a boycott of SWA, which, I've already been flying United lately. They've been just as cheap if not cheaper lately, and have been so much more pleasant. And I really like having an assigned seat.

Come on, chubby folks. Let's stop letting people be hostile and hateful and hit 'em where it hurts.

It just gets worse and worse.

Read this.

Huh.

In follow up to Tuesday's post, it seems that not only is there no such thing as safety online, but you're not even safe from the people who are trying to keep you safe.

Then again, I guess that's not a new truth, either. But this does rather take it to a whole new level.

Scary out there

So, I've always said, you can't shelter your kids from the world. To protect them, you have to stay with them, know where they're going, teach them how to protect themselves when they're not there. No child-safe internet blocker is ever going to work, because kids will find ways around everything.

They're kids. They're adaptive, and creative, and sneaky. It's what they do.

Things like this prove my point.

So, a friend commented on Facebook that she had to look up this thing she'd heard about called Chat Roulette. I, of course, tend to be curious about everything, and also, I have two adolescents therapy kids with whom I work closely (and, as I've discovered lately, I have to keep up with my 66 year old patient as well. But, I don't worry as much about her being preyed on. She's pretty sharp). Plus, I'm on the child unit, and headed into a child fellowship. I like to keep an eye on the landscape, know what's out there for them to get into.

The concept of this is kinda cool, right? You log on...well, not even that, because it's completely anonymous. You click a button, and you get matched up with a random stranger anywhere in the world. In one respect, this is awesome. I spent about 20 minutes wandering around, chatted briefly with some very nice people in France, and Australia, and elsewhere in the US. I talked for a bit with a nice man in China who's trying to improve his English. I got to use a little of my terrible French. The worst thing any of them said to me was that the one of the people in France told me I was old. I guess when you're 18... But in that aspect, it makes the world a little smaller, allows you to interact with people in other cultures, etc.

That, I recognize, is a tremendously idealistic view.

So, many of the people on this thing have webcams. I saw a lot of high school and college kids, who, yeah, kind of a vulnerable group. Especially considering some of the other things I managed to see on there. Wow. Not enough eye bleach in the world.


::sigh:: It's amazing. I'm guessing that wouldn't even be blocked at the hospital (whereas, you know, everything else is). The anonymity is superficially protective, but also disinhibiting. It perpetuates this idea that you can say or do or be anything you want, and not worry about it, when in fact you should worry about it quite a bit. Especially if your judgment isn't very good because, say, your frontal lobes aren't fully formed yet. There's no guarantee that the people on the site are over 16 (by clicking the button you agree that you're over 16. There isn't even a checky-box. Oh, yeah, that's gonna work...). Or aren't, say, serial killers and pedophiles. In fact, I'm guessing this would be a deviant Mecca in a way that Facebook or MySpace or any of the other sites we worry so much about never could.


Yeesh.


Now, admittedly, I'm a hypervigilant, socially suspicious psychiatrist with a trauma history. But, seriously, folks. The shit that's out there is scary. 

You betcha

One of my med students pulled this up at the end of team rounds yesterday. If you haven't seen it yet, I think it's one of the very funniest most fucking retarded things I've seen in a long time....

The Colbert Report	Mon - Thurs 11:30pm / 10:30c
Sarah Palin Uses a Hand-O-Prompter
www.colbertnation.com
Colbert Report Full Episodes Political Humor Economy

Best intentions

So, the following is something I received in an email today. It's a forwarded email from a physician who went down to Haiti to provide care. I know I thought of going. Yes, I'm a shrink, but I am an MD, which means I can provide basic medical care. I used to be a surgeon, so while I couldn't necessarily operate on my own, I'm an excellent first assist. I pick things up quickly, so can provide a versatile range of services. Not the least of which is, you know, I'm a shrink. Ultimately, though, I concluded I had neither the flexibility of schedule nor the funds to do so.

