So I spent six and a half hours in the Selection Committee meeting today, where we helped decide the fate of the 100+ people that interviewed for 13 spots at our program. The other part of their fate, of course, is decided by them and the other programs that rank them. But it was such an interesting experience to sit in on the other side of that selection process at Big Blue. Alls I can say about the meeting itself are these two things: A, I'm really glad I'm not applying this year, because wow, do we have a strong applicant pool; and 2, I'm really glad they had cookies. But beyond that, it really made me think about what I looked like as an applicant. I'm a good doctor, and I was a good med student, but I was not the strongest candidate because of what happened at The Emerald Palace. I wondered about the discussion that happened when they ranked me. I wondered who objected, who went to bat for me, or if that actually needed to happen. I thought about the years that have passed since then. I thought about what a different person I am...and the ways in which, for better or worse, I'm still the same.
I'm really glad they took a chance on me.
Showing posts with label the emerald palace. Show all posts
Showing posts with label the emerald palace. Show all posts
Tuesday, February 01, 2011
Tuesday, December 01, 2009
One day closer to Friday
I'm so freakin' tired...
The consult service, at least, had a reasonable day. I'm sure we'll get slammed tomorrow. I spent a lot of time fighting with a particular medicine service about why high sodium, dehydration, and a white count could still be making my patient delirious, even though she'd already had antibiotics...so, uh, maybe you should give her some fluids. Even if it means tying her down a little. I mean, soft restraints, not ideal, but dying? Less ideal. Seriously, people, why am I doing your job for you? Remember, I'm "just" a psychiatrist.
In better news, my dad is home from the hospital. Which is making *me* very anxious, because this afternoon they were like, "we need to do surgery!!" and then like an minute later were all, "Never mind. We're discharging you. Go see your real doctor." I'd been trying really hard not to "interfere" to that point (SO difficult...I know enough to get freaked out by everything). But at that point I was like, "GO CALL YOUR CARDIOLOGIST. RIGHT. NOW." Which he did. And said Cardiologist - whom I learned Cardiology from - was okay with them discharging my dad. Him I trust. So, okay.
Still. Bleh.
One nice thing, though, about all of this - when I heard the whole surgery thing, I went and told the people I needed to tell that I might have to bolt in a hurry. Everyone was like, no problem. Do what you need to do. We'll get it taken care of. Don't even worry about it. I also brought up with most of them that I might need to have my knee scoped in the near future, and got the same response.
Back at the Emerald Palace, I neglected my abscessed tooth for about six weeks. By the time I actually went to a dentist, he was like, "Oh, holy crap!", started me on a course of antibiotics before he'd even really look at it, and sent me to an endodontist for the root canal because it was too complicated for him. I think I went to the dentist post-call, but when I tried to take an afternoon off (on Anesthesia, who, of course, were like, yeah, get out of here, hope they give you the good drugs) to have my root canal done? I was "abusing the system."
So much better here. I really like the people I work with, and it's nice to know they've got my back. And not because they're sticking a knife in it.
The consult service, at least, had a reasonable day. I'm sure we'll get slammed tomorrow. I spent a lot of time fighting with a particular medicine service about why high sodium, dehydration, and a white count could still be making my patient delirious, even though she'd already had antibiotics...so, uh, maybe you should give her some fluids. Even if it means tying her down a little. I mean, soft restraints, not ideal, but dying? Less ideal. Seriously, people, why am I doing your job for you? Remember, I'm "just" a psychiatrist.
In better news, my dad is home from the hospital. Which is making *me* very anxious, because this afternoon they were like, "we need to do surgery!!" and then like an minute later were all, "Never mind. We're discharging you. Go see your real doctor." I'd been trying really hard not to "interfere" to that point (SO difficult...I know enough to get freaked out by everything). But at that point I was like, "GO CALL YOUR CARDIOLOGIST. RIGHT. NOW." Which he did. And said Cardiologist - whom I learned Cardiology from - was okay with them discharging my dad. Him I trust. So, okay.
Still. Bleh.
One nice thing, though, about all of this - when I heard the whole surgery thing, I went and told the people I needed to tell that I might have to bolt in a hurry. Everyone was like, no problem. Do what you need to do. We'll get it taken care of. Don't even worry about it. I also brought up with most of them that I might need to have my knee scoped in the near future, and got the same response.
Back at the Emerald Palace, I neglected my abscessed tooth for about six weeks. By the time I actually went to a dentist, he was like, "Oh, holy crap!", started me on a course of antibiotics before he'd even really look at it, and sent me to an endodontist for the root canal because it was too complicated for him. I think I went to the dentist post-call, but when I tried to take an afternoon off (on Anesthesia, who, of course, were like, yeah, get out of here, hope they give you the good drugs) to have my root canal done? I was "abusing the system."
So much better here. I really like the people I work with, and it's nice to know they've got my back. And not because they're sticking a knife in it.
Saturday, October 17, 2009
Hawaii By Night
(...is actually the name of the strip club across the street from where I'm sitting. But it also seemed like a fitting title...)
I'm sitting outside the Starbucks at Kuhio and Seaside on a lovely, breezy, Honolulu evening. There's a couple of street performers down the way, and the low rhythmic drumming pulses like a heartbeat as the nightlife flows by. This really is a very pleasant city. Beautiful scenery, lovely weather, wonderful people. Hawaii has such a unique and adaptive culture. I'd love to know more about what goes on when the tourists aren't looking.
I get the sense, though, that I wouldn't actually want to live here. I'm not really sure why I think that.
When we were in medical school, one of my colleagues was in the military, and discovered that if you didn't match into any of the military programs, you could go through the general match process and get into a civilian one. He thought, no problem, and just didn't interview at any of the military programs, so that he could match into a civilian program closer to his family. Great idea, right?
Except...
He was one wicked smart guy. In the top ranks of our class, good CV, excellent board scores. He looked so good on paper, in fact, that at least one of the military programs ranked him without even meeting him. And he matched in Hawaii.
I always have felt kind of bad for him in that Hawaii and Iowa are a long way apart. And that was the same year I matched into a program I wasn't expecting (although, I ranked them third, it was kind of my fault. Or, at least I had a hand in it). And I can imagine being stuck on an island in the middle of the Pacific can be daunting for a Midwesterner. And certainly one person's paradise can be another one's hell.
But still.
I have distinct memories of a weekend sometime about January. I was in the middle of a q2 weekend, which meant I hadn't slept all night, and was due for another sleepless night of call the next day. I already hated my life and my program and felt for all the world like the worst resident ever. And I dig my damn car out of where it's been plowed in, and I drive home, and there's four fucking feet of snow in my driveway.
I thought of my friend from medical school at that moment. I thought of the night we'd spent out drinking with a bunch of our other friends during Senior Disorientation Week, and we talked about how we were both trying very hard to accept where we'd been sent, were trying to be optimistic, but when the veil of denial was lifted by a large bucket of something rum-containing and fruity with eight straws and half a bottle of maraschino cherries in it, neither of us was really very happy with the way things turned out.
I felt like FedExing him four feet of snow.
In the end, I lost touch with him, because I lost touch with almost everyone during that year, and he's not on Facebook (which is how I've managed to reconnect with a lot of my classmates). I still think about him once in a while. He was a good guy, and a good friend, and I hope that in the end, his misstep worked out as well as mine ultimately did. I thought about asking if anyone knew if he was still on the island, but his residency should be over, and I expect that he isn't.
Besides, how would I explain that big soggy box he got intern year?
I'm sitting outside the Starbucks at Kuhio and Seaside on a lovely, breezy, Honolulu evening. There's a couple of street performers down the way, and the low rhythmic drumming pulses like a heartbeat as the nightlife flows by. This really is a very pleasant city. Beautiful scenery, lovely weather, wonderful people. Hawaii has such a unique and adaptive culture. I'd love to know more about what goes on when the tourists aren't looking.
I get the sense, though, that I wouldn't actually want to live here. I'm not really sure why I think that.
When we were in medical school, one of my colleagues was in the military, and discovered that if you didn't match into any of the military programs, you could go through the general match process and get into a civilian one. He thought, no problem, and just didn't interview at any of the military programs, so that he could match into a civilian program closer to his family. Great idea, right?
Except...
He was one wicked smart guy. In the top ranks of our class, good CV, excellent board scores. He looked so good on paper, in fact, that at least one of the military programs ranked him without even meeting him. And he matched in Hawaii.
I always have felt kind of bad for him in that Hawaii and Iowa are a long way apart. And that was the same year I matched into a program I wasn't expecting (although, I ranked them third, it was kind of my fault. Or, at least I had a hand in it). And I can imagine being stuck on an island in the middle of the Pacific can be daunting for a Midwesterner. And certainly one person's paradise can be another one's hell.
But still.
I have distinct memories of a weekend sometime about January. I was in the middle of a q2 weekend, which meant I hadn't slept all night, and was due for another sleepless night of call the next day. I already hated my life and my program and felt for all the world like the worst resident ever. And I dig my damn car out of where it's been plowed in, and I drive home, and there's four fucking feet of snow in my driveway.
I thought of my friend from medical school at that moment. I thought of the night we'd spent out drinking with a bunch of our other friends during Senior Disorientation Week, and we talked about how we were both trying very hard to accept where we'd been sent, were trying to be optimistic, but when the veil of denial was lifted by a large bucket of something rum-containing and fruity with eight straws and half a bottle of maraschino cherries in it, neither of us was really very happy with the way things turned out.
I felt like FedExing him four feet of snow.
In the end, I lost touch with him, because I lost touch with almost everyone during that year, and he's not on Facebook (which is how I've managed to reconnect with a lot of my classmates). I still think about him once in a while. He was a good guy, and a good friend, and I hope that in the end, his misstep worked out as well as mine ultimately did. I thought about asking if anyone knew if he was still on the island, but his residency should be over, and I expect that he isn't.
Besides, how would I explain that big soggy box he got intern year?
Tuesday, June 16, 2009
Every now and then every girl needs...
Which is a reference to this song:
(I really like Leann Rimes. Like, as an entity. She's grown up quite gracefully.)
Today did not go especially well.
Call was fine. I was on with Scott and then Fang. Scott, who was on for the third time in five days and was supposed to leave by 10pm, left at 2am. Which was partially my (and Fang's) fault - we kept talking to him. If we'd just ignored him and made him write his notes, maybe he would've gotten out of there before I went to bed. But on the whole, the evening did not suck.
Strangely, I'm not as excited about this "end of call" thing as I want to be. I'm a little freaked out by it, frankly. Like, it definitely marks the end of something, a change, an evolution of my professional life. For the past seven years it's been part of my identity. Even when I was "on sabbatical" and not actively taking call, it was something I did, planned to do again, a fact of my life. It's something that is very different from normal people's jobs.
I don't think I'm trying to say I'm afraid to be normal. I just think, it's a shift. A harbinger of change.
I spent a good deal of time today contemplating the difference between novelty and change. I like novelty. Change makes me anxious. But I'm not entirely certain how they're different.
Gomer sent me a weirdly cryptic text yesterday afternoon, saying "be sure to watch the news tonight for important gym information." I was like, what?? I finally pestered him again around 11, because there was no "watching the news" in my evening, and he confirmed what I've been saying for over a month - our gym is closing. June 30th. Frack. So we talked about it a bit and came up with a plan because they were going to relocate him to the location Ruthie goes to. It's a meat market, and everyone from work goes there, but I like my trainer and so, fine, for him I'd go to Ruthie's club. Except then, this morning, there was this article in the local paper saying that the chain is closing all of the Triangle locations within three months.
I'm so not pleased. I like my gym. I like the people at my gym. My gym is comfortable and generally emotionally safe. I have gym friends. Where are we all going to go?
Allegedly, the gym that's next door to my apartment bought out all of my gym's current contracts. Which, I guess that's handy. I don't know what that means for me and Gomer. I like Gomer. Gomer and I work well together. He's pretty. He's also comfortable and generally emotionally safe.
Do they not understand how hard it is for me to go to the gym in the first place? Some day I'll post about just how unbelievably charged this whole thing actually is for me...
I also got my TSH drawn today. My doc and I have been steadily increasing my dose of thyroid hormone for several months now. At the last draw, it was down to high-normal, which meant it was responding to a reasonable dose of the meds. That was three months ago. Today? The highest it's ever been. What the fuck, people? That makes no sense.
I also got called into the principle's office today. Okay, because of a problem I went to her with, but I have to go meet with my program director tomorrow. I feel like I'm so very in trouble, primarily because of the way she worded her email, which was not actually indicative of me being so very in trouble, but rather of her paying attention to what I was saying. However, she happened to use the exact same phrase that my program director at the Emerald Palace used to basically tell me they wanted to put me on probation ("We should talk about this." Not exactly an uncommon bit of verbiage). That's definitely not what's happening here. But logically knowing that doesn't make me any less anxious about it.
A couple of other things happened. All in all, it was not a good day.
But then, I got a little nap, got a little shower (since I finally went to the gym today, and of course, now there's NO air conditioning at all), and went and picked Maggie up from the daycare. And then I went and got a cheap manicure at this place I went to a couple of times when I lived here first year. They're extremely reasonable and they do pretty good work. And then I went and had dinner with Sparrow and Rene at this local Mexican place I've been wanting to try (Ruthie got lost and Peng was on call, but I like to think they were there in spirit). And by the end of that, I felt so. much. better.
LeAnn knows what she's talking about.
Thanks, ladies.
(I really like Leann Rimes. Like, as an entity. She's grown up quite gracefully.)
Today did not go especially well.
Call was fine. I was on with Scott and then Fang. Scott, who was on for the third time in five days and was supposed to leave by 10pm, left at 2am. Which was partially my (and Fang's) fault - we kept talking to him. If we'd just ignored him and made him write his notes, maybe he would've gotten out of there before I went to bed. But on the whole, the evening did not suck.
Strangely, I'm not as excited about this "end of call" thing as I want to be. I'm a little freaked out by it, frankly. Like, it definitely marks the end of something, a change, an evolution of my professional life. For the past seven years it's been part of my identity. Even when I was "on sabbatical" and not actively taking call, it was something I did, planned to do again, a fact of my life. It's something that is very different from normal people's jobs.
I don't think I'm trying to say I'm afraid to be normal. I just think, it's a shift. A harbinger of change.
I spent a good deal of time today contemplating the difference between novelty and change. I like novelty. Change makes me anxious. But I'm not entirely certain how they're different.
Gomer sent me a weirdly cryptic text yesterday afternoon, saying "be sure to watch the news tonight for important gym information." I was like, what?? I finally pestered him again around 11, because there was no "watching the news" in my evening, and he confirmed what I've been saying for over a month - our gym is closing. June 30th. Frack. So we talked about it a bit and came up with a plan because they were going to relocate him to the location Ruthie goes to. It's a meat market, and everyone from work goes there, but I like my trainer and so, fine, for him I'd go to Ruthie's club. Except then, this morning, there was this article in the local paper saying that the chain is closing all of the Triangle locations within three months.
I'm so not pleased. I like my gym. I like the people at my gym. My gym is comfortable and generally emotionally safe. I have gym friends. Where are we all going to go?
Allegedly, the gym that's next door to my apartment bought out all of my gym's current contracts. Which, I guess that's handy. I don't know what that means for me and Gomer. I like Gomer. Gomer and I work well together. He's pretty. He's also comfortable and generally emotionally safe.
Do they not understand how hard it is for me to go to the gym in the first place? Some day I'll post about just how unbelievably charged this whole thing actually is for me...
I also got my TSH drawn today. My doc and I have been steadily increasing my dose of thyroid hormone for several months now. At the last draw, it was down to high-normal, which meant it was responding to a reasonable dose of the meds. That was three months ago. Today? The highest it's ever been. What the fuck, people? That makes no sense.