What I wasn't expecting to hear from those on the front line was how unbelievably primitive the medical conditions were before the quake. I....find this unfathomable, that we, the major powers of the world, allow this to happen in less developed nations. This email, I think, does an excellent job of pointing out why the "a little here, a little there" approach to aid to Haiti pre-earthquake just doesn't cut it in any sort of humanitarian sense. What little I personally can do about this, I think, is give them a venue to disseminate this message.
************************
I believe we went in with a reasonably comprehensive service we wanted to provide acute trauma care in an orthopedic disaster.  Our plan was to be at a hospital where we could utilize our abilities as trauma surgeons treat the acute injuries involved in an orthopaedic disaster.  We expected many amputations however came with a philosophy that would reasonably start limb salvage in what we thought was a salvageable limb.

We put a team together which  included:
2 orthopaedic trauma surgeons
3 orthopaedic trauma fellows
2 highly skilled anesthiologists
1 general surgery trauma surgeon
2 synthes reps who were also scrub techs
1 trauma nurse practitioner to do triage
2 OR nurses

Our equipment including a huge amount of anesth medications and equipment, ability to construct 150 ex fix both small and large, OR equipment including scalpels etc, OR soft goods, splint material, OR prep material. We also had a plan of physician and equipment replacement that was dynamic where w/i 24hrs we could bring in what was necessary on the Synthes private jet.

We thought the plan was a good one.

We were incredibly naïve.

Disaster management on the ground was nonexistent.  The difficulties in getting in despite the intelligence we had from people on the ground and david helfet's high political connections with Partner's in Health as well as the Clintons only portended the difficulties we would have once we arrived.

We started out friday morning, got a slot to get in friday that was eventually canceled when we were on the runway to be rescheduled the next day.  We diverted to the DR and planned on arriving in POP saturday. Once on the ground we had intelligence that the hospital was up and running with 2 OR's General Hospital was included severely in the earthquake and not capable of running functioning OR's as there was no running water and only a limited electrical supply on generator.

We quickly took our second option

Community Hospital of Haiti.  We found approx 750 pt in the hospital upon our initial eval, the hospital had running water, electricity and 2 functional OR's. Our naivette did not expect that the 2 anesth machines would not work, there would be 1 cautery for the hospital, autoclave that fit instruments the size of a cigar box, no sterile saline, no functioning fluoro and no local staff only a ragtag group of voluntary health providers who like us had made it there on there own.

To summarize, we had no clue the medical infrastructure of the country was so poor.

As we got up and running in the OR and organized the patients for surgery we communicated our new needs back to Synthes and more supplies were loaded for a second trip - these included battery operated pulse lavage, a huge supply of saline, soft goods in the OR.  This plane landed as planned sunday pm, equipment was loaded on a truck and subsequent hijacked between the airport and the hospital. At the hospital we had zero security despite promises form NYPD and NYFD to provide that to us.

Our philosophy was to work like this was a marathon: run the OR's around the clock with the idea that we would have a defined extraction time of 11pm tues.  The plane that extracted us would come in with a new medical staff compliment to replace us. Equipment included urgent things to maximize issues that were nonexistent in the hospital that would enable us to provide better and more efficient care:
2 portable anesth machines
2electrocautery
2 portable monitors for the pacu
2autoclaves
Replacement exfix
Things that didn't arive with the previous flight

That plane's slot was cancelled by the military at 6am tues.

We also previously had seen daylight in the remaining patients monday night having completed approx 100 surgeries.  However on tues morning we found a huge # of new patients.  The hospital was forced to undergo lockdown closing its gates to the outside and outside crowd becoming angry. We also noted tues morning that many of the patients we were operating on were becoming septic.
We finished operating at noon tues, the last surgery our group assisting an obstetrician on a caesarian and resuscitating a baby that was not breathing.

We decided as a group the situation for us at the hospital was untenable supplies were running out, team was exhauted, safety a huge concern, and no extraction plan with resupply.  We decided to make our way to airport thru the help of a hospital benefactor.  Jamaican soldiers with M-16 were necessary to escort us out with our luggage as the crowd outside saw us abandoning the hospital. We made it to airport on back of a pickup track, got onto the tarmac, hailed a commercial plane that carried cargo to montreal and had private jet pick us up there.