I also got called into the principle's office today. Okay, because of a problem I went to her with, but I have to go meet with my program director tomorrow. I feel like I'm so very in trouble, primarily because of the way she worded her email, which was not actually indicative of me being so very in trouble, but rather of her paying attention to what I was saying. However, she happened to use the exact same phrase that my program director at the Emerald Palace used to basically tell me they wanted to put me on probation ("We should talk about this." Not exactly an uncommon bit of verbiage). That's definitely not what's happening here. But logically knowing that doesn't make me any less anxious about it.
A couple of other things happened. All in all, it was not a good day.
But then, I got a little nap, got a little shower (since I finally went to the gym today, and of course, now there's NO air conditioning at all), and went and picked Maggie up from the daycare. And then I went and got a cheap manicure at this place I went to a couple of times when I lived here first year. They're extremely reasonable and they do pretty good work. And then I went and had dinner with Sparrow and Rene at this local Mexican place I've been wanting to try (Ruthie got lost and Peng was on call, but I like to think they were there in spirit). And by the end of that, I felt so. much. better.
LeAnn knows what she's talking about.
Thanks, ladies.
Thursday, March 12, 2009
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.
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.
Saturday, December 06, 2008
Cycles
Ohh, I'm so glad this week is over. Actually, the week itself wasn't so dramatic (I was home sick Wednesday and Thursday, after all), but, I'm just so glad it's the weekend.
I need some vacation time. Fortunately, I have a week coming up, but I'm not anticipating that to be very relaxing, since I'm going back to Chicago (the week of New Years, for those who might have a vested interest in that). Good, of course, just kind of frenetic.
The coming week is going to be...um, let's go with...interesting. I'm on Walk-Ins Monday through Thursday (there's a long involved story about why Ed and I switched Fridays...so I have four days this week and one day next week, and then I'm on call twice the week of Christmas...). Walk-Ins refers to the Walk-In clinic, which is just what it sounds like - ideally, an urgent care clinic (I need my meds today because I'm about to run out. I'm going to kill myself. I'm going to kill someone, possibly me, if we don't get this depression treated quickly. You get the idea). You also cover the ER during the day. So it's like daytime call. Or as I tend to refer to it, Day Float.
What's nice is that it's 8:30-5. You plan accordingly and you sign out to the incoming call team at 4:30. Done. What's...um, let's go with...interesting about it is that we have this group of social workers and psych NPs and such that's supposed to be doing all this with us. They're part of the "crisis team" and are salaried to do Day Float things. This sounds great in theory, right, because in theory it would free up the physician (there's only one) to do doctor-y kinds of things. You know, stuff clinical social workers can't do (meds) or aren't really trained to deal with (complicating/complicated medical issues, physicals, orders, etc). Problem is, our crisis team tends to be...um, let's go with...inefficient. They're nice people, just sort of...unmotivated. With a different work ethic than residents tend to have. And rather thanfiring their asses encouraging efficiency (it doesn't have to be the threat of unemployment that's used to motivate them. How about praise? Incentives? A higher standard and expectation?), they're coddled and stroked because we don't want them to leave.
The residents this year have all been like, so let them leave. They either need to get moving, or get out of the way. We...you know, we're a hard-working bunch. We'll get in there shoulder to shoulder and fight through the roughest of shifts. And, fine, so residents in general are more used to hard work and long hours, we're sort of a masochistic group anyway, etc, but, damn it, if we're in there hip-deep, we expect the people who are paid a heck of a lot more than us to do this very job to be in there with us.
We'll see how it goes. There's a new guy, Charlie, who seems promising. We hired him away from one of the community hospitals, and every time I've worked with him on call he seems to be busting his ass. He's been doing this for a number of years, so I don't think he's going to burn out, and he doesn't seem like the type to be lazy just because everyone else is and he can get away with it, so, maybe the rest of the crew will have to step up to keep from looking bad.
A girl can hope...
I went to this talk this morning for the PECC (more about that in a minute), and the speaker was talking about what he referred to as The Lead Rule - do unto others as others have done unto you. It's so simple and obvious (and sardonic), but damn if that doesn't sum up a lot of issues in medical education. We get into these ruts of "this is how it's been" and "if I had to do it, so do you." This is particularly rampant in the surgical disciplines, but, I think it's pervasive. And I think it occasionally translates into, if no one else has to do it, why should I?
Sometimes? Life kind of stinks. Sometimes you have to do things because it's the right thing to do, or they have to get done, or whatever, even if they're unpleasant or tedious or not what you'd rather be doing. But, if we ALL do this, then it tends to mean less unpleasantness for everyone.
Amazing how many people look at that and say, well, too bad. You can take my share of the unpleasantness. I'm going to go over here...
Also at this talk this morning, I met up with one of my colleagues who told me some disappointing things about our current chief class and how unhelpful and minimally mediocre they've been for the intern class. This upsets me. Because, last year? Our chiefs rocked. They weren't always perfect, but, they always made an effort. And we were all interns once. And it sucked, but we got through it, and that support made it so much easier. This year? You know, I think the thing that bothers me most is that their attitude is contagious. Like, I've always jumped in when someone was sick. I took on May's work when she was ill when we were on together at State Hospital. I took calls for Cleo and Fang on less than 12 hours' notice (about three hours, in Fang's case). I dug in and took on some of Mike's work when he was overwhelmed or had a bad night on Family. I was q2 for a week when Peng had dental surgery. You get the idea. We help each other out, you know? Two weeks ago, when I had a 102 temp and needed my call covered? It was next to impossible to find someone to step up (Sparrow = goddess. Have I mentioned that? JD also rocks) and Ruthie said there was a lot of "fighting" about who was going to take it. I just sort of shook my head at this, because I think it's spilled over from the "I don't want to do more than I have to" attitude that's at the top of our pyramid right now. I think the next three chief classes look promising, though. And you know...as much as I rant about things sometimes....
Holy freakin' cow am I glad I'm here.
Yesterday was an interview day. We had I think seven candidates, all in their smart black suits, all on their best behavior. It's cute. They seemed like a nice bunch (one of them reads my blog! How cool is that?!! Hi, D!!). In general, this year, I've been so pleased with the candidates. Anyway, they'd assembled in Corrina's office and got escorted off to lunch, leaving Peng and me and a couple of the other residents to talk about them, er, discuss recruitment. And we were like, I hope they realize we're all pretty much as we seem, here. We get along. We're a quirky but genuine group of overall good people. The interns lost their tiny little office space? A bunch of us stepped up and procured for them what I now like to call the Intern Rec Room. The Child/Adolescent month was too scattered, we got it changed to being just Adolescent. The faculty supports us, the chair is very interested in how we think things are running, and overwhelmingly people are interested in teaching, learning, and being colleagues. We like each other. We respect each other. I can't even express how important that is.
This time of year always leaves me a littleretraumatized nostalgic about life at the Emerald Palace. I remember talking to one of the candidates that would eventually become one of the interns in the class after mine, whom I liked a great deal. I remember thinking I should tell her to run screaming (RUN. RIGHT NOW. AS FAST AS YOU BLOODY CAN. RIGHT. NOW), but what I told her was, intern year is a hard year. The dynamics here are difficult sometimes, and you have to watch out for yourself, but if you know that coming in, I suppose it's easier to handle ("But, gosh, the program has so many positives, too." Like...uh...the way our labor deck is set up. And the cool robotic system in the OR. And, uh, the scrubs are free. And working at Student Health (not here). And the off service months (not here). And the ER attendings (not ours)...). Yesterday, I'm interviewing this guy (I got to interview! It was fun), and I was like, you know...intern year is a hard year. Harder here that most places, but gosh, you learn so much. You come out of it so much stronger in your professional sense of self. And the faculty is supportive, and the upper classes are supportive, and people are genuinely interested in you here. And we're social, and we have fun, and we work hard but we're encouraged to get the hell out of here and be well rounded people. And yeah, not everything works perfectly, or even as well as we'd like it to. But even when there's nothing that can be done about that, they hear us.
He asked me if I was happy. I said, without a second thought, "I love it here." And I meant it. And then he commented on what a good research program we are, and I thought about that for a little while, and he said, all nervous, "Well, you may not agree with that, I guess." And I said, no...actually, I do agree with that. But don't think we're just about research...and then we had a nice discussion of how we're very patient centered and we emphasize psychotherapy and how many opportunities we have here.
The Emerald Palace taught me a lot. In my time there, and in the subsequent cleanup, I've learned a lot about myself. I learned a lot about interpersonal dynamics and group psychopathology and systems errors. I learned a lot from them about what I don't want, and a little about what I do. I learned what it means to be "the doctor" - the program might have rarely let me be that person, but my patients did in spades. I even learned how to do a colposcopy and run the cool robotic system in the OR and do a wicked good circumcision. But the best thing they did for me? They got me here.
I wish I was the kind of person that could thank them for that. I'm still going to go with, "Fuck you."
I need some vacation time. Fortunately, I have a week coming up, but I'm not anticipating that to be very relaxing, since I'm going back to Chicago (the week of New Years, for those who might have a vested interest in that). Good, of course, just kind of frenetic.
The coming week is going to be...um, let's go with...interesting. I'm on Walk-Ins Monday through Thursday (there's a long involved story about why Ed and I switched Fridays...so I have four days this week and one day next week, and then I'm on call twice the week of Christmas...). Walk-Ins refers to the Walk-In clinic, which is just what it sounds like - ideally, an urgent care clinic (I need my meds today because I'm about to run out. I'm going to kill myself. I'm going to kill someone, possibly me, if we don't get this depression treated quickly. You get the idea). You also cover the ER during the day. So it's like daytime call. Or as I tend to refer to it, Day Float.
What's nice is that it's 8:30-5. You plan accordingly and you sign out to the incoming call team at 4:30. Done. What's...um, let's go with...interesting about it is that we have this group of social workers and psych NPs and such that's supposed to be doing all this with us. They're part of the "crisis team" and are salaried to do Day Float things. This sounds great in theory, right, because in theory it would free up the physician (there's only one) to do doctor-y kinds of things. You know, stuff clinical social workers can't do (meds) or aren't really trained to deal with (complicating/complicated medical issues, physicals, orders, etc). Problem is, our crisis team tends to be...um, let's go with...inefficient. They're nice people, just sort of...unmotivated. With a different work ethic than residents tend to have. And rather than
The residents this year have all been like, so let them leave. They either need to get moving, or get out of the way. We...you know, we're a hard-working bunch. We'll get in there shoulder to shoulder and fight through the roughest of shifts. And, fine, so residents in general are more used to hard work and long hours, we're sort of a masochistic group anyway, etc, but, damn it, if we're in there hip-deep, we expect the people who are paid a heck of a lot more than us to do this very job to be in there with us.
We'll see how it goes. There's a new guy, Charlie, who seems promising. We hired him away from one of the community hospitals, and every time I've worked with him on call he seems to be busting his ass. He's been doing this for a number of years, so I don't think he's going to burn out, and he doesn't seem like the type to be lazy just because everyone else is and he can get away with it, so, maybe the rest of the crew will have to step up to keep from looking bad.
A girl can hope...
I went to this talk this morning for the PECC (more about that in a minute), and the speaker was talking about what he referred to as The Lead Rule - do unto others as others have done unto you. It's so simple and obvious (and sardonic), but damn if that doesn't sum up a lot of issues in medical education. We get into these ruts of "this is how it's been" and "if I had to do it, so do you." This is particularly rampant in the surgical disciplines, but, I think it's pervasive. And I think it occasionally translates into, if no one else has to do it, why should I?
Sometimes? Life kind of stinks. Sometimes you have to do things because it's the right thing to do, or they have to get done, or whatever, even if they're unpleasant or tedious or not what you'd rather be doing. But, if we ALL do this, then it tends to mean less unpleasantness for everyone.
Amazing how many people look at that and say, well, too bad. You can take my share of the unpleasantness. I'm going to go over here...
Also at this talk this morning, I met up with one of my colleagues who told me some disappointing things about our current chief class and how unhelpful and minimally mediocre they've been for the intern class. This upsets me. Because, last year? Our chiefs rocked. They weren't always perfect, but, they always made an effort. And we were all interns once. And it sucked, but we got through it, and that support made it so much easier. This year? You know, I think the thing that bothers me most is that their attitude is contagious. Like, I've always jumped in when someone was sick. I took on May's work when she was ill when we were on together at State Hospital. I took calls for Cleo and Fang on less than 12 hours' notice (about three hours, in Fang's case). I dug in and took on some of Mike's work when he was overwhelmed or had a bad night on Family. I was q2 for a week when Peng had dental surgery. You get the idea. We help each other out, you know? Two weeks ago, when I had a 102 temp and needed my call covered? It was next to impossible to find someone to step up (Sparrow = goddess. Have I mentioned that? JD also rocks) and Ruthie said there was a lot of "fighting" about who was going to take it. I just sort of shook my head at this, because I think it's spilled over from the "I don't want to do more than I have to" attitude that's at the top of our pyramid right now. I think the next three chief classes look promising, though. And you know...as much as I rant about things sometimes....
Holy freakin' cow am I glad I'm here.
Yesterday was an interview day. We had I think seven candidates, all in their smart black suits, all on their best behavior. It's cute. They seemed like a nice bunch (one of them reads my blog! How cool is that?!! Hi, D!!). In general, this year, I've been so pleased with the candidates. Anyway, they'd assembled in Corrina's office and got escorted off to lunch, leaving Peng and me and a couple of the other residents to talk about them, er, discuss recruitment. And we were like, I hope they realize we're all pretty much as we seem, here. We get along. We're a quirky but genuine group of overall good people. The interns lost their tiny little office space? A bunch of us stepped up and procured for them what I now like to call the Intern Rec Room. The Child/Adolescent month was too scattered, we got it changed to being just Adolescent. The faculty supports us, the chair is very interested in how we think things are running, and overwhelmingly people are interested in teaching, learning, and being colleagues. We like each other. We respect each other. I can't even express how important that is.
This time of year always leaves me a little
He asked me if I was happy. I said, without a second thought, "I love it here." And I meant it. And then he commented on what a good research program we are, and I thought about that for a little while, and he said, all nervous, "Well, you may not agree with that, I guess." And I said, no...actually, I do agree with that. But don't think we're just about research...and then we had a nice discussion of how we're very patient centered and we emphasize psychotherapy and how many opportunities we have here.
The Emerald Palace taught me a lot. In my time there, and in the subsequent cleanup, I've learned a lot about myself. I learned a lot about interpersonal dynamics and group psychopathology and systems errors. I learned a lot from them about what I don't want, and a little about what I do. I learned what it means to be "the doctor" - the program might have rarely let me be that person, but my patients did in spades. I even learned how to do a colposcopy and run the cool robotic system in the OR and do a wicked good circumcision. But the best thing they did for me? They got me here.
I wish I was the kind of person that could thank them for that. I'm still going to go with, "Fuck you."
Saturday, November 22, 2008
Admitting defeat
Damn stupid virus.
So, last night, right, Sparrow and I had left it that I would go in for call this morning, insisting of course that I was fine, and then Cleo (who was on call last night) would assess me, and if she felt I lacked capacity to make the decision about taking call (sorry, shrink joke), she'd send me home and Sparrow would pinch hit, at least for the day shift. But, of course, I would be fine.
Ah, it was a good plan...
So I got all, like, I'm going to bed. I'm going to be well-rested and fine tomorrow. Ahh, bed. Except...once I laid down...I couldn't breathe. No, really. My nose was dripping, my sinuses were full of concrete, and every time I relaxed enough to get to sleep I'd shut my mouth and then start suffocating. Which was between the times I started choking and coughing as I kept drowning in my own secretions. Ugh, it was awful.
So I finally gave up around 12:30 and decided to do something about it. I put on some passable clothing, climbed into my car, and headed for the Walgreens.
::sigh:: I hadn't even made it past the hospital before I got pulled over.
Okay, fine, so my tags are expired. Because in Illinois, they send you a letter reminding you that your plates are about to expire. In North Carolina, they send you a letter reminding you that, hey darlin', your tags expired two months ago and you should really get that fixed.
How was I supposed to know?
Fortunately, Officer Friendly was "feelin' the holidays" and took pity on my snotty, pathetic, transplanted self. So I went to Walgreens, bought cough syrup, and Afrin, and nose strips, and saline spray. And wound up continuing to cough and drip and drown all night. Except I couldn't swallow, because my throat was so sore from the Afrin. And I was sweating and tossing and turning and, oh, yech, it was a terrible night.
This morning, when my alarm went off at 6:30, there was just no way I was going to be of use to anybody today. And, my temp was still 102. So Sparrow took the first half of my shift (did I mention she was a goddess?) and JD took the overnight (he is also fabulous, although - to his relief, I'm sure - not a goddess). Ohh, thank God.
Although...I can't even begin to tell you how guilty I feel. I know, I know, stupid, unwarranted (ahem, 102) - and not that I won't pay back the time - but there nonetheless.
So, Maggie and I sat around most of the day trying to nap (she was a lot more successful at that than I) and watching TV. The unfortunate part of that is, while Thursday and yesterday I had a lot of good stuff accumulated on the DVR...today, the TV was crappy.
Which did not stop me from watching it. Despite all the interspersed commercials about how part of a healthy lifestyle is limiting TV to two hours per day or less (ha!). And my increasing guilt about what a disaster the house is (because I haven't really moved in. For a whole bunch of ridiculous neurotic reasons and a couple of moderately reasonable ones - like I have too much stuff and a significant paucity of time). But I'm siiiiiiiiiiick....
I watched a documentary on the Jonestown tragedy (which was 30 years ago this week) on the History Channel. I watched a terrible Lifetime movie. I watched a couple of episodes of Scrubs, and M*A*S*H, and the Cosby Show. I forgot how much I used to want to be Claire Huxtable...
I watched a show on Freebirthing on Discovery Health that was...well, interesting. My cousin blogged about this (and the show I watched after it) earlier in the week, and I was intrigued. Hmm. As a former deliverer of babies, I cannot in any way condone what they're doing. Cannot condone no prenatal care (a drug store BP cuff and a fetoscope? Come on). Cannot condone knowing that you may have something wrong that could easily kill you and your baby in minutes and not getting it checked out. Cannot condone such over the top disregard of what we've learned over the past several thousand years.
There was this one woman I just wanted to slap (the one with the drugstore prenatal care and the possible low-lying placenta. Minutes). She was going on and on about how horrible her first birth was and, you know, if she'd only known how risky the interventions were that they were doing (minutes!! Bloody! Horrible! Traumatic! Well before your husband would even call EMS!). Please. Because a shoulder dystocia or a cord accident without the benefit of a trained attendant, yeah, that's not risky. She also ranted about how, at her first delivery, the doctors kept yelling at her that she wasn't pushing right. And she didn't know "what the big deal was, because, you know, it only took like ten minutes."
That's when I started yelling (well, rasping) at the TV.
Okay, now, I concede that I haven't delivered as many babies as she - oh, no, wait, I probably have a couple hundred on her. And I can tell you, when we start saying things like that in a situation like she described, it's because the baby's in trouble.
Which is the PERFECT indication to have a baby far away from any medical care. Idiot. Shouldn't be allowed to breed.
Ahem.
But on the other side of it...you know, I don't support unattended births. I don't even really support home births, because they scare me. I concede that women have been doing this for thousands of years. I absolutely concede that more births around the world occur outside of the Western medical setting than not. But I also would point out how many fewer moms and/or babies die in childbirth or have poor delivery outcomes in the Western world than in the third word or developing nations. But by the same token, I don't either entirely support the medical, institutionalized birth. I've said this before on here, that I dislike the assembly line, everyone gets an epidural at 4 cm, everyone delivers in lithotomy kind of birth, which we do because it makes us feel as practitioners like we're more in control of a chaotic process. But the truth is, I think it often leaves us less in control. I got in so much trouble for deviating from that standardized delivery, but I really felt like everyone was better for it, including me. As I told my patients time after time, my philosophy was this: look, it's your birth, your body, and your baby; I'm just here to keep everybody safe. So, within reason, we'll do this however you want it. Which involved any number of things, even in my short career - backrubs, perineal massage, mineral oil, olive oil, music, Wiccan sand circles, I delivered babies with their moms in pretty much any position they could come up with, and once or twice I was more or less on my back.
Interesting, isn't it, that as much as they complained about my "avoiding" the OR, the only time they commented on how I jumped in on the labor deck was to tell me I was somehow doing it wrong...
Anyhow. The bigger point is, I loved labor and delivery.
So there was this woman on the Freebirthing show who had this completely amazing delivery. It was a water birth (one thing I haven't done, partly because we didn't have the facilities, partly because it yicks me out), and wow, it was so peaceful. There was no screaming and raving and wailing. She just let things happen, accepted them as they came. She claimed it was more or less pain-free, which, I think that depends on your definition of "pain-free" (i.e., I've seen plenty of women control a reasonable level of labor pain with meditation and self-hypnosis). But it was just entrancing to watch. She was nearly silent through the whole thing. And her baby came out, sweet, beautiful, and didn't cry. I, of course, got worried, and apparently she did too, but the kid was breathing just fine. I guess he just didn't have a lot to say. She interpreted this as him being "relaxed", and I'm not sure I disagree with that. The whole thing was completely beautiful. The only thing I would've done differently (aside from being somewhere less than 500 feet from a functional OR) is that her husband didn't touch her the whole time, apparently to protect himself from some British law regarding unlicensed attendants at a birth. Which is sort of sad.
Still. Would it kill you to have a midwife on hand?
The other program I watched was on the "pregnant man." That was a lot more productive. I still don't consider him a pregnant man (uterus = not a pregnant man), but I really support what they did, and I can see his point. I had a lot more respect for them after I saw the program. They seemed like a sweet family. I really appreciated the wife's efforts to breastfeed. I did think it was sort of interesting how quickly they seemed to fall into traditional gender roles. They seem like they have been (the wife has two daughters from a previous marriage) and will be good parents (which is fortunate, because there's another one on the way), and really, can you ask for anything more than that? Everybody's family is different. Everybody's parents screw them up. And the show was an interesting and compassionate commentary on the issues that transgendered couples face. Plus, that kid's adorable. And, I do not envy any boy who comes sniffing around her in 15 years or so - she is so going to be daddy's little girl!
I did get two very amusing quotes out of today's TV watching extravaganza, though. The first, from the stupid Lifetime movie:
"Regional forecast...warm, and no babies."
If I was an OB, I'd so totally steal that (hmm...maybe I can still make it work...)
Okay, yeah, I'm done babbling...
So, last night, right, Sparrow and I had left it that I would go in for call this morning, insisting of course that I was fine, and then Cleo (who was on call last night) would assess me, and if she felt I lacked capacity to make the decision about taking call (sorry, shrink joke), she'd send me home and Sparrow would pinch hit, at least for the day shift. But, of course, I would be fine.
Ah, it was a good plan...
So I got all, like, I'm going to bed. I'm going to be well-rested and fine tomorrow. Ahh, bed. Except...once I laid down...I couldn't breathe. No, really. My nose was dripping, my sinuses were full of concrete, and every time I relaxed enough to get to sleep I'd shut my mouth and then start suffocating. Which was between the times I started choking and coughing as I kept drowning in my own secretions. Ugh, it was awful.
So I finally gave up around 12:30 and decided to do something about it. I put on some passable clothing, climbed into my car, and headed for the Walgreens.
::sigh:: I hadn't even made it past the hospital before I got pulled over.
Okay, fine, so my tags are expired. Because in Illinois, they send you a letter reminding you that your plates are about to expire. In North Carolina, they send you a letter reminding you that, hey darlin', your tags expired two months ago and you should really get that fixed.
How was I supposed to know?
Fortunately, Officer Friendly was "feelin' the holidays" and took pity on my snotty, pathetic, transplanted self. So I went to Walgreens, bought cough syrup, and Afrin, and nose strips, and saline spray. And wound up continuing to cough and drip and drown all night. Except I couldn't swallow, because my throat was so sore from the Afrin. And I was sweating and tossing and turning and, oh, yech, it was a terrible night.
This morning, when my alarm went off at 6:30, there was just no way I was going to be of use to anybody today. And, my temp was still 102. So Sparrow took the first half of my shift (did I mention she was a goddess?) and JD took the overnight (he is also fabulous, although - to his relief, I'm sure - not a goddess). Ohh, thank God.
Although...I can't even begin to tell you how guilty I feel. I know, I know, stupid, unwarranted (ahem, 102) - and not that I won't pay back the time - but there nonetheless.
So, Maggie and I sat around most of the day trying to nap (she was a lot more successful at that than I) and watching TV. The unfortunate part of that is, while Thursday and yesterday I had a lot of good stuff accumulated on the DVR...today, the TV was crappy.
Which did not stop me from watching it. Despite all the interspersed commercials about how part of a healthy lifestyle is limiting TV to two hours per day or less (ha!). And my increasing guilt about what a disaster the house is (because I haven't really moved in. For a whole bunch of ridiculous neurotic reasons and a couple of moderately reasonable ones - like I have too much stuff and a significant paucity of time). But I'm siiiiiiiiiiick....
I watched a documentary on the Jonestown tragedy (which was 30 years ago this week) on the History Channel. I watched a terrible Lifetime movie. I watched a couple of episodes of Scrubs, and M*A*S*H, and the Cosby Show. I forgot how much I used to want to be Claire Huxtable...
I watched a show on Freebirthing on Discovery Health that was...well, interesting. My cousin blogged about this (and the show I watched after it) earlier in the week, and I was intrigued. Hmm. As a former deliverer of babies, I cannot in any way condone what they're doing. Cannot condone no prenatal care (a drug store BP cuff and a fetoscope? Come on). Cannot condone knowing that you may have something wrong that could easily kill you and your baby in minutes and not getting it checked out. Cannot condone such over the top disregard of what we've learned over the past several thousand years.
There was this one woman I just wanted to slap (the one with the drugstore prenatal care and the possible low-lying placenta. Minutes). She was going on and on about how horrible her first birth was and, you know, if she'd only known how risky the interventions were that they were doing (minutes!! Bloody! Horrible! Traumatic! Well before your husband would even call EMS!). Please. Because a shoulder dystocia or a cord accident without the benefit of a trained attendant, yeah, that's not risky. She also ranted about how, at her first delivery, the doctors kept yelling at her that she wasn't pushing right. And she didn't know "what the big deal was, because, you know, it only took like ten minutes."
That's when I started yelling (well, rasping) at the TV.
Okay, now, I concede that I haven't delivered as many babies as she - oh, no, wait, I probably have a couple hundred on her. And I can tell you, when we start saying things like that in a situation like she described, it's because the baby's in trouble.
Which is the PERFECT indication to have a baby far away from any medical care. Idiot. Shouldn't be allowed to breed.
Ahem.
But on the other side of it...you know, I don't support unattended births. I don't even really support home births, because they scare me. I concede that women have been doing this for thousands of years. I absolutely concede that more births around the world occur outside of the Western medical setting than not. But I also would point out how many fewer moms and/or babies die in childbirth or have poor delivery outcomes in the Western world than in the third word or developing nations. But by the same token, I don't either entirely support the medical, institutionalized birth. I've said this before on here, that I dislike the assembly line, everyone gets an epidural at 4 cm, everyone delivers in lithotomy kind of birth, which we do because it makes us feel as practitioners like we're more in control of a chaotic process. But the truth is, I think it often leaves us less in control. I got in so much trouble for deviating from that standardized delivery, but I really felt like everyone was better for it, including me. As I told my patients time after time, my philosophy was this: look, it's your birth, your body, and your baby; I'm just here to keep everybody safe. So, within reason, we'll do this however you want it. Which involved any number of things, even in my short career - backrubs, perineal massage, mineral oil, olive oil, music, Wiccan sand circles, I delivered babies with their moms in pretty much any position they could come up with, and once or twice I was more or less on my back.
Interesting, isn't it, that as much as they complained about my "avoiding" the OR, the only time they commented on how I jumped in on the labor deck was to tell me I was somehow doing it wrong...
Anyhow. The bigger point is, I loved labor and delivery.
So there was this woman on the Freebirthing show who had this completely amazing delivery. It was a water birth (one thing I haven't done, partly because we didn't have the facilities, partly because it yicks me out), and wow, it was so peaceful. There was no screaming and raving and wailing. She just let things happen, accepted them as they came. She claimed it was more or less pain-free, which, I think that depends on your definition of "pain-free" (i.e., I've seen plenty of women control a reasonable level of labor pain with meditation and self-hypnosis). But it was just entrancing to watch. She was nearly silent through the whole thing. And her baby came out, sweet, beautiful, and didn't cry. I, of course, got worried, and apparently she did too, but the kid was breathing just fine. I guess he just didn't have a lot to say. She interpreted this as him being "relaxed", and I'm not sure I disagree with that. The whole thing was completely beautiful. The only thing I would've done differently (aside from being somewhere less than 500 feet from a functional OR) is that her husband didn't touch her the whole time, apparently to protect himself from some British law regarding unlicensed attendants at a birth. Which is sort of sad.
Still. Would it kill you to have a midwife on hand?
The other program I watched was on the "pregnant man." That was a lot more productive. I still don't consider him a pregnant man (uterus = not a pregnant man), but I really support what they did, and I can see his point. I had a lot more respect for them after I saw the program. They seemed like a sweet family. I really appreciated the wife's efforts to breastfeed. I did think it was sort of interesting how quickly they seemed to fall into traditional gender roles. They seem like they have been (the wife has two daughters from a previous marriage) and will be good parents (which is fortunate, because there's another one on the way), and really, can you ask for anything more than that? Everybody's family is different. Everybody's parents screw them up. And the show was an interesting and compassionate commentary on the issues that transgendered couples face. Plus, that kid's adorable. And, I do not envy any boy who comes sniffing around her in 15 years or so - she is so going to be daddy's little girl!
I did get two very amusing quotes out of today's TV watching extravaganza, though. The first, from the stupid Lifetime movie:
"Your son is looking at porn on the internet!"
"That's nice, honey. G'night."
(which, incidentally, was the correct response, at least initially. You know, before he developed his big porn addiction and started lying and stealing and the whole world came catastrophically crashing down...in typical Lifetime fashion...)
And, care of Dr. Huxtable...
"Regional forecast...warm, and no babies."
If I was an OB, I'd so totally steal that (hmm...maybe I can still make it work...)
Okay, yeah, I'm done babbling...
Friday, October 17, 2008
A post about sex, and religion
One of my friends emailed me this article today.
I've always liked the Jesuits.
So, I, myself personally, am not Catholic. Or Lutheran. Or particularly religious, for that matter, although I identify myself as Orthodox Christian. But I tend to find my spirituality much more important than organized worship, and in my own faith have learned from a lot of different traditions. And yet I went to a very religious, conservative Lutheran college, and a very religious, more liberal Jesuit medical school. Maybe it was just that the Jesuits seemed so much more realistic than the crazy fringe Lutherans we went to undergrad with (okay, they weren't all crazy, but some of them were reasonably extreme. I once witnessed an LCMS Lutheran and an ELCA Lutheran get into a fistfight over who performed the baptism sacrament most according to God's plan or something like that. I thought this was especially ridiculous, because from the Orthodox Christian perspective, you're both doing it wrong!), but I really got comfortable in that environment. We had a ministry office in the commons of the medical school, replete with priests and nuns and other ministering types, and I tell you, that was the nicest place to be on a bad day. I sang in the Gospel Choir every year on Martin Luther King Day (it was really the only time we performed, but man, you should hear this crazy white girl belt out "We shall overcome"). We celebrated Ramadan, and the Jewish holidays, and Orthodox Easter. They were such a welcoming, accepting, inclusive bunch, and that really surprised me.