The issues we were unprepared for and witnessed were
1.  The amount of human devastation
2.  The complete lack of a medical infrastructure in the country
3.  The lack of support of the haitian medical community
4.  The complete lack of any organization on the ground.  No one was in charge, we had the first functional up and running hospital in the POP area yet no one and I mean NO ONE came to the hospital to assess what we were doing, what we were capable of doing and what we would need, to be more efficient.  The fact that the military could not or would not protect the resupply equipment on sunday or let the tues flight come in says it all.
5.  Lack of any security at all at the hospital

I would take away that disasters like this need organization on a much higher level than we had with the clear involvement and approval of the military from the beginning. Currently there is no one obviously running the show and care is in chaotic at best.  MD's are coming in country with no plan of what the are going to do.  Surgeons that expect to just show up and operate are delusional as to what their role would be as without a complement of support staff and supplies they would be of limited or no value.

For all that are thinking of going, I hope this helps.  We all felt as though we abandoned these patients and that country and feel terrible.  Our role now being back in NY is to expose the inadequacies of the system to the media in the hopes of effecting a change in this system immediatly.  We feel that the only way to really help now is an urgent programtic change and organization in the support of the medical staff on the ground and what is critically needed to expeditiosly bring in.

Cherrios on the tarmac are not getting it done on these patients which clearly would be savable if good care could urgently be provided.

Please share this email with everyone and anyone you find might help.

Better laid plans...

....still didn't happen.

So, I've been thinking a lot about the life of Dr. King, lately. As I've said every MLK day for a few years now, I respect the work that he did. I admire that he died for the cause. And I think he changed the world, for which I'm grateful.

And I've been pondering over the past couple of days, what to say in today's post. And, once again, I had big plans for today. Mags and I slept in, then got up and got breakfast and went to PetSmart. After that I Furminated her, and by the time Mags decided she'd had enough I had over half a plastic grocery bag full of undercoat (which I saved, and will continue to add to it, and intend to someday spin). I was contemplating meals and groceries (I am determined to get back on my meal plan...you know, eventually...), did a bit of other stuff, showered, and then Faye was like, "Hey, want to get lunch?" So we did, and it was lovely, and then I stopped by my friends' house on the way home. Just to drop in. For, you know, not more than a half an hour. No, seriously, I was going to leave by 3:30 - 4 at the very latest - because I wanted to hit the grocery store and then come home and finish the laundry and clean the kitchen and get the Christmas tree put up and make dinner and...

So, I left around nine.

We had a lovely time. It was a good end to the weekend. We talked and laughed and told stories, messed with the Wii, ate dip. I knit, and actually got quite a lot done on my current project. And I finally was like, no really, I have to get home (because as I type this, it's 11pm, and I start on the Crisis unit in the morning). And so I got home, and made some dinner, and was fussing with the laundry, and I thought, you know, well, this was probably a much better course of action for the day. My house may still be a disaster, but my soul feels better. And that's really the point, right?

And then I was thinking about the blog, and what I was going to write before I went to bed, and then, it suddenly dawned on me that the friends with whom I was hanging out were black.

And I thought....you know...I'm not sure I could think of a better way to honor Dr. King's vision than to spend 6 hours on an impromptu social call, having discussions of various family members' skin tones and assorted cultural mores of both "my people" (the Greeks) and "their people," and generally enjoying the company of good friends, without it ever really occurring to me to question that they were any more different from me than anybody else who was raised in a different cultural subset of Americans.

Thank God Almighty...is this "free at last?"

"True" story

See? I'm not the only one who thinks Pat Robertson is the devil.



I couldn't have said it better myself, Mr. Olbermann.

Sex on CNN

So, I'm trolling for something interesting to post tonight (with my exhausted mush-for-brains dribbling out my ear), and two linked articles on CNN.com caught my eye.