We also had 12 full time chaplains on staff at the hospital, and a bevy of part timers, and they all had pagers and specialties and assigned areas of the hospital. There was a chaplain in-house, on duty, 24 hours a day. They responded to traumas, codes, and plain old requests. The medical students had to do shifts with the chaplains. I cannot tell you the impact this had on patient care, and frankly, the whole mood and mode of the hospital was influenced by the Jesuit ideals. The way we practiced was more holistic, more inclusive of families, more centered on the patient as a person.
It definitely tied our hands sometimes - i.e., one of the most heartbreaking cases I had as a med student was this woman who had a baby with anencephaly - a baby in whom the brain had not, and would not, develop. This kid's head literally stopped at its ears. These babies, obviously, cannot survive long, if at all, when disconnected from their mothers. We were a Catholic hospital, so we couldn't offer her a genetic termination. She was Catholic, so she wouldn't have done it anyway (or so she said...who knows, if we'd been able to provide it, if that would've changed things). It was absolutely heart-wrenching, to watch her go through the pregnancy, feeling her baby move, having strangers come up to her and ask when she was due, if it was a boy or a girl, did she have a name...knowing her child would be born with no chance at life. It struck me as months and months of torture, and I couldn't fathom the idea that God wouldn't understand her decision to terminate.
But that whole respect for life thing was, in general, a really positive influence on my education. I did a rotation in Child Advocacy my 4th year. I talked to my patients, their families. I did a sub-internship in the NICU, and watched the way those little lives were cared for as they walked that line between life and death, how they were respected as full human beings with resplendent potential. How they were held up in those final hours. One night, I stayed several hours after my shift was over because one of the 24 week twins I'd delivered a few days earlier (when I was doing an OB rotation) was dying. Her sister had passed the night before, and her parents were so distraught they couldn't bear to be up there once they'd made the decision to let her go. We took her off the ventilator, swaddled her tiny body in handknit cloth, and the nurses and I took turns holding her until her little heart finally stopped.
I know a lot about end of life care, and am comfortable with the inevitability of death, at least professionally. I can deliver bad news like no one's business. I think I've mentioned on here before how, at the Emerald Palace, I felt like the angel of death on my ICU month, because the team always waited until I was on call to withdraw support from our patients, because I was "so good with the families," and I was "just so much better at it." Likewise, when I was on the labor deck, I always, always took the genetic terminations. Because my cohorts would check in at the beginning of the shift, and then leave them alone until something happened. You know, "so they could have their privacy" (read: "we don't know how to deal with them, so we won't"). I, on the other hand, went in, introduced myself, asked how they were feeling, learned everybody's names in the room, asked if the baby had a name and referred to it as such if it did, and checked in every two hours like I did with my other laboring moms. Plus, delivering a significantly pre-term, dead, and often deformed fetus takes some skill - not so much technical skill, but skill at knowing how and when to do things. They're fragile, their skin is delicate, you can damage them easily. It's important to know how to collect and present the fetus so it looks like a real baby, so they can touch and hold and understand their child. It's important to understand the pain of malpresentation, even for someone so small, and how much it hurts to force an immature uterus to contract. It's important to respect the life ending and the ones being left behind. It was such a horrible, traumatic experience for most of these women anyway, that a cold, impersonal stranger rushing in awkwardly at the last minute to deliver their child was just unacceptable to me.
Interestingly, it was my Jesuit medical school at which I also did my sex therapy training. We only treated married couples in the clinic, and we would talk about God if the patients wanted to, but beyond that there was little to brand the therapy as "Catholic" or "faith-based". But there was something there that went unsaid, this undercurrent of respect and celebration of life, union, and effort that imbued the way we taught, and interacted with, our couples. So many of them came in with taboos, misconceptions, and shame that had been imparted under a guise of "religion"; we were open, accepting, unfazed. We touted sex as a good thing and an important piece of a good Christian marriage. We taught masturbation (yes, yes we did) as a means of exploring, accepting, and learning about one's God-given body. We "preached" love, tolerance, compromise, and connection. It was a nice view.
The article above reminded me of all this. I particularly like how she holds casual sex up not as "sinful" and in a punitive light, not as a "violation of sex", but rather, a disappointment, a failure to expect enough of themselves and their partners, that they are "not asking enough" of sex. That good sex is an expression of incarnation, a celebration of our physical nature, given to us by God. Who can argue with that?
Just an interesting read, and a nice foray into musing philosophical.
(PS - Comment with reckless abandon, but, I don't want to hear about the evils of abortion or how abstinence is the only way. Go blog about that on your own space.)
I've always liked the Jesuits.
So, I, myself personally, am not Catholic. Or Lutheran. Or particularly religious, for that matter, although I identify myself as Orthodox Christian. But I tend to find my spirituality much more important than organized worship, and in my own faith have learned from a lot of different traditions. And yet I went to a very religious, conservative Lutheran college, and a very religious, more liberal Jesuit medical school. Maybe it was just that the Jesuits seemed so much more realistic than the crazy fringe Lutherans we went to undergrad with (okay, they weren't all crazy, but some of them were reasonably extreme. I once witnessed an LCMS Lutheran and an ELCA Lutheran get into a fistfight over who performed the baptism sacrament most according to God's plan or something like that. I thought this was especially ridiculous, because from the Orthodox Christian perspective, you're both doing it wrong!), but I really got comfortable in that environment. We had a ministry office in the commons of the medical school, replete with priests and nuns and other ministering types, and I tell you, that was the nicest place to be on a bad day. I sang in the Gospel Choir every year on Martin Luther King Day (it was really the only time we performed, but man, you should hear this crazy white girl belt out "We shall overcome"). We celebrated Ramadan, and the Jewish holidays, and Orthodox Easter. They were such a welcoming, accepting, inclusive bunch, and that really surprised me.
We also had 12 full time chaplains on staff at the hospital, and a bevy of part timers, and they all had pagers and specialties and assigned areas of the hospital. There was a chaplain in-house, on duty, 24 hours a day. They responded to traumas, codes, and plain old requests. The medical students had to do shifts with the chaplains. I cannot tell you the impact this had on patient care, and frankly, the whole mood and mode of the hospital was influenced by the Jesuit ideals. The way we practiced was more holistic, more inclusive of families, more centered on the patient as a person.
It definitely tied our hands sometimes - i.e., one of the most heartbreaking cases I had as a med student was this woman who had a baby with anencephaly - a baby in whom the brain had not, and would not, develop. This kid's head literally stopped at its ears. These babies, obviously, cannot survive long, if at all, when disconnected from their mothers. We were a Catholic hospital, so we couldn't offer her a genetic termination. She was Catholic, so she wouldn't have done it anyway (or so she said...who knows, if we'd been able to provide it, if that would've changed things). It was absolutely heart-wrenching, to watch her go through the pregnancy, feeling her baby move, having strangers come up to her and ask when she was due, if it was a boy or a girl, did she have a name...knowing her child would be born with no chance at life. It struck me as months and months of torture, and I couldn't fathom the idea that God wouldn't understand her decision to terminate.
But that whole respect for life thing was, in general, a really positive influence on my education. I did a rotation in Child Advocacy my 4th year. I talked to my patients, their families. I did a sub-internship in the NICU, and watched the way those little lives were cared for as they walked that line between life and death, how they were respected as full human beings with resplendent potential. How they were held up in those final hours. One night, I stayed several hours after my shift was over because one of the 24 week twins I'd delivered a few days earlier (when I was doing an OB rotation) was dying. Her sister had passed the night before, and her parents were so distraught they couldn't bear to be up there once they'd made the decision to let her go. We took her off the ventilator, swaddled her tiny body in handknit cloth, and the nurses and I took turns holding her until her little heart finally stopped.
I know a lot about end of life care, and am comfortable with the inevitability of death, at least professionally. I can deliver bad news like no one's business. I think I've mentioned on here before how, at the Emerald Palace, I felt like the angel of death on my ICU month, because the team always waited until I was on call to withdraw support from our patients, because I was "so good with the families," and I was "just so much better at it." Likewise, when I was on the labor deck, I always, always took the genetic terminations. Because my cohorts would check in at the beginning of the shift, and then leave them alone until something happened. You know, "so they could have their privacy" (read: "we don't know how to deal with them, so we won't"). I, on the other hand, went in, introduced myself, asked how they were feeling, learned everybody's names in the room, asked if the baby had a name and referred to it as such if it did, and checked in every two hours like I did with my other laboring moms. Plus, delivering a significantly pre-term, dead, and often deformed fetus takes some skill - not so much technical skill, but skill at knowing how and when to do things. They're fragile, their skin is delicate, you can damage them easily. It's important to know how to collect and present the fetus so it looks like a real baby, so they can touch and hold and understand their child. It's important to understand the pain of malpresentation, even for someone so small, and how much it hurts to force an immature uterus to contract. It's important to respect the life ending and the ones being left behind. It was such a horrible, traumatic experience for most of these women anyway, that a cold, impersonal stranger rushing in awkwardly at the last minute to deliver their child was just unacceptable to me.
Interestingly, it was my Jesuit medical school at which I also did my sex therapy training. We only treated married couples in the clinic, and we would talk about God if the patients wanted to, but beyond that there was little to brand the therapy as "Catholic" or "faith-based". But there was something there that went unsaid, this undercurrent of respect and celebration of life, union, and effort that imbued the way we taught, and interacted with, our couples. So many of them came in with taboos, misconceptions, and shame that had been imparted under a guise of "religion"; we were open, accepting, unfazed. We touted sex as a good thing and an important piece of a good Christian marriage. We taught masturbation (yes, yes we did) as a means of exploring, accepting, and learning about one's God-given body. We "preached" love, tolerance, compromise, and connection. It was a nice view.
The article above reminded me of all this. I particularly like how she holds casual sex up not as "sinful" and in a punitive light, not as a "violation of sex", but rather, a disappointment, a failure to expect enough of themselves and their partners, that they are "not asking enough" of sex. That good sex is an expression of incarnation, a celebration of our physical nature, given to us by God. Who can argue with that?
Just an interesting read, and a nice foray into musing philosophical.
(PS - Comment with reckless abandon, but, I don't want to hear about the evils of abortion or how abstinence is the only way. Go blog about that on your own space.)
Friday, August 22, 2008
Accidentally on call
(Which, if you didn't know, is a reference to this song. Good song. Weird video.)
So I got home today around noon. I didn't have any patients scheduled, so I went in for lecture, did some stuff, called some people, faxed some things, and then left, because, why just stick around? I got home, played with Maggie, checked my email, and, well, I was just going to lie down while I watched TV...well, maybe I'd take a little nap...
I woke up when Fang called me at 3:30. Poor guy's been sick as a damn dog all week, and was supposed to take call tonight. And he'd been feeling better, but...you know, as those things often go...so could I take his call tonight?
Of course. Except, because he woke me up, "of course" turned into "Yeah, yeah...sure....okay, wait, what time is it? Oh. Um, yeah, of course I can, yeah. Wait, um, let me think about what I, I, um, have to get some stuff together. Yeah. Okay. Let me do that. I'll be there by 4:30. I think I will. Yeah, okay..."
Articulate.
Anyhow.
I figured, what the hell, right? It's not like I had anything else pressing to do with my Friday night (sad, I know). I'd had a nap. Plus, I'm on with Renee tonight, so, that can't be bad.
It started out as one of those nights that was weirdly busy - like, there's still only one person on our call sheet (but there's two more in the ER we're going to get called on), but, that totally undeerrepresents the amount of work we've had tonight. Between the crisis pager, floor calls, other random shit...lots of fires to put out, stuff up in the air, etc.
And then, as my friend Barb would say, then the bulldog showed up.
So, I'm sitting in my office, finally eating my dinner that I had to order twice (because they somehow didn't get the order the first time), and I hear this tiny little voice in the distance...and it seemed to be saying, "Adult Rapid Response, 3 Neuroscience". Over and over again. A rapid response is like a step below a code blue. And the Neurosciences hospital is the one in which I live, er, in which all my patients are contained (psychiatry has floors 1 and 3-5; Neuro has 6 and some clinics on G. So Neurosciences. Plus, the ER's in the basement). So, I thought, wow. Shit. I probably should go. And so I open my door and Renee is standing in the hallway about to knock.
Turns out this is her very first rapid response.
So we hurried upstairs (you run to a code. You move quickly to a rapid response while hoping the medicine team will beat you there) and this patient of Ruthie's had a seizure. So he's lying on the ground drooling, having fallen out and conked his head on the chair on the way down (and yes, I did use the words "fallen out" and "conked" when conveying this to the medicine team that showed up. It's how we roll in the Dirty South). We got an IV started, we ordered some tests, we got him off the floor, etc. We fussed around like we knew what we were doing (and, okay, on this one, I actually did). I argued with neurology over whose service he should be on (theirs. But, knowing the resident on call as I do, he wasn't going to take him. And he's probably in better hands on our floor).
And then, right in the middle of all of this pandemonium, Renee grabs my sleeve and says, "Hey, can you help me with this?" Dr. Morgan, who supervises my psychotic disorders clinic, had paged her to find out some information on a patient from our clinic.
She killed herself tonight.
Apparently, her husband called Dr. Morgan at home (how he got that number, I don't know) to tell him. Dr. M was calling to get some information from the records from our ER. We couldn't find her in the ER census. We called the ER; they didn't know about her. So I called Dr. Morgan back, and it turns out she never made it to the ER - she was dead at the scene. I don't know the details, but it was like a bucket of cold water.
Wow, I hate it when they do that.
It reminded me of the first patient I disconnected from life support at the Emerald Palace (have I told y'all this story already? I can't find it, but I didn't look very long, either). I was on my ICU rotation, and this woman came in having run her car off the road. Her abdomen was still open because her liver was hamburger and she was too unstable to do anything but pack off her liver and run her up to the ICU. There's actually a much longer story attached to this event, but the short version is, her family finally faxed us her living will (which was handwritten and signed with a peace sign and a heart before her name - peace and love), and they decided that they didn't want to come in, because "that wasn't her anymore." Well, maybe, but she'd only been in the ICU a few hours and this was sudden and unexpected. And I wrote the order to turn off support, and then I walked into her room. And the nurses were like, it's okay, this could take a while, we'll call you when she's dead. And I said, no....someone needs to be with her when she dies. And the social worker overheard this, and he came in with me. And I held her hand as they turned off the vent and the meds keeping her pressure up and she didn't even try to draw a breath. It was over in less than two minutes. Quiet, peaceful, just like that. I pronounced her. I turned, and I walked out of the room, and I filled out my paperwork (there's always just so much paperwork), and I called the medical examiner (with whom I would be on a first name basis by the end of that month. I was the friggin' Angel of Death that month, I swear to God...).
And then I went into my call room, curled into the fetal position, and bawled like a frightened child for three hours. Or until I had to be a grown up again.
I can't imagine dying like that. Alone, in some big sterile place, with some strange woman holding my hand because she didn't want me to die alone. Not that I would begrudge my family for not coming - they were right, that probably wasn't really her anymore. But it still felt so...discarded. Oh well. What's for dinner?
I remember looking at her chart later and finding a whole bunch of psych notes, talking about her depression and including one admission for suicidality. And I felt this chill run down my spine.
I tried to convince myself that, because she'd had her dog (who, by the way, came through this whole crash unscathed, at least physically) in the car with her, it couldn't possibly have been a suicide attempt. But I still don't believe that. And I guess we'll never know the truth of whether or not it was, but...man, I just don't understand.
I had that same feeling tonight, trying to deal with this issue in the vacuum of the expanding chaos that surrounded me on the unit right then. That same cold emptiness and confusion at the pit of my soul that I felt that winter night in the call room. Except it was more solid and contained, because I was still the person in charge, I was still dealing with the seizure guy, I wasn't in the quiet solitude of my ICU call room. Or severely clinically depressed, like I was that cold November day.