Let me preface this by saying, I debated for several minutes whether or not it was appropriate to post this. Because, you know, "old" people read my blog. And then I came to the conclusion that, look, if it's safe for work, it's safe for people over the age of 60.

Isn't it funny how we spend so much time as parents (or parental-y figures) trying to protect our kids from smut, and then eventually, as kids we spend so much time trying - in a very similar fashion, honestly - to protect our parents from smut.

I'm also reminded of this story from when I was home in July. Really, people. I was 30 years old. And, um, I can spell.

Anyhow. So the article that originally caught my eye was this one. Which did so because, back during my year working in yarn sales and sex therapy, the existence of the G-spot was a HUGELY contested issue in the Sex Clinic. Like, I'm not sure I can think of an issue we collectively argued about more. I'm in the "of course it exists" camp, my supervisor was in the "of course it doesn't exist" camp. I think this study CNN references is poorly constructed and the results are useless. But it continues to amaze me that we as clinicians and as women argue so hotly the very existence of this. Like unicorns. Or Dissociative Identity Disorder.

Sheesh.

But then, that article was linked to this one. Which just upset me. Because I'm perpetually amazed at how often my adolescent patients, or their friends, or whomever, have "pregnancy scares" these days. Or get knocked up. I brought this up to one of my patients one day, after reading that they were teaching abstinence-only sex ed in our public schools, and she was like, "No, not really. Mostly what we talk about in Health class is what to do with your baby while you're in school." Which kind of made me want to bang my head on my desk for a while.

Not to mention, uh, pregnancy cures itself. AIDS is forever.

It's just sex, people. Humankind will not shatter if we discuss anatomy and sexual health. Your children will not burst into flames if you teach them how to use a condom.

(But I was brought by a stork. And I refuse to believe otherwise, so don't even argue.)

Friday Fragments, inspired by gravity

So I'm sitting in the airport in Chicago. My flight, previously scheduled to leave at 7:40, is now scheduled to leave at 8.

Yeah, I got here three hours early.

Part of that was kind of unintentional. I had an awesome, awesome lunch with my folks and my cousins (who just got back from Mexico last night, and were very tan and still on South of the Border time). We met at 2, ate freakin' awesome stuffed pizza, and chatted and visited, and then, you know, it was a little earlier than I'd planned on getting here (I usually aim for 90 to 120 minutes before departure time. After the Christmas day loveliness, I thought I'd shoot for 2-2.5h), but, fine, whatever. So I got here around 4:40. I cleared security at 4:56. Aaaaand....so.....now.....here I am.

I bought a couple of books. I browsed in a bunch of kiosk stores. Starbucks got my drink wrong. I finally succumbed and let myself be robbed at gunpoint bought in to the ridiculous expensive airport wireless. So, while I'm at it, let's do a little Friday Fragments. Quickly, before my battery dies.
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I'm sitting on the floor against the window. It's 14 degrees outside. I finally put my coat on just now. But during this visit, I also acquired a lap blanket that my grandmother knitted. When I checked in my bag, it was 1 pound overweight, so I took the blanket out and put it in my backpack. I'm thinking about whipping that thing out...
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I've been watching a lot of men and women (mostly men) in fatigues in the airport today. And to them I'd like to say two things. 1. Thanks for serving. We feel safer with you around. And 2, couldn't you have worn your dress uniforms today? I know they're uncomfortable, but they're just so scenic...
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This guy sitting next to me at the gate doesn't know it, but I've been watching the movie on his laptop for the past 30 minutes. I'm thinking of asking him for an earbud.
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I struggle with the question every time I come home of whether to move back here or to stay in NC when I'm done with residency. I don't have to make this decision for at LEAST two years. I think, more than anything, it represents me being homesick.
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I really like the internet. It amazes me that I've been able to meet people all over the world, can share pictures and words, thoughts and experiences, philosophies, observations, and amusement. I can feel close to people who are nowhere near me, to some whom I've never met in person. The world is getting smaller by the second.
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My good friends introduced me to Skype this week. I've always been sort of like, yeah, yeah, Skype, I have a phone, whatever, but they regularly eat dinner with their parents/in-laws over Skype. I think this is very cool.
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Have I mentioned the adorableness of my friends' kids? I'd tell you more, but I'd hate to have to shout over that loud, infernal ticking...
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The title of today's post is a reference to an Indigo Girls song, "Airplane." Which is one of my all-time favorites and is quite likely my favorite travel song. You know, when I'm flying.
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In other lyrics-related news, Barb mentioned on FB the other day that her daughter was cracking up at her misinterpretation of the lyrics to Jay-Zs "Empire State of Mind." Google says the chorus starts with "Concrete jungles that dreams are made of." But I was listening to this on the radio today, and I'll be damned if it doesn't actually sound like Alicia Keys is talking about "wintry tomatoes."
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That story also reminds me of this SNL sketch, which I find hilarious.