It's 1:15 am now, and I'm still dealing with the seizure guy, in case you were wondering. All sorts of fussing. It's ridiculous. I think I finally have it straightened out, but I think I'm giving up and going to bed soon....
All I can hope is that Ms. J found her peace today. That she's liberated from her pain, and her voices, and the demons that haunted her. I can only hope she's in as beautiful a place as we all hope to find beyond this life. And I hope that where she is, her husband, her children can finally understand, have moved beyond their grief and resentment and confusion. That she's finally free in the arms of her God.
Rest in sweet, sweet peace tonight, Ms. J.
So I got home today around noon. I didn't have any patients scheduled, so I went in for lecture, did some stuff, called some people, faxed some things, and then left, because, why just stick around? I got home, played with Maggie, checked my email, and, well, I was just going to lie down while I watched TV...well, maybe I'd take a little nap...
I woke up when Fang called me at 3:30. Poor guy's been sick as a damn dog all week, and was supposed to take call tonight. And he'd been feeling better, but...you know, as those things often go...so could I take his call tonight?
Of course. Except, because he woke me up, "of course" turned into "Yeah, yeah...sure....okay, wait, what time is it? Oh. Um, yeah, of course I can, yeah. Wait, um, let me think about what I, I, um, have to get some stuff together. Yeah. Okay. Let me do that. I'll be there by 4:30. I think I will. Yeah, okay..."
Articulate.
Anyhow.
I figured, what the hell, right? It's not like I had anything else pressing to do with my Friday night (sad, I know). I'd had a nap. Plus, I'm on with Renee tonight, so, that can't be bad.
It started out as one of those nights that was weirdly busy - like, there's still only one person on our call sheet (but there's two more in the ER we're going to get called on), but, that totally undeerrepresents the amount of work we've had tonight. Between the crisis pager, floor calls, other random shit...lots of fires to put out, stuff up in the air, etc.
And then, as my friend Barb would say, then the bulldog showed up.
So, I'm sitting in my office, finally eating my dinner that I had to order twice (because they somehow didn't get the order the first time), and I hear this tiny little voice in the distance...and it seemed to be saying, "Adult Rapid Response, 3 Neuroscience". Over and over again. A rapid response is like a step below a code blue. And the Neurosciences hospital is the one in which I live, er, in which all my patients are contained (psychiatry has floors 1 and 3-5; Neuro has 6 and some clinics on G. So Neurosciences. Plus, the ER's in the basement). So, I thought, wow. Shit. I probably should go. And so I open my door and Renee is standing in the hallway about to knock.
Turns out this is her very first rapid response.
So we hurried upstairs (you run to a code. You move quickly to a rapid response while hoping the medicine team will beat you there) and this patient of Ruthie's had a seizure. So he's lying on the ground drooling, having fallen out and conked his head on the chair on the way down (and yes, I did use the words "fallen out" and "conked" when conveying this to the medicine team that showed up. It's how we roll in the Dirty South). We got an IV started, we ordered some tests, we got him off the floor, etc. We fussed around like we knew what we were doing (and, okay, on this one, I actually did). I argued with neurology over whose service he should be on (theirs. But, knowing the resident on call as I do, he wasn't going to take him. And he's probably in better hands on our floor).
And then, right in the middle of all of this pandemonium, Renee grabs my sleeve and says, "Hey, can you help me with this?" Dr. Morgan, who supervises my psychotic disorders clinic, had paged her to find out some information on a patient from our clinic.
She killed herself tonight.
Apparently, her husband called Dr. Morgan at home (how he got that number, I don't know) to tell him. Dr. M was calling to get some information from the records from our ER. We couldn't find her in the ER census. We called the ER; they didn't know about her. So I called Dr. Morgan back, and it turns out she never made it to the ER - she was dead at the scene. I don't know the details, but it was like a bucket of cold water.
Wow, I hate it when they do that.
It reminded me of the first patient I disconnected from life support at the Emerald Palace (have I told y'all this story already? I can't find it, but I didn't look very long, either). I was on my ICU rotation, and this woman came in having run her car off the road. Her abdomen was still open because her liver was hamburger and she was too unstable to do anything but pack off her liver and run her up to the ICU. There's actually a much longer story attached to this event, but the short version is, her family finally faxed us her living will (which was handwritten and signed with a peace sign and a heart before her name - peace and love), and they decided that they didn't want to come in, because "that wasn't her anymore." Well, maybe, but she'd only been in the ICU a few hours and this was sudden and unexpected. And I wrote the order to turn off support, and then I walked into her room. And the nurses were like, it's okay, this could take a while, we'll call you when she's dead. And I said, no....someone needs to be with her when she dies. And the social worker overheard this, and he came in with me. And I held her hand as they turned off the vent and the meds keeping her pressure up and she didn't even try to draw a breath. It was over in less than two minutes. Quiet, peaceful, just like that. I pronounced her. I turned, and I walked out of the room, and I filled out my paperwork (there's always just so much paperwork), and I called the medical examiner (with whom I would be on a first name basis by the end of that month. I was the friggin' Angel of Death that month, I swear to God...).
And then I went into my call room, curled into the fetal position, and bawled like a frightened child for three hours. Or until I had to be a grown up again.
I can't imagine dying like that. Alone, in some big sterile place, with some strange woman holding my hand because she didn't want me to die alone. Not that I would begrudge my family for not coming - they were right, that probably wasn't really her anymore. But it still felt so...discarded. Oh well. What's for dinner?
I remember looking at her chart later and finding a whole bunch of psych notes, talking about her depression and including one admission for suicidality. And I felt this chill run down my spine.
I tried to convince myself that, because she'd had her dog (who, by the way, came through this whole crash unscathed, at least physically) in the car with her, it couldn't possibly have been a suicide attempt. But I still don't believe that. And I guess we'll never know the truth of whether or not it was, but...man, I just don't understand.
I had that same feeling tonight, trying to deal with this issue in the vacuum of the expanding chaos that surrounded me on the unit right then. That same cold emptiness and confusion at the pit of my soul that I felt that winter night in the call room. Except it was more solid and contained, because I was still the person in charge, I was still dealing with the seizure guy, I wasn't in the quiet solitude of my ICU call room. Or severely clinically depressed, like I was that cold November day.
It's 1:15 am now, and I'm still dealing with the seizure guy, in case you were wondering. All sorts of fussing. It's ridiculous. I think I finally have it straightened out, but I think I'm giving up and going to bed soon....
All I can hope is that Ms. J found her peace today. That she's liberated from her pain, and her voices, and the demons that haunted her. I can only hope she's in as beautiful a place as we all hope to find beyond this life. And I hope that where she is, her husband, her children can finally understand, have moved beyond their grief and resentment and confusion. That she's finally free in the arms of her God.
Rest in sweet, sweet peace tonight, Ms. J.
Wednesday, August 20, 2008
I'm a loser, baby...
This is today's song that's been lodged in my head.
This annoys me. For two reasons. A, I'm not a huge fan of Beck (although, I'll confess, that song has always sort of amused me...although, you can't listen to the lyrics too closely...). But B, because it's a symptom of just how effed up I am. Because you know when this started? Walking out of the auditorium.
I got a teaching award today.
No, no, yay for me. I got a similar award at The Emerald Palace, but it wasn't nearly as big a deal. Well, who knows, maybe it was, I'd already left. But it's really quite an nice thing - each year, one intern and one resident in each of the six core specialties receives this award, which is bestowed by the third year medical students. There was a ceremony and a check and a certificate suitable for framing involved. I really can't tell you how honored and humbled I am that they picked me. But initially, I was like, aww, thanks, that's nice. And then there was a lunch I was supposed to attend. And then, wait, it was a lecture. And then it turned into today, which turned out to be this giant auditorium (it has balcony seats!) about 60%-ish full of people, including all sorts of deans and faculty and students and then having to go up on stage (with about 8 or so other residents, thankfully) and me in the front row hyperventilating a little and wearing tennis shoes because it was kind of a hike from the hospital and I'm still having a lot of ankle issues. There were a lot of other awards handed out today, too, so it wasn't like it was all about me. Except in my head, where I was somehow ignoring the external validation and just focused on the fact that I looked like a Chicago commuter and was being completely neurotic about a whole host of other things.
Fortunately, no one else could hear the neurosing, no matter how loud it was in my head. It was a nice little shin-dig; this pathology prof gave a lecture about the history of medical education through the last three or so thousand years, the central point of which was, of course, everything comes from the Greeks. She started talking about how they evolved up from "this is punishment from the Gods" to the Hippocratic-era development of the four humours, and how disease resulted from their imbalance, and how redistribution of fluid was the answer back in 500 BCE, and I really, really wanted to yell, "just put some Windex on it!" It was actually quite a good lecture, though. I can see why she was their teacher of the year. And then there was lots of acknowledging of people who've done a good job with the med students this past year - best clinical rotation (Pedes), various faculty awards, a bunch of awards to this year's (as in, '09) graduating class. I cut out early because I had to get back for our afternoon of didactics, but I think there may have been a little buffet afterward, too.
I am so completely amazed that they thought enough of me to pick me. I seriously, truly, fully cannot tell you how much that means, especially after all of the intern-year PTSD and whatnot. Not to mention how much fun I had with the students this year. I mean, I really had some rock stars.
Okay, okay, I'm done.
Tonight I also had my first meeting as one of the Psych reps to the Housestaff Council (like Student Council, but, post-graduate. Residents and fellows, for those who aren't aware, are considered "housestaff". This is our governing body. You know, ish). It was quite nice. It was held in one of the conference rooms of this reasonably posh hotel in town. There was a good buffet, good conversation, and we got a little work done, too. I sat at a table with the other psych rep and our child fellow counterpart, a clutch of Family residents, an ER doc and this new Dermatology guy (Cute. Single. A little young). Basically we meet four times during the year at fairly upscale places, eat, and discuss a relevant issue or two. Not a bad gig.
Meanwhile, the outer bands of TS Fay have reached Carolina del Norte, although the bulk of the storm is still in Florida, at least according to all the NOAA emails I've been getting (I'm on their Storm Advisory Listserv - Atlantic). So it's raining nicely out there. I'm really, really hoping it grounds my plane in the morning, for no good reason at all except I, a, could really use the day off, and 2, so don't want to fly through a tropical storm - even the very edge of one, which, according to Forecaster Knabb, is currently back over water and gaining intensity - in a Coke can with wings that only flies a mile up off the ground. Yes, yes, I know that these are the same planes that they send directly into the eye of the storm, but, not with a flight-nervous psychiatrist on board!
This annoys me. For two reasons. A, I'm not a huge fan of Beck (although, I'll confess, that song has always sort of amused me...although, you can't listen to the lyrics too closely...). But B, because it's a symptom of just how effed up I am. Because you know when this started? Walking out of the auditorium.
I got a teaching award today.
No, no, yay for me. I got a similar award at The Emerald Palace, but it wasn't nearly as big a deal. Well, who knows, maybe it was, I'd already left. But it's really quite an nice thing - each year, one intern and one resident in each of the six core specialties receives this award, which is bestowed by the third year medical students. There was a ceremony and a check and a certificate suitable for framing involved. I really can't tell you how honored and humbled I am that they picked me. But initially, I was like, aww, thanks, that's nice. And then there was a lunch I was supposed to attend. And then, wait, it was a lecture. And then it turned into today, which turned out to be this giant auditorium (it has balcony seats!) about 60%-ish full of people, including all sorts of deans and faculty and students and then having to go up on stage (with about 8 or so other residents, thankfully) and me in the front row hyperventilating a little and wearing tennis shoes because it was kind of a hike from the hospital and I'm still having a lot of ankle issues. There were a lot of other awards handed out today, too, so it wasn't like it was all about me. Except in my head, where I was somehow ignoring the external validation and just focused on the fact that I looked like a Chicago commuter and was being completely neurotic about a whole host of other things.
Fortunately, no one else could hear the neurosing, no matter how loud it was in my head. It was a nice little shin-dig; this pathology prof gave a lecture about the history of medical education through the last three or so thousand years, the central point of which was, of course, everything comes from the Greeks. She started talking about how they evolved up from "this is punishment from the Gods" to the Hippocratic-era development of the four humours, and how disease resulted from their imbalance, and how redistribution of fluid was the answer back in 500 BCE, and I really, really wanted to yell, "just put some Windex on it!" It was actually quite a good lecture, though. I can see why she was their teacher of the year. And then there was lots of acknowledging of people who've done a good job with the med students this past year - best clinical rotation (Pedes), various faculty awards, a bunch of awards to this year's (as in, '09) graduating class. I cut out early because I had to get back for our afternoon of didactics, but I think there may have been a little buffet afterward, too.
I am so completely amazed that they thought enough of me to pick me. I seriously, truly, fully cannot tell you how much that means, especially after all of the intern-year PTSD and whatnot. Not to mention how much fun I had with the students this year. I mean, I really had some rock stars.
Okay, okay, I'm done.
Tonight I also had my first meeting as one of the Psych reps to the Housestaff Council (like Student Council, but, post-graduate. Residents and fellows, for those who aren't aware, are considered "housestaff". This is our governing body. You know, ish). It was quite nice. It was held in one of the conference rooms of this reasonably posh hotel in town. There was a good buffet, good conversation, and we got a little work done, too. I sat at a table with the other psych rep and our child fellow counterpart, a clutch of Family residents, an ER doc and this new Dermatology guy (Cute. Single. A little young). Basically we meet four times during the year at fairly upscale places, eat, and discuss a relevant issue or two. Not a bad gig.
Meanwhile, the outer bands of TS Fay have reached Carolina del Norte, although the bulk of the storm is still in Florida, at least according to all the NOAA emails I've been getting (I'm on their Storm Advisory Listserv - Atlantic). So it's raining nicely out there. I'm really, really hoping it grounds my plane in the morning, for no good reason at all except I, a, could really use the day off, and 2, so don't want to fly through a tropical storm - even the very edge of one, which, according to Forecaster Knabb, is currently back over water and gaining intensity - in a Coke can with wings that only flies a mile up off the ground. Yes, yes, I know that these are the same planes that they send directly into the eye of the storm, but, not with a flight-nervous psychiatrist on board!
Sunday, June 29, 2008
Sunday, Sunday
So, here I am again...I'm sitting in the little intern office on the women's unit at State Hospital, waiting for my suicidal drunk guy to come in from the local ER. It's stormy and windy and Maggie was not pleased as I frenetically packed up my stuff. I kept having to stop and snuggle the big, wide-eyed, thunderstorm-averse pup. Fortunately, Sparrow came to rescue her and take her over to stay with them right as I was leaving.
I took the Ruthie approach to packing for call and brought a little bag of random things-crackers, dried fruit, an apple, peanut butter, carrots, I don't know what the hell I threw in there. Ruthie usually brings a large grocery bag of randomness whenever she's on call. Consequently, our office here at State Hospital looks like some sort of organic food bomb exploded in it. Followed by a big paperwork bomb. We should really clean this place up, you know?
I've also adopted her habit of not wearing scrubs on call, but rather, comfy clothes. Not, like, flannel pants, but not my "business casual" finest, either. Things in which I can sleep (ha) but still be seen in public. She's an ex-surgeon as well, and makes the very good point that we spent enough time in scrubs in our former life, and, let's face it - scrubs just aren't that comfortable. Plus, both of us are reasonably curvy women, and scrubs are usually cut for men. Who? Aren't curvy. It makes a difference.
I think she's been a bad influence on me...
So it's my last call at State Hospital. From now on, if I'm on call here, I'll be moonlighting, which means they have to pay me handsomely. But it also means that I have to get re-fingerprinted and get new letters of reference (from people who've known me at least ten years. What? I mean, I have plenty of people who've known me for that long, but do they really care what my best friend the lawyer or my grade-school friend the Spanish teacher think about my ability to practice medicine?? The NC Medical Board is weird) and stand on my head while drinking water or some such nonsense. And after I do all that, then I have to wait six months for them to decide if I'm worthy of the privilege of having a permanent medical license. Which, knowing the issues I had with them at the beginning of the year, probably means that I'll have to go sing the entire score of Die Fledermaus at a meeting of the general assembly or something. In German, while patting my head and rubbing my stomach.
Oh, but how I could use the money. To quote Mike, I am just broke as a joke right now. Or alternatively, to use my aunt's phrase, po'. As in, so poor I can't even afford an "r". But, in time, these things will come. By which I mean in time for me to start paying off my med school loans. Remember when doctors used to drive $100,000 cars and every psychiatrist had a house in the Hamptons?
Ah, well. Clearly, I'm not in this for the money, and let's face it, I'm not living in a box, or bunking with my patients in the South Wilmington Street Shelter.
It's interesting, actually...I had lunch with one of my med students today that I worked with earlier in the year. She's going into OB, silly girl (says the one spending her Sunday night in a state mental institution wearing mismatched socks and listening to opera on YouTube...), and wanted some advice. So we had a very nice brunch, and of course I came home and spent the rest of the afternoon playing the "what if?" game.
If I'd stayed at the Emerald Palace...I'd have graduated probably last week, instead of still being an intern for another month. I'd probably have moved back to Chicago for fellowship, or maybe gone somewhere else. I suspect that I might not actually be doing high-risk obstetrics, but possibly minimally invasive gynecology, which is the direction to which I was starting to lean by the time I left. Which is nice, because that's a shorter, if non-accredited, fellowship. I...okay, you know what? Realistically, if I'd stayed there, I'd be dead by now. Or some very different, hardened, torn-down, bitter version of myself that in no way resembles the person I want to be. So let's just take that option off the table right now.
The issue for "what if," I guess, is more what if I'd stayed in OB/GYN? I do miss it from time to time. I miss the procedural nature of things, the adrenaline rush of delivery. I miss the sweet moments as a family is forged. The pulling undertow of fate as lives are changed in an instant. I miss the excitement of the OR. I miss feeling dexterous and that moment of alignment as the counterintuitive movements of laparoscopy suddenly make sense. I miss the comforting repetition of scrubbing, those contemplative moments gazing over the scrub sink through the windows into the OR, mentally prepping for a case. I miss the give of a uterine sound as the internal os concedes and dilates, and the instrument slides in to hit its mark. I miss the solid bite of suturing a uterus, the snap of a hemostat, the rhythm of an imbricating stitch. I miss the satisfaction of the cervix popping into view on the first try. I miss the flow of clinic and the smell of Chlor-prep (although there are a lot of other smells I don't miss from my job, let me tell you).
I love my job, my work, now, in so many ways. And I think it's where I'm supposed to be. I think I can be more useful, my work more meaningful, from this side of things. But occasionally, it saddens me that I had to leave all those things behind. What saddens me more is how I feel like something I loved was stolen from me, with all that happened up north. But, a door never closes without another one opening. And I really do love what I do.
Speaking of which, I have to go admit someone. So maybe I'd better go do what I do...
I took the Ruthie approach to packing for call and brought a little bag of random things-crackers, dried fruit, an apple, peanut butter, carrots, I don't know what the hell I threw in there. Ruthie usually brings a large grocery bag of randomness whenever she's on call. Consequently, our office here at State Hospital looks like some sort of organic food bomb exploded in it. Followed by a big paperwork bomb. We should really clean this place up, you know?
I've also adopted her habit of not wearing scrubs on call, but rather, comfy clothes. Not, like, flannel pants, but not my "business casual" finest, either. Things in which I can sleep (ha) but still be seen in public. She's an ex-surgeon as well, and makes the very good point that we spent enough time in scrubs in our former life, and, let's face it - scrubs just aren't that comfortable. Plus, both of us are reasonably curvy women, and scrubs are usually cut for men. Who? Aren't curvy. It makes a difference.
I think she's been a bad influence on me...
So it's my last call at State Hospital. From now on, if I'm on call here, I'll be moonlighting, which means they have to pay me handsomely. But it also means that I have to get re-fingerprinted and get new letters of reference (from people who've known me at least ten years. What? I mean, I have plenty of people who've known me for that long, but do they really care what my best friend the lawyer or my grade-school friend the Spanish teacher think about my ability to practice medicine?? The NC Medical Board is weird) and stand on my head while drinking water or some such nonsense. And after I do all that, then I have to wait six months for them to decide if I'm worthy of the privilege of having a permanent medical license. Which, knowing the issues I had with them at the beginning of the year, probably means that I'll have to go sing the entire score of Die Fledermaus at a meeting of the general assembly or something. In German, while patting my head and rubbing my stomach.
Oh, but how I could use the money. To quote Mike, I am just broke as a joke right now. Or alternatively, to use my aunt's phrase, po'. As in, so poor I can't even afford an "r". But, in time, these things will come. By which I mean in time for me to start paying off my med school loans. Remember when doctors used to drive $100,000 cars and every psychiatrist had a house in the Hamptons?
Ah, well. Clearly, I'm not in this for the money, and let's face it, I'm not living in a box, or bunking with my patients in the South Wilmington Street Shelter.
It's interesting, actually...I had lunch with one of my med students today that I worked with earlier in the year. She's going into OB, silly girl (says the one spending her Sunday night in a state mental institution wearing mismatched socks and listening to opera on YouTube...), and wanted some advice. So we had a very nice brunch, and of course I came home and spent the rest of the afternoon playing the "what if?" game.
If I'd stayed at the Emerald Palace...I'd have graduated probably last week, instead of still being an intern for another month. I'd probably have moved back to Chicago for fellowship, or maybe gone somewhere else. I suspect that I might not actually be doing high-risk obstetrics, but possibly minimally invasive gynecology, which is the direction to which I was starting to lean by the time I left. Which is nice, because that's a shorter, if non-accredited, fellowship. I...okay, you know what? Realistically, if I'd stayed there, I'd be dead by now. Or some very different, hardened, torn-down, bitter version of myself that in no way resembles the person I want to be. So let's just take that option off the table right now.
The issue for "what if," I guess, is more what if I'd stayed in OB/GYN? I do miss it from time to time. I miss the procedural nature of things, the adrenaline rush of delivery. I miss the sweet moments as a family is forged. The pulling undertow of fate as lives are changed in an instant. I miss the excitement of the OR. I miss feeling dexterous and that moment of alignment as the counterintuitive movements of laparoscopy suddenly make sense. I miss the comforting repetition of scrubbing, those contemplative moments gazing over the scrub sink through the windows into the OR, mentally prepping for a case. I miss the give of a uterine sound as the internal os concedes and dilates, and the instrument slides in to hit its mark. I miss the solid bite of suturing a uterus, the snap of a hemostat, the rhythm of an imbricating stitch. I miss the satisfaction of the cervix popping into view on the first try. I miss the flow of clinic and the smell of Chlor-prep (although there are a lot of other smells I don't miss from my job, let me tell you).
I love my job, my work, now, in so many ways. And I think it's where I'm supposed to be. I think I can be more useful, my work more meaningful, from this side of things. But occasionally, it saddens me that I had to leave all those things behind. What saddens me more is how I feel like something I loved was stolen from me, with all that happened up north. But, a door never closes without another one opening. And I really do love what I do.
Speaking of which, I have to go admit someone. So maybe I'd better go do what I do...
Saturday, June 21, 2008
Let's get drunk and forget what we did
No, there wasn't another night of moonshine-fueled debauchery. I was thinking about this day last year (you know how I'm all about the anniversary reactions) and went back and read this post from same.
In which, of course I recounted the song playing on my CD player when I arrived at the Chair's house was this one. Which, honestly, I've sort of considered to be the theme song of my intern year (which is better than the theme song of my last residency, the chorus of which is, "Get back, muhfucka, you don't know me like that!"), with its references to being "faded, a little grey from every time that you've been hurt," that "the rain just ain't enough when you're this dry," never fitting in your own skin, wearing out shoes that someone else should be wearing now, etc, etc. It's all about letting go and giving up an identity that doesn't fit anymore, letting people in, connecting and being available to receive what people will give you.
It's interesting...when I first moved here, I had this gospel station as one of my radio presets (there are a lot of gospel stations here in the buckle of the Bible Belt) because I liked this morning show they had. I don't remember her name, the host, but she was positive and upbeat and didn't smack you over the head with ol' time Religion. And she was talking to her co-host (okay, sidekick) one morning when I was listening, during the time that I was still without license and bumming around with my anxiety brewing, and she said to him, "You're going to have a blessed day, I can feel it." And his response to her has stuck with me. He said,
"I believe it, I receive it!"
Hmm. Fairly Secret-esque, and those who had the misfortune of hearing my tirade about how I think The Secret is crap (okay, not crap, but intuitive, and more what I think is that the hype and commercialism around it is exploitative and aimed at a particularly vulnerable population) will tell you how much I buy into THAT. Except, I think he captured (for free, and in six words) the real point of what that whole thing is trying to say. But I also think that point is important. I think it's probably the key to getting anywhere in life, and I think it's something that often impedes us. Because being open to receive something, even a positive something, makes us vulnerable. Change makes us vulnerable. But the only constant in life is change, so, your choices are limited. You can waste a lot of energy resisting, or channel that into opening up and receiving - events, people, things, whatever.
Not that I've been the best at this this year. But hey, I'm human and flawed, and sometimes being able to accept things is all about receiving them at the right speed. There are still plenty of things to which I haven't been able to open myself, because even though I want them, and they may present themselves, it's still too threatening, too frightening, too vulnerable to do so. But that's why life is an ongoing journey, not a destination.
Wow. Could I throw a few more cliches in there? It's true, though, is the thing. Anyway, I think my point was, that stuck with me, and it's something I need to keep working on as I look towards revisiting this post next year.
I also commented that had I chosen my CDs differently, this could well have been the song playing when I pulled up (my favorite line in which is the title of today's post). Which, frankly, would've set a whole different tone for the year.
(I swear to God, I remember every single minute of Porkfest. For the record.)
I can't believe it's been a year since this whole adventure started. Tomorrow night is the resident thing for the new interns at the same place we had ours. It was a nice night. I played pool with Benny and PenguinShrink and Chef, got lei'd by the curly-haired chief (that was how they identified who the members of the new class were - we got plastic flower lei's to wear. It was helpful), spent a while talking to Mike, met a few of the upperclassmen I still consider to be some of my better friends in the program. And most importantly, discovered that the rest of my classmates were scared out of their skin, too, if for slightly different reasons than I was. But, we were all in the same boat.
I also spent a good deal of time talking to D, who left our program the day after I got my license. Just didn't show up to work one day. He was older, had been practicing in another specialty for 20-some years. I thought maybe he was dead, because he didn't come to work, wasn't answering his pager, wasn't answering his phone, and that everyone should stop being so mad at him until we were certain he hadn't just keeled over in the shower that morning. But ultimately the higher-ups confirmed that he was, indeed, still breathing, and in time we hired Ruthie and Faye in his place. So, ultimately it worked out okay. But no one in our class ever heard from him again. Which was sad, because I liked him, and his partner, too.
It really scared me when he left, I'll be honest. Because I identified with him. I mean, I didn't have a spouse and two mortgages and five kids, but he and I - and Comrade, who's of course still with us - were outsiders. We hadn't just come out of medical school, we'd been in a whole different part of medicine and chose to come to psychiatry. For us, I thought, it was a decision of a different magnitude. One of my friends told me recently that he chose psychiatry because, out of everything he tried in med school, it seemed to suck the least (I mean, I guess when you get right down to it, that's really why you choose anything, but usually, it's not that conscious a factor). But to make a switch from a whole other specialty, right, you do it for different reasons. It's a bigger leap. Something. But whatever happened, he didn't make it. And of course, since I came in to the program unable to see things turning out much differently than they had before, this fact scared the crap out of me. I mean, at that point I was still operating on the conditioning of the Emerald Palace and assuming that they were right and I was a really, really bad doctor. D was a good one. He'd been practicing for a long time. So, in my irrational state, if he couldn't handle it, that really didn't bode well for me.
It ended up having nothing to do with me. Because, of course, we're two different people, with different skills, neuroses, demands, and strengths. Which, logically, I knew, but since when have I been ruled by my logical mind?
Hmm.
I guess it'll be interesting to see the next generation tomorrow night and see what they think, who they've connected with, and what they're ready to receive.
Meanwhile, this year, today was a fairly full day. I got up, went to Starbucks and worked on some very delinquent discharge summaries (still not done), came home, unpacked a bunch of the kitchen. I discovered that the gas isn't on in my house, because the stove didn't work. I mused to the woman at the gas company (they're coming on Monday) about how ridiculous it was that I'd lived here a week and was just figuring out that the stove didn't work. I hung out with Sparrow while the handyman swapped our refrigerators (long story). I fell out of her hammock (it was funny). I found all the pieces to my water cooler and got that working for the first time in about a month (there was an algae incident a few weeks before the move, but it's clean now). I laid on my bed with my sweet sleeping puppy and watched as the sun broke through a beautiful summer squall. Oh, and I made a couple of acquisitions:
On the right is my snazzy new, double-insulated, looks just like the cup I get every morning, stylish Starbucks tumbler that I broke down and bought this morning for all the above reasons. On the left are some hydrangeas in a mason jar that Sparrow brought over for Mags and me, because she thought we needed them.
She was right.
I believe it, I receive it. It's gonna be a good year.
In which, of course I recounted the song playing on my CD player when I arrived at the Chair's house was this one. Which, honestly, I've sort of considered to be the theme song of my intern year (which is better than the theme song of my last residency, the chorus of which is, "Get back, muhfucka, you don't know me like that!"), with its references to being "faded, a little grey from every time that you've been hurt," that "the rain just ain't enough when you're this dry," never fitting in your own skin, wearing out shoes that someone else should be wearing now, etc, etc. It's all about letting go and giving up an identity that doesn't fit anymore, letting people in, connecting and being available to receive what people will give you.
It's interesting...when I first moved here, I had this gospel station as one of my radio presets (there are a lot of gospel stations here in the buckle of the Bible Belt) because I liked this morning show they had. I don't remember her name, the host, but she was positive and upbeat and didn't smack you over the head with ol' time Religion. And she was talking to her co-host (okay, sidekick) one morning when I was listening, during the time that I was still without license and bumming around with my anxiety brewing, and she said to him, "You're going to have a blessed day, I can feel it." And his response to her has stuck with me. He said,
"I believe it, I receive it!"
Hmm. Fairly Secret-esque, and those who had the misfortune of hearing my tirade about how I think The Secret is crap (okay, not crap, but intuitive, and more what I think is that the hype and commercialism around it is exploitative and aimed at a particularly vulnerable population) will tell you how much I buy into THAT. Except, I think he captured (for free, and in six words) the real point of what that whole thing is trying to say. But I also think that point is important. I think it's probably the key to getting anywhere in life, and I think it's something that often impedes us. Because being open to receive something, even a positive something, makes us vulnerable. Change makes us vulnerable. But the only constant in life is change, so, your choices are limited. You can waste a lot of energy resisting, or channel that into opening up and receiving - events, people, things, whatever.
Not that I've been the best at this this year. But hey, I'm human and flawed, and sometimes being able to accept things is all about receiving them at the right speed. There are still plenty of things to which I haven't been able to open myself, because even though I want them, and they may present themselves, it's still too threatening, too frightening, too vulnerable to do so. But that's why life is an ongoing journey, not a destination.
Wow. Could I throw a few more cliches in there? It's true, though, is the thing. Anyway, I think my point was, that stuck with me, and it's something I need to keep working on as I look towards revisiting this post next year.