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Alright. I think I'm going to go read something now....

Silence, part two (take two)

So, here's the thing.

There's this "silent protest" going on at work. Because...um........okay, I'm not entirely sure what we're supposed to be protesting. The idea, I guess, is that there are things about our residency that aren't perfect. And if we continue to recruit people to the program, then nothing will ever get fixed. So, instead, a couple of my cohorts are promoting that we should abstain from all contact with the prospectives that are filing through in small, black-suited droves three times a week.

I......I can't even enumerate all the things wrong with this plan.

Let's start with, they're tweaking things at our program all the time. Two, our program? Pretty much rocks. We work hard, harder than most psych programs, but we get solid training as a result. They listen to us, they support us, we work with good people and we get a very broad range of experiences. Three, if none of us were to do recruiting, then we would end up with poor quality residents in the next class. 3.5, if you don't like the kind of people in the residency, you're shooting yourself in the foot by not having a say in who comes in next year. Four, this leaves a significant burden on those of us who now have to pick up the slack from those who aren't participating. Which means, for example, I'm interviewing every week and attending between two and four recruitment events per week. Five, the people who are "protesting?" Are the ones who don't want to get involved to effect change, and in fact are resisting the proposed changes the hardest. Six? Don't think the administration isn't well aware of who's in the pit up to their elbows and who is standing on the sidelines whining.

To name a few.

But beyond that, the principle of this whole thing irritates me. I mean...the thing about a silent protest is, no one can hear you. And don't misunderstand - I'm all for civil disobedience. This country wouldn't be where it is right now if it weren't for a tired black woman on a bus. But to do nothing and expect that to cause things to change? Um, go back to elementary physics, my friends, and talk to a man named Newton....

I'm the first one to point out that you cannot apply logic to an irrational situation, which this clearly is, but come on, people!!! There is absolutely no logic in this!

And, we do this. We, as humans, we want people to "just know." We don't want to have to tell our husband what we want for Christmas; instead, we buy into this notion that if we were important enough to him, he would know us well enough to get the perfect gift. But here's the kicker - no matter how important someone is to you, no matter how well you know them, you still can't induce telepathy. And let me tell ya...the sooner we let go of this notion, the better.

No one can read your mind, so you have to tell people what's in it.

The thing that is really pissing me off, here, is the reluctance of those complaining to do anything active to fix the problem. And I get it, I do. It's easy to whine, to be unhappy, but it's scary to try the unknown, even if it might be better. But it's irritating as shit to the people around you, especially when they're trying to help and you just keep pushing back.

Here's the thing, folks - there's a lot of truth to the adage about how if you aren't part of the solution, you're part of the problem. And in refusing to become part of the solution, in my humble little opinion, you forfeit your right to whine about what's not working. You can either complain, or do nothing, but you can't do both.

So I'm irritated about this situation, obviously. But I've decided that being pissed off about it is also not part of the solution. I'm not entirely sure what *is,* yet, but I'm working on it.