I also commented that had I chosen my CDs differently, this could well have been the song playing when I pulled up (my favorite line in which is the title of today's post). Which, frankly, would've set a whole different tone for the year.
(I swear to God, I remember every single minute of Porkfest. For the record.)
I can't believe it's been a year since this whole adventure started. Tomorrow night is the resident thing for the new interns at the same place we had ours. It was a nice night. I played pool with Benny and PenguinShrink and Chef, got lei'd by the curly-haired chief (that was how they identified who the members of the new class were - we got plastic flower lei's to wear. It was helpful), spent a while talking to Mike, met a few of the upperclassmen I still consider to be some of my better friends in the program. And most importantly, discovered that the rest of my classmates were scared out of their skin, too, if for slightly different reasons than I was. But, we were all in the same boat.
I also spent a good deal of time talking to D, who left our program the day after I got my license. Just didn't show up to work one day. He was older, had been practicing in another specialty for 20-some years. I thought maybe he was dead, because he didn't come to work, wasn't answering his pager, wasn't answering his phone, and that everyone should stop being so mad at him until we were certain he hadn't just keeled over in the shower that morning. But ultimately the higher-ups confirmed that he was, indeed, still breathing, and in time we hired Ruthie and Faye in his place. So, ultimately it worked out okay. But no one in our class ever heard from him again. Which was sad, because I liked him, and his partner, too.
It really scared me when he left, I'll be honest. Because I identified with him. I mean, I didn't have a spouse and two mortgages and five kids, but he and I - and Comrade, who's of course still with us - were outsiders. We hadn't just come out of medical school, we'd been in a whole different part of medicine and chose to come to psychiatry. For us, I thought, it was a decision of a different magnitude. One of my friends told me recently that he chose psychiatry because, out of everything he tried in med school, it seemed to suck the least (I mean, I guess when you get right down to it, that's really why you choose anything, but usually, it's not that conscious a factor). But to make a switch from a whole other specialty, right, you do it for different reasons. It's a bigger leap. Something. But whatever happened, he didn't make it. And of course, since I came in to the program unable to see things turning out much differently than they had before, this fact scared the crap out of me. I mean, at that point I was still operating on the conditioning of the Emerald Palace and assuming that they were right and I was a really, really bad doctor. D was a good one. He'd been practicing for a long time. So, in my irrational state, if he couldn't handle it, that really didn't bode well for me.
It ended up having nothing to do with me. Because, of course, we're two different people, with different skills, neuroses, demands, and strengths. Which, logically, I knew, but since when have I been ruled by my logical mind?
Hmm.
I guess it'll be interesting to see the next generation tomorrow night and see what they think, who they've connected with, and what they're ready to receive.
Meanwhile, this year, today was a fairly full day. I got up, went to Starbucks and worked on some very delinquent discharge summaries (still not done), came home, unpacked a bunch of the kitchen. I discovered that the gas isn't on in my house, because the stove didn't work. I mused to the woman at the gas company (they're coming on Monday) about how ridiculous it was that I'd lived here a week and was just figuring out that the stove didn't work. I hung out with Sparrow while the handyman swapped our refrigerators (long story). I fell out of her hammock (it was funny). I found all the pieces to my water cooler and got that working for the first time in about a month (there was an algae incident a few weeks before the move, but it's clean now). I laid on my bed with my sweet sleeping puppy and watched as the sun broke through a beautiful summer squall. Oh, and I made a couple of acquisitions:
On the right is my snazzy new, double-insulated, looks just like the cup I get every morning, stylish Starbucks tumbler that I broke down and bought this morning for all the above reasons. On the left are some hydrangeas in a mason jar that Sparrow brought over for Mags and me, because she thought we needed them.
She was right.
I believe it, I receive it. It's gonna be a good year.
Monday, April 14, 2008
Serious as a gas attack
You know, I had this whole post written about today being the third anniversary of my escape from the Emerald Palace. But you know...I'm just not feeling it. I'm feeling the moving on.
I can't really tell you why, exactly, because honestly, there was actually quite a bit that was unpleasant about it, but...I had a really good day.
And. Bones is back.
I'm postcall and got home late and am completely exhausted and it's totally freezing in my house because it's 40 in North Carolina and all the windows in my house are open because it very recently was a lot more than 40 and I'm seriously just so tired and hungry and whatever, and still had to stay up and watch it.
And got great quotes like the title, and these:
Booth: What are we, brook trout?
Cam: The body was braised like osso buco.
Hodgins: I do bugs and slime, I don't do arithmetic.
Booth: Special Agent Seely Booth. Special.
Brennan: Oh, we're not blue fish.
Booth: That's very damn poetic of you.
Brennan: You want to come? To go bowling with us at the bowling rink?
Sweets: Me? I'm a dog person. I think that has meaning.
And my personal favorite -
Booth: I thought the whole point of therapy was to give us peace of mind, not to drive us crazy.
Ohh, how I've missed Booth and Brennan.
And now Maggie's barking in her sleep, which is the most adorable thing ever.
I'm just so glad to be living my life right now.
I can't really tell you why, exactly, because honestly, there was actually quite a bit that was unpleasant about it, but...I had a really good day.
And. Bones is back.
I'm postcall and got home late and am completely exhausted and it's totally freezing in my house because it's 40 in North Carolina and all the windows in my house are open because it very recently was a lot more than 40 and I'm seriously just so tired and hungry and whatever, and still had to stay up and watch it.
And got great quotes like the title, and these:
Booth: What are we, brook trout?
Cam: The body was braised like osso buco.
Hodgins: I do bugs and slime, I don't do arithmetic.
Booth: Special Agent Seely Booth. Special.
Brennan: Oh, we're not blue fish.
Booth: That's very damn poetic of you.
Brennan: You want to come? To go bowling with us at the bowling rink?
Sweets: Me? I'm a dog person. I think that has meaning.
And my personal favorite -
Booth: I thought the whole point of therapy was to give us peace of mind, not to drive us crazy.
Ohh, how I've missed Booth and Brennan.
And now Maggie's barking in her sleep, which is the most adorable thing ever.
I'm just so glad to be living my life right now.
Saturday, April 12, 2008
I don't own emotion, I rent
Ah, if only that were true.
Feeling a little better, on all fronts. Actually a little bummed that I missed the conference at this point, but less guilty that I missed it because I couldn't move without thinking my head was about to explode than if I had just chickened out and not gone. Not that this migraine wasn't in large part caused by stress, anxiety and general battiness (plus, a little pollen, I think. The crazy doesn't get all the credit), but, seriously, the wandering around in the dark this morning saying "Nono, doggie, shhh, shhhhhhhhh!" whenever the pooch made a sound, it does sort of legitimize and validate things.
Monday. Monday's going to be the really bad day, I can already tell you.
I'm for some reason very sensitive to anniversaries (probably because I don't do anticipatory anxiety very well). But this year is by far the worst, for the obvious reasons. Next year, when I'm actually a second year, and I actually got through my intern year okay, it's going to be so much better.
After I slept through most of the day, I finally watched Rent, which had been on my DVR since September. I was a little disappointed. I mean, it doesn't help that I can recite the score of the musical pretty much from "December 24th, 9pm, Eastern Standard Time" straight through to the last "No day but today." And it also doesn't help that the first time I saw it on stage the cast was phenomenal. Oh, my gosh, they were so good. I think the movie did it justice, but, eh, they broke up a lot of songs that needed to be sort of all over the place, they left out one of my favorite songs (Happy New Year), and their Maureen was a little disappointing. Now, no one could be as good as the Angel I saw on stage, so it's probably not his fault that this one wasn't quite as charismatic and engaging. And they left out some really good lines. But I do think they cleaned up the second half well. It's always been a little...mmm...floppy and not quite as together as the first half. The movie did a much better job with the second half.
Anyhow.
I'm on call tomorrow, so I should get to bed. So much for vacation.
Feeling a little better, on all fronts. Actually a little bummed that I missed the conference at this point, but less guilty that I missed it because I couldn't move without thinking my head was about to explode than if I had just chickened out and not gone. Not that this migraine wasn't in large part caused by stress, anxiety and general battiness (plus, a little pollen, I think. The crazy doesn't get all the credit), but, seriously, the wandering around in the dark this morning saying "Nono, doggie, shhh, shhhhhhhhh!" whenever the pooch made a sound, it does sort of legitimize and validate things.
Monday. Monday's going to be the really bad day, I can already tell you.
I'm for some reason very sensitive to anniversaries (probably because I don't do anticipatory anxiety very well). But this year is by far the worst, for the obvious reasons. Next year, when I'm actually a second year, and I actually got through my intern year okay, it's going to be so much better.
After I slept through most of the day, I finally watched Rent, which had been on my DVR since September. I was a little disappointed. I mean, it doesn't help that I can recite the score of the musical pretty much from "December 24th, 9pm, Eastern Standard Time" straight through to the last "No day but today." And it also doesn't help that the first time I saw it on stage the cast was phenomenal. Oh, my gosh, they were so good. I think the movie did it justice, but, eh, they broke up a lot of songs that needed to be sort of all over the place, they left out one of my favorite songs (Happy New Year), and their Maureen was a little disappointing. Now, no one could be as good as the Angel I saw on stage, so it's probably not his fault that this one wasn't quite as charismatic and engaging. And they left out some really good lines. But I do think they cleaned up the second half well. It's always been a little...mmm...floppy and not quite as together as the first half. The movie did a much better job with the second half.
Anyhow.
I'm on call tomorrow, so I should get to bed. So much for vacation.
Friday, April 11, 2008
Freaking Out Friday
So, in roughly twelve hours I'm supposed to be at this conference, right? Gosh, it seemed like such a good idea at the time. It's right down the street from the hospital, sponsored by our department, four or five nice little talks, a good lunch. And the department offered to pay for the first ten residents who wanted to go. End of my vacation. Nice idea.
Except, I didn't realize the weekend when I asked to go.
And now I'm having a relatively big panic attack at the prospect of going to this thing tomorrow.
Oh, it's totally irrational. Although it was totally escalated when I just looked at the flier and realized that it's not being held where I thought it was and I actually have no earthly idea where this place is on campus.
So, three years ago, I spent the second weekend in April at this conference. It's the one I mentioned as being the event that changed my life and ultimately led to me not taking any more shit from the man behind the curtain and leaving the Emerald Palace. I was in all sorts of trouble for going to the AAGL class, right? But I went anyway. I thought maybe I could learn something. I thought maybe I could prove myself, you know? But I just ended up in trouble. So, anyway, I went to this thing, and all morning, I'm listening to these talks, you know, and that's fine, but in the breaks I start talking to talk to the other residents who are there. And they're listening to my stories - which I'm telling because I think they're normal - and they're all like, wow, that's...that's not good. I was like....um....okay....
And then we had lunch. There were these roundtable discussions, and I had, like, my top six choices all ranked in the program, and so I was headed to, table number 3 or whatever, for, like, Pearls for Reducing Your Rate of Complications in Hysteroscopy or something like that, when, suddenly, I didn't. For reasons I still can't explain I veered to what I think was my fifth choice, named something along the lines of Teaching Yourself Laparoscopy in Residency. Where I ended up sitting at a table full of residents, with one other intern who was SOOOOOOOOOO excited about her program, and the speaker, we'll call him Tony, who used to be a program director. I spent most of the lunch with my head down trying not to cry. These people were in a whole other world than I was. Tony was all "my residents" this and "my residents" that, so protective of them, and he had been in private practice for a couple of years by then.
Later that afternoon, we had labs. I spent the first half mostly with equipment reps, using the virtual reality trainer, picking seeds out of a pepper with a hysteroscope, plucking potato and toothpick "tumors" out of a pig bladder, that sort of thing. And then I went to the other room, to work on the older trainers and the foam rubber uteri with the real doctors and the real instruments.
And I was really good.
So here I am, right, on the trainer, and Tony comes up to me, watches me for a while, corrects my posture. He's like, you're really good. What are you, third year? I said, no, remember, I'm the intern who's in trouble for being here. I was running circles around my training partner, who actually was a third year. He's like, you have great dexterity. You're a really quick learner. Wow, you've got great strategy. And then I rotated on, and the next thing I know I'm doing moderately complex maneuvers with three of the best endoscopic surgeons in the country when back home, I couldn't tie a open field square knot without getting yelled at. It was surreal.
At one point, this black woman, who was like a fourth year resident somewhere else, she and I were talking, and I said something about things getting better when I got to second year. And she says, "Well, or you'll realize that your program just sucks." Um. Well...or there's that...
And then that night, I met up with my friends from home. I was still a little stunned from the day's events. And they were all like, good God, you look like hell, what are they doing to you up there?
It was a good question.
I went back the next morning (because it was a two-day conference), and talked to this other woman, this Greek girl who was doing her residency in Boston somewhere. I talked to Tony a little more, because it turned out that he and this Greek girl had gone to the same medical school. I listened to his lecture, which was essentially the same thing he'd told us at the roundtable the day before, but, it was, again, there was that undertone of "this is what you're entitled to as a resident. Someone's required to teach you, you're entitled to learn."
It was like someone had flipped a switch that first day. It was like some of the color had come back into my grey life. I went back, and within four hours of getting home my world started collapsing. My life, my career, my sanity, it imploded four days later. I can't even begin to explain the magnitude of that decision. How far-reaching the fallout would be. I still don't even comprehend the full scope of what happened. That sounds overdramatic, but trust me, it's not even close.
And Tony, well, Tony's a whole other post. Hell, Tony's a whole other blog.
Everything changed that weekend. Because I went to some random conference.
I know it's a whole different situation now. I know that what happened needed to happen. I know I'm in a very different place living a very different life now than I was then. I know I was skidding towards that catastrophe long before I even signed up for the AAGL class, that it was just a catalyst for things that had to happen. That this is so different. Different time, different people, different situation.
But that's not how PTSD works.
I don't know if I can go tomorrow. I don't know if I can do this. I don't know that it's the worst thing ever that I don't, and if I had shelled out for the registration myself I wouldn't think twice about not going. But I didn't pay for it. Now, honestly, I don't really know that the department did, either - I mean it's their conference.
It's totally irrational and superstitious, but you know, things are going well right now. I don't know if I can run the risk of everything changing again. I'm just completely terrified of it.
Okay, you know what? I never said I wasn't crazy.
Except, I didn't realize the weekend when I asked to go.
And now I'm having a relatively big panic attack at the prospect of going to this thing tomorrow.
Oh, it's totally irrational. Although it was totally escalated when I just looked at the flier and realized that it's not being held where I thought it was and I actually have no earthly idea where this place is on campus.
So, three years ago, I spent the second weekend in April at this conference. It's the one I mentioned as being the event that changed my life and ultimately led to me not taking any more shit from the man behind the curtain and leaving the Emerald Palace. I was in all sorts of trouble for going to the AAGL class, right? But I went anyway. I thought maybe I could learn something. I thought maybe I could prove myself, you know? But I just ended up in trouble. So, anyway, I went to this thing, and all morning, I'm listening to these talks, you know, and that's fine, but in the breaks I start talking to talk to the other residents who are there. And they're listening to my stories - which I'm telling because I think they're normal - and they're all like, wow, that's...that's not good. I was like....um....okay....
And then we had lunch. There were these roundtable discussions, and I had, like, my top six choices all ranked in the program, and so I was headed to, table number 3 or whatever, for, like, Pearls for Reducing Your Rate of Complications in Hysteroscopy or something like that, when, suddenly, I didn't. For reasons I still can't explain I veered to what I think was my fifth choice, named something along the lines of Teaching Yourself Laparoscopy in Residency. Where I ended up sitting at a table full of residents, with one other intern who was SOOOOOOOOOO excited about her program, and the speaker, we'll call him Tony, who used to be a program director. I spent most of the lunch with my head down trying not to cry. These people were in a whole other world than I was. Tony was all "my residents" this and "my residents" that, so protective of them, and he had been in private practice for a couple of years by then.
Later that afternoon, we had labs. I spent the first half mostly with equipment reps, using the virtual reality trainer, picking seeds out of a pepper with a hysteroscope, plucking potato and toothpick "tumors" out of a pig bladder, that sort of thing. And then I went to the other room, to work on the older trainers and the foam rubber uteri with the real doctors and the real instruments.
And I was really good.
So here I am, right, on the trainer, and Tony comes up to me, watches me for a while, corrects my posture. He's like, you're really good. What are you, third year? I said, no, remember, I'm the intern who's in trouble for being here. I was running circles around my training partner, who actually was a third year. He's like, you have great dexterity. You're a really quick learner. Wow, you've got great strategy. And then I rotated on, and the next thing I know I'm doing moderately complex maneuvers with three of the best endoscopic surgeons in the country when back home, I couldn't tie a open field square knot without getting yelled at. It was surreal.
At one point, this black woman, who was like a fourth year resident somewhere else, she and I were talking, and I said something about things getting better when I got to second year. And she says, "Well, or you'll realize that your program just sucks." Um. Well...or there's that...
And then that night, I met up with my friends from home. I was still a little stunned from the day's events. And they were all like, good God, you look like hell, what are they doing to you up there?
It was a good question.
I went back the next morning (because it was a two-day conference), and talked to this other woman, this Greek girl who was doing her residency in Boston somewhere. I talked to Tony a little more, because it turned out that he and this Greek girl had gone to the same medical school. I listened to his lecture, which was essentially the same thing he'd told us at the roundtable the day before, but, it was, again, there was that undertone of "this is what you're entitled to as a resident. Someone's required to teach you, you're entitled to learn."
It was like someone had flipped a switch that first day. It was like some of the color had come back into my grey life. I went back, and within four hours of getting home my world started collapsing. My life, my career, my sanity, it imploded four days later. I can't even begin to explain the magnitude of that decision. How far-reaching the fallout would be. I still don't even comprehend the full scope of what happened. That sounds overdramatic, but trust me, it's not even close.
And Tony, well, Tony's a whole other post. Hell, Tony's a whole other blog.
Everything changed that weekend. Because I went to some random conference.
I know it's a whole different situation now. I know that what happened needed to happen. I know I'm in a very different place living a very different life now than I was then. I know I was skidding towards that catastrophe long before I even signed up for the AAGL class, that it was just a catalyst for things that had to happen. That this is so different. Different time, different people, different situation.
But that's not how PTSD works.
I don't know if I can go tomorrow. I don't know if I can do this. I don't know that it's the worst thing ever that I don't, and if I had shelled out for the registration myself I wouldn't think twice about not going. But I didn't pay for it. Now, honestly, I don't really know that the department did, either - I mean it's their conference.
It's totally irrational and superstitious, but you know, things are going well right now. I don't know if I can run the risk of everything changing again. I'm just completely terrified of it.
Okay, you know what? I never said I wasn't crazy.
Tuesday, April 08, 2008
More nostalgia
Three years ago today, I was on a plane to Chicago. My aunt, my uncle, my cousin came over for dinner. I remember feeling so wiped out, and, like, not even there. I felt grey. Colorless. Numb. I pulled out the two variations on black that I'd brought for the conference and picked one. And then I lay in my bed and stared at the ceiling fan and wished I could feel something other than blackness.
Three years ago today, I still wasn't thinking of leaving my program.
Today, I woke up at half past dark and pulled on my work clothes (still, variations on black, I admit) and went to a meeting about crazy pregnant lady with the OB/G department. I discovered that I was "famous" over there as the psych resident who can check a cervix. They love me. They? Seem to think I know OB. I find this really ironic. And they gave me a cookie for coming in at quarter to early on my vacation.
I'm a sucker for a cookie and some validation.
So then I went and checked in on the unit. Talked to one of my patients, who was like "You've been gone one day and they already changed my medication for no good reason and they're screwing it up." Then I did some paperwork, and then I had my annual review with my program director.
They like me. They really like me.
It was nice. I mean, I kinda knew that, since my attending gave me a review last week and said things like "I really think you were born to do this." But it was really nice to hear. And she asked if this experience was different from the last one. She says, "I hope it's like night and day." I laughed.
It's like night and penguins.
So then I spent a while on a conference call with crazy pregnant lady's guardian and her boss. Then I went to the noon lecture/conference/support group/free lunch thingie. Then I'm finally walking out of the hospital, and the woman whose house I'm trying to rent in June calls me. So I pop on over, chat with her, meet the dog, discuss the specifics. Somewhere in there my crazy friend Rachel calls me, and she's sick, and could I pick up her antibiotics? Of course I can. And then I had to get her car out of the muddy ditch at the end of her driveway, because I'm from Chicago, and we know how to do those things.
Then I came home and decided to brush out the dog for like a half hour. Which took almost two hours, because the little girls across the way decided they wanted to help. Still got a lot of fur off, though, eventually. And then I came in, changed out of the clothes covered in dog hair, and took leftover chili over to my aunt's. We ate chili. we watched a really sweet movie (The Jane Austen Book Club. I could've sworn I'd read the book, but, maybe I never got around to it. I know I own it, because my friend Sue gave it to me). I was instantly in love with the adorable male lead. So adorable.
It was a nice day.
Three years ago today, I still wasn't thinking of leaving my program.
Today, I woke up at half past dark and pulled on my work clothes (still, variations on black, I admit) and went to a meeting about crazy pregnant lady with the OB/G department. I discovered that I was "famous" over there as the psych resident who can check a cervix. They love me. They? Seem to think I know OB. I find this really ironic. And they gave me a cookie for coming in at quarter to early on my vacation.
I'm a sucker for a cookie and some validation.
So then I went and checked in on the unit. Talked to one of my patients, who was like "You've been gone one day and they already changed my medication for no good reason and they're screwing it up." Then I did some paperwork, and then I had my annual review with my program director.
They like me. They really like me.
It was nice. I mean, I kinda knew that, since my attending gave me a review last week and said things like "I really think you were born to do this." But it was really nice to hear. And she asked if this experience was different from the last one. She says, "I hope it's like night and day." I laughed.
It's like night and penguins.
So then I spent a while on a conference call with crazy pregnant lady's guardian and her boss. Then I went to the noon lecture/conference/support group/free lunch thingie. Then I'm finally walking out of the hospital, and the woman whose house I'm trying to rent in June calls me. So I pop on over, chat with her, meet the dog, discuss the specifics. Somewhere in there my crazy friend Rachel calls me, and she's sick, and could I pick up her antibiotics? Of course I can. And then I had to get her car out of the muddy ditch at the end of her driveway, because I'm from Chicago, and we know how to do those things.
Then I came home and decided to brush out the dog for like a half hour. Which took almost two hours, because the little girls across the way decided they wanted to help. Still got a lot of fur off, though, eventually. And then I came in, changed out of the clothes covered in dog hair, and took leftover chili over to my aunt's. We ate chili. we watched a really sweet movie (The Jane Austen Book Club. I could've sworn I'd read the book, but, maybe I never got around to it. I know I own it, because my friend Sue gave it to me). I was instantly in love with the adorable male lead. So adorable.
It was a nice day.
Monday, April 07, 2008
Reflections on a new beginning
You'll forgive me if the next week or so I spend a lot of time waxing philosophical.
Know what I'm doing right now? I'm sitting in a Barnes and Noble in Durham, in the Cafe, drinking a Cinnamon Dolce White Mocha and blogging. I was planning on coming in and working on my many delinquent discharge summaries, but, alas, I'm on vacation. Sort of (I mean, I'm going in to work at quarter past early tomorrow for a meeting with the OB/G dept about my crazy pregnant patient, and then I have my review later in the morning, and then I'm probably going to stay for intern support group so I can kibbutz. And Saturday I'm spending at a conference here in town - which is really, really ironic, for reasons that will become apparent soon - and I'm probably taking call on Sunday. But, you know, vacation).
Know what I was doing right now (well, it may have been about an hour from now) three years ago?
I was getting in SO MUCH TROUBLE. Why? Because I was going to a conference on the 9th and 10th.
Also, I had just delivered my very last baby. But we'll talk about that some other time.
So there was this conference I wanted to go to in '05. In February, I pulled the flier out of my mailbox and went to toss it in the recycle bin like all the other solicitations I got, but for some reason it caught my eye. It was a conference for residents to improve their laparoscopic skills. Of which mine we very limited, because I was the bad intern and no one would ever let me play with the toys except for Ben, who liked having me operate with him alone (i.e., no upper level resident) on his laparoscopic or hysteroscopic cases. And it was in Chicago, so, bonus, no lodging costs. Plus I would be on my Anesthesia rotation, who made it abundantly clear (as in, they said it outright) that they didn't care if we came in at all for the whole month, this was clearly for our learning. Lots of the upper levels told me they went in one or two days a week while on Anesthesia (since you still had OB/G call and clinic responsibilities). Cool. So I emailed our program coordinator and said, can I go to this conference two whole months from now? And she said, this is how much you have left in your educational account, tell me if you want to use it on registration fees. And then I got my department chair to write them a letter saying that yes, I was a resident in our department, thus making me eligible for the resident rate and membership in the organization. I was excited. It looked really interesting. And maybe it would help me to improve my skills enough that someone would actually let me operate once in a while. I was trying to be better, despite the fact that I knew I was never going to be good enough.
So, the Wednesday before this conference, I send my duty hours in, and say, oh, by the way, don't forget that I'm going to this thing this weekend. At which point my program director was like, "What? What conference? Interns aren't allowed to go to conferences." I said, remember how I emailed y'all about this in February? And then by today, which was Thursday, she had concluded that I was totally abusing the system by taking Friday and Monday off to travel. I said, but Anesthesia's okay with me being gone, and Dr. A - the anesthetist in charge of me - and I have already worked out a plan to make up the hours I'm going to miss.
She said, "I see no reason to involve the Anesthesia department in this."
Um...other than the fact that I was responsible to them that month?
And it wasn't like I was going to the coast for a four day weekend, or skiing, or to Martha's Vineyard, like so many of my cohorts had done on that rotation. I was going to a conference. To learn surgical techniques they wouldn't teach me. Oh, my gosh, though, I was in so much trouble.
I was "allowed" to go to the conference, because I'd already made plane reservations but we were going to have to "talk about this when I got back."
I should've said it right then. I should've said it months before. I should've pulled out the "oh, fuck you." I should've told them I wasn't coming back from Chicago. I should've told her that if she were doing her damn job, instead of abusing and scapegoating me for everything that went wrong, instead of throwing me to the wolves when she wanted to avoid confrontation, if she would've acknowledged my strengths and been constructive instead of abusive, I wouldn't have been so miserable, confused, and demoralized that I was clinging to the last jagged shards of my sanity. I should've told her precisely what was wrong with this picture. I should've told her exactly how much more and how much better I was than she was portraying me to be.
But I didn't. Because at that point, I was so broken down I didn't know any better.
I did, however, go to the conference.
And the conference changed my life. In fact, I think it's not at all an exaggeration to say that it saved my life. You'll hear about that in a couple of days, I'm sure.
I doubt Saturday's conference is going to as life altering. But let me just say that not only am I going with the department's blessing, they're paying my $200 registration fee. I mean, it probably helps that we're hosting the conference, but, still.
I'm so grateful for my life right now. I'm so grateful for where I am, so grateful for what it, and I, are becoming. So grateful for what the last four years have taught me. So grateful that I'm even alive, and have a career ahead of me to speak of. So I guess there's really only one thing left to say, today.
Fuck you, Karen George.
Know what I'm doing right now? I'm sitting in a Barnes and Noble in Durham, in the Cafe, drinking a Cinnamon Dolce White Mocha and blogging. I was planning on coming in and working on my many delinquent discharge summaries, but, alas, I'm on vacation. Sort of (I mean, I'm going in to work at quarter past early tomorrow for a meeting with the OB/G dept about my crazy pregnant patient, and then I have my review later in the morning, and then I'm probably going to stay for intern support group so I can kibbutz. And Saturday I'm spending at a conference here in town - which is really, really ironic, for reasons that will become apparent soon - and I'm probably taking call on Sunday. But, you know, vacation).
Know what I was doing right now (well, it may have been about an hour from now) three years ago?
I was getting in SO MUCH TROUBLE. Why? Because I was going to a conference on the 9th and 10th.
Also, I had just delivered my very last baby. But we'll talk about that some other time.
So there was this conference I wanted to go to in '05. In February, I pulled the flier out of my mailbox and went to toss it in the recycle bin like all the other solicitations I got, but for some reason it caught my eye. It was a conference for residents to improve their laparoscopic skills. Of which mine we very limited, because I was the bad intern and no one would ever let me play with the toys except for Ben, who liked having me operate with him alone (i.e., no upper level resident) on his laparoscopic or hysteroscopic cases. And it was in Chicago, so, bonus, no lodging costs. Plus I would be on my Anesthesia rotation, who made it abundantly clear (as in, they said it outright) that they didn't care if we came in at all for the whole month, this was clearly for our learning. Lots of the upper levels told me they went in one or two days a week while on Anesthesia (since you still had OB/G call and clinic responsibilities). Cool. So I emailed our program coordinator and said, can I go to this conference two whole months from now? And she said, this is how much you have left in your educational account, tell me if you want to use it on registration fees. And then I got my department chair to write them a letter saying that yes, I was a resident in our department, thus making me eligible for the resident rate and membership in the organization. I was excited. It looked really interesting. And maybe it would help me to improve my skills enough that someone would actually let me operate once in a while. I was trying to be better, despite the fact that I knew I was never going to be good enough.
So, the Wednesday before this conference, I send my duty hours in, and say, oh, by the way, don't forget that I'm going to this thing this weekend. At which point my program director was like, "What? What conference? Interns aren't allowed to go to conferences." I said, remember how I emailed y'all about this in February? And then by today, which was Thursday, she had concluded that I was totally abusing the system by taking Friday and Monday off to travel. I said, but Anesthesia's okay with me being gone, and Dr. A - the anesthetist in charge of me - and I have already worked out a plan to make up the hours I'm going to miss.
She said, "I see no reason to involve the Anesthesia department in this."
Um...other than the fact that I was responsible to them that month?
And it wasn't like I was going to the coast for a four day weekend, or skiing, or to Martha's Vineyard, like so many of my cohorts had done on that rotation. I was going to a conference. To learn surgical techniques they wouldn't teach me. Oh, my gosh, though, I was in so much trouble.
I was "allowed" to go to the conference, because I'd already made plane reservations but we were going to have to "talk about this when I got back."
I should've said it right then. I should've said it months before. I should've pulled out the "oh, fuck you." I should've told them I wasn't coming back from Chicago. I should've told her that if she were doing her damn job, instead of abusing and scapegoating me for everything that went wrong, instead of throwing me to the wolves when she wanted to avoid confrontation, if she would've acknowledged my strengths and been constructive instead of abusive, I wouldn't have been so miserable, confused, and demoralized that I was clinging to the last jagged shards of my sanity. I should've told her precisely what was wrong with this picture. I should've told her exactly how much more and how much better I was than she was portraying me to be.
But I didn't. Because at that point, I was so broken down I didn't know any better.
I did, however, go to the conference.
And the conference changed my life. In fact, I think it's not at all an exaggeration to say that it saved my life. You'll hear about that in a couple of days, I'm sure.
I doubt Saturday's conference is going to as life altering. But let me just say that not only am I going with the department's blessing, they're paying my $200 registration fee. I mean, it probably helps that we're hosting the conference, but, still.
I'm so grateful for my life right now. I'm so grateful for where I am, so grateful for what it, and I, are becoming. So grateful for what the last four years have taught me. So grateful that I'm even alive, and have a career ahead of me to speak of. So I guess there's really only one thing left to say, today.
Fuck you, Karen George.
